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Sample records for high surgical risk

  1. [Anesthesiological management of the high-risk surgical patient].

    Science.gov (United States)

    Bertoldi, G; Avalle, M

    1980-03-01

    Evaluation of the anaesthesiological risk in surgical patients is described and an account is given of results obtained with an association of ketamin and NLA II in 57 high-risk patients subjected to general surgical management.

  2. Surgical embolectomy for high-risk acute pulmonary embolism is standard therapy.

    Science.gov (United States)

    Shiomi, Daisuke; Kiyama, Hiroshi; Shimizu, Masatsugu; Yamada, Muneaki; Shimada, Naohiro; Takahashi, Aya; Kaki, Nobuaki

    2017-08-01

    Acute massive pulmonary embolism (AMPE) is a life-threatening condition that often induces rapid haemodynamic deterioration. The mortality of surgical embolectomy is still poor in patients with preoperative cardiopulmonary arrest (CPA). We analysed the outcome of surgical pulmonary embolectomy for haemodynamically unstable patients. Thirty-one patients underwent surgical embolectomy for haemodynamically unstable AMPE. The indications for surgical embolectomy were (i) Pulmonary Embolism Severity Index (PESI) and simplified PESI scores were 158 ± 51 and 2.4 ± 0.9, respectively. The hospital mortality rate was 12.9% (n = 4). Two patients died of hypoxia. Multiorgan failure occurred by sepsis and by right ventricular failure in 1 patient each. No hospital deaths occurred in patients with preoperative PCPS (n = 9). The mean follow-up period was 47.7 ± 35.9 months (range, 3 - 134 months) and the 5-year survival rate was 83.2 ± 6.9%. Postoperative pulmonary artery pressure significantly decreased from 52.7 to 25.8 mmHg. Surgical embolectomy for high-risk AMPE patients has an excellent operative mortality and long-term outcome. Preoperative PCPS may lead to an immediate stable haemodynamic state and improve surgical embolectomy results, especially in high-risk patients (e.g. those with preoperative CPA). Surgical embolectomy for AMPE is an established operation and considered as the first-line therapy.

  3. Endovascular Repair of Thoracoabdominal Aortic Aneurysm in High-Surgical Risk Patients: Fenestrated and Branched Endografts.

    Science.gov (United States)

    Gallitto, Enrico; Gargiulo, Mauro; Freyrie, Antonio; Massoni, Claudio B; Pini, Rodolfo; Mascoli, Chiara; Faggioli, Gianluca; Ancetti, Stefano; Stella, Andrea

    2017-04-01

    To report early and mid-term results of endovascular repair of thoracoabdominal aortic aneurysms (TAAAs) by using Cook Zenith fenestrated/branched endografts (FB-EVAR) in high surgical risk patients unfit for open repair (OR). Between January 2012 and April 2015, all the patients with TAAA, considered at high surgical risk for OR and treated by Cook Zenith FB-EVAR, were prospectively enrolled. Patients were studied using a thoracoabdominal computer tomography angiography (CTA) and dedicated software for advanced vessels analysis. Follow-up was performed by duplex ultrasound (DU), contrast-enhanced DU, and/or CTA. Early end points were the following: technical success (TS), spinal cord ischemia (SCI), and 30-day morbidity/mortality. Follow-up end points were the following: survival, TAAA-related mortality, target visceral vessels (TVV) patency, type I/III endoleaks, and freedom from reinterventions (FFRs). Thirty patients (male 77%, mean age 73 ± 7 years, American Society of Anesthesiologists 3/4 60%/40%) affected by TAAA type I (4%), II (21%), III (57%), and IV (18%) were enrolled. The mean aneurysm diameter was 66 ± 14 mm. The overall number of TVV was 107 (3.5 ± 0.9 vessels/patients). Custom-made and off-the-shelf endografts were used in 22 (73%) and 8 (23%) cases, respectively. The procedure was performed in multiple steps in 23 cases (77%). There were not intraoperative mortality and type I-III endoleaks, and the TVV patency was 97% (104/107). TS was 87%.There were 2 irreversible paraplegias (6.6%) and 1 reversible paraparesis (3.4%). Postoperative cardiac and pulmonary complications occurred in 2 (6.6%) and 2 (6.6%) patients, respectively. Renal function worsening (≥30% of the baseline level) was detected in 4 cases (13%). The 30-day mortality was 6.6%. Survival at 6, 12, and 24 months was 90%, 85%, and 68%, respectively. There was no TAAA-related mortality. The TVV patency at 3, 6, and 24 months was 95%, 90%, and 90%, respectively, and there

  4. Association between surgical delay and survival in high-risk emergency abdominal surgery. A population-based Danish cohort study

    DEFF Research Database (Denmark)

    Vester-Andersen, Morten; Lundstrøm, Lars Hyldborg; Buck, David Levarett

    2016-01-01

    OBJECTIVE: In patients with perforated peptic ulcer, surgical delay has recently been shown to be a critical determinant of survival. The aim of the present population-based cohort study was to evaluate the association between surgical delay by hour and mortality in high-risk patients undergoing ...... abdominal surgery, no statistically significant adjusted association between mortality and surgical delay was found. Additional research in diagnosis-specific subgroups of high-risk patients undergoing emergency abdominal surgery is warranted....... emergency abdominal surgery in general. MATERIAL AND METHODS: All in-patients aged ≥18 years having emergency abdominal laparotomy or laparoscopy performed within 48 h of admission between 1 January 2009 and 31 December 2010 in 13 Danish hospitals were included. Baseline and clinical data, including......OBJECTIVE: In patients with perforated peptic ulcer, surgical delay has recently been shown to be a critical determinant of survival. The aim of the present population-based cohort study was to evaluate the association between surgical delay by hour and mortality in high-risk patients undergoing...

  5. Renal embolization and nephrectomy in a single surgical act in high-risk renal tumor pathology.

    Science.gov (United States)

    Rodríguez Carvajal, Rubén; Orgaz, Antonio; Leal, José I; Peinado, F Javier; Vicente, Sandra; Gil, José; Flores, Angel; Fontcuberta, Juan; Buendia, Elena; Bolufer, Eduardo; Gómez, Antonio; Doblas, Manuel

    2011-02-01

    , whereas for the other cases, a mean volume of 71 mL of iodinated contrast was used. Among all the patients, only two of them required to be cared at the intensive care unit during 24 hours. On an average, reported blood loss was 380 mL. During the procedure, two patients (28.6%) required a transfusion of two units of red cells. No cases of perioperative or postoperative mortality were reported. With respect to morbidity, only one patient (14.3%) experienced a complication in the form of a superficial infection of the surgical wound, which was later resolved by antibiotic therapy. One patient (14.3%) presented a slightly higher preintervention level of creatinine (1.42). Two patients (28.6%), both of whom underwent embolization by using coils, experienced deterioration of postoperative renal function. Preoperative embolization of the renal artery as a coadjuvant treatment option in high-risk renal neoplasia has clear technical benefits for the subsequent nephrectomy and also medical benefits for the patients. Performing both the procedures concomitantly as a single surgical act seems to retain the advantages of the embolization procedure, by reducing mortality rates and producing little associated morbidity. Technically, embolization with Amplatzer plugs seems to be faster and easier as compared with embolization with coils. Copyright © 2011 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  6. Association between surgical delay and survival in high-risk emergency abdominal surgery. A population-based Danish cohort study.

    Science.gov (United States)

    Vester-Andersen, Morten; Lundstrøm, Lars Hyldborg; Buck, David Levarett; Møller, Morten Hylander

    2016-01-01

    In patients with perforated peptic ulcer, surgical delay has recently been shown to be a critical determinant of survival. The aim of the present population-based cohort study was to evaluate the association between surgical delay by hour and mortality in high-risk patients undergoing emergency abdominal surgery in general. All in-patients aged ≥ 18 years having emergency abdominal laparotomy or laparoscopy performed within 48 h of admission between 1 January 2009 and 31 December 2010 in 13 Danish hospitals were included. Baseline and clinical data, including surgical delay and 90-day mortality were collected. The crude and adjusted association between surgical delay by hour and 90-day mortality was assessed by binary logistic regression. A total of 2803 patients were included. Median age (interquartile range [IQR]) was 66 (51-78) years, and 515 patients (18.4%) died within 90 days of surgery. Over the first 24 h after hospital admission, each hour of surgical delay beyond hospital admission was associated with a median (IQR) decrease in 90-day survival of 2.2% (1.9-3.3%). No statistically significant association between surgical delay by hour and 90-day mortality was shown; crude and adjusted odds ratio with 95% confidence interval 1.016 (1.004-1.027) and 1.003 (0.989-1.017), respectively. Sensitivity analyses confirmed the primary finding. In the present population-based cohort study of high-risk patients undergoing emergency abdominal surgery, no statistically significant adjusted association between mortality and surgical delay was found. Additional research in diagnosis-specific subgroups of high-risk patients undergoing emergency abdominal surgery is warranted.

  7. Endocrine effects of dopexamine vs. dopamine in high-risk surgical patients.

    Science.gov (United States)

    Schilling, T; Strang, C M; Wilhelm, L; Möritz, K U; Siegmund, W; Gründling, M; Hachenberg, T

    2001-12-01

    To compare the endocrine effects of dopexamine and dopamine on prolactin (PRL), dihydroepiandrosterone sulfate (DHEAS), cortisol, thyrotropin (TSH), and peripheral thyroid hormone serum concentrations in surgical patients at risk of developing postoperative complications because of hypoperfusion of various organ systems. A prospective, randomized, placebo-controlled, blinded clinical trial in an adult surgical intensive care unit in a university hospital. Thirty-two male surgical risk patients undergoing elective major abdominal surgery. Patients were randomized to receive placebo ( n=8), dopexamine (0.5 microg kg(-1) min(-1), n=8), dopexamine (1 microg kg(-1) min(-1), n=8) or dopamine (5 microg kg(-1) min(-1), n=8) on the first postoperative day. All patients received either a placebo or catecholamine infusion for 24 h. Blood samples were obtained every 2 h for the next 2 days. PRL, DHEAS, cortisol, TSH, triiodothyronine, thyroxin, free triiodothyronine, and free thyroxin serum concentrations were determined by radioimmunoassay or luminescence immunoassay. Dopexamine (0.5 microg kg(-1) min(-1)) had no effects on serum concentrations of PRL or TSH. Higher doses of dopexamine (1 microg kg(-1) min(-1)) suppressed PRL secretion significantly, but not TSH. In contrast, infusion of dopamine (5 microg kg(-1) min(-1)) completely inhibited PRL and TSH secretion. DHEAS, cortisol, and thyroid hormone serum concentrations were not affected by either dopexamine or dopamine infusion. Measurements of hemodynamic parameters, peripheral oxygen saturation, diuresis, blood gases, and standard laboratory parameters were repeated hourly. Significant differences were not found between placebo, dopexamine (0.5 microg kg(-1) min(-1)) and dopamine (5 microg kg(-1) min(-1)) group. Dopexamine at 1 microg kg(-1) min(-1) increased the heart rate significantly. Routine postoperative optimizing of men undergoing abdominal surgical procedures with dopexamine at higher doses or dopamine induces

  8. Percutaneous implantation of thoracic and abdominal aortic prostheses in patients at high surgical risk

    Directory of Open Access Journals (Sweden)

    Juan C Ortiz

    2013-02-01

    intraluminal stent implantation is an alternative. Objective: to analyze the impact of percutaneous implantation of aortic stents in high-risk surgical patients with a minimum of one y ear follow-up. Method: Descriptive study conducted from December 2005 to March 2010 which included 125 patients with thoracic or abdominal aortic aneurysm, meeting surgical criteria by its diameter and that were rejected from surgery due to their high risk. The outcomes were intraoperative death from any cause and aneurysm-related at one, six and twelve months. Complications were defined as vascular occurred during the first thirty days. Results: Abdominal aneurysm was more frequent (70.4%. The overall mortality at 25.7 months follow-up was 14.8%. Of this percentage, 5.2% died from causes related to the aneurysm. One patient died during surgery. 4.3% were reoperated for leaks. There was higher aneurysm-related mortality in the thoracic (14.7 vs. 1.2% p = 0.003 and a trend in those of larger diameter (6.9 vs. 5.7 cm p = 0.210. There was no association between mortality and diabetes mellitus, smoking, heart disease, hypertension or dyslipidemia. Conclusions: aneurysm-related mortality in patients undergoing aortic stent graft is low. Mortality was associated with thoracic aneurysm and to its greater diameter. Complications did not imply an increase in mortality. In conclusion, in patients with aortic aneurysm and high surgical risk rejected for open surgery, percutaneous approach is a safe and effective treatment in a medium-term follow-up.

  9. Transapical Implantation of a 2nd-Generation JenaValve Device in Patient with Extremely High Surgical Risk

    Directory of Open Access Journals (Sweden)

    Juan Mieres

    2015-01-01

    Full Text Available Transcatheter Aortic Valve Replacement (TAVR is performed in patients who are poor surgical candidates. Many patients have inadequate femoral access, and alternative access sites have been used such as the transapical approach discussed in this paper. We present an elderly and fragile patient not suitable for surgery for unacceptable high risk, including poor ventricular function, previous myocardial infarction with percutaneous coronary intervention, pericardial effusion, and previous cardiac surgery with replacement of mechanical mitral valve. Transapical aortic valve replacement with a second-generation self-expanding JenaValve is performed. The JenaValve is a second-generation transapical TAVR valve consisting of a porcine root valve mounted on a low-profile nitinol stent. The valve is fully retrievable and repositionable. We discuss transapical access, implantation technique, and feasibility of valve implantation in this extremely high surgical risk patient.

  10. Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

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    Kim, Young Hwan [Keimyung University, College of Medicine, Daegu (Korea, Republic of); Kim, Yong Joo [Andong General Hospital, Andong (Korea, Republic of); Shin, Tae Beom [Gyeonsang National University, College of Medicine, Jinju (Korea, Republic of)

    2011-04-15

    To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis. Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique. Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days). Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis

  11. Prediction of Outcome After Emergency High-Risk Intra-abdominal Surgery Using the Surgical Apgar Score

    DEFF Research Database (Denmark)

    Cihoric, Mirjana; Toft Tengberg, Line; Bay-Nielsen, Morten

    2016-01-01

    BACKGROUND: With current literature quoting mortality rates up to 45%, emergency high-risk abdominal surgery has, compared with elective surgery, a significantly greater risk of death and major complications. The Surgical Apgar Score (SAS) is predictive of outcome in elective surgery, but has never...... been validated exclusively in an emergency setting. METHODS: A consecutive prospective single-center cohort study of 355 adults undergoing emergency high-risk abdominal surgery between June 2013 and May 2014 is presented. The primary outcome measure was 30-day mortality. Secondary outcome measures were...... emergency high-risk abdominal surgery. Despite its predictive value, the SAS cannot in its current version be recommended as a standalone prognostic tool in an emergency setting....

  12. Prediction of Outcome After Emergency High-Risk Intra-abdominal Surgery Using the Surgical Apgar Score.

    Science.gov (United States)

    Cihoric, Mirjana; Toft Tengberg, Line; Bay-Nielsen, Morten; Bang Foss, Nicolai

    2016-12-01

    With current literature quoting mortality rates up to 45%, emergency high-risk abdominal surgery has, compared with elective surgery, a significantly greater risk of death and major complications. The Surgical Apgar Score (SAS) is predictive of outcome in elective surgery, but has never been validated exclusively in an emergency setting. A consecutive prospective single-center cohort study of 355 adults undergoing emergency high-risk abdominal surgery between June 2013 and May 2014 is presented. The primary outcome measure was 30-day mortality. Secondary outcome measures were postoperative major complications, defined according to the Clavien-Dindo scale as well as the American College of Surgeons' National Surgical Quality Improvement Program guidelines, and intensive care unit admission. The SAS was calculated postoperatively. Cochran-Armitage test for trend was used to evaluate the incidence of both outcomes. Area under the curve was used to demonstrate the scores' discriminatory power. One hundred eighty-one (51.0%) patients developed minor or no complications. The overall incidence of major complications was 32.7% and the overall death rate was 16.3%. Risk of major complications, death, and intensive care unit admission increased significantly with decreasing SAS (P high-risk abdominal surgery. Despite its predictive value, the SAS cannot in its current version be recommended as a standalone prognostic tool in an emergency setting.

  13. Innovative approach using interprofessional simulation to educate surgical residents in technical and nontechnical skills in high-risk clinical scenarios.

    Science.gov (United States)

    Nicksa, Grace A; Anderson, Cristan; Fidler, Richard; Stewart, Lygia

    2015-03-01

    The Accreditation Council for Graduate Medical Education core competencies stress nontechnical skills that can be difficult to evaluate and teach to surgical residents. During emergencies, surgeons work in interprofessional teams and are required to perform certain procedures. To obtain proficiency in these skills, residents must be trained. To educate surgical residents in leadership, teamwork, effective communication, and infrequently performed emergency surgical procedures with the use of interprofessional simulations. SimMan 3GS was used to simulate high-risk clinical scenarios (15-20 minutes), followed by debriefings with real-time feedback (30 minutes). A modified Oxford Non-Technical Skills scale (score range, 1-4) was used to assess surgical resident performance during the first half of the academic year (July-December 2012) and the second half of the academic year (January-June 2013). Anonymous online surveys were used to solicit participant feedback. Simulations were conducted in the operating room, intensive care unit, emergency department, ward, and simulation center. A total of 43 surgical residents (postgraduate years [PGYs] 1 and 2) participated in interdisciplinary clinical scenarios, with other health care professionals (nursing, anesthesia, critical care, medicine, respiratory therapy, and pharmacy; mean number of nonsurgical participants/session: 4, range 0-9). Thirty seven surgical residents responded to the survey. Simulation of high-risk clinical scenarios: postoperative pulmonary embolus, pneumothorax, myocardial infarction, gastrointestinal bleeding, anaphylaxis with a difficult airway, and pulseless electrical activity arrest. Evaluation of resident skills: communication, leadership, teamwork, problem solving, situation awareness, and confidence in performing emergency procedures (eg, cricothyroidotomy). A total of 31 of 35 (89%) of the residents responding found the sessions useful. Additionally, 28 of 33 (85%) reported improved confidence

  14. Use of steel bands in sternotomy closure: implications in high-risk cardiac surgical population.

    Science.gov (United States)

    Franco, Sergio; Herrera, Ana M; Atehortúa, Mauricio; Vélez, Luis; Botero, Juan; Jaramillo, Juan S; Vélez, Juan F; Fernández, Hugo

    2009-02-01

    A retrospective-prospective descriptive and comparative study of two sternal closure techniques in a population of 621 patients divided into: group A, steel band closure (n=300) and group B, conventional technique closure (n=321), was carried out between January 2005 and December 2007 in order to describe and compare the results of both techniques in high-risk patients for sternal dehiscence and mediastinitis. Differences between both groups and association with risk factors were obtained using non-parametric tests for statistical analysis. No complications or mortality related to the use of the steel sternal bands were found. A statistically significant difference was found in the frequency of sternal dehiscence between both groups (P=0.022) in favor of group A. Although the frequency of mediastinitis was higher in group B, a statistically significant difference could not be established in terms of this complication. Sternal dehiscence was found to be a risk factor for mediastinitis. This study demonstrates that the use of steel bands for median sternotomy closure is a safe, reliable and reproducible technique. The frequency of sternal dehiscence significantly decreases with this technique in high-risk patients.

  15. Acute cholecystitis in high risk surgical patients: percutaneous cholecystostomy versus laparoscopic cholecystectomy (CHOCOLATE trial): Study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Kortram, Kirsten; van Ramshorst, Bert; Bollen, Thomas L.; Besselink, Marc G. H.; Gouma, Dirk J.; Karsten, Tom; Kruyt, Philip M.; Nieuwenhuijzen, Grard A. P.; Kelder, Johannes C.; Tromp, Ellen; Boerma, Djamila

    2012-01-01

    Background: Laparoscopic cholecystectomy in acute calculous cholecystitis in high risk patients can lead to significant morbidity and mortality. Percutaneous cholecystostomy may be an alternative treatment option but the current literature does not provide the surgical community with evidence based

  16. A systematic review on the safety and efficacy of percutaneous edge-to-edge mitral valve repair with the MitraClip system for high surgical risk candidates

    DEFF Research Database (Denmark)

    Munkholm-Larsen, Stine; Wan, Benjamin; Tian, David H

    2014-01-01

    BACKGROUND: MitraClip implantation has emerged as a viable option in high surgical risk patients with severe mitral regurgitation (MR). We performed the present systematic review to assess the safety and efficacy of the MitraClip system for high surgical risk candidates with severe organic and...... be implanted with reproducible safety and feasibility profile in this subgroup of patients. Further prospective trials with mid- to long-term follow-up are required....

  17. Effects of dopexamine, dobutamine or dopamine on prolactin and thyreotropin serum concentrations in high-risk surgical patients.

    Science.gov (United States)

    Schilling, Thomas; Gründling, Matthias; Strang, Christof M; Möritz, Klaus-Uwe; Siegmund, Werner; Hachenberg, Thomas

    2004-06-01

    Catecholamines are often used for optimisation of cardiac index and oxygen delivery in high-risk surgical patients; however, infusions of dopamine and dopexamine are associated with dose-dependent hypophysiotropic and thyreotropic properties. The objective was to compare endocrine effects of equipotent inotropic doses of dopexamine, dobutamine and dopamine on prolactin and thyreotropin release perioperatively. A prospective, randomised, blinded clinical trial. Adult surgical intensive care unit in a university hospital. Thirty male patients (ASA III) undergoing elective major abdominal surgery. Patients were randomised to receive dopexamine (DX, n=10), dobutamine (DO, n=10) or dopamine (DA, n=10) on the first postoperative day for 8 h. All patients received a catecholamine infusion in doses adjusted to increase cardiac index by 35% within the first hour. Blood samples were obtained and prolactin and thyreotropin serum concentrations were determined by radioimmunoassays. Mean doses of dopexamine, dobutamine and dopamine used were 0.73+/-0.27, 4.06+/-1.95 and 5.0+/-1.84 micro g kg(-1)min(-1), respectively. Cardiac index was increased by 36% (DX group), 38% (DO group) and 38% (DA group). Alterations of oxygen delivery and oxygen consumption were not significantly different between the study groups. Dopexamine and dobutamine had no hypophysiotropic effects. In contrast, dopamine suppressed prolactin and thyreotropin secretion with a maximal effect after 4 h. After dopamine withdrawal, a rebound release of prolactin and thyreotropin was observed. In high-risk surgical patients dopexamine or dobutamine produced fewer effects on prolactin and thyreotropin serum concentrations in comparison with DA when used in equivalent dosages.

  18. [Application of non-invasive hemodynamic monitoring on high-risk surgical patients in the early stages after emergency admission].

    Science.gov (United States)

    Lu, Jun-qiang; Li, Chun-sheng; Yang, Jia-yong; Zhu, Jay; Wo, Charles; Shoemaker, Willaim

    2003-12-01

    Pulmonary artery (PA) catheterization monitoring (Swan-Ganz) is usually not available to critically high-risk surgical patients before admission to ICU, where action to correct values derived from such monitoring may be too late. To explored the effect of non-invasive monitoring systems that allow hemodynamic monitoring during the early stages after trauma. The early temporal hemodynamic patterns after high-risk trauma with non-invasive monitoring systems were evaluated, and compared these to invasive PA monitoring. The study included 156 patients monitored shortly after admission to the emergency department. The non-invasive impedance cardiac output estimations under extenuating emergency conditions were similar to those of the thermodilution method: r=0.69, r(2)=0.87, Parterial hemoglobin desaturation, low transcutaneous oxygen and high transcutaneous carbon dioxide tension, and low oxygen consumption during initial resuscitation. Low flow and poor tissue perfusion were more pronounced in non-survivors by both METHODS. Multicomponent non-invasive monitoring systems offer continuous on-line, real-time display of hemodynamic data, they allow early recognition of circulatory dysfunction. Such systems provide information similar to that provided by the invasive thermodilution method, and are more effective and safer.

  19. [Cognitive and quality of life trajectory after either surgical or transcatheter aortic valve replacement in high-risk patients].

    Science.gov (United States)

    Ciuca, Cristina; Fortuna, Daniela; Ferrari, Susy; Salizzoni, Stefano; Grisoglio, Enrica; Punta, Giuseppe; Del Ponte, Stefano; Aranzulla, Tiziana Claudia; Gabbieri, Davide; Gandolfo, Caterina; Dispensa, Flavia; Vecchio Verderame, Lavinia; Tamburino, Corrado; Caruso, Cinzia; Grossi, Claudio; Mikus, Elisa; Guiducci, Vincenzo; Violini, Roberto; Rongoni, Silvia; Pandolfi, Claudia; Moretti, Carolina; De Palma, Rossana; Chattat, Rabih; Savini, Carlo; Marzocchi, Antonio; Saia, Francesco

    2016-12-01

    The impact of transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (AVR) on cognitive status and quality of life in high-risk patients has been incompletely investigated. We conducted a prospective, multicenter study including all patients treated with TAVI and high-risk patients undergoing AVR (age ≥80 years or logistic EuroSCORE ≥15%) at participating centers. Multidimensional geriatric evaluation including Mini Mental State Examination (MMSE), EuroQol 5D (EQ5D) and Minnesota Living With Heart Failure Questionnaire (MLHFQ) were performed at baseline and at 3- and 12-month follow-up. A total of 518 patients (151 AVR and 367 TAVI) were enrolled in 10 Italian institutions. Patients receiving AVR were older (82.7 ± 2.4 years), with a lower logistic EuroSCORE (12.5 ± 7.1%) as compared with TAVI patients (81.5 ± 6.2 years and 19.6 ± 14.0%, respectively, p=0.001 and ppatients showed some degree of cognitive impairment at baseline, with no differences between groups. No significant changes in the cognitive status were observed between baseline and follow-up and between groups at any time point. TAVI patients had a lower quality of life at baseline as compared with AVR patients. Generic and heart failure-related quality of life improved significantly after either procedure. In high-risk patients, both TAVI and AVR are associated with a significant improvement of quality of life up to 1 year without a detrimental effect on cognitive function.

  20. Surgical versus conservative treatment for high-risk stress fractures of the lower leg (anterior tibial cortex, navicular and fifth metatarsal base): a systematic review

    NARCIS (Netherlands)

    Mallee, W.H.; Weel, H.; van Dijk, C.N.; van Tulder, M.W.; Kerkhoffs, G.M.; Lin, C.W.C.

    2015-01-01

    Aim To compare surgical and conservative treatment for high-risk stress fractures of the anterior tibial cortex, navicular and proximal fifth metatarsal. Methods Systematic searches of CENTRAL, MEDLINE, EMBASE, CINAHL, SPORTDiscus and PEDro were performed to identify relevant prospective and

  1. Long-term functional outcome and risk factors for recurrence after surgical treatment for low and high perianal fistulas of cryptoglandular origin

    NARCIS (Netherlands)

    van Koperen, Paul J.; Wind, Jan; Bemelman, Willem A.; Bakx, Roel; Reitsma, Johannes B.; Slors, J. Frederik M.

    2008-01-01

    PURPOSE: This study assessed long-term functional outcome and explored risk factors for fistula recurrence in patients surgically treated for cryptoglandular fistulas. METHODS: Three hundred ten consecutive patients were surgically treated for perianal fistulas. After exclusion of patients with

  2. EUS-guided gallbladder drainage in patients with acute cholecystitis and high surgical risk using an electrocautery-enhanced lumen-apposing metal stent device.

    Science.gov (United States)

    Dollhopf, Markus; Larghi, Alberto; Will, Uwe; Rimbaş, Mihai; Anderloni, Andrea; Sanchez-Yague, Andres; Teoh, Anthony Yuen Bun; Kunda, Rastislav

    2017-10-01

    In high-risk surgical patients, the treatment of choice of acute cholecystitis is percutaneous transhepatic gallbladder drainage (PTGBD). Recently, a novel endoscopic device containing a lumen-apposing metal stent with an electrocautery (ECE-LAMS) on the tip has been developed. High-risk surgical patients with acute cholecystitis who underwent EUS-guided gallbladder drainage (EUS-GBD) with the novel device were retrospectively retrieved from 7 tertiary care referral centers. Main endpoints were technical and clinical success rates, rate of procedural adverse events, and short- and long-term adverse events. Seventy-five patients (mean age, 75 ± 11 years; 36 men) underwent EUS-GBD. The procedure was technically and clinically successful in 98.7% and 95.9% of cases, respectively. Three patients without resolution of cholecystitis died, and 2 patients had procedure-related adverse events: 1 perforation requiring surgery and 1 major bleeding resolved conservatively. The mean follow-up for the entire cohort was 201 ± 226 days. Seven patients (9.6%) died within the first 30 days; 50 patients (71.4%) were alive at the last date of follow-up. Short- and long-term adverse events occurred in 6 patients: 3 had recurrent cholecystitis, 2 had migration of the stent, and 1 developed Bouveret syndrome, all managed nonsurgically. Overall, 8 adverse events (10.7%) occurred in the entire cohort of patients. The novel ECE-LAMS for high-risk surgical patients with acute cholecystitis is safe, with a high technical and clinical success rate. Future multicenter studies comparing EUS-GBD versus PTGBD are warranted to determine which procedure is safer and clinically more effective for patients with high surgical risk acute cholecystitis. Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

  3. The re-infection rate of high-risk HPV and the recurrence rate of vulvar intraepithelial neoplasia (VIN) usual type after surgical treatment.

    Science.gov (United States)

    Frega, Antonio; Sopracordevole, Francesco; Scirpa, Paolo; Biamonti, Alberto; Lorenzon, Laura; Scarani, Simona; De Sanctis, Luana; Pacchiarotti, Arianna; Moscarini, Massimo; French, Deborah

    2011-09-01

    VIN usual type appears to be related to the HPV's oncogenic types. The aim of this prospective multicenter study was to evaluate the re-infection rate of high-risk HPV and the recurrence rate of VIN usual type after surgical treatment. The study enrolled 103 women affected by VIN usual type. They underwent wide local excision by CO2 laser. The patients were investigated by clinical evaluation and HPV DNA test 6 months after surgical treatment, and then were followed-up at 12, 18, 24, and 36 months. The recurrences were treated with re-excision. The rate of HPV infection after surgical treatment was 34% at 6 months, 36.9% at 12 months, 40% at 18 months, 41.7% at 24 months and 44.7% at 36 months. The mean time from HPV infection to the development of VIN was 18.8 months. HPV testing in the follow-up of VIN usual type patients might be useful for identifying those patients with a higher risk of recurrence after surgical treatment, although more studies are needed. These preliminary data suggest that the test, in addition to clinical examination, can improve the efficacy of the follow-up.

  4. Transcatheter versus Surgical Aortic Valve Replacement in Patients with Diabetes and Severe Aortic Stenosis at High Risk for Surgery: An Analysis of the PARTNER Trial

    Science.gov (United States)

    Lindman, Brian R.; Pibarot, Philippe; Arnold, Suzanne V.; Suri, Rakesh; McAndrew, Thomas C.; Maniar, Hersh S.; Zajarias, Alan; Kodali, Susheel; Kirtane, Ajay J.; Thourani, Vinod H.; Tuzcu, E. Murat; Svensson, Lars G.; Waksman, Ron; Smith, Craig R.; Leon, Martin B.

    2013-01-01

    Objectives To determine whether a less invasive approach to aortic valve replacement (AVR) improves clinical outcomes in diabetic patients with aortic stenosis (AS). Background Diabetes is associated with increased morbidity and mortality after surgical AVR for AS. Methods Among treated patients with severe symptomatic AS at high-risk for surgery in the PARTNER trial, we examined outcomes stratified by diabetes status of patients randomly assigned to transcatheter or surgical AVR. The primary outcome was all-cause mortality at 1 year. Results Among 657 patients enrolled in PARTNER who underwent treatment, there were 275 patients with diabetes (145 transcatheter, 130 surgical). There was a significant interaction between diabetes and treatment group for 1-year all-cause mortality (p=0.048). Among diabetic patients, all-cause mortality at 1 year was 18.0% in the transcatheter group and 27.4% in the surgical group (HR 0.60; 95% CI, 0.36–0.99; p=0.04). Results were consistent among patients treated via transfemoral or transapical routes. In contrast, among non-diabetic patients, there was no significant difference in all-cause mortality at 1 year (p=0.48). Among diabetic patients, the 1-year rates of stroke were similar between treatment groups (3.5% transcatheter vs. 3.5% surgery, p=0.88), but the rates of renal failure requiring dialysis >30 days were lower in the transcatheter group (0% vs. 6.1%, p=0.003). Conclusions Among patients with diabetes and severe symptomatic AS at high-risk for surgery, this post-hoc stratified analysis of the PARTNER trial suggests there is a survival benefit, no increase in stroke, and less renal failure from treatment with transcatheter compared to surgical AVR. PMID:24291272

  5. Transcatheter aortic valve replacement in patients with severe aortic stenosis who are at high risk for surgical complications: summary assessment of the California Technology Assessment Forum.

    Science.gov (United States)

    Tice, Jeffrey A; Sellke, Frank W; Schaff, Hartzell V

    2014-08-01

    The California Technology Assessment Forum is dedicated to assessment and public reporting of syntheses of available data on medical technologies. In this assessment, transcatheter aortic valve replacement (TAVR) was evaluated for patients with severe aortic stenosis (AS) who are at high risk for complications. In this assessment, 5 criteria were used: Regulatory approval, sufficient scientific evidence to allow conclusions on effectiveness, evidence that the technology improves net health outcomes, evidence that the technology is as beneficial as established methods, and availability of the technology outside investigational settings. In this assessment, all 5 criteria were judged to have been met. The primary benefit of TAVR is the ability to treat AS in patients who would otherwise be ineligible for surgical aortic valve replacement. It may also be useful for patients at high surgical risk by potentially reducing periprocedural complications and avoiding the morbidity and recovery from undergoing heart surgery. Potential harms include the need for conversion to an open procedure, perioperative death, myocardial infarction, stroke, bleeding, valve embolization, aortic regurgitation, heart block that requires a permanent pacemaker, renal failure, pulmonary failure, and major vascular complications such as cardiac perforation or arterial dissection. Potential long-term harms include death, stroke, valve failure or clotting, and endocarditis. As highlighted at the February 2012 California Technology Assessment Forum meeting, the dispersion of this technology to new centers across the United States must proceed with careful thought given to training and proctoring multidisciplinary teams to become new centers of excellence. TAVR is a potentially lifesaving procedure that may improve quality of life for patients at high risk for surgical AVR. However, attention needs to be paid to appropriate patient selection, their preoperative evaluation, surgical techniques, and

  6. Modifiable risk factors for surgical site infection.

    Science.gov (United States)

    Moucha, Calin S; Clyburn, Terry A; Evans, Richard P; Prokuski, Laura

    2011-01-01

    Multiple risk factors for orthopaedic surgical site infection have been identified. Some of these factors directly affect the wound-healing process, whereas others can lead to blood-borne sepsis or relative immunosuppression. Modifying a patient's medications; screening for comorbidities, such as HIV or diabetes mellitus; and advising the patient on options to diminish or eliminate adverse behaviors, such as smoking, should lower the risk for surgical site infections.

  7. A pragmatic multi-centre randomised controlled trial of fluid loading and level of dependency in high-risk surgical patients undergoing major elective surgery: trial protocol.

    Science.gov (United States)

    Cuthbertson, Brian H; Campbell, Marion K; Stott, Stephen A; Vale, Luke; Norrie, John; Kinsella, John; Cook, Jonathan; Brittenden, Julie; Grant, Adrian

    2010-04-16

    Patients undergoing major elective or urgent surgery are at high risk of death or significant morbidity. Measures to reduce this morbidity and mortality include pre-operative optimisation and use of higher levels of dependency care after surgery. We propose a pragmatic multi-centre randomised controlled trial of level of dependency and pre-operative fluid therapy in high-risk surgical patients undergoing major elective surgery. A multi-centre randomised controlled trial with a 2 * 2 factorial design. The first randomisation is to pre-operative fluid therapy or standard regimen and the second randomisation is to routine intensive care versus high dependency care during the early post-operative period. We intend to recruit 204 patients undergoing major elective and urgent abdominal and thoraco-abdominal surgery who fulfil high-risk surgical criteria. The primary outcome for the comparison of level of care is cost-effectiveness at six months and for the comparison of fluid optimisation is the number of hospital days after surgery. We believe that the results of this study will be invaluable in determining the future care and clinical resource utilisation for this group of patients and thus will have a major impact on clinical practice. Trial registration number - ISRCTN32188676.

  8. High lung cancer surgical procedure volume is associated with shorter length of stay and lower risks of re-admission and death: National cohort analysis in England.

    Science.gov (United States)

    Møller, Henrik; Riaz, Sharma P; Holmberg, Lars; Jakobsen, Erik; Lagergren, Jesper; Page, Richard; Peake, Michael D; Pearce, Neil; Purushotham, Arnie; Sullivan, Richard; Vedsted, Peter; Luchtenborg, Margreet

    2016-09-01

    It is debated whether treating cancer patients in high-volume surgical centres can lead to improvement in outcomes, such as shorter length of hospital stay, decreased frequency and severity of post-operative complications, decreased re-admission, and decreased mortality. The dataset for this analysis was based on cancer registration and hospital discharge data and comprised information on 15,738 non-small-cell lung cancer patients resident and diagnosed in England in 2006-2010 and treated by surgical resection. The number of lung cancer resections was computed for each hospital in each calendar year, and patients were assigned to a hospital volume quintile on the basis of the volume of their hospital. Hospitals with large lung cancer surgical resection volumes were less restrictive in their selection of patients for surgical management and provided a higher resection rate to their geographical population. Higher volume hospitals had shorter length of stay and the odds of re-admission were 15% lower in the highest hospital volume quintile compared with the lowest quintile. Mortality risks were 1% after 30 d and 3% after 90 d. Patients from hospitals in the highest volume quintile had about half the odds of death within 30 d than patients from the lowest quintile. Variations in outcomes were generally small, but in the same direction, with consistently better outcomes in the larger hospitals. This gives support to the ongoing trend towards centralisation of clinical services, but service re-organisation needs to take account of not only the size of hospitals but also referral routes and patient access. Copyright © 2016. Published by Elsevier Ltd.

  9. Neoadjuvant Chemotherapy with Capecitabine, Oxaliplatin and Bevacizumab Followed by Concomitant Chemoradiation and Surgical Resection in Locally Advanced Rectal Cancer with High Risk of Recurrence - A Phase II Study.

    Science.gov (United States)

    Eisterer, Wolfgang; Piringer, Gudrun; DE Vries, Alexander; Öfner, Dietmar; Greil, Richard; Tschmelitsch, Jörg; Samonigg, Hellmut; Sölkner, Lidija; Gnant, Michael; Thaler, Josef

    2017-05-01

    To evaluate feasibility and safety of neoadjuvant chemotherapy with capecitabine, oxaliplatin and bevacizumab followed by concomitant standard chemoradiation and surgical resection in patients with high-risk locally advanced rectal cancer. Magnetic resonance imaging (MRI)-defined high-risk cT3/4 rectal cancer patients were treated with 3 cycles of neoadjuvant chemotherapy with capecitabine (1,000 mg/m2 twice daily days 1-14, 22-35, 43-56), oxaliplatin (130 mg/sqm on days 1, 22, 43) and bevacizumab (7.5 mg/kg on days 1, 22, 43) followed by capecitabine (825 mg/m2 twice daily on radiotherapy days week 1-4) concomitantly with radiotherapy (1.8 Gy daily up to 45 Gy in 5 weeks) and surgical resection by total mesorectal excision. Feasibility, safety, response rate and postoperative morbidity were evaluated. Twenty-five patients were recruited. Median age was 62 years (range=24-78 years) and all patients had Eastern Cooperation Oncology Group (ECOG) performance status 0. From all patients, 79.2% finished neoadjuvant chemotherapy. Twenty patients underwent surgery. Pathologic complete remission rate, R0 resection and T-downstaging were achieved in 25%, 95% and 54.2% of the "intention to treat" (ITT) patients. The most common grade 3 adverse events (AEs) during neoadjuvant chemotherapy were diarrhea (16.6%) and mucositis (12.5%). In one patient, a grade 4 acute renal failure occurred (4.2%). During chemoradiation, skin reactions (5.3%) were the most common grade 3 AEs. Two major perioperative complications required re-intervention. Neoadjuvant chemotherapy with bevacizumab, capecitabine and oxaliplatin followed by concomitant standard chemoradiation is feasible in patients with high-risk locally advanced rectal cancer (LARC) and resulted in complete pathologic remission (pCR) rate of 25% and neoadjuvant chemotherapy completion rate of 80%. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  10. SURGICAL TREATMENT FOR VERY HIGH-RISK LOCALLY RECURRENT PROSTATE CANCER AFTER RADICAL RETROPUBIC PROSTATECTOMY: A CLINICAL CASE

    Directory of Open Access Journals (Sweden)

    E. I. Veliyev

    2014-07-01

    Full Text Available Locally recurrent prostate cancer (PC in the bladder neck can substantially worsen quality of life in patients and hinder further treatment when castration-resistant PC develops. The paper describes a clinical case of very high-risk PC in a 55-year-old patient in whom radical cystectomy (RCE with removal of metastases in the bladder neck and the Bricker ileal conduit were performed for a local recurrence after radical retropubic prostatectomy (RPE. It gives the data of preoperative examination, the technical features of the primary operation RPE, the data of postoperative observation, the technical aspects and outcomes of еру surgery for a local recurrence, as well as the results of a 1.5-year follow-up after RCE. 

  11. SURGICAL TREATMENT FOR VERY HIGH-RISK LOCALLY RECURRENT PROSTATE CANCER AFTER RADICAL RETROPUBIC PROSTATECTOMY: A CLINICAL CASE

    Directory of Open Access Journals (Sweden)

    E. I. Veliyev

    2014-01-01

    Full Text Available Locally recurrent prostate cancer (PC in the bladder neck can substantially worsen quality of life in patients and hinder further treatment when castration-resistant PC develops. The paper describes a clinical case of very high-risk PC in a 55-year-old patient in whom radical cystectomy (RCE with removal of metastases in the bladder neck and the Bricker ileal conduit were performed for a local recurrence after radical retropubic prostatectomy (RPE. It gives the data of preoperative examination, the technical features of the primary operation RPE, the data of postoperative observation, the technical aspects and outcomes of еру surgery for a local recurrence, as well as the results of a 1.5-year follow-up after RCE. 

  12. Decreasing 30-day surgical mortality in a VA Medical Center utilizing the ACS NSQIP Surgical Risk Calculator.

    Science.gov (United States)

    Kuy, SreyRam; Romero, Ramon A L

    2017-07-01

    The Overton Brooks VA Medical Center Surgical Service had a high mortality. In an effort to reduce surgical mortality, we implemented a series of quality improvement interventions, including utilization of the ACS Surgical Risk Calculator to identify high-risk surgical patients for discussion in a multidisciplinary Pre-Operative Consultation Committee. Retrospective study describing the implementation of a risk stratification intervention incorporating the ACS Surgical Risk Calculator Tool and a multidisciplinary Pre-Operative Consultation Committee to target high-risk patients. Measurement of 30 day surgical mortality and risk adjusted Observed to Expected (O/E) mortality ratio. From May 2013 to September 2014, 614 high-risk patients were selected utilizing the ACS Risk Calculator and presented at the Pre-Operative Consultation Committee. Following implementation of this risk stratification intervention, 30-day mortality decreased by 66% from 0.9% to 0.3%, and risk adjusted O/E mortality ratio decreased from 2.5 to 0.8. Among the high risk patients presented, there was no increase in referrals to other facilities. There was a significant increase in cases requiring further preoperative optimization, from 6.3% at the beginning of the study period to 17.5% at the end of the study period. Implementation of a preoperative risk stratification intervention utilizing the ACS Surgical Risk Calculator along with a multidisciplinary Pre-Operative Consultation Committee can be successfully accomplished, with a significant decrease in 30-day surgical mortality. This is the first published report of utilization of the ACS Risk calculator as part of a systematic quality improvement tool to decrease surgical mortality. Published by Elsevier Inc.

  13. Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery in High Surgical Risk Patients With Left Main or Three-Vessel Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Tonga Nfor

    2015-08-01

    Full Text Available Purpose: Previous studies comparing percutaneous coronary intervention (PCI with coronary artery bypass graft surgery (CABG in patients with unprotected left main or three-vessel coronary artery disease (LM-3VD have excluded patients at high surgical risk. We compared clinical outcomes after PCI with drug-eluting stents to CABG in high surgical risk patients with LM-3VD. Methods: Patients with symptomatic LM-3VD who had Society of Thoracic Surgeons (STS-predicted operative mortality > 5% and were undergoing either PCI with drug-eluting stents or CABG at a tertiary care center from January 2009 to December 2010 were enrolled in this nonrandomized prospective study. Results: Mean STS score was 14.5 ± 5.8% for PCI (n=83 vs. 13.6 ± 7.1% for CABG (n=187 (P=0.31. After mean follow-up of 37 months, incidence of the composite primary endpoint (death, myocardial infarction or stroke was 42.2% for PCI and 39.6% for CABG (P=0.69, hazard ratio 1.3, 95% confidence interval 0.5-2.8. There were no differences in the individual components of the primary endpoint between PCI and CABG. Repeat revascularization was 30.1% for PCI vs. 9.6% for CABG (P=0.001. Major adverse cardiac and cerebrovascular event rates were similar between PCI and CABG, 50.6% vs. 42.2%, respectively (P=0.23. Patients in the PCI group were less likely than those in the CABG group to be discharged to a nursing home (12.1% vs. 47.1%, P 5%.

  14. Surgical site infections among high-risk patients in clean-contaminated head and neck reconstructive surgery: concordance with preoperative oral flora.

    Science.gov (United States)

    Yang, Ching-Hsiang; Chew, Khong-Yik; Solomkin, Joseph S; Lin, Pao-Yuan; Chiang, Yuan-Cheng; Kuo, Yur-Ren

    2013-12-01

    Salivary contamination of surgical wounds in clean-contaminated head and neck surgery with free flap reconstruction remains a major cause of infection and leads to significant morbidity. This study investigates the correlation between intraoral flora and surgical site infections (SSIs) among high-risk head and neck cancer patients undergoing resection and free flap reconstruction. One hundred twenty-nine patients were identified as being at high risk for infective complications based on cancer stage, tumor size, comorbid factors, and extent of reconstruction. All patients had intraoral swab cultures before surgery. Patients with culture-confirmed SSI after surgery were chosen for analysis, using the κ index and its 95% confidence interval for concordance analysis. All patients received clindamycin and gentamicin for antibiotic prophylaxis for 5 days. Antibiotic susceptibility testing of all isolates was obtained and analyzed. Thirty-seven patients experienced SSI, or an infection rate of 28.3%, occurring at a mean of 9.3 postoperative days. The overall concordance between oral flora and SSI was fair to moderate (κ index of 0.25), but detailed analysis shows a higher concordance for known and opportunistic pathogens, such as Pseudomonas aeruginosa and Enterococcus faecalis, compared to typical oral commensals. Antibiotic susceptibility tests show rapid and significant increases in resistance to clindamycin, indicating a need for a more effective alternative. Predicting pathogens in SSI using preoperative oral swabs did not demonstrate a good concordance in general for patients undergoing clean-contaminated head and neck surgery, although concordance for certain pathogenic species seem to be higher than for typical intraoral commensals. The rapid development of resistance to clindamycin precludes its use as a prophylactic agent.

  15. Building consensus: development of a Best Practice Guideline (BPG) for surgical site infection (SSI) prevention in high-risk pediatric spine surgery.

    Science.gov (United States)

    Vitale, Michael G; Riedel, Matthew D; Glotzbecker, Michael P; Matsumoto, Hiroko; Roye, David P; Akbarnia, Behrooz A; Anderson, Richard C E; Brockmeyer, Douglas L; Emans, John B; Erickson, Mark; Flynn, John M; Lenke, Lawrence G; Lewis, Stephen J; Luhmann, Scott J; McLeod, Lisa M; Newton, Peter O; Nyquist, Ann-Christine; Richards, B Stephens; Shah, Suken A; Skaggs, David L; Smith, John T; Sponseller, Paul D; Sucato, Daniel J; Zeller, Reinhard D; Saiman, Lisa

    2013-01-01

    Perioperative surgical site infection (SSI) after pediatric spine fusion is a recognized complication with rates between 0.5% and 1.6% in adolescent idiopathic scoliosis and up to 22% in "high risk" patients. Significant variation in the approach to infection prophylaxis has been well documented. The purpose of this initiative is to develop a consensus-based "Best Practice" Guideline (BPG), informed by both the available evidence in the literature and expert opinion, for high-risk pediatric patients undergoing spine fusion. For the purpose of this effort, high risk was defined as anything other than a primary fusion in a patient with idiopathic scoliosis without significant comorbidities. The ultimate goal of this initiative is to decrease the wide variability in SSI prevention strategies in this area, ultimately leading to improved patient outcomes and reduced health care costs. An expert panel composed of 20 pediatric spine surgeons and 3 infectious disease specialists from North America, selected for their extensive experience in the field of pediatric spine surgery, was developed. Using the Delphi process and iterative rounds using a nominal group technique, participants in this panel were as follows: (1) surveyed for current practices; (2) presented with a detailed systematic review of the relevant literature; (3) given the opportunity to voice opinion collectively; and (4) asked to vote regarding preferences privately. Round 1 was conducted using an electronic survey. Initial results were compiled and discussed face-to-face. Round 2 was conducted using the Audience Response System, allowing participants to vote for (strongly support or support) or against inclusion of each intervention. Agreement >80% was considered consensus. Interventions without consensus were discussed and revised, if feasible. Repeat voting for consensus was performed. Consensus was reached to support 14 SSI prevention strategies and all participants agreed to implement the BPG in their

  16. Feasibility of robot-assisted radical prostatectomy for very-high risk prostate cancer: surgical and oncological outcomes in men aged ≥70 years

    Directory of Open Access Journals (Sweden)

    Kyo Chul Koo

    2014-09-01

    Conclusions: RALP-PLND is a feasible option for VHPCa in elderly patients with satisfactory oncologic outcomes; however, functional outcomes were not as favorable. Patients who are unable to accept the risk of adjuvant therapy and its side effects or incontinence should be deterred from surgical treatment, and other options such as radiation therapy could be an alternative.

  17. Prevention of Surgical Site Infection After Ankle Surgery Using Vacuum-Assisted Closure Therapy in High-Risk Patients With Diabetes.

    Science.gov (United States)

    Zhou, Zhen-Yu; Liu, Ya-Ke; Chen, Hong-Lin; Liu, Fan

    2016-01-01

    Patients with diabetes have a high risk of surgical site infection (SSI) after ankle surgery. The aim of the present study was to investigate the efficacy of vacuum-assisted closure (VAC) in the prevention of SSI after ankle surgery compared with the efficacy of standard moist wound care (SMWC). A retrospective study was performed of unstable ankle fractures for surgical fixation in patients with diabetes from January 2012 to December 2014. VAC and SMWC were used for surgical incision coverage. The primary outcome was the incidence of SSI, and the secondary outcomes were the length of hospital stay and crude hospital costs. The data from 76 patients were analyzed, with 22 (28.95%) in the VAC group and 54 (71.05%) in the SMWC group. The incidence of SSI was 4.6% in the VAC group compared with 27.8% in the SMWC group (chi-square 5.076; p = .024), and the crude odds ratio for SSI in the VAC group was 0.124 (95% confidence interval 0.002 to 0.938). The length of hospital stay was lower in the VAC group than in the SMWC group (12.6 ± 2.7 days and 15.2 ± 3.5 days, respectively; t = 3.122, p = .003). The crude hospital costs were also lower in the VAC group than in the SMWC group (Chinese yuan 8643.2 ± 1195.3 and 9456.2 ± 1106.3, respectively; t = 2.839, p = .006). After logistic regression analysis, the adjusted odds ratio for the total SSI rate comparing VAC and SMWC was 0.324 (95% confidence interval 0.092 to 0.804; p = .021). Compared with SMWC, VAC can decrease the SSI rate after ankle surgery in patients with diabetes. This finding should be confirmed by prospective, randomized controlled clinical trials. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Coronectomy versus surgical removal of the lower third molars with a high risk of injury to the inferior alveolar nerve. A bibliographical review

    Science.gov (United States)

    Moreno-Vicente, Javier; Schiavone-Mussano, Rocío; Clemente-Salas, Enrique; Marí-Roig, Antoni; Jané-Salas, Enric

    2015-01-01

    Background Coronectomy is the surgical removal of the crown of the tooth deliberately leaving part of its roots. This is done with the hope of eliminating the pathology caused, and since the roots are still intact, the integrity of the inferior alveolar nerve is preserved. Objectives The aim is to carry out a systematic review in order to be able to provide results and conclusions with the greatest scientific evidence possible. Material and Methods A literature review is carried out through the following search engines: Pubmed MEDLINE, Scielo, Cochrane library and EMI. The level of evidence criteria from the Agency for Healthcare Research and Quality was applied, and the clinical trials’ level of quality was analyzed by means of the JADAD criteria. Results The following articles were obtained which represents a total of 17: 1 systematic review, 2 randomized clinical trials and 2 non-randomized clinical trials, 3 cohort studies, 2 retrospective studies, 3 case studies and 4 literature reviews. Conclusions Coronectomy is an adequate preventative technique in protecting the inferior alveolar nerve, which is an alternative to the conventional extraction of third molars, which unlike the former technique, presents a high risk of injury to the inferior alveolar nerve. However, there is a need for new clinical studies, with a greater number of samples and with a longer follow-up period in order to detect potential adverse effects of the retained roots. Key words: Coronectomy, inferior alveolar nerve, nerve injury, wisdom tooth removal, paresthesia, and systematic review. PMID:25858081

  19. Tooth extractions in high-risk patients under bisphosphonate therapy and previously affected with osteonecrosis of the jaws: surgical protocol supported by low-level laser therapy.

    Science.gov (United States)

    Vescovi, Paolo; Giovannacci, Ilaria; Merigo, Elisabetta; Meleti, Marco; Manfredi, Maddalena; Fornaini, Carlo; Nammour, Samir

    2015-05-01

    Trauma during dental surgery is a predisposing factor for medication-related osteonecrosis of the jaws (MRONJ). There are no specific guidelines for the management of dental extractions in patients under bisphosphonate therapy (BPT). The authors proposed in 2013 a successful protocol for tooth extractions in patients under BPT supported by Nd:YAG low-level laser therapy (LLLT). The aim of this study was to validate the safety and efficacy of this protocol reporting the data related to its application in a particular category of patients under BPT at high risk for MRONJ and who were previously affected with MRONJ. Eighty-two tooth extractions were performed in 36 patients previously affected with MRONJ. Antibiotic treatment was administered 3 days before and 2 weeks after tooth extractions. Patients were additionally treated with Nd:YAG LLLT, 5 applications of 1 minute each. Patients were evaluated 3 days and once a week for 2 months after the extractions and every time they received LLLT. In a total of 82 extractions, minimal bone exposure was observed in 2 cases, treated with Er:YAG laser vaporization and then completely healed. The data confirmed that laser biostimulation is a reliable technique that can be considered in the surgical protocol for patients under BPT.

  20. Surgical Nasal Implants: Indications and Risks.

    Science.gov (United States)

    Genther, Dane J; Papel, Ira D

    2016-10-01

    Rhinoplasty often requires the use of grafting material, and the goal of the specific graft dictates the ideal characteristics of the material to be used. An ideal material would be biologically inert, resistant to infection, noncarcinogenic, nondegradable, widely available, cost-effective, readily modifiable, and easily removable, have compatible biomechanical characteristics, retain physical properties over time, and not migrate. Unfortunately, no material currently in existence meets all of these criteria. In modern rhinoplasty, autologous grafts are the gold standard against which all other nasal implants are measured and offer the safest long-term results for most patients. They are easily manipulated, have inherent stability and biomechanical characteristics similar to the native nasal framework, and confer minimal risk of complications. Modern homologous and alloplastic materials have gained considerable support in recent years because they are readily available in endless quantity, do not require a second surgical site for harvest, and are generally considered safe if most circumstances, but they confer additional risk and have biomechanical characteristics different from that of the native nasal framework. To address some of these issues, we provide a contemporary review of autologous, homologous, and alloplastic materials commonly used in rhinoplasty surgery. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  1. Surgical jejunostomy in aspiration risk patients.

    Science.gov (United States)

    Weltz, C R; Morris, J B; Mullen, J L

    1992-01-01

    One hundred patients underwent laparotomy for independent jejunal feeding tube placement. Neurologic disease was present in 50%, and obtundation (28) and oropharyngeal dysmotility (25) were the most common indications for enteral feeding. The post-pyloric route was chosen because of aspiration risk in almost all (94%) patients. Postoperative (30-day) mortality rate was 21%, because of cardiopulmonary failure in most (18). One death resulted directly from aspiration of tube feeds. Two surgical complications required reoperation: one wound dehiscence and one small bowel obstruction. Four wound infections occurred. Two patients underwent reoperation after tube removal, and four tubes required fluoroscopically guided reinsertion for peritubular drainage (2), removal (1), and occlusion (1). Aspiration pneumonia was present in 18 patients preoperatively and in eight postoperatively. None of the patients with feeding-related preoperative aspiration pneumonia (13) had a recurrence while fed by jejunostomy. Three patients developed postoperative aspiration pneumonia before initiation of jejunostomy feedings. Jejunostomy may be performed with low morbidity rate and substantial reduction of feeding-related aspiration pneumonia, and is the feeding route of choice in aspiration risk patients. PMID:1546899

  2. Omentoplasty as an effective surgical modality for managing a high ...

    African Journals Online (AJOL)

    Omentoplasty as an effective surgical modality for managing a high risk patient with deep sternal wound infection. ... The PDF file you selected should load here if your Web browser has a PDF reader plug-in installed (for example, a recent version of Adobe Acrobat Reader). If you would like more information about how to ...

  3. High reliability organizations and surgical microsystems: re-engineering surgical care.

    Science.gov (United States)

    Sanchez, Juan A; Barach, Paul R

    2012-02-01

    Error prevention and mitigation is the primary goal in high-risk health care, particularly in areas such as surgery. There is growing consensus that significant improvement is hard to come by as a result of the vast complexity and inefficient processes of the health care system. Recommendations and innovations that focus on individual processes do not address the larger and often intangible systemic and cultural factors that create vulnerabilities throughout the entire system. This article introduces basic concepts of complexity and systems theory that are useful in redesigning the surgical work environment to create safety, quality, and reliability in surgical care. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Surgical Site Infection In Orthopaedic Surgery: Correlation Between Age, Diabetes, Smoke And Surgical Risk.

    Science.gov (United States)

    Fisichella, Leonardo; Fenga, Domenico; Rosa, Michele Attilio

    2014-01-01

    Surgical site infection is a common complication after orthopaedic surgery. It can be associated with increased morbidity rate and social cost. The accurate identification of risk factors is essential so that strategies to prevent these potentially devastating infections can be developed. We have conducted this study to determine the possible risk factors for the surgical site infections. We aimed at finding exhaustive evidence concerning the potential risk factors for infections in orthopaedic surgery. Between October 2009 and December 2011, we identified 84 patients with a superficial and/or deep surgical site infection and compared them with 203 uninfected patients (control group), taken out from a series of 486 patients. We considered the following risk factors: diabetes, BMI >30, ASA Score of 3 or 4, smoking and age. The most frequently performed operations of the 287 examined patients were the knee and hip arthroplasties (n = 32, 11.14%) and open fracture reductions (n = 178, 62.02%). Staphylococcus Aureus was the most common identified pathogen (n = 63, 75%). The analyses (preoperative and postoperative) of the infected patients showed them to have significantly high serum glucose levels in comparison with the control group (odds ratio = 8.7). We found a significant high rate of infection in patients smoking for more than 20 years (67 patients, 79.7%). The remaining variables (BMI, OR = 2.21; ASA score, OR = 1.3) showed no significant differences between the study group and controls. We also found a correlation between > 65-year-old patients and infections at the surgical site (61 patients, 72.6%). We found that there was correlation between diabetes, smoking and age as risk factors with the development of infection at the surgical site; other variables such as the ASA score and BMI are not relevant here (contrary to what is reported in literature). We believe that postoperative results can be improved considerably with a properly conducted antibiotic

  5. Serial post-surgical stimulated and unstimulated highly sensitive thyroglobulin measurements in low- and intermediate-risk papillary thyroid carcinoma patients not receiving radioactive iodine.

    Science.gov (United States)

    Kashat, Lawrence; Orlov, Steven; Orlov, David; Assi, Jasmeet; Salari, Farnaz; Walfish, Paul G

    2016-11-01

    The purpose of this study was to determine the natural temporal trends of serial thyroglobulin (Tg) among low/intermediate-risk PTC patients not receiving radioactive iodine (RAI) using TSH-stimulated Tg (Stim-Tg) and unstimulated highly sensitive Tg (u-hsTg). We prospectively analyzed serial Stim-Tg measurements after total thyroidectomy ± therapeutic central neck dissection among 121 consecutive low/intermediate-risk PTC patients who did not receive RAI, of whom 104 also had serial u-hsTg measurements available. Median follow-up was 6.5 years with Stim-Tg measurements commencing 3 months after surgery and u-hsTg commencing 1.8 years after surgery (when the assay became available). TSH stimulation was performed with 9-day T3 withdrawal, 22-day T4 withdrawal, or using recombinant human TSH (rhTSH). To account for within-patient correlations of repeated Tg measurements, temporal trends in Stim-Tg and u-hsTg were assessed using Generalized Estimating Equations. Stim-Tg models were adjusted for the method of TSH stimulation, whereas the u-hsTg models were adjusted for concurrent TSH level. Linear regression modeling was used to assess the trend in serial Stim-Tg and u-hsTg measurements as a function time from time of surgery throughout the duration of follow-up. The main outcome measured was the change in u-hsTg and Stim-Tg measurements over time. A total of 337 Stim-Tg (2.8/patient) and 602 u-hsTg (5.8/patient) measurements were analyzed. Among the 337 Stim-Tg measurements, Stim-Tg was assessed using rhTSH in 202 (60 %), T4 withdrawal in 41 (12 %), and T3 withdrawal in 94 (28 %) measurements. The overall mean ± 1SD for Stim-Tg and u-hsTg measured was 1.0 ± 1.2 and 0.2 ± 0.1 μg/L, respectively. When adjusted for method of TSH stimulation, serial Stim-Tg measurements did not significantly change over time (all p = NS). The estimated changes in Stim-Tg per year for rhTSH, T4 withdrawal, and T3 withdrawal were 0.01, -0.08, and 0.04

  6. Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high-risk surgical patients : a prospective randomized multicentre study

    NARCIS (Netherlands)

    Scheeren, Thomas W. L.; Wiesenack, Christoph; Gerlach, Herwig; Marx, Gernot

    Perioperative hemodynamic optimisation improves postoperative outcome for patients undergoing high-risk surgery (HRS). In this prospective randomized multicentre study we studied the effects of an individualized, goal-directed fluid management based on continuous stroke volume variation (SVV) and

  7. Preventing the progression to type 2 diabetes mellitus in adults at high risk: a systematic review and network meta-analysis of lifestyle, pharmacological and surgical interventions.

    Science.gov (United States)

    Stevens, John W; Khunti, Kamlesh; Harvey, Rebecca; Johnson, Maxine; Preston, Louise; Woods, Helen Buckley; Davies, Melanie; Goyder, Elizabeth

    2015-03-01

    Individuals with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) have an increased risk of progression to Type 2 diabetes mellitus. The objective of this review was to quantify the effectiveness of lifestyle, pharmacological and surgical interventions in reducing the progression to Type 2 diabetes mellitus in people with IFG or IGT. A systematic review was carried out. A network meta-analysis (NMA) of log-hazard ratios was performed. Results are presented as hazard ratios and the probabilities of treatment rankings. 30 studies were included in the NMA. There was a reduced hazard of progression to Type 2 diabetes mellitus associated with all interventions versus standard lifestyle advice; glipizide, diet plus pioglitazone, diet plus exercise plus metformin plus rosiglitazone, diet plus exercise plus orlistat, diet plus exercise plus pedometer, rosiglitazone, orlistat and diet plus exercise plus voglibose produced the greatest effects. Lifestyle and some pharmacological interventions are beneficial in reducing the risk of progression to Type 2 diabetes mellitus. Lifestyle interventions require significant behaviour changes that may be achieved through incentives such as the use of pedometers. Adverse events and cost of pharmacological interventions should be taken into account when considering potential risks and benefits. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. Risk factors for deep surgical site infections after spinal fusion.

    Science.gov (United States)

    Schimmel, J J P; Horsting, P P; de Kleuver, M; Wonders, G; van Limbeek, J

    2010-10-01

    Surgical site infections (SSI) are undesired and troublesome complications after spinal surgery. The reported infection rates range from 0.7 to 11.9%, depending on the diagnosis and the complexity of the procedure. Besides operative factors, patient characteristics could also account for increased infection rates. Because the medical, economic and social costs of SSI are enormous, any significant reduction in risks will pay dividends. The purpose of this study is to compare patients who developed deep SSI following lumbar or thoracolumbar spinal fusion with a randomly selected group of patients who did not develop this complication in order to identify changeable risk factors. With a case-control analysis nested in a historical cohort of patients who had had a spinal fusion between January 1999 and December 2008, we identified 36 cases with deep SSI (CDC criteria). Information regarding patient-level and surgical-level risk factors was derived from standardized but routinely recorded data and compared with those acquired in a random selection of 135 uninfected patients. Univariate analyses and a multivariate logistic regression were performed. The overall rate of infection in 1,615 procedures (1,568 patients) was 2.2%. A positive history of spinal surgery was associated with an almost four times higher infection rate (OR = 3.7, 95% BI = 1.6-8.6). The risk of SSI increased with the number of levels fused, patients with diabetes had an almost six times higher risk and smokers had more than a two times higher risk for deep SSI. The most common organism cultured was Staphylococcus aureus. All infected patients underwent at least one reoperation, including an open débridement and received appropriate antibiotics to treat the organism. Patients who had had a previous spinal surgery are a high-risk group for infection compared with those that never had surgery. Total costs associated with preventive measures are substantial and should be compensated by health care

  9. [Nutritional risk screening and its clinical significance in 706 children hospitalized in the surgical department].

    Science.gov (United States)

    Peng, Lu-Ting; Li, Rong; Zhao, Wei-Hua; Chen, Yin-Hua; Li, Xiao-Mei; Chen, Meng-Ying; Cao, Jia; Li, Xiao-Nan

    2013-10-01

    To investigate nutritional risk and its relationship with clinical outcome in children hospitalized in the surgical department, and to provide a scientific basis for clinical nutrition management. Nutritional risk screening was performed on 706 children hospitalized in the surgical department using the Screening Tool for Risk on Nutritional Status and Growth. The data on nutritional support during hospitalization, incidence of infectious complications, length of hospital stay, post operative length of hospital stay and total hospital expenses were recorded. Of the 706 cases, 11.5% had high nutritional risk, 46.0% had moderate nutritional risk, and 42.5% had low nutritional risk. Congenital hypertrophic pyloric stenosis, intestinal obstruction and congenital heart disease were the three most common types of high nutritional risk. The incidence of high nutritional risk was significantly higher in infants than in other age groups (Pnutritional risk received parenteral nutrition. Children with high nutritional risk were significantly more likely to have weight loss than children with low nutritional risk (Pnutritional risk had significantly increased incidence of infectious complications, length of hospital stay, post operative length of hospital stay and total hospital expenses compared with those with moderate or low nutritional risk (Pnutritional risk is seen in children hospitalized in the surgical department. Nutritional risk score is correlated with clinical outcome. Nutritional support for these children is not yet properly provided. Nutritional risk screening and standard nutritional support should be widely applied among hospitalized children.

  10. Risk of surgical glove perforation in oral and maxillofacial surgery.

    Science.gov (United States)

    Kuroyanagi, N; Nagao, T; Sakuma, H; Miyachi, H; Ochiai, S; Kimura, Y; Fukano, H; Shimozato, K

    2012-08-01

    Oral and maxillofacial surgery, which involves several sharp instruments and fixation materials, is consistently at a high risk for cross-contamination due to perforated gloves, but it is unclear how often such perforations occur. This study aimed to address this issue. The frequency of the perforation of surgical gloves (n=1436) in 150 oral and maxillofacial surgeries including orthognathic surgery (n=45) was assessed by the hydroinsufflation technique. Orthognathic surgery had the highest perforation rate in at least 1 glove in 1 operation (91.1%), followed by cleft lip and palate surgery (55.0%), excision of oral soft tumour (54.5%) and dental implantation (50.0%). The perforation rate in scrub nurses was 63.4%, followed by 44.4% in surgeons and first assistants, and 16.3% in second assistants. The odds ratio for the perforation rate in orthognathic surgery versus other surgeries was 16.0 (95% confidence interval: 5.3-48.0). The protection rate offered by double gloving in orthognathic surgery was 95.2%. These results suggest that, regardless of the surgical duration and blood loss in all fields of surgery, orthognathic surgery must be categorized in the highest risk group for glove perforation, following gynaecological and open lung surgery, due to the involvement of sharp objects. Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Risk factors for surgical site infection after dermatological surgery.

    Science.gov (United States)

    Heal, Clare F; Buettner, Petra G; Drobetz, Herwig

    2012-07-01

    Surgical site infection (SSI) following minor surgery contributes to patient morbidity and compromises cosmetic outcomes. The purpose of this study was to determine the incidence of and risk factors for SSI after dermatological surgery in general practice.   A prospective, observational study which assessed infection among 972 patients was conducted in regional north Queensland, Australia. Consecutive patients presenting for minor skin excisions were invited to participate. Wounds were assessed for SSI at the time of removal of sutures. Infection occurred in 85 of the 972 excisions; thus, the overall incidence of infection was 8.7% (95% confidence interval 6.5-11.0). Excisions in the upper (Pfactors for wound infection. The length of the excision (Pfactors for infection. Diabetes was not found to be an independent risk factor for infection (P=0.891). Prophylactic antibiotics are probably prescribed excessively or inappropriately for dermatological surgery, and overall we wish to discourage their use. The results of this study may encourage the more judicial use of prophylactic antibiotics by defining high-risk procedures, such as excisions from the extremities, excision of BCC or SCC, and larger excisions, and patients who are at high risk for infection, such as ex-smokers. © 2012 The International Society of Dermatology.

  12. Risk Factors of Surgical Site Infection at Muhimbili National Hospital ...

    African Journals Online (AJOL)

    Superficial SSI was the most commonly observed type, 54.8%. Overall HIV prevalence in this study was 16.9% with a 5 times risk of developing SSI. Conclusions: Surgical site infection has remained a major Nosocomial infection in developing countries. Factors shown to be associated with increased risk are wound class, ...

  13. A phase II study evaluating neo-/adjuvant EIA chemotherapy, surgical resection and radiotherapy in high-risk soft tissue sarcoma

    Directory of Open Access Journals (Sweden)

    Schmitt Thomas

    2011-12-01

    Full Text Available Abstract Background The role of chemotherapy in high-risk soft tissue sarcoma is controversial. Though many patients undergo initial curative resection, distant metastasis is a frequent event, resulting in 5-year overall survival rates of only 50-60%. Neo-adjuvant and adjuvant chemotherapy (CTX has been applied to achieve pre-operative cytoreduction, assess chemosensitivity, and to eliminate occult metastasis. Here we report on the results of our non-randomized phase II study on neo-adjuvant treatment for high-risk STS. Method Patients with potentially curative high-risk STS (size ≥ 5 cm, deep/extracompartimental localization, tumor grades II-III [FNCLCC] were included. The protocol comprised 4 cycles of neo-adjuvant chemotherapy (EIA, etoposide 125 mg/m2 iv days 1 and 4, ifosfamide 1500 mg/m2 iv days 1 - 4, doxorubicin 50 mg/m2 day 1, pegfilgrastim 6 mg sc day 5, definitive surgery with intra-operative radiotherapy, adjuvant radiotherapy and 4 adjuvant cycles of EIA. Result Between 06/2005 and 03/2010 a total of 50 subjects (male = 33, female = 17, median age 50.1 years were enrolled. Median follow-up was 30.5 months. The majority of primary tumors were located in the extremities or trunk (92%, 6% originated in the abdomen/retroperitoneum. Response by RECIST criteria to neo-adjuvant CTX was 6% CR (n = 3, 24% PR (n = 12, 62% SD (n = 31 and 8% PD (n = 4. Local recurrence occurred in 3 subjects (6%. Distant metastasis was observed in 12 patients (24%. Overall survival (OS and disease-free survival (DFS at 2 years was 83% and 68%, respectively. Multivariate analysis failed to prove influence of resection status or grade of histological necrosis on OS or DFS. Severe toxicities included neutropenic fever (4/50, cardiac toxicity (2/50, and CNS toxicity (4/50 leading to CTX dose reductions in 4 subjects. No cases of secondary leukemias were observed so far. Conclusion The current protocol is feasible for achieving local control rates, as well as OS

  14. [High dynamic risk cystoceles].

    Science.gov (United States)

    Salinas Casado, Jesús; Méndez Rubio, Santiago; Virseda Chamorro, Miguel; Pelaquim, Humberto; Silmi Moyano, Angel

    2010-06-01

    To assess the bladder compliance in a series of cystoceles referred for urodynamic study. Retrospective study of a series of patients with cystocele undergoing medical history, videurodynamic study, pelvic MRI and lower urinary tract, urological ultrasound and cystoscopy. We Excluded cases with neurogenic dysfunction and urinary infection. The terminology followed the criteria of the ICS, if not specified otherwise. The series includes 3333 cases of cystocele 616 of which are grade III cystocele. There were 3 cases with low bladder compliance; this is 0.0009% of total (1:1000) and 0.5% of grade III cystocele (1:200) All cases of cystocele whith low compliance were associated with feeling of a bulk in the vagina and functional symptoms of lower urinary tract(LUTS). No urinary incontinence was related to cough. These patients also showed urodynamic alterations in the voiding phase, type hypo / acontractile detrusor and postvoid residual. The patients were subjected to various techniques of abdominal and transvaginal cystocele repair (with preventive anti-incontinence surgery), getting a vagina bulk disappearance, improvement of symptoms of lower urinary tract function, normalization of bladder compliance and detrusor contractility, with elimination of the postvoid residual. Although they are not frequent, high-risk cystoceles should be discarded in high-grade cystocele that apart from low bladder accommodation, have a hipo/acontractile detrusor and postvoid residual. Surgical correction of cystocele not only reduces the bulk and LUTS, but normalizes urodynamic alterations.

  15. Risk-factors for surgical delay following hip fracture.

    Science.gov (United States)

    Sanz-Reig, J; Salvador Marín, J; Ferrández Martínez, J; Orozco Beltrán, D; Martínez López, J F

    To identify pre-operative risk factors for surgical delay of more than 2 days after admission in patients older than 65 years with a hip fracture. A prospective observational study was conducted on 180 hip fractures in patients older than 65 years of age admitted to our hospital from January 2015 to April 2016. The data recorded included, patient demographics, day of admission, pre-fracture comorbidities, mental state, level of mobility and physical function, type of fracture, antiaggregant and anticoagulant medication, pre-operative haemoglobin value, type of treatment, and surgical delay. The mean age of the patients was 83.7 years. The mean Charlson Index was 2.8. The pre-fracture baseline co-morbidities were equal or greater than 2 in 70% of cases. Mean timing of surgery was 3.1 days. At the time of admission, 122 (67.7%) patients were fit for surgery, of which 80 (44.4%) underwent surgery within 2 days. A Charlson index greater than 2, anticoagulant therapy, and admission on Thursday to Saturday, were independently associated with a surgical delay greater than 2 days. The rate of hip fracture patients undergoing surgery within 2 days is low. Risk factors associated to surgical delay are non-modifiable. However, their knowledge should allow the development of protocols that can reduce surgical delay in this group of patients. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Transcatheter Tricuspid Valve-In-Valve Implantation in Patients with Tricuspid Bioprosthetic Valve Degeneration at High Surgical Risk: A Multicenter Case Series.

    Science.gov (United States)

    Landes, Uri; Kerner, Arthur; Segev, Amit; Danenberg, Haim; Shapira, Yaron; Finkelstein, Ariel; Kornowski, Ran

    2017-03-01

    Transcatheter tricuspid valve-in-valve implantation (TVIV) is an attractive yet under-explored alternative to redo valve surgery. To report the multicenter TVIV experience in Israel. We approached multiple centers and collected data regarding seven TVIV cases. The study group comprised seven participants: five females and two males, with a mean age of 63 ± 12 years and EuroSCORE-II 13.6 ± 3.3%. Follow-up ranged from 3 to 21 months (mean 8 ± 6 months). All presented with advanced heart failure. The indication for valve intervention was a predominant tricuspid stenosis in three patients, significant tricuspid regurgitation in one and a mixture in three. Six procedures were conducted via a transfemoral approach and one by transatrial access. The Edwards SAPIENTM XT valve was used in four cases and the SAPIENTM 3 in three. Without pre-stenting/rapid pacing, all participants underwent successful valve implantation. Mean transvalvular gradient decreased from 11 ± 3 mmHg to 6 ± 3 mmHg (P = 0.003) and regurgitation decreased from moderate/severe (in four cases) to none/trace (in six of the seven cases). One patient remained severely symptomatic and died 3.5 months after the implantation. All others achieved a functional capacity improvement and amelioration of symptoms soon after the implantation, which persisted during follow-up. TVIV may be a safe and effective strategy to treat carefully selected patients with degenerated bioprosthetic tricuspid valve at high operative risk.

  17. Risk Factors and Predictive Model Development of Thirty-Day Post-Operative Surgical Site Infection in the Veterans Administration Surgical Population.

    Science.gov (United States)

    Li, Xinli; Nylander, William; Smith, Tracy; Han, Soonhee; Gunnar, William

    2018-02-01

    Surgical site infection (SSI) complicates approximately 2% of surgeries in the Veterans Affairs (VA) hospitals. Surgical site infections are responsible for increased morbidity, length of hospital stay, cost, and mortality. Surgical site infection can be minimized by modifying risk factors. In this study, we identified risk factors and developed accurate predictive surgical specialty-specific SSI risk prediction models for the Veterans Health Administration (VHA) surgery population. In a retrospective observation study, surgical patients who underwent surgery from October 2013 to September 2016 from 136 VA hospitals were included. The Veteran Affairs Surgical Quality Improvement Program (VASQIP) database was used for the pre-operative demographic and clinical characteristics, intra-operative characteristics, and 30-day post-operative outcomes. The study population represents 11 surgical specialties: neurosurgery, urology, podiatry, otolaryngology, general, orthopedic, plastic, thoracic, vascular, cardiac coronary artery bypass graft (CABG), and cardiac valve/other surgery. Multivariable logistic regression models were developed for the 30-day post-operative SSIs. Among 354,528 surgical procedures, 6,538 (1.8%) had SSIs within 30 days. Surgical site infection rates varied among surgical specialty (0.7%-3.0%). Surgical site infection rates were higher in emergency procedures, procedures with long operative duration, greater complexity, and higher relative value units. Other factors associated with increased SSI risk were high level of American Society of Anesthesiologists (ASA) classification (level 4 and 5), dyspnea, open wound/infection, wound classification, ascites, bleeding disorder, chemotherapy, smoking, history of severe chronic obstructive pulmonary disease (COPD), radiotherapy, steroid use for chronic conditions, and weight loss. Each surgical specialty had a distinct combination of risk factors. Accurate SSI risk-predictive surgery specialty

  18. Retrospective review of risk factors for surgical wound dehiscence and incisional hernia.

    Science.gov (United States)

    Walming, Sofie; Angenete, Eva; Block, Mattias; Bock, David; Gessler, Bodil; Haglind, Eva

    2017-02-22

    Several factors and patient characteristics influence the risk of surgical wound dehiscence and incisional hernia after midline laparotomy. The purpose of this study was to investigate whether a specified, or not specified, suture quota in the operative report affects the incidence of surgical wound complications and to describe the previously known risk factors for these complications. Retrospective data collection from medical records of all vascular procedures and laparotomies engaging the small intestines, colon and rectum performed in 2010. Patients were enrolled from four hospitals in the region Västra Götaland, Sweden. Unadjusted and adjusted Cox regression analyses were used when calculating the impact of the risk factors for surgical wound dehiscence and incisional hernia. A total of 1,621 patients were included in the study. Wound infection was a risk factor for both wound dehiscence and incisional hernia. BMI 25-30, 30-35 and >35 were risk factors for wound dehiscence and BMI 30-35 was a risk factor for incisional hernia. We did not find that documentation of the details of suture technique, regarding wound and suture length, influenced the rate of wound dehiscence or incisional hernia. These results support previous findings identifying wound infection and high BMI as risk factors for both wound dehiscence and incisional hernia. Our study indicates the importance of preventive measures against wound infection and a preoperative dietary regiment could be considered as a routine worth testing for patients with high BMI planned for abdominal surgical precedures.

  19. The risk of lymphedema after breast cancer surgical treatment.

    Science.gov (United States)

    Diaconu, C; Livadariu, Roxana-Maria; Dogaru, C

    2012-01-01

    The aim of this study is to emphasize the importance of knowing the predisposing factors of the occurrence of homolateral upper limb lymphedema after breast cancer surgery. The study included 1104 patients with breast cancer, who were hospitalized in the IIIrd Surgical Clinic, lasi, between 2000 and 2010, for surgical treatment followed by oncological adjuvant therapy. The surgical intervention was conservative in 228 cases and modified radical mastectomy - Madden type - in 876 patients. Periodic clinical follow-ups were done every 3 months during the first postoperative year, every 6 months during the second year and annually thereafter. Early lymphedema occurring in the first 14 postoperative days or between day 14 and day 21 was found in 8 patients. Late lymphedema, occurring up to 12 months or more after surgery, was diagnosed in 41 patients. Medium and severe lymphedema occurred at 42 patients. We evaluated the preexisting risk factors, the risk factors related to the type of surgery and those related to the cancer staging. It's ideal to identify predisposing factors of developing lymphedema related to breast cancer surgery before applying any type of treatment, There are therapeutic methods (general, drug therapy, physiotherapy) and methods related to the surgical act that influences the prophylaxis of lymphedema or have an amazing effect on already occurred lymphedema.

  20. Risk factors and prognosis of hypoalbuminemia in surgical septic patients

    Directory of Open Access Journals (Sweden)

    Jia-Kui Sun

    2015-10-01

    Full Text Available The aim of this study was to investigate the risk factors of hypoalbuminemia and effects of different albumin levels on the prognosis of surgical septic patients. We preformed a retrospective clinical study including 135 adult patients from September 2011 to June 2014. The albumin levels and severity markers were recorded during the first 48 h after enrollment, and logistic regression analyses were used to determine the risk factors. The outcomes of patients with different albumin levels were also compared. The acute physiology and chronic health evaluation II (APACHE II score (OR 1.786, 95% CI [1.379–2.314], P < 0.001, C-reactive protein (CRP (OR 1.016, 95% CI [1.005–1.027], P = 0.005, and blood lactate (OR 1.764, 95% CI [1.141–2.726], P = 0.011 were established as the independent risk factors of hypoalbuminemia in patients with surgical sepsis. The severity markers and outcomes of patients with albumin levels ≤20 g/L were significantly worse than that of 21–25 g/L and ≥26 g/L, whereas the latter two groups had similar prognosis. Every 1 g/L decrease of albumin level below the optimal cut-off (23 g/L was associated with a 19.4% increase in hospital mortality and a 28.7% increase in the incidence of multiple organ dysfunction syndrome. In conclusion, APACHE II score (≥14.5, CRP (≥34.25 mg/L, and blood lactate (≥.35 mmol/L were established as the independent risk factors of hypoalbuminemia in the early stage of surgical sepsis. Patients with baseline albumin level ≤20 g/L had worse prognosis than that of albumin level ≥21 g/L. Albumin levels were negatively correlated the prognosis of surgical sepsis when below about 23 g/L.

  1. Nutritional risk and status of surgical patients; the relevance of nutrition training of medical students.

    Science.gov (United States)

    Ferreira, C; Lavinhas, C; Fernandes, L; Camilo, Ma; Ravasco, P

    2012-01-01

    The prevalence of undernutrition among surgical patients is thought to be high, and negatively influencing outcomes. However, recent evidence shows the increase of overweight/obesity in hospitalised patients. A pilot cross-sectional study was conducted in 50 patients of a Surgical Department of the University Hospital of Santa Maria (CHLN) that aimed: 1) to assess nutritional risk and status through validated methods; 2) to explore the presence of overweight/obesity; 3) to evaluate the prevalence of metabolic risk associated with obesity. Nutritional risk was assessed by Malnutrition Universal Screening Tool (MUST), nutritional status by Body Mass Index (BMI), waist circumference (WC), & Subjective Global Assessment (SGA). Statistical significance was set for p nutrition discipline in the medical curricula, limits the multiprofessional management and a better understanding of the more adequate approaches to these patients. Further, the change in the clinical scenario argues for more studies to clarify the prevalence and consequences of sarcopenic obesity in surgical patients.

  2. Surgical risk index and surgical site infection in postpartum women submitted to cesarean section.

    Directory of Open Access Journals (Sweden)

    Luana Machado Chianca

    2015-01-01

    Full Text Available Backgound and Objectives: Considering the use of active surveillance assists in infection identification and the need for studies that use Surgical Risk Index (SRI for assessment of Surgical Site Infection (SSI in cesareans, this study aims to determine the incidence of SSI and analyze the applicability of SRI in the prediction of SSI in women in the postpartum period after being submitted to a cesarean section at a university hospital between April 2012 and March of 2013. Methods: Prospective cohort study. Information notifying SSI by active surveillance was collected daily from the medical records. After hospital discharge, the mothers were contacted through telephone calls to identify infection criteria within 30 days after the cesarean. Descriptive and comparative analyses were performed. The chi-square test was used to compare groups. Results: 737 cesareans were performed. Telephone contact was achieved with 507 (68.8% women up to 30 days postpartum, with loss of follow-up of 230 cases (31.2%. The medical consultation in the post-partum period occurred with 188 (37.08% women, with whom telephone contact was obtained, on average, 17.28 days (SD=8.39 after delivery. It was verified that 21 patients met the criteria for SSI, with a 4.14% rate. A total of 12 cases (57.1% were classified as superficial SSI, 5 (23.8% as deep and 4 (19.1% as infection of organs and cavities. The SRI and its risk variables were not associated with SSI in patients submitted to cesarean sections. Conclusion: The SRI and the risk variables included in this index were not associated to SSI in patients submitted to cesarean sections. KEYWORDS: Cesarean Section; Surgical Wound Infection; Epidemiological Surveillance; Infection Control; Risk Index; Disease Notification.

  3. Are cardiac surgical patients at increased risk of difficult intubation?

    Directory of Open Access Journals (Sweden)

    Deepak Prakash Borde

    2017-01-01

    Full Text Available Background and Aims: Safe airway management is the cornerstone of contemporary anaesthesia practice, and difficult intubation (DI remains a major cause of anaesthetic morbidity and mortality. The surgical category, particularly cardiac surgery as a risk factor for DI has not been studied extensively. The aim of this study was to test the hypothesis whether cardiac surgical patients are at increased risk of DI. Methods: During the study, 627 patients (329 cardiac and 298 non-cardiac surgical were enrolled. Pre-operative demographic and other variables associated with DI were assessed. Patients with Cormack Lehane grade III and IV or use of bougie in Cormack grade II were defined as DI. The incidence of anticipated and unanticipated DI was assessed. Factors associated with DI were described using univariate and multivariate logistic regression models. Results: The overall incidence of DI was 122/627 (19.46%. The incidence of DI was higher in cardiac surgery patients (24% as compared to non-cardiac surgery patients (14.4% P = 0.002. On multivariate analysis, factors independently associated with DI were greater age, male sex, higher Mallampati grade, and anticipated DI, but not cardiac surgery. The incidence of unanticipated DI was 48.1% and 53.4% in cardiac and non-cardiac surgery patients, respectively. Conclusion: Although there was a higher incidence of DI in cardiac surgical patients, cardiac surgery is not an independent risk factor for DI. Rather, other factors play more important role. About half of the DI both in cardiac and non-cardiac surgeries were unanticipated.

  4. Infected primary knee arthroplasty: Risk factors for surgical treatment failure

    Directory of Open Access Journals (Sweden)

    Joao Gabriel Duarte Paes Pradella

    2013-09-01

    Full Text Available OBJECTIVE: To present epidemiological data and risk factors associated with surgical out-comes favorable or unfavorable for the treatment of infection in infected total knee arthroplasty. METHODS: We reviewed medical records of 48 patients who underwent treatment of primary total knee arthroplasty for infection between January 1994 and December 2008, in the Orthopedics and Traumatology Department of the Santa Casa de Misericórdia de São Paulo. The variables associated with favorable outcome of surgical treatment (debridement and retention or exchange arthroplasty in two days or unfavorable (arthrodesis or death infection. RESULTS: A total of 39 cases of infection after primary total knee arthroplasty, 22 progressed to 17 for a favorable outcome and unfavorable outcome. Early infections (OR: 14.0, 95% CI 1.5-133.2, p = 0.016 and diabetes (OR: 11.3, 95% CI 1.4-89.3, p = 0.032 were associated with arthrodesis joint and death respectively. CONCLUSION: Patients with early infection had a higher risk of developing surgical procedure with unfavorable outcome (arthrodesis and diabetics had higher odds of death after infection of primary knee arthroplasties.

  5. Assessment scale of risk for surgical positioning injuries.

    Science.gov (United States)

    Lopes, Camila Mendonça de Moraes; Haas, Vanderlei José; Dantas, Rosana Aparecida Spadoti; Oliveira, Cheila Gonçalves de; Galvão, Cristina Maria

    2016-08-29

    to build and validate a scale to assess the risk of surgical positioning injuries in adult patients. methodological research, conducted in two phases: construction and face and content validation of the scale and field research, involving 115 patients. the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning contains seven items, each of which presents five subitems. The scale score ranges between seven and 35 points in which, the higher the score, the higher the patient's risk. The Content Validity Index of the scale corresponded to 0.88. The application of Student's t-test for equality of means revealed the concurrent criterion validity between the scores on the Braden scale and the constructed scale. To assess the predictive criterion validity, the association was tested between the presence of pain deriving from surgical positioning and the development of pressure ulcer, using the score on the Risk Assessment Scale for the Development of Injuries due to Surgical Positioning (pDesarrollo de Lesiones Debidas al Posicionamiento Quirúrgico contiene siete ítems, siendo que cada uno presenta cinco subítems. La puntuación de esa escala varia de siete a 35 puntos en que, cuanto mayor la puntuación, mayor el riesgo del paciente. El Índice de Validez de Contenido de la escala fue 0,88. Mediante la aplicación de la prueba t de Student, para igualdad de medias, fue constatada validez de criterio concurrente entre los scores de la escala de Braden y de la escala construida. Para evaluar la validez de criterio predictiva, fue testada la asociación de la presencia de dolor debido al posicionamiento quirúrgico y el desarrollo de úlcera por presión con el score de la Escala de Evaluación de Riesgo para el Desarrollo de Lesiones Debidas al Posicionamiento Quirúrgico (p<0,001). La confiabilidad interobservadores fue verificada mediante el coeficiente de correlación intraclase, cuyo valor alcanzado fue 0,99 (p<0,001). la escala es un

  6. Use of the surgical Apgar score to enhance Veterans Affairs Surgical Quality Improvement Program surgical risk assessment in veterans undergoing major intra-abdominal surgery.

    Science.gov (United States)

    Masi, Antonio; Amodeo, Salvatore; Hatzaras, Ioannis; Pinna, Antonio; Rosman, Alan S; Cohen, Steven; Saunders, John K; Berman, Russell; Newman, Elliot; Ballantyne, Garth H; Pachter, Leon H; Melis, Marcovalerio

    2017-04-01

    We investigated whether the surgical Apgar score (SAS) may enhance the Veterans Affairs Surgical Quality Improvement Program (VASQIP) risk assessment for prediction of early postoperative outcomes. We retrospectively evaluated demographics, medical history, procedure, SAS, VASQIP assessment, and postoperative data for patients undergoing major/extensive intra-abdominal surgery at the Manhattan Veterans Affairs between October 2006 and September 2011. End points were overall morbidity and 30-, 60- , and 90-day mortality. Pearson's chi-square, ANOVA, and multivariate regression modeling were employed. Six hundred twenty-nine patients were included. Apgar groups did not differ in age, sex, and race. Low SASs were associated with worse functional status, increased postoperative morbidity, and 30-, 60- , and 90-day mortality rates. SAS did not significantly enhance VASQIP prediction of postoperative outcomes, although a trend was detected. Multivariate analysis confirmed SAS as an independent predictor of morbidity and mortality. SAS effectively identifies veterans at high risk for poor postoperative outcome. Additional studies are necessary to evaluate the role of SAS in enhancing VASQIP risk prediction. Published by Elsevier Inc.

  7. Surgical and pharmacological reassignment: influence on transsexual cardiovascular risk profile.

    Science.gov (United States)

    Ciccone, Marco M; Loverro, Giuseppe; Scicchitano, Pietro; Loverro, Matteo; Ricci, Gabriella; Scaramuzzi, Francesca; Gesualdo, Michele; Zito, Annapaola; Campagna, Marcello; Moncelli, Michele; Nicolardi, Vittorio; Manca, Fabio; Boninfante, Barbara; Carbonara, Santa; Cortese, Francesca; Todarello, Orlando; Bettocchi, Carlo

    2017-11-01

    To evaluate and stratify early cardiovascular risk of transsexuals who underwent pharmacological and/or surgical gender reassignment. Fifty-six transsexuals were divided into two groups: group 1 - underwent gonadectomy (orchiectomy for transwomen and hystero-annessiectomy for transmen); group 2 - hormone replacement therapy alone. All participants underwent carotid artery intima-media thickness (C-IMT) and flow-mediated vasodilation (FMD) of brachial artery evaluations. FMD was lower in patients who had undergone gonadectomy compared with non-surgically treated patients (Group 1: 5.711 vs Group 2: 7.339, P < 0.0001). Mean C-IMT was higher in group 1 than group 2 (group 1: 0.733 vs group 2: 0.582). The duration of hormone therapy correlates positively with mean C-IMT (B = 0.001) and negatively with FMD (%) (B = - 0.007). Cardiovascular risk, which is expressed in terms of endothelial (FMD) and morphological (C-IMT) dysfunction, increases in subjects undergoing gonadectomy compared with those receiving cross-sex reassignment therapy alone. © 2017 Royal Australasian College of Physicians.

  8. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk

    DEFF Research Database (Denmark)

    Jie, Bin; Jiang, Zhu-Ming; Nolan, Marie T

    2012-01-01

    This multicenter, prospective cohort study evaluated the effect of preoperative nutritional support in abdominal surgical patients at nutritional risk as defined by the Nutritional Risk Screening Tool 2002 (NRS-2002).......This multicenter, prospective cohort study evaluated the effect of preoperative nutritional support in abdominal surgical patients at nutritional risk as defined by the Nutritional Risk Screening Tool 2002 (NRS-2002)....

  9. Surgical virtual reality - highlights in developing a high performance surgical haptic device.

    Science.gov (United States)

    Custură-Crăciun, D; Cochior, D; Constantinoiu, S; Neagu, C

    2013-01-01

    Just like simulators are a standard in aviation and aerospace sciences, we expect for surgical simulators to soon become a standard in medical applications. These will correctly instruct future doctors in surgical techniques without there being a need for hands on patient instruction. Using virtual reality by digitally transposing surgical procedures changes surgery in are volutionary manner by offering possibilities for implementing new, much more efficient, learning methods, by allowing the practice of new surgical techniques and by improving surgeon abilities and skills. Perfecting haptic devices has opened the door to a series of opportunities in the fields of research,industry, nuclear science and medicine. Concepts purely theoretical at first, such as telerobotics, telepresence or telerepresentation,have become a practical reality as calculus techniques, telecommunications and haptic devices evolved,virtual reality taking a new leap. In the field of surgery barrier sand controversies still remain, regarding implementation and generalization of surgical virtual simulators. These obstacles remain connected to the high costs of this yet fully sufficiently developed technology, especially in the domain of haptic devices. Celsius.

  10. Risk Factors for Surgical Site Infections in Dermatological Surgery

    Directory of Open Access Journals (Sweden)

    Xiaomeng Liu

    2017-11-01

    Full Text Available Current literature on risk factors for surgical site infection (SSI in dermatological surgery in the absence of antibiotic prophylaxis is limited. The aim of this study was to retrospectively evaluate patients presenting for dermatological surgery. A total of 1,977 procedures were reviewed. SSI was clinically suspected in 79 (4.0% patients and confirmed by culture in 38 (1.9%. Using the strictest definition of SSI (clinical symptoms with positive culture significantly higher risk of SSI was found for location on the ear (odds ratio (OR 6.03, 95% confidence interval (95% CI 2.12–17.15, larger defects (OR 1.08 per cm2 increase, 95% CI 1.03–1.14, closure with flaps (OR 6.35, 95% CI 1.33–30.28 and secondary intention (OR 3.01, 95% CI 1.11–8.13. These characteristics were also associated with higher risk of clinically suspected SSI regardless of culture results with slightly lower ORs. In conclusion, the risk of acquiring a SSI is increased in surgeries performed on the ear, in larger wounds and in defects closed with flaps or healed by secondary intention.

  11. [Surgical site infections in orthognathic surgery and risk factors associated].

    Science.gov (United States)

    Barrier, A; Breton, P; Girard, R; Dubost, J; Bouletreau, P

    2009-06-01

    Surgical site infections (SSI) in orthognathic surgery are considered infrequent and without any important consequence for the final operative result. A procedure of epidemiological surveillance was implemented to determine the frequency of SSI in orthognathic surgery and to better document their risk factors. This prospective study included all interventions in our orthognathic surgery department between September 1(st) 2006 and August 31(st) 2007. SSI and their risk factors were documented for up to one year of follow-up. Risk factors were correlated to SSI using monovariate and multivariate analyses. Ten (7%) out of 143 consecutive interventions in orthognathic surgery were complicated by a SSI. All the SSI were secondary to a mandibular ramus sagittal split osteotomy. The two significantly correlated risk factors with the SSI in multivariate analysis were the length of surgery and the type of antibiotic prophylaxis. This rate of SSI correlates to published data. To decrease this rate, it would be necessary, in association with the usual precautionary measures, to limit the operating time and to recommend an antibioprophylaxis combining amoxicillin plus clavulanic acid (Augmentin).

  12. Nutritional assessment and surgical risk makers in children submitted to cardiac surgery

    Directory of Open Access Journals (Sweden)

    Heitor Pons Leite

    Full Text Available In order to assess the nutritional status of children with heart diseases and to evaluate nutritional parameters for predicting postoperative complications, 50 children undergoing to cardiac surgery and classified in high and low surgical risk prospectively evaluated. Assessment parameters included anthropometry and plasma proteins albumin, transferrin and prealbumin. The nutritional classification according to Waterlow's modified criteria showed a high prevalence of malnutrition in the population studied (78%. The measures of arm circumference when located below the 5th percentile showed a significant association with general postoperative complications in the high risk group (arm circumference, p = 0,0019; arm muscle circumference, p = 0,0419. The percentage of weight per height, serum albumin and transferrin has not played a prognostic role concerning postoperative morbidity. The mean value of prealbumin was significantly lower in high risk group patients developing postoperative infections (p < 0,01 compared to those who did not. The sensitivity-specificity analysis of prealbumin as risk indicator for postoperative infection was 87.5% and 59% respectively. The nutritional risk classification seems to be a good way to identify the subgroups of children with additional postoperative surgical risk. However, more specific and sensitive tests are desirable to provide an individual identification of these children.

  13. Malnutrition risk predicts surgical outcomes in patients undergoing gastrointestinal operations: Results of a prospective study.

    Science.gov (United States)

    Ho, Judy W C; Wu, Arthur H W; Lee, Michelle W K; Lau, So-ying; Lam, Pui-shan; Lau, Wai-shan; Kwok, Sam S S; Kwan, Rosa Y H; Lam, Cheuk-fan; Tam, Chun-kit; Lee, Suk-on

    2015-08-01

    Patients undergoing gastrointestinal operations are at risk of malnutrition which may increase the chance of adverse surgical outcomes. This prospective study aimed at correlating nutritional status of patients having gastrointestinal operations with their short-term surgical outcomes captured by a territory-wide Surgical Outcomes Monitoring and Improvement Program. The preoperative malnutrition risk of Chinese adult patients undergoing elective/emergency ultra-major/major gastrointestinal operations in two surgical departments over a 12-month period were assessed by Chinese version of Malnutrition Universal Screening Tool. Their perioperative risk factors and clinical outcomes, including length of hospital stay, mortality and morbidity, were retrieved from the above mentioned program. Correlation of malnutrition risk with clinical outcomes was assessed by logistic regression analysis after controlling for known confounders. 943 patients (58% male; mean age 65.9 ± 14.8 years) underwent gastrointestinal operations (40.3% emergency operation; 52.7% ultra-major procedures; 66.9% bowel resections) had analyzable data. 15.8% and 17.1% of patients were at medium and high risk of malnutrition, respectively. Malnutrition risk score according to the screening tool was an independent predictor of length of hospital stay, 30-day mortality, 60-day mortality and minor medical complications. Similar correlations were found for various sub-scores of malnutrition risk. Weight loss sub-score was predictive of 30-day mortality, 60-day mortality and minor medical complications. Body mass index was predictive of mortality (30- and 60- day) whereas the acute disease sub-score was predictive of length of hospital stay. Preoperative malnutrition was an important predictor of poor clinical outcomes in patients undergoing gastrointestinal operations in Hong Kong. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  14. Total lymphocyte count and serum albumin as predictors of nutritional risk in surgical patients.

    Science.gov (United States)

    Rocha, Naruna Pereira; Fortes, Renata Costa

    2015-01-01

    Early detection of changes in nutritional status is important for a better approach to the surgical patient. There are several nutritional measures in clinical practice, but there is not a complete method for determining the nutritional status, so, health professionals should only choose the best method to use. To evaluate the total lymphocyte count and albumin as predictors of identification of nutritional risk in surgical patients. Prospective longitudinal study was conducted with 69 patients undergoing surgery of the gastrointestinal tract. The assessment of nutritional status was evaluated by objective methods (anthropometry and biochemical tests) and subjective methods (subjective global assessment). All parameters used in the nutritional assessment detected a high prevalence of malnutrition, with the exception of BMI which detected only 7.2% (n=5). The albumin (p=0.01), the total lymphocytes count (p=0.02), the percentage of adequacy of skinfolds (plymphocyte count and higher the score the subjective global assessment were higher risks of surgical complications. A high prevalence of malnutrition was found, except for BMI. The use of albumin and total lymphocyte count were good predictor for the risk of postoperative complications and when used with other methods of assessing the nutritional status, such as the subjective global assessment and the percentage of adequacy of skinfolds, can be useful for identification of nutritional risk and postoperative complications.

  15. Preoperative testing before low-risk surgical procedures

    Science.gov (United States)

    Kirkham, Kyle R.; Wijeysundera, Duminda N.; Pendrith, Ciara; Ng, Ryan; Tu, Jack V.; Laupacis, Andreas; Schull, Michael J.; Levinson, Wendy; Bhatia, R. Sacha

    2015-01-01

    Background: There is concern about increasing utilization of low-value health care services, including preoperative testing for low-risk surgical procedures. We investigated temporal trends, explanatory factors, and institutional and regional variation in the utilization of testing before low-risk procedures. Methods: For this retrospective cohort study, we accessed linked population-based administrative databases from Ontario, Canada. A cohort of 1 546 223 patients 18 years or older underwent a total of 2 224 070 low-risk procedures, including endoscopy and ophthalmologic surgery, from Apr. 1, 2008, to Mar. 31, 2013, at 137 institutions in 14 health regions. We used hierarchical logistic regression models to assess patient- and institution-level factors associated with electrocardiography (ECG), transthoracic echocardiography, cardiac stress test or chest radiography within 60 days before the procedure. Results: Endoscopy, ophthalmologic surgery and other low-risk procedures accounted for 40.1%, 34.2% and 25.7% of procedures, respectively. ECG and chest radiography were conducted before 31.0% (95% confidence interval [CI] 30.9%–31.1%) and 10.8% (95% CI 10.8%–10.8%) of procedures, respectively, whereas the rates of preoperative echocardiography and stress testing were 2.9% (95% CI 2.9%–2.9%) and 2.1% (95% CI 2.1%–2.1%), respectively. Significant variation was present across institutions, with the frequency of preoperative ECG ranging from 3.4% to 88.8%. Receipt of preoperative ECG and radiography were associated with older age (among patients 66–75 years of age, for ECG, adjusted odds ratio [OR] 18.3, 95% CI 17.6–19.0; for radiography, adjusted OR 2.9, 95% CI 2.8–3.0), preoperative anesthesia consultation (for ECG, adjusted OR 8.7, 95% CI 8.5–8.8; for radiography, adjusted OR 2.2, 95% CI 2.1–2.2) and preoperative medical consultation (for ECG, adjusted OR 6.8, 95% CI 6.7–6.9; for radiography, adjusted OR 3.6, 95% CI 3.5–3.6). The median ORs

  16. [Detecting high risk pregnancy].

    Science.gov (United States)

    Doret, Muriel; Gaucherand, Pascal

    2009-12-20

    Antenatal care is aiming to reduce maternal land foetal mortality and morbidity. Maternal and foetal mortality can be due to different causes. Their knowledge allows identifying pregnancy (high risk pregnancy) with factors associated with an increased risk for maternal and/or foetal mortality and serious morbidity. Identification of high risk pregnancies and initiation of appropriate treatment and/or surveillance should improve maternal and/or foetal outcome. New risk factors are continuously described thanks to improvement in antenatal care and development in biology and cytopathology, increasing complexity in identifying high risk pregnancies. Level of risk can change all over the pregnancy. Ideally, it should be evaluated prior to the pregnancy and at each antenatal visit. Clinical examination is able to screen for intra-uterin growth restriction, pre-eclampsia, threatened for preterm labour; ultrasounds help in the diagnosis of foetal morphological anomalies, foetal chromosomal anomalies, placenta praevia and abnormal foetal growth; biological exams are used to screen for pre-eclampsia, gestational diabetes, trisomy 21 (for which screening method just changed), rhesus immunisation, seroconversion for toxoplasmosis or rubeola, unknown infectious disease (syphilis, hepatitis B, VIH). During pregnancy, most of the preventive strategies have to be initiated during the first trimester or even before conception. Prevention for neural-tube defects, neonatal hypocalcemia and listeriosis should be performed for all women. On the opposite, some measures are concerning only women with risk factors such as prevention for toxoplasmosis, rhesus immunization (which recently changed), tobacco complications and pre-eclampsia and intra-uterine growth factor restriction.

  17. Surgical wound infection in urology. Analysis of risk factors and associated microorganisms.

    Science.gov (United States)

    Alonso-Isa, M; Medina-Polo, J; Lara-Isla, A; Pérez-Cadavid, S; Arrébola-Pajares, A; Sopeña-Sutil, R; Benítez-Sala, R; Justo-Quintas, J; Gil-Moradillo, J; Passas-Martínez, J B; Tejido-Sánchez, A

    2017-03-01

    Open surgery continues to have a fundamental role in urology, and one of its main complications is surgical wound infection. Our objective was to analyse surgical wound infection in patients who underwent surgery in our Department of Urology and to assess the risk factors, microorganisms and resistances by type of surgery. This was a prospective observational study that included 940 patients: 370 abdominal/open lumbar surgeries and 570 genitoperineal surgeries. We analysed age, sex, comorbidities, stay and type of surgery, as well as the causal microorganisms and antibiotic resistances. For genitoperineal surgery, we found 15 cases (2.6%) of surgical wound infection associated with previous urinary catheterisation. Most of the isolated microorganisms corresponded to enterobacteriaceae, highlighting the resistance to beta-lactam. In abdominal/lumbar surgery, we found 41 cases (11.1%) of surgical wound infection. The incidence rate was 3.3% in prostate surgery; 9.8% in renal surgery; and 45.0% in cystectomy. Heart disease was associated with a higher incidence rate of surgical wound infection. The most common microorganisms were Enterococcus spp. (27.1%), E.coli (22.9%) and Staphylococcus aureus (14.6%). Enterococcus and beta-lactamase-producing E.coli are resistant to ampicillin in 37.5% and 41.7% of cases, respectively. We found a low incidence rate of surgical wound infection in genitoperineal surgery, compared with renal surgery and cystectomy. The presence of heart disease and carrying a previous urinary catheter are factors associated with surgical wound infection. Enterococcus and E.coli are the most common pathogens, with high rates of resistance. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Management of chronic empyema with unexpandable lung in poor surgical risk patients using an empyema tube

    Directory of Open Access Journals (Sweden)

    Abhishek Biswas

    2016-01-01

    Full Text Available Objectives: High preoperative risk precludes decortication and other surgical interventions in some patients with chronic empyema. We manage such patients by converting the chest tube into an "empyema tube," cutting the tube near the skin and securing the end with a sterile clip to allow for open pleural drainage. The patient is followed serially, and the tube gradually withdrawn based on radiological resolution and amount of drainage. Methods: Between 2010 and 2014, patients with chronic empyema and unexpandable lung, deemed high-risk surgical candidates, had staged chest tube removal, and were included for the study. The volume of fluid drained, culture results, duration of drainage, functional status, and comorbidities were recorded. Measurements and Results: Eight patients qualified. All had resolution of infection. The tube was removed after an average of 73.6 ± 49.73 (95% confidence interval [CI] days. The mean duration of antibiotic treatment was 5.37 ± 1.04 (95% CI weeks. None required surgery or experienced complications from an empyema tube. Conclusion: A strategy of empyema tube drainage with staged removal is an option in appropriately selected patients with chronic empyema, unexpandable lung, and poor surgical candidacy.

  19. Obesity and the Risk for Surgical Site Infection in Abdominal Surgery.

    Science.gov (United States)

    Winfield, Robert D; Reese, Stacey; Bochicchio, Kelly; Mazuski, John E; Bochicchio, Grant V

    2016-04-01

    Obesity is a risk factor for surgical site infection (SSI) after abdominal procedures; however, data characterizing the risk of SSI in obese patients during abdominal procedures are lacking. We hypothesized that obesity is an independent risk factor for SSI across wound classes. We analyzed American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data for 2011. We calculated body mass index (BMI), classifying patients according to National Institute of Health (NIH) BMI groups. We excluded records in which height/weight was not recorded and patients with BMI less than 18.5. We examined patients undergoing open abdominal procedures, performing univariate and multivariate analyses to assess the relative contribution of obesity to SSI. Study criteria were met by 89,148 patients. Obese and morbidly obese patients had significantly greater SSI rates in clean and clean-contaminated cases but not contaminated or dirty/infected cases. Logistic regression confirmed obesity and morbid obesity as being independently associated with the overall SSI development, specifically in clean [Obesity odds ratio (OR) = 1.757, morbid obesity OR = 2.544, P < 0.001] and clean-contaminated (obesity OR = 1.239, morbid obesity OR = 1.287, P < 0.001) cases. Obesity is associated with increased risk of SSI overall, specifically in clean and clean-contaminated abdominal procedures; this is independent of diabetes mellitus. Novel techniques are needed to reduce SSI in this high-risk patient population.

  20. Incidence and risk factors for surgical site infection following ...

    African Journals Online (AJOL)

    Prolonged preoperative and intraoperative duration, dirty wounds and perioperative transfusion was associated with increased rate of SSI. Surveillance on SSI by surgical team, public health education on alcohol and cigarettes consumption, prompt surgical intervention and judicial use of blood could reduce incidence of ...

  1. Risk for surgical complications after previous stereotactic body radiotherapy of the spine.

    Science.gov (United States)

    Roesch, Johannes; Cho, John B C; Fahim, Daniel K; Gerszten, Peter C; Flickinger, John C; Grills, Inga S; Jawad, Maha; Kersh, Ronald; Letourneau, Daniel; Mantel, Frederick; Sahgal, Arjun; Shin, John H; Winey, Brian; Guckenberger, Matthias

    2017-09-11

    Stereotactic body radiotherapy (SBRT) for vertebral metastases has emerged as a promising technique, offering high rates of symptom relief and local control combined with low risk of toxicity. Nonetheless, local failure or vertebral instability may occur after spine SBRT, generating the need for subsequent surgery in the irradiated region. This study evaluated whether there is an increased incidence of surgical complications in patients previously treated with SBRT at the index level. Based upon a retrospective international database of 704 cases treated with SBRT for vertebral metastases, 30 patients treated at 6 different institutions were identified who underwent surgery in a region previously treated with SBRT. Thirty patients, median age 59 years (range 27-84 years) underwent SBRT for 32 vertebral metastases followed by surgery at the same vertebra. Median follow-up time from SBRT was 17 months. In 17 cases, conventional radiotherapy had been delivered prior to SBRT at a median dose of 30 Gy in median 10 fractions. SBRT was administered with a median prescription dose of 19.3 Gy (range 15-65 Gy) delivered in median 1 fraction (range 1-17) (median EQD2/10 = 44 Gy). The median time interval between SBRT and surgical salvage therapy was 6 months (range 1-39 months). Reasons for subsequent surgery were pain (n = 28), neurological deterioration (n = 15) or fracture of the vertebral body (n = 13). Open surgical decompression (n = 24) and/or stabilization (n = 18) were most frequently performed; Five patients (6 vertebrae) were treated without complications with vertebroplasty only. Increased fibrosis complicating the surgical procedure was explicitly stated in one surgical report. Two durotomies occurred which were closed during the operation, associated with a neurological deficit in one patient. Median blood loss was 500 ml, but five patients had a blood loss of more than 1 l during the procedure. Delayed wound healing was reported in two

  2. The prevalence of risk factors for cardiovascular diseases among Polish surgical patients over 65 years.

    Science.gov (United States)

    Kołtuniuk, Aleksandra; Rosińczuk, Joanna

    2016-01-01

    Cardiovascular diseases (CVDs) are the leading cause of mortality among adults in Poland. A number of risk factors have significant influence on CVD incidence. Early identification of risk factors related to our lifestyle facilitates taking proper actions aiming at the reduction of their negative impact on health. The aim of the study was to compare the prevalence of CVD risk factors between patients aged over 65 years and patients of other age groups in surgical wards. The study was conducted for assessment and finding the distribution of major risk factors of CVD among 420 patients aged 18-84 years who were hospitalized in surgical wards. Interview, anthropometric measurements, blood pressure, and fasting blood tests for biochemical analysis were conducted in all subjects. Statistical analysis of the material was performed using Student's t-test, chi-square test, Fisher's exact test, Mann-Whitney U-test, and analysis of variance. While abdominal obesity (83.3%), overweight and obesity (68%), hypertension (65.1%), hypercholesterolemia (33.3%), and low level of physical activity (29.1%) were the most common CVD risk factors among patients over 65 years old, abdominal obesity (36.2%), overweight and obesity (36.1%), and current smoking were the most common CVD risk factors among patients up to the age of 35. In the age group over 65, the least prevalent risk factors for CVD were diabetes mellitus (14.8%), depressive episodes (13.6%), abuse of alcohol (11.4%), and smoking (7.8%). In the group under 35 years, we have not reported any cases of hypercholesterolemia and a lesser number of patients suffered from diabetes and HTN. Distribution of the major risk factors for CVD is quite high in the adult population, especially in the age group over 65, which can result in serious problems of health and increased rates of chronic diseases, especially CVDs.

  3. Combining the ASA Physical Classification System and Continuous Intraoperative Surgical Apgar Score Measurement in Predicting Postoperative Risk.

    Science.gov (United States)

    Jering, Monika Zdenka; Marolen, Khensani N; Shotwell, Matthew S; Denton, Jason N; Sandberg, Warren S; Ehrenfeld, Jesse Menachem

    2015-11-01

    The surgical Apgar score predicts major 30-day postoperative complications using data assessed at the end of surgery. We hypothesized that evaluating the surgical Apgar score continuously during surgery may identify patients at high risk for postoperative complications. We retrospectively identified general, vascular, and general oncology patients at Vanderbilt University Medical Center. Logistic regression methods were used to construct a series of predictive models in order to continuously estimate the risk of major postoperative complications, and to alert care providers during surgery should the risk exceed a given threshold. Area under the receiver operating characteristic curve (AUROC) was used to evaluate the discriminative ability of a model utilizing a continuously measured surgical Apgar score relative to models that use only preoperative clinical factors or continuously monitored individual constituents of the surgical Apgar score (i.e. heart rate, blood pressure, and blood loss). AUROC estimates were validated internally using a bootstrap method. 4,728 patients were included. Combining the ASA PS classification with continuously measured surgical Apgar score demonstrated improved discriminative ability (AUROC 0.80) in the pooled cohort compared to ASA (0.73) and the surgical Apgar score alone (0.74). To optimize the tradeoff between inadequate and excessive alerting with future real-time notifications, we recommend a threshold probability of 0.24. Continuous assessment of the surgical Apgar score is predictive for major postoperative complications. In the future, real-time notifications might allow for detection and mitigation of changes in a patient's accumulating risk of complications during a surgical procedure.

  4. Prognosis of Carotid Endarterectomy in High Risk Patients

    Directory of Open Access Journals (Sweden)

    MH Modaghegh

    2016-04-01

    Full Text Available Introduction: Carotid Endarterectomy (CE can be mentioned as a valuable theraputic method for primary and secondary prevention of stroke, provided it can be performed in vascular surgery centers with a low surgical risk. Thus, the present study aimed to assess prognosis of CE in high risk patients of an Iranian vascular surgery center. Methods: This prospective observational study consisted of 50 high risk CE patients during 2011-14 in Mashhad University of Medical Sciences. All the high risk CE were performed by a vascular surgeon and a surgical carotid shunt was placed in each CE. Neurologic evaluation was performed before CE and serial neurologic axamination was done after CE by a neurologist. Surgical complications including stroke, death and lower cranial nerve palsy were recorded for 30 days after operation. Results: The study results revealed that 80% of high risk CE patients had symptomatic carotid stenosis on the operation side and 80% had carotid stenosis contralateral to the operation side. Thirteen high risk CE were performed simultaneously with coronary artery by pass graft and 24 patients were demonstrated to have diabetes. Post surgical death and stroke in the high risk CE patients were reported 2% and 4%, respectively. Lower cranial nerve palsy appeared in 2% of patients. Conclusion: The 6% post operative stroke and death rate in the high risk CE patients are comparable to best vascular surgery centers in Europe and North America.

  5. Adhering to a national surgical care bundle reduces the risk of surgical site infections

    NARCIS (Netherlands)

    Koek, Mayke B. G.; Hopmans, Titia E. M.; Soetens, Loes C.; Wille, Jan C.; Geerlings, Suzanne E.; Vos, Margreet C.; van Benthem, Birgit H. B.; de Greeff, Sabine C.

    2017-01-01

    In 2008, a bundle of care to prevent Surgical Site Infections (SSIs) was introduced in the Netherlands. The bundle consisted of four elements: antibiotic prophylaxis according to local guidelines, no hair removal, normothermia and 'hygiene discipline' in the operating room (i.e. number of door

  6. Adhering to a national surgical care bundle reduces the risk of surgical site infections

    NARCIS (Netherlands)

    Koek, M.B.G. (Mayke B. G.); Hopmans, T.E.M. (Titia E. M.); Soetens, L.C. (Loes C.); J.C. Wille (Jan); S.E. Geerlings (Suzanne); M.C. Vos (Margreet); B.H. van Benthem (Birgit); S.C. de Greeff (Sabine C.)

    2017-01-01

    textabstractBackground: In 2008, a bundle of care to prevent Surgical Site Infections (SSIs) was introduced in the Netherlands. The bundle consisted of four elements: antibiotic prophylaxis according to local guidelines, no hair removal, normothermia and ‘hygiene discipline’

  7. Integrated high pressure microhydraulic actuation and control for surgical instruments.

    Science.gov (United States)

    Moers, A J M; De Volder, M F L; Reynaerts, D

    2012-08-01

    To reduce the surgical trauma to the patient, minimally invasive surgery is gaining considerable importance since the eighties. More recently, robot assisted minimally invasive surgery was introduced to enhance the surgeon's performance in these procedures. This resulted in an intensive research on the design, fabrication and control of surgical robots over the last decades. A new development in the field of surgical tool manipulators is presented in this article: a flexible manipulator with distributed degrees of freedom powered by microhydraulic actuators. The tool consists of successive flexible segments, each with two bending degrees of freedom. To actuate these compliant segments, dedicated fluidic actuators are incorporated, together with compact hydraulic valves which control the actuator motion. Especially the development of microvalves for this application was challenging, and are the main focus of this paper. The valves distribute the hydraulic power from one common high pressure supply to a series of artificial muscle actuators. Tests show that the angular stroke of the each segment of this medical instrument is 90°.

  8. Perceptions of high risk sports.

    Science.gov (United States)

    Pedersen, D M

    1997-10-01

    High risk sports were rated as to risk, appeal, and likelihood of participation by 282 men and 162 women. Ascending order of perceived risk was skiing, scuba diving, bungee jumping, rock climbing, motorcycle racing, hang gliding, cliff jumping, and skydiving. Profile analysis showed stated likelihood of participation to be directly related to appeal and inversely related to perceived risk.

  9. Surgical risks and perioperative complications of instrumented lumbar surgery in patients with liver cirrhosis

    Directory of Open Access Journals (Sweden)

    Tung-Yi Lin

    2014-02-01

    Full Text Available Background: Patients with liver cirrhosis have high surgical risks due to malnutrition, impaired immunity, coagulopathy, and encephalopathy. However, there is no information in English literature about the results of liver cirrhotic patients who underwent instrumented lumbar surgery. The purpose of this study is to report the perioperative complications, clinical outcomes and determine the surgical risk factors in cirrhotic patients. Methods: We retrospectively reviewed 29 patients with liver cirrhosis who underwent instrumented lumbar surgery between 1997 and 2009. The hepatic functional reserves of the patients were recorded according to the Child-Turcotte-Pugh scoring system. Besides, fourteen other variables and perioperative complications were also collected. To determine the risks, we divided the patients into two groups according to whether or not perioperative complications developed. Results: Of the 29 patients, 22 (76% belonged to Child class A and 7 (24% belonged to Child class B. Twelve patients developed one or more complications. Patients with Child class B carried a significantly higher incidence of complications than those with Child class A (p = 0.011. In the Child class A group, patients with 6 points had a significantly higher incidence of complications than those with 5 points (p = 0.025. A low level of albumin was significantly associated with higher risk, and a similar trend was also noted for the presence of ascites although statistical difference was not reached. Conclusion: The study concludes that patients with liver cirrhosis who have undergone instrumented lumbar surgery carry a high risk of developing perioperative complications, especially in those with a Child-Turcotte-Pugh score of 6 or more.

  10. Risk factors, diagnosis and non-surgical treatment for meniscal tears

    DEFF Research Database (Denmark)

    Thorlund, Jonas Bloch; Juhl, Carsten Bogh; Ingelsrud, Lina Holm

    2018-01-01

    This statement aimed at summarising and appraising the available evidence for risk factors, diagnostic tools and non-surgical treatments for patients with meniscal tears. We systematically searched electronic databases using a pragmatic search strategy approach. Included studies were synthesised ...

  11. Percutaneous cholecystostomy for patients with acute cholecystitis and an increased surgical risk

    NARCIS (Netherlands)

    H. van Overhagen (H.); H. Meyers (Hjalmar); H.W. Tilanus (Hugo); J. Jeekel (Hans); J.S. Laméris (Johan )

    1996-01-01

    textabstractPurpose: To evaluate percutaneous cholecystostomy in patients with acute cholecystitis and an increased surgical risk. Methods: Thirty-three patients with acute cholecystitis (calculous, n = 22; acalculous, n = 11) underwent percutaneous cholecystostomy by means of a transhepatic (n =

  12. Surgical Site Infection Rate and Risk Factors among Obstetric Cases ...

    African Journals Online (AJOL)

    Chorioamnionitis, presence of meconium, large intraoperative blood loss and Perioperative blood transfusion were associated with increased severity of SSIs with p < 0.001. Absence of antenatal care follow up was also associated with increased severity of Surgical Site Infections. CONCLUSION: it has been revealed that ...

  13. Surgical outcomes in phacoemulsification after application of a risk stratification system

    Directory of Open Access Journals (Sweden)

    Tsinopoulos IT

    2013-05-01

    Full Text Available Ioannis T Tsinopoulos,1 Lampros P Lamprogiannis,2 Konstantinos T Tsaousis,1 Asimina Mataftsi,1 Chrysanthos Symeonidis,1 Nikolaos T Chalvatzis,1 Stavros A Dimitrakos11Second Department of Ophthalmology, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece; 2First Department of Ophthalmology, Aristotle University of Thessaloniki, AHEPA General Hospital, Thessaloniki, GreeceBackground: The purpose of this study was to determine whether application of a risk stratification system during preoperative assessment of cataract patients and subsequent allocation of patients to surgeons with matching experience may reduce intraoperative complications.Methods: Nine hundred and fifty-three consecutive patients (1109 eyes undergoing phacoemulsification cataract surgery were assigned to two groups, ie, group A (n = 498 patients, 578 eyes and group B (n = 455 patients, 531 eyes. Patients from group A were allocated to surgeons with varying experience with only a rough estimate of the complexity of their surgery. Patients from group B were assigned to three risk groups (no added risk, low risk, and moderate-high risk according to risk factors established during their preoperative assessment and were respectively allocated to resident surgeons, low-volume surgeons, or high-volume surgeons. Data were collected and entered into a computerized database. The intraoperative complication rate was calculated for each group.Results: The intraoperative complication rate was significantly lower in group B than in group A (group A, 5.88%; group B, 3.2%; P < 0.05. Patients from group B with no added risk and allocated to resident surgeons had a significantly lower rate of intraoperative complications than those from group A allocated to resident surgeons (group A, 7.2%; group B, 3.08%; P < 0.05.Conclusion: Our study demonstrates that allocation of cataract patients to surgeons matched for experience according to a uniform and reliable

  14. The South African Vascular Surgical Cardiac Risk Index (SAVS-CRI ...

    African Journals Online (AJOL)

    The South African Vascular Surgical Cardiac Risk Index (SAVS-CRI): A prospective observational study. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... Recent evidence suggests that application of the Revised Cardiac Risk Index (RCRI) for peri-operative cardiovascular risk stratification in vascular surgery patients ...

  15. A Comprehensive, High-Quality Orthopedic Intern Surgical Skills Program.

    Science.gov (United States)

    Ford, Samuel E; Patt, Joshua C; Scannell, Brian P

    2016-01-01

    To design and implement a month-long, low-cost, comprehensive surgical skills curriculum built to address the needs of orthopedic surgery interns with high satisfaction among both interns and faculty. The study design was retrospective and descriptive. The study was conducted at tertiary care referral center with a medium sized orthopedic residency surgery program (5 residents/year). Totally 5 orthopedic surgery residents and 16 orthopedic surgery faculty participated. A general mission was established-to orient the resident to the postgraduate year 1 and prepare them for success in residency. The basic tenets of the American Board of Orthopaedic Surgeons surgical skills program framework were built. Curricular additions included anatomic study, surgical approaches, joint-specific physical examination, radiographic interpretation, preoperative planning, reduction techniques, basic emergency and operating room procedures, cadaveric procedure practice, and introduction to arthroplasty. The program was held in August during protected time for intern participants. In total, 16 orthopedic surgeons instructed 85% of the educational sessions. One faculty member did most of the preparation and organization to facilitate the program. The program ran for a cumulative 89 hours, including 14.5 hours working with cadaveric specimens. The program cost a total of $8100. The average module received a 4.15 rating on a 5-point scale, with 4 representing "good" and 5 representing "excellent." The program was appropriately timed and addressed topics relevant to the intern without sacrificing clinical experience or burdening inpatient services with interns' absence. The program received high satisfaction ratings from both the interns as well as the faculty. Additionally, the program fostered early relationships between interns and faculty-an unforeseen benefit. In the future, our program plans to better integrate validated learning metrics and improve instruction pertaining to both

  16. Performance assessment of the risk index category for surgical site infection after colorectal surgery.

    Science.gov (United States)

    Watanabe, Masanori; Suzuki, Hideyuki; Nomura, Satoshi; Hanawa, Hidetsugu; Chihara, Naoto; Mizutani, Satoshi; Yoshino, Masanori; Uchida, Eiji

    2015-02-01

    The traditional National Healthcare Safety Network (previously National Nosocomial Infections Surveillance) risk index is used to predict the risk of surgical site infection across many operative procedures. However, this index may be too simple to predict risk in the various procedures performed in colorectal surgery. The aim of this study was to evaluate the usefulness of the risk index by analyzing the impact of the risk index factors on surgical site infection after abdominal colorectal surgery. Using our surgical site infection surveillance database, we analyzed retrospectively 538 consecutive patients who underwent abdominal colorectal surgery between 2005 and 2010. Correlations between surgical site infection and the following risk index factors were analyzed: length of operation, American Society of Anesthesiologists score, wound classification, and use of laparoscopy. The 75th percentile for length of operation was determined separately for open and laparoscopic surgery in the study model. Univariate analyses showed that surgical site infection was more strongly associated with a >75th percentile length of operation in the study model (odds ratio [OR], 2.07) than in the traditional risk index model (OR, 1.64). Multivariable analysis found that surgical site infection was independently associated with a >75th percentile length of operation in the study model (OR, 2.75; 95% confidence interval [CI], 1.66-4.55), American Society of Anesthesiologists score ≥3 (OR, 2.22; 95% CI, 1.10-4.34), wound classification ≥III (OR, 5.29; 95% CI, 2.62-10.69), and open surgery (OR, 2.21; 95% CI, 1.07-5.17). Performance of the risk index category was improved in the study model compared with the traditional model. The risk index category is sufficiently useful for predicting the risk of surgical site infection after abdominal colorectal surgery. However, the 75th percentile length of operation should be set separately for open and laparoscopic surgery.

  17. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients.

    Science.gov (United States)

    Leon, Martin B; Smith, Craig R; Mack, Michael J; Makkar, Raj R; Svensson, Lars G; Kodali, Susheel K; Thourani, Vinod H; Tuzcu, E Murat; Miller, D Craig; Herrmann, Howard C; Doshi, Darshan; Cohen, David J; Pichard, Augusto D; Kapadia, Samir; Dewey, Todd; Babaliaros, Vasilis; Szeto, Wilson Y; Williams, Mathew R; Kereiakes, Dean; Zajarias, Alan; Greason, Kevin L; Whisenant, Brian K; Hodson, Robert W; Moses, Jeffrey W; Trento, Alfredo; Brown, David L; Fearon, William F; Pibarot, Philippe; Hahn, Rebecca T; Jaber, Wael A; Anderson, William N; Alu, Maria C; Webb, John G

    2016-04-28

    Previous trials have shown that among high-risk patients with aortic stenosis, survival rates are similar with transcatheter aortic-valve replacement (TAVR) and surgical aortic-valve replacement. We evaluated the two procedures in a randomized trial involving intermediate-risk patients. We randomly assigned 2032 intermediate-risk patients with severe aortic stenosis, at 57 centers, to undergo either TAVR or surgical replacement. The primary end point was death from any cause or disabling stroke at 2 years. The primary hypothesis was that TAVR would not be inferior to surgical replacement. Before randomization, patients were entered into one of two cohorts on the basis of clinical and imaging findings; 76.3% of the patients were included in the transfemoral-access cohort and 23.7% in the transthoracic-access cohort. The rate of death from any cause or disabling stroke was similar in the TAVR group and the surgery group (P=0.001 for noninferiority). At 2 years, the Kaplan-Meier event rates were 19.3% in the TAVR group and 21.1% in the surgery group (hazard ratio in the TAVR group, 0.89; 95% confidence interval [CI], 0.73 to 1.09; P=0.25). In the transfemoral-access cohort, TAVR resulted in a lower rate of death or disabling stroke than surgery (hazard ratio, 0.79; 95% CI, 0.62 to 1.00; P=0.05), whereas in the transthoracic-access cohort, outcomes were similar in the two groups. TAVR resulted in larger aortic-valve areas than did surgery and also resulted in lower rates of acute kidney injury, severe bleeding, and new-onset atrial fibrillation; surgery resulted in fewer major vascular complications and less paravalvular aortic regurgitation. In intermediate-risk patients, TAVR was similar to surgical aortic-valve replacement with respect to the primary end point of death or disabling stroke. (Funded by Edwards Lifesciences; PARTNER 2 ClinicalTrials.gov number, NCT01314313.).

  18. Brain Arteriovenous Malformations Located in Language Area: Surgical Outcomes and Risk Factors for Postoperative Language Deficits.

    Science.gov (United States)

    Jiao, Yuming; Lin, Fuxin; Wu, Jun; Li, Hao; Chen, Xin; Li, Zhicen; Ma, Ji; Cao, Yong; Wang, Shuo; Zhao, Jizong

    2017-09-01

    Case selection for surgical treatment of language-area brain arteriovenous malformations (L-BAVMs) remains difficult. This study aimed to determine the surgical outcomes and risk factors for postoperative language deficits (LDs) in patients with L-BAVMs. Patients with L-BAVMs who underwent microsurgical resection between September 2012 and June 2016 were reviewed. All patients had undergone preoperative functional magnetic resonance imaging and diffusion tensor imaging. Both functional and angioarchitectural factors were analyzed regarding the postoperative LD. Functional factors included the eloquence involved, the side of blood-oxygenation level-dependent signal activation and the white-matter fibers (anterior segment, long segment [LS], and posterior segment of arcuate fasciculus, and the inferior fronto-occipital fasciculus) involved. Sixty-nine patients with L-BAVMs were reviewed. Postoperative short- and long-term LD was found in 32 (46.4%) and 14 (20.3%) patients, respectively. Twelve of the 14 patients with Geschwind's territory L-BAVMs (85.7%) had short-term LD, compared with 10 (34.5%) in Wernicke's and 10 (38.5%) in Broca's area. LS involvement (P = 0.001) and larger nidus size (P = 0.017) were independent risk factors for the short-term LD. Meanwhile, nidus size (P = 0.007), preoperative LD (P = 0.008), and LS involvement (P = 0.028) were independent risk factors for long-term LD. L-BAVMs located in Geschwind's territory can cause a high incidence of LD. LS involvement and larger nidus size are risk factors for postoperative short- and long-term LD, and preoperative LD is a risk factor for postoperative, long-term LD. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. HIV prevalence, risk behavior, hormone use and surgical history among transgender persons in Thailand.

    Science.gov (United States)

    Guadamuz, Thomas E; Wimonsate, Wipas; Varangrat, Anchalee; Phanuphak, Praphan; Jommaroeng, Rapeepun; McNicholl, Janet M; Mock, Philip A; Tappero, Jordan W; van Griensven, Frits

    2011-04-01

    While Male-to-female transgender persons (TG) are believed to often engage in sex work and have high HIV infection risk, little is known about demographics, surgical and hormone use history, risk behaviors and HIV prevalence. Between March and October 2005, 474 TG from Bangkok, Chiangmai, and Phuket were surveyed using venue-day-time sampling. Of 474 participants, overall HIV prevalence was 13.5%. Most participants had completed at least secondary or vocational education (79.2%), gender self-identified as female (89.0%), had received money, gifts or valuables for sex (60.8%), and reported hormone use (88.6%). Surgical history was taken from 325 participants. Of these, 68.6% reported some form of surgery and 11.1% had undergone penile-vaginal reconstructive surgery. In multivariate analysis, being recruited from a park/street; older age, anal sex role identification as "versatile" and anal sex debut before age 13 were independently associated with HIV prevalence. The development, implementation and evaluation of culturally appropriate sexual health interventions for Thai TG is urgently needed.

  20. High-Risk Pregnancy

    Science.gov (United States)

    ... risk? » Related A-Z Topics Diabetes Pregnancy Loss Preeclampsia and Eclampsia NICHD News Spotlights Podcast: NICHD launches PregSource to learn more about pregnancy News Release: NIH Begins Large HIV Treatment Study in Pregnant Women Spotlight: Zika Research after ...

  1. [From guilt and shame to professional handling of mistakes--risk management in surgical medicine].

    Science.gov (United States)

    Slany, E; Reuter, W; Thüsing, C; Schmidt, C E

    2011-12-01

    Medical advances in diagnosis and therapy, especially in medical technology, lead to differenciated and more complex strategies in therapy with higher risks. Patients show higher expectations concerning the results of a therapy and claim more often that a mistake in treatment has been made. This makes patients turn to arbitration boards more often. They may also want to bring civil action against physicians and hospitals, claiming for compensation and damages. Personal liability insurances have to pay more for damages. Medical insurances have more recourse demands due to mistake in treatment. Hospital and especially operative medicine do have high chances of risks and mistakes. The implementation of a modern risk management system in the hospitals is becoming more and more important, for patients as well as for the surgical departments. A structured reporting system of critical incidents can produce indicators of potential sources of mistakes, which appears to be a successful approach to reduce or avoid typical risks and mistakes in medical treatment. Risk management in medical treatment must be more than just a trendy word, because its roots are in the medical principles of "primum nihil nocere". It is a challenge to today's and tomorrow's medicine. This article is a general overview of current strategies for avoiding mistakes: It is meant to be the basis of a new culture of mistake avoidance as a part of a future quality competition.

  2. The effect of intraoral suction on oxygen-enriched surgical environments: a mechanism for reducing the risk of surgical fires.

    Science.gov (United States)

    VanCleave, Andrea M; Jones, James E; McGlothlin, James D; Saxen, Mark A; Sanders, Brian J; Vinson, LaQuia A

    2014-01-01

    In this study, a mechanical model was applied in order to replicate potential surgical fire conditions in an oxygen-enriched environment with and without high-volume suction typical for dental surgical applications. During 41 trials, 3 combustion events were measured: an audible pop, a visible flash of light, and full ignition. In at least 11 of 21 trials without suction, all 3 conditions were observed, sometimes with an extent of fire that required early termination of the experimental trial. By contrast, in 18 of 20 with-suction trials, ignition did not occur at all, and in the 2 cases where ignition did occur, the fire was qualitatively a much smaller, candle-like flame. Statistically comparing these 3 combustion events in the no-suction versus with-suction trials, ignition (P = .0005), audible pop (P = .0211), and flash (P = .0092) were all significantly more likely in the no-suction condition. These results suggest a possible significant and new element to be added to existing surgical fire safety protocols toward making surgical fires the "never-events" they should be.

  3. Is there an increased risk of post-operative surgical site infection ...

    African Journals Online (AJOL)

    Background: There is dilemma as to whether patients infected with the Human Immunodeficiency Virus (HIV) requiring implant orthopaedic surgery are at an increased risk for post-operative surgical site infection (SSI). We conducted a systematic review to determine the effect of HIV on the risk of post-operative SSI and ...

  4. Prophylactic Antibiotic Choice and Risk of Surgical Site Infection After Hysterectomy.

    Science.gov (United States)

    Uppal, Shitanshu; Harris, John; Al-Niaimi, Ahmed; Swenson, Carolyn W; Pearlman, Mark D; Reynolds, R Kevin; Kamdar, Neil; Bazzi, Ali; Campbell, Darrell A; Morgan, Daniel M

    2016-02-01

    To evaluate associations between prophylactic preoperative antibiotic choice and surgical site infection rates after hysterectomy. A retrospective cohort study was performed of patients in the Michigan Surgical Quality Collaborative undergoing hysterectomy from July 2012 to February 2015. The primary outcome was a composite outcome of any surgical site infection (superficial surgical site infections or combined deep organ space surgical site infections). Preoperative antibiotics were categorized based on the recommendations set forth by the American College of Obstetricians and Gynecologists and the Surgical Care Improvement Project. Patients receiving a recommended antibiotic regimen were categorized into those receiving β-lactam antibiotics and those receiving alternatives to β-lactam antibiotics. Patients receiving nonrecommended antibiotics were categorized into those receiving overtreatment (excluded from further analysis) and those receiving nonstandard antibiotics. Multivariable logistic regression models were developed to estimate the independent effect of antibiotic choice. Propensity score matching analysis was performed to validate the results. The study included 21,358 hysterectomies. The overall rate of any surgical site infection was 2.06% (n=441). Unadjusted rates of "any surgical site infection" were 1.8%, 3.1%, and 3.7% for β-lactam, β-lactam alternatives, and nonstandard groups, respectively. After adjusting for patient and operative factors within clusters of hospitals, compared with the β-lactam antibiotics (reference group), the risk of "any surgical site infection" was higher for the group receiving β-lactam alternatives (odds ratio [OR] 1.7, confidence interval [CI] 1.27-2.07) or the nonstandard antibiotics (OR 2.0, CI 1.31-3.1). Compared with women receiving β-lactam antibiotic regimens, there is a higher risk of surgical site infection after hysterectomy among those receiving a recommended β-lactam alternative or nonstandard regimen.

  5. Systematic review of risk factors for surgical site infection in pediatric scoliosis surgery.

    Science.gov (United States)

    Subramanyam, Rajeev; Schaffzin, Joshua; Cudilo, Elizabeth M; Rao, Marepalli B; Varughese, Anna M

    2015-06-01

    Risk factors for surgical site infection (SSI) in children derived from the studies in the adult population are potentially misleading because of differences in pathophysiology and management. This systematic review addresses the key question: What are the risk factors for SSI in pediatric patients undergoing scoliosis surgery? This is a qualitative systematic literature review. Retrospective and observational trials of children undergoing scoliosis surgery reported on the occurrence of risk factors for SSI and the occurrence of SSI. Pubmed (Medline), Ovid Evidence-Based Medicine Reviews (EBMR), Scopus, and Cumulative Index to Nursing and Allied Health (CINAHL) were searched electronically for relevant articles in all the languages between January 1, 1991 and August 27, 2012, and cross-references were checked. Two independent reviewers identified articles and appraised quality with the Agency for Healthcare Research and Quality (AHRQ) criteria based on a weighted scoring of 0 to 100. Our search identified 135 abstracts and 14 studies meeting the inclusion criteria. The AHRQ grading showed that five articles were high quality with a score of greater than 67, and five articles were moderate quality with a score between 50 and 67. The percent agreement between the two independent reviewers was 84%, and kappa agreement score was 0.91 (95% confidence interval [CI]: 0.78-1.03). There were 76 risk factors identified, of which 22 factors were reported in more than one study. Odds ratios and 95% CIs were reported inconsistently. Pooled p analysis of high- and moderate-quality articles identified five risk factors predictive of SSI: inappropriate antibiotic use (p=.001), neuromuscular scoliosis (p=.014), instrumentation (p=.023), increased hospital stay days (p=.003), and residual postoperative curve (p=.003). The systematic review identified inappropriate antibiotic use, neuromuscular scoliosis, instrumentation, increased hospital stay days, and residual postoperative curve

  6. Surgical site infections after abdominal surgery: incidence and risk factors. A prospective cohort study.

    Science.gov (United States)

    Aga, Emil; Keinan-Boker, Lital; Eithan, Arieh; Mais, Tamar; Rabinovich, Alia; Nassar, Faris

    2015-01-01

    Abdominal surgeries have high rates of surgical site infections (SSIs), contributing to increased morbidity and mortality and costs for hospitalization. The aim of this study was to determine the SSI incidence rates and risk factors after abdominal surgeries. This prospective cohort study included all patients undergoing abdominal surgeries between 2005 and 2007 in the Western Galilee Medical Center in Nahariya, Israel. SSI incidence rates were calculated per 100 operations. Odds ratios (ORs) were estimated for each risk factor using univariate and multivariate analyses by logistic regression models. Among 302 patients in the study cohort, the total SSI incidence rate was 22.2%. The univariate analysis defined 13 variables significantly associated with SSI: age > 60 years, lower functional status, diabetes mellitus, congestive heart failure, immunocompromising underlying disease, treatment with chemotherapy and other immunosuppressive medications, impaired immune system open cholecystectomy, laparotomy, an American Society of Anesthesiologists (ASA) score > 2, drain insertion, and 'dirty wound' classification. In multivariate regression analysis, treatment with immunosuppressive medications (OR = 2.5, 95% confidence interval (CI) = 1.099-143.443), open cholecystectomy (OR = 2.25, 95% CI = 2.242-40.109), and dirty wound classification (OR = 2.179, 95% CI = 3.80-20.551) were significantly associated with SSI. The significant risk factors defined should be addressed preoperatively to decrease the risk for SSI. Wound surveillance in the post-discharge period is necessary for correct estimation of SSI rates.

  7. Analysis of Surgical Site Infection after Musculoskeletal Tumor Surgery: Risk Assessment Using a New Scoring System

    Directory of Open Access Journals (Sweden)

    Satoshi Nagano

    2014-01-01

    Full Text Available Surgical site infection (SSI has not been extensively studied in musculoskeletal tumors (MST owing to the rarity of the disease. We analyzed incidence and risk factors of SSI in MST. SSI incidence was evaluated in consecutive 457 MST cases (benign, 310 cases and malignant, 147 cases treated at our institution. A detailed analysis of the clinical background of the patients, pre- and postoperative hematological data, and other factors that might be associated with SSI incidence was performed for malignant MST cases. SSI occurred in 0.32% and 12.2% of benign and malignant MST cases, respectively. The duration of the surgery (P=0.0002 and intraoperative blood loss (P=0.0005 was significantly more in the SSI group than in the non-SSI group. We established the musculoskeletal oncological surgery invasiveness (MOSI index by combining 4 risk factors (blood loss, operation duration, preoperative chemotherapy, and the use of artificial materials. The MOSI index (0–4 points score significantly correlated with the risk of SSI, as demonstrated by an SSI incidence of 38.5% in the group with a high score (3-4 points. The MOSI index score and laboratory data at 1 week after surgery could facilitate risk evaluation and prompt diagnosis of SSI.

  8. Surgical treatment of esophageal high-grade dysplasia.

    Science.gov (United States)

    Reed, Michael F; Tolis, George; Edil, Barish H; Allan, James S; Donahue, Dean M; Gaissert, Henning A; Moncure, Ashby C; Wain, John C; Wright, Cameron D; Mathisen, Douglas J

    2005-04-01

    Barrett's esophagus, high-grade dysplasia (HGD), and invasive cancer are steps in the progression of esophageal adenocarcinoma. While surgery is recommended for resectable invasive adenocarcinoma, a number of treatment modalities are advocated for HGD. The purpose of this study is to determine the outcomes after surgery for HGD. We identified cases of HGD based on endoscopic biopsy in a single institution's databases from 1980 through 2001. Records were reviewed for patient characteristics, treatments, staging, and outcomes. In a 22-year period, 869 cases of esophageal adenocarcinoma and 1,614 cases of Barrett's esophagus were diagnosed. Of these, 115 had HGD without pretreatment evidence of invasion. Forty-nine patients with HGD underwent resection (mean age, 59 years) as initial treatment. Forty-seven had endoscopic treatment (mean age, 70 years) by photodynamic therapy or endoscopic mucosal resection. Seven of the endoscopically treated patients failed, with three undergoing surgery and four observation. Nineteen patients were initially observed, with six eventually having surgery. For the 49 initially treated surgically, one (2%) operative mortality occurred. Invasive adenocarcinoma was present in 18 (37%). The five-year survival was 83% for all resected HGD patients (91% for those without invasion, 68% with invasion). Three of the eight deaths in those with invasion were from recurrent adenocarcinoma. Surgical resection of esophageal HGD can be performed with low mortality and allows long-term survival. A significant percentage with an initial diagnosis of HGD will have invasive disease at resection. Surgery is the optimal treatment for HGD unless contraindicated by severe comorbidities.

  9. Risk Factors for Surgical Site Infections Following Neurosurgical Spinal Fusion Operations: A Case Control Study.

    Science.gov (United States)

    Walsh, Thomas L; Querry, Ashley M; McCool, Sheila; Galdys, Alison L; Shutt, Kathleen A; Saul, Melissa I; Muto, Carlene A

    2017-03-01

    OBJECTIVE To determine risk factors for the development of surgical site infections (SSIs) in neurosurgery patients undergoing spinal fusion. DESIGN Retrospective case-control study. SETTING Large, academic, quaternary care center. PATIENTS The study population included all neurosurgery patients who underwent spinal fusion between August 1, 2009, and August 31, 2013. Cases were defined as patients in the study cohort who developed an SSI. Controls were patients in the study cohort who did not develop an SSI. METHODS To achieve 80% power with an ability to detect an odds ratio (OR) of 2, we performed an unmatched case-control study with equal numbers of cases and controls. RESULTS During the study period, 5,473 spinal fusion procedures were performed by neurosurgeons in our hospital. With 161 SSIs recorded during the study period, the incidence of SSIs associated with these procedures was 2.94%. While anterior surgical approach was found to be a protective factor (OR, 0.20; 95% confidence interval [CI], 0.08-0.52), duration of procedure (OR, 1.58; 95% CI, 1.29-1.93), American Society of Anesthesiologists score of 3 or 4 (OR, 1.79; 95% CI, 1.00-3.18), and hospitalization within the prior 30 days (OR, 5.8; 95% CI, 1.37-24.57) were found in multivariate analysis to be independent predictors of SSI following spinal fusion. Prior methicillin-resistant Staphylococcus aureus (MRSA) nares colonization was highly associated with odds 20 times higher of SSI following spinal fusion (OR, 20.30; 95% CI, 4.64-8.78). CONCLUSIONS In additional to nonmodifiable risk factors, prior colonization with MRSA is a modifiable risk factor very strongly associated with development of SSI following spinal fusion. Infect Control Hosp Epidemiol 2017;38:348-352.

  10. Risk factors for surgical site infection following cesarean delivery: a retrospective cohort study.

    Science.gov (United States)

    Ketcheson, Felicia; Woolcott, Christy; Allen, Victoria; Langley, Joanne M

    2017-07-11

    The rate of cesarean delivery is increasing in North America. Surgical site infection following this operation can make it difficult to recover, care for a baby and return home. We aimed to determine the incidence of surgical site infection to 30 days following cesarean delivery, associated risk factors and whether risk factors differed for predischarge versus postdischarge infection. We identified a retrospective cohort in Nova Scotia by linking the provincial perinatal database to hospital admissions and physician billings databases to follow women for 30 days after they had given birth by cesarean delivery between Jan. 1, 1997 and Dec. 31, 2012. Logistic regression with generalized estimating equations was used to determine risk factors for infection. A total of 25 123 women had 33 991 cesarean deliveries over the study period. Of the 25 123, 923 had surgical site infections, giving an incidence rate of 2.7% (95% CI 2.54%-2.89%); the incidence decreased over time. Risk factors for infection (adjusted odds ratios ≥ 1.5) were prepregnancy weight 87.0 kg or more, gaining 30.0 kg or more during pregnancy, chorioamnionitis, maternal blood transfusion, anticoagulation therapy, alcohol or drug abuse, second stage of labour before surgery, delivery in 1997-2000 and delivery in a hospital performing 130-1249 cesarean deliveries annually. Women who gave birth earlier in the study period, those who gave birth in a hospital with 130-949 cesarean deliveries per year and those with more than 1 fetus were at a significantly higher risk for surgical site infection before discharge; women who smoked were at significantly higher risk for surgical site infection after discharge. Most risk factors are known before delivery, and some are potentially modifiable. Although the incidence of surgical site infection decreased over time, targeted clinical and infection prevention and control interventions could further reduce the burden of illness associated with this health

  11. Sarcopenia and Postoperative Complication Risk in Gastrointestinal Surgical Oncology

    DEFF Research Database (Denmark)

    Simonsen, Casper; de Heer, Pieter; Bjerre, Eik D

    2018-01-01

    across stratification by sarcopenia criteria, assessment methods, study quality, and diagnoses. CONCLUSIONS: Sarcopenia was associated with an increased risk of complications after gastrointestinal tumor resection, but lack of methodological consensus hampers the interpretation and clinical utilization......OBJECTIVE: The aim of the study was to evaluate sarcopenia as a predictor of postoperative risk of major and total complications after surgery for gastrointestinal cancer. BACKGROUND: Sarcopenia is associated with poor survival in gastrointestinal cancer patients, but the role of sarcopenia...... used to estimate the pooled risk ratio for postoperative complications by Clavien-Dindo grade (total complications: grade ≥2; major complications: grade ≥3) in patients with sarcopenia versus patients without sarcopenia. Stratified analyses were performed by sarcopenia criteria, cutoff level...

  12. Risk Factors for Surgical Results of Hirayama Disease: A Retrospective Analysis of a Large Cohort.

    Science.gov (United States)

    Song, Jian; Wang, Hong-Li; Zheng, Chao-Jun; Jiang, Jian-Yuan

    2017-09-01

    To explore risk factors affecting surgical results of Hirayama disease. A retrospective analysis of 210 patients was performed to identify risk factors affecting surgical results of Hirayama disease by using univariate and multivariate analyses. A receiver operating characteristic curve and area under the curve were applied to evaluate the significant results of the multivariate analysis and the optimal reference value. The mean follow-up period was 27.3 months (range, 14-45 months), and 194 patients with clinical and radiographic data completed the final follow-up. Multivariate analysis identified age of patients (cutoff value 22.5 years), duration of the disease (cutoff value 33 months), physiologic reflex, and pathologic reflex as independent risk factors for surgical results of Hirayama disease. The receiver operating characteristic curve analysis and area under the curve showed that good reference value was obtained for the risk factors. Age of patient, duration of the disease, physiologic reflex, and pathologic reflex are the main risk factors affecting surgical results of Hirayama disease. Receiver operating characteristic analysis shows that good reference value was obtained for the risk factors. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Extubation to high-flow nasal cannula in critically ill surgical patients.

    Science.gov (United States)

    Dhillon, Navpreet K; Smith, Eric J T; Ko, Ara; Harada, Megan Y; Polevoi, Danielle; Liang, Richard; Barmparas, Galinos; Ley, Eric J

    2017-09-01

    High-flow nasal cannula (HFNC) is increasingly used to reduce reintubations in patients with respiratory failure. Benefits include providing positive end expiratory pressure, reducing anatomical dead space, and decreasing work of breathing. We sought to compare outcomes of critically ill surgical patients extubated to HFNC versus conventional therapy. A retrospective review was conducted in the surgical intensive care unit of an academic center during August 2015 to February 2016. Data including demographics, ventilator days, oxygen therapy after extubation, reintubation rates, surgical intensive care unit and hospital length of stay, and mortality were collected. Self and palliative extubations were excluded. Characteristics and outcomes, with the primary outcome being reintubation, were compared between those extubated to HFNC versus cool mist/nasal cannula (CM/NC). Of the 184 patients analyzed, 46 were extubated to HFNC and 138 to CM/NC. Mean age and days on ventilation before extubation were 57.8 years and 4.3 days, respectively. Both cohorts were similar in age, sex, and had a similar prevalence of cardiopulmonary diagnoses at admission. Although prior to extubation HFNC had lengthier ventilation requirements (7.1 versus 3.4 days, P < 0.01) and ICU stays (7.8 versus 4.1 days, P < 0.01), the rate of reintubation was similar to CM/NC (6.5% versus 13.8%, P = 0.19). Multivariable analysis demonstrated HFNC to be associated with a lower risk of reintubation (adjusted odds ratio = 0.15, P = 0.02). Mortality rates were similar. Ventilated patients at risk for recurrent respiratory failure have reduced reintubation rates when extubated to HFNC. Patients with prolonged intubation or those with high-risk comorbidities may benefit from extubation to HFNC. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Risk factors for Staphylococcus aureus surgical site infection during an outbreak in patients undergoing cardiovascular surgery.

    Science.gov (United States)

    Tadros, Manal A; Williams, Victoria R; Plourde, Suzanne; Callery, Sandra; Simor, Andrew E; Vearncombe, Mary

    2013-06-01

    This study examined the epidemiology of an outbreak of Staphylococcus aureus surgical site infections (SSI) after cardiovascular surgery, and analyzed risk factors for S aureus SSIs. This was a retrospective case-control study to determine risk factors for S aureus SSI in 38 patients who developed S aureus SSI during the outbreak period, compared with age-, sex-, and procedure-matched controls. S aureus strains were typed by pulsed-field gel electrophoresis. A total of 38 patients had S aureus SSI. Pulsed-field gel electrophoresis identified transmission of 3 S aureus clones (2 MSSA clones and 1 MRSA clone). Twenty-one health care workers were carriers of outbreak strains. In multivariate analysis, the significant risk factors for S aureus SSI were previous cardiac surgery (odds ratio, 7.41; 95% confidence interval, 1.05-52.16) and long procedure duration (odds ratio, 1.49; 95% confidence interval, 1.00-2.21). This outbreak demonstrates evidence of nosocomial transmission of 3 clones of S aureus in the setting of incomplete compliance with recommended standard perioperative infection control measures, associated with a high prevalence of staff carriage of the predominant outbreak strains. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  15. Health risks associated with exposure to surgical smoke for surgeons and operation room personnel.

    Science.gov (United States)

    Okoshi, Kae; Kobayashi, Katsutoshi; Kinoshita, Koichi; Tomizawa, Yasuko; Hasegawa, Suguru; Sakai, Yoshiharu

    2015-08-01

    Although surgical smoke contains potentially hazardous substances, such as cellular material, blood fragments, microorganisms, toxic gases and vapors, many operating rooms (ORs) do not provide protection from exposure to it. This article reviews the hazards of surgical smoke and the means of protecting OR personnel. Our objectives are to promote surgeons' acceptance to adopt measures to minimize the hazards. Depending on its components, surgical smoke can increase the risk of acute and chronic pulmonary conditions, cause acute headaches; irritation and soreness of the eyes, nose and throat; dermatitis and colic. Transmission of infectious disease may occur if bacterial or viral fragments present in the smoke are inhaled. The presence of carcinogens in surgical smoke and their mutagenic effects are also of concern. This review summarizes previously published reports and data regarding the toxic components of surgical smoke, the possible adverse effects on the health of operating room personnel and measures that can be used to minimize exposure to prevent respiratory problems. To reduce the hazards, surgical smoke should be removed by an evacuation system. Surgeons should assess the potential dangers of surgical smoke and encourage the use of evacuation devices to minimize potential health hazards to both themselves and other OR personnel.

  16. Osteoporosis and shoulder osteoarthritis: incidence, risk factors, and surgical implications.

    Science.gov (United States)

    Pervaiz, Khurram; Cabezas, Andres; Downes, Katheryne; Santoni, Brandon G; Frankle, Mark A

    2013-03-01

    Patients with osteoarthritis undergoing shoulder arthroplasty may suffer from osteoporosis. The purpose of this study was to determine whether computed tomography (CT)-derived Hounsfield unit (HU) measurements correlate with bone mineral density (BMD) and whether these data could predict implant size and fixation choice. The study analyzed preoperative dual energy x-ray absorptiometry and shoulder CT scans for 230 patients who underwent total shoulder arthroplasty. Hip BMD and T scores and HU attenuation in the humerus were correlated. HU cutoff values were developed to aid in differentiating patients whose BMD values were within normal reference ranges from patients with osteopenia or osteoporosis. Risk factors associated with low BMD were correlated, and the effect of BMD on humeral stem size, and fixation method was investigated. Significant correlations between HU and hip BMD and T score were identified (P risk factors. Age at time of surgery was a predictor of cemented stem fixation (P = .024). Patients with a lower BMD were statistically more likely to receive a larger-diameter humeral stem (P = .016). Orthopedic surgeons may be able to use data obtained from shoulder CT scans to predict the need for larger stem size or cement fixation during shoulder arthroplasty. In combination with the risk factor profile, these data may be useful in predicting the need for an osteoporosis workup and treatment. Level III, Study of Nonconsecutive Patients, Diagnostic Study. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  17. High incidence of erysipelas after surgical treatment for vulvar carcinoma : An observational study

    NARCIS (Netherlands)

    Leermakers, Maria E J; Pleunis, Noortje; Boll, Dorry; Hermans, Ralph H; Ezendam, N.P.M.; Pijnenborg, Johanna M A

    2016-01-01

    Objectives: Vulvar carcinoma is mainly treated surgically and has an overall good prognosis. Despite the development of minimally invasive surgical procedures in recent years, morbidity remains significant. The aim of the study was to determine the incidence and risk factors of erysipelas after

  18. High Incidence of Erysipelas After Surgical Treatment for Vulvar Carcinoma: An Observational Study

    NARCIS (Netherlands)

    Leermakers, M.E.; Pleunis, N.; Boll, D.; Hermans, R.H.; Ezendam, N.P.; Pijnenborg, J.M.A.

    2016-01-01

    OBJECTIVES: Vulvar carcinoma is mainly treated surgically and has an overall good prognosis. Despite the development of minimally invasive surgical procedures in recent years, morbidity remains significant. The aim of the study was to determine the incidence and risk factors of erysipelas after

  19. Preoperative delay of more than 1 hour increases the risk of surgical site infection.

    Science.gov (United States)

    Radcliff, Kris E; Rasouli, Mohammad R; Neusner, Alex; Kepler, Christopher K; Albert, Todd J; Rihn, Jeffrey A; Hilibrand, Alan S; Vaccaro, Alexander R

    2013-07-01

    Retrospective institutional database review. To determine whether preoperative in-room time is a risk factor for surgical site infection (SSI). Prior to spine surgery, while the patient is in the operating room, several procedures may be performed that may delay surgery. During this time, the sterile field may be exposed and may become contaminated. The hypothesis of this study was that the length of time in the operative room prior to surgical incision (anesthesia ready time [ART]) was related to the risk of SSI. From 2005 to 2009, we identified 276 patients who developed SSI out of 7991 cases that underwent spine surgery from 2005 to 2009. Patient demographic factors, American Society of Anesthesiologists score, wound classification, number of levels, anatomic region, type of surgical approach, and length of surgery were extrapolated. ART was calculated as the time after the patient was brought into the operating room prior to surgical incision. Multivariate analysis was performed to identify risk factors for SSI. Mean ART was significantly (P = 0.001) higher in patients with infection (68 min) compared with those without infection (60 min). The infection rate was higher in cases with ART more than 1 hour compared with those with less than 1 hour (4.9% vs. 2.3%, P = 0.001). In multivariate analysis, ART more than 1 hour was an independent risk factor for SSI, along with number of levels, American Society of Anesthesiologists score and posterior approach. The highest percentage of cases with ART more than 1 hour occurred in August and September. Preoperative in-room time prior to the start of surgical incision is an independent risk factor for SSI. All possible steps should be taken prior to entry into the operating theater to reduce in-room time and opening of surgical sterile instrumentation be delayed until the surgery is ready to proceed.

  20. The influence of clinical risk factors on pre-operative B-type natriuretic peptide risk stratification of vascular surgical patients.

    Science.gov (United States)

    Biccard, B M; Lurati Buse, G A; Burkhart, C; Cuthbertson, B H; Filipovic, M; Gibson, S C; Mahla, E; Leibowitz, D W; Rodseth, R N

    2012-01-01

    The role of the revised cardiac risk index in risk stratification has recently been challenged by studies reporting on the superior predictive ability of pre-operative B-type natriuretic peptides. We found that in 850 vascular surgical patients initially risk stratified using B-type natriuretic peptides, reclassification with the number of revised cardiac risk index risk factors worsened risk stratification (p  0, > 2, > 3 and > 4 risk factors, and p = 0.23 for > 1 risk factor). When evaluated with pre-operative B-type natriuretic peptides, none of the revised cardiac risk index risk factors were independent predictors of major adverse cardiac events in vascular patients. The only independent predictor was B-type natriuretic peptide stratification (OR 5.1, 95% CI 1.8-15 for the intermediate class, and OR 25, 95% CI 8.7-70 for the high-risk class). The clinical risk factors in the revised cardiac risk index cannot improve a risk stratification model based on B-type natriuretic peptides. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.

  1. Length of preoperative hospital stay: a risk factor for reducing surgical infection in femoral fracture cases

    Directory of Open Access Journals (Sweden)

    Hoberdan Oliveira Pereira

    2015-12-01

    Full Text Available ABSTRACT OBJECTIVE: To analyze infections of the surgical site among patients undergoing clean-wound surgery for correction of femoral fractures. METHODS: This was a historical cohort study developed in a large-sized hospital in Belo Horizonte. Data covering the period from July 2007 to July 2009 were gathered from the records in electronic medical files, relating to the characteristics of the patients, surgical procedures and surgical infections. The risk factors for infection were identified by means of statistical tests on bilateral hypotheses, taking the significance level to be 5%. Continuous variables were evaluated using Student'sttest. Categorical variables were evaluated using the chi-square test, or Fisher's exact test, when necessary. For each factor under analysis, a point estimate and the 95% confidence interval for the relative risk were obtained. In the final stage of the study, multivariate logistic regression analysis was performed. RESULTS: 432 patients who underwent clean-wound surgery for correcting femoral fractures were included in this study. The rate of incidence of surgical site infections was 4.9% and the risk factors identified were the presence of stroke (odds ratio, OR = 5.0 and length of preoperative hospital stay greater than four days (OR = 3.3. CONCLUSION: To prevent surgical site infections in operations for treating femoral fractures, measures involving assessment of patients' clinical conditions by a multiprofessional team, reduction of the length of preoperative hospital stay and prevention of complications resulting from infections will be necessary.

  2. Surgical Apgar Score predicts an increased risk of major complications and death after renal mass excision.

    Science.gov (United States)

    Ito, Timothy; Abbosh, Philip H; Mehrazin, Reza; Tomaszewski, Jeffrey J; Li, Tianyu; Ginzburg, Serge; Canter, Daniel J; Greenberg, Richard E; Viterbo, Rosalia; Chen, David Y; Kutikov, Alexander; Smaldone, Marc C; Uzzo, Robert G

    2015-06-01

    Tailoring perioperative management to minimize the postoperative complication rates depends on reliable prognostication of patients most at risk. The Surgical Apgar Score is an objective measure of the operative course validated to predict major complications and death after general/vascular surgery. We assessed the ability of the Surgical Apgar Score to identify patients most at risk for postoperative morbidity and mortality after renal mass excision. Data for 886 patients undergoing renal mass excision via radical or partial nephrectomy from 2010 to 2013 were extracted from a prospectively collected database. The Surgical Apgar Score was calculated using electronic anesthesia records. Major postoperative complications, readmission and reoperation within 30 days of surgery as well as 90-day mortality were examined. Overall 13.2% of patients experienced major postoperative complications at 30 days. Clavien grade I, II, III, IV and V complications were experienced by 1.7%, 2.9%, 5.8%, 1.9% and 0.9%, respectively. The 90-day all cause mortality rate was 1.4%. The Surgical Apgar Score was significantly lower in patients experiencing major complications (mean 7.3 vs 7.8, p=0.004) and death (6.3 vs 7.7, p=0.03). Patients with a Surgical Apgar Score of 4 or less were 3.7 times more likely to experience a major complication (p=0.01) and 24 times more likely to die within 90 days of surgery (p=0.0007) compared to patients with a Surgical Apgar Score greater than 8. The Surgical Apgar Score is an easily collected metric that can identify patients at higher risk for major complications and death after renal mass excision. A prospective trial to help further delineate the optimal use of this tool in an adjusted perioperative management approach with patients undergoing renal mass excision is warranted. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  3. Single-port risk-reducing salpingo-oophorectomy with and without hysterectomy: surgical outcomes and learning curve analysis.

    Science.gov (United States)

    Escobar, Pedro F; Starks, David C; Fader, Amanda Nickles; Barber, Matthew; Rojas-Espalliat, Luis

    2010-10-01

    Based on considerable prospective data, risk-reducing salpingo-oophorectomy (RRSO) is one of the most beneficial interventions available to reduce ovarian/breast cancer risk in BRCA carriers and high-risk women. The purpose of this study was to describe the initial surgical outcomes and learning curve analysis associated with laparoendoscopic single-site (LESS) RRSO with and without hysterectomy. A retrospective, multi-institutional analysis of BRCA carriers and women at high risk for breast/ovarian cancer who underwent LESS RRSO with and without hysterectomy in 2009 was performed. Data collected included age, BMI, procedure, operative time, length of hospital stay, postoperative pain scores, and post operative complications. Student t-test, Pearson correlation coefficient, and multivariate linear regression were used for analysis. A total of 58 patients were evaluated; 36 (63%) were BRCA1/2 carriers and 38 (63%) had breast cancer. Patients' mean age and BMI were 46 years and 27 kg/m(2), respectively. Most patients were Caucasian (76%), and at the time of prophylactic surgery, 53% of patients were undergoing active breast cancer treatment. Mean operative time was 38.1 minutes (16-80 minutes). All cases were performed successfully via the LESS approach, and there were no surgical complications. Multivariate linear regression analysis was done, and after controlling for study site, previous abdominal surgery, active cancer treatment, and BMI, operative time was only influence by number of cases performed, p=0.019. LESS RRSO is feasible and safe with favorable surgical and cosmetic outcomes. In our experience, surgical proficiency is possible after 10-15 cases. The LESS approach may be ideal for BRCA mutation carriers and breast cancer patients because of a short convalescence, permitting minimal interruption in any ongoing cancer treatment and the potential psychological benefits from improved cosmesis and pain control. Prospective studies are needed to assess the

  4. The influence of physiological and surgical menopause on coronary heart disease risk markers

    NARCIS (Netherlands)

    Verhoeven, Marieke O.; van der Mooren, Marius J.; Teerlink, Tom; Verheijen, Rene H. M.; Scheffer, Peter G.; Kenemans, Peter

    2009-01-01

    Objective: To investigate the influence of physiological and surgical menopause oil Serum concentrations of corollary heart disease (CHD) risk markers and sex hormones. Design: Physiological menopausal transition was investigated in two studies. In a longitudinal Study, 16 women were followed from 2

  5. Midregional Proadrenomedullin Improves Risk Stratification beyond Surgical Risk Scores in Patients Undergoing Transcatheter Aortic Valve Replacement.

    Directory of Open Access Journals (Sweden)

    Adam Csordas

    Full Text Available Conventional surgical risk scores lack accuracy in risk stratification of patients undergoing transcatheter aortic valve replacement (TAVR. Elevated levels of midregional proadrenomedullin (MR-proADM levels are associated with adverse outcome not only in patients with manifest chronic disease states, but also in the general population.We investigated the predictive value of MR-proADM for mortality in an unselected contemporary TAVR population.We prospectively included 153 patients suffering from severe aortic stenosis who underwent TAVR from September 2013 to August 2014. This population was compared to an external validation cohort of 205 patients with severe aortic stenosis undergoing TAVR. The primary endpoint was all cause mortality.During a median follow-up of 258 days, 17 out of 153 patients who underwent TAVR died (11%. Patients with MR-proADM levels above the 75th percentile (≥ 1.3 nmol/l had higher mortality (31% vs. 4%, HR 8.9, 95% CI 3.0-26.0, P 6.8 only showed a trend towards higher mortality (18% vs. 9%, HR 2.1, 95% CI 0.8-5.6, P = 0.13. The Harrell's C-statistic was 0.58 (95% CI 0.45-0.82 for the EuroSCORE II, and consideration of baseline MR-proADM levels significantly improved discrimination (AUC = 0.84, 95% CI 0.71-0.92, P = 0.01. In bivariate analysis adjusted for EuroSCORE II, MR-proADM levels ≥1.3 nmol/l persisted as an independent predictor of mortality (HR 9.9, 95% CI (3.1-31.3, P <0.01 and improved the model's net reclassification index (0.89, 95% CI (0.28-1.59. These results were confirmed in the independent validation cohort.Our study identified MR-proADM as a novel predictor of mortality in patients undergoing TAVR. In the future, MR-proADM should be added to the commonly used EuroSCORE II for better risk stratification of patients suffering from severe aortic stenosis.

  6. Surgical site infection after total en bloc spondylectomy: Risk factors and the preventive new technology

    OpenAIRE

    Hayashi, Hiroyuki; Murakami, Hideki; Demura, Satoru; Kato, Satoshi; Yoshioka, Katsuhito; Shinmura, Kazuya; Yokogawa, Noriaki; Ishii, Takayoshi; Fang, Xiang; Shirai, Toshiharu; Tsuchiya, Hiroyuki

    2015-01-01

    Background context Surgical site infection (SSI) associated with instruments remains a serious and common complication in patients who undergo total en bloc spondylectomy (TES). It is very important that the risk factors for SSI are known to prevent it.Purpose The purpose of the study was to identify independent risk factors for SSI after TES and evaluate the positive effect of iodine-supported spinal instruments in the prevention of SSI after TES.Study design This is a retrospective clinical...

  7. Current surgical instrument labeling techniques may increase the risk of unintentionally retained foreign objects: a hypothesis.

    Science.gov (United States)

    Ipaktchi, Kyros; Kolnik, Adam; Messina, Michael; Banegas, Rodrigo; Livermore, Meryl; Price, Connie

    2013-09-30

    Marking of surgical instruments is essential to ensure their proper identification after sterile processing. The National Quality Forum defines unintentionally retained foreign objects in a surgical patient as a serious reportable event also called "never event." We hypothesize that established practices of surgical instrument identification using unkempt tape labels and plastic tags may expose patients to "never events" from retained disintegrating labels. We demonstrate the near miss of a "never event" during a surgical case in which the breakage of an instrument label remained initially unwitnessed. A fragment of the plastic label was accidentally found in the wound upon closing. Further clinical testing of the occurrence of this "never event" appears not feasible. As the name implies a patient should never be exposed to the risk of fragmenting labels. Current practice does not mandate verifying intact instrument markers as part of the instrument count. The clinical confirmation of our hypothesis mandates a change in perioperative practice: Mechanical labels need to undergo routine inspection and maintenance. The perioperative count must not only verify the quantity of surgical instruments but also the intactness of labels to ensure that no part of an instrument is left behind. Proactive maintenance of taped and dipped labels should be performed routinely. The implementation of newer labeling technologies - such as laser engraved codes - appears to eliminate risks seen in traditional mechanical labels.This article reviews current instrument marking technologies, highlights shortcomings and recommends safe instrument handling and marking practices implementing newer available technologies.

  8. Amikacin prophylaxis and risk factors for surgical site infection after kidney transplantation.

    Science.gov (United States)

    Freire, Maristela P; Antonopoulos, Ioannis M; Piovesan, Affonso Celso; Moura, Maria L; de Paula, Flávio Jota; Spadão, Fernanda; Guimarães, Thais; David-Neto, Elias; Nahas, William C; Pierrotti, Ligia C

    2015-03-01

    Antibiotic prophylaxis plays a major role in preventing surgical site infections (SSIs). This study aimed to evaluate antibiotic prophylaxis in kidney transplantation and identify risk factors for SSIs. We evaluated all kidney transplantation recipients from January 2009 and December 2012. We excluded patients who died within the first 72 hr after transplantation, were undergoing simultaneous transplantation of another organ, or were below 12 years of age. The main outcome measure was SSI during the first 60 days after transplantation. A total of 819 kidney transplants recipients were evaluated, 65% of whom received a deceased-donor kidney. The antibiotics used as prophylaxis included cephalosporin, in 576 (70%) cases, and amikacin, in 233 (28%). We identified SSIs in 106 cases (13%), the causative agent being identified in 72 (68%). Among the isolated bacteria, infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae predominated. Multivariate analysis revealed that the risk factors for post-kidney transplantation SSIs were deceased donor, thin ureters at kidney transplantation, antithymocyte globulin induction therapy, blood transfusion at the transplantation procedure, high body mass index, and diabetes mellitus. The only factor associated with a reduction in the incidence of SSIs was amikacin use as antibiotic prophylaxis. Factors associated with reduced graft survival were: intraoperative blood transfusions, reoperation, human leukocyte antigen mismatch, use of nonstandard immunosuppression therapy, deceased donor, post-kidney transplantation SSIs, and delayed graft function. Amikacin prophylaxis is a useful strategy for preventing SSIs.

  9. Improved implementation of the risk-adjusted Bernoulli CUSUM chart to monitor surgical outcome quality.

    Science.gov (United States)

    Keefe, Matthew J; Loda, Justin B; Elhabashy, Ahmad E; Woodall, William H

    2017-06-01

    The traditional implementation of the risk-adjusted Bernoulli cumulative sum (CUSUM) chart for monitoring surgical outcome quality requires waiting a pre-specified period of time after surgery before incorporating patient outcome information. We propose a simple but powerful implementation of the risk-adjusted Bernoulli CUSUM chart that incorporates outcome information as soon as it is available, rather than waiting a pre-specified period of time after surgery. A simulation study is presented that compares the performance of the traditional implementation of the risk-adjusted Bernoulli CUSUM chart to our improved implementation. We show that incorporating patient outcome information as soon as it is available leads to quicker detection of process deterioration. Deterioration of surgical performance could be detected much sooner using our proposed implementation, which could lead to the earlier identification of problems.

  10. Usefulness and capability of three-dimensional, full high-definition movies for surgical education

    OpenAIRE

    Takano, M.; Kasahara, K.; Sugahara, K.; Watanabe, A; Yoshida, S.; Shibahara, T

    2017-01-01

    Background Because of changing surgical procedures in the fields of oral and maxillofacial surgery, new methods for surgical education are needed and could include recent advances in digital technology. Many doctors have attempted to use digital technology as educational tools for surgical training, and movies have played an important role in these attempts. We have been using a 3D full high-definition (full-HD) camcorder to record movies of intra-oral surgeries. Method The subjects were medi...

  11. Risk factors of erectile dysfunction and penile vascular changes after surgical repair of penile fracture.

    Science.gov (United States)

    El-Assmy, A; El-Tholoth, H S; Abou-El-Ghar, M E; Mohsen, T; Ibrahiem, E H I

    2012-01-01

    This study was conducted to determine the preoperative and intraoperative risk factors of ED and the underlying penile vascular abnormalities among patients with penile fracture treated surgically. In all, 180 patients with penile fracture were treated surgically and followed up in one center. None of our patients had ED before the penile trauma and only two of them had risk factors for systemic vascular diseases, such as diabetes mellitus (one patient) and hypertension (one patient). After a mean follow-up of 106 months, 11 patients (6.6%) developed ED, 7 had mild ED and 4 had moderate ED. The main risk factors for subsequent ED were aging, >50 years, and bilateral corporal involvement. Among the 11 patients with ED, color Doppler ultrasonography (CDU) showed normal Doppler indices in 4 (36.4%), veno-occlusive dysfunction in 4 (36.4%) and arterial insufficiency in the remaining 3 (27.2%) patients. CDU assessments from the injured and intact sides were comparable. ED of either a psychological or vascular origin can be encountered as a long-term sequel of surgical treatment of penile fracture. Aging, >50 years, at presentation and bilateral corporal involvement is the main risk factors for subsequent development of ED.

  12. The independent effect of cancer on outcomes: a potential limitation of surgical risk prediction.

    Science.gov (United States)

    Leeds, Ira L; Canner, Joseph K; Efron, Jonathan E; Ahuja, Nita; Haut, Elliott R; Wick, Elizabeth C; Johnston, Fabian M

    2017-12-01

    Cancer patients are often thought to have worse surgical outcomes. There is a growing view that risk models do not adequately predict these outcomes. This study aims to compare the use of common risk models for benign versus malignant gastrointestinal disease. The National Surgical Quality Improvement Program (NSQIP) 2005-2015 participant use files were queried for patients undergoing elective surgery for benign and malignant diseases with a primary procedure code for major colon, pancreas, or stomach resection. Multivariable logistic regression was performed to identify independent predictors of mortality and morbidity. We identified 264,401 cases (111,563 malignant). The gastrointestinal cancer population was disproportionately male, older than 65, nonwhite, and less functionally independent. Comorbidities more common in the cancer population included diabetes, hypertension, dyspnea, and chronic obstructive pulmonary disease. Cancer patients had a longer length of stay (+0.9 days), higher mortality rate (1.7% versus 1.1%), and higher complication rate (27.4% versus 23.2%). NSQIP prediction models for complications in cancer versus noncancer patients underperformed for predicting mortality (P < 0.001). Multivariable regression demonstrated that a diagnosis of cancer requiring surgery independently conferred an 18% increased odds of death, a 9% increased odds of a complication, and an 8% increased odds of multiple complications compared to patients with benign disease. NSQIP prediction models less effectively evaluate the risk of death in cancer patients as compared to patients with benign disease. A diagnosis of cancer is independently associated with an increased risk of surgical complications. Incorporating cancer diagnosis into surgical risk models may better inform patient and surgeon expectations. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. [Fertility and risk of recurrence after surgical treatment of an ectopic pregnancy (EP): Salpingostomy versus salpingectomy].

    Science.gov (United States)

    Jamard, A; Turck, M; Pham, A D; Dreyfus, M; Benoist, G

    2016-02-01

    Two surgical techniques can be performed for the treatment of an ectopic pregnancy (EP): a conservative one called salpingostomy and a radical one called salpingectomy. We compared both techniques to find differences about fertility or risk of recurrence. We retrospectively reviewed all the women who underwent a surgical treatment for an ectopic pregnancy in the university's hospital of Caen between 2008 and 2011. We compared the results of both techniques. The primary end-point was the rate of intra-uterine pregnancy and the second end-point was the rate of recurrence of the EP. We also try to identify other risk factor of infertility. One hundred and fifty-two patients have been listed initially. Ninety-eight patients still attempt to become pregnant after the EP. In the conservative group, the rate of intra-uterine pregnancy was 88% (n=22) and the rate of recurrence was 8% (n=2). In the radical group, the rate of intra-uterine pregnancy was 68% (n=50) and the rate of recurrence was 5% (n=3). We could not identify any significant difference in the subsequent fertility or in the recurrence's risk between conservative and radical surgery. The age of the patient has been identified as a significative risk factor of infertility. To choose the surgical technique of an EP, the wish of pregnancy, the risk factor of infertility of the patient and the laparoscopic observations have to be taken into account. It seems that there is no difference between the two surgical techniques. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. Health risk to medical personnel of surgical smoke produced during laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Miłosz Dobrogowski

    2015-10-01

    Full Text Available Objectives: During laparoscopic cholecystectomy, the removal of the gall bladder, pyrolysis occurs in the peritoneal cavity. Chemical substances which are formed during this process escape into the operating room through trocars in the form of surgical smoke. The aim of this study was to identify and quantitatively measure a number of selected chemical substances found in surgical smoke and to assess the risk they carry to medical personnel. Material and Methods: The study was performed at the Maria Skłodowska-Curie Memorial Provincial Specialist Hospital in Zgierz between 2011 and 2013. Air samples were collected in the operating room during laparoscopic cholecystectomy. Results: A complete qualitative and quantitative analysis of the air samples showed a number of chemical substances present, such as aldehydes, benzene, toluene, ethylbenzene, xylene, ozone, dioxins and others. Conclusions: The concentrations of these substances were much lower than the hygienic standards allowed by the European Union Maximum Acceptable Concentration (MAC. The calculated risk of developing cancer as a result of exposure to surgical smoke during laparoscopic cholecystectomy is negligible. Yet it should be kept in mind that repeated exposure to a cocktail of these substances increases the possibility of developing adverse effects. Many of these compounds are toxic, and may possibly be carcinogenic, mutagenic or genotoxic. Therefore, it is necessary to remove surgical smoke from the operating room in order to protect medical personnel.

  15. Aprotinin may increase mortality in low and intermediate risk but not in high risk cardiac surgical patients compared to tranexamic acid and ε-aminocaproic acid -- a meta-analysis of randomised and observational trials of over 30.000 patients.

    Science.gov (United States)

    Meybohm, Patrick; Herrmann, Eva; Nierhoff, Julia; Zacharowski, Kai

    2013-01-01

    To compare the effect of aprotinin with the effect of lysine analogues (tranexamic acid and ε-aminocaproic acid) on early mortality in three subgroups of patients: low, intermediate and high risk of cardiac surgery. We performed a meta-analysis of randomised controlled trials and observational with the following data sources: Medline, Cochrane Library, and reference lists of identified articles. The primary outcome measure was early (in-hospital/30-day) mortality. The secondary outcome measures were any transfusion of packed red blood cells within 24 hours after surgery, any re-operation for bleeding or massive bleeding, and acute renal dysfunction or failure within the selected cited publications, respectively. Out of 328 search results, 31 studies (15 trials and 16 observational studies) included 33,501 patients. Early mortality was significantly increased after aprotinin vs. lysine analogues with a pooled risk ratio (95% CI) of 1.58 (1.13-2.21), p<0.001 in the low (n = 14,297) and in the intermediate risk subgroup (1.42 (1.09-1.84), p<0.001; n = 14,427), respectively. Contrarily, in the subgroup of high risk patients (n = 4,777), the risk for mortality did not differ significantly between aprotinin and lysine analogues (1.03 (0.67-1.58), p = 0.90). Aprotinin may be associated with an increased risk of mortality in low and intermediate risk cardiac surgery, but presumably may has no effect on early mortality in a subgroup of high risk cardiac surgery compared to lysine analogues. Thus, decisions to re-license aprotinin in lower risk patients should critically be debated. In contrast, aprotinin might probably be beneficial in high risk cardiac surgery as it reduces risk of transfusion and bleeding complications.

  16. Aprotinin may increase mortality in low and intermediate risk but not in high risk cardiac surgical patients compared to tranexamic acid and ε-aminocaproic acid -- a meta-analysis of randomised and observational trials of over 30.000 patients.

    Directory of Open Access Journals (Sweden)

    Patrick Meybohm

    Full Text Available BACKGROUND: To compare the effect of aprotinin with the effect of lysine analogues (tranexamic acid and ε-aminocaproic acid on early mortality in three subgroups of patients: low, intermediate and high risk of cardiac surgery. METHODS AND FINDINGS: We performed a meta-analysis of randomised controlled trials and observational with the following data sources: Medline, Cochrane Library, and reference lists of identified articles. The primary outcome measure was early (in-hospital/30-day mortality. The secondary outcome measures were any transfusion of packed red blood cells within 24 hours after surgery, any re-operation for bleeding or massive bleeding, and acute renal dysfunction or failure within the selected cited publications, respectively. Out of 328 search results, 31 studies (15 trials and 16 observational studies included 33,501 patients. Early mortality was significantly increased after aprotinin vs. lysine analogues with a pooled risk ratio (95% CI of 1.58 (1.13-2.21, p<0.001 in the low (n = 14,297 and in the intermediate risk subgroup (1.42 (1.09-1.84, p<0.001; n = 14,427, respectively. Contrarily, in the subgroup of high risk patients (n = 4,777, the risk for mortality did not differ significantly between aprotinin and lysine analogues (1.03 (0.67-1.58, p = 0.90. CONCLUSION: Aprotinin may be associated with an increased risk of mortality in low and intermediate risk cardiac surgery, but presumably may has no effect on early mortality in a subgroup of high risk cardiac surgery compared to lysine analogues. Thus, decisions to re-license aprotinin in lower risk patients should critically be debated. In contrast, aprotinin might probably be beneficial in high risk cardiac surgery as it reduces risk of transfusion and bleeding complications.

  17. An Online Tool for Global Benchmarking of Risk-Adjusted Surgical Outcomes.

    Science.gov (United States)

    Spence, Richard T; Chang, David C; Chu, Kathryn; Panieri, Eugenio; Mueller, Jessica L; Hutter, Matthew M

    2017-01-01

    Increasing evidence demonstrates significant variation in adverse outcomes following surgery between countries. In order to better quantify these variations, we hypothesize that freely available online risk calculators can be used as a tool to generate global benchmarking of risk-adjusted surgical outcomes. This is a prospective cohort study conducted at an academic teaching hospital in South Africa (GSH). Consecutive adult patients undergoing major general or vascular surgery who met the ACS-NSQIP inclusion criteria for a 3-month period were included. Data variables required by the ACS risk calculator were prospectively collected, and patients were followed for 30 days post-surgery for the occurrence of endpoints. Calculating observed-to-expected ratios for ten outcome measures of interest generated risk-adjusted outcomes benchmarked against the ACS-NSQIP consortium. A total of 373 major general and vascular surgery procedures met the inclusion criteria. The GSH operative cohort varied significantly compared to the 2012 ACS-NSQIP database. The risk-adjusted O/E ratios were significant for any complication O/E 1.91 (95 % CI 1.57-2.31), surgical site infections O/E 4.76 (95 % CI 3.71-6.01), renal failure O/E 3.29 (95 % CI 1.50-6.24), death O/E 3.43 (95 % CI 2.19-5.11), and total length of stay (LOS) O/E 3.43 (95 % CI 2.19-5.11). Freely available online risk calculators can be utilized as tools for global benchmarking of risk-adjusted surgical outcomes.

  18. Surgical mistake causing an high recto-vaginal fistula. A case report with combined surgical and endoscopic approach: therapeutic considerations

    Science.gov (United States)

    2013-01-01

    Background Rectovaginal fistulas (RVFs) have multiple causes, size and location on which the surgical treatment depends. Description The Authors consider different approaches to RVFs and describe a clinical case of recurrent high RVF. Conclusions Most RVFs can be successfully repaired, although many interventions may be necessary. A colostomy with delayed repair may improve RVFs outcome. Moreover, several authors indicate Mucosal Advancement Flap and Babcock-Bacon technique as the treatments of choice respectively for low and high RVFs (complex and recurrent) and emphasize the placement of endoscopic prothesis in cases of difficult healing of the anastomosis. PMID:24266908

  19. Risk factors associated with intestinal necrosis in children with failed non-surgical reduction for intussusception.

    Science.gov (United States)

    Huang, Hui-Ya; Huang, Xiao-Zhong; Han, Yi-Jiang; Zhu, Li-Bin; Huang, Kai-Yu; Lin, Jing; Li, Zhong-Rong

    2017-05-01

    Intestinal necrosis is the most serious complication of intussusception. The risk factors associated with intestinal necrosis in pediatric patients with intussusception have not been well characterized. This study aimed to investigate the risk factors associated with intestinal necrosis in pediatric patients with failed non-surgical reduction for intussusception. Hospitalized patients who failed the air-enema reduction for intussusception in the outpatient department and subsequently underwent surgery were retrospectively reviewed. All cases were categorized into two groups: intestinal necrosis group and non-intestinal necrosis group based on the surgical findings. Demographic and clinical features including the findings from the surgery were recorded and analyzed. Factors associated with intestinal necrosis were analyzed using univariate and multivariate unconditional logistic regression analyses. A total of 728 cases were included. Among them, 171 had intestinal necrosis at the time of surgery. The group with intestinal necrosis had a longer duration of symptom or length of illness (P = 0.000), and younger (P = 0.000) than the non-intestinal necrosis group. Complex/compound type of intussusceptions is more likely to have intestinal necrosis. Multivariate analysis showed that the presence of grossly bloody stool (OR = 2.12; 95% CI 1.19-3.76, P = 0.010) and duration of symptom (OR = 1.07; 95% CI 1.06-1.08, P = 0.000) were independent risk factors for intestinal necrosis in patients hospitalized for surgical reduction for intussusceptions. At time of admission, the presence of bloody stools and duration of symptom are the important risk factors for developing intestinal necrosis for those patients who failed non-surgical reduction. The length of illness has the highest sensitivity and specificity to correlate with intestinal necrosis. This finding may suggest that we should take the intussusception cases that have the longer duration of

  20. Hypoxaemia in the general surgical ward--a potential risk factor?

    DEFF Research Database (Denmark)

    Rosenberg, J

    1994-01-01

    After major operations, hypoxaemia is common in the late postoperative period in the surgical ward. Recent studies of humans after major operations showed that such hypoxaemia may be related to the development of myocardial ischaemia and cardiac arrhythmias, even in patients with no preoperative...... postoperative period. Hypoxaemia may therefore prove to be a risk factor in the late postoperative period, and further studies are needed to clarify its pathogenesis and rational treatment....

  1. Risks and risk-analysis for the development of pressure ulcers in surgical patients

    NARCIS (Netherlands)

    Keller, Bastiaan Paul Johan Aart

    2006-01-01

    With prevalence figures of 13% for university hospitals and 23% for general hospitals, pressure ulcers are a major health care issue in The Netherlands. Pressure ulcers in surgical patients are frequently encountered, as is illustrated by reported incidence rates up to 66%. The number of patients at

  2. Pediatric Intussusception: Decreased Surgical Risk with Timely Transfer to a Children's Hospital.

    Science.gov (United States)

    Blackwood, Brian P; Theodorou, Christina M; Hebal, Ferdynand; Hunter M, Catherine J

    2016-01-01

    Intussusception is a potentially life-threatening condition, and a frequent cause of bowel obstruction during the first two years of life. We hypothesized that patients who were transferred from outside community hospitals, or OSH, without tertiary care capabilities for pediatric services to a large academic children's hospital with intussusception were more likely to require operative management for their intussusception than those who were directly admitted. The electronic medical record was queried for patients presenting to Ann and Robert H. Lurie Children's Hospital of Chicago with a diagnosis of intussusception (July 1st, 2009-July 1st, 2014). Age, sex, symptom duration, radiologic management, and surgical care were recorded. OSH and transfer reports were analyzed for those patients that presented as a transfer. Statistical analysis was performed. We identified 270 patients with intussusception. 232 (80%) were successfully treated non-surgically. 58 (20%) required surgical management. Of the patients requiring surgery, there were 38 reductions (24 laparoscopic, 14 open) and 20 bowel resections (1 laparoscopic, 19 open). Of those patients requiring surgery, 37 (63.8%) had presented as a transfer from an OSH. We found that transferred patients, requiring surgery, spent a mean 7.77 hours at the OSH compared to 4.03 hours for the transferred patients that did not require surgery (p=0.0188). There was no significant difference in transport time (p=0.44). In conclusion, we identified the amount of time patients spend at hospitals without pediatric surgical capabilities as an independent risk factor necessitating surgical management of intussusception. These data suggest that patients with intussusception who present to hospitals without pediatric radiology or pediatric surgery, should be transferred in an expedited fashion. In the event of a failed enema reduction at an OSH, the transport of the patient should not be delayed as this may result in a higher

  3. Risk factors of nosocomial bloodstream infections in surgical intensive care unit.

    Science.gov (United States)

    Zhang, Xing; Tong, Meng-Meng; Zhang, Miao-Zun; Zhu, Hui-Peng

    2015-01-01

    Many studies have examined risk factors of nosocomial bloodstream infections. However risk factors of nosocomial bloodstream infections in surgical intensive care unit have never been reported. The aim of this study was to investigate this topic. Retrospective surgical intensive care unit patients' data were collected in a tertiary hospital from January 2010 to August 2014. Infected and non-infected patients were compared with univariate analysis of categorical variables to obtain statistical significance risk factors. Then multivariate logistic regression analysis was performed to acquire the final risk factors. 98 patients were diagnosed with nosocomial bloodstream infections in total. Mortality rate was 29.6% (n=29). The data indicated gram-positive cocci were the main pathogens (64.3%; n=63). Multivariate logistic analysis indicated that age (>65 years old) (OR, 2.297; CI95, 0.870 to 6.062), acute physiology and chronic health evaluation II score (>18) (OR, 6.981; CI95, 2.330 to 15.865), multiple organ dysfunction score (>8) (OR, 9.857; CI95, 6.395 to 19.505), mechanical ventilation (OR, 4.583; CI95, 2.134 to 10.956), central venous catheter (OR, 5.875; CI95, 2.212 to 13.456) and selective surgery (OR, 3.455; CI95, 3.442-9.235) were risk factors of nosocomial BSI. Patients with nosocomial bloodstream infections in surgical intensive care unit setting often have a poor prognosis. Age (>65 years old), chronic health evaluation II score (>18), multiple organ dysfunction score (>8), usage of mechanical ventilation, central venous catheter and selective surgery can be regarded as risk factors.

  4. High-intensity interval training (HIT) for effective and time-efficient pre-surgical exercise interventions

    National Research Council Canada - National Science Library

    Weston, Matthew; Weston, Kathryn L; Prentis, James M; Snowden, Chris P

    2016-01-01

    .... Indeed, the general benefits of exercise training have the potential to pre-operatively optimise several pre-surgical risks factors, including cardiorespiratory function, frailty and cognitive function...

  5. Doses baixas de dobutamina e fluidos no pós-operatório de pacientes de alto risco: efeitos sobre a oxigenação tecidual, resposta inflamatória e morbidade Low-doses dobutamine and fluids in high-risk surgical patients: effects on tissue oxygenation, inflammatory response and morbidity

    Directory of Open Access Journals (Sweden)

    Adriana da Silva Arantes

    2007-03-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A dobutamina é um agente inotrópico com propriedade adrenérgica beta-1 predominante e freqüentemente usado para aumentar o fluxo sanguíneo em pacientes críticos. Dobutamina pode ter um papel no aumento da perfusão esplâncnica, desse modo protegendo esta área de lesão isquêmica. O objetivo deste estudo foi investigar os efeitos de baixas doses de dobutamina (5 mig/kg/min sobre a oxigenação tecidual, resposta inflamatória e complicações pós-operatória em pacientes de alto risco. MÉTODO: Estudo prospectivo, aleatório, encoberto e placebo-controlado. Cem pacientes cirúrgicos admitidos em Unidade Semi-Intensiva foram avaliados e 82 pacientes foram incluídos, 42 pacientes no grupo controle (solução fisiológica e 40 no grupo tratamento (5 mig/kg/min de dobutamina por 24 horas. Os mesmos procedimentos terapêuticos foram usados nos dois grupos. A infusão de líquidos deveria ser realizada em caso de taquicardia ou hipotensão após a infusão de dobutamina, pela possibilidade de hipovolemia. RESULTADOS: O volume total de fluidos administrado foi significativamente maior no grupo dobutamina do que no grupo controle (7351 ± 2082 mL versus 6074 ± 2386 mL, respectivamente, p BACKGROUND AND OBJECTIVES: Dobutamine is an inotropic agent with predominant beta1- adrenergic properties frequently used to increase blood flow in critically ill patients. Dobutamine may have a role in increasing splanchnic perfusion, thereby protecting this area from further injury. We investigated the effects of low doses dobutamine (5 mug/kg/min on tissue oxygenation, inflammatory response and postoperative complications in high-risk surgical patients. METHODS: Prospective, randomized, blinded and placebo-controlled study. One hundred surgical patients admitted in a step-down unit were evaluated and 82 patients were enrolled, 42 in the control group (saline and 40 in the treatment group (5 mug/kg/h during 24 hours. Similar

  6. Postoperative junctional ectopic tachycardia: risk factors for occurrence in the modern surgical era.

    Science.gov (United States)

    Moak, Jeffrey P; Arias, Patricio; Kaltman, Jonathan R; Cheng, Yao; McCarter, Robert; Hanumanthaiah, Sridhar; Martin, Gerard R; Jonas, Richard A

    2013-09-01

    Postoperative (PO) junctional ectopic tachycardia (JET) can be a life-threatening arrhythmia that follows surgical repair of congenital heart disease (CHD) and results in PO morbidity. We reviewed 750 open heart surgeries (OHS) for CHD performed between January 2005 and February 2009. Kaplan-Meier and Cox proportional hazards model analyses were used to estimate the frequency and evaluate risk factors that might predict JET occurrence. The patients ranged in age from 1 day to 36.6 years; half were less than 4.8 months at the time of OHS. JET occurred in 115 of 750 (15.3%) OHS. JET was bimodally distributed by age with a peak incidence between 1-2 weeks and 1-3 years. JET occurred more commonly: (1) in specific types of OHS (single ventricle [19.5%] and cono-truncal defects [19.3%]) (P = 0.03); (2) with increased total surgical time (P = 0.001), aortic cross-clamp time (P < 0.001), cardiopulmonary bypass time (P < 0.001); and (3) followed use of inotropic agents (dopamine or milrinone, P < 0.001). JET lengthened intensive care stay by 3 days (P = 0.0001) and increased mortality (+JET [9.6%] vs -JET [4.6%], P = 0.03). In a multiple variable Cox regression model, total surgical time and PO use of milrinone were the best predictors for JET risk. PO administration of nitroprusside decreased risk of JET. JET occurred more commonly following OHS associated with prolonged surgical times and PO use of inotropic medications. In contrast to previous reports, our results suggest that mechanical injury to the atrioventricular node area is not strongly associated with JET. ©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.

  7. Preoperative Chlorhexidine Gluconate Use Can Increase Risk for Surgical Site Infections after Ventral Hernia Repair.

    Science.gov (United States)

    Prabhu, Ajita S; Krpata, David M; Phillips, Sharon; Huang, Li-Ching; Haskins, Ivy N; Rosenblatt, Steven; Poulose, Benjamin K; Rosen, Michael J

    2017-03-01

    There is varying evidence about the use of preoperative chlorhexidine gluconate to decrease surgical site infection for elective surgery. This intervention has never been studied in ventral hernia repair, the most common general surgery procedure in the US. We aimed to determine whether preoperative chlorhexidine gluconate decreases the risk of 30-day wound morbidity in patients undergoing ventral hernia repair. All patients undergoing ventral hernia repair in the Americas Hernia Society Quality Collaborative were separated into 2 groups: 1 group received preoperative chlorhexidine scrub and the other did not. The 2 groups were evaluated for 30-day wound morbidity, including surgical site occurrence (SSO), surgical site infection (SSI), and SSO requiring procedural intervention. Statistical analysis was performed using multivariate regression analysis and propensity score modeling. Multiple factors were controlled for statistical analysis, including patient-related factors and operative factors. In total, 3,924 patients were included for comparison. After multivariate logistic regression modeling, the preoperative chlorhexidine scrub group had a higher incidence of SSOs (odds ratio [OR] = 1.34; 95% CI 1.11 to 1.61) and SSIs (OR = 1.46; 95% CI 1.03 to 2.07). After propensity score modeling, the increased risk of SSO and SSI persisted (SSO: OR = 1.39; 95% CI 1.15 to 1.70; SSI: OR = 1.45; 95% CI 1.011 to 2.072, respectively). Prehospital chlorhexidine gluconate scrub appears to increase the risk of 30-day wound morbidity in patients undergoing ventral hernia repair. These findings suggest that the generalized use of prehospital chlorhexidine might not be desirable for all surgical populations. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  8. Nosocomial transmission of sporadic Creutzfeldt-Jakob disease: results from a risk-based assessment of surgical interventions

    DEFF Research Database (Denmark)

    de Pedro-Cuesta, Jesús; Mahillo-Fernández, Ignacio; Rábano, Alberto

    2011-01-01

    Evidence of surgical transmission of sporadic Creutzfeldt-Jakob disease (sCJD) remains debatable in part due to misclassification of exposure levels. In a registry-based case-control study, the authors applied a risk-based classification of surgical interventions to determine the association betw...

  9. Failure to Redose Antibiotic Prophylaxis in Long Surgery Increases Risk of Surgical Site Infection.

    Science.gov (United States)

    Kasatpibal, Nongyao; Whitney, Joanne D; Dellinger, E Patchen; Nair, Bala G; Pike, Kenneth C

    Antibiotic prophylaxis is a key component of the prevention of surgical site infection (SSI). Failure to manage antibiotic prophylaxis effectively may increase the risk of SSI. This study aimed to examine the effects of antibiotic prophylaxis on SSI risk. A retrospective cohort study was conducted among patients having general surgery between May 2012 and June 2015 at the University of Washington Medical Center. Peri-operative data extracted from hospital databases included patient and operation characteristics, intra-operative medication and fluid administration, and survival outcome. The effects of antibiotic prophylaxis and potential factors on SSI risk were estimated using multiple logistic regression and were expressed as risk ratios (RRs). A total of 4,078 patients were eligible for analysis. Of these, 180 had an SSI. Mortality rates within and after 30 days were 0.8% and 0.3%, respectively. Improper antibiotic redosing increased the risk of SSI (RR 4.61; 95% confidence interval [CI] 1.33-15.91). Other risk factors were in-patient status (RR 4.05; 95% CI 1.69-9.66), smoking (RR 1.63; 95% CI 1.03-2.55), emergency surgery (RR 1.97; 95% CI 1.26-3.08), colectomy (RR 3.31; 95% CI 1.19-9.23), pancreatectomy (RR 4.52; 95% CI 1.53-13.39), proctectomy (RR 5.02; 95% CI 1.72-14.67), small bowel surgery (RR 6.16; 95% CI 2.13-17.79), intra-operative blood transfusion >500 mL (RR 2.76; 95% CI 1.45-5.26), and multiple procedures (RR 1.40; 95% CI 1.01-1.95). These data demonstrate that failure to redose prophylactic antibiotic during long operations increases the risk of SSI. Strengthening a collaborative surgical quality improvement program may help to eradicate this risk.

  10. Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review.

    Science.gov (United States)

    Cheng, Hang; Chen, Brian Po-Han; Soleas, Ireena M; Ferko, Nicole C; Cameron, Chris G; Hinoul, Piet

    The incidence of surgical site infection (SSI) across surgical procedures, specialties, and conditions is reported to vary from 0.1% to 50%. Operative duration is often cited as an independent and potentially modifiable risk factor for SSI. The objective of this systematic review was to provide an in-depth understanding of the relation between operating time and SSI. This review included 81 prospective and retrospective studies. Along with study design, likelihood of SSI, mean operative times, time thresholds, effect measures, confidence intervals, and p values were extracted. Three meta-analyses were conducted, whereby odds ratios were pooled by hourly operative time thresholds, increments of increasing operative time, and surgical specialty. Pooled analyses demonstrated that the association between extended operative time and SSI typically remained statistically significant, with close to twice the likelihood of SSI observed across various time thresholds. The likelihood of SSI increased with increasing time increments; for example, a 13%, 17%, and 37% increased likelihood for every 15 min, 30 min, and 60 min of surgery, respectively. On average, across various procedures, the mean operative time was approximately 30 min longer in patients with SSIs compared with those patients without. Prolonged operative time can increase the risk of SSI. Given the importance of SSIs on patient outcomes and health care economics, hospitals should focus efforts to reduce operative time.

  11. Blocking Surgically Induced Lysyl Oxidase Activity Reduces the Risk of Lung Metastases

    Directory of Open Access Journals (Sweden)

    Chen Rachman-Tzemah

    2017-04-01

    Full Text Available Surgery remains the most successful curative treatment for cancer. However, some patients with early-stage disease who undergo surgery eventually succumb to distant metastasis. Here, we show that in response to surgery, the lungs become more vulnerable to metastasis due to extracellular matrix remodeling. Mice that undergo surgery or that are preconditioned with plasma from donor mice that underwent surgery succumb to lung metastases earlier than controls. Increased lysyl oxidase (LOX activity and expression, fibrillary collagen crosslinking, and focal adhesion signaling contribute to this effect, with the hypoxic surgical site serving as the source of LOX. Furthermore, the lungs of recipient mice injected with plasma from post-surgical colorectal cancer patients are more prone to metastatic seeding than mice injected with baseline plasma. Downregulation of LOX activity or levels reduces lung metastasis after surgery and increases survival, highlighting the potential of LOX inhibition in reducing the risk of metastasis following surgery.

  12. Risk factors for postoperative anxiety and depression after surgical treatment for lung cancer†.

    Science.gov (United States)

    Park, Samina; Kang, Chang Hyun; Hwang, Yoohwa; Seong, Yong Won; Lee, Hyun Joo; Park, In Kyu; Kim, Young Tae

    2016-01-01

    Psychological distress associated with cancer treatment is an emerging issue in the management of cancer patients. The aim of this study was to identify the prevalence of postoperative anxiety and depression after surgical treatment for lung cancer, and to assess the risk factors associated with these phenomena. Patients who underwent curative surgical resection for primary lung cancer were included in this study. Patients with complex treatment histories (recurrent or metastatic lung cancer or neoadjuvant treatment) and those taking psychiatric medication were excluded. We prospectively evaluated the degrees of pre- and postoperative anxiety and depression using a Hospital Anxiety Depression Scale questionnaire. The relationships between clinical and patient factors and anxiety and depression after surgical treatment for lung cancer were assessed. A total of 278 patients were enrolled. The mean age was 62 years. Thoracoscopic resection was performed in 246 patients (89%). The prevalence rates of preoperative anxiety and depression were 8% (n = 22) and 12% (n = 32), and changed to 9% (n = 26) and 19% (n = 54) postoperatively (P = 0.37 and pulmonary function and preoperative comorbidities were not associated with postoperative anxiety and depression. Multivariate analysis revealed that thoracotomy was a risk factor for postoperative anxiety after adjusting for preoperative anxiety (odds ratio [OR] = 4.5, P = 0.002). Thoracotomy (OR = 3.4, P = 0.009), postoperative dyspnoea (OR = 4.8, P mental health professionals and provided with supportive psychotherapy or pharmacological intervention. Of these, 14 patients (56%) were diagnosed with an adjustment disorder. Postoperative psychological distress and, in particular, depression increased after surgical treatment for lung cancer. Postoperative anxiety and depression were aggravated by residual symptoms after surgery. Careful psychological evaluation and appropriate management are required to improve patients' quality of

  13. High-intensity interval training (HIT) for effective and time-efficient pre-surgical exercise interventions.

    Science.gov (United States)

    Weston, Matthew; Weston, Kathryn L; Prentis, James M; Snowden, Chris P

    2016-01-01

    The advancement of perioperative medicine is leading to greater diversity in development of pre-surgical interventions, implemented to reduce patient surgical risk and enhance post-surgical recovery. Of these interventions, the prescription of pre-operative exercise training is gathering momentum as a realistic means for enhancing patient surgical outcome. Indeed, the general benefits of exercise training have the potential to pre-operatively optimise several pre-surgical risks factors, including cardiorespiratory function, frailty and cognitive function. Any exercise programme incorporated into the pre-operative pathway of care needs to be effective and time efficient in that any fitness gains are achievable in the limited period between the decision for surgery and operation (e.g. 4 weeks). Fortunately, there is a large volume of research describing effective and time-efficient exercise training programmes within the discipline of sports science. Accordingly, the objective of our commentary is to synthesise contemporary exercise training research, both from non-clinical and clinical populations, with the overarching aim of informing the development of effective and time-efficient pre-surgical exercise training programmes. The development of such exercise training programmes requires the careful consideration of several key principles, namely frequency, intensity, time, type and progression of exercise. Therefore, in light of more recent evidence demonstrating the effectiveness and time efficiency of high-intensity interval training-which involves brief bouts of intense exercise interspersed with longer recovery periods-the principles of exercise training programme design will be discussed mainly in the context of such high-intensity interval training programmes. Other issues pertinent to the development, implementation and evaluation of pre-operative exercise training programmes, such as individual exercise prescription, training session monitoring and potential

  14. An analysis of surgical and nonsurgical operating room times in high-volume shoulder arthroplasty.

    Science.gov (United States)

    Padegimas, Eric M; Hendy, Benjamin A; Lawrence, Cassandra; Devasagayaraj, Richard; Zmistowski, Benjamin M; Abboud, Joseph A; Lazarus, Mark D; Williams, Gerald R; Namdari, Surena

    2017-06-01

    A significant portion of operating room time in shoulder arthroplasty is devoted to nonsurgical tasks. To maximize efficiency and to increase access to care, it is important to accurately quantify surgical and nonsurgical time for shoulder arthroplasty. This study aimed to evaluate surgical vs. nonsurgical time and to assess the viability of using a 1-surgeon, 2-operating room model. An institutional database was used to identify all primary and revision shoulder arthroplasty cases from February 2011 through December 2013. Time intervals were analyzed, including anesthesia and positioning time, surgical time, conclusion time, and turnover time. We identified 1062 shoulder arthroplasties. The average anesthesia and positioning time was 48.2 ± 11.7 minutes, surgical time was 122.7 ± 36.4  minutes, and conclusion time was 10.5 ± 7.0  minutes. Average turnover time at our institution was 40 minutes. An average of 58.8 ± 13.8 minutes (33.2%) of the patient's time in the operating room was not surgical. A 1-room surgical model, with each case following the next, would allow 3 arthroplasties to be performed in a 10-hour surgical day. A 2-room model would allow 4 cases to be performed in a 9-hour surgical day or 5 in an 11-hour day. In this 2-room model, there would be no time in which the surgeon is absent for any surgical portion of the case. For a high-volume shoulder arthroplasty practice, a 2-room model leads to greater efficiency and patient access to care without sacrificing the surgeon's presence during surgical portions of the case. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  15. High-concentration oxygen and surgical site infections in abdominal surgery: a meta-analysis.

    Science.gov (United States)

    Patel, Sunil V; Coughlin, Shaun C; Malthaner, Richard A

    2013-08-01

    There has been recent interest in using high-concentration oxygen to prevent surgical site infections (SSIs). Previous meta-analyses in this area have produced conflicting results. With the publication of 2 new randomized controlled trials (RCTs) that were not included in previous meta-analyses, an updated review is warranted. Our objective was to perform a meta-analysis on RCTs comparing high- and low- concentration oxygen in adults undergoing open abdominal surgery. We completed independent literature reviews using electronic databases, bibliographies and other sources of grey literature to identify relevant studies. We assessed the overall quality of evidence using grade guidelines. Statistical analysis was performed on pooled data from included studies. A priori subgroup analyses were planned to explain statistical and clinical heterogeneity. Overall, 6 studies involving a total of 2585 patients met the inclusion criteria. There was no evidence of a reduction in SSIs with high-concentration oxygen (risk ratio 0.77, 95% confidence interval 0.50-1.19, p = 0.24). We observed substantial heterogeneity among studies. There is moderate evidence that high-concentration oxygen does not reduce SSIs in adults undergoing open abdominal surgery.

  16. Frailty and cardiovascular disease: potential role of gait speed in surgical risk stratification in older adults

    Science.gov (United States)

    Chen, Michael A.

    2015-01-01

    Frailty is a state of late life decline and vulnerability, typified by physical weakness and decreased physiologic reserve. The epidemiology and pathophysiology of frailty share features with those of cardiovascular disease. Gait speed can be used as a measure of frailty and is a powerful predictor of mortality. Advancing age is a potent risk factor for cardiovascular disease and has been associated with an increased risk of adverse outcomes. Older adults comprise approximately half of cardiac surgery patients, and account for nearly 80% of the major complications and deaths following surgery. The ability of traditional risk models to predict mortality and major morbidity in older patients being considered for cardiac surgery may improve if frailty, as measured by gait speed, is included in their assessment. It is possible that in the future frailty assessment may assist in choosing among therapies (e.g., surgical vs. percutaneous aortic valve replacement for patients with aortic stenosis). PMID:25678904

  17. The effects of high perioperative inspiratory oxygen fraction for adult surgical patients

    DEFF Research Database (Denmark)

    Wetterslev, Jørn; Meyhoff, Christian S; Jørgensen, Lars N

    2015-01-01

    with a control FIO2 at or below 40% in the perioperative setting in terms of mortality, surgical site infection, respiratory insufficiency, serious adverse events and length of stay during the index admission for adult surgical patients.We looked at various outcomes, conducted subgroup and sensitivity analyses...... in individuals 18 years of age or older. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently. We conducted random-effects and fixed-effect meta-analyses, and for dichotomous outcomes, we calculated risk ratios (RRs). We used published data and data obtained by contacting trial authors.......To minimize the risk of systematic error, we assessed the risk of bias of the included trials. To reduce the risk of random errors caused by sparse data and repetitive updating of cumulative meta-analyses, we applied trial sequential analyses. We used Grades of Recommendation, Assessment, Development...

  18. Persistent very high output lymphatic drainage after radical nephrectomy successfully treated with surgical management.

    Science.gov (United States)

    Ciftci, Seyfettin; Ozbudak, Ersan; Yilmaz, Hasan; Ustuner, Murat; Ozkan, Levend; Culha, Mustafa Melih

    2016-04-01

    Persistent lymphatic drainage is uncommon after most of the surgical operations. It is related with mechanical, nutritional and immunological problems as well as electrolyte imbalance and protein deficiency. It is most commonly seen in retroperitoneal surgeries including abdominal aortic surgery and retroperitoneal lymph node dissection. Conservative management is the first treatment choice and resolves the problem in most cases. However persistent high output drainage may not be resolved with conservative approach and surgical or invasive treatment may become necessary. Additionally, surgical management of persistent lymphatic drainage has not been sufficiently discussed in the literature. In this study, we present a case of persistent very high output lymphatic drainage after right radical nephrectomy which failed with conservative approach and was successfully treated with surgical management.

  19. [Risk factors of rupture of internal carotid artery during surgical resection of carotid body tumor].

    Science.gov (United States)

    Li, Y H; Wang, J S; Yao, C; Chang, G Q; Yin, H H; Li, S Q; Lü, W M; Hu, Z J; Wang, S M

    2017-06-13

    Objective: To investigate risk factors of rupture of internal carotid artery resection during carotid body tumor resection and to summarize our treatment experience. Methods: During the period from 1991 to 2016, rupture of internal carotid artery occurred in 27 patients (28 tumors) during surgical resection of carotid body tumor in the First Affiliated Hospital of Sun Yat-sen University. Their clinical and follow-up data were retrospectively collected and analyzed. For all patients underwent surgical resection during this period, Logistic regression analysis was used to investigate the risk factors of intraoperative rupture of internal carotid artery. Results: Of these 28 tumors, there were 15 (53.6%) tumors with diameter≥5 cm and 20 (71.4%) Shamblin Ⅲ tumors. Intraoperatively, shunt was applied for 8 (28.6%) cases. Thirteen (46.4%) patients underwent ligation of external carotid artery, while 2 (7.1%) patients accepted resection of cranial nerves. Direct closure/patchplasty, autologous vessels or graft reconstruction was used in 16, 10 and 2 cases, respectively. Postoperatively, stroke occurred in 4(14.3%) cases and cranial nerve deficit in 15 (53.6%) cases. During a median length of 36 (14-125) months, cranial nerve deficit persisted in 5 cases. Follow-up radiologic examination indicated 3 (10.7%) cases of targeted vessel occlusion. However, no new-onset stroke was identified. Among all patients underwent surgical resection of carotid body tumor, female (OR=3.650, P=0.012), age≤25 years old (OR=3.710, P=0.013) and Shamblin Ⅲ tumor (OR=4.631, P=0.008) increase the risks of intraoperative carotid artery rupture. Conclusions: Shamblin Ⅲ tumor is the predictor of rupture of internal carotid artery. Intraoperative, properly increased blood pressure, intraoperative heparinization and use of shunt for those cases without well-compensated cranial collateral arteries are likely to decreasing the incidence of stroke.

  20. Results after surgical treatment of liver metastases in patients with high-grade gastroenteropancreatic neuroendocrine carcinomas

    DEFF Research Database (Denmark)

    Galleberg, R. B.; Knigge, U; Tiensuu Janson, E.

    2017-01-01

    Background: Gastroenteropancreatic neuroendocrine carcinomas (GEP-NEC) are generally characterized by synchronous metastases, high aggressiveness and a dismal prognosis. Current international guidelines do not recommend surgical treatment of liver metastases, however the existing data are scarce......, particularly for the group with a Ki-67 in the relatively lower G3 range. Our findings indicate a possible role for surgical treatment of liver metastases in the management of this patient population....

  1. Risk of kidney stones with surgical intervention in living kidney donors.

    Science.gov (United States)

    Thomas, S M; Lam, N N; Welk, B K; Nguan, C; Huang, A; Nash, D M; Prasad, G V R; Knoll, G A; Koval, J J; Lentine, K L; Kim, S J; Lok, C E; Garg, A X

    2013-11-01

    A kidney stone in a person with a solitary kidney requires urgent attention, which may result in surgical and/or hospital attention. We conducted a matched retrospective cohort study to determine if living kidney donors compared to healthy nondonors have a higher risk of: (i) kidney stones with surgical intervention, and (ii) hospital encounters for kidney stones. We reviewed all predonation charts for living kidney donations from 1992 to 2009 at five major transplant centers in Ontario, Canada, and linked this information to healthcare databases. We selected nondonors from the healthiest segment of the general population and matched 10 nondonors to every donor. Of the 2019 donors and 20 190 nondonors, none had evidence of kidney stones prior to cohort entry. Median follow-up time was 8.4 years (maximum 19.7 years; loss to follow-up kidney stones with surgical intervention in donors compared to nondonors (8.3 vs. 9.7 events/10 000 person-years; rate ratio 0.85; 95% confidence interval [CI] 0.47-1.53). Similarly there was no difference in the rate of hospital encounters for kidney stones (12.1 vs. 16.1 events/10 000 person-years; rate ratio 0.75; 95% CI 0.45-1.24). These interim results are reassuring for the safety of living kidney donation. © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.

  2. Risk management and errors in the surgical clinic of Serres hospital compared with the requirements of standard OHSAS 18001: 1999

    Directory of Open Access Journals (Sweden)

    Maria Eleni Megalomystaka

    2016-12-01

    Full Text Available The purpose of this study was to investigate the measures implemented to manage risks at work in the surgical clinic of a public hospital in Northern Greece, in relation to the requirements of the standard OHSAS 18001: 1999, and to refer to an integrated program to manage those risks. The right to safe and high-quality patient care and management of adverse events is part of the quality system and must be pursued by every health organization. In recent years, in Greece, there are measures taken by the country to align with European Union directives on matters related to safety in the workplace. In this direction, this hospital takes the initiative to reduce accidents and improve working conditions. The ELOT 1801 is a model for the management of health and safety, it is compatible and has technical equivalence with the corresponding BSI-OHSAS 18001: 1999. Since the relevant investigation found that the implementation of policy on health and safety in the surgical clinic under hospital study showed that there is a will by the authorities to adopt and implement procedures that contribute to the proper management and reduction of upcoming events. However, improvement actions are related to staff training can be made in the provision of health services, while considered necessary staffing the department with personnel and equipping adequate consumables.

  3. Risk of surgical site infection in paediatric herniotomies without any prophylactic antibiotics: A preliminary experience

    Directory of Open Access Journals (Sweden)

    Dhananjay Vaze

    2014-01-01

    Full Text Available Background: Different studies underline the use of pre-operative antibiotic prophylaxis in clean surgeries like herniotomy and inguinal orchiopexy. But, the meta-analyses do not recommend nor discard the use of prophylactic pre-operative antibiotics. The scarcity of controlled clinical trials in paediatric population further vitiates the matter. This study assessed the difference in the rate of early post-operative wound infection cases in children who received single dose of pre-operative antibiotics and children who did not receive antibiotics after inguinal herniotomy and orchiopexy. Materials and Methods: This randomised prospective study was conducted in Paediatric Surgery department of PGIMER Chandigarh. Out of 251 patients, 112 patients were randomised to the case group and 139 were ascribed to the control group. The patients in control group were given a standard regimen of single dose of intravenous antibiotic at the time of induction followed by 3-4 days of oral antibiotic. Case group patients underwent the surgical procedure in similar manner with no antibiotic either at the time of induction or post-operatively. Results: The incidence of surgical site infection in case group was 3.73 % and that in control group was 2.22%. The observed difference in the incidence of surgical site infection was statistically insignificant (P value = 0.7027. The overall infection rate in case and control group was 2.89%. Conclusions: Our preliminary experience suggests that there is no statistically significant difference in the proportion of early post-operative wound infection between the patients who received single dose of pre-operative antibiotics and the patients who received no antibiotics after inguinal herniotomy and orchiopexy. The risk of surgical site infection in paediatric heriotomies does not increase even if the child′s weight is less than his/her expected weight for age.

  4. Risks of Endoscopic Temporal Ventriculocisternostomy for Isolated Lateral Ventricle: Anatomic Surgical Nuances.

    Science.gov (United States)

    Hasegawa, Takatoshi; Ogiwara, Toshihiro; Nagm, Alhusain; Goto, Tetsuya; Aoyama, Tatsuro; Hongo, Kazuhiro

    2018-02-01

    Entrapment of the temporal horn, known as isolated lateral ventricle (ILV), is a rare type of noncommunicating focal hydrocephalus, and standard treatment has not been established. We report 2 cases of endoscopic surgery for ILV and highlight the anatomic surgical nuances to avoid associated surgical risks. The first patient presented with recurrent ILV following initial shunt placement for ILV, owing to shunt malfunction. In the second patient, ILV recurred secondary to choroid plexus inflammation caused by cryptococcal infection. Endoscopic temporal ventriculocisternostomy was effective in both cases. However, in the second case, the choroidal fissure was fenestrated, which led to cerebral infarction in the territory of the choroidal artery zone, attributed to damage of the branches of the choroidal segment of the anterior choroidal artery. Although endoscopic temporal ventriculocisternostomy is considered a safe and less invasive procedure for treatment of symptomatic ILV, the technique is still associated with risks. To avoid complications, it is necessary to be familiar with the anatomy of the choroidal arteries and the pertinent endoscopic intraventricular orientation. Additionally, sufficient experience is required before it can be recommended as the treatment of choice. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Rates and risk factors of unplanned 30-day readmission following general and thoracic pediatric surgical procedures.

    Science.gov (United States)

    Polites, Stephanie F; Potter, Donald D; Glasgow, Amy E; Klinkner, Denise B; Moir, Christopher R; Ishitani, Michael B; Habermann, Elizabeth B

    2017-08-01

    Postoperative unplanned readmissions are costly and decrease patient satisfaction; however, little is known about this complication in pediatric surgery. The purpose of this study was to determine rates and predictors of unplanned readmission in a multi-institutional cohort of pediatric surgical patients. Unplanned 30-day readmissions following general and thoracic surgical procedures in children Pediatric. Time-dependent rates of readmission per 30 person-days were determined to account for varied postoperative length of stay (pLOS). Patients were randomly divided into 70% derivation and 30% validation cohorts which were used for creation and validation of a risk model for readmission. Readmission occurred in 1948 (3.6%) of 54,870 children for a rate of 4.3% per 30 person-days. Adjusted predictors of readmission included hepatobiliary procedures, increased wound class, operative duration, complications, and pLOS. The predictive model discriminated well in the derivation and validation cohorts (AUROC 0.710 and 0.701) with good calibration between observed and expected readmission events in both cohorts (p>.05). Unplanned readmission occurs less frequently in pediatric surgery than what is described in adults, calling into question its use as a quality indicator in this population. Factors that predict readmission including type of procedure, complications, and pLOS can be used to identify at-risk children and develop prevention strategies. III. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Using Both Clinical Registry and Administrative Claims Data to Measure Risk-adjusted Surgical Outcomes.

    Science.gov (United States)

    Lawson, Elise H; Louie, Rachel; Zingmond, David S; Sacks, Greg D; Brook, Robert H; Hall, Bruce Lee; Ko, Clifford Y

    2016-01-01

    To examine the validity of hybrid quality measures that use both clinical registry and administrative claims data, capitalizing on the strengths of each data source. Previous studies demonstrate substantial disagreement between clinical registry and administrative claims data on the occurrence of postoperative complications. Clinical data have greater validity than claims data for quality measurement but can be burdensome for hospitals to collect. American College of Surgeons National Surgical Quality Improvement Program records were linked to Medicare inpatient claims (2005-2008). National Quality Forum-endorsed risk-adjusted measures of 30-day postoperative complications or death assessed hospital quality for patients undergoing colectomy, lower extremity bypass, or all surgical procedures. Measures use hierarchical multivariable logistic regression to identify statistical outliers. Measures were applied using clinical data, claims data, or a hybrid of both data sources. Kappa statistics assessed agreement on determinations of hospital quality. A total of 111,984 patients participated from 206 hospitals. Agreement on hospital quality between clinical and claims data was poor. Hybrid models using claims data to risk-adjust complications identified by clinical data had moderate agreement with all clinical data models, whereas hybrid models using clinical data to risk-adjust complications identified by claims data had routinely poor agreement with all clinical data models. Assessments of hospital quality differ substantially when using clinical registry versus administrative claims data. A hybrid approach using claims data for risk adjustment and clinical data for complications may be a valid alternative with lower data collection burden. For quality measures focused on postoperative complications to be meaningful, such policies should require, at a minimum, collection of clinical outcomes data.

  7. The postoperative venous thromboembolism (TREVO) study - risk and case mortality by surgical specialty.

    Science.gov (United States)

    Amaral, Cristina; Guimarães Pereira, Luís; Moreto, Ana; Sá, Ana Carolina; Azevedo, Ana

    2017-09-01

    Venous thromboembolism, risk of which is increased in surgical patients, is a preventable cause of morbidity and death. The primary objective of this study was to estimate the incidence of symptomatic postoperative venous thromboembolism in adults at a tertiary university hospital, overall and by surgical specialty. The secondary objective was to analyze severity of and mortality from thromboembolic events. We performed a retrospective study to identify cases of in-hospital postoperative venous thromboembolism, encoded by the International Classification of Diseases, Ninth Revision, according to the Joint Commission International criteria. Adult patients admitted for surgery in 2008-2012 were included. Among 67 635 hospitalizations, 90 cases of postoperative symptomatic venous thromboembolism were identified, corresponding to an incidence of 1.33/1000 admissions (95% confidence interval [CI] 1.1-1.6/1000). Neurosurgery had the highest risk (4.07/1000), followed by urological surgery and general surgery (p<0.001). There were 50 cases of pulmonary embolism, 11 of which were fatal. Of the 90 cases, 12.2% occurred under neuraxial anesthesia and 55.1% in patients with American Society of Anesthesiology III physical status. At least 37.7% of patients with events received a prophylactic dose of injectable anticoagulant postoperatively. The overall risk decreased from 2008 to 2012. Venous thromboembolism-associated mortality during hospitalization was 21.1% (95% CI 13.6-30.4). The incidence of postoperative symptomatic venous thromboembolism was 1.33/1000. Neurosurgery showed the greatest risk. Mortality was 21.1%. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Risk factors associated with oroantral perforation during surgical removal of maxillary third molar teeth.

    Science.gov (United States)

    Hasegawa, Takumi; Tachibana, Akira; Takeda, Daisuke; Iwata, Eiji; Arimoto, Satomi; Sakakibara, Akiko; Akashi, Masaya; Komori, Takahide

    2016-12-01

    The relationship between radiographic findings and the occurrence of oroantral perforation is controversial. Few studies have quantitatively analyzed the risk factors contributing to oroantral perforation, and no study has reported multivariate analysis of the relationship(s) between these various factors. This retrospective study aims to fill this void. Various risk factors for oroantral perforation during maxillary third molar extraction were investigated by univariate and multivariate analysis. The proximity of the roots to the maxillary sinus floor (root-sinus [RS] classification) was assessed using panoramic radiography and classified as types 1-5. The relationship between the maxillary second and third molars was classified according to a modified version of the Archer classification. The relative depth of the maxillary third molar in the bone was classified as class A-C, and its angulation relative to the long axis of the second molar was also recorded. Performance of an incision (OR 5.16), mesioangular tooth angulation (OR 6.05), and type 3 RS classification (i.e., significant superimposition of the roots of all posterior maxillary teeth with the sinus floor; OR 10.18) were all identified as risk factors with significant association to an outcome of oroantral perforation. To our knowledge, this is the first multivariate analysis of the risk factors for oroantral perforation during surgical extraction of the maxillary third molar. This RS classification may offer a new predictive parameter for estimating the risk of oroantral perforation.

  9. External Validation of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) Risk Model to Predict Operative Risk in Perihilar Cholangiocarcinoma.

    Science.gov (United States)

    Coelen, Robert J S; Olthof, Pim B; van Dieren, Susan; Besselink, Marc G H; Busch, Olivier R C; van Gulik, Thomas M

    2016-12-01

    Resection of perihilar cholangiocarcinoma (PHC) is high-risk surgery, with reported operative mortality up to 17%. Therefore, preoperative risk assessment is needed to identify high-risk patients and anticipate postoperative adverse outcomes. To provide external validation of the Estimation of Physiologic Ability and Surgical Stress (E-PASS) risk model in a Western PHC cohort. The E-PASS variables were obtained from a database that included 156 consecutive patients who underwent resection for suspected PHC between January 1, 2000, and December 31, 2015, at the Academic Medical Center, Amsterdam, the Netherlands. The accuracy of E-PASS using intraoperative variables and its modified form that can be used before surgery (mE-PASS) in predicting mortality was assessed by area under the curve analysis (discrimination) and by the Hosmer-Lemeshow goodness-of-fit test (calibration). In-hospital mortality, severe morbidity (Clavien-Dindo grade≥III), and a high Comprehensive Complication Index. Among 156 patients included in the study, the median age was 63 years, and 62.8% (n = 98) were male. Of them, 85.3% (n = 133) underwent major liver resection. Severe morbidity occurred in 51.3% (n = 80), and in-hospital mortality was 13.5% (n = 21). Both E-PASS and mE-PASS had adequate discriminative performance, with areas under the curve of 0.78 (95% CI, 0.67-0.88) and 0.79 (95% CI, 0.70-0.89), respectively, while E-PASS showed better calibration (P = .33 vs P = .02, Hosmer-Lemeshow goodness-of-fit test). The ratios of observed to expected mortality were 1.31 for E-PASS and 1.24 for mE-PASS. Both models were able to distinguish groups with low risk, intermediate risk, and high risk, with observed mortality rates of 0.0% to 3.6%, 8.3% to 9.0%, and 25.0% to 28.3%, respectively. Severe morbidity and a high Comprehensive Complication Index were more frequently observed among high-risk patients. Both E-PASS models accurately identify patients at high risk of

  10. Surgical treatment of high-standing greater trochanter.

    Science.gov (United States)

    Takata, K; Maniwa, S; Ochi, M

    1999-01-01

    Eleven patients with high-standing greater trochanter (13 joints) aged 13-36 years underwent surgery. Distal transfer of the greater trochanter (group T) was performed in 4 patients (5 joints) and lateral displacement osteotomy (group L) in 7 (8 joints). The average follow-up duration was 13.4 years in group T and 5.9 years in group L. Clinical results were evaluated by the hip score according to Merle d'Aubigne. The mean hip score in group T was 13.4 points before operation and 15.4 points after operation, and in group L, 12.8 and 17.4 points, respectively. The postoperative clinical results of group L were significantly better than those of group T (P = 0.0494). In radiological evaluation, although the articulo-trochanteric distance (ATD) increased in both groups in group L it improved remarkably from 9.8 to 24.3, indicating a large descending distance of the greater trochanter. The lever arm ratio (LAR) did not change significantly in group T, but it decreased from 1.97 to 1.60 in group L (P = 0.004). This means that the lever arm of the abductors can certainly be extended by lateral displacement osteotomy. Lateral displacement osteotomy is the most effective procedure for high-standing greater trochanter.

  11. Risk Factors for Surgical Site Infection After Spinal Surgery: A Meta-Analysis.

    Science.gov (United States)

    Fei, Qi; Li, Jinjun; Lin, JiSheng; Li, Dong; Wang, BingQiang; Meng, Hai; Wang, Qi; Su, Nan; Yang, Yong

    2016-11-01

    Surgical-site infection (SSI) after spinal surgery is the most common complication, which results in greater morbidity, mortality, and health care costs. Identifying risk factors of SSI is an important point for preventive strategies to reduce the incidence of SSI. The aim of this meta-analysis is to investigate the most important risk factors for SSI after spinal surgery. PubMed, Embase, and Web of Science were systematically searched to identify cohort or case-control studies that investigated the risk factors for SSI following spinal surgery. A fixed-effects or random-effects model was used to pool the estimates, depending on the heterogeneity among the included studies. Heterogeneity between the studies was assessed by I2 and Cochran's Q test. Twelve studies with a total of 13,476 patients met the inclusion criteria were included in this meta-analysis. Of them, 1 was a nested case-control studies, 7 were case-control studies, and 4 were cohort studies. The most important predictors of SSI were diabetes (risk ratio [RR] = 2.22, 95% confidence interval [95% CI] 1.38-3.60; P = 0.001), prolonged operative times (>3 hours) (RR = 2.16, 95% CI 1.12-4.19; P = 0.009), body mass index more than 35 (RR = 2.36, 95% CI 1.47-3.80; P = 0.000), and posterior approach (RR = 1.22, 95% CI 1.05-1.41; P = 0.009). Diabetes, prolonged operative times (>3 hours), body mass index more than 35, posterior approach, and number of intervertebral levels (≥7) are associated with an increased risk of SSI after spinal surgery. Almost all these risk factors are in line with the known risk factors for SSI in patients who underwent spinal surgery. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Application of a Compact High-Definition Exoscope for Illumination and Magnification in High-Precision Surgical Procedures.

    Science.gov (United States)

    Krishnan, Kartik G; Schöller, Karsten; Uhl, Eberhard

    2017-01-01

    The basic necessities for surgical procedures are illumination, exposure, and magnification. These have undergone transformation in par with technology. One of the recent developments is the compact magnifying exoscope system. In this report, we describe the application of this system for surgical operations and discuss its advantages and pitfalls. We used the ViTOM exoscope mounted on the mechanical holding arm. The following surgical procedures were conducted: lumbar and cervical spinal canal decompression (n = 5); laminotomy and removal of lumbar migrated disk herniations (n = 4); anterior cervical diskectomy and fusion (n = 1); removal of intraneural schwannomas (n = 2); removal of an acute cerebellar hemorrhage (n = 1); removal of a parafalcine atypical cerebral hematoma caused by a dural arteriovenous fistula (n = 1); and microsutures and anastomoses of a nerve (n = 1), an artery (n = 1), and veins (n = 2). The exoscope offered excellent, magnified, and brilliantly illuminated high-definition images of the surgical field. All surgical operations were successfully completed. The main disadvantage was the adjustment and refocusing using the mechanical holding arm. The time required for the surgical operation under the exoscope was slightly longer than the times required for a similar procedure performed using an operating microscope. The magnifying exoscope is an effective and nonbulky tool for surgical procedures. In visualization around the corners, the exoscope has better potential than a microscope. With technical and technologic modifications, the exoscope might become the next generation in illumination, visualization, exposure, and magnification for high-precision surgical procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. High Frequency of Polymicrobial Infections After Surgical Resection of Malignant Bone and Soft Tissue Tumors: A Retrospective Cohort Study.

    Science.gov (United States)

    Vos, Laura M; Morand, Philippe C; Biau, David; Archambeau, Denis; Eyrolle, Luc-Jean; Loubinoux, Julien; Perut, Valerie; Leclerc, Philippe; Arends, Joop E; Anract, Philippe; Salmon, Dominique

    2015-09-01

    Surgical resection of a malignant bone tumor (BT) or soft tissue tumor (STT), with or without prosthetic replacement, carries a high risk of developing postoperative infections. There is limited knowledge on the bacteriological spectrum of these postsurgical infections that necessitate empirical antibiotic therapy. The aim of this study was to analyze the incidence and microbiological features of site infections following BT or STT resection. In this retrospective mono-center study, we analyzed the surgical and bacteriological data of all consecutive patients who developed an infection after surgical resection of a BT or STT between January 2010 and April 2014. Seventy-two consecutive patients who developed an infection on the site of surgical treatment for a BT (n = 42) or SST (n = 30) were included. Polymicrobism was frequently observed, more often associated with STTs (93%) than BTs (71%; P = 0.03). Gram-negative bacteria were more frequently isolated in STTs (55%) than in BTs (26%; P = 0.01) and non-prosthesis-associated infections (54%) than prosthesis-associated infections (29%; P = 0.04), whereas staphylococci were more frequently found in BTs (76%) than in STTs (52%; P = 0.03). Overall, we found gram negatives in 82% of early acute infections, 11% of chronic infections and 7% of late acute infections (P infections in patients after surgical resection of BTs or STTs were often polymicrobial, especially following STTs. Causative bacteria were often gram negatives in STTs and non-prosthesis-associated infections, whereas staphylococci were predominant in BTs. Based on these findings, we recommend antibiotic coverage of both gram-positive and -negative bacteria with a combination of broad-spectrum antibiotics in STTs and antistaphylococcal antibiotics as first-line therapy in infections following BT surgery.

  14. Post-traumatic stress disorder amongst surgical trainees: An unrecognised risk?

    Science.gov (United States)

    Thompson, Christopher V; Naumann, David N; Fellows, Jodie L; Bowley, Douglas M; Suggett, Nigel

    2017-06-01

    Experiences of actual/threatened death or serious injury to patients are commonplace in surgery. Pathological symptoms following stress may lead to Acute Stress Reaction (ASR) and Post-Traumatic Stress Disorder (PTSD). PTSD symptoms of insomnia, anger, poor concentration, hyper-vigilance and exaggerated startle have implications for patient safety. The current study investigates the prevalence of occult, untreated psychological morbidity amongst surgical trainees. A web-based survey of UK surgical trainees based upon the Impact of Events Scale-Revised (IES-R) was distributed using social media platforms and email. A score of ≥33 was indicative of ASR or PTSD (the former lasting 1 month). Additional questions concerned chronicity of symptoms, mentorship, team-working and access to support. For 167 returned surveys the mean age was 32.7 (SD 3.6) years; 102/167 (61%) were male. Mean years in training were 6.1 (SD 3.6). Median IES-R score was 14 (IQR 7-23.5). Of 144 respondents who answered about stress symptoms, 23/144 (16%) had IES-R score ≥ 33; 6 of these had symptoms 1 month (suggesting PTSD). Those with IES-R ≥ 33 group were more likely to have repeated years of training, and have witnessed severe pain, traumatic injury, and acute haemorrhage. Seven with score ≥ 33 had sought support. Occult psychological morbidity amongst surgical trainees may be higher than in the general population. Recognition and management of this risk is important for the mental health of trainees and the safety of patients. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  15. Comparison of Internal Medicine and General Surgery Residents' Assessments of Risk of Postsurgical Complications in Surgically Complex Patients.

    Science.gov (United States)

    Healy, James M; Davis, Kimberly A; Pei, Kevin Y

    2017-10-11

    Anticipating postsurgical complications is a vital physician skill, particularly when counseling surgically complex patients on their risks of intervention. Although internists and surgeons both counsel patients on surgical risks, it is uncertain who is better equipped to accurately anticipate surgical complications. To examine how internal medicine and general surgery trainees compare in their assessment of risk of surgically complex patients. General surgery and internal medicine residents (urban, tertiary, and academic medical center) answered an anonymous, online assessment of 7 real-life, complex clinical scenarios. Participants estimated the chance of any morbidity, mortality, surgical site infection, pneumonia, and cardiac complications. Scenarios represented a diverse general surgery practice, including colectomy, duodenal ulcer repair, inguinal hernia repair, perforated viscus exploration, small-bowel resection, cholecystectomy, and mastectomy in surgically complex patients likely to be comanaged by surgical and internal medicine services. Responses were compared with risk-adjusted outcomes reported by the American College of Surgeons' National Surgical Quality Improvement Project (NSQIP) online calculator. A total of 76 general surgery residents (50 [65.8%] male and 26 [34.2%] female) and 76 internal medicine residents (36 [47.4%] male and 40 [52.6%] female) participated (64% overall response rate). General surgery residents were significantly more confident with their responses (general surgery residents' mean response, 3.6 [95% CI, 3.4-2.8]; internal medicine residents' mean response, 2.8 [95% CI, 2.6-3.0]; P surgery residents' mean response, 4.3 [95% CI, 4.1-4.4]; internal medicine residents' mean response, 3.7 [95% CI, 3.4-3.9]; P = .006) but less likely to discuss code status (general surgery residents' mean response, 3.2 [95% CI, 2.9-3.4]; internal medicine residents' mean response, 3.8 [95% CI, 3.5-4.1]; P surgery residents' mean response

  16. Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures

    Science.gov (United States)

    Dicks, Kristen V.; Baker, Arthur W.; Durkin, Michael J.; Anderson, Deverick J.; Moehring, Rebekah W.; Chen, Luke F.; Sexton, Daniel J.; Weber, David J.; Lewis, Sarah S.

    2016-01-01

    OBJECTIVE To determine the association (1) between shorter operative duration and surgical site infection (SSI) and (2) between surgeon median operative duration and SSI risk among first-time hip and knee arthroplasties. DESIGN Retrospective cohort study SETTING A total of 43 community hospitals located in the southeastern United States. PATIENTS Adults who developed SSIs according to National Healthcare Safety Network criteria within 365 days of first-time knee or hip arthroplasties performed between January 1, 2008 and December 31, 2012. METHODS Log-binomial regression models estimated the association (1) between operative duration and SSI outcome and (2) between surgeon median operative duration and SSI outcome. Hip and knee arthroplasties were evaluated in separate models. Each model was adjusted for American Society of Anesthesiology score and patient age. RESULTS A total of 25,531 hip arthroplasties and 42,187 knee arthroplasties were included in the study. The risk of SSI in knee arthroplasties with an operative duration shorter than the 25th percentile was 0.40 times the risk of SSI in knee arthroplasties with an operative duration between the 25th and 75th percentile (risk ratio [RR], 0.40; 95% confidence interval [CI], 0.38–0.56; P operative duration did not demonstrate significant association with SSI for hip arthroplasties (RR, 1.04; 95% CI, 0.79–1.37; P =.36). Knee arthroplasty surgeons with shorter median operative durations had a lower risk of SSI than surgeons with typical median operative durations (RR, 0.52; 95% CI, 0.43–0.64; P operative durations were not associated with a higher SSI risk for knee or hip arthroplasty procedures in our analysis. PMID:26391277

  17. High-Quality See-Through Surgical Guidance System Using Enhanced 3-D Autostereoscopic Augmented Reality.

    Science.gov (United States)

    Zhang, Xinran; Chen, Guowen; Liao, Hongen

    2017-08-01

    Precise minimally invasive surgery (MIS) has significant advantages over traditional open surgery in clinic. Although pre-/intraoperative diagnosis images can provide necessary guidance for therapy, hand-eye discoordination occurs when guidance information is displayed away from the surgical area. In this study, we introduce a real three-dimensional (3-D) see-through guidance system for precision surgery. To address the resolution and viewing angle limitation as well as the accuracy degradation problems of autostereoscopic 3-D display, we design a high quality and high accuracy 3-D integral videography (IV) medical image display method. Furthermore, a novel see-through microscopic device is proposed to assist surgeons with the superimposition of real 3-D guidance onto the surgical target is magnified by an optical visual magnifier module. Spatial resolutions of 3-D IV image in different depths have been increased 50%∼70%, viewing angles of different image sizes have been increased 9%∼19% compared with conventional IV display methods. Average accuracy of real 3-D guidance superimposed on surgical target was 0.93 mm ± 0.41 mm. Preclinical studies demonstrated that our system could provide real 3-D perception of anatomic structures inside the patient's body. The system showed potential clinical feasibility to provide intuitive and accurate in situ see-through guidance for microsurgery without restriction on observers' viewing position. Our system can effectively improve the precision and reliability of surgical guidance. It will have wider applicability in surgical planning, microscopy, and other fields.

  18. Risk Factors for Distant Metastasis in Patients with Oral Cavity Squamous Cell Carcinoma Undergoing Surgical Treatment.

    Science.gov (United States)

    Aires, Felipe Toyama; Lin, Chin Shien; Matos, Leandro Luongo; Kulcsar, Marco Aurélio Vamondes; Cernea, Claudio Roberto

    2018-01-23

    The aim of this study is to investigate the clinical and pathological factors related to distant metastasis in patients with oral cavity squamous cell carcinoma (OCSCC) undergoing surgery. A retrospective data review was conducted on patients who underwent primary surgery for OCSCC at the Instituto do Cancer do Estado de São Paulo (ICESP) between 2009 and 2015. Distant metastasis rates were calculated and predictive factors were determined by the Cox proportional-hazards model. There was a total of 274 patients, including 210 (76.6%) men and 64 (23.4%) women, with a mean age of 59.9 ± 10.9 years. The incidence of distant metastasis was 9.6%, with the lung being the most common site. The mean time interval between surgical treatment and the diagnosis of distant metastasis was 12 months (range 2-40 months). In the multivariate analysis, angiolymphatic invasion (HR = 2,87; p = 0.023), contralateral cervical metastasis (HR = 3.3; p = 0,007), tumor thickness >25 mm (HR = 3.50; p = 0.009), and locoregional recurrence (HR = 6.59; p 25 mm, angiolymphatic invasion, or locoregional recurrence after surgical treatment have a greater risk of developing distant metastasis. © 2018 S. Karger AG, Basel.

  19. Blocking Surgically Induced Lysyl Oxidase Activity Reduces the Risk of Lung Metastases.

    Science.gov (United States)

    Rachman-Tzemah, Chen; Zaffryar-Eilot, Shelly; Grossman, Moran; Ribero, Dario; Timaner, Michael; Mäki, Joni M; Myllyharju, Johanna; Bertolini, Francesco; Hershkovitz, Dov; Sagi, Irit; Hasson, Peleg; Shaked, Yuval

    2017-04-25

    Surgery remains the most successful curative treatment for cancer. However, some patients with early-stage disease who undergo surgery eventually succumb to distant metastasis. Here, we show that in response to surgery, the lungs become more vulnerable to metastasis due to extracellular matrix remodeling. Mice that undergo surgery or that are preconditioned with plasma from donor mice that underwent surgery succumb to lung metastases earlier than controls. Increased lysyl oxidase (LOX) activity and expression, fibrillary collagen crosslinking, and focal adhesion signaling contribute to this effect, with the hypoxic surgical site serving as the source of LOX. Furthermore, the lungs of recipient mice injected with plasma from post-surgical colorectal cancer patients are more prone to metastatic seeding than mice injected with baseline plasma. Downregulation of LOX activity or levels reduces lung metastasis after surgery and increases survival, highlighting the potential of LOX inhibition in reducing the risk of metastasis following surgery. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

  20. The Baptist Health High-Risk Falls Assessment: One Assessment Fits All.

    Science.gov (United States)

    Bugajski, Andrew; Lengerich, Alex; McCowan, Denise; Merritt, Sharon; Moe, Krista; Hall, Brittany; Nelson, Debbie; Brockopp, Dorothy

    Assessing high risk for falling among psychiatric inpatients is particularly challenging in that assessments with strong sensitivity and specificity are not available. The purpose of this study was to determine the sensitivity, specificity, and diagnostic odds ratio of the Baptist Health High Risk Falls Assessment (BHHRFA), a medical-surgical fall risk assessment, in a psychiatric inpatient population. Data collected on 5910 psychiatric inpatients using the BHHRFA showed acceptable sensitivity, specificity, and diagnostic odds ratio (0.68/0.70/4.964).

  1. Risk Factors for Postoperative Fibrinogen Deficiency after Surgical Removal of Intracranial Tumors.

    Directory of Open Access Journals (Sweden)

    Naili Wei

    Full Text Available Higher levels of fibrinogen, a critical element in hemostasis, are associated with increased postoperative survival rates, especially for patients with massive operative blood loss. Fibrinogen deficiency after surgical management of intracranial tumors may result in postoperative intracranial bleeding and severely worsen patient outcomes. However, no previous studies have systematically identified factors associated with postoperative fibrinogen deficiency. In this study, we retrospectively analyzed data from patients who underwent surgical removal of intracranial tumors in Beijing Tiantan Hospital date from 1/1/2013to12/31/2013. The present study found that patients with postoperative fibrinogen deficiency experienced more operative blood loss and a higher rate of postoperative intracranial hematoma, and they were given more blood transfusions, more plasma transfusions, and were administered larger doses of hemocoagulase compared with patients without postoperative fibrinogen deficiency. Likewise, patients with postoperative fibrinogen deficiency had poorer extended Glasgow Outcome Scale (GOSe, longer hospital stays, and greater hospital expenses than patients without postoperative fibrinogen deficiency. Further, we assessed a comprehensive set of risk factors associated with postoperative fibrinogen deficiency via multiple linear regression. We found that body mass index (BMI, the occurrence of postoperative intracranial hematoma, and administration of hemocoagulasewere positively associated with preoperative-to-postoperative plasma fibrinogen consumption; presenting with a malignant tumor was negatively associated with fibrinogen consumption. Contrary to what might be expected, intraoperative blood loss, the need for blood transfusion, and the need for plasma transfusion were not associated with plasma fibrinogen consumption. Considering our findings together, we concluded that postoperative fibrinogen deficiency is closely associated with

  2. An aid to the explanation of surgical risks and complications: the International Spinal Surgery Information Sheet.

    Science.gov (United States)

    Ng, Chye Yew; Gibson, J N Alastair

    2011-12-15

    Presentation and analysis of a patient information sheet. To produce an evidence-based information sheet that will serve as an aide-memoire to the process of taking informed consent prior to spinal surgery. Consent for a surgical intervention is the end of a process of discussion between the surgeon and the patient. It is essential that the patient has been provided with sufficient information to make an informed judgment as to whether the benefits of a proposed procedure will outweigh its risks. We searched MEDLINE, the Cochrane database of systematic reviews and personal libraries for articles reporting complications of the surgical treatment of spinal diseases with particular reference to the most commonly treated conditions. A draft document was drawn up referencing the odds of specific complications. This was circulated to the National Health Service Scotland Central Legal Office for scrutiny and to an English language expert at the University of Edinburgh for translation to lay English. Finally, the document was issued to 50 patients in the outpatient clinic and scored on visual analog scales (VAS) for the ease of understanding, usefulness, and length. The product of this project was a two-page A4 sheet, with the front page outlining information applicable to spinal surgery "in general" and a back page detailing all common risks, relating to a headline procedure, that a Court of Law would expect a surgeon to discuss. The patients' VAS score (0-10) for "ease of understanding" was 8.8 ± 1.3 and for "usefulness" 8.9 ± 1.0 (means ± SD). Forty-three of 50 patients (86%) indicated that the length of the document was "just right" and seven (14%) of them that it was "too long." The ISSiS is user friendly and can be employed as a tool in the process of obtaining consent.

  3. Risk Factors for 30-Day Unplanned Readmission and Major Perioperative Complications Following Spine Fusion Surgery in Adults: A Review of the National Surgical Quality Improvement Program (NSQIP) Database

    Science.gov (United States)

    Su, Alvin W.; Habermann, Elizabeth B.; Thomsen, Kristine M.; Milbrandt, Todd A.; Nassr, Ahmad; Larson, A. Noelle

    2017-01-01

    Study Design Retrospective review of a prospective cohort Objective To determine the patient characteristics and surgical procedure factors related to increased rates of 30-day unplanned readmission and major perioperative complications after spinal fusion surgery, as well as the association between unplanned readmission and major complications. Summary of Background Data Reducing unplanned readmissions can reduce the cost of healthcare. Payers are implementing penalties for 30-day readmissions following discharge. There is limited data regarding the current rates and risk factors for unplanned readmission and major complications related to spinal fusion surgery. Methods Spine fusion patients were identified using the 2012 and 2013 American College of Surgeons National Surgical Quality Improvement Program Participant User File. Rates of readmissions within 30 days following spine fusion surgery were calculated using the person-years method. Cox proportional hazards models were used to assess the independent associations of spine surgical procedure types, diagnoses, patient profiles and major perioperative complications with unplanned related readmissions. Independent risk factors for major complications were assessed by multivariable logistic regression. Results Of 18,602 identified patients, there was a 5.2% overall major perioperative complication rate. There was a rate of 4.4% per 30 person-days for unplanned readmissions related to index surgery. Independent risk factors for both readmissions and major perioperative complications included combined anterior and posterior surgery, diagnosis of solitary tumor, older age, and higher American Society of Anesthesiologists class. Patients with deep/organ surgical site infection carried higher risk of having unplanned readmission, followed by pulmonary embolism, acute renal failure and stroke/CVA with neurological deficit. Conclusions This study provides benchmark rates of 30-day readmission based on diagnosis and

  4. Risk Factors for 30-Day Unplanned Readmission and Major Perioperative Complications After Spine Fusion Surgery in Adults: A Review of the National Surgical Quality Improvement Program Database.

    Science.gov (United States)

    Su, Alvin W; Habermann, Elizabeth B; Thomsen, Kristine M; Milbrandt, Todd A; Nassr, Ahmad; Larson, A Noelle

    2016-10-01

    Retrospective review of a prospective cohort. The aim of the study was to determine the patient characteristics and surgical procedure factors related to increased rates of 30-day unplanned readmission and major perioperative complications after spinal fusion surgery, and the association between unplanned readmission and major complications. Reducing unplanned readmissions can reduce the cost of healthcare. Payers are implementing penalties for 30-day readmissions after discharge. There is limited data regarding the current rates and risk factors for unplanned readmission and major complications related to spinal fusion surgery. Spine fusion patients were identified using the 2012 and 2013 American College of Surgeons National Surgical Quality Improvement Program Participant User File. Rates of readmissions within 30 days after spine fusion surgery were calculated using the person-years method. Cox proportional hazards models were used to assess the independent associations of spine surgical procedure types, diagnoses, patient profiles, and major perioperative complications with unplanned related readmissions. Independent risk factors for major complications were assessed by multivariable logistic regression. Of the 18,602 identified patients, there was a 5.2% overall major perioperative complication rate. There was a rate of 4.4% per 30 person-days for unplanned readmissions related to index surgery. Independent risk factors for both readmissions and major perioperative complications included combined anterior and posterior surgery, diagnosis of solitary tumor, older age, and higher American Society of Anesthesiologists class. Patients with deep/organ surgical site infection carried higher risk of having unplanned readmission, followed by pulmonary embolism, acute renal failure, and stroke/cerebral vascular accident with neurological deficit. This study provides benchmark rates of 30-day readmission based on diagnosis and procedure codes from a high

  5. Early Detection of High Risk Pregnancy

    OpenAIRE

    Kurniawan, Arif; Sistiarani, Colti; Hariyadi, Bambang

    2017-01-01

    There are 30.939 pregnant women in Banyumas, with 6.206 cases referred due to high-risk pregnancies. Petahunan village in Pekuncen has the the highest incidence of high-risk pregnancies compared with other villages. The purpose of this study is to describe the implementation of early detection of high-risk pregnancies in Petahunan village, Pekuncen. This study used qualitative research methods with case study approach. Research instruments used in-depth interviews and focus group disscussion ...

  6. [Socioeconomic factors in high risk pregnancy].

    Science.gov (United States)

    Armas Domínguez, J; Shor Pinsker, V; Mac Gregor, C; Karchmer, S

    1977-05-01

    The study of high risk during pregnancy was undertaken to show the most viable ways for solving those problems affecting maternal-fetal morbidity and mortality. The authors are hopeful that in the future, the 2 branches of medicine, perinatology and obstetrics, will no longer differentiate between high risk for mother and fetus or neonate but will direct attention to what is high risk for 1 society in particular. These professionals will undertake an interdisciplinary approach of the problem to benefit society. (author's)

  7. Usefulness and capability of three-dimensional, full high-definition movies for surgical education.

    Science.gov (United States)

    Takano, M; Kasahara, K; Sugahara, K; Watanabe, A; Yoshida, S; Shibahara, T

    2017-12-01

    Because of changing surgical procedures in the fields of oral and maxillofacial surgery, new methods for surgical education are needed and could include recent advances in digital technology. Many doctors have attempted to use digital technology as educational tools for surgical training, and movies have played an important role in these attempts. We have been using a 3D full high-definition (full-HD) camcorder to record movies of intra-oral surgeries. The subjects were medical students and doctors receiving surgical training who did not have actual surgical experience (n = 67). Participants watched an 8-min, 2D movie of orthognathic surgery and subsequently watched the 3D version. After watching the 3D movie, participants were asked to complete a questionnaire. A lot of participants (84%) felt a 3D movie excellent or good and answered that the advantages of a 3D movie were their appearance of solidity or realism. Almost all participants (99%) answered that 3D movies were quite useful or useful for medical practice. Three-dimensional full-HD movies have the potential to improve the quality of medical education and clinical practice in oral and maxillofacial surgery.

  8. Solitary thyroid nodule: the risk of cancer and the extent of surgical ...

    African Journals Online (AJOL)

    Objectives: To study the incidence of thyroid malignancy in patients with solitary thyroid nodule presenting to surgical clinics and assessing the extent of the surgical therapy offered. Design: Cross-sectional study. Setting: King Khalid University Hospital, Riyadh, Saudi Arabia. Subjects: The surgical and histological data of ...

  9. High-Risk Stress Fractures: Diagnosis and Management.

    Science.gov (United States)

    McInnis, Kelly C; Ramey, Lindsay N

    2016-03-01

    Stress fractures are common overuse injuries in athletes. They occur during periods of increased training without adequate rest, disrupting normal bone reparative mechanisms. There are a host of intrinsic and extrinsic factors, including biochemical and biomechanical, that put athletes at risk. In most stress fractures, the diagnosis is primarily clinical, with imaging indicated at times, and management focused on symptom-free relative rest with advancement of activity as tolerated. Overall, stress fractures in athletes have an excellent prognosis for return to sport, with little risk of complication. There is a subset of injuries that have a greater risk of fracture progression, delayed healing, and nonunion and are generally more challenging to treat with nonoperative care. Specific locations of high-risk stress fracture include the femoral neck (tension side), patella, anterior tibia, medial malleolus, talus, tarsal navicular, proximal fifth metatarsal, and great toe sesamoids. These sites share a characteristic region of high tensile load and low blood flow. High-risk stress fractures require a more aggressive approach to evaluation, with imaging often necessary, to confirm early and accurate diagnosis and initiate immediate treatment. Treatment consists of nonweight-bearing immobilization, often with a prolonged period away from sport, and a more methodic and careful reintroduction to athletic activity. These stress fractures may require surgical intervention. A high index of suspicion is essential to avoid delayed diagnosis and optimize outcomes in this subset of stress fractures. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  10. Radiological and clinical outcome of non surgical management for pediatric high grade spondylolisthesis.

    Science.gov (United States)

    Bourassa-Moreau, Etienne; Labelle, Hubert; Mac-Thiong, Jean-Marc

    2010-01-01

    To describe and compare the quality of life of patients with pediatric high-grade spondylolisthesis managed non-operatively and operatively. Some authors consider pediatric high-grade spondylolisthesis as an absolute indication for surgery, regardless of symptoms while others sometimes recommend observation in asymptomatic patients. Very little is known about the indications and outcome of non-operatively managed high-grade spondylolisthesis. A prospective database comprising all the spondylolisthesis cases from a single pediatric institution was reviewed in order to identify all cases of high grade spondylolisthesis. Quality of life data from Short form (SF)-12 and Scoliosis Research Society (SRS)-22 questionnaires were collected. Non-operatively treated patients were identified and compared to surgically treated patients at baseline and at last follow-up. 34 spondylolisthesis were identified as high grade and 5 of them were non-operatively treated. Quality of life questionnaires showed less impairment in the non-operative group when compared to the surgical group preoperatively. Moreover at last follow-up, quality of life questionnaires were similar between the two groups. There was no worsening of quality of life observed in non-operative patients during follow-up. The quality of life after surgical treatment of high grade spondylolisthesis is similar to that of patients with high grade spondylolisthesis and mild symptoms undergoing non-operative treatment.

  11. Development and Validation of a Methodology to Reduce Mortality Using the Veterans Affairs Surgical Quality Improvement Program Risk Calculator.

    Science.gov (United States)

    Keller, Deborah S; Kroll, Donald; Papaconstantinou, Harry T; Ellis, C Neal

    2017-04-01

    To identify patients with a high risk of 30-day mortality after elective surgery, who may benefit from referral for tertiary care, an institution-specific process using the Veterans Affairs Surgical Quality Improvement Program (VASQIP) Risk Calculator was developed. The goal was to develop and validate the methodology. Our hypothesis was that the process could optimize referrals and reduce mortality. A VASQIP risk score was calculated for all patients undergoing elective noncardiac surgery at a single Veterans Affairs (VA) facility. After statistical analysis, a VASQIP risk score of 3.3% predicted mortality was selected as the institutional threshold for referral to a tertiary care center. The model predicted that 16% of patients would require referral, and 30-day mortality would be reduced by 73% at the referring institution. The main outcomes measures were the actual vs predicted referrals and mortality rates at the referring and receiving facilities. The validation included 565 patients; 90 (16%) had VASQIP risk scores greater than 3.3% and were identified for referral; 60 consented. In these patients, there were 16 (27%) predicted mortalities, but only 4 actual deaths (p = 0.007) at the receiving institution. When referral was not indicated, the model predicted 4 mortalities (1%), but no actual deaths (p = 0.1241). These data validate this methodology to identify patients for referral to a higher level of care, reducing mortality at the referring institutions and significantly improving patient outcomes. This methodology can help guide decisions on referrals and optimize patient care. Further application and studies are warranted. Copyright © 2017 American College of Surgeons. All rights reserved.

  12. Low risk and high risk human papillomaviruses (HPVs) and cervical ...

    African Journals Online (AJOL)

    Low risk and high risk human papillomaviruses (HPVs) and cervical cancer in Zimbabwe: epidemiological evidence. M Chirara, G A Stanczuk, S A Tswana, L Nystrom, S Bergstrom, S R Moyo, M J Nzara. Abstract. No Abstract. Central African Journal of Medicine Vol. 47 (2) 2001: pp. 32-34.

  13. The Impact of a Reported Penicillin Allergy on Surgical Site Infection Risk.

    Science.gov (United States)

    Blumenthal, Kimberly G; Ryan, Erin E; Li, Yu; Lee, Hang; Kuhlen, James L; Shenoy, Erica S

    2018-01-18

    A reported penicillin allergy may compromise receipt of recommended antibiotic prophylaxis intended to prevent surgical site infections (SSIs). Most patients with a reported penicillin allergy are not allergic. We determined the impact of a reported penicillin allergy on the development of SSIs. In this retrospective cohort study of Massachusetts General Hospital hip arthroplasty, knee arthroplasty, hysterectomy, colon surgery, and coronary artery bypass grafting patients from 2010 to 2014, we compared patients with and without a reported penicillin allergy. The primary outcome was an SSI, as defined by the Centers for Disease Control and Prevention's National Healthcare Safety Network. The secondary outcome was perioperative antibiotic use. Of 8385 patients who underwent 9004 procedures, 922 (11%) reported a penicillin allergy, and 241 (2.7%) had an SSI. In multivariable logistic regression, patients reporting a penicillin allergy had increased odds (adjusted odds ratio, 1.51; 95% confidence interval, 1.02-2.22) of SSI. Penicillin allergy reporters were administered less cefazolin (12% vs 92%; P penicillin allergy. The increased SSI risk was entirely mediated by the patients' receipt of an alternative perioperative antibiotic; between 112 and 124 patients with reported penicillin allergy would need allergy evaluation to prevent 1 SSI. Patients with a reported penicillin allergy had a 50% increased odds of SSI, attributable to the receipt of second-line perioperative antibiotics. Clarification of penicillin allergies as part of routine preoperative care may decrease SSI risk.

  14. Recurrence patterns of oral leukoplakia after curative surgical resection: important factors that predict the risk of recurrence and malignancy.

    Science.gov (United States)

    Kuribayashi, Yuri; Tsushima, Fumihiko; Sato, Masaru; Morita, Kei-ichi; Omura, Ken

    2012-10-01

    Oral leukoplakia can be treated using a variety of treatment procedures; however, the lesions recur in many cases irrespective of the treatment procedure used. The rate of recurrence was from 7.7% to 38.1%. This study aims to identify the important factors that can lower the risk of recurrence of oral leukoplakia treated by curative surgical resection. The clinical records of 52 patients with oral leukoplakia (53 lesions) who underwent curative surgical resection between 2004 and 2009 were retrospectively analyzed for the rate of recurrence, clinical outcome, epithelial dysplasia, lesion location, and resection margins. The recurrence rate following curative surgical resection was 15.1%, with the most common site being the gingiva. Malignant transformation occurred in a single patient (1.9%). Minimal resection margins (oral leukoplakia is curative only if all areas of epithelial abnormalities are identified and resected. Moreover, an adequate resection margin may reduce the risk of recurrence. © 2012 John Wiley & Sons A/S.

  15. Surgical site infection after total en bloc spondylectomy: risk factors and the preventive new technology.

    Science.gov (United States)

    Hayashi, Hiroyuki; Murakami, Hideki; Demura, Satoru; Kato, Satoshi; Yoshioka, Katsuhito; Shinmura, Kazuya; Yokogawa, Noriaki; Ishii, Takayoshi; Fang, Xiang; Shirai, Toshiharu; Tsuchiya, Hiroyuki

    2015-01-01

    Surgical site infection (SSI) associated with instruments remains a serious and common complication in patients who undergo total en bloc spondylectomy (TES). It is very important that the risk factors for SSI are known to prevent it. The purpose of the study was to identify independent risk factors for SSI after TES and evaluate the positive effect of iodine-supported spinal instruments in the prevention of SSI after TES. This is a retrospective clinical study. One hundred twenty-five patients who underwent TES for vertebral tumor were evaluated. Incidence rate of SSI, risk factors for SSI after TES, and safety of iodine-supported spinal instruments were the outcome measures. Risk factors for SSI were analyzed using logistic regression. In recent 69 patients with iodine-supported spinal instruments, the thyroid hormone levels in the blood were examined to confirm if iodine from the implant influenced thyroid function. Postoperative radiological evaluations were performed regularly. The rate of SSI was 6.4% (8/125 patients). By multivariate logistic regression, combined anterior and posterior approach and nonuse of iodine-supported spinal instruments were associated with an increased risk of SSI. The rate of SSI without iodine-supported spinal instruments was 12.5%, whereas the rate with iodine-supported spinal instruments was 1.4%. This difference was statistically significant. There were no detected abnormalities of thyroid gland function with the use of iodine-supported instruments. Among the 69 patients with iodine-supported spinal instruments, 2 patients required additional surgery because of instrument failure. However, there were no obvious involvements with the use of iodine-supported spinal instruments. This study identified combined anterior and posterior approach and nonuse of iodine-supported spinal instruments to be independent risk factors for SSI after TES. Iodine-supported spinal instrument was extremely effective for prevention of SSI in patients

  16. Correlation between high-resolution computed tomography and surgical findings in congenital aural atresia.

    Science.gov (United States)

    Mehra, Y N; Dubey, S P; Mann, S B; Suri, S

    1988-02-01

    Congenital aural atresia poses a great challenge, even to a competent otologic surgeon, due to innumerable types of malformations affecting the conduction and perception of sound. Roentgenographic evaluation by plain roentgenography is inconclusive in most cases; polytomography is helping to some extent. Recent generations of high-resolution computed tomographic (CT) scanners are probably the best. Seven cases of unilateral and three cases of bilateral congenital aural atresia were evaluated with high-resolution CT. Subsequently, ten ears were operated on. Surgical findings were correlated with CT scan findings with respect to atresia plate, extent of pneumatization, ossicular anomalies, bony facial nerve canal, and inner ear. Use of CT scans bears considerable importance in the management of these types of cases. High-resolution CT scan, when targeted for maximal bony detail, is possibly the method of choice in congenital aural atresia when surgical correction is contemplated.

  17. The effect of quitting smoking on the risk of unfavorable events after surgical treatment of oral potentially malignant lesions

    DEFF Research Database (Denmark)

    Vladimirov, B S; Schiødt, Morten

    2009-01-01

    The aim of this study was to examine if cessation of smoking after surgical excision of oral potentially malignant lesions in smokers reduced the risk of recurrences, development of new lesions or malignancies. 51 patients with oral leukoplakia or erythroplakia were included. They were daily smok...

  18. Incidence and risk factors of surgical site infection and septic arthritis after elective arthroscopy in horses.

    Science.gov (United States)

    Brunsting, Julie Y; Pille, Frederik J; Oosterlinck, Maarten; Haspeslagh, Maarten; Wilderjans, Hans C

    2017-10-16

    To determine the incidence of infection and associated risk factors, after elective arthroscopy. Retrospective case study. Horses (n=1079) undergoing elective arthroscopy. Medical records of all horses that underwent elective arthroscopy between 2006 and 2013 were reviewed. Age, gender, breed, surgeon, number of joints operated, total anesthetic time, perioperative antimicrobial administration, and the presence and size of osteochondral fragments/subchondral lesions were recorded. For each operated joint, the development of postoperative infection (surgical site infection [SSI] and/or septic arthritis) and long-term outcome (>6 months) were recorded. Multivariate logistic regression was used to test for association between the independent variables and the dependent outcomes. A total of 1741 joints in 1079 horses underwent arthroscopy. SSI without septic arthritis occurred in 1 fetlock joint (0.14%), 1 tibiotarsal joint (0.19%), and 6 femoropatellar joints (1.67%). Thirteen joints (0.75%) were diagnosed with septic arthritis, including 1 fetlock joint (0.14%), 4 tibiotarsal joints (0.74%), and 8 femoropatellar joints (2.23%). The probability of postoperative SSI was higher when large lesions (>40 mm long) were treated, compared to medium (20-40 mm, P = .005) and small (<20 mm, P < .001) lesions. SSI was a significant risk factor for the development of septic arthritis (P < .001). Although age did not affect the incidence of SSI, increasing age was associated with a lower rate of septic arthritis rate (P = .028). Septic arthritis after elective arthroscopy was more likely in the presence of SSI and younger age. Horses with large lesions were at risk for SSI, which translated into a higher incidence of postoperative septic arthritis after femoropatellar arthroscopy. © 2017 The American College of Veterinary Surgeons.

  19. Risk factors for surgical site infections after neurosurgery: A focus on the postoperative period.

    Science.gov (United States)

    Cassir, Nadim; De La Rosa, Silvestre; Melot, Anthony; Touta, Adamou; Troude, Lucas; Loundou, Anderson; Richet, Hervé; Roche, Pierre-Hugues

    2015-12-01

    Surgical site infection (SSI) after neurosurgery has potentially devastating consequences. A prospective cohort study was conducted over a period of 24 months in a university center. All adult patients undergoing neurosurgical procedures, with exception of open skull fractures, were included. Multivariate logistic regression analysis was used to identify independent risk factors. We included 949 patients. Among them, 43 were diagnosed with SSI (4.5%). A significant reduction in postneurosurgical SSI from 5.8% in 2009 to 3.0% in 2010 (P = .04) was observed. During that period, an active surveillance with regular feedback was established. The most common microorganisms isolated from SSI were Staphylococcus aureus (23%), Enterobacteriaceae (21%), and Propionibacterium acnes (12%). We identified the following independent risk factors for SSI postcranial surgery: intensive care unit (ICU) length of stay ≥7 days (odds ratio [OR] = 6.1; 95% confidence interval [CI], 1.7-21.7), duration of drainage ≥3 days (OR = 3.3; 95% CI, 1.1-11), and cerebrospinal fluid leakage (OR = 5.6; 95% CI, 1.1-30). For SSIs postspinal surgery, we identified the following: ICU length of stay ≥7 days (OR = 7.2; 95% CI, 1.6-32.1), coinfection (OR = 9.9; 95% CI, 2.2-43.4), and duration of drainage ≥3 days (OR = 5.7; 95% CI, 1.5-22). Active surveillance with regular feedback proved effective in reducing SSI rates. The postoperative period is associated with overlooked risk factors for neurosurgical SSI. Infection control measures targeting this period are therefore promising. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  20. Impact of surgical complications on the risk of hepatocellular carcinoma recurrence after hepatic resection.

    Science.gov (United States)

    Pravisani, Riccardo; Baccarani, Umberto; Isola, Miriam; Adani, Gianluigi; Lorenzin, Dario; Terrosu, Giovanni; Risaliti, Andrea

    2017-09-15

    Surgery-related morbidity has been identified as prognostic risk factor for tumor recurrence for several tumor types, but data regarding hepatocellular carcinoma (HCC) are limited and controversial. The aim of this study was to analyze the impact of surgical complications on the risk of HCC recurrence after hepatic resection (HR). A Retrospective study was conducted on a cohort of patients submitted to HR in a tertiary teaching hospital, between January 2006 and December 2015. 112 patients were submitted to HR during the study period. Cirrhosis was present in 84% of cases, with portal hypertension in 19.6%. The median MELD score was 8 (range 6-15). The median number of lesions per patient was 1 (range 1-5) with a mean diameter of 5.4 ± 3.8 cm. Major HR were performed in 18.2% of cases. Overall post-op morbidity was 48.2% with Clavien-Dindo (CD) severity score ≥3 in 15.2% of cases. The most frequent complications were infected biloma (19.6%) and liver failure (14%). HCC recurred in 48% of patients. At univariate analysis overall post-op complications (HR 2.313, p = 0.003), CD score >2 (HR 2.075, p = 0.047), post-op liver failure (HR 2.990, p = 0.007), post-op iperbilirubinemia (HR 1.151, p = 0.049), post-op bleeding (HR 2.633, p failure (HR 4.081, p failure and infected biloma are risk factors for HCC recurrence.

  1. High-frequency ultrasound in carpal tunnel syndrome: assessment of patient eligibility for surgical treatment

    Directory of Open Access Journals (Sweden)

    Katarzyna Kapuścińska

    2015-09-01

    Full Text Available Carpal tunnel syndrome (CTS is the most common entrapment neuropathy and a frequent cause of sick leaves because of work-related hand overload. That is why an early diagnosis and adequate treatment (conservative or surgical are essential for optimal patient management. Aim: The aim of the study is to assess the usefulness of high-frequency ultrasound in CTS for the assessment of patient eligibility for surgical treatment. Material and methods: The study involved 62 patients (50 women and 12 men, aged 28–70, mean age 55.2 with scheduled surgeries of CTS on the basis of clinical symptoms, physical examination performed by a neurosurgeon and a positive result of EMG testing. The ultrasound examinations of the wrist were performed in all these patients. On the basis of the collected data, the author has performed multiple analyses to confi rm the usefulness of ultrasound imaging in assessing patient eligibility for surgical treatment of CTS. Results: US examinations showed evidence of median nerve compression at the level of the carpal tunnel in all of the examined patients. This was further confi rmed during surgical procedures. The mean value of the cross-sectional area at the proximal part of the pisiform bone was 17.45 mm2 (min. 12 mm2 , max. 31 mm2 . Nerve hypoechogenicity proximal to the nerve compression site was visible in all 62 patients (100%. Increased nerve vascularity on the transverse section was present in 50 patients (80.65%. Conclusions: Ultrasonography with the use of high-frequency transducers is a valuable diagnostic tool both for assessing patient eligibility for surgical treatment of CTS, and in postoperative assessment of the treatment efficacy.

  2. Risk assessment of accidental exposure of surgeons to blood during orthopedic surgery. Are we safe in surgical gloves?

    Directory of Open Access Journals (Sweden)

    Dariusz Timler

    2014-03-01

    Full Text Available Aim. To analyze tears in sterile surgical gloves used by surgeons in the operating theatre of the Trauma and Orthopedic Surgery Department, Copernicus Memorial Hospital, Łódź, Poland Materials and Method. This study analyzes tears in sterile surgical gloves used by surgeons by ICD-9 and ICD-10 codes. 1,404 gloves were collected from 581 surgical procedures. All gloves were tested immediately following surgery using the test method described in Standard EN455–1 (each glove was inflated with 1,000 ± 50 ml of water and observed for leaks for 2–3 min.. Results. Analysis of tears took into consideration the role of medical personnel (operator, first assistant, second assistant during surgical procedure, the type of procedure according to ICD-9 and ICD-10 codes, and the elective or emergency nature of the procedure. The results of the study show that these factors have a significant influence on the risk of glove tears. Significant differences were observed in tear frequency and tear location depending on the function performed by the surgeon during the procedure. Conclusion. The study proved that the role performed by the surgeon during the procedure (operator, first assistant, second assistant has a significant influence on the risk of glove tearing. The role in the procedure determines exposure to glove tears. Implementing a double gloving procedure in surgical procedures or using single gloves characterized by higher tear resistance should be considered.

  3. 5-Aminolevulinic acid fluorescence in high grade glioma surgery: surgical outcome, intraoperative findings, and fluorescence patterns.

    Science.gov (United States)

    Della Puppa, Alessandro; Ciccarino, Pietro; Lombardi, Giuseppe; Rolma, Giuseppe; Cecchin, Diego; Rossetto, Marta

    2014-01-01

    5-Aminolevulinic acid (5-ALA) fluorescence is a validated technique for resection of high grade gliomas (HGG); the aim of this study was to evaluate the surgical outcome and the intraoperative findings in a consecutive series of patients. Clinical and surgical data from patients affected by HGG who underwent surgery guided by 5-ALA fluorescence at our Department between June 2011 and February 2014 were retrospectively evaluated. Surgical outcome was evaluated by assessing the resection rate as gross total resection (GTR) > 98% and GTR > 90%. We finally stratified data for recurrent surgery, tumor location, tumor size, and tumor grade (IV versus III grade sec. WHO). 94 patients were finally enrolled. Overall GTR > 98% and GTR > 90% was achieved in 93% and 100% of patients. Extent of resection (GTR > 98%) was dependent on tumor location, tumor grade (P < 0.05), and tumor size (P < 0.05). In 43% of patients the boundaries of fluorescent tissue exceeded those of tumoral tissue detected by neuronavigation, more frequently in larger (57%) (P < 0.01) and recurrent (60%) tumors. 5-ALA fluorescence in HGG surgery enables a GTR in 100% of cases even if selection of patients remains a main bias. Recurrent surgery, and location, size, and tumor grade can predict both the surgical outcome and the intraoperative findings.

  4. 5-Aminolevulinic Acid Fluorescence in High Grade Glioma Surgery: Surgical Outcome, Intraoperative Findings, and Fluorescence Patterns

    Directory of Open Access Journals (Sweden)

    Alessandro Della Puppa

    2014-01-01

    Full Text Available Background. 5-Aminolevulinic acid (5-ALA fluorescence is a validated technique for resection of high grade gliomas (HGG; the aim of this study was to evaluate the surgical outcome and the intraoperative findings in a consecutive series of patients. Methods. Clinical and surgical data from patients affected by HGG who underwent surgery guided by 5-ALA fluorescence at our Department between June 2011 and February 2014 were retrospectively evaluated. Surgical outcome was evaluated by assessing the resection rate as gross total resection (GTR>98% and GTR>90%. We finally stratified data for recurrent surgery, tumor location, tumor size, and tumor grade (IV versus III grade sec. WHO. Results. 94 patients were finally enrolled. Overall GTR>98% and GTR>90% was achieved in 93% and 100% of patients. Extent of resection (GTR>98% was dependent on tumor location, tumor grade (P<0.05, and tumor size (P<0.05. In 43% of patients the boundaries of fluorescent tissue exceeded those of tumoral tissue detected by neuronavigation, more frequently in larger (57% (P<0.01 and recurrent (60% tumors. Conclusions. 5-ALA fluorescence in HGG surgery enables a GTR in 100% of cases even if selection of patients remains a main bias. Recurrent surgery, and location, size, and tumor grade can predict both the surgical outcome and the intraoperative findings.

  5. High risk of permafrost thaw

    Science.gov (United States)

    E.A.G. Schuur; B.W. Abbott; W.B. Bowden; V. Brovkin; P. Camill; J.P. Canadell; F.S. Chapin; T.R. Christensen; J.P. Chanton; P. Ciais; P.M. Crill; B.T. Crosby; C.I. Czimczik; G. Grosse; D.J. Hayes; G. Hugelius; J.D. Jastrow; T. Kleinen; C.D. Koven; G. Krinner; P. Kuhry; D.M. Lawrence; S.M. Natali; C.L. Ping; A. Rinke; W.J. Riley; V.E. Romanovsky; A.B.K. Sannel; C. Schadel; K. Schaefer; Z.M. Subin; C. Tarnocai; M. Turetsky; K. M. Walter-Anthony; C.J. Wilson; S.A. Zimov

    2011-01-01

    Arctic temperatures are rising fast, and permafrost is thawing. Carbon released into the atmosphere from permafrost soils will accelerate climate change, but the magnitude of this effect remains highly uncertain. Our collective estimate is that carbon will be released more quickly than models suggest, and at levels that are cause for serious concern. We calculate that...

  6. Efficacy of Eyesi surgical simulator training in improving high-tension capsules capsulorhexis performance

    Directory of Open Access Journals (Sweden)

    Tiago Bisol

    Full Text Available ABSTRACT Purpose: To evaluate if Eyesi cataract surgical simulator training using its standard course curriculum is effective in improving performance of cataract surgery trainees on creating capsulorhexis on high-tension capsules on the simulator. Methods: We retrospectively analyzed training reports of ophthalmic surgery trainees (2nd and 3rd year residents and cataract fellowship trainees that have accomplished the standard Eyesi cataract surgery simulator training course version 2.1 between May 2012 and August 2013 at Instituto de Diagnostico e Terapia Ocular, Rio de Janeiro, Brazil. We compared the mean score (from 0 to 100 attributed by the simulator on performing the same task, a capsulorhexis on a high-tension capsule, on the surgical simulator "before training" (during beginning of the course and "after training" (at later stages of the course. Results: Thirty-seven trainees' reports were analyzed. Mean and standard deviation "before training" high-tension capsulorhexis score was 41.73 ± 27.08 points and the mean "after training" score was 72.55 ± 16.40 points, a difference of +30.82 points (p value <0.001 on Paired t test, representing a 73% improvement on performance. Conclusions: Eyesi surgical simulator training on course version 2.1 curriculum was effective in improving performance of cataract surgery trainees on creating capsulorhexis on high-tension capsules.

  7. Environment of care: Is it time to reassess microbial contamination of the operating room air as a risk factor for surgical site infection in total joint arthroplasty?

    Science.gov (United States)

    Parvizi, Javad; Barnes, Sue; Shohat, Noam; Edmiston, Charles E

    2017-11-01

    In the modern operating room (OR), traditional surgical mask, frequent air exchanges, and architectural barriers are viewed as effective in reducing airborne microbial populations. Intraoperative sampling of airborne particulates is rarely performed in the OR because of technical difficulties associated with sampling methodologies and a common belief that airborne contamination is infrequently associated with surgical site infections (SSIs). Recent studies suggest that viable airborne particulates are readily disseminated throughout the OR, placing patients at risk for postoperative SSI. In 2017, virtually all surgical disciplines are engaged in the implantation of selective biomedical devices, and these implants have been documented to be at high risk for intraoperative contamination. Approximately 1.2 million arthroplasties are performed annually in the United States, and that number is expected to increase to 3.8 million by the year 2030. The incidence of periprosthetic joint infection is perceived to be low (air quality standards on their manufacturing processes, there is currently no U.S. standard for acceptable air quality within the OR environment. This review documents the contribution of air contamination to the etiology of periprosthetic joint infection, and evidence for selective innovative strategies to reduce the risk of intraoperative microbial aerosols. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  8. An Internet-based survey of risk factors for surgical gastric dilatation-volvulus in dogs.

    Science.gov (United States)

    Pipan, Marko; Brown, Dorothy Cimino; Battaglia, Carmelo L; Otto, Cynthia M

    2012-06-15

    To evaluate risk factors for gastric dilatation-volvulus (GDV) in a large number of privately owned dogs across a wide geographic area. Internet-based, cross-sectional study. 2,551 privately owned dogs. A questionnaire addressed dog-specific, management, environmental, and personality-associated risk factors for GDV in dogs. Respondents were recruited through the posting of the electronic link to the questionnaire on websites for dog owners; the information was also disseminated at meetings of dog owners and via newsletters, e-mail lists for dog owners and breeders, owner-oriented dog publications, and e-mails forwarded by participants. Descriptive statistics and logistic regression analysis were performed. Factors significantly associated with an increased risk of GDV were being fed dry kibble, anxiety, residence in the United Kingdom, being born in the 1990s, being a family pet, and spending at least 5 hours a day with the owner. Factors associated with a decreased risk of GDV were playing with other dogs and running the fence after meals, fish and egg dietary supplements, and spending equal time indoors and outdoors. A significant interaction between sex and neuter status was observed, with sexually intact females having the highest risk for GDV. In dogs with a high risk of GDV, regular moderate daily and postprandial activity appeared to be beneficial. Feeding only commercial dry dog food may not be the best choice for dogs at risk; however, supplements with fish or eggs may reduced this risk. The effect of neuter status on GDV risk requires further characterization.

  9. Adjacent tooth trauma in complicated mandibular third molar surgery: Risk degree classification and digital surgical simulation.

    Science.gov (United States)

    Ye, Zhou-Xi; Yang, Chi; Ge, Jing

    2016-12-15

    Analysis of adjacent tooth resistance is essential in wisdom teeth extraction to prevent adjacent tooth trauma, however it lacks adequate attention nowadays. This study aims at suggesting special extraction methods based on adjacent tooth resistance analysis for prevention of adjacent tooth damage. In this study, 136 complicated mandibular third molars extracted using piezosurgery were reviewed and classified based on the adjacent teeth resistances shown in orthopantomogram (OPG) during their mesio-distal rotations: degree I refers to teeth with no adjacent teeth resistance; degree II refers to teeth with resistance released after mesial-half crown sectioning; degree III refers to teeth which still had resistance after mesial-half crown sectioning. With the use of surgical simulations using cone beam computerized tomography (CBCT) reconstruction, all teeth in degree I were designed to rotate mesio-distally; 86.36%(38/44) teeth in degree II were designed to rotate mesio-distally after mesio-half crown sectioning; 69.09%(36/55) teeth in degree III were designed to rotate bucco-lingually. All teeth were extracted successfully, and only one adjacent tooth was subluxated due to the incomplete bone removal. Our study suggested that in order to prevent adjacent teeth trauma, complete bone removal is of importance, and impacted teeth with higher adjacent teeth trauma risks should consider bucco-lingual rotations.

  10. Risk factors for hypoxemia following surgical repair of acute type A aortic dissection.

    Science.gov (United States)

    Liu, Nan; Zhang, Wei; Ma, Weiguo; Shang, Wei; Zheng, Jun; Sun, Lizhong

    2017-02-01

    To identify the risk factors for hypoxaemia following surgical repair of acute type A aortic dissection. This was a retrospective study of patients treated between October 2013 and December 2014 at the Department of Cardiovascular Surgery, Anzhen Hospital, China. Univariable and multivariable analyses were performed on the clinical data of 160 patients with acute type A dissection and who underwent ascending aortic and arch replacement under deep hypothermic circulatory arrest. Hypoxaemia occurred in 30% (48/160) of patients (age: 49 ± 7.9 years; 40 males, 83.3%). The duration of ventilation and the lengths of intensive care unit and hospital stays were significantly longer in patients with hypoxemia (77.9 ± 56.0 vs 16.5 ± 11.5 h, P 15 000/μl (odds ratio, 9.79; 95% CI, 2.47-38.87; P = 0.001); and deep hypothermic circulatory arrest time >25 min (odds ratio, 3.26; 95% CI, 1.18-8.99; P = 0.023). Time from symptom onset to surgery ≤72 h, preoperative PaO2/FiO2 ≤300, white blood cell count >15 000/μl and deep hypothermic circulatory arrest time >25 min were found to be independently associated with hypoxaemia after surgery for acute type A aortic dissection.

  11. Risk factors for continuous renal replacement therapy after surgical repair of type A aortic dissection.

    Science.gov (United States)

    Wu, Hai-Bo; Ma, Wei-Guo; Zhao, Hong-Lei; Zheng, Jun; Li, Jian-Rong; Liu, Ou; Sun, Li-Zhong

    2017-04-01

    To identify the risk factors for continuous renal replacement therapy (CRRT) following surgical repair of type A aortic dissection (TAAD) using the total arch replacement and frozen elephant trunk (TAR + FET) technique. The study included 330 patients with TAAD repaired using TAR + FET between January 2014 and April 2015. Mean age was 47.1±10.2 years (range, 18-73 years) and 242 were male (73.3%). Univariate and multivariate analyses were used to identify the risk factors for CRRT. Postoperative CRRT was required in 38 patients (mean age 50.7±10.0 years; 27 males). Operative death occurred in 12 patients (3.6%, 12/330). The mortality rate was 23.7% (9/38) in patients with CRRT and 1.0% (3/292) in those without CRRT (PCRRT were age (50.7±10.0 vs. 46.7±10.2 years, P=0.023), preoperative serum creatinine (sCr) (135.0±154.2 vs. 85.7±37.0 µmol/L, PCRRT were CPB time (minute) [odds ratio (OR) 1.018; 95% confidence interval (CI), 1.007-1.029; P=0.002], preoperative sCr level (µmol/L) (OR, 1.008; 95% CI, 1.000-1.015; P=0.040), and the amount of red blood cell transfused intraoperatively (unit) (OR, 1.206; 95% CI, 1.077-1.350; PCRRT after TAR + FET.

  12. Risk of Acute Kidney Injury with Amikacin versus Gentamycin both in Combination with Metronidazole for Surgical Prophylaxis.

    Science.gov (United States)

    Giri, Vishal Prakash; Giri, Om Prakash; Bajracharya, Subarna; Khan, Farhan Ahmad; Sinha, Shanker Prasad; Kanodia, Shubhra; Bansal, Chitrak

    2016-01-01

    Surgical site infection is one of the most important complication of surgery. It increases the mortality and morbidity. In order to decrease the incidence of surgical site infections perioperative antimicrobial prophylaxis has been recommended in certain types of clean and clean contaminated surgeries. Aminoglycosides are indicated as surgical prophylaxis for prevention of surgical site infection in patients with B-lactam allergy. The present study was carried out to study and compare the renal safety profile of single high dose gentamycin and amikacin as surgical prophylactic antibiotic. Prospective and randomized study was carried out on 100 patients for over one year period in a tertiary care teaching hospital of western Uttar Pradesh, India. Patients in amikacin group received amikacin 15 mg/kg + metronidazole 500 mg intravenously single dose and those in the gentamycin group had gentamycin 5 mg/kg + metronidazole 500 mg intravenously single dose, one hour prior to incision. A total of 16% patients of amikacin group and 24% patients of gentamycin group developed acute kidney injury within one week of drug administration. The rise in serum creatinine was temporary as all patients had normal serum creatinine level at one month follow up. Aminoglycoside intravenous single high dose is not safe as surgical prophylaxis.

  13. Improving antenatal risk assessment in women exposed to high risks.

    Science.gov (United States)

    Perry, Natasha; Newman, Louise K; Hunter, Mick; Dunlop, Adrian

    2015-01-01

    Antenatal substance use and related psychosocial risk factors are known to increase the likelihood of child protection involvement; less is known about the predictive nature of maternal reflective functioning (RF) in this population. This preliminary study assessed psychosocial and psychological risk factors for a group of substance dependent women exposed to high risks in pregnancy, and their impact on child protection involvement. Pregnant women on opiate substitution treatment (n = 11) and a comparison group (n = 15) were recruited during their third trimester to complete measures of RF (Pregnancy Interview), childhood trauma, mental health and psychosocial assessments. At postnatal follow-up, RF was reassessed (Parent Development Interview - Revised Short Version) and mother-infant dyads were videotaped to assess emotional availability (EA). Child protection services were contacted to determine if any concerns had been raised for infant safety. Significant between-group differences were observed for demographics, psychosocial factors, trauma and mental health symptoms. Unexpectedly, no significant differences were found for RF or EA between groups. Eight women in the 'exposed to high risks' group became involved with child protection services. Reflective functioning was not significantly associated with psychosocial risk factors, and therefore did not mediate the outcome of child protection involvement. Women 'exposed to high risks' were equally able to generate a model of their own and their infants' mental states and should not be seen within a deficit perspective. Further research is required to better understand the range of risk factors that predict child protection involvement in high risk groups. © The Author(s) 2013.

  14. The high-risk plaque initiative

    DEFF Research Database (Denmark)

    Falk, Erling; Sillesen, Henrik; Muntendam, Pieter

    2011-01-01

    The High-Risk Plaque (HRP) Initiative is a research and development effort to advance the understanding, recognition, and management of asymptomatic individuals at risk for a near-term atherothrombotic event such as myocardial infarction or stroke. Clinical studies using the newest technologies...

  15. High risk of permafrost thaw

    Energy Technology Data Exchange (ETDEWEB)

    Schuur, E.A.G.; Abbott, B.; Koven, C.D,; Riley, W.J.; Subin, Z.M.; al, et

    2011-11-01

    In the Arctic, temperatures are rising fast, and permafrost is thawing. Carbon released to the atmosphere from permafrost soils could accelerate climate change, but the likely magnitude of this effect is still highly uncertain. A collective estimate made by a group of permafrost experts, including myself, is that carbon could be released more quickly than models currently suggest, and at levels that are cause for serious concern. While our models of carbon emission from permafrost thaw are lacking, experts intimately familiar with these landscapes and processes have accumulated knowledge about what they expect to happen, based on both quantitative data and qualitative understanding of these systems. We (the authors of this piece) attempted to quantify this expertise through a survey developed over several years, starting in 2009. Our survey asked experts what percentage of surface permafrost they thought was likely to thaw, how much carbon would be released, and how much of that would be methane, for three time periods and under four warming scenarios that are part of the new IPCC Fifth Assessment Report.

  16. High risk pregnancy monitored antenatally at home

    NARCIS (Netherlands)

    Monincx, W. M.; Zondervan, H. A.; Birnie, E.; Ris, M.; Bossuyt, P. M.

    1997-01-01

    OBJECTIVE: Is domiciliary antenatal fetal surveillance for selected high risk pregnancies, a feasible alternative for hospital admission? DESIGN: A randomized controlled trial conducted at the Academical Medical Centre, Amsterdam, The Netherlands. SUBJECTS: Between September 1992 and June 1994, 76

  17. Resection of ictal high-frequency oscillations leads to favorable surgical outcome in pediatric epilepsy

    Science.gov (United States)

    Fujiwara, Hisako; Greiner, Hansel M.; Lee, Ki Hyeong; Holland-Bouley, Katherine D.; Seo, Joo Hee; Arthur, Todd; Mangano, Francesco T.; Leach, James L.; Rose, Douglas F.

    2012-01-01

    Summary Purpose Intracranial electroencephalography (EEG) is performed as part of an epilepsy surgery evaluation when noninvasive tests are incongruent or the putative seizure-onset zone is near eloquent cortex. Determining the seizure-onset zone using intracranial EEG has been conventionally based on identification of specific ictal patterns with visual inspection. High-frequency oscillations (HFOs, >80 Hz) have been recognized recently as highly correlated with the epileptogenic zone. However, HFOs can be difficult to detect because of their low amplitude. Therefore, the prevalence of ictal HFOs and their role in localization of epileptogenic zone on intracranial EEG are unknown. Methods We identified 48 patients who underwent surgical treatment after the surgical evaluation with intracranial EEG, and 44 patients met criteria for this retrospective study. Results were not used in surgical decision making. Intracranial EEG recordings were collected with a sampling rate of 2,000 Hz. Recordings were first inspected visually to determine ictal onset and then analyzed further with time-frequency analysis. Forty-one (93%) of 44 patients had ictal HFOs determined with time-frequency analysis of intracranial EEG. Key Findings Twenty-two (54%) of the 41 patients with ictal HFOs had complete resection of HFO regions, regardless of frequency bands. Complete resection of HFOs (n = 22) resulted in a seizure-free outcome in 18 (82%) of 22 patients, significantly higher than the seizure-free outcome with incomplete HFO resection (4/19, 21%). Significance Our study shows that ictal HFOs are commonly found with intracranial EEG in our population largely of children with cortical dysplasia, and have localizing value. The use of ictal HFOs may add more promising information compared to interictal HFOs because of the evidence of ictal propagation and followed by clinical aspect of seizures. Complete resection of HFOs is a favorable prognostic indicator for surgical outcome. PMID

  18. Unmet needs and current and future approaches for osteoporotic patients at high risk of hip fracture.

    Science.gov (United States)

    Ferrari, Serge; Reginster, Jean-Yves; Brandi, Maria Luisa; Kanis, John A; Devogelaer, Jean-Pierre; Kaufman, Jean-Marc; Féron, Jean-Marc; Kurth, Andreas; Rizzoli, René

    2016-12-01

    This review provides a critical analysis of currently available approaches to increase bone mass, structure and strength through drug therapy and of possible direct intra-osseous interventions for the management of patients at imminent risk of hip fracture. Osteoporotic hip fractures represent a particularly high burden in morbidity-, mortality- and health care-related costs. There are challenges and unmet needs in the early prevention of hip fractures, opening the perspective of new developments for the management of osteoporotic patients at imminent and/or at very high risk of hip fracture. Amongst them, preventive surgical intervention needs to be considered. A European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO)/International Osteoporosis Foundation (IOF) working group reviewed the presently available intervention modalities including preventive surgical options for hip fragility. This paper represents a summary of the discussions. Prevention of hip fracture is currently based on regular physical activity; prevention of falls; correction of nutritional deficiencies, including vitamin D repletion; and pharmacological intervention. However, efficacy of these various measures to reduce hip fractures is at most 50% and may need months or years before becoming effective. To face the challenges of early prevention of hip fractures for osteoporotic patients at imminent and/or at very high risk of hip fracture, preventive surgical intervention needs further investigation. Preventive surgical intervention needs to be appraised for osteoporotic patients at imminent and/or at very high risk of hip fracture.

  19. Assessment of anal fistulas with high-resolution subtraction MR-fistulography: comparison with surgical findings.

    Science.gov (United States)

    Schaefer, Oliver; Lohrmann, Christian; Langer, Mathias

    2004-01-01

    To investigate a new MR-imaging protocol defined as subtraction MR-fistulography for the detection of fistula-in-ano. A total of 36 patients (18 men, 18 women) with the clinical diagnosis of anal fistula or abscess who were scheduled for surgical exploration were preoperatively imaged at 1.5 T in the supine position; coronal STIR sequences and axial T1-weighted three-dimensional FLASH sequences before and after intravenous injection of gadobenate dimeglumine (Gd-BOPTA) were obtained. Image subtraction was routinely used. The image findings were compared with the findings at surgical exploration according to a uniform classification system. A total of 46 fistulas were seen on subtraction MR-fistulography, whereas surgery described 41 fistulas. MRI and surgery concordantly depicted a total number of 40 fistulas, six fistulas were only described by MRI, and one fistula was only seen during surgery. A total of 27 abscesses were detected with MRI, compared to 22 during surgery. A total of 22 abscesses were concordantly diagnosed. Complete agreement between subtraction MR-fistulography and surgery occurred in 32 (89%) of the 36 patients. The four patients in whom both procedures disagreed had complex anal sepsis with multiple fistulas and/or abscesses due to Crohn disease. High-resolution subtraction MR-fistulography is an important complement to surgical exploration and especially suitable for investigating complex anal sepsis. Copyright 2003 Wiley-Liss, Inc.

  20. [Is obesity a risk factor for complications, hospital admissions, and surgical cancellations in ambulatory surgery?].

    Science.gov (United States)

    Arance García, M; Docobo Durántez, F; Conde Guzmán, C; Pérez Torres, M C; Martín-Gil Parra, R; Fernández Jiménez, P E

    2015-03-01

    To determine the incidence of outcomes, unanticipated admissions and cancellations in patients operated in an Ambulatory surgery unit, and to establish the relationships with their body mass index (BMI). An observational descriptive prospective study was conducted in the Ambulatory surgery unit of the University Hospital Virgen del Rocío of Seville, on ASA I or II adult patients proposed for day case surgery with loco-regional or general anesthesia. A cohort of 1,088 patients was classified according to their body mass index into four groups: no obesity (BMI<30), obesity i (BMI 30-34.9), obesity ii (BMI 35-39.9), and morbid obesity iii (BMI 40-49.9). Postoperative outcomes (48h), inpatient admissions, and cancellations where calculated. The obesity ii (BMI 35-39.9) group showed a higher incidence of postoperative complications (7.69%), unplanned admissions (7.69%), and surgical cancellations (4.87%), doubling, at least, the incidence of adverse events of the other study groups, even when no significant difference was found. Outcomes where similar in all study groups. The results of this study suggest that moderate and severe obesity should be a risk factor for postoperative complications, unplanned admissions, and cancellations in outpatient surgery. Adequate patient selection and preoperative evaluation, as well as strategies for the prevention and control of the most frequents complications in obese patients are the key factors for their integration in major ambulatory surgery programs. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Incidence and risk factors for surgical site infections in obstetric and gynecological surgeries from a teaching hospital in rural India

    Directory of Open Access Journals (Sweden)

    Ashish Pathak

    2017-06-01

    Full Text Available Abstract Background Surgical site infections (SSI are one of the most common healthcare associated infections in the low-middle income countries. Data on incidence and risk factors for SSI following surgeries in general and Obstetric and Gynecological surgeries in particular are scare. This study set out to identify risk factors for SSI in patients undergoing Obstetric and Gynecological surgeries in an Indian rural hospital. Methods Patients who underwent a surgical procedure between September 2010 to February 2013 in the 60-bedded ward of Obstetric and Gynecology department were included. Surveillance for SSI was based on the Centre for Disease Control (CDC definition and methodology. Incidence and risk factors for SSI, including those for specific procedure, were calculated from data collected on daily ward rounds. Results A total of 1173 patients underwent a surgical procedure during the study period. The incidence of SSI in the cohort was 7.84% (95% CI 6.30–9.38. Majority of SSI were superficial. Obstetric surgeries had a lower SSI incidence compared to gynecological surgeries (1.2% versus 10.3% respectively. The risk factors for SSI identified in the multivariate logistic regression model were age (OR 1.03, vaginal examination (OR 1.31; presence of vaginal discharge (OR 4.04; medical disease (OR 5.76; American Society of Anesthesia score greater than 3 (OR 12.8; concurrent surgical procedure (OR 3.26; each increase in hour of surgery, after the first hour, doubled the risk of SSI; inappropriate antibiotic prophylaxis increased the risk of SSI by nearly 5 times. Each day increase in stay in the hospital after the surgery increased the risk of contacting an SSI by 5%. Conclusions Incidence and risk factors from prospective SSI surveillance can be reported simultaneously for the Obstetric and Gynecological surgeries and can be part of routine practice in resource-constrained settings. The incidence of SSI was lower for Obstetric surgeries

  2. Management of high-risk pregnancy.

    Science.gov (United States)

    Coco, L; Giannone, T T; Zarbo, G

    2014-08-01

    Today, 88% of pregnancies has a physiological course during which just basic care, while in 12% of cases there is a high-risk pregnancy that requires additional assistance and specific. The approach that should be used is that of supervision in all pregnant women considering their potential to have a normal pregnancy until there is no clear evidence to the contrary. Pregnancy is considered at risk if there are medical conditions that may affect maternal or fetal health or life of the mother, fetus or both. Among the risk factors for pregnancy there is first the woman's age, in fact the increase in high-risk pregnancies in the last 20 years is attributable to the increase in the average age of women who face pregnancy. In addition, the diet is very important during pregnancy and diabetes or autoimmune diseases often lead to the failure of a pregnancy. Risk factors for pregnancy, also, are the complications that occur during its course as hypertension during pregnancy, and infectious diseases. Fears and anxieties typical of a high-risk pregnancy prevent the couple to live happily in the months of gestation. Effective communication, control and early detection are important tools that doctors must be able to ensure that women in order to plan the best treatment strategies and to minimize the risks of maternal and / or fetal.

  3. Risk factors for surgical site infection and delayed wound healing after orthopedic surgery in rheumatoid arthritis patients.

    Science.gov (United States)

    Kadota, Yasutaka; Nishida, Keiichiro; Hashizume, Kenzo; Nasu, Yoshihisa; Nakahara, Ryuichi; Kanazawa, Tomoko; Ozawa, Masatsugu; Harada, Ryozo; Machida, Takahiro; Ozaki, Toshifumi

    2016-01-01

    To investigate the prevalence and the risk factors of surgical-site infection (SSI) and delayed wound healing (DWH) in patients with rheumatoid arthritis (RA) underwent orthopedic surgery. We reviewed the records of 1036 elective orthopedic procedures undertaken in RA patients. Risk factors for SSI and DWH were assessed by logistic regression analysis using age, body mass index, disease duration, pre-operative laboratory data, surgical procedure, corticosteroid use, co-morbidity, and use of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) and biological DMARDs (bDMARDs) as variables. SSI and DWH were identified in 19 cases and 15 cases, respectively. One case of SSI and three cases of DWH were recorded among 196 procedures in patients using bDMARDs. Foot and ankle surgery was associated with an increased risk of SSI (odds ratio (OR), 3.167; 95% confidence interval (CI), 1.256-7.986; p = 0.015). Total knee arthroplasty (TKA; OR, 4.044; 95% CI, 1.436-11.389; p = 0.008) and disease duration (OR, 1.004; 95% CI, 1.000-1.007; p = 0.029) were associated with an increased risk of DWH. Our results indicated foot and ankle surgery, and TKA and disease duration as risk factors for SSI and DWH, respectively. bDMARDs was not associated with an increased risk of SSI and DWH.

  4. National surveillance of surgical site infections after coronary artery bypass grafting in Norway: incidence and risk factors.

    Science.gov (United States)

    Berg, Thale Cathrine; Kjørstad, Knut E; Akselsen, Per Espen; Seim, Bjørn Edvard; Løwer, Hege Line; Stenvik, Maryann Nesset; Sorknes, Nina Kristine; Eriksen, Hanne-Merete

    2011-12-01

    A mandatory national surveillance system for surgical site infections (SSIs) following certain surgical procedures, including coronary artery bypass grafting (CABG), was introduced in Norway in 2005. The objectives of this study were to measure national baseline incidence rates of SSIs after CABG, describe the characteristics of the patients and procedures, and identify possible risk factors for infection. In 2005-2009, all hospitals that performed CABG were invited to assess all patients undergoing CABG surgery in 3-month periods for SSIs. The hospitals evaluated infection status at discharge and 30 days after surgery by sending post-discharge questionnaires to all patients. We calculated incidence proportions and risk ratios for different risk factors. We applied the National Nosocomial Infection Surveillance (NNIS) risk index to the data. In total, 2440 patients were included. Altogether, 124 sternal and 217 harvest site infections were registered, giving incidence proportions of 5.1% and 8.9%, respectively. Over 95% of infections occurred post-discharge from the hospital. No risk factors were identified. Incidence did not significantly increase with higher NNIS risk index; however, 93% of the patients fell into the same risk category. We have provided a baseline rate for SSIs after CABG procedures in Norway. The results show the importance of post-hospital discharge follow-up. The NNIS risk index did not adequately stratify CABG patients. We recommend that more potential risk variables should be included in the surveillance, such as the European System for Cardiac Operative Risk Evaluation (EuroSCORE), height, weight, and diabetes. Copyright © 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  5. Risk Factors Associated with Loco-Regional Failure after Surgical Resection in Patients with Resectable Pancreatic Cancer.

    Science.gov (United States)

    Kim, Hyun Ju; Lee, Woo Jung; Kang, Chang Moo; Hwang, Ho Kyoung; Bang, Seung Min; Song, Si Young; Seong, Jinsil

    2016-01-01

    To evaluate the risk factors associated with loco-regional failure after surgical resection and to identify the subgroup that can obtain benefits from adjuvant radiotherapy (RT). We identified patients treated with surgical resection for resectable pancreatic cancer at Severance hospital between January 1993 and December 2014. Patients who received any neoadjuvant or adjuvant RT were excluded. A total of 175 patients were included. Adjuvant chemotherapy was performed in 107 patients with either a gemcitabine-based regimen (65.4%) or 5-FU based one (34.9%). The median loco-regional failure-free survival (LRFFS) and overall survival (OS) were 23.9 and 33.6 months, respectively. A recurrence developed in 108 of 175 patients (61.7%). The predominant pattern of the first failure was distant (42.4%) and 47 patients (26.9%) developed local failure as the first site of recurrence. Multivariate analysis identified initial CA 19-9 ≥ 200 U/mL, N1 stage, perineural invasion (PNI), and resection margin as significant independent risk factors for LRFFS. Patients were divided into four groups according to the number of risk factors, including initial CA 19-9, N stage, and PNI. Patients exhibiting two risk factors had 3.2-fold higher loco-regional failure (P < 0.001) and patients with all risk factors showed a 6.5-fold increase (P < 0.001) compared with those with no risk factors. In the analysis for OS, patients with more than two risk factors also had 3.3- to 6-fold higher risk of death with statistical significance. The results suggest that patients who exhibit more than two risk factors have a higher risk of locoregional failure and death. This subgroup could be benefited by the effective local adjuvant treatment.

  6. Major abdominal surgery in octogenarians: should high age affect surgical decision-making?

    Science.gov (United States)

    Straatman, Jennifer; Van der Wielen, Nicole; Cuesta, Miguel A; de Lange-de Klerk, Elly S M; van der Peet, Donald L

    2016-11-01

    Over the last decades longevity has increased significantly, with more octogenarians undergoing surgery. Here, we assess surgical outcomes after major abdominal surgery in octogenarians. Observational cohort of 874 patients undergoing major abdominal elective surgery between January 2009 and March 2014. Seventy-six octogenarians were propensity matched to 76 younger patients, corrected for sex, body mass index, American Society of Anesthesiologists classification, comorbidity, indication, and type of surgery. Minor complications were more prevalent in octogenarians (P = .01) and consisted mainly of respiratory complications; progressing to respiratory insufficiency requiring intubation in 28.6%. Preoperative weight loss (odds ratio 3 [1.1 to 8.3]) and upper gastrointestinal surgery (odds ratio 11 [2 to 60]) were associated with minor complications. Octogenarians are at increased risk of minor complications after major abdominal surgery. Major complication rates were similar, indicating the importance of preoperative assessment and standardized surgical techniques. Taking into account preoperative morbidities and type of surgery and techniques. Implementation of quality control algorithms may further improve outcomes in octogenarians. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Electroconvulsive therapy during high-risk pregnancy.

    Science.gov (United States)

    Walker, R; Swartz, C M

    1994-09-01

    Pregnancy increases the risk of injury associated with mental illness. The varieties of malnutrition, substance abuse, and aggression that may accompany mental illness can injure the unborn child in more severe ways than the patient herself. Dangers associated with illness-related behavior can outweight the risks of pharmacotherapy, but no psychotropic drug is approved for use during pregnancy. Failure to produce a prompt or lasting remission of psychiatric symptoms also is a significant possibility with medication. The morbidity from continued illness and the incompletely described adverse effects of psychotropic drugs increases the attractiveness of ECT for severely depressed pregnant patients, especially with associated high-risk conditions. This paper discusses physiologic changes occurring during pregnancy and ECT and reviews contemporary monitors of maternal and fetal well-being. Guidelines are suggested for ECT during regular and high-risk pregnancies. The authors conclude that using additional precautions with high-risk pregnant patients permits ECT to be given with relative safety; medical and obstetric risk factors need not prevent its use.

  8. Evaluation of biochemical recurrence-free survival after radical prostatectomy by cancer of the prostate risk assessment post-surgical (CAPRA-S) score.

    Science.gov (United States)

    Aktas, Binhan Kagan; Ozden, Cuneyt; Bulut, Suleyman; Tagci, Suleyman; Erbay, Guven; Gokkaya, Cevdet Serkan; Baykam, Mehmet Murat; Memis, Ali

    2015-01-01

    The cancer of the prostate risk assessment (CAPRA) score has been defined to predict prostate cancer recurrence based on the pre-clinical data, then pathological data have also been incorporated. Thus, CAPRA post-surgical (CAPRA-S) score has been developed based on six criteria (prostate specific antigen (PSA) at diagnosis, pathological Gleason score, and information on surgical margin, seminal vesicle invasion, extracapsular extension and lymph node involvement) for the prediction of post-surgical recurrences. In the present study, biochemical recurrence (BCR)-free probabilities after open retropubic radical prostatectomy (RP) were evaluated by the CAPRA-S scoring system and its three-risk level model. CAPRA-S scores (0-12) of our 240 radical prostatectomies performed between January 2000-May 2011 were calculated. Patients were distributed into CAPRA-S score groups and also into three-risk groups as low, intermediate and high. BCR-free probabilities were assessed and compared using Kaplan-Meier analysis and Cox proportional hazards regression. Ability of CAPRA-S in BCR detection was evaluated by concordance index (c-index). BCR was present in 41 of total 240 patients (17.1%) and the mean follow-up time was 51.7±33.0 months. Mean BCR-free survival time was 98.3 months (95% CI: 92.3-104.2). Of the patients in low, intermediate and high risk groups, 5.4%, 22.0% and 58.8% had BCR, respectively and the difference among the three groups was significant (P=0.0001). C-indices of CAPRA-S score and three-risk groups for detecting BCR-free probabilities in 5-yr were 0.87 and 0.81, respectively. Both CAPRA-S score and its three-risk level model well predicted BCR after RP with high c-index levels in our center. Therefore, it is a clinically reliable post-operative risk stratifier and disease recurrence predictor for prostate cancer.

  9. Highly sensitive rapid fluorescence detection of protein residues on surgical instruments

    Energy Technology Data Exchange (ETDEWEB)

    Kovalev, Valeri I [School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS (United Kingdom); Bartona, James S [School of Engineering and Physical Sciences, Heriot-Watt University, Edinburgh EH14 4AS (United Kingdom); Richardson, Patricia R [School of Chemistry, University of Edinburgh, Edinburgh, EH9 3JJ (United Kingdom); Jones, Anita C [School of Chemistry, University of Edinburgh, Edinburgh, EH9 3JJ (United Kingdom)

    2006-07-15

    There is a risk of contamination of surgical instruments by infectious protein residues, in particular, prions which are the agents for Creutzfeldt-Jakob Disease in humans. They are exceptionally resistant to conventional sterilization, therefore it is important to detect their presence as contaminants so that alternative cleaning procedures can be applied. We describe the development of an optimized detection system for fluorescently labelled protein, suitable for in-hospital use. We show that under optimum conditions the technique can detect {approx}10 attomole/cm{sup 2} with a scan speed of {approx}3-10 cm{sup 2}/s of the test instrument's surface. A theoretical analysis and experimental measurements will be discussed.

  10. High-grade ureteroscopic biopsy is associated with advanced pathology of upper-tract urothelial carcinoma tumors at definitive surgical resection.

    Science.gov (United States)

    Clements, Thomas; Messer, Jamie C; Terrell, John D; Herman, Michael P; Ng, Casey K; Scherr, Douglas S; Scoll, Benjamin; Boorjian, Stephen A; Uzzo, Robert G; Wille, Mark; Eggener, Scott E; Lucas, Steven M; Lotan, Yair; Shariat, Shahrokh F; Raman, Jay D

    2012-04-01

    Accurate assessment of upper-tract urothelial carcinoma (UTUC) pathology may guide use of endoscopic vs extirpative therapy. We present a multi-institutional cohort of patients with UTUC who underwent surgical resection to characterize the association of ureteroscopic (URS) biopsy features with final pathology results. URS biopsy data were available in 238 patients who underwent surgical resection of UTUC. Biopsies were performed using a brush biopsy kit, mechanical biopsy device, or basket. Stage was classified as a positive brush, nonmuscle-invasive (biopsy, 88/238 (37%) patients had a positive brush, 140 (59%) had a diagnosis of non-MI, and 10 (4%) had MI disease. Biopsy results showed low-grade cancer in 140 (59%) and high-grade cancer in 98 (41%). Pathologic evaluation at surgical resection demonstrated non-MI tumors in 140 (59%) patients, MI in 98 (41%), and high-grade disease in 150 (63%). On univariate analysis, high URS biopsy grade was associated with high-grade (positive predictive value [PPV] 92%, Pbiopsy stage, however, was associated with surgical pathology grade (P=0.005), but not MI (P=0.16) disease. On multivariate analysis, high URS grade, but not biopsy stage, was associated with high final pathology grade (hazard ratio [HR] 16.6, 95% confidence interval [CI] 7.0-39.5, Pbiopsy grade, but not stage, is associated with adverse tumor pathology. This information may play a valuable role for risk stratification and in the appropriate selection of endoscopic management vs surgical extirpation for UTUC.

  11. Prophylactic negative-pressure wound therapy after cesarean is associated with reduced risk of surgical site infection: a systematic review and meta-analysis.

    Science.gov (United States)

    Yu, Lulu; Kronen, Ryan J; Simon, Laura E; Stoll, Carolyn R T; Colditz, Graham A; Tuuli, Methodius G

    2017-09-23

    The objective of the study was to assess the effect of prophylactic negative-pressure wound therapy on surgical site infections and other wound complications in women after cesarean delivery. We searched Ovid Medline, Embase, SCOPUS, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. We included randomized controlled trials and observational studies comparing prophylactic negative-pressure wound therapy with standard wound dressing for cesarean delivery. The primary outcome was surgical site infection after cesarean delivery. Secondary outcomes were composite wound complications, wound dehiscence, wound seroma, endometritis, and hospital readmission. Heterogeneity was assessed using Higgin's I2. Relative risks with 95% confidence intervals were calculated using random-effects models. Six randomized controlled trials and 3 cohort studies in high-risk mostly obese women met inclusion criteria and were included in the meta-analysis. Six were full-text articles, 2 published abstracts, and 1 report of trial results in ClinicalTrials.gov. Studies were also heterogeneous in the patients included and type of negative-pressure wound therapy device. The risk of surgical site infection was significantly lower with the use of prophylactic negative-pressure wound therapy compared with standard wound dressing (7 studies: pooled risk ratio, 0.45; 95% confidence interval, 0.31-0.66; adjusted risk ratio, -6.0%, 95% confidence interval, -10.0% to -3.0%; number needed to treat, 17, 95% confidence interval, 10-34). There was no evidence of significant statistical heterogeneity (I2 = 9.9%) or publication bias (Egger P = .532). Of the secondary outcomes, only composite wound complications were significantly reduced in patients receiving prophylactic negative-pressure wound therapy compared with standard dressing (9 studies: pooled risk ratio, 0.68, 95% confidence interval, 0.49-0.94). Studies on the effectiveness of prophylactic negative-pressure wound therapy at

  12. Defining the Tipping Point in Surgical Performance for Laparoscopic Donor Nephrectomy Among Transplant Surgery Fellows: A Risk-Adjusted Cumulative Summation Learning Curve Analysis.

    Science.gov (United States)

    Serrano, O K; Bangdiwala, A S; Vock, D M; Berglund, D; Dunn, T B; Finger, E B; Pruett, T L; Matas, A J; Kandaswamy, R

    2017-07-01

    The United Network for Organ Sharing recommends that fellowship-trained surgeons participate in 15 laparoscopic donor nephrectomy (LDN) procedures to be considered proficient. The American Society of Transplant Surgeons (ASTS) mandates 12 LDNs during an abdominal transplant surgery fellowship. We performed a retrospective intraoperative case analysis to create a risk-adjusted cumulative summation (RACUSUM) model to assess the learning curve of novice transplant surgery fellows (TSFs). Between January 2000 and December 2014, 30 novice TSFs participated in the organ procurement rotation of our ASTS-approved abdominal transplant surgery fellowship. Measures of surgical performance included intraoperative time, estimated blood loss, and incidence of intraoperative complications. The performance of senior TSFs was used to benchmark novice TSF performance. Scores were tabulated in a learning curve model, adjusting for case complexity and prior TSF case volume. Rates of adverse surgical events were significantly higher for novice TSFs than for senior TSFs. In univariable analysis, multiple renal arteries, high BMI, prior abdominal surgery, male donor, and nephrolithiasis were correlated with higher incidence of adverse surgical events. Based on the RACUSUM model, high intraoperative time is mitigated after 28 procedures, incidence of intraoperative complications tends to diminish after 24 procedures, and improvement in estimated blood loss did not remain consistent. TSFs exhibit a tipping point in LDN performance by 24-28 cases and proficiency by 35-38 cases. © 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

  13. No clinical effect of prosthesis-patient mismatch after transcatheter versus surgical aortic valve replacement in intermediate- and low-risk patients with severe aortic valve stenosis at mid-term follow-up

    DEFF Research Database (Denmark)

    Thyregod, Hans Gustav Hørsted; Steinbrüchel, Daniel Andreas; Ihlemann, Nikolaj

    2016-01-01

    OBJECTIVES: Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (SAVR) for severe aortic valve stenosis (AVS) is common, but less common after transcatheter aortic valve replacement (TAVR) in patients considered at high risk for death after surgery. The objectives of this st...

  14. A Preoperative Scale for Determining Surgical Readmission Risk After Total Knee Arthroplasty.

    Science.gov (United States)

    Siracuse, Brianna L; Ippolito, Joseph A; Gibson, Peter D; Ohman-Strickland, Pamela A; Beebe, Kathleen S

    2017-11-01

    Total knee arthroplasty (TKA) is one of the most common orthopaedic procedures performed in the U.S. The purpose of this study was to develop and verify a scale to preoperatively stratify a patient's risk of being readmitted to the hospital following a TKA. Discharge data on 433,638 patients from New York and California (derivation cohort) and 269,934 patients from Florida and Washington (validation cohort) who underwent TKA were collected from the State Inpatient Database, a part of the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality (2006 to 2011). Demographic and clinical characteristics of patients were abstracted and analyzed to develop the Readmission After Total Knee Arthroplasty (RATKA) Scale. Overall 30-day readmission rates in the derivation and validation cohorts were 5.11% and 4.98%, respectively. The following factors were significantly associated with increased 30-day readmission rates in the derivation cohort: age of 41 to 50 years (odds ratio [OR] = 1.13), age of 71 to 80 years (OR = 1.21), age of 81 to 90 years (OR = 1.70), male sex (OR = 1.19), African-American race (OR = 1.37), "other" race/ethnicity (OR = 1.08), Medicaid payer (OR = 1.43), Medicare payer (OR = 1.27), anemia (OR = 1.19), chronic obstructive pulmonary disease (OR = 1.29), coagulopathy (OR = 1.22), congestive heart failure (OR = 1.64), diabetes (OR = 1.19), fluid and electrolyte disorder (OR = 1.25), hypertension (OR = 1.10), liver disease (OR = 1.27), renal failure (OR = 1.33), and rheumatoid arthritis (OR = 1.14). These factors were used to create the RATKA Scale. The RATKA score was then used to define 3 levels of risk for readmission: low (RATKA score of 16; 7.6% readmission rate). The relative risk of readmission was 2.06 for the high-risk group compared with the low-risk group. The RATKA Scale derived from patient data from the derivation cohort was reliably able to explain readmission variability after TKA for patients in the

  15. High Throughput Assay for Bacterial Adhesion on Acellular Dermal Matrices and Synthetic Surgical Materials

    Science.gov (United States)

    Nyame, Theodore T.; Lemon, Katherine P.; Kolter, Roberto; Liao, Eric C.

    2013-01-01

    Background There has been increasing use of various synthetic and biologically derived materials in surgery. Biologic surgical materials are used in many plastic surgery procedures, ranging from breast reconstruction to hernia repairs. In particular, acellular dermal matrix (ADM) material has gained popularity in these applications. There is a paucity of data on how ADM compares to other surgical materials as a substrate for bacterial adhesion, the first step in formation biofilm, which occurs in prosthetic wound infections. We have designed a high throughput assay to evaluate Staphylococcus aureus adherence on various synthetic and biologically derived materials. Methods Clinical isolates of Staphylococcus aureus (strains SC-1 and UAMS-1) were cultured with different materials and bacterial adherence was measured using a resazurin cell vitality reporter microtiter assay. Four materials that are commonly utilized in reconstructive procedures were evaluated: prolene mesh, vicryl mesh, and two different ADM preparations (AlloDerm®, FlexHD®). We were able to develop a high throughput and reliable assay for quantifying bacterial adhesion on synthetic and biologically derived materials. Results The resazurin vitality assay can be reliably used to quantify bacterial adherence to acellular dermal matrix material, as well as synthetic material. S. aureus strains SC-1 and UAMS-1 both adhered better to ADM materials (AlloDerm® vs. FlexHD®) than to the synthetic material prolene. S. aureus also adhered better to vicryl than to prolene. Strain UAMS-1 adhered better to vicryl and ADM materials than did strain SC-1. Conclusion Our results suggest that S. aureus adheres more readily to ADM material than to synthetic material. We have developed an assay to rapidly test bacterial formation on surgical materials, using two S. aureus bacterial strains. This provides a standard method to evaluate existing and new materials with regard to bacterial adherence and potential

  16. High risk process control system assessment methodology

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Venetia [Pontificia Universidade Catolica do Rio de Janeiro (PUC-Rio), RJ (Brazil); Zamberlan, Maria Cristina [National Institute of Tehnology (INT), Rio de Janeiro, RJ (Brazil). Human Reliability and Ergonomics Research Group for the Oil, Gas and Energy Sector

    2009-07-01

    The evolution of ergonomics methodology has become necessary due to the dynamics imposed by the work environment, by the increase of the need of human cooperation and by the high interaction between various sections within a company. In the last 25 years, as of studies made in the high risk process control, we have developed a methodology to evaluate these situations that focus on the assessment of activities and human cooperation, the assessment of context, the assessment of the impact of work of other sectors in the final activity of the operator, as well as the modeling of existing risks. (author)

  17. Penicillin allergy and surgical prophylaxis: Cephalosporin cross-reactivity risk in a pediatric tertiary care center.

    Science.gov (United States)

    Beltran, Ralph J; Kako, Hiromi; Chovanec, Thomas; Ramesh, Archana; Bissonnette, Bruno; Tobias, Joseph D

    2015-05-01

    First generation cephalosporins are commonly used as antibiotic prophylaxis prior to surgery. Patients labeled as penicillin-allergic are often precluded from receiving cephalosporins because of an allergic cross-reactivity. The aims of this study were to evaluate the clinical practice for surgical prophylaxis at Nationwide Children's Hospital and to determine the incidence of adverse effects and allergic reactions when using cephalosporins in patients labeled as penicillin-allergic. A retrospective chart review was performed to identify patients who were allergic to penicillin, penicillin antibiotic family, who required surgical treatment for an existing medical condition, and received an antibiotic to prevent surgical site infection. Five hundred thirteen penicillin-allergic patients were identified, encompassing 624 surgical cases. Cephalosporins were administered in 153 cases (24.5%) with cefazolin used 83% of the time. Only one documented case of nonanaphylactic reaction was reported. Clindamycin was the most common cephalosporin substitute (n=387), and the reported adverse reaction rate was 1.5%. No cases of anaphylaxis were documented. Our data suggest that the administration of cephalosporins for surgical prophylaxis following induction of anesthesia in a patient with a known or reported penicillin-allergy appears appropriate and results in a lower adverse event rate that when clindamycin is administered. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Risk factors and prognosis of intravesical recurrence after surgical management of upper tract urothelial carcinoma: A 30-year single centre experience

    Directory of Open Access Journals (Sweden)

    Mohamed Mohamed Elawdy

    2017-09-01

    Conclusions: In our present series, bladder cancer recurrence of urothelial malignancy occurred in nearly half of the patients after surgical management of UTUC. Ureteric tumour was the only identifiable risk factor, thus patients with ureteric tumours may benefit from prophylactic intravesical chemoimmunotherapy. Bladder recurrence does not appear to affect the cancer-specific survival after surgical management of UTUC.

  19. Radical prostatectomy in high-risk and locally advanced prostate cancer: Mayo Clinic perspective.

    Science.gov (United States)

    Stewart, Suzanne B; Boorjian, Stephen A

    2015-05-01

    Men diagnosed with high-risk prostate cancer represent the cohort of prostate cancer patients at greatest risk for subsequent disease-specific mortality. Unfortunately, however, the classification of high-risk tumors remains imprecise and heterogeneous. There has been a historical reluctance to offer such patients aggressive local treatment, and considerable debate exists regarding the optimal management in this setting. We present here our institutional experience, as well as data from several other centers, with radical prostatectomy for high-risk tumors. We discuss that surgery affords accurate pathological staging, thereby improving the identification of patients for secondary therapies. Moreover, prostatectomy not only provides durable local disease control but in addition numerous contemporary surgical series in high-risk patients have shown radical prostatectomy to be associated with excellent long-term cancer-specific survival. Further, although studies comparing surgical and radiotherapy modalities in high-risk prostate patients have been wrought with methodological challenges, consistently these observational studies have found equivalent to improved oncologic outcomes when surgery is utilized as the primary treatment. Herein, we review the advantages, long-term outcomes, and technique of surgery for high-risk prostate cancer. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Treatment of high-risk smoldering myeloma.

    Science.gov (United States)

    Korde, Neha

    2016-12-01

    Multiple myeloma (MM) is a hematologic malignancy of the plasma cell that causes symptoms of bone pain, renal failure, and anemia. It is usually preceded by a precursor disease state, such as smoldering multiple myeloma (SMM) or monoclonal gammopathy of undetermined significance (MGUS), and traditional dogma dictates that treatment should be initiated on frank MM symptom development. Emerging evidence suggests that a defined group of "high-risk SMM" may benefit from early treatment, before organ damage and symptoms actually occur. The following article frames the evidence for treatment of high-risk SMM by defining risk categories, reviewing existing therapeutic trial data, and exploring the long-term biologic implications of early treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Not all risks are equal: the risk taking inventory for high-risk sports.

    Science.gov (United States)

    Woodman, Tim; Barlow, Matt; Bandura, Comille; Hill, Miles; Kupciw, Dominika; Macgregor, Alexandra

    2013-10-01

    Although high-risk sport participants are typically considered a homogenous risk-taking population, attitudes to risk within the high-risk domain can vary considerably. As no validated measure allows researchers to assess risk taking within this domain, we validated the Risk Taking Inventory (RTI) for high-risk sport across four studies. The RTI comprises seven items across two factors: deliberate risk taking and precautionary behaviors. In Study 1 (n = 341), the inventory was refined and tested via a confirmatory factor analysis used in an exploratory fashion. The subsequent three studies confirmed the RTI's good model-data fit via three further separate confirmatory factor analyses. In Study 2 (n = 518) and in Study 3 (n = 290), concurrent validity was also confirmed via associations with other related traits (sensation seeking, behavioral activation, behavioral inhibition, impulsivity, self-esteem, extraversion, and conscientiousness). In Study 4 (n = 365), predictive validity was confirmed via associations with mean accidents and mean close calls in the high-risk domain. Finally, in Study 4, the self-report version of the inventory was significantly associated with an informant version of the inventory. The measure will allow researchers and practitioners to investigate risk taking as a variable that is conceptually distinct from participation in a high-risk sport.

  2. Risk factors for and consequences of inadequate surgical margins in oral squamous cell carcinoma

    DEFF Research Database (Denmark)

    Lawaetz, Mads; Homøe, Preben

    2014-01-01

    OBJECTIVE: The purpose of this study was to examine which factors are associated with inadequate surgical margins and to assess the postoperative consequences. STUDY DESIGN: A retrospective cohort of 110 patients with oral squamous cell carcinoma treated with surgery during a 2-year period...... was examined. Clinical, histopathologic, and operative variables were related to the surgical margin status. Furthermore postoperative treatment data were compared with margin status. RESULTS: Univariate statistically significant associations were found between the tumor site in the floor of mouth, more...

  3. Surgical hip dislocation for the treatment of femoroacetabular impingement in high-level athletes.

    Science.gov (United States)

    Naal, Florian D; Miozzari, Hermes H; Wyss, Tobias F; Nötzli, Hubert P

    2011-03-01

    Midterm outcome studies show that symptomatic femoroacetabular impingement (FAI) can be successfully treated by addressing the underlying pathomorphology with open or arthroscopic surgery. Although athletes may be vulnerable to hip injury from impingement, limited information is available regarding the results of open surgery in this group. High-level athletes with FAI can resume their sports after surgical hip dislocation and continue professional careers for a significant period. Case series; Level of evidence, 4. Twenty-two professional male athletes (19.7 ± 2.2 years) were evaluated by postal survey at a mean of 45.1 months (range, 12 to 79) after treatment by surgical hip dislocation (30 hips, cam- or mixed-type FAI; mean α angle, 69.3°; 14 ice hockey players). Evaluation included types and level of sports, subjective ratings, and CLINICAL OUTCOMES: Hip Outcome Score, SF-12, UCLA (University of California, Los Angeles) activity scale, Hip Sports Activity Scale, visual analog scale for pain. The primary outcome variable was return to professional sports; the clinical result was the secondary outcome variable. At follow-up, 21 of 22 patients (96%) were still competing professionally: 19 at their previous level and 2 in minor leagues. Eighteen (82%) were satisfied with their hip surgery and 19 (86%) with their sports ability. Mean activity levels were 9.8 per the UCLA scale and 7.6 per the Hip Sports Activity Scale. Mean scores of the Hip Outcome Score-Activities of Daily Living and Sport subscales were 94.5 and 89.1. Mean scores of the SF-12 physical and mental component summaries were 51.1 and 54.3. Pain levels during sports were 1.8 per the visual analog scale. Surgical hip dislocation for the treatment of FAI allows athletes to resume sports and continue professional careers at the same level for several years. Clinical outcomes in terms of subjective ratings and scores were favorable.

  4. Breast MRI in high risk patients

    NARCIS (Netherlands)

    A.I.M. Obdeijn (Inge-Marie)

    2015-01-01

    markdownabstractAbstract In this thesis we address various indications of breast MRI, with the emphasis on the value of MRI in screening of women with high genetic risk for breast cancer, and especially in BRCA1 mutation carriers. We showed that in the era of up-to-date MRI expertise and

  5. Trends in emerging and high risk activities

    Science.gov (United States)

    Robert C. White; Richard Schreyer; Kent Downing

    1980-01-01

    Newly emerging and high risk activities have increased markedly in the last generation, yet little is known about trends in participation. Factors such as technological innovation and creative experimentation with traditional activities appear to play a major role in the development of new activities. Christy's criteria for mass demand in recreation are used to...

  6. High grade neuroendocrine lung tumors: pathological characteristics, surgical management and prognostic implications.

    Science.gov (United States)

    Grand, Bertrand; Cazes, Aurélie; Mordant, Pierre; Foucault, Christophe; Dujon, Antoine; Guillevin, Elizabeth Fabre; Barthes, Françoise Le Pimpec; Riquet, Marc

    2013-09-01

    Among non-small cell lung cancers (NSCLC), large cell carcinoma (LCC) is credited of significant adverse prognosis. Its neuroendocrine subtype has even a poorer diagnosis, with long-term survival similar to small cell lung cancer (SCLC). Our purpose was to review the surgical characteristics of those tumors. The clinical records of patients who underwent surgery for lung cancer in two French centers from 1980 to 2009 were retrospectively reviewed. We more particularly focused on patients with LCC or with high grade neuroendocrine lung tumors. High grade neuroendocrine tumors were classified as pure large cell neuroendocrine carcinoma (pure LCNEC), NSCLC combined with LCNEC (combined LCNEC), and SCLC combined with LCNEC (combined SCLC). There were 470 LCC and 155 high grade neuroendocrine lung tumors, with no difference concerning gender, mean age, smoking habits. There were significantly more exploratory thoracotomies in LCC, and more frequent postoperative complications in high grade neuroendocrine lung tumors. Pathologic TNM and 5-year survival rates were similar, with 5-year ranging from 34.3% to 37.6% for high grade neuroendocrine lung tumors and LCC, respectively. Induction and adjuvant therapy were not associated with an improved prognosis. The subgroups of LCNEC (pure NE, combined NE) and combined SCLC behaved similarly, except visceral pleura invasion, which proved more frequent in combined NE and less frequent in combined SCLC. Survival analysis showed a trend toward a lower 5-year survival in case of combined SCLC. Therefore, LCC, LCNEC and combined SCLC share the same poor prognosis, but surgical resection is associated with long-term survival in about one third of patients. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  7. The risk of post-operative complications in psoriasis and psoriatic arthritis patients on biologic therapy undergoing surgical procedures.

    Science.gov (United States)

    Bakkour, W; Purssell, H; Chinoy, H; Griffiths, C E M; Warren, R B

    2016-01-01

    There is limited evidence as to whether biologic therapy should be stopped or continued in patients with psoriasis and/or psoriatic arthritis (PsA) who are undergoing surgical procedures. Current guidelines of care recommend a planned break from biologic therapy in those undergoing major surgical procedures. To audit current practice of managing biologic therapy peri-operatively in a tertiary referral psoriasis clinic against guidelines of care and to investigate the effects of continuing/stopping biologic therapy in psoriasis and PsA patients. A retrospective audit of psoriasis and PsA patients who had a surgical procedure whilst on biologic therapy. A proforma was used to collect information on the biologics used, whether they were stopped peri-operatively and whether patients developed post-operative complications and/or disease flare. A total of 42 patients who had 77 procedures were identified. Procedures ranged from skin surgery to orthopaedic and cardiothoracic surgery. Biologic therapy was continued in the majority of procedures (76%). There was no significant difference in post-operative risk of infection and delayed wound healing between those patients who continued and those who stopped biologic therapy, including those undergoing major surgery. Interrupting biologic therapy peri-operatively was associated with a significant (P = 0.003) risk of flare of psoriasis or PsA. Continuing biologic therapy in psoriasis and PsA patients peri-operatively did not increase the risk of post-operative complications. Interrupting biologic therapy peri-operatively significantly increased the risk of disease flare. This study is limited by cohort size and requires replication, ideally in a prospective randomized controlled manner. © 2015 European Academy of Dermatology and Venereology.

  8. Surgical Treatment as a Principle for Patients with High-Grade Pancreatic Neuroendocrine Carcinoma

    DEFF Research Database (Denmark)

    Haugvik, Sven-Petter; Janson, Eva Tiensuu; Österlund, Pia

    2016-01-01

    BACKGROUND: This study aimed to evaluate the role of surgery for patients with high-grade pancreatic neuroendocrine carcinoma (hgPNEC) in a large Nordic multicenter cohort study. Prior studies evaluating the role of surgery for patients with hgPNEC are limited, and the benefit of the surgery...... is uncertain. METHODS: Data from patients with a diagnosis of hgPNEC determined between 1998 and 2012 were retrospectively registered at 10 Nordic university hospitals. Kaplan-Meier curves were used to compare the overall survival of different treatment groups, and Cox-regression analysis was used to evaluate....... Patients selected for resection of the primary tumor and synchronous liver metastases had a high 3-year survival rate. Selected patients with both localized hgPNEC and metastatic hgPNEC should be considered for radical surgical treatment....

  9. High-frequency, high-intensity transcutaneous electrical nerve stimulation as treatment of pain after surgical abortion.

    Science.gov (United States)

    Platon, B; Andréll, P; Raner, C; Rudolph, M; Dvoretsky, A; Mannheimer, C

    2010-01-01

    The aim of the study was to compare the pain-relieving effect and the time spent in the recovery ward after treatment with high-frequency, high-intensity transcutaneous electrical nerve stimulation (TENS) or intravenous (IV) conventional pharmacological treatment after surgical abortion. Two-hundred women who underwent surgical abortion and postoperatively reported a visual analogue scale (VAS) pain score3 were included. The patients were randomised to TENS or conventional pharmacological treatment for their postoperative pain. The TENS treatment was given with a stimulus intensity between 20 and 60 mA during 1 min and repeated once if insufficient pain relief (VAS3). In the conventional pharmacological treatment group, a maximum dose of 100 microg fentanyl was given IV. There was no difference between the groups with regard to pain relief according to the VAS pain score (TENS=VAS 1.3 vs. IV opioids=VAS 1.6; p=0.09) upon discharge from the recovery ward. However, the patients in the TENS group spent shorter time (44 min) in the recovery ward than the conventional pharmacological treatment group (62 min; p<0.0001). The number of patients who needed additional analgesics in the recovery ward was comparable in both groups, as was the reported VAS pain score upon leaving the hospital (TENS=2.0 vs. conventional pharmacological treatment=1.8, NS). These results suggest that the pain-relieving effect of TENS seems to be comparable to conventional pharmacological treatment with IV opioids. Hence, TENS may be a suitable alternative to conventional pain management with IV opioids after surgical abortion. Copyright 2009 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  10. Early post-surgical cognitive dysfunction is a risk factor for mortality among hip fracture hospitalized older persons.

    Science.gov (United States)

    Ruggiero, C; Bonamassa, L; Pelini, L; Prioletta, I; Cianferotti, L; Metozzi, A; Benvenuti, E; Brandi, G; Guazzini, A; Santoro, G C; Mecocci, P; Black, D; Brandi, M L

    2017-02-01

    This study investigates the relationship between cognitive dysfunction or delirium detected in the early post-surgical phase and the 1-year mortality among 514 hip fracture hospitalized older persons. Patients with early cognitive dysfunction or delirium experienced a 2-fold increased mortality risk. Early post-operative cognitive dysfunction and delirium are negative prognostic factors for mortality. Premorbid cognitive impairment and dementia in older individuals negatively affect functional recovery after hip fracture. Additionally, post-operative delirium is an established risk factor for negative outcomes among hip fracture patients. While the majority of hip fracture patients experience minor post-surgical cognitive dysfunction, the prognostic value of this phenomenon is unknown. Therefore, we investigated the relationship between minor cognitive dysfunction or delirium detected in the early post-surgical phase and the 1-year mortality after index hip fracture. We enrolled 514 patients with hip fracture (77.4 % women), aged 65 years or older (mean age 83.1 ± 7.3 years), who underwent surgical hip fracture repair. Patients were assessed daily from the second to the fourth post-operative day and at 3, 6, and 12 months thereafter. All participants underwent comprehensive assessment, including detection of delirium by using the confusion assessment method and evaluation of cognitive function by using mini-mental state examination (MMSE; score range 0 to 30, with lower scores indicating poorer performance). In the absence of delirium, post-surgical cognitive dysfunction was defined as having low performance on MMSE. Vital status of 1 year after the index fracture and date of death were gathered from local registries. The observed 1-year mortality rate was 14.8 %. Men were more likely to die than women within 1 year of the index fracture (p post-surgical phase is a negative prognostic factor for mortality among elderly hip fracture patients. The burden

  11. Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk.

    NARCIS (Netherlands)

    Pull ter Gunne, A.F.; Laarhoven, C.J.H.M. van; Cohen, D.B.

    2010-01-01

    Surgical site infection (SSI) following spinal surgery is a frequent complication and results in higher morbidity, mortality and healthcare costs. Patients undergoing surgery for spinal deformity (scoliosis/kyphosis) have longer surgeries, involving more spinal levels and larger blood losses than

  12. Solitary thyroid nodule: the risk of cancer and the extent of surgical ...

    African Journals Online (AJOL)

    Results: Thirteen point nine percent of patients were found to have malignancy on final paraffin section, most of them were papillary type. Fifty nine per cent of patients underwent lobectomy + isthmusectomy. All patients who developed recurrence after surgery had only lobectomy as their initial surgical therapy. Conclusion: ...

  13. A high-accuracy surgical augmented reality system using enhanced integral videography image overlay.

    Science.gov (United States)

    Zhang, Xinran; Chen, Guowen; Liao, Hongen

    2015-01-01

    Image guided surgery has been used in clinic to improve the surgery safety and accuracy. Augmented reality (AR) technique, which can provide intuitive image guidance, has been greatly evolved these years. As one promising approach of surgical AR systems, integral videography (IV) autostereoscopic image overlay has achieved accurate fusion of full parallax guidance into surgical scene. This paper describes an image enhanced high-accuracy IV overlay system. A flexible optical image enhancement system (IES) is designed to increase the resolution and quality of IV image. Furthermore, we introduce a novel IV rendering algorithm to promote the spatial accuracy with the consideration of distortion introduced by micro lens array. Preliminary experiments validated that the image accuracy and resolution are improved with the proposed methods. The resolution of the IV image could be promoted to 1 mm for a micro lens array with pitch of 2.32 mm and IES magnification value of 0.5. The relative deviation of accuracy in depth and lateral directions are -4.68 ± 0.83% and -9.01 ± 0.42%.

  14. Metabolic Acidosis Assessment in High-Risk Surgeries: Prognostic Importance.

    Science.gov (United States)

    Silva, João Manoel; Ribas Rosa de Oliveira, Amanda Maria; Mendes Nogueira, Fernando Augusto; Vianna, Pedro M M; Amendola, Cristina Prata; Carvalho Carmona, Maria José; Sá Malbouisson, Luiz M

    2016-11-01

    Metabolic acidosis frequently is present in surgical patients; however, different types of metabolic acidosis (hyperlactatemia, hyperchloremia, and others) may have different relationships to perioperative outcomes. We hypothesized that in postoperative surgical patients, distinctive types of metabolic acidosis would correlate differently with the outcomes of high-risk surgeries. A prospective, multicenter observational study was performed in 3 different tertiary care hospitals. Patients who required postoperative admission to the intensive care unit (ICU) were included in this study. Patients with a short life expectancy (those with untreated cancer and limited treatment), hepatic failure, renal failure, or a diagnosis of diabetes were excluded. Patients were classified at ICU admission according to the presence and type of metabolic acidosis into 4 groups: those without acidosis, those with a base excess 12 mmol/L, and those with a base excess 2 mmol/L. Furthermore, patients were reclassified 12 hours after admission to the ICU to verify the metabolic acidosis behavior and outcome differences among the groups. The study included 618 patients. The incidence of acidosis at ICU admission was 59.1%; 23.9% presented with hyperchloremia, 21.3% with hyperlactatemia, 13.9% with increased anion gap, and 40.9% of the patients presented without metabolic acidosis. Patients whose metabolic acidosis persisted for 12 hours had an incidence of ICU complications rates in hyperlactatemia group of 68.8%, increased anion gap of 68.6%, hyperchloremic of 65.8%, and those without acidosis over 12 hours of 59.3%. A Cox regression model for postoperative 30-day mortality showed: in hyperlactatemic acidosis, hazard ratio (HR) = 1.74, 95% confidence interval (CI) = 1.02-2.96; increased anion gap acidosis, HR = 1.68, 95% CI = 0.85-3.81; hyperchloremic acidosis, HR = 1.47, 95% CI = 0.75-2.89, and 10.3% of 30-day mortality rate in patients without acidosis. An adjusted survival curve by Cox

  15. Surgical Resection of Brain Metastases and the Risk of Leptomeningeal Recurrence in Patients Treated With Stereotactic Radiosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, Matthew D., E-mail: Matthewjohnson@beaumont.edu [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Avkshtol, Vladimir [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Baschnagel, Andrew M. [Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (United States); Meyer, Kurt; Ye, Hong; Grills, Inga S.; Chen, Peter Y.; Maitz, Ann [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States); Olson, Rick E.; Pieper, Daniel R. [Department of Neurosurgery, William Beaumont Hospital, Royal Oak, Michigan (United States); Krauss, Daniel J. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan (United States)

    2016-03-01

    Purpose: Recent prospective data have shown that patients with solitary or oligometastatic disease to the brain may be treated with upfront stereotactic radiosurgery (SRS) with deferral of whole-brain radiation therapy (WBRT). This has been extrapolated to the treatment of patients with resected lesions. The aim of this study was to assess the risk of leptomeningeal disease (LMD) in patients treated with SRS to the postsurgical resection cavity for brain metastases compared with patients treated with SRS to intact metastases. Methods and Materials: Four hundred sixty-five patients treated with SRS without upfront WBRT at a single institution were identified; 330 of these with at least 3 months' follow-up were included in this analysis. One hundred twelve patients had undergone surgical resection of at least 1 lesion before SRS compared with 218 treated for intact metastases. Time to LMD and overall survival (OS) time were estimated from date of radiosurgery, and LMD was analyzed by the use of cumulative incidence method with death as a competing risk. Univariate and multivariate analyses were performed with competing risk regression to determine whether various clinical factors predicted for LMD. Results: With a median follow-up time of 9.0 months, 39 patients (12%) experienced LMD at a median of 6.0 months after SRS. At 1 year, the cumulative incidence of LMD, with death as a competing risk, was 5.2% for the patients without surgical resection versus 16.9% for those treated with surgery (Gray test, P<.01). On multivariate analysis, prior surgical resection (P<.01) and breast cancer primary (P=.03) were significant predictors of LMD development. The median OS times for patients undergoing surgery compared with SRS alone were 12.9 and 10.6 months, respectively (log-rank P=.06). Conclusions: In patients undergoing SRS with deferral of upfront WBRT for intracranial metastatic disease, prior surgical resection and breast cancer primary are associated with an

  16. Incidence and risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture: A systematic review and meta-analysis.

    Science.gov (United States)

    Shao, Jiashen; Chang, Hengrui; Zhu, Yanbin; Chen, Wei; Zheng, Zhanle; Zhang, Huixin; Zhang, Yingze

    2017-05-01

    This study aimed to quantitatively summarize the risk factors associated with surgical site infection after open reduction and internal fixation of tibial plateau fracture. Medline, Embase, CNKI, Wanfang database and Cochrane central database were searched for relevant original studies from database inception to October 2016. Eligible studies had to meet quality assessment criteria according to the Newcastle-Ottawa Scale, and had to evaluate the risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture. Stata 11.0 software was used for this meta-analysis. Eight studies involving 2214 cases of tibial plateau fracture treated by open reduction and internal fixation and 219 cases of surgical site infection were included in this meta-analysis. The following parameters were identified as significant risk factors for surgical site infection after open reduction and internal fixation of tibial plateau fracture (p external fixation (OR 2.07; 95% CI 1.05-4.09). Other factors, including male sex, were not identified as risk factors for surgical site infection. Patients with the abovementioned medical conditions are at risk of surgical site infection after open reduction and internal fixation of tibial plateau fracture. Surgeons should be cognizant of these risks and give relevant preoperative advice. Copyright © 2017. Published by Elsevier Ltd.

  17. Risk factors for superficial vs deep/organ-space surgical site infections: implications for quality improvement initiatives.

    Science.gov (United States)

    Lawson, Elise H; Hall, Bruce Lee; Ko, Clifford Y

    2013-09-01

    Surgical site infections (SSIs) are the focus of numerous quality improvement initiatives because they are a common and costly cause of potentially preventable patient morbidity. Superficial and deep/organ-space SSIs differ in terms of anatomical location and clinical severity. To identify risk factors that are uniquely predictive of superficial vs deep/organ-space SSIs occurring after colectomy procedures. Retrospective cohort study. American College of Surgeons National Surgical Quality Improvement Program. Patients undergoing colectomy procedures in 2011 were identified by Current Procedural Terminology codes. Colectomy procedures. We compared rates of superficial SSI and deep/organ-space SSI associated with perioperative variables of interest: demographics; preoperative clinical severity, risk factors, and comorbidities and variables related to the hospitalization or procedure. Hierarchical multivariable logistic regression models were developed to identify risk-adjusted predictors of each SSI type. Among 27 011 patients identified from 305 hospitals, 6.2% developed a superficial SSI and 4.7% developed a deep/organ-space SSI. Risk factors common to the occurrence of both SSI types were identified: open surgery (vs laparoscopic) and current smoker. Risk factors with differential effects on each SSI type included specific postoperative diagnoses, disseminated cancer, and irradiation therapy, which were all associated with increased odds of deep/organ-space SSI only. The graded relationship between increasing body mass index and SSI occurrence appeared to be stronger for superficial SSI. Risk factors for superficial SSI and deep/organ-space SSI vary in terms of magnitude and significance, suggesting that these SSI types are somewhat different disease processes. Groups interested in preventing SSIs might improve success by considering these SSI types independently for root-cause analyses and development of best practices and interventions.

  18. High-risk neighborhoods and high-risk families: the human ecology of child maltreatment.

    Science.gov (United States)

    Garbarino, J; Sherman, D

    1980-03-01

    Based on multiple regression analysis to identify the socioeconomic, demographic, and attitudinal correlates of neighborhood differences in the rate of child abuse and neglect, a pair of neighborhoods matched for socioeconomic level was selected, one high risk, the other low risk. Interviews with expert informants ranging from elementary school principals to mailmen were used to develop neighborhood profiles. Samples of families were drawn from each neighborhood and interviews conducted to identify stresses and supports, with special emphasis on sources of help, social networks, evaluation of the neighborhood, and use of formal family support systems. The results lend support to the concept of neighborhood "risk." Families in the high-risk neighborhood, though socioeconomically similar to families in the low-risk neighborhood, report less positive evaluation of the neighborhood as a context for child and family development. Furthermore, they reveal a general pattern of "social impoverishment" in comparison with families in the low-risk neighborhood.

  19. Reducing the risk of surgical site infection: a case controlled study of contamination of theatre clothing.

    Science.gov (United States)

    Sivanandan, Indu; Bowker, Karen E; Bannister, Gordon C; Soar, Jasmeet

    2011-02-01

    Surgical site infections are one of the most important causes of healthcare associated infections (HCAI), accounting for 20% of all HCAIs. Surgical site infections affect 1% of joint replacement operations. This study was designed to assess whether theatre clothing is contaminated more inside or outside the theatre suite. Petri dishes filled with horse blood agar were pressed on theatre clothes at 0, 2, 4, 6 and 8 hours to sample bacterial contamination in 20 doctors whilst working in and outside the theatre suite. The results showed that there was greater bacterial contamination when outside the theatre suite at 2 hours. There were no differences in the amount of contamination at 4, 6 and 8 hours. This study suggests that the level of contamination of theatre clothes is similar both inside and outside the theatre setting.

  20. High-resolution computed tomography of cholesteatoma of the middle ear. CT, otological, and surgical correlation

    Energy Technology Data Exchange (ETDEWEB)

    Ishii, Kiyoshi; Fukusumi, Akio; Okudera, Toshio; Kato, Toshihiko; Soda, Toyoji

    1988-08-01

    The high-resolution computed tomography (CT) appearances of 72 consecutive cases (92 ears) of chronic otomastoiditis were reviewed. The cholesteatomas were verified surgically and/or otologically in 35 of these 92 ears. Discussion was made with special emphasis on the differential diagnosis of cholesteatoma of the middle ear from the non-cholesteatoma otitis media. The CT findings suggestive of cholesteatoma were as follows: the definitive findings was of a soft-tissue opacity filling Purssak's space, with a medial displacement of the malleus and the incus; the possible findings were 1) a bony erosion of the wall of the middle ear cavity, 2) a partial or complete disappearance of the malleus and/or the incus, and 3) an opacification of Purssak's space and the superomedial aspect of the external auditory meatus.

  1. Identification of prostate cancer risk categories according to surgical margins status, pathological stage and Gleason score.

    Science.gov (United States)

    Schiavina, Riccardo; Borghesi, Marco; Fiorentino, Michelangelo; Brunocilla, Eugenio; Manferrari, Fabio; Vagnoni, Valerio; Martorana, Giuseppe

    2013-11-01

    One-third of patients with positive surgical margins after radical prostatectomy develop recurrent disease. The distinction between pT2 with positive margins and pT3a can be difficult. Aim of the present study was to assess the impact of positive surgical margins on biochemical relapse after radical prostatectomy, adjusted for pathological stage and Gleason score. We retrospectively evaluated 837 consecutive patients who underwent radical prostatectomy for organ-confined or locally-advanced prostate cancer. Exclusion criteria were: presence of node or distant metastases, neo-adjuvant or adjuvant therapy, and unavailability of full data regarding pathological stage and margin status. A single dedicated genitourinary pathologist evaluated all the specimens. The Kaplan-Meier method and univariable and multivariable Cox regressions were applied for survival analyses. The median follow up was 54.0 ± 35.0 months. Margin status, prostate-specific antigen and Gleason score significantly predicted biochemical relapse in the pT2 group at multivariable analysis, whereas only pathological stage and pathological Gleason score were significant predictors of recurrence in pT3a patients. There were no significant differences in biochemical disease-free survival among pT2 with positive margins patients and pT3a patients (with or without positive surgical margins). Pathological Gleason score was the only significant predictor of biochemical relapse in patients with negative and positive margins, regardless of the pathological stage. pT2 patients with positive surgical margins and pT3a (with or without positive margins) seem to have similar biochemical disease-free survival. Positive margins and pathological stage might be insufficient clinical predictors. Gleason score remains the most reliable prognostic factor. © 2013 The Japanese Urological Association.

  2. Incidence, microbiological profile of nosocomial infections, and their antibiotic resistance patterns in a high volume Cardiac Surgical Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Manoj Kumar Sahu

    2016-01-01

    Full Text Available Background: Nosocomial infections (NIs in the postoperative period not only increase morbidity and mortality, but also impose a significant economic burden on the health care infrastructure. This retrospective study was undertaken to (a evaluate the incidence, characteristics, risk factors and outcomes of NIs and (b identify common microorganisms responsible for infection and their antibiotic resistance profile in our Cardiac Surgical Intensive Care Unit (CSICU. Patients and Methods: After ethics committee approval, the CSICU records of all patients who underwent cardiovascular surgery between January 2013 and December 2014 were reviewed retrospectively. The incidence of NI, distribution of NI sites, types of microorganisms and their antibiotic resistance, length of CSICU stay, and patient-outcome were determined. Results: Three hundred and nineteen of 6864 patients (4.6% developed NI after cardiac surgery. Lower respiratory tract infections (LRTIs accounted for most of the infections (44.2% followed by surgical-site infection (SSI, 11.6%, bloodstream infection (BSI, 7.5%, urinary tract infection (UTI, 6.9% and infections from combined sources (29.8%. Acinetobacter, Klebsiella, Escherichia coli, and Staphylococcus were the most frequent pathogens isolated in patients with LRTI, BSI, UTI, and SSI, respectively. The Gram-negative bacteria isolated from different sources were found to be highly resistant to commonly used antibiotics. Conclusion: The incidence of NI and sepsis-related mortality, in our CSICU, was 4.6% and 1.9%, respectively. Lower respiratory tract was the most common site of infection and Gram-negative bacilli, the most common pathogens after cardiac surgery. Antibiotic resistance was maximum with Acinetobacter spp.

  3. High-throughput assay for bacterial adhesion on acellular dermal matrices and synthetic surgical materials.

    Science.gov (United States)

    Nyame, Theodore T; Lemon, Katherine P; Kolter, Roberto; Liao, Eric C

    2011-11-01

    There has been increasing use of synthetic and acellular dermal matrix materials in surgery, ranging from breast reconstruction to hernia repairs. There is a paucity of data on how acellular dermal matrix compares with other surgical materials as a substrate for bacterial adhesion, the first step in formation biofilm, which occurs in prosthetic wound infections. The authors have designed a high-throughput assay to evaluate Staphylococcus aureus adherence on various synthetic and biologically derived materials. Clinical isolates of S. aureus (strains SC-1 and UAMS-1) were cultured with different materials, and bacterial adherence was measured using a resazurin cell vitality assay. Four materials that are commonly used in surgery were evaluated: Prolene mesh, Vicryl mesh, and two different acellular dermal matrix preparations (AlloDerm and FlexHD). The authors were able to develop a high-throughput and reliable assay for quantifying bacterial adhesion on synthetic and biologically derived materials. The resazurin vitality assay can be reliably used to quantify bacterial adherence to acellular dermal matrix material and synthetic material. S. aureus strains SC-1 and UAMS-1 both adhered better to acellular dermal matrix materials (AlloDerm versus FlexHD) than to the synthetic material Prolene. S. aureus also adhered better to Vicryl than to Prolene. Strain UAMS-1 adhered better to Vicryl and acellular dermal matrix materials than did strain SC-1. The results show that S. aureus adheres more readily to acellular dermal matrix material than to synthetic material. The resazurin assay provides a standard method for evaluating surgical materials with regard to bacterial adherence and potential propensity for biofilm development.

  4. Surgical Versus Nonsurgical Treatment for High-Grade Spondylolisthesis in Children and Adolescents

    Science.gov (United States)

    Xue, Xuhong; Wei, Xiaochun; Li, Li

    2016-01-01

    Abstract The optimal management of high-grade spondylolisthesis in children and adolescent is controversial. There is a paucity of literature regarding operatively or nonoperative management in this setting. To assessment of the current state of evidence regarding high-grade spondylolisthesis treatment with the goal of obtaining outcome comparisons in these patients managed either operatively or nonoperatively. We performed a systematic literature search up to November 2014, using Medline, Embase, and The Cochrane Library. The analysis and eligibility criteria were documented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-guidelines) and Cochrane Back Review Group editorial board. We used the Newcastle–Ottawa quality assessment scale (NOS-scale) to assess the quality. Five observational studies were considered eligible for analysis based on the evaluation of 1596 identified papers. The mean overall difference in the Scoliosis Research Society questionnaire 22 between the surgical and nonsurgical groups was not statistically significant (95% CI: −0.17 to 0.21, P = 0.84). The pooled mean difference in progression of slip between the surgical and nonsurgical groups was no significant difference (OR: 0.47, 95% CI: 0.12–1.81, P = 0.27, I2 = 0%). Because of the preponderance of uncontrolled case series, low-quality evidence indicates that the quality of life and progression of slips was no significant difference between surgery and nonoperation group. Nonoperative patients had no radiologic progression of their slip during the follow-up period. PMID:26986134

  5. Effect of femoral head size and surgical approach on risk of revision for dislocation after total hip arthroplasty.

    Science.gov (United States)

    Zijlstra, Wierd P; De Hartog, Bas; Van Steenbergen, Liza N; Scheurs, B Willem; Nelissen, Rob G H H

    2017-08-01

    Background and purpose - Recurrent dislocation is the commonest cause of early revision of a total hip arthropasty (THA). We examined the effect of femoral head size and surgical approach on revision rate for dislocation, and for other reasons, after total hip arthroplasty (THA). Patients and methods - We analyzed data on 166,231 primary THAs and 3,754 subsequent revision THAs performed between 2007 and 2015, registered in the Dutch Arthroplasty Register (LROI). Revision rate for dislocation, and for all other causes, were calculated by competing-risk analysis at 6-year follow-up. Multivariable Cox proportional hazard regression ratios (HRs) were used for comparisons. Results - Posterolateral approach was associated with higher dislocation revision risk (HR =1) than straight lateral, anterolateral, and anterior approaches (HR =0.5-0.6). However, the risk of revision for all other reasons (especially stem loosening) was higher with anterior and anterolateral approaches (HR =1.2) and lowest with posterolateral approach (HR =1). For all approaches, 32-mm heads reduced the risk of revision for dislocation compared to 22- to 28-mm heads (HR =1 and 1.6, respectively), while the risk of revision for other causes remained unchanged. 36-mm heads increasingly reduced the risk of revision for dislocation but only with the posterolateral approach (HR =0.6), while the risk of revision for other reasons was unchanged. With the anterior approach, 36-mm heads increased the risk of revision for other reasons (HR =1.5). Interpretation - Compared to the posterolateral approach, direct anterior and anterolateral approaches reduce the risk of revision for dislocation, but at the cost of more stem revisions and other revisions. For all approaches, there is benefit in using 32-mm heads instead of 22- to 28-mm heads. For the posterolateral approach, 36-mm heads can safely further reduce the risk of revision for dislocation.

  6. Effect of femoral head size and surgical approach on risk of revision for dislocation after total hip arthroplasty

    Science.gov (United States)

    Zijlstra, Wierd P; De Hartog, Bas; Van Steenbergen, Liza N; Scheurs, B Willem; Nelissen, Rob G H H

    2017-01-01

    Background and purpose Recurrent dislocation is the commonest cause of early revision of a total hip arthropasty (THA). We examined the effect of femoral head size and surgical approach on revision rate for dislocation, and for other reasons, after total hip arthroplasty (THA). Patients and methods We analyzed data on 166,231 primary THAs and 3,754 subsequent revision THAs performed between 2007 and 2015, registered in the Dutch Arthroplasty Register (LROI). Revision rate for dislocation, and for all other causes, were calculated by competing-risk analysis at 6-year follow-up. Multivariable Cox proportional hazard regression ratios (HRs) were used for comparisons. Results Posterolateral approach was associated with higher dislocation revision risk (HR =1) than straight lateral, anterolateral, and anterior approaches (HR =0.5–0.6). However, the risk of revision for all other reasons (especially stem loosening) was higher with anterior and anterolateral approaches (HR =1.2) and lowest with posterolateral approach (HR =1). For all approaches, 32-mm heads reduced the risk of revision for dislocation compared to 22- to 28-mm heads (HR =1 and 1.6, respectively), while the risk of revision for other causes remained unchanged. 36-mm heads increasingly reduced the risk of revision for dislocation but only with the posterolateral approach (HR =0.6), while the risk of revision for other reasons was unchanged. With the anterior approach, 36-mm heads increased the risk of revision for other reasons (HR =1.5). Interpretation Compared to the posterolateral approach, direct anterior and anterolateral approaches reduce the risk of revision for dislocation, but at the cost of more stem revisions and other revisions. For all approaches, there is benefit in using 32-mm heads instead of 22- to 28-mm heads. For the posterolateral approach, 36-mm heads can safely further reduce the risk of revision for dislocation. PMID:28440704

  7. Carotid Stenting in Patients With High Risk Versus Standard Risk for Open Carotid Endarterectomy (REAL-1 Trial).

    Science.gov (United States)

    De Haro, Joaquin; Michel, Ignacio; Bleda, Silvia; Cañibano, Cristina; Acin, Francisco

    2017-07-15

    Carotid stenting (CAS) has been mainly offered to those patients considered at "high risk" for open carotid endarterectomy based on available data from large randomized clinical trials. However, several recent studies have called medical "high risk" into question for CAS indication. The REAL-1 trial evaluated the safety and perioperative and long-term effectiveness in patients with significant carotid artery stenosis with "high-risk" criteria treated with CAS and proximal protection device (MOMA) compared with those with standard surgical-risk features. This nonrandomized double-arm registry included 125 patients (40% symptomatic), 71 (56%) with "standard-risk" and 54 (44%) with "high-risk" criteria. The primary end point was the cumulative incidence of any major adverse event, a composite of stroke, myocardial infarction, and death within 30 days after the intervention or ipsilateral stroke after 30 days and up to 4 years. There was no significant difference in primary end point rate at 30 days between patients at "standard risk" and those with "high risk" (1.4% vs 1.9% respectively; hazard ratio for "standard risk" 1.1; 95% CI 0.8 to 1.2, p = 0.77) nor estimated 4-year rate of ipsilateral stroke (1.3% vs 1.8%; hazard ratio for "standard risk" 1.05, 95% CI 0.86 to 1.14, p = 0.9). In conclusion, 4-year postprocedure results demonstrated that CAS with proximal device (MOMA) is safe and effective for patients with and without "high-risk" for carotid endarterectomy. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Effect of phenylephrine/ketorolac on iris fixation ring use and surgical times in patients at risk of intraoperative miosis

    Directory of Open Access Journals (Sweden)

    Visco D

    2018-02-01

    Full Text Available Denise Visco Eyes of York Cataract & Laser Center, York, PA, USA Purpose: To evaluate the effect of intracameral phenylephrine/ketorolac (1%/0.3% during cataract surgery on the use of iris fixation ring and surgical time in patients with poor pupil dilation (≤5.0 mm or intraoperative floppy iris syndrome (IFIS. Setting: Private practice outpatient surgical center. Design: This retrospective analysis was conducted from January 1, 2014 to October 7, 2015. Materials and methods: The use of iris fixation rings was evaluated in a retrospective analysis of 46 patients who underwent cataract surgery from January 1, 2014, to October 7, 2015, and who were identified before surgery to be at risk for intraoperative miosis. The qualifying factors were presurgical examination of pupil dilation ≤5.0 mm after being administered topical tropicamide 1% and phenylephrine 2.5% or history of IFIS during surgery in the fellow eye. All patients received a 2-day preoperative course of topical nonsteroidal anti-inflammatory drugs (NSAIDs and day-of-surgery preoperative dilation using topical cyclopentolate 1%, tropicamide 1%, and phenylephrine 10%. Phenylephrine/ketorolac 1%/0.3% (Omidria® or epinephrine 1:1,000 with sulfites was added to the ophthalmic irrigation solution and delivered intracamerally at the start of the procedure and throughout surgery. The use of iris fixation rings and surgical time for each patient were captured for each group. Results: Eighteen (50% of the patients in the epinephrine group and no patients in the phenylephrine/ketorolac group required iris fixation ring insertion to maintain pupil dilation or to control IFIS (p=0.0034. Mean surgical time was significantly shorter in the group of patients who received phenylephrine/ketorolac (p=0.0068. Conclusion: In this retrospective cohort analysis of patients with poorly dilated pupils and/or IFIS, the use of intracameral phenylephrine/ketorolac in patients at risk for intraoperative

  9. Major Risk Factors for Heart Disease: High Blood Cholesterol

    Science.gov (United States)

    ... Major Risk Factors for Heart Disease High Blood Cholesterol High blood cholesterol is another major risk factor for heart disease ... can do something about. The higher your blood cholesterol level, the greater your risk for developing heart ...

  10. Nutritional risk index as an independent predictive factor for the development of surgical site infection after pancreaticoduodenectomy.

    Science.gov (United States)

    Shinkawa, Hiroji; Takemura, Shigekazu; Uenishi, Takahiro; Sakae, Masayuki; Ohata, Kazunori; Urata, Yorihisa; Kaneda, Kazuhisa; Nozawa, Akinori; Kubo, Shoji

    2013-03-01

    Malnutrition has been considered a risk factor for the development of a surgical site infection (SSI). The aim of this study was to determine the relationship between preoperative nutritional screening scores and the development of SSI after pancreaticoduodenectomy. We examined 64 patients who had undergone pancreaticoduodenectomy. Their clinical data, nutritional risk index (NRI), and nutritional risk screening 2002 (NRS-2002) score were recorded. SSIs were diagnosed according to the definitions of wound infection established by the Center for Disease Control and Prevention and were confirmed by a microbiological examination. Data were analyzed using the Fisher exact probability method and a multivariate logistic regression analysis. SSIs developed in 21 patients (33 %). Eleven patients had wound infections, and 14 patients had an intra-abdominal abscess. A univariate analysis of perioperative factors revealed that a pancreatic fistula, the NRS-2002, and the NRI were significantly associated with the development of SSI (p risk factors for SSI. By analyzing the pre- and intra-operative factors after excluding the 11 patients with pancreatic fistulas, the NRI was still an independent risk factor for SSI. The present study showed the NRI to be an independent factor for predicting the risk of SSI after pancreaticoduodenectomy.

  11. Risk factors for colonization by carbapenemase-producing enterobacteria at admission to a Surgical ICU: A retrospective study.

    Science.gov (United States)

    Maseda, Emilio; Salgado, Patricia; Anillo, Víctor; Ruiz-Carrascoso, Guillermo; Gómez-Gil, Rosa; Martín-Funke, Carmen; Gimenez, Maria-Jose; Granizo, Juan-José; Aguilar, Lorenzo; Gilsanz, Fernando

    In 2011, a hospital-wide outbreak of OXA-48 producing Klebsiella pneumoniae occurred in our hospital, an epidemiological setting of high ESBL-producing K. pneumoniae rates. This study identifies risk factors for colonization with carbapenemase-producing enterobacteria (CPE) at Surgical Intensive Care Unit (SICU) admission. A 2-year retrospective study was performed in all patients admitted to the SICU that following routine had a rectal swab collected upon admission. Of 254 patients admitted, 41 (16.1%) harbored CPE (five showing two carbapenemase-producing isolates). Most frequent carbapenemase-producing isolates and carbapenemases were K. pneumoniae (39/46, 84.8%) and OXA-48 (31/46; 76.1%), respectively. Carriers significantly had higher rates of chronic renal disease, previous digestive/biliary endoscopy, hospitalization, ICU/SICU admission, intraabdominal surgery, and antibiotic intake, as well as higher median values of clinical scores (SOFA, SAPS II and APACHE II). In the multivariate analysis (R(2)=0.309, p<0.001), CPE carriage was associated with prior administration of 3rd-4th generation cephalosporins (OR=27.96, 95%CI=6.88, 113.58, p<0.001), β-lactam/β-lactamase inhibitor (OR=11.71, 95%CI=4.51, 30.43, p<0.001), abdominal surgery (OR=6.33, 95%CI=2.12, 18.89, p=0.001), and prior digestive/biliary endoscopy (OR=3.88, 95%CI=1.56, 9.67, p=0.004). A strong association between production of ESBLs and carriage of CPE (mainly OXA-48 producing K. pneumoniae) was found. According to the model, the co-selection of β-lactamases by previous exposure to broad-spectrum cephalosporins and β-lactam/β-lactamase inhibitors (with lower relative risk), abdominal surgery and prior digestive/biliary endoscopy were factors associated with CPE carriage. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  12. A Framework to Improve Surgeon Communication in High-Stakes Surgical Decisions: Best Case/Worst Case.

    Science.gov (United States)

    Taylor, Lauren J; Nabozny, Michael J; Steffens, Nicole M; Tucholka, Jennifer L; Brasel, Karen J; Johnson, Sara K; Zelenski, Amy; Rathouz, Paul J; Zhao, Qianqian; Kwekkeboom, Kristine L; Campbell, Toby C; Schwarze, Margaret L

    2017-06-01

    Although many older adults prefer to avoid burdensome interventions with limited ability to preserve their functional status, aggressive treatments, including surgery, are common near the end of life. Shared decision making is critical to achieve value-concordant treatment decisions and minimize unwanted care. However, communication in the acute inpatient setting is challenging. To evaluate the proof of concept of an intervention to teach surgeons to use the Best Case/Worst Case framework as a strategy to change surgeon communication and promote shared decision making during high-stakes surgical decisions. Our prospective pre-post study was conducted from June 2014 to August 2015, and data were analyzed using a mixed methods approach. The data were drawn from decision-making conversations between 32 older inpatients with an acute nonemergent surgical problem, 30 family members, and 25 surgeons at 1 tertiary care hospital in Madison, Wisconsin. A 2-hour training session to teach each study-enrolled surgeon to use the Best Case/Worst Case communication framework. We scored conversation transcripts using OPTION 5, an observer measure of shared decision making, and used qualitative content analysis to characterize patterns in conversation structure, description of outcomes, and deliberation over treatment alternatives. The study participants were patients aged 68 to 95 years (n = 32), 44% of whom had 5 or more comorbid conditions; family members of patients (n = 30); and surgeons (n = 17). The median OPTION 5 score improved from 41 preintervention (interquartile range, 26-66) to 74 after Best Case/Worst Case training (interquartile range, 60-81). Before training, surgeons described the patient's problem in conjunction with an operative solution, directed deliberation over options, listed discrete procedural risks, and did not integrate preferences into a treatment recommendation. After training, surgeons using Best Case/Worst Case clearly presented a choice between

  13. Risk factors for mortality in geriatric hip fractures: a compressional study of different surgical procedures in 785 consecutive patients.

    Science.gov (United States)

    Ercin, Ersin; Bilgili, M Gokhan; Sari, Cihangir; Basaran, S Hakan; Tanriverdi, Bulent; Edipoglu, Erdem; Celen, K Mumtaz; Cetingok, Halil; Kural, Cemal

    2017-01-01

    Only a little is known about whether type of surgical intervention has an effect on mortality of these patients. Our primary objective was to assess whether different type of surgical procedures has an effect on mortality among elderly patients with hip fracture. A secondary objective was to examine factors that are related to mortality in our patient population. Our hypothesis is that type of surgical procedure, especially external fixation, should have an influence on mortality outcomes. We included 785 patients age 65 years or older, with hip fractures. Operative treatment consisted of external fixation, internal fixation, total hip arthroplasty and hip hemiarthroplasty. Age, gender, type of fracture, type of surgery performed, American Society of Anesthesiology (ASA) grade, clinical comorbidities, anesthesia type, blood transfusion requirement, time to surgery, intensive care unit requirement, operation length and length of hospital stay and number of comorbidities were documented. During the study period, 785 patients (262 male, 523 female) were included to study, Overall mortality rate was 37.2 % (292/785). Their age ranged between 65 and 100 years (mean 81). Surgery type Kaplan-Meier cumulative mortality curves suggested no significant difference between four different types of surgery groups (p = 0.064). Transfusion requirement was significantly lower in external fixation group comparing to other groups (p = 0.014). Cox regression analysis showed the number of comorbidities 2 and ≥ 3 (p = 0.0027, p = 0.015), transfusion requirement (p = 0.0001), ASA 4 (p = 0.016) to be significant predictors of mortality. Transfusion requirement, ASA grade 4 and having more than two comorbidities are risk factors for mortality in geriatric hip fractures. Type of surgical intervention and fracture type had similar mortality rates in our patient population.

  14. Identifying High-Risk Patients without Labeled Training Data: Anomaly Detection Methodologies to Predict Adverse Outcomes.

    Science.gov (United States)

    Syed, Zeeshan; Saeed, Mohammed; Rubinfeld, Ilan

    2010-11-13

    For many clinical conditions, only a small number of patients experience adverse outcomes. Developing risk stratification algorithms for these conditions typically requires collecting large volumes of data to capture enough positive and negative for training. This process is slow, expensive, and may not be appropriate for new phenomena. In this paper, we explore different anomaly detection approaches to identify high-risk patients as cases that lie in sparse regions of the feature space. We study three broad categories of anomaly detection methods: classification-based, nearest neighbor-based, and clustering-based techniques. When evaluated on data from the National Surgical Quality Improvement Program (NSQIP), these methods were able to successfully identify patients at an elevated risk of mortality and rare morbidities following inpatient surgical procedures.

  15. Feasibility of Using Ultra-High Field (7 T) MRI for Clinical Surgical Targeting

    Science.gov (United States)

    Duchin, Yuval; Abosch, Aviva; Yacoub, Essa; Sapiro, Guillermo; Harel, Noam

    2012-01-01

    The advantages of ultra-high magnetic field (7 Tesla) MRI for basic science research and neuroscience applications have proven invaluable. Structural and functional MR images of the human brain acquired at 7 T exhibit rich information content with potential utility for clinical applications. However, (1) substantial increases in susceptibility artifacts, and (2) geometrical distortions at 7 T would be detrimental for stereotactic surgeries such as deep brain stimulation (DBS), which typically use 1.5 T images for surgical planning. Here, we explore whether these issues can be addressed, making feasible the use of 7 T MRI to guide surgical planning. Twelve patients with Parkinson's disease, candidates for DBS, were scanned on a standard clinical 1.5 T MRI and a 7 T MRI scanner. Qualitative and quantitative assessments of global and regional distortion were evaluated based on anatomical landmarks and transformation matrix values. Our analyses show that distances between identical landmarks on 1.5 T vs. 7 T, in the mid-brain region, were less than one voxel, indicating a successful co-registration between the 1.5 T and 7 T images under these specific imaging parameter sets. On regional analysis, the central part of the brain showed minimal distortion, while inferior and frontal areas exhibited larger distortion due to proximity to air-filled cavities. We conclude that 7 T MR images of the central brain regions have comparable distortions to that observed on a 1.5 T MRI, and that clinical applications targeting structures such as the STN, are feasible with information-rich 7 T imaging. PMID:22615980

  16. Reducing the risk of surgical site infection using a multidisciplinary approach: an integrative review

    Directory of Open Access Journals (Sweden)

    Gillespie BM

    2015-10-01

    Full Text Available Brigid M Gillespie,1 Evelyn Kang,1 Shelley Roberts,1 Frances Lin,1,2 Nicola Morley,3 Tracey Finigan,3 Allison Homer,3 Wendy Chaboyer1 1National Health and Medical Research Council Research Centre for Clinical Excellence in Nursing Interventions (NCREN and Centre for Healthcare Practice Innovation (HPI, Menzies Health Institute, 2School of Nursing and Midwifery, Griffith University, 3Surgical and Procedural Services, Gold Coast University Hospital, Gold Coast, QLD, Australia Purpose: To identify and describe the strategies and processes used by multidisciplinary teams of health care professionals to reduce surgical site infections (SSIs.Materials and methods: An integrative review of the research literature was undertaken. Searches were conducted in April 2015. Following review of the included studies, data were abstracted using summary tables and the methodological quality of each study assessed using the Standards for Quality Improvement Reporting Excellence guidelines by two reviewers. Discrepancies were dealt with through consensus. Inductive content analysis was used to identify and describe the strategies/processes used by multidisciplinary health care teams to prevent SSI.Results and discussion: In total, 13 studies met the inclusion criteria. Of these, 12 studies used quantitative methods, while a single study used qualitative interviews. The majority of the studies were conducted in North America. All quantitative studies evaluated multifaceted quality-improvement interventions aimed at preventing SSI in patients undergoing surgery. Across the 13 studies reviewed, the following multidisciplinary team-based approaches were enacted: using a bundled approach, sharing responsibility, and, adhering to best practice. The majority of studies described team collaborations that were circumscribed by role. None of the reviewed studies used strategies that included the input of allied health professionals or patient participation in SSI prevention

  17. [Orbital vasculonervous network and orbital surgical compartments by high field magnetic resonance].

    Science.gov (United States)

    Hernández González, L C; Suárez Suárez, E; Dos Santos Bernardo, V; Junceda Moreno, J; Recio Rodríguez, M; Martínez De Vega, V; Viaño López, J

    2003-10-01

    To elucidate the possibilities and indications of high-resolution magnetic resonance imaging (MRI) in the study of the orbit and its contents. Orbital anatomy was studied in sliced specimens of fifteen fresh frozen cadavers and the results were compared with those obtained in thirty asymptomatic subjects who underwent a magnetic resonance with 1.5 Tesla equipment. The information obtained was used to interpret the findings in twenty-two patients with various orbital diseases. High-resolution MRI allows visualization of structures difficult to assess previously, like the cerebrospinal fluid (CSF) surrounding the optic nerve, the complete intraorbital route and the exit of the third cranial nerve, the ophthalmic artery and the intraorbital relationships of the sixth cranial nerve, which can be clearly differentiated from the lateral rectus muscle. High-resolution MRI is a very useful tool for the study of the orbit and its content. It provides accurate diagnoses through non-invasive procedures and facilitates the planning of the surgical approaches by improving the visualization of pathologic orbital structures. lcarlos@correo.uniovi.es

  18. Protocol for the BAG-RECALL clinical trial: a prospective, multi-center, randomized, controlled trial to determine whether a bispectral index-guided protocol is superior to an anesthesia gas-guided protocol in reducing intraoperative awareness with explicit recall in high risk surgical patients

    Directory of Open Access Journals (Sweden)

    Villafranca Alex

    2009-11-01

    Full Text Available Abstract Background Awareness with explicit recall of intra-operative events is a rare and distressing complication that may lead to severe psychological symptoms. Candidate depth of anesthesia monitors have been developed, partly with the aim of preventing this complication. Despite conflicting results from clinical trials and the lack of incisive validation, such monitors have enjoyed widespread clinical adoption, in particular the bispectral index. The American Society of Anesthesiologists has called for adequately powered and rigorously designed clinical trials to determine whether the use of such monitors decreases the incidence of awareness in various settings. The aim of this study is to determine with increased precision whether incorporating the bispectral index into a structured general anesthesia protocol decreases the incidence of awareness with explicit recall among a subset of surgical patients at increased risk for awareness and scheduled to receive an inhalation gas-based general anesthetic. Methods/Design BAG-RECALL is a multi-center, randomized, controlled clinical trial, in which 6,000 patients are being assigned to bispectral index-guided anesthesia (target range, 40 to 60 or end-tidal anesthetic gas-guided anesthesia (target range, 0.7 to 1.3 age-adjusted minimum alveolar concentration. Postoperatively, patients are being assessed for explicit recall at two intervals (0 to 72 hours, and 30 days after extubation. The primary outcome of the trial is awareness with explicit recall. Secondary outcomes include postoperative mortality, psychological symptoms, intensive care and hospital length of stay, average anesthetic gas administration, postoperative pain and nausea and vomiting, duration of stay in the recovery area, intra-operative dreaming, and postoperative delirium. Discussion This trial has been designed to complement two other clinical trials: B-Unaware and MACS (ClinicalTrials.gov numbers, NCT00281489 and NCT00689091

  19. Risk Factors Influencing Development Of Surgical Site Infection In Patients Who Were Operated Due To Endometrial Cancer

    Directory of Open Access Journals (Sweden)

    Ayse Inci

    2016-06-01

    Full Text Available Endometrial cancer is the most commonly encountered malignancy of female genital system. Surgery is the main treatment approach in endometrial cancer. The frequency of surgical site infections (SSI has recently increased. Prediction of risk factors which may cause SSI and taking due precautions may provide a decrease in frequency of these infections. The aim of this study was to determine the risk factors for SSI after surgery for endometrial cancer. The medical records of patients who were operated due to endometrial cancer in Kanuni Sultan Suleyman Education and Research Hospital between January 1st, 2015 and July 31st, 2015 were retrospectively reviewed. Patients were divided into two groups; those that developed SSI following the operation and those that did not develop SSI. Surgical site infections were diagnosed based on Center for Disease Control and Prevention criteria. Ages, co-morbid diseases, body mass index (BMI, ASA (American Society of Anesthesiologists scores, smoking, durations of operation, presence of drainage, blood transfusion, pre-op hemoglobin level and pre-op glucose level of patients were recorded. A p [Dis Mol Med 2016; 4(2.000: 13-17

  20. Incidence and risk factors of neurological deficits of surgical correction for scoliosis: analysis of 1373 cases at one Chinese institution.

    Science.gov (United States)

    Qiu, Yong; Wang, Shoufeng; Wang, Bin; Yu, Yang; Zhu, Feng; Zhu, Zezhang

    2008-03-01

    A retrospective study. To investigate the incidence of neurologic deficits after scoliosis correction at 1 institution and identify the risk factors for such deficits in scoliosis correction. Neurologic deficit is one of the risks of surgical correction of scoliosis. Reports of the incidence of the neurologic deficits involving a large number of cases at 1 institution are rare. Statistical analysis of the neurologic deficits was performed in 1373 scoliosis cases treated at 1 institution by etiologies in light of the patients' sex, age, sagittal profile, surgical approach, Cobb's angle, and the type of surgery. The total incidence of neurologic deficits was 1.89% and that of serious and mild ones was 0.51% and 1.38%, respectively. The total incidence of neurologic deficits were 1.06% in adolescent idiopathic scoliosis patients and 2.89% in congenital scoliosis (CS) patients, 3.32% in scoliosis patients with hyperkyphosis (>40 degrees ) and 1.38% in those without hyperkyphosis, 3.43% for combined procedures and 1.24% for single posterior procedures, 3.69% in patients with Cobb's angle more than 90 degrees and 1.45% in those with an angle less than 90 degrees , 1.68% with primary surgery and 5.97% with revision surgery, the difference between them was significant (P hyperkyphosis and 0.61% without hyperkyphosis, the difference between them was significant (P hyperkyphosis, scoliosis correction by combined procedures, scoliosis with a Cobb's angle more than 90 degrees , and a revision surgery.

  1. Violation of prophylactic vancomycin administration timing is a potential risk factor for rate of surgical site infections in cardiac surgery patients: a prospective cohort study.

    Science.gov (United States)

    Cotogni, Paolo; Barbero, Cristina; Passera, Roberto; Fossati, Lucina; Olivero, Giorgio; Rinaldi, Mauro

    2017-03-08

    Intensivists and cardiothoracic surgeons are commonly worried about surgical site infections (SSIs) due to increasing length of stay (LOS), costs and mortality. The antimicrobial prophylaxis is one of the most important tools in the prevention of SSIs. The objective of this study was to investigate the relationship between the timing of antimicrobial prophylaxis administration and the rate of SSIs. A prospective cohort study was carried out over 1-year period in all consecutive adult patients undergoing elective cardiac surgery. The population was stratified in patients whose antimicrobial prophylaxis administration violated or not the vancomycin timing protocol (i.e., when the first skin incision was performed before the end of vancomycin infusion). To compare SSI rates, the cohort was further stratified in patients at low and high risk of developing SSIs. Over the study period, 1020 consecutive adult patients underwent cardiac surgery and according to study inclusion criteria, 741 patients were prospectively enrolled. A total of 60 SSIs were identified for an overall infection rate of 8.1%. Vancomycin prophylaxis timing protocol was violated in 305 (41%) out of 741 enrolled patients. SSIs were observed in 3% of patients without violation of the antimicrobial prophylaxis protocol (13/436) compared with 15.4% of patients with a violation of the timing protocol (47/305) (P violation had a higher occurrence of SSIs (P = 0.004) and mortality (P = 0.03) versus patients at low risk without protocol violation. Similarly, patients at high risk with protocol violation had a higher occurrence of SSIs (P violation. The logistic regression analysis showed that internal mammary artery use (P = 0.025), surgical time (P violation (P violation (P violation of the timing of prophylactic vancomycin administration significantly increased the probability of SSIs and mortality from infectious cause in cardiac surgery patients.

  2. Can the surgical checklist reduce the risk of wrong site surgery in orthopaedics? - can the checklist help? Supporting evidence from analysis of a national patient incident reporting system

    Directory of Open Access Journals (Sweden)

    Cleary Kevin

    2011-04-01

    Full Text Available Abstract Background Surgical procedures are now very common, with estimates ranging from 4% of the general population having an operation per annum in economically-developing countries; this rising to 8% in economically-developed countries. Whilst these surgical procedures typically result in considerable improvements to health outcomes, it is increasingly appreciated that surgery is a high risk industry. Tools developed in the aviation industry are beginning to be used to minimise the risk of errors in surgery. One such tool is the World Health Organization's (WHO surgery checklist. The National Patient Safety Agency (NPSA manages the largest database of patient safety incidents (PSIs in the world, already having received over three million reports of episodes of care that could or did result in iatrogenic harm. The aim of this study was to estimate how many incidents of wrong site surgery in orthopaedics that have been reported to the NPSA could have been prevented by the WHO surgical checklist. Methods The National Reporting and Learning Service (NRLS database was searched between 1st January 2008- 31st December 2008 to identify all incidents classified as wrong site surgery in orthopaedics. These incidents were broken down into the different types of wrong site surgery. A Likert-scale from 1-5 was used to assess the preventability of these cases if the checklist was used. Results 133/316 (42% incidents satisfied the inclusion criteria. A large proportion of cases, 183/316 were misclassified. Furthermore, there were fewer cases of actual harm [9% (12/133] versus 'near-misses' [121/133 (91%]. Subsequent analysis revealed a smaller proportion of 'near-misses' being prevented by the checklist than the proportion of incidents that resulted in actual harm; 18/121 [14.9% (95% CI 8.5 - 21.2%] versus 10/12 [83.3% (95%CI 62.2 - 104.4%] respectively. Summatively, the checklist could have been prevented 28/133 [21.1% (95%CI 14.1 - 28.0%] patient safety

  3. Impact of occupational mechanical exposures on risk of lateral and medial inguinal hernia requiring surgical repair

    DEFF Research Database (Denmark)

    Vad, Marie Vestergaard; Frost, Poul; Bay-Nielsen, Morten

    2012-01-01

    We undertook a register-based cohort study to evaluate exposure-response relations between cumulative occupational mechanical exposures, and risk of lateral and medial inguinal hernia repair.......We undertook a register-based cohort study to evaluate exposure-response relations between cumulative occupational mechanical exposures, and risk of lateral and medial inguinal hernia repair....

  4. Comparison of high-energy pulsed carbon dioxide laser resurfacing and dermabrasion in the revision of surgical scars.

    Science.gov (United States)

    Nehal, K S; Levine, V J; Ross, B; Ashinoff, R

    1998-06-01

    Both dermabrasion and high-energy pulsed carbon dioxide (CO2) laser resurfacing can improve the appearance of surgical scars. Although the results of these two procedures have been compared using historical data, a prospective evaluation has never been performed in humans. To prospectively compare the clinical effects of dermabrasion and high-energy pulsed CO2 laser resurfacing in the revision of surgical scars. Facial surgical scars in four patients were prospectively revised using a split scar model. One half of the scar was dermabraded and the other half was resurfaced with the high-energy pulsed CO2 laser. Comparisons of the two treatment modalities were performed through clinical assessment, photographic evaluation, and textural analysis of the scars. The high-energy pulsed CO2 laser-resurfaced halves of the scar were bloodless with less postoperative crusting in comparison with the dermabraded halves. Reepithelialization time and degree and duration of postoperative erythema were similar for both treatment halves. Photographic evaluation and textural analysis showed comparable improvement in the clinical appearance and surface texture of the scars with both treatment modalities. Both the high-energy pulsed CO2 laser and dermabrasion can achieve comparable clinical improvement in the revision of surgical scars. The high-energy pulsed CO2 laser offers the advantage of a bloodless field and a more precise method of tissue ablation. Postoperative erythema, however, is an expected finding with both treatment modalities.

  5. Defining high risk in endovascular aneurysm repair.

    Science.gov (United States)

    Mastracci, Tara M; Greenberg, Roy K; Hernandez, Adrian V; Morales, Catherine

    2010-05-01

    Long-term survival benefit contrasted with rupture risk should determine which patients are suitable for abdominal aortic aneurysm (AAA) intervention. Our aim was to develop a model capable of predicting long-term survival based on preoperative characteristics. A prospective cohort study using Cox regression modeling. We aimed to associate preoperative characteristics with long-term mortality, and create a predictive nomogram, which was then externally validated on an independent cohort (697 patients) who underwent endovascular abdominal aortic aneurysm (AAA) repair. We pooled the results of 412 patients undergoing endovascular repair of infrarenal and juxtarenal aneurysm who were high risk (average Glasgow aneurysm scores of 72.8 [SD 10.4]). Despite anatomic differences, there were no statistically significant differences in perioperative or long-term outcomes between infrarenal and juxtarenal aneurysms (log rank test, P = .5). Data from this group (64% infrarenal aneurysms and 36% juxtarenal aneurysms) were randomly and evenly split into a model development and test group. Independent predictors of mortality included in the model are age, aneurysm diameter, history of peripheral artery disease, chronic obstructive pulmonary disease (COPD), or congestive heart failure, requirement for supplemental home oxygen, and use of salicylates. Internal validation reveals good calibration and discriminative ability (c-statistic 0.68 [95% confidence interval 0.65-0.71]). External validation confirms good calibration. In the context of acceptable perioperative results, long-term mortality risk can be predicted in endovascular AAA repair and must be balanced against risk of rupture to determine which patients should be offered treatment. Copyright (c) 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  6. Perioperative high inspired oxygen fraction therapy reduces surgical site infection with Pseudomonas aeruginosa in rats.

    Science.gov (United States)

    Kroin, Jeffrey S; Li, Jinyuan; Goldufsky, Josef W; Gupta, Kajal H; Moghtaderi, Masoomeh; Buvanendran, Asokumar; Shafikhani, Sasha H

    2016-08-01

    Surgical site infection (SSI) remains one of the most important causes of healthcare-associated infections, accounting for ~17 % of all hospital-acquired infections. Although short-term perioperative treatment with high fraction of inspired oxygen (FiO2) has shown clinical benefits in reducing SSI in colorectal resection surgeries, the true clinical benefits of FiO2 therapy in reducing SSI remain unclear because randomized controlled trials on this topic have yielded disparate results and inconsistent conclusions. To date, no animal study has been conducted to determine the efficacy of short-term perioperative treatments with high (FiO2>60 %) versus low (FiO2oxygen in reducing SSI. In this report, we designed a rat model for muscle surgery to compare the effectiveness of short-term perioperative treatments with high (FiO2=80 %) versus a standard low (FiO2=30 %) oxygen in reducing SSI with Pseudomonas aeruginosa - one of the most prevalent Gram-negative pathogens, responsible for nosocomial SSIs. Our data demonstrate that 5 h perioperative treatment with 80 % FiO2 is significantly more effective in reducing SSI with P. aeruginosa compared to 30 % FiO2 treatment. We further show that whilst 80 % FiO2 treatment does not affect neutrophil infiltration into P. aeruginosa-infected muscles, neutrophils in the 80 % FiO2-treated and infected animal group are significantly more activated than neutrophils in the 30 % FiO2-treated and infected animal group, suggesting that high oxygen perioperative treatment reduces SSI with P. aeruginosa by enhancing neutrophil activation in infected wounds.

  7. Highly Enhanced Risk Management Emergency Satellite

    DEFF Research Database (Denmark)

    Dalmeir, Michael; Gataullin, Yunir; Indrajit, Agung

    HERMES (Highly Enhanced Risk Management Emergency Satellite) is potential European satellite mission for global flood management, being implemented by Technical University Munich and European Space Agency. With its main instrument - a reliable and precise Synthetic Aperture Radar (SAR) antenna...... - and its orbit characteristics (covering the whole earth surface in 3 days, low altitude), HERMES will provide stand-alone-data for: flood disaster monitoring, flood forecasting and flood prevention. Data obtained by HERMES can be used for commercial soil type maps (e.g. for optimized land use). As only...... highly effective and orbit proven hardware is used, HERMES is designed to be reliable, precise and of low cost. The project can be extended for use on other space bodies (planets) for rapid observation of the planetary surface....

  8. Using a change model to reduce the risk of surgical site infection.

    Science.gov (United States)

    Burden, Mel

    2016-09-22

    A surgical site infection (SSI) surveillance module completed in 2014 highlighted that infection rates for breast surgery inpatients and readmissions at an acute trust had increased to 2.2%, from 0.5% in 2012. The national benchmark for 2014 established by Public Health England (PHE) was 1.0%. This demonstrated a greater than fourfold absolute increase in SSI for breast surgery during these periods. The infection rate could have been due to chance, but warranted investigation. The results were presented to the breast team and used to drive practice transformation through audit and observation, identifying areas of change to improve patient safety. The project used a recognised 8-step model for leading change developed by John Kotter, a professor at Harvard Business School and world-renowned change expert. The project presented opportunities to promote infection prevention while implementing care improvement strategies and behaviour change in partnership with the breast team.

  9. Dry socket following surgical removal of impacted third molar in an Iranian population: incidence and risk factors.

    Science.gov (United States)

    Eshghpour, M; Nejat, A H

    2013-01-01

    Dry socket (DS) is the most common post-surgical complication following extraction of impacted molar teeth. Various risk factors have been mentioned for this complication including gender, age, amount of trauma during extraction, difficulty of surgery, inappropriate irrigation, infection, smoking, and oral contraceptive use. The aim of the current study was to evaluate the incidence of DS among surgical removal of impacted third mandibular molar in an Iranian Oral and Maxillofacial Clinic and also identifying the background risk factors. A total of 189 patients with a total of 256 surgeries entered this study. Surgeries to remove impacted third mandibular molar teeth between April 2009 and August 2010 were included in this study. A questionnaire containing two sections was designed; in the first section demographic data along with smoking status, oral contraceptive use, menstrual cycle phase, systemic disorders, and use of antibiotics prior to surgery collected; in the second section data regarding difficulty of surgery according to radiograph and surgeon perception after surgery, length of surgery, and number of anesthetic carpules along with data regarding cases returning with DS recorded. Data were reported descriptively and analyzed with Fisher's exact test and Chi-square with the confidence interval of 95%. The incidence of DS was 19.14%. Age, gender, systemic disorder, and antibiotics use prior to surgery revealed no significant associations with DS ( P > 0.05). However, incidence of DS was significantly relevant to smoking, oral contraceptive use, menstruation cycle, difficulty of the surgery according to pre-surgery radiograph evaluation and perception of surgeon post-surgery, length of surgery, and number of carpules used to reach anesthesia ( P risk groups when performing extraction surgeries to consider measures in order to reduce postoperative complications.

  10. Does laparoendoscopic single-site adrenalectomy increase surgical risk in patients with pheochromocytoma?

    Science.gov (United States)

    Hattori, Seiya; Miyajima, Akira; Maeda, Takahiro; Hasegawa, Masanori; Takeda, Toshikazu; Kosaka, Takeo; Kikuchi, Eiji; Nakagawa, Ken; Oya, Mototsugu

    2013-02-01

    LESS (laparoendoscopic single-site) surgery has been developed as a treatment option for adrenal tumors that has less postoperative pain and greater cosmetic benefits. Some reports proposed that patient selection criteria should be stringent, and pheochromocytoma (PHE) should be taken as an advanced indication. The aim of this study is to compare LESS adrenalectomy (ADX) with conventional adrenalectomy (CL-ADX) in patients with PHE, with attention paid not only to immediate postoperative outcomes but also to the intraoperative hemodynamic changes that occur with each technique. The records of 265 consecutive patients who underwent laparoscopic ADX at Keio University Hospital in Tokyo from January 2001 to June 2011 were entered into a database. Surgical procedures were performed or supervised by two experienced laparoscopic surgeons, who performed more than 100 cases of urologic laparoscopic surgery in 2011. Twenty consecutive patients who underwent LESS-ADX from December 2009 to October 2011 were compared with patients who underwent CL-ADX (controls, n = 30) to look at differences in hemodynamic parameters and surgical outcomes in a case-control analysis. Each group was equivalent with respect to age, sex, and BMI. The mean size of 50 PHE was 45.1 ± 4.0 mm, the mean operative time was 151.8 ± 10.6 min, and there was no significant difference between the two groups. In one case of LESS-ADX, two additional ports were added. There was no significant difference between the CL-ADX and LESS-ADX groups in terms of operation time, total fluid during the operation, estimated blood loss, first oral feeding, postoperative stay in the intensive care unit, or postoperative hospital stay. We consider the safety of LESS-ADX of PHE as similar to that of CL-ADX. With appropriate pre- and intraoperative hemodynamic control and experienced hands, LESS-ADX could become one of the treatments of choice for resection of PHE.

  11. Risk factors for surgical site infection in a teaching hospital: a prospective study of 1,138 patients

    Directory of Open Access Journals (Sweden)

    Cheng K

    2015-08-01

    Full Text Available Keping Cheng, Jiawei Li, Qingfang Kong, Changxian Wang, Nanyuan Ye, Guohua Xia Department of Infection Control, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, People’s Republic of China Background: The purpose of this study was to identify risk factors for surgical site infection (SSI in a teaching hospital.Methods: A prospective study was initiated to investigate risk factors for SSI at a university-affiliated tertiary care center from July 2013 to December 2014. The chi-square test for categorical variables was used to determine the significance of association, whereas the multivariate logistic regression model was used to examine independent risk factors for SSI.Results: A total of 1,138 patients met the inclusion criteria, in whom 36 cases of infection occurred during the hospitalization period and two cases occurred after discharge. Univariate analysis showed that SSI was associated with the type of operation, wound classification, volume of blood loss, blood transfusion, American Society of Anesthesiology score before surgery, risk index, duration of surgery, diabetes, cancer, gastrointestinal catheter, urinary catheter, postoperative drainage, and preprocedural white blood cell count. Multivariate analysis identified six independent parameters correlating with the occurrence of SSI: diabetes (odds ratio [OR] 6.400; 95% confidence interval [CI] 2.582–15.866; P=0.000; cancer (OR 2.427; 95% CI 1.028–5.732; P=0.043; preprocedural white blood cell count more than 10×109/L (OR 6.988; CI 3.165–15.425; P=0.000; wound classification (clean contaminated [OR: 7.893; CI: 2.244–27.762; P=0.001]; contaminated [OR: 7.031; CI: 1.652–29.922; P=0.008]; dirty [OR: 48.778; CI: 5.418–439.164; P=0.001]; operative duration more than 120 minutes (OR 4.289; CI 1.773–10.378; P=0.001; and postoperative drainage (OR 3.957; CI 1.422–11.008; P=0.008.Conclusion: Our data suggest that all these risk factors

  12. Incremental value of anemia in cardiac surgical risk prediction with the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II model.

    Science.gov (United States)

    Scrascia, Giuseppe; Guida, Pietro; Caparrotti, Sergio Maria; Capone, Giuseppe; Contini, Marco; Cassese, Mauro; Fanelli, Vitantonio; Martinelli, Gianluca; Mazzei, Valerio; Zaccaria, Salvatore; Paparella, Domenico

    2014-09-01

    Anemia is a risk factor for adverse events after cardiac operations. We evaluated the incremental value of preoperative anemia over the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II to predict hospital death after cardiac operations. Data for 4,594 consecutive adults (1,548 women [33.7%]), aged 67 ± 11 years, who underwent cardiac operations from January 2011 to July 2013 were extracted from the Regional Cardiac Surgery Registry of Puglia. The last preoperative hemoglobin value was used, according to World Health Organization criteria, to classify anemia as mild (hemoglobin 11.0 to 12.9 g/dL in men and 11.0 to 11.9 g/dL in women) in 1,021 patients (22.2%) and as moderate to severe (hemoglobin anemia, with model discrimination quantified by C statistic and risk classification by the use of net reclassification improvement (NRI). Overall expected and observed mortality rates were 4.4% and 5.9%. Anemia was significantly associated with a mortality rate of 3.4% in patients without anemia, 7.7% in mild anemia, and 15.7% in moderate to severe anemia (p anemia was analyzed with EuroSCORE II, the model improved in discrimination (C statistic = 0.852 vs 0.860; p = 0.007) and reclassification (category free-NRI, 0.592; p anemia has strong association with operative death in cardiac surgical patients. Anemia provides significant incremental value over the EuroSCORE II and should be considered for assessment of cardiac surgical risk. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Smoking and Risk of Surgical Site Infection after Spinal Surgery: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Kong, Lingde; Liu, Zhao; Meng, Fei; Shen, Yong

    The effect of smoking on the risk of surgical site infection (SSI) after spinal surgery remains controversial. Therefore, we conducted a meta-analysis to determine whether there is an association between smoking and the risk of SSI and to calculate the relative risk of infections attributable to smoking. We performed a literature search of cohort and case-control studies in the MEDLINE, Embase, and ISI Web of Science databases. Sensitivity and subgroup analyses were performed to test the robustness of overall estimates of risk and to investigate potential sources of heterogeneity. We further calculated the population-attributable fraction (PAF) to evaluate the proportion of SSIs associated with smoking. In total, 26 independent observational studies involving 67,405 patients who underwent spinal surgery were analyzed. Smokers had a significantly higher risk of SSI than did nonsmokers (odds ratio [OR] 1.26; 95% confidence interval [CI] 1.05-1.51). Subgroup analysis according to the study design revealed an apparent association between smoking and SSI in the cohort subgroup (OR 1.40; 95% CI 1.17-1.66), but not in the case-control subgroup (OR 0.99; 95% CI 0.64-1.53). After evaluation of the PAF, the proportion of SSIs associated with smoking increased to 10.37%. This meta-analysis demonstrated that smoking increases the risk of SSI after spinal surgery. False-negative associations in other studies may have resulted from defects in the study design. However, because of the heterogeneity among the studies in the present meta-analysis, the results should be interpreted with caution.

  14. Micro-surgical endodontics.

    Science.gov (United States)

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

    2014-02-01

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

  15. [Antiphospholipid antibodies in high-risk pregnancy].

    Science.gov (United States)

    Nestorowicz, B; Ostanek, L; Ronin-Walknowska, E; Fiedorowicz-Fabrycy, I; Skoczowska, M; Czajkowska, E; Fischer, K

    2000-06-01

    Recently the connection of antiphospholipid antibodies (aPLs) presence with pregnancy loss and complications in pregnancy has been observed APLs related obstetric complications include: miscarriages after 10 weeks, IUGR, intrauterine foetal death, preeclampsia and severe preeclampsia. Our objective was to determine the aPLs prevalence in patients with recurrent pregnancy loss and/or complicated pregnancy. We examined 154 pregnant women aged 19-42 (average of 29.1) with recurrent pregnancy loss, current pregnancy complicated by preeclampsia and severe preeclampsia and/or IUGR, thrombotic episodes, thrombocytopenia or autoimmune disease. In all the patients anticardiolipin antibodies (aCL) were determined at least twice using ELISA and their coagulation system was tested including lupus anticoagulant (LA) test. In justified cases immunological examinations detecting connective tissue systemic diseases were conducted. Increased aCL titre was detected in 54 (34.4%) women. Statistically significant risk of increased aCL titre was observed in patients with autoimmunological diseases (RR = 4.3). Increased, but Statistically insignificant, risk of high aCL titre was observed in patients with venous thrombosis (RR = 2.45) as well as in patients with thrombocytopenia (RR = 2.45). LA prevailed significantly more often in patients with venous thrombosis episodes (RR = 6.33) and with autoimmunological diseases (RR = 17.4). Preterm deliveries were significantly more frequent in pregnant women with increased aCL titre and/or LA. Moreover, in this group foetal death and preterm stillbirth more often occurred. The above mentioned risks increased when aCL and LA coexisted. No relation between increased aPLs and miscarriage frequency was observed. 1) Increased aPLs titre prevail in multiparas with bad obstetrical anamnesis and with pathological course in present pregnancy, 2) increased aPLs titre prevail in patients with autoimmunological diseases, 3) increased aPLs titre are

  16. Which Kind of Provider's Operation Volumes Matters? Associations between CABG Surgical Site Infection Risk and Hospital and Surgeon Operation Volumes among Medical Centers in Taiwan.

    Directory of Open Access Journals (Sweden)

    Tsung-Hsien Yu

    Full Text Available Volume-infection relationships have been examined for high-risk surgical procedures, but the conclusions remain controversial. The inconsistency might be due to inaccurate identification of cases of infection and different methods of categorizing service volumes. This study takes coronary artery bypass graft (CABG surgical site infections (SSIs as an example to examine whether a relationship exists between operation volumes and SSIs, when different SSIs case identification, definitions and categorization methods of operation volumes were implemented.A population-based cross-sectional multilevel study was conducted. A total of 7,007 patients who received CABG surgery between 2006 and 2008 from 19 medical centers in Taiwan were recruited. SSIs associated with CABG surgery were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM codes and a Classification and Regression Trees (CART model. Two definitions of surgeon and hospital operation volumes were used: (1 the cumulative CABG operation volumes within the study period; and (2 the cumulative CABG operation volumes in the previous one year before each CABG surgery. Operation volumes were further treated in three different ways: (1 a continuous variable; (2 a categorical variable based on the quartile; and (3 a data-driven categorical variable based on k-means clustering algorithm. Furthermore, subgroup analysis for comorbidities was also conducted.This study showed that hospital volumes were not significantly associated with SSIs, no matter which definitions or categorization methods of operation volume, or SSIs case identification approaches were used. On the contrary, the relationships between surgeon's volumes varied. Most of the models demonstrated that the low-volume surgeons had higher risk than high-volume surgeons.Surgeon volumes were more important than hospital volumes in exploring the relationship between CABG operation volumes and

  17. Risk factors and outcomes of organ-space surgical site infections after elective colon and rectal surgery

    Directory of Open Access Journals (Sweden)

    Aina Gomila

    2017-04-01

    Full Text Available Abstract Background Organ-space surgical site infections (SSI are the most serious and costly infections after colorectal surgery. Most previous studies of risk factors for SSI have analysed colon and rectal procedures together. The aim of the study was to determine whether colon and rectal procedures have different risk factors and outcomes for organ-space SSI. Methods A multicentre observational prospective cohort study of adults undergoing elective colon and rectal procedures at 10 Spanish hospitals from 2011 to 2014. Patients were followed up until 30 days post-surgery. Surgical site infection was defined according to the Centers for Disease Control and Prevention criteria. Oral antibiotic prophylaxis (OAP was considered as the administration of oral antibiotics the day before surgery combined with systemic intravenous antibiotic prophylaxis. Results Of 3,701 patients, 2,518 (68% underwent colon surgery and 1,183 (32% rectal surgery. In colon surgery, the overall SSI rate was 16.4% and the organ-space SSI rate was 7.9%, while in rectal surgery the rates were 21.6% and 11.5% respectively (p < 0.001. Independent risk factors for organ-space SSI in colon surgery were male sex (Odds ratio -OR-: 1.57, 95% CI: 1.14–2.15 and ostomy creation (OR: 2.65, 95% CI: 1.8–3.92 while laparoscopy (OR: 0.5, 95% CI: 0.38–0.69 and OAP combined with intravenous antibiotic prophylaxis (OR: 0.7, 95% CI: 0.51–0.97 were protective factors. In rectal surgery, independent risk factors for organ-space SSI were male sex (OR: 2.11, 95% CI: 1.34–3.31 and longer surgery (OR: 1.49, 95% CI: 1.03–2.15, whereas OAP with intravenous antibiotic prophylaxis (OR: 0.49, 95% CI: 0.32–0.73 was a protective factor. Among patients with organ-space SSI, we found a significant difference in the overall 30-day mortality, being higher in colon surgery than in rectal surgery (11.5% vs 5.1%, p = 0.04. Conclusions Organ-space SSI in colon and rectal surgery has some

  18. Prenatal screening with evaluated high risk scores.

    Science.gov (United States)

    Papiernik, E; Grangé, G

    1999-01-01

    This paper reviews data that support the effectiveness of the French approach of using risk scoring for evaluating the risk of preterm delivery. This approach, which was developed in 1969 and spread to obstetricians and midwives throughout France in the early 1970s, includes systematic information about the recognition of uterine contractions, advice about reduction of physical exercise, and the prescription of work-leave for women with heavy or physically demanding work loads. The effectiveness of this prevention strategy is assessed using three different data sets: an evaluation of a preterm prevention program in the Alsace Region of France, five successive French national sample surveys which collected data on pregnant women, and a study of the effectiveness of a prevention program for twins in the district of Haut de Seine near Paris. The authors show that the rate of preterm birth in France declined substantially, but that the decline was concentrated among singleton spontaneous births. Since the 1970s induced preterm births have increased, and, interventions have not reduced the high rates of preterm birth among twins.

  19. High-risk obstetrics, medicolegal problems.

    Science.gov (United States)

    Herczeg, J

    1997-02-01

    The perinatal period is one of the most dangerous time of life. The responsibilities of the obstetricians are multifold. It is very difficult to draw a line between good and substandard care, therefore in perinatology and especially in high-risk obstetrical cases there are no absolute rules of management. The lay public is convinced through media channels, that modern reproductive research eliminated all the risks and hazards associated with childbirths, therefore only 100% healthy babies are accepted. Pregnancy is regarded as a 'success story' and if the baby is born with neurological defects (cerebral palsy) the parents and their advisors feel, that someone responsible for the defect should be found in the chain of management. This attitude starts a legal battle focusing on the events of labor and delivery. But in most cases it is very difficult to determine if a peripartal neonatal encephalopathy originated from the time period of labor and delivery, or started weeks earlier during pregnancy as an unnoticed event. Perinatal morbidity indicators are best based on neonatal clinical signs, which are predictive of later morbidity of the child. Neonatal seizures within 48 h of delivery of the baby could be a good index of later morbidity.

  20. Image-defined risk factors in unresectable neuroblastoma: SIOPEN study on incidence, chemotherapy-induced variation, and impact on surgical outcomes.

    Science.gov (United States)

    Avanzini, Stefano; Pio, Luca; Erminio, Giovanni; Granata, Claudio; Holmes, Keith; Gambart, Marion; Buffa, Piero; Castel, Victoria; Valteau Couanet, Dominique; Garaventa, Alberto; Pistorio, Angela; Cecchetto, Giovanni; Martucciello, Giuseppe; Mattioli, Girolamo; Sarnacki, Sabine

    2017-11-01

    To evaluate the impact of image-defined risk factor (IDRF) modification after chemotherapy on surgical outcomes, event-free survival (EFS), and overall survival (OS) among patients enrolled in the European Unresectable Neuroblastoma (EUNB) study. IDRFs were assigned according to the corresponding surgical risk factors list reported in the database. Surgical outcomes, EFS, and OS were related to IDRF modification with chemotherapy. The predictive value of preoperative IDRF for surgical outcomes was analyzed. Cox proportional hazards models for EFS and OS, including preoperative IDRF, surgical outcomes, and other known clinical risk factors, were created. Of the 160 patients enrolled in the EUNB study, 143 patients met the inclusion criteria. A total of 228 IDRF were thus collected. Following chemotherapy, 76 (33%) IDRF disappeared in 32.2% of patients, 33 (14%) new IDRF appeared in 18.8% of patients, and 49% of patients did not show any IDRF change. Complete resection/minimal residual disease (71.2%) was more frequent among children who had disappearance/numerical reduction of IDRF (P = 0.005). Infiltration of the branches of the mesenteric artery was predictive of an unfavorable surgical outcome. Prolonged preoperative chemotherapy over five courses and encasement of the celiac axis and/or mesenteric artery origin impacted EFS and OS. The unchanged IDRF pattern in 50% of patients and the appearance of new IDRF during chemotherapy in approximately 20% of patients strengthens the idea that prolonged chemotherapy is useless for improving surgical resection in this population of patients. In addition, midline perivascular abdominal preoperative IDRF appeared to be predictive not only of surgical outcomes but also of EFS and OS. © 2017 Wiley Periodicals, Inc.

  1. Impact of intraoperative MRI on the surgical results for high-grade gliomas.

    Science.gov (United States)

    Hirschberg, H; Samset, E; Hol, P K; Tillung, T; Lote, K

    2005-04-01

    The impact of intraoperative MRI (iMRI) on the surgical procedure, patient outcome and median survival for a series of patients harbouring high-grade gliomas forms the basis of this study. Their outcome has been compared to a matched cohort of patients operated in a conventional manner to determine if the use of intraoperative MRI can be shown to improve the results of surgery and prognosis for this type of patient. 32 microsurgical open craniotomies, performed in the intraoperative iMRI scanner for grade IV supratentorial gliomas, with follow-up periods of more than 2 months, were analyzed for this study. A group of 32 primary high-grade glioma patients (no recurrent tumors) were matched for age, preoperative clinical grade, gender and histology and operated during a corresponding time interval in a conventional manner acted as controls. All 64 patients were examined and analyzed for the occurrence of postoperative increased neurological morbidity or death. No complications directly related to the intraoperative scanning procedures were observed and no intraoperative death occurred in either group. The average operating time in the intraoperative scanner was 5.1 hours and was significantly longer than in the conventional OR (3.4 hours). The mean overall survival time for the 32 patients in the study group was 14.5 months (95 % confidence interval 12.0 - 16.6) compared to 12.1 months (95 % confidence interval 10.2 - 14.1) for the matched control group. Although iMRI is an effective way of imaging residual tumor, this study could not demonstrate an increased efficacy of surgery utilizing this technique for patients harbouring grade IV gliomas compared to more conventional methods. No statistical significance was noted between the two groups (p = 0.14). The complication rate was within the range reported for other series, in both control as well as the study group.

  2. Suicide risk assessment in high-risk adolescents.

    Science.gov (United States)

    Gray, Barbara P; Dihigo, Sharolyn K

    2015-09-13

    A significant number of adolescents experience depression and other mental health disorders that may put them at risk for suicide. Mental health assessment is an important component of primary healthcare. Depression and suicide risk screening can assist healthcare providers in preventing suicides.

  3. High body mass index and cancer risk

    DEFF Research Database (Denmark)

    Benn, Marianne; Tybjærg-Hansen, Anne; Smith, George Davey

    2016-01-01

    alleles was associated with a 3 % higher BMI (P cancer. In instrumental variable analysis for a 10 kg/m(2) higher genetically determined BMI the odds ratio for any non-skin cancer was 1.16 (0.64-2.09), with a corresponding observational estimate of 0.94 (0.88-1.01). Using......High body mass index (BMI) has been associated with increased risk of some cancer. Whether these reflect causal associations is unknown. We examined this issue. Using a Mendelian randomisation approach, we studied 108,812 individuals from the general population. During a median of 4.7 years...... of follow-up (range 0-37), 8002 developed non-skin cancer, 3347 non-melanoma skin cancer, 1396 lung cancer, 637 other smoking related cancers, 1203 colon cancer, 159 kidney cancer, 1402 breast cancer, 1062 prostate cancer, and 2804 other cancers. Participants were genotyped for five genetic variants...

  4. Safety culture in high-risk industries.

    Science.gov (United States)

    Martyka, Joanna; Lebecki, Kazimierz

    2014-01-01

    This paper addresses the question of whether adopting safety culture improves hazard prevention in enterprises characterized by high primary risk. To answer this question, sample underground coal mines were examined to investigate the basic elements of the safety culture of employees. This paper presents the results of a diagnosis of the basic elements of the safety culture of supervisors (midlevel managers) and blue-collar workers in 3 underground coal mines. The study used 2 techniques: a Likert-type scale and a questionnaire. The results indicate the need to introduce changes in the safety culture of underground coal mine employees. This study also presents the conditions for improvement. Special attention was paid to (a) the conditions for improving safety culture and (b) a programme for modifying risky behaviours.

  5. External Validation of Risk Prediction Scores for Invasive Candidiasis in a Medical/Surgical Intensive Care Unit: An Observational Study

    Science.gov (United States)

    Ahmed, Armin; Baronia, Arvind Kumar; Azim, Afzal; Marak, Rungmei S. K.; Yadav, Reema; Sharma, Preeti; Gurjar, Mohan; Poddar, Banani; Singh, Ratender Kumar

    2017-01-01

    Background: The aim of this study was to conduct external validation of risk prediction scores for invasive candidiasis. Methods: We conducted a prospective observational study in a 12-bedded adult medical/surgical Intensive Care Unit (ICU) to evaluate Candida score >3, colonization index (CI) >0.5, corrected CI >0.4 (CCI), and Ostrosky's clinical prediction rule (CPR). Patients' characteristics and risk factors for invasive candidiasis were noted. Patients were divided into two groups; invasive candidiasis and no-invasive candidiasis. Results: Of 198 patients, 17 developed invasive candidiasis. Discriminatory power (area under receiver operator curve [AUROC]) for Candida score, CI, CCI, and CPR were 0.66, 0.67, 0.63, and 0.62, respectively. A large number of patients in the no-invasive candidiasis group (114 out of 181) were exposed to antifungal agents during their stay in ICU. Subgroup analysis was carried out after excluding such patients from no-invasive candidiasis group. AUROC of Candida score, CI, CCI, and CPR were 0.7, 0.7, 0.65, and 0.72, respectively, and positive predictive values (PPVs) were in the range of 25%–47%, along with negative predictive values (NPVs) in the range of 84%–96% in the subgroup analysis. Conclusion: Currently available risk prediction scores have good NPV but poor PPV. They are useful for selecting patients who are not likely to benefit from antifungal therapy. PMID:28904481

  6. The incidence of surgical site dehiscence following full-thickness gastrointestinal biopsy in dogs and cats and associated risk factors.

    Science.gov (United States)

    Swinbourne, F; Jeffery, N; Tivers, M S; Artingstall, R; Bird, F; Charlesworth, T; Doran, I; Freeman, A; Hall, J; Hattersley, R; Henken, J; Hughes, J; de la Puerta, B; Rutherford, L; Ryan, T; Williams, H; Woods, S; Nicholson, I

    2017-09-01

    The objectives of this study were to: (1) document the incidence of surgical site dehiscence after full-thickness gastrointestinal biopsy in dogs and cats and (2) identify potential risk factors. Data relating to dogs and cats undergoing full-thickness gastrointestinal biopsy were reviewed retrospectively following submission of a completed questionnaire by 12 referral institutions. Outcome measures were definite dehiscence, possible dehiscence (clinical records suggestive of dehiscence but not confirmed), suspected dehiscence (definite and possible combined) and death within 14 days. Logistic regression was planned for analysis of association of dehiscence with low preoperative serum albumin, biopsy through neoplastic tissue, biopsy alongside another major abdominal surgical procedure and biopsy of the colon. Of 172 cats, two (1·2%) had definite dehiscence, and four (2·3%) had possible dehiscence. Low preoperative serum albumin was significantly associated with definite dehiscence in univariable analysis and with suspected dehiscence and death within 14 days in univariable analysis, but all odds ratios had wide 95% confidence intervals. A histopathological diagnosis of neoplasia was significantly associated with death within 14 days in univariable analysis. Of 195 dogs, two (1·0%) had definite dehiscence, and three (1·5%) had possible dehiscence. In dogs, there was no association between any outcome measure and the putative risk factors. Incidence of dehiscence following full-thickness gastrointestinal biopsy was low in this study. When determining the appropriateness of biopsy in individual cases, this information should be balanced against the potentially life-threatening consequences of dehiscence. © 2017 British Small Animal Veterinary Association.

  7. Risk factors associated with positive surgical margins following radical prostatectomy for clinically localized prostate cancer

    DEFF Research Database (Denmark)

    Røder, Martin Andreas; Thomsen, Frederik Birkebæk; Christensen, Ib Jarle

    2014-01-01

    consecutive single-institution Danish cohort of 1148 patients undergoing RP between 1995 and 2011 was investigated. To analyse the impact of covariates on risk of PSM, a multivariate logistic regression model was used, including cT category, biopsy Gleason score, prostate-specific antigen (PSA), percentage...

  8. Clinical risk factors and urodynamic predictors prior to surgical treatment for stress urinary incontinence

    DEFF Research Database (Denmark)

    Bing, Mette Hornum; Gimbel, Helga; Greisen, Susanne

    2015-01-01

    and the predictive value of urodynamic testing in patients with urinary incontinence, where surgery is considered. Because of the paucity of evidence based on randomized controlled trials, we conducted a narrative review of the published literature. RESULTS: Clinical risk factors in terms of mixed urinary...

  9. Endovascular Management of Infected Femoral Artery Pseudoaneurysms in High-Risk Patients: A Case Series

    Energy Technology Data Exchange (ETDEWEB)

    D’Oria, Mario, E-mail: mario.doria88@outlook.com; Sgorlon, Giada; Calvagna, Cristiano; Zamolo, Francesca; Chiarandini, Stefano; Adovasio, Roberto; Griselli, Filippo [University Hospital of Cattinara, Vascular and Endovascular Surgery Unit (Italy)

    2017-04-15

    We report our experience with the urgent treatment of two high-risk patients with infected femoral artery pseudoaneurysms (IFAPs) with the placement of a self-expandable covered stent (SECS). In both cases, there was no perioperative mortality and the aneurysm exclusion was successful without early or late stent thrombosis/stent fracture nor acute or chronic limb ischemia or limb loss. There was no recurrence of local or systemic infection during the follow-up period. Endovascular therapy represents a feasible treatment option for IFAPs in those patients for whom the risk of open surgical repair would be prohibitive, especially under urgent circumstances.

  10. Risk of cardiovascular thrombotic events after surgical castration versus gonadotropin-releasing hormone agonists in Chinese men with prostate cancer

    Directory of Open Access Journals (Sweden)

    Jeremy YC Teoh

    2015-06-01

    Full Text Available We investigated the cardiovascular thrombotic risk after surgical castration (SC versus gonadotropin-releasing hormone agonists (GnRHa in Chinese men with prostate cancer. All Chinese prostate cancer patients who were treated with SC or GnRHa from year 2000 to 2009 were reviewed and compared. The primary outcome was any new-onset of cardiovascular thrombotic events after SC or GnRHa, which was defined as any event of acute myocardial infarction or ischemic stroke. The risk of new-onset cardiovascular thrombotic event was compared between the SC group and the GnRHa group using Kaplan-Meier method. Multivariate Cox regression analysis was performed to adjust for other potential confounding factors. A total of 684 Chinese patients was included in our study, including 387 patients in the SC group and 297 patients in the GnRHa group. The mean age in the SC group (75.3 ± 7.5 years was significantly higher than the GnRHa group (71.8 ± 8.3 years (P < 0.001. There was increased risk of new cardiovascular thrombotic events in the SC group when compared to the GnRHa group upon Kaplan-Meier analysis (P = 0.014. Upon multivariate Cox regression analysis, age (hazard ratio [HR] 1.072, 95% confidence interval [CI] 1.04-1.11, P< 0.001, hyperlipidemia (HR 2.455, 95% CI 1.53-3.93, P< 0.001, and SC (HR 1.648, 95% CI 1.05-2.59, P= 0.031 were significant risk factors of cardiovascular thrombotic events. In conclusion, SC was associated with increased risk of cardiovascular thrombotic events when compared to GnRHa. This is an important aspect to consider while deciding on the method of androgen deprivation therapy, especially in elderly men with known history of hyperlipidemia.

  11. Prescription of the High Risk Narcotics and Trading or Illicit Purchasing of High Risk Narcotics

    Directory of Open Access Journals (Sweden)

    Nicoleta-Elena Buzatu

    2012-05-01

    Full Text Available The present essay will analyze the offence of prescribing high risk narcotics and trading or illicit purchasing of high risk narcotics, as it was regulated - together with other offences - by Law no 143 of July 26, 2000 on preventing and fighting against the traffic and illicit consumption of narcotics. The same law defines the meaning of such a phrase “substances which are under national control” by mentioning the fact that they are the narcotics and their precursors listed in Annexes I-IV of the law. The analysis of the offence of prescribing the high risk narcotics and trading or illicit purchasing of high risk narcotics is following the already known structure mentioned in the doctrine and which consists of: object and subjects of the offence, its constituent content: the objective side with its material element, the immediate consequence and causality connections; the subjective side of the offence, as well as forms and modalities of these offences, and the applicable sanctions, of course.

  12. SURGICAL ANATOMY

    African Journals Online (AJOL)

    SURGICAL ANATOMY. Rare high origin of the radial artery: a bilateral, symmetrical ease. I. O. ()koro and B. C. J iburum. Department of Anatomy, College of Medicine, lrno State University, Owerri, Nigeria. Reprint requests to: Dr I. O. 0k0r0, Department of Anatomy, [mo State University, P. M. B. 2000. Owerri, Nigeria.

  13. The effectiveness of high fidelity simulation on medical-surgical registered nurses' ability to recognise and respond to clinical emergencies.

    Science.gov (United States)

    Buckley, Thomas; Gordon, Christopher

    2011-10-01

    There is a paucity of evidence regarding the efficacy in preparing medical-surgical nurses to respond to patients with acutely deteriorating conditions. The aim of this study was to evaluate registered nurses' ability to respond to the deteriorating patient in clinical practise following training using immersive simulation and use of a high fidelity simulator. This study was a follow-up survey of medical-surgical graduate nurses following immersive high fidelity simulation training. Thirty eight registered nurses practising in medical-surgical areas completed the simulation as part of university graduate study. A follow-up survey of the graduate medical-surgical registered nurses conducted three months following completion of a high fidelity simulation-based learning experience. Outcomes consisted of the number of times skills were used in practise and the usefulness of simulation in preparing for actual emergency events. Participants reported a total of 164 clinical patient emergencies in the follow-up time period including: 46% cardiac, 32% respiratory, 10% neurological, 7% cardiac arrest and 5% related to electrolyte disturbances. The ability to respond in a systematic way, handover to the emergency team and airway management were identified as the skills most improved during patient emergencies following simulation. The most useful aspects of the simulation experience identified were scenario debriefing and assertiveness training. Participants with less years of clinical experience were more likely to report practising the team leader role and debriefing as the most useful aspects of simulation. The skills practised in simulation were highly relevant to participants practise in medical-surgical areas. Non-technical skills, including assertiveness skills should be considered in future emergency training courses for nurses. Copyright © 2010 Elsevier Ltd. All rights reserved.

  14. Abortion - surgical

    Science.gov (United States)

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

  15. Does pregnancy increase the risk of abdominal hernia recurrence after prepregnancy surgical repair?

    Science.gov (United States)

    Lappen, Justin R; Sheyn, David; Hackney, David N

    2016-09-01

    By increasing intraabdominal pressure, pregnancy may increase the risk of abdominal hernia recurrence. Current data are limited to studies with small sample size and thus the impact of pregnancy on recurrence is unclear. The objective of this analysis was to evaluate the impact of pregnancy on clinically significant abdominal hernia recurrence in a large multicenter cohort. A multiinstitution deidentified electronic health record database, EPM: Explore (Explorys Inc, Cleveland, OH) was utilized to perform a retrospective cohort study of women aged 18-45 years with a history of an abdominal hernia repair from 1999 through 2013. Abdominal hernia was defined to include ventral and incisional hernias, and other types were excluded. The presence or absence of a pregnancy following primary hernia repair was elucidated from the database. Subjects were excluded if a hernia repair occurred during pregnancy. The rate of hernia recurrence, defined as reoperation, was calculated. The association between pregnancy and hernia recurrence was evaluated with logistic regression, both unadjusted and adjusted for diabetes, obesity (body mass index >30 kg/m(2)), tobacco abuse, and wound complication at the time of initial hernia repair. A total of 11,020 women with a history of hernia repair were identified, of whom 840 had a subsequent pregnancy. Overall, 915 women in the cohort had a hernia recurrence (8.3%). Women with a history of pregnancy following primary hernia repair were more likely to have a body mass index >30 kg/m(2), a history of tobacco abuse, and a wound complication at the time of primary repair. In an unadjusted analysis, pregnancy was associated with an increase in the risk of hernia recurrence (13.1% vs 7.1%, odds ratio, 1.96, 95% confidence interval, 1.60-2.42). The association between pregnancy and hernia recurrence was attenuated but persisted after adjusting for confounding factors (adjusted odds ratio, 1.73, 95% confidence interval, 1.40-2.14). Pregnancy is

  16. Does topical rifampicin reduce the risk of surgical field infection in hernia repair?

    Science.gov (United States)

    Kahramanca, Şahin; Kaya, Oskay; Azılı, Cem; Celep, Bahadır; Gökce, Emre; Küçükpınar, Tevfik

    2013-01-01

    Inguinal hernia operations are common procedures in general surgery. There have been many approaches in the historical development of hernia repair; tension free repair with mesh being the most commonly used technique today. Although it is a clean wound, antibiotic use is still controversial due to concerns about infection related to synthetic mesh. We aimed to determine the probable role of topical rifampicin in patients with tension-free hernia repair and mesh support. The charts of patients who underwent tension-free inguinal hernia repair were retrospectively analyzed. Information and operative notes on patients, in whom synthetic materials were used, were identified. The patients were divided into two groups, placebo group (G1) and patients with application of topical rifampicin on the mesh (G2). Infection rates between the groups in the early postoperative period were compared. The mean age of the 278 patients who were included in the study was 49.6±15.39 and the female/male ratio was 10/268. There were recurrent hernias in four patients and superficial wound infections in 22 patients in the early period. One patient had testicle torsion and underwent an orchiectomy. There were no significant differences between the groups in terms of age and gender. The types of hernia and body mass index were homogenous between the two groups. In the early postoperative period the infection rates were 16/144 (11.1%) and 6/134 (4.48%) in the groups, respectively, with the difference being statistically significant (p=0.041). We suggest that applying rifampicin locally can decrease surgical site infection in hernia operations where meshes are used.

  17. [The application of the modern high-energy laser technologies for the surgical treatment of the patients presenting with otosclerosis].

    Science.gov (United States)

    Vishnyakov, V V; Svistushkin, V M; Sin'kov, E V

    The objective of the present study was to determine the optimal parameters of radiation of the CO2 laser during the surgical intervention for the treatment of the patients presenting with otosclerosis. The experimental part of the study was carried out with the use of the isolated temporal bones. Under the clinical conditions, the patients with the tympanic and mixed forms of otosclerosis underwent stapedoplasty with the use of the CO2 laser. It was shown that the use of the CO2 laser at different stages of stapedoplasty considerably reduces the risk of development of the post-operative complications. It is concluded that the proposed stapedoplastic technique makes it possible to decrease the duration of post-surgical rehabilitation of the patients suffering from otosclerosis.

  18. Changes in inflammatory endometrial cancer risk biomarkers in individuals undergoing surgical weight loss.

    Science.gov (United States)

    Linkov, Faina; Goughnour, Sharon L; Ma, Tianzhou; Xu, Zhongying; Edwards, Robert P; Lokshin, Anna E; Ramanathan, Ramesh C; Hamad, Giselle G; McCloskey, Carol; Bovbjerg, Dana H

    2017-10-01

    Obesity has been strongly linked to endometrial cancer (EC) risk. A number of potential EC risk biomarkers have been proposed, including heightened pro-inflammatory cytokines and adipokines. To evaluate if bariatric surgery can serve as a means for altering levels of such EC risk biomarkers, we investigated changes in these biomarkers after weight loss. Blood samples were collected pre-operatively and 6months post-operatively in 107 female bariatric surgery patients aged 18-72years. Wilcoxon signed-rank tests were used to compare biomarker levels (measured using xMAP immunoassays) pre- and post-surgery. Normative comparisons were implemented to contrast 6-month post-surgery biomarker levels to levels in a sample of 74 age-matched non-obese women. Linear regression was used to evaluate the relationship between biomarker expression at baseline and 6months post-surgery and the relationship between race and biomarker levels. On average, participants lost 30.15kg (SD: 12.26) after the bariatric intervention. Levels of C-peptide, insulin, CRP, leptin, IL-1Rα, and IL-6 significantly decreased, while levels of SHBG, IGFBP1, and adiponectin significantly increased with weight loss. Normative comparisons showed the levels of SHBG, C-peptide, insulin, IGFBP1, adiponectin, CRP, and TNFα after bariatric intervention approached the level of markers in comparison group. Multiple regression analyses revealed significant relationships between changes in BMI and changes in biomarker levels. The changes in IL-1Rα were significantly associated with race. Our findings demonstrate that normalization of EC risk biomarkers can be achieved with bariatric surgery. Improved understanding of biological mechanisms associated with weight loss may inform preventive strategies for EC. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Challenging Propofol Sedation in Gastrointestinal Endoscopy: High Risk Patients and High Risk Procedures

    Directory of Open Access Journals (Sweden)

    Eduardo Redondo-Cerezo

    2012-12-01

    Full Text Available Sedation is increasingly becoming a must for most endoscopic procedures. Non-anesthesiologist administration of propofol is the standard of practice in many European countries. Nevertheless, despite anesthesiology societies concerns about sedation guided by endoscopist, practitioners find some limits to propofol administration, related to high risk patients or high risk and complex procedures, which can be long lasting and technically challenging. The main patient related risk factors for sedation are elderly patients, obesity, ASA≥3 patients, individuals with craniofacial abnormalities or with pharyngolaringeal tumors, patients with an acute gastrointestinal bleeding, under pain medications, sedatives, antidepressants, or who consume significant amounts of alcohol or drugs. Procedure related risk factors have more to do with the duration and complexity of the procedure than with other factors, in which considering a general anesthesia allows the endoscopist to concentrate on a difficult task. Published papers addressing the most challenging sedation groups in endoscopy are exploring and even trespassing previously assumed frontiers, and new scenarios are opening to the endoscopist, increasing his/her autonomy, reducing costs and giving patients levels of comfort previously unknown. In this review we analyse each risk group determining the ones in which a sedation protocol could be widely applied, and other in which the published evidence does not guarantee a safe endoscopist guided propofol sedation.

  20. Association between periodontitis needing surgical treatment and subsequent diabetes risk: a population-based cohort study.

    Science.gov (United States)

    Lin, Shih-Yi; Lin, Cheng-Li; Liu, Jiung-Hsiun; Wang, I-Kuan; Hsu, Wu-Huei; Chen, Chao-Jung; Ting, I-Wen; Wu, I-Ting; Sung, Fung-Chang; Huang, Chiu-Ching; Chang, Yen-Jung

    2014-06-01

    It is well known that patients with diabetes have higher extent and severity of periodontitis, but the backward relationship is little investigated. The relationship between periodontitis needing dental surgery and subsequent type 2 diabetes mellitus (DMT2) in those individuals without diabetes was assessed. This is a retrospective cohort study using data from the national health insurance system of Taiwan. The periodontitis cohort involved 22,299 patients, excluding those with diabetes already or those diagnosed with diabetes within 1 year from baseline. Each study participant was randomly frequency matched by age, sex, and index year with one individual from the general population without periodontitis. Cox proportional hazards regression analysis was used to estimate the influence of periodontitis on the risk of diabetes. The mean follow-up period is 5.47 ± 3.54 years. Overall, the subsequent incidence of DMT2 was 1.24-fold higher in the periodontitis cohort than in the control cohort, with an adjusted hazard ratio of 1.19 (95% confidence interval = 1.10 to 1.29) after controlling for sex, age, and comorbidities. This is the largest nation-based study examining the risk of diabetes in Asian patients with periodontitis. Those patients with periodontitis needing dental surgery have increased risk of future diabetes within 2 years compared with those participants with periodontitis not requiring dental surgery.

  1. Risk of epilepsy in surgical patients undergoing general or neuraxial anaesthesia.

    Science.gov (United States)

    Chang, H C; Liao, C C; Chang, C C; Huang, S Y; Yeh, C C; Hu, C J; Cherng, Y G; Chen, T L

    2017-11-27

    Limited information is available on the risks of epilepsy after surgery in patients receiving general or neuraxial anaesthesia. Using Taiwan's National Health Insurance Research Database, we identified 1,478,977 patients aged ≥ 20 years who underwent surgery (required general or neuraxial anaesthesia with hospitalisation for more than one day) between 2004 and 2011. We selected 235,066 patients with general anaesthesia and 235,066 patients with neuraxial anaesthesia using a frequency-matching procedure for age and sex. We did not study those with co-existing epilepsy-related risk factors. The adjusted rate ratios (RRs) and 95% confidence intervals (CIs) of newly diagnosed epilepsy 1 year after surgery associated with general anaesthesia were analysed in the multivariate Poisson regression model. The one-year incidence of postoperative epilepsy for patients with general anaesthesia and neuraxial anaesthesia were 0.41 and 0.32 per 1000 persons, respectively, and the corresponding RR was 1.27 (95%CI 1.15-1.41). The association between general anaesthesia and postoperative epilepsy was significant in men (RR = 1.22; 95%CI 1.06-1.40), women (RR = 1.33; 95%CI 1.15-1.55) and 20-39-year-old patients. The risk of postoperative epilepsy increased in patients with general anaesthesia who had co-existing medical conditions and postoperative complications. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

  2. Modeling HIV Risk in Highly Vulnerable Youth

    Science.gov (United States)

    Huba, G. J.; Panter, A. T.; Melchior, Lisa A.; Trevithick, Lee; Woods, Elizabeth R.; Wright, Eric; Feudo, Rudy; Tierney, Steven; Schneir, Arlene; Tenner, Adam; Remafedi, Gary; Greenberg, Brian; Sturdevant, Marsha; Goodman, Elizabeth; Hodgins, Antigone; Wallace, Michael; Brady, Russell E.; Singer, Barney; Marconi, Katherine

    2003-01-01

    This article examines the structure of several HIV risk behaviors in an ethnically and geographically diverse sample of 8,251 clients from 10 innovative demonstration projects intended for adolescents living with, or at risk for, HIV. Exploratory and confirmatory factor analyses identified 2 risk factors for men (sexual intercourse with men and a…

  3. Modeling HIV risk in highly vulnerable youth

    NARCIS (Netherlands)

    Huba, GJ; Panter, AT; Melchior, LA; Trevithick, L; Woods, ER; Wright, E; Feudo, R; Tierney, S; Schneir, A; Tenner, A; Remafedi, G; Greenberg, B; Sturdevant, M; Goodman, E; Hodgins, A; Wallace, M; Brady, RE; Singer, B; Marconi, K

    2003-01-01

    This article examines the structure of several HIV risk behaviors in an ethnically and geographically diverse sample of 8,251 clients from 10 innovative demonstration projects intended for adolescents living with, or at risk for, HIV. Exploratory and confirmatory factor analyses identified 2 risk

  4. Assessing surgical risk for adults with congenital heart disease: are pediatric scoring systems appropriate?

    Science.gov (United States)

    Kogon, Brian; Oster, Matthew

    2014-02-01

    Patients with congenital heart disease are frequently surviving into adulthood, and many of them will require surgery. Currently, there is no validated risk scoring system for adult congenital heart surgery, and predicting outcomes in these patients is challenging. Our objective was to determine if commonly used pediatric congenital heart disease surgery risk scores are also applicable to adults. Four hundred fifty-eight adult (age ≥ 18 years) operations involving cardiac surgery for congenital heart disease between 2000 and 2010 at a single institution were studied retrospectively. The pediatric scores evaluated were the Risk Adjustment for Congenital Heart Surgery (RACHS-1) score, the Aristotle Basic Score, and the Society of Thoracic Surgery-European Association for Cardio-Thoracic Surgery (STAT) Congenital Heart Surgery Mortality score. Receiver operating characteristic (ROC) curves were generated to assess the ability of the scoring systems to predict mortality, major adverse events (stroke, renal failure, prolonged ventilation, prolonged coma, deep sternal infection, reoperation, and operative mortality), and prolonged length of stay (>7 days). Of 458 operations, there were 16 (3%) deaths, 94 (21%) major adverse events, and 90 (20%) prolonged lengths of stay. Four hundred thirty (94%) of the operations were included in all 3 scoring systems and the ROC analysis. For mortality, areas under the ROC curve were 0.91, 0.91, and 0.65 for the Aristotle, STAT, and RACHS-1 scores, respectively. For major adverse event, areas under the ROC curves were 0.81, 0.76, and 0.61 for the Aristotle, STAT, and RACHS-1 scores, respectively. For prolonged length of stay, areas under the ROC curve were 0.82, 0.76, and 0.61 for the Aristotle, STAT, and RACHS-1 scores, respectively. Pediatric risk scoring systems such as Aristotle, STAT, and RACHS-1 offer prognostic value in adults undergoing congenital heart surgery. The scores are predictive of mortality, major adverse events

  5. Primary uterine cancer in Maryland: impact of distance on access to surgical care at high-volume hospitals.

    Science.gov (United States)

    Gunderson, Camille C; Tergas, Ana I; Fleury, Aimee C; Diaz-Montes, Teresa P; Giuntoli, Robert L

    2013-09-01

    To evaluate the influence of distance on access to high-volume surgical treatment for patients with uterine cancer in Maryland. The Maryland Health Services Cost Review Commission database was retrospectively searched to identify primary uterine cancer surgical cases from 1994 to 2010. Race, type of insurance, year of surgery, community setting, and both surgeon and hospital volume were collected. Geographical coordinates of hospital and patient's zip code were used to calculate primary independent outcomes of distance traveled and distance from nearest high-volume hospital (HVH). Logistic regression was used to calculate odds ratios and confidence intervals. From 1994 to 2010, 8529 women underwent primary surgical management of uterine cancer in Maryland. Multivariable analysis demonstrated white race, rural residence, surgery by a high-volume surgeon and surgery from 2003 to 2010 to be associated with both travel 50 miles or more to the treating hospital and residence 50 miles or more from the nearest HVH (all P Maryland, 50 miles or more from residence to the nearest HVH is a barrier to high-volume care. However, patients who travel 50 miles or more seem to do so to receive care by a high-volume surgeon at an HVH. In Maryland, Nonwhites are more likely to live closer to an HVH and more likely to use these services.

  6. Risk Factors of Otitis Media in Children Associated With Surgical Treatment

    Directory of Open Access Journals (Sweden)

    Aylin Gül

    2014-08-01

    Full Text Available IntroductionAn analysis of the factors contributing to the risk of repeat ventilation tube placement among patients undergoing ventilation tube placement with adenoidectomy and patients undergoing ventilation tube placement only.MethodologyWe conducted a retrospective review of the medical records of 66 patients ages 3 to 10 who underwent ventilation tube placement only or adenoidectomy plus ventilation tube placement at Otorhinolaryngology and Head and Neck Surgery Clinic between January 2011 and January 2013.ResultsThe analysis revealed no significant relationships between the risk factors evaluated and the need for repeated ventilation tube placement. A repeat ventilation tube placement procedure was required in 7.7% of patients in the age 6-10 age group. This rate of incidence was significant relative to the other age groups evaluated.ConclusionsAdenoidectomy during the initial ventilation tube placement procedure may reduce the need for repeat ventilation tube placement in patients of 6 to 10 years of age with otitis media.

  7. Role of robot-assisted radical prostatectomy in the management of high-risk prostate cancer

    Directory of Open Access Journals (Sweden)

    Akshay Sood

    2014-01-01

    Full Text Available We aimed to evaluate the role of robot-assisted radical prostatectomy (RARP in the management of high-risk prostate cancer (PCa, with a focus on oncological, functional and perioperative outcomes. Further, we also aimed to briefly describe our novel modification to conventional RARP that allows immediate organ retrieval and examination for intra-operative surgical margin assessment. A literature search of PubMed was performed for articles on the management of high-risk PCa. Papers written in English and concerning clinical outcomes following RARP for locally advanced and high-risk PCa were selected. Outcomes data from our own center were also included. A total of 10 contemporary series were evaluated. Biopsy Gleason score ≥ 8 was the most common cause for classification of patients into the high-risk PCa group. Biochemical failure rate, in the few series that looked at long-term follow-up, varied from 9% to 26% at 1 year. The positive surgical margin rate varied from 12% to 53.3%. Urinary continence rates varied from 78% to 92% at 1 year. The overall complication rates varied from 2.4% to 30%, with anastomotic leak and lymphocele being the most common complications. Long-term data on oncological control following RARP in high-risk patients is lacking. Short-term oncological outcomes and functional outcomes are equivalent to open radical prostatectomy (RP. Safety outcomes are better in patients undergoing RARP when compared with open RP. Improved tools for predicting the presence of organ-confined disease (OCD are available. High-risk patients with OCD would be ideal candidates for RARP and would benefit most from surgery alone.

  8. Minimizing cardiac surgery risks in a Hepatitis C patient: Changing surgical strategy after evaluation by modern imaging technologies

    Directory of Open Access Journals (Sweden)

    Felix Kur

    2009-05-01

    Full Text Available Felix Kur1, Andres Beiras-Fernandez1, Martin Oberhoffer1, Konstantin Nikolaou2, Calin Vicol1, Bruno Reichart11Department of Cardiac Surgery, 2Department of Radiology, University Hospital Grosshadern, Munich, GermanyAbstract: Minimizing operative risks for the surgical team in infectious patients is crucial. We report on a patient suffering from Hepatitis C undergoing re-operative aortic valve and ascending aorta replacement for aortic aneurysm and paravalvular leakage due to recurrent endocarditis of a Smeloff–Cutter aortic ball prosthesis. Preoperative multi-slice computed tomography and real-time three-dimensional echocardiography proved helpful in changing operative strategy by detecting a previously unknown aortic aneurysm, assessing its extent, and demonstrating the close proximity of the right coronary artery, right ventricle, and the aortic aneurysm to the sternum. Thus, cardiopulmonary bypass was instituted via the femoral vessels, instead of conventionally. Location, morphology, and extent of the paravalvular defect could also be assessed.Keywords: aortic valve replacement, aorta, surgery, risk analysis

  9. LED surgical lighting system with multiple free-form surfaces for highly sterile operating theater application.

    Science.gov (United States)

    Liu, Peng; Zhang, Yaqin; Zheng, Zhenrong; Li, Haifeng; Liu, Xu

    2014-06-01

    Although the ventilation system is widely employed in the operating theater, a strictly sterile surgical environment still cannot be ensured because of laminar disturbance, which is mainly caused by the surgical lighting system. Abandoning traditional products, we propose an LED surgical lighting system, which can alleviate the laminar disturbance and provide an appropriate lighting condition for surgery. It contains a certain amount of LED lens units, which are embedded in the ceiling and arranged around the air supply smallpox. The LED lens unit integrated with an LED light source and a free-form lens is required to produce a uniform circular illumination with a large tolerance to the change of lighting distance. To achieve such a dedicated lens, two free-form refractive surfaces, which are converted into two ordinary differential equations by the design method presented in this paper, are used to deflect the rays. The results show that the LED surgical lighting system can provide an excellent illumination environment for surgery, and, apparently, the laminar disturbance also can be relieved.

  10. Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery

    DEFF Research Database (Denmark)

    Meyhoff, Christian S; Wetterslev, Jørn; Jorgensen, Lars N

    2009-01-01

    Control and Prevention. Secondary outcomes included atelectasis, pneumonia, respiratory failure, and mortality. RESULTS: Surgical site infection occurred in 131 of 685 patients (19.1%) assigned to receive 80% oxygen vs 141 of 701 (20.1%) assigned to receive 30% oxygen (odds ratio [OR], 0.94; 95...

  11. Reduction of Venous Thromboembolism in Surgical Patients Using a Mandatory Risk-Scoring System: 5-Year Follow-Up of an American College of Surgeons National Surgical Quality Improvement Program.

    Science.gov (United States)

    Nimeri, Abdelrahman A; Gamaleldin, Maysoon M; McKenna, Karen L; Turrin, Nicolas P; Mustafa, Bisher O

    2017-05-01

    Sheikh Khalifa Medical City's (SKMC) surgery institute was identified as a high outlier in the incidence of venous thromboembolism (VTE; deep vein thrombosis [DVT] and pulmonary embolism [PE]) based on the semiannual report of the American College of Surgeon's National Surgical Quality Improvement Program (ACS NSQIP) in June 2010. To report our rates of VTE at SKMC, the results, and 5-year follow-up after an ACS NSQIP quality improvement program. A multidisciplinary VTE task force was established in June 2010. We instituted a compulsory risk assessment for VTE and utilized the ACS NSQIP best practice guidelines to review cases of VTE. We prospectively evaluated the observed/expected (O/E) ratio for DVT/PE after implementing the action plan. The O/E ratio for PE/DVT in general and general/vascular (GV) surgery was 6.00 and 4.86 in June 2010. Our compliance with ordering antithrombotic prophylactic measures was as low and it improved to 100% and our O/E ratio decreased to 1.18 and 1.5 in July 2011 and stabilized for the next 4 years. Currently, our compliance with ordering antithrombotic prophylactic measures is 100%, and our last 2 O/E ratio for DVT/PE are 0.74 and 0.75 in GV surgery and 0.82 and 0.78 in the entire surgery institute, respectively, and we are considered an exemplary site of the ACS NSQIP in GV surgery. A compulsory risk assessment for VTE has led to an overall improvement in DVT/PE rates in the surgery institute and for GV surgery to become an exemplary site for the ACS NSQIP.

  12. Direct inguinal hernias and anterior surgical approach are risk factors for female inguinal hernia recurrences

    DEFF Research Database (Denmark)

    Burcharth, Jakob; Andresen, Kristoffer; Pommergaard, Hans-Christian

    2014-01-01

    PURPOSE: The purpose of this study was to establish the risk of recurrence after direct and indirect inguinal hernia operation in a large-scale female population and to establish the relationship between the type of hernia at the primary and recurrent procedure. METHODS: Using data from the Danish...... Hernia Database (DHDB), a cohort was generated: all females operated on electively for a primary inguinal hernia by either Lichtenstein’s technique or laparoscopy from 1998 to 2012. Within this prospectively collected cohort, the hernia type at the primary procedure (direct inguinal hernia (DIH......), indirect inguinal hernia (IIH), combination hernia), the hernia type at the recurrent procedure (DIH, IIH, combination hernia, femoral hernia), anesthesia type, and time from primary procedure to reoperation were registered. RESULTS: A total of 5,893 females with primary elective inguinal hernia operation...

  13. Prevalence and Risk Factors of High Risk Human Papillomavirus ...

    African Journals Online (AJOL)

    Cervical cancer is the most common female cancer in northern Nigeria, yet the pattern of infection with human papillomavirus, the principal aetiologic agent is unknown. This was a preliminary study conducted in two referral hospitals in order to establish base-line data on the prevalence and risk factors for the infection in ...

  14. Risk stratification for surgical outcomes in older colorectal cancer patients using ISAR-HP and G8 screening tools.

    Science.gov (United States)

    Souwer, Esteban T D; Verweij, Norbert M; van den Bos, Frederiek; Bastiaannet, Esther; Slangen, Rob M E; Steup, Willem H; Hamaker, Marije E; Portielje, Johanna E A

    2017-11-09

    Older patients are at risk for adverse outcomes after surgical treatment of cancer. Identifying patients at risk could affect treatment decisions and prevent functional decline. Screening tools are available to select patients for Geriatric Assessment. Until now their predictive value for adverse outcomes in older colorectal cancer patients has not been investigated. To study the predictive value of the Geriatric 8 (G8) and Identification of Seniors at Risk for Hospitalized Patients (ISAR-HP) screening tools for adverse outcomes after elective colorectal surgery in patients older than 70years. Primary outcomes were 30-day complication rates, secondary outcomes were the length of hospital stay and six-month mortality. Multicentre cohort study from two hospitals in the Netherlands. Frail was defined as a G8 ≤14 and/or ISAR-HP ≥2. Odds ratio (OR) is given with 95% CI. Overall, 139 patients (52%) out of 268 patients were included; 32 patients (23%) were ISAR-HP-frail, 68 (50%) were G8-frail, 20 were frail on both screening tools. Median age was 77.7years. ISAR-HP frail patients were at risk for 30-day complications OR 2.4 (CI 1.1-5.4, p=0.03), readmission OR 3.4 (1.1-11.0), cardiopulmonary complications OR 5.9 (1.6-22.6), longer hospital stay (10.3 versus 8.9day) and six-months mortality OR 4.9 (1.1-23.4). When ISAR-HP and G8 were combined OR increased for readmission, 30-day and six-months mortality. G8 alone had no predictive value. ISAR-HP-frail patients are at risk for adverse outcomes after colorectal surgery. ISAR-HP combined with G8 has the strongest predictive value for complications and mortality. Patients screening frail on ISAR-HP are at increased risk for morbidity and mortality. Screening results of G8 alone was not predictive for postoperative outcomes. Predictive value increased when G8 and ISAR-HP were combined. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Surgical Risks and Costs of Care are Greater in Patients Who Are Super Obese and Undergoing THA.

    Science.gov (United States)

    Meller, Menachem M; Toossi, Nader; Gonzalez, Mark H; Son, Min-Sun; Lau, Edmund C; Johanson, Norman

    2016-11-01

    Patients with morbid obesity, defined as a BMI greater than 40 kg/m(2), and super obesity, defined as a BMI greater than 50 kg/m(2), increasingly present for total hip replacement. There is disagreement in the literature whether these individuals have greater surgical risks and costs for the episode of care, and the magnitude of those risks and costs. There also is no established threshold for obesity as defined by BMI in identifying increased complications, risks, and costs of care. Until recently, analysis of higher BMI data was limited to small cohorts from hospital-based data banks, based on BMI or height and weight only, often as part of a multivariate analysis. On October 1, 2010 the Centers for Medicare & Medicaid Services added a fifth digit to the BMI data, V85.xx, in the Medicare data bank, which allowed data mining of cases of patients with higher BMI. To our knowledge, our study is the first large retrospective Medicare data mining study, which allows us to examine BMI levels greater than 40 and 50 kg/m(2) to delineate risks, complications, and costs for these patients. We sought to quantify (1) the surgical risk, and (2) the costs associated with complications after THA in patients who were morbidly obesity (BMI ≥ 40 kg/m(2)) or super obese (BMI ≥ 50 kg/m(2)). This is a retrospective study of patients, using Medicare hospital claims data, who underwent THA. The ICD-9 Clinical Modification (CM) diagnosis code V85.4x was used to identify patients with morbid obesity and with super obesity from October 1, 2010 through December 31, 2014. Patients without any BMI-related diagnosis codes were used as the control group. Twelve complications occurring during the 90 days after THA were analyzed using multivariate Cox models adjusting for patient demographic, comorbidities, and institutional factors. In addition, hospital charges and payments were compared from primary surgery through the subsequent 90 days. Patients with morbid obesity had increased

  16. Non-apical positive surgical margins after radical prostatectomy for pT2 prostate cancer is associated with the highest risk of recurrence

    DEFF Research Database (Denmark)

    Roder, Martin Andreas; Kawa, Sandra; Scheike, Thomas

    2014-01-01

    BACKGROUND AND OBJECTIVE: To investigate how location of positive surgical margins (PSM) in pT2 tumors affect the risk of biochemical recurrence (BR). METHODS: The study includes 1,133 consecutive patients from 1995 until end of 2011, who had organ-confined disease (pT2) following RP. The locatio...

  17. High-grade MRI bone oedema is common within the surgical field in rheumatoid arthritis patients undergoing joint replacement and is associated with osteitis in subchondral bone

    DEFF Research Database (Denmark)

    McQueen, F M; Gao, A; Ostergaard, M

    2007-01-01

    was observed at 60% of surgical sites vs 38% of non-surgical sites. High-grade bone oedema (score >/=50% maximum) was strongly associated with the surgical field (OR 9.3 (3.5 to 24.2), pCRP (r = 0.86, p = 0.01). In 4 of the 7 bone...... and severity of MRI bone oedema and osteitis on histology, with an MRI threshold effect due to differences in image resolution....

  18. Independent risk factors for surgical site infection after cesarean delivery in a rural tertiary care medical center.

    Science.gov (United States)

    Vallejo, Manuel C; Attaallah, Ahmed F; Shapiro, Robert E; Elzamzamy, Osama M; Mueller, Michael G; Eller, Warren S

    2017-02-01

    We aimed to determine the incidence of surgical site infection (SSI) after cesarean delivery (CD) and identify the risk factors in a rural population. We identified 218 SSI patients by International Classification of Disease codes and matched them with 3131 parturients (control) from the electronic record database in a time-matched retrospective quality assurance analysis. The incidence of SSI after CD was 7.0 %. Risk factors included higher body mass index (BMI) [40.30 ± 10.60 kg/m2 SSI (95 % CI 38.73-41.87) vs 34.05 ± 8.24 kg/m2 control (95 % CI 33.75-34.35, P < 0.001)], years of education [13.28 ± 2.44 years SSI (95 % CI 12.9-13.66) vs 14.07 ± 2.81 years control (95 % CI 13.96-14.18, P < 0.001)], number of prior births [2 (1-9) SSI vs 1 (1-11) control (P < 0.001)], tobacco use (OR 1.49; 95 % CI 1.06-2.09, P = 0.03), prior diagnosis of hypertension (OR 1.80; 95 % CI 1.34-2.42, P < 0.001), gestational diabetes (OR 1.59; 95 % CI 1.18-2.13, P = 0.003), and an emergency/STAT CD (OR 1.6; 95 % CI 1.1-2.3, P = 0.01). Risk factors for SSI after CD included higher BMI, less years of education, higher prior births, tobacco use, prior diagnosis of hypertension, gestational diabetes, and emergency/STAT CD. The presence of ruptured membranes was protective against SSI.

  19. High-frequency oscillations in epilepsy and surgical outcome. A meta-analysis.

    Directory of Open Access Journals (Sweden)

    Höller eYvonne

    2015-10-01

    Full Text Available High frequency oscillations (HFOs are estimated as a potential marker for epileptogenicity. Current research strives for valid evidence that these HFOs could aid the delineation of the to-be resected area in patients with refractory epilepsy and improve surgical outcomes. In the present meta-analysis, we evaluated the relation between resection of regions from which HFOs can be detected and outcome after epilepsy surgery.We conducted a systematic review of all studies that related the resection of HFO-generating areas to postsurgical outcome. We related the outcome (seizure freedom to resection ratio, that is, the ratio between the number of channels on which HFOs were detected and, among these, the number of channels that were inside the resected area. We compared the resection ratio between seizure free and not seizure free patients.In total, 11 studies were included. In 10 studies, ripples (80-200 Hz were analyzed, and in 7 studies, fast ripples (>200 Hz were studied. We found comparable differences (dif and largely overlapping confidence intervals (CI in resection ratios between outcome groups for ripples (dif=0.18; CI: 0.10-0.27 and fast ripples (dif=0.17; CI: 0.01-0.33. Subgroup analysis showed that automated detection (dif=0.22; CI: 0.03-0.41 was comparable to visual detection (dif=0.17; CI: 0.08-0.27. Considering frequency of HFOs (dif=0.24; CI: 0.09-0.38 was related more strongly to outcome than considering each electrode that was showing HFOs (dif=0.15; CI=0.03-0.27.The effect sizes found in the meta-analysis are small but significant. Automated detection and application of a detection threshold in order to detect channels with a frequent occurrence of HFOs is important to yield a marker that could be useful in presurgical evaluation. In order to compare studies with different methodological approaches, detailed and standardized reporting is warranted.

  20. Acetabular Dysplasia and Surgical Approaches Other Than Direct Anterior Increases Risk for Malpositioning of the Acetabular Component in Total Hip Arthroplasty

    DEFF Research Database (Denmark)

    Gromov, Kirill; Greene, Meridith E; Huddleston, James I

    2016-01-01

    BACKGROUND: Persistent acetabular dysplasia (AD) after periacetabular osteotomy has been hypothesized to increase the risk for malpositioning of the acetabular component. In this study, we investigate whether AD is an independent risk factor for cup malpositioning during primary total hip...... arthroplasty (THA). METHODS: Patient demographics, surgical approach, presence of AD assessed using the lateral center-edge angle, and acetabular cup positioning determined using Martell Hip Analysis Suite were investigated in 836 primary THA patients enrolled in a prospective multicenter study. RESULTS: We...

  1. Direct inguinal hernias and anterior surgical approach are risk factors for female inguinal hernia recurrences.

    Science.gov (United States)

    Burcharth, Jakob; Andresen, Kristoffer; Pommergaard, Hans-Christian; Bisgaard, Thue; Rosenberg, Jacob

    2014-01-01

    The purpose of this study was to establish the risk of recurrence after direct and indirect inguinal hernia operation in a large-scale female population and to establish the relationship between the type of hernia at the primary and recurrent procedure. Using data from the Danish Hernia Database (DHDB), a cohort was generated: all females operated on electively for a primary inguinal hernia by either Lichtenstein’s technique or laparoscopy from 1998 to 2012. Within this prospectively collected cohort, the hernia type at the primary procedure (direct inguinal hernia (DIH), indirect inguinal hernia (IIH), combination hernia), the hernia type at the recurrent procedure (DIH, IIH, combination hernia, femoral hernia), anesthesia type, and time from primary procedure to reoperation were registered. A total of 5,893 females with primary elective inguinal hernia operation on in the study period (61 % IIH, 37 % DIH, 2 % combined hernias) were included with a median follow-up time of 72 months (range 0 to 169). A total of 305 operations for suspected recurrences were registered (61 % inguinal recurrences, 38 % femoral recurrences, 1 % no hernias), which corresponded to an overall reoperation rate of 5.2 %. All femoral recurrences occurred after a previous open anterior operation. The crude reoperation rate after primary DIH operation was 11.0 %, 3.0 % after primary IIH operation and 0.007 % after combined hernia operation (p hernia recurrences exclusively existed after anterior open primary operation.

  2. Communicating about risk: strategies for situations where public concern is high but the risk is low

    OpenAIRE

    Claire Hooker; Adam Capon; Julie Leask

    2017-01-01

    In this article, we summarise research that identifies best practice for communicating about hazards where the risk is low but public concern is high. We apply Peter Sandman’s ‘risk = hazard + outrage’ formulation to these risks, and review factors associated with the amplification of risk signals. We discuss the structures that determine the success of risk communication strategies, such as the capacity for early communication to ‘capture’ the dominant representation of risk issues, the impo...

  3. Ability to predict the development of surgical site infection in cardiac surgery using the Australian Clinical Risk Index versus the National Nosocomial Infections Surveillance-derived Risk Index.

    Science.gov (United States)

    Figuerola-Tejerina, A; Bustamante, E; Tamayo, E; Mestres, C A; Bustamante-Munguira, J

    2017-06-01

    Surgical site infection (SSI) is a major infectious complication that increases mortality, morbidity, and healthcare costs. There are scores attempting to classify patients for calculating SSI risk. Our objectives were to validate the Australian Clinical Risk Index (ACRI) in a European population after cardiac surgery, comparing it against the National Nosocomial Infections Surveillance-derived risk index (NNIS) and analyzing the predictive power of ACRI for SSI in valvular patients. All the patients that who underwent cardiac surgery in a tertiary university hospital between 2011 and 2015 were analyzed. The patients were divided into valvular and coronary groups, excluding mixed patients. The ACRI score was validated in both groups and its ability to predict SSI was compared to the NNIS risk index. We analyzed 1,657 procedures. In the valvular patient group (n: 1119), a correlation between the ACRI score and SSI development (p < 0.05) was found; there was no such correlation with the NNIS index. The area under the receiver-operating characteristic curve (AUC) was 0.64 (confidence interval [CI] 95%, 0.5-0.7) for ACRI and 0.62 (95% CI, 0.5-0.7) for NNIS. In the coronary group (n: 281), there was a correlation between ACRI and SSI but no between NNIS and SSI. The ACRI AUC was 0.70 (95% CI, 0.5-0.8) and the NNIS AUC was 0.60 (95% CI, 0.4-0.7). The ACRI score has insufficient predictive power, although it predicts SSI development better than the NNIS index, fundamentally in coronary artery bypass grafting (CABG). Further studies analyzing determining factors are needed.

  4. Influence of surgical bleeding on the relationship between admission coagulopathy and risk of massive transfusion: lesson from 704 severe trauma patients.

    Science.gov (United States)

    Charbit, J; Lakhal, K; Deras, P; Dehon, A; Latry, P; Boissier, E; Schved, J-F; Capdevila, X

    2016-08-01

    This study hypothesized that the relationship between early coagulopathy and massive transfusion (MT) in trauma was highly dependent on the presence of surgical bleeding. Consecutive severe trauma patients admitted to our institution over a 4-year period were included in this retrospective study. Surgical bleeding was defined as an injury requiring an invasive endovascular or surgical haemostatic procedure. The ability of prothrombin time ratio (PTr) and activated partial thromboplastin time ratio (aPTTr) to predict MT (≥10 units of packed red blood cells during the first 24 h) was determined by ROC curves. The strength of association and interaction between PTr, surgical bleeding and MT was assessed using a logistic regression analysis. Among the 704 patients included (ISS 21·0 ± 16·2), MT rate was higher in patients with surgical bleeding than in those with no surgical bleeding (47% vs. 5%; P coagulopathy (P coagulopathy monitoring in trauma patients without considering the surgical bleeding does not allow a reliable determination of MT probability. © 2016 International Society of Blood Transfusion.

  5. Advanced Risk Analysis for High-Performing Organizations

    National Research Council Canada - National Science Library

    Alberts, Christopher; Dorofee, Audrey

    2006-01-01

    ...) are not readily identified using traditional risk analysis techniques. High-performing organizations have the basic skills needed to identify and manage these new types of risk, but lack sufficient techniques...

  6. Systemic immunomodulatory strategies in high-risk corneal transplantation

    Directory of Open Access Journals (Sweden)

    Tulio B Abud

    2017-01-01

    Full Text Available The cornea is the most commonly transplanted tissue in the body. Although corneal grafts generally have high success rates, transplantation onto inflamed and vascularized host beds, or so-called high-risk corneal transplantation, has a high rate of graft rejection. The management of this high-risk corneal transplantation is challenging and involves numerous measures. One of the key measures to prevent graft rejection in these cases is the use of systemic immunosuppressive agents. In this article, we will review the systemic immunosuppressive agents most commonly used for high-risk corneal transplantation, which include corticosteroids, cysclosporine A, tacrolimus, mycophenolate mofetil, and rapamycin. Benefits, risks, and published data on the use of these medications for high-risk corneal transplantation will be detailed. We will also summarize novel immunoregulatory approaches that may be used to prevent graft rejection in high-risk corneal transplantation.

  7. Prolonged Isotretinoin in Ultra High-Risk Neuroblastoma.

    Science.gov (United States)

    Cash, Thomas; Alazraki, Adina; Qayed, Muna; Katzenstein, Howard M

    2017-01-01

    Patients with high-risk neuroblastoma remain a therapeutic challenge with significant numbers of patients failing to respond sufficiently to initial therapy. These patients with poor response to induction are considered as ultra high-risk and are in need of novel treatment strategies. Isotretinoin is part of the standard of care treatment for patients with high-risk disease who undergo high-dose chemotherapy with autologous stem cell rescue although some have questioned the optimal administration schedule. Prolonged use of isotretinoin was well tolerated and may have contributed to long-term survival in a group of patients with ultra high-risk neuroblastoma.

  8. [High-definition real-time ultrasonic echography of tumors of the thyroid gland. Apropos of 379 surgically treated cases].

    Science.gov (United States)

    Bruneton, J N; Caramella, E; Fenart, D; Ettore, F; Manzino, J J; Demard, F; Vallicioni, J

    1985-01-01

    The authors present the results of a review of 379 cases of benign and malignant thyroid tumors examined by high frequency (7 MHz) ultrasound prior to surgery. Features of the 37 cases of cancer are described. Hyperechogenicity was almost always correlated with benign lesions (only 1 cancer out of 71 hyperechoic nodules). For 313 of the 342 cases of benign tumors a good correlation was found between sonograms and intraoperative examination of the two thyroid lobes. In the case of clinically evident polyadenomatous goiters, ultrasound is a highly accurate means of determining whether any zones of healthy tissue remain (sensitivity 104/110 cases, i. e. 93.7%). When a contralateral lobe is normal on sonograms, intraoperative examination only rarely reveals lesions (12/159 cases, including 2 false positives for surgical investigation). Due to the excellent concordance between ultrasound and intraoperative exploration, and the difficulties involved in anterior dissection, the results of sonograms can be used to decide on the surgical approach. Direct intraoperative surgical exploration of the lobe opposite a thyroid lesion appears unnecessary if the sonogram is normal (cases of non suspected occult thyroid cancer). Since intraoperative exploration can give false negatives, intraoperative ultrasound can be used in the rare cases where 1 or 2 deep micronodules have been detected by pre-surgery sonograms in the lobe contralateral to the main lesion.

  9. Analysis of Surgical Mortality for Congenital Heart Defects Using RACHS-1 Risk Score in a Brazilian Single Center

    Directory of Open Access Journals (Sweden)

    Candice Torres de Melo Bezerra Cavalcante

    Full Text Available ABSTRACT Introduction: Risk Adjustment for Congenital Heart Surgery 1 (RACHS-1 score is a simple model that can be easily applied and has been widely used for mortality comparison among pediatric cardiovascular services. It is based on the categorization of several surgical palliative or corrective procedures, which have similar mortality in the treatment of congenital heart disease. Objective: To analyze the in-hospital mortality in pediatric patients (<18 years submitted to cardiac surgery for congenital heart disease based on RACHS-1 score, during a 12-year period. Methods: A retrospective date analysis was performed from January 2003 to December 2014. The survey was divided in two periods of six years long each, to check for any improvement in the results. We evaluated the numbers of procedures performed, complexity of surgery and hospital mortality. Results: Three thousand and two hundred and one surgeries were performed. Of these, 3071 were able to be classified according to the score RACHS-1. Among the patients, 51.7% were male and 47.5% were younger than one year of age. The most common RACHS-1 category was 3 (35.5%. The mortality was 1.8%, 5.5%, 14.9%, 32.5% and 68.6% for category 1, 2, 3, 4 and 6, respectively. There was a significant increase in the number of surgeries (48% and a significant reduction in the mortality in the last period analysed (13.3% in period I and 10.4% in period II; P=0.014. Conclusion: RACHS-1 score was a useful score for mortality risk in our service, although we are aware that other factors have an impact on the total mortality.

  10. Robotic radical prostatectomy in high-risk prostate cancer: current perspectives.

    Science.gov (United States)

    Canda, Abdullah Erdem; Balbay, Mevlana Derya

    2015-01-01

    Around 20%-30% of patients diagnosed with prostate cancer (PCa) still have high-risk PCa disease (HRPC) that requires aggressive treatment. Treatment of HRPC is controversial, and multimodality therapy combining surgery, radiation therapy, and androgen deprivation therapy have been suggested. There has been a trend toward performing radical prostatectomy (RP) in HRPC and currently, robot-assisted laparoscopic RP (RARP) has become the most common approach. Number of publications related to robotic surgery in HRPC is limited in the literature. Tissue and Tumor characteristics might be different in HRPC patients compared to low-risk group and increased surgical experience for RARP is needed. Due to the current literature, RARP seems to have similar oncologic outcomes including surgical margin positivity, biochemical recurrence and recurrence-free survival rates, additional cancer therapy needs and lymph node (LN) yields with similar complication rates compared to open surgery in HRPC. In addition, decreased blood loss, lower rates of blood transfusion and shorter duration of hospital stay seem to be the advantages of robotic surgery in this particular patient group. RARP in HRPC patients seems to be safe and technically feasible with good intermediate-term oncologic results, acceptable morbidities, excellent short-term surgical and pathological outcomes and satisfactory functional results.

  11. Robotic radical prostatectomy in high-risk prostate cancer: current perspectives

    Directory of Open Access Journals (Sweden)

    Abdullah Erdem Canda

    2015-01-01

    Full Text Available Around 20%-30% of patients diagnosed with prostate cancer (PCa still have high-risk PCa disease (HRPC that requires aggressive treatment. Treatment of HRPC is controversial, and multimodality therapy combining surgery, radiation therapy, and androgen deprivation therapy have been suggested. There has been a trend toward performing radical prostatectomy (RP in HRPC and currently, robot-assisted laparoscopic RP (RARP has become the most common approach. Number of publications related to robotic surgery in HRPC is limited in the literature. Tissue and Tumor characteristics might be different in HRPC patients compared to low-risk group and increased surgical experience for RARP is needed. Due to the current literature, RARP seems to have similar oncologic outcomes including surgical margin positivity, biochemical recurrence and recurrence-free survival rates, additional cancer therapy needs and lymph node (LN yields with similar complication rates compared to open surgery in HRPC. In addition, decreased blood loss, lower rates of blood transfusion and shorter duration of hospital stay seem to be the advantages of robotic surgery in this particular patient group. RARP in HRPC patients seems to be safe and technically feasible with good intermediate-term oncologic results, acceptable morbidities, excellent short-term surgical and pathological outcomes and satisfactory functional results.

  12. Distinguishing predictive profiles for patient-based risk assessment and diagnostics of plaque induced, surgically and prosthetically triggered peri-implantitis.

    Science.gov (United States)

    Canullo, Luigi; Tallarico, Marco; Radovanovic, Sandro; Delibasic, Boris; Covani, Ugo; Rakic, Mia

    2016-10-01

    To investigate whether specific predictive profiles for patient-based risk assessment/diagnostics can be applied in different subtypes of peri-implantitis. This study included patients with at least two implants (one or more presenting signs of peri-implantitis). Anamnestic, clinical, and implant-related parameters were collected and scored into a single database. Dental implant was chosen as the unit of analysis, and a complete screening protocol was established. The implants affected by peri-implantitis were then clustered into three subtypes in relation to the identified triggering factor: purely plaque-induced or prosthetically or surgically triggered peri-implantitis. Statistical analyses were performed to compare the characteristics and risk factors between peri-implantitis and healthy implants, as well as to compare clinical parameters and distribution of risk factors between plaque, prosthetically and surgically triggered peri-implantitis. The predictive profiles for subtypes of peri-implantitis were estimated using data mining tools including regression methods and C4.5 decision trees. A total of 926 patients previously treated with 2812 dental implants were screened for eligibility. Fifty-six patients (6.04%) with 332 implants (4.44%) met the study criteria. Data from 125 peri-implantitis and 207 healthy implants were therefore analyzed and included in the statistical analysis. Within peri-implantitis group, 51 were classified as surgically triggered (40.8%), 38 as prosthetically triggered (30.4%), and 36 as plaque-induced (28.8%) peri-implantitis. For peri-implantitis, 51 were associated with surgical risk factor (40.8%), 38 with prosthetic risk factor (30.4%), 36 with purely plaque-induced risk factor (28.8%). The variables identified as predictors of peri-implantitis were female sex (OR = 1.60), malpositioning (OR = 48.2), overloading (OR = 18.70), and bone reconstruction (OR = 2.35). The predictive model showed 82.35% of accuracy and

  13. Rescue surgical pulmonary embolectomy for acute massive pulmonary embolism

    Directory of Open Access Journals (Sweden)

    Ahmed Abdulrahman Elassal

    2016-08-01

    Conclusion: Surgical pulmonary embolectomy is a rescue operation in high-risk PE. It could save patients with preoperative cardiac arrest. Early diagnosis, interdisciplinary team action, appropriate and emergent treatment strategy are necessary for favorable outcome.

  14. Heterogeneity of Psychosis Risk Within Individuals at Clinical High Risk: A Meta-analytical Stratification

    NARCIS (Netherlands)

    Fusar-Poli, Paolo; Cappucciati, Marco; Borgwardt, Stefan; Woods, Scott W.; Addington, Jean; Nelson, Barnaby; Nieman, Dorien H.; Stahl, Daniel R.; Rutigliano, Grazia; Riecher-Rössler, Anita; Simon, Andor E.; Mizuno, Masafumi; Lee, Tae Young; Kwon, Jun Soo; Lam, May M. L.; Perez, Jesus; Keri, Szabolcs; Amminger, Paul; Metzler, Sibylle; Kawohl, Wolfram; Rössler, Wulf; Lee, Jimmy; Labad, Javier; Ziermans, Tim; An, Suk Kyoon; Liu, Chen-Chung; Woodberry, Kristen A.; Braham, Amel; Corcoran, Cheryl; McGorry, Patrick; Yung, Alison R.; McGuire, Philip K.

    2016-01-01

    Individuals can be classified as being at clinical high risk (CHR) for psychosis if they meet at least one of the ultra-high-risk (UHR) inclusion criteria (brief limited intermittent psychotic symptoms [BLIPS] and/or attenuated psychotic symptoms [APS] and/or genetic risk and deterioration syndrome

  15. Compliance with adjuvant treatment guidelines in endometrial cancer: room for improvement in high risk patients.

    Science.gov (United States)

    Eggink, F A; Mom, C H; Boll, D; Ezendam, N P M; Kruitwagen, R F P M; Pijnenborg, J M A; van der Aa, M A; Nijman, H W

    2017-08-01

    Compliance of physicians with guidelines has emerged as an important indicator for quality of care. We evaluated compliance of physicians with adjuvant therapy guidelines for endometrial cancer patients in the Netherlands in a population-based cohort over a period of 10years. Data from all patients diagnosed with endometrial cancer between 2005 and 2014, without residual tumor after surgical treatment, were extracted from the Netherlands Cancer Registry (N=14,564). FIGO stage, grade, tumor type and age were used to stratify patients into risk groups. Possible changes in compliance over time and impact of compliance on survival were assessed. Patients were stratified into low/low-intermediate (52%), high-intermediate (21%) and high (20%) risk groups. Overall compliance with adjuvant therapy guidelines was 85%. Compliance was highest in patients with low/low-intermediate risk (98%, no adjuvant therapy indicated). The lowest compliance was determined in patients with high risk (61%, external beam radiotherapy with/without chemotherapy indicated). Within this group compliance decreased from 64% in 2005-2009 to 57% in 2010-2014. In high risk patients with FIGO stage III serous disease compliance was 55% (chemotherapy with/without radiotherapy indicated) and increased from 41% in 2005-2009 to 66% in 2010-2014. While compliance of physicians with adjuvant therapy guidelines is excellent in patients with low and low-intermediate risk, there is room for improvement in high risk endometrial cancer patients. Eagerly awaited results of ongoing randomized clinical trials may provide more definitive guidance regarding adjuvant therapy for high risk endometrial cancer patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Fluorescence-Guided versus Conventional Surgical Resection of High Grade Glioma: A Single-Centre, 7-Year, Comparative Effectiveness Study.

    Science.gov (United States)

    Ng, Wei Ping; Liew, Boon Seng; Idris, Zamzuri; Rosman, Azmin Kass

    2017-03-01

    High grade gliomas (HGGs) are locally invasive brain tumours that carry a dismal prognosis. Although complete resection increases median survival, the difficulty in reliably demonstrating the tumour border intraoperatively is a norm. The Department of Neurosurgery, Hospital Sungai Buloh is the first public hospital in Malaysia to overcome this problem by adopting fluorescence-guided (FG) surgery using 5-aminolevulinic acid (5-ALA). A total of 74 patients with histologically proven HGGs treated between January 2008 and December 2014, who fulfilled the inclusion criteria, were enrolled. Kaplan-Meier survival estimates and Cox proportional hazard regression were used. Significant longer survival time (months) was observed in the FG group compared with the conventional group (12 months versus 8 months, P 80 (P = 0.010), histology (P < 0.001), surgical method (P < 0.001) and adjuvant therapy (P < 0.001). This study showed a significant clinical benefit for HGG patients in terms of overall survival using FG surgery as it did not result in worsening of post-operative function outcome when compared with the conventional surgical method. We advocate a further multicentered, randomised controlled trial to support these findings before FG surgery can be implemented as a standard surgical adjunct in local practice for the benefit of HGG patients.

  17. Evaluation of Risk Management Strategies for a Low-Cost, High-Risk Project

    Science.gov (United States)

    Shishko, Robert; Jorgensen, Edward J.

    1996-01-01

    This paper summarizes work in progress to define and implement a risk management process tailored to a low-cost, high-risk, NASA mission -the Microrover Flight Experiment (MFEX, commonly called the Mars microrover).

  18. Standardizing care for high-risk patients in spine surgery: the Northwestern high-risk spine protocol.

    Science.gov (United States)

    Halpin, Ryan J; Sugrue, Patrick A; Gould, Robert W; Kallas, Peter G; Schafer, Michael F; Ondra, Stephen L; Koski, Tyler R

    2010-12-01

    Review article of current literature on the preoperative evaluation and postoperative management of patients undergoing high-risk spine operations and a presentation of a multidisciplinary protocol for patients undergoing high-risk spine operation. To provide evidence-based outline of modifiable risk factors and give an example of a multidisciplinary protocol with the goal of improving outcomes. Protocol-based care has been shown to improve outcomes in many areas of medicine. A protocol to evaluate patients undergoing high-risk procedures may ultimately improve patient outcomes. The English language literature to date was reviewed on modifiable risk factors for spine surgery. A multidisciplinary team including hospitalists, critical care physicians, anesthesiologists, and spine surgeons from neurosurgery and orthopedics established an institutional protocol to provide comprehensive care in the pre-, peri-, and postoperative periods for patients undergoing high-risk spine operations. An example of a comprehensive pre-, peri-, and postoperative high-risk spine protocol is provided, with focus on the preoperative assessment of patients undergoing high-risk spine operations and modifiable risk factors. Standardizing preoperative risk assessment may lead to better outcomes after major spine operations. A high-risk spine protocol may help patients by having dedicated physicians in multiple specialties focusing on all aspects of a patients care in the pre-, intra-, and postoperative phases.

  19. High prevalence of unsuspected abdominal aortic aneurysms in patients hospitalised for surgical coronary revascularisation.

    Science.gov (United States)

    Monney, Pierre; Hayoz, Daniel; Tinguely, Francine; Cornuz, Jacques; Haesler, Erik; Mueller, Xavier M; von Segesser, Ludwig K; Tevaearai, Hendrik T

    2004-01-01

    Prevalence of abdominal aortic aneurysms (AAA) is not exactly known among patients with coronary artery disease (CAD) who are considered for surgical revascularisation. We evaluated the value of screening AAA among coronary patients admitted in our cardiovascular surgery unit. Over a 24-month period, an abdominal echography was proposed to male patients aged 60 or more while hospitalised for surgical coronary revascularisation. Patients with previous investigation of the aorta were excluded. The aorta was considered aneurysmal when the anterior-posterior diameter was of 30 mm or more. Three hundred and ninety-five consecutive patients all accepted a proposed abdominal echographic screening for AAA. Forty unsuspected AAA were detected (10.1%). The mean diameter was 38.9 +/- 1.3 mm. Four AAA were larger than 50 mm and considered for surgery after the CABG procedure. Surveillance was proposed to the other 36, especially the 10 patients with an AAA larger than 40 mm. Patients with AAA were significantly older than those without AAA (71.3 +/- 0.8 vs. 69.4 +/- 0.3 years, P<0.05). Smoking history (P<0.05) and hypertension (P<0.05) were also associated more frequently with AAA. More than 16% of the patients being smokers and suffering hypertension presented with unsuspected AAA. In-hospital screening of AAA is very efficient among patients with coronary artery disease. Therefore, patients with CAD may be considered for routine AAA screening.

  20. High-Risk and Low-Risk Human Papillomavirus and the Absolute Risk of Cervical Intraepithelial Neoplasia or Cancer

    DEFF Research Database (Denmark)

    Thomsen, Louise T; Frederiksen, Kirsten; Munk, Christian

    2014-01-01

    OBJECTIVE: To determine the absolute risk of cervical intraepithelial neoplasia (CIN) grade 3 or cervical cancer (CIN 3 or worse) after detection of low-risk human papillomavirus (HPV) and after a negative high-risk HPV test. METHODS: In this prospective cohort study, consecutive liquid-based cer......OBJECTIVE: To determine the absolute risk of cervical intraepithelial neoplasia (CIN) grade 3 or cervical cancer (CIN 3 or worse) after detection of low-risk human papillomavirus (HPV) and after a negative high-risk HPV test. METHODS: In this prospective cohort study, consecutive liquid...

  1. Risk factors for Clostridium difficile infection in surgical patients hospitalized in a tertiary hospital in Belgrade, Serbia: a case–control study

    Directory of Open Access Journals (Sweden)

    Vesna Šuljagić

    2017-03-01

    Full Text Available Abstract Background The objective of this study was to investigate independent risk factors (RFs connected with healthcare-associated (HA Clostridium difficile infection (CDI in surgical patients, its frequency per surgical wards and in-hospital-mortality at a single hospital. Methods Risk factors for the infection were prospectively assessed among surgical patients with laboratory confirmed HA CDI and compared with a control group without HA CDI. Results The overall incidence rate of HA CDI was 2.6 per 10000 patient-days. Significant independent RFs for HA CDI were the use of carbapenems (P = 0.007, OR: 10.62, 95% CI: 1.93–58.4, the admission to intensive care unit (P = 0.004, OR:3.00, 95% CI:1.41–6.40, and the administration of 3rd generation cephalosporins (P = 0.014, OR:2.27, 95% CI:1.18–4.39. Patients with HA CDI had significantly higher in–hospital mortality compared to controls (P: 0.007; OR: 8.95; 95% CI: 1.84–43.43. Conclusions CDI is an important HA infection in population of surgical patients and this study emphasizes the importance of the wise use of antibiotics, and other infection control strategies in order to prevent HA CDI, and to decrease the incidence and in-hospital mortality rate.

  2. Incidence of Incomplete Excision in Surgically Treated Cutaneous Squamous Cell Carcinoma and Identification of the Related Risk Factors

    Directory of Open Access Journals (Sweden)

    Sara Sabouri Rad

    2011-12-01

    Full Text Available Squamous cell carcinoma (SCC is the second most common type of skin cancer with potential risks for metastasis and recurrence if left untreated or incompletely excised. This case series study was designed to determine the frequency of incompletely excised SCCs and the related risk factors. A total of 273 SCCs (253 patients excised in Razi dermatology hospital of Tehran from 2006-2008, were evaluated and were analyzed by Chi-square or t-test. The incidence of incomplete excision was 17.58 % and deep margin involvement was observed in 73% of lesions. Risk factors associated with incomplete excision of SCCs were being female, location of the tumors (in particular the lesions on lateral canthus, upper lip, foot, forehead, cheek, neck, nose and ear, large lesions and grafting method of repair. There was no statistically significant difference for the age, degree of histological differentiation, childhood history of radiotherapy for tinea capitis and the type of anesthesia. More care should be taken for high risk SCCs as complete excision avoids potential risk of recurrence and metastasis.

  3. Safe Reentry for False Aneurysm Operations in High-Risk Patients.

    Science.gov (United States)

    Martinelli, Gian Luca; Cotroneo, Attilio; Caimmi, Philippe Primo; Musica, Gabriele; Barillà, David; Stelian, Edmond; Romano, Angelo; Novelli, Eugenio; Renzi, Luca; Diena, Marco

    2017-06-01

    In the absence of a standardized safe surgical reentry strategy for high-risk patients with large or anterior postoperative aortic false aneurysm (PAFA), we aimed to describe an effective and safe approach for such patients. We prospectively analyzed patients treated for PAFA between 2006 and 2015. According to the preoperative computed tomography scan examination, patients were divided into two groups according to the anatomy and extension of PAFA: in group A, high-risk PAFA (diameter ≥3 cm) developed in the anterior mediastinum; in group B, low-risk PAFA (diameter <3 cm) was situated posteriorly. For group A, a safe surgical strategy, including continuous cerebral, visceral, and coronary perfusion was adopted before resternotomy; group B patients underwent conventional surgery. We treated 27 patients (safe reentry, n = 13; standard approach, n = 14). Mean age was 60 years (range, 29 to 80); 17 patients were male. Mean interval between the first operation and the last procedure was 4.3 years. Overall 30-day mortality rate was 7.4% (1 patient in each group). No aorta-related mortality was observed at 1 and 5 years in either group. The Kaplan-Meier overall survival estimates at 1 and 5 years were, respectively, 92.3% ± 7.4% and 73.4% ± 13.4% in group A, and 92.9% ± 6.9% and 72.2% ± 13.9% in group B (log rank test, p = 0.830). Freedom from reoperation for recurrent aortic disease was 100% at 1 year and 88% at 5 years. The safe reentry technique with continuous cerebral, visceral, and coronary perfusion for high-risk patients resulted in early and midterm outcomes similar to those observed for low-risk patients undergoing conventional surgery. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Antibacterial Surgical Silk Sutures Using a High-Performance Slow-Release Carrier Coating System.

    Science.gov (United States)

    Chen, Xiaojie; Hou, Dandan; Wang, Lu; Zhang, Qian; Zou, Jiahan; Sun, Gang

    2015-10-14

    Sutures are a vital part for surgical operation, and suture-associated surgical site infections are an important issue of postoperative care. Antibacterial sutures have been proved to reduce challenging complications caused by bacterial infections. In recent decades, triclosan-free sutures have been on their way to commercialization. Alternative antibacterial substances are becoming relevant to processing surgical suture materials. Most of the antibacterial substances are loaded directly on sutures by dipping or coating methods. The aim of this study was to optimize novel antibacterial braided silk sutures based on levofloxacin hydrochloride and poly(ε-caprolactone) by two different processing sequences, to achieve suture materials with slow-release antibacterial efficacy and ideal physical and handling properties. Silk strands were processed into sutures on a circular braiding machine, and antibacterial treatment was introduced alternatively before or after braiding by two-dipping-two-rolling method (M1 group and M2 group). The antibacterial activity and durability against Staphylococcus aureus and Escherichia coli were tested. Drug release profiles were measured in phosphate buffer with different pH values, and release kinetics model was built to analyze the sustained drug release mechanism between the interface of biomaterials and the in vitro aqueous environment. Knot-pull tensile strength, thread-to-thread friction, and bending stiffness were determined to evaluate physical and handling properties of sutures. All coated sutures showed continuous antibacterial efficacy and slow drug release features for more than 5 days. Besides, treated sutures fulfilled U.S. Pharmacopoeia required knot-pull tensile strength. The thread-to-thread friction and bending stiffness for the M1 group changed slightly when compared with those of uncoated ones. However, physical and handling characteristics of the M2 group tend to approach those of monofilament ones. The novel suture

  5. High Blood Pressure, Afib and Your Risk of Stroke

    Science.gov (United States)

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More High Blood Pressure, AFib and Your Risk of Stroke Updated:Aug ... have a stroke for the first time have high blood pressure . And an irregular atrial heart rhythm — a condition ...

  6. Elite High Schools Breed Higher Risk of Addiction

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_166144.html Elite High Schools Breed Higher Risk of Addiction: Study ... from drug addiction, new research suggests. Teens at elite U.S. high schools seem to face a higher ...

  7. Surgical lighting

    NARCIS (Netherlands)

    Knulst, A.J.

    2017-01-01

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

  8. Preoperative quality of life and surgical outcomes in gynecologic oncology patients: a new predictor of operative risk?

    Science.gov (United States)

    Doll, K M; Snavely, A C; Kalinowski, A; Irwin, D E; Bensen, J T; Bae-Jump, V; Boggess, J F; Soper, J T; Brewster, W R; Gehrig, P A

    2014-06-01

    Quality of life (QoL) for women with gynecologic malignancies is predictive of chemotherapy related toxicity and overall survival but has not been studied in relation to surgical outcomes and hospital readmissions. Our goal was to evaluate the association between baseline, pre-operative QoL measures and 30-day post-operative morbidity and health resource utilization by gynecologic oncology patients. We analyzed prospectively collected survey data from an institution-wide cohort study. Patients were enrolled from 8/2012 to 6/2013 and medical record data was abstracted (demographics, comorbid conditions, and operative outcomes). Responses from several validated health-related QoL instruments were collected. Bivariate tests and multivariable linear and logistic regression models were used to evaluate factors associated with QoL scores. Of 182 women with suspected gynecologic malignancies, 152 (84%) were surveyed pre-operatively and 148 (81%) underwent surgery. Uterine (94; 63.5%), ovarian (26; 17.5%), cervical (15; 10%), vulvar/vaginal (8; 5.4%), and other (5; 3.4%) cancers were represented. There were 37 (25%) cases of postoperative morbidity (PM), 18 (12%) unplanned ER visits, 9(6%) unplanned clinic visits, and 17 (11.5%) hospital readmissions (HR) within 30days of surgery. On adjusted analysis, lower functional well-being scores resulted in increased odds of PM (OR 1.07, 95%CI 1.01-.1.21) and HR (OR 1.11, 95%CI 1.03-1.19). A subjective global assessment score was also strongly associated with HR (OR 1.89, 95%CI 1.14, 3.16). Lower pre-operative QoL scores are significantly associated with post-operative morbidity and hospital readmission in gynecologic cancer patients. This relationship may be a novel indicator of operative risk. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. [THE RISK OF ACUTE RENAL LESIONS AND ITS PROGNOSTIC SIGNIFICANCE IN PATIENTS WITH CHRONIC RENAL DISEASE UNDERGOING CARDIAC SURGICAL INTERVENTION].

    Science.gov (United States)

    Iskenderov, B G; Sisina, O N; Budagovskaia, Z M

    2015-01-01

    to determine the frequency and risk factors of acute renal lesions (ARL) and their prognostic significance in patients with chronic renal disease (CRD) undergoing surgical intervention. The study included 1122 patients (586 men and 536 women) aged 32-68 (mean 62.3 ± 5.2) years who underwent correction of valvular defects, aortocoronary bypass surgery or their combination). Initial glomerular filtration rate was higher than 90 ml/min/l.73 m2 in 656 patients (group 1) and 89-60 ml/min/l/73 m2 in 470 ones (group 2). ARL were diagnosed based on the serum creatinine level using RIFLE criteria. In the early postoperative period, ARL were diagnosed in 23.9% of the patients in group I and 38.7% of those in group 2 (p < 0.001). Intra-hospital lethality in group 1 was 4.9% (14.1% in patients with ARL) and 12.1% in group 2 (18.1% iin patients with ARL). In group 2, 47.9% of the patients with ARL experienced regress of renal dysfunction during 12 months compared with 56.9% ones without ARL. The progress of CRD was documented in 11% of group 2 patients with ARL and in (4.5% without AR (p = 0.013). 5.7% of the patients in group 1 developed CRD after ARL. 4.9% of the patients in group 2 needed programmed hemodialysis. The development of ARL in patients with CRD is associated with unfvouravle cardiovascular prognosis following cardiosurgery.

  10. Risk factors for early failure of surgical amputations: an analysis of 8,878 isolated lower extremity amputation procedures.

    Science.gov (United States)

    O'Brien, Patrick J; Cox, Mitchell W; Shortell, Cynthia K; Scarborough, John E

    2013-04-01

    There are very few data currently published on risk factors for early failure of lower extremity amputation procedures. All patients from the 2005-2010 American College of Surgeons NSQIP database who underwent isolated lower extremity amputation were included for analysis (excluding patients with earlier operation within 30 days, patients undergoing an open amputation, and patients undergoing another procedure during amputation). Multivariate logistic regression was used to determine predictors of early amputation failure (defined as need for reoperation within 30 days postoperatively) after adjustment for a number of preoperative and intraoperative variables. A total of 8,878 patients were included for analysis (4,258 below-knee amputations [BKA]; 3,415 above-knee amputations; and 1,205 transmetatarsal amputations). Overall rate of early amputation failure was 12.7% (12.6% for BKA, 8.1% for above-knee amputations, and 26.4% for transmetatarsal amputations; p amputation failure, including emergency operation, transmetatarsal amputation (reference = BKA), sepsis (reference = no sepsis), septic shock (reference = no sepsis), end-stage renal disease, systemic inflammatory response syndrome (reference = no sepsis), intraoperative surgical trainee participation, body mass index ≥30, and ongoing tobacco use. Characteristics associated with decreased early amputation failure include age 80 years or older (reference = younger than 65 years), locoregional anesthesia, above-knee amputation (reference = BKA), operative time 40 to 59 minutes (reference = amputation failure. In addition, specific clinical situations, such as sepsis or emergency procedures, should prompt vascular surgeons to consider either an open amputation procedure or a more proximal closed amputation. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  11. [Immunological aspects of corneal graft rejection and own experience in immunosuppressive therapy in high risk patients].

    Science.gov (United States)

    Kamińska, Anna; Szaflik, Jerzy; Minkiewicz-Timler, Grazyna; Sybilska, Małgorzata; Pawluczyk-Dyjecińska, Martyna; Smolarek, Monika

    2004-01-01

    The aim of the study was to present factors responsible for immune privilege of corneal graft, pathogenesis of immunological corneal graft rejection, and the influence of immunosuppressive therapy on keeping clarity of corneal graft. We also present retrospective evaluation of prophylactic immunosuppressive therapy in high-risk patients and in cases of graft rejection, in group of patients after corneal transplantation performed in Department of Ophthalmology in years 2001-2003. 349 cases of penetrating keratoplasty, lamellar or penetrating with limbal transplantation were analyzed. Condition requiring keratoplasty, surgical procedures, profile of immunosuppressive therapy, number of recurrences of corneal graft rejection and changes of visual acuity were evaluated. Immunosuppressive therapy with oral corticosteroids and systemic Cyclosporine allow to keep clarity of corneal graft and useful visual acuity in 60% cases of high-risk patients.

  12. A psychological profile of depressed and nondepressed women at high risk for breast cancer.

    Science.gov (United States)

    Wellisch, D K; Lindberg, N M

    2001-01-01

    This study examines the difference on several demographic and psychosocial variables between women at high risk for breast cancer above and below the cut-off point of a depression measure (Center for Epidemiological Study Depression Scale). Data are presented for 430 consecutive patients from the UCLA Revlon Breast Center High Risk Clinic. Women scoring above the depression cut-off point were younger, had more relatives with breast cancer, reported more symptoms of anxiety, and had more self-perceived vulnerability to breast cancer. In addition, women above the depression cut-off point were more likely to be single, childless, to have not viewed the results of the surgical treatment of their relative, and to feel more anxiety regarding screening practices (mammography, pap smears, and breast self-examinations).

  13. Design for Collaboration in Health Care: Experiences from Highly Specialized Surgical Care in Sweden

    DEFF Research Database (Denmark)

    Bødker, Susanne; Schroll, Jeremiah; Groth, Kristina

    Medical Information Systems often need to be custom designed to fit the organization where they will be implemented. Participatory Design (PD) is a well known method for eliciting the user input that is necessary during this process. Recently it has been suggested that PD as it is often practiced...... falls short of providing the necessary level of user input that is needed to meet the evolving needs of users over time. It is suggested that we refocus and look at design itself as a socio-technical process within healthcare organizations. By building “socio-technical systems that design themselves” we...... will better meet these evolving needs. In this paper we present a case study of design as it is practiced at a gastro-surgical department at a University hospital in Sweden. The experiences of the department are used as a framework for discussing this issue and its implications for the CSCW/HCI community....

  14. Sexual risk behaviours of high school female learners in Mbonge ...

    African Journals Online (AJOL)

    Introduction: since female learners in high schools in Cameroon fall within the age group hardest hit by HIV/AIDS, it is assumed that these learners might be exposed to sexual risk behaviours. However, little has been explored on the sexual risk behaviours of high school female learners in Cameroon. This study aimed at ...

  15. Alcohol consumption and high risk sexual behaviour among female ...

    African Journals Online (AJOL)

    Alcohol consumption has been associated with high risk sexual behaviour among key populations such as female sex workers. We explored the drivers of alcohol consumption and its relationship to high risk sexual behaviour. Participants were drawn from a cohort of 1 027 women selected from 'hot spots' in the suburbs of ...

  16. Correlation between high-risk pregnancy and developmental delay ...

    African Journals Online (AJOL)

    Background: The future development of children is considered more than ever now due to the advances in medical knowledge and thus the increase in survival rates of high-risk infants. This study investigated the correlation between high-risk pregnancy and developmental delay in children aged 4- 60 months. Methods: ...

  17. High Risk Behavior among Adolescent Mothers: The Problem in Context.

    Science.gov (United States)

    Kissman, Kris

    1998-01-01

    Discusses the particular consequences of high-risk behavior for adolescent women, including unintended pregnancies, sexually transmitted diseases, school dropout and poverty, developmental disabilities, and poor school performance. Considers the role of male partners in teenage women's high risk behavior. Describes prevention efforts such as…

  18. Elevated level of serum triglyceride among high risk stress bank ...

    African Journals Online (AJOL)

    The objective of this study was to estimate lipid profile among high risk stress bank employees' correlated with heart disorders in Riyadh, Saudi Arabia. A total of 129 patients with high risk stress employees were involved in this study, which were divided into 69 males and 60 females between the age of 25 to 55 years.

  19. Prevalence and risk factors of obesity and high blood pressure ...

    African Journals Online (AJOL)

    Risk factors for these diseases have been well studied in high income countries but less studied in developing countries. Objective: The study was to document the prevalence and risk factors of Obesity and high blood pressure among healthy adults in a military settlement in Ibagwa, Southern Nigeria. The study also sought ...

  20. Early Molecular Stratification of High-risk Primary Biliary Cholangitis.

    Science.gov (United States)

    Hardie, Claire; Green, Kile; Jopson, Laura; Millar, Ben; Innes, Barbara; Pagan, Sarah; Tiniakos, Dina; Dyson, Jessica; Haniffa, Muzlifah; Bigley, Venetia; Jones, David E; Brain, John; Walker, Lucy J

    2016-12-01

    High-risk primary biliary cholangitis (PBC), defined by inadequate response at one year to Ursodeoxycholic acid (UDCA), is associated with disease progression and liver transplantation. Stratifying high-risk patients early would facilitate improved approaches to care. Using long-term follow-up data to define risk at presentation, 6 high-risk PBC patients and 8 low-risk patients were identified from biopsy, transplant and biochemical archival records. Formalin-fixed paraffin-embedded (FFPE) liver biopsies taken at presentation were graded (Scheuer and Nakanuma scoring) and gene expression analysed using the NanoString® nCounter PanCancer Immunity 770-gene panel. Principle component analysis (PCA) demonstrated discrete gene expression clustering between controls and high- and low-risk PBC. High-risk PBC was characterised by up-regulation of genes linked to T-cell activation and apoptosis, INF-γ signalling and leukocyte migration and down-regulation of those linked to the complement pathway. CDKN1a, up-regulated in high-risk PBC, correlated with significantly increased expression of its gene product, the senescence marker p21 WAF1/Cip , by biliary epithelial cells. Our findings suggest high- and low-risk PBC are biologically different from disease outset and senescence an early feature in high-risk disease. Identification of a high-risk 'signal' early from standard FFPE tissue sections has clear clinical utility allowing for patient stratification and second-line therapeutic intervention. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

  1. Evaluating levels and health risk of heavy metals in exposed workers from surgical instrument manufacturing industries of Sialkot, Pakistan.

    Science.gov (United States)

    Junaid, Muhammad; Hashmi, Muhammad Zaffar; Malik, Riffat Naseem

    2016-09-01

    The study aimed to monitor heavy metal (chromium, Cr; cadmium, Cd; nickel, Ni; copper, Cu; lead, Pb; iron, Fe; manganese, Mn; and zinc, Zn) footprints in biological matrices (urine, whole blood, saliva, and hair), as well as in indoor industrial dust samples, and their toxic effects on oxidative stress and health risks in exposed workers. Overall, blood, urine, and saliva samples exhibited significantly higher concentrations of toxic metals in exposed workers (Cr; blood 16.30 μg/L, urine 58.15 μg/L, saliva 5.28 μg/L) than the control samples (Cr; blood 5.48 μg/L, urine 4.47 μg/L, saliva 2.46 μg/L). Indoor industrial dust samples also reported to have elevated heavy metal concentrations, as an example, Cr quantified with concentration of 299 mg/kg of dust, i.e., more than twice the level of Cr in household dust (136 mg/kg). Superoxide dismutase (SOD) level presented significant positive correlation (p ≤ 0.01) with Cr, Zn, and Cd (Cr > Zn > Cd) which is an indication of heavy metal's associated raised oxidative stress in exposed workers. Elevated average daily intake (ADI) of heavy metals resulted in cumulative hazard quotient (HQ) range of 2.97-18.88 in workers of different surgical units; this is an alarming situation of health risk implications. Principal component analysis-multiple linear regression (PCA-MLR)-based pie charts represent that polishing and cutting sections exhibited highest metal inputs to the biological and environmental matrices than other sources. Heavy metal concentrations in biological matrices and dust samples showed a significant positive correlation between Cr in dust, urine, and saliva samples. Current study will help to generate comprehensive base line data of heavy metal status in biomatrices and dust from scientifically ignored industrial sector. Our findings can play vital role for health departments and industrial environmental management system (EMS) authorities in policy making and implementation.

  2. High Center Volume Does Not Mitigate Risk Associated with Using High Donor Risk Organs in Liver Transplantation.

    Science.gov (United States)

    Beal, Eliza W; Black, Sylvester M; Mumtaz, Khalid; Hayes, Don; El-Hinnawi, Ashraf; Washburn, Kenneth; Tumin, Dmitry

    2017-09-01

    High-risk donor allografts increase access to liver transplant, but potentially reduce patient and graft survival. It is unclear whether the risk associated with using marginal donor livers is mitigated by increasing center experience. The United Network for Organ Sharing registry was queried for adult first-time liver transplant recipients between 2/2002 and 12/2015. High donor risk was defined as donor risk index >1.9, and 1-year patient and graft survival were compared according to donor risk index in small and large centers. Multivariable Cox regression estimated the hazard ratio (HR) associated with using high-risk donor organs, according to a continuous measure of annual center volume. The analysis included 51,770 patients. In 67 small and 67 large centers, high donor risk index predicted increased mortality (p = 0.001). In multivariable analysis, high-donor risk index allografts predicted greater mortality hazard at centers performing 20 liver transplants per year (HR 1.35; 95% CI 1.22, 1.49; p transplant. Specific strategies to mitigate the risk of liver transplant involving high-risk donors are needed, in addition to accumulation of center expertise.

  3. Surgical lighting

    OpenAIRE

    Knulst, A.J.

    2017-01-01

    The surgical light is an important tool for surgeons to create and maintain good visibility on the surgical task. Chapter 1 gives background to the field of (surgical) lighting and related terminology. Although the surgical light has been developed strongly since its introduction a long time ago, the last decades only minor developments have been made. This lack of significant development suggests that the current state of surgical lighting is perfectly developed and functions without any fla...

  4. Risk factors for surgical site infection after stoma closure comparison between pursestring wound closure and conventional linear wound closure: Propensity score matching analysis.

    Science.gov (United States)

    Yamamoto, Masashi; Tanaka, Keitaro; Masubuchi, Shinsuke; Ishii, Masatsugu; Hamamoto, Hiroki; Suzuki, Shigenori; Ueda, Yasuhiko; Okuda, Junji; Uchiyama, Kazuhisa

    2018-01-01

    Stoma closure has been associated with a high rate of surgical site infection (SSI) and the optimal skin closure method is still controversial. The aim of this study was to compare the short-term and long-term outcomes between the conventional linear closure (CC) and the persestring closure (PC) using propensity score matching analysis. We analysed the data of 360 patients who underwent stoma closure with CC or PC between January 2000 and December 2014. The propensity score was calculated from age, gender, body mass index, primary disease, type of stoma, diabetes mellitus, history of smoking, steroid use, the American Society of Anesthesiologists score, Prognostic Nutritional Index and modified Glasgow Prognostic Score. There was no difference in operative variables between the two groups. The CC group and the PC group were comparable with regards to overall SSI (25.0 vs. 7.8%; P = 0.007), superficial SSI (21.9 vs. 4.7%; P = 0.003). Significant risk factor for SSI was conventional linear closure (OR, 4.14; 95% CI, 1.448-13.91). Our study suggests that a pursestring stoma closure leads to less SSI. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Association of Burnout With Emotional Intelligence and Personality in Surgical Residents: Can We Predict Who Is Most at Risk?

    Science.gov (United States)

    Lindeman, Brenessa; Petrusa, Emil; McKinley, Sophia; Hashimoto, Daniel A; Gee, Denise; Smink, Douglas S; Mullen, John T; Phitayakorn, Roy

    Burnout is common among surgical residents and may be related to personality characteristics, emotional intelligence (EI), or work experiences. Longitudinal cohort study over 1 year. Tertiary academic medical centers in the Northeast. All general surgery residents in 2 programs (n = 143) were invited to complete an electronic survey at 3 time points; 88, 64, and 69 residents completed the survey (overall response rate 52%). Severe burnout was observed in 51% of residents (n = 41). Higher scores were associated with female sex (p = 0.02). Burnout scores were highest at the beginning and end of the academic year; EI and personality scores remained stable. On bivariate analysis, high EI score (p burnout. Higher EI and positive work experiences were independent predictors of lower burnout (p burnout. Higher EI and positive work experiences are associated with lower burnout. Focused interventions to improve EI and optimize the work environment may prevent or lessen burnout. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  6. Neurilemmomas of the Hand—A Review of the Clinical Presentation, Surgical Outcome, and Potential Risk Factors

    Directory of Open Access Journals (Sweden)

    Ka-Chun Jonathan Chan

    2017-06-01

    Conclusion: Neurilemmoma should be one of the differential diagnoses when dealing with hand masses. Tinel's sign should be done routinely on examination to facilitate correct preoperative diagnosis. Loupe magnification should be used during operation for optimal surgical outcome.

  7. Reporting of Randomized Controlled Trials With Statistically Nonsignificant Primary Outcomes Published in High-impact Surgical Journals.

    Science.gov (United States)

    Arunachalam, Lakshmanan; Hunter, Iain A; Killeen, Shane

    2017-06-01

    To determine the nature and frequency of distorted presentation or "spin" (ie, specific reporting strategies which highlight that the experimental treatment is beneficial, despite a statistically nonsignificant difference for the primary outcome, or distract the reader from statistically nonsignificant results) in published reports of randomized controlled trials (RCTs) with statistically nonsignificant results for primary outcomes in surgical journals. Multiple reports have suggested that interpretation of RCT results in medical journals can be distorted by authors of published reports. Using a defined search strategy, RCTs with clearly nonsignificant results for the primary outcome (P > 0.05) form 10 high-impact factor surgical journals (Annals of Surgery, Journal of Neurology, Neurosurgery and Psychiatry, Journal of Heart and Lung Transplantation, American Journal of Transplantation, British Journal of Surgery, Journal of Bone and Joint Surgery, Journal of the American College of Surgeons, Endoscopy, Archives of Surgery, and Liver transplantation), published between July 2013 to July 2015, were identified. Two reviewers independently appraised each selected article using a validated, standardized data abstraction form. In all, 110 eligible RCTs with nonsignificant primary outcomes were appraised. The title was reported with spin in 8 (7%) articles. Forty-four (40%) included abstracts and 39 (35%) main texts were classified as having spin in at least 1 section. The level of spin was high in 16 (14%) abstract and 19 (19%) main-text "Conclusions" sections. Twenty-five articles (23%) recommended the intervention of interest despite a nonsignificant primary outcome. There was no relationship between trial funding source, use of statistician and article section, and the presence of spin. In RCTs with statistically nonsignificant primary outcomes published in surgical journals, the reporting and interpretation of findings was frequently inconsistent with the results.

  8. Percutaneous cholecystostomy: a nonsurgical therapeutic option for acute cholecystitis in high-risk and critically ill patients

    Directory of Open Access Journals (Sweden)

    Guilherme de Castro Dabus

    Full Text Available Percutaneous cholecystostomy offers a potentially important type of therapy for critically ill patients with acute cholecystitis who present high risk when undergoing laparotomy or laparoscopy under general anesthesia. It offers a distinct advantage for these kinds of patients by avoiding the risks of the surgical intervention. Percutaneous cholecystostomy is a safe and effective minimally invasive procedure with a high success rate and low procedure-related complications. It should be considered not only in temporary management of calculous cholecystitis, but also in definitive treatment in cases of acalculous cholecystitis.

  9. Does surgical site infection after Caesarean section in Polish hospitals reflect high-quality patient care or poor postdischarge surveillance? Results from a 3-year multicenter study.

    Science.gov (United States)

    Różańska, Anna; Jarynowski, Andrzej; Kopeć-Godlewska, Katarzyna; Wójkowska-Mach, Jadwiga; Misiewska-Kaczur, Agnieszka; Lech, Marzena; Rozwadowska, Małgorzata; Karwacka, Marlena; Liberda, Joanna; Domańska, Joanna

    2018-01-01

    Caesarean sections (CSs) are associated with a high infection risk. Surgical site infection (SSI) incidence is among the markers of effectiveness of infection prevention efforts. The aim of this study was to analyze risk factors for SSI, incidence, and microbiology in patients who underwent CS. The study was conducted during 2013-2015 using active infection surveillance in 5 Polish hospitals according to the European Centre for Disease Prevention and Control surveillance network known as HAI-Net. For each procedure, the following data were registered: age, American Society of Anesthesiologists score, procedure time, elective or emergency procedure, use of perioperative antibiotic prophylaxis, microbiology, the treatment used, and other information. SSI incidence was 0.5% and significant differences were noted among hospitals (between 0.1% and 1.8%), for different American Society of Anesthesiologists scales (between 0.2% and 4.8%) and different values of standardized SSI risk index (between 0.0% and 0.8%). In 3.1% of procedures, with no antibiotic prophylaxis, SSI risk was significantly higher. Deep infections dominated: 61.5% with superficial infections in only approximately 30% of cases and 2.6% of infections were detected postdischarge without readmissions. Results showed high incidence of SSI in Poland without perioperative antibiotic prophylaxis, and secondly, ineffective surveillance according to CS status, considering outpatient obstetric care. Without postdischarge surveillance, it is not possible to recognize the epidemiologic situation, and further, to set priorities and needs when it comes to infection prophylaxis, especially because such low incidence may indicate no need for improvement in infection control. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  10. Mortality prediction following transcatheter aortic valve replacement: A quantitative comparison of risk scores derived from populations treated with either surgical or percutaneous aortic valve replacement. The Israeli TAVR Registry Risk Model Accuracy Assessment (IRRMA) study.

    Science.gov (United States)

    Halkin, Amir; Steinvil, Arie; Witberg, Guy; Barsheshet, Alon; Barkagan, Michael; Assali, Abid; Segev, Amit; Fefer, Paul; Guetta, Victor; Barbash, Israel M; Kornowski, Ran; Finkelstein, Ariel

    2016-07-15

    Accurate risk stratification is pivotal for appropriate selection of patients with severe symptomatic aortic stenosis for either surgical or transcatheter aortic valve replacement (TAVR). We sought to determine whether recent risk prediction models developed specifically in TAVR patients enhance prognostication in comparison with previous surgical scores used in clinical practice (EuroScore I, EuroScore II, STS). The Israeli TAVR Registry Risk Model Accuracy Assessment (IRRMA) study utilized a multicenter prospective TAVR database (n=1327) to perform a quantitative comparison between previous risk scores developed in either surgical or TAVR populations, with the present registry serving as an independent external validation set. In the IRRMA population, 4 variables (NYHA functional class IV, chronic obstructive pulmonary disease, systolic pulmonary artery pressure ≥60mmHg, vascular access other than by the femoral route) identified by cross-validation and leave-one-out analyses provided the most discriminative model (C-statistic=0.63) for predicting 30-day mortality. Previous scores developed in surgical (EuroScores I and II, STS), TAVR (FRANCE-2, OBSERVANT), or mixed (German AV score) populations were applied to the IRRMA cohort. Resultant C-statistics ranged between 0.52-0.71 (for the German AV and FRANCE-2 scores, respectively) and did not differ significantly (p=0.07 for the comparison between the lowest and highest C-statistics). The observed C-statistic for 5 of these 6 scores was lower than originally reported when applied to the IRRMA population. Available TAVR risk scores showed limited accuracy when applied to an independent validation set and did not enhance prognostication in comparison to previous surgical scores. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. [Cartilage island versus temporalis fascia in high-risk tympanic perforation].

    Science.gov (United States)

    Durán-Padilla, Carmen Lucía; Martínez-Chávez, Jaime; Amador-Licona, Norma; Pereyra-Nobara, Texar Alfonso

    2017-01-01

    The tympanoplasty for high-risk tympanic membrane perforation is a challenge. It is necessary to compare the most useful and feasible surgical technics in our environment for these patients. The objective was to compare the cartilage island tympanoplasty for the treatment of high-risk tympanic membrane perforations versus the use of temporalis fascia. Randomized controlled clinical trial in 69 patients of ten years or older, diagnosed with high-risk tympanic membrane perforation in a third level hospital. The MERI index was determined and an initial audiometry was obtained. 7, 30 and 60 days after the tympanoplasty the tympanic graft integrity was evaluated. The audiometry was only repeated at 60 days. 69 patients were included, 33 received cartilage island (group 1) and 36 temporalis fascia (group 2). 93.9% was the success rate for group 1 at 30 and 60 days and 83.3% for group 2 (p = 0.17). Hearing improvement was neither different between groups (33.1 vs. 33.6 dB; p = 0.88), for group 1 and 2, respectively. No difference in morphological and audiological outcomes using cartilage island tympanoplasty or temporalis fascia for the treatment of high-risk tympanic membrane perforation was found.

  12. Deep vein thrombosis in medical and surgical Intensive Care Unit patients in a Tertiary Care Centre in North India: Incidence and risk factors

    OpenAIRE

    Ashish Kumar; Yatin Mehta; Tariq Ali; Mukesh Kumar Gupta; George, Joby V

    2017-01-01

    Background and Aims: Deep venous thrombosis (DVT) prophylaxis is underutilized, and there is a paucity of data reflecting the incidence of DVT in Indian Intensive Care Unit (ICU) population. We sought to evaluate the incidence and risk factors for DVT in medical and surgical ICU patients with DVT prophylaxis. Material and Methods: The ICU patients more than 18 years old, expected to be in the ICU for more than 48 h were enrolled and DVT prophylaxis were given as per risk and were observed ...

  13. Efficacy of high intensity diode laser as an adjunct to non-surgical periodontal treatment: a randomized controlled trial.

    Science.gov (United States)

    De Micheli, Giorgio; de Andrade, Ana Karina Pinto; Alves, Vanessa Tubero Euzebio; Seto, Marcio; Pannuti, Cláudio Mendes; Cai, Silvana

    2011-01-01

    The high intensity diode laser has been studied in periodontics for the reduction of subgingival bacteria in non-surgical treatment. Our study evaluated the bacterial effect as well as changes in periodontal clinical parameters promoted by root scaling and planing associated with this wavelength. Twenty-seven patients randomly assigned in two groups underwent root scaling and planing on the tested sites, and only the experimental group received the diode laser irradiation. Among the clinical parameters studied, the clinical probing depth (CPD) and the clinical attachment level (CAL) resulted in significant enhancement in the control group when compared with the experimental group (P = 0.014 and P = 0.039, respectively). The results were similar for both groups regarding the plaque index (PI) and bleeding on probing (BP). No significant difference in the microbiological parameters was observed between the control and experimental groups. It was possible to conclude that the high power diode laser adjunct to the non-surgical periodontal treatment did not promote additional effects to the conventional periodontal treatment.

  14. Should high risk patients with concomitant severe aortic stenosis and mitral valve disease undergo double valve surgery in the TAVR era?

    Science.gov (United States)

    Yu, Pey-Jen; Mattia, Allan; Cassiere, Hugh A; Esposito, Rick; Manetta, Frank; Kohn, Nina; Hartman, Alan R

    2017-12-29

    Significant mitral regurgitation in patients undergoing transcatheter aortic valve replacement (TAVR) is associated with increased mortality. The aim of this study is to determine if surgical correction of both aortic and mitral valves in high risk patients with concomitant valvular disease would offer patients better outcomes than TAVR alone. A retrospective analysis of 43 high-risk patients who underwent concomitant surgical aortic valve replacement and mitral valve surgery from 2008 to 2012 was performed. Immediate and long term survival were assessed. There were 43 high-risk patients with severe aortic stenosis undergoing concomitant surgical aortic valve replacement and mitral valve surgery. The average age was 80 ± 6 years old. Nineteen (44%) patients had prior cardiac surgery, 15 (34.9%) patients had chronic obstructive lung disease, and 39 (91%) patients were in congestive heart failure. The mean Society of Thoracic Surgeons Predicted Risk of Mortality for isolated surgical aortic valve replacement for the cohort was 10.1% ± 6.4%. Five patients (11.6%) died during the index admission and/or within thirty days of surgery. Mortality rate was 25% at six months, 35% at 1 year and 45% at 2 years. There was no correlation between individual preoperative risk factors and mortality. High-risk patients with severe aortic stenosis and mitral valve disease undergoing concomitant surgical aortic valve replacement and mitral valve surgery may have similar long term survival as that described for such patients undergoing TAVR. Surgical correction of double valvular disease in this patient population may not confer mortality benefit compared to TAVR alone.

  15. High Framingham risk score decreases quality of life in adults

    Directory of Open Access Journals (Sweden)

    Christian Yosaputra

    2010-04-01

    Full Text Available Cardiovascular disease (CVD risk factors, such as diabetes, hypertension, hypercholesterolemia, smoking, and obesity tend to occur together in the general population. Increasing prevalence of multiple CVD risk factors has been related to increased risk of death from coronary heart disease and stroke. Studies have suggested that people with several risk factors of CVD may have impaired health-related quality of life. The objective of this study was to assess the association of CVD risk factors with quality of life (QOL among adults aged 40 to 65 years. A cross-sectional study was conducted involving 220 subjects 40 - 65 years of age at a health center. The CVD risk factors were assessed using the Framingham risk score that is the standard instrument for assessment of the risk of a first cardiac event. The risk factors assessed were age, smoking, blood pressure, total cholesterol and high density lipoprotein cholesterol concentrations. QOL was assessed by means of the WHOQOL-BREF instrument that had been prevalidated. The results of the study showed that 28.2% of subjects were smokers, 56.4% had stage 1 hypertension, 42.8% high total cholesterol and 13.6% low HDL cholesterol. The high risk group amounted to 45.5% and 42.3% constitued an intermediate risk group. High CVD risk scores were significantly associated with a low QOL for all domains (physical, psychological, social and environment (p=0.000. Preventing or reducing the multiple CVD risk factors to improve QOL is necessary among adults.

  16. SUVmax of 18FDG PET/CT as a predictor of high-risk endometrial cancer patients

    DEFF Research Database (Denmark)

    Antonsen, Sofie Leisby; Loft, Annika; Fisker, Rune Vincents

    2013-01-01

    OBJECTIVE: To evaluate SUVmax in the assessment of endometrial cancer preoperatively with particular focus on myometrial invasion (MI), cervical invasion (CI), FIGO stage, risk-stratification and lymph node metastases (LNM). METHODS: A total of 268 women with endometrial cancer or atypical...... endometrial hyperplasia underwent FDG PET/CT imaging before surgical treatment. SUVmax of the primary tumour was compared with histological prognostic factors. RESULTS: SUVmax was significantly higher in patients with high FIGO stages (p...

  17. Treatment of a High-Risk Diabetic Patient with Peripheral Vascular Disease and Osteomyelitis.

    Science.gov (United States)

    Allen, Latricia L; Kalmar, Garrett; Driver, Vickie R

    2016-06-01

    We report a case of calcaneal osteomyelitis that was surgically resected from a patient with diabetes and peripheral vascular disease. A 91-year-old male with history of type 2 diabetes, peripheral vascular disease, balloon angioplasty, and recent (2 months ago) stent of the superficial femoral artery presented to the emergency department with a left heel wound infection probed to bone. The patient reported having been on intravenous Zosyn for several months via an outside infectious disease provider for clinical suspicion of osteomyelitis, but noted no improvement. This report includes information regarding the clinical examination and imaging findings, which were used to assess this high-risk patient. Our patient underwent a partial calcanectomy and completed a 6-week course of intravenous antibiotics. The purpose of this case report is to illustrate limb preservation in a high-risk patient with compromised vascular supply who underwent a partial calcanectomy for treatment of calcaneal osteomyelitis. The patient underwent surgical resection of the calcaneus without complications and healed unremarkably with the ability to ambulate while wearing an ankle foot orthosis with a custom shoe. This report was authorized for publication as an educational report to contribute to generalizable knowledge and does not include any patient health information. Copyright © 2016. Published by Elsevier Inc.

  18. Respiratory volume monitoring in an obese surgical population and the prediction of postoperative respiratory depression by the STOP-bang OSA risk score.

    Science.gov (United States)

    Schumann, Roman; Kwater, Andrzej P; Bonney, Iwona; Ladd, Diane; Kim, Julie; Gupta, Anupriya; Gumbert, Sam D; Pivalizza, Evan G

    2016-11-01

    To evaluate use of a respiratory volume monitor (RVM; ExSpiron, Respiratory Motion, Inc., Waltham, MA, USA) that provides minute ventilation (MV), tidal volume (TV) and respiratory rate (RR) measurements in obese surgical patients, hitherto undescribed. Prospective, IRB-approved observational study of RVM parameter accuracy in obese surgical patients, designed to test the ability of the RVM to detect predefined postoperative respiratory depression (PORD) and apneic events (POA) and to correlate STOP-Bang scores with PORD and POA. Pre-, intra-, and post-op patient-care areas, including the post-anesthesia care unit (PACU) in 2 academic centers with bariatric populations. 80 patients (47±12 years), BMI of 43±7 kg/m(2) undergoing elective surgery were enrolled. Data collected included patient characteristics, STOP-Bang scores and RVM data from immediately preoperatively through PACU completion without effecting standard clinical care. Low minute ventilation (LMV) was defined as 40% of predicted MV, and PORD was defined as sustained LMV for 5 minutes. Appropriate parametric and non-parametric statistical analyses were performed, PSTOP-Bang risk categories (P>.2). There was excellent correlation and accuracy between the RVM and ventilator volumes in obese surgical patients. A considerable number of patients exhibited PORD and POA in the PACU. The STOP-Bang risk scores correlated poorly with PORD and POA which suggests that obese surgical patients remain at risk for early post-operative respiratory events irrespective of the STOP-Bang score. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. 'High-risk' pregnancy after perinatal loss: understanding the label.

    Science.gov (United States)

    Simmons, Heather A; Goldberg, Lisa S

    2011-08-01

    to explore women's experience of living with a 'high-risk' pregnancy following a perinatal loss. a feminist phenomenological methodology provided the framework for the research study. the experience of 'high-risk' pregnancy following perinatal loss of seven women receiving care at a tertiary health centre in Atlantic Canada was explored by way of conversational interviews and reflective journaling. four themes emerged through thematic analysis and researcher interpretation: (1) understanding the meaning in the label of 'high-risk' pregnancy, (2) relational engagement with the unborn infant, (3) insight and acceptance of the influence of previous loss, and (4) essentiality of information. Taken together, these four themes represent the storied text embedded in the research study. The focus of attention in this article is based solely on the first theme, understanding the meaning in the label of 'high-risk' pregnancy, in so far as this fosters an ability to attend to the interpretive text in the methodological manner appropriate to phenomenological inquiry. although previous research indicates that the label of 'high-risk' in pregnancy is often associated with increased anxiety and fear, findings from this study suggest that a 'high-risk' pregnancy following perinatal loss results in women embracing the 'high-risk' label. By recognising the possibility that women experiencing 'high-risk' pregnancy following perinatal loss may perceive the label of 'high-risk' pregnancy in a positive way, nurses, midwives and other health-care providers may begin to alter their practices when caring for these women in current health-care environments. Copyright © 2010 Elsevier Ltd. All rights reserved.

  20. Radical prostatectomy in clinically localized high-risk prostate cancer

    DEFF Research Database (Denmark)

    Røder, Martin Andreas; Berg, Kasper Drimer; Christensen, Ib Jarle

    2013-01-01

    Abstract Objective. The optimal therapeutic strategy for high-risk localized prostate cancer (PCa) is controversial. Supported by randomized trials, the combination of external beam radiation therapy (EBRT) and endocrine therapy (ET) is advocated by many, while radical prostatectomy (RP......) is regarded as primary therapy by others. This study examined the outcome for high-risk localized PCa patients treated with RP. Material and methods. Of 1300 patients who underwent RP, 231 were identified as high-risk. Patients were followed for biochemical recurrence (BCR) (defined as prostate...

  1. High-risk extracranial chondrosarcoma: long-term results of surgery and radiation therapy.

    Science.gov (United States)

    Goda, Jayant Sastri; Ferguson, Peter C; O'Sullivan, Brian; Catton, Charles N; Griffin, Anthony M; Wunder, Jay S; Bell, Robert S; Kandel, Rita A; Chung, Peter W

    2011-06-01

    A study was undertaken to evaluate results of surgery and radiotherapy (RT) for high-risk extracranial chondrosarcomas. Between 1986 and 2006, 60 patients underwent surgery and RT for extracranial high-risk chondrosarcoma. Preoperative RT (median, 50 gray [Gy]) and postoperative RT (median, 60 Gy) were used in 40% and 60% patients, respectively. Sites included pelvis/lower extremity (48%), chest wall (22%), spine/paraspinal (17%), and head and neck (13%). Overall, median tumor size was 7 cm (range, 1-22 cm), and tumor grade was I, II, and III in 22%, 64%, and 14% of cases, respectively. Pathologically clear surgical margins (R0) were present in 50%, microscopic positive margins (R1) in 28%, and gross positive margins (R2) in 13%, half of whom had clinically detectable residual disease; surgical margin was unknown in 8%. Median follow-up was 75 months (range, 5-230 months). The crude local control rate was 90%. Patients with R0, R1, and R2 resections had local control of 100%, 94%, and 42%, respectively. Of the 8 cases that had R2 resection, 3 experienced uncontrolled progression, but 5 patients had stable disease with long-term follow-up. The 10-year overall survival, progression-free survival, and cause-specific survival were 86%, 80.5%, and 89.4%, respectively. Younger age and grade III tumors were associated with worse progression-free survival (P = .03 and .0003, respectively). Although surgery with complete resection is paramount in management of chondrosarcoma, RT is a useful adjuvant treatment and appears to offer excellent and durable local control where wide surgical resection is difficult to accomplish. Copyright © 2011 American Cancer Society.

  2. [Choice of components and a method of anesthesia in geriatric cancer patients with high cardiovascular risk].

    Science.gov (United States)

    Khoronenko, V E; Osipova, N A; Shemetova, M M; Edeleva, N V

    2009-01-01

    Investigations were made at surgical treatment stages in 102 cancer patients (mean age 72 +/- 5.8 years) at high cardiovascular risk, who received continuous therapy that reduced heart rate and blood pressure, in order to compensate for the course of coronary heart disease and arterial hypertension. The time course of changes in the major circulatory and metabolic parameters was analyzed in patients during operations on the abdomen and small pelvis while using three different multimodal anesthetic techniques (general intravenous anesthesia-based diazepam, propofol, fentanyl, ketamine; sevofluorane-based inhalational; combined epidural and intravenous one). The advantages and limitations of the above methods were shown in patients on cardio- and vasotropic therapies. Correcting modes (transesophageal atrial pacing, morning-dose drug withdrawal) for its possible related bradycardiac and hypotensive disorders, which reduce a risk of perioperative cardiovascular complications, are set forth.

  3. A social work study high-risk behavior among teenagers

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Iravani

    2012-01-01

    Full Text Available Teenagers are believed the people who are supposed to build the world's future. High-risk behaviors such as addiction to drugs, smoking cigarettes, sex, etc. could significantly hurts teenagers and there must be some supporting programs to reduce these issues as much as possible. This paper performs an empirical investigation to study the different factors influencing high- risk behavior among teenagers who live in a city of Esfahan, Iran. The proposed study designs a questionnaire and distribute between two groups of female and male teenagers. The results indicate that while there is a meaningful relationship between high-risk behaviors and average high school marks among male students there is no meaningful relationship between high-risk behaviors and high school grades among female students. The results also indicate that there is a meaningful difference between gender and high-risk behavior. The season of birth for female and male students is another important factor for having high-risk behaviors. While the order of birth plays an important role among male students, the order of birth is not an important factor among female teenagers. Finally, the results indicate that teenagers' parental financial affordability plays a vital role on both female and male teenagers.

  4. High-grade MRI bone oedema is common within the surgical field in rheumatoid arthritis patients undergoing joint replacement and is associated with osteitis in subchondral bone

    DEFF Research Database (Denmark)

    McQueen, F M; Gao, A; Ostergaard, M

    2007-01-01

    was observed at 60% of surgical sites vs 38% of non-surgical sites. High-grade bone oedema (score >/=50% maximum) was strongly associated with the surgical field (OR 9.3 (3.5 to 24.2), p... in resected bone. METHODS: Preoperative contrast-enhanced MRI scans were obtained in 11 RA patients scheduled for orthopaedic surgery to the hands/wrists or feet. In 9, MRI scans were scored by 2 readers for bone oedema (RAMRIS system). Its distribution with respect to surgical site was investigated. In 4...... samples, there was concordance between bone oedema and subchondral osteitis. In 3, there was no MRI bone oedema, and osteitis was "slight". CONCLUSION: High-grade MRI bone oedema was common within the field of intended surgery and associated with pain. There was concordance between the presence...

  5. Awareness and prevalence of metabolic syndrome among high-risk ...

    African Journals Online (AJOL)

    MetS) in high-risk individuals attending 30 internal medicine clinics in Amman, Jordan, and also to evaluate the various factors associated with increased risk of MetS among them. Methods: This retrospective cross-sectional study was carried out ...

  6. [Is There an Age Limit for Surgical Interventions?].

    Science.gov (United States)

    Mennigen, R; Senninger, N

    2015-06-01

    The demographic development leads to an increase of elderly patients (> 70 years) who require surgical interventions. Nowadays, even complex surgical interventions are performed with good results in very old patients. In view of an increasing life expectancy, radical oncological surgery makes sense even in high age. High age itself is not a risk factor for perioperative morbidity and mortality, and therefore there is no age limit for surgical interventions. However, comorbidities are more frequent in old patients, and these can massively increase the risk of surgery. Thus, for the individual patient, pros and cons of surgical interventions have to be weighed up. A specialised geriatric assessment and an optimal perioperative management of the old patient can improve the results of surgical therapy. Georg Thieme Verlag KG Stuttgart · New York.

  7. A framework for the recognition of high-level surgical tasks from video images for cataract surgeries

    Science.gov (United States)

    Lalys, Florent; Riffaud, Laurent; Bouget, David; Jannin, Pierre

    2012-01-01

    The need for a better integration of the new generation of Computer-Assisted-Surgical (CAS) systems has been recently emphasized. One necessity to achieve this objective is to retrieve data from the Operating Room (OR) with different sensors, then to derive models from these data. Recently, the use of videos from cameras in the OR has demonstrated its efficiency. In this paper, we propose a framework to assist in the development of systems for the automatic recognition of high level surgical tasks using microscope videos analysis. We validated its use on cataract procedures. The idea is to combine state-of-the-art computer vision techniques with time series analysis. The first step of the framework consisted in the definition of several visual cues for extracting semantic information, therefore characterizing each frame of the video. Five different pieces of image-based classifiers were therefore implemented. A step of pupil segmentation was also applied for dedicated visual cue detection. Time series classification algorithms were then applied to model time-varying data. Dynamic Time Warping (DTW) and Hidden Markov Models (HMM) were tested. This association combined the advantages of all methods for better understanding of the problem. The framework was finally validated through various studies. Six binary visual cues were chosen along with 12 phases to detect, obtaining accuracies of 94%. PMID:22203700

  8. Surgical Checklist Implementation Project: The Impact of Variable WHO Checklist Compliance on Risk-adjusted Clinical Outcomes After National Implementation: A Longitudinal Study.

    Science.gov (United States)

    Mayer, Erik K; Sevdalis, Nick; Rout, Shantanu; Caris, Jochem; Russ, Stephanie; Mansell, Jenny; Davies, Rachel; Skapinakis, Petros; Vincent, Charles; Athanasiou, Thanos; Moorthy, Krishna; Darzi, Ara

    2016-01-01

    To evaluate impact of WHO checklist compliance on risk-adjusted clinical outcomes, including the influence of checklist components (Sign-in, Time-out, Sign-out) on outcomes. There remain unanswered questions surrounding surgical checklists as a quality and safety tool, such as the impact in cases of differing complexity and the extent of checklist implementation. Data were collected from surgical admissions (6714 patients) from March 2010 to June 2011 at 5 academic and community hospitals. The primary endpoint was any complication, including mortality, occurring before hospital discharge. Checklist usage was recorded as checklist completed in full/partly. Multilevel modeling was performed to investigate the association between complications/mortality and checklist completion. Significant variability in checklist usage was found: although at least 1 of the 3 components was completed in 96.7% of cases, the entire checklist was only completed in 62.1% of cases. Checklist completion did not affect mortality reduction, but significantly lowered risk of postoperative complication (16.9% vs. 11.2%), and was largely noticed when all 3 components of the checklist had been completed (odds ratio = 0.57, 95% confidence interval: 0.37-0.87, P checklist was implemented. Checklist implementation was associated with reduced case-mix-adjusted complications after surgery and was most significant when all 3 components of the checklist were completed. Full, as opposed to partial, checklist completion provides a health policy opportunity to improve checklist impact on surgical safety and quality of care.

  9. Surgical Technologists

    Science.gov (United States)

    ... State & Area Data Explore resources for employment and wages by state and area for surgical technologists. Similar Occupations Compare the job duties, education, job growth, and pay of surgical technologists with ...

  10. Brachytherapy boost and cancer-specific mortality in favorable high-risk versus other high-risk prostate cancer

    Directory of Open Access Journals (Sweden)

    Vinayak Muralidhar

    2016-02-01

    Full Text Available Purpose : Recent retrospective data suggest that brachytherapy (BT boost may confer a cancer-specific survival benefit in radiation-managed high-risk prostate cancer. We sought to determine whether this survival benefit would extend to the recently defined favorable high-risk subgroup of prostate cancer patients (T1c, Gleason 4 + 4 = 8, PSA 20 ng/ml. Material and methods: We identified 45,078 patients in the Surveillance, Epidemiology, and End Results database with cT1c-T3aN0M0 intermediate- to high-risk prostate cancer diagnosed 2004-2011 treated with external beam radiation therapy (EBRT only or EBRT plus BT. We used multivariable competing risks regression to determine differences in the rate of prostate cancer-specific mortality (PCSM after EBRT + BT or EBRT alone in patients with intermediate-risk, favorable high-risk, or other high-risk disease after adjusting for demographic and clinical factors. Results : EBRT + BT was not associated with an improvement in 5-year PCSM compared to EBRT alone among patients with favorable high-risk disease (1.6% vs. 1.8%; adjusted hazard ratio [AHR]: 0.56; 95% confidence interval [CI]: 0.21-1.52, p = 0.258, and intermediate-risk disease (0.8% vs. 1.0%, AHR: 0.83, 95% CI: 0.59-1.16, p = 0.270. Others with high-risk disease had significantly lower 5-year PCSM when treated with EBRT + BT compared with EBRT alone (3.9% vs. 5.3%; AHR: 0.73; 95% CI: 0.55-0.95; p = 0.022. Conclusions : Brachytherapy boost is associated with a decreased rate of PCSM in some men with high-risk prostate cancer but not among patients with favorable high-risk disease. Our results suggest that the recently-defined “favorable high-risk” category may be used to personalize therapy for men with high-risk disease.

  11. Physical activity barriers and motivators among high-risk employees.

    Science.gov (United States)

    Paguntalan, John C; Gregoski, Mathew

    2016-11-22

    Worksite wellness programs offer an ideal setting to target high-risk sedentary workers to improve health status. Lack of physical activity is associated with increased risk for coronary heart disease and mortality. Despite the risks, the number of sedentary workers is increasing. This study examined the perceived barriers and motivators for physical activity among employees at high-risk for coronary heart disease. A purposive sample of 24 high-risk workers participating in a wellness program in rural South Carolina were enrolled in the study. Qualitative data was obtained through semi-structured face-to-face interviews. Grounded theory was used to analyze qualitative data, and identify overarching themes. Physical limitations due to pain and weakness, lack of motivation, and lack of time emerged as the main barriers to physical activity. Family relationships were reported as the strongest motivator along with social support and potential health benefits. Findings highlight the unique experience of high-risk workers with physical activity. The findingsunderscore the need to design and implement effective interventions specifically designed to meet the needs of high-risk employees.

  12. DASH - Youth Risk Behavior Surveillance System (YRBSS): High School

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1991-2015. High School Dataset. The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health behaviors among youth and young...

  13. Suicide Risk Especially High for U.S. Farmers

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_166800.html Suicide Risk Especially High for U.S. Farmers Other occupations ... Two decades after the U.S. farm crisis, the suicide rate among American farmers remains much higher than ...

  14. Sensation seeking in males involved in recreational high risk sports

    National Research Council Canada - National Science Library

    Guszkowska, M; Bołdak, A

    2010-01-01

    ...) of Zuckerman was applied.Results show, that high risk sports males are featured by stronger need of sensations in comparison to control group and this concerned all but one aspect of sensation seeking variable...

  15. High prevalence of cardiovascular risk factors in Durban South ...

    African Journals Online (AJOL)

    High prevalence of cardiovascular risk factors in Durban South African Indians: The Phoenix Lifestyle Project. ... All participants had demographic, anthropometric and biochemical measurements using the modified World Health Organization (WHO) STEPwise survey methods. Hypertension, obesity, lipid abnormalities and ...

  16. Psychological characteristics in high-risk MSM in China

    National Research Council Canada - National Science Library

    Chen, Guanzhi; Li, Yang; Zhang, Beichuan; Yu, Zengzhao; Li, Xiufang; Wang, Lixin; Yu, Ziming

    2012-01-01

    .... To date, little is known regarding the behavioral, social and psychological characteristics in Chinese MSM, which makes the implementation of preventive and therapeutic strategies for this high-risk...

  17. Treating Patients with High-Risk Smoldering Myeloma

    Science.gov (United States)

    In this phase III clinical trial, patients with smoldering myeloma classified as high risk for progression will be randomly assigned to undergo standard observation or six 4-week courses of treatment with the drug lenalidomide.

  18. High alcohol consumption causes high IgE levels but not high risk of allergic disease

    DEFF Research Database (Denmark)

    Lomholt, Frederikke K; Nielsen, Sune F; Nordestgaard, Børge G

    2016-01-01

    .2-2.5) for 1 allergic disease, 3.9 (95% CI, 3.5-4.4) for 2 allergic diseases, and 7.5 (95% CI, 6.2-9.0) for 3 allergic diseases. High alcohol consumption was associated with high IgE levels but not with high risk of allergic disease. The odds ratio for high versus low IgE levels per 1 alcoholic drink per week......BACKGROUND: High alcohol consumption is associated with high IgE levels in observational studies; however, whether high alcohol consumption leads to high IgE levels and allergic disease is unclear. OBJECTIVE: We tested the hypothesis that high alcohol consumption is associated with high IgE levels...... for the alcohol-metabolizing enzymes alcohol dehydrogenase 1B (ADH-1B; rs1229984) and alcohol dehydrogenase 1c (ADH-1C; rs698). Observationally, we investigated associations between IgE levels and allergic disease (allergic asthma, rhinitis, and eczema) and between alcohol consumption and IgE levels and allergic...

  19. Vaginal micronized progesterone and risk of preterm delivery in high-risk twin pregnancies

    DEFF Research Database (Denmark)

    Klein, K; Rode, L; Nicolaides, K H

    2011-01-01

    OBJECTIVES: Progesterone treatment reduces the risk of preterm delivery in high-risk singleton pregnancies. Our aim was to evaluate the preventive effect of vaginal progesterone in high-risk twins. METHODS: This was a subanalysis of a Danish-Austrian, double-blind, placebo-controlled, randomized...... trial (PREDICT study), in which women with twin pregnancies were randomized to daily treatment with progesterone or placebo pessaries from 20-24 weeks until 34 weeks' gestation. This subpopulation consisted of high-risk pregnancies, defined by the finding of cervical length ≤ 10th centile at 20-24 weeks...... (10.6%) of the 677 women participating in the PREDICT study, the pregnancy was considered to be high-risk, including 47 with cervical length ≤ 10th centile, 28 with a history of preterm delivery or late miscarriage and three fulfilling both criteria. Baseline characteristics for progesterone...

  20. Novel High Efficient Coatings for Anti-Microbial Surgical Sutures Using Chlorhexidine in Fatty Acid Slow-Release Carrier Systems

    Science.gov (United States)

    Obermeier, Andreas; Schneider, Jochen; Wehner, Steffen; Matl, Florian Dominik; Schieker, Matthias; von Eisenhart-Rothe, Rüdiger; Stemberger, Axel; Burgkart, Rainer

    2014-01-01

    Sutures can cause challenging surgical site infections, due to capillary effects resulting in bacteria permeating wounds. Anti-microbial sutures may avoid these complications by inhibiting bacterial pathogens. Recently, first triclosan-resistances were reported and therefore alternative substances are becoming clinically relevant. As triclosan alternative chlorhexidine, the “gold standard” in oral antiseptics was used. The aim of the study was to optimize novel slow release chlorhexidine coatings based on fatty acids in surgical sutures, to reach a high anti-microbial efficacy and simultaneously high biocompatibility. Sutures were coated with chlorhexidine laurate and chlorhexidine palmitate solutions leading to 11, 22 or 33 µg/cm drug concentration per length. Drug release profiles were determined in aqueous elutions. Antibacterial efficacy against Staphylococcus aureus was assessed in agar diffusion tests. Biocompatibility was evaluated via established cytotoxicity assay (WST-1). A commercially triclosan-containing suture (Vicryl Plus), was used as anti-microbial reference. All coated sutures fulfilled European Pharmacopoeia required tensile strength and proved continuous slow drug release over 96 hours without complete wash out of the coated drug. High anti-microbial efficacy for up to 5 days was observed. Regarding biocompatibility, sutures using 11 µg/cm drug content displayed acceptable cytotoxic levels according to ISO 10993-5. The highest potential for human application were shown by the 11 µg/cm chlorhexidine coated sutures with palmitic acid. These novel coated sutures might be alternatives to already established anti-microbial sutures such as Vicryl Plus in case of triclosan-resistance. Chlorhexidine is already an established oral antiseptic, safety and efficacy should be proven for clinical applications in anti-microbial sutures. PMID:24983633

  1. High-Risk Human Papillomavirus Targets Crossroads in Immune Signaling

    OpenAIRE

    Bart Tummers; van der Burg, Sjoerd H

    2015-01-01

    Persistent infections with a high-risk type human papillomavirus (hrHPV) can progress to cancer. High-risk HPVs infect keratinocytes (KCs) and successfully suppress host immunity for up to two years despite the fact that KCs are well equipped to detect and initiate immune responses to invading pathogens. Viral persistence is achieved by active interference with KCs innate and adaptive immune mechanisms. To this end hrHPV utilizes proteins encoded by its viral genome, as well as exploits cellu...

  2. Outcomes of parental investment in high-risk children.

    Science.gov (United States)

    Bugental, Daphne Blunt; Corpuz, Randy; Samec, Rachel

    2013-09-01

    This study assesses the combined effects of children's early medical risk (e.g., preterm status) and parental investment levels (time spent in provision of care to target children as opposed to other family members) on children's response to novel, potentially distressing stimuli. While engaged in play activities, children were exposed to stimuli that were either neutral (a speaker on television with a calm voice) or threatening (a speaker with an angry voice). A significant interaction between children's risk status and parental investment was found only for threatening stimuli. High-risk children with high-investing parents showed high visual engagement with potentially threatening responses, whereas high-risk children with low-investing parents were more likely to show visual avoidance. No comparable effects were found for low-risk children. Findings were interpreted as showing that high-risk children with a history of high parental investment are more likely to attend to potentially threatening events, an adaptive response in the presence of reliable support. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Endovascular revascularization is associated with a lower risk of above knee amputation than surgical or combined modalities. Analysis of English hospital admissions over a six year period.

    Science.gov (United States)

    Ahmad, Naseer; Thomas, Neil; Gill, Paramjit; Torella, Francesco

    2016-10-01

    We aimed to determine whether revascularization modality affected risk of an above knee amputation (AKA) in patients with peripheral arterial disease. We used English hospital data and began by determining the number of major amputations and revascularization procedures performed between 1st April 2003- 31st March 2009. We then extracted demographic (age, sex, level of deprivation, treatment location), comorbidity (diabetes, hypertension, hypercholesterolemia, coronary heart disease, ischemic cerebrovascular disease and smoking) and revascularization modality (endovascular/surgical) data. Multi-variate analysis determined the odds ratios of an AKA in relation to previous revascularization attempts (if any). Over the six year period, there were 25,312 major amputations of which 7544 (29.4%) were linked to a revascularization attempt. Level of amputation was significantly influenced by previous revascularization. Compared to patients not linked to revascularization, those requiring endovascular treatment were less likely to undergo an AKA (OR 0.82; 95% CI 0.75-0.90). Surgical (OR 1.16; 1.07-1.25) and combined endovascular/surgical treatment (OR 1.24; 1.09-1.40) had the opposite effect. Men (0.64; 0.55-0.74) and diabetics (0.44; 0.55-0.74) were less likely to undergo an AKA whereas patients with coronary (1.28; 1.10-1.47) or cerebrovascular (1.90; 1.33-2.71) disease were more likely to have the procedure. Age, deprivation, hypertension, hypercholesterolemia, smoking and geographical location did not influence the level of amputation. When a major leg amputation is necessary, the risk of this being carried out above the knee may be lowest after endovascular revascularization attempts and highest after combined endovascular and surgical treatment.

  4. Local Control With 21-Gy Radiation Therapy for High-Risk Neuroblastoma.

    Science.gov (United States)

    Casey, Dana L; Kushner, Brian H; Cheung, Nai-Kong V; Modak, Shakeel; LaQuaglia, Michael P; Wolden, Suzanne L

    2016-10-01

    To evaluate local control after 21-Gy radiation therapy (RT) to the primary site in patients with high-risk neuroblastoma. After receiving dose-intensive chemotherapy and gross total resection (GTR), 246 patients (aged 1.2-17.9 years, median 4.0 years) with high-risk neuroblastoma underwent RT to the primary site at Memorial Sloan Kettering from 2000 to 2014. Radiation therapy consisted of 21 Gy in twice-daily fractions of 1.5 Gy each. Local failure (LF) was correlated with biologic prognostic factors and clinical findings at the time of diagnosis and start of RT. Median follow-up of surviving patients was 6.4 years. Cumulative incidence of LF was 7.1% at 2 years after RT and 9.8% at 5 years after RT. The isolated LF rate was 3.0%. Eighty-six percent of all local failures were within the RT field. Local control was worse in patients who required more than 1 surgical resection to achieve GTR (22.4% vs 8.3%, P=.01). There was also a trend toward inferior local control with MYCN-amplified tumors or serum lactate dehydrogenase ≥1500 U/L (P=.09 and P=.06, respectively). After intensive chemotherapy and maximal surgical debulking, hyperfractionated RT with 21 Gy in high-risk neuroblastoma results in excellent local control. Given the young patient age, concern for late effects, and local control >90%, dose reduction may be appropriate for patients without MYCN amplification who achieve GTR. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Local Control With 21-Gy Radiation Therapy for High-Risk Neuroblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Casey, Dana L. [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Kushner, Brian H.; Cheung, Nai-Kong V.; Modak, Shakeel [Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York (United States); LaQuaglia, Michael P. [Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Wolden, Suzanne L., E-mail: woldens@mskcc.org [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States)

    2016-10-01

    Purpose: To evaluate local control after 21-Gy radiation therapy (RT) to the primary site in patients with high-risk neuroblastoma. Methods and Materials: After receiving dose-intensive chemotherapy and gross total resection (GTR), 246 patients (aged 1.2-17.9 years, median 4.0 years) with high-risk neuroblastoma underwent RT to the primary site at Memorial Sloan Kettering from 2000 to 2014. Radiation therapy consisted of 21 Gy in twice-daily fractions of 1.5 Gy each. Local failure (LF) was correlated with biologic prognostic factors and clinical findings at the time of diagnosis and start of RT. Results: Median follow-up of surviving patients was 6.4 years. Cumulative incidence of LF was 7.1% at 2 years after RT and 9.8% at 5 years after RT. The isolated LF rate was 3.0%. Eighty-six percent of all local failures were within the RT field. Local control was worse in patients who required more than 1 surgical resection to achieve GTR (22.4% vs 8.3%, P=.01). There was also a trend toward inferior local control with MYCN-amplified tumors or serum lactate dehydrogenase ≥1500 U/L (P=.09 and P=.06, respectively). Conclusion: After intensive chemotherapy and maximal surgical debulking, hyperfractionated RT with 21 Gy in high-risk neuroblastoma results in excellent local control. Given the young patient age, concern for late effects, and local control >90%, dose reduction may be appropriate for patients without MYCN amplification who achieve GTR.

  6. High-risk smoldering myeloma: Perspective on watchful monitoring.

    Science.gov (United States)

    Leng, Siyang; Lentzsch, Suzanne

    2016-12-01

    In a 2008 paper, Dispenzieri and colleagues at the Mayo Clinic proposed a risk stratification system for patients with smoldering multiple myeloma (SMM) based on the presence of three risk factors: serum M-protein ≥3 g/dL, bone marrow plasma cell percentage ≥10%, and a free light chain (FLC) ratio (κ to λ) of either ≤0.125 or ≥8. The patient in this vignette has all three risk factors, classifying him as high-risk, with an associated median time to progression (TTP) of 1.9 years. This is significantly worse than a patient with intermediate-risk (median TTP 5.1 years) or low-risk (10 years) disease. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Internal Drainage of an Esophageal Perforation in a Patient with a High Surgical Risk

    Directory of Open Access Journals (Sweden)

    Hongsun Kim

    2017-10-01

    Full Text Available A 71-year-old man presented with a productive cough and fever, and he was diagnosed as having an esophageal perforation and a mediastinal abscess. He had a history of traumatic hemothorax and pleural drainage for empyema in the right chest and was considered unable to tolerate thoracic surgery because of sepsis and progressive aspiration pneumonia. In order to aggressively drain the mediastinal contamination, we performed internal drainage by placing a Levin tube into the mediastinum through the perforation site. This procedure, in conjunction with controlling sepsis and providing sufficient postpyloric nutrition, allowed the esophageal injury to completely heal.

  8. Surgical Versus Nonsurgical Treatment for High-Grade Spondylolisthesis in Children and Adolescents

    OpenAIRE

    Xue, Xuhong; Wei, Xiaochun; Li, Li

    2016-01-01

    Abstract The optimal management of high-grade spondylolisthesis in children and adolescent is controversial. There is a paucity of literature regarding operatively or nonoperative management in this setting. To assessment of the current state of evidence regarding high-grade spondylolisthesis treatment with the goal of obtaining outcome comparisons in these patients managed either operatively or nonoperatively. We performed a systematic literature search up to November 2014, using Medline, Em...

  9. Use of high-magnification loupes or surgical operating microscope when performing prophylaxes, scaling or root planing procedures.

    Science.gov (United States)

    Mamoun, John

    2013-01-01

    The use of high-level magnification (6-8x loupes magnification, or higher degrees of magnification provided by the surgical operating microscope), combined with head-mounted, coaxial lighting, may improve the ability of a dentist or dental hygienist to perform prophylaxis or scaling and root planing procedures, compared to the performance of these tasks using unaided vision or entry-level (2.5x) magnification, combined with overhead operatory lighting. A magnified view of the supragingival contours of a tooth surface facilitates visualizing the dimensions and curvature of the unseen sub-gingival tooth surfaces, which facilitates detection and removal of calculus that is located on these subgingival surfaces. Improved calculus removal ability may lead to better periodontal disease outcomes.

  10. Predicting reattendance at a high-risk breast cancer clinic.

    Science.gov (United States)

    Ormseth, Sarah R; Wellisch, David K; Aréchiga, Adam E; Draper, Taylor L

    2015-10-01

    The research about follow-up patterns of women attending high-risk breast-cancer clinics is sparse. This study sought to profile daughters of breast-cancer patients who are likely to return versus those unlikely to return for follow-up care in a high-risk clinic. Our investigation included 131 patients attending the UCLA Revlon Breast Center High Risk Clinic. Predictor variables included age, computed breast-cancer risk, participants' perceived personal risk, clinically significant depressive symptomatology (CES-D score ≥ 16), current level of anxiety (State-Trait Anxiety Inventory), and survival status of participants' mothers (survived or passed away from breast cancer). A greater likelihood of reattendance was associated with older age (adjusted odds ratio [AOR] = 1.07, p = 0.004), computed breast-cancer risk (AOR = 1.10, p = 0.017), absence of depressive symptomatology (AOR = 0.25, p = 0.009), past psychiatric diagnosis (AOR = 3.14, p = 0.029), and maternal loss to breast cancer (AOR = 2.59, p = 0.034). Also, an interaction was found between mother's survival and perceived risk (p = 0.019), such that reattendance was associated with higher perceived risk among participants whose mothers survived (AOR = 1.04, p = 0.002), but not those whose mothers died (AOR = 0.99, p = 0.685). Furthermore, a nonlinear inverted "U" relationship was observed between state anxiety and reattendance (p = 0.037); participants with moderate anxiety were more likely to reattend than those with low or high anxiety levels. Demographic, medical, and psychosocial factors were found to be independently associated with reattendance to a high-risk breast-cancer clinic. Explication of the profiles of women who may or may not reattend may serve to inform the development and implementation of interventions to increase the likelihood of follow-up care.

  11. Knee Joint Distraction as an Alternative Surgical Treatment for Osteoarthritis: Rationale and Design of two Randomized Controlled Trials (vs High Tibial Osteotomy and Total Knee Prosthesis

    Directory of Open Access Journals (Sweden)

    Karen Wiegant

    2015-08-01

    Full Text Available AIM: In case of refractory knee osteoarthritis at a relatively young age causing persisting pain, treatment options are limited. In case of medial degeneration high tibial osteotomy (HTO may be considered, or in case of more generalized OA, a total knee prosthesis (TKP. However, these young and active patients have a major risk of revision surgery. Knee joint distraction (KJD could be an alternative treatment; prolonged clinical benefit and cartilage tissue repair have been demonstrated. Therefore, two RCTs were designed, evaluating clinical efficacy and for HTO additionally comparing cartilage tissue repair. MATERIALS AND METHODS: Patients<65 years of age considered in regular clinical practice for TKP or HTO were included. TKP and HTO were performed according to usual standard of care. KJD was performed for six continuous weeks by use of an external fixator bridging the joint, fixed at each side to two bone pins. RESULTS: Inclusion rate was stable over time and took 42 and 22 months for TKP vs KJD and HTO vs KJD, respectively. At baseline, patient characteristics differed: age was 55.2±0.9 and 50.0±0.7 p<0.000, KOOS-score was 36.6±1.4 and 42.2±1.6 p=0.012, and VAS-pain was 68.7±2.1 and 61.4±2.4 p=0.028, in the KJD-TKP cohort and KJD-HTO cohort, respectively. CONCLUSIONS: For implementation of KJD a comparison with available surgical alternatives is needed. TKP and HTO were chosen as the most relevant comparators. Inclusion is closed, and all treatments are completed. Data have to be awaited to determine the position of KJD in surgical treatment of refractory knee OA.

  12. Communicating about risk: strategies for situations where public concern is high but the risk is low.

    Science.gov (United States)

    Hooker, Claire; Capon, Adam; Leask, Julie

    2017-01-15

    In this article, we summarise research that identifies best practice for communicating about hazards where the risk is low but public concern is high. We apply Peter Sandman's 'risk = hazard + outrage' formulation to these risks, and review factors associated with the amplification of risk signals. We discuss the structures that determine the success of risk communication strategies, such as the capacity for early communication to 'capture' the dominant representation of risk issues, the importance of communicating uncertainty, and the usefulness of engaging with communities. We argue that, when facing trade-offs in probable outcomes from communication, it is always best to choose strategies that maintain or build trust, even at the cost of initial overreactions. We discuss these features of successful risk communication in relation to a range of specific examples, particularly opposition to community water fluoridation, Ebola, and routine childhood immunisation.

  13. Communicating about risk: strategies for situations where public concern is high but the risk is low

    Directory of Open Access Journals (Sweden)

    Claire Hooker

    2017-02-01

    Full Text Available In this article, we summarise research that identifies best practice for communicating about hazards where the risk is low but public concern is high. We apply Peter Sandman’s ‘risk = hazard + outrage’ formulation to these risks, and review factors associated with the amplification of risk signals. We discuss the structures that determine the success of risk communication strategies, such as the capacity for early communication to ‘capture’ the dominant representation of risk issues, the importance of communicating uncertainty, and the usefulness of engaging with communities. We argue that, when facing trade-offs in probable outcomes from communication, it is always best to choose strategies that maintain or build trust, even at the cost of initial overreactions. We discuss these features of successful risk communication in relation to a range of specific examples, particularly opposition to community water fluoridation, Ebola, and routine childhood immunisation.

  14. Risk of Local Failure in Breast Cancer Patients With Lobular Carcinoma In Situ at the Final Surgical Margins: Is Re-excision Necessary?

    Energy Technology Data Exchange (ETDEWEB)

    Sadek, Betro T.; Shenouda, Mina N.; Abi Raad, Rita F. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Niemierko, Andrzej [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Statistics Section, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Keruakous, Amany R. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Goldberg, Saveli I. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Statistics Section, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Taghian, Alphonse G., E-mail: ataghian@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States)

    2013-11-15

    Purpose: To compare the outcome of patients with invasive breast cancer both with and without lobular carcinoma in situ (LCIS)-positive/close surgical margins after breast-conserving treatment. Methods and Materials: We retrospectively studied 2358 patients with T1-T2 invasive breast cancer treated with lumpectomy and radiation therapy from January 1980 to December 2009. Median age was 57 years (range, 24-91 years). There were 82 patients (3.5%) with positive/close LCIS margins (<0.2 cm) and 2232 patients (95.7%) with negative margins. A total of 1789 patients (76%) had negative lymph nodes. Patients who received neoadjuvant chemotherapy were excluded. A total of 1783 patients (76%) received adjuvant systemic therapy. Multivariable analysis (MVA) was performed using Cox's proportional hazards model. Results: The 5-year cumulative incidence of locoregional recurrence (LRR) was 3.2% (95% confidence interval [CI] 2.5%-4.1%) for the 2232 patients with LCIS-negative surgical margins (median follow-up 104 months) and 2.8% (95% CI 0.7%-10.8%) for the 82 patients with LCIS-positive/close surgical margins (median follow-up 90 months). This was not statistically significant (P=.5). On MVA, LCIS-positive margins after the final surgery were not associated with increased risk of LRR (hazard ratio [HR] 3.4, 95% CI 0.5-24.5, P=.2). Statistically significant prognostic variables on Cox's MVA for risk of LRR included systemic therapy (HR 0.5, 95% CI 0.33-0.75, P=.001), number of positive lymph nodes (HR 1.11, 95% CI 1.05-1.18, P=.001), menopausal status (HR 0.96, 95% CI 0.95-0.98, P=.001), and histopathologic grade (grade 3 vs grade 1/2) (HR 2.6, 95% CI 1.4-4.7, P=.003). Conclusion: Our results suggest that the presence of LCIS at the surgical margin after lumpectomy does not increase the risk of LRR or the final outcome. These findings suggest that re-excision or mastectomy in patients with LCIS-positive/close final surgical margins is unnecessary.

  15. The Braden Scale cannot be used alone for assessing pressure ulcer risk in surgical patients: a meta-analysis.

    Science.gov (United States)

    He, Wei; Liu, Peng; Chen, Hong-Lin

    2012-02-01

    The validity and reliability of the Braden Scale for pressure ulcer development has been established in a variety of patient care settings, but studies suggest the scale does not capture risk factors in surgical patients. The purpose of this metaanalysis was to assess the predictive validity of the Braden Scale for pressure ulcer development in surgical patients. A literature search using PubMed and Web of Science databases (through July 2011) was conducted to identify all clinical studies on predicting pressure ulcers in surgical patients using the Braden Scale. To be eligible for inclusion, studies had to include sensitivity (true positive rate, TPR) and specificity (true negative rate, TNR) results or include sufficient data to calculate these factors. Study quality was assessed using the 14-item Quality Assessment of Diagnostic Accuracy Studies (QUADAS) instrument, and two-by-two tables of predictive validity were constructed from each article. Meta-analysis for predictive validity was performed, including calculation of pooled sensitivity, pooled specificity, diagnostic odds ratio (DOR), construction of summary receiver operating characteristic (SROC) curves, and overall diagnostic accuracy (Q*). Three studies (N = 609 patients) met the meta-analysis inclusion criteria. The pooled estimates for sensitivity and specificity were 0.42 (95% CI: 0.38 to 0.47) and 0.84 (95% CI: 0. 83 to 0.85), respectively, yielding a combined DOR of 4.40 (95% CI: 2.98 to 6.50). The area under the ROC curve (AUC) was 0.6921 ± 0.0346, and the Q* was 0.6466 ± 0.0274. Significant heterogeneity was noted between the included studies with Q value 34.49 (P = 0.0321), and I2 for pooled sensitivity, pooled specificity, and pooled DOR was 88.7%, 98.6%, and 39.1%, respectively. Although the observed heterogeneity between studies may have affected the results, the low values for overall diagnostic accuracy (Q*) and diagnostic capability (AUC) indicate the Braden Scale has low predictive

  16. Attitudes towards Lung Cancer Screening in an Australian High-Risk Population

    Directory of Open Access Journals (Sweden)

    Alexandra E. Flynn

    2013-01-01

    Full Text Available Objectives. To determine whether persons at high risk of lung cancer would participate in lung cancer screening test if available in Australia and to elicit general attitudes towards cancer screening and factors that might affect participation in a screening program. Methods. We developed a 20-item written questionnaire, based on two published telephone interview scripts, addressing attitudes towards cancer screening, perceived risk of lung cancer, and willingness to be screened for lung cancer and to undertake surgery if lung cancer were detected. The questionnaire was given to 102 current and former smokers attending the respiratory clinic and pulmonary rehabilitation programmes. Results. We gained 90 eligible responses (M:F, 69:21. Mean [SD] age was 63 [11] and smoking history was 32 [21] pack years. 95% of subjects would participate in a lung cancer screening test, and 91% of these would consider surgery if lung cancer was detected. 44% of subjects considered that they were at risk of lung cancer. This was lower in ex-smokers than in current smokers. Conclusions. There is high willingness for lung cancer screening and surgical treatment. There is underrecognition of risk among ex-smokers. This misperception could be a barrier to a successful screening or case-finding programme in Australia.

  17. Genomic analysis of high-risk smoldering multiple myeloma.

    Science.gov (United States)

    López-Corral, Lucía; Mateos, María Victoria; Corchete, Luis A; Sarasquete, María Eugenia; de la Rubia, Javier; de Arriba, Felipe; Lahuerta, Juan-José; García-Sanz, Ramón; San Miguel, Jesús F; Gutiérrez, Norma C

    2012-09-01

    Smoldering myeloma is an asymptomatic plasma cell dyscrasia with a heterogeneous propensity to progress to active myeloma. In order to investigate the biology of smoldering myeloma patients with high risk of progression, we analyzed the genomic characteristics by FISH, SNP-arrays and gene expression profile of a group of patients with high-risk smoldering myeloma included in a multicenter randomized trial. Chromosomal abnormalities detected by FISH and SNP-arrays at diagnosis were not associated to risk of progression to symptomatic myeloma. However, the overexpression of four SNORD genes (SNORD25, SNORD27, SNORD30 and SNORD31) was correlated with shorter time to progression (Psmoldering patients who progressed to symptomatic myeloma were sequentially analyzed, newly acquired lesions together with an increase in the proportion of plasma cells carrying a given abnormality were observed. These findings suggest that gene expression profiling is a valuable technique to identify smoldering myeloma patients with high risk of progression. (Clinical Trials NCT00443235).

  18. Surgical Versus Nonsurgical Treatment for High-Grade Spondylolisthesis in Children and Adolescents: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Xue, Xuhong; Wei, Xiaochun; Li, Li

    2016-03-01

    The optimal management of high-grade spondylolisthesis in children and adolescent is controversial. There is a paucity of literature regarding operatively or nonoperative management in this setting. To assessment of the current state of evidence regarding high-grade spondylolisthesis treatment with the goal of obtaining outcome comparisons in these patients managed either operatively or nonoperatively. We performed a systematic literature search up to November 2014, using Medline, Embase, and The Cochrane Library. The analysis and eligibility criteria were documented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-guidelines) and Cochrane Back Review Group editorial board. We used the Newcastle-Ottawa quality assessment scale (NOS-scale) to assess the quality. Five observational studies were considered eligible for analysis based on the evaluation of 1596 identified papers. The mean overall difference in the Scoliosis Research Society questionnaire 22 between the surgical and nonsurgical groups was not statistically significant (95% CI: -0.17 to 0.21, P = 0.84). The pooled mean difference in progression of slip between the surgical and nonsurgical groups was no significant difference (OR: 0.47, 95% CI: 0.12-1.81, P = 0.27, I = 0%). Because of the preponderance of uncontrolled case series, low-quality evidence indicates that the quality of life and progression of slips was no significant difference between surgery and nonoperation group. Nonoperative patients had no radiologic progression of their slip during the follow-up period.

  19. Quality of life of patients with high-grade spondylolisthesis: minimum 2-year follow-up after surgical and nonsurgical treatments.

    Science.gov (United States)

    Bourassa-Moreau, Étienne; Mac-Thiong, Jean-Marc; Joncas, Julie; Parent, Stefan; Labelle, Hubert

    2013-07-01

    Surgical intervention is generally indicated in a pediatric high-grade spondylolisthesis to prevent the progression of deformity or neurologic deterioration and improve the quality of life. However, the outcome of the treatment on the health-related quality of life (HRQOL) of patients with high-grade spondylolisthesis remains largely unknown. To describe the changes in the HRQOL of patients with pediatric high-grade spondylolisthesis after surgical and nonsurgical managements. Observational case series with a minimal of 2-year follow-up. Twenty-eight pediatric patients with high-grade spondylolisthesis from a single institution filled the inclusion criteria. Twenty-three patients were managed surgically and five were managed nonsurgically. Self-report measures: Scoliosis Research Society questionnaires (SRS-22). Neurologic examination, radiographic evaluation of slip grade. The SRS-22 questionnaire was collected at the baseline (initial presentation for the nonsurgical group and preoperative visit for the surgical group) and at the last follow-up. Differences between baseline and last follow-up were evaluated in both groups. Correlation between the baseline score of SRS-22 score and improvement in the SRS-22 score was determined in surgical patients. In surgical patients, total SRS-22 scores were 3.31 ± 0.50 at the baseline and 4.26 ± 0.50 at the last follow-up. In nonsurgical patients, total SRS-22 scores were 4.12 ± 0.16 at the baseline and 4.14 ± 0.38 at the last follow-up. Therefore, variation in the SRS-22 total score was +0.94 ± 0.77 (pHRQOL improves after a surgical intervention for high-grade spondylolisthesis. Patients with lower baseline HRQOL scores are those who benefit the most from surgery. Close observation is a safe and feasible option in selected patients with a good baseline HRQOL and no neurologic impairment. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. High alcohol consumption causes high IgE levels but not high risk of allergic disease.

    Science.gov (United States)

    Lomholt, Frederikke K; Nielsen, Sune F; Nordestgaard, Børge G

    2016-11-01

    High alcohol consumption is associated with high IgE levels in observational studies; however, whether high alcohol consumption leads to high IgE levels and allergic disease is unclear. We tested the hypothesis that high alcohol consumption is associated with high IgE levels and allergic disease both observationally and genetically using a Mendelian randomization design free of reverse causation and largely free of confounding. Among 111,408 subjects aged 20 to 100 years from the general population, 50,019 had plasma IgE measurements, and 102,270 were genotyped for the alcohol-metabolizing enzymes alcohol dehydrogenase 1B (ADH-1B; rs1229984) and alcohol dehydrogenase 1c (ADH-1C; rs698). Observationally, we investigated associations between IgE levels and allergic disease (allergic asthma, rhinitis, and eczema) and between alcohol consumption and IgE levels and allergic disease. Genetically, we explored potential causal relationships between alcohol consumption and IgE levels and allergic disease. The multivariable adjusted odds ratio for IgE levels greater than versus less than 150 kU/L and compared with subjects without allergic disease was 2.3 (95% CI, 2.2-2.5) for 1 allergic disease, 3.9 (95% CI, 3.5-4.4) for 2 allergic diseases, and 7.5 (95% CI, 6.2-9.0) for 3 allergic diseases. High alcohol consumption was associated with high IgE levels but not with high risk of allergic disease. The odds ratio for high versus low IgE levels per 1 alcoholic drink per week higher consumption was 1.12 (95% CI, 1.02-1.23) genetically and 1.01 (95% CI, 1.01-1.02) observationally; for allergic disease, the corresponding odds ratios were 0.96 (95% CI, 0.92-1.00) genetically and 1.00 (95% CI, 1.00-1.00) observationally. High alcohol consumption is associated observationally and genetically with high IgE levels but not with high risk of allergic disease. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  1. Does osteoporosis increase complication risk in surgical fracture treatment? A protocol combining new endpoints for two prospective multicentre open cohort studies

    Directory of Open Access Journals (Sweden)

    Marent Marta

    2010-11-01

    Full Text Available Abstract Background With an ever-increasing elderly population, orthopaedic surgeons are faced with treating a high number of fragility fractures. Biomechanical tests have demonstrated the potential role of osteoporosis in the increased risk of fracture fixation complications, yet this has not been sufficiently proven in clinical practice. Based on this knowledge, two clinical studies were designed to investigate the influence of local bone quality on the occurrence of complications in elderly patients with distal radius and proximal humerus fractures treated by open reduction and internal fixation. Methods/Design The studies were planned using a prospective multicentre open cohort design and included patients between 50 and 90 years of age. Distal radius and proximal humerus fractures were treated with locking compression 2.4 mm and proximal humerus internal locking plates, respectively. Follow-up examinations were planned for 6 weeks, 3 and 12 months as well as a telephone interview at 6 months. The primary outcome focuses on the occurrence of at least one local bone quality related complication. Local bone quality is determined by measuring bone mineral density and bone mineral content at the contralateral radius. Primary complications are categorised according to predefined factors directly related to the bone/fracture or the implant/surgical technique. Secondary outcomes include the documentation of soft tissue/wound or general/systemic complications, clinical assessment of range of motion, and patient-rated evaluations of upper limb function and quality of life using both objective and subjective measures. Discussion The prospective multicentre open cohort studies will determine the value of local bone quality as measured by bone mineral density and content, and compare the quality of local bone of patients who experience a complication (cases following surgery with that of patients who do not (controls. These measurements are novel and

  2. Viable adhered Staphylococcus aureus highly reduced on novel antimicrobial sutures using chlorhexidine and octenidine to avoid surgical site infection (SSI)

    Science.gov (United States)

    Schneider, Jochen; Harrasser, Norbert; Tübel, Jutta; Mühlhofer, Heinrich; Pförringer, Dominik; von Deimling, Constantin; Foehr, Peter; Kiefel, Barbara; Krämer, Christina; Stemberger, Axel; Schieker, Matthias

    2018-01-01

    Background Surgical sutures can promote migration of bacteria and thus start infections. Antiseptic coating of sutures may inhibit proliferation of adhered bacteria and avoid such complications. Objectives This study investigated the inhibition of viable adhering bacteria on novel antimicrobially coated surgical sutures using chlorhexidine or octenidine, a critical factor for proliferation at the onset of local infections. The medical need, a rapid eradication of bacteria in wounds, can be fulfilled by a high antimicrobial efficacy during the first days after wound closure. Methods As a pretesting on antibacterial efficacy against relevant bacterial pathogens a zone of inhibition assay was conducted with middle ranged concentrated suture coatings (22 μg/cm). For further investigation of adhering bacteria in detail the most clinically relevant Staphylococcus aureus (ATCC®49230™) was used. Absorbable braided sutures were coated with chlorhexidine-laurate, chlorhexidine-palmitate, octenidine-laurate, and octenidine-palmitate. Each coating type resulted in 11, 22, or 33 μg/cm drug content on sutures. Scanning electron microscopy (SEM) was performed once to inspect the coating quality and twice to investigate if bacteria have colonized on sutures. Adhesion experiments were assessed by exposing coated sutures to S. aureus suspensions for 3 h at 37°C. Subsequently, sutures were sonicated and the number of viable bacteria released from the suture surface was determined. Furthermore, the number of viable planktonic bacteria was measured in suspensions containing antimicrobial sutures. Commercially available sutures without drugs (Vicryl®, PGA Resorba®, and Gunze PGA), as well as triclosan-containing Vicryl® Plus were used as control groups. Results Zone of inhibition assay documented a multispecies efficacy of novel coated sutures against tested bacterial strains, comparable to most relevant S. aureus over 48 hours. SEM pictures demonstrated uniform layers on

  3. Viable adhered Staphylococcus aureus highly reduced on novel antimicrobial sutures using chlorhexidine and octenidine to avoid surgical site infection (SSI).

    Science.gov (United States)

    Obermeier, Andreas; Schneider, Jochen; Harrasser, Norbert; Tübel, Jutta; Mühlhofer, Heinrich; Pförringer, Dominik; Deimling, Constantin von; Foehr, Peter; Kiefel, Barbara; Krämer, Christina; Stemberger, Axel; Schieker, Matthias; Burgkart, Rainer; von Eisenhart-Rothe, Rüdiger

    2018-01-01

    Surgical sutures can promote migration of bacteria and thus start infections. Antiseptic coating of sutures may inhibit proliferation of adhered bacteria and avoid such complications. This study investigated the inhibition of viable adhering bacteria on novel antimicrobially coated surgical sutures using chlorhexidine or octenidine, a critical factor for proliferation at the onset of local infections. The medical need, a rapid eradication of bacteria in wounds, can be fulfilled by a high antimicrobial efficacy during the first days after wound closure. As a pretesting on antibacterial efficacy against relevant bacterial pathogens a zone of inhibition assay was conducted with middle ranged concentrated suture coatings (22 μg/cm). For further investigation of adhering bacteria in detail the most clinically relevant Staphylococcus aureus (ATCC®49230™) was used. Absorbable braided sutures were coated with chlorhexidine-laurate, chlorhexidine-palmitate, octenidine-laurate, and octenidine-palmitate. Each coating type resulted in 11, 22, or 33 μg/cm drug content on sutures. Scanning electron microscopy (SEM) was performed once to inspect the coating quality and twice to investigate if bacteria have colonized on sutures. Adhesion experiments were assessed by exposing coated sutures to S. aureus suspensions for 3 h at 37°C. Subsequently, sutures were sonicated and the number of viable bacteria released from the suture surface was determined. Furthermore, the number of viable planktonic bacteria was measured in suspensions containing antimicrobial sutures. Commercially available sutures without drugs (Vicryl®, PGA Resorba®, and Gunze PGA), as well as triclosan-containing Vicryl® Plus were used as control groups. Zone of inhibition assay documented a multispecies efficacy of novel coated sutures against tested bacterial strains, comparable to most relevant S. aureus over 48 hours. SEM pictures demonstrated uniform layers on coated sutures with higher roughness for

  4. The risk ogf high-risk jobs : psychological health consequences in forensic physicians and ambulance workers

    NARCIS (Netherlands)

    Ploeg, E. van der

    2003-01-01

    The risk of high-risk jobs: Psychological health consequences in forensic doctors and ambulance workers This thesis has shown that forensic physicians and ambulance personnel frequently suffer from psychological complaints as a result of dramatic events and sources of chronic work stress. A

  5. Risk factors for congenital anomalies in high risk pregnant women: A ...

    African Journals Online (AJOL)

    Tella Sunitha

    2016-05-14

    May 14, 2016 ... Abstract Background: High Risk Pregnancy (HRP) is a condition where mother or developing fetus or both are at increased risk of complications during or after pregnancy and birth. There are no studies so far which have characterized congenital anomalies (CAs) in HRP women with dif- ferent previous ...

  6. Risk factors for congenital anomalies in high risk pregnant women: A ...

    African Journals Online (AJOL)

    Tella Sunitha

    2016-05-14

    May 14, 2016 ... Rubella;. CMV and HSV. Abstract Background: High Risk Pregnancy (HRP) is a condition where mother or developing fetus or both are at increased risk of complications during or after pregnancy and birth. There are no studies so far which have characterized congenital anomalies (CAs) in HRP women ...

  7. On risk, leverage and banks: do highly leveraged banks take on excessive risk?

    NARCIS (Netherlands)

    Koudstaal, M.; van Wijnbergen, S.

    2012-01-01

    This paper deals with the relation between excessive risk taking and capital structure in banks. Examining a quarterly dataset of U.S. banks between 1993 and 2010, we find that equity is valued higher when more risky portfolios are chosen when leverage is high, and that more risk taking has a

  8. Clinical risk factors for gestational hypertensive disorders in pregnant women at high risk for developing preeclampsia

    NARCIS (Netherlands)

    Wong, Tsz Y.; Groen, Henk; Faas, Marijke M.; van Pampus, Maria G.

    2013-01-01

    Objectives: To evaluate clinical risk factors for the development of gestational hypertensive disorders in a group of pregnant women at high risk for developing preeclampsia. Secondly we evaluated the incidence and recurrence rate of preeclampsia and pregnancy-induced hypertension. Study design: A

  9. Who Takes Risks in High-Risk Sports? A Typological Personality Approach

    Science.gov (United States)

    Castanier, Carole; Le Scanff, Christine; Woodman, Tim

    2010-01-01

    We investigated the risk-taking behaviors of 302 men involved in high-risk sports (downhill skiing, mountaineering, rock climbing, paragliding, or skydiving). The sportsmen were classified using a typological approach to personality based on eight personality types, which were constructed from combinations of neuroticism, extraversion, and…

  10. Risk behaviors for the health of adolescents from High School

    Directory of Open Access Journals (Sweden)

    José Henrique Ramos

    2009-09-01

    Full Text Available Objective: To investigate the risk behaviors (smoking addiction, alcoholism, drug use and sexual risk behavior of adolescents from High School. Methods: It was an analytical and cross-sectional study. The sample consisted of 720 scholars (252 boys and 468 girls from the age group of 16 to 17 years-old, from three public schools in Florianopolis/SC. The data was collected through two types of self administrated questionnaires; one for the parents and another one for the students, from March to December, 2005. The studied variables were legal and illegal drug use and sexual risk behavior. The descriptive statistics and the chi- squared test were used to carry out the data analysis Results: The beginning of risk behaviors occurred between 14 and 15 years old, for both genders. It was observed that 26 (3.6% scholars drank alcohol regularly; 38 (5.3% smoked daily; 66 (9.2 % were drug users or had used drugs several times and 14 (2% were drug dependents. Concerning to sexual risk behavior, 318 (44.5% scholars had sexual risk behavior and from those, 97 (13.6% did not always use condom. From the studied sample, 545 (76.5% scholars did not present any risk behavior. Among risk behaviors, sexual risk prevailed (42.5%. Conclusion: The number of adolescents with risk behavior was not high. Nevertheless, there is a small proportion of adolescents that smoke, drink and do drugs and have sexual risk behavior. This points out to the need of a bigger supervision and guidance for these students.

  11. Smoking as an Independent Risk Factor for Postoperative Complications in Plastic Surgical Procedures: A Propensity Score-Matched Analysis of 36,454 Patients from the NSQIP Database from 2005 to 2014.

    Science.gov (United States)

    Toyoda, Yoshiko; Fu, Rose H; Li, Lu; Otterburn, David M; Rohde, Christine H

    2018-01-01

    Smoking has been associated with wound healing complications and overall morbidity in multiple specialties, including plastic surgery. From 2005 to 2014, smoking prevalence among U.S. adults decreased from 20.9 percent to 16.8 percent. This study aims to investigate whether smoking prevalence among plastic surgery patients paralleled the national trend and whether smoking was an independent risk factor for postoperative complications. The 2005 to 2014 American College of Surgeons National Surgical Quality Improvement Program database was used to examine smoking prevalence and 30-day postoperative complications in 36,454 patients who underwent common plastic surgical procedures with extensive planes of dissection. Patients were propensity score-matched for demographics and comorbidities. Smokers were stratified by pack-years. Compared to the national trend, a significantly smaller percentage of plastic surgical patients were smokers (p = 0.01), with a less dramatic decline in prevalence. Smokers had significantly increased deep incisional surgical-site infections, incisional dehiscence, and reoperation (p smoking as a risk factor for postoperative complications in plastic surgical procedures. Smoking was an independent risk factor for deep incisional surgical-site infection, incisional dehiscence, and reoperation. Interestingly, superficial surgical-site infection rates were not significantly different. The authors recommend continued judicious patient selection and preoperative smoking counseling to optimize postoperative outcomes. Risk, II.

  12. Early Parental Adaptation, Prenatal Distress, and High-Risk Pregnancy.

    Science.gov (United States)

    Dollberg, Daphna G; Rozenfeld, Tamir; Kupfermincz, Michael

    2016-09-01

    To examine the examined the effects of high risk pregnancy and prenatal distress on parental postnatal adaptation. A sample of 111 expecting parents, consisting of 32 high risk pregnancy (HRP) mothers and 21 spouses and 36 matched low risk pregnancy (LRP) mothers and 22 spouses completed reports of depression symptoms (BDI) and pregnancy related concerns prenatally. At three months postpartum, parent-infant direct observations and reports of parenting alliance (PAI), stress (PSI-SF), satisfaction and efficacy (PSOC) were gathered. Data was analyzed with GLM multivariate analyses and the actor-partner interdependence model. Parents' prenatal BDI predicted postnatal parental stress. BDI and concerns predicted postnatal satisfaction, but only for mothers. Mother's concerns predicted low maternal and high paternal parenting alliance. Partner effect was found so that high concerns predicted high reports of parenting alliance by spouse. Mean-group differences were found between HRP and LRP during parent-infant observations, so that HRP parents displayed lower sensitivity and reciprocity. Prenatal distress, and to some degree high risk pregnancy, are risk factors that may interfere with the early formation of parent-infant relationship. Clinical implications of these findings are presented. © The Author 2016. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. Specialty Linens and Pressure Injuries in High-Risk Patients in the Intensive Care Unit.

    Science.gov (United States)

    Freeman, Regi; Smith, Andrew; Dickinson, Sharon; Tschannen, Dana; James, Shandra; Friedman, Candace

    2017-11-01

    The cardiovascular and surgical intensive care units had the highest unit-acquired pressure injury rates at an institution. Patients in these units had multiple risk factors for pressure injuries. Various interventions had been used to minimize pressure injuries, with limited results. To evaluate the effect of specialty linens on the rate of pressure injuries in high-risk patients. The specialty linen was a synthetic silklike fabric that addressed the microclimate surrounding the patient, with the purpose of minimizing friction, shear, moisture, and heat. The specialty linen was tried on 24 beds in the cardiovascular intensive care unit and 20 beds in the surgical intensive care unit, including sheets, underpads, gowns, and pillow cases. Data obtained from a retrospective review of electronic health records were compared for 9 months before and 10 months after specialty linens were implemented. Total unit-acquired pressure injury rates for both units combined declined from 7.7% (n = 166) before to 5.3% (n = 95) after the intervention. The intervention was associated with a significant reduction in posterior (coccyx, sacrum, back, buttock, heel, and spine) pressure injury rates, from 5.2% (n = 113) before to 2.8% (n = 51) after specialty linens were implemented ( P < .001). Addressing the microclimate, friction, and shear by using specialty linens reduces the number of posterior pressure injuries. The use of specialty linens in addition to standard techniques for preventing pressure injuries can help prevent pressure injuries from developing in high-risk patients in intensive care units. ©2017 American Association of Critical-Care Nurses.

  14. Minimally Invasive Surgical Approach for Odontoid Lesions: A Technical Description in a Case of High Cervical Osteomyelitis and Abscess.

    Science.gov (United States)

    Riley, Kyle; Singh, Harshpal; Meyer, Scott A; Jenkins, Arthur L

    2016-07-01

    Cervical approaches to the dens are limited by the presence of several structures, including the spinal cord, vertebral arteries, C1 articular pillars, and C2 nerves. Surgical approaches to access the high anterior cervical spine classically encompass the extended anterior retropharyngeal route, transoral route, and extreme lateral route, each of which has its own pattern of morbidity or complications. Percutaneous procedures to drain infections in this area have a limited yield. Osteomyelitis of the dens is a rare but serious condition that is associated with significant mortality. Patients with cervical osteomyelitis and epidural abscess are likely to have significant coexistent medical comorbidities and are often poor candidates for extensive surgical procedures. A minimally invasive approach that gives access to the entire odontoid process would allow for more aggressive treatments and potentially even a complete odontoidectomy without resection of the C1 anterior arch. We describe a minimally invasive approach to drainage and debridement of an atlantoaxial epidural abscess and osteomyelitis. Using minimally invasive techniques from a posterolateral trajectory in a cadaveric specimen, we were able to safely access the anterior epidural space, odontoid, and retropharynx. We then performed this approach in our patient who was unable to tolerate a large surgical procedure. We developed, tested, and then applied a minimally invasive approach that combined tubular retractors with positioning of the head and neck to optimize the exposure in a patient with a complex abscess that involved the ventral epidural space, odontoid process, and retropharyngeal space. The abscesses were successfully drained along with local tissue debridement without complication. A posterolateral minimally invasive approach is a safe alternative in patients with an atlantoaxial epidural abscess, odontoid osteomyelitis, or retropharyngeal abscess with significant medical comorbidities who are

  15. Predictive Value of Dynamic Cerebral Autoregulation Assessment in Surgical Management of Patients with High-Grade Carotid Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Vladimir B. Semenyutin

    2017-11-01

    Full Text Available Dynamic cerebral autoregulation (DCA capacity along with the degree of internal carotid artery (ICA stenosis and characteristics of the plaque can also play an important role in selection of appropriate treatment strategy. This study aims to classify the patients with severe ICA stenosis according to preoperative state of DCA and to assess its dynamics after surgery. Thirty-five patients with severe ICA stenosis having different clinical type of disease underwent reconstructive surgery. DCA was assessed with transfer function analysis (TFA by calculating phase shift (PS between Mayer waves of blood flow velocity (BFV and blood pressure (BP before and after operation. In 18 cases, regardless of clinical type, preoperative PS on ipsilateral side was within the normal range and did not change considerably after surgery. In other 17 cases preoperative PS was reliably lower both in patients with symptomatic and asymptomatic stenosis. Surgical reconstruction led to restoration of impaired DCA evidenced by significant increase of PS in postoperative period. Our data suggest that regardless clinical type of disease various state of DCA may be present in patients with severe ICA stenosis. This finding can contribute to establishing the optimal treatment strategy, and first of all for asymptomatic patients. Patients with compromised DCA should be considered as ones with higher risk of stroke and first candidates for reconstructive surgery.

  16. The risk of hydrogen explosion in a submarine p. IV The implementation of high risk projects

    Directory of Open Access Journals (Sweden)

    Kłos Ryszard

    2017-06-01

    Full Text Available This series of articles on high risk projects looks at the example of the modernisation of hydrogen incinerators on a submarine. The article describes problems connected with the management of such a project.

  17. Cumulative Experiences of Violence among High-Risk Urban Youth

    Science.gov (United States)

    Taylor, Catherine A.; Boris, Neil W.; Heller, Sherryl Scott; Clum, Gretchen A.; Rice, Janet C.; Zeanah, Charles H.

    2008-01-01

    This study examines type-specific and cumulative experiences of violence among a vulnerable population of youth. Sixty high-risk, shelter-dwelling, urban youth were interviewed regarding their history of childhood maltreatment, exposure to community violence (ECV), and experience with intimate partner violence (IPV). Results show a high prevalence…

  18. An assessment of high risk sexual behaviour and HIV transmission ...

    African Journals Online (AJOL)

    Method: A total of 300 randomly selected migrant oil workers were assessed using structured questionnaires to evaluate key highrisk sexual behavioral parameters such as multiplicity of sexual partners, bisexuality (closet homosexuality), high grade sexual behaviour and lesbianism. Sampling period was two months with ...

  19. Surgical site infections following oral cavity cancer resection and reconstruction is a risk factor for plate exposure.

    Science.gov (United States)

    Yao, Christopher M; Ziai, Hedyeh; Tsang, Gordon; Copeland, Andrea; Brown, Dale; Irish, Jonathan C; Gilbert, Ralph W; Goldstein, David P; Gullane, Patrick J; de Almeida, John R

    2017-04-08

    Plate-related complications following head and neck cancer ablation and reconstruction remains a challenging problem often requiring further management and reconstructive surgeries. We aim to identify an association between surgical site infections (SSI) and plate exposure. A retrospective study between 1997 and 2014 was performed to study the association between postoperative SSI and plate exposures. Eligible patients included those with a history of oral squamous cell carcinoma who underwent surgical resection, neck dissection, and free tissue reconstruction. Demographic and treatment related information was collected. SSI were classified based on CDC definition and previously published literature. Univariable analysis on demographic factors, smoking history, diabetes, radiation, surgical and hardware related factors; while multivariable analysis on SSI, plate height, segmental mandibulectomy defects and radiation were conducted such as using cox proportional hazard models. Three hundred sixty-five patients were identified and included in our study. The mean age of the study group was 59.2 (+/-13.8), with a predominance of male patients (61.9%). 10.7% of our patient cohort had diabetes, and another 63.8% had post-operative radiation therapy. Patients with SSI were more likely to have plate exposure (25 vs. 6.4%, p <0.001). Post-operative SSI, mandibulectomy defects, and plate profile/thickness were associated with plate exposure on univariable analysis (OR = 5.72, p < 0.001; OR = 2.56, p = 0.014; OR = 1.44, p = 0.003 respectively) and multivariable analysis (OR = 5.13, p < 0.001; OR = 1.36, p = 0.017; OR = 2.58, p = 0.02 respectively). Surgical site infections are associated with higher rates of plate exposure. Plate exposure may require multiple procedures to manage and occasionally free flap reconstruction.

  20. Superficial myxofibrosarcoma: assessment of recurrence risk according to the surgical margin following resection. A series of 21 patients.

    Science.gov (United States)

    Riouallon, G; Larousserie, F; Pluot, E; Anract, P

    2013-06-01

    Superficial myxofibrosarcomas are malignant connective tissue tumors, whose very frequent recurrence influences the local and vital prognosis. Even when resection seems to be macroscopically complete it is very often microscopically contaminated. The aim of this study was to evaluate recurrence in relation to the surgical margins and to compare, when possible, tumor size, evaluated clinically and macroscopically by the pathologist. This was a single center study of 21 patients, mean age 67 years old, treated for superficial myxofibrosarcoma. The number, date and location of recurrence were collected for each patient. A clinical and pathological measurement was made of the longest axis of the tumor in each case of recurrence. Fifty-seven percent of patients presented with recurrent tumors. The mean number of recurrences was 1.4 per patient (1-8). The surgical margins were wide in four cases, marginal in two cases and incomplete/intralesional in 15 other patients with a rate of recurrence of 25, 50 and 67% respectively. The size evaluated during the preoperative clinical examination (14 cases) was underestimated by a mean 2.4 cm compared to the macroscopic pathology assessment. The preoperative size on MRI (5 cases) was also underestimated by a mean 1.3 cm. Superficial myxofibrosarcomas are tumors that are difficult to resect completely because they are infiltrative, a feature that is often underestimated before surgery. Surgical treatment of this entity requires a much larger surgical margin than that suggested by the preoperative clinical and MRI evaluations. In case of incomplete resection, revision scar surgery should systematically be performed. Level IV. Retrospective study. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  1. High-Fat Diet in the Absence of Obesity Does Not Aggravate Surgically Induced Lymphoedema in Mice.

    Science.gov (United States)

    Gousopoulos, Epameinondas; Karaman, Sinem; Proulx, Steven T; Leu, Kristin; Buschle, Dorina; Detmar, Michael

    2017-01-01

    Lymphoedema represents the cardinal manifestation of lymphatic dysfunction and is associated with expansion of the adipose tissue in the affected limb. In mice, high-fat diet (HFD)-induced obesity was associated with impaired collecting lymphatic vessel function, and adiposity aggravated surgery-induced lymphoedema in a mouse model. The aim of the current study was to investigate whether adiposity is necessary to impair lymphatic function or whether increased lipid exposure alone might be sufficient in a surgical lymphoedema model. To investigate the role of increased lipid exposure in lymphoedema development we used a well-established mouse tail lymphoedema model. Female mice were subjected to a short-term (6 weeks) HFD, without development of obesity, before surgical induction of lymphedema. Lymphoedema was followed over a period of 6 weeks measuring oedema, evaluating tissue histology and lymphatic vascular function. HFD increased baseline angiogenesis and average lymphatic vessel size in comparison to the chow control group. Upon induction of lymphedema, HFD-treated mice did not exhibit aggravated oedema and no morphological differences were observed in the blood and lymphatic vasculature. Importantly, the levels of fibro-adipose tissue deposition were comparable between the 2 groups and lymphatic vessel function was not impaired as a result of the HFD. Although the net immune cell infiltration was comparable, the HFD group displayed