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Sample records for patients underwent transradial

  1. Safety and Feasibility of Transradial Access for Visceral Interventions in Patients with Thrombocytopenia.

    Science.gov (United States)

    Titano, J J; Biederman, D M; Marinelli, B S; Patel, R S; Kim, E; Tabori, N E; Nowakowski, F S; Lookstein, R A; Fischman, A M

    2016-05-01

    Transradial access (TRA) has shown lower morbidity and decreased bleeding complications compared to transfemoral access. This study evaluates the safety and feasibility of TRA in thrombocytopenic patients undergoing visceral interventions. Patients who underwent visceral interventions via the radial artery with platelet count less than or equal to 50,000/µL were included in the study. Outcome variables included technical success, access site, bleeding, transfusion, and neurological complications. From July 1, 2012, to May 31, 2015, a total of 1353 peripheral interventions via TRA were performed, of which 85 procedures were performed in 64 patients (mean age 62.2 years) with a platelet count <50,000/µL (median 39,000/µL). Interventions included chemoembolization (n = 46), selective internal radiation therapy (n = 30), and visceral embolization (n = 9). Technical success was 97.6% with two cases of severe vessel spasm requiring ipsilateral femoral crossover. There was no major access site, bleeding, or neurological adverse events at 30 days. Minor access site hematomas occurred in five cases (5.9%) and were treated conservatively in all cases. Pre-procedural platelet transfusions were administered in 23 (27.1%) cases. There was no statistically significant difference in access site or bleeding complications between the transfused and nontransfused groups. Transradial visceral interventions in patients with thrombocytopenia are both feasible and safe, possibly without the need for platelet transfusions.

  2. Safety and Feasibility of Transradial Access for Visceral Interventions in Patients with Thrombocytopenia

    International Nuclear Information System (INIS)

    Titano, J. J.; Biederman, D. M.; Marinelli, B. S.; Patel, R. S.; Kim, E.; Tabori, N. E.; Nowakowski, F. S.; Lookstein, R. A.; Fischman, A. M.

    2016-01-01

    PurposeTransradial access (TRA) has shown lower morbidity and decreased bleeding complications compared to transfemoral access. This study evaluates the safety and feasibility of TRA in thrombocytopenic patients undergoing visceral interventions.Methods and MaterialsPatients who underwent visceral interventions via the radial artery with platelet count less than or equal to 50,000/µL were included in the study. Outcome variables included technical success, access site, bleeding, transfusion, and neurological complications.ResultsFrom July 1, 2012, to May 31, 2015, a total of 1353 peripheral interventions via TRA were performed, of which 85 procedures were performed in 64 patients (mean age 62.2 years) with a platelet count <50,000/µL (median 39,000/µL). Interventions included chemoembolization (n = 46), selective internal radiation therapy (n = 30), and visceral embolization (n = 9). Technical success was 97.6 % with two cases of severe vessel spasm requiring ipsilateral femoral crossover. There was no major access site, bleeding, or neurological adverse events at 30 days. Minor access site hematomas occurred in five cases (5.9 %) and were treated conservatively in all cases. Pre-procedural platelet transfusions were administered in 23 (27.1 %) cases. There was no statistically significant difference in access site or bleeding complications between the transfused and nontransfused groups.ConclusionsTransradial visceral interventions in patients with thrombocytopenia are both feasible and safe, possibly without the need for platelet transfusions.

  3. Safety and Feasibility of Transradial Access for Visceral Interventions in Patients with Thrombocytopenia

    Energy Technology Data Exchange (ETDEWEB)

    Titano, J. J., E-mail: joseph.titano@mountsinai.org; Biederman, D. M., E-mail: derek.biederman@mountsinai.org; Marinelli, B. S., E-mail: brett.marinelli@exchange.mssm.edu; Patel, R. S., E-mail: rahul.patel@mountsinai.org; Kim, E., E-mail: edward.kim@mountsinai.org; Tabori, N. E., E-mail: nora.tabori@mountsinai.org; Nowakowski, F. S., E-mail: scott.nowakowski@mountsinai.org; Lookstein, R. A., E-mail: robert.lookstein@mountsinai.org; Fischman, A. M., E-mail: aaron.fischman@mountsinai.org [Icahn School of Medicine at Mount Sinai, Department of Interventional Radiology (United States)

    2016-05-15

    PurposeTransradial access (TRA) has shown lower morbidity and decreased bleeding complications compared to transfemoral access. This study evaluates the safety and feasibility of TRA in thrombocytopenic patients undergoing visceral interventions.Methods and MaterialsPatients who underwent visceral interventions via the radial artery with platelet count less than or equal to 50,000/µL were included in the study. Outcome variables included technical success, access site, bleeding, transfusion, and neurological complications.ResultsFrom July 1, 2012, to May 31, 2015, a total of 1353 peripheral interventions via TRA were performed, of which 85 procedures were performed in 64 patients (mean age 62.2 years) with a platelet count <50,000/µL (median 39,000/µL). Interventions included chemoembolization (n = 46), selective internal radiation therapy (n = 30), and visceral embolization (n = 9). Technical success was 97.6 % with two cases of severe vessel spasm requiring ipsilateral femoral crossover. There was no major access site, bleeding, or neurological adverse events at 30 days. Minor access site hematomas occurred in five cases (5.9 %) and were treated conservatively in all cases. Pre-procedural platelet transfusions were administered in 23 (27.1 %) cases. There was no statistically significant difference in access site or bleeding complications between the transfused and nontransfused groups.ConclusionsTransradial visceral interventions in patients with thrombocytopenia are both feasible and safe, possibly without the need for platelet transfusions.

  4. Patient radiation exposure in right versus left trans-radial approach for coronary procedures

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    Rigattieri, Stefano; Di Russo, Cristian; Cera, Maria; Fedele, Silvio; Sciahbasi, Alessandro [Interventional Cardiology Unit, Sandro Pertini Hospital, Rome (Italy); Pugliese, Francesco Rocco [Emergency Department Sandro Pertini Hospital, Rome (Italy)

    2015-01-15

    Objectives: The aim of this study was to compare radiation exposure, assessed by dose-area product (DAP), in right trans-radial approach (RR) versus left trans-radial approach (LR) for coronary procedures. Background: In LR the catheter course is more similar to trans-femoral approach, thus allowing an easier negotiation of coronary ostia which, in turn, might translate into reduced fluoroscopy time (FT) and radiation exposure as compared to RR. Methods: We retrospectively selected diagnostic and interventional procedures (PCI) performed by RR or LR at our center from May 2009 to May 2014. We only included in the analysis the procedures in which DAP values were available. Results: We analyzed 1464 procedures, 1175 of which performed by RR (80.3%) and 289 by LR (19.7%). Median DAP values were significantly higher in RR as compared to LR for diagnostic and interventional procedures (4482 vs. 3540 cGy.cm{sup 2} and 11523 vs. 10086 cGy.cm{sup 2}, respectively; p < 0.05). No significant differences were observed in FT and in contrast volume (CV). In the propensity-matched cohort, consisting of 269 procedures for each group, no significant differences between LR and RR were observed in median DAP values for both diagnostic and interventional procedures (3990 vs. 3542 cGy.cm{sup 2} and 9964 vs. 10216 cGy.cm{sup 2}, respectively; p = ns); FT and CV were also similar. At multiple linear regression analysis laterality of trans-radial approach was not associated with DAP. Conclusions: In an experienced trans-radial center LR is not associated with a reduction in radiation exposure, FT or CV as compared to RR. - Highlights: • Right trans-radial approach is by far more commonly used than left trans-radial approach. • Left trans-radial approach has the advantage of an easier catheter manipulation, more similar to trans-femoral approach. • This could reduce fluoroscopy time and radiation exposure. • We conducted a retrospective study to investigate patient radiation

  5. Prevalence of chronic kidney disease among patients undergoing transradial percutaneous coronary interventions.

    Science.gov (United States)

    Hossain, Mohammad A; Quinlan, Amy; Heck-Kanellidis, Jennifer; Calderon, Dawn; Patel, Tejas; Gandhi, Bhavika; Patel, Shrinil; Hetavi, Mahida; Costanzo, Eric J; Cosentino, James; Patel, Chirag; Dewan, Asa; Kuo, Yen-Hong; Salman, Loay; Vachharajani, Tushar J

    2018-03-01

    While transradial approach to conduct percutaneous coronary interventions offers multiple advantages, the procedure can cause radial artery damage and occlusion. Because radial artery is the preferred site for the creation of an arteriovenous fistula to provide dialysis, patients with chronic kidney disease are particularly dependent on radial artery for their long-term survival. In this retrospective study, we investigated the prevalence of chronic kidney disease in patients undergoing coronary interventions via radial artery. Stage of chronic kidney disease was based on estimated glomerular filtration rate and National Kidney Foundation - Kidney Disease Outcomes Quality Initiative guidelines. A total of 497 patients undergoing transradial percutaneous coronary interventions were included. Over 70.4% (350/497) of the patients had chronic kidney disease. Stage II chronic kidney disease was observed in 243 (69%) patients (estimated glomerular filtration rate = 76.0 ± 8.4 mL/min). Stage III was observed in 93 (27%) patients (estimated glomerular filtration rate = 49 ± 7.5 mL/min). Stage IV chronic kidney disease was observed in 5 (1%) patients (estimated glomerular filtration rate = 25.6 ± 4.3 mL/min) and Stage V chronic kidney disease was observed in 9 (3%) patients (estimated glomerular filtration rate = 9.3 ± 3.5 mL/min). Overall, 107 of 350 patients (30%) had advanced chronic kidney disease, that is, stage III-V chronic kidney disease. Importantly, 14 of the 107 (13%) patients had either stage IV or V chronic kidney disease. This study finds that nearly one-third of the patients undergoing transradial percutaneous coronary interventions have advanced chronic kidney disease. Because many of these patients may require dialysis, the use of radial artery to conduct percutaneous coronary interventions must be carefully considered in chronic kidney disease population.

  6. Access site-related complications after transradial catheterization can be reduced with smaller sheath size and statins.

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    Honda, Tsuyoshi; Fujimoto, Kazuteru; Miyao, Yuji; Koga, Hidenobu; Hirata, Yoshihiro

    2012-09-01

    The aim of this study was to investigate the risk factors for access site-related complications after transradial coronary angiography (CAG) or percutaneous coronary intervention (PCI). Transradial PCI has been shown to reduce access site-related bleeding complications compared with procedures performed through a femoral approach. Although previous studies focused on risk factors for access site-related complications after a transfemoral approach or transfemoral and transradial approaches, it is uncertain which factors affect vascular complications after transradial catheterization. We enrolled 500 consecutive patients who underwent transradial CAG or PCI. We determined the incidence and risk factors for access site-related complications such as radial artery occlusion and bleeding complications. Age, sheath size, the dose of heparin and the frequency of PCI (vs. CAG) were significantly greater in patients with than without bleeding complications. However, body mass index (BMI) was significantly lower in patients with than without bleeding complications. Sheath size was significantly higher and the frequency of statin use was significantly lower in patients with than without radial artery occlusion. Multiple logistic analysis revealed that sheath size [odds ratio (OR) 5.5; P strategy that could prevent radial artery occlusion after transradial procedures.

  7. Patient Versus Physician Variation in Use of Transradial Percutaneous Coronary Intervention.

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    Shamim, Shariq; Tang, Fengming; Safley, David; Jones, Philip; Spertus, John A; Baklanov, Dmitri

    2017-06-15

    The prevalence of radial access for transradial catheterization remains low in the United States, occurring in only 28% of cases in the National Cardiovascular Data Registry (NCDR) CathPCI. It is unknown whether the low adoption rate has been influenced by patient characteristics or is more operator dependent. In a 10-center study, we compared clinical and demographic characteristics among 323 radial and 1,506 femoral access percutaneous coronary intervention (PCIs) performed by 65 interventionists capable of radial PCI. We created a hierarchical logistic regression model to identify operator and patient characteristics associated with radial PCI and the median rate ratio to quantify the variation across operators. A subset was interviewed to assess health literacy and preferences in shared medical decision making. Radial access was used in 17.7% of patients. Patient factors associated with lower rate of radial PCI were previous PCI (33.4% vs 41.4%, p = 0.008), history of coronary artery bypass graft (8.4% vs 23.0%, p <0.001), and chronic total occlusion PCI (10.2% vs 17.9%, p <0.001). Operator characteristics associated with lower rate of radial PCI are being older, being longer in practice, lower number of publications, and Southern practice location. The range of radial use across operators was 1% to 99% and the median rate ratio was 1.97. Patients with radial access had lower health literacy, as assessed by the Rapid Estimate of Adult Literacy in Medicine Revised (REALM) score (6.6 ± 2.6 vs 7.1 ± 2.0, p = 0.03) but did not differ in their preferences for shared decision making. In conclusion, our study demonstrates a high degree of variability of radial access for PCI among different operators, with few differences in patient characteristics, suggesting that improvement efforts should focus on operators. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

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    S. S. Davydova

    2013-01-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  9. ALGORITHM FOR MANAGEMENT OF HYPERTENSIVE PATIENTS UNDERWENT UROLOGY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    S. S. Davydova

    2015-09-01

    Full Text Available Aim. To study the efficacy of cardiovascular non-invasive complex assessment and pre-operative preparation in hypertensive patients needed in surgical treatment of urology dis- eases.Material and methods. Males (n=883, aged 40 to 80 years were included into the study. The main group consisted of patients that underwent laparotomic nephrectomy (LTN group; n=96 and patients who underwent laparoscopic nephrectomy (LSN group; n=53. Dynamics of ambulatory blood pressure monitoring (ABPM data was analyzed in these groups in the immediate postoperative period. The efficacy of a package of non-invasive methods for cardiovascular system assessment was studied. ABPM was performed after nephrectomy (2-nd and 10-th days after surgery in patients with complaints of vertigo episodes or intense general weakness to correct treatment.Results. In LTN group hypotension episodes or blood pressure (BP elevations were observed in 20 (20.8% and 22 (22.9% patients, respectively, on the 2-nd day after the operation. These complications required antihypertensive treatment correction. Patients with hypotension episodes were significantly older than patients with BP elevation and had significantly lower levels of 24-hour systolic BP, night diastolic BP and minimal night systolic BP. Re-adjustment of antihypertensive treatment on the 10-th postoperative day was required to 2 (10% patients with hypotension episodes and to 1 (4.5% patient with BP elevation. Correction of antihypertensive therapy was required to all patients in LSN group on the day 2, and to 32 (60.4% patients on the 10-th day after the operation. Reduction in the incidence of complications (from 1.2% in 2009 to 0.3% in 2011, p<0.001 was observed during the application of cardiovascular non-invasive complex assessment and preoperative preparation in hypertensive patients.Conclusion. The elaborated management algorithm for patients with concomitant hypertension is recommended to reduce the cardiovascular

  10. Intraoperative seizures and seizures outcome in patients underwent awake craniotomy.

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    Yuan, Yang; Peizhi, Zhou; Xiang, Wang; Yanhui, Liu; Ruofei, Liang; Shu, Jiang; Qing, Mao

    2016-11-25

    Awake craniotomies (AC) could reduce neurological deficits compared with patients under general anesthesia, however, intraoperative seizure is a major reason causing awake surgery failure. The purpose of the study was to give a comprehensive overview the published articles focused on seizure incidence in awake craniotomy. Bibliographic searches of the EMBASE, MEDLINE,were performed to identify articles and conference abstracts that investigated the intraoperative seizure frequency of patients underwent AC. Twenty-five studies were included in this meta-analysis. Among the 25 included studies, one was randomized controlled trials and 5 of them were comparable studies. The pooled data suggested the general intraoperative seizure(IOS) rate for patients with AC was 8%(fixed effect model), sub-group analysis identified IOS rate for glioma patients was 8% and low grade patients was 10%. The pooled data showed early seizure rates of AC patients was 11% and late seizure rates was 35%. This systematic review and meta-analysis shows that awake craniotomy is a safe technique with relatively low intraoperative seizure occurrence. However, few RCTs were available, and the acquisition of further evidence through high-quality RCTs is highly recommended.

  11. Safety and Outcomes of Transradial Access in Patients with International Normalized Ratio 1.5 or above.

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    Titano, Joseph J; Biederman, Derek M; Zech, John; Korff, Ricki; Ranade, Mona; Patel, Rahul; Kim, Edward; Nowakowski, Francis; Lookstein, Robert; Fischman, Aaron M

    2018-03-01

    To examine the safety and outcomes for patients undergoing transradial noncoronary interventions with international normalized ratio (INR) ≥1.5. A retrospective review of 2,271 transradial access (TRA) cases performed from July 2012 to July 2016 was conducted. Criteria for inclusion were moderate bleeding risk cases with preprocedure INR ≥1.5. Within the study period, there were 176 moderate bleeding risk procedures (transarterial chemoembolization: 70/176 [39.8%]; Barbeau B: 121/176 [68.8%]; 5-F sheath: 157/176 [89.2%]) performed on 122 patients (age 61.6 ± 12.1 years, 68.9% male, body mass index 28.0 kg/m 2 ) with INR ≥1.5. Technical success was achieved in 98.9% of cases. Grade 1/2 hematomas developed in 10 cases (5.7%). Age ≥65 years (P = .042) and female sex (P = .046) were predictive of access site bleeding complications. Fresh frozen plasma (FFP) transfusion was administered in 11.4% of cases (n = 20). Baseline INR and creatinine were significantly different between transfused and nontransfused cases (P values .006 and .028, respectively). Minor access site bleeding occurred in 3/20 cases (15%) receiving prior FFP transfusion and 7/156 nontransfused cases (4.5%), with no significant difference between these 2 groups (P = .072). TRA in patients with elevated INR appears to be safe in our experience. Age ≥65 years and female sex were associated with increased incidence of access site bleeding. Although INR correction was not standardized in this cohort, preprocedure FFP transfusion did not decrease bleeding complications. Copyright © 2017 SIR. Published by Elsevier Inc. All rights reserved.

  12. Transradial access for coronary angiography: a single operator's experience of 500 cases

    International Nuclear Information System (INIS)

    Ali, J.; Aziz, S.; Javed, A.; Kayani, A.M.

    2011-01-01

    Objective: The purpose of the present study was to assess the feasibility, success, and safety of the transradial approach (TRA) for diagnostic coronary angiography. Study Design: Descriptive study. Place and Duration of Study: The study was carried out in Armed Forces Institute of Cardiology- National Institute of Heart Diseases (AFIC-NIHD) over a period of ten months from June 2009 to March 2010. Patients and Methods: We collected data of 500 consecutive patients who underwent coronary catheterization by the transradial approach. Transradial access was performed only if the Allen's test was normal (positive). Patients with previous CABG or requiring right heart catheterization were excluded from this study. Study endpoints included procedure success rate, vascular complications at access site, and major adverse cardiac and cerebrovascular events during hospitalization. Results: Mean age of the patients was 52 years (range 33-77 yrs) and 72.8% (n= 364) were men and 27.2% (n=136) were females. The vast majority of cases (98.4%) were elective. The right radial artery was used in 98% of cases. Procedural success was achieved in 90.6% cases (453/500). No case of vascular complications such as major access site bleeding, vascular perforation, radial artery occlusion, forearm ischemia, compartment syndrome or MACE was observed. Conclusion: Transradial access for coronary angiography is a safe, effective and elegant alternative to trans femoral access. (author)

  13. The effect of vasodilatory medications on radial artery spasm in patients undergoing transradial coronary artery procedures: a systematic review.

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    Curtis, Elizabeth; Fernandez, Ritin; Lee, Astin

    2017-07-01

    The uptake of percutaneous coronary procedures via the radial artery has increased internationally due to the decreased risk of complications and increased patient satisfaction. The increased susceptibility of the radial artery to spasm however presents a potential risk for procedural failure. Although most experts agree on the need for prophylactic medications to reduce radial artery spasm, currently there is inconsistency in literature regarding the most effective vasodilatory medication or combination of medications. The objective of this study is to identify the effectiveness of vasodilatory medications on radial artery spasm in patients undergoing transradial coronary artery procedures. This review considered studies that included participants aged 18 years and over undergoing non-emergent transradial percutaneous coronary artery procedures. This review considered studies that used vasodilating intravenous and intra-arterial medications or combinations of medications prior to commencing and during transradial coronary approaches to reduce radial artery spasm. The outcomes of interest were the incidence of radial artery spasm during percutaneous coronary procedure using objective and/or subjective measures and its effect on the successful completion of the procedure. Randomized controlled trials published in the English language between 1989 to date were considered for inclusion. The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in this review. An initial search of MEDLINE, CINAHL and Scopus was undertaken, followed by a search for unpublished studies. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments. Any disagreements that arose between the reviewers were resolved through discussion. Quantitative data was extracted from papers included in the review using the

  14. Posterior Reversible Encephalopathy Syndrome in Patients who Underwent Cardiovascular Surgery

    International Nuclear Information System (INIS)

    Granados, Ana Maria; Bueno Melo, Juliana; Acosta Puentes, Diana

    2012-01-01

    The etiology of posterior reversible encephalopathy syndrome (pres) is not well understood. This entity has been reported in relation to multiple clinical conditions. It has been proposed that the vertebrobasilar circulation is more sensitive to injuries sustained by the central nervous system. Consequently, the main radiologic manifestations of this condition occur in the pareto-occipital regions. As its name implies, pres has a reversible nature. Once the noxious factors are withdrawn, both the vasogenic edema in affected areas, as well as neurological symptoms tends to resolve, whereas if the situation persists the lesions may progress to parenchymal ischemia. Cerebral computed tomography (CT) in pres may show hypodense areas in the affected white matter. Magnetic resonance (MR) imaging is used to better characterize the abnormal regions. This modality is capable of displaying an increased signal intensity in these areas on T2-weighted FLAIR sequences that is less apparent on diffusion-weighted images. In order to confirm this diagnosis, a follow up imaging study either with CT or MR can be performed approximately four weeks after the onset of symptoms. Nevertheless, an exact consensus with respect to the follow-up period has not been reached. The supporting findings for this diagnosis include resolution of the affected white matter and clinical remission without neurological sequelae. We hereby report three proven cases of pres in patients of different age groups that had undergone major cardiovascular surgery with extracorporeal circulation, a common factor that was thought to have been the precursor to this condition in these individuals.

  15. Serum Zn levels in dysphagic patients who underwent endoscopic gastrostomy for long term enteral nutrition

    OpenAIRE

    Adriana Santos, Carla; Fonseca, Jorge; Brito, José; Fernandes, Tânia; Gonçalves, Luísa; Sousa Guerreiro, António

    2014-01-01

    Background and aims: Dysphagic patients who underwent endoscopic gastrostomy (PEG) usually present protein-energy malnutrition, but little is known about micronutrient malnutrition. The aim of the present study was the evaluation of serum zinc in patients who underwent endoscopic gastrostomy and its relationship with serum proteins, whole blood zinc, and the nature of underlying disorder. Methods: From patients that underwent gastrostomy a blood sample was obtained minutes before the procedur...

  16. Erosion of Embolization Coils into the Renal Collecting System: Removal with Prone Transradial Renal Arteriography and Nephroscopy.

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    Srinivasa, Ravi N; Chick, Jeffrey Forris Beecham; Hage, Anthony; Ramamurthi, Aishu; Wolf, J Stuart; Gemmete, Joseph J; Dauw, Casey A

    2017-10-01

    Removal of embolization coils eroded into the renal collecting system poses a risk of hemorrhage, which may need to be addressed with arteriography and embolization at the time of treatment. The purpose of this report is to describe a novel approach, by which prone percutaneous nephroscopic coil retrieval is coupled with simultaneous prone transradial renal arterial access to mitigate this potential complication. A retrospective chart review of the electronic medical record systems was performed from January 2008 to May 2017 to identify patients who had undergone percutaneous removal of embolization coils eroded into the renal collecting system. Patients who had migration of embolization coils into the renal collecting system who were symptomatic with pain, hydronephrosis, or infection were considered for inclusion. Patients who had coil migration, but were asymptomatic were not offered removal. Patient demographics and case characteristics were examined as were operative outcomes. A total of three patients fulfilled the study criteria. Migrated embolization coils were able to be effectively removed in all patients. Of the patients, two underwent simultaneous prone transradial renal arteriography with placement of an occlusion balloon catheter into the segmental artery of interest. In one patient, significant arterial bleeding was encountered after coil removal, which was effectively addressed with simultaneous arteriography and glue embolization. Erosion of embolization coils into the renal collecting system, while rare, may be a significant long-term complication of coil embolization. Combining nephroscopy with prone transradial arteriography in preparation for procedure-associated hemorrhage may make removal of migrated coils safer.

  17. [A Distal Bile Duct Carcinoma Patient Who Underwent Surgical Resection for Liver Metastasis].

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    Komiyama, Sosuke; Izumiya, Yasuhito; Kimura, Yu; Nakashima, Shingo; Kin, Syuichi; Kawakami, Sadao

    2018-03-01

    A 70-year-old man with distal bile duct carcinoma underwent a subtotal stomach-preserving pancreaticoduodenectomy without adjuvant chemotherapy. One and a half years after the surgery, elevated levels of serum SPan-1(38.1 U/mL)were observed and CT scans demonstrated a solitary metastasis, 25mm in size, in segment 8 of the liver. The patient received 2 courses of gemcitabine-cisplatin combination chemotherapy. No new lesions were detected after chemotherapy and the patient underwent a partial liver resection of segment 8. The pathological examination revealed a metachronous distant metastasis originating from the bile duct carcinoma. Subsequently, the patient received S-1 adjuvant chemotherapy for 6 months. Following completion of all therapies, the patient survived without tumor recurrence for 3 years and 10 months after the initial operation. Thus, surgical interventions might be effective in improving prognosis among selected patients with postoperative liver metastasis of bile duct carcinoma.

  18. Comparison of Voice Quality Between Patients Who Underwent Inferior Turbinoplasty or Radiofrequency Cauterization.

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    Göker, Ayşe Enise; Aydoğdu, İmran; Saltürk, Ziya; Berkiten, Güler; Atar, Yavuz; Kumral, Tolgar Lütfi; Uyar, Yavuz

    2017-01-01

    The aim of this study was to analyze and compare the vocal quality in patients who underwent either submucosal turbinectomy or radiofrequency cauterization. In this study, we enrolled 60 patients diagnosed with inferior concha hypertrophy. These patients were divided into two groups by using computer program "Research Randomizer." Of the 60 patients, 30 underwent submucosal inferior turbinoplasty and 30 underwent radiofrequency cauterization. The control group was composed of 30 healthy adults with no nasal or upper aerodigestive system pathology. The patients were checked at weeks 1, 2, and 4. Voice records were taken before the procedure and at week 4 postprocedure. The mean age of patients in the inferior turbinoplasty group was 29.4 years (range: 19-42 years); in the radiofrequency group, it was 30.30 years (range: 18-50 years). There was no statistical difference in age between groups. In the inferior turbinoplasty group, there were 16 male and 14 female patients, and in the radiofrequency group, there were 13 male and 17 female patients. There was no significant difference in the number of males and females between groups. Voice professionals, especially singers, actors, and actresses, should be informed about possible voice changes before undergoing endonasal surgery because these individuals are more sensitive to changes in resonance organs. We believe that voice quality should be regarded as a highly important parameter when measuring the success of endonasal surgery. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  19. Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

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    Esdras Marques Lins

    2013-12-01

    Full Text Available BACKGROUND: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. OBJECTIVE: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. MATERIAL AND METHODS: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours. RESULTS: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6% of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. CONCLUSION: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

  20. Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

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    Alain Moré Duarte

    2016-01-01

    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks.Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass.Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014.Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively.Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  1. Effect of using pump on postoperative pleural effusion in the patients that underwent CABG

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    Mehmet Özülkü

    2015-08-01

    Full Text Available Abstract Objective: The present study investigated effect of using pump on postoperative pleural effusion in patients who underwent coronary artery bypass grafting. Methods: A total of 256 patients who underwent isolated coronary artery bypass grafting surgery in the Cardiovascular Surgery clinic were enrolled in the study. Jostra-Cobe (Model 043213 105, VLC 865, Sweden heart-lung machine was used in on-pump coronary artery bypass grafting. Off-pump coronary artery bypass grafting was performed using Octopus and Starfish. Proximal anastomoses to the aorta in both on-pump and off-pump techniques were performed by side clamps. The patients were discharged from the hospital between postoperative day 6 and day 11. Results: The incidence of postoperative right pleural effusion and bilateral pleural effusion was found to be higher as a count in Group 1 (on-pump as compared to Group 2 (off-pump. But the difference was not statistically significant [P>0.05 for right pleural effusion (P=0.893, P>0.05 for bilateral pleural effusion (P=0.780]. Left pleural effusion was encountered to be lower in Group 2 (off-pump. The difference was found to be statistically significant (P<0.05, P=0.006. Conclusion: Under the light of these results, it can be said that left pleural effusion is less prevalent in the patients that underwent off-pump coronary artery bypass grafting when compared to the patients that underwent on-pump coronary artery bypass grafting.

  2. Incidence of Bradycardia and Outcomes of Patients Who Underwent Orbital Atherectomy Without a Temporary Pacemaker.

    Science.gov (United States)

    Lee, Michael S; Nguyen, Heajung; Shlofmitz, Richard

    2017-02-01

    We analyzed the incidence of bradycardia and the safety of patients with severely calcified coronary lesions who underwent orbital atherectomy without the insertion of a temporary pacemaker. The presence of severely calcified coronary lesions can increase the complexity of percutaneous coronary intervention due to the difficulty in advancing and optimally expanding the stent. High-pressure inflations to predilate calcified lesions may cause angiographic complications like perforation and dissection. Suboptimal stent expansion is associated with stent thrombosis and restenosis. Orbital atherectomy safely and effectively modifies calcified plaque to facilitate optimal stent expansion. The incidence of bradycardia in orbital atherectomy is unknown. Fifty consecutive patients underwent orbital atherectomy from February 2014 to September 2016 at our institution, none of whom underwent insertion of a temporary pacemaker. The final analysis included 47 patients in this retrospective study as 3 patients were excluded because of permanent pacemaker implantation. The primary endpoint was significant bradycardia, defined as bradycardia requiring emergent pacemaker placement or a heart rate pacemaker appears to be safe.

  3. Dysphagia among Adult Patients who Underwent Surgery for Esophageal Atresia at Birth

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    Valérie Huynh-Trudeau

    2015-01-01

    Full Text Available BACKGROUND: Clinical experiences of adults who underwent surgery for esophageal atresia at birth is limited. There is some evidence that suggests considerable long-term morbidity, partly because of dysphagia, which has been reported in up to 85% of adult patients who undergo surgery for esophageal atresia. The authors hypothesized that dysphagia in this population is caused by dysmotility and/or anatomical anomalies.

  4. Incidence of vascular complications in patients submitted to percutaneous transluminal coronary angioplasty by transradial and transfemoral arterial approach Incidencia de complicaciones vasculares en pacientes sometidos a angioplastía coronaria transluminal percutánea por vía arterial transradial y transfemoral Incidência de complicações vasculares em pacientes submetidos a angioplastia coronariana transluminal percutânea por via arterial transradial e transfemoral

    Directory of Open Access Journals (Sweden)

    Marinez Kellermann Armendaris

    2008-03-01

    Full Text Available OBJECTIVE: To describe the vascular complications of transradial and transfemoral artery punctures in patients submitted to percutaneous transluminal coronary angioplasty (PTCA. METHODS: Prospective cohort study including patients submitted to PTCA. An interview was performed and an instrument applied to collect risk factors/predictors of complications. After the procedure, a physical examination was performed, vital signs were measured and the puncture site was assessed. RESULTS: 199 patients were included, age 64±10 years. Complications found for the radial and femoral approach were respectively: ecchymosis (18.29%, (17.14%; bruising (17.66%, (14.27%; urinary retention (2.43%, (25.71%; loss of vessel permeability (8.53%, (0%. CONCLUSION: The complications found were considered minor or secondary, depending on the classification found in literature. A higher rate of vascular complications related to transradial artery punctures compared to the interventions performed by transfemoral approach.OBJETIVO: Describir complicaciones vasculares relacionadas a punciones arteriales transradial y transfemoral en pacientes sometidos a angioplastía coronaria transluminal percutánea (ACTP. MÉTODOS: Se trata de un estudio de cohorte prospectivo realizado con pacientes sometidos a ACTP. Se llevó a cabo una entrevista y aplicó un instrumento para obtener factores de riesgo/predictores. Fue realizado un examen físico, medición de signos vitales y se evaluó el lugar de punción. RESULTADOS: Fueron incluidos 199 pacientes, edad 64±10 años. Las complicaciones encontradas para vía radial y femoral respectivamente, fueron: esquimosis (18,29%, (17,14%; hematoma (17,66%, (14,27%; retención urinaria (2,43%, (25,71%; pérdida de permeabilidad de vaso (8,53%, (0%. CONCLUSIÓN: Las complicaciones fueron consideradas menores o secundarias conforme clasificación literaria. Existe una mayor incidencia de complicaciones vasculares relacionadas a punciones

  5. Sarcopenia: a new predictor of postoperative complications for elderly gastric cancer patients who underwent radical gastrectomy.

    Science.gov (United States)

    Zhou, Chong-Jun; Zhang, Feng-Min; Zhang, Fei-Yu; Yu, Zhen; Chen, Xiao-Lei; Shen, Xian; Zhuang, Cheng-Le; Chen, Xiao-Xi

    2017-05-01

    A geriatric assessment is needed to identify high-risk elderly patients with gastric cancer. However, the current geriatric assessment has been considered to be either time-consuming or subjective. The present study aimed to investigate the predictive effect of sarcopenia on the postoperative complications for elderly patients who underwent radical gastrectomy. We conducted a prospective study of patients who underwent radical gastrectomy from August 2014 to December 2015. Computed tomography-assessed lumbar skeletal muscle, handgrip strength, and gait speed were measured to define sarcopenia. Sarcopenia was present in 69 of 240 patients (28.8%) and was associated with lower body mass index, lower serum albumin, lower hemoglobin, and higher nutritional risk screening 2002 scores. Postoperative complications significantly increased in the sarcopenic patients (49.3% versus 24.6%, P sarcopenia (odds ratio: 2.959, 95% CI: 1.629-5.373, P Sarcopenia, presented as a new geriatric assessment factor, was a strong and independent risk factor for postoperative complications of elderly patients with gastric cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Factors related to postoperative pain among patients who underwent radiofrequency ablation of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Hsieh, Y.-C.; Yap, Y.-S.; Hung, C.-H.; Chen, C.-H.; Lu, S.-N.; Wang, J.-H.

    2013-01-01

    Aim: To evaluate the incidence and associated factors of postoperative intense pain and haemodynamic changes during radiofrequency ablation of hepatocellular carcinoma. Materials and methods: A total of 123 consecutive hepatocellular carcinoma patients who underwent radiofrequency ablation were prospectively recruited. Patient factors, tumour characteristics, procedural factors, intraoperative haemodynamic changes, complications, postoperative events, laboratory values before and after ablation, and postoperative pain were evaluated. Postoperative pain was scored using a visual analogue scale after the procedure. Results: The mean age of the patients was 65.6 ± 9.6 years. In multiple logistic regression analysis, patients who underwent general anaesthesia [odds ratio (95% CI): 2.68 (1.23–5.81); p = 0.013] and had more postoperative nausea and vomiting episodes [3.10 (1.11–8.63); p = 0.036] were associated with intense pain. These findings remain robust after propensity score matching. For mean difference values between before and after RFA, higher in change in aspartate transaminase (p = 0.026), alanine transaminase (p = 0.016) and white blood cell count (p = 0.015), and lower in change in haemoglobin (p = 0.009) were also correlated with intense pain. There was no significant difference in haemodynamic changes between the general anaesthesia and local anaesthesia group during ablation. Conclusion: General anaesthesia, postoperative nausea and vomiting, and laboratory factors were associated with postoperative intense pain in patients who underwent radiofrequency ablation. Counselling and modification of analgesics should be considered in patients with related factors for intense pain

  7. Safety and Tolerability of Transitioning from Cangrelor to Ticagrelor in Patients Who Underwent Percutaneous Coronary Intervention.

    Science.gov (United States)

    Badreldin, Hisham A; Carter, Danielle; Cook, Bryan M; Qamar, Arman; Vaduganathan, Muthiah; Bhatt, Deepak L

    2017-08-01

    The 3 phase 3 CHAMPION (Cangrelor vs Standard Therapy to Achieve Optimal Management of Platelet Inhibition) trials collectively demonstrated the safety of transitioning from cangrelor, a potent, parenteral rapidly-acting P2Y 12 inhibitor, to clopidogrel in patients who underwent percutaneous coronary intervention (PCI). However, variation in timing of therapy, site-specific binding, and drug half-lives may theoretically complicate switching to other oral P2Y 12 inhibitors. Since regulatory approval, limited data are available regarding the "real-world" safety and tolerability of transitioning to these more potent oral P2Y 12 antagonists. From November 2015 to January 2017, we evaluated the clinical profiles and efficacy and safety outcomes in cangrelor-treated patients who underwent PCI transitioned to clopidogrel (n = 42) or ticagrelor (n = 82) at a large, tertiary care center. Most patients receiving cangrelor underwent PCI with a drug-eluting stent for acute coronary syndrome via a radial approach in the background of unfractionated heparin. Stent thrombosis within 48 hours was rare and occurred in 1 patient treated with ticagrelor. Global Use of Strategies to Open Occluded Coronary Arteries-defined bleeding occurred in 20% of patients switched to ticagrelor and 29% of patients switched to clopidogrel, but none were severe or life-threatening. In conclusion, rates of stent thrombosis and severe/life-threatening bleeding were low and comparable with those identified in the CHAMPION program, despite use of more potent oral P2Y 12 inhibition. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Clinical outcomes for 14 consecutive patients with solid pseudopapillary neoplasms who underwent laparoscopic distal pancreatectomy.

    Science.gov (United States)

    Nakamura, Yoshiharu; Matsushita, Akira; Katsuno, Akira; Yamahatsu, Kazuya; Sumiyoshi, Hiroki; Mizuguchi, Yoshiaki; Uchida, Eiji

    2016-02-01

    The postoperative results of laparoscopic distal pancreatectomy for solid pseudopapillary neoplasm of the pancreas (SPN), including the effects of spleen-preserving resection, are still to be elucidated. Of the 139 patients who underwent laparoscopic pancreatectomy for non-cancerous tumors, 14 consecutive patients (average age, 29.6 years; 1 man, 13 women) with solitary SPN who underwent laparoscopic distal pancreatectomy between March 2004 and June 2015 were enrolled. The tumors had a mean diameter of 4.8 cm. Laparoscopic spleen-preserving distal pancreatectomy was performed in eight patients (spleen-preserving group), including two cases involving pancreatic tail preservation, and laparoscopic spleno-distal pancreatectomy was performed in six patients (standard resection group). The median operating time was 317 min, and the median blood loss was 50 mL. Postoperatively, grade B pancreatic fistulas appeared in two patients (14.3%) but resolved with conservative treatment. No patients had postoperative complications, other than pancreatic fistulas, or required reoperation. The median postoperative hospital stay was 11 days, and the postoperative mortality was zero.None of the patients had positive surgical margins or lymph nodes with metastasis. The median follow-up period did not significantly differ between the two groups (20 vs 39 months, P = 0.1368). All of the patients are alive and free from recurrent tumors without major late-phase complications. Laparoscopic distal pancreatectomy might be a suitable treatment for patients with SPN. A spleen-preserving operation is preferable for younger patients with SPN, and this study demonstrated the non-inferiority of the procedure compared to spleno-distal pancreatectomy. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  9. Surrogate pregnancy in a patient who underwent radical hysterectomy and bilateral transposition of ovaries.

    Science.gov (United States)

    Azem, Foad; Yovel, Israel; Wagman, Israel; Kapostiansky, Rita; Lessing, Joseph B; Amit, Ami

    2003-05-01

    To evaluate IVF-surrogate pregnancy in a patient with ovarian transposition after radical hysterectomy for carcinoma of the cervix. Case report. A maternity hospital in Tel Aviv that is a major tertiary care and referral center. A 29-year-old woman who underwent Wertheim's hysterectomy for carcinoma of the uterine cervix and ovarian transposition before total pelvic irradiation. Standard IVF treatment, transabdominal oocyte retrieval, and transfer to surrogate mother. Outcome of IVF cycle. A twin pregnancy in the first cycle. This is the second reported case of controlled ovarian stimulation and oocyte retrieval performed on a transposed ovary.

  10. Effect of different pneumoperitoneum pressure on stress state in patients underwent gynecological laparoscopy

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    Ai-Yun Shen

    2016-10-01

    Full Text Available Objective: To observe the effect of different CO2 pneumoperitoneum pressure on the stress state in patients underwent gynecological laparoscopy. Methods: A total of 90 patients who were admitted in our hospital from February, 2015 to October, 2015 for gynecological laparoscopy were included in the study and divided into groups A, B, and C according to different CO2 pneumoperitoneum pressure. The changes of HR, BP, and PetCO2 during the operation process in the three groups were recorded. The changes of stress indicators before operation (T0, 30 min during operation (T1, and 12 h after operation (T2 were compared. Results: The difference of HR, BP, and PetCO2 levels before operation among the three groups was not statistically significant (P>0.05. HR, BP, and PetCO2 levels 30 min after pneumoperitoneum were significantly elevated when compared with before operation (P0.05. PetCO2 level 30 min after pneumoperitoneum in group B was significantly higher than that in group A (P0.05. Conclusions: Low pneumoperitoneum pressure has a small effect on the stress state in patients underwent gynecological laparoscopy, will not affect the surgical operation, and can obtain a preferable muscular relaxation and vision field; therefore, it can be selected in preference.

  11. Outcome of Patients Underwent Emergency Department Thoracotomy and Its Predictive Factors

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    Shahram Paydar

    2014-08-01

    Full Text Available Introduction: Emergency department thoracotomy (EDT may serve as the last survival chance for patients who arrive at hospital in extremis. It is considered as an effective tool for improvement of traumatic patients’ outcome. The present study was done with the goal of assessing the outcome of patients who underwent EDT and its predictive factors. Methods: In the present study, medical charts of 50 retrospective and 8 prospective cases underwent emergency department thoracotomy (EDT were reviewed during November 2011 to June 2013. Comparisons between survived and died patients were performed by Mann-Whitney U test and the predictive factors of EDT outcome were measured using multivariate logistic regression analysis. P < 0.05 considered statistically significant. Results: Fifty eight cases of EDT were enrolled (86.2% male. The mean age of patients was 43.27±19.85 years with the range of 18-85. The mean time duration of CPR was recorded as 37.12±12.49 minutes. Eleven cases (19% were alive to be transported to OR (defined as ED survived. The mean time of survival in ED survived patients was 223.5±450.8 hours. More than 24 hours survival rate (late survived was 6.9% (4 cases. Only one case (1.7% survived to discharge from hospital (mortality rate=98.3%. There were only a significant relation between ED survival and SBP, GCS, CPR duration, and chest trauma (p=0.04. The results demonstrated that initial SBP lower than 80 mmHg (OR=1.03, 95% CI: 1.001-1.05, p=0.04 and presence of chest trauma (OR=2.6, 95% CI: 1.75-3.16, p=0.02 were independent predictive factors of EDT mortality. Conclusion: The findings of the present study showed that the survival rate of trauma patients underwent EDT was 1.7%. In addition, it was defined that falling systolic blood pressure below 80 mmHg and blunt trauma of chest are independent factors that along with poor outcome.

  12. Study of the seroma volume changes in the patients who underwent Accelerated Partial Breast Irradiation

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    Kim, Dae Ho; Son, Sang Jun; Mun, Jun Ki; Seo, Seok Jin; Lee, Je Hee [Dept. of Radiation Oncology, Seoul National University Hospital, Seoul (Korea, Republic of)

    2016-06-15

    By analyzing seroma volume changes in the patients who underwent Partial breast radiation therapy after breast conserving surgery, we try to contribute to the improvement of radiotherapy effect. Enrolled 20 patients who underwent partial breast radiation therapy by ViewRay MRIdian System were subject. After seeking for the size of the removed sample in the patients during surgery and obtained seroma volume changes on a weekly basis. On the Basis of acquired volume, it was compared with age, term from start of the first treatment after surgery, BMI (body mass index) and the extracted sample size during surgery. And using the ViewRay MRIdian RTP System, the figure was analyzed by PTV(=seroma volume + margin) to obtain a specific volume of the Partial breast radiation therapy. The changes of seroma volume from MR simulation to the first treatment (a week) is 0~5% in 8, 5~10% in 3, 10 to 15% in 2, and 20% or more in 5 people. Two patients(A, B patient) among subjects showed the biggest change. The A patient's 100% of the prescribed dose volume is 213.08 cc, PTV is 181.93 cc, seroma volume is 15.3 cc in initial plan. However, while seroma volume decreased 65.36% to 5.3 cc, 100% of the prescribed dose volume was reduced to 3.4% to 102.43 cc and PTV also did 43.6% to 102.54 cc. In the case of the B patient, seroma volume decreased 42.57% from 20.2 cc to 11.6 cc. Because of that, 100% of the prescribed dose volume decreased 8.1% and PTV also did to 40%. As the period between the first therapy and surgery is shorter, the patient is elder and the size of sample is smaller than 100 cc, the change grow bigger. It is desirable to establish an adaptive plan according to each patient's changes of seroma volume through continuous observation. Because partial breast patients is more sensitive than WBRT patients about dose conformity in accordance with the volume change.

  13. Study of the seroma volume changes in the patients who underwent Accelerated Partial Breast Irradiation

    International Nuclear Information System (INIS)

    Kim, Dae Ho; Son, Sang Jun; Mun, Jun Ki; Seo, Seok Jin; Lee, Je Hee

    2016-01-01

    By analyzing seroma volume changes in the patients who underwent Partial breast radiation therapy after breast conserving surgery, we try to contribute to the improvement of radiotherapy effect. Enrolled 20 patients who underwent partial breast radiation therapy by ViewRay MRIdian System were subject. After seeking for the size of the removed sample in the patients during surgery and obtained seroma volume changes on a weekly basis. On the Basis of acquired volume, it was compared with age, term from start of the first treatment after surgery, BMI (body mass index) and the extracted sample size during surgery. And using the ViewRay MRIdian RTP System, the figure was analyzed by PTV(=seroma volume + margin) to obtain a specific volume of the Partial breast radiation therapy. The changes of seroma volume from MR simulation to the first treatment (a week) is 0~5% in 8, 5~10% in 3, 10 to 15% in 2, and 20% or more in 5 people. Two patients(A, B patient) among subjects showed the biggest change. The A patient's 100% of the prescribed dose volume is 213.08 cc, PTV is 181.93 cc, seroma volume is 15.3 cc in initial plan. However, while seroma volume decreased 65.36% to 5.3 cc, 100% of the prescribed dose volume was reduced to 3.4% to 102.43 cc and PTV also did 43.6% to 102.54 cc. In the case of the B patient, seroma volume decreased 42.57% from 20.2 cc to 11.6 cc. Because of that, 100% of the prescribed dose volume decreased 8.1% and PTV also did to 40%. As the period between the first therapy and surgery is shorter, the patient is elder and the size of sample is smaller than 100 cc, the change grow bigger. It is desirable to establish an adaptive plan according to each patient's changes of seroma volume through continuous observation. Because partial breast patients is more sensitive than WBRT patients about dose conformity in accordance with the volume change

  14. Dysphagia among adult patients who underwent surgery for esophageal atresia at birth.

    Science.gov (United States)

    Huynh Trudeau, Valérie; Maynard, Stéphanie; Terzic, Tatjana; Soucy, Geneviève; Bouin, Mickeal

    2015-03-01

    Clinical experiences of adults who underwent surgery for esophageal atresia at birth is limited. There is some evidence that suggests considerable long-term morbidity, partly because of dysphagia, which has been reported in up to 85% of adult patients who undergo surgery for esophageal atresia. The authors hypothesized that dysphagia in this population is caused by dysmotility and⁄or anatomical anomalies. To determine the motor and anatomical causes of dysphagia. A total of 41 adults, followed at the Esophageal Atresia Clinic at Hôpital Saint-Luc (Montreal, Quebec), were approached to particpate in the present prospective study. Evaluation was completed using upper endoscopy, manometry and barium swallow for the participants who consented. The medical charts of respondents were systematically reviewed from the neonatal period to 18 years of age to assess medical and surgical history. All 41 patients followed at the clinic consented and were included in the study. Dysphagia was present in 73% of patients. Esophagogastroduodenoscopy was performed in 32 patients: hiatal hernia was present in 62% (n=20); esophageal diverticulum in 13% (n=4); macroscopic Barrett esophagus in 31% (n=10); and esophagitis in 19% (n=6). Histological esophagitis was present in 20% and intestinal metaplasia in 10%. There were no cases of dysplagia or adenocarcinoma. Esophageal manometry was performed on 56% of the patients (n=23). Manometry revealed hypomotility in 100% of patients and included an insufficient number of peristaltic waves in 96%, nonpropagating peristalsis in 78% and low-wave amplitude in 95%. Complete aperistalsis was present in 78%. The lower esophageal sphincter was abnormal in 12 (52%) patients, with incomplete relaxation the most common anomaly. Of the 41 patients, 29 (71%) consented to a barium swallow, which was abnormal in 13 (45%). The anomalies found were short esophageal dilation in 28%, delay in esophageal emptying in 14%, diverticula in 14% and stenosis in 7

  15. Correlation between location of transposed ovary and function in cervical cancer patients who underwent radical hysterectomy.

    Science.gov (United States)

    Yoon, Aera; Lee, Yoo-Young; Park, Won; Huh, Seung Jae; Choi, Chel Hun; Kim, Tae-Joong; Lee, Jeong-Won; Kim, Byoung-Gie; Bae, Duk-Soo

    2015-05-01

    The study investigated the association between the location of transposed ovaries and posttreatment ovarian function in patients with early cervical cancer (IB1-IIA) who underwent radical hysterectomy and ovarian transposition with or without adjuvant therapies. Retrospective medical records were reviewed to enroll the patients with early cervical cancer who underwent ovarian transposition during radical hysterectomy at Samsung Medical Center between July 1995 and July 2012. Serum follicle-stimulating hormone (FSH) level was used as a surrogate marker for ovarian function. Twenty-one patients were enrolled. The median age and body mass index (BMI) were 31 years (range, 24-39 years) and 21.3 kg/m² (range, 17.7-31.2 kg/m²), respectively. The median serum FSH level after treatment was 7.9 mIU/mL (range, 2.4-143.4 mIU/mL). The median distance from the iliac crest to transposed ovaries on erect plain abdominal x-ray was 0.5 cm (range, -2.7 to 5.2 cm). In multivariate analysis, posttreatment serum FSH levels were significantly associated with the location of transposed ovaries (β = -8.1, P = 0.032), concurrent chemoradiation (CCRT) as an adjuvant therapy (β = 71.08, P = 0.006), and BMI before treatment (underweight: β = -59.93, P = 0.05; overweight: β = -40.62, P = 0.041). Location of transposed ovaries, adjuvant CCRT, and BMI before treatment may be associated with ovarian function after treatment. We suggest that ovaries should be transposed as highly as possible during radical hysterectomy to preserve ovarian function in young patients with early cervical cancer who might be a candidate for adjuvant CCRT and who have low BMI before treatment.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  17. Endovascular Therapy of the Superficial Femoral Artery Via a Stand-Alone Transradial Access: A Single-Center Experience.

    Science.gov (United States)

    Hanna, Elias B; Ababneh, Bashar A; Amin, Amit N

    2018-02-01

    We describe our experience in transradial recanalization of the superficial femoral artery (SFA), and we provide a stepwise approach accounting for the patient's height and optimizing the yield of currently available devices. Fifteen patients with simple SFA disease, including 4 patients with total SFA occlusions monorail balloons) in all patients, and orbital atherectomy in 6 patients. We illustrate the steps and challenges of the transradial approach, namely the limited support in complex disease and the limited reach of current equipment. In patients with simple SFA disease, transradial recanalization appears feasible and safe but currently limited to balloon angioplasty ± orbital atherectomy. Proximal SFA stenting may be feasible in patients <160 cm in height.

  18. Comparative analysis of pain in patients who underwent total knee replacement regarding the tourniquet pressure

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    Marcos George de Souza Leão

    Full Text Available ABSTRACT OBJECTIVES: To evaluate through the visual analog scale (VAS the pain in patients undergoing total knee replacement (TKR with different pressures of the pneumatic tourniquet. METHODS: An observational, randomized, descriptive study on an analytical basis, with 60 patients who underwent TKR, divided into two groups, which were matched: a group where TKR was performed with tourniquet pressures of 350 mmHg (standard and the other with systolic blood pressure plus 100 mmHg (P + 100. These patients had their pain assessed by VAS at 48 h, and at the 5th and 15th days after procedure. Secondarily, the following were also measured: range of motion (ROM, complications, and blood drainage volume in each group; the data were subjected to statistical analysis. RESULTS: After data analysis, there was no statistical difference regarding the incidence of complications (p = 0.612, ROM (p = 0.202, bleeding after 24 and 48 h (p = 0.432 and p = 0.254 or in relation to VAS. No correlation was observed between time of ischemia compared to VAS and bleeding. CONCLUSIONS: The use of the pneumatic tourniquet pressure at 350 mmHg or systolic blood pressure plus 100 mmHg did not influence the pain, blood loss, ROM, and complications. Therefore the pressures at these levels are safe and do not change the surgery outcomes; the time of ischemia must be closely observed to avoid major complications.

  19. Association of PTP1B with Outcomes of Breast Cancer Patients Who Underwent Neoadjuvant Chemotherapy.

    Science.gov (United States)

    Rivera Franco, Monica M; Leon Rodriguez, Eucario; Martinez Benitez, Braulio; Villanueva Rodriguez, Luisa G; de la Luz Sevilla Gonzalez, Maria; Armengol Alonso, Alejandra

    2016-01-01

    PTP1B is involved in the oncogenesis of breast cancer. In addition, neoadjuvant therapy has been widely used in breast cancer; thus, a measurement to assess survival improvement could be pathological complete response (pCR). Our objective was to associate PTP1B overexpression with outcomes of breast cancer patients who underwent neoadjuvant chemotherapy. Forty-six specimens were included. Diagnostic biopsies were immunostained using anti-PTP1B antibody. Expression was categorized as negative (<5%) and overexpression (≥5%). Patients' responses were graded according to the Miller-Payne system. Sixty-three percent of patients overexpressed PTP1B. There was no significant association between PTP1B overexpression and pCR ( P = 0.2). However, when associated with intrinsic subtypes, overexpression was higher in human epidermal growth factor receptor 2-positive-enriched specimens ( P = 0.02). Ten-year progression-free survival showed no differences. Our preliminary results do not show an association between PTP1B over-expression and pCR; however, given the limited sample and heterogeneous treatment in our cohort, this hypothesis cannot be excluded.

  20. Association of PTP1B with Outcomes of Breast Cancer Patients who Underwent Neoadjuvant Chemotherapy

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    Monica M. Rivera Franco

    2016-01-01

    Full Text Available PTP1B is involved in the oncogenesis of breast cancer. In addition, neoadjuvant therapy has been widely used in breast cancer; thus, a measurement to assess survival improvement could be pathological complete response (pCR. Our objective was to associate PTP1B overexpression with outcomes of breast cancer patients who underwent neoadjuvant chemotherapy. Forty-six specimens were included. Diagnostic biopsies were immunostained using anti-PTP1B antibody. Expression was categorized as negative (<5% and overexpression (≥5%. Patients' responses were graded according to the Miller-Payne system. Sixty-three percent of patients overexpressed PTP1B. There was no significant association between PTP1B overexpression and pCR (P = 0.2. However, when associated with intrinsic subtypes, overexpression was higher in human epidermal growth factor receptor 2-positive-enriched specimens (P = 0.02. Ten-year progression-free survival showed no differences. Our preliminary results do not show an association between PTP1B overexpression and pCR; however, given the limited sample and heterogeneous treatment in our cohort, this hypothesis cannot be excluded.

  1. Comparison of the patient radiation exposure during coronary angiography and angioplasty procedures using trans-radial and trans-femoral access

    Directory of Open Access Journals (Sweden)

    Ali Tarighatnia

    2016-06-01

    Conclusion: On the basis of the results obtained in this study, no differences were found in patients’ radiation dose in both access groups, therefore with regard to comparatively more clinical advantages associated with the Trans-radial access technique it might be a good substitute for Trans-femoral access.

  2. [A survey of perioperative asthmatic attack among patients with bronchial asthma underwent general anesthesia].

    Science.gov (United States)

    Ie, Kenya; Yoshizawa, Atsuto; Hirano, Satoru; Izumi, Sinyuu; Hojo, Masaaki; Sugiyama, Haruhito; Kobayasi, Nobuyuki; Kudou, Kouichirou; Maehara, Yasuhiro; Kawachi, Masaharu; Miyakoshi, Kouichi

    2010-07-01

    We investigated the risk factor of perioperative asthmatic attack and effectiveness of preventing treatment for asthmatic attack before operation. We performed retrospective chart review of one hundred eleven patients with asthma underwent general anesthesia and surgical intervention from January 2006 to October 2007 in our hospital. The rate of perioperative asthmatic attack were as follows; 10.2% (5 in 49 cases) in no pretreatment group, 7.5% (3 in 40 cases) in any pretreatments except for systemic steroid, and 4.5% (1 in 22 cases) in systemic steroid pretreatment group. Neither preoperative asthma severity nor duration from the last attack had significant relevancy to perioperative attack rate. The otolaryngological surgery, especially those have nasal polyp and oral surgery had high perioperative asthma attack rate, although there was no significant difference. We recommend the systemic steroid pretreatment for asthmatic patients, especially when they have known risk factor such as administration of the systemic steroid within 6 months, or possibly new risk factor such as nasal polyp, otolaryngological and oral surgery.

  3. Predictors of weight regain in patients who underwent Roux-en-Y gastric bypass surgery.

    Science.gov (United States)

    Shantavasinkul, Prapimporn Chattranukulchai; Omotosho, Philip; Corsino, Leonor; Portenier, Dana; Torquati, Alfonso

    2016-11-01

    Roux-en-Y gastric bypass (RYGB) is a highly effective treatment for obesity and results in long-term weight loss and resolution of co-morbidities. However, weight regain may occur as soon as 1-2 years after surgery. This retrospective study aimed to investigate the prevalence of weight regain and possible preoperative predictors of this phenomenon after RYGB. An academic medical center in the United States. A total of 1426 obese patients (15.8% male) who underwent RYGB during January 2000 to 2012 and had at least a 2-year follow-up were reviewed. We included only patients who were initially successful, having achieved at least 50% excess weight loss at 1 year postoperatively. Patients were then categorized into either the weight regain group (WR) or sustained weight loss (SWL) group based upon whether they gained≥15% of their 1-year postoperative weight. Weight regain was observed in 244 patients (17.1%). Preoperative body mass index was similar between groups. Body mass index was significantly higher and percent excess weight loss was significantly lower in the WR group (Pweight regain was 19.5±9.3 kg and-.8±8.5 in the WR and SWL groups, respectively (Pweight loss. Moreover, a longer duration after RYGB was associated with weight regain. Multivariate analysis revealed that younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The present study confirmed that a longer interval after RYGB was associated with weight regain. Younger age was a significant predictor of weight regain even after adjusting for time since RYGB. The findings of this study underscore the complexity of the mechanisms underlying weight loss and regain after RYGB. Future prospective studies are needed to further explore the prevalence, predictors, and mechanisms of weight regain after RYGB. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  4. Quality of life in locally advanced prostate cancer patients who underwent hormonal treatment combined with radiotherapy

    International Nuclear Information System (INIS)

    Koga, Hirofumi; Naito, Seiji; Fukui, Iwao; Tsukamoto, Taiji; Matsuoka, Naoki; Fujimoto, Hiroyuki

    2004-01-01

    The aim of this study is to estimate the feasibility of quality of life (QOL) research and to evaluate the QOL prospectively in locally advanced prostate cancer patients treated with hormonal treatment combined with radiotherapy. The treatment schedule was that patients with decreasing prostatic specific antigen (PSA) levels below 10 ng/ml after receiving 6 months of neoadjuvant hormonal treatment were randomly divided into two groups; one group was the continuous hormonal treatment group and the other was the intermittent hormonal treatment group. Both groups received a total dose of 72 Gy external beam radiotherapy with concomitant hormonal treatment followed by 6 months of adjuvant hormonal treatment following radiotherapy. At 14 months, patients either underwent continuous or intermittent hormonal treatment according to the random allocation. QOL was assessed at baseline, and at 6, 8, 14, and 20 months after treatment using functional assessment of cancer treatment-general (FACT-G), P with the other 3 items comprising bother of urination, bother of bowel movement, and bother of sexual activity. Between January 2000 and June 2003, a total of 188 patients were enrolled in this study. The rate of collection of baseline QOL sheets was 98.0%. The rate of answer to questions of QOL sheets was 99.0%. At baseline, the average score of FACT-G, P was 120.7 and the maximum score was more than twice the minimum score. Dysfunction of urination and bowel movement was correlated with the bother of urination and bowel movement, respectively. On the other hand, dysfunction of sexual activity was not correlated with the bother of sexual activity. In June 2003, all of the QOL sheets at baseline, and at 6, 8, and 14 months were completely collected from a total of 72 patients. Although QOL at 8 months was significantly affected compared with QOL at baseline and at 6 months, QOL at 14 months was significantly improved compared with that at 8 months and there was no significant

  5. Transradial percutaneous coronary intervention for left main bifurcation lesions using 7.5-Fr sheathless guide catheter.

    Science.gov (United States)

    Zhao, Huiqiang; Banerjee, Subhash; Chen, Hui; Li, Hongwei

    2018-05-01

    Recent studies have shown sheathless guide catheters (GCs) to be safe and effective during complex lesions such as bifurcations, chronic total occlusion (CTO), and/or calcified lesions. We investigated the feasibility and safety of using 7.5-Fr sheathless GC for transradial percutaneous coronary intervention (PCI) to treat left main bifurcation lesions.A total of 82 patients were consecutively enrolled from March 2013 to February 2016. They underwent transradial PCI for left main bifurcation lesions using the 7.5-Fr sheathless GC.The mean syntax score was 28.1 ± 6.1, and the majority (n = 55, 67.1%) was intermediate scores (23∼32). The unprotected LM disease was present in 67 of 82 patients (81.7%), and true bifurcation (Medina 1, 1, 1) was present in 46 of 82 patients (56.1%). The 2-stent technique was used in 62 of 82 patients (75.6%). The 2-stent technique included 31 cases (37.8%) of "Crush," 18 cases (22.0%) of "Cullote," and 13 (15.8%) cases of "T stent and modified T stent" (T stent). Immediate angiographic success rate was 100% (82/82), and procedural success rate was 97.6% (80/82). The vascular complications occurred in 3 patients (3/82, 3.7%).The use of 7.5-Fr sheathless GC is safe and allows PCI for complex bifurcation lesions located in the distal of left main to be performed transradially with a high success rate.

  6. [Findings from Total Colonoscopy in Obstructive Colorectal Cancer Patients Who Underwent Stent Placement as a Bridge to Surgery(BTS)].

    Science.gov (United States)

    Maruo, Hirotoshi; Tsuyuki, Hajime; Kojima, Tadahiro; Koreyasu, Ryohei; Nakamura, Koichi; Higashi, Yukihiro; Shoji, Tsuyoshi; Yamazaki, Masanori; Nishiyama, Raisuke; Ito, Tatsuhiro; Koike, Kota; Ikeda, Takashi; Takayanagi, Yasuhiro; Kubota, Hiroyuki

    2017-11-01

    We clinically investigated 34 patients with obstructive colorectal cancer who underwent placement of a colonic stent as a bridge to surgery(BTS), focusing on endoscopic findings after stent placement.Twenty -nine patients(85.3%)underwent colonoscopy after stent placement, and the entire large intestine could be observed in 28(96.6%).Coexisting lesions were observed in 22(78.6%)of these 28 patients.The lesions comprised adenomatous polyps in 17 patients(60.7%), synchronous colon cancers in 5 patients(17.9%), and obstructive colitis in 3 patients(10.7%), with some overlapping cases.All patients with multiple cancers underwent one-stage surgery, and all lesions were excised at the same time.Colonoscopy after colonic stent placement is important for preoperative diagnosis of coexisting lesions and planning the extent of resection. These considerations support the utility of colonic stenting for BTS.

  7. Impact of Polypharmacy on Adherence to Evidence-Based Medication in Patients who Underwent Percutaneous Coronary Intervention.

    Science.gov (United States)

    Mohammed, Shaban; Arabi, Abdulrahaman; El-Menyar, Ayman; Abdulkarim, Sabir; AlJundi, Amer; Alqahtani, Awad; Arafa, Salah; Al Suwaidi, Jassim

    2016-01-01

    The primary objective of this study was to evaluate the impact of polypharmacy on primary and secondary adherence to evidence-based medication (EBM) and to measure factors associated with non-adherence among patients who underwent percutaneous coronary intervention (PCI). We conducted a retrospective analysis for patients who underwent PCI at a tertiary cardiac care hospital in Qatar. Patients who had polypharmacy (defined as ≥6 medications) were compared with those who had no polypharmacy at hospital discharge in terms of primary and secondary adherence to dual antiplatelet therapy (DAPT), beta-blockers (BB), angiotensin converting enzyme inhibitors (ACEIs) and statins. A total of 557 patients (mean age: 53±10 years; 85%; males) who underwent PCI were included. The majority of patients (84.6%) received ≥6 medications (polypharmacy group) while only 15.4% patients received ≥5 medications (nonpolypharmacy group). The two groups were comparable in term of gender, nationality, socioeconomic status and medical insurance. The non-polypharmacy patients had significantly higher adherence to first refill of DAPT compared with patients in the polypharmacy group (100 vs. 76.9%; p=0.001). Similarly, the non-polypharmacy patients were significantly more adherent to secondary preventive medications (BB, ACEI and statins) than the polypharmacy group. In patients who underwent PCI, polypharmacy at discharge could play a negative role in the adherence to the first refill of EBM. Further studies should investigate other parameters that contribute to long term non-adherence.

  8. Radial artery spasm occurred in transradial coronary intervention for coronary heart disease: its occurrence and predictors

    International Nuclear Information System (INIS)

    Zhong Jiming; Li Lang; Lu Yongguang; Zeng Shuyi

    2011-01-01

    Objective: To discuss the incidence and clinical predictors of radial artery spasm occurred in performing transradial coronary intervention for coronary heart disease. Methods: A total of 1020 patients, who underwent transradial coronary procedures for coronary heart disease during the period of May 2007 Jan 2010 in authors' hospital, were enrolled in this study. All clinical information and medication were recorded in detail. Arteriography via radial artery was performed in all patients. The diameter of the radial artery as well as the arterial anatomy, including arterial variations, were determined and observed, which was follow by coronary angiography or percutaneous coronary intervention. Multivariate Logistic regression analysis was adopted to evaluate the variables, such as clinical parameters, angiographic characteristics of the radial artery and procedure-related factors, in predicting the occurrence of radial artery spasm. Results: Radial artery spasm occurred in 209 (20.5%) patients. Multivariate Logistic regression analysis showed that the following eight factors were independently associated with the occurrence of radial artery spasm. These factors were as follows: female gender (OR=2.8, 95% CI 2.5-5.8; P=0.001), age (OR=0.68, 95% CI 0.60-0.92; P=0.003), smoking (OR=2.3, 95% CI 1.8-4.1; P=0.026), moderate-to-severe pain of forearm during radial artery cannulation (OR=3.0, 95% CI 2.3-4.8; P=0.006), radial artery anatomical abnormalities (OR=4.7, 95% CI 3.6-7.2; P=0.002), the ratio of radial artery diameter to patient's height (RAH) (OR=5.2, 95% CI 3.7-8.1; P=0.012), the ratio of radial artery diameter to outer diameter of the sheath (RAOD) (OR=5.8, 95% CI 4.2-6.9; P=0.006) and the number of catheter exchange (OR=2.3, 95% CI 1.4-4.3; P=0.038). Conclusion: Radial artery spasm occurred in performing transradial coronary intervention for coronary heart disease is frequently seen in clinical practice. Female gender, younger age, smoking, forearm pain during

  9. Comparison of propofol effect with Ketamine for sedation induction in pediatric patients who underwent cardiol catheterization

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    Houshang Shahryari

    2010-04-01

    Full Text Available Background: The goals for sedation in pediatric patients scheduled to undergo cardiac catheterization include immobility, analgesia, cardiovascular and respiratory stability. We investigated the effects of Propofol and Ketamine on hemodynamic, respiratory status, sedation level, pain score and recovery period in pediatric patients undergoing cardiac catheterization. Methods: We preformed a randomized clinical trial study on 40 pediatric patients. The patients were randomly assigned to two groups, so that 20 patients received Ketamine and 20 patients received Propofol. In all patients, sedation was started with Midazolam (0.03mg/kg, then followed by Propofol in the first group and Ketamine in the second one. The hemodynamic responses, respiratory parameters, recovery characteristics (Ramsey scale, pain score VAS and relevant adverse effects of the two groups were recorded. Data was analyzed using Paired T Test, ANOVA and Stearman correlation coefficient. Results: Five patients in the Propofol group andon patients in the Ketamine group experienced a transient decrease in mean systolic blood pressure greater than 10% of baseline(p=0.034. Time to full recovery (mean ± SD was not significantly different in the Propofol group and Ketamine group (1.8 min vs. 2.9 min, P > 0.05. Pain scores were significantly different in both groups (P= 0.010. Patients’ heart rates were significantly higher in Ketamine group(P=0.029. No significant difference in respiratory rate was recorded in both groups(p›0.05. Conclusion: Both Ketamine and Propofol are useful and safe in pediatric patients undergoing cardiac catheterization but it seems that it is better to use Propofol in stable hemodynamic pediatric patients under continuous blood pressure monitoring.

  10. Comparing efficacy of preemptively used dexketoprofen and tramadol for postoperative pain in patients underwent laparoscopic cholecystectomy

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    Süreyya Özkan

    2015-03-01

    Full Text Available Objective: In our study, we aimed to compare effects of preoperative dexketoprofen and tramadol administered by intravenous route on intraoperative and postoperative analgesic consumption, postoperative pain, durations of hospital stay and patient satisfaction in patients, undergoing laparoscopic cholecystectomy. Methods:After approval of ethic committee and written consent of patients were obtained, 60 patients between 18-70 years old with ASA I-II were included in the study. After routine monitorization and 20 minutes before induction of anesthesia, dexketoprofen 50 mg in 100 cc 0.9% NaCl was administered in Dexketoprofen Group and tramadol 100 mg in 100 cc 0.9% NaCl in Tramadol Group as intravenous infusion during 20 minutes. Intraoperative hemodynamic parameters, analgesic-anesthetic consumptions and complications of patients, on whom standard general anesthesia was applied, were recorded. Pain severity, degree of sedation, morphine consumptions and hemodynamic parameters were recorded at postoperative 30 th minute, and 4 th, 8th, 12th and 24 th hours. Additional analgesia requirement, times for requiring first analgesia, duration of hospital stay, postoperative complications and patient satisfactions were recorded. Results: Intraoperative analgesic-anesthetic consumptions, postoperative visual analogue scale (VAS scores, sedation degrees, intravenous patient controlled analgesia (PCA and morphine consumptions, times for requiring first analgesic, durations of hospital stay, intraoperative-postoperative complications developed and patient satisfactions were similar in both groups. Consequently, postoperative analgesic efficacy of pre-emptive dexketoprofen intravenous 50 mg and tramadol intravenous 100 mg administered was found to be similar in cases, who had laparoscopic cholecystectomy operation. Conclusion:Because VAS scores were low in our patients, morphine consumptions with intravenous PCA were similar in both groups, and there wasn

  11. Analysis of Recurrence Management in Patients Who Underwent Nonsurgical Treatment for Acute Appendicitis

    Science.gov (United States)

    Liang, Tsung-Jung; Liu, Shiuh-Inn; Tsai, Chung-Yu; Kang, Chi-Hsiang; Huang, Wei-Chun; Chang, Hong-Tai; Chen, I-Shu

    2016-01-01

    Abstract The recurrence rate for acute appendicitis treated nonoperatively varies between studies. Few studies have adequately evaluated the management of these patients when appendicitis recurs. We aimed to explore the recurrence rate and management of patients with acute appendicitis that were first treated nonoperatively. We identified patients in the Taiwan National Health Insurance Research Database who were hospitalized due to acute appendicitis for the first time between 2000 and 2010 and received nonsurgical treatment. The recurrence and its management were recorded. Data were analyzed to access the risk factors for recurrence and factors that influenced the management of recurrent appendicitis. Among the 239,821 patients hospitalized with acute appendicitis for the first time, 12,235 (5.1%) patients were managed nonoperatively. Of these, 864 (7.1%) had a recurrence during a median follow-up of 6.5 years. Appendectomy was performed by an open and laparoscopic approach in 483 (55.9%) and 258 (29.9%) patients, respectively. The remaining 123 (14.2%) patients were again treated nonsurgically. Recurrence was independently associated with young age, male sex, percutaneous abscess drainage, and medical center admission by multivariable analysis. In addition, age appendicitis, percutaneous abscess drainage, nor length of first time hospital stay had an influence on the selection of surgical approach. In conclusion, a laparoscopic appendectomy can be performed in recurrent appendicitis cases, and its application may not be related to previous appendicitis severity. PMID:27015200

  12. Do submucous myoma characteristics affect fertility and menstrual outcomes in patients underwent hysteroscopic myomectomy?

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    Ahmed Namazov

    2015-06-01

    Full Text Available Background: Submucous myomas may be associated with menorrhagia, infertility and dysmenorrhea. Objective: The aim of this study was to determine the long term effects of submucousal myoma resection on menorrhagia and infertility; also to detect whether the type, size, and location of myoma affect the surgical success. Materials and Methods: .Totally 98 women referred to hysteroscopy for symptomatic submucousal fibroids (menorrhagia (n=51 and infertility (n=47 between 2005- 2010 were enrolled in this historical cohort study Pregnancy rates and menstrual improvement rates were compared according to myoma characteristics (size, type and location. Results: After a mean postoperative period of 23±10 months in 51 patients with excessive bleeding, 13 had recurrent menorrhagia (25%. In Other 38 patients excessive bleeding was improved (75%. The improvement rates by location and myoma type: lower segment 100%, fundus 92%, and corpus 63%; type 0 70%, type 1 78%, type 2 80%. The mean sizes of myoma in recurred and improved patients were 23.33 mm and 29.88 mm respectively. 28 of 47 infertile women spontaneously experienced thirty pregnancies (60%. Pregnancy rates according to myoma location and type: lower segment 50%, fundus 57%, and corpus 80%; type 0 75%, type 1 62%, type 2 50%. The mean myoma size in patients who became pregnant was 30.38 mm; in patients who did not conceive was 29.95 mm. Conclusion: The myoma characetesitics do not affect improvement rates after hysteroscopic myomectomy in patients with unexplained infertility or excessive uterine bleeding.

  13. Predictive factors of unfavorable prostate cancer in patients who underwent prostatectomy but eligible for active surveillance

    Directory of Open Access Journals (Sweden)

    Seol Ho Choo

    2014-06-01

    Conclusions: A significant proportion of patients who were candidates for active surveillance had unfavorable prostate cancer. Age, PSA density, and two positive cores were independent significant predictive factors for unfavorable prostate cancer. These factors should be considered when performing active surveillance.

  14. [Contribution of Perioperative Oral Health Care and Management for Patients who Underwent General Thoracic Surgery].

    Science.gov (United States)

    Saito, Hajime; Minamiya, Yoshihiro

    2016-01-01

    Due to the recent advances in radiological diagnostic technology, the role of video-assisted thoracoscopic surgery in thoracic disease has expanded, surgical indication extended to the elderly patients. Cancer patients receiving surgery, radiation therapy and/or chemotherapy may encounter complications in conjunction with the oral cavity such as aspiration pneumonia, surgical site infection and various type of infection. Recently, it is recognized that oral health care management is effective to prevent the postoperative infectious complications, especially pneumonia. Therefore, oral management should be scheduled before start of therapy to prevent these complications as supportive therapy of the cancer treatment. In this background, perioperative oral function management is highlighted in the remuneration for dental treatment revision of 2012,and the importance of oral care has been recognized in generally. In this manuscript, we introduce the several opinions and evidence based on the recent previous reports about the perioperative oral health care and management on thoracic surgery.

  15. Optical Coherence Tomography Parameters in Morbidly Obese Patients Who Underwent Laparoscopic Sleeve Gastrectomy

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    Berna Dogan

    2016-01-01

    Full Text Available Purpose. To investigate changes in optical coherence tomography parameters in morbidly obese patients who had undergone laparoscopic sleeve gastrectomy (LSG. Methods. A total of 41 eyes of 41 morbidly obese patients (BMI ≥ 40 who had undergone LSG were included in study. The topographic optic disc parameters, central macular thickness (CMT, total macular volume (TMV, and retinal ganglion cell layer (RGCL were measured by spectral-domain optical coherence tomography (SD-OCT. Subfoveal choroidal thickness (SFCT was measured by enhanced deep imaging-optical coherence tomography (EDI-OCT. Results. The mean CMT was 237.4±24.5 μm, 239.3±24.1 μm, and 240.4±24.5 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. The mean TMV was 9.88±0.52 mm3, 9.96±0.56 mm3, and 9.99±0.56 mm3 preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. The mean RGCL was 81.2±6.5 μm, 82.7±6.6 μm, and 82.9±6.5 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. The mean SFCT was 309.8±71.8 μm, 331.0±81.4 μm, and 352.7±81.4 μm preoperatively, 3 months postoperatively, and 6 months postoperatively, respectively (p<0.01. No statistically significant differences were found between the preoperative values and 3- and 6-month postoperative values in rim area (p=0.34, disc area (p=0.64, vertical cup/disc ratio (p=0.39, cup volume (p=0.08, or retinal nerve fiber layer (p=0.90. Conclusions. Morbidly obese patients who undergo LSG experience a statistically significant increase in CMT, TMV, SFCT, and RGCL at 3 months and 6 months after surgery.

  16. The Demographics of Patients with Skin Cancer who Underwent Surgery in Diyarbakır and Performed Surgical Techniques

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    Burhan Özalp

    2018-06-01

    Full Text Available Objective: The major factor for developing malignant skin cancers is sunlight exposure. This study aimed to evaluate the demographics of patients with skin cancers who underwent surgery in Diyarbakır where the population is exposed to more sunlight than most other Turkish cities. Methods: The medical records of patients who underwent surgery for malignant skin cancer excision between 2011 and 2016 were searched using University Hospital’s patient database program. Data about patients’ demographics, cancer features, and the surgical techniques performed were collected. Results: Over a 5-year period, 190 patients underwent surgical excision. The male to female ratio was 1.56, and the mean age was 65.8 ± 15.7 (range, 20-94 years. The most common skin cancer was basal cell carcinoma (n=138, 72.7%, followed by squamous cell carcinoma (n=45, 23.7% and malignant melanoma (n=5, 2.6%. The most common surgery was primary excision, which was performed in 90 of 190 patients (47.36%; tissue reconstruction with a skin graft or flap surgery was required for the remaining 100 (52.63%, showing a significant difference (p<0.001. Conclusion: Basal cell carcinoma is the most common skin cancer, and less than half of the patients sought treatment immediately after they recognized the lesion. The public should be educated about skin cancers to increase early diagnosis and encourage timely treatment, thereby decreasing morbidity and mortality from skin cancer.

  17. Clinical Outcomes of patients with coronary artery disease who underwent FFR evaluation of intermediate coronary lesionS– COFFRS study

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    Srinivasa Prasad

    2017-07-01

    Conclusion: In our experience, MACE events were not higher in patients with FFR > 0.8 and kept under medical therapy and were similarly lower in patients with FFR ≤0.8 and underwent revascularisation (p = 0.73. Also MACE events were higher in patients with FFR ≤ 0.8 and did not undergo revascularisation compared to other two appropriately treated groups (p = 0.03. FFR based revascularization decision appears to be a safe strategy in Indian patients.

  18. Microdose flare-up vs. flexible-multidose GnRH antagonist protocols for poor responder patients who underwent ICSI.

    Science.gov (United States)

    Esinler, I

    2014-01-01

    To compare the performance of microdose flare-up (MF) and flexible-multidose gonadotropin-releasing hormone (GnRH) antagonist protocols in poor responder patients who underwent intracytoplasmic sperm injection (ICSI). One hundred and 12 consecutive patients (217 cycles) suspected to have poor ovarian response were enrolled. Group 1 (MF GnRH agonist group) constituted 64 patients (135 cycles) who underwent MF GnRH agonist protocol. Group 2 (flexible-multidose GnRH antagonist group) constituted 48 patients (82 cycles) who underwent flexible-multidose GnRH antagonist protocol. The duration of stimulation (d) (11.5 +/- 2.1 vs. 10.4 +/- 2.7, p or = seven blastomeres and < 10% fragmentation at day 3 (35.9% vs. 65.1%, p < 0.05) were significantly lower in Group 1 when compared to Group 2. The number of embryos transferred (2.2 +/- 1.3 vs. 2.4 +/- 0.9), the clinical pregnancy per embryo transfer (16.3% vs. 25.8%), and the implantation rate (8.6% vs. 12.2%) were comparable between groups. Although the flexible-multidose GnRH antagonist protocol produced better oocyte and embryo parameters, the clinical pregnancy rate and the implantation rates were comparable between the flexible-multidose GnRH antagonist and MF protocols in poor responder patients.

  19. Comparison of transradial and transfemoral artery approach for percutaneous coronary angiography and angioplasty: A retrospective seven-year experience from a north Indian center

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    Satyendra Tewari

    2013-07-01

    Conclusion: The number of percutaneous transradial procedures have increased significantly with reduced complication rates and comparable success rate to transfemoral approach, along with the additional benefits to patient in terms of patient comfort, preference and reduced cost of health delivery.

  20. Transradial access: lessons learned from cardiology.

    Science.gov (United States)

    Snelling, Brian M; Sur, Samir; Shah, Sumedh Subodh; Marlow, Megan M; Cohen, Mauricio G; Peterson, Eric C

    2018-05-01

    Innovations in interventional cardiology historically predate those in neuro-intervention. As such, studying trends in interventional cardiology can be useful in exploring avenues to optimise neuro-interventional techniques. One such cardiology innovation has been the steady conversion of arterial puncture sites from transfemoral access (TFA) to transradial access (TRA), a paradigm shift supported by safety benefits for patients. While neuro-intervention has unique anatomical challenges, the access itself is identical. As such, examining the extensive cardiology literature on the radial approach has the potential to offer valuable lessons for the neuro-interventionalist audience who may be unfamiliar with this body of work. Therefore, we present here a report, particularly for neuro-interventionalists, regarding the best practices for TRA by reviewing the relevant cardiology literature. We focused our review on the data most relevant to our audience, namely that surrounding the access itself. By reviewing the cardiology literature on metrics such as safety profiles, cost and patient satisfaction differences between TFA and TRA, as well as examining the technical nuances of the procedure and post-procedural care, we hope to give physicians treating complex cerebrovascular disease a broader data-driven understanding of TRA. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. Tumor deposit is a poor prognostic indicator in patients who underwent simultaneous resection for synchronous colorectal liver metastases

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    Lin Q

    2015-01-01

    Full Text Available Qi Lin,# Ye Wei,# Li Ren,# Yunshi Zhong,# Chunzhi Qin, Peng Zheng, Pingping Xu, Dexiang Zhu, Meiling Ji, Jianmin XuDepartment of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China#These authors contributed equally to this workBackground: Tumor deposits are one of the important influencing factors among the different editions of Tumor, Node, Metastasis classification. Incidence and prognosis of tumor deposits in stage I, II, and III colorectal cancer patients has been explored. The aim of this study was to determine the prognostic value of tumor deposits in stage IV colorectal cancer patients who underwent simultaneous resection for synchronous colorectal liver metastases (SCRLM.Methods: Clinicopathological and outcome data of 146 consecutive SCRLM patients who underwent simultaneous R0 resection between July 2003 and July 2013 were collected from our prospectively established SCRLM database. The prognostic value of tumor deposits was evaluated by Kaplan–Meier and Cox regression analysis.Results: Tumor deposits were detected in 41.8% (61/146 of these SCRLM patients. Tumor deposits were significantly correlated with lymph node metastasis and nerve invasion of the primary tumors (P=0.002, P=0.041; respectively. The Kaplan–Meier survival analysis revealed that the overall survival (OS and disease-free survival (DFS of SCRLM patients with tumor deposits were significantly poorer than those with no tumor deposits (P=0.039, P=0.001; respectively. And with multivariate analysis, we found that positive tumor deposits were significantly associated with shorter DFS independent of lymph node status (P=0.002. Subgroup analysis found that of the 57 SCRLM patients with negative lymph node status, the OS and DFS of patients with positive tumor deposits were significantly shorter than those with negative tumor deposits (P=0.002 and P=0.031, respectively. Of the 89 patients with positive lymph node status, the OS of

  2. [Evaluation of the antithrombotic strategy in low thrombotic risk patients who underwent aortic valve replacement with a bioprosthesis].

    Science.gov (United States)

    Aceves-Velázquez, Eduardo; Vieyra-Herrera, Gerardo; Rodríguez-Chávez, Laura; Herrera-Alarcón, Valentín

    2017-07-16

    According to current guidelines, in patients without additional risk factors who have undergone aortic valve replacement with a bioprosthesis, anticoagulation in the first 3 months after surgery is still a matter of debate. According to current evidence, aspirin in low doses is a reasonable alternative to vitamin K antagonists (VKA). A comparison is made between the incidence of thrombotic and haemorrhagic complications in patients with low thrombotic risk who underwent aortic valve replacement with a bioprosthesis in the National Institute of Cardiology of Ignacio Chávez of Mexico. The hypothesis: aspirin as monotherapy has a beneficial effect compared to VKA. The studied patients were the low thrombotic risk patients who underwent aortic valve replacement with a bioprosthesis in the National Institute of Cardiology of Ignacio Chávez of Mexico from 2011 to 2015. The groups studied were: aspirin only, VKA only, and the combination of VKA plus aspirin. The patients were retrospectively followed-up for 12 months, and the thrombotic and haemorrhagic complications were documented. Of the 231 patients included in the study, only one patient in the VKA only group presented with a haemorrhagic complication. No thrombotic complications were observed. In the present study no thrombotic complications were observed in patients who did not receive anticoagulation in the first 3 months after an aortic valve replacement with a bioprosthesis after a follow up period of 12 months. This suggests that the use of aspirin only is safe during this period. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  3. Contralateral prophylactic mastectomy rate and predictive factors among patients with breast cancer who underwent multigene panel testing for hereditary cancer.

    Science.gov (United States)

    Elsayegh, Nisreen; Webster, Rachel D; Gutierrez Barrera, Angelica M; Lin, Heather; Kuerer, Henry M; Litton, Jennifer K; Bedrosian, Isabelle; Arun, Banu K

    2018-05-07

    Although multigene panel testing is increasingly common in patients with cancer, the relationship between its use among breast cancer patients with non-BRCA mutations or variants of uncertain significance (VUS) and disease management decisions has not been well described. This study evaluated the rate and predictive factors of CPM patients who underwent multigene panel testing. Three hundred and fourteen patients with breast cancer who underwent multigene panel testing between 2014 and 2017 were included in the analysis. Of the 314 patients, 70 elected CPM. Election of CPM by gene status was as follows: BRCA carriers (42.3%), non-BRCA carriers (30.1%), and VUS (10.6%). CPM election rates did not differ between non-BRCA carriers and BRCA carriers (P = 0.6205). Among non-BRCA carriers, negative hormone receptor status was associated with CPM (P = 0.0115). For those with a VUS, hormone receptor status was not associated with CPM (P = 0.1879). Although the rate of CPM between BRCA carriers and non-BRCA carriers was not significantly different, the predictors of CPM were different in each group. Our analyses shed the light on the increasing use of CPM among patients who are non-BRCA carriers as well those with a VUS. Our study elucidates the differing predictive factors of CPM election among BRCA carriers, non-BRCA carries, and those with a VUS. Our findings reveal the need for providers to be cognizant that non-BRCA genes and VUS drive women to elect CPM despite the lack of data for contralateral breast cancer risk associated with these genes. © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

  4. Anatomical location of metastatic lymph nodes: an indispensable prognostic factor for gastric cancer patients who underwent curative resection.

    Science.gov (United States)

    Zhao, Bochao; Zhang, Jingting; Zhang, Jiale; Chen, Xiuxiu; Chen, Junqing; Wang, Zhenning; Xu, Huimian; Huang, Baojun

    2018-02-01

    Although the numeric-based lymph node (LN) staging was widely used in the worldwide, it did not represent the anatomical location of metastatic lymph nodes (MLNs) and not reflect extent of LN dissection. Therefore, in the present study, we investigated whether the anatomical location of MLNs was still necessary to evaluate the prognosis of node-positive gastric cancer (GC) patients. We reviewed 1451 GC patients who underwent radical gastrectomy in our institution between January 1986 and January 2008. All patients were reclassified into several groups according to the anatomical location of MLNs and the number of MLNs. The prognostic differences between different patient groups were compared and clinicopathologic features were analyzed. In the present study, both anatomical location of MLNs and the number of MLNs were identified as the independent prognostic factors (p location of MLNs was considered (p location of MLNs had no significant effect on the prognosis of these patients, the higher number of MLNs in the extraperigastric area was correlated with the unfavorable prognosis (p location of MLNs was an important factor influencing the prognostic outcome of GC patients. To provide more accurate prognostic information for GC patients, the anatomical location of MLNs should not be ignored.

  5. Citrus aurantium Naringenin Prevents Osteosarcoma Progression and Recurrence in the Patients Who Underwent Osteosarcoma Surgery by Improving Antioxidant Capability

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    Lirong Zhang

    2018-01-01

    Full Text Available Citrus aurantium is rich in flavonoids, which may prevent osteosarcoma progression, but its related molecular mechanism remains unclear. Flavonoids were extracted from C. aurantium and purified by reparative HPLC. Each fraction was identified by using electrospray ionisation mass spectrometry (ESI-MS. Three main components (naringin, naringenin, and hesperetin were isolated from C. aurantium. Naringenin inhibited the growth of MG-63 cells, whereas naringin and hesperetin had no inhibitory function on cell growth. ROS production was increased in naringin- and hesperetin-treated groups after one day of culture while the level was always lowest in the naringenin-treated group after three days of culture. 95 osteosarcoma patients who underwent surgery were assigned into two groups: naringenin group (NG, received 20 mg naringenin daily, n=47 and control group (CG, received 20 mg placebo daily, n=48. After an average of two-year follow-up, osteosarcoma volumes were smaller in the NG group than in the CG group (P>0.01. The rate of osteosarcoma recurrence was also lower in the NG group than in CG group. ROS levels were lower in the NG group than in the CG group. Thus, naringenin from Citrus aurantium inhibits osteosarcoma progression and local recurrence in the patients who underwent osteosarcoma surgery by improving antioxidant capability.

  6. Citrus aurantium Naringenin Prevents Osteosarcoma Progression and Recurrence in the Patients Who Underwent Osteosarcoma Surgery by Improving Antioxidant Capability.

    Science.gov (United States)

    Zhang, Lirong; Xu, Xiaohua; Jiang, Tiechao; Wu, Kunzhe; Ding, Chuanbo; Liu, Zhen; Zhang, Xuanhe; Yu, Tianhua; Song, Changlong

    2018-01-01

    Citrus aurantium is rich in flavonoids, which may prevent osteosarcoma progression, but its related molecular mechanism remains unclear. Flavonoids were extracted from C. aurantium and purified by reparative HPLC. Each fraction was identified by using electrospray ionisation mass spectrometry (ESI-MS). Three main components (naringin, naringenin, and hesperetin) were isolated from C. aurantium . Naringenin inhibited the growth of MG-63 cells, whereas naringin and hesperetin had no inhibitory function on cell growth. ROS production was increased in naringin- and hesperetin-treated groups after one day of culture while the level was always lowest in the naringenin-treated group after three days of culture. 95 osteosarcoma patients who underwent surgery were assigned into two groups: naringenin group (NG, received 20 mg naringenin daily, n = 47) and control group (CG, received 20 mg placebo daily, n = 48). After an average of two-year follow-up, osteosarcoma volumes were smaller in the NG group than in the CG group ( P > 0.01). The rate of osteosarcoma recurrence was also lower in the NG group than in CG group. ROS levels were lower in the NG group than in the CG group. Thus, naringenin from Citrus aurantium inhibits osteosarcoma progression and local recurrence in the patients who underwent osteosarcoma surgery by improving antioxidant capability.

  7. Clinical and echocardiographic findings of patients with suspected acute pulmonary thromboembolism who underwent computed tomography pulmonary angiography

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    Atoosa Adibi

    2016-01-01

    Full Text Available Background: The aim of the study was to determine the correlation between clinical and echocardiographic findings and risk factors of patients with suspected acute pulmonary thromboembolism (PTE who underwent computed tomography pulmonary angiography (CTPA. Materials and Methods: In this cross-sectional study, 310 hospitalized patients aged >18 years with high clinical suspicion of PTE referred to imaging center of our hospital from different wards for CTPA were enrolled. The frequency of different clinical presentations, risk factors, items of Wells' criteria, and echocardiographic findings was compared in patients with and without PTE, which have been diagnosed according to the CTPA results. Results: PTE was diagnosed in 53 (17.1% of patients with suspected PTE. From clinical manifestations, tachypnea, pleuritic chest pain, and edema of lower extremities were significantly more frequent among patients with PTE (P < 0.05. Major surgery was the risk factor which was significantly more prevalent among patients with PTE (P < 0.05. Frequency of all criteria of Wells' criteria, except hemoptysis, was significantly higher in patients with PTE (P < 0.05. The frequency of all studied echocardiographic variables was significantly higher in patients with PTE (P < 0.05. Conclusion: It is suggested that we could use the results of this study for utilizing the diagnostic process of PTE in patients with highly clinical suspicion of PTE and providing more validated decision. Using the results of this study, we could identify high-risk patients and made appropriate risk assessment for better management of patients with suspected PTE as well as reduce the rate of unnecessary CTPA and its related adverse consequences.

  8. Transradial PCI and Same Day Discharge.

    Science.gov (United States)

    Elfandi, Ali; Safirstein, Jordan G

    2018-02-24

    The evolution of cardiac catheterization has led to the development of well-refined, more effective, and safer devices that allow cardiovascular interventionalists to deliver high-quality percutaneous interventions (PCI). Transradial PCI (TRI) has gained more popularity in the USA over the past 10 years, and as experience and volume of TRI grow, studies adopting same day radial PCI protocols have emerged and are showing promising results. We sought to review the current literature on TRI and same day discharge (SDD). This literature review was performed to evaluate the studies that were published over the last 17 years regarding TRI and SDD. A literature search using PubMed, Cochran database, Google Scholar, and Embase was performed for studies evaluating TRI and SDD from January 1, 2000, to August 1, 2017. Observational studies, randomized clinical trials, meta-analyses, and consensus statements were included in our review. We used the following terms in our search: "same day," "same day discharge," "outpatient," and "ambulatory radial PCI." Articles with data pertinent to the subject matter were included. We did not limit our searches to specific journals. The available literature supports SDD for selected radial PCI patients. The advancement in PCI devices and pharmacology has enhanced the safety of post-PCI disposition leading to the evolution from traditional overnight stays to the development of same day discharge programs. We conclude that outpatient TRI for appropriately selected patients will be the standard of care in the future. This will lead to increased patient satisfaction, improved hospital throughput, and reduced hospital costs, without increased procedural complications.

  9. Randomized comparison of operator radiation exposure comparing transradial and transfemoral approach for percutaneous coronary procedures: rationale and design of the minimizing adverse haemorrhagic events by TRansradial access site and systemic implementation of angioX – RAdiation Dose study (RAD-MATRIX)

    International Nuclear Information System (INIS)

    Sciahbasi, Alessandro; Calabrò, Paolo; Sarandrea, Alessandro; Rigattieri, Stefano; Tomassini, Francesco; Sardella, Gennaro; Zavalloni, Dennis; Cortese, Bernardo; Limbruno, Ugo; Tebaldi, Matteo; Gagnor, Andrea; Rubartelli, Paolo; Zingarelli, Antonio; Valgimigli, Marco

    2014-01-01

    Background: Radiation absorbed by interventional cardiologists is a frequently under-evaluated important issue. Aim is to compare radiation dose absorbed by interventional cardiologists during percutaneous coronary procedures for acute coronary syndromes comparing transradial and transfemoral access. Methods: The randomized multicentre MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) trial has been designed to compare the clinical outcome of patients with acute coronary syndromes treated invasively according to the access site (transfemoral vs. transradial) and to the anticoagulant therapy (bivalirudin vs. heparin). Selected experienced interventional cardiologists involved in this study have been equipped with dedicated thermoluminescent dosimeters to evaluate the radiation dose absorbed during transfemoral or right transradial or left transradial access. For each access we evaluate the radiation dose absorbed at wrist, at thorax and at eye level. Consequently the operator is equipped with three sets (transfemoral, right transradial or left transradial access) of three different dosimeters (wrist, thorax and eye dosimeter). Primary end-point of the study is the procedural radiation dose absorbed by operators at thorax. An important secondary end-point is the procedural radiation dose absorbed by operators comparing the right or left radial approach. Patient randomization is performed according to the MATRIX protocol for the femoral or radial approach. A further randomization for the radial approach is performed to compare right and left transradial access. Conclusions: The RAD-MATRIX study will probably consent to clarify the radiation issue for interventional cardiologist comparing transradial and transfemoral access in the setting of acute coronary syndromes

  10. Randomized comparison of operator radiation exposure comparing transradial and transfemoral approach for percutaneous coronary procedures: rationale and design of the minimizing adverse haemorrhagic events by TRansradial access site and systemic implementation of angioX – RAdiation Dose study (RAD-MATRIX)

    Energy Technology Data Exchange (ETDEWEB)

    Sciahbasi, Alessandro, E-mail: alessandro.sciahbasi@fastwebnet.it [Interventional Cardiology, Sandro Pertini Hospital – ASL RMB, Rome (Italy); Calabrò, Paolo [Division of Cardiology - Department of Cardio-Thoracic Sciences - Second University of Naples (Italy); Sarandrea, Alessandro [HSE Management, Rome (Italy); Rigattieri, Stefano [Interventional Cardiology, Sandro Pertini Hospital – ASL RMB, Rome (Italy); Tomassini, Francesco [Department of Cardiology, Infermi Hospital, Rivoli (Italy); Sardella, Gennaro [La Sapienza University, Rome (Italy); Zavalloni, Dennis [UO Emodinamica e Cardiologia Invasiva, IRCCS, Istituto Clinico Humanitas, Rozzano (Italy); Cortese, Bernardo [Interventional Cardiology, Fatebenefratelli Hospital, Milan (Italy); Limbruno, Ugo [Cardiology Unit, Misericordia Hospital, Grosseto (Italy); Tebaldi, Matteo [Cardiology Department, University of Ferrara, Department of Cardiology (Italy); Gagnor, Andrea [Department of Cardiology, Infermi Hospital, Rivoli (Italy); Rubartelli, Paolo [Villa Scassi Hospital, Genova (Italy); Zingarelli, Antonio [San Martino Hospital, Genova (Italy); Valgimigli, Marco [Thoraxcenter, Rotterdam (Netherlands)

    2014-06-15

    Background: Radiation absorbed by interventional cardiologists is a frequently under-evaluated important issue. Aim is to compare radiation dose absorbed by interventional cardiologists during percutaneous coronary procedures for acute coronary syndromes comparing transradial and transfemoral access. Methods: The randomized multicentre MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) trial has been designed to compare the clinical outcome of patients with acute coronary syndromes treated invasively according to the access site (transfemoral vs. transradial) and to the anticoagulant therapy (bivalirudin vs. heparin). Selected experienced interventional cardiologists involved in this study have been equipped with dedicated thermoluminescent dosimeters to evaluate the radiation dose absorbed during transfemoral or right transradial or left transradial access. For each access we evaluate the radiation dose absorbed at wrist, at thorax and at eye level. Consequently the operator is equipped with three sets (transfemoral, right transradial or left transradial access) of three different dosimeters (wrist, thorax and eye dosimeter). Primary end-point of the study is the procedural radiation dose absorbed by operators at thorax. An important secondary end-point is the procedural radiation dose absorbed by operators comparing the right or left radial approach. Patient randomization is performed according to the MATRIX protocol for the femoral or radial approach. A further randomization for the radial approach is performed to compare right and left transradial access. Conclusions: The RAD-MATRIX study will probably consent to clarify the radiation issue for interventional cardiologist comparing transradial and transfemoral access in the setting of acute coronary syndromes.

  11. Randomized comparison of operator radiation exposure comparing transradial and transfemoral approach for percutaneous coronary procedures: rationale and design of the minimizing adverse haemorrhagic events by TRansradial access site and systemic implementation of angioX - RAdiation Dose study (RAD-MATRIX).

    Science.gov (United States)

    Sciahbasi, Alessandro; Calabrò, Paolo; Sarandrea, Alessandro; Rigattieri, Stefano; Tomassini, Francesco; Sardella, Gennaro; Zavalloni, Dennis; Cortese, Bernardo; Limbruno, Ugo; Tebaldi, Matteo; Gagnor, Andrea; Rubartelli, Paolo; Zingarelli, Antonio; Valgimigli, Marco

    2014-06-01

    Radiation absorbed by interventional cardiologists is a frequently under-evaluated important issue. Aim is to compare radiation dose absorbed by interventional cardiologists during percutaneous coronary procedures for acute coronary syndromes comparing transradial and transfemoral access. The randomized multicentre MATRIX (Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX) trial has been designed to compare the clinical outcome of patients with acute coronary syndromes treated invasively according to the access site (transfemoral vs. transradial) and to the anticoagulant therapy (bivalirudin vs. heparin). Selected experienced interventional cardiologists involved in this study have been equipped with dedicated thermoluminescent dosimeters to evaluate the radiation dose absorbed during transfemoral or right transradial or left transradial access. For each access we evaluate the radiation dose absorbed at wrist, at thorax and at eye level. Consequently the operator is equipped with three sets (transfemoral, right transradial or left transradial access) of three different dosimeters (wrist, thorax and eye dosimeter). Primary end-point of the study is the procedural radiation dose absorbed by operators at thorax. An important secondary end-point is the procedural radiation dose absorbed by operators comparing the right or left radial approach. Patient randomization is performed according to the MATRIX protocol for the femoral or radial approach. A further randomization for the radial approach is performed to compare right and left transradial access. The RAD-MATRIX study will probably consent to clarify the radiation issue for interventional cardiologist comparing transradial and transfemoral access in the setting of acute coronary syndromes. Copyright © 2014 Elsevier Inc. All rights reserved.

  12. Complex Regional Pain Syndrome after Transradial Cardiac Catheterization

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    Chih-Jou Lai

    2006-04-01

    Full Text Available Complex regional pain syndrome (CRPS is a disease with unclear pathophysiology. The condition is characterized by pain, soft tissue change, vasomotor change, and even psychosocial disturbance. It may affect the upper more than the lower extremities, and the distal more than the proximal. The trigger factors include carpal tunnel release, Dupuytren's repair, tendon release procedures, knee surgery, crush injury, ankle arthrodesis, amputation, and hip arthroplasty. Rarely, it has been associated with stroke, mastectomy, pregnancy, and osteogenesis imperfecta. Herein, we present a rare case of a patient who was diagnosed with CRPS after transradial cardiac catheterization. CRPS was first diagnosed due to hand swelling, allodynia, paresthesia, and the limited range of motion of interphalangeal, metacarpophalangeal, and wrist joints, with the preceding factor of transradial cardiac catheterization, and was then confirmed by a three-phase bone scan. After intensive physical therapy with hydrotherapy, manual soft tissue release, and occupational therapy for the hand function, there was much improvement in range of motion and hand function. There was no allodynia or painful sensation in the follow-up. After training, the functional status of this patient was adequate for daily activity.

  13. Accuracy of bone SPECT/CT for identifying hardware loosening in patients who underwent lumbar fusion with pedicle screws

    Energy Technology Data Exchange (ETDEWEB)

    Hudyana, Hendrah; Maes, Alex [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Hospital Leuven, Department of Morphology and Medical Imaging, Leuven (Belgium); Vandenberghe, Thierry; Fidlers, Luc [AZ Groeninge, Department of Neurosurgery, Kortrijk (Belgium); Sathekge, Mike [University of Pretoria, Department of Nuclear Medicine, Pretoria (South Africa); Nicolai, Daniel [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); Wiele, Christophe van de [AZ Groeninge, Department of Nuclear Medicine, Kortrijk (Belgium); University Ghent, Department of Radiology and Nuclear Medicine, Ghent (Belgium)

    2016-02-15

    The aim of this retrospective study was to evaluate the accuracy of bone SPECT (single photon emission computed tomography)/CT (computed tomography) in diagnosing loosening of fixation material in patients with recurrent or persistent back pain that underwent lumbar arthrodesis with pedicle screws using surgery and clinical follow-up as gold standard A total of 48 patients (median age 49 years, range 21-81 years; 17 men) who had undergone lumbar spinal arthrodesis were included in this retrospective analysis. SPECT/CT results were compared to the gold standard of surgical evaluation or clinical follow-up. Positive SPECT/CT results were considered true positives if findings were confirmed by surgery or if clinical and other examinations were completely consistent with the positive SPECT/CT finding. They were considered false positives if surgical evaluation did not find any loose pedicle screws or if symptoms subsided with non-surgical therapy. Negative SPECT/CT scans were considered true negatives if symptoms either improved without surgical intervention or remained stable over a minimum follow-up period of 6 months. Negative SPECT/CT scans were determined to be false negatives if surgery was still required and loosening of material was found. The median length of time from primary surgery to bone SPECT/CT referral was 29.5 months (range 12-192 months). Median follow-up was 18 months (range 6-57) for subjects who did not undergo surgery. Thirteen of the 48 patients were found to be positive for loosening on bone SPECT/CT. Surgical evaluation (8 patients) and clinical follow-up (5 patients) showed that bone SPECT/CT correctly predicted loosening in 9 of 13 patients, while it falsely diagnosed loosening in 4 patients. Of 35 negative bone SPECT/CT scans, 12 were surgically confirmed. In 18 patients, bone SPECT/CT revealed lesions that could provide an alternative explanation for the symptoms of pain (active facet degeneration in 14 patients, and disc and sacroiliac

  14. Transcranial doppler sonography in two patients who underwent decompressive craniectomy for traumatic brain swelling: report of two cases

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    Bor-Seng-Shu Edson

    2004-01-01

    Full Text Available The role of decompressive craniectomy in the treatment of severe posttraumatic cerebral swelling remains quite a controversial issue. To the best of our knowledge, there is no study demonstrating the effect of decompressive craniectomy on cerebral blood flow (CBF velocity by means of transcranial Doppler sonography (TCD. We present two patients who developed traumatic brain swelling and uncontrollable intracranial hypertension with coma and signs of transtentorial herniation. One patient underwent bifrontal, while the second, unilateral, frontotemporoparietal decompressive craniectomy with dural expansion. In both patients, TCD examinations were performed immediately before and after surgery to study the cerebral hemodynamic changes related to the operations. Pre and postoperative TCD examinations demonstrated a significant increase in blood flow velocity in the intracranial arteries in both subjects. In conclusion, our cases suggest that decompressive craniectomy with dural expansion may result in elevation of CBF velocity in patients with massive brain swelling. The increase in CBF velocity appears to occur not only in the decompressed hemisphere, but also on the opposite side.

  15. The Effect of Prazosin and Oxybutynin on the Symptoms Due to Using Double J Catheter in Patients Underwent TUL

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    K. Tavakkoli Tabassi

    2014-01-01

    Full Text Available Background & Aims: Double J catheter has been used for years as an independent practice or a part of other urological practices. Although these catheters have solved many patients’ problems but those can cause symptoms and problems for patients. The aim of this study was the investigation the effect of prazosin and oxybutynin on the degree of symptoms due to using Double J catheter. Methods: In this interventional study, patients who underwent TUL from July 2008 to march 2008 in the lithotripsy ward of Imam Reza hospital were entered to the study and randomly divided in 3 groups randomly. In the first group, placebo, in the second group, oxybutynin, in the third group prazosin were prescribed. Three weeks later standard questionnaire Ureteric Stent Symptom Questionnaire (USSQ was completed. After collecting data, was analyzed using SPSS software. Results: A total of 113 patients (70 men 43 women were included to the study. The mean age was 39 years. There were no significance difference among urinary symptoms score pain of body and physical activity problems in three groups (P>0.05, but there was a significant difference in general health and work problems among them (P<0.05. Conclusion: Oxybutynin caused a low effect on improvement of general health and work problems in patients who were studied. It might Prazosin does not has a sufficient time to affect on urinary symptoms, because of shortness of usage.

  16. The effects of transfusion of irradiated blood upon cellular immune response in patients underwent open heart surgery

    International Nuclear Information System (INIS)

    Togashi, Ken-ichi; Nakazawa, Satoshi; Moro, Hisanaga; Yazawa, Masatomo; Kanazawa, Hiroshi; Hayashi, Jun-ichi; Yamazaki, Yoshihiko; Eguchi, Shoji

    1989-01-01

    The purpose of this paper is to demonstrate the effect of the transfusion of blood received 1500 rad exposure upon the immune response in 14 patients underwent various type of cardiac surgery. 13 patients received known amounts banked blood and irradiated fresh blood, while one patient received a lot of amounts of banked and irradiated and non-irradiated fresh blood. The authors studied the numbers of lymphocytes as well as lymphocyte subsets such as pan-T cells, B cells, helper/inducer T cells (T H/I ), cytotoxic/supressor T cells (T C/S ), active T cells, natural killer (NK) cells and NK cell activity during two weeks after surgeries. In all 14 patients, pan-T lymphocytes decreased markedly in a few days after surgeries, but increased to higher levels on the eight postoperative day than the levels preoperatively. T H/I and T C/S lymphocytes changed on the similar pattern as pan-T lymphocytes. Active T and B cells did not change significantly in two weeks. The number and activity of NK cells gave the lowest levels on the second postoperative day and did not recovery to the preoperative levels in two weeks. One patient received non-irradiated fresh blood showed the similar immune response as other 13 patients, while he gave the lower levels than others did. This patient died of graft-versus-host disease (GVHD)-like syndrome on the 36th postoperative day. It may be thought that the transfusion of irradiated blood would prevent the host from GVHD and gave the better effects on the immune response than that of non-irradiated blood following open-heart surgeries. (author)

  17. CA-125–indicated asymptomatic relapse confers survival benefit to ovarian cancer patients who underwent secondary cytoreduction surgery

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    Wang Fang

    2013-02-01

    Full Text Available Abstract Background There is no consensus regarding the management of ovarian cancer patients, who have shown complete clinical response (CCR to primary therapy and have rising cancer antigen CA-125 levels but have no symptoms of recurrent disease. The present study aims to determine whether follow-up CA-125 levels can be used to identify the need for imaging studies and secondary cytoreductive surgery (CRS. Methods We identified 410 ovarian cancer patients treated at The University of Texas MD Anderson Cancer Center between 1984 and 2011. These patients had shown CCR to primary therapy. Follow-up was conducted based on the surveillance protocol of the MD Anderson Cancer Center. We used the Cox proportional hazards model and log-rank test to assess the associations between the follow-up CA-125 levels and secondary CRS and survival duration. Results The CA-125 level of 1.68 × nadir was defined as the indicator of recurrent disease (p  1.68 × nadir at relapse (55.7 and 10.4 months; p = 0.04 and 0.01, respectively. The overall and progression free survival duration of patients with asymptomatic relapse and underwent a secondary CRS was longer than that of patients with symptomatic relapse (p = 0.02 and 0.04 respectively. Conclusions The increase of serum CA-125 levels is an early warning of clinical relapse in ovarian cancer. Using CA-125 levels in guiding the treatment of patients with asymptomatic recurrent ovarian cancer, who have shown CCR to primary therapy, can facilitate optimal secondary CRS and extend the survival duration of the patients.

  18. Periodical assessment of genitourinary and gastrointestinal toxicity in patients who underwent prostate low-dose-rate brachytherapy

    International Nuclear Information System (INIS)

    Tanaka, Nobumichi; Asakawa, Isao; Anai, Satoshi; Hirayama, Akihide; Hasegawa, Masatoshi; Konishi, Noboru; Fujimoto, Kiyohide

    2013-01-01

    To compare the periodical incidence rates of genitourinary (GU) and gastrointestinal (GI) toxicity in patients who underwent prostate low-dose-rate brachytherapy between the monotherapy group (seed implantation alone) and the boost group (in combination with external beam radiation therapy (EBRT)). A total of 218 patients with a median follow-up of 42.5 months were enrolled. The patients were divided into 2 groups by treatment modality, namely, the monotherapy group (155 patients) and the boost group (63 patients). The periodical incidence rates of GU and GI toxicity were separately evaluated and compared between the monotherapy group and the boost group using the National Cancer Institute - Common Terminology Criteria for Adverse Events, version 3.0. To elucidate an independent factor among clinical and postdosimetric parameters to predict grade 2 or higher GU and GI toxicity in the acute and late phases, univariate and multivariate logistic regression analyses were carried out. Of all patients, 78.0% showed acute GU toxicity, and 7.8% showed acute GI toxicity, while 63.8% showed late GU toxicity, and 21.1% showed late GI toxicity. The incidence rates of late GU and GI toxicity were significantly higher in the boost group. Multivariate analysis showed that the International Prostate Symptom Score (IPSS) before seed implantation was a significant parameter to predict acute GU toxicity, while there were no significant predictive parameters for acute GI toxicity. On the other hand, combination with EBRT was a significant predictive parameter for late GU toxicity, and rectal volume (mL) receiving 100% of the prescribed dose (R100) was a significant predictive parameter for late GI toxicity. The boost group showed higher incidence rates of both GU and GI toxicity. Higher IPSS before seed implantation, combination with EBRT and a higher R100 were significant predictors for acute GU, late GU and late GI toxicity

  19. Prosthetic reconstruction with an obturator using swing-lock attachment for a patient underwent maxillectomy: A clinical report

    Science.gov (United States)

    2016-01-01

    Patients who underwent resection of maxilla due to benign or malignant tumor, or accident will have defect in palatal area. They get retention, support and stability from remaining tissues which are hardly optimal. The advantage of swing-lock attachment design is having multiple contacts on labial and lingual side of the abutment teeth by retentive strut and palatal bracing component. Because the force is distributed equally to abutment teeth, abutment teeth of poor prognosis can be benefited from it. It is also more advantageous to cover soft tissue defects which are hard to reach with conventional prosthesis. A 56-year-old female patient who had undergone a maxillectomy due to malignant melanoma complaining of loose and unstable surgical obturator. Surveyed crowns were placed on #12, 26, and 27. Teeth #11, 21, 22, and 23 had lingual rest seat and #24 had mesial rest seat to improve stability and support of the obturator. This clinical report presents the prosthetic management of a patient treated with obturator on the maxilla using swing-lock attachment to the remaining teeth. PMID:27826392

  20. The Characteristics of Cervical Cancer Patients Who Underwent a Radical Hysterectomy at Sanglah Hospital Denpasar in 2015

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    I Nyoman Bayu Mahendra

    2016-05-01

    Full Text Available Background: Cervical cancer is the most common gynecologic cancer in women. It is the main cause of cancer-related death in women in developing countries. Cervical cancer in Indonesia is the second most cancer affecting Indonesian women and the prevalence is relatively stable in the last 30 years. Cervical cancer was closely related to the histologic type of itself. A squamous cell carcinoma has a specific route of local spreading and a lymphatic route. The sample of this study are cervical cancer patients who underwent a radical hysterectomy from January 1 to December 31, 2015 in Sanglah Hospital Denpasar, Bali. The aim of this study is to discover the characteristics of the patients by age, parity, education level, marital status, sexual activity, the first symptoms and the early screening done, and the clinical staging. Methods: This descriptive study involved 20 patients in Sanglah Hospital Denpasar who had a radical hysterectomy from January 1 until December 31, 2015. The characteristics are gathered from the patients’ medical record. Results: The most cases done radical hysterectomy between 41-45 years old which proportion was 40%, the most parity was parity 2 (60%, elementary school was the most education level (35%, all of the samples only married once and sexually active, the most first symptom was vaginal bleeding (55%, only 10% had pap smear as early detection, and the most clinical stage was stage IIB (50%.

  1. A systematic review of methods for quantifying serum testosterone in patients with prostate cancer who underwent castration.

    Science.gov (United States)

    Comas, I; Ferrer, R; Planas, J; Celma, A; Regis, L; Morote, J

    2018-03-01

    The clinical practice guidelines recommend measuring serum testosterone in patients with prostate cancer (PC) who undergo castration. The serum testosterone concentration should be IA) has become widespread, although their metrological characteristics do not seem appropriate for quantifying low testosterone concentrations. The objective of this review is to analyse the methods for quantifying testosterone and to establish whether there is scientific evidence that justifies measuring it in patients with PC who undergo castration, through liquid chromatography attached to a mass spectrometry in tandem (LC-MSMS). We performed a search in PubMed with the following MeSH terms: measurement, testosterone, androgen suppression and prostate cancer. We selected 12 studies that compared the metrological characteristics of various methods for quantifying serum testosterone compared with MS detection methods. IAs are standard tools for measuring testosterone levels; however, there is evidence that IAs lack accuracy and precision for quantifying low concentrations. Most chemiluminescent IAs overestimate their concentration, especially below 100ng/dL. The procedures that use LC-MSMS have an adequate lower quantification limit and proper accuracy and precision. We found no specific evidence in patients with PC who underwent castration. LC-MSMS is the appropriate method for quantifying low serum testosterone concentrations. We need to define the level of castration with this method and the optimal level related to better progression of the disease. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. The transradial approach for selective carotid and vertebral angiography

    Energy Technology Data Exchange (ETDEWEB)

    Iwasaki, S.; Ueda, K.; Sueyosi, S.; Nagasawa, M.; Ude, K. [Higashiosaka City General Hospital, Osaka (Japan). Dept. of Radiology; Yokoyama, K. [Higashiosaka City General Hospital, Osaka (Japan). Dept. of Neurosurgery; Takayama, K.; Nakagawa, H.; Kichikawa, K. [Nara Medical Univ., Osaka (Japan). Dept. of Radiology

    2002-11-01

    Purpose: The transradial approach is not so popular in cerebral angiography. The purpose of this study was therefore to present our experience of success rate and safety of this method. Material and Methods: From December 1998 to June 2001, 526 carotid and vertebral angiographies with DSA were performed via the radial artery. A 1.4-mm catheter was used through a 1.4-mm introducer sheath. We evaluated the procedure as successful if sufficient images for diagnosis were obtained of the bilateral carotid arteries and unilateral vertebral artery. Each patient was reassessed for any complications, occurring until the next morning. The length of time needed for an examination was measured in the last 10 cases. Results: In all but 5 cases, the procedures were evaluated as successful (99.0%). Unsuccessful cases manifested severe pain at the radial puncture, angiospasm at the radial artery, loop formation at the radial artery, occlusion at the subclavian artery, and an aberrant right subclavian artery. No severe complications including neurological ones were encountered. Minor complications were noted in 17 cases (3.2%): 4 cases of thrombus at the ulnar artery, 1 angiospasm at the radial artery, and 12 cases of small hematoma at the puncture site. The radial approach took 14 min less in the common carotid study and 3 min 30 s less in the internal carotid study than by the femoral approach. Conclusion: The transradial approach enabled selective studies for carotid and vertebral angiography with a high success rate and safety with few complications.

  3. The transradial approach for selective carotid and vertebral angiography

    International Nuclear Information System (INIS)

    Iwasaki, S.; Ueda, K.; Sueyosi, S.; Nagasawa, M.; Ude, K.; Yokoyama, K.; Takayama, K.; Nakagawa, H.; Kichikawa, K.

    2002-01-01

    Purpose: The transradial approach is not so popular in cerebral angiography. The purpose of this study was therefore to present our experience of success rate and safety of this method. Material and Methods: From December 1998 to June 2001, 526 carotid and vertebral angiographies with DSA were performed via the radial artery. A 1.4-mm catheter was used through a 1.4-mm introducer sheath. We evaluated the procedure as successful if sufficient images for diagnosis were obtained of the bilateral carotid arteries and unilateral vertebral artery. Each patient was reassessed for any complications, occurring until the next morning. The length of time needed for an examination was measured in the last 10 cases. Results: In all but 5 cases, the procedures were evaluated as successful (99.0%). Unsuccessful cases manifested severe pain at the radial puncture, angiospasm at the radial artery, loop formation at the radial artery, occlusion at the subclavian artery, and an aberrant right subclavian artery. No severe complications including neurological ones were encountered. Minor complications were noted in 17 cases (3.2%): 4 cases of thrombus at the ulnar artery, 1 angiospasm at the radial artery, and 12 cases of small hematoma at the puncture site. The radial approach took 14 min less in the common carotid study and 3 min 30 s less in the internal carotid study than by the femoral approach. Conclusion: The transradial approach enabled selective studies for carotid and vertebral angiography with a high success rate and safety with few complications

  4. Assessment of quality of life of patients who underwent anterior cruciate ligament reconstruction and a rehabilitation program

    Directory of Open Access Journals (Sweden)

    Moises Cohen

    2004-12-01

    Full Text Available Introduction: Quality of life can be defined as the expression of aconceptual model that tries to represent patient’s perspectivesand his/her level of satisfaction expressed by numbers. Theobjective of this study is to evaluate the parameters of quality oflife of 23 patients who underwent surgery for anterior cruciateligament reconstruction. Methods: We adopted SF-36, a generichealth-related evaluation questionnaire, to obtain informationregarding several aspects of patients’ health conditions, and theLysholm questionnaire, specific to evaluate the symptoms andfunction of the knee. The questionnaires were applied at two stagesof the treatment: pre- and postoperatively (after the rehabilitationprogram. Results: Before surgery, the Lysholm questionnairepresented the following results: excellent in 4% of the cases, goodin 22%, fair in 22%, and poor in 52%. After surgery (Lysholm e SF-36 the correlation level was approximately 44% (p = 0.041.Discussion: The correlation between the Lysholm and the SF-36questionnaires showed the following: the lower the level of pain,the higher the Lysholm score. The high scores presented by theLysholm questionnaire are directly proportional to physical andemotional aspects, and to functional capacity. Conclusion:Analysis of both questionnaires, as well as of their correlation,showed some improvement in patients´ quality of life. We werealso able to demonstrate the importance and usefulness of applyingthe two questionnaires at three different moments: before, duringand after physiotherapeutic intervention.

  5. Early prediction of treatment response by serum CRP levels in patients with advanced esophageal cancer who underwent definitive chemoradiotherapy

    International Nuclear Information System (INIS)

    Yoneda, Masayuki; Fujiwara, Hitoshi; Okamura, Shinichi

    2010-01-01

    Serum C reactive protein (CRP) has been shown to be associated with the progression of esophageal cancer. The purpose of this study was to examine the relationship between treatment response and serum CRP levels in time course during definitive chemoradiotherapy (CRT) in terms of early prediction of CRT response by serum CRP. The subjects of this study were 36 patients with cT3/cT4 esophageal squamous cell carcinoma who underwent definitive CRT in our hospital. Serum CRP levels during definitive CRT (pretreatment, 1W, 2W and 3W after CRT initiation) were compared between CR and non-CR group. In addition, partition model was constructed to discriminate CR with non-CR and the prediction accuracy was evaluated. The patients were consisted of 28 males and 8 females. At pretreatment diagnosis, tumors were categorized as T3 (n=21) and T4 (n=15). Thirty four patients received FP-based chemotherapy and 2 patients received docetaxel-based chemotherapy. Treatment responses were categorized as CR (n=8), partial response (PR) (n=14), no change (NC) (n=2) and progressive disease (PD) (n=12). Serum CRP levels at the time of 2W after CRT initiation (CRT2W) in CR group were low compared to those in non-CR group (p=0.071). The partition model was constructed based on CRP levels at CRT2W. The prediction accuracies to discriminate CR from non-CR by CRP ≤0.1 were 50%, 82%, and 75% in sensitivity, specificity and accuracy, respectively. Serum CRP is a useful biomarker for an early prediction of CRT response. (author)

  6. 65. Impact of focused echocardiography in clinical decision of patients presented with STMI, underwent primary percutenouse angioplasty

    Directory of Open Access Journals (Sweden)

    M. Qasem

    2016-07-01

    Full Text Available Echocardiography in coronary artery diseases is an essential, routine echocardiography prior to primary percutaneous angioplasty is not clear. In our clinical practice in primary angioplasty we faced lots of complications either before or during or after the procedure. Moreover, lots of incidental findings that discovered after the procedure which if known will affect the plan of management. One-hundred-nineteen consecutive underwent primary angioplasty. All patients underwent FE prior to the procedure in catheterization lab while the patient was preparing for the procedure. FE with 2DE of LV at base, mid and apex, and apical stander views. Diastology grading, E/E′ and color doppler of mitral and aortic valve were performed. (N = 119 case of STMI were enrolled, mean age 51 ± 12 year. Eleven cases (9.2% had normal coronary and normal LV function. Twenty cases (17% of MI complication detected before the procedures: RV infarction 8.4% (5.1% asymptomatic and 3.3% symptomatic, ischemic MR (8.4%, LV apical aneurysm (0.8%, significant pericardial effusion (0.80%. Acute pulmonary edema in 17 cases (14.3%: six cases (5.1% developed acute pulmonary edema on the cath lab with grade 3 diastolic dysfunction and E/E ′  >20, 9 cases (7.6% develop acute pulmonary edema in CCU with grade 2–3 diastolic dysfunction and E/E′ 15–20. 2 cases (2.7% develop acute pulmonary in CCU with grade 1–2 diastolic dysfunction and E/E′ 9–14. One case (0.8% presented cardiac tamponade 2 h post PCI. Incidental finding not related to STMI were as follow: 2 cases (1.7% with severe fibro degenerative MR, 2 cases (1.7% with mild to moderate AR and 2 cases (1.7% with mild to moderate AS. Isoled CABG 5/4.2% and CABG and MVR 2/1.7%. FE play an important role in guiding the management, early detection the incidental findings and complication post PCI.

  7. Studies on the clinical course of chronic hepatitis in the patients who underwent serial needle liver biopsies

    International Nuclear Information System (INIS)

    Hirata, Tetsuro

    1984-01-01

    In order to evaluate the changes in biochemical liver function tests and hepatic scintigraphic findings of chronic hepatitis, the author analyzed 35 patients who underwent serial liver biopsies. The results were summerized as follows: 1. Histological deteriorations in chronic hepatitis more inclined to be presented in the scintigraphic abnormalities such as the increased uptake of radioisotope in the spleen and bone marrow than the deteriorations in biochemical liver function tests. Moreover, the increased radioisotope uptake by spleen and bone marrow in hepatic scintigram highly correlated with histological deteriorations. On the other hand, in the cases with histological improvement no scintigraphic improvement was ovserved. 2. Comparing the changes in the result of liver function tests with histological features, biochemical deteriorations significantly correlated with histological deteriorations, although biochemical improvements were not reliable indicators of histological improvements. 3. Changes in biochemical parameters such as serum GOT, GPT, albumin, γ-globulin, TTT and ALP were analyzed by means of Hayashi's second method of quantification and predictive values for histological feactures were calculated. As a result, histological deteriorations were predicted in 89.5% of the cases, but histological improvements were predicted only in 66.7%. In the various biochemical parameters, γ-globulin was considered as most important in predicting histological features and ALP was ranked the second. (J.P.N.)

  8. Feasibility and utility of transradial cerebral angiography: experience during the learning period

    International Nuclear Information System (INIS)

    Kim, Ji Hyung; Park, Yong Sung; Chung, Chul Gu; Park, Kyeong Sug; Chung, Dong Jin; Kim, Hyun Jin

    2006-01-01

    We wanted to present our experiences for performing transradial cerebral angiography during the learning period, and we also wanted to demonstrate this procedure's technical feasibility and utility in various clinical situations. Thirty-two patients were enrolled in the study. All of them had unfavorable situations for performing transfemoral angiography, i.e., IV lines in the bilateral femoral vein, a phobia for groin puncture, decreased blood platelet counts, large hematoma or bruise, atherosclerosis in the bilateral femoral artery and the insistence of patients for choosing another procedure. After con firming the patency of the ulnar artery with a modified Allen's test and a pulse oximeter, the procedure was done using a 21-G micorpuncture set and 5-F Simon II catheters. After angiography, hemostasis was achieved with 1-2 minutes of manual compression and the subsequent application of a hospital-made wrist brace for two hours. The technical feasibility and procedure-related immediate and delayed complications were evaluated. The procedure was successful in 30/32 patients (93.8%). Failure occurred in two patients; one patient had hypoplasia of the radial artery and one patient had vasospasm following multiple puncture trials for the radial artery. Transradial cerebral angiography was technically feasible without significant difficulties even though it was tried during the learning period. Pain in the forearm or arm developed in some patients during the procedures, but this was usually mild and transient. Procedure-related immediate complications included severe bruising in one patient and a small hematoma in one patient. Any clinically significant complication or delayed complication such as radial artery occlusion was not demonstrated in our series. Transradial cerebral angiography is a useful alternative for the patients who have unfavorable clinical situations or contraindications for performing transfemoral cerebral angiography. For the experienced

  9. Feasibility and utility of transradial cerebral angiography: experience during the learning period

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Hyung; Park, Yong Sung; Chung, Chul Gu; Park, Kyeong Sug; Chung, Dong Jin; Kim, Hyun Jin [Konyang University Hospital, Daejeon (Korea, Republic of)

    2006-03-15

    We wanted to present our experiences for performing transradial cerebral angiography during the learning period, and we also wanted to demonstrate this procedure's technical feasibility and utility in various clinical situations. Thirty-two patients were enrolled in the study. All of them had unfavorable situations for performing transfemoral angiography, i.e., IV lines in the bilateral femoral vein, a phobia for groin puncture, decreased blood platelet counts, large hematoma or bruise, atherosclerosis in the bilateral femoral artery and the insistence of patients for choosing another procedure. After con firming the patency of the ulnar artery with a modified Allen's test and a pulse oximeter, the procedure was done using a 21-G micorpuncture set and 5-F Simon II catheters. After angiography, hemostasis was achieved with 1-2 minutes of manual compression and the subsequent application of a hospital-made wrist brace for two hours. The technical feasibility and procedure-related immediate and delayed complications were evaluated. The procedure was successful in 30/32 patients (93.8%). Failure occurred in two patients; one patient had hypoplasia of the radial artery and one patient had vasospasm following multiple puncture trials for the radial artery. Transradial cerebral angiography was technically feasible without significant difficulties even though it was tried during the learning period. Pain in the forearm or arm developed in some patients during the procedures, but this was usually mild and transient. Procedure-related immediate complications included severe bruising in one patient and a small hematoma in one patient. Any clinically significant complication or delayed complication such as radial artery occlusion was not demonstrated in our series. Transradial cerebral angiography is a useful alternative for the patients who have unfavorable clinical situations or contraindications for performing transfemoral cerebral angiography. For the experienced

  10. Golf hand prosthesis performance of transradial amputees.

    Science.gov (United States)

    Carey, Stephanie L; Wernke, Matthew M; Lura, Derek J; Kahle, Jason T; Dubey, Rajiv V; Highsmith, M Jason

    2015-06-01

    Typical upper limb prostheses may limit sports participation; therefore, specialized terminal devices are often needed. The purpose of this study was to evaluate the ability of transradial amputees to play golf using a specialized terminal device. Club head speed, X-factor, and elbow motion of two individuals with transradial amputations using an Eagle Golf terminal device were compared to a non-amputee during a golf swing. Measurements were collected pre/post training with various stances and grips. Both prosthesis users preferred a right-handed stance initially; however, after training, one preferred a left-handed stance. The amputees had slower club head speeds and a lower X-factor compared to the non-amputee golfer, but increased their individual elbow motion on the prosthetic side after training. Amputees enjoyed using the device, and it may provide kinematic benefits indicated by the increase in elbow flexion on the prosthetic side. The transradial amputees were able to swing a golf club with sufficient repetition, form, and velocity to play golf recreationally. Increased elbow flexion on the prosthetic side suggests a potential benefit from using the Eagle Golf terminal device. Participating in recreational sports can increase amputees' health and quality of life. © The International Society for Prosthetics and Orthotics 2014.

  11. Preoperative evaluation of myocardial viability by thallium-201 imaging in patients with old myocardial infarction who underwent coronary revascularization

    International Nuclear Information System (INIS)

    Naruse, Hitoshi; Ohyanagi, Mitsumasa; Iwasaki, Tadaaki; Miyamoto, Takashi; Fukuchi, Minoru

    1992-01-01

    The myocardial uptake and redistribution in thallium scintigraphy and the regional wall motion by echocardiography were evaluated by a semi-quantitative method in 42 patients who previously had myocardial infarction (50 target vessels) and underwent coronary revascularization. The aim of this study was to elucidate the significance of the initial image, delayed image and redistribution on thallium-201 scintigraphy for clinical diagnosis of the myocardial viability. As a semi-quantitative analysis, we used a bull's-eye display for thallium image and centerline method for echocardiographic wall motion, and compared the results before and after revascularization. As a result, the thallium grade improved postoperatively in all 17 areas which preoperatively had showed redistribution, and also in 11 of the 32 areas without preoperative redistribution. The sensitivity, specificity and accuracy of preoperative thallium redistribution for predicting myocardial viability were 61%, 100% and 78%, respectively, when the postoperative improvement in the thallium grade was used as the standard. The postoperative probability of improvement in the thallium grade increased in proportion to the preoperative grade (delayed image)(p<0.01). There was no correlation between the preoperative thallium delayed image and postoperative improvement in wall motion. Postoperative improvement in thallium image and wall motion could not be predicted from the preoperative wall motion. Thus, postoperative improvement in thallium images can be anticipated if redistribution is present on the preoperative thallium image, and the preoperative thallium delayed image is useful for predicting myocardial viability. Improvement in wall motion could not be predicted preoperatively by these methods. (author)

  12. Compare Complication of Classic versus Patent Hemostasis in Transradial Coronary Angiography

    OpenAIRE

    Roghani, Farshad; Tajik, Mohammad Nasim; Khosravi, Alireza

    2017-01-01

    Background: Coronary artery disease (CAD) is multifactorial disease, in which thrombotic occlusion and calcification occur usually. New strategies have been made for diagnosis and treatment of CAD, such as transradial catheterization. Hemostasis could be done in two approaches: traditional and patent. Our aim is to find the best approach with lowest complication. Materials and Methods: In a comparative study, 120 patients were recruited and divided randomly into two subgroups, including tradi...

  13. Prediction of Pathological Complete Response Using Endoscopic Findings and Outcomes of Patients Who Underwent Watchful Waiting After Chemoradiotherapy for Rectal Cancer.

    Science.gov (United States)

    Kawai, Kazushige; Ishihara, Soichiro; Nozawa, Hiroaki; Hata, Keisuke; Kiyomatsu, Tomomichi; Morikawa, Teppei; Fukayama, Masashi; Watanabe, Toshiaki

    2017-04-01

    Nonoperative management for patients with rectal cancer who have achieved a clinical complete response after chemoradiotherapy is becoming increasingly important in recent years. However, the definition of and modality used for patients with clinical complete response differ greatly between institutions, and the role of endoscopic assessment as a nonoperative approach has not been fully investigated. This study aimed to investigate the ability of endoscopic assessments to predict pathological regression of rectal cancer after chemoradiotherapy and the applicability of these assessments for the watchful waiting approach. This was a retrospective comparative study. This study was conducted at a single referral hospital. A total of 198 patients with rectal cancer underwent preoperative endoscopic assessments after chemoradiotherapy. Of them, 186 patients underwent radical surgery with lymph node dissection. The histopathological findings of resected tissues were compared with the preoperative endoscopic findings. Twelve patients refused radical surgery and chose watchful waiting; their outcomes were compared with the outcomes of patients who underwent radical surgery. The endoscopic criteria correlated well with tumor regression grading. The sensitivity and specificity for a pathological complete response were 65.0% to 87.1% and 39.1% to 78.3%. However, endoscopic assessment could not fully discriminate pathological complete responses, and the outcomes of patients who underwent watchful waiting were considerably poorer than the patients who underwent radical surgery. Eventually, 41.7% of the patients who underwent watchful waiting experienced uncontrollable local failure, and many of these occurrences were observed more than 3 years after chemoradiotherapy. The number of the patients treated with the watchful waiting strategy was limited, and the selection was not randomized. Although endoscopic assessment after chemoradiotherapy correlated with pathological response

  14. Development of novel 3D-printed robotic prosthetic for transradial amputees.

    Science.gov (United States)

    Gretsch, Kendall F; Lather, Henry D; Peddada, Kranti V; Deeken, Corey R; Wall, Lindley B; Goldfarb, Charles A

    2016-06-01

    Upper extremity myoelectric prostheses are expensive. The Robohand demonstrated that three-dimensional printing reduces the cost of a prosthetic extremity. The goal of this project was to develop a novel, inexpensive three-dimensional printed prosthesis to address limitations of the Robohand. The prosthesis was designed for patients with transradial limb amputation. It is shoulder-controlled and externally powered with an anthropomorphic terminal device. The user can open and close all five fingers, and move the thumb independently. The estimated cost is US$300. After testing on a patient with a traumatic transradial amputation, several advantages were noted. The independent thumb movement facilitated object grasp, the device weighed less than most externally powered prostheses, and the size was easily scalable. Limitations of the new prosthetic include low grip strength and decreased durability compared to passive prosthetics. Most children with a transradial congenital or traumatic amputation do not use a prosthetic. A three-dimensional printed shoulder-controlled robotic prosthesis provides a cost effective, easily sized and highly functional option which has been previously unavailable. © The International Society for Prosthetics and Orthotics 2015.

  15. Usefulness of Interventional Treatment for Dysfunctional Hemodialysis Shunts of the Upper Arm by Means of the Retrograde Transradial Approach

    International Nuclear Information System (INIS)

    Shin, Hwa Seon; Shin, Tae Beom; Na, Jae Beom; Jung, Seong Hoon; Kim, Hyun Jung; Lee, Jung Eun; Song, Yun Gyu; Jung, Gyoo Sik

    2010-01-01

    This study was designed to evaluate the technical feasibility and clinical outcome of endovascular intervention using the retrograde transradial approach to treat dysfunctional hemodialysis shunts of the upper arms. During the last 3 years, sixteen procedures were performed by the transradial approach in 13 patients with dysfunctional hemodialysis shunts of the upper arms. The radial artery was accessed with the use of 20-gauge needle and a 6-Fr sheath. Angiography was performed using a 5-Fr catheter placed in the brachial artery, and then the interventional procedure was performed. The technical and clinical success rates, complications and patency rates were evaluated. Fistulography and percutaneous transluminal angioplasty via the transradial approach were performed in 16 cases of the 13 patients. Fistulography demonstrated stenosis in 7 cases and occlusions in 9 cases. Lesion multiplicity was identified in 9 out of 16 cases. Balloon angioplasty was performed in all cases and a stent was placed to overcome restenosis or to treat venous rupture in two cases. The technical success rate of balloon angioplasty was 87.5% (14/16) and the technical success rate with including stent insertion was 100% (16/16). The clinical success rate was 93.8%. There was one procedural-related complication. The primary patency rates at 6 and 12 months were 84.6% and 74%, respectively. The transradial approach seems to be technically feasible and effective for the management of insufficient hemodialysis shunts of the upper arms

  16. Quality of life of patients who underwent aesthetic rhinoplasty: 100 cases assessed with the Glascow Benefit Inventory.

    Science.gov (United States)

    Kotzampasakis, Dimitrios; Piniara, Anastasia; Themelis, Sotirios; Kotzampasakis, Stylianos; Gabriel, Eustratios; Maroudias, Nikos; Nikolopoulos, Thomas

    2017-09-01

    The aim of the present study is to assess the long-term effect of classic rhinoplasty on patients' quality of life. Outcomes research. The study included 100 operated patients; there were 34 males and 66 females. The ages ranged between 23 and 57 years old, with a mean of 36.4 years. A minimum of 3 years between the operation and the study was selected to assess the long-term effect of the operation on the patients' quality of life and exclude any short-term impressions. The time elapsed between surgery and the time of the study ranged from 3 to 13 years, with a mean of 6.8 years. Patients were assessed using the Glasgow Benefit Inventory, which has been proven valid and reliable in ear, nose, and throat interventions. From the 100 patients included in the study, 92 reported improvement in their quality of life due to the operation and only eight worsening. In the social support subscale, 97 patients reported better quality of life, and only three patients reported worse quality of life. The patients' overall life markedly improved, reaching a mean of 80% in the Glasgow Benefit Inventory. The present long-term study using a validated and reliable instrument concludes that rhinoplasty improves the quality of life of patients in all sectors. 2c Laryngoscope, 127:2017-2025, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  17. Management of antithrombotic therapy in patients with coronary artery disease or atrial fibrillation who underwent abdominal surgical operations.

    Science.gov (United States)

    Schizas, Dimitrios; Kariori, Maria; Boudoulas, Konstantinos Dean; Siasos, Gerasimos; Patelis, Nikolaos; Kalantzis, Charalampos; Carmen-Maria, Moldovan; Vavuranakis, Manolis

    2018-04-02

    Patients treated with antithrombotic therapy that require abdominal surgical procedures has progressively increased overtime. The management of antithrombotics during both the peri- and post- operative period is of crucial importance. The goal of this review is to present current data concerning the management of antiplatelets in patients with coronary artery disease and of anticoagulants in patients with atrial fibrillation who had to undergo abdominal surgical operations. For this purpose, incidence of major adverse cardiovascular events (MACE) and risk of antithrombotic use during surgical procedures, as well as the recommendations based on recent guidelines were reported. A thorough search of PubMed, Scopus and the Cochrane Databases was conducted to identify randomized controlled trials, observational studies, novel current reviews, and ESC and ACC/AHA guidelines on the subject. Antithrombotic use in daily clinical practice results to two different pathways: reduction of thromboembolic risk, but a simultaneous increase of bleeding risk. This may cause a therapeutic dilemma during the perioperative period. Nevertheless, careless cessation of antithrombotics can increase MACE and thromboembolic events, however, maintenance of antithrombotic therapy may increase bleeding complications. Studies and current guidelines can assist clinicians in making decisions for the treatment of patients that undergo abdominal surgical operations while on antithrombotic therapy. Aspirin should not be stopped perioperatively in the majority of surgical operations. Determining whether to discontinue the use of anticoagulants before surgery depends on the surgical procedure. In surgical operations with a low risk for bleeding, oral anticoagulants should not be discontinued. Bridging therapy should only be considered in patients with a high risk of thromboembolism. Finally, patients with an intermediate risk for thromboembolism, management should be individualized according to patient

  18. Comparison of the feasibility and effectiveness of transradial coronary angiography via right versus left radial artery approaches (from the PREVAIL Study).

    Science.gov (United States)

    Pelliccia, Francesco; Trani, Carlo; Biondi-Zoccai, Giuseppe G L; Nazzaro, Marco; Berni, Andrea; Patti, Giuseppe; Patrizi, Roberto; Pironi, Bruno; Mazzarotto, Pietro; Gioffrè, Gaetano; Speciale, Giulio; Pristipino, Christian

    2012-09-15

    It remains undefined if transradial coronary angiography from a right or left radial arterial approach differs in real-world practice. To address this issue, we performed a subanalysis of the PREVAIL study. The PREVAIL study was a prospective, multicenter, observational survey of unselected consecutive patients undergoing invasive cardiovascular procedures over a 1-month observation period, specifically aimed at assessing the outcomes of radial approach in the contemporary real world. The choice of arterial approach was left to the discretion of the operator. Prespecified end points of this subanalysis were procedural characteristics. Of 1,052 patients consecutively enrolled, 509 patients underwent transradial catheterization, 304 with a right radial and 205 with a left radial approach. Procedural success rates were similar between the 2 groups. Compared to the left radial group, the right radial group had longer procedure duration (46 ± 29 vs 33 ± 24 minutes, p <0.0001) and fluoroscopy time (765 ± 787 vs 533 ± 502, p <0.0001). At multivariate analysis, including a parsimonious propensity score for the choice of left radial approach, duration of procedure (beta coefficient 11.38, p <0.001) and total dose-area product (beta coefficient 11.38, p <0.001) were independently associated with the choice of the left radial artery approach. The operator's proficiency in right/left radial approach did not influence study results. In conclusion, right and left radial approaches are feasible and effective to perform percutaneous procedures. In the contemporary real world, however, the left radial route is associated with shorter procedures and lower radiologic exposure than the right radial approach, independently of an operator's proficiency. Copyright © 2012 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2016-01-01

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

  20. Impact of laser therapy on the condition of oral cavity mucosa in chemotherapy treated patients who underwent bone marrow transplantation

    Directory of Open Access Journals (Sweden)

    Tomasz Krzysztof Bąk

    2017-08-01

    Full Text Available Patological disorders within oral mucosa (so called mucositis are the most common stomatological complications among chemotherapy treated leukemic patients scheduled for bone marrow transplantation. Early diagnosis of such oral disorders leads to numerous side effects, decreasing quality of life and systemic complications is required. Furthermore, most patients require analgesic treatment, very often using narcotic pain medications. Presently the largest role of prevention and treatment of mucositis is preventative dentistry along with maintaining strict oral hygiene. This course of action aims to reduce pain and prevention of infections. Investigation of novel non-invasive therapeutic methods that could improve treatment outcomes seems justified. Among the most promising methods, the Low-level Laser Therapy (LLLT treatment demonstrates many beneficial effects for patients suffering from chemotherapy complications. It promotes mucosal healing and helps improve patients' quality of life. These advantages may be a result of a LLLT anti-inflammatory and analgesic effect. LLLT also promotes tissue regeneration through chemical changes in cells (cell repair. In recent clinical studies conducted on a group of patients with oral mucositis, the significant acceleration of mentioned disorders regression was noted. Moreover, reduction of pain after application of LLLT was recorded. Discussed in the article LLLT is easily accessible for clinical practice . Mentioned arguments justify a wider use of such a tool in non-invasive treatment of acute oral cavity inflammation.

  1. Estimation of absorbed dose of radiosensitive organs and effective sose in patients underwent abdominopelvic spiral CT scan using impact CT patient dosimetry

    Directory of Open Access Journals (Sweden)

    Ayoub Amirnia

    2017-05-01

    Full Text Available Background: Due to the presence of radiosensitive organs in the abdominopelvic region and increasing the number of requests for CT scan examinations, concerns about increasing radiation doses in patients has been greatly elevated. Therefore, the goal of this study was to determine the absorbed dose of radiosensitive organs and the effective dose in patients underwent abdominopelvic CT scan using ImPACT CT patient dosimetry Calculator (version 1.0.4, Imaging Performance Assessment on Computed Tomography, www.impactscan.org. Methods: This prospective cross-sectional study was conducted in Imam Reza Hospital from November to February 2015 February 2015 in the Imam Reza Hospital, in Urmia, Iran. The demographic and dosimetric information of 100 patients who underwent abdominopelvic CT scan in a 6-slice CT scanner were obtained through the data collection forms. The demographic data of the patients included age, weight, gender, and BMI. The dosimetric parameters included pitch value, CT dose volume index (CTDIvol, dose-length product (DLP, tube voltage, tube current, exposure time, collimation size, scan length, and scan time. To determine the absorbed dose of radiosensitive organs and also the effective dose in patients, ImPACT CT patient dosimetry calculator was used. Results: The results of this study demonstrated that the mean and standard deviation (SD of patients' effective dose in abdominopelvic CT scan was 4.927±0.164 mSv. The bladder in both genders had the greatest mean organ dose, which was 64.71±17.15 mGy for men and 77.56±18.48 mGy for women (P<0.001. Conclusion: The effective dose values of this examination are in the same range as previous studies, as well as International Commission on Radiological Protection (ICRP recommendations. However, the radiation dose from CT scan has the largest contribution to the medical imaging. According to the ALARA principle, it is recommended that the scan parameters, especially mAs, should be

  2. Epidural Hematoma and Abscess Related to Thoracic Epidural Analgesia: A Single-Center Study of 2,907 Patients Who Underwent Lung Surgery.

    Science.gov (United States)

    Kupersztych-Hagege, Elisa; Dubuisson, Etienne; Szekely, Barbara; Michel-Cherqui, Mireille; François Dreyfus, Jean; Fischler, Marc; Le Guen, Morgan

    2017-04-01

    To report the major complications (epidural hematoma and abscess) of postoperative thoracic epidural analgesia in patients who underwent lung surgery. Prospective, monocentric study. A university hospital. All lung surgical patients who received postoperative thoracic epidural analgesia between November 2007 and November 2015. Thoracic epidural analgesia for patients who underwent lung surgery. During the study period, data for 2,907 patients were recorded. The following 3 major complications were encountered: 1 case of epidural hematoma (0.34 case/1,000; 95% confidence interval 0.061-1.946), for which surgery was performed, and 2 cases of epidural abscesses (0.68 case/1,000; 95% confidence interval 0.189-2.505), which were treated medically. The risk range of serious complications was moderate; only the patient who experienced an epidural hematoma also experienced permanent sequelae. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. The predictive value of three-dimensional Doppler ultrasonography in determining implantation in patients underwent in vitro fertilization

    Directory of Open Access Journals (Sweden)

    Yusuf Çakmak

    2015-12-01

    Full Text Available Objective: The aim of this study is to evaluate the relationship between endometrial and sub-endometrial blood flow and implantation rate in patients whose undergone in vitro fertilization. Methods: A prospective study was conducted. Long protocol and antagonist regimens were administered to the patients. Endometrial and sub-endometrial blood flow was evaluated by using 3 dimensional Doppler ultrasonography on the day of oocyt retrieval measurement. For comparison pregnant and non-pregnant women in terms of endometrial and sub-endometrial blood flow, t test was used. The p value was considered statistically meaningful as 0.05. In long protocol group, the number of embryo was greater in pregnant women than non-pregnant women (p=0.012. The number of transferred embryo increased pregnancy rate almost 3.5 fold (p=0.002. Conclusion: The endometrial and subendometrial blood flow is not reliable factor in prediction pregnancy or implantation.

  4. A prospective study on the risk of contrast induced nephropathy in the patients who underwent contrast-enhanced CT examination

    International Nuclear Information System (INIS)

    Zhang Baocui; Zhang Yudong; Zhao Kai; Wang Xiaoying; Jiang Xuexiang

    2013-01-01

    Objective: To investigate the incidence of contrast induced nephropathy (CIN) among different patient groups after contrast agent injection. Methods: A total of 1243 patients were included in this study (male = 694, female = 549). The SCr level one week before and 72 hours after the CT examination and the incidence of CIN were recorded and comparison was made among groups according to sex, age, body mass index (BMI), the history of high blood pressure (HBP), diabetes mellitus (DM), chronic kidney disease (CKD), chronic heart failure (CHF), tumor, nephrotoxicity drug (NTD) usage. The frequency, type, dose and injection velocity of the contrast media (CM) were also recorded. Multivariate predictors of CIN were identified by Logistic regression using step-wise selection with entry and exit criteria of P 1). Conclusion: Women, age ≥ 75 years, LOCM, NTD, tumor, and the frequency of using CM more than once per month were more likely to develop CIN. (authors)

  5. Percentages of NKT cells in the tissues of patients with non-small cell lung cancer who underwent surgical treatment.

    Science.gov (United States)

    Pyszniak, Maria; Rybojad, Paweł; Pogoda, Katarzyna; Jabłonka, Andrzej; Bojarska-Junak, Agnieszka; Tabarkiewicz, Jacek

    2014-03-01

    Natural killer T (NKT) cells are involved in the antitumor response by direct cytotoxicity and indirectly through activation of effector cells. Recent studies have shown a relationship between the number and function of NKT cells and clinical outcomes. NKT cells seem to represent a promising tool for immunotherapy of cancer. The aim of the study was to evaluate the distribution of NKT cells in peripheral blood, lymph nodes and tumor tissue of non-small cell lung cancer (NSCLC) patients, as well as development of the most efficient set of cytokines stimulating differentiation of NKT cells. We evaluated the percentage of iNKT+CD3+ cells in the tissues collected from patients with NSCLC. For the generation of NKT cells, we cultured cells isolated from the blood of 20 healthy donors and from the tissues of 4 NSCLC patients. Cells were stimulated with α-GalCer in combinations with cytokines. We noted significant differences in the percentages of NKT cells in the patients' tissues. The highest percentage of these cells was observed in the tumor tissue and the lowest in the lymph nodes. In vitro, in healthy donors all α-GalCer-cytokine combinations were effective in stimulation of NKT cells' proliferation. NKT cells' proliferation was the most efficiently stimulated by α-GalCer+IL-2+IL-7 and α-GalCer+IL-2+IFN-γ. Our results suggest that in the course of NSCLC, NKT cells migrate to the primary tumor and accumulate therein. All tested combinations of α-GalCer and cytokines were capable of generation of NKT cells in vitro.

  6. Decreased Oxidative Stress in Male Patients with Active Phase Ankylosing Spondylitis Who Underwent Whole-Body Cryotherapy in Closed Cryochamber

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    Agata Stanek

    2018-01-01

    Full Text Available Objective. The aim of the study was to estimate the impact of whole body cryotherapy (WBC on oxidative stress when performed in a closed cryochamber on patients with ankylosing spondylitis (AS. Material and methods. The effect of ten WBC procedures lasting 3 minutes a day with a subsequent 60-minute session kinesiotherapy on oxidative stress in male AS patients (WBC group n=16 was investigated. To assess the disease activity, the Bath Ankylosing Spondylitis Diseases Activity Index (BASDAI and Bath Ankylosing Spondylitis Functional Index (BASFI were calculated. The WBC group was compared to the kinesiotherapy only (KT; n=16 group. The routine parameters of oxidative stress (antioxidant enzymatic and nonenzymatic antioxidant status, lipid peroxidation products, total oxidative status (TOS, and oxidative stress index (OSI were estimated one day before the beginning and one day after the completion of the research program. Results. After the completion of the treatment in the WBC group, a significant decrease of oxidative stress markers (TOS and OSI and a significant increase of total antioxidant status were observed. The erythrocyte activity of glutathione peroxidase, glutathione reductase decreased significantly in both groups, but the differences of activity of that enzymes prior to post treatment values (Δ in the KT group were significantly higher as compared to the WBC group. The activity of erythrocyte catalase and plasma ZnCu isoenzyme of superoxide dismutase showed a decreased tendency; erythrocyte total superoxide dismutase activity showed an increased tendency in the WBC group after the completion of the treatment. The BASDAI and BASFI decreased significantly in both groups, but the differences of value indexes prior to post treatment (Δ were significantly higher in the WBC than KT group. Conclusion. WBC performed in a closed cryochamber decreases oxidative stress and improves BASDAI and BASFI indexes in male patients during the active

  7. SU-E-T-548: How To Decrease Spine Dose In Patients Who Underwent Sterotactic Spine Radiosurgery?

    International Nuclear Information System (INIS)

    Acar, H; Altinok, A; Kucukmorkoc, E; Kucuk, N; Caglar, H

    2014-01-01

    Purpose: Stereotactic radiosurgery for spine metastases involves irradiation using a single high dose fraction. The purpose of this study was to dosimetrically compare stereotactic spine radiosurgery(SRS) plans using a recently new volumetric modulated arc therapy(VMAT) technique against fix-field intensity-modulated radiotherapy(IMRT). Plans were evaluated for target conformity and spinal cord sparing. Methods: Fifteen previously treated patients were replanned using the Eclipse 10.1 TPS AAA calculation algorithm. IMRT plans with 7 fields were generated. The arc plans used 2 full arc configurations. Arc and IMRT plans were normalized and prescribed to deliver 16.0 Gy in a single fraction to 90% of the planning target volume(PTV). PTVs consisted of the vertebral body expanded by 3mm, excluding the PRV-cord, where the cord was expanded by 2mm.RTOG 0631 recommendations were applied for treatment planning. Partial spinal cord volume was defined as 5mm above and below the radiosurgery target volume. Plans were compared for conformity and gradient index as well as spinal cord sparing. Results: The conformity index values of fifteen patients for two different treatment planning techniques were shown in table 1. Conformity index values for 2 full arc planning (average CI=0.84) were higher than that of IMRT planning (average CI=0.79). The gradient index values of fifteen patients for two different treatment planning techniques were shown in table 2. Gradient index values for 2 full arc planning (average GI=3.58) were higher than that of IMRT planning (average GI=2.82).The spinal cord doses of fifteen patients for two different treatment planning techniques were shown in table 3. D0.35cc, D0.03cc and partial spinal cord D10% values in 2 full arc plannings (average D0.35cc=819.3cGy, D0.03cc=965.4cGy, 10%partial spinal=718.1cGy) were lower than IMRT plannings (average D0.35cc=877.4cGy, D0.03c=1071.4cGy, 10%partial spinal=805.1cGy). Conclusions: The two arc VMAT technique is

  8. Comparative study of short-term cardiovascular autonomic control in cardiac surgery patients who underwent coronary artery bypass grafting or correction of valvular heart disease.

    Science.gov (United States)

    Shvartz, Vladimir A; Kiselev, Anton R; Karavaev, Anatoly S; Vulf, Kristina A; Borovkova, Ekaterina I; Prokhorov, Mikhail D; Petrosyan, Andrey D; Bockeria, Olga L

    2018-01-01

    Introduction: Our aim was to perform a comparative study of short-term cardiovascular autonomic control in cardiac surgery patients who underwent coronary artery bypass grafting (CABG) or surgical correction of valvular heart disease (SCVHD ). Methods: The synchronous 15 minutes records of heart rate variability (HRV) and finger's photoplethysmographic waveform variability (PPGV) were performed in 42 cardiac surgery patients (12 women) aged 61.8 ± 8.6 years (mean ± standard deviation), who underwent CABG, and 36 patients (16 women) aged 54.2 ± 14.9 years, who underwent SCVHD , before surgery and in 5-7 days after surgery. Conventional time and frequency domain measures of HRV and index S of synchronization between the slow oscillations in PPGV and HRV were analyzed. We also calculated personal dynamics of these indices after surgery. Results: We found no differences ( Р > 0.05) in all studied autonomic indices (preoperative and post-surgery) between studied patients' groups, except for the preoperative heart rate, which was higher in patients who underwent SCVHD ( P = 0.013). We have shown a pronounced preoperative and post-surgery variability (magnitude of inter-quartile ranges) of all autonomic indices in studied patients. In the cluster analysis based on cardiovascular autonomic indices (preoperative and post-surgery), we divided all patients into two clusters (38 and 40 subjects) which did not differ in all clinical characteristics (except for the preoperative hematocrit, P = 0.038), index S, and all post-surgery HRV indices. First cluster (38 patients) had higher preoperative values of the HR, TP, HF, and HF%, and lower preoperative values of the LF% and LF/HF. Conclusion: The variability of cardiovascular autonomic indices in on-pump cardiac surgery patients (two characteristic clusters were identified based on preoperative indices) was not associated with their clinical characteristics and features of surgical procedure (including cardioplegia).

  9. Gender-linked impact of epicardial adipose tissue volume in patients who underwent coronary artery bypass graft surgery or non-coronary valve surgery

    OpenAIRE

    Maimaituxun, Gulinu; Shimabukuro, Michio; Salim, Hotimah Masdan; Tabata, Minoru; Yuji, Daisuke; Morimoto, Yoshihisa; Akasaka, Takeshi; Matsuura, Tomomi; Yagi, Shusuke; Fukuda, Daiju; Yamada, Hirotsugu; Soeki, Takeshi; Sugimoto, Takaki; Tanaka, Masashi; Takanashi, Shuichiro

    2017-01-01

    Background Traditional and non-traditional risk factors for atherosclerotic cardiovascular disease (ASCVD) are different between men and women. Gender-linked impact of epicardial adipose tissue volume (EATV) in patients undergoing coronary artery bypass grafting (CABG) remains unknown. Methods Gender-linked impact of EATV, abdominal fat distribution and other traditional ASCVD risk factors were compared in 172 patients (men: 115; women: 57) who underwent CABG or non-coronary valvular surgery ...

  10. Increased cartilage volume after injection of hyaluronic acid in osteoarthritis knee patients who underwent high tibial osteotomy.

    Science.gov (United States)

    Chareancholvanich, Keerati; Pornrattanamaneewong, Chaturong; Narkbunnam, Rapeepat

    2014-06-01

    High tibial osteotomy (HTO) is a surgical procedure used to correct abnormal mechanical loading of the knee joint; additionally, intra-articular hyaluronic acid injections have been shown to restore the viscoelastic properties of synovial fluid and balance abnormal biochemical processes. It was hypothesized that combining HTO with intra-articular hyaluronic acid injections would have benefit to improve the cartilage volume of knee joints. Forty patients with medial compartment knee osteoarthritis (OA) were randomly placed into 1 of 2 groups. The study group (n = 20) received 2 cycles (at 6-month intervals) of 5 weekly intra-articular hyaluronic acid injections after HTO operation. The control group (n = 20) did not receive any intra-articular injections after HTO surgery. Cartilage volume (primary outcome) was assessed by magnetic resonance imaging (MRI) pre-operatively and 1 year post-operatively. Treatment efficacy (secondary outcomes) was evaluated with the Western Ontario and McMaster Universities OA Index (WOMAC) and by the comparison of the total rescue medication (paracetamol/diclofenac) used (weeks 6, 12, 24, 48). MRI studies showed a significant increase in total cartilage volume (p = 0.033), lateral femoral cartilage volume (p = 0.044) and lateral tibial cartilage volume (p = 0.027) in the study group. Cartilage volume loss was detected at the lateral tibial plateau in the control group. There were significant improvements after surgery in both groups for all subscales of WOMAC scores (p hyaluronic acid injections may be beneficial for increasing total cartilage volume and preventing the loss of lateral tibiofemoral joint cartilage after HTO. Therapeutic study, Level I.

  11. Comparison of PSA value at last follow-up of patients who underwent low-dose rate brachytherapy and intensity-modulated radiation therapy for prostate cancer.

    Science.gov (United States)

    Tanaka, Nobumichi; Asakawa, Isao; Nakai, Yasushi; Miyake, Makito; Anai, Satoshi; Fujii, Tomomi; Hasegawa, Masatoshi; Konishi, Noboru; Fujimoto, Kiyohide

    2017-08-25

    To compare the PSA value at the last follow-up of patients who underwent prostate low-dose rate brachytherapy (LDR-BT) with that of patients who underwent intensity-modulated radiation therapy (IMRT). A total of 610 prostate cancer patients (cT1c-3bN0M0) were enrolled, and 445 of them underwent LDR-BT, while 165 received IMRT (74-76 Gy). The median follow-up period of these two groups was 75 months (LDR-BT) and 78 months (IMRT), respectively. We also evaluated the biochemical recurrence (BCR)-free rate using two definitions (Phoenix definition and PSA ≥ 0.2 ng/mL). The percentage of patients who achieved PSA LDR-BT group and 49.7% in the IMRT group (p LDR-BT group and 32.1% in the IMRT group (p LDR-BT groups was 89.5 and 95.0% (p LDR-BT groups, respectively (p LDR-BT was significantly lower than that of IMRT, and this result was particularly marked in patients with a normal testosterone level at the last follow-up.

  12. Effect of preinfarction angina pectoris on long-term survival in patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention.

    Science.gov (United States)

    Taniguchi, Tomohiko; Shiomi, Hiroki; Toyota, Toshiaki; Morimoto, Takeshi; Akao, Masaharu; Nakatsuma, Kenji; Ono, Koh; Makiyama, Takeru; Shizuta, Satoshi; Furukawa, Yutaka; Nakagawa, Yoshihisa; Ando, Kenji; Kadota, Kazushige; Horie, Minoru; Kimura, Takeshi

    2014-10-15

    The influence of preinfarction angina pectoris (AP) on long-term clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) remains controversial. In 5,429 patients with acute myocardial infarction (AMI) enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto AMI Registry, the present study population consisted of 3,476 patients with STEMI who underwent primary PCI within 24 hours of symptom onset and in whom the data on preinfarction AP were available. Preinfarction AP defined as AP occurring within 48 hours of hospital arrival was present in 675 patients (19.4%). Patients with preinfarction AP was younger and more often had anterior AMI and longer total ischemic time, whereas they less often had history of heart failure, atrial fibrillation, and shock presentation. The infarct size estimated by peak creatinine phosphokinase was significantly smaller in patients with than in patients without preinfarction AP (median [interquartile range] 2,141 [965 to 3,867] IU/L vs 2,462 [1,257 to 4,495] IU/L, p <0.001). The cumulative 5-year incidence of death was significantly lower in patients with preinfarction AP (12.4% vs 20.7%, p <0.001) with median follow-up interval of 1,845 days. After adjusting for confounders, preinfarction AP was independently associated with a lower risk for death (hazard ratio 0.69, 95% confidence interval 0.54 to 0.86, p = 0.001). The lower risk for 5-year mortality in patients with preinfarction AP was consistently observed across subgroups stratified by total ischemic time, initial Thrombolysis In Myocardial Infarction flow grade, hemodynamic status, infarct location, and diabetes mellitus. In conclusion, preinfarction AP was independently associated with lower 5-year mortality in patients with STEMI who underwent primary PCI. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Impact of high-density lipoprotein 3 cholesterol subfraction on periprocedural myocardial injury in patients who underwent elective percutaneous coronary intervention.

    Science.gov (United States)

    Harada, Kazuhiro; Kikuchi, Ryosuke; Suzuki, Susumu; Tanaka, Akihito; Aoki, Toshijiro; Iwakawa, Naoki; Kojima, Hiroki; Hirayama, Kenshi; Mitsuda, Takayuki; Sumi, Takuya; Negishi, Yosuke; Ishii, Hideki; Murohara, Toyoaki

    2018-02-02

    Periprocedural myocardial injury (PMI) is a major complication of percutaneous coronary intervention (PCI) and is associated with atherosclerotic coronary plaque and worse clinical outcomes. High-density lipoprotein cholesterol (HDL-C) is a protective factor for cardiovascular disease. However, the role of HDL-C subfractions, such as HDL2 cholesterol (HDL2-C) or HDL3 cholesterol (HDL3-C), in cardiovascular disease remains unclear. The purpose of the study was to investigate the relationship between HDL2-C and HDL3-C subfractions and the incidence of PMI in patients who underwent elective PCI. We enrolled 129 patients who underwent elective PCI for stable angina pectoris. PMI was defined as an increase in high-sensitivity troponin T levels > 5 times the upper normal limit (> 0.070 ng/mL) at 24 h after PCI. Serum HDL-C subfractions (HDL2-C and HDL3-C) were assessed using ultracentrifugation in patients with and those without PMI. HDL3-C levels were significantly lower in patients with PMI than in those without (15.1 ± 3.0 mg/dL vs. 16.4 ± 2.9 mg/dL, p = 0.016) and had an independent and inverse association with PMI (odds ratio, 0.86; 95% confidence interval, 0.74-0.99; p = 0.038). When divided by the cut-off value of HDL3-C for PMI (14.3 mg/dL), the incidence of PMI was significantly higher in low HDL3-C patients than in high HDL3-C patients (51.2% vs. 30.2%, p = 0.020). HDL3-C was an independent inverse predictor of PMI in patients who underwent elective PCI.

  14. Assessing the cardiology community position on transradial intervention and the use of bivalirudin in patients with acute coronary syndrome undergoing invasive management: results of an EAPCI survey.

    Science.gov (United States)

    Adamo, Marianna; Byrne, Robert A; Baumbach, Andreas; Haude, Michael; Windecker, Stephan; Valgimigli, Marco

    2016-10-20

    Our aim was to report on a survey initiated by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) collecting the opinion of the cardiology community on the invasive management of acute coronary syndrome (ACS), before and after the MATRIX trial presentation at the American College of Cardiology (ACC) 2015 Scientific Sessions. A web-based survey was distributed to all individuals registered on the EuroIntervention mailing list (n=15,200). A total of 572 and 763 physicians responded to the pre- and post-ACC survey, respectively. The radial approach emerged as the preferable access site for ACS patients undergoing invasive management with roughly every other responder interpreting the evidence for mortality benefit as definitive and calling for a guidelines upgrade to class I. The most frequently preferred anticoagulant in ACS patients remains unfractionated heparin (UFH), due to higher costs and greater perceived thrombotic risks associated with bivalirudin. However, more than a quarter of participants declared the use of bivalirudin would increase after MATRIX. The MATRIX trial reinforced the evidence for a causal association between bleeding and mortality and triggered consensus on the superiority of the radial versus femoral approach. The belief that bivalirudin mitigates bleeding risk is common, but UFH still remains the preferred anticoagulant based on lower costs and thrombotic risks.

  15. Retrospective, Demographic, and Clinical Investigation of the Causes of Postoperative Infection in Patients With Lumbar Spinal Stenosis Who Underwent Posterior Stabilization.

    Science.gov (United States)

    Yaldiz, Can; Yaldiz, Mahizer; Ceylan, Nehir; Kacira, Ozlem Kitiki; Ceylan, Davut; Kacira, Tibet; Kizilcay, Gokhan; Tanriverdi, Taner

    2015-07-01

    Owing to the increasing population of elderly patients, a large number of patients with degenerative spondylosis are currently being surgically treated. Although basic measures for decreasing postoperative surgical infections (PSIs) are considered, it still remains among the leading causes of morbidity and mortality. The aim of this retrospective analysis is to present possible causes leading to PSI in patients who underwent surgery for lumbar degenerative spondylosis and highlight how it can be avoided to decrease morbidity and mortality. The study included 540 patients who underwent posterior stabilization due to degenerative lumbar stenosis between January 2013 and January 2014. The data before and after surgery was retrieved from the hospital charts. Patients with degenerative lumbar stenosis who were operated upon in this study had >2 levels of laminectomy and facetectomy. For this reason, posterior stabilization was performed for all the patients included in this study. Determining the causes of postoperative infection (PI) following spinal surgeries performed with instrumentation is a struggle. Seventeen different parameters that may be related to PI were evaluated in this study. The presence of systemic diseases, unknown glove perforations, and perioperative blood transfusions were among the parameters that increased the prevalence of PI. Alternatively, prolene sutures, double-layered gloves, and the use of rifampicin Sv (RIS) decreased the incidence of PI. Although the presence of systemic diseases, unnoticed glove perforations, and perioperative blood transfusions increased PIs, prolene suture material, double-layered gloves, and the use of RIS decreased PIs.

  16. The SmartHand transradial prosthesis

    Directory of Open Access Journals (Sweden)

    Carrozza Maria Chiara

    2011-05-01

    Full Text Available Abstract Background Prosthetic components and control interfaces for upper limb amputees have barely changed in the past 40 years. Many transradial prostheses have been developed in the past, nonetheless most of them would be inappropriate if/when a large bandwidth human-machine interface for control and perception would be available, due to either their limited (or inexistent sensorization or limited dexterity. SmartHand tackles this issue as is meant to be clinically experimented in amputees employing different neuro-interfaces, in order to investigate their effectiveness. This paper presents the design and on bench evaluation of the SmartHand. Methods SmartHand design was bio-inspired in terms of its physical appearance, kinematics, sensorization, and its multilevel control system. Underactuated fingers and differential mechanisms were designed and exploited in order to fit all mechatronic components in the size and weight of a natural human hand. Its sensory system was designed with the aim of delivering significant afferent information to the user through adequate interfaces. Results SmartHand is a five fingered self-contained robotic hand, with 16 degrees of freedom, actuated by 4 motors. It integrates a bio-inspired sensory system composed of 40 proprioceptive and exteroceptive sensors and a customized embedded controller both employed for implementing automatic grasp control and for potentially delivering sensory feedback to the amputee. It is able to perform everyday grasps, count and independently point the index. The weight (530 g and speed (closing time: 1.5 seconds are comparable to actual commercial prostheses. It is able to lift a 10 kg suitcase; slippage tests showed that within particular friction and geometric conditions the hand is able to stably grasp up to 3.6 kg cylindrical objects. Conclusions Due to its unique embedded features and human-size, the SmartHand holds the promise to be experimentally fitted on transradial

  17. The importance of superficial basal cell carcinoma in a retrospective study of 139 patients who underwent Mohs micrographic surgery in a Brazilian university hospital

    Directory of Open Access Journals (Sweden)

    Luciana Takata Pontes

    2015-11-01

    Full Text Available OBJECTIVE: Mohs micrographic surgery is a specialized surgical procedure used to treat skin cancer. The purpose of this study was to better understand the profile of the patients who underwent the procedure and to determine how histology might be related to complications and the number of stages required for complete removal. METHODS: The records of patients who underwent Mohs micrographic surgery from October 2008 to November 2013 at the Dermatology Division of the Hospital of the Campinas University were assessed. The variables included were gender, age, anatomical location, histology, number of stages required and complications. RESULTS: Contingency tables were used to compare the number of stages with the histological diagnosis. The analysis showed that patients with superficial basal cell carcinoma were 9.03 times more likely to require more than one stage. A comparison between complications and histological diagnosis showed that patients with superficial basal cell carcinoma were 6.5 times more likely to experience complications. CONCLUSION: Although superficial basal cell carcinoma is typically thought to represent a less-aggressive variant of these tumors, its propensity for demonstrating “skip areas” and clinically indistinct borders make it a challenge to treat. Its particular nature may result in the higher number of surgery stages required, which may, as a consequence, result in more complications, including recurrence. Recurrence likely occurs due to the inadequate excision of the tumors despite their clear margins. Further research on this subtype of basal cell carcinoma is needed to optimize treatments and decrease morbidity.

  18. Association of Blood Fatty Acid Composition and Dietary Pattern with the Risk of Non-Alcoholic Fatty Liver Disease in Patients Who Underwent Cholecystectomy.

    Science.gov (United States)

    Shim, Poyoung; Choi, Dongho; Park, Yongsoon

    2017-01-01

    The relationship between diet and non-alcoholic fatty liver disease (NAFLD) in patients with gallstone disease and in those who have a high risk for NAFLD has not been investigated. This study was conducted to investigate the association between the risk of NAFLD and dietary pattern in patients who underwent cholecystectomy. Additionally, we assessed the association between erythrocyte fatty acid composition, a marker for diet, and the risk of NAFLD. Patients (n = 139) underwent liver ultrasonography to determine the presence of NAFLD before laparoscopic cholecystectomy, reported dietary intake using food frequency questionnaire, and were assessed for blood fatty acid composition. Fifty-eight patients were diagnosed with NAFLD. The risk of NAFLD was negatively associated with 2 dietary patterns: consuming whole grain and legumes and consuming fish, vegetables, and fruit. NAFLD was positively associated with the consumption of refined grain, meat, processed meat, and fried foods. Additionally, the risk of NAFLD was positively associated with erythrocyte levels of 16:0 and 18:2t, while it was negatively associated with 20:5n3, 22:5n3, and Omega-3 Index. The risk of NAFLD was negatively associated with a healthy dietary pattern of consuming whole grains, legumes, vegetables, fish, and fruit and with an erythrocyte level of n-3 polyunsaturated fatty acids rich in fish. © 2017 S. Karger AG, Basel.

  19. A New Risk Factor Profile for Contrast-Induced Acute Kidney Injury in Patients Who Underwent an Emergency Percutaneous Coronary Intervention.

    Science.gov (United States)

    Yuan, Ying; Qiu, Hong; Song, Lei; Hu, Xiaoying; Luo, Tong; Zhao, Xueyan; Zhang, Jun; Wu, Yuan; Qiao, Shubin; Yang, Yuejin; Gao, Runlin

    2018-07-01

    We developed a new risk factor profile for contrast-induced acute kidney injury (CI-AKI) under a new definition in patients who underwent an emergency percutaneous coronary intervention (PCI). Consecutive patients (n = 1061) who underwent an emergency PCI were divided into a derivation group (n = 761) and a validation group (n = 300). The rates of CI-AKI were 23.5% (definition 1: serum creatinine [SCr] increase ≥25% in 72 hours), 4.3% (definition 2: SCr increase ≥44.2 μmol/L in 72 hours), and 7.0% (definition 3: SCr increase ≥44.2 μmol/L in 7 days). Due to the high sensitivity of definition 1 and the high rate of missed cases for late diagnosis of CI-AKI under definition 2, definition 3 was used in the study. The risk factor profile included body surface area 15.00 × 10 9 /L ( P = .047), estimated glomerular filtration rate 133 μmol/L ( P = .007), intra-aortic balloon pump application ( P = .006), and diuretics administration ( P risk factor profile of CI-AKI under a new CI-AKI definition in emergency PCI patients is easily applicable with a useful predictive value.

  20. The preoperative plasma fibrinogen level is an independent prognostic factor for overall survival of breast cancer patients who underwent surgical treatment.

    Science.gov (United States)

    Wen, Jiahuai; Yang, Yanning; Ye, Feng; Huang, Xiaojia; Li, Shuaijie; Wang, Qiong; Xie, Xiaoming

    2015-12-01

    Previous studies have suggested that plasma fibrinogen contributes to tumor cell proliferation, progression and metastasis. The current study was performed to evaluate the prognostic relevance of preoperative plasma fibrinogen in breast cancer patients. Data of 2073 consecutive breast cancer patients, who underwent surgery between January 2002 and December 2008 at the Sun Yat-sen University Cancer Center, were retrospectively evaluated. Plasma fibrinogen levels were routinely measured before surgeries. Participants were grouped by the cutoff value estimated by the receiver operating characteristic (ROC) curve analysis. Overall survival (OS) was assessed using Kaplan-Meier analysis, and multivariate Cox proportional hazards regression model was performed to evaluate the independent prognostic value of plasma fibrinogen level. The optimal cutoff value of preoperative plasma fibrinogen was determined to be 2.83 g/L. The Kaplan-Meier analysis showed that patients with high fibrinogen levels had shorter OS than patients with low fibrinogen levels (p factor for OS in breast cancer patients (HR = 1.475, 95% confidence interval (CI): 1.177-1.848, p = 0.001). Subgroup analyses revealed that plasma fibrinogen level was an unfavorable prognostic parameter in stage II-III, Luminal subtypes and triple-negative breast cancer patients. Elevated preoperative plasma fibrinogen was independently associated with poor prognosis in breast cancer patients and may serve as a valuable parameter for risk assessment in breast cancer patients. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  1. Improved predictive value of GRACE risk score combined with platelet reactivity for 1-year cardiovascular risk in patients with acute coronary syndrome who underwent coronary stent implantation.

    Science.gov (United States)

    Li, Shan; Liu, Hongbin; Liu, Jianfeng; Wang, Haijun

    2016-11-01

    Both high platelet reactivity (HPR) and Global Registry of Acute Coronary Events (GRACE) risk score have moderate predictive value for major adverse cardiovascular disease (CVD) events in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI), whereas the prognostic significance of GRACE risk score combined with platelet function testing remains unclear. A total of 596 patients with non-ST elevation ACS who underwent PCI were enrolled. The P2Y 12 reaction unit (PRU) value was measured by VerifyNow P2Y 12 assay and GRACE score was calculated by GRACE risk 2.0 calculator. Patients were stratified by a pre-specified cutoff value of PRU 230 and GRACE score 140 to assess 1-year risk of cardiovascular death, non-fatal myocardial infarction (MI), and stent thrombosis. Seventy-two (12.1%) patients developed CVD events during 1-year follow-up. Patients with CVD events had a higher PRU value (244.6 ± 50.9 vs. 203.7 ± 52.0, p risk independently. Compared to patients with normal platelet reactivity (NPR) and GRACE score risk (HR: 5.048; 95% CI: 2.268-11.237; p risk score yielded superior risk predictive capacity beyond GRACE score alone, which is shown by improved c-statistic value (0.871, p = 0.002) as well as net reclassification improvement (NRI 0.263, p risk of adverse CVD events. The combination of platelet function testing and GRACE score predicted 1-year CVD risk better.

  2. Prognostic significance of nuclear factor of activated T-cells 5 expression in non-small cell lung cancer patients who underwent surgical resection.

    Science.gov (United States)

    Cho, Hyun Jin; Yun, Hwan-Jung; Yang, Hee Chul; Kim, Soo Jin; Kang, Shin Kwang; Che, Chengri; Lee, Sang Do; Kang, Min-Woong

    2018-06-01

    Nuclear factor of activated T-cells 5 (NFAT5) is known to be correlated with migration or invasion of tumor cells based on previous in vitro studies. The aim of this study was to analyze the relationship between NFAT5 expression and clinical prognosis in non-small cell lung cancer (NSCLC) patients who underwent surgical resection. A total of 92 NSCLC patients who underwent surgical resection were enrolled. The tissue microarray core was obtained from surgically resected tumor specimens. NFAT5 expression was evaluated by immunohistochemistry. Relationships of NFAT5 expression with disease recurrence, overall survival, and disease-free survival (DFS) were analyzed. The mean age of 92 patients was 63.7 y. The median follow-up duration was 63.3 mo. Fifty-one (55%) patients exhibited positive expression of NFAT5. Disease recurrence in the NFAT5-positive group was significantly (P = 0.022) higher than that in the NFAT5-negative group. NFAT5-positive expression (odds ratio: 2.632, 95% confidence interval: 1.071-6.465, P = 0.035) and pathologic N stage (N1-2 versus N0; odds ratio: 3.174, 95% confidence interval: 1.241-8.123, P = 0.016) were independent and significant risk factors for disease recurrence. DFS of the NFAT5-positive group was significantly worse than that of the NFAT5-negative group (89.7 versus 48.7 mo, P = 0.011). A multivariate analysis identified NFAT5 expression (P < 0.029) as a significant independent risk factor for DFS of patients with postoperative pathologic T and N stages (P < 0.001 and P = 0.017, respectively). NFAT5 expression is a useful prognostic biomarker for NSCLC patients who underwent surgical resection. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. Accuracy of MDCT in the preoperative definition of Peritoneal Cancer Index (PCI) in patients with advanced ovarian cancer who underwent peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC).

    Science.gov (United States)

    Mazzei, Maria Antonietta; Khader, Leila; Cirigliano, Alfredo; Cioffi Squitieri, Nevada; Guerrini, Susanna; Forzoni, Beatrice; Marrelli, Daniele; Roviello, Franco; Mazzei, Francesco Giuseppe; Volterrani, Luca

    2013-12-01

    To evaluate the accuracy of MDCT in the preoperative definition of Peritoneal Cancer Index (PCI) in patients with advanced ovarian cancer who underwent a peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) after neoadjuvant chemotherapy to obtain a pre-surgery prognostic evaluation and a prediction of optimal cytoreduction surgery. Pre-HIPEC CT examinations of 43 patients with advanced ovarian cancer after neoadjuvant chemotherapy were analyzed by two radiologists. The PCI was scored according to the Sugarbaker classification, based on lesion size and distribution. The results were compared with macroscopic and histologic data after peritonectomy and HIPEC. To evaluate the accuracy of MDCT to detect and localize peritoneal carcinomatosis, both patient-level and regional-level analyses were conducted. A correlation between PCI CT and histologic values for each patient was searched according to the PCI grading. Considering the patient-level analysis, CT shows a sensitivity, specificity, PPV, NPV, and an accuracy in detecting the peritoneal carcinomatosis of 100 %, 40 %, 93 % 100 %, and 93 %, respectively. Considering the regional level analysis, a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 72 %, 80 %, 66 %, 84 %, and 77 %, respectively were obtained for the correlation between CT and histology. Our results encourage the use of MDCT as the only technique sufficient to select patients with peritoneal carcinomatosis for cytoreductive surgery and HIPEC on the condition that a CT examination will be performed using a dedicated protocol optimized to detect minimal peritoneal disease and CT images will be analyzed by an experienced reader.

  4. Recursive partition analysis of peritoneal and systemic recurrence in patients with gastric cancer who underwent D2 gastrectomy: Implications for neoadjuvant therapy consideration.

    Science.gov (United States)

    Chang, Jee Suk; Kim, Kyung Hwan; Keum, Ki Chang; Noh, Sung Hoon; Lim, Joon Seok; Kim, Hyo Song; Rha, Sun Young; Lee, Yong Chan; Hyung, Woo Jin; Koom, Woong Sub

    2016-12-01

    To classify patients with nonmetastatic advanced gastric cancer who underwent D2-gastrectomy into prognostic groups based on peritoneal and systemic recurrence risks. Between 2004 and 2007, 1,090 patients with T3-4 or N+ gastric cancer were identified from our registry. Recurrence rates were estimated using a competing-risk analysis. Different prognostic groups were defined using recursive partitioning analysis (RPA). Median follow-up was 7 years. In the RPA-model for peritoneal recurrence risk, the initial node was split by T stage, indicating that differences between patients with T1-3 and T4 cancer were the greatest. The 5-year peritoneal recurrence rates for patients with T4 (n = 627) and T1-3 (n = 463) disease were 34.3% and 9.1%, respectively. N stage and neural invasion had an additive impact on high-risk patients. The RPA model for systemic relapse incorporated N stage alone and gave two terminal nodes: N0-2 (n = 721) and N3 (n = 369). The 5-year cumulative incidences were 7.7% and 24.5%, respectively. We proposed risk stratification models of peritoneal and systemic recurrence in patients undergoing D2-gastrectomy. This classification could be used for stratification protocols in future studies evaluating adjuvant therapies such as preoperative chemoradiotherapy. J. Surg. Oncol. 2016;114:859-864. © 2016 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  5. A controlled clinical study of serosa-invasive gastric carcinoma patients who underwent surgery plus intraperitoneal hyperthermo-chemo-perfusion (IHCP).

    Science.gov (United States)

    Kim, J Y; Bae, H S

    2001-01-01

    Despite recent advances in the treatment of advanced gastric carcinomas, no satisfactory outcomes are available because of micrometastases and free-floating carcinoma cells already existing in the peritoneal cavity. From 1990, we started using intraperitoneal hyperthermo-chemo-perfusion (IHCP) to prevent and to treat peritoneal metastasis after surgical resection of stomach cancer. We analyzed 103 serosa-invasive gastric carcinoma patients who underwent surgical resection between 1990 and 1995. Fifty-two patients who received surgery plus IHCP were compared with 51 patients who underwent surgery only, as controls. IHCP was administered for 2 h with an automatic IHCP device (closed-circuit system) just after surgical resection, with the patient under hypothermic general anesthesia (32.4 degrees C-34.0 degrees C). As perfusate, we used 1.5% peritoneal dialysis solution mixed with 10 micrograms/ml of mitomycin-C (MMC), warmed at an inflow temperature of over 44 degrees C. The overall 5-year survival rate (5-YSR) of the 103 patients was 29.97%. The 5-YSR was higher in the IHCP group than in the control group, at 32.7% and 27.1%, respectively, but this difference was not significant. However, in the 65 serosa-invasive gastric carcinoma patients (excluding those in stage IV) the 5-YSR was significantly higher (P = 0.0379) in the IHCP group than in the control group, at 58.6% and 44.4%, respectively. On multivariate analysis of all 103 patients, depth of tumor invasion and lymph node metastasis were significant factors for survival, whereas significant factors on univariate analysis, such as combined operation, distant metastasis, and peritoneal metastasis, were not significant. The most common recurrence patterns were loco-regional in the IHCP group and peritoneal in the control group. Complete cytoreductive surgery plus IHCP is effective to prevent and to treat peritoneal metastasis, and it should lead to long-term survival for serosa-invasive gastric carcinoma patients

  6. A Case Series of Patients Who Underwent Laparoscopic Extraperitoneal Radical Prostatectomy with the Simultaneous Implant of a Penile Prosthesis: Focus on Penile Length Preservation

    Science.gov (United States)

    2018-01-01

    Purpose There are many grey areas in the field of penile rehabilitation after radical prostatectomy (RP). The preservation of the full dimensions of the penis is an important consideration for improving patients' compliance for the treatment. We present the first case series of patients treated by laparoscopic extraperitoneal RP and simultaneous penile prosthesis implantation (PPI) in order to preserve the full length of the penis and to improve patients' satisfaction. Materials and Methods From June 2013 to June 2014, 10 patients underwent simultaneous PPI (with an AMS InhibiZone prosthesis) and RP. Patients were evaluated by means of urological visits, questionnaires, and objective measurements before surgery, at discharge from the hospital, on postoperative days 21 to 28, each 3 months for the first year, and each 6 months thereafter. The main outcome measures were biochemical recurrence-free rate, penile length, and quality of life. Results Ten patients (mean age of 61 years; completed the study follow-up period (median, 32.2 months). No difference was found between the time of surgery and the 2-year follow-up evaluation in terms of penile length. The pre-surgery 36-Item Short Form Health Survey (SF-36) median score was 97. Patients were satisfied with their penile implants, and couples' level of sexual satisfaction was rated median 8. The median postoperative SF-36 score was 99 at 3 months follow-up. Conclusions Laparoscopic extraperitoneal RP surgery with simultaneous PPI placement seems to be an interesting possibility to propose to motivated patients for preserving the length of the penis and improving their satisfaction. PMID:29623695

  7. Evaluation of late redislocation in patients who underwent open reduction and pelvic osteotomy as treament for developmental dysplasia of the hip.

    Science.gov (United States)

    Tuhanioğlu, Ümit; Cicek, Hakan; Ogur, Hasan U; Seyfettinoglu, Firat; Kapukaya, Ahmet

    2017-10-16

    The goal in the treatment of developmental dysplasia of the hip (DDH) is to achieve a stable and concentric reduction and to create a congruent relationship between the femoral head and the acetabulum. This study discusses the causes of loss of reduction in DDH patients who had a concentrically reduced hip at the time of removal of the hip spica cast and cessation of brace use and who later appeared with hip redislocation after mobilisation and ambulation. In addition, the possible interventions in such cases are also discussed. A retrospective evaluation was made of 13 patients diagnosed with DDH who developed redislocation following primary surgery. 6 of them had undergone the 1st surgery in our department between 2008 and 2016 and 7 had udergone surgery in another centre. For comparison reasons a 2nd group was formed of 13 demographically and clinically matched patients who had no loss of reduction. The groups were compared in terms of acetabular index, pelvic length, pelvic width, abduction degree of plaster, ossifying nucleus diameter, acetabular depth, and acetabular volume parameters. The average age of the patients was 23 months at initial surgery and 29 months at the time of revision surgery. No significant difference was found between the groups in terms of acetabular inclination angle, ossifying nucleus diameter, pelvic size, pelvic width, centre edge angle, acetabular volume, and depth. Contracted inferomedial capsule was found in 1 patient who underwent revision surgery and intact transverse acetabular ligament was seen in 1 patient. The loss of reduction in the remaining 11 patients was associated with high total anteversion of the femoral head and acetabulum. Correction of increased combined anteversion by femoral osteotomy can create a safe zone in terms of redislocation and can significantly contribute to the stability provided by capsulorrhaphy and pelvic osteotomy.

  8. Improved image quality in abdominal CT in patients who underwent treatment for hepatocellular carcinoma with small metal implants using a raw data-based metal artifact reduction algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Sofue, Keitaro; Sugimura, Kazuro [Kobe University Graduate School of Medicine, Department of Radiology, Kobe, Hyogo (Japan); Yoshikawa, Takeshi; Ohno, Yoshiharu [Kobe University Graduate School of Medicine, Advanced Biomedical Imaging Research Center, Kobe, Hyogo (Japan); Kobe University Graduate School of Medicine, Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe, Hyogo (Japan); Negi, Noriyuki [Kobe University Hospital, Division of Radiology, Kobe, Hyogo (Japan); Inokawa, Hiroyasu; Sugihara, Naoki [Toshiba Medical Systems Corporation, Otawara, Tochigi (Japan)

    2017-07-15

    To determine the value of a raw data-based metal artifact reduction (SEMAR) algorithm for image quality improvement in abdominal CT for patients with small metal implants. Fifty-eight patients with small metal implants (3-15 mm in size) who underwent treatment for hepatocellular carcinoma were imaged with CT. CT data were reconstructed by filtered back projection with and without SEMAR algorithm in axial and coronal planes. To evaluate metal artefact reduction, mean CT number (HU and SD) and artefact index (AI) values within the liver were calculated. Two readers independently evaluated image quality of the liver and pancreas and visualization of vasculature using a 5-point visual score. HU and AI values and image quality on images with and without SEMAR were compared using the paired Student's t-test and Wilcoxon signed rank test. Interobserver agreement was evaluated using linear-weighted κ test. Mean HU and AI on images with SEMAR was significantly lower than those without SEMAR (P < 0.0001). Liver and pancreas image qualities and visualizations of vasculature were significantly improved on CT with SEMAR (P < 0.0001) with substantial or almost perfect agreement (0.62 ≤ κ ≤ 0.83). SEMAR can improve image quality in abdominal CT in patients with small metal implants by reducing metallic artefacts. (orig.)

  9. Improved image quality in abdominal CT in patients who underwent treatment for hepatocellular carcinoma with small metal implants using a raw data-based metal artifact reduction algorithm

    International Nuclear Information System (INIS)

    Sofue, Keitaro; Sugimura, Kazuro; Yoshikawa, Takeshi; Ohno, Yoshiharu; Negi, Noriyuki; Inokawa, Hiroyasu; Sugihara, Naoki

    2017-01-01

    To determine the value of a raw data-based metal artifact reduction (SEMAR) algorithm for image quality improvement in abdominal CT for patients with small metal implants. Fifty-eight patients with small metal implants (3-15 mm in size) who underwent treatment for hepatocellular carcinoma were imaged with CT. CT data were reconstructed by filtered back projection with and without SEMAR algorithm in axial and coronal planes. To evaluate metal artefact reduction, mean CT number (HU and SD) and artefact index (AI) values within the liver were calculated. Two readers independently evaluated image quality of the liver and pancreas and visualization of vasculature using a 5-point visual score. HU and AI values and image quality on images with and without SEMAR were compared using the paired Student's t-test and Wilcoxon signed rank test. Interobserver agreement was evaluated using linear-weighted κ test. Mean HU and AI on images with SEMAR was significantly lower than those without SEMAR (P < 0.0001). Liver and pancreas image qualities and visualizations of vasculature were significantly improved on CT with SEMAR (P < 0.0001) with substantial or almost perfect agreement (0.62 ≤ κ ≤ 0.83). SEMAR can improve image quality in abdominal CT in patients with small metal implants by reducing metallic artefacts. (orig.)

  10. Changes in neurotic personality profile associated with reduction of suicidal ideation in patients who underwent psychotherapy in the day hospital for the treatment of neurotic and behavioral disorders.

    Science.gov (United States)

    Rodziński, Paweł; Rutkowski, Krzysztof; Sobański, Jerzy A; Mielimąka, Michał; Murzyn, Agnieszka; Cyranka, Katarzyna; Dembińska, Edyta; Grządziel, Karolina; Klasa, Katarzyna; Müldner-Nieckowski, Łukasz; Smiatek-Mazgaj, Bogna

    2015-01-01

    Analysis of associations between changes in neurotic personality profile and reductionof suicidal ideation (SI) - or lack of such reduction - defined as its elimination or reduction of its intensity in patients who underwent a course of intensive psychotherapy conducted in integrative approach with predominance of psychodynamic approach. Symptom Checklist KO"O", Neurotic Personality Questionnaire KON-2006 and Life Inventory completed by 461 women and 219 men treated due to neurotic, behavioral or personality disorders in a day hospital between 2005-2013. During the qualification for the therapy 134 women and 80 men reported SI, of whom 84.3% and 77.5% respectively improved. Patients who improved in terms of SI obtained significantly greater reduction of global neurotic personality disintegration (neuroticism) than others (ppsychotherapy as a treatment method that leads to comprehensive improvement encompassing reduction of neurotic personality disorders (neuroticism) and of majority of neurotic personality traits, as well as SI reduction. The revealed associations weigh in favor of hypothesis on neuroticism as SI predisposing factor in patients with neurotic, behavioral and personality disorders.

  11. Morphological and functional consequences of transradial coronary angiography on the radial artery: implications for its use as a bypass conduit.

    Science.gov (United States)

    Gaudino, Mario; Leone, Alessandro; Lupascu, Andrea; Toesca, Amelia; Mazza, Andrea; Ponziani, Francesca Romana; Flore, Roberto; Tondi, Paolo; Massetti, Massimo

    2015-09-01

    To assess the degree of damage to the radial artery (RA) in coronary artery bypass grafting (CABG) patients who underwent preoperative transradial coronary angiography (RA-CA). From May 2012 to October 2013, 50 consecutive CABG patients who underwent RA-CA were prospectively enrolled in the study. All patients underwent echo-Doppler evaluation of the RA of the catheterized arm; the contralateral RA was used as control. The distal segment of the RA was submitted to immunohistochemical assessment of endothelial integrity. Patients were divided in three groups according to the time interval from angiography to evaluation: ≤24 h, >24 h to <7 days and ≥7 days. Baseline RA median diameters were 0.25 ± 0.04 cm in the cannulated arm and 0.22 ± 0.04 cm in the non-cannulated arm (P = 0.01). The flow-mediated dilatation (FMD) in the RA in the catheterized arm and in the control arm were 11.6 ± 7.9 and 14.2 ± 8.9 (P = 0.01), respectively. A statistically significant correlation was found between FMD of the catheterized RA and the time from RA-CA (Pearson's r = 0.348). Linear regression analysis confirmed that the FMD of the catheterized RA was dependent on days elapsed from the procedure (P = 0.032; OR 1.11, CI 0.009-0.203). Immunohistochemical evaluation showed extensive endothelial lesion in all examined RAs, with a trend towards reduction of the damage with time. Endothelial function and integrity of the cannulated arm did not reach those of the control arm in any of the study patients. RA-CA produces extensive damage to the RA. The lesions tend to heal with time but incomplete recovery of endothelial integrity and function is still present more than 30 days after the procedure. After RA-CA, the cannulated RA should not be used for CABG. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  12. Evaluation of long-term results and quality of life in patients who underwent rib fixation with titanium devices after trauma.

    Science.gov (United States)

    Billè, Andrea; Okiror, Lawrence; Campbell, Aideen; Simons, Jason; Routledge, Tom

    2013-06-01

    To describe the long-term results, quality of life and chronic pain after chest wall fixation for traumatic rib fracture using a quality of life (QOL) score and a numeric pain score. Retrospective analysis of 10 consecutive patients who underwent surgery for rib fractures after trauma and reconstruction between October 2010 and March 2012. Chest rib fractures were fixed with titanium clips and bars or titanium plates and screws through a posterolateral thoracotomy. Pain was assessed with a numeric pain scale 0-10 and quality of life (QOL) with the EORTC questionnaire QLQ-C30. There were 5 males and 5 females. The median age was 58 years (range 21-80). There were no postoperative deaths. The only postoperative complication observed was a contralateral pleural effusion requiring drainage. Median length of stay of the drain and median length of hospital stay were 2 days (range 0-8) and 4 days (range 1-42 days), respectively. The average follow-up period of operatively managed patients was 14 months (range 8-23.5 months). Seven patients scored the pain as 0, one as 1 (mild), one as 4 (moderate) and one as 8 (severe). Only two patients are taking occasionally pain killers. Only one patient presents severe limitation in his life scoring his QOL as poor. Titanium devices (clips and bars; screws and plates) are effective and safe for repair of rib fractures and showed good long-term results in terms of pain and quality of life after the operation.

  13. Improved image quality in abdominal CT in patients who underwent treatment for hepatocellular carcinoma with small metal implants using a raw data-based metal artifact reduction algorithm.

    Science.gov (United States)

    Sofue, Keitaro; Yoshikawa, Takeshi; Ohno, Yoshiharu; Negi, Noriyuki; Inokawa, Hiroyasu; Sugihara, Naoki; Sugimura, Kazuro

    2017-07-01

    To determine the value of a raw data-based metal artifact reduction (SEMAR) algorithm for image quality improvement in abdominal CT for patients with small metal implants. Fifty-eight patients with small metal implants (3-15 mm in size) who underwent treatment for hepatocellular carcinoma were imaged with CT. CT data were reconstructed by filtered back projection with and without SEMAR algorithm in axial and coronal planes. To evaluate metal artefact reduction, mean CT number (HU and SD) and artefact index (AI) values within the liver were calculated. Two readers independently evaluated image quality of the liver and pancreas and visualization of vasculature using a 5-point visual score. HU and AI values and image quality on images with and without SEMAR were compared using the paired Student's t-test and Wilcoxon signed rank test. Interobserver agreement was evaluated using linear-weighted κ test. Mean HU and AI on images with SEMAR was significantly lower than those without SEMAR (P small metal implants by reducing metallic artefacts. • SEMAR algorithm significantly reduces metallic artefacts from small implants in abdominal CT. • SEMAR can improve image quality of the liver in dynamic CECT. • Confidence visualization of hepatic vascular anatomies can also be improved by SEMAR.

  14. In vitro fertilization surrogate pregnancy in a patient who underwent radical hysterectomy followed by ovarian transposition, lower abdominal wall radiotherapy, and chemotherapy.

    Science.gov (United States)

    Steigrad, Stephen; Hacker, Neville F; Kolb, Bradford

    2005-05-01

    To describe an IVF surrogate pregnancy from a patient who had a radical hysterectomy followed by excision of a laparoscopic port site implantation with ovarian transposition followed by abdominal wall irradiation and chemotherapy, which resulted in premature ovarian failure from which there was partial recovery. Case report. Tertiary referral university women's hospital in Sydney, Australia and private reproductive medicine clinic in California. A 34-year-old woman who underwent laparoscopy for pelvic pain, shortly afterward followed by radical hysterectomy and pelvic lymph node dissection, who subsequently developed a laparoscopic port site recurrence, which was excised in association with ovarian transposition before abdominal wall irradiation and chemotherapy. Modified IVF treatment, transabdominal oocyte retrieval, embryo cryopreservation in Australia, and transfer to a surrogate mother in the United States. Pregnancy. Miscarriage in the second cycle and a twin pregnancy in the fourth cycle. This is the first case report of ovarian stimulation and oocyte retrieval performed on transposed ovaries after a patient developed premature ovarian failure after radiotherapy and chemotherapy with subsequent partial ovarian recovery.

  15. Diagnosis of accessory conduction pathway using ECG-gated emission CT analysis. Studies in patients with WPW syndrome who underwent surgery

    Energy Technology Data Exchange (ETDEWEB)

    Misaki, Takuro; Mukai, Keiichi; Tsubota, Makoto; Iwa, Takashi; Nakajima, Ken-ichi; Hisada, Kin-ichi

    1987-09-01

    Pinpointing the location of accessory conduction pathway (ACP) is of great importance in the surgical treatment for Wolff-Parkinson-White (WPW) syndrome. For this purpose, this study explored the usefulness of ECG-gated emission computed tomography (Gated-ECT) in 30 patients who preoperatively underwent Gated-ECT. The site of earliest contraction at level of atrioventicular valves, obtained on tomographic phase analysis, was compared with the site of earliest activation, obtained on epicardial mapping during surgery. The concordance rate of the two methods was 94 % (28/30). Among them, one patient was found to have the association of corrected transposition of great arteries on Gated-ECT. Gated-ECT was, however, of limited value in differentiating right posterior ACP from right postseptal ACP. The discordance between the sites of earliest contraction and activation, which was observed in the two others, was likely due to decreased wall motion resulting from myocardial disturbance. Gated-ECT may have a diagnostic potential for the location of ACP, especially in view of providing images that corresponded to the surgical anatomy. (Namekawa, K.).

  16. Effect of right ventricular electrode location (outflow tract vs. apex) on mechanical Ventricular synchrony in patients that underwent pacemaker implant therapy

    International Nuclear Information System (INIS)

    Rincon, Oscar S; Saenz, Luis C; Salazar, Gabriel; Hernandez, Edgar

    2008-01-01

    Objective: to assess in depth the effect of ventricular stimulation from the right ventricular outflow tract and the apex on mechanical ventricular synchrony. Materials And Methods: cohort analytical study. 20 patients with indication of definitive pacemaker indication underwent trans thoracic echocardiogram before and after pacemaker implant with electrode implantation in the right ventricular outflow tract and in the apex (10 patients in each group). There was no structural cardiopathy, ejection fraction was ? 50%, QRS and AV conduction were normal. Mechanical ventricular asynchrony (M mode and tissue doppler) and implant and device parameters were evaluated. Statistical Analysis: results are given as mean values, standard deviation or percentages.Continuous variables were compared using Chi-square test and ANOVA. A p <0.05 value was considered statistically significant. Results: in five patients (25%) a pre-implant ventricular asynchrony was found; in seven (70%) ventricular asynchrony post-implant in the right ventricle outflow tract and in 5 (50%) in the apex. Mean interventricular pot-implant delay was 21,6 ms in the right ventricular outflow tract and 11,5 ms in the apex (p = 0,8); mean septal to lateral wall delay was 73 ms in the right ventricular outflow tract and 26 ms in the apex (p = 0,8). QRS post-implant delay was 134 ms in the right ventricular outflow tract and 140 ms in the apex (p = 0,1). No differences between implant parameters and device programming were found. Conclusions: presence of ventricular asynchrony was evidenced in patients with normal QRS and structurally healthy heart. Ventricular stimulation with pacemaker from the apex or the right ventricular outflow tract suggests acute ventricular asynchrony at least in 60% of the cases, without statistically significant difference between both groups.

  17. Changes in blood glucose level during and after light sedations using propofol-fentanyl and midazolam-fentanyl in diabetic patients who underwent cataract surgery.

    Science.gov (United States)

    Khalighinejad, Pooyan; Rahimi, Mojtaba; Naghibi, Khosro; Niknam, Negar

    2015-01-01

    Surgeries may trigger the stress response which leads to changes in blood glucose level, and studies suggest that different sedation and anesthesia methods have different effects on blood glucose level. The aim of this study was to investigate changes of blood glucose levels in diabetic patients and compare them in two sedation methods of propofol + fentanyl and midazolam + fentanyl. Totally, 80 diabetic candidates for cataract surgery who had all the inclusion criteria, underwent cataract surgery using two methods of propofol (1 mg/kg/h) + fentanyl (2 μg/kg) (Group P) and midazolam (0.03 mg/kg) + fentanyl (2 μg/kg) (Group M) for light sedation. In the end, 70 patients (Group P n = 35 and Group M n = 35) remained in the study. Patients' blood glucose levels, vital signs, and hemodynamic data were assessed 30 min prior to the surgery, each 15 min during surgery and at the end of surgery. Hemodynamic parameters did not have a statistically significant difference between the two groups mean blood glucose level in Group M was 149.15 mg/dl and in Group P was 149.2 mg/dl, and based on repeated measures analysis of variance test, significant differences were not observed between the two groups (P = 0.99). T-test showed no significant differences in the blood glucose level at any time of the study between the two groups. Light sedation methods of propofol + fentanyl and midazolam + fentanyl did not have any differences in alteration of blood glucose level.

  18. The Effect of Two Different Hand Exercises on Grip Strength, Forearm Circumference, and Vascular Maturation in Patients Who Underwent Arteriovenous Fistula Surgery

    Science.gov (United States)

    Kong, Sangwon; Lee, Kyung Soo; Kim, Junho

    2014-01-01

    Objective To compare the effect of two different hand exercises on hand strength and vascular maturation in patients who underwent arteriovenous fistula surgery. Methods We recruited 18 patients who had chronic kidney disease and had undergone arteriovenous fistula surgery for hemodialysis. After the surgery, 10 subjects performed hand-squeezing exercise with GD Grip, and other 8 subjects used Soft Ball. The subjects continued the exercises for 4 weeks. The hand grip strength, pinch strength (tip, palmar and lateral pinch), and forearm circumference of the subjects were assessed before and after the hand-squeezing exercise. The cephalic vein size, blood flow velocity and volume were also measured by ultrasonography in the operated limb. Results All of the 3 types of pinch strengths, grip strength, and forearm circumference were significantly increased in the group using GD Grip. Cephalic vein size and blood flow volume were also significantly increased. However, blood flow velocity showed no difference after the exercise. The group using Soft Ball showed a significant increase in the tip and lateral pinch strength and forearm circumference. The cephalic vein size and blood flow volume were also significantly increased. On comparing the effect of the two different hand exercises, hand-squeezing exercise with GD Grip had a significantly better effect on the tip and palmar pinch strength than hand-squeezing exercise with Soft Ball. The effect on cephalic vein size was not significantly different between the two groups. Conclusion The results showed that hand squeezing exercise with GD Grip was more effective in increasing the tip and palmar pinch strength compared to hand squeezing exercise with soft ball. PMID:25379494

  19. Gender-linked impact of epicardial adipose tissue volume in patients who underwent coronary artery bypass graft surgery or non-coronary valve surgery.

    Directory of Open Access Journals (Sweden)

    Gulinu Maimaituxun

    Full Text Available Traditional and non-traditional risk factors for atherosclerotic cardiovascular disease (ASCVD are different between men and women. Gender-linked impact of epicardial adipose tissue volume (EATV in patients undergoing coronary artery bypass grafting (CABG remains unknown.Gender-linked impact of EATV, abdominal fat distribution and other traditional ASCVD risk factors were compared in 172 patients (men: 115; women: 57 who underwent CABG or non-coronary valvular surgery (non-CABG.In men, EATV, EATV index (EATV/body surface area and the markers of adiposity such as body mass index, waist circumference and visceral fat area were higher in the CABG group than in the non-CABG group. Traditional ASCVD risk factors were also prevalent in the CABG group. In women, EATV and EATV index were higher in the CABG group, but other adiposity markers were comparable between CABG and non-CABG groups. Multivariate logistic regression analysis showed that in men, CABG was determined by EATV Index and other ASCVD risk factors including hypertension, dyslipidemia, adiponectin, high sensitive C-reactive protein (hsCRP and type 2 diabetes mellitus (Corrected R2 = 0.262, p < 0.0001, while in women, type 2 diabetes mellitus is a single strong predictor for CABG, excluding EATV Index (Corrected R2 = 0.266, p = 0.005.Our study found that multiple risk factors, including epicardial adipose tissue volume and traditional ASCVD factors are determinants for CABG in men, but type 2 diabetes mellitus was the sole determinant in women. Gender-specific disparities in risk factors of CABG prompt us to evaluate new diagnostic and treatment strategies and to seek underlying mechanisms.

  20. Gender-linked impact of epicardial adipose tissue volume in patients who underwent coronary artery bypass graft surgery or non-coronary valve surgery.

    Science.gov (United States)

    Maimaituxun, Gulinu; Shimabukuro, Michio; Salim, Hotimah Masdan; Tabata, Minoru; Yuji, Daisuke; Morimoto, Yoshihisa; Akasaka, Takeshi; Matsuura, Tomomi; Yagi, Shusuke; Fukuda, Daiju; Yamada, Hirotsugu; Soeki, Takeshi; Sugimoto, Takaki; Tanaka, Masashi; Takanashi, Shuichiro; Sata, Masataka

    2017-01-01

    Traditional and non-traditional risk factors for atherosclerotic cardiovascular disease (ASCVD) are different between men and women. Gender-linked impact of epicardial adipose tissue volume (EATV) in patients undergoing coronary artery bypass grafting (CABG) remains unknown. Gender-linked impact of EATV, abdominal fat distribution and other traditional ASCVD risk factors were compared in 172 patients (men: 115; women: 57) who underwent CABG or non-coronary valvular surgery (non-CABG). In men, EATV, EATV index (EATV/body surface area) and the markers of adiposity such as body mass index, waist circumference and visceral fat area were higher in the CABG group than in the non-CABG group. Traditional ASCVD risk factors were also prevalent in the CABG group. In women, EATV and EATV index were higher in the CABG group, but other adiposity markers were comparable between CABG and non-CABG groups. Multivariate logistic regression analysis showed that in men, CABG was determined by EATV Index and other ASCVD risk factors including hypertension, dyslipidemia, adiponectin, high sensitive C-reactive protein (hsCRP) and type 2 diabetes mellitus (Corrected R2 = 0.262, p EATV Index (Corrected R2 = 0.266, p = 0.005). Our study found that multiple risk factors, including epicardial adipose tissue volume and traditional ASCVD factors are determinants for CABG in men, but type 2 diabetes mellitus was the sole determinant in women. Gender-specific disparities in risk factors of CABG prompt us to evaluate new diagnostic and treatment strategies and to seek underlying mechanisms.

  1. Use of orbital atherectomy in acute myocardial infarction via the transradial approach

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    Mowakeaa, Samer; Snyder, Branden; Kakouros, Nikolaos

    2016-01-01

    Severe coronary artery calcifications pose an ongoing challenge when performing percutaneous coronary interventions, resulting in an increased likelihood of procedural complications. Orbital atherectomy (OA) has emerged as a promising technology that helps improve outcomes in this complex patient population. Its safety and efficacy are yet to be demonstrated in the setting of acute myocardial infarction. We present a case of a patient with acute ST-elevation myocardial infarction (STEMI) evaluated with emergent transradial coronary angiography. The culprit lesion was a severely stenotic, heavily calcified, segment of the right coronary artery. The use of OA facilitated lesion expansion and implantation of a drug-eluting stent. Although OA should be considered as contraindicated for the management of soft-ruptured plaque, which accounts for the majority of STEMI presentations, it may be well applied to the small subset of patients with calcified nodule pathology, even in the acute setting. PMID:28180008

  2. KRAS Mutant Status, p16 and β-catenin Expression May Predict Local Recurrence in Patients Who Underwent Transanal Endoscopic Microsurgery (TEMS) for Stage I Rectal Cancer.

    Science.gov (United States)

    Sideris, Michail; Moorhead, Jane; Diaz-Cano, Salvador; Bjarnason, Ingvar; Haji, Amyn; Papagrigoriadis, Savvas

    2016-10-01

    Transanal endoscopic microsurgery (TEMS) is emerging as an alternative treatment for rectal cancer Stage I. There remains a risk of local recurrence. The Aim of the study was to study the effect of biomarkers in local recurrence for Stage I rectal cancer following TEMS plus or minus radiotherapy. This is a case control study where we compared 10 early rectal cancers that had recurred, against 19 cases with no recurrence, total 29 patients (age=28.25-86.87, mean age=67.92 years, SD=14.91, Male, N=18, Female, N=11). All patients underwent TEMS for radiological Stage I rectal cancer (yT1N0M0 or yT2N0M0) established with combination of magnetic resonance imaging (MRI) and endorectal ultrasound. We prospectively collected all data on tumour histology, morphological features, as well as follow-up parameters. Molecular analysis was performed to identify their status on BRAF, KRAS, p16 O 6 -methylguanine-DNA methyltransferase (MGMT) and β-catenin. Out of 29 specimens analyzed, 19 were KRAS wild type (65.9%) and 10 mutant (34.5%). Recurrence of the tumour was noted in 10 cases (34.5%) from which 60% were pT1 (N=6) and 40% pT2 (N=4). There was a statistically significant association between KRAS mutant status and local recurrence (N=6, p=0.037). P16 expression greater than 5% (mean=10.8%, min=0, max=95) is linked with earlier recurrence within 11.70 months (N=7, p=0.004). Membranous β-catenin expression (N=12, 48%) was also related with KRAS mutant status (p=0.006) but not with survival (p>0.05). BRAF gene was found to be wild type in all cases tested (N=23). KRAS/p16/β-catenin could be used as a combined biomarker for prediction of local recurrence and stratification of the risk for further surgery. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  3. Current practice of transradial approach for coronary procedures: A survey by the Italian Society of Interventional Cardiology (SICI-GISE) and the Italian Radial Club

    International Nuclear Information System (INIS)

    Rigattieri, Stefano; Valsecchi, Orazio; Sciahbasi, Alessandro; Tomassini, Francesco; Limbruno, Ugo; Marchese, Alfredo; La Manna, Alessio; Mauro, Ciro; Varbella, Ferdinando; Berti, Segio; Tarantino, Fabio F.; Musumeci, Giuseppe

    2017-01-01

    Background: Transradial approach (TRA) for percutaneous coronary procedures is associated with improved patient outcome and is being increasingly adopted worldwide. We surveyed Italian interventional cardiologists in order to take a snapshot of the current practice of TRA. Methods: A web-based questionnaire was emailed to all members of the Italian Society of Interventional Cardiology. Results: The survey was taken by 508 respondents. Cardiogenic shock and chronic total occlusions represented the principal limitations to TRA. Right TRA was the default approach for 81% of respondents. Both diagnostic and interventional procedures were routinely performed through 6 Fr sheaths (83% and 93%, respectively); dedicated TRA curves were used in 11% of diagnostic and in about 3% of interventional procedures. Almost 70% of the operators did not assess dual hand circulation. In case of crossover, the contralateral radial artery was the preferred site (57%). Radial artery hemostasis was mostly achieved by pneumatic bracelet (64%) and patency of the radial artery during hemostasis was ensured in 60% of cases. Pre-discharge patency of the radial artery was routinely assessed by almost 60% of respondents. For diagnostic procedures, adequate heparin anticoagulation (5000 IU) was only given by 45% of operators. Most respondents believed that TRA is associated with greater radiation exposure for both the patient (82%) and the operator (98%) as compared to transfemoral approach. Conclusions: This survey provides contemporary data about the adoption of TRA in Italy and gives interesting insights about several technical and clinical issues related to the practice of this vascular approach for coronary procedures. - Highlights: • Transradial approach for coronary procedures is becoming increasingly popular. • We conducted a survey on the contemporary practice of transradial approach in Italy. • We appraised several clinical and technical issues related to transradial approach.

  4. Current practice of transradial approach for coronary procedures: A survey by the Italian Society of Interventional Cardiology (SICI-GISE) and the Italian Radial Club

    Energy Technology Data Exchange (ETDEWEB)

    Rigattieri, Stefano, E-mail: stefanorigattieri@yahoo.it [Interventional Cardiology Unit, Sandro Pertini Hospital, Roma (Italy); Valsecchi, Orazio [Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo (Italy); Sciahbasi, Alessandro [Interventional Cardiology Unit, Sandro Pertini Hospital, Roma (Italy); Tomassini, Francesco [Cardiology Department, Ospedale degli Infermi, Rivoli (Italy); Limbruno, Ugo [Cardiology Unit, Azienda USL Toscana Sudest, Grosseto (Italy); Marchese, Alfredo [Interventional Cardiology Unit, Anthea Hospital, GVM Care & Research, Bari (Italy); La Manna, Alessio [Cardiovascular Department, Ferrarotto Hospital, University of Catania (Italy); Mauro, Ciro [Cardiovascular Department, Cardarelli Hospital, Napoli (Italy); Varbella, Ferdinando [Cardiology Department, Ospedale degli Infermi, Rivoli (Italy); Berti, Segio [Department of Cardiology, Fondazione Toscana “Gabriele Monasterio”, Ospedale del Cuore, Massa (Italy); Tarantino, Fabio F. [Cardiology Unit, Ospedale G.B. Morgagni-L. Pierantoni, Forlì (Italy); Musumeci, Giuseppe [Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo (Italy)

    2017-04-15

    Background: Transradial approach (TRA) for percutaneous coronary procedures is associated with improved patient outcome and is being increasingly adopted worldwide. We surveyed Italian interventional cardiologists in order to take a snapshot of the current practice of TRA. Methods: A web-based questionnaire was emailed to all members of the Italian Society of Interventional Cardiology. Results: The survey was taken by 508 respondents. Cardiogenic shock and chronic total occlusions represented the principal limitations to TRA. Right TRA was the default approach for 81% of respondents. Both diagnostic and interventional procedures were routinely performed through 6 Fr sheaths (83% and 93%, respectively); dedicated TRA curves were used in 11% of diagnostic and in about 3% of interventional procedures. Almost 70% of the operators did not assess dual hand circulation. In case of crossover, the contralateral radial artery was the preferred site (57%). Radial artery hemostasis was mostly achieved by pneumatic bracelet (64%) and patency of the radial artery during hemostasis was ensured in 60% of cases. Pre-discharge patency of the radial artery was routinely assessed by almost 60% of respondents. For diagnostic procedures, adequate heparin anticoagulation (5000 IU) was only given by 45% of operators. Most respondents believed that TRA is associated with greater radiation exposure for both the patient (82%) and the operator (98%) as compared to transfemoral approach. Conclusions: This survey provides contemporary data about the adoption of TRA in Italy and gives interesting insights about several technical and clinical issues related to the practice of this vascular approach for coronary procedures. - Highlights: • Transradial approach for coronary procedures is becoming increasingly popular. • We conducted a survey on the contemporary practice of transradial approach in Italy. • We appraised several clinical and technical issues related to transradial approach.

  5. Usefulness and safety of a guide catheter extension system for the percutaneous treatment of complex coronary lesions by a transradial approach.

    Science.gov (United States)

    García-Blas, Sergio; Núñez, Julio; Mainar, Luis; Miñana, Gema; Bonanad, Clara; Racugno, Paolo; Rodríguez, Juan Carlos; Moyano, Patricia; Sanchis, Juan

    2015-01-01

    The aim of this study was to describe our initial experience with the GuideLiner® catheter (Vascular Solutions Inc.) in the transradial treatment of complex lesions. The clinical, angiographic and procedural data of percutaneous coronary interventions where GuideLiner was used during 2013 were collected. The transradial approach was used in all cases. The indication for its use, efficacy and periprocedural complications were determined. Sixteen consecutive procedures (in 15 patients; 12 males and 3 females) were evaluated. The indication for the use of GuideLiner was a difficulty to advance and properly position a stent through a tortuous and/or calcified artery despite using high-support guide catheters or other useful techniques. Of the 16 angiographic procedures, 14 (87.5%) were successful (stent deployment in 13 cases and a drug-eluting balloon in 1 case). Unsuccessful cases were a chronic total occlusion and a diffusely diseased left anterior descendant artery. A type B dissection of a proximal left circumflex artery was the only periprocedural complication. Use of the GuideLiner was an effective and safe technique for the percutaneous treatment of complex coronary lesions in which the adequate progress of angioplasty devices had failed. GuideLiner was particularly helpful when using the transradial approach. Only one minor complication was recorded. © 2014 S. Karger AG, Basel.

  6. Demographic And Technical Risk Factors Of 30-Day Stroke, Myocardial Infarction, And/Or Death In Standard And High Risk Patients Who Underwent Carotid Angioplasty And Stenting

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    Samaneh Yousefi

    2017-02-01

    Full Text Available Background: Carotid angioplasty and stenting (CAS is an accepted treatment to prevent stroke in patients with carotid artery stenosis. The purpose of this study is to identify risk factors for major complications after carotid angioplasty and stenting. Methods and Material: This is a prospective study conducted at Shiraz University of Medical Sciences in southern Iran from March 2011 to June 2014. Consecutive patients undergoing carotid angioplasty and stenting were enrolled. Both standard risk and high risk patients for endarterectomy were enrolled. Demographic data, atherosclerotic risk factors, site of stenosis, degree of stenosis, and data regarding technical factors were recorded. 30-day stroke, myocardial infarction, and/or death were considered as the composite primary outcome of the study. Results:  two hundred and fifty one patients were recruited (mean age: 71.1+ 9.6 years, male: 65.3%.  One hundred and seventy eight (70.9% patients were symptomatic; 73 (29.1%, 129 (51.4%, 165 (65.7% and 62 (24.7% patients were diabetic, hyperlipidemic, hypertensive and smoker respectively. CAS performed for left ICA in 113 (45.4% patients. 14 (5.6% patients had Sequential bilateral stenting. Mean stenosis of operated ICA was 80.2 +13.8 %. Embolic protection device was used in 203 (96.2% patients. Predilation and post-dilation were performed in 39 (18.5% and 182 (86.3% patients respectively. Composite outcome was observed in 3.6% (3.2% stroke, 0% myocardial infarction and 1.2% death. Left sided lesions and presence of DM was significantly associated with poor short term outcome. (P value: 0.025 and 0.020, respectively Conclusion: There was a higher risk of short term major complications in diabetic patients and left carotid artery intervention.

  7. The Biological Activity of Propolis-Containing Toothpaste on Oral Health Environment in Patients Who Underwent Implant-Supported Prosthodontic Rehabilitation

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    Tadeusz Morawiec

    2013-01-01

    Full Text Available The soft and periodontal tissues surrounding dental implants are particularly susceptible to bacteria invasion and inflammatory reactions due to complex histological structures. This study was carried out to investigate the influence of a propolis-containing hygienic agent on selected oral health parameters, oral microflora, and the condition of periodontal health. Sixteen subjects who underwent an oral rehabilitation with dental implants were selected and randomly assigned into two groups, which received a newly formulated propolis-containing toothpaste (3% (CA or a negative control without an active ingredient (CC. Approximal plaque index (API, oral hygiene index (OHI, debris component, and sulcus bleeding index (SBI were assessed in three subsequent stages. During the first and last examinations, the swabs were employed for microbiological inoculation. Propolis-containing toothpaste was found to be distinctively effective in improving oral health and the occurrence of gingivitis triggered by dental plaque. The qualitative and quantitative changes in oral bacteria spectrum were observed. Antibacterial measures containing propolis might be used as a natural adjuvant to other active substances in individuals with a high risk of periodontal problems against pathogenic oral microflora.

  8. The Prevalence of Risk Factors of Coronary Artery Disease in the Patients who Underwent Coronary Artery Bypass Graft, Shiraz, Iran: Suggesting a Model

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    Mohammad Ali Ostovan

    2014-12-01

    Full Text Available Background: Cardiovascular diseases are the main cause of 40% of deaths in Iran annually. Many patients undergoing coronary artery bypass graft surgery have previous cardiovascular risk factors which could be prevented. Objectives: The present study aimed to assess the prevalence of cardiovascular risk factors in the patients undergoing coronary artery bypass graft surgery. Materials and Methods: In this cross-sectional (descriptive – analytical study, a data collecting form was used. A total of 246 patients were selected from six hospitals of Shiraz using random stratification. Descriptive statistics were presented through figures and tables and t-test was used to analyze the continuous variables. All the statistical analyses were performed using the SPSS statistical software (version 15.0. Besides, P < 0.05 was considered as statistically significant. Results: Among the study patients, only 11.67% had no risk factors and 88.33% had one or more risk factors. The most common risk factors observed in the patients were hypertension, obesity and overweight, hyperlipidemia, and diabetes mellitus. The results showed a significant difference between males and females regarding the prevalence of hypertension (P = 0.001, diabetes (P = 0.028, hypercholesterolemia (P = 0.020, and cigarette smoking (P = 0.001. In addition, the patients' mean levels of cholesterol, LDL, triglyceride, and fasting blood sugar were higher than the acceptable level, while that of HDL was lower than the accepted level. Conclusions:: These patients are recommended to be trained regarding lifestyle changes. Also, prevention strategies can play an important role in reducing patient morbidity and mortality.

  9. Clinical outcomes for T1-2N0-1 oral tongue cancer patients underwent surgery with and without postoperative radiotherapy

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    Choi Eun

    2010-05-01

    Full Text Available Abstract Background The aim of this study was to assess the results of curative surgery with and without radiotherapy in patients with T1-2N0-1 oral tongue squamous cell carcinoma (OSCC and to evaluate survival and prognostic factors. Methods Retrospective analysis of 86 patients with T1-2N0-1 OSCC who received surgery between January 2000 and December 2006. Fourteen patients (16.3% received postoperative radiotherapy (PORT. Patient characteristics, tumor characteristics, treatment modality, failure patterns, and survival rates were analyzed. Results The median follow-up was 45 months. The five-year overall survival (OS and disease-free survival (DFS rates were 80.8% and 80.2%, respectively. Higher tumor grade and invasion depth ≥ 0.5 cm were the significant prognostic factors affecting five-year OS and DFS (OS rate; 65% vs. 91%, p = 0.001 for grade; 66% vs. 92%, p = 0.01 for invasion depth: DFS rate; 69% vs. 88%, p = 0.005 for grade; 66% vs. 92%, p = 0.013 for invasion depth. In the risk group, there was no local failure in patients with postoperative radiotherapy. Conclusions In T1-2N0-1 OSCC, factors that affected prognosis after primary surgery were higher tumor grade and deep invasion depth over 0.5 cm. Postoperative radiotherapy should be considered in early oral tongue cancer patients with these high-risk pathologic features.

  10. Hemoglobin, ferritin, vitamin B12 and helicobacter pylori infection: a study in patients underwent upper GI endoscopy at civil hospital karachi

    International Nuclear Information System (INIS)

    Zuberi, B.F.; Asar, S.; Qadeer, R.; Baloch, I.; Saeed, M.

    2007-01-01

    To compare hemoglobin, ferritin, and vitamin B12 levels in patients undergoing upper GI endoscopy according to their Helicobacter pylori status. All patients undergoing upper GI Endoscopy were selected, while patients of active peptic ulcers, malignancy, varices, malabsorption and recent blood donation were excluded. Blood samples for CBC, serum ferritin and vitamin B12 were collected and H.pylori status was ascertained by urease test on gastric biopsy. Differences in mean values of age, ferritin, hemoglobin, MCV and vitamin B12 were done by students t-test. Significant confounding factors were identified on multivariate analysis and were further analyzed by univariate analysis. Two hundred and eighty-five subjects were studied, including 171 males and 114 females. H-pylori was positive in 214 (75.1%) patients. Significantly low levels of hemoglobin (p =0.0), ferritin (p = 0.0) and vitamin B12 (p = 0.0) were found in patients with H-pylori infection. Gender, menopause, contraception and history of peptic ulcer disease were identified as significant confounders. Significantly low levels of hemoglobin, ferritin and vitamin B12 were found in patients with H-pylori infection. (author)

  11. Clinical outcomes for T1-2N0-1 oral tongue cancer patients underwent surgery with and without postoperative radiotherapy

    International Nuclear Information System (INIS)

    Shim, Su Jung; Cha, Jihye; Koom, Woong Sub; Kim, Gwi Eon; Lee, Chang Geol; Choi, Eun Chang; Keum, Ki Chang

    2010-01-01

    The aim of this study was to assess the results of curative surgery with and without radiotherapy in patients with T 1-2 N 0-1 oral tongue squamous cell carcinoma (OSCC) and to evaluate survival and prognostic factors. Retrospective analysis of 86 patients with T 1-2 N 0-1 OSCC who received surgery between January 2000 and December 2006. Fourteen patients (16.3%) received postoperative radiotherapy (PORT). Patient characteristics, tumor characteristics, treatment modality, failure patterns, and survival rates were analyzed. The median follow-up was 45 months. The five-year overall survival (OS) and disease-free survival (DFS) rates were 80.8% and 80.2%, respectively. Higher tumor grade and invasion depth ≥ 0.5 cm were the significant prognostic factors affecting five-year OS and DFS (OS rate; 65% vs. 91%, p = 0.001 for grade; 66% vs. 92%, p = 0.01 for invasion depth: DFS rate; 69% vs. 88%, p = 0.005 for grade; 66% vs. 92%, p = 0.013 for invasion depth). In the risk group, there was no local failure in patients with postoperative radiotherapy. In T 1-2 N 0-1 OSCC, factors that affected prognosis after primary surgery were higher tumor grade and deep invasion depth over 0.5 cm. Postoperative radiotherapy should be considered in early oral tongue cancer patients with these high-risk pathologic features

  12. FUNCTIONAL STATE OF THE MICROCIRCULATION OF THE SKIN ACCORDING TO LASER DOPPLER FLOWMETRY IN PATIENTS WITH ATRIAL FIBRILLATION WHO UNDERWENT CARDIOEMBOLIC STROKE

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    I. A. Zolotovskaya

    2017-01-01

    Full Text Available Aim. To evaluate the features of blood flow at the level of the microcirculatory bed of the skin (MC in the conditions of comorbid pathology and increased coagulation potential of the blood in patients with atrial fibrillation (AF.Material and methods. The following groups were formed by random sampling: the main (group 1, n=50 group of patients with paroxysmal or persistent form of AF, after cardioembolic stroke. The comparison group (group 2, n=50 consisted of patients with paroxysmal or persistent AF without a history of stroke. The control group (group 3, n=50 – patients comparable on the basic parameters of patients from groups 1 and 2, but without AF and stroke. The plasma levels of von Willebrand factor (vWF, tissue plasminogen activator inhibitor-1 (PAI-1, antithrombin III (AT III and plasminogen were determined. All MC parameters were studied with a single-channel laser cutaneous blood flow analyzer for the general practitioner "LAKK-OP" in the area of the finger pad during the period, when a patient had sinus rhythm.Results. The obtained results indicate the disorders of microcirculation processes in patients with AF after stroke, which are expressed in decrease in tissue perfusion, specific oxygen consumption (I and relative perfusion of the microcirculation saturation (Sm. Significantly higher levels of vWF, PAI-1 and low levels of AT III were observed in patients with AF and stroke than these in the group of patients with AF. It was found that Sm in patients of the group 1 statistically significantly correlated with vWF (r=-0.61; p=0.0032, plasminogen (r=0.45; p=0.0084, PAI-1 (r=-0.43; p=0.0027 and AT III (r=0.49; p=0.0065.Conclusion. The revealed disorders of microcirculatory processes are significantly related with the disturbances of the hemostatic function of the endothelium. From the pathophysiological point of view, that is one of the negative risk factors of the development of recurrent thrombus formation.

  13. How many ELNs are optimal for breast cancer patients with more than three PLNs who underwent MRM? A large population-based study

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    Wang X

    2018-02-01

    Full Text Available Xiaohui Wang,1 Changbin Ji,2 Huiying Chi,3 Haiyong Wang4 1Research Service Office, Shandong Liaocheng People’s Hospital, Liaocheng, China; 2Orthopedics Department, Shandong Liaocheng People’s Hospital, Liaocheng, China; 3Shanghai Geriatrics Institute of Traditional Chinese Medicine, Shanghai, China; 4Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China Background: Few studies have focused on the optimal threshold of examed lymph nodes (ELNs for breast cancer patients with more than three positive lymph nodes after modified radical mastectomy.Materials and methods: The X-tile and the minimum P-value models were applied to determine the optimal threshold. Cox proportional hazard analysis was used to analyze the cancer-specific survival and perform subgroup analysis.Results: The results showed that 12 ELNs was the optimal threshold for these patients, and the patients with >12 ELNs had a better cancer-specific survival benefit compared with the patients with <12 ELNs (P<0.001. Conclusion: The number 12 can be selected as the optimal threshold of ELNs for breast cancer patients with >3 positive lymph nodes after modified radical mastectomy. Keywords: breast cancer, mastectomy, ELNs, positive lymph nodes, X-tile 

  14. CLINICAL CASE OF PERFORMING A TWO-ST AGE LOVER RESECTION BY TYPE ALPPS IN PATIENT WHO PREVIOUSLY UNDERWENT ANATOMIC RESECTION OF THE RIGHT LOBE OF THE LIVER

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    D. V. Sidorov

    2015-01-01

    Full Text Available Abstract:One of the variants for the surgical treatment of patients with bilobal liver metastases is to perform two-stage anatomic resections. Thus, at least in a quarter of the patients it is impossible to perform the second stage of intervention because of absence of hypertrophy of the remaining liver parenchyma or progression of disease during standby. The most modern and promising way of overcoming this obstacle is to perform the so-called ALPPS (Associating Liver Partition and Portal vein Ligation for Staged hepatectomy or «in situ slit» liver resections. In this article we present a clinical case of performing a two-stage hepatectomy by type ALPPS in patients with metastatic colorectal cancer liver, who previously undergone the anatomic bisegmentectomy SVI-SVII. The present observation is the first in the available literature, evidence of justification perform repeated liver resections in patients with metastatic colorectal cancer and demonstrates the possibility of ALPPS techniques when performing extensive anatomical liver resections in patients who have undergone previous removal of the parenchyma of the right lobe.

  15. Determination of auto-antibodies to native and oxidized low-density lipoproteins (LDL) in serum of patients underwent coronariography in the Medical-Surgical Research Center (MSRC)

    International Nuclear Information System (INIS)

    Conde CerdeiraI, Hector; Soto Lopez, Yosdel; Aroche Aportela, Ronald

    2010-01-01

    Low-density lipoprotein (LDL) oxidation is an important event in atherosclerosis development. The relationship between oxidized LDL (oxLDL) autoantibodies and coronary artery disease (CAD) remains controversial. IgM and IgG autoantibodies to oxLDL were measured in twenty patients undergoing clinically indicated coronary angiography, and in ten young healthy volunteers from the Center of Molecular Immunology. The levels of IgM autoantibodies to oxLDL did not differ between no CAD patients and healthy subjects, but the levels of IgM autoantibodies to oxLDL of these two groups were higher compared with the one of CAD patient group. Our results, although preliminary, supports the hypothesis that this kind of Abs might be inversely associated with the presence of atherosclerosis

  16. Predictive value of preoperative tests in estimating difficult intubation in patients who underwent direct laryngoscopy in ear, nose, and throat surgery

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    Osman Karakus

    2015-04-01

    Full Text Available BACKGROUND AND OBJECTIVES: Predictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy (DL were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated. METHODS: Preoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened. RESULTS: A total of 2611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS system Class 4 (50%, Cormack-Lehane classification (CLS Grade 4 (95.7%, previous knowledge of difficult airway (86.2%, restricted neck movements (cervical ROM (75.8%, short thyromental distance (TMD (81.6%, vocal cord mass (49.5% as indicated in parentheses (p < 0.0001. MS had a low sensitivity, while restricted cervical ROM, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in CLS grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases. CONCLUSION: Test results predicting difficult intubations in cases with DL had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation.

  17. [Predictive value of preoperative tests in estimating difficult intubation in patients who underwent direct laryngoscopy in ear, nose, and throat surgery].

    Science.gov (United States)

    Karakus, Osman; Kaya, Cengiz; Ustun, Faik Emre; Koksal, Ersin; Ustun, Yasemin Burcu

    2015-01-01

    Predictive value of preoperative tests in estimating difficult intubation may differ in the laryngeal pathologies. Patients who had undergone direct laryngoscopy (DL) were reviewed, and predictive value of preoperative tests in estimating difficult intubation was investigated. Preoperative, and intraoperative anesthesia record forms, and computerized system of the hospital were screened. A total of 2611 patients were assessed. In 7.4% of the patients, difficult intubations were detected. Difficult intubations were encountered in some of the patients with Mallampati scoring (MS) system Class 4 (50%), Cormack-Lehane classification (CLS) Grade 4 (95.7%), previous knowledge of difficult airway (86.2%), restricted neck movements (cervical ROM) (75.8%), short thyromental distance (TMD) (81.6%), vocal cord mass (49.5%) as indicated in parentheses (p<0.0001). MS had a low sensitivity, while restricted cervical ROM, presence of a vocal cord mass, short thyromental distance, and MS each had a relatively higher positive predictive value. Incidence of difficult intubations increased 6.159 and 1.736-fold with each level of increase in CLS grade and MS class, respectively. When all tests were considered in combination difficult intubation could be classified accurately in 96.3% of the cases. Test results predicting difficult intubations in cases with DL had observedly overlapped with the results provided in the literature for the patient populations in general. Differences in some test results when compared with those of the general population might stem from the concomitant underlying laryngeal pathological conditions in patient populations with difficult intubation. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  18. The Bt-DUX: Development of a subjective measure of health-related quality of life in patients who underwent surgery for lower extremity malignant bone tumor

    NARCIS (Netherlands)

    W.P. Bekkering (Peter); T.P.M. Vliet Vlieland (Theodora); H.M. Koopman (Hendrik); G.R. Schaap (Gerard); H.W.B. Schreuder; A. Beishuizen (Auke); W.J.E. Tissing (Wim); P.M. Hoogerbrugge (Peter); J.K. Anninga (Jacob); A.H.M. Taminiau (Antonie)

    2009-01-01

    textabstractBackground. To examine the practical applicability, internal consistency, and validity of the Bt-DUX, a disease-specific Health Related Quality of Life (HRQoL) instrument. The Bt-Dux was developed to examine patients' individual values of their life after a malignant bone tumor of the

  19. Study on Patients Who Underwent Suspected Diagnosis of Allergy to Amide-Type Local Anesthetic Agents by the Leukocyte Migration Test

    Directory of Open Access Journals (Sweden)

    Mikio Saito

    2014-01-01

    Conclusions:: There is a high possibility that these adverse reactions were caused by pseudoallergy to drug. Even by allergic reactions, it was assumed that 80% of them might be caused by antiseptic agents such as paraben. In addition, it was suggested that ALAs, especially lidocaine hydrochloride preparations have high antigenicity (sensitizing property. Furthermore, it was considered that patients with past history of drug or food allergies have a high potential for manifestation of the reactions.

  20. Prognostic value of pretreatment albumin–globulin ratio in predicting long-term mortality in gastric cancer patients who underwent D2 resection

    Directory of Open Access Journals (Sweden)

    Liu J

    2017-04-01

    Full Text Available Jianjun Liu,1,2,* Shangxiang Chen,1,2,* Qirong Geng,1,3 Xuechao Liu,1,2 Pengfei Kong,1,2 Youqing Zhan,1,2 Dazhi Xu1,2 1State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 2Department of Gastric and Pancreatic Surgery, Sun Yat-sen University Cancer Center, 3Department of Hematology Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China *These authors contributed equally to this work Background: Several studies have highlighted the prognostic value of the albumin–globulin ratio (AGR in various kinds of cancers. Our study was designed to assess whether AGR is associated with the prognosis of gastric cancer patients. Patients and methods: A total of 507 gastric cancer patients between 2005 and 2012 were included. The AGR was defined as the ratio of serum albumin to nonalbumin and calculated by the equation: albumin/(total protein - albumin. Furthermore, AGR was divided into two groups (low and high using the X-tile software. Survival analysis stratified by AGR groups was performed. Results: The mean survival time for each group was 36.62 months (95% CI: 33.92–39.32 for the low AGR group and 48.95 months (95% CI: 41.93–55.96, P=0.003 for the high AGR group. Patients in the high group (AGR ≥1.93 had a significantly lower 5-year mortality in comparison with the low group (AGR <1.93 (52.4% vs 78.5%, P=0.003. The high AGR group showed obviously better overall survival than the low AGR group according to Kaplan–Meier curves (P=0.003. Multivariate analysis showed that AGR was an independent predictive factor of prognosis in gastric patients. Conclusion: Pretreatment AGR is a significant and independent predictive factor of prognosis. Keywords: gastric cancer, survival, inflammation, albumin–globulin ratio

  1. Predictive values of the ultrasonographic findings of patients who underwent hysteroscopy on an outpatient basis at the Servicio de Ginecologia of Hospital Mexico in 2010

    International Nuclear Information System (INIS)

    Mena Bejarano, Nasser Yamal; Calvo Chaves, Luis Antonio

    2013-01-01

    Sensitivity, specificity and predictivity were determined for ultrasonographic findings of the endometrial cavity with the findings in the outpatient surgery program of the Servicio de Ginecologia of Hospital Mexico in 2010. The data were collected retrospectively by taking randomly a sample of the total of 147 patients with hysteroscopy. Data from selected clinical records are taken to perform statistical analysis using histories for the most frequent findings and to measure the diagnostic accuracy of both transvaginal econography and hysteroscopy. Necmar's 2x2 table is used, for to calculate the values of sensitivity, specificity, positive and negative and to obtain the comparative results. The ultrasonographic findings were: endometrial polipo 60%, endometrial thickening 20% and submucous myoma 11%. The postoperative diagnoses were: endometrial polyposis 65%, endometrial cavity without lesions 11%, submucous myoma 9%, endometrial hyperplasia 7% and endometrial atrophy 3%. Transvaginal ultrasound is proved to be an acceptable diagnostic method for endometrial polipo because it had a positive predictive value of 79%. In the submucous myoma, are found values of specificity and a very high negative predictive value, which indicates that ultrasound is actually able to rule out the presence of this pathology [es

  2. Comportamiento de los pacientesancianosoperados de cirugíacardíaca con circulaciónextracorpórea/ Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Alain Moré Duarte

    2015-10-01

    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks. Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass. Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014. Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively. Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  3. Effectiveness of sublingual nitroglycerin before puncture compared with conventional intra-arterial nitroglycerin in transradial procedures: a randomized trial

    Energy Technology Data Exchange (ETDEWEB)

    Turan, Burak, E-mail: drburakturan@gmail.com; Daşlı, Tolga; Erkol, Ayhan; Erden, İsmail

    2015-10-15

    Aim: Sublingual (SL) nitroglycerin administered before radial artery puncture can improve cannulation success and decrease the incidence of radial artery spasm (RAS) compared with intra-arterial (IA) nitroglycerin in transradial procedures. Methods: Patients undergoing diagnostic transradial angiography were randomized to IA (200 mcg) or SL (400 mcg) nitroglycerin. Primary endpoints were puncture time and puncture attempts. Secondary endpoint was the incidence of RAS. Results: Total of 101 participants (mean age 60 ± 11 years, 53% male) were randomized (51 in IA and 50 in SL groups). Puncture time (50 [36–75] vs 50 [35–90] sec), puncture attempts (1.18 ± 0.48 vs 1.20 ± 0.49), multiple punctures (13.7 vs 16.0%) and RAS (19.6 vs 24.0%) were not statistically different between IA vs SL groups respectively. A composite endpoint of all adverse events related to transradial angiography (multiple punctures, RAS, access site crossover, hypotension/bradycardia associated with nitroglycerin and radial artery occlusion) was very similar in IA vs SL groups (39 vs 40%, respectively). However puncture time was significantly longer with SL nitroglycerin in patients < 1.65 m height (47 [36–66] vs 63 [41–110] sec, p = 0.042). Multiple punctures seemed higher with SL nitroglycerin in patients with diabetes (0 vs 30%, p = 0.028) or in patients < 1.65 m height (7.4 vs 25%, p = 0.085). Likewise, RAS with SL nitroglycerin seemed more frequent in smokers compared to IA nitroglycerin (0 vs 27%, p = 0.089). Conclusions: SL nitroglycerin was not different from IA nitroglycerin in terms of efficiency and safety in overall study population. However it may be inferior to IA nitroglycerin in certain subgroups (shorter individuals, diabetics and smokers). - Highlights: • Improvement in radial artery puncture time and success with subcutaneous nitrate was reported. • Giving nitrate sublingually may have vasodilation along entire length of radial artery and may prevent RAS

  4. Six-year clinical follow-up after treatment of diffuse in-stent restenosis with cutting balloon angioplasty followed by intracoronary brachytherapy with liquid rhenium-188-filled balloon via transradial approach

    International Nuclear Information System (INIS)

    Hang Chiling; Wu Chiungjen; Hsieh Bortsung

    2010-01-01

    Long-term follow-up studies revealed a significant decline in the benefits of intracoronary radiation for in-stent restenosis. A total of 25 study and 25 contemporaneous control patients with diffuse in-stent restenosis who underwent cutting balloon angioplasty (CBA) transradially, followed by subsequent intracoronary irradiation with a liquid β-emitter Rhenium-188 ( 188 Re)-filled balloon were enrolled in the study. The mean clinical follow-up durations were 64.9±13.0 and 66.3±13.8 months for the irradiated and control patients, respectively. Six-month angiographic restenosis was observed in 16% (4 of 25) of the patients in the irradiated group and 48% (12 of 25) of the patients in the control groups (P=0.03). The 6-month major adverse cardiac events (MACE) rate was 12% and 44%, respectively (P=0.025). The 3-year follow-up angiography was performed in 16 of 21 (76%) irradiated patients and in 4 of 13 (31%) control patients who had no significant restenosis at the 6-month angiographic follow-up. Restenosis occurred in 1 of 16 (7%) irradiated patients and 2 of 4 (50%) control patients. Late target lesion revascularization was performed in 1 irradiated and 2 control patients. The MACE rate within 6 years was significantly reduced in the irradiated group (20% vs. 56%, P=0.019). Brachytherapy using 188 Re-filled balloon following CBA for diffuse in-stent restenotic native coronary arteries is effective in reducing target lesion restenosis and improving long-term outcomes. (author)

  5. Minimal percentage of dose received by 90% of the urethra (%UD90) is the most significant predictor of PSA bounce in patients who underwent low-dose-rate brachytherapy (LDR-brachytherapy) for prostate cancer.

    Science.gov (United States)

    Tanaka, Nobumichi; Asakawa, Isao; Fujimoto, Kiyohide; Anai, Satoshi; Hirayama, Akihide; Hasegawa, Masatoshi; Konishi, Noboru; Hirao, Yoshihiko

    2012-09-14

    To clarify the significant clinicopathological and postdosimetric parameters to predict PSA bounce in patients who underwent low-dose-rate brachytherapy (LDR-brachytherapy) for prostate cancer. We studied 200 consecutive patients who received LDR-brachytherapy between July 2004 and November 2008. Of them, 137 patients did not receive neoadjuvant or adjuvant androgen deprivation therapy. One hundred and forty-two patients were treated with LDR-brachytherapy alone, and 58 were treated with LDR-brachytherapy in combination with external beam radiation therapy. The cut-off value of PSA bounce was 0.1 ng/mL. The incidence, time, height, and duration of PSA bounce were investigated. Clinicopathological and postdosimetric parameters were evaluated to elucidate independent factors to predict PSA bounce in hormone-naïve patients who underwent LDR-brachytherapy alone. Fifty patients (25%) showed PSA bounce and 10 patients (5%) showed PSA failure. The median time, height, and duration of PSA bounce were 17 months, 0.29 ng/mL, and 7.0 months, respectively. In 103 hormone-naïve patients treated with LDR-brachytherapy alone, and univariate Cox proportional regression hazard model indicated that age and minimal percentage of the dose received by 30% and 90% of the urethra were independent predictors of PSA bounce. With a multivariate Cox proportional regression hazard model, minimal percentage of the dose received by 90% of the urethra was the most significant parameter of PSA bounce. Minimal percentage of the dose received by 90% of the urethra was the most significant predictor of PSA bounce in hormone-naïve patients treated with LDR-brachytherapy alone.

  6. Compare Complication of Classic versus Patent Hemostasis in Transradial Coronary Angiography.

    Science.gov (United States)

    Roghani, Farshad; Tajik, Mohammad Nasim; Khosravi, Alireza

    2017-01-01

    Coronary artery disease (CAD) is multifactorial disease, in which thrombotic occlusion and calcification occur usually. New strategies have been made for diagnosis and treatment of CAD, such as transradial catheterization. Hemostasis could be done in two approaches: traditional and patent. Our aim is to find the best approach with lowest complication. In a comparative study, 120 patients were recruited and divided randomly into two subgroups, including traditional group (60 patients; 24 females, 36 males; mean age: 64.35 ± 10.56 years) and patent group (60 patients; 28 females, 32 males; mean age: 60.15 ± 8.92 years). All demographic data including age, gender, body mass index, and CAD-related risk factors (smoking, diabetes, hypertension) and technical data including the number of catheters, procedure duration, and hemostatic compression time and clinical outcomes (radial artery occlusion [RAO], hematoma, bleeding) were collected. Data were analyzed by SPSS version 16. Our findings revealed that the incidence of RAO was significantly lower in patent groups compared with traditional group ( P = 0.041). Furthermore, the difference incidence of RAO was higher in early occlusion compare with late one ( P = 0.041). Moreover, there were significant relationship between some factors in patients of traditional group with occlusion (gender [ P = 0.038], age [ P = 0.031], diabetes mellitus [ P = 0.043], hemostatic compression time [ P = 0.036]) as well as in patent group (age [ P = 0.009], hypertension [ P = 0.035]). Our findings showed that RAO, especially type early is significantly lower in patent method compared classic method; and patent hemostasis is the safest method and good alternative for classical method.

  7. Compare Complication of Classic versus Patent Hemostasis in Transradial Coronary Angiography

    Directory of Open Access Journals (Sweden)

    Farshad Roghani

    2017-01-01

    Full Text Available Background: Coronary artery disease (CAD is multifactorial disease, in which thrombotic occlusion and calcification occur usually. New strategies have been made for diagnosis and treatment of CAD, such as transradial catheterization. Hemostasis could be done in two approaches: traditional and patent. Our aim is to find the best approach with lowest complication. Materials and Methods: In a comparative study, 120 patients were recruited and divided randomly into two subgroups, including traditional group (60 patients; 24 females, 36 males; mean age: 64.35 ± 10.56 years and patent group (60 patients; 28 females, 32 males; mean age: 60.15 ± 8.92 years. All demographic data including age, gender, body mass index, and CAD-related risk factors (smoking, diabetes, hypertension and technical data including the number of catheters, procedure duration, and hemostatic compression time and clinical outcomes (radial artery occlusion [RAO], hematoma, bleeding were collected. Data were analyzed by SPSS version 16. Results: Our findings revealed that the incidence of RAO was significantly lower in patent groups compared with traditional group (P = 0.041. Furthermore, the difference incidence of RAO was higher in early occlusion compare with late one (P = 0.041. Moreover, there were significant relationship between some factors in patients of traditional group with occlusion (gender [P = 0.038], age [P = 0.031], diabetes mellitus [P = 0.043], hemostatic compression time [P = 0.036] as well as in patent group (age [P = 0.009], hypertension [P = 0.035]. Conclusion: Our findings showed that RAO, especially type early is significantly lower in patent method compared classic method; and patent hemostasis is the safest method and good alternative for classical method.

  8. Low-Level Laser and Light-Emitting Diode Therapy for Pain Control in Hyperglycemic and Normoglycemic Patients Who Underwent Coronary Bypass Surgery with Internal Mammary Artery Grafts: A Randomized, Double-Blind Study with Follow-Up.

    Science.gov (United States)

    Lima, Andréa Conceição Gomes; Fernandes, Gilderlene Alves; Gonzaga, Isabel Clarisse; de Barros Araújo, Raimundo; de Oliveira, Rauirys Alencar; Nicolau, Renata Amadei

    2016-06-01

    This study aimed to evaluate the efficacy of low-level laser therapy (LLLT) and light-emitting diodes (LEDs) for reducing pain in hyperglycemic and normoglycemic patients who underwent coronary artery bypass surgery with internal mammary artery grafts. This study was conducted on 120 volunteers who underwent elective coronary artery bypass graft (CABG) surgery. The volunteers were randomly allocated to four different groups of equal size (n = 30): control, placebo, LLLT [λ = 640 nm and spatial average energy fluence (SAEF) = 1.06 J/cm(2)], and LED (λ = 660 ± 20 nm and SAEF = 0.24 J/cm(2)). Participants were also divided into hyperglycemic and normoglycemic subgroups, according to their fasting blood glucose test result before surgery. The outcome assessed was pain during coughing by a visual analog scale (VAS) and the McGill Pain Questionnaire. The patients were followed for 1 month after the surgery. The LLLT and LED groups showed a greater decrease in pain, with similar results, as indicated by both the VAS and the McGill questionnaire (p ≤ 0.05), on the 6th and 8th postoperative day compared with the placebo and control groups. The outcomes were also similar between hyperglycemic and normoglycemic patients. One month after the surgery, almost no individual reported pain during coughing. LLLT and LED had similar analgesic effects in hyperglycemic and normoglycemic patients, better than placebo and control groups.

  9. Trans-radial Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction

    International Nuclear Information System (INIS)

    Hussain, S.; Kayani, A. M.; Munir, R.

    2014-01-01

    Objective: To study the effect of trans-radial approach (TRA) on achievement of a door-to-balloon time (DBT) of A/sup 2/ 90 minutes in primary PCI percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). Study Design: Case series. Place and Duration of Study: Armed Forces Institute of Cardiology - National Institute of Heart Diseases (AFIC -NIHD), Rawalpindi, from October 2011 to August 2012. Methodology: Systems goal for door-to-balloon time (DBT - time elapsed between first medical contact and restoration of flow in the infarct related artery (IRA)) was set at < 90 minutes. Procedural success was defined as restoration of TIMI 3 flow in the IRA with less than 30% residual stenosis and discharge from hospital. Non-infarct related arteries were not treated. Bleeding episodes were defined by TIMI definitions. Results: For vascular access for PPCI in a total of 207 patients, TRA was 91.3% (n = 189), transfemoral approach (TFA) 6.3% (n = 13) and brachial 2.4% (n = 5). Males represented 90.3% of cases and 7% were females. Mean age was 55 A +- 10.86 years. Procedural success rate was 97.1%. Mean DBT was 54.1 minutes. DBT was less A/sup 2/ 60 and 90 minutes in 75% and 94.2% of patients respectively. DBT A/sup 2/ 89.50 minutes was achieved in 90% of patients. The difference in DBT between the different access groups was not markedly different between the three groups. There were 6 (2.9%) in-hospital deaths and no major bleeds. Conclusion: TRA for PPCI poses no hindrance to achieving a DBT of < 90 minutes in PPCI for STEMI. Furthermore, the in-hospital mortality rates are acceptable and within rational limits. (author)

  10. Effects of two doses of anti-T lymphocyte globulin-Fresenius given after full-match sibling stem cell transplantation in acute myeloblastic leukemia patients who underwent myeloablative fludarabine/busulfan conditioning.

    Science.gov (United States)

    Boga, Can; Yeral, Mahmut; Gereklioglu, Ciğdem; Asma, Suheyl; Maytalman, Erkan; Aytan, Pelin; Kozanoglu, Ilknur; Sariturk, Cagla; Ozdogu, Hakan

    2018-02-20

    Anti-T lymphocyte globulin Fresenius (rATG-F; ATG-Fresenius) and antithymocyte globulin (thymoglobulin), which are included in transplant protocols, are used to reduce the risk of chronic graft-versus-host disease (cGVHD) or suppress allograft rejection. Available clinical studies have been conducted in heterogenous patient populations and with different administration protocols including stem cell sources. Additionally, the pharmacokinetics of ATG is variable, and the clinically effective dose of rATG-F, in particular, is not exactly known. The aim of the study was to investigate the clinical outcomes of acute myeloid leukemia (AML) patients who underwent hemopoietic peripheral stem cell transplantation from full-matched sibling donors and given two different doses of r-ATG-F. This was a single-center, retrospective chart review conducted between July 2005 and July 2016. Sixty-nine consecutive AML patients who underwent transplant with fludarabine- and busulfan-based conditioning were included in the study. Patients in Group 1 received 15 mg/kg body weight rATG-F to 2013 (n = 46), and Group 2 received 30 mg/kg of rATG-F dose begining in 2013 to reduce to cGVHD (n = 23). Cyclosporine and methotrexate were used to treat acute GVHD (aGVHD) prophylaxis. Outcome parameters were compared between the groups. Although the recommended dose r-ATG-F had led to a decrease in the cumulative incidence of cGVHD (27 [58.7%] vs. 8 [34.8%]; p = .03), it also increased the infection rate at 1 year (3 [6.5%] vs. 4 [17.4%]; p = .02). The two groups were similar in terms of engraftment time, aGVHD, relapse, nonrelapse mortality, and rATG-F-related toxicity. A Cox regression model revealed that aGVHD III-IV was associated with increased nonrelapse mortality at 1 year (hazard ratio = 18.2; 95% confidence interval, 1.667-199.255; p = <.02). No patients developed rATG-F-related severe adverse events (Common Terminology Criteria grade 4 or 5). Dose difference of

  11. The Prognostic Significance of Elevated Serum Ferritin Levels Prior to Transplantation in Patients With Lymphoma Who Underwent Autologous Hematopoietic Stem Cell Transplantation (autoHSCT): Role of Iron Overload.

    Science.gov (United States)

    Sivgin, Serdar; Karamustafaoglu, Mehmet Fatih; Yildizhan, Esra; Zararsiz, Gokmen; Kaynar, Leylagul; Eser, Bulent; Cetin, Mustafa; Unal, Ali

    2016-08-01

    Hematopoietic stem cell transplantation is a common and preferred treatment of lymphomas in many centers. Our goal was to determine the association between pretransplant iron overload and survival in patients who underwent autologous hematopoietic stem cell transplantation (autoHSCT). A total of 165 patients with lymphoma, who underwent autoHSCT between the years of 2007 and 2014, were included in this study. Ferritin levels were used to determine iron status; the cut-off value was 500 ng/mL. The relationship between iron overload and survival was assessed by statistical analysis. The median ferritin level in the normal ferritin (ferritin < 500) group was 118 ng/mL (range, 9-494 ng/mL) and in the high-ferritin group (ferritin ≥ 500), it was 908 ng/mL (range, 503-4549 ng/mL). A total of 64 (38.8%) patients died during follow-up. Of these patients that died, 52 (81.25%) were in the high-ferritin group, and 12 (18.75%) were in the normal ferritin group (P ≤ .001). Twelve (14.1%) of 85 patients died in the normal ferritin group, and 52 (65.0%) of 80 patients died in the high-ferritin group. The overall mortality was significantly higher in the high-ferritin group (P < .001). The median overall survival was 42 months (range, 25-56 months) in the normal-ferritin group and20 months (range, 5-46) in the high-ferritin group. The difference between the groups was statistically significant (P < .001). The median disease-free survival was 39 months (range, 16-56) in the normal ferritin group and 10 months (range, 3-29) in the high-ferritin group. The difference between the groups was statistically significant (P < .001). Elevated serum ferritin levels might predict poorer survival in autoHSCT recipients. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. [The Effects of Smart Program for Patients Who Underwent Percutaneous Coronary Intervention (SP-PCI) on Disease-Related Knowledge, Health Behavior, and Quality of Life: A Non-Randomized Controlled Trial].

    Science.gov (United States)

    Lee, Jueun; Lee, Haejung

    2017-12-01

    To identify the effects of a smart program for the patients who underwent percutaneous coronary intervention (SP-PCI) on coronary disease-related knowledge, health behaviors, and quality of life. A nonequivalent control group with a non-synchronized design was utilized and 48 participants (experimental=22, control=26) were recruited from a university hospital in Gyeongsang area from May to December, 2016. The 12-week SP-PCI consisted of self-study of health information using smart phone applications (1/week), walking exercise (>5/week) using smart band, feedback using Kakao talk (2/week), and telephone counseling (1/week). Patients in the control group received usual care from their primary health care providers and a brief health education with basic self-management brochure after the PCI. Data were analyzed using the SPSS 21.0 program through descriptive statistics, χ² test, and t-test. After the 12-week SP-PCI, the experimental group showed higher levels of coronary disease-related knowledge (t=2.43, p=.019), heart-related health behaviors (t=5.96, pPCI provided easy access and cost-effective intervention for patients after PCI and improved their knowledge of the disease, performance of health behaviors, and quality of life. Further study with a wider population is needed to evaluate the effects of SP-PCI on disease recurrence and quality of life for patients after PCI. © 2017 Korean Society of Nursing Science

  13. Assessment of peri- and postoperative complications and Karnofsky-performance status in head and neck cancer patients after radiation or chemoradiation that underwent surgery with regional or free-flap reconstruction for salvage, palliation, or to improve function

    Directory of Open Access Journals (Sweden)

    Sertel Serkan

    2011-09-01

    Full Text Available Abstract Background Surgery after (chemoradiation (RCTX/RTX is felt to be plagued with a high incidence of wound healing complications reported to be as high as 70%. The additional use of vascularized flaps may help to decrease this high rate of complications. Therefore, we examined within a retrospective single-institutional study the peri--and postoperative complications in patients who underwent surgery for salvage, palliation or functional rehabilitation after (chemoradiation with regional and free flaps. As a second study end point the Karnofsky performance status (KPS was determined preoperatively and 3 months postoperatively to assess the impact of such extensive procedures on the overall performance status of this heavily pretreated patient population. Findings 21 patients were treated between 2005 and 2010 in a single institution (17 male, 4 female for salvage (10/21, palliation (4/21, or functional rehabilitation (7/21. Overall 23 flaps were performed of which 8 were free flaps. Major recipient site complications were observed in only 4 pts. (19% (1 postoperative haemorrhage, 1 partial flap loss, 2 fistulas and major donor site complications in 1 pt (wound dehiscence. Also 2 minor donor site complications were observed. The overall complication rate was 33%. There was no free flap loss. Assessment of pre- and postoperative KPS revealed improvement in 13 out of 21 patients (62%. A decline of KPS was noted in only one patient. Conclusions We conclude that within this (chemoradiated patient population surgical interventions for salvage, palliation or improve function can be safely performed once vascularised grafts are used.

  14. Changes in intensity of neurotic symptoms associated with reduction of suicidal ideation in patients who underwent psychotherapy in the day hospital for the treatment of neurotic and behavioral disorders.

    Science.gov (United States)

    Rodziński, Paweł; Rutkowski, Krzysztof; Murzyn, Agnieszka; Sobański, Jerzy A; Cyranka, Katarzyna; Dembińska, Edyta; Grządziel, Karolina; Klasa, Katarzyna; Mielimąka, Michał; Müldner-Nieckowski, Łukasz; Smiatek-Mazgaj, Bogna

    2017-06-18

    Analysis of associations between changes in the intensity of neurotic symptoms and reduction of suicidal ideation (SI) or lack of SI reduction, in patients who underwent a course of intensive psychotherapy conducted in integrative approach with predominance of psychodynamic approach in a day hospital. Symptom Checklist KO"O" and Life Inventory completed by 461 women and 219 men treated in the psychotherapeutic day hospital due to neurotic, behavioral or personality disorders between 2005-2013. During the qualification for the therapy 134 women and 80 men reported SI, of whom 84.3% and 77.5% respectively improved. The reduction of neurotic symptoms intensity was greater in patients of both genders who improved in terms of SI than in those who did not. This referred to global intensity of neurotic symptoms (OWK coefficient) in both genders (ppsychotherapy as a treatment method that leads to improvement in terms of both SI and neurotic symptoms. This suggests that the applied therapy may be effective in preventing suicidality in this group of patients. The observed associations also point in favor of hypothesis on similarities in etiopathogenesis of and partly identical personality-related factors predisposing to SI and neurotic disorders.

  15. Diagnostic Accuracy of Detecting Hashimoto's Thyroiditis in Thyroid Cancer Patients Who Underwent Thyroid Surgery: Comparison of Ultrasonography, Positron Emission Tomography/CT, Contrast Enhanced CT, and Anti-Thyroid Antibody

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Gyun; Lee, Tae Hyun; Park, Dong Hee; Nam, Sang Been [Dept. of Radiology, Korea Cancer Center Hospital, Seoul (Korea, Republic of)

    2012-11-15

    To compare the diagnostic accuracy of ultrasonography (US), F18-fluorodeoxyglucose positron emission tomography/CT (PET/CT), contrast enhanced CT (CECT), serum anti-thyroid antibody for detecting Hashimoto's thyroiditis in thyroid cancer patients who underwent neck surgery. A total of 150 patients with suspicious for thyroid cancer, who had previously undergone US guided needle aspiration of thyroid, were evaluated with the use of US, PET/CT, CECT and serum anti-thyroid antibody. The four studies were performed within two months before neck surgery. Hashimoto's thyroiditis was confirmed by histopathological results. The diagnostic accuracy of US, PET/CT, CECT and serum anti-thyroid antibody were calculated statistically. Hashimoto's thyroiditis was diagnosed in 51 out of the 150 patients, following neck surgery. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US were 76.5%, 92.9%, 84.8%, 88.5%, and 87.3%, respectively. The corresponding values of PET/CT were 37.3%, 96.0%, 82.6%, 74.8%, and 76.0%, and CECT were 62.7%, 89.9%, 76.2%, 82.4%, and 80.7%, and serum anti-thyroid antibody level were 90.2%, 93.9%, 88.5%, 94.9%, and 92.7%, respectively. McNemar test revealed significant difference among PET/CT and others, but no significant differences among US, CECT and serum anti-thyroid antibody. Overall, serum anti-thyroid antibody showed most accurate diagnostic performance. In detecting Hashimoto's thyroiditis, serum anti-thyroid antibody showed higher diagnostic accuracy than others. US also showed relatively high diagnostic accuracy.

  16. Diagnostic Accuracy of Detecting Hashimoto's Thyroiditis in Thyroid Cancer Patients Who Underwent Thyroid Surgery: Comparison of Ultrasonography, Positron Emission Tomography/CT, Contrast Enhanced CT, and Anti-Thyroid Antibody

    International Nuclear Information System (INIS)

    Kim, Young Gyun; Lee, Tae Hyun; Park, Dong Hee; Nam, Sang Been

    2012-01-01

    To compare the diagnostic accuracy of ultrasonography (US), F18-fluorodeoxyglucose positron emission tomography/CT (PET/CT), contrast enhanced CT (CECT), serum anti-thyroid antibody for detecting Hashimoto's thyroiditis in thyroid cancer patients who underwent neck surgery. A total of 150 patients with suspicious for thyroid cancer, who had previously undergone US guided needle aspiration of thyroid, were evaluated with the use of US, PET/CT, CECT and serum anti-thyroid antibody. The four studies were performed within two months before neck surgery. Hashimoto's thyroiditis was confirmed by histopathological results. The diagnostic accuracy of US, PET/CT, CECT and serum anti-thyroid antibody were calculated statistically. Hashimoto's thyroiditis was diagnosed in 51 out of the 150 patients, following neck surgery. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US were 76.5%, 92.9%, 84.8%, 88.5%, and 87.3%, respectively. The corresponding values of PET/CT were 37.3%, 96.0%, 82.6%, 74.8%, and 76.0%, and CECT were 62.7%, 89.9%, 76.2%, 82.4%, and 80.7%, and serum anti-thyroid antibody level were 90.2%, 93.9%, 88.5%, 94.9%, and 92.7%, respectively. McNemar test revealed significant difference among PET/CT and others, but no significant differences among US, CECT and serum anti-thyroid antibody. Overall, serum anti-thyroid antibody showed most accurate diagnostic performance. In detecting Hashimoto's thyroiditis, serum anti-thyroid antibody showed higher diagnostic accuracy than others. US also showed relatively high diagnostic accuracy.

  17. Feasibility and Safety of Transradial Arterial Approach for Simultaneous Right and Left Vertebral Artery Angiographic Studies and Stenting

    International Nuclear Information System (INIS)

    Yip, H.-K.; Youssef, Ali A.; Chang, W.-N.; Lu, C.-H.; Yang, C.-H.; Chen, S.-M.; Wu, C.-J.

    2007-01-01

    Objectives. This study investigated whether the transradial artery (TRA) approach using a 6-French (F) Kimny guiding catheter for right vertebral artery (VA) angiographic study and stenting is safe and effective for patients with significant VA stenosis. Background. The TRA approach is commonly performed worldwide for both diagnostic cardiac catheterization and catheter-based coronary intervention. However, to our knowledge, the safety and feasibility of left and right VA angiographic study and stenting, in the same procedure, using the TRA approach for patients with brain ischemia have not been reported. Methods. The study included 24 consecutive patients (22 male, 2 female; age, 63-78 years). Indications for VA angiographic study and stenting were (1) prior stroke or symptoms related to vertebrobasilar ischemia and (2) an asymptomatic but vertebral angiographic finding of severe stenosis (>70%). A combination of the ipsilateral and retrograde-engagement technique, which involved a looping 6-F Kimny guiding catheter, was utilized for VA angiographic study. For VA stenting, an ipsilateral TRA approach with either a Kimny guiding catheter or a left internal mammary artery guiding catheter was utilized in 22 patients and retrograde-engagement technique in 2 patients. Results. A technically successful procedure was achieved in all patients, including left VA stenting in 15 patients and right VA stenting in 9 patients. The mean time for stenting (from engagement to stent deployment) was 12.7 min. There were no vascular complications or mortality. However, one patient suffered from a transient ischemic attack that resolved within 3 h. Conclusion. We conclude that TRA access for both VA angiographic study and VA stenting is safe and effective, and provides a simple and useful clinical tool for patients unsuited for femoral arterial access

  18. Terminal ileum of patients who underwent colonoscopy: endoscopic, histologic and clinical aspects Íleo terminal de pacientes submetidos a colonoscopia: aspectos endoscópicos, histológicos e clínicos

    Directory of Open Access Journals (Sweden)

    Marcelo Maia Caixeta de Melo

    2009-06-01

    Full Text Available CONTEXT: For the diagnosis of the diseases which affect the terminal ileum, the colonoscopy allows macroscopic evaluation and the performing of biopsies. Studies with criteria for the endoscopic and histological characterization of this segment are scarce and there are still some doubts about the need of biopsies in patients with normal ileoscopy. OBJECTIVE: Study the terminal ileum of patients who underwent colonoscopy considering: endoscopic and histological correlation; agreement between results of the initial histological evaluation and slides review, and the chance of subjects with normal ileoscopy with abdominal pain and/or chronic diarrhea to show histological alterations. METHODS: In a prospective study, 111 patients who presented smooth mucosa without enanthema in the endoscopic exam of the terminal ileum were selected. Biopsies of the ileal mucosa of such patients were performed, being the slides routinely examined and reviewed afterwards. RESULTS: The correlation between patients with normal ileoscopy and ileum with preserved histological architecture was of 99.1%. The agreement between initial histological evaluation and slides review calculated by the Kappa test was 0.21. In patients with abdominal pain and/or chronic diarrhea, the chance of showing histological alterations was 2.5 times higher than the others. CONCLUSIONS: The correlation between endoscopic and histological findings was high. The agreement between the initial histologic evaluation and slides review was not satisfactory. The chance of subjects with normal ileoscopy with abdominal pain and/or chronic diarrhea, showing histological alterations was higher in relation to the asymptomatic ones or with other symptoms, although the clinical importance of this datum was not evaluated.CONTEXTO: Para o diagnóstico de doenças que afetam o íleo terminal, a colonoscopia permite avaliação macroscópica e realização de biopsias. Estudos com critérios para caracteriza

  19. Revealing the impact of local access-site complications and upper extremity dysfunction post transradial percutaneous coronary procedures

    NARCIS (Netherlands)

    Zwaan, E.M.; Koopman, A.G.M.M.; Holtzer, C.A.J.; Zijlstra, F.; Ritt, M.J.P.F.; Amoroso, G.; Moerman, E.; Kofflard, M.J.M.; Ijsselmuiden, A.J.J.

    2015-01-01

    Objectives Little is known about local access-site complications and upper extremity dysfunction after transradial percutaneous coronary procedures (TR-PCP). This systematic review study aimed to summarise the current knowledge on the incidences of access-site complications and upper extremity

  20. Endothelial dysfunction and the occurrence of radial artery spasm during transradial coronary procedures: The ACRA-Spasm study

    NARCIS (Netherlands)

    Van Der Heijden, D.J. (Dirk J.); M.A.H. van Leeuwen (Maarten); G.N. Janssens (Gladys N.); Hermie, J. (Jailen); M.J. Lenzen (Mattie); M.J.P.F. Ritt; P.M. van de Ven (Peter); F. Kiemeneij (Ferdinand); N. van Royen (Niels)

    2016-01-01

    textabstractAims: The aim of this study was to analyse the relation between endothelial dysfunction (ED) and the occurrence of radial artery spasm (RAS) during transradial coronary procedures. Methods and results: From May 2014 to June 2015, endothelial function was assessed by EndoPAT and FMD

  1. Usefulness and Safety of a Guide Catheter Extension System for the Percutaneous Treatment of Complex Coronary Lesions by a Transradial Approach

    OpenAIRE

    García-Blas, Sergio; Núñez, Julio; Mainar, Luis; Miñana, Gema; Bonanad, Clara; Racugno, Paolo; Rodríguez, Juan Carlos; Moyano, Patricia; Sanchis, Juan

    2014-01-01

    Objective The aim of this study was to describe our initial experience with the GuideLiner® catheter (Vascular Solutions Inc.) in the transradial treatment of complex lesions. Materials and Methods The clinical, angiographic and procedural data of percutaneous coronary interventions where GuideLiner was used during 2013 were collected. The transradial approach was used in all cases. The indication for its use, efficacy and periprocedural complications were determined. Sixteen consecutive proc...

  2. [Successful One-lung Ventilation with a Right-sided Double-lumen Tube in a Patient with a Right Upper Tracheal Bronchus, who Underwent Left Pneumonectomy for Left Hilar Lung Cancer].

    Science.gov (United States)

    Kawagoe, Izumi; Kohchiyama, Tsukasa; Hayashida, Masakazu; Satoh, Daizoh; Suzuki, Kenji; Inada, Eiichi

    2016-06-01

    A 60-year-old male patient with left hilar lung cancer was scheduled to undergo left pneumonectomy or left sleeve lower lobectomy. Preoperative computer tomographic and bronchoscopic examinations revealed that the bronchus (B1) to the right apical segment (S1) was a tracheal bronchus (TB) originating from the trachea approximately 10 mm above the carina. Because the left main bronchus was to be dissected, a right-sided double-lumen tube (DLT) was selected to completely protect the right lung from spillage of secretions or cancer cells from the left lung. The right-sided DLT was placed so as to fit its lateral opening of the bronchial lumen to normal upper branches (B2, B3), while sacrificing ventilation of S1 with an abnormal branch (B1). However, one-lung ventilation (OLV) of the right lung could not be achieved, since a gas leakage from the opened tracheal lumen occurred, most probably due to intra-lobar micro-airway communications between S1 and S2/S3. The DLT was withdrawn until the blue bronchial cuff occluded the orifice of the TB (B1). Although the upper half of the blue bronchial cuff appeared above the tracheal carina, OLV through the two bronchial lumen openings could be achieved due to a specific, slanted doughnut shape of the blue bronchial cuff and the location of the abnormal branch (B1) approximate to the carina. Left pneumonectomy using successful OLV was completed safely without hypoxemia or hypercapnea. Our experience indicates that management of OLV for patients with a thoracheal bronchus needs special considerations of the exact location of the TB and intra-lobar micro-airway communications, in addition to types of scheduled surgical procedures.

  3. Operator radiation exposure during right or left transradial coronary angiography: A phantom study

    International Nuclear Information System (INIS)

    Sciahbasi, Alessandro; Rigattieri, Stefano; Sarandrea, Alessandro; Cera, Maria; Di Russo, Cristian; Fedele, Silvio; Romano, Silvio; Pugliese, Francesco Rocco; Penco, Maria

    2015-01-01

    but with a significant higher radiation dose at hip level whereas the radiation dose at left side of the head did not show significant differences between the two approaches. - Highlights: • Phantom study simulating transradial coronary angiography • Evaluation of radiation dose absorbed by operators during right of left transradial access • Operators equipped with electronic dosimeters at thorax, head, wrist and hip • Higher dose at thorax and wrist during right transradial access • Higher dose at hip during left transradial approach • No radiation dose differences at head

  4. Megarectumsigma underwent surgery for chronic faecal impact action

    International Nuclear Information System (INIS)

    Canessa, C.; Gomez del Valle, M.; Caraballo, M.

    2002-01-01

    Seven patients with megarectumsigma underwent surgery for chronic faecal impaction,reviewing clinical diagnosis, aetiology and medical and surgical management.It is suggested medical management of chronic faecal impaction trying to achieve elective surgery.The curative surgery should include the resection of all pathologic bowel, but in Duhamel procedure and its modifications distal rectal tran section should be at the peritoneal reflection.Habr-Gama modification has shown to be technically easier and it has been communicated good functional results.Local unfavourable conditions may be resolve by staged surgery,which allows outline definitive bowel reconstruction after functional assessment

  5. Comparison of Hemostasis Times With a Kaolin-Based Hemostatic Pad (QuikClot Radial) vs Mechanical Compression (TR Band) Following Transradial Access: A Pilot Prospective Study.

    Science.gov (United States)

    Roberts, Jonathan S; Niu, Jianli; Pastor-Cervantes, Juan A

    2017-10-01

    Hemostasis following transradial access (TRA) is usually achieved by mechanical compression. We investigated use of the QuikClot Radial hemostasis pad (Z-Medica) compared with the TR Band (Terumo Medical) to shorten hemostasis after TRA. Thirty patients undergoing TRA coronary angiography and/or percutaneous coronary intervention were randomized into three cohorts post TRA: 10 patients received mechanical compression with the TR Band, 10 patients received 30 min of compression with the QuikClot Radial pad, and 10 patients received 60 min of compression with the QuikClot Radial pad. Times to hemostasis and access-site complications were recorded. Radial artery patency was evaluated 1 hour after hemostasis by the reverse Barbeau's test. There were no differences in patient characteristics, mean dose of heparin (7117 ± 1054 IU), or mean activated clotting time value (210 ± 50 sec) at the end of procedure among the three groups. Successful hemostasis was achieved in 100% of patients with both the 30-min and 60-min compression groups using the QuikClot pad. Hemostasis failure occurred in 50% of patients when the TR Band was initially weaned at the protocol-driven time (40 min after sheath removal). Mean compression time for hemostasis with the TR Band was 149.4 min compared with 30.7 min and 60.9 min for the 30-min and 60-min QuikClot groups, respectively. No radial artery occlusion occurred in any subject at the end of the study. Use of the QuikClot Radial pad following TRA in this pilot trial significantly shortened hemostasis times when compared with the TR Band, with no increased complications noted.

  6. Comparison of a priori versus provisional heparin therapy on radial artery occlusion after transradial coronary angiography and patent hemostasis (from the PHARAOH Study).

    Science.gov (United States)

    Pancholy, Samir B; Bertrand, Olivier F; Patel, Tejas

    2012-07-15

    Systemic anticoagulation decreases the risk of radial artery occlusion (RAO) after transradial catheterization and standard occlusive hemostasis. We compared the efficacy and safety of provisional heparin use only when the technique of patent hemostasis was not achievable to standard a priori heparin administration after radial sheath introduction. Patients referred for coronary angiography were randomized in 2 groups. In the a priori group, 200 patients received intravenous heparin (50 IU/kg) immediately after sheath insertion. In the provisional group, 200 patients did not receive heparin during the procedure. After sheath removal, hemostasis was obtained using a TR band (Terumo corporation, Tokyo, Japan) with a plethysmography-guided patent hemostasis technique. In the provisional group, no heparin was given if radial artery patency could be obtained and maintained. If radial patency was not achieved, a bolus of heparin (50 IU/kg) was given. Radial artery patency was evaluated at 24 hours (early RAO) and 30 days after the procedure (late RAO) by plethysmography. Patent hemostasis was obtained in 67% in the a priori group and 74% in the provisional group (p = 0.10). Incidence of RAO remained similar in the 2 groups at the early (7.5% vs 7.0%, p = 0.84) and late (4.5% vs 5.0%, p = 0.83) evaluations. Women, patients with diabetes, patients having not received heparin, and patients without radial artery patency during hemostasis had more RAO. By multivariate analysis, patent radial artery during hemostasis (odds ratio [OR] 0.03, 95% confidence interval [CI] 0.004 to 0.28, p = 0.002) and diabetes (OR 11, 95% CI 3 to 38,p patent hemostasis is maintained. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. HyPro: A Multi-DoF Hybrid-Powered Transradial Robotic Prosthesis

    Directory of Open Access Journals (Sweden)

    C. L. Semasinghe

    2018-01-01

    Full Text Available This paper proposes a multi-DoF hybrid-powered transradial robotic prosthesis, named HyPro. The HyPro consists of two prosthetic units: hand and wrist that can achieve five grasping patterns such as power grasp, tip grasp, lateral grasp, hook grasp, and index point. It is an underactuated device with 15 degrees of freedom. A hybrid powering concept is proposed and implemented on hand unit of HyPro where the key focus is on restoration of grasp functions of biological hand. A novel underactuated mechanism is introduced to achieve the required hand preshaping for a given grasping pattern using electric power in the pregrasp stage and body power is used in grasp stage to execute the final grasping action with the selected fingers. Unlike existing hybrid prostheses where each of the joints is separately controlled by either electric or body power, the proposed prosthesis is capable of delivering grasping power in combination. The wrist unit of HyPro is designed and developed to achieve flexion-extension and supination-pronation using electric power. Experiments were carried out to evaluate the functionality and performance of the proposed hybrid-powered robotic prosthesis. The results verified the potential of HyPro to perform intended grasping patterns effectively and efficiently.

  8. Comparison of risk of acute kidney injury after primary percutaneous coronary interventions with the transradial approach versus the transfemoral approach (from the PRIPITENA urban registry).

    Science.gov (United States)

    Cortese, Bernardo; Sciahbasi, Alessandro; Sebik, Rodrigo; Rigattieri, Stefano; Alonzo, Alessandro; Silva-Orrego, Pedro; Belloni, Flavia; Seregni, Romano G; Giovannelli, Francesca; Tespili, Maurizio; Ricci, Roberto; Berni, Andrea

    2014-09-15

    The risk of acute kidney injury (AKI) is a major issue after percutaneous coronary interventions (PCIs), especially in the setting of ST-elevation myocardial infarction. Preliminary data from large retrospective registries seem to show a reduction of AKI when a transradial (TR) approach for PCI is adopted. Little is known about the relation between vascular access and AKI after emergent PCI. We here report the results of the Primary PCI from Tevere to Navigli (PRIPITENA), a retrospective database of primary PCI performed at high-volume centers in the urban areas of Rome and Milan. Primary end point of this study was the occurrence of AKI in the TR and transfemoral (TF) access site groups. Secondary end points were major adverse cardiovascular events, stent thrombosis, and Thrombolysis in Myocardial Infarction major and minor bleedings. The database included 1,330 patients, 836 treated with a TR and 494 with a TF approach. After a propensity-matched analysis performed to exclude possible confounders, we identified 450 matched patients (225 TR and 225 TF). The incidence of AKI in the 2 matched groups was lower in patients treated with TR primary PCI (8.4% vs 16.9%, p = 0.007). Major adverse cardiovascular events and stent thrombosis were not different among study groups, whereas major bleedings were more often seen in the TF group. At multivariate analysis, femoral access was an independent predictor of AKI (odds ratio 1.654, 95% confidence interval 1.084 to 2.524, p = 0.042). In conclusion, in this database of primary PCI, the risk of AKI was lower with a TR approach, and the TF approach was an independent predictor for the occurrence of this complication. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Efficacy of a one-catheter concept for transradial coronary angiography.

    Directory of Open Access Journals (Sweden)

    Christoph Langer

    Full Text Available Transradial coronary angiography (TRC can be performed with a one-catheter approach for the right and left coronary ostium (R/LCO. We investigated the performance of a special diagnostic catheter widely used for the one-catheter-approach, the Tiger (Tiger II, TerumoTM.In a dual center registry we analyzed 1412 TRC-procedures exclusively performed by experienced TRC-operators. We compared the performance of the Tiger with Judkins catheters by retrospectively judging ostial catheter stability during contrast injection, and by measuring contrast use, fluoroscopy time (FT and complication rate.Poor or failed ostial engagement was found in 40.5% in the Tiger group, compared to 46.6% with the use of Judkins catheters (p<0.183. Ostial instability of the Tiger was found more often during engagement of the LCO than the RCO (34.4% vs. 10.8%, p<0.001, whereas it was similar in the LCO and RCO for Judkins catheters (27.4% vs. 26.7%, p = 0.840. TRC-procedures performed with Tiger catheters were associated with less contrast volume (63.48 ± 29.83mL vs. 82.51 ± 56.58mL, p<0.004 and shorter FT than with Judkins catheters. (198.27 ± 194.8sec vs. 326.85 ± 329.70sec. Forearm hematomas occurred less often with the Tiger (1.2% vs. 6.6%, p< 0.02.The Tiger employed as a single catheter in TRC is an effective tool to achieve lower contrast volume and fluoroscopy time at a low complication rate. Unstable engagement affects predominantly the left coronary artery, but its overall frequency is similar for both, the Tiger and Judkins catheters.

  10. Single Center Retrospective Analysis of Conventional and Radial TIG Catheters for Transradial Diagnostic Coronary Angiography.

    Science.gov (United States)

    Vorpahl, Marc; Koehler, Till; Foerst, Jason; Panagiotopoulos, Spyridon; Schleiting, Heinrich; Koss, Klaus; Ziegler, Gunda; Brinkmann, Hilmar; Seyfarth, Melchior; Tiroch, Klaus

    2015-01-01

    Current guidelines favor the radial approach for coronary angiography. Therefore, specialty radial diagnostic catheters were designed to engage both coronary arteries with a single device. However, it is unclear if single catheters are superior to conventional catheters. A retrospective analysis was performed of consecutive right radial coronary angiographies to determine catheter use, fluoroscopy time, radiation dosage, and consumption of contrast. Procedures were performed with a single TIG catheter or conventional catheters (CONV). Procedures with coronary artery bypass grafts or ventricular angiographies were excluded. 273 transradial procedures were performed successfully. 95 procedures were performed with CONV and 178 procedures with a TIG. Crossover to additional catheters was higher in TIG (15.2%) compared to CONV (5.3%, p = 0.02). Fluoroscopy time was comparable between CONV and TIG, without crossover (2.2 ± 1.2 min versus 2.3 ± 1.2 min; n.s.), however, greater in the case of crossover for CONV (5.8 ± 0.7) and TIG (7.6 ± 3.0; p = 0.0001). Radiation dosage was similar in CONV and the TIG, without crossover (1419 ± 1075, cGy∗cm(2) versus 1690 ± 1138; n.s.), however, greater for CONV (2374 ± 620) and TIG (3733 ± 2281, p = 0.05) with crossover. Overall, the amount of contrast was greater in TIG (56 ± 13 mL) versus CONV (48 ± 3 mL; p = 0.0003). CONV femoral catheters may be the primary choice for radial approach.

  11. Presentación de un modelo antropométrico para la evaluación del paciente sometido a distracción osteogénica mandibular An anthropometric model presentation to assess the patient underwent to mandibular osteogenic distraction

    Directory of Open Access Journals (Sweden)

    Dadonim Vila Morales

    2009-09-01

    Full Text Available Propósito del estudio: proponer un modelo antropométrico que permita evaluar de forma homogénea la evolución de los pacientes sometidos a distracción osteogénica mandibular. Métodos: se realizó un estudio previo en el que se constató la ausencia de un protocolo internacional que estandarice el estudio y evaluación de los resultados obtenidos con distracción osteogénica mandibular y que permita evaluar la recidiva esqueletal a largo plazo. Se tomó como elementos de medidas los estudios cefalométricos angulares y lineales de McNamara y Steiner y se incluyó el panorograma de Simoes. Se diseñó un modelo matemático con fórmulas que permiten evaluar la distracción obtenida en rama y cuerpo, así como la efectividad del tratamiento y la estabilidad a largo plazo. Se propuso además una valoración de los cambios oclusales obtenidos. Resultados: el modelo antropométrico propuesto constituye un instrumento útil para implementar el método científico en el estudio y evaluación de los pacientes tratados con distracción osteogénica mandibular. Conclusiones: el modelo antropométrico propuesto es un método idóneo para evaluar, de forma homogénea, la evolución de los pacientes sometidos a distracción osteogénica mandibular.Aim: To propose a anthropometric model allows in a homogenous way to assess the course of patients underwent to mandibular osteogenic distraction. Methods: A prior study was carried out which allow us to confirm the lack of a international protocol generalizing the study and the evaluation of results achieved with the mandibular osteogenic distraction and also allows to assess the long-term skeletal relapse. Measurements elements include the McNamara and Steiner's angular and linear cephalometry studies as well as the Simoes panography. A mathematical model was designed with formulae allowing assessing the distraction achieved in branch and body as well as the effectiveness of treatment and long

  12. Reabilitação de pacientes portadores da doença de Kienböck submetidos a ressecção da fileira proximal do carpo Rehabilitation of patients with Kienböck disease underwent proximal row carpectomy

    Directory of Open Access Journals (Sweden)

    S.M.P.F. Lima

    2000-06-01

    Full Text Available A proposta deste estudo foi a aplicação de um protocolo de avaliação e tratamento desenvolvido no Serviço de Terapia da Mão do Setor de Terapia Ocupacional da Disciplina de Fisiatria do Departamento de Ortopedia e Traumatologia da Universidade Federal de São Paulo, destinado a pacientes portadores da Doença de Kienböck e submetidos a técnica cirúrgica de ressecção da fileira proximal do carpo. O protocolo de avaliação foi aplicado em 16 pacientes que foram avaliados no pré e pós-tratamento, considerando-se a dor, perímetro do punho, força muscular, amplitude articular do antebraço e punho e a capacidade funcional. Considerou-se também alguns referenciais subjetivos, no que se refere à satisfação pessoal do paciente quanto ao tratamento. Os resultados mostraram que o protocolo de tratamento aplicado foi eficaz na redução da dor, no aumento do arco de movimento da pronação e supinação do antebraço, abdução e adução do punho e favoreceu a melhora da capacidade funcional da mão afetada. Na avaliação subjetiva 90% dos pacientes tratados em nosso protocolo estavam satisfeitos com a sua recuperação.The aim of this study was to apply an evaluation and treatment protocol developed by the Hand Therapy Department of the Occupational Therapy Group of Physiatrics Medicine, Department of Orthopedics and Traumatology, University of São Paulo, to patients with Kienböck disease underwent proximal row carpectomy. The protocol was applied to 16 patients who were assessed in the pretreatment and post-treatment periods concerning some objective parameters, such as pain, wrist circumference, muscular strength, forearm / wrist articular range of motion and functional capacity. Patients' satisfaction with their evolution was evaluated through a questionnaire according to the treatment. Results have shown that the group underwent a rehabilitation approach showed better outcomes concerning pain, muscle strength, supination

  13. Fractal and twin SVM-based handgrip recognition for healthy subjects and trans-radial amputees using myoelectric signal.

    Science.gov (United States)

    Arjunan, Sridhar Poosapadi; Kumar, Dinesh Kant; Jayadeva J

    2016-02-01

    Identifying functional handgrip patterns using surface electromygram (sEMG) signal recorded from amputee residual muscle is required for controlling the myoelectric prosthetic hand. In this study, we have computed the signal fractal dimension (FD) and maximum fractal length (MFL) during different grip patterns performed by healthy and transradial amputee subjects. The FD and MFL of the sEMG, referred to as the fractal features, were classified using twin support vector machines (TSVM) to recognize the handgrips. TSVM requires fewer support vectors, is suitable for data sets with unbalanced distributions, and can simultaneously be trained for improving both sensitivity and specificity. When compared with other methods, this technique resulted in improved grip recognition accuracy, sensitivity, and specificity, and this improvement was significant (κ=0.91).

  14. Resultado funcional e índice macular em portadores de buraco macular submetidos à cirurgia com remoção da membrana limitante interna Functional outcome and macular index in macular hole patients who underwent surgery with internal limiting membrane removal

    Directory of Open Access Journals (Sweden)

    José Ricardo Diniz

    2008-04-01

    Full Text Available OBJETIVOS: Avaliar o resultado funcional e o índice macular dos portadores de buraco macular submetidos à cirurgia com remoção da membrana limitante interna. MÉTODOS: Quinze olhos de 15 pacientes com buraco macular estágios 2, 3 e 4 foram incluídos no estudo. Todos foram submetidos à cirurgia de buraco macular convencional com remoção da membrana limitante interna corada pelo azul de tripan. Melhor acuidade visual com correção e cortes transversais medidos por tomografia de coerência óptica (OCT foram avaliados no pré- e pós-operatório. O índice macular (razão entre a altura e base do buraco macular foi calculado e correlacionado com o diâmetro mínimo do buraco macular e o ganho de acuidade visual pós-operatória. RESULTADOS: Obteve-se fechamento do buraco macular em todos pacientes operados. Em 86,7%, houve ganho de pelo menos três linhas de visão. O índice macular demonstrou correlação negativa significante com o diâmetro mínimo (r=0,811. Não foi observada correlação significante entre o índice macular e o ganho de acuidade visual pós-operatória (r=0,351. CONCLUSÃO: Os resultados funcionais na cirurgia do buraco macular com remoção da membrana limitante interna foram bons neste grupo de pacientes. O índice macular demonstrou ser compatível com a configuração espacial do buraco macular, porém não foi preditor de resultados visuais.PURPOSE: To evaluate the functional outcome and macular index in patients with macular hole who underwent surgery with internal limiting membrane removal. METHODS: Fifteen eyes of 15 patients with idiopathic macular hole stages 2, 3 or 4 were enrolled in this study. All patients underwent conventional macular hole surgery with trypan blue staining to remove the internal limiting membrane. The best-corrected visual acuity and cross-sectional images of macular hole measured by optical coherence tomography (OCT were evaluated pre- and postoperatively. The macular hole index

  15. Radial artery anomalies in patients undergoing transradial coronary procedures – An Egyptian multicenter experience

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    Ayman K.M. Hassan

    2016-03-01

    Conclusion: There is a relatively significant presence of radial anomalies, with different degrees of impact on procedural failure rate, in our Egyptian population. Further collaborative studies are recommended to increase our success rates.

  16. Análise da evolução tardia de 291 pacientes submetidos a substituição valvar por próteses metálicas Late follow-up of 291 patients who underwent heart valve replacement with mechanical valves

    Directory of Open Access Journals (Sweden)

    Carlos M. A Brandão

    1995-03-01

    Full Text Available No período de janeiro de 1980 a dezembro de 1993, 291 pacientes foram submetidos a substituição valvar por próteses metálicas, no Instituto do Coração do HCFMUSP. Cento e oitenta e sete (64,3% pacientes eram do sexo masculino, com idade variando de 2 meses a 78 anos (média de 38,3 +/-18,5. A etiologia das lesões foi reumática em 132 (45,4% pacientes. Foram realizadas 201 substituições da valva aórtica, 77 da valva mitral, 15 duplas substituições mitro-aórticas, 2 substituições da valva tricúspide, 1 dupla substituição mitro-tricuspídea e 1 tríplice substituição mitro-aórtico-tricuspídea, totalizando 315 substituições valvares. Cirurgias associadas foram realizadas em 164 (56,4% pacientes, sendo a mais freqüente a correção de aneurisma de aorta ascendente em 49 (16,8% pacientes Cento e quarenta e um (48,4% pacientes foram submetidos anteriormente a cirurgias valvares. Os pacientes foram avaliados clinicamente no pós-operatório tardio, segundo a classe funcional (NYHA e o aparecimento de complicações relacionadas às próteses e à anticoagulação. A mortalidade imediata foi de 36 (12,4% pacientes. Foram estudados 159 pacientes no pós-operatório tardio, com um tempo médio de evolução de 40,6 meses (10078 meses/paciente. As taxas linearizadas para tromboembolismo, hemorragia relacionada à anticoagulação, óbito tardio, endocardite, escape paravalvar e hemólise no pós-operatório tardio foram, respectivamente, 1,33%, 0,95%, 1,9%, 0,19%, 0,57% e 0,57% pacientes/ano. A curva actuarial de sobrevida em 14 anos é de 63,8%. Oitenta e dois porcento dos pacientes encontram-se em classe funcional I no pós-operatório tardio. Podemos concluir que os nossos resultados foram bastante satisfatórios com a utilização de próteses metálicas.Between January 1980 and December 1993, 291 patients underwent valve replacement with mechanical valves in the Heart Institute of HCFMUSP. One hundred and eighty seven (64

  17. The feasibility of transradial laser atherectomy for chronic total occlusion using the 5 Fr sheath system

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    Khaled Sherif

    2016-05-01

    Full Text Available Objective. We present a case of chronic total occlusion (CTO approached with LASER endovascular intervention by radial artery approach using a 5 French sheath. Case report. A 57-year-old man presented to our hospital having had retrosternal chest pain for two days. Physical examination was normal at the time of presentation. The laboratory tests were within normal limits, including cardiac enzymes except the lipid panel which showed hypertriglyceridemia. The patient underwent a myocardial perfusion scintigraphy stress test that revealed inferior wall ischemia, with normal left ventricular ejection fraction. A 5-French vascular sheath was placed in the right radial artery. Selective coronary artery angiography was performed, which showed right coronary artery (RCA CTO. A 5-French JR4 guide catheter successfully engaged the RCA and Laser angioplasty was performed across the CTO into the RCA. A marked improvement of flow was evident thereafter. Conclusion. To best of our knowledge this is the first case report showing the feasibility of laser atherectomy using the 5 French sheath system in a coronary arterial CTO.

  18. The feasibility of transradial laser atherectomy for chronic total occlusion using the 5 Fr sheath system.

    Science.gov (United States)

    Sherif, Khaled; Yaqub, Yasir; Suarez, Jose A

    2016-05-01

    We present a case of chronic total occlusion (CTO) approached with LASER endovascular intervention by radial artery approach using a 5 French sheath. A 57-year-old man presented to our hospital having had retrosternal chest pain for two days. Physical examination was normal at the time of presentation. The laboratory tests were within normal limits, including cardiac enzymes except the lipid panel which showed hypertriglyceridemia. The patient underwent a myocardial perfusion scintigraphy stress test that revealed inferior wall ischemia, with normal left ventricular ejection fraction. A 5-French vascular sheath was placed in the right radial artery. Selective coronary artery angiography was performed, which showed right coronary artery (RCA) CTO. A 5-French JR4 guide catheter successfully engaged the RCA and Laser angioplasty was performed across the CTO into the RCA. A marked improvement of flow was evident thereafter. To best of our knowledge this is the first case report showing the feasibility of laser atherectomy using the 5 French sheath system in a coronary arterial CTO. Copyright © 2016 by Academy of Sciences and Arts of Bosnia and Herzegovina.

  19. Efecto de la localización del electrodo ventricular derecho (tracto de salida vs. ápex sobre la sincronía ventricular mecánica, en pacientes sometidos a terapia de implante de marcapaso cardiaco Effect of right ventricular electrode location (outflow tract vs. apex on mechanical ventricular synchrony in patients that underwent pacemaker implant therapy

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    Oscar S Rincón

    2008-12-01

    Full Text Available Objetivo: evaluar a profundidad el efecto de la estimulación ventricular desde el tracto de salida del ventrículo derecho y el ápex, sobre la sincronía ventricular mecánica. Materiales y métodos: estudio analítico de cohorte, en el que se realizó ecocardiograma transtorácico pre y post implante de marcapaso a 20 pacientes (diez por cada grupo con indicación de marcapaso definitivo, con implante del electrodo en el tracto de salida del ventrículo derecho y el ápex, sin cardiopatía estructural, fracción de eyección > 50%; QRS y conducción aurículo-ventricular normal, con el fin de evaluar la asincronía ventricular mecánica (modo M y Doppler tisular y los parámetros de implante y programación del dispositivo. Análisis estadístico: los resultados se presentan como promedios, desviación estándar o porcentajes. Las variables continuas se compararon utilizando prueba Chi cuadrado y ANOVA. Se consideró como estadísticamente significativa una p Objective: to assess in depth the effect of ventricular stimulation from the right ventricular outflow tract and the apex on mechanical ventricular synchrony. Materials and Methods: cohort analytical study. 20 patients with indication of definitive pacemaker indication underwent transthoracic echocardiogram before and after pacemaker implant with electrode implantation in the right ventricular outflow tract and in the apex (10 patients in each group. There was no structural cardiopathy, ejection fraction was > 50%, QRS and AV conduction were normal. Mechanical ventricular asynchrony (M mode and tissue doppler and implant and device parameters were evaluated. Statistical Analysis: results are given as mean values, standard deviation or percentages. Continuous variables were compared using Chi-square test and ANOVA. A p <0.05 value was considered statistically significant. Results: in five patients (25% a pre-implant ventricular asynchrony was found; in seven (70% ventricular asynchrony

  20. Improving the Robustness of Real-Time Myoelectric Pattern Recognition against Arm Position Changes in Transradial Amputees

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    Yanjuan Geng

    2017-01-01

    Full Text Available Previous studies have showed that arm position variations would significantly degrade the classification performance of myoelectric pattern-recognition-based prosthetic control, and the cascade classifier (CC and multiposition classifier (MPC have been proposed to minimize such degradation in offline scenarios. However, it remains unknown whether these proposed approaches could also perform well in the clinical use of a multifunctional prosthesis control. In this study, the online effect of arm position variation on motion identification was evaluated by using a motion-test environment (MTE developed to mimic the real-time control of myoelectric prostheses. The performance of different classifier configurations in reducing the impact of arm position variation was investigated using four real-time metrics based on dataset obtained from transradial amputees. The results of this study showed that, compared to the commonly used motion classification method, the CC and MPC configurations improved the real-time performance across seven classes of movements in five different arm positions (8.7% and 12.7% increments of motion completion rate, resp.. The results also indicated that high offline classification accuracy might not ensure good real-time performance under variable arm positions, which necessitated the investigation of the real-time control performance to gain proper insight on the clinical implementation of EMG-pattern-recognition-based controllers for limb amputees.

  1. [A Case of Ascending Colon Cancer with Lynch Syndrome Who Underwent XELOX Adjuvant Chemotherapy].

    Science.gov (United States)

    Takase, Koki; Murata, Kohei; Kagawa, Yoshinori; Nose, Yohei; Kawai, Kenji; Sakamoto, Takuya; Naito, Atsushi; Murakami, Kohei; Katsura, Yoshiteru; Omura, Yoshiaki; Takeno, Atsushi; Nakatsuka, Shinichi; Takeda, Yutaka; Kato, Takeshi; Tamura, Shigeyuki

    2018-01-01

    Lynch syndrome is an inherited syndrome with the development of the colorectal and various other cancers. Lynch syndrome is caused by mutations in the mismatch repair genes. A 33 year-old male underwent XELOX adjuvant chemotherapy for ascending colon cancer with Lynch syndrome. Although efficacy of 5-FU is not demonstrated in Lynch syndrome, MOSAIC trial had suggested a benefit from FOLFOX compared with 5-FU in patients who have colorectal cancer with Lynch syndrome. Oxaliplatin-based adjuvant chemotherapy can be a therapeutic option for colorectal cancer in lynch syndrome patients.

  2. The Results of Open-Label, Multicenter, Non-Randomized Study on the Efficacy and Safety of Insulins: Insuman Basal®, Insuman Comb 25®, Insuman Rapid® in Patients with Diabetes Mellitus Type 2 Who Underwent Basic Training in Diabetes Schools (SPIRIT

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    A.S. Larin

    2015-04-01

    Conclusions. Treatment with Insuman® insulins of patients with DM-2, who were not compensated while taking OADs, was associated with improved glycemic control without an increase in the incidence of severe hypoglycemia. There was no statistically significant increase in the effectiveness of therapy in patients, who have successfully completed a training program at diabetes school, compared with evaluation of overall efficiency. The state of young studied population of patients with inadequate control at baseline, and those who had developed cardiovascular complications associated with DM, improved in most cases in terms of glycemic control, and, at that, episodes of severe hypoglycemia were not detected. This may be due to the positive influence of training in diabetes school.

  3. APACHE II SCORING SYSTEM AND ITS MODIFICATION FOR THE ASSESSMENT OF DISEASE SEVERITY IN CHILDREN WHO UNDERWENT POLYCHEMOTHERAPY

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    А. V. Sotnikov

    2014-01-01

    Full Text Available Short-term disease prognosis should be considered for the appropriate treatment policy based on the assessment of disease severity in patients with acute disease. The adequate assessment of disease severity and prognosis allows the indications for transferring patients to the resuscitation and intensive care department to be defined more precisely. Disease severity of patients who underwent polychemotherapy was assessed using APACHE II scoring system.

  4. Femoral Access PCI in a Default Radial Center Identifies High-Risk Patients With Poor Outcomes.

    Science.gov (United States)

    Uddin, Muezz; Bundhoo, Shantu; Mitra, Rito; Ossei-Gerning, Nicholas; Morris, Keith; Anderson, Richard; Kinnaird, Tim

    2015-10-01

    Increasingly the trans-radial route (TRR) is preferred over the trans-femoral route (TFR) for PCI. However, even in high volume default TRR centers a cohort of patients undergo TFR PCI. We examined the demographics, procedural characteristics, and outcomes of patients undergoing PCI via the TF. The patient demographics, procedural data, and outcomes of 5,379 consecutive patients undergoing PCI at a default radial center between 2009 and 2012 were examined. Major bleeding (MB) was classified by ACUITY and BARC definitions. A total of 559 (10.4%) patients underwent PCI via the TFR and 4,820 patients via the TRR (89.6%). Baseline variables associated with TFR were shock, previous CABG, chronic total occlusion intervention, rotablation/laser use, female sex, and renal failure. Sixty-five patients of the TFR cohort (11.6%) experienced MB with 27 (41.5%) being access site related. MB was significantly more frequent than in the radial cohort. The variables independently associated with MB in the TFR cohort were renal failure, acute presentation, shock, and age. In the TFR, patients with MB mortality was high at 30 days (17.2% vs 2.6% for no MB, P default radial PCI center 10% of patients undergo PCI via the femoral artery. These patients have high baseline bleeding risk and undergo complex interventions. As a result the incidence of major bleeding, transfusion and death are high. Alternative strategies are required to optimize outcomes in this select group. © 2015, Wiley Periodicals, Inc.

  5. Avaliação da lordose da coluna cervical nos pacientes com escoliose do tipo Lenke I submetidos ao tratamento cirúrgico Evaluación de la lordosis de la columna cervical en los pacientes con escoliosis del tipo Lenke I sometidos al tratamiento quirúrgico Evaluation of cervical behavior in patients with scoliosis Lenke who underwent surgery

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    José Lucas Batista Junior

    2011-01-01

    Full Text Available OBJETIVO: Avaliar a angulação da lordose cervical nos pacientes portadores de Escoliose Idiopática do Adolescente (EIA do tipo Lenke I, no período pré- e pós-operatório. MÉTODO: Estudo prospectivo e descritivo em que foram avaliados pacientes com EIA, sendo documentadas medidas antropométricas. Foram avaliadas as angulações das radiografias (posição ortostática em perfil cervical de C3 a C7 no período pré- e pós-operatório, estabelecendo como normal a lordose cervical entre 10 e 30 graus. RESULTADOS: Participaram 26 pacientes com EIA, sendo a maioria do sexo feminino (73%, com média de idade de 14,3 anos. Observamos que no período pré-operatório 80,9% dos pacientes apresentavam angulação cervical não fisiológica, sendo que 42,3% dos pacientes apresentavam diminuição da lordose cervical (OBJETIVO: Evaluar el ángulo de la lordosis cervical en pacientes con Escoliosis Idiopática del Adolescente (EIA, clasificados en Lenke I en el pre y posoperatorio. MÉTODOS: Estudio prospectivo y descriptivo, en el que se evaluó a pacientes con EIA y se documentaron mediciones antropométricas. Se evaluó la angulación de las radiografías (posición ortostásica de perfil de columna cervical de C3 a C7, en el entorno de pre y posoperatorias, estableciéndose como normal la lordosis cervical entre 10 y 30 grados. RESULTADOS: Un total de 26 pacientes fue evaluado, en su mayoría mujeres (73% con edad promedio de 14,3 años. Observamos que, en el período preoperatorio, 80,9% de los pacientes presentaban angulación cervical no fisiológica, siendo que 42,3% de los pacientes habían reducido la lordosis cervical (OBJECTIVE: This study was to evaluate the angle of cervical lordosis in patients with Adolescent Idiopathic Scoliosis (AIS ranked in Lenke I pre- and postoperatively. METHODS: Prospective and descriptive study, which evaluated patients with AIS and documented anthropometric measures. We assessed the angulations of the

  6. Avaliação dos níveis basais de FSH em pacientes inférteis com endometriose profunda de ovário tratadas cirurgicamente Evaluation of basal FSH serum levels in infertile patients with deep ovarian endometriosis who underwent surgery

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    Sandra Frankfurt

    2009-07-01

    Full Text Available OBJETIVO: avaliar a reserva ovariana de pacientes inférteis portadoras de endometriose profunda de ovário, submetidas à cirurgia excisional dos endometriomas, atendidas entre os meses de Fevereiro e Novembro de 2008. MÉTODOS: estudo prospectivo que incluiu 30 pacientes portadoras de endometriose graus III e IV com comprometimento profundo de ovário submetidas à cirurgia excisional dos endometriomas e 30 pacientes portadoras de endometriose graus I e II que foram alocadas como Grupo Controle. A reserva ovariana foi avaliada indiretamente a partir do valor do hormônio folículo estimulante (FSH basal (U/L, entre o terceiro e quinto dias do ciclo, após um período de 12 meses da cirurgia. O índice de massa corpórea (IMC foi calculado conforme a fórmula de Quetelet [peso (kg/estatura (cm²]. Para a comparação das variáveis "idade", "IMC" e "valores de FSH basal" entre os grupos, foi utilizado o teste não paramétrico U de Mann-Whitney. RESULTADOS: não foi encontrada diferença significativa entre os grupos em relação à idade e ao IMC. Em relação ao FSH basal, observou-se que, no grupo das pacientes com endometriose profunda, o valor médio foi de 7,0 U/L, enquanto que, no Grupo Controle, foi de 5,6 U/L (p=0,3, o que demonstra que a diferença no valor médio de FSH encontrado nos dois grupos não foi significativa. CONCLUSÕES: a cirurgia não influenciou de forma deletéria a reserva ovariana das pacientes com endometriose profunda de ovário.PURPOSE: to evaluate the ovarian reserve of infertile patients with severe ovarian endrometriosis, submitted to excisional surgery of endometriomas and attended from February to November, 2008. METHODS: prospective study, including 30 patients with endometriosis grades III and IV, with severe ovarian impairment, submitted to excisional surgery of the endometriomas, and 30 patients with endometriosis grades I and II, allocated as a Control Group. The ovarian reserve was indirectly assessed

  7. Beneficial Effect of the Nutritional Support in Children Who Underwent Hematopoietic Stem Cell Transplant.

    Science.gov (United States)

    Koç, Nevra; Gündüz, Mehmet; Tavil, Betül; Azik, M Fatih; Coşkun, Zeynep; Yardımcı, Hülya; Uçkan, Duygu; Tunç, Bahattin

    2017-08-01

    The aim of this study was to evaluate nutritional status in children who underwent hematopoietic stem cell transplant compared with a healthy control group. A secondary aim was to utilize mid-upper arm circumference as a measure of nutritional status in these groups of children. Our study group included 40 children (18 girls, 22 boys) with mean age of 9.2 ± 4.6 years (range, 2-17 y) who underwent hematopoietic stem cell transplant. Our control group consisted of 20 healthy children (9 girls, 11 boys). The children were evaluated at admission to the hospital and followed regularly 3, 6, 9, and 12 months after discharge from the hospital. In the study group, 27 of 40 patients (67.5%) received nutritional support during hematopoietic stem cell transplant, with 15 patients (56%) receiving enteral nutrition, 6 (22%) receiving total parenteral nutrition, and 6 (22%) receiving enteral and total parenteral nutrition. Chronic malnutrition rate in the study group was 47.5% on admission to the hospital, with the control group having a rate of 20%. One year after transplant, the rate decreased to 20% in the study group and 5% in the control group. The mid-upper arm circumference was lower in children in the study group versus the control group at the beginning of the study (P groups at follow-up examinations (P > .05). During follow-up, all anthropometric measurements increased significantly in both groups. Monitoring nutritional status and initiating appropriate nutritional support improved the success of hematopoietic stem cell transplant and provided a more comfortable process during the transplant period. Furthermore, mid-upper arm circumference is a more sensitive, useful, and safer parameter that can be used to measure nutritional status of children who undergo hematopoietic stem cell transplant.

  8. Influence of timing of chest tube removal on early outcome of patients underwent lung resection

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    Ahmed Labib Dokhan

    2016-05-01

    Conclusion: Early removal of chest tube may have beneficial effect on control of post-thoracotomy pain, improvement of pulmonary functions and decreasing the risk of complications after lung resection.

  9. Cost-effectiveness of positive contrast and nuclear arthrography in patients who underwent total hip arthroplasty

    International Nuclear Information System (INIS)

    Swan, J.S.; Braunstein, E.M.; Capello, W.; Wellman, H.

    1989-01-01

    The authors have compared the cost effectiveness of contrast arthrography (CA) and nuclear arthrography (NA), in which In-111 chloride is injected with the contrast material, of total hip arthroplasties. Their series included 48 cases of surgically proved loose femoral components. The cost per true-positive result was obtained by taking the total cost of the examinations in surgically proved cases and dividing by the number of true-position cases. The cost of CA was $297 and the cost of NA was $335. For CA, the cost per true positive was $1,018, and for the NA the cost per true positive was $946. In spite of higher initial cost, NA is more cost effective than CA on a cost per true-positive case basis. NA is cost effective in evaluating hip arthroplasties in which there is suspicion of a loose femoral component

  10. Comparising the Succinylcholine onset effect with Atracurium - Alfentanyl in patient underwent rapid sequence Induction

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    hasan Teimouri

    2005-12-01

    Conclusion: According to results, use of Atra + Alfen method can replace the standard method (succinylcholine for contraindicated condition. Mild vocal cord movement and mild bucking in the Atracurium + Alfentanyl can be control by that a increase in Atracurium dose.

  11. Ultrahigh-resolution ultrasound characterization of access site trauma and intimal hyperplasia following use of a 7F sheathless guide versus 6F sheath/guide combination for transradial artery PCI: Results of the PRAGMATIC trial.

    Science.gov (United States)

    Batchelor, Wayne; Dahya, Vishal; McGee, Dan; Katopodis, John; Dixon, William; Campbell, James; Meredith, Ashley; Knap, Patty; Parkin, Mathew; Noel, Thomas

    2018-04-01

    There exist limited data on the relative degree of acute injury and late healing of the radial artery after transradial artery (TRA) percutaneous coronary intervention (PCI) with a 7F sheathless guide catheter compared with a 6F sheath/guide combination. We used ultrahigh-resolution (55 MHz) vascular ultrasound to compare intimal-medial thickening (IMT) and early and late radial artery (RA) injury resulting from a sheathless 7F guide catheter versus a 6F sheath/guide combination for TRA-PCI. Forty-one consecutive consenting patients undergoing elective nonemergent TRA-PCI at a single institution from June 2016 to December 2016 were included. Patients were randomized (stratified by sex) to undergo TRA-PCI using a 7F sheathless guide catheter versus a 6F sheath/6F guide combination. Ultrahigh-resolution vascular ultrasound (55MHz) of the RA access site was performed at 24hours and 90days post-TRA-PCI. The primary outcome of the study was a noninferiority comparison of radial artery IMT thickness at 90days. PCI success rates, fluoroscopy times, number of guides used, and crossover rates to a femoral approach were also compared. Baseline characteristics were similar between groups. Radial arterial IMT (mm) was similar between the 7F sheathless and 6F sheath/guide groups at 24hours (0.27 vs 0.29, respectively; P=.43) and at 90days (0.35 vs 0.34, respectively; P=.96). The P value for the noninferiority testing of a 0.07-mm limit was .002. Limited access site intimal tears were relatively common in both groups at 24hours (4 vs 5, P=.53) but often healed by 90days. Radial artery occlusion was infrequent at 90days (2 vs 1, P=.10), and no frank dissections were noted. PCI success rates (100% vs 95%, P=.59), fluoroscopy times (16 vs 12minutes, P=.17), number of guides used (1.1 vs 1.2, P=.48), and femoral crossover rates (0% vs 0%) were similar between the 2 respective groups. A 7F sheathless approach to TRA-PCI results in no more IMT and early or late RA trauma than a

  12. Association between ambient air pollution and pregnancy rate in women who underwent IVF.

    Science.gov (United States)

    Choe, S A; Jun, Y B; Lee, W S; Yoon, T K; Kim, S Y

    2018-04-05

    Are the concentrations of five criteria air pollutants associated with probabilities of biochemical pregnancy loss and intrauterine pregnancy in women? Increased concentrations of ambient particulate matter (PM10), nitrogen dioxide (NO2), carbon monoxide (CO) during controlled ovarian stimulation (COS) and after embryo transfer were associated with a decreased probability of intrauterine pregnancy. Exposure to high ambient air pollution was suggested to be associated with low fertility and high early pregnancy loss in women. Using a retrospective cohort study design, we analysed 6621 cycles of 4581 patients who underwent one or more fresh IVF cycles at a fertility centre from January 2006 to December 2014, and lived in Seoul at the time of IVF treatment. To estimate patients' individual exposure to air pollution, we computed averages of hourly concentrations of five air pollutants including PM10, NO2, CO, sulphur dioxide (SO2) and ozone (O3) measured at 40 regulatory monitoring sites in Seoul for each of the four exposure periods: period 1 (start of COS to oocyte retrieval), period 2 (oocyte retrieval to embryo transfer), period 3 (embryo transfer to hCG test), and period 4 (start of COS to hCG test). Hazard ratios (HRs) from the time-varying Cox-proportional hazards model were used to estimate probabilities of biochemical pregnancy loss and intrauterine pregnancy for an interquartile range (IQR) increase in each air pollutant concentration during each period, after adjusting for individual characteristics. We tested the robustness of the result using generalised linear mixed model, accounting for within-woman correlation. Mean age of the women was 35 years. Average BMI was 20.9 kg/m2 and the study population underwent 1.4 IVF cycles on average. Cumulative pregnancy rate in multiple IVF cycles was 51.3% per person. Survival analysis showed that air pollution during periods 1 and 3 was generally associated with IVF outcomes. Increased NO2 (adjusted HR = 0.93, 95% CI

  13. Autotransplantation of spleen tissue in children with mansonic schistosomiasis who underwent splenectomy: Evaluation of splenic residual functions

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    Brandt Carlos Teixeira

    1998-01-01

    Full Text Available Autotransplantation of spleen tissue is an attempt for maintenance of splenic functions when splenectomy is indicated in children. It minimizes the risks of overwhelming postsplenectomy infection and it has been done in children with severe portal hypertension due to hepatosplenic mansonic schistosomiasis that underwent splenectomy. The purposes of this investigation were to study the morphology of the residual splenic tissue; to evaluate the residual filtration function of this splenosis; and to assess the immune response to polyvalent pneumococcal vaccine of these patients. Twenty-three children with portal hypertension from mansonic schistosomiasis who underwent splenectomy, ligature of the left gastric vein, autotransplantation of spleen tissue into an omental pouch were evaluated for residual splenic parenchyma and functions. Tc-99m sulfur colloid liver-spleen scans were used for detection of splenic nodules. The search for Howell Jolly bodies were used for assessing the filtration function and Enzyme-linked immunosorbent assay was used for measuring the relative rise in titter of specific pneumococcal antibodies. Splenosis was evident in all children; however, in two there were less than five splenic nodules in the greater omentum, which was considered insufficient. Howell-Jolly bodies were found in the peripheral blood only in these two patients with less evident splenosis. The immune response was adequate in 15 patients; it was intermediate in 4 patients and inadequate in 4 patients. Autotransplantation of spleen tissue into an omental pouch is efficient in maintaining the filtration splenic function in more than 90% of the cases and the immune response to pneumococcal vaccination in approximately 65% of the children.

  14. HLA-G regulatory haplotypes and implantation outcome in couples who underwent assisted reproduction treatment.

    Science.gov (United States)

    Costa, Cynthia Hernandes; Gelmini, Georgia Fernanda; Wowk, Pryscilla Fanini; Mattar, Sibelle Botogosque; Vargas, Rafael Gustavo; Roxo, Valéria Maria Munhoz Sperandio; Schuffner, Alessandro; Bicalho, Maria da Graça

    2012-09-01

    The role of HLA-G in several clinical conditions related to reproduction has been investigated. Important polymorphisms have been found within the 5'URR and 3'UTR regions of the HLA-G promoter. The aim of the present study was to investigate 16 SNPs in the 5'URR and 14-bp insertion/deletion (ins/del) polymorphism located in the 3'UTR region of the HLA-G gene and its possible association with the implantation outcome in couples who underwent assisted reproduction treatments (ART). The case group was composed of 25 ART couples. Ninety-four couples with two or more term pregnancies composed the control group. Polymorphism haplotype frequencies of the HLA-G were determined for both groups. The Haplotype 5, Haplotype 8 and Haplotype 11 were absolute absence in ART couples. The HLA-G*01:01:02a, HLA-G*01:01:02b alleles and the 14-bp ins polymorphism, Haplotype 2, showed an increased frequency in case women and similar distribution between case and control men. However, this susceptibility haplotype is significantly presented in case women and in couple with failure implantation after treatment, which led us to suggest a maternal effect, associated with this haplotype, once their presence in women is related to a higher number of couples who underwent ART. Copyright © 2012. Published by Elsevier Inc.

  15. Circulating S100B and Adiponectin in Children Who Underwent Open Heart Surgery and Cardiopulmonary Bypass

    Directory of Open Access Journals (Sweden)

    Alessandro Varrica

    2015-01-01

    Full Text Available Background. S100B protein, previously proposed as a consolidated marker of brain damage in congenital heart disease (CHD newborns who underwent cardiac surgery and cardiopulmonary bypass (CPB, has been progressively abandoned due to S100B CNS extra-source such as adipose tissue. The present study investigated CHD newborns, if adipose tissue contributes significantly to S100B serum levels. Methods. We conducted a prospective study in 26 CHD infants, without preexisting neurological disorders, who underwent cardiac surgery and CPB in whom blood samples for S100B and adiponectin (ADN measurement were drawn at five perioperative time-points. Results. S100B showed a significant increase from hospital admission up to 24 h after procedure reaching its maximum peak (P0.05 have been found all along perioperative monitoring. ADN/S100B ratio pattern was identical to S100B alone with the higher peak at the end of CPB and remained higher up to 24 h from surgery. Conclusions. The present study provides evidence that, in CHD infants, S100B protein is not affected by an extra-source adipose tissue release as suggested by no changes in circulating ADN concentrations.

  16. Correlação dos fatores condicionantes básicos para o autocuidado dos pacientes pós-revascularização do miocárdio Correlación de los factores condicionantes básicos para lo autocuidado de los pacientes sometidos a revascularización miocárdica Correlation of basic conditioning factors for selfcare of patients who underwent coronary bypass

    Directory of Open Access Journals (Sweden)

    Francisca Elisângela Teixeira Lima

    2005-10-01

    cardiovasculares practican lo autocuidado y mejoran, principalmente cuando el paciente está jubilado. La conclusión es que pacientes que participaron en esta investigación, tienen un autocuidado satisfactorio, mientras apoyando la importancia del proceso de la orientación en el grupo, de una manera continua y con los acercamientos diferentes para proporcionar al paciente que ha sido sometido a revascularization del miocardio condiciones para la práctica del autocuidado.It was aimed at to correlate selfcare actions developed by patients that undergone coronary bypass with the variables: gender, age, occupation, marital status and family antecedents for cardiovascular diseases. Exploratory-descriptive study, carried out at a cardiology hospital, in Fortaleza-CE, with 52 patients that had undergone coronary bypass in a period less than one year. The patients' has the following profile: majority was men (53,84%, age from 65 years-old or more (59,61%, retired (71,15%, married (63,46%, with family predisposition for cardiovascular diseases (67,30%. Women, elderly patients, married patients and the ones who have family predisposition for cardiovascular alterations had better selfcare practices, mainly when the patient is retired. The conclusion is that patients that participated in this research, keep a satisfactory selfcare level, supporting the importance of the group orientation process, in a continuous way and with different approaches to provide conditions to the patient who have been submitted to the coronary bypass to practice the selfcare.

  17. The association between orthostatic hypotension and cognitive state among adults 65 years and older who underwent a comprehensive geriatric assessment

    Science.gov (United States)

    Punchick, Boris; Freud, Tamar; Press, Yan

    2016-01-01

    Abstract The prevalence of cognitive impairment and orthostatic hypotension (OH) increases with age, but the results of studies that assessed possible associations between them are inconsistent. The aim of this study is to assess possible associations between cognitive impairment and OH in patients ≥65 years of age who underwent a comprehensive geriatric assessment. A retrospective analysis was conducted of the computerized medical records of the study population from 2005 to 2013. Data collected included blood pressure measurements that enabled the calculation of OH, results of the mini-mental state examination (MMSE), results of the Montreal cognitive assessment (MoCA) test, and cognitive diagnoses that were determined over the course of the assessment. The rate of OH in the study population of 571 adults was 32.1%. The mean MMSE score was 22.5 ± 5.2 among participants with OH and 21.6 ± 5.8 among those without OH (P = 0.09). The absence of a significant association between OH and MMSE remained after adjusting the MMSE score for age and education level. The mean MoCA score was 16.4 ± 5.0 among participants with OH and 16.4 ± 4.8 among those without (P = 0.33). The prevalence of OH was 39% among participants without cognitive impairment, 28.9% among those with mild cognitive impairment (MCI), and 30.6% among those with dementia (P = 0.13). There was no association between OH and cognitive impairment in adults who underwent a comprehensive geriatric assessment. PMID:27442658

  18. Stress and Quality of Life for Taiwanese Women Who Underwent Infertility Treatment.

    Science.gov (United States)

    Cheng, Ching-Yu; Stevenson, Eleanor Lowndes; Yang, Cheng-Ta; Liou, Shwu-Ru

    2018-04-28

    To describe the psychological stress and quality of life experienced by women who underwent fertility treatment in Taiwan. Cross-sectional, correlational study. Recruitment was conducted and questionnaires administered at a reproductive medicine center in Chiayi City, Taiwan. Informed consent to participate was obtained from 126 women who sought fertility treatment at the center. The Chinese Fertility Problem Inventory and Fertility Quality of Life scale were used to measure participants' levels of fertility-related stress and fertility-related quality of life. Descriptive statistics, correlation, and regression analysis were used. Overall, participants reported low levels of fertility-related stress and fertility-related quality of life; however, they had relatively high levels of stress related to need for parenthood. Women who were older, had greater body mass indexes, and consumed coffee regularly had lower fertility-related quality of life. Social and relationship concerns and stress related to need for parenthood were significant predictors of low fertility-related quality of life. In a culture in which childbearing is generally an expectation and an important part of family life, women who experience infertility are at risk to experience fertility-related stress. Social support and family consultation might be offered to improve women's fertility-related quality of life. Copyright © 2018 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  19. The Effectiveness of Adjuvant Hyperbaric Oxygen Therapy in Adults who Underwent Hypospadias Surgery

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    Onder Kara

    2017-01-01

    Full Text Available Aim: To evaluate the role of hyperbaric oxygen therapy (HBO2T with buccal mucosal tube urethroplasty in adult patients with hypospadias. Material and Method: Sixteen adult patients with hypospadias were included in our study. Patients with a short urethra and penile curvature were treated in two stages (orthoplasty buccal mucosal tube urethroplasty. Buccal mucosa was taken and prepared for tube urethroplasty around a 16 French (Fr nelaton catheter and the urethral tube was introduced between the urethral meatus and glans penis. Beginning the 1st postoperative day (HBO2T was applied for 10 sessions during weekdays in 13 patients. Results: The mean age was 21 (±1.23 years and mean follow-up time was 10.1 (±2.1 months. In the group who received HBO2T postoperatively (n=13, a two-stage (orthoplasty buccal mucosal tube urethroplasty procedure was performed in 6 (46%, and the mean length of graft was 5.4 (±1.23 cm. In this group of 13 the success rate without any additional manipulations (urethrotomy intern, fistula repair was 54% (7/13. After additional manipulations, complete healing was achieved in 11 out of 13 patients (84.6%. In the group who did not receive HBO2T postoperatively (n=3, a two-stage procedure was performed in 1 patient (33%, and the mean length of graft was 8 (±5 cm. In this group of 3, complete healing was not achieved in any of these patients as a result of the hypospadias surgery. However, after the additional manipulations, complete healing was achieved in 1 patient (33%. Discussion: Given the promising rates of surgical success, postoperative HBO2T might be considered as a supportive treatment modality for adult patients with hypospadias who undergo buccal mucosal tube urethroplasty. Randomized controlled studies are needed.

  20. Comparison of quality of life between men and women who underwent Transforaminal Percutaneous Endoscopic Discectomy for lumbar disc herniation.

    Science.gov (United States)

    Kapetanakis, Stylianos; Gkasdaris, Grigorios; Thomaidis, Tryfon; Charitoudis, Georgios; Kazakos, Konstantinos

    2017-01-01

    Studies describing the efficacy of TPED on shortness of recovery and improvement of postoperative quality of life are limited, especially regarding gender something that has never been reported before in the literature. The purpose of this study is to evaluate possible differences of the health-related quality of life in patients who underwent TPED for LDH in accordance with sex. Seventy-six patients diagnosed and treated with TPED for LDH with 1 year follow-up were selected and divided into two groups of equal number depending on sex. Their quality of life was evaluated by using the SF-36 before the operation, six weeks, three, six and twelve months postoperatively. A statistical analysis was conducted, in order to compare the 8 scaled scores of the SF-36 combining each time two chronological phases in the total of patients, in each group and between groups. Fifty-two (68.4%) patients were ≤63 years old, while the rest 24 (31,4%) were >63 years old (mean ±SD = 56,5 ±12,1 years). Apart from the PF domain, the scores were higher in every visit for the two groups, but the change between groups was not significant. Women had a significantly higher increase of PF score in 3 months after TPED and in the interval 6 weeks-3 months comparing with men. However, in the intervals 3 months-6 months and 3 months-12 months men presented significantly higher increase compared to women. Statistically significant improvement of the quality of life for both men and women was observed. Generally, there was no significant difference between the two groups. As regards to the physical functioning, it appears to be a significant difference which is counterpoised over time. 2. TPED for LDH does not present major differences in the improvement of quality of life regarding gender.

  1. Reduction of scatter radiation during transradial percutaneous coronary angiography: a randomized trial using a lead-free radiation shield.

    Science.gov (United States)

    Politi, Luigi; Biondi-Zoccai, Giuseppe; Nocetti, Luca; Costi, Tiziana; Monopoli, Daniel; Rossi, Rosario; Sgura, Fabio; Modena, Maria Grazia; Sangiorgi, Giuseppe M

    2012-01-01

    Occupational radiation exposure is a growing problem due to the increasing number and complexity of interventional procedures performed. Radial artery access has reduced the number of complications at the price of longer procedure duration. Radpad® scatter protection is a sterile, disposable bismuth-barium radiation shield drape that should be able to decrease the dose of operator radiation during diagnostic and interventional procedures. Such radiation shield has never been tested in a randomized study in humans. Sixty consecutive patients undergoing coronary angiography by radial approach were randomized 1:1 to Radpad use versus no radiation shield protection. The sterile shield was placed around the area of right radial artery sheath insertion and extended medially to the patient trunk. All diagnostic procedures were performed by the same operator to reduce variability in radiation absorption. Radiation exposure was measured blindly using thermoluminescence dosimeters positioned at the operator's chest, left eye, left wrist, and thyroid. Despite similar fluoroscopy time (3.52 ± 2.71 min vs. 3.46 ± 2.77 min, P = 0.898) and total examination dose (50.5 ± 30.7 vs. 45.8 ± 18.0 Gycm(2), P = 0.231), the mean total radiation exposure to the operator was significantly lower when Radpad was utilized (282.8 ± 32.55 μSv vs. 367.8 ± 105.4 μSv, P Radpad utilization at all body locations ranging from 13 to 34% reduction. This first-in-men randomized trial demonstrates that Radpad significantly reduces occupational radiation exposure during coronary angiography performed through right radial artery access. Copyright © 2011 Wiley Periodicals, Inc.

  2. N-acetyl cysteine in ovulation induction of PCOS women underwent intrauterine insemination: An RCT

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    Tahereh Behrouzi Lak

    2017-08-01

    Full Text Available Background: N-acetyl cysteine (NAC was proposed as an adjuvant to clomiphene citratefor ovulation induction in patients with polycystic ovary syndrome (PCOS without clomiphene citrate resistance. Objective: To evaluate the effect of NAC on pregnancy rate in PCOS patients who were candidates for intrauterine insemination. Materials and Methods: In this randomized clinical trial 97 PCOS women aged 18-38 years were enrolled in two groups, randomly. For the case group (n=49, NAC (1.2 gr+ clomiphene citrate (100 mg + letrozole (5mg were prescribed Daily from the third day of menstruation cycle for five days. The control group (n=48 had the same drug regimen without NAC. In order to follicular development, GONALF was injected on days of 7-11 menstrual cycles in all participants. When the follicle size was 18mm or more, HCG (10000 IU was injected intramuscular and the intrauterine insemination was performed after 34-36 hr. Results: There were not significant differences between study groups regarding mean endometrial thickness (p=0.14, mean number of mature follicles (p=0.20 and the pregnancy rate (p=0.09. Conclusion: NAC is ineffective in inducing or augmenting ovulation in PCOS patients who were candidates for intrauterine insemination and cannot be recommended as an adjuvant to CC in such patients.

  3. Vaginal carcinoma in a young woman who underwent fertility-sparing treatment involving chemotherapy and conservative surgery.

    Science.gov (United States)

    Mabuchi, Yasushi; Yahata, Tamaki; Kobayashi, Aya; Tanizaki, Yuko; Minami, Sawako; Ino, Kazuhiko

    2015-06-01

    Vaginal carcinoma is a rare gynecological malignancy that is usually treated by radiation therapy and/or surgery combined with chemotherapy. Here, we report a case of invasive vaginal carcinoma in a young woman who underwent fertility-sparing treatment involving neoadjuvant chemotherapy and conservative surgery. A 36-year-old non-parous woman had a solid tumor in the vagina. Positron emission tomography/computed tomography showed a tumor in the vagina with high FDG uptake (SUV = 17.33) but no metastatic lesions. The patient was diagnosed with vaginal squamous cell carcinoma, FIGO stage I, T1N0M0. Because she wished to retain her fertility, neoadjuvant chemotherapy consisting of irinotecan hydrochloride and nedaplatin was initiated. After four courses of chemotherapy, partial vaginectomy was carried out and the pathological diagnosis of the residual lesion was VAIN 3. Following two further courses of the same chemotherapy, she obtained complete response, and has shown no evidence of disease for 14 months. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

  4. Physical activity in the elderly who underwent joint replacement surgery in the course of rheumatic diseases

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    Agnieszka Prusinowska

    2016-07-01

    Full Text Available According to the forecasts of the Central Statistical Office of Poland, in 2030 people at the age of 65 and older will account for 23.8%, i.e. their number will amount to approx. 8.5 m people. Geriatric rheumatic patients more often decide to undergo surgical joint replacement. According to the National Health Fund, the number of joint replacement services provided in 2014 increased by 93%, as compared to 2005. Improving the physical performance of this constantly expanding group of patients requires taking into account many factors to raise their functional status, reduce the risk of falling, teach rules of proper functioning with an artificial joint and encourage unassisted physical activity. Restoring fitness and independence is a difficult but necessary task due to an increasing number of seniors with replaced joint.

  5. Citrus aurantium Naringenin Prevents Osteosarcoma Progression and Recurrence in the Patients Who Underwent Osteosarcoma Surgery by Improving Antioxidant Capability

    OpenAIRE

    Zhang, Lirong; Xu, Xiaohua; Jiang, Tiechao; Wu, Kunzhe; Ding, Chuanbo; Liu, Zhen; Zhang, Xuanhe; Yu, Tianhua; Song, Changlong

    2018-01-01

    Citrus aurantium is rich in flavonoids, which may prevent osteosarcoma progression, but its related molecular mechanism remains unclear. Flavonoids were extracted from C. aurantium and purified by reparative HPLC. Each fraction was identified by using electrospray ionisation mass spectrometry (ESI-MS). Three main components (naringin, naringenin, and hesperetin) were isolated from C. aurantium. Naringenin inhibited the growth of MG-63 cells, whereas naringin and hesperetin had no inhibitory f...

  6. Patterns and Timing of Failure for Diffuse Large B-Cell Lymphoma After Initial Therapy in a Cohort Who Underwent Autologous Bone Marrow Transplantation for Relapse

    Energy Technology Data Exchange (ETDEWEB)

    Dhakal, Sughosh; Bates, James E. [Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York (United States); Casulo, Carla; Friedberg, Jonathan W.; Becker, Michael W.; Liesveld, Jane L. [Department of Medicine, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York (United States); Constine, Louis S., E-mail: louis_constine@urmc.rochester.edu [Department of Radiation Oncology, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York (United States)

    2016-10-01

    Purpose: To evaluate the location and timing of initial recurrence in patients with diffuse large B-cell lymphoma (DLBCL) who subsequently underwent high-dose chemotherapy with autologous stem cell transplant (HDC/ASCT), to direct approaches for disease surveillance, elucidate the patterns of failure of contemporary treatment strategies, and guide adjuvant treatment decisions. Methods and Materials: We analyzed consecutive patients with DLBCL who underwent HDC/ASCT between May 1992 and March 2014 at our institution. Of the 187 evaluable patients, 8 had incomplete data, and 79 underwent HDC/ASCT as a component of initial treatment for de novo or refractory DLBCL and were excluded from further analysis. Results: The median age was 50.8 years; the median time to relapse was 1.3 years. Patients were segregated according to the initial stage at diagnosis, with early stage (ES) defined as stage I/II and advanced stage (AS) defined as stage III/IV. In total, 40.4% of the ES and 75.5% of the AS patients relapsed in sites of initial disease; 68.4% of those with ES disease and 75.0% of those with AS disease relapsed in sites of initial disease only. Extranodal relapses were common (44.7% in ES and 35.9% in AS) and occurred in a variety of organs, although gastrointestinal tract/liver (n=12) was most frequent. Conclusions: Most patients with DLBCL who relapse and subsequently undergo HDC/ASCT initially recur in the previously involved disease site(s). Time to recurrence is brief, suggesting that frequency of screening is most justifiably greatest in the early posttherapy years. © 2016 Elsevier Inc.

  7. A randomised controlled study of standard versus accelerated deflation of the Terumo radial band haemostasis device after transradial diagnostic cardiac catheterisation.

    Science.gov (United States)

    Deuling, J Han; Vermeulen, Robert P; van den Heuvel, Ad Fm; Schurer, Remco Aj; van der Harst, Pim

    2017-04-01

    Radial access is the preferential access route in patients undergoing diagnostic coronary angiography. We hypothesised that we could reduce hospital stay and improve patient comfort by accelerated deflation of the radial compression device (Terumo radial band). The aim of this study was to compare accelerated pressure reduction with a standard Terumo radial band protocol with regard to local bleeding complications and reported pain scores after cardiac catheterisation. We performed a single centre prospective randomised trial to compare accelerated care to standard care for patients undergoing diagnostic catheterisation through radial access. Patients in the accelerated care group started deflation after 1 hour, with a 2 ml/10-minute interval. Patients in the standard care group started after 2 hours with additional steps of deflation at 3 and 4 hours. Of the 173 analysed patients 86 received accelerated care and 87 patients standard care. A total of 19 patients had pulsatile bleeding, which occurred similarly in the two groups (standard care 11 vs. accelerated care 8, P=0.47). The time to Terumo radial band removal was on average 129 minutes shorter for accelerated care patients compared to standard care ( P<0.01). At 1 hour after Terumo radial band placement, accelerated care patients more often reported pain scores of 0 than standard care patients (89% vs. 74%, P=0.02). There was no increase in local bleedings in the accelerated pressure reduction of the Terumo radial band after diagnostic cardiac catheterisation, increasing patient comfort and reducing hospital stay. These findings will further facilitate the widespread implementation of radial access.

  8. A randomised controlled study of standard versus accelerated deflation of the Terumo radial band haemostasis device after transradial diagnostic cardiac catheterisation

    NARCIS (Netherlands)

    Deuling, J. Han; Vermeulen, Robert P.; van den Heuvel, A. F. M.; Schurer, Remco A. J.; van der Harst, Pim

    2017-01-01

    Background: Radial access is the preferential access route in patients undergoing diagnostic coronary angiography. We hypothesised that we could reduce hospital stay and improve patient comfort by accelerated deflation of the radial compression device (Terumo radial band). Aims: The aim of this

  9. Academic performance of students who underwent psychiatric treatment at the students’ mental health service of a Brazilian university

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    Cláudia Ribeiro Franulovic Campos

    Full Text Available ABSTRACT CONTEXT AND OBJECTIVE: University students are generally at the typical age of onset of mental disorders that may affect their academic performance. We aimed to characterize the university students attended by psychiatrists at the students’ mental health service (SAPPE and to compare their academic performance with that of non-patient students. DESIGN AND SETTING: Cross-sectional study based on review of medical files and survey of academic data at a Brazilian public university. METHODS: Files of 1,237 students attended by psychiatrists at SAPPE from 2004 to 2011 were reviewed. Their academic performance coefficient (APC and status as of July 2015 were compared to those of a control group of 2,579 non-patient students matched by gender, course and year of enrolment. RESULTS: 37% of the patients had had psychiatric treatment and 4.5% had made suicide attempts before being attended at SAPPE. Depression (39.1% and anxiety disorders/phobias (33.2% were the most frequent diagnoses. Severe mental disorders such as psychotic disorders (3.7% and bipolar disorder (1.9% were less frequent. Compared with non-patients, the mean APC among the undergraduate patients was slightly lower (0.63; standard deviation, SD: 0.26; versus 0.64; SD: 0.28; P = 0.025, but their course completion rates were higher and course abandonment rates were lower. Regarding postgraduate students, patients and non-patients had similar completion rates, but patients had greater incidence of discharge for poor performance and lower dropout rates. CONCLUSION: Despite the inclusion of socially vulnerable people with severe mental disorders, the group of patients had similar academic performance, and in some aspects better, than, that of non-patients.

  10. Academic performance of students who underwent psychiatric treatment at the students' mental health service of a Brazilian university.

    Science.gov (United States)

    Campos, Cláudia Ribeiro Franulovic; Oliveira, Maria Lilian Coelho; Mello, Tânia Maron Vichi Freire de; Dantas, Clarissa de Rosalmeida

    2017-01-01

    University students are generally at the typical age of onset of mental disorders that may affect their academic performance. We aimed to characterize the university students attended by psychiatrists at the students' mental health service (SAPPE) and to compare their academic performance with that of non-patient students. Cross-sectional study based on review of medical files and survey of academic data at a Brazilian public university. Files of 1,237 students attended by psychiatrists at SAPPE from 2004 to 2011 were reviewed. Their academic performance coefficient (APC) and status as of July 2015 were compared to those of a control group of 2,579 non-patient students matched by gender, course and year of enrolment. 37% of the patients had had psychiatric treatment and 4.5% had made suicide attempts before being attended at SAPPE. Depression (39.1%) and anxiety disorders/phobias (33.2%) were the most frequent diagnoses. Severe mental disorders such as psychotic disorders (3.7%) and bipolar disorder (1.9%) were less frequent. Compared with non-patients, the mean APC among the undergraduate patients was slightly lower (0.63; standard deviation, SD: 0.26; versus 0.64; SD: 0.28; P = 0.025), but their course completion rates were higher and course abandonment rates were lower. Regarding postgraduate students, patients and non-patients had similar completion rates, but patients had greater incidence of discharge for poor performance and lower dropout rates. Despite the inclusion of socially vulnerable people with severe mental disorders, the group of patients had similar academic performance, and in some aspects better, than, that of non-patients.

  11. The Disability Impact and Associated Cost per Disability in Women Who Underwent Surgical Revision of Transvaginal Mesh Kits for Prolapse Repair.

    Science.gov (United States)

    Javadian, Pouya; Shobeiri, S Abbas

    2017-09-13

    The aim of this study was to investigate disability impact in patients and cost to the families of patients who have had complications of transvaginal prolapse mesh kits and underwent surgical revision. Patients who developed complications of transvaginal mesh kits for prolapse and who had undergone vaginal prolapse mesh surgical revision/removal in 2009 to 2014 at a single institution were identified by Current Procedural Terminology codes. The group was invited to complete a phone survey pertaining to the initial vaginal mesh used for prolapse surgery utilizing Sheehan Disability Scale (scale 0-10) and Years of life Lived with Disability (YLDs) questionnaires. The data collected were used to estimate the disability and cost analysis. We used our data to estimate the economic and quality-of-life impact of vaginal mesh complications on patients in the United States RESULTS: Sixty-two patients (62/198 [31.2%]) were consented to participate and completed the questionnaires by phone. Extremely disabled patients were 18 (29%) of 62 of whole cases, and 5 (8%) of 62 reported that they had no disability after vaginal mesh surgery. The median for overall disability score after vaginal mesh procedure was 8 (which reflects marked disability on a scale of 0-10). The majority of patients missed a median of 12 months of their school or work because of their mesh complications. Thirty-seven (59.6%) of 62 did not improve after mesh removal. Twenty-one (33.9%) of 62 stated that their family income dropped because of productivity loss related to mesh complications. The mean time between vaginal mesh surgery and mesh removal procedure was 4.7 years. Sheehan Disability Scale scores are significantly correlated with YLDs outcomes. Patients' overall disability score showed a significant correlation with YLDs scores (P mesh for prolapse reduction complications had a sustained disability impact that continued despite mesh removal. Likewise, the complications were associated with

  12. Intervenção coronariana percutânea primária pelo acesso transulnar: segurança e eficácia Primary percutaneous coronary intervention through transulnar approach: safety and effectiveness

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    Pedro Beraldo de Andrade

    2008-10-01

    Full Text Available O acesso transradial é seguro e eficaz na realização de procedimentos coronários. Porém, seu uso pode estar comprometido em casos de variações anatômicas da artéria radial, espasmo e negatividade do teste de Allen. O acesso transulnar surge como uma alternativa viável em substituição à abordagem transradial. Reportamos o caso de um paciente submetido à angioplastia primária pela via ulnar com sucesso, sem complicações isquêmicas da mão, a despeito de oclusão prévia da artéria radial correspondente.The transradial approach is safe and effective for coronary procedures. However, its use may be compromised in cases of variations in radial artery anatomy, spasms, and negative Allen's test. The transulnar approach emerges as a viable alternative to transradial approach. We report on a patient who underwent primary angioplasty via ulnar artery without ischemic hand complications despite prior occlusion of the ipsilateral radial artery.

  13. Combined Radial-Pedal Access Strategy and Radial-Pedal Rendezvous in the Revascularization of Complex Total Occlusions of the Superficial Femoral Artery (the "No Femoral Access" Strategy).

    Science.gov (United States)

    Hanna, Elias B; Prout, Davey L

    2016-04-01

    To describe the combined use of radial-pedal access for recanalization of complex superficial femoral artery (SFA) occlusions unsuitable for transfemoral recanalization. Patients are selected for this strategy if they have a long (≥ 10 cm) SFA occlusion with unfavorable aortoiliac anatomy, an absent ostial stump, or severely diseased and calcified distal reconstitution. Left radial artery and distal anterior or posterior tibial artery are accessed with 6-F and 4-F sheaths, respectively. The SFA lesion is crossed retrogradely with a 0.035-inch wire system. If retrograde crossing is not immediately successful, transradial subintimal tracking and radial-pedal subintimal rendezvous are used to allow retrograde reentry. Fifteen patients (mean age 62 ± 5 years; 11 men) have been treated in this fashion, and frequently stented, through the tibiopedal access. Seven patients required radial-pedal rendezvous to facilitate retrograde reentry. Two patients underwent transradial iliac stenting during the same session, and 1 patient underwent transradial kissing angioplasty of the profunda. No major complication occurred in any patient. After the procedure, the pulse across the accessed tibial artery was palpable in all patients. In patients with long and complex SFA occlusion unsuitable for transfemoral recanalization, a radial-pedal strategy can overcome revascularization obstacles. © The Author(s) 2016.

  14. Manejo da osteorradionecrose em pacientes submetidos à radioterapia de cabeça e pescoço = Osteoradionecrosis management in patients underwent head and neck radiotherapy

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    Vier, Fabiana Vieira

    2005-01-01

    Full Text Available Os efeitos colaterais da radioterapia instituída para tratamento de pacientes com câncer da região de cabeça e pescoço interferem significativamente na qualidade de vida desses indivíduos. Entre esses efeitos, podem-se citar mucosite, hipossialia, ageusia, cáries por radiação, trismo e osteorradionecrose (ORN. Esta última constitui uma complicação grave e de difícil tratamento. A presente revisão da literatura objetiva enfatizar aspectos da osteorradionecrose, abordando fatores etiológicos, características clínicas e radiográficas, prevalência, tratamento e prognóstico da enfermidade. O cumprimento de medidas protocolares antes, durante e após a radioterapia de cabeça e pescoço previne e minimiza a ocorrência de complicações como a ORN. As consultas de controle após o término da radioterapia são imprescindíveis e devem ser garantidas pela conscientização do paciente sobre a importância das mediadas preventivas

  15. Radial artery approach for coronary intervention - early experience

    International Nuclear Information System (INIS)

    Jan, H.; Hadi, A.; Fahim, M.; Gul, A.M.; Irfan, M.; Khan, S.B.; Hafizullah, M.

    2012-01-01

    Objective: To see the clinical outcome of patients undergoing Transradial Coronary Angioplasty with stable Angina. Methodology: This was a single center observational study with prospective data collection of 338 patients who underwent transradial coronary angioplasty from September 2009 to August 2011, at Post Graduate Medical Institute, Lady Reading Hospital, Peshawar. Patients of both genders and all ages who had transradial coronary angioplasty for chronic stable angina were included in the study. Patients were clinically examined in out patients department on first month of hospital discharge and clinical outcome data was recorded. Results: A total of 338 patients were included in the study. Male were 58.8% and 41.2% were female with mean age of 52+-7 years. All the patients had coronary intervention through right radial artery. Baseline characteristics of the patients were; 48.2% diabetic, 43.2% hypertensive, 30.5% smokers, dyslipidemia was 45.7% and mean values of serum creatinine and Hemoglobin were 1.1+-0.3 and 11.5+-1.5, respectively. The frequency of various complications were as follow; hematoma 1.3%, nausea and vomiting 2.2%, pain in hand 11.2%, re admission to hospital for chest pain 6.5%, need for revascularization 2.2%, hand ischemia 1.8%, minor bleeding 0.9%, no major bleeding and 1.9% mortality. Conclusion: The radial artery approach for coronary intervention is useful with low degree of access site vascular complications and an early mobilization. (author)

  16. Radial artery approach for coronary intervention - early experience

    Energy Technology Data Exchange (ETDEWEB)

    Jan, H; Hadi, A; Fahim, M; Gul, A M; Irfan, M; Khan, S B; Hafizullah, M [Lady Reading Hospital and Khyber Medical University, Peshawar (Pakistan). Dept. of Cardiology

    2012-01-15

    Objective: To see the clinical outcome of patients undergoing Transradial Coronary Angioplasty with stable Angina. Methodology: This was a single center observational study with prospective data collection of 338 patients who underwent transradial coronary angioplasty from September 2009 to August 2011, at Post Graduate Medical Institute, Lady Reading Hospital, Peshawar. Patients of both genders and all ages who had transradial coronary angioplasty for chronic stable angina were included in the study. Patients were clinically examined in out patients department on first month of hospital discharge and clinical outcome data was recorded. Results: A total of 338 patients were included in the study. Male were 58.8% and 41.2% were female with mean age of 52+-7 years. All the patients had coronary intervention through right radial artery. Baseline characteristics of the patients were; 48.2% diabetic, 43.2% hypertensive, 30.5% smokers, dyslipidemia was 45.7% and mean values of serum creatinine and Hemoglobin were 1.1+-0.3 and 11.5+-1.5, respectively. The frequency of various complications were as follow; hematoma 1.3%, nausea and vomiting 2.2%, pain in hand 11.2%, re admission to hospital for chest pain 6.5%, need for revascularization 2.2%, hand ischemia 1.8%, minor bleeding 0.9%, no major bleeding and 1.9% mortality. Conclusion: The radial artery approach for coronary intervention is useful with low degree of access site vascular complications and an early mobilization. (author)

  17. Long-term psychological distress, and styles of coping, in parents of children and adolescents who underwent invasive treatment for congenital cardiac disease

    NARCIS (Netherlands)

    Spijkerboer, Alinda W.; Helbing, Willem A.; Bogers, Ad J. J. C.; van Domburg, Ron T.; Verhulst, Frank C.; Utens, Elisabeth M. W. J.

    2007-01-01

    To assess the level of psychological distress and styles of coping in both mothers and fathers of children who underwent invasive treatment for congenital cardiac disease at least 7 years and 6 months ago. The General Health Questionnaire and the Utrecht Coping List were completed by parents of

  18. Time-trend analyses of bleeding and mortality after primary percutaneous coronary intervention during out of working hours versus in-working hours: an observational study of 11 466 patients.

    Science.gov (United States)

    Iqbal, M Bilal; Khamis, Ramzi; Ilsley, Charles; Mikhail, Ghada; Crake, Tom; Firoozi, Sam; Kalra, Sundeep; Knight, Charles; Archbold, Andrew; Lim, Pitt; Mathur, Anthony; Meier, Pascal; Rakhit, Roby D; Redwood, Simon; Whitbread, Mark; Bromage, Dan; Rathod, Krishna; Jones, Daniel A; Wragg, Andrew; Dalby, Miles; MacCarthy, Phil; Malik, Iqbal S

    2015-06-01

    Primary percutaneous coronary intervention (PPCI) is the treatment of choice for ST-segment-elevation myocardial infarction. Resources are limited during out of working hours (OWH). Whether PPCI outside working hours is associated with worse outcomes and whether outcomes have improved over time are unknown. We analyzed 11 466 patients undergoing PPCI between 2004 and 2011 at all 8 tertiary cardiac centers in London, United Kingdom. We defined working hours as 9 am to 5 pm (Monday to Friday). We analyzed in-hospital bleeding and all-cause mortality ≤3 years, comparing OWH versus in-working hours. A total of 7494 patients (65.3%) were treated during OWH. Multivariable analyses demonstrated that PPCI during OWH was not a predictor for bleeding (odds ratio, 1.47; 95% confidence interval [CI], 0.97-2.24; P=0.071) or 3-year mortality (hazard ratio, 1.11; 95% CI, 0.94-1.32; P=0.20). This was confirmed in propensity-matched analyses. Time-stratified analyses demonstrated that PPCI during OWH was a predictor for bleeding (odds ratio, 2.00; 95% CI, 1.06-3.80; P=0.034) and 3-year mortality during 2005 to 2008 (hazard ratio, 1.23; 95% CI, 1.00-1.50; P=0.050), but this association was lost during 2009 to 2011. During 2005 to 2008, transradial access was predominantly used during in-working hours and PPCI during OWH was predictive of reduced transradial access use (odds ratio, 0.83; 95% CI, 0.71-0.98; P=0.033), but this association was lost during 2009 to 2011. In this study of unselected patients with ST-segment-elevation myocardial infarction, PPCI during OWH versus in-working hours had comparable bleeding and mortality. Time-stratified analyses demonstrated a reduction in adjusted bleeding and mortality during OWH over time. This may reflect the improved service provision, but the increased adoption of transradial access during OWH may also be contributory. © 2015 American Heart Association, Inc.

  19. Vaginal delivery among women who underwent labor induction with vaginal dinoprostone (PGE2) insert: a retrospective study of 1656 women in China.

    Science.gov (United States)

    Zhao, Lei; Lin, Ying; Jiang, Ting-Ting; Wang, Ling; Li, Min; Wang, Ying; Sun, Guo-Qiang; Xiao, Mei

    2017-12-21

    This study aimed to qualify relevant factors for vaginal delivery among women who underwent labor induction with vaginal dinoprostone (PGE2) insert in a Chinese tertiary maternity hospital. A retrospective study was conducted in Hubei Maternal and Child Health Hospital. A total of 1656 pregnancies that underwent labor induction with vaginal dinoprostone insert between January and August 2016 were finally included in this study. Data were analyzed using univariate and multivariable regression modeling. Of 1656 women with PGE2-induced labor at term, 396 (23.91%) gave birth by cesarean section, 1260 (76.09%) had a vaginal delivery among which 921 (55.61%) delivered vaginally within 24 h. Multivariable regression analysis showed that maternal age (p labor induction, which was markedly higher than the overall annual vaginal delivery rate of 65.1% in China during 2014. Maternal age, parity, baseline fetal heart rate, and birth weight were significant factors for vaginal delivery. This study enables us to better understand the efficiency of dinoprostone and the potential predictors of vaginal delivery in dinoprostone-induced labor, which may be helpful to guide the clinical use of dinoprostone and therefore provide better service clinically.

  20. Functional Changes of Dendritic Cells in C6 Glioma-Bearing Rats That Underwent Combined Argon-Helium Cryotherapy and IL-12 Treatment.

    Science.gov (United States)

    Li, Ming; Cui, Yao; Li, Xiqing; Guo, Yanwu; Wang, Bin; Zhang, Jiadong; Xu, Jian; Han, Shuangyin; Shi, Xiwen

    2016-08-01

    The aim of this study was to explore changes in tumor tissues of glioma-bearing rats that underwent argon-helium cryoablation as well as changes in antitumor immunity before and after combined interleukin 12 treatment. Two hundred sixty Wistar rats were randomly divided into a blank control group, intravenous injection interleukin-12 group, cryotherapy group, and cryotherapy + intravenous injection group. C6 glioma cells proliferated in vitro were implanted subcutaneously on the backs of rats to establish C6 glioma-bearing animal models. Each group underwent the corresponding treatments, and morphological changes in tumor tissues were examined using hematoxylin-eosin staining. CD11c staining was examined using immunohistochemistry, and differences in dendritic cells and T-cell subsets before and after treatment were analyzed using flow cytometry. The control group showed no statistical changes in terms of tumor tissue morphology and cellular immunity, cryotherapy group, and cryotherapy + intravenous injection group, among which the count for the cryotherapy + intravenous injection group was significantly higher than those of all other groups. In the argon-helium cryotherapy group, tumor cells were damaged and dendritic cell markers were positive. The number of CD11c+ and CD86+ cells increased significantly after the operation as did the cytokine interferon-γ level (P < .01), suggesting a shift toward Th1-type immunity. Combined treatment of argon-helium cryoablation and interleukin 12 for gliomas not only effectively injured tumor tissues but also boosted immune function and increased antitumor ability. Therefore, this approach is a promising treatment measure for brain gliomas. © The Author(s) 2015.

  1. HO-1 gene overexpression enhances the beneficial effects of superparamagnetic iron oxide labeled bone marrow stromal cells transplantation in swine hearts underwent ischemia/reperfusion: an MRI study.

    Science.gov (United States)

    Jiang, Yibo; Chen, Lijuan; Tang, Yaoliang; Ma, Genshan; Shen, Chengxing; Qi, Chunmei; Zhu, Qi; Yao, Yuyu; Liu, Naifeng

    2010-05-01

    To determine the effect of intracoronary transfer of superparamagnetic iron oxide (SPIO) labeled heme oxygenase-1 (HO-1) overexpressed bone marrow stromal cells (BMSCs) in a porcine myocardial ischemia/reperfusion model. Cell apoptosis was assayed and supernatant cytokine concentrations were measured in BMSCs that underwent hypoxia/reoxygen in vitro. Female mini-swines that underwent 1 h LAD occlusion followed by 1 h reperfusion were randomly allocated to receive intracoronary saline (control), 1 x 10(7) SPIO-labeled BMSCs transfected with pcDNA3.1-Lacz plasmid (Lacz-BMSCs), pcDNA3.1-human HO-1 (HO-1-BMSCs), pcDNA3.1-hHO-1 pretreated with a HO inhibitor, tin protoporphyrin (SnPP, n = 10 each). MRI and postmortem histological analysis were made at 1 week or 3 months thereafter. Post hypoxia/reoxygen in vitro, apoptosis was significantly reduced, supernatant VEGF significantly increased while TNF-alpha and IL-6 significantly reduced in HO-1-BMSCs group compared with Lacz-BMSCs group (all p < 0.05). Myocardial expression of VEGF was significantly higher in HO-1-BMSCs than in Lacz-BMSCs group at 1 week post transplantation (all p < 0.05). Signal voids induced by the SPIO were detected in the peri-infarction region in all BMSC groups at 1 week but not at 3 months post transplantation and the extent of the hypointense signal was the highest in HO-1-BMSCs group, and histological analysis showed that signal voids represented cardiac macrophages that engulfed the SPIO-labeled BMSCs. Pretreatment with SnPP significantly attenuated the beneficial effects of HO-1-BMSCs. Transplantation of HO-1-overexpressed BMSCs significantly enhanced the beneficial effects of BMSCs on improving cardiac function in this model.

  2. Clinical observation of the adverse drug reactions caused by non-ionic iodinated contrast media: results from 109,255 cases who underwent enhanced CT examination in Chongqing, China.

    Science.gov (United States)

    Li, X; Chen, J; Zhang, L; Liu, H; Wang, S; Chen, X; Fang, J; Wang, S; Zhang, W

    2015-03-01

    To analyse the pattern and factors that influence the incidence of adverse drug reactions (ADRs) induced by non-ionic iodinated contrast media and to evaluate their safety profiles. Data from 109,255 cases who underwent enhanced CT examination from 1 January 2008 to 31 August 2013 were analysed. ADRs were classified according to the criteria issued by the American College of Radiology and the Chinese Society of Radiology. A total of 375 (0.34%) patients had ADRs, including 281 mild (0.26%); 80 moderate (0.07%); and 14 severe (0.01%) ADRs; no death was found. 302 (80.53%) of the ADRs occurred within 15 min after examination. Patients aged 40-49 years (204 cases, 0.43%; p contrast media are mainly mild ones, while moderate or severe ADRs are relatively rare, suggesting that enhanced CT examination with non-ionic iodinated contrast media is highly safe, and severe adverse events will seldom occur under appropriate care. The study included 109,255 patients enrolled in various types of enhanced CT examinations, which could reflect ADR conditions and regulations in Chinese population accurately and reliably.

  3. Combined Radial and Femoral Access Strategy and Radial-Femoral Rendezvous in Patients With Long and Complex Iliac Occlusions.

    Science.gov (United States)

    Hanna, Elias B; Mogabgab, Owen N; Baydoun, Hassan

    2018-01-01

    We present cases of complex, calcified iliac occlusive disease revascularized via a combined radial-femoral access strategy. Through a 6-French, 125-cm transradial guiding catheter, antegrade guidewires and catheters are advanced into the iliac occlusion, while retrograde devices are advanced transfemorally. The transradial and transfemoral channels communicate, allowing the devices to cross the occlusion into the true lumen (radial-femoral antegrade-retrograde rendezvous).

  4. Phytophthora megakarya and Phytophthora palmivora, Closely Related Causal Agents of Cacao Black Pod Rot, Underwent Increases in Genome Sizes and Gene Numbers by Different Mechanisms

    Science.gov (United States)

    Ali, Shahin S.; Shao, Jonathan; Lary, David J.; Kronmiller, Brent A.; Shen, Danyu; Strem, Mary D.; Amoako-Attah, Ishmael; Akrofi, Andrew Yaw; Begoude, B.A. Didier; ten Hoopen, G. Martijn; Coulibaly, Klotioloma; Kebe, Boubacar Ismaël; Melnick, Rachel L.; Guiltinan, Mark J.; Tyler, Brett M.; Meinhardt, Lyndel W.

    2017-01-01

    Phytophthora megakarya (Pmeg) and Phytophthora palmivora (Ppal) are closely related species causing cacao black pod rot. Although Ppal is a cosmopolitan pathogen, cacao is the only known host of economic importance for Pmeg. Pmeg is more virulent on cacao than Ppal. We sequenced and compared the Pmeg and Ppal genomes and identified virulence-related putative gene models (PGeneM) that may be responsible for their differences in host specificities and virulence. Pmeg and Ppal have estimated genome sizes of 126.88 and 151.23 Mb and PGeneM numbers of 42,036 and 44,327, respectively. The evolutionary histories of Pmeg and Ppal appear quite different. Postspeciation, Ppal underwent whole-genome duplication whereas Pmeg has undergone selective increases in PGeneM numbers, likely through accelerated transposable element-driven duplications. Many PGeneMs in both species failed to match transcripts and may represent pseudogenes or cryptic genetic reservoirs. Pmeg appears to have amplified specific gene families, some of which are virulence-related. Analysis of mycelium, zoospore, and in planta transcriptome expression profiles using neural network self-organizing map analysis generated 24 multivariate and nonlinear self-organizing map classes. Many members of the RxLR, necrosis-inducing phytophthora protein, and pectinase genes families were specifically induced in planta. Pmeg displays a diverse virulence-related gene complement similar in size to and potentially of greater diversity than Ppal but it remains likely that the specific functions of the genes determine each species’ unique characteristics as pathogens. PMID:28186564

  5. [A Case with Metastatic Huge Ovarian Tumor from Transverse Colon Cancer, Who Underwent Systemic Chemotherapy after Bilateral Oophorectomy and Right Hemi Colectomy].

    Science.gov (United States)

    Miyanari, Shun; Nagasaki, Toshiya; Minami, Hironori; Fukuoka, Hironori; Murahashi, Satoshi; Suzuki, Shinsuke; Ushigome, Hajime; Akiyoshi, Takashi; Konishi, Tsuyoshi; Fujimoto, Yoshiya; Nagayama, Satoshi; Fukunaga, Yosuke; Ueno, Masashi

    2017-11-01

    Metastatic ovarian tumors from colon cancer would be resistant to chemotherapy, and compromising quality of life(QOL) of these patients was caused by acute enlargement of the tumors. A 37-year-old woman with abdominal distension was diagnosed with transverse colon cancer, bilateral ovarian metastases, liver metastases, and peritoneal dissemination at prior hospital. Two courses of chemotherapy(FOLFOX)were administered, but metastaticovarian tumors enlarged. Chemotherapy was discontinued and she was referred to our institution. To achieve symptom relief, improving QOL, and to resume chemotherapy, we planned bilateral oophorectomy and primary tumor resection if other stenotic lesion was not present. As a result, we safely performed open bilateral oophorectomy and right hemi colectomy, and the patient discharged on postoperative day 11 without complications. Chemotherapy was resumed and continued for 7 months up to this time. Even though, curative resection could not be achieved, oophorectomy should be performed in patients with enlarged metastatic ovarian tumor from colon cancer, in spite of administration of chemotherapy.

  6. Quality of Life and Psychopathology in Adults Who Underwent Hematopoietic Stem Cell Transplantation (HSCT in Childhood: A Qualitative and Quantitative Analysis

    Directory of Open Access Journals (Sweden)

    Francesco Sinatora

    2017-08-01

    Full Text Available Background: Patients who undergo pediatric Hematopoietic Stem Cell Transplantation (HSCT may experience long-term psychological sequelae and poor Quality of Life (QoL in adulthood. This study aimed to investigate subjective illness experience, QoL, and psychopathology in young adults who have survived pediatric HSCT.Method: The study involved patients treated with HSCT in the Hematology-Oncology Department between 1984 and 2007. Psychopathology and QoL were investigated using the SCL-90-R and SF-36. Socio-demographic and medical information was also collected. Finally, participants were asked to write a brief composition about their experiences of illness and care. Qualitative analysis of the texts was performed using T-LAB, an instrument for text analysis that allows the user to highlight the occurrences and co-occurrences of lemma. Quantitative analyses were performed using non-parametric tests (Spearman correlations, Kruskal-Wallis and Mann-Whitney tests.Results: Twenty-one patients (9 males participated in the study. No significant distress was found on the SCL-90 Global Severity Index, but it was found on specific scales. On the SF-36, lower scores were reported on scales referring to bodily pain, general health, and physical and social functioning. All the measures were significantly (p < 0.05 associated with specific socio-demographic and medical variables (gender, type of pathology, type of HSCT, time elapsed between communication of the need to transplant and effective transplantation, and days of hospitalization. With regard to the narrative analyses, males focused on expressions related to the body and medical therapies, while females focused on people they met during treatment, family members, and donors. Low general health and treatment with autologous HSCT were associated with memories about chemotherapy, radiotherapy, and the body parts involved, while high general health was associated with expressions focused on gratitude (V

  7. Outcome of recipients of human leukocyte antigen incompatible kidney transplants who underwent desensitization at King Fahad Specialist Hospital, Dammam, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Mohammed Abdulrahim Idris

    2017-01-01

    Full Text Available In patients whom are highly sensitized immunologically, the benefit of kidney transplantation can be extended to this population through the utilization of organs from human leukocyte antigen incompatible (HLAi donors. This retrospective observational study was designed to identify the incidence and predictors of acute antibody-mediated rejection/acute cellular rejection (AMR/ACR in our kidney recipients from living kidney donors (sensitized and those with low immunologic risk. This single-center study has been conducted at King Fahad Specialist Hospital, Dammam (KFSH-D, Saudi Arabia; during the period of September 2008- August 2013. All eligible recipients of living donor kidneys during the study period were included (n = 213 in the study. Over 60% of patients in the study were females. Thirty of the 213 kidneys were from HLAi donors. During the follow-up period (median follow-up time = 16 months; 3–27 months, the incidence rate of ACR among HLA compatible (HLAc and HLAi groups was 22.2% and 16.7%, respectively (P >0.05. The incidence rate of AMR was 2.6% in HLAc group and 16.7%in the HLAi group (P<0.05. The significantly higher incidence of AMR in HLAi group can be explained by the presence of the donor-specific antibodies in weak titers. These results are consistent with studies from similar populations in published literature. However, the relatively small number and short duration of the study are considered, and longer follow-up of this population will be needed for conclusions on the sustainability of our findings.

  8. Use and outcome of radial versus femoral approach for primary PCI in patients with acute ST elevation myocardial infarction without cardiogenic shock: results from the ALKK PCI registry.

    Science.gov (United States)

    Bauer, Timm; Hochadel, Matthias; Brachmann, Johannes; Schächinger, Volker; Boekstegers, Peter; Zrenner, Bernhard; Zahn, Ralf; Zeymer, Uwe

    2015-10-01

    This study sought to compare the use and outcome of radial versus femoral access in patients treated with primary percutaneous coronary intervention (PCI) for acute ST elevation myocardial infarction (STEMI) in clinical practice. The radial approach for PCI in patients with STEMI has been suggested to have a lower rate of complications and bleeding and to improve prognosis compared with the femoral approach. However, there still is a large regional and national variation in its use. Between 2008 and 2012 a total of 17,865 patients with STEMI without cardiogenic shock undergoing primary PCI were prospectively enrolled in the observational German PCI registry of the Arbeitsgemeinschaft leitende kardiologische Krankenhausärzte (ALKK). Transfemoral (TF) access was used in 15,270 (85.5%), transradial (TR) access in 2,530 (14.2%), and other access in 65 (0.3%) patients. In this analysis, 10,264 patients from 20 centers that had performed at least 5 TR-PCI for STEMI were included. This study compared TR-PCI (n = 2,454 23.9%) with TF-PCI (n = 7,810, 76.1%). Procedural success was high in both cohorts. Hospital mortality (1.8 vs. 5.1%, P PCI can be performed with excellent procedural success in selected STEMI patients and is associated with a lower rate of vascular access complications and hospital mortality. © 2015 Wiley Periodicals, Inc.

  9. Impact of anticoagulation strategy with bivalirudin or heparin on nonaccess site bleeding in percutaneous coronary interventions: A meta-analysis of randomized trials

    NARCIS (Netherlands)

    Verdoia, M.; Barbieri, L.; Parodi, G.; Bellandi, B.; Schaffer, A.; Suryapranata, H.; Luca, G. De

    2017-01-01

    BACKGROUND: Transradial approach has significantly decreased the rate of access site bleeding in patients undergoing percutaneous coronary interventions (PCI), therefore potentially mitigating the benefits offered by bivalirudin in lowering major bleeding complications as compared to heparin.

  10. Anterior ischemic optic neuropathy in patients undergoing hemodialysis

    NARCIS (Netherlands)

    DoorenbosBot, ACC; Geerlings, W; Houtman, IA

    Four patients are discussed who underwent hemodialysis and developed anterior ischemic optic neuropathy (AION). Three patients had been treated by hemodialysis for several years. One patient developed bilateral optic neuropathy after the first hemodialysis session, So far, only four hemodialysis

  11. Patients with carcinoid syndrome exhibit symptoms of aggressive impulse dysregulation

    NARCIS (Netherlands)

    Russo, S; Boon, JC; Kema, IP; Willemse, PHB; den Boer, JA; Korf, J; de Vries, EGE

    2004-01-01

    Objective: Carcinoid tumors can produce excessive amounts of biogenic amines, notably serotonin. We assessed psychiatric symptoms in carcinoid patients and peripheral metabolism of tryptophan, the precursor of serotonin. Methods: Twenty consecutive patients with carcinoid syndrome underwent a

  12. Enhancing contrast of magnetic resonance imaging in patients with ...

    African Journals Online (AJOL)

    DTPA), a recent magnetic resonance imaging (MRI) contrast agent, in hepatobiliary system of patients with liver cirrhosis. Methods: Liver cirrhosis patients that underwent contrast MRI examination at Renai Hospital, Taipei City, Taiwan were ...

  13. Genito-Urinary Fistula Patients at Bugando Medical Centre ...

    African Journals Online (AJOL)

    Genito-Urinary Fistula Patients at Bugando Medical Centre. ... Interventions: A total of 1294 patients underwent surgical treatment of incontinence. ... study shows that low education and poverty were the key factors in the development of fistula.

  14. Incidence of postoperative implant-related bacterial endocarditis in dogs that underwent trans-catheter embolization of a patent ductus arteriosus without intra- and post-procedural prophylactic antibiotics.

    Science.gov (United States)

    Szatmári, Viktor

    2017-08-01

    Intra- and post-procedural prophylactic antibiotics are routinely administered by veterinary cardiologists to dogs that undergo trans-catheter embolization of a patent ductus arteriosus for prevention of implant-related infective endocarditis. The hypothesis of our study was that primary antibiotic prophylaxis is not necessary to prevent bacterial endocarditis. In this retrospective case series 54 client-owned dogs that underwent trans-catheter occlusion of a patent ductus arteriosus in a single tertiary veterinary referral center between 2004 and 2016 were evaluated. Follow-up information was gained by telephone interviews with the owners or the referring veterinarians, or from the digital archives of the authors' clinic. Inclusion criteria were that at least one metal implant (a coil or an Amplatz duct occluder) had to be delivered in the ductal ampulla, no local or systemic antibiotics were given on the day of the intervention or the week thereafter, at least 3 months of postoperative follow-up information was available, and the author was performing the procedure either as the primary or as the supervising cardiology specialist. None of the 54 dogs developed infective endocarditis in the postoperative 3 months. A study describing a similar population reports 2 of the included 47 dogs having developed infective endocarditis in the postoperative period despite the administration of intra- and post-procedural prophylactic antibiotics. We conclude that intra- and post-procedural antibiotic prophylaxis is not justified in dogs that undergo trans-catheter closure of a patent ductus arteriosus. Proper surgical technique and the use of new sterile catheters and implants are sufficient to prevent infective endocarditis in these dogs. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. The importance of patient-centered care for various patient groups.

    NARCIS (Netherlands)

    Boer, D. de; Delnoij, D.; Rademakers, J.

    2013-01-01

    Objectives: To assess differences in the importance ascribed to patient-centered care between various patient groups and demographic groups. Methods: Survey data collected using questionnaires were analyzed for patients that underwent hip or knee surgery (n=214), patients suffering from rheumatoid

  16. Preceding immunosuppressive therapy with antithymocyte globulin and ciclosporin increases the incidence of graft rejection in children with aplastic anaemia who underwent allogeneic bone marrow transplantation from HLA-identical siblings.

    Science.gov (United States)

    Kobayashi, Ryoji; Yabe, Hiromasa; Hara, Junichi; Morimoto, Akira; Tsuchida, Masahiro; Mugishima, Hideo; Ohara, Akira; Tsukimoto, Ichiro; Kato, Koji; Kigasawa, Hisato; Tabuchi, Ken; Nakahata, Tatsutoshi; Ohga, Shoichi; Kojima, Seiji

    2006-12-01

    The incidence of graft rejection was determined in 66 children with acquired aplastic anaemia (AA) following bone marrow transplantation (BMT) from a related donor. Eleven of 65 evaluable patients experienced either early or late rejection. Multivariate analysis identified previous immunosuppressive therapy with antithymocyte-globulin (ATG) and ciclosporin (CsA) as a risk factor for graft rejection (relative risk: 16.6, P = 0.001). Patients who received ATG and CsA had a significantly lower probability of failure-free survival than those who did not (69.7 +/- 6.2% vs. 87.9 +/- 8.0%, P = 0.044). These results suggest that BMT should be instituted immediately in children with severe AA who have human leucocyte antigen-identical siblings.

  17. Lung cancer incidence and mortality in National Lung Screening Trial participants who underwent low-dose CT prevalence screening: a retrospective cohort analysis of a randomised, multicentre, diagnostic screening trial.

    Science.gov (United States)

    Patz, Edward F; Greco, Erin; Gatsonis, Constantine; Pinsky, Paul; Kramer, Barnett S; Aberle, Denise R

    2016-05-01

    -211·93] per 100 000 person-years vs 277·20 [252·28-303·90]). The yield of lung cancer at the T1 screen among participants with a negative T0 screen was 0·34% (62 screen-detected cancers out of 18 121 screened participants), compared with a yield at the T0 screen among all T0-screened participants of 1·0% (267 of 26 231). We estimated that if the T1 screen had not been done in the T0 negative group, at most, an additional 28 participants in the T0 negative group would have died from lung cancer (a rise in mortality from 185·82 [95% CI 162·17-211·93] per 100 000 person-years to 212·14 [186·80-239·96]) over the course of the trial. Participants with a negative low-dose CT prevalence screen had a lower incidence of lung cancer and lung cancer-specific mortality than did all participants who underwent a prevalence screen. Because overly frequent screening has associated harms, increasing the interval between screens in participants with a negative low-dose CT prevalence screen might be warranted. None. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Direct vision internal urethrotomy in 459 urethral stricture patients at ...

    African Journals Online (AJOL)

    Four hundred and fifty nine patients seen with simple urethral strictures between 1990 and 1998 underwent direct vision urethrotomy.. The procedure was successful in 441 patients and failed in only 18 patients. Postoperative complications included fever in 31 patients, urethral bleeding in 14 and epididymitis in 17 patients.

  19. Estudo dos lipídios em jovens portadores de esquistossomose hepatoesplênica submetidos a tratamento cirúrgico A lipid study of schistosomotic young people underwent surgical treatment

    Directory of Open Access Journals (Sweden)

    Schirley Nóbrega da Silva

    2002-08-01

    Full Text Available Objetivo: Avaliar o metabolismo lipídico em uma população de jovens portadores de esquistossomose na forma hepatoesplênica associada a varizes sangrentas de esôfago. Métodos: Foram selecionados, aleatoriamente, 20 jovens com estas anormalidades, submetidos a esplenectomia, ligadura da veia gástrica esquerda e auto-implante de tecido esplênico no omento maior. Como controle foram selecionados 20 adolescentes saudáveis, com a mesma condição sócio-econômico ambiental do grupo estudo. Destes dois grupos, obtiveram-se plasma e eritrócitos de onde foram extraídos, separados e dosados os lipídios neutros, colesterol livre e esterificado, fosfolipídios e triglicerídios. Resultados: A concentração molar de colesterol total do grupo de pacientes foi discretamente reduzida quando comparada ao grupo de indivíduos controles. Resultados similares foram observados com as frações de colesterol esterificado e colesterol livre. Houve redução na concentração de triglicerídios plasmáticos mas não significativa. Os fosfolipídios individuais apresentarem concentração relativa similar aos do grupo controle, entretanto houve redução significativa (p Objective: To evaluate the lipid metabolism in a population of young people, with the hepatesplenic form of schistosomiasis mansoni, associated with bleeding esophageal varices. Methods: 20 young patients were selected, at random, and compared to a control group of 20 healthy young people with the same social, economical and environmental conditions. The patients had undergone splenectomy, ligature of the left gastric vein and auto implantation of spleen tissue into the major omentum. From these two groups were obtained plasma and erythrocytes, and it were extracted, separated and determinated the neutral lipids, free cholesterol and ester, phospholipids and triglicerides levels. Results: The results appointed that the total molar concentration of total, cholesterol was similar to the

  20. Evaluación nutricional de niños con insuficiencia renal aguda que reciben diálisis Nutritional assessment of children presenting with acute renal insufficiency and underwent to dialysis

    Directory of Open Access Journals (Sweden)

    Jorge Silva Ferrera

    2010-03-01

    Full Text Available INTRODUCCIÓN. La insuficiencia renal aguda se produce en horas o en algunos días, y durante su evolución se produce un deterioro del estado nutricional del paciente. El objetivo de este estudio fue caracterizar el estado nutricional de niños con esta enfermedad que requirieron terapias de reemplazo renal. MÉTODOS. Se realizó un estudio retrospectivo y transversal que incluyó a los pacientes ingresados por insuficiencia renal aguda en dos hospitales pediátricos de Santiago de Cuba entre diciembre de 2006 y diciembre de 2008. Se analizó edad, sexo, etiología, terapia de reemplazo renal, causa del uso de nutrición parenteral, evaluación nutricional según tablas cubanas de percentiles y parámetros antropométricos (edad, peso, talla y aporte de nutrientes parenterales. RESULTADOS. Eventos prerrenales fueron la causa de la insuficiencia renal aguda en el 44,4 % de los casos, y renales y posrenales, en el 33,4 y 22,2 %, respectivamente. Como método de depuración renal se utilizó la diálisis peritoneal en el 66,6 % de los casos y la hemodiálisis en los restantes pacientes. Las principales causas que motivaron la nutrición parenteral fueron las afecciones quirúrgicas, los estados hipercatabólicos, la hemorragia digestiva y la pancreatitis, en orden decreciente. Cuatro pacientes fueron evaluados como de bajo peso. CONCLUSIONES. El aporte promedio de proteínas y lípidos estuvo por debajo de los aportes nutricionales establecidos, y el aporte de kilocalorías fue superior a lo recomendado. Se deben mejorar estos parámetros en el tratamiento de estos pacientes.INTRODUCTION: Acute renal insufficiency appears in hours or in a few days and during its course there is a deterioration of patient nutritional status. The aim of present study was to characterize the nutritional status of children with this disease requiring renal replacement therapies. METHODS: A crossed-sectional and retrospective study was conducted including the patients

  1. High progesterone levels during the luteal phase related to the use of an aromatase inhibitor in breast cancer patients

    DEFF Research Database (Denmark)

    Alviggi, C; Marci, R; Vallone, R

    2017-01-01

    OBJECTIVE: To evaluate the hormonal profile in three breast cancer patients who underwent controlled ovarian stimulation in the presence of the aromatase inhibitor letrozole. PATIENTS AND METHODS: In IVF University referral center, a case series of three breast cancer patients who underwent contr...

  2. Awake craniotomy. A patient`s perspective.

    Science.gov (United States)

    Bajunaid, Khalid M; Ajlan, Abdulrazag M

    2015-07-01

    To report the personal experiences of patients undergoing awake craniotomy for brain tumor resection. We carried out a qualitative descriptive survey of patients` experiences with awake craniotomies for brain tumor resection. The survey was conducted through a standard questionnaire form after the patient was discharged from the hospital. Of the 9 patients who met the inclusion criteria and underwent awake craniotomy, 3 of those patients reported no recollection of the operation. Five patients had auditory recollections from the operation. Two-thirds (6/9) reported that they did not perceive pain. Five patients remembered the head clamp fixation, and 2 of those patients classified the pain from the clamp as moderate. None of the patients reported that the surgery was more difficult than anticipated. Awake craniotomy for surgical resection of brain tumors was well tolerated by patients. Most patients reported that they do not recall feeling pain during the operation. However, we feel that further work and exploration are needed in order to achieve better control of pain and discomfort during these types of operations.

  3. Outcomes of colon resection in patients with metastatic colon cancer.

    Science.gov (United States)

    Moghadamyeghaneh, Zhobin; Hanna, Mark H; Hwang, Grace; Mills, Steven; Pigazzi, Alessio; Stamos, Michael J; Carmichael, Joseph C

    2016-08-01

    Patients with advanced colorectal cancer have a high incidence of postoperative complications. We sought to identify outcomes of patients who underwent resection for colon cancer by cancer stage. The National Surgical Quality Improvement Program database was used to evaluate all patients who underwent colon resection with a diagnosis of colon cancer from 2012 to 2014. Multivariate logistic regression analysis was performed to investigate patient outcomes by cancer stage. A total of 7,786 colon cancer patients who underwent colon resection were identified. Of these, 10.8% had metastasis at the time of operation. Patients with metastatic disease had significantly increased risks of perioperative morbidity (adjusted odds ratio [AOR]: 1.44, P = .01) and mortality (AOR: 3.72, P = .01). Patients with metastatic disease were significantly younger (AOR: .99, P colon cancer have metastatic disease. Postoperative morbidity and mortality are significantly higher than in patients with localized disease. Published by Elsevier Inc.

  4. Choledocholitiasis. Endoskopisk behandling af 416 konsekutive patienter

    DEFF Research Database (Denmark)

    Pedersen, F M; Brandt, C J; Schaffalitzky de Muckadell, O B

    1998-01-01

    patients who underwent ERC for common bile duct stones between January 1990 and January 1995. The overall success rate of achieving a common bile duct free of stones was 89.0%, and in 94.7% of the patients endoscopic treatment was definitive. The overall complication rate was 9.6% and the 30-day mortality...

  5. Patient dosimetry in hysterosalpingography

    International Nuclear Information System (INIS)

    Khoury, H.J.; Maia, A.; Oliveira, M.; Kramer, R.; Drexler, G.

    2001-01-01

    The objectives of this study were to determine the entrance surface dose to the patient and to estimate the dose to the uterus and ovaries due to hysterosalpingography (HSG) diagnostic examinations performed in Recife-Pe, Brazil. The entrance doses were measured using four thermoluminescent dosimeters per patient, attached to anatomical landmarks on the patient's skin. The study was carried out on 25 patients between 21 and 45 years of age who underwent the HSG examinations in two training hospitals and one private radiodiagnostic institute. The number of exposures performed ranged from 4 to 15 radiographs per patient measured. Entrance surface doses varied between 4.99 and 36.6 mGy, with an average of 12.6mGy. The doses to the ovaries and uterus ranged from 0.80 mGy to 5.8 mGy and 1.10mGy to 8.05 mGy, respectively. (author)

  6. Postanesthetic Emergence Agitation in Pediatric Patients under General Anesthesia

    OpenAIRE

    Mohkamkar, Masoumeh; Farhoudi, Fatemeh; Alam-Sahebpour, Alireza; Mousavi, Seyed-Abdullah; Khani, Soghra; Shahmohammadi, Soheila

    2014-01-01

    Abstract Objective Postanesthetic emergence agitation is a common problem in pediatric postanesthetic care unit with an incidence ranging from 10 to 80%. This study was done to determine the prevalence of emergence agitation and associated risk factors in pediatric patients who underwent general anesthesia. Methods This cross-sectional descriptive and analytic study was performed on 747 pediatric patients aged 3- 7 years that underwent general anesthesia for various elective surgeries at Bou-...

  7. A case that underwent bilateral video- assisted thoracoscopic ...

    African Journals Online (AJOL)

    Adele

    C ventilator was used for controlled ventilation of the lungs. Pres- ... sufficient tidal volume, and the PaO2 value of the Paratrend 7TN ... operative lung. The cause was probably airway obstruction due to his intraluminal tumor plus secretions.

  8. Management of isolated nonresectable liver metastases in colorectal cancer patients: a case-control study of isolated hepatic perfusion with melphalan versus systemic chemotherapy

    NARCIS (Netherlands)

    van Iersel, L. B. J.; Koopman, M.; van de Velde, C. J. H.; Mol, L.; van Persijn van Meerten, E. L.; Hartgrink, H. H.; Kuppen, P. J. K.; Vahrmeijer, A. L.; Nortier, J. W. R.; Tollenaar, R. A. E. M.; Punt, C.; Gelderblom, H.

    2010-01-01

    To compare the median overall survival of patients with isolated nonresectable liver metastases in comparable groups of patients treated with either isolated hepatic perfusion (IHP) with melphalan or systemic chemotherapy. Colorectal cancer patients with isolated liver metastases, who underwent IHP,

  9. Pancreatic duct stones in patients with chronic pancreatitis: surgical outcomes.

    Science.gov (United States)

    Liu, Bo-Nan; Zhang, Tai-Ping; Zhao, Yu-Pei; Liao, Quan; Dai, Meng-Hua; Zhan, Han-Xiang

    2010-08-01

    Pancreatic duct stone (PDS) is a common complication of chronic pancreatitis. Surgery is a common therapeutic option for PDS. In this study we assessed the surgical procedures for PDS in patients with chronic pancreatitis at our hospital. Between January 2004 and September 2009, medical records from 35 patients diagnosed with PDS associated with chronic pancreatitis were retrospectively reviewed and the patients were followed up for up to 67 months. The 35 patients underwent ultrasonography, computed tomography, or both, with an overall accuracy rate of 85.7%. Of these patients, 31 underwent the modified Puestow procedure, 2 underwent the Whipple procedure, 1 underwent simple stone removal by duct incision, and 1 underwent pancreatic abscess drainage. Of the 35 patients, 28 were followed up for 4-67 months. There was no postoperative death before discharge or during follow-up. After the modified Puestow procedure, abdominal pain was reduced in patients with complete or incomplete stone clearance (P>0.05). Steatorrhea and diabetes mellitus developed in several patients during a long-term follow-up. Surgery, especially the modified Puestow procedure, is effective and safe for patients with PDS associated with chronic pancreatitis. Decompression of intraductal pressure rather than complete clearance of all stones predicts postoperative outcome.

  10. Patient satisfaction with cataract surgery

    Directory of Open Access Journals (Sweden)

    Wasfi Ehab I

    2008-10-01

    Full Text Available Abstract Introduction Measuring the patient satisfaction is a very important issue that will help very much in improving the service provided to patients and improve the level of satisfaction. Aim To evaluate patient satisfaction with the cataract surgery service and identify any areas for improvement, determination of patient satisfaction with referral, out-patient consultation, pre-assessment clinic, surgery and post-operative care, also to report patients' comments relating to improvement in service provision. Methodology A retrospective study was undertaken for 150 patients underwent cataract surgery at Barrow General Hospital, UK, the survey sample was by postal questionnaires. We collected our data from the theatre lists for a period of 4 month. Results This study included 150 patients; the response rate was (72% 108 patients, Most patients were referred from their general practitioner 86.1%, 93 (86.1% patients were happy with the time interval from seeing their GP to eye clinic. In the eye out patient department many factors significantly affected the level of patient satisfaction, in general the more information provided for the patient the more the satisfaction. Conclusion Patient satisfaction is on important health outcome old understanding both the domains of satisfaction as well as their relative importance to patients is necessary to improve the overall quality of patient care. Meeting the doctor, presenting all relevant information and giving printed information are very important factors in improving the patient's satisfaction with cataract surgery.

  11. Potencial fitotóxico de Dicranopteris flexuosa (Schrad. Underw. (Gleicheniaceae Phytotoxic potential of Dicranopteris flexuosa (Schrad. Underw. (Gleicheniaceae

    Directory of Open Access Journals (Sweden)

    Valerí Schmidt da Silva

    2011-03-01

    Full Text Available O objetivo deste trabalho foi determinar o potencial fitotóxico do extrato etanólico bruto e das frações semipurificadas de Dicranopteris flexuosa por meio de bioensaios de germinação e crescimento de Lactuca sativa L. (alface, Lycopersicon esculentum L. (tomate, Allium cepa L. (cebola e Triticum aestivum L. (trigo em laboratório e casa de vegetação e quantificar o teor total de fenóis e flavonóides dos extratos e frações. Nos bioensaios realizados em laboratório foram utilizadas quatro concentrações (0, 250, 500, 1000 mg L-1, com quatro repetições de 50 sementes. A análise dos resultados indica redução da velocidade e/ou inibição da germinação, estímulo do crescimento da raiz das eudicotiledôneas e inibição da raiz adventícia das monocotiledôneas estudadas. Nos bioensaios realizados em casa de vegetação foram utilizadas as mesmas concentrações dos bioensaios em laboratório, com oito repetições de cinco sementes por vaso. A análise dos resultados indica que o comprimento da raiz foi afetado pelo extrato etanólico bruto, ocorrendo estímulo em tomate e inibição em cebola e trigo. A produção de massa seca da parte aérea foi estimulada na menor concentração em alface e trigo. A fração acetato de etila foi a que apresentou os maiores teores de fenóis e flavonóides totais. Embora os resultados sejam preliminares, observa-se que o extrato etanólico e as frações semipurificadas de D. flexuosa também contêm substâncias que interferem no crescimento das plântulas de alface, tomate, cebola e trigo.This work aimed to determine the phytotoxic potential of crude ethanol extract and semipurified fractions of Dicranopteris flexuosa on the germination and growth of Lactuca sativa L. (lettuce, Lycopersicon esculentum L. (tomato, Allium cepa L. (onion and Triticum aestivum L. (wheat in laboratory and greenhouse bioassays and determine total phenolic and flavonoid content. For the tests carried out in laboratory, four concentrations (0, 250, 500, 1000 mg.L-1 were applied to four replicates of 50 seeds each. Analysis of the results indicates a reduction in speed and/or inhibition of germination, stimulation of root growth in eudicots and root inhibition in the monocots studied. For the bioassays carried out in the greenhouse, the plant materials were applied at the same concentrations as those in the laboratory bioassays, with eight replicates of five seeds each. Analysis of the results indicates that root length was affected by the crude ethanol extract resulting in stimulation in tomato and inhibition in onion and wheat. Aerial dry mass was higher at the lower concentration in lettuce and wheat. The ethyl acetate fraction presented higher content of total phenols and flavonoids. Although the results are preliminary, they indicate that ethanol extract and semipurified fractions of D. flexuosa contain substances that modify seedling growth of lettuce, tomato, onion and wheat.

  12. Patient-centered outcomes to decide treatment strategy for patients with low rectal cancer.

    Science.gov (United States)

    Honda, Michitaka; Akiyoshi, Takashi; Noma, Hisashi; Ogura, Atsushi; Nagasaki, Toshiya; Konishi, Tsuyoshi; Fujimoto, Yoshiya; Nagayama, Satoshi; Fukunaga, Yosuke; Ueno, Masashi

    2016-10-01

    For patients with low-lying rectal cancer, the feasibility of anus-preserving surgery in combination with neoadjuvant chemoradiotherapy (NACRT) has been not well established from the perspective of patient-centered outcomes. We investigated 278 patients with low-lying rectal adenocarcinoma from 2005 to 2012. We compared their symptoms and QOL scores of patients who underwent anus-preserving surgery with (n = 88) and without (n = 143) NACRT according to the Wexner scale, EORTC QLQ C-30, CR29, and the modified fecal incontinence quality life scale (mFIQL). Furthermore, to assess the rationale for intersphincteric resection (ISR) with NACRT, we also compared QOL of patients who underwent ISR with NACRT (n = 31) and abdominoperineal resection (APR, n = 47). The adjusted mean differences of the Wexner score estimates of the patients who underwent ISR and very low anterior resection (VLAR) with or without NACRT were 5.29 (P = 0.004) and 2.67 (P = 0.009), respectively. No significant difference was observed in the QOL scores of two treatment groups. Furthermore, there were no significant differences in the QOL or function scores of patients who underwent ISR with NACRT and APR. The incontinence was significantly worse in patients who receive NACRT. However, there were no significant differences in their QOL or function scores. J. Surg. Oncol. 2016;114:630-636. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  13. Direct vision internal urethrotomy in 459 urethral stricture patients at ...

    African Journals Online (AJOL)

    Keywords: Direct vision, internal, urethrotomy, urethral and stricture.;. Four hundred and fifty nine patients seen with simple urethral strictures between 1990 and 1998 underwent direct vision urethrotomy.. The procedure was successful in 441 patients and failed in only 18 patients. Postoperative complications included fever.

  14. A prospective comparison of transvaginal ultrasonography and diagnostic hysteroscopy in the evaluation of patients with abnormal uterine bleeding: clinical implications

    NARCIS (Netherlands)

    Emanuel, M. H.; Verdel, M. J.; Wamsteker, K.; Lammes, F. B.

    1995-01-01

    We determined the diagnostic value of transvaginal ultrasonography for endometrial and intrauterine abnormalities in patients with abnormal uterine bleeding. Between June 1, 1992, and June 1, 1993, 279 consecutive patients underwent transvaginal ultrasonography. Findings were compared with the final

  15. Cholecystectomy in sickle cell anemia patients : Perioperative outcome of 364 cases from the national preoperative transfusion study

    NARCIS (Netherlands)

    Haberkern, CM; Neumayr, LD; Orringer, EP; Earles, AN; Robertson, SM; Abboud, MR; Koshy, M; Idowu, O; Vichinsky, EP; Black, D.

    1997-01-01

    Cholecystectomy is the most common surgical procedure performed in sickle cell anemia (SCA) patients. We investigated the effects of transfusion and surgical method on perioperative outcome. A total of 364 patients underwent cholecystectomy: group 1 (randomized to aggressive transfusion) 110

  16. High-Grade Hydronephrosis Predicts Poor Outcomes After Radical Cystectomy in Patients with Bladder Cancer

    OpenAIRE

    Kim, Dong Suk; Cho, Kang Su; Lee, Young Hoon; Cho, Nam Hoon; Oh, Young Taek; Hong, Sung Joon

    2010-01-01

    We examined whether the presence and severity of preoperative hydronephrosis have prognostic significance in patients who underwent radical cystectomy for transitional cell carcinoma of the bladder. The medical records of 457 patients who underwent radical cystectomy for bladder cancer between 1986 and 2005 were retrospectively reviewed. Following the Society for Fetal Urology grading system, patients were divided into low-, and high-grade hydronephrosis groups. Clinicopathologic factors asso...

  17. Comparison of Causes of Death After Heart Transplantation in Patients With Left Ventricular Ejection Fractions ≤35% Versus >35.

    Science.gov (United States)

    Birati, Edo Y; Mathelier, Hansie; Molina, Maria; Hanff, Thomas C; Mazurek, Jeremy A; Atluri, Pavan; Acker, Michael A; Rame, J Eduardo; Margulies, Kenneth B; Goldberg, Lee R; Jessup, Mariell

    2016-04-15

    Sudden cardiac death (SCD) is a common cause of death in the general population, occurring in 300,000 to 350,000 people in the United States alone. Currently, there are no data supporting implantable cardioverter-defibrillator therapy in patients who underwent orthotopic heart transplant (OHT) with low left ventricular ejection fraction (LVEF). In this retrospective study, we included all patients who underwent primary OHT at our institution from 2007 to 2013. We compared the cause of death in patients who underwent OHT and evaluated the correlation of the cause of death and the patients' LVEF. Our objectives were to determine whether patients who underwent OHT with LVEF 6 months after OHT. Surviving patients had higher LVEF compared with deceased patients (64 ± 7% and 50 ± 24%, respectively, p ≤0.001). In all, 10 (25%) of the deceased patients died suddenly, 9 (23%) from sepsis, and 8 (20%) from malignancy. Of the 11 deceased patients with LVEF ≤35%, 2 patients (18%) died suddenly compared with 9 SCDs among the 29 deceased patients (31%) with LVEF >35% (p = 0.54). In conclusion, patients who underwent OHT who died were more likely to have LVEF <35%, and a quarter of the deceased patients who underwent OHT died suddenly. A reduced LVEF was not associated with an increased risk of SCD. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Plaque Characteristics of Patients with Symptomatic Mild Carotid Artery Stenosis.

    Science.gov (United States)

    Takai, Hiroki; Uemura, Juniti; Yagita, Yoshiki; Ogawa, Yukari; Kinoshita, Keita; Hirai, Satoshi; Ishihara, Manabu; Hara, Keijirou; Toi, Hiroyuki; Matsubara, Shunji; Nishimura, Hirotake; Uno, Masaaki

    2018-03-20

    Carotid revascularization may be considered for severe stenosis, but its use for symptomatic mild stenosis (<50%) with vulnerable plaque or ulcer remains uncertain. The characteristics of patients with symptomatic mild stenosis who underwent revascularization are reviewed. The subjects of this study were 18 patients with symptomatic mild stenosis (<50%) on angiography from among 175 patients who underwent revascularization in our department. The plaques were evaluated by black-blood magnetic resonance imaging (BB-MRI) and ultrasonography (US) and classified into 2 types: type 1 (n = 15), a lesion with an ulcer or mobile plaque or thrombosis on angiography or US; and type 2 (n = 3), a lesion without any of the above. Fourteen patients underwent carotid endarterectomy (CEA), and 4 patients underwent carotid artery stenting. The stenosis on angiography was 27.2% ± 10.7 (5%-41%), and the area carotid artery stenosis rate on US was 69.8 ± 14.5% (44.5%-97%). The stenosis rate of these 2 methods was not at all correlated. In type 1 plaque that underwent CEA, 10 of 11 patients had vulnerable plaque by histopathology, and 1 patient had thrombus on the plaque by operative findings. In type 2 plaque that underwent CEA, all patients had vulnerable plaque by histopathology. During the follow-up period, none of the patients had restenosis or stroke. The findings of US and BB-MRI in patients with symptomatic mild stenosis (<50%) on angiography are important for determining treatment. If BB-MRI or US shows the findings of vulnerable plaque in mild stenosis, surgical treatment may be considered for these patients. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  19. [Laparoscopic cholecystectomy in transplant patients].

    Science.gov (United States)

    Coelho, Júlio Cezar Uili; Contieri, Fabiana L C; de Freitas, Alexandre Coutinho Teixeira; da Silva, Fernanda Cristina; Kozak, Vanessa Nascimento; da Silva Junior, Alzemir Santos

    2010-02-01

    This study reviews our experience with laparoscopic cholecystectomy in the treatment of cholelithiasis in transplant patients. Demographic data, medications used, and operative and postoperative data of all transplant recipients who were subjected to laparoscopic cholecystectomy for cholelithiasis at our hospital were obtained. A total of 15 transplant patients (13 renal transplantation and 2 bone marrow transplantation) underwent laparoscopic cholecystectomy. All patients were admitted to the hospital on the day of the operation. The immunosuppressive regimen was not modified during hospitalization. Clinical presentation of cholelithiasis was biliary colicky (n=12), acute cholecystitis (n=2), and jaundice (n=1). The operation was uneventful in all patients. Postoperative complications were nausea and vomiting in 2 patients, prolonged tracheal intubation in 1, wound infection in 1 and large superficial hematoma in 1 patient. Laparoscopic cholecystectomy is associated to a low morbidity and mortality and good postoperative outcome in transplant patients with uncomplicated cholecystitis.

  20. Development of gastric dysplasia in pernicious anaemia: a clinical and endoscopic follow up study of 80 patients.

    OpenAIRE

    Armbrecht, U; Stockbrügger, R W; Rode, J; Menon, G G; Cotton, P B

    1990-01-01

    The development of gastric dysplasia and neoplasia in patients with pernicious anaemia has been evaluated in a prospective clinical and endoscopic follow up study. After initial screening of 80 patients between 1978 and 1980, one patient underwent total gastrectomy for a gastric malignancy and 12 were kept under surveillance and underwent endoscopy at a mean interval of 14 months. In the remaining 67 patients further investigation was attempted six to seven years after the initial investigati...

  1. Measurement of patient radiation doses in certain urography procedures

    International Nuclear Information System (INIS)

    Sulieman, A.; Barakat, H.; Zailae, A.; Abuderman, A.; Theodorou, K.

    2015-01-01

    Patients are exposed to significant radiation doses during diagnostic and interventional urological procedures. This study aimed to measure patient entrance surface air kerma (ESAK) and to estimate the effective dose during intravenous urography (IVU), extracorporeal shock-wave lithotripsy (ESWL), and ascending urethrogram (ASU) procedures. ESAK was measured in patients using calibrated thermo luminance dosimeters, GR200A). Effective doses (E) were calculated using the National Radiological Protection Board (NRPB) software. A total of 179 procedures were investigated. 27.9 % of the patients underwent IVU procedures, 27.9 % underwent ESWL procedures and 44.2 % underwent ASU procedures. The mean ESAK was 2.1, 4.18 and 4.9 mGy for IVU, ESWL, and ASU procedures, respectively. Differences in patient ESAK for the same procedure were observed. The mean ESAK values were comparable with those in previous studies. (authors)

  2. The impact of exercise myocardial perfusion SPECT imaging on the selection of patients for coronary angiography

    International Nuclear Information System (INIS)

    Song Liping; He Zuoxiang; Liu Xiujie; Shi Rongfang; Liu Yunzhong; Tian Yueqin; Zhang Xiaoli; Qin Xuewen; Chen Jilin; Gao Runlin

    2001-01-01

    Objective: Exercise 99 Tc m -MIBI myocardial perfusion SPECT is accurate for the diagnosis of coronary artery disease (CAD). This study assessed the impact of exercise myocardial perfusion imaging on the selection of patients for coronary angiography. Methods: 2188 consecutive patients who underwent exercise myocardial perfusion SPECT in authors' department in 1999 were retrospectively analyzed. Among them, 1807 were men, 381 women (average age: 53.5 +- 7.2 years). Overall, exercise myocardial SPECT was normal in 1731 patients, abnormal in 359 cases, and equivocal in 98 patients. There were 141 patients who underwent CAG within 60 days after myocardial SPECT. Results: Overall, 12% of the patients with abnormal SPECT imaging underwent coronary angiography, but only 5% of the patients with a normal SPECT imaging did (P < 0.001). Among these 141 patients who underwent coronary angiography, significant coronary stenosis was present in 91% of the patients who had had an abnormal SPECT imaging, but only 8% of those who had had a normal SPECT imaging (P < 0.001). In those patients who underwent coronary angiography, revascularization rate was 25% for the patients with abnormal SPECT imaging, but only 1% for the patients with a normal SPECT imaging. Conclusion: The results of exercise myocardial perfusion SPECT have a significant impact on the selection of patients for coronary angiography and revascularization

  3. Genital reconstruction in exstrophy patients

    Directory of Open Access Journals (Sweden)

    R B Nerli

    2012-01-01

    Full Text Available Introduction: Surgery for bladder exstrophy has been evolving over the last four to five decades. Because survival has become almost universal, the focus has changed in the exstrophy-epispadias complex to improving quality of life. The most prevalent problem in the long-term function of exstrophy patients is the sexual activity of the adolescent and adult males. The penis in exstrophy patients appears short because of marked congenital deficiency of anterior corporal tissue. Many patients approach for genital reconstruction to improve cosmesis as well as to correct chordee. We report our series of male patients seeking genital reconstruction following exstrophy repair in the past. Materials and Methods: Fourteen adolescent/adult male patients attended urology services during the period January 2000-December 2009 seeking genital reconstruction following exstrophy repair in the past. Results: Three patients underwent epispadias repair, four patients had chordee correction with cosmetic excision of skin tags and seven patients underwent chordee correction with penile lengthening. All patients reported satisfaction in the answered questionnaire. Patients undergoing penile lengthening by partial corporal dissection achieved a mean increase in length of 1.614 ± 0.279 cm dorsally and 1.543 ± 0.230 cm ventrally. The satisfactory rate assessed by the Short Form-36 (SF-36 showed that irrespective of the different genital reconstructive procedures done, the patients were satisfied with cosmetic and functional outcome. Conclusions: Surgical procedures have transformed the management in these patients with bladder exstrophy. Bladders can be safely placed within the pelvis, with most patients achieving urinary continence and cosmetically acceptable external genitalia. Genital reconstruction in the form of correction of chordee, excision of ugly skin tags and lengthening of penis can be performed to give the patients a satisfactory cosmetic and functional

  4. More patients should undergo surgery after sigmoid volvulus.

    Science.gov (United States)

    Ifversen, Anne Kathrine Wewer; Kjaer, Daniel Willy

    2014-12-28

    To assess the outcome of patients treated conservatively vs surgically during their first admission for sigmoid volvulus. We conducted a retrospective study of 61 patients admitted to Aarhus University Hospital in Denmark between 1996 and 2011 for their first incidence of sigmoid volvulus. The condition was diagnosed by radiography, sigmoidoscopy or surgery. Patients treated with surgery underwent either a sigmoid resection or a percutaneous endoscopic colostomy (PEC). Conservatively treated patients were managed without surgery. Data was recorded into a Microsoft Access database and calculations were performed with Microsoft Excel. Kaplan-Meier plotting and Mantel-Cox (log-rank) testing were performed using GraphPad Prism software. Mortality was defined as death within 30 d after intervention or surgery. Among the total 61 patients, 4 underwent emergency surgery, 55 underwent endoscopy, 1 experienced resolution of the volvulus after contrast enema, and 1 died without treatment because of large bowel perforation. Following emergency treatment, 28 patients underwent sigmoid resection (semi-elective n = 18; elective n = 10). Two patients who were unfit for surgery underwent PEC and both died, 1 after 36 d and the other after 9 mo, respectively. The remaining 26 patients were managed conservatively without sigmoid resection. Patients treated conservatively on their first admission had a poorer survival rate than patients treated surgically on their first admission (95%CI: 3.67-14.37, P = 0.036). Sixty-three percent of the 26 conservatively treated patients had not experienced a recurrence 3 mo after treatment, but that number dropped to 24% 2 years after treatment. Eight of the 14 patients with recurrence after conservative treatment had surgery with no 30-d mortality. Surgically-treated sigmoid volvulus patients had a higher long-term survival rate than conservatively managed patients, indicating a benefit of surgical resection or PEC insertion if feasible.

  5. Radiation safety and vascular access: attitudes among cardiologists worldwide

    Energy Technology Data Exchange (ETDEWEB)

    Vidovich, Mladen I., E-mail: miv@uic.edu [Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois (United States); Khan, Asrar A. [Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois (United States); Xie, Hui [Division of Epidemiology and Biostatistics and Cancer Center, University of Illinois at Chicago, Chicago, Illinois (United States); Shroff, Adhir R. [Department of Medicine, Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois (United States)

    2015-03-15

    Objectives: To determine opinions and perceptions of interventional cardiologists on the topic of radiation and vascular access choice. Background: Transradial approach for cardiac catheterization has been increasing in popularity worldwide. There is evidence that transradial access (TRA) may be associated with increasing radiation doses compared to transfemoral access (TFA). Methods: We distributed a questionnaire to collect opinions of interventional cardiologists around the world. Results: Interventional cardiologists (n = 5332) were contacted by email to complete an on-line survey from September to October 2013. The response rate was 20% (n = 1084). TRA was used in 54% of percutaneous coronary interventions (PCIs). Most TRAs (80%) were performed with right radial access (RRA). Interventionalists perceived that TRA was associated with higher radiation exposure compared to TFA and that RRA was associated with higher radiation exposure that left radial access (LRA). Older interventionalists were more likely to use radiation protection equipment and those who underwent radiation safety training gave more importance to ALARA (as low as reasonably achievable). Nearly half the respondents stated they would perform more TRA if the radiation exposure was similar to TFA. While interventionalists in the United States placed less importance to certain radiation protective equipment, European operators were more concerned with physician and patient radiation. Conclusions: Interventionalists worldwide reported higher perceived radiation doses with TRA compared to TFA and RRA compared to LRA. Efforts should be directed toward encouraging consistent radiation safety training. Major investment and application of novel radiation protection tools and radiation dose reduction strategies should be pursued. - Highlights: • We examined radiation safety and arterial access practices among 1000 cardiologists. • Radial access is perceived as having higher radiation dose compared to

  6. Phlebography in patients on hemidialysis

    International Nuclear Information System (INIS)

    Ernsting, M.D.; Heidler, R.; Wiedmann, C.

    1980-01-01

    20% of 450 patients on various programs of hemodialysis underwent phlebography and, in some cases, also arteriography for evaluation and radiographic documentation of their shunt. The most frequent complications thus found were: Congenital variants, thrombosis and stenosis due to fibrotic scanning. Of 224 new shunts placed in 1979, there were 98 with late and only 25 with early complications. In case of complications, date and type of corrective surgery were markedly influenced by phlebography. (orig.) [de

  7. The role of transcervical thymectomy in patients with hyperparathyroidism.

    Science.gov (United States)

    Welch, Kellen; McHenry, Christopher R

    2012-03-01

    The most common location for supernumerary or ectopic parathyroid glands is the thymus. A review of patients who underwent parathyroidectomy for hyperparathyroidism from 1990 to 2010 was completed to determine indications for thymectomy, the yield of parathyroid tissue, and outcome of therapy. Seventy of 379 patients with hyperparathyroidism underwent parathyroidectomy and transcervical thymectomy. Intrathymic parathyroid tissue was present in 23 (33%) patients, including supernumerary glands in 8 patients (11%). Indications for thymectomy were renal hyperparathyroidism in 35 patients (50%) and primary hyperparathyroidism with a missing inferior gland in 20 patients (29%), an ectopic adenoma in 9 patients (13%), hyperplasia in 5 patients (7%), and carcinoma in 1 patient (1%). Cure rates were similar (96% and 98%; P = not significant) and only transient hypocalcemia was higher (51% vs 24%, P hyperparathyroidism. Copyright © 2012 Elsevier Inc. All rights reserved.

  8. Hypogonadism in patients with chronic obstructive pulmonary ...

    African Journals Online (AJOL)

    ... free testosterone (FT), sex hormone binding globulins (SHBG), luteinizing hormone (LH), follicle-stimulating hormone (FSH) and 17b estradiol levels (E2), the exercise capacity (6-minute walk distance (6MWT)) and quadriceps muscle force (One repetition maximum (1RM) and EMG). COPD patients underwent spirometry.

  9. Percutaneous biliary drainage in patients with cholangiocarcinoma

    International Nuclear Information System (INIS)

    Mehta, A.C.; Gobel, R.J.; Rose, S.C.; Hayes, J.K.; Miller, F.J.

    1990-01-01

    This paper determines whether radiation therapy (RT) is a risk factor for infectious complications (particularly hepatic abscess formation) related to percutaneous biliary drainage (PBD). The authors retrospectively reviewed the charts of 98 consecutive patients who had undergone PBD for obstruction. In 34 patients with benign obstruction, three infectious complications occurred, none of which were hepatic abscess or fatal sepsis. In 39 patients who had malignant obstruction but did not have cholangiocarcinoma, 13 infectious complications occurred, including two hepatic abscesses and three cases of fatal sepsis. Of the 25 patients with cholangiocarcinoma, 15 underwent RT; in these 15 patients, 14 infectious complications occurred, including six hepatic abscesses and two cases of fatal sepsis

  10. The haematocrit – an important factor causing impaired haemostasis in patients with cyanotic congenital heart disease

    DEFF Research Database (Denmark)

    Jensen, A S; Johansson, P I; Idorn, L

    2013-01-01

    of haematocrit, platelet count and thrombelastography(TEG) was characterized in ninety-eight CCHD patients. To evaluate the influence of haematocrit on the haemostatic profile, 21 of the patients underwent phlebotomy and 16 patients received treatment with an iron supplement. Furthermore ten patients...

  11. Laser prostatectomy in high-risk patients

    International Nuclear Information System (INIS)

    Tayib, Abdulmalik M.

    2008-01-01

    Objective was to evaluate the short-term tolerability and outcome of high power green light potassium titanyl phosphate laser prostatectomy in high-risk patients with symptomatic benign prostatic hyperplasia. Eleven high risk operative patients were included in this study at the International Medical Center, Jeddah, Kingdom of Saudi Arabia, between January and September 2007. Patients enrolled in this study underwent preoperative and postoperative, cardiac and anesthesia evaluation. Clinical presentations, ultrasound of urinary tract and preoperative laboratory investigation were recorded. All patients underwent high power green light laser prostatectomy using the green light photo vaporization system with setting of 120 watts. The intraoperative and postoperative complications and follow-up were recorded. The patient's age varied between 65-82 years with a mean age of 75.3+-8.6 years old. Seven patients presented with refractory acute urinary retention and 4 patients presented with severe lower urinary tract symptoms. The average prostate volume was 61.22 cc. All patients had uneventful intra- and postoperative course, without the intensive care. The average blood loss was insignificant and only one of the patients required blood transfusion. Foley catheters were removed one day after the procedure. All patients voided satisfactorily after removal of catheter and 8 patients complained of urgency. High power green light laser prostatectomy is a safe and effective method of treating symptomatic benign prostatic hyperplasia in patients with high operative risk. (author)

  12. C-Reactive protein level in morbidly obese patients before and after bariatric surgery

    Directory of Open Access Journals (Sweden)

    M.E. Rojano-Rodríguez

    2014-04-01

    Conclusions: Preoperative CRP had a significant lineal relation to weight and body mass index. Patients who underwent bariatric surgery had a significant decrease in CRP, weight, and fasting glucose at 6 months after surgery.

  13. Focus assessed transthoracic echocardiography for preoperative assessment in patients scheduled for acute surgery

    DEFF Research Database (Denmark)

    Bøtker, Morten Thingemann; Frederiksen, C.A.; Lauridsen Vang, M.K.

    2013-01-01

    on predefined study days were included. Age and American Society of Anesthesiologists (ASA) physical status classification was registered. Before induction of anaesthesia, all patients underwent FATE examination at the bedside. Interpretation of the images was performed immediately and pathological findings...

  14. Radiation pneumonitis in non‑small‑cell lung cancer patients treated ...

    African Journals Online (AJOL)

    Common Terminology Criteria for Adverse Events, version 3.0. Results: We found that ... lung cancer (NSCLC) patients who underwent radiotherapy with HT in our ..... might have a different effect on lung toxicity in the subject undergoing the ...

  15. Estudo preliminar das relações entre duração da parada cardiorrespiratória e suas consequências nas vítimas de trauma Preliminary study of the relationship between the cardiopulmonary arrest time and its consequences in patients who underwent trauma

    Directory of Open Access Journals (Sweden)

    Andréia Bertelli

    1999-06-01

    Full Text Available Foi proposta desta pesquisa obter subsídios para iniciar ou manter manobras de reanimação cardiopulmonar (RCP especificamente em vítimas de trauma. A duração da parada e reanimação cardiopulmonar de sobreviventes foi descrita, assim como, o desempenho cerebral e mortalidade dessas vítimas 24, 48 e 72 horas após tais eventos terem ocorrido. Com os resultados dessa caracterização estudou-se a relação entre tempo de parada e reanimação cardiorrespiratória, e, mortalidade. Os dados foram obtidos em plantões no Pronto Socorro do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Grande parte das vítimas (93,4% apresentaram trauma grave e a principal "causa mortis" foi trauma crânio-encefálico. A sobrevivência ao período de 72 horas foi de 10%. A avaliação de 72 horas, das vítimas sobreviventes a parada cardiorrespiratória (PCR de causa traumática mostrou mau desempenho cerebral dessas vítimas no período. A sobrevida após o primeiro episódio de PCR relacionou-se mais consistentemente com o tempo de PCR das vítimas de trauma do que o tempo de RCP. O tempo de PCR The proposal of this research was to obtain parameters to start or maintain cardiopulmonary resuscitation (CPR in victims of trauma. The duration of the cardiac arrest and the CPR of the survivors was described, as well as the cerebral performance and the mortality of these victims 24, 48 and 72 hours after these events had happened. With the results of this caracterization the relation between duration of cardiac arrest time, CPR and mortality were described. Data for this report were coleted in Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo emergency departament. A big amount of the victims (93, 4% presents severe trauma and main cause of death was brain injury. Survival at 72 hours after CPR was 10%. The assessment, during the 72 hour period, of the survivors from cardiac arrest of traumatic cause has shown bad cerebral performance of those victims in that period of time. The survivor after the first episod of CPR was strongly related to cardiac arrest time when compared with CPR time. The time of cardiac arrest ¡Ü 4 minuts and CPR ¡Ü 20 minuts was related to survival more than 72 hours.

  16. Avaliação da lordose da coluna cervical nos pacientes com escoliose do tipo Lenke I submetidos ao tratamento cirúrgico Evaluación de la lordosis de la columna cervical en los pacientes con escoliosis del tipo Lenke I sometidos al tratamiento quirúrgico Evaluation of cervical behavior in patients with scoliosis Lenke who underwent surgery

    OpenAIRE

    José Lucas Batista Junior; Priscila Rossi de Batista; Diogo Miranda Barbosa; Igor Cardoso Machado; Rodrigo Rezende

    2011-01-01

    OBJETIVO: Avaliar a angulação da lordose cervical nos pacientes portadores de Escoliose Idiopática do Adolescente (EIA) do tipo Lenke I, no período pré- e pós-operatório. MÉTODO: Estudo prospectivo e descritivo em que foram avaliados pacientes com EIA, sendo documentadas medidas antropométricas. Foram avaliadas as angulações das radiografias (posição ortostática) em perfil cervical de C3 a C7 no período pré- e pós-operatório, estabelecendo como normal a lordose cervical entre 10 e 30 graus. R...

  17. Patient satisfaction related to rigid external distraction osteogenesis

    NARCIS (Netherlands)

    van Eggermont, Bas; Jansma, J.; Bierman, M. W. J.; Stegenga, B.

    2007-01-01

    The aim of this study was to evaluate satisfaction with treatment among cleft lip and palate patients who underwent maxillary advancement using a rigid external distraction (RED) device. Nine patients (four boys, five girls), mean age 17.7 years (SD 4.0), were included in the study. Outcome measures

  18. The clinical course of patients with suspected pulmonary embolism

    NARCIS (Netherlands)

    van Beek, E. J.; Kuijer, P. M.; Büller, H. R.; Brandjes, D. P.; Bossuyt, P. M.; ten Cate, J. W.

    1997-01-01

    BACKGROUND: The outcome of patients with suspected pulmonary embolism is known to a limited extent only. OBJECTIVE: To address this limited knowledge in a cohort in whom pulmonary embolism was proved or ruled out. METHODS: Consecutive patients with clinically suspected pulmonary embolism underwent

  19. Ten-year survival of patients with oesophageal squamous cell ...

    African Journals Online (AJOL)

    patients with oesophageal SCC continues to be poor, with 5-year survival rates ranging from 26.2% to ... approach, and the cervico-thoraco-abdominal procedure. The .... abuse, a family history of any cancer, neo-adjuvant treatment, pathological ... Of the entire series, 72 patients (6.9%) underwent neo-adjuvant therapy, and.

  20. Atrial electromechanical delay in patients undergoing heart transplantation

    Directory of Open Access Journals (Sweden)

    Mustafa Bulut, MD

    2017-04-01

    Conclusion: Inter-AEMD and intra-AEMD were prolonged in patients who underwent heart transplantation as compared to a control population. This may explain the increased atrial fibrillation and other atrial arrhythmia incidences associated with the biatrial anastomosis heart transplantation technique and may contribute to the treatment of atrial fibrillation in this special patient group.

  1. Employment among patients with multiple sclerosis - A population study

    OpenAIRE

    Lunde, Hanne Marie; Telstad, Wenche; Torkildsen, Nina Agnethe Grytten; Kyte, Lars; Aarseth, Jan; Myhr, Kjell-Morten; Bø, Lars

    2014-01-01

    OBJECTIVE: To investigate demographic and clinical factors associated with employment in MS. METHODS: The study included 213 (89.9%) of all MS patients in Sogn and Fjordane County, Western Norway at December 31st 2010. The patients underwent clinical evaluation, structured interviews and completed self-reported questionnaires. Demographic and clinical factors were compared between patients being employed versus patients being unemployed and according to disease course of MS. Logist...

  2. Effect of aquatic dual-task training on balance and gait in stroke patients

    OpenAIRE

    Kim, Kyoung; Lee, Dong-Kyu; Kim, Eun-Kyung

    2016-01-01

    [Purpose] The purpose of this study was to determine the effect of aquatic dual-task training on balance and gait in stroke patients. [Subjects and Methods] Twenty stroke patients were divided into the experimental (n=10) and control (n=10) groups. Both groups underwent neurodevelopmental treatment. The experimental group additionally underwent aquatic dual-task training for 30 minutes a day, 5 days a week, for 6 weeks. Balance was measured using the Berg balance scale, Five Times Sit-to Stan...

  3. Feedforward control strategies of subjects with transradial amputation in planar reaching.

    Science.gov (United States)

    Metzger, Anthony J; Dromerick, Alexander W; Schabowsky, Christopher N; Holley, Rahsaan J; Monroe, Brian; Lum, Peter S

    2010-01-01

    The rate of upper-limb amputations is increasing, and the rejection rate of prosthetic devices remains high. People with upper-limb amputation do not fully incorporate prosthetic devices into their activities of daily living. By understanding the reaching behaviors of prosthesis users, researchers can alter prosthetic devices and develop training protocols to improve the acceptance of prosthetic limbs. By observing the reaching characteristics of the nondisabled arms of people with amputation, we can begin to understand how the brain alters its motor commands after amputation. We asked subjects to perform rapid reaching movements to two targets with and without visual feedback. Subjects performed the tasks with both their prosthetic and nondisabled arms. We calculated endpoint error, trajectory error, and variability and compared them with those of nondisabled control subjects. We found no significant abnormalities in the prosthetic limb. However, we found an abnormal leftward trajectory error (in right arms) in the nondisabled arm of prosthetic users in the vision condition. In the no-vision condition, the nondisabled arm displayed abnormal leftward endpoint errors and abnormally higher endpoint variability. In the vision condition, peak velocity was lower and movement duration was longer in both arms of subjects with amputation. These abnormalities may reflect the cortical reorganization associated with limb loss.

  4. Efficacy and safety of transradial percutaneous coronary intervention using sheathless guide catheter technique

    Directory of Open Access Journals (Sweden)

    Mohamed Aboel-Kassem F. Abdelmegid

    2014-03-01

    Conclusions: TR PCI via standard and sheathless hydrophilic-coated GC techniques are effective and safe with high rate of procedural success and low rate of asymptomatic radial artery occlusion. Moreover, TR PCI using sheathless GC technique has the advantage of performing complex intervention requiring large bore catheters that can not be performed via standard TR PCI using 6F GC.

  5. Spinal deformity in patients with Sotos syndrome (cerebral gigantism).

    Science.gov (United States)

    Tsirikos, Athanasios I; Demosthenous, Nestor; McMaster, Michael J

    2009-04-01

    Retrospective review of a case series. To present the clinical characteristics and progression of spinal deformity in patients with Sotos syndrome. There is limited information on the development of spinal deformity and the need for treatment in this condition. The medical records and spinal radiographs of 5 consecutive patients were reviewed. All patients were followed to skeletal maturity (mean follow-up: 6.6 y). The mean age at diagnosis of spinal deformity was 11.9 years (range: 5.8 to 14.5) with 4 patients presenting in adolescence. The type of deformity was not uniform. Two patients presented in adolescence with relatively small and nonprogressive thoracolumbar and lumbar scoliosis, which required observation but no treatment until the end of spinal growth. Three patients underwent spinal deformity correction at a mean age of 11.7 years (range: 6 to 15.4). The first patient developed a double structural thoracic and lumbar scoliosis and underwent a posterior spinal arthrodesis extending from T3 to L4. Five years later, she developed marked degenerative changes at the L4/L5 level causing symptomatic bilateral lateral recess stenosis and affecting the L5 nerve roots. She underwent spinal decompression at L4/L5 and L5/S1 levels followed by extension of the fusion to the sacrum. The second patient developed a severe thoracic kyphosis and underwent a posterior spinal arthrodesis. The remaining patient presented at the age of 5.9 years with a severe thoracic kyphoscoliosis and underwent a 2-stage antero-posterior spinal arthrodesis. The development of spinal deformity is a common finding in children with Sotos syndrome and in our series it occurred in adolescence in 4 out of 5 patients. There is significant variability on the pattern of spine deformity, ranging from a scoliosis through kyphoscoliosis to a pure kyphosis, and also the age at presentation and need for treatment.

  6. Pre-procedural fasting for coronary interventions: is it time to change practice?

    Science.gov (United States)

    Hamid, Tahir; Aleem, Qaiser; Lau, Yeecheng; Singh, Ravi; McDonald, John; Macdonald, John E; Sastry, Sanjay; Arya, Sanjay; Bainbridge, Anthony; Mudawi, Telal; Balachandran, Kanarath

    2014-04-01

    Traditionally, patients are kept nil-per-os/nil-by-mouth (NPO/NBM) prior to invasive cardiac procedures, yet there exists neither evidence nor clear guidance about the benefits of this practice. To demonstrate that percutaneous cardiac catheterisation does not require prior fasting. The data source is a retrospective analysis of data registry of consecutive patients who underwent percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and stable angina at two district general hospitals in the UK with no on-site cardiac surgery services. A total of 1916 PCI procedures were performed over a 3-year period. None of the patients were kept NPO/NBM prior to their coronary procedures. The mean age was 67±16 years. 1349 (70%) were men; 38.5% (738/1916) had chronic stable angina, while the rest had ACS. 21% (398/1916) were diabetics while 53% (1017/1916) were hypertensive. PCI was technically successful in 95% (1821/1916) patients. 88.5% (1697/1916) had transradial approach. 77% (570/738) of elective PCI patients were discharged within 6 h postprocedure. No patients required emergency endotracheal intubation and there were no occurrences of intraprocedural or postprocedural aspiration pneumonia. Our observational study demonstrates that patients undergoing PCI do not need to be fasted prior to their procedures.

  7. [Thyroid cancer in patients with Grave's Disease].

    Science.gov (United States)

    Mssrouri, R; Benamr, S; Essadel, A; Mdaghri, J; Mohammadine, El H; Lahlou, M-K; Taghy, A; Belmahi, A; Chad, B

    2008-01-01

    To evaluate the incidence of thyroid carcinoma in patients operated on for Graves' disease, to identify criteria which may predict malignancy, and to develop a practical approach to determine the extensiveness of thyroidectomy. Retrospective study of all patients who underwent thyroidectomy for Graves' disease between 1995 and 2005. 547 patients underwent subtotal thyroidectomy for Graves' disease during this period. Post-operative pathology examination revealed six cases of thyroid cancer (1.1%). All six cases had differentiated thyroid carcinoma (papillary carcinoma in 3 cases, follicular carcinoma in 2 cases and papillo-follicular carcinoma in 1 case). The indication for initial thyroidectomy was a palpable thyroid nodule in 3 cases (50%), failure of medical treatment for Grave's disease in 2 cases (33%), and signs of goiter compression in 1 case (17%). Five patients underwent re-operative total thyroidectomy. This study shows that while malignancy in Grave's disease is uncommon, the presence of thyroid nodule(s) in patients with Grave's disease may be considered as an indication for radical surgery. The most adequate radical surgery in this situation is to perform a total thyroidectomy.

  8. Psychological benefits of virtual reality for patients in rehabilitation therapy.

    Science.gov (United States)

    Chen, Chih-Hung; Jeng, Ming-Chang; Fung, Chin-Ping; Doong, Ji-Liang; Chuang, Tien-Yow

    2009-05-01

    Whether virtual rehabilitation is beneficial has not been determined. To investigate the psychological benefits of virtual reality in rehabilitation. An experimental group underwent therapy with a virtual-reality-based exercise bike, and a control group underwent the therapy without virtual-reality equipment. Hospital laboratory. 30 patients suffering from spinal-cord injury. A designed rehabilitation therapy. Endurance, Borg's rating-of-perceived-exertion scale, the Activation-Deactivation Adjective Check List (AD-ACL), and the Simulator Sickness Questionnaire. The differences between the experimental and control groups were significant for AD-ACL calmness and tension. A virtual-reality-based rehabilitation program can ease patients' tension and induce calm.

  9. Reliability and validity of the Beck depression inventory in patients with Parkinson's disease

    NARCIS (Netherlands)

    Visser, Martine; Leentjens, Albert F. G.; Marinus, Johan; Stiggelbout, Anne M.; van Hilten, Jacobus J.

    2006-01-01

    We evaluated the validity, reliability, and potential responsiveness of the Beck Depression Inventory (BDI) in patients with Parkinson's disease (PD). In part 1 of the study, 92 patients with PD underwent a structured clinical interview for DSM major depression and based on this patients were

  10. Retinal changes detected by wide-field autofluorescence imaging of patients with primary rhegmatogenous retinal detachment

    DEFF Research Database (Denmark)

    Poulsen, Christina Døfler; Grauslund, Jakob; Peto, Tunde

    2014-01-01

    .2 million inhabitants. Methods: A clinical prospective study of 99 eyes in 99 patients undergoing surgery for primary RRD between 1st of January 2013 and 12th of July 2013. All patients underwent surgery with pars plana vitrectomy (PPV) and had either gas or silicone oil tamponade. Patients were examined...

  11. Characteristics of Hemorrhagic Peptic Ulcers in Patients Receiving Antithrombotic/Nonsteroidal Antiinflammatory Drug Therapy

    OpenAIRE

    Nakamura, Kazuhiko; Akahoshi, Kazuya; Ochiai, Toshiaki; Komori, Keishi; Haraguchi, Kazuhiro; Tanaka, Munehiro; Nakamura, Norimoto; Tanaka, Yoshimasa; Kakigao, Kana; Ogino, Haruei; Ihara, Eikichi; Akiho, Hirotada; Motomura, Yasuaki; Kabemura, Teppei; Harada, Naohiko

    2012-01-01

    Background/Aims Antithrombotic/nonsteroidal antiinflammatory drug (NSAID) therapies increase the incidence of upper gastrointestinal bleeding. The features of hemorrhagic peptic ulcer disease in patients receiving antithrombotic/NSAID therapies were investigated. Methods We investigated the medical records of 485 consecutive patients who underwent esophagogastroduodenoscopy and were diagnosed with hemorrhagic gastroduodenal ulcers. The patients treated with antithrombotic agents/NSAIDs were c...

  12. Results of surgical excision of urethral prolapse in symptomatic patients.

    Science.gov (United States)

    Hall, Mary E; Oyesanya, Tola; Cameron, Anne P

    2017-11-01

    Here, we present the clinical presentation and surgical outcomes of women with symptomatic urethral prolapse presenting to our institution over 20 years, and seek to provide treatment recommendations for management of symptomatic urethral prolapse and caruncle. A retrospective review of medical records from female patients who underwent surgery for symptomatic urethral prolapse from June 1995 to August 2015 was performed. Surgical technique consisted of a four-quadrant excisional approach for repair of urethral prolapse. A total of 26 patients were identified with a mean age of 38.8 years (range 3-81). The most common presentations were vaginal bleeding, hematuria, pain, and dysuria. All patients underwent surgical excision of urethral prolapse via a standard approach. Follow-up data was available in 24 patients. Six patients experienced temporary postoperative bleeding, and one patient required placement of a Foley catheter for tamponade. One patient experienced temporary postoperative urinary retention requiring Foley catheter placement. Three patients had visible recurrence of urethral prolapse, for which one later underwent re-excision. Surgical excision of urethral prolapse is a reasonable treatment option in patients who have tried conservative management without relief, as well as in those who present with severe symptoms. Possible complications following excision include postoperative bleeding and recurrence, and patients must be counseled accordingly. In this work, we propose a treatment algorithm for symptomatic urethral prolapse. © 2017 Wiley Periodicals, Inc.

  13. Infantile neuroaxonal dystrophy: neuroradiological studies in 11 patients

    Energy Technology Data Exchange (ETDEWEB)

    Farina, L.; Bruzzone, M.G.; D`Incerti, L.; Savoiardo, M. [Department of Neuroradiology, Istituto Nazionale Neurologico C. Besta, Milan (Italy); Nardocci, N.; Zorzi, G. [Department of Child Neurology, Istituto Nazionale Neurologico C. Besta, Milan (Italy); Verga, L.; Morbin, M. [Department of Neuropathology, Istituto Nazionale, Neurologico C. Besta, Milan (Italy)

    1999-05-01

    We report the imaging findings in 11 patients with infantile neuroaxonal dystrophy. Ten patients underwent 15 MRI examinations; one patient had only CT. Of the ten patients who underwent MRI, eight had cerebellar atrophy and mildly increased signal from the cerebellar cortex on T2-weighted images. With T2 weighting there was slightly increased signal from the dentate nuclei in two patients and from the posterior periventricular white matter in three. We saw four patients with a thin optic chiasm. The only two brothers in the series had markedly low signal from the globus pallidus and substantia nigra on 1.5 T T2-weighted images, as seen in Hallervorden-Spatz disease (HSD). Abnormalities of the globus pallidus may be related to a protracted course of the disease. However, an overlap with HSD should be considered. (orig.) With 3 figs., 1 tab., 28 refs.

  14. [Valve-sparing Replacement in Patients with Aortic Root Dilatation].

    Science.gov (United States)

    Yamazaki, Kazuhiro; Minatoya, Kenji; Ueda, Ryoma; Takehara, Masato; Sakamoto, Kazuhisa; Ide, Yujiro; Kanemitsu, Hideo; Ueyama, Koji; Ikeda, Tadashi

    2018-01-01

    Valve-sparing root replacement is increasingly used to overcome drawbacks associated with valvular prostheses. In our institution, 7 patients underwent valve-sparing root replacement from August 2016 to July 2017. The mean age was 45 years (range, 14~69 years). Three patients had Marfan syndrome and 1 had Loeys-Dietz syndrome with acute aortic dissection. All patients underwent surgery with reimplantation technique using a Valsalva graft. Two patients required repair of aortic valve leaflet prolapse. All patients had an excellent clinical course, with mild or no aortic regurgitation and a decrease in end-diastolic volume on echocardiography. These results support the continued use of valve-sparing root replacement in selected patients.

  15. Infantile neuroaxonal dystrophy: neuroradiological studies in 11 patients

    International Nuclear Information System (INIS)

    Farina, L.; Bruzzone, M.G.; D'Incerti, L.; Savoiardo, M.; Nardocci, N.; Zorzi, G.; Verga, L.; Morbin, M.

    1999-01-01

    We report the imaging findings in 11 patients with infantile neuroaxonal dystrophy. Ten patients underwent 15 MRI examinations; one patient had only CT. Of the ten patients who underwent MRI, eight had cerebellar atrophy and mildly increased signal from the cerebellar cortex on T2-weighted images. With T2 weighting there was slightly increased signal from the dentate nuclei in two patients and from the posterior periventricular white matter in three. We saw four patients with a thin optic chiasm. The only two brothers in the series had markedly low signal from the globus pallidus and substantia nigra on 1.5 T T2-weighted images, as seen in Hallervorden-Spatz disease (HSD). Abnormalities of the globus pallidus may be related to a protracted course of the disease. However, an overlap with HSD should be considered. (orig.)

  16. Role of myocardial perfusion scintigraphy post invasive coronary angiography in patients with myocardial infarction

    International Nuclear Information System (INIS)

    Harisankar, C.N.B.; Mittal, Bhagwant Rai; Kamaleshwaran, K.K.; Bhattacharya, Anish; Singh, Baljinder; Mahajan, Rajiv

    2010-01-01

    The presence of severe hypokinesia or akinesia and near complete stenotic lesions on coronary angiography, in a patient with acute myocardial infarction raises a question of viability in the involved territory and its response to revascularization. The decision of revascularization can be effectively taken after myocardial perfusion scintigraphy (MPS). Aim: To evaluate the role of MPS in patients with acute or recent myocardial infarction after invasive coronary angiography. Materials and Methods: Thirty-five patients (27 Males, 8 Females; Mean age 54 years) with acute myocardial infarction, who underwent invasive angiography, were included prospectively. Invasive angiography was attempted during the episode of acute chest pain in 20 patients. Fifteen patients underwent angiography without MPS because of non-availability of MPS at the time of initial presentation in the referring hospital. Revascularization was deferred because of complete/near complete block of artery with hypokinesia/akinesia of the distal LV segments in 32/35 patients and 50 to 70% block in 3/35. These patients were subjected to MPS. Results: Twenty patients underwent stress MPS and 15 underwent nitrate-augmented rest re-distribution study (RR study). Imaging was performed using the hybrid SPECT/CT system. The average defect size of the perfusion defect was 34% (5 - 57% range). Sixteen patients (46%) had fixed perfusion defects. Reversible ischemia was present in 19 (54%). Ten patients had a 10% of the LV myocardium, and underwent the invasive revascularization procedure. Conclusion: MPS is invaluable in patients who have total/near total occlusion of the coronary artery and distal segment hypokinesia or akinesia on invasive angiography. One in four patients, deemed to have non-viable myocardium, underwent an invasive revascularization after undergoing MPS. (author)

  17. Patients with colorectal lung oligometastases (L-OMD) treated by dose adapted SABR at diagnosis of oligometastatic disease have better outcomes than patients previously treated for their metastatic disease.

    LENUS (Irish Health Repository)

    Mihai, Alina

    2017-01-01

    To evaluate the clinical outcomes of patients with OMD from a CRC primary, who underwent SABR either as first treatment at diagnosis of metachronous oligometastatic disease to lung or at progression in lung after prior treatments for metastatic disease.

  18. Tacrolimus-induced thrombotic microangiopathy in orthotopic liver transplant patients: case series of four patients.

    Science.gov (United States)

    Nwaba, A; MacQuillan, G; Adams, L A; Garas, G; Delriviere, L; Augustson, B; DeBoer, B; Moody, H; Jeffrey, G P

    2013-03-01

    Thrombotic microangiopathy (TMA) is a potentially fatal complication in solid organ and bone marrow transplant patients, with reported incidence of 0.5-3% and mortality of about 75%. To emphasise the importance of early diagnosis and prompt commencement of therapy results in improved clinical outcomes. A retrospective study of all patients who underwent orthotopic liver transplantation (OLTX) at the Western Australian Liver Transplantation Service from May 1994 to December 2010 was conducted to identify patients who developed tacrolimus-induced TMA. We identified four patients with tacrolimus-induced TMA post-OLTX, derived from a cohort of 104 patients treated with tacrolimus in our institution. The mean age at diagnosis was 40 years, and the mean time of onset was 63 ± 7.5 weeks after OLTX. The indications for OLTX in the four patients were fulminant hepatic failure in three (Wilson disease, paracetamol overdose and post-partum thrombotic thrombocytopenic purpura) and hepatitis C virus-related cirrhosis. All patients had tacrolimus post-OLTX. At diagnosis, tacrolimus was discontinued in all patients, and three of the four patients underwent plasma exchange and all patients improved clinically. Mean duration of follow up was 15 ± 7.5 months. There was no mortality 6 months post-TMA. Early diagnosis with immediate discontinuation or conversion of calcineurin inhibitors and plasma exchange should be offered to OLTX patients with TMA as it results in good outcomes. © 2013 The Authors; Internal Medicine Journal © 2013 Royal Australasian College of Physicians.

  19. Evaluation of the macular architecture of patients operated on from macula-off rhegmatogenous retinal detachment using optical coherence tomography

    International Nuclear Information System (INIS)

    Ramos Lopez, Meisy; Obret Mendive, Isabel; Hernandez Silva, Juan Raul

    2010-01-01

    With the support of optical coherence tomography, to evaluate the macular condition of the patients operated on from rhegmatogenous retinal detachment, with detached macula, who underwent buckling surgery and pars plana vitrectomy

  20. ENDOVASCULAR HEMOSTASIS IN UTERINE BLEEDING IN PATIENTS WITH UTERINE LEIOMYOMA

    Directory of Open Access Journals (Sweden)

    M. M. Damirov

    2017-01-01

    Full Text Available We report results of treatment for 72 patients with uterine leiomyoma (LM of various sizes and location, who had arrived with excessive uterine bleeding. All patients underwent urgent or urgently-delayed endovascular hemostasis by performing uterine arteries embolization (UAE. We analyzed clinical features of the disease after UAE in various sizes of tumors and studied immediate and long-term results of UAE in patients with LM.

  1. Daily dialysis reduces pulse wave velocity in chronic hemodialysis patients.

    Science.gov (United States)

    Di Micco, Lucia; Torraca, Serena; Sirico, Maria Luisa; Tartaglia, Domenico; Di Iorio, Biagio

    2012-05-01

    Pulse wave velocity (PWV) is a predictor of morbidity and mortality in patients with end-stage renal disease (ESRD). Dialysis patients show cyclic changes in PWV related to their hydration status and blood pressure. Our aim is to assess the impact of daily dialysis on PWV. We performed a randomized crossover study of 60 patients who underwent standard hemodialysis (HD) three times per week for at least 6 months. Patients were classified into three groups according to their PWV values before (pre-) and after (post-) HD, with a cutoff value of 12 m s(-1), as follows: the low-low (LL) group had normal pre-HD and post-HD PWV; the high-low (HL) group had high pre-HD PWV and normal post-HD PWV; and the high-high (HH) group had high pre- and post-HD PWV. All patients continued standard HD for 2 weeks. A total of 10 patients from each group were randomly assigned to continue standard HD for 1 week and then underwent daily dialysis for 1 week. The remaining 10 patients underwent daily dialysis for 1 week and then underwent standard HD for 1 week. PWV values were measured before and 1 h after each dialysis session. With daily dialysis treatment, 2 of 20 patients (10%) moved from the PWV-HH group to the PWV-HL group, whereas 18 of 20 patients (90%) moved from the PWV-HL group to the PWV-LL group (P = 0.030). Daily dialysis reduces PWV in the ESRD patients. As PWV is a strong predictor of mortality in ESRD and has cyclic variations in patients who are on standard HD, we believe that daily dialysis may be used in patients with high PWV levels to reduce their mortality risk.

  2. Giant encephalocele: a study of 14 patients.

    Science.gov (United States)

    Mahapatra, A K

    2011-01-01

    Giant encephalocele is a rare condition and few published reports are available in the English literature. It is a challenge to neurosurgeons, even today. This series consists of 14 patients with giant encephaloceles treated at our institute. Over a period of 8 years, from 2002 to 2009, 110 patients with encephaloceles were managed at our institute. Amongst them, 14 were children with giant encephaloceles. All patients had CT/MRI or both prior to surgery, and all were operated upon. Four patients were neonates, under 1 month of age, and 9/14 patients (64%) were under 3 months. The youngest child was a newborn baby aged 2 days. Except for 1 with an anterior encephalocele, the rest were patients with occipital encephaloceles. A CT scan was performed on 5 and an MRI on 1 patient. Both CT and MRI scans were performed on the other 8 patients. MRI/CT showed hydrocephalus in 10/14 patients. Of these, 7 required ventriculoperitoneal (VP) shunt, and the remaining 3 with mild to moderate hydrocephalus did not. Of the 7 patients who underwent VP shunt, 5 had a shunt during the encephalocele repair and 2 had a postoperative shunt for increasing hydrocephalus. Other associated anomalies recorded were acquired Chiari malformation in 3 patients, secondary craniostenosis with microcephaly in 5, and syringomyelia in 1 patient. All the patients underwent repair of encephalocele and 4 had suturectomy of coronal suture for the secondary craniostenosis. There were 2 postoperative deaths due to hypothermia. Among the 12 surviving patients, 9 had a good outcome and 3 had poor mental development. The present study shows overall good outcomes in 9/14 (66%) patients. Copyright © 2012 S. Karger AG, Basel.

  3. CLINICAL STUDY TO EVALUATE THE VISUAL OUTCOME AND PATIENT COMFORT IN LASIK AND PHOTOREFRACTIVE KERATECTOMY IN LOW-TO-MODERATE MYOPIC ASTIGMATISM PATIENTS

    OpenAIRE

    Ashok Kumar P; Ananda Babu M; Radha Priyadharshini R; Jeevitha A

    2017-01-01

    BACKGROUND To evaluate visual outcomes following LASIK and Photorefractive Keratectomy (PRK) in low-to-moderate myopia and/or myopic astigmatism in age and refractive error matched eyes. MATERIALS AND METHODS Of a total 30 patients aged ≥21 years, 20 (40 eyes) underwent LASIK and 10 (20 eyes) underwent PRK for low-to-moderate myopia or myopic astigmatism. LASIK was performed with the Alcon wave light 500 and PRK with the alcohol application for epithelial removal. All abl...

  4. Prevalence of obstructive sleep apnea in patients with chronic wounds.

    Science.gov (United States)

    Patt, Brian T; Jarjoura, David; Lambert, Lynn; Roy, Sashwati; Gordillo, Gayle; Schlanger, Richard; Sen, Chandan K; Khayat, Rami N

    2010-12-15

    Chronic non-healing wounds are a major human and economic burden. Obstructive sleep apnea (OSA) is prevalent in patients with obesity, diabetes, aging, and cardiovascular disease, all of which are risk factors for chronic wounds. We hypothesized that OSA would have more prevalence in patients of a wound center than the general middle-aged population. Consecutive patients of the Ohio State University Comprehensive Wound Center (CWC) were surveyed with the Berlin and Epworth questionnaires. In the second stage of the protocol, 50 consecutive unselected CWC patients with lower extremity wounds underwent home sleep studies. In 249 patients of the CWC who underwent the survey study, OSA had been previously diagnosed in only 22%. The prevalence of high-risk status based on questionnaires for OSA was 46% (95% CI 40%, 52%). In the 50 patients who underwent home sleep studies, and using an apnea hypopnea index of 15 events per hour, the prevalence of OSA was 57% (95% CI 42%, 71%). There was no difference between the Berlin questionnaire score and weight between patients with OSA and those without. The prevalence of OSA in patients with chronic wounds exceeds the estimated prevalence of OSA in the general middle aged population. This study identifies a previously unrecognized population with high risk for OSA. Commonly used questionnaires were not sufficiently sensitive for the detection of high risk status for OSA in this patient population.

  5. Eosinophilic Esophagitis in Brazilian Pediatric Patients

    Directory of Open Access Journals (Sweden)

    Mayra Isabel Correia Pinheiro

    2013-01-01

    Full Text Available We examined 11 pediatric patients with eosinophilic esophagitis with a tardy diagnosis. The symptoms were initially thought to be related to other diseases, leading to the use of inadequate therapeutic approaches. The patients were between 3 and 17 years old (mean 7.8 ± 3.8 years, and 8 of the patients were male. Common symptoms included abdominal pain, regurgitation, difficulty in gaining weight, vomiting, dysphagia, and coughing. The mean age for the onset of symptoms was 4.3 ± 2.9 years. Endoscopic findings included normal mucosa in five (45% patients, thickening of the mucosa with longitudinal grooves in three (27%, erosive esophagitis in two (18%, and a whitish stippling in one (9% patient. Treatment included the use of a topical corticosteroid for 10 patients. In eight (73% cases, the treatment made the symptoms disappear. Ten patients underwent histopathological management after treatment, with a decrease in the number of eosinophils.

  6. Coronary computed tomography and triple rule out CT in patients with acute chest pain and an intermediate cardiac risk profile. Part 1: Impact on patient management

    International Nuclear Information System (INIS)

    Gruettner, Joachim; Fink, Christian; Walter, Thomas; Meyer, Mathias; Apfaltrer, Paul; Schoepf, U. Joseph; Saur, Joachim; Sueselbeck, Tim; Traunwieser, Dominik; Takx, Richard

    2013-01-01

    Objective: To evaluate the impact of coronary CT angiography (coronary CTA) or “triple-rule-out” CT angiography (TRO-CTA) on patient management in the work-up of patients with acute chest pain and an intermediate cardiac risk profile. Materials and methods: 100 patients with acute chest pain and an intermediate cardiac risk for acute coronary syndrome (ACS) underwent coronary CTA or TRO-CTA for the evaluation of chest pain. Patients with a high and low cardiac risk profile were not included in this study. All patients with significant coronary stenosis >50% on coronary CTA underwent invasive coronary catheterization (ICC). Important other pathological findings were recorded. All patients had a 90-day follow-up period for major adverse cardiac events (MACE). Results: Based on a negative coronary CTA 60 of 100 patients were discharged on the same day. None of the discharged patients showed MACE during the 90-day follow-up. Coronary CTA revealed a coronary stenosis >50% in 19 of 100 patients. ICC confirmed significant coronary stenosis in 17/19 patients. Among the 17 true positive patients, 9 underwent percutaneous coronary intervention with stent implantation, 7 were received intensified medical therapy, and 1 patient underwent coronary artery bypass surgery. A TRO-CTA protocol was performed in 36/100 patients due to elevated D-dimer levels. Pulmonary embolism was present in 5 patients, pleural effusion of unknown etiology in 3 patients, severe right ventricular dysfunction with pericardial effusion in 1 patient, and an incidental bronchial carcinoma was diagnosed in 1 patient. Conclusion: Coronary CTA and TRO-CTA allow a rapid and safe discharge in the majority of patients presenting with acute chest pain and an intermediate risk for ACS while at the same time identifies those with significant coronary artery stenosis

  7. Coronary computed tomography and triple rule out CT in patients with acute chest pain and an intermediate cardiac risk profile. Part 1: Impact on patient management

    Energy Technology Data Exchange (ETDEWEB)

    Gruettner, Joachim, E-mail: joachim.gruettner@umm.de [Emergency Department, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Fink, Christian, E-mail: Christian.Fink@umm.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Walter, Thomas, E-mail: thomas.walter@umm.de [Emergency Department, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167 Mannheim (Germany); Meyer, Mathias, E-mail: mr.meyer.mathias@gmail.com [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Apfaltrer, Paul, E-mail: Paul.Apfaltrer@umm.de [Institute of Clinical Radiology and Nuclear Medicine, University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Schoepf, U. Joseph, E-mail: schoepf@musc.edu [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260 (United States); Saur, Joachim, E-mail: joachim.saur@umm.de [1st Department of Medicine (Cardiology), University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Sueselbeck, Tim, E-mail: tim.sueselbeck@umm.de [1st Department of Medicine (Cardiology), University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Traunwieser, Dominik, E-mail: dominik.traunwieser@umm.de [1st Department of Medicine (Cardiology), University Medical Center, Medical Faculty Mannheim, Heidelberg University, Mannheim (Germany); Takx, Richard, E-mail: richard.takx@gmail.com [Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, Ashley River Tower, 25 Courtenay Drive, Charleston, SC 29425-2260 (United States); and others

    2013-01-15

    Objective: To evaluate the impact of coronary CT angiography (coronary CTA) or “triple-rule-out” CT angiography (TRO-CTA) on patient management in the work-up of patients with acute chest pain and an intermediate cardiac risk profile. Materials and methods: 100 patients with acute chest pain and an intermediate cardiac risk for acute coronary syndrome (ACS) underwent coronary CTA or TRO-CTA for the evaluation of chest pain. Patients with a high and low cardiac risk profile were not included in this study. All patients with significant coronary stenosis >50% on coronary CTA underwent invasive coronary catheterization (ICC). Important other pathological findings were recorded. All patients had a 90-day follow-up period for major adverse cardiac events (MACE). Results: Based on a negative coronary CTA 60 of 100 patients were discharged on the same day. None of the discharged patients showed MACE during the 90-day follow-up. Coronary CTA revealed a coronary stenosis >50% in 19 of 100 patients. ICC confirmed significant coronary stenosis in 17/19 patients. Among the 17 true positive patients, 9 underwent percutaneous coronary intervention with stent implantation, 7 were received intensified medical therapy, and 1 patient underwent coronary artery bypass surgery. A TRO-CTA protocol was performed in 36/100 patients due to elevated D-dimer levels. Pulmonary embolism was present in 5 patients, pleural effusion of unknown etiology in 3 patients, severe right ventricular dysfunction with pericardial effusion in 1 patient, and an incidental bronchial carcinoma was diagnosed in 1 patient. Conclusion: Coronary CTA and TRO-CTA allow a rapid and safe discharge in the majority of patients presenting with acute chest pain and an intermediate risk for ACS while at the same time identifies those with significant coronary artery stenosis.

  8. The value of radionuclide cerebrospinal fluid scintigraphy in the diagnosis and treatment of patients with hydrocephalus

    International Nuclear Information System (INIS)

    Feng Fang; Wang Hui; Fu Hongliang; Li Jianing; Zou Renjian; Gu Zhenhui; Wu Jingchuan

    2009-01-01

    Objective: Radionuclide cerebrospinal fluid scintigraphy (RCFS) has been applied to make diagnosis of hydrocephalus clinically for a long time. This study aimed to evaluate clinical value of RCFS in guiding the management of patients with hydrocephalus. Methods: All 13 patients with hydrocephalus (8 adults, 5 children) underwent RCFS and CT/MRI examination before treatment and then follow-up imaging after treatment.Results: Four of 7 patients (6 adults, 1 child) diagnosed as obstructive hydrocephalus by RCFS underwent endoscopic third ventriculostomy (ETV), and 5 of 6 patients (2 adults, 4 children) diagnosed as obstructive hydrocephalus underwent ventriculo peritoneal shunt (VPS). All patients had good recovery after operation and favorable prognosis in follow-up for at least one year. Conclusion: RCFS could differentiate obstructive hydrocephalus from communicating hydrocephalus and had important guiding significance in the treatment of hydrocephalus. (authors)

  9. Safety of Monopolar Electrocautery in Patients With Cochlear Implants.

    Science.gov (United States)

    Tien, Duc A; Woodson, Erika A; Anne, Samantha

    2016-09-01

    The outcomes of 2 patients with cochlear implants (CIs) who underwent adenotonsillectomy (AT) with inadvertent use of monopolar cautery are presented. The safety data regarding monopolar cautery use in CI recipients is also reviewed. This is a retrospective case series of 2 CI recipients that underwent AT with monopolar cautery and literature review of electrocautery safety in the setting of CI. Two patients with CIs underwent AT with use of monopolar cautery inadvertently by surgeons that do not routinely perform cochlear implants as part of his or her clinical practice. Patient 1 was a 9-year-old female who had AT for obstructive sleep apnea (OSA) after undergoing unilateral CI for profound congenital sensorineural hearing loss (SNHL) 8 years ago. Patient 2 was a 7-year-old female who underwent AT for OSA 4 months after undergoing unilateral CI for congenital SNHL. Both patients had no immediate signs of complications with their CI use postoperatively. Both patients demonstrated unchanged postoperative neural response telemetry and behavioral audiometric testing. Patient 1 continues to have no CI-related complications 3.5 years after the procedure. Patient 2 has been followed for at least 3 months by audiometric testing and 10 months by otolaryngologist with no CI-related complications. Although animal and cadaveric studies suggest that monopolar cautery may be safely used in patients with cochlear implants, there have been no in vivo human studies that have evaluated the risk to the patient or implant. This is a report of a small, unintended experience with 2 patients, both of whom exhibit no complications or changes to CI function thus far. © The Author(s) 2016.

  10. Oncologic Outcomes of Patients With Gleason Score 7 and Tertiary Gleason Pattern 5 After Radical Prostatectomy

    OpenAIRE

    Leng, Yi-Hsueh; Lee, Won Jun; Yang, Seung Ok; Lee, Jeong Ki; Jung, Tae Young; Kim, Yun Beom

    2013-01-01

    Purpose We evaluated oncologic outcomes following radical prostatectomy (RP) in patients with a Gleason score (GS) of 7 with tertiary Gleason pattern 5 (TGP5). Materials and Methods We retrospectively reviewed the medical records of 310 patients who underwent RP from 2005 to 2010. Twenty-four patients who received neoadjuvant or adjuvant antiandrogen deprivation or radiation therapy were excluded. Just 239 (GS 6 to 8) of the remaining 286 patients were included in the study. Patients were cla...

  11. Patient Compliance With Electronic Patient Reported Outcomes Following Shoulder Arthroscopy.

    Science.gov (United States)

    Makhni, Eric C; Higgins, John D; Hamamoto, Jason T; Cole, Brian J; Romeo, Anthony A; Verma, Nikhil N

    2017-11-01

    To determine the patient compliance in completing electronically administered patient-reported outcome (PRO) scores following shoulder arthroscopy, and to determine if dedicated research assistants improve patient compliance. Patients undergoing arthroscopic shoulder surgery from January 1, 2014, to December 31, 2014, were prospectively enrolled into an electronic data collection system with retrospective review of compliance data. A total of 143 patients were included in this study; 406 patients were excluded (for any or all of the following reasons, such as incomplete follow-up, inaccessibility to the order sets, and inability to complete the order sets). All patients were assigned an order set of PROs through an electronic reporting system, with order sets to be completed prior to surgery, as well as 6 and 12 months postoperatively. Compliance rates of form completion were documented. Patients who underwent arthroscopic anterior and/or posterior stabilization were excluded. The average age of the patients was 53.1 years, ranging from 20 to 83. Compliance of form completion was highest preoperatively (76%), and then dropped subsequently at 6 months postoperatively (57%) and 12 months postoperatively (45%). Use of research assistants improved compliance by approximately 20% at each time point. No differences were found according to patient gender and age group. Of those completing forms, a majority completed forms at home or elsewhere prior to returning to the office for the clinic visit. Electronic administration of PRO may decrease the amount of time required in the office setting for PRO completion by patients. This may be mutually beneficial to providers and patients. It is unclear if an electronic system improves patient compliance in voluntary completion PRO. Compliance rates at final follow-up remain a concern if data are to be used for establishing quality or outcome metrics. Level IV, case series. Copyright © 2017 Arthroscopy Association of North

  12. Selective decontamination of the gastrointestinal tract in patients undergoing esophageal resection

    Directory of Open Access Journals (Sweden)

    Lange Jochen

    2010-12-01

    Full Text Available Abstract Background Selective decontamination of the digestive tract (SDD to eliminate gram-negative bacteria is still not widely accepted, although it reduces the incidence of nosocomial infections. In a previous retrospective study, a clear benefit to perioperative morbidity, and a reduction in nosocomial infections were found in patients who underwent an esophageal anastomosis. Thus, SDD was applied routinely for esophageal anastomoses. We report the outcome of a cohort of 81 patients who underwent this treatment. Methods From 2002, patients who underwent an esophageal anastomosis (esophagojejunostomy were prospectively recorded. Perioperatively, patients received polymyxin, tobramycin, vancomycin and nystatin by mouth four times a day. Outcome was compared to a control group that was treated before 2002 (68 patients without SDD and 53 patients with SDD. Postoperative morbidity and mortality were assessed. Results Between 2002 and 2007, 81 patients who underwent an esophageal anastomosis received SDD. Compared to a retrospective control group, patients with SDD had significantly less pneumonia (OR 0.06 (0.01-0.46, p Conclusions SDD significantly reduces perioperative morbidity and mortality in patients who undergo a distal esophageal anastomosis compared to a historical control group. In patients with an anastomotic leakage, there was a strong tendency of SDD to reduce postoperative mortality.

  13. ABPM in COPD patients with sleep desaturation.

    Science.gov (United States)

    Aidar, Neila Anders; Silva, Márcio Alberto Carvalho da; Melo e Silva, César Augusto; Ferreira Júnior, Pedro Nery; Tavares, Paulo

    2009-09-01

    Sleep hypoxemia may change blood pressure by sympathetic activation. Few studies have analyzed blood pressure parameters in COPD patients who do not present sleep apnea, but do present sleep desaturation. To analyze blood pressure parameters in COPD patients with sleep desaturation not caused by apnea. Thirteen patients with COPD underwent spirometry, blood gas, polysomnography and ABPM for blood pressure evaluation. Fourteen patients without COPD underwent spirometry, oximetry and ABPM. Blood pressure analyses were carried out both during wakefulness and sleep. Both groups were comprised of patients with no history of hypertension. The two groups were similar as regards age, height, weight, and body mass index. A significant difference (p<0.05) was found between blood pressure levels during the wakefulness, sleep, 24-hour and sleep dip periods. Higher blood pressure levels were observed in patients with COPD, except for diastolic levels during wakefulness and maximum values during sleep and in the 24 hours. Sleep dip in the COPD group was attenuated, whereas physiological dip was observed in the control group, with lower blood pressure levels. Systolic and diastolic blood pressure levels in the COPD group were higher than those of the control group, with a significant difference found for all periods studied, except for diastolic levels during wakefulness and in the 24 hours. We can conclude that the group of COPD patients with sleep desaturation has significantly higher blood pressure levels than the control group.

  14. Acute limb ischemia in cancer patients: should we surgically intervene?

    LENUS (Irish Health Repository)

    Tsang, Julian S

    2012-02-01

    BACKGROUND: Cancer patients have an increased risk of venous thromboembolic events. Certain chemotherapeutic agents have also been associated with the development of thrombosis. Reported cases of acute arterial ischemic episodes in cancer patients are rare. METHODS: Patients who underwent surgery for acute limb ischemia associated with malignancy in a university teaching hospital over a 10-year period were identified. Patient demographics, cancer type, chemotherapy use, site of thromboembolism, treatment and outcome were recorded. RESULTS: Four hundred nineteen patients underwent surgical intervention for acute arterial ischemia, 16 of these patients (3.8%) had associated cancer. Commonest cancer sites were the urogenital tract (n = 5) and the lungs (n = 5). Eight patients (50%) had been recently diagnosed with cancer, and four (25%) of these cancers were incidental findings after presentation with acute limb ischemia. Four patients (25%) developed acute ischemia during chemotherapy. The superficial femoral artery was the most frequent site of occlusion (50%), followed by the brachial (18%) and popliteal (12%) arteries. All patients underwent thromboembolectomy, but two (12%) patients subsequently required a bypass procedure. Six patients (37%) had limb loss, and in-patient mortality was 12%. Histology revealed that all occlusions were due to thromboembolism, with no tumor cells identified. At follow-up, 44% of patients were found to be alive after 1 year. CONCLUSION: Cancer and chemotherapy can predispose patients to acute arterial ischemia. Unlike other reports that view this finding as a preterminal event most appropriately treated by palliative measures, in this series, early diagnosis and surgical intervention enabled limb salvage and patient survival.

  15. Reduced Baroreflex Sensitivity in Cluster Headache Patients

    DEFF Research Database (Denmark)

    Barloese, Mads C J; Mehlsen, Jesper; Brinth, Louise

    2015-01-01

    by baroreflex sensitivity (BRS) in CH patients. METHODS: Twenty-six active CH patients and an equal number of age-, sex-, and BMI-matched controls underwent head-up tilt table test and BRS was determined by the sequence method. RESULTS: Compared with controls, patients exhibited a blunted reactivity of RR...... patients who had not (n = 13, 16.0 ms/mmHg, P = .1523). In the tilted position, the drop in SBP at the carotid sinuses was higher in patients who had recently suffered an attack. Despite this, they exhibited a less marked shortening of RR intervals when compared with patients who had been attack free...... of the autonomic nervous system or in the central relay of impulses from the baroreceptors....

  16. Routine airway surveillance in pediatric tracheostomy patients.

    Science.gov (United States)

    Gergin, Ozgul; Adil, Eelam; Kawai, Kosuke; Watters, Karen; Moritz, Ethan; Rahbar, Reza

    2017-06-01

    The aim of this study is to review airway findings in children with tracheostomies who underwent surveillance direct laryngoscopy and bronchoscopy (DLB) to determine the yield of routine airway evaluation in these patients. Retrospective chart review at tertiary referral children's hospital. A retrospective chart review was conducted of all of the children with tracheostomies who underwent DLB after tracheostomy between 1984 and 2015. A total of 303 patients met inclusion criteria. The median time interval between tracheostomy and first follow-up DLB was 12.0 months (IQR 4.8-28.9 months). There was no significant difference in the incidence of airway lesions between patients who underwent endoscopy tracheostomy versus those who had a longer time interval between tracheostomy and DLB (p = 0.16). One hundred sixty seven patients (55.1%) were diagnosed with lesions, with suprastomal granulation (39.9%) being the most common. Symptomatic patients were significantly more likely to have an airway lesion identified (69.9% versus 42.0%; p tracheostomy were significantly more likely to have an airway lesion (p = 0.01). The high incidence of airway lesions noted during surveillance DLB support the utility of routine airway endoscopy in pediatric tracheostomy patients. Symptomatic patients, those with ventilator dependence, or cardiopulmonary or trauma indications for tracheostomy are more likely to have airway lesions and should be monitored closely. The ideal time interval between surveillance endoscopies needs to be examined further. Copyright © 2017. Published by Elsevier B.V.

  17. Preoperative imaging and surgical margins in maxillectomy patients

    NARCIS (Netherlands)

    Kreeft, Anne Marijn; Smeele, Ludwig E.; Rasch, Coen R. N.; Hauptmann, Michael; Rietveld, Derk H. F.; Leemans, C. René; Balm, Alfons J. M.

    2012-01-01

    Background High rates of positive surgical margins are reported after a maxillectomy. A large part of tumors that are preoperatively considered operable can thus not be resected with tumor-free margins. Methods This was a retrospective study on medical files of 69 patients that underwent

  18. Computed Tomography of Patients with Head Trauma following ...

    African Journals Online (AJOL)

    METHODS: Retrospective analysis of cranial computed tomography (CT) films, request cards, duplicate copy of radiology reports, soft copy CT images and case notes of 61 patients who underwent cranial CT scan on account of road traffic accidents. The study CT scans were performed at the radiology department of ...

  19. Anaesthesia for a morbidly obese patient with schizophrenia and ...

    African Journals Online (AJOL)

    We report the case of a morbidly obese woman with schizophrenia and intellectual disability who underwent dental treatment using general anaesthesia. The 38-year-old patient was 156 cm tall and weighed 140 kg, with a body mass index of 57.5 kg.m-2. Her developmental age was less than five or six years. She had ...

  20. Comparison of patients with and without intellectual disability under ...

    African Journals Online (AJOL)

    Background and Purpose: We analyzed and retrospectively compared patients with and without intellectual disability (ID) who underwent oral surgery under general anesthesia at Istanbul University, Faculty of Dentistry, Department of General Anesthesia, between October 2012 and June 2013 with regard to the following ...

  1. Structural findings at hysterosalpingography in patients with infertility ...

    African Journals Online (AJOL)

    Materials and Methods: A retrospective review of 289 consecutive patients who underwent hysterosalpingography using ionic water-soluble contrast media was done at 2 private x-ray units in Kampala. Clinical notes and radiological findings were analysed for demographic data, uterine status, tubal and pelvic pathology.

  2. The eventual outcome of patients who had lower limb amputations ...

    African Journals Online (AJOL)

    C De Klerk

    Background: Peripheral vascular disease (PVD) presenting with irreversible lower limb pathology has a high morbidity and mortality rate. This study aimed to determine the outcome of patients who underwent lower limb amputations (LLAs) because of PVD at Pelonomi Hospital, Bloemfontein, 2008–2011. Methods: ...

  3. Evaluation of Ocular Movements in Patients with Dyslexia

    Science.gov (United States)

    Vagge, Aldo; Cavanna, Margherita; Traverso, Carlo Enrico; Iester, Michele

    2015-01-01

    The aims of this study were to analyze the relationship between dyslexia and eye movements and to assess whether this method can be added to the workup of dyslexic patients. The sample was comprised of 11 children with a diagnosis of dyslexia and 11 normal between 8 and 13 years of age. All subjects underwent orthoptic evaluation, ophthalmological…

  4. Should nonionic radiographic contrast media be given to all patients?

    International Nuclear Information System (INIS)

    Parfrey, P.S.; Cramer, B.C.; McManamon, P.J.

    1988-01-01

    In the 1970s about one patient of every 40,000 who underwent intravenous urography died. It has been suggested that lives can be saved by using only nonionic or low-osmolarity contrast agents. The authors suggest a multicentre double-blind randomized controlled trial of nonionic versus ionic contrast media

  5. Stereotactic Radiosurgery for Poor Performance Status Patients

    Energy Technology Data Exchange (ETDEWEB)

    Kubicek, Gregory J., E-mail: kubicek-gregory@cooperhealth.edu [Department of Radiation Oncology, Cooper University Hospital, Camden, New Jersey (United States); Turtz, Alan [Department of Neurological Surgery, Cooper University Hospital, Camden, New Jersey (United States); Xue, Jinyu; Patel, Ashish; Richards, Gregory; LaCouture, Tamara [Department of Radiation Oncology, Cooper University Hospital, Camden, New Jersey (United States); Cappelli, Louis; Diestelkamp, Tim [Rowan Graduate School, Camden, New Jersey (United States); Saraiya, Piya [Department of Diagnostic Radiology, Cooper University Hospital, Camden, New Jersey (United States); Bexon, Anne [Department of Neurological Surgery, Cooper University Hospital, Camden, New Jersey (United States); Lerman, Nati [Department of Medical Oncology, Cooper University Hospital, Camden, New Jersey (United States); Goldman, Howard Warren [Department of Neurological Surgery, Cooper University Hospital, Camden, New Jersey (United States)

    2016-07-01

    Purpose: Patients with poor performance status (PS), usually defined as a Karnofsky Performance Status of 60 or less, were not eligible for randomized stereotactic radiosurgery (SRS) studies, and many guidelines suggest that whole-brain radiation therapy (WBRT) is the most appropriate treatment for poor PS patients. Methods and Materials: In this retrospective review of our SRS database, we identified 36 patients with PS of 60 or less treated with SRS for central nervous system (CNS) metastatic disease. PS, as defined by the Karnofsky Performance Status, was 60 (27 patients), 50 (8 patients), or 40 (1 patient). The median number of CNS lesions treated was 3. Results: Median overall survival (OS) was 7.2 months (range, 0.73-25.6 months). Fifteen patients (41%) were alive at 6 months, and 6 patients (16.6%) were alive at 1 year. There was no difference in OS in patients who underwent previous WBRT. There were no local failures or cases of radiation toxicity. Distant CNS failures were seen in 9 patients (25%). Conclusions: Our patients with poor PS had reasonable median OS and relatively low distant CNS failure rates. Patients in this patient population may be ideal candidates for SRS compared with WBRT given the low incidence of distant failure over their remaining lives and the favorable logistics of single-fraction treatment for these patients with debility and their caregivers.

  6. Brain magnetic resonance imaging screening is not useful for HIV-1-infected patients without neurological symptoms.

    Science.gov (United States)

    Nishijima, Takeshi; Gatanaga, Hiroyuki; Teruya, Katsuji; Tajima, Tsuyoshi; Kikuchi, Yoshimi; Hasuo, Kanehiro; Oka, Shinichi

    2014-10-01

    We investigated the diagnostic usefulness of brain magnetic resonance imaging (MRI) screening in HIV-1-infected patients without neurological symptoms in detecting intracranial diseases at early stages. In this retrospective analysis, the study patients were HIV-1-infected patients who underwent brain MRI scan in clinical practice between 2001 and 2013. We excluded patients with MRI for (1) follow-up examination for prediagnosed intracranial diseases, (2) cancer staging, (3) screening mycobacterium/bacteria/fungi disease proliferation in the brain, and (4) evaluation for meningitis/encephalitis. The study patients (n=485) were classified into two groups: those who underwent brain MRI scan without any neurological symptoms/signs (asymptomatic patients, n=158) and those who underwent MRI due to such symptoms (symptomatic patients, n=327). Asymptomatic patients had lower CD4 counts than symptomatic patients (median 78 versus 241/μl). Intracranial diseases were detected in three (2%) of the asymptomatic patients [two toxoplasmosis and one progressive multifocal leukoencephalopathy (PML)] compared to 58 (19%) of the symptomatic patients (the χ(2) test, pHIV-associated dementia (n=17). Among symptomatic patients, intracranial diseases were common in those with slurred speech (3/6, 50%), seizure (4/10, 40%), eyesight/vision abnormality (5/16, 31%), altered mental status (8/31, 26%), and hemiplegia/numbness (13/50, 26%). For patients with CD4 count HIV-1-infected patients without neurological symptoms is of little value.

  7. Hypocalcemia development in patients operated for primary hyperparathyroidism: Can it be predicted preoperatively?

    Science.gov (United States)

    Kaya, Cafer; Tam, Abbas Ali; Dirikoç, Ahmet; Kılıçyazgan, Aylin; Kılıç, Mehmet; Türkölmez, Şeyda; Ersoy, Reyhan; Çakır, Bekir

    2016-10-01

    Primary hyperparathyroidism (PHP) is a common endocrine disease, and its most effective treatment is surgery. Postoperative hypocalcemia is a morbidity of parathyroid surgeries, and it may extend hospitalization durations. The purpose of this study is to determine the predictive factors related to the development of hypocalcemia and hungry bone syndrome (HBS) in patients who underwent parathyroidectomy for PHP. Laboratory data comprising parathyroid hormone (PTH), calcium, phosphate, 25-OHD, albumin, magnesium, alkaline phosphatase (ALP), blood urea nitrogen (BUN), and thyroid stimulating hormone (TSH) of the patients were recorded preoperatively, on the 1st and 4th days postoperatively, and in the 6th postoperative month, and their neck ultrasound (US) and bone densitometry data were also recorded. Hypocalcemia was seen in 63 patients (38.4%) on the 1st day after parathyroidectomy. Ten patients (6.1%) had permanent hypocalcemia in the 6th month after surgery. Out of the patients who underwent parathyroidectomy for PHP, 22 (13.4%) had HBS. The incidence of postoperative hypocalcemia was higher in patients who underwent parathyroidectomy for PHP, who had parathyroid hyperplasia, and who had osteoporosis. Preoperative PTH, ALP, and BUN values were higher in those patients who developed HBS. Furthermore, HBS was more common in patients who had osteoporosis, who had parathyroid hyperplasia, and who underwent thyroidectomy simultaneously with parathyroidectomy. As a result, patients who have the risk factors for development of hypocalcemia and HBS should be monitored more attentively during the perioperative period.

  8. Phase 2 Trial of Induction Gemcitabine, Oxaliplatin, and Cetuximab Followed by Selective Capecitabine-Based Chemoradiation in Patients With Borderline Resectable or Unresectable Locally Advanced Pancreatic Cancer

    International Nuclear Information System (INIS)

    Esnaola, Nestor F.; Chaudhary, Uzair B.; O'Brien, Paul; Garrett-Mayer, Elizabeth; Camp, E. Ramsay; Thomas, Melanie B.; Cole, David J.; Montero, Alberto J.; Hoffman, Brenda J.; Romagnuolo, Joseph; Orwat, Kelly P.; Marshall, David T.

    2014-01-01

    Purpose: To evaluate, in a phase 2 study, the safety and efficacy of induction gemcitabine, oxaliplatin, and cetuximab followed by selective capecitabine-based chemoradiation in patients with borderline resectable or unresectable locally advanced pancreatic cancer (BRPC or LAPC, respectively). Methods and Materials: Patients received gemcitabine and oxaliplatin chemotherapy repeated every 14 days for 6 cycles, combined with weekly cetuximab. Patients were then restaged; “downstaged” patients with resectable disease underwent attempted resection. Remaining patients were treated with chemoradiation consisting of intensity modulated radiation therapy (54 Gy) and concurrent capecitabine; patients with borderline resectable disease or better at restaging underwent attempted resection. Results: A total of 39 patients were enrolled, of whom 37 were evaluable. Protocol treatment was generally well tolerated. Median follow-up for all patients was 11.9 months. Overall, 29.7% of patients underwent R0 surgical resection (69.2% of patients with BRPC; 8.3% of patients with LAPC). Overall 6-month progression-free survival (PFS) was 62%, and median PFS was 10.4 months. Median overall survival (OS) was 11.8 months. In patients with LAPC, median OS was 9.3 months; in patients with BRPC, median OS was 24.1 months. In the group of patients who underwent R0 resection (all of which were R0 resections), median survival had not yet been reached at the time of analysis. Conclusions: This regimen was well tolerated in patients with BRPC or LAPC, and almost one-third of patients underwent R0 resection. Although OS for the entire cohort was comparable to that in historical controls, PFS and OS in patients with BRPC and/or who underwent R0 resection was markedly improved

  9. Phase 2 Trial of Induction Gemcitabine, Oxaliplatin, and Cetuximab Followed by Selective Capecitabine-Based Chemoradiation in Patients With Borderline Resectable or Unresectable Locally Advanced Pancreatic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Esnaola, Nestor F. [Department of Surgery, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Chaudhary, Uzair B.; O' Brien, Paul [Division of Hematology and Oncology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Garrett-Mayer, Elizabeth [Division of Biostatistics and Epidemiology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Camp, E. Ramsay [Department of Surgery, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Thomas, Melanie B. [Division of Hematology and Oncology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Cole, David J. [Department of Surgery, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Montero, Alberto J. [Division of Hematology and Oncology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Hoffman, Brenda J.; Romagnuolo, Joseph [Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Orwat, Kelly P. [Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States); Marshall, David T., E-mail: marshadt@musc.edu [Department of Radiation Oncology, Hollings Cancer Center, Medical University of South Carolina, Charleston, South Carolina (United States)

    2014-03-15

    Purpose: To evaluate, in a phase 2 study, the safety and efficacy of induction gemcitabine, oxaliplatin, and cetuximab followed by selective capecitabine-based chemoradiation in patients with borderline resectable or unresectable locally advanced pancreatic cancer (BRPC or LAPC, respectively). Methods and Materials: Patients received gemcitabine and oxaliplatin chemotherapy repeated every 14 days for 6 cycles, combined with weekly cetuximab. Patients were then restaged; “downstaged” patients with resectable disease underwent attempted resection. Remaining patients were treated with chemoradiation consisting of intensity modulated radiation therapy (54 Gy) and concurrent capecitabine; patients with borderline resectable disease or better at restaging underwent attempted resection. Results: A total of 39 patients were enrolled, of whom 37 were evaluable. Protocol treatment was generally well tolerated. Median follow-up for all patients was 11.9 months. Overall, 29.7% of patients underwent R0 surgical resection (69.2% of patients with BRPC; 8.3% of patients with LAPC). Overall 6-month progression-free survival (PFS) was 62%, and median PFS was 10.4 months. Median overall survival (OS) was 11.8 months. In patients with LAPC, median OS was 9.3 months; in patients with BRPC, median OS was 24.1 months. In the group of patients who underwent R0 resection (all of which were R0 resections), median survival had not yet been reached at the time of analysis. Conclusions: This regimen was well tolerated in patients with BRPC or LAPC, and almost one-third of patients underwent R0 resection. Although OS for the entire cohort was comparable to that in historical controls, PFS and OS in patients with BRPC and/or who underwent R0 resection was markedly improved.

  10. PATIENTS WITH SQUAMOUS-CELL VERSUS ADENO(SQUAMOUS) CARCINOMA OF THE CERVIX, WHAT FACTORS DETERMINE THE PROGNOSIS

    NARCIS (Netherlands)

    TINGA, DJ; BOUMA, J; AALDERS, JG

    1992-01-01

    Patients with squamous cell carcinoma of the cervix FIGO stages IB to IV (n = 306) were compared to patients with adeno(squamous) carcinoma (n = 70). There was no difference between the mean ages of the groups. In the patients who underwent radical surgical treatment, whether or not in combination

  11. Stress urinary incontinence in patients treated for cervical cancer: is TVT-Secur a valuable treatment option?

    NARCIS (Netherlands)

    Hazewinkel, Menke H.; Schilthuis, Marten S.; Roovers, Jan-Paul

    2009-01-01

    We present two patients with bothersome stress urinary incontinence (SUI) following radical hysterectomy and pelvic lymphadenectomy for early stage cervical cancer. One patient underwent adjuvant radiotherapy. We selected, after extensive counseling, TVT-Secur in these two patients as we aimed to

  12. Relationship between the mechanism of gastro-oesophageal reflux and oesophageal acid exposure in patients with reflux disease

    NARCIS (Netherlands)

    Scheffer, R. C. H.; Wassenaar, E. B.; Herwaarden, M. A.; Holloway, R. H.; Samsom, M.; Smout, A. J. P. M.; Akkermans, L. M. A.

    2005-01-01

    This study investigated the relationship between the oesophageal acid exposure time and the underlying manometric motor events in patients with gastro-oesophageal reflux disease (GORD). In 31 patients, 3-hour oesophageal motility and pH were measured after a test meal. Ten patients underwent 24-hour

  13. Sacral Neuromodulation in Patients With a Cardiac Pacemaker

    Directory of Open Access Journals (Sweden)

    Abdullah A. Gahzi

    2016-09-01

    Full Text Available The objective of this study was to describe our experience using sacral neuromodulation to treat urinary urgency, frequency, urge incontinence, and chronic urinary retention in patients with cardiac pacemakers. With the increasingly widespread use of InterStim for bladder function restoration, we are seeing more complex patients with multiple comorbidities, including cardiac conditions. Herein, we report 3 cases of individuals with cardiac pacemakers who underwent InterStim implantation to treat urinary conditions. This study is a case series of 3 patients with cardiac pacemakers who underwent sacral neuromodulation to treat refractory voiding dysfunction. The initial patient screening for InterStim therapy involved percutaneous nerve evaluation (PNE, in which a temporary untined lead wire was placed through the S3 foramen. Patients who did not respond to PNE proceeded to a staged implant. All patients in this study had a greater than 50% improvement of their urinary symptoms during the initial trial and underwent placement of the InterStim implantable pulse generator (IPG. Postoperative programming was done under electrocardiogram monitoring by a cardiologist. No interference was observed between the Inter-Stim IPG and the cardiac pacemaker. In this group of patients, sacral neuromodulation in the presence of a cardiac pacemaker appears to have been safe.

  14. Composite augmentation phalloplasty: personal experience after 275 patients

    Directory of Open Access Journals (Sweden)

    Juan Monreal

    2015-03-01

    Full Text Available Aim: To report the author's experience in augmentation phalloplasty by studying a retrospective series of patients who underwent fat grafting for girth enhancement or a composite technique based on suspensory ligament release plus fat grafting performed simultaneously. Methods: The author analyzed retrospectively the outcomes of 275 augmentation phalloplasty procedures performed in 259 patients until November 2013. Of these, 127 correspond to girth augmentation with fat grafting and 148 to composite augmentation phalloplasty (girth augmentation with fat grafting and length improvement by suspensory ligament release. In 16 patients girth and length enhancement were performed in two separate procedures. Results: Of this 259 patients, 87 underwent postoperative follow-up for at least 12 months and 160 patients underwent follow-up for at least 6 months. The average increase in circumference at 6 months was 1.7 cm (1.57 cm at 12 months and the average increase in length of 3.2 cm (3.1 cm at 12 months. Twenty-two patients showed minor complications that were treated without sequelae and without influencing the final result. Conclusion: By judicious use of currently available techniques, it is possible to achieve stable increases in penis size. The use of composite techniques provides better final results than the use of individual techniques performed alone due to the increase of the actual volume of the penis. An adequate informed consent is essential in all patients due to the unrealistic expectations expressed by the majority of them.

  15. Assessing Patient-Reported Outcomes Following Orthognathic Surgery and Osseous Genioplasty.

    Science.gov (United States)

    Schwitzer, Jonathan A; Albino, Frank P; Mathis, Ryan K; Scott, Amie M; Gamble, Laurie; Baker, Stephen B

    2015-11-01

    Primary outcomes for orthognathic surgery and genioplasty patients include satisfaction with appearance, improved motor function, and enhanced quality of life. The goal of this study was to assess outcomes among patients undergoing these procedures, and to highlight the potential use of FACE-Q instrument for use in patients with dentofacial deformities. A total of 56 patients presenting for orthognathic surgery and/or osseous genioplasty completed the FACE-Q during preoperative and/or at postoperative visits. FACE-Q scores increased following surgery in satisfaction with facial appearance overall (+24.5, P jawline (+40.7, P < 0.01), and in all satisfaction with chin items (profile, prominence, shape, and overall). Patients also demonstrated increased social confidence (+8.9, P = 0.29). There was no improvement in psychologic well-being (-0.8, P = 0.92). All 3 surgical groups of patients experienced gains in satisfaction with appearance following surgery. Patients who underwent orthognathic surgery either alone or in combination with genioplasty demonstrated statistically significant improvements in satisfaction with facial appearance overall (P < 0.01 for both groups), whereas patients who underwent genioplasty alone did not (P = 0.13). In addition, patients who underwent orthognathic surgery combined with genioplasty demonstrated greater improvement in satisfaction with chin than patients who underwent genioplasty alone. In conclusion, patients who underwent orthognathic surgery and/or genioplasty demonstrated improvement in appearance and social confidence. The use of this model supports the successful outcomes possible for patients undergoing these procedures.

  16. Speech Outcomes after Tonsillectomy in Patients with Known Velopharyngeal Insufficiency

    Directory of Open Access Journals (Sweden)

    L. M. Paulson

    2012-01-01

    Full Text Available Introduction. Controversy exists over whether tonsillectomy will affect speech in patients with known velopharyngeal insufficiency (VPI, particularly in those with cleft palate. Methods. All patients seen at the OHSU Doernbecher Children's Hospital VPI clinic between 1997 and 2010 with VPI who underwent tonsillectomy were reviewed. Speech parameters were assessed before and after tonsillectomy. Wilcoxon rank-sum testing was used to evaluate for significance. Results. A total of 46 patients with VPI underwent tonsillectomy during this period. Twenty-three had pre- and postoperative speech evaluation sufficient for analysis. The majority (87% had a history of cleft palate. Indications for tonsillectomy included obstructive sleep apnea in 11 (48% and staged tonsillectomy prior to pharyngoplasty in 10 (43%. There was no significant difference between pre- and postoperative speech intelligibility or velopharyngeal competency in this population. Conclusion. In this study, tonsillectomy in patients with VPI did not significantly alter speech intelligibility or velopharyngeal competence.

  17. Patient acceptance of awake craniotomy.

    Science.gov (United States)

    Wrede, Karsten H; Stieglitz, Lennart H; Fiferna, Antje; Karst, Matthias; Gerganov, Venelin M; Samii, Madjid; von Gösseln, Hans-Henning; Lüdemann, Wolf O

    2011-12-01

    The aim of this study was to objectively assess the patients' acceptance for awake craniotomy in a group of neurosurgical patients, who underwent this procedure for removal of lesions in or close to eloquent brain areas. Patients acceptance for awake craniotomy under local anesthesia and conscious sedation was assessed by a formal questionnaire (PPP33), initially developed for general surgery patients. The results are compared to a group of patients who had brain surgery under general anesthesia and to previously published data. The awake craniotomy (AC) group consisted of 37 male and 9 female patients (48 craniotomies) with age ranging from 18 to 71 years. The general anesthesia (GA) group consisted of 26 male and 15 female patients (43 craniotomies) with age ranging from 26 to 83 years. All patients in the study were included in the questionnaire analysis. In comparison to GA the overall PPP33 score for AC was higher (p=0.07), suggesting better overall acceptance for AC. The subscale scores for AC were also significantly better compared to GA for the two subscales "postoperative pain" (p=0.02) and "physical disorders" (p=0.01) and equal for the other 6 subscales. The results of the overall mean score and the scores for the subscales of the PPP33 questionnaire verify good patients' acceptance for AC. Previous studies have shown good patients' acceptance for awake craniotomy, but only a few times using formal approaches. By utilizing a formal questionnaire we could verify good patient acceptance for awake craniotomy for the treatment of brain tumors in or close to eloquent areas. This is a novel approach that substantiates previously published experiences. Copyright © 2011 Elsevier B.V. All rights reserved.

  18. The Usefulness of Intraoperative Colonic Irrigation and Primary Anastomosis in Patients Requiring a Left Colon Resection.

    Science.gov (United States)

    Hong, Youngki; Nam, Soomin; Kang, Jung Gu

    2017-06-01

    The aim of this study is to assess the short-term outcome of intraoperative colonic irrigation and primary anastomosis and to suggest the usefulness of the procedure when a preoperative mechanical bowel preparation is inappropriate. This retrospective study included 38 consecutive patients (19 male patients) who underwent intraoperative colonic irrigation and primary anastomosis for left colon disease between January 2010 and December 2016. The medical records of the patients were reviewed to evaluate the patients' characteristics, operative data, and postoperative short-term outcomes. Twenty-nine patients had colorectal cancer, 7 patients had perforated diverticulitis, and the remaining 2 patients included 1 with sigmoid volvulus and 1 with a perforated colon due to focal colonic ischemia. A diverting loop ileostomy was created in 4 patients who underwent a low anterior resection. Complications occurred in 15 patients (39.5%), and the majority was superficial surgical site infections (18.4%). Anastomotic leakage occurred in one patient (2.6%) who underwent an anterior resection due sigmoid colon cancer with obstruction. No significant difference in overall postoperative complications and superficial surgical site infections between patients with obstruction and those with peritonitis were noted. No mortality occurred during the first 30 postoperative days. The median hospital stay after surgery was 15 days (range, 8-39 days). Intraoperative colonic irrigation and primary anastomosis seem safe and feasible in selected patients. This procedure may reduce the burden of colostomy in patients requiring a left colon resection with an inappropriate preoperative mechanical bowel preparation.

  19. Impact of high dose versus low dose atorvastatin on contrast induced nephropathy in diabetic patients with acute coronary syndrome undergoing early percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Haitham Galal

    2015-12-01

    Conclusion: No significant difference between high and low doses of atorvastatin in preventing CIN in diabetic patients with normal or mild renal impairment presenting with acute coronary syndrome who underwent early PCI.

  20. Cost-effectiveness profile, organizational implications and patient preferences on the use of exogenous TSH therapy (Thyrogen® vs. THW in thyroid residue ablation in Italy

    Directory of Open Access Journals (Sweden)

    Gianluca De Danieli

    2016-10-01

    CONCLUSION: Thyrogen® represents a cost-effective option for patients with differentiated thyroid cancer who underwent total or near-total thyroidectomy in Italy. Our findings are consistent with other cost-utility analyses.

  1. Use of sugammadex in a patient with progressive muscular atrophy and in a patient with amyotrophic lateral sclerosis

    Science.gov (United States)

    Yoo, Jae Hwa; Kim, Soon Im; Park, Sun Young; Jun, Mi Roung; Kim, Yong Eun; Kim, Hyoung June

    2017-01-01

    Abstract Introduction: We herein present 2 cases involving the combination of rocuronium and sugammadex in patients with motor neuron disease. The patients were a 54-year-old man with progressive muscular atrophy who underwent removal of internal fixators in the arm and leg, and a 66-year-old woman with amyotrophic lateral sclerosis who underwent skin grafting in the left lower leg. General anesthesia was induced with propofol, rocuronium, and remifentanil and maintained with desflurane and remifentanil. At the end of the surgical procedure, we administered sugammadex. Three or 4 minutes after administration of sugammadex, the patients began to breathe spontaneously and were extubated without complications. Conclusion: Sugammadex can be used successfully to reverse neuromuscular blockade in patients with motor neuron disease. PMID:28591053

  2. Use of lower abdominal compression to combat orthostatic hypotension in patients with autonomic dysfunction

    NARCIS (Netherlands)

    Smit, Adrianus A. J.; Wieling, Wouter; Fujimura, Jiro; Denq, Jong C.; Opfer-Gehrking, Tonette L.; Akarriou, Mohammed; Karemaker, John M.; Low, Phillip A.

    2004-01-01

    The aim of this study was to investigate in patients with neurogenic orthostatic hypotension the mechanism and usefulness of abdominal compression to increase standing blood pressure. in three protocols, 23 patients underwent abdominal compression. Protocol 1 evaluated in a 40-60degrees head-up-tilt

  3. Leadless pacemaker implantation in a patient with complex congenital heart disease and limited vascular access

    Directory of Open Access Journals (Sweden)

    Paolo Ferrero

    2016-11-01

    Full Text Available Management of rhythm related issues might be particularly challenging in patients with congenital heart disease due to complex anatomy and restricted vascular access. The leadless technology appears a suitable and attractive alternative for this population. We describe a patient with single ventricle physiology who successfully underwent implantation of a leadless pacemaker.

  4. Nonelective colon cancer resections in elderly patients: results from the dutch surgical colorectal audit

    NARCIS (Netherlands)

    Kolfschoten, N. E.; Wouters, M. W. J. M.; Gooiker, G. A.; Eddes, E. H.; Kievit, J.; Tollenaar, R. A. E. M.; Marang-van de Mheen, P. J.; Bemelman, W. A.; Busch, O. R. C.; van Dam, R. M.; van der Harst, E.; Jansen-Landheer, M. L. E. A.; Karsten, Th M.; van Krieken, J. H. J. M.; Kuijpers, W. G. T.; Lemmens, V. E.; Manusama, E. R.; Meijerink, W. J. H. J.; Rutten, H. J. T.; van de Velde, C. J. H.; Wiggers, T.

    2012-01-01

    The aim of the study was to assess which factors contribute to postoperative mortality, especially in elderly patients who undergo emergency colon cancer resections, using a nationwide population-based database. 6,161 patients (1,172 nonelective) who underwent a colon cancer resection in 2010 in the

  5. Effects of vacuum compression therapy on skin microcirculation in patients suffering from lower limb ischaemia

    NARCIS (Netherlands)

    Ubbink, D. T.; van der Oord, B. M.; Sobotka, M. R.; Jacobs, M. J.

    2000-01-01

    We investigated the short-term effect of vacuum compression (VC) treatment on skin microcirculatory perfusion in the foot of patients with lower limb ischaemia and healthy controls. Ten patients with intermittent claudication or rest pain and 5 healthy controls underwent vacuum-compression treatment

  6. Coronary artery bypass grafting-related bleeding complications in patients treated with dual antiplatelet treatment

    NARCIS (Netherlands)

    Tomšič, Anton; Schotborgh, Mark A.; Manshanden, Johan S. J.; Li, Wilson W. L.; de Mol, Bas A. J. M.

    2016-01-01

    To evaluate the relationship between the timing of either ticagrelor or clopidogrel discontinuation and bleeding-related complications in patients undergoing isolated on-pump coronary artery bypass grafting (CABG). Between January 2012 and December 2014, 705 consecutive patients underwent isolated

  7. Gait and electromyographic analysis of patients recovering after limb-saving surgery

    NARCIS (Netherlands)

    De Visser, E; Mulder, T; Schreuder, HWB; Veth, RPH; Duysens, J

    2000-01-01

    Objective. Control of gait after limb-saving surgery. Design. Case series study. Background. At the moment little is known about adaptations in patients' gait after limb-saving surgery. Methods. Nineteen patients who underwent limb-saving surgery at least 1 yr earlier and 10 normal subjects were

  8. Criteria for the selective use of chest computed tomography in blunt trauma patients.

    NARCIS (Netherlands)

    Brink, M.; Deunk, J.; Dekker, H.M.; Edwards, M.J.R.; Kool, D.R.; Vugt, A.B. van; Kuijk, C. van; Blickman, J.G.

    2010-01-01

    PURPOSE: The purpose of this study was to derive parameters that predict which high-energy blunt trauma patients should undergo computed tomography (CT) for detection of chest injury. METHODS: This observational study prospectively included consecutive patients (>or=16 years old) who underwent

  9. Clinical evaluation of patients undergoing dynamic pedicle fixation in lumbar spine

    Directory of Open Access Journals (Sweden)

    Felipe José Vieira Figueiredo

    2015-06-01

    Full Text Available OBJECTIVE: To evaluate the preliminary clinical results and complications in patients undergoing dynamic pedicle fixation of the spine in the treatment of a specific group of degenerative lumbar disease.METHODS: In this preliminary retrospective study, we selected 14 patients who underwent surgery from January 2006 to July 2010. We selected only patients with spondylolisthesis without spondylolysis (Grade 1 Meyerding. All patients underwent surgery at one level and the levels mostly addressed were: L3-L4, L4-L5 or L5-S1. The approach was the same in all patients (posterior median approach with preservation of the posterior elements. All patients underwent intense conservative treatment without clinical response and the same research algorithm preoperatively.RESULTS: Retrospective analysis of Oswestry questionnaire after selection and publication of results of 14 patients with Grade 1 spondylolisthesis who underwent dynamic pedicle stabilization in a total of 56 pedicle screws, being all in one level. There was no fracture of any screws, the mean hospital stay was a day and a half, no patient required blood transfusion and there were no cases of infection, with significant improvement in the Oswestry questionnaire.CONCLUSION: In this study, the dynamic pedicle stabilization method proved to be an excellent treatment option when surgical criteria are strictly adhered to. There was an improvement in Oswestry values, lower hospital stay and low rate of complications, consisting of an alternative in motion preservation surgery.

  10. Delayed diagnosis of severe tuberculous spondylodiscitis in an asylum seeker; patient or doctors delay?

    DEFF Research Database (Denmark)

    Kristensen, Kristina Langholz; Podlekareva, Daria; Ravn, Pernille

    2017-01-01

    sterile axillary and perianal abscesses for years, but TB was never properly ruled out. The patient underwent surgery, responded well to antibiotics and regained the ability to walk. After 6 month of treatment the patient was lost to follow-up. In light of the increasing migration from TB high...

  11. Effects of exercise training in patients with idiopathic pulmonary arterial hypertension

    NARCIS (Netherlands)

    de Man, F.S.; Handoko, M.L.; Groepenhoff, H.; van 't Hul, A.J.; Abbink, J.; Koppers, R.J.H.; Grotjohan, H.P.; Twisk, J.W.R.; Bogaard, H.J.; Boonstra, A.; Postmus, P.E.; Westerhof, N.; van der Laarse, W.J.; Vonk Noordegraaf, A.

    2009-01-01

    We determined the physiological effects of exercise training on exercise capacity and quadriceps muscle function in patients with idiopathic pulmonary arterial hypertension (iPAH). In total, 19 clinically stable iPAH patients (New York Heart Association II-III) underwent a supervised exercise

  12. Three-year followup of patients treated with lower energy microwave thermotherapy

    NARCIS (Netherlands)

    de Wildt, M. J.; D'Ancona, F. C.; Hubregtse, M.; Carter, S. S.; Debruyne, F. M.; de la Rosette, J. J.

    1996-01-01

    A retrospective study was done to investigate the long-term outcome of patients treated with lower energy transurethral microwave thermotherapy. A total of 305 patients with lower urinary tract symptoms and benign prostatic hypertrophy underwent transurethral microwave thermotherapy according to a

  13. Prognostic value of nodal micrometastases in patients with cancer of the gastro-oesophageal junction

    NARCIS (Netherlands)

    Heeren, PAM; Kelder, W; Blondeel, [No Value; van Westreenen, HL; Hollema, H; Plukker, JT

    Aims. Aim of this study was to examine the presence and the prognostic impact of immunohistochemically identified nodal micrometastases in patients with astro-oesophageal junction (GEJ) carcinomas. Methods. Between January 1988 and December 2000, 148 patients underwent a radical (R0) resection with

  14. Cerebral oxygen metabolism in patients with early Parkinson's disease

    DEFF Research Database (Denmark)

    Borghammer, Per; Cumming, Paul; Østergaard, Karen

    2012-01-01

    ) and cerebral blood flow (CBF) PET scans from PD patients and healthy controls. MATERIALS AND METHODS: Nine early-stage PD patients and 15 healthy age-matched controls underwent PET scans for quantitative mapping of CMRO(2) and CBF. Between-group differences were evaluated for absolute data and intensity...... in spatially contiguous cortical regions in early PD, and support the hypothesis that ETC dysfunction could be a primary pathogenic mechanism in early PD....

  15. Segmental thoracic spinal anesthesia in patient with Byssinosis undergoing nephrectomy.

    Science.gov (United States)

    Patel, Kiran; Salgaonkar, Sweta

    2012-01-01

    Byssinosis is an occupational disease occurring commonly in cotton mill workers; it usually presents with features of chronic obstructive pulmonary disease (COPD). The management of patients with COPD presents a significant challenges to the anesthetist. Regional anesthesia is preferred in most of these patients to avoid perioperative and postoperative complications related to general anesthesia. We report a known case of Byssinosis who underwent nephrectomy under segmental spinal anesthesia at the low thoracic level.

  16. Segmental thoracic spinal anesthesia in patient with Byssinosis undergoing nephrectomy

    OpenAIRE

    Patel, Kiran; Salgaonkar, Sweta

    2012-01-01

    Byssinosis is an occupational disease occurring commonly in cotton mill workers; it usually presents with features of chronic obstructive pulmonary disease (COPD). The management of patients with COPD presents a significant challenges to the anesthetist. Regional anesthesia is preferred in most of these patients to avoid perioperative and postoperative complications related to general anesthesia. We report a known case of Byssinosis who underwent nephrectomy under segmental spinal anesthesia ...

  17. Termination of Pregnancy in a Patient with Advanced Ovarian Cancer

    OpenAIRE

    Suna Özdemir; Çetin Çelik; Kazım Gezginç; Hasan Esen

    2010-01-01

    Ovarian cancer during pregnancy is a rare entity and the management of the disease can be challenging for the patient and the clinician. In this case, we report a case of advanced ovarian carcinoma diagnosed during pregnancy, which was managed with termination of pregnancy and chemotheraphy. The patient was underwent exploratory laparatomy including the right ovarian cystectomy, omentectomy, appendectomy, pelvic and para-aortic lymphadenectomy after frozen section of borderline serous cystade...

  18. ISCHEMIC HEART DISEASE IN PATIENTS OF CHRONIC KIDNEY DISEASE ON MAINTENANCE HEMODIALYSIS

    OpenAIRE

    Dr. Aijaz Ahmed, Dr. Muhammad Nadeem Ahsan, Dr. Pooran Mal*, Dr. Hamid Nawaz Ali Memon, Dr. Samreen and Dr. Sajjad Ali

    2017-01-01

    Objective: To determine the frequency of ischemic heart disease in patients of chronic kidney disease on maintenance hemodialysis Patients and Methods: A total of 160 patients with diagnosis of CKD in department of Nephrology, Liaquat National Hospital Karachi were recruited in this six months cross sectional study. Demographic information was recorded. Then patients were underwent ECG. Reports were assessed and ischemic heart disease was labeled while all the data was collected using the pro...

  19. Rehabilitation of limb apraxia improves daily life activities in patients with stroke.

    Science.gov (United States)

    Smania, N; Aglioti, S M; Girardi, F; Tinazzi, M; Fiaschi, A; Cosentino, A; Corato, E

    2006-12-12

    We randomly assigned 33 patients with left hemisphere stroke, limb apraxia, and aphasia to an apraxia or a control (aphasia) treatment group. Before and after each treatment, patients underwent a comprehensive neuropsychological testing battery and a caregiver evaluation of patient's activities of daily life (ADL) independence. Apraxia severity was related with ADL independence. Control (aphasia) treatment improved patients' language and intelligence performance. Apraxia treatment specifically improved praxic function and ADL.

  20. Patient expectations for radiology in noninteractive encounters

    International Nuclear Information System (INIS)

    Altmaier, E.; Smith, W.L.; Ross, R.; Johnson, B.; Berberoglu, L.

    1988-01-01

    One hundred seven patients who underwent procedures not involving direct interaction with a radiologist were interviewed regarding their experience. The 545 responses divided clearly into items regarding the physical facility (parking, room temperature, etc) and items directly under control of radiology. The latter were twofold: waiting time and technologist behavior. Specific behaviors judged critical for technologists included ability to impart clear instructions, interpersonal behaviors, concern for physical comfort, and skill in procedure performance. A final question involved the role of the ''unseen'' radiologist. Patients desired a high level of skill in study interpretation and that the radiologist possess several positive personality traits even though they never anticipated direct contact

  1. Prevalence of Upper Abdominal Complaints in Patients Who Have Undergone Partial Gastrectomy

    Directory of Open Access Journals (Sweden)

    RJLF Loffeld

    2000-01-01

    Full Text Available Little is known about the long term occurrence and prevalence of upper abdominal complaints after previous partial gastrectomy. Therefore, a retrospective, uncontrolled, cross-sectional, descriptive, clinical, endoscopic study was done. A questionnaire was mailed to patients who had undergone partial gastrectomy and been sent for upper gastrointestinal endoscopy. Eight questions were scored on a five-point Likert scale, and a symptom score was calculated. During the five-year study period, 189 patients (137 men, 52 women were identified as having had a partial gastrectomy -- 143 (76% received the Billroth II operation and 46 (24% received the Billroth I operation. The questionnaire was mailed to 124 patients, of whom 79 (64% responded. Eighty-eight per cent of patients had undergone surgery more than 15 years earlier. Fifty-nine patients (75% suffered from upper abdominal symptoms. Regurgitation of food, retrosternal heartburn and bile reflux occurred significantly more often in patients who underwent the Billroth II operation. The mean symptom score of patients who underwent Billroth I resection was significantly lower (4.5 [SD 3.6] than that of patients who underwent Billroth II resection (7.1 [SD 4.4](P=0.04. One or more symptoms indicative of dumping were found in 70% of patients who underwent Billroth II resection and in 59% of patients who underwent Billroth I resection (not significant. Many patients who had undergone a partial gastrectomy developed upper abdominal symptoms during long term follow-up that were not specifically linked to dumping.

  2. Patient satisfaction

    Directory of Open Access Journals (Sweden)

    Bhanu Prakash

    2010-01-01

    Full Text Available Patient satisfaction is an important and commonly used indicator for measuring the quality in health care. Patient satisfaction affects clinical outcomes, patient retention, and medical malpractice claims. It affects the timely, efficient, and patient-centered delivery of quality health care. Patient satisfaction is thus a proxy but a very effective indicator to measure the success of doctors and hospitals. This article discusses as to how to ensure patient satisfaction in dermatological practice.

  3. Patient satisfaction.

    Science.gov (United States)

    Prakash, Bhanu

    2010-09-01

    Patient satisfaction is an important and commonly used indicator for measuring the quality in health care. Patient satisfaction affects clinical outcomes, patient retention, and medical malpractice claims. It affects the timely, efficient, and patient-centered delivery of quality health care. Patient satisfaction is thus a proxy but a very effective indicator to measure the success of doctors and hospitals. This article discusses as to how to ensure patient satisfaction in dermatological practice.

  4. Use of Computed Tomography and Positron Emission Tomography/Computed Tomography for Staging of Local Extent in Patients With Malignant Pleural Mesothelioma

    OpenAIRE

    Frauenfelder, Thomas; Kestenholz, Peter; Hunziker, Roger; Nguyen, Thi Dan Linh; Fries, Martina; Veit-Haibach, Patrick; Husmann, Lars; Stahel, Rolf; Weder, Walter; Opitz, Isabelle

    2015-01-01

    PURPOSE The objective of this study was to determine the diagnostic value of computed tomography (CT) and positron emission tomography (PET)/CT for staging of malignant pleural mesothelioma (MPM) in patients undergoing induction chemotherapy. METHODS Sixty-two patients (median age, 61 years; female: n = 9) with proven MPM underwent CT after induction chemotherapy. Of these, 28 underwent additional PET/CT. Extrapleural pneumonectomy was performed for pathological TNM staging. Clinical TNM s...

  5. The Impact of Laparoscopic Approaches on Short-term Outcomes in Patients Undergoing Liver Surgery for Metastatic Tumors.

    Science.gov (United States)

    Karagkounis, Georgios; Seicean, Andreea; Berber, Eren

    2015-06-01

    To compare the perioperative outcomes associated with open and laparoscopic (LAP) surgical approaches for liver metastases. The American College of Surgeons National Surgical Quality Improvement Program database was used to identify all adult patients who underwent surgical therapy for metastatic liver tumors between 2006 and 2012 (N=7684). Patients who underwent >1 procedure were excluded. Logistic regression after matching on propensity scores was used to assess the association between surgical approaches and perioperative outcomes. A total of 4555 patients underwent open resection, 387 LAP resection, 297 open radiofrequency ablation (RFA), and 265 LAP RFA. In propensity-matched samples (over 95% of patients successfully matched), there was no significant difference between LAP resection and LAP RFA in perioperative complications and length of stay and both compared favorably with their open counterparts. Minimally invasive approaches for secondary hepatic malignancies were associated with improved postoperative morbidity and length of stay and should be preferred in appropriate patients.

  6. Patients with Acromegaly Presenting with Colon Cancer: A Case Series

    Directory of Open Access Journals (Sweden)

    Murray B. Gordon

    2016-01-01

    Full Text Available Introduction. Frequent colonoscopy screenings are critical for early diagnosis of colon cancer in patients with acromegaly. Case Presentations. We performed a retrospective analysis of the incidental diagnoses of colon cancer from the ACCESS trial (ClinicalTrials.gov identifier: NCT01995734. Colon cancer was identified in 2 patients (4.5%. Case  1 patient was a 36-year-old male with acromegaly who underwent transsphenoidal surgery to remove the pituitary adenoma. After surgery, the patient underwent routine colonoscopy screening, which revealed a 40 mm tubular adenoma in the descending colon. A T1N1a carcinoma was surgically removed, and 1 of 22 lymph nodes was positive for metastatic disease, leading to a diagnosis of stage 3 colon cancer. Case  2 patient was a 50-year-old male with acromegaly who underwent transsphenoidal surgery to remove a 2 cm pituitary adenoma. The patient reported severe cramping and lower abdominal pain, and an invasive 8.1 cm3 grade 2 adenocarcinoma with signet rings was identified in the ascending colon and removed. Of the 37 lymph nodes, 34 were positive for the presence of tumor cells, and stage 3c colon cancer was confirmed. Conclusion. Current guidelines for colonoscopy screening at the time of diagnosis of acromegaly and at appropriate follow-up intervals should be followed.

  7. Selection of oncoplastic surgical technique in Asian breast cancer patients

    Directory of Open Access Journals (Sweden)

    Eui Sun Shin

    2018-01-01

    Full Text Available Background Oncoplastic surgery is being increasingly performed in Korean women; however, unlike Westerners, Korean women usually have small to moderate-sized breasts. To achieve better outcomes in reconstructed breasts, several factors should be considered to determine the optimal surgical method. Methods A total of 108 patients who underwent oncoplastic surgery from January 2013 to December 2016 were retrospectively investigated. We used various methods, including glandular tissue reshaping, latissimus dorsi (LD flap transposition, and reduction oncoplasty, to restore the breast volume and symmetry. Results The mean weight of the tumor specimens was 40.46 g, and the ratio of the tumor specimen weight to breast volume was 0.12 g/mL in the patients who underwent glandular tissue reshaping (n=59. The corresponding values were 101.47 g and 0.14 g/mL, respectively, in the patients who underwent reduction oncoplasty (n=17, and 82.54 g and 0.20 g/mL, respectively, in those treated with an LD flap (n=32. Glandular tissue reshaping was mostly performed in the upper outer quadrant, and LD flap transposition was mostly performed in the lower inner quadrant. No major complications were noted. Most patients were satisfied with the aesthetic results. Conclusions We report satisfactory outcomes of oncoplastic surgical procedures in Korean patients. The results regarding specimen weight and the tumor-to-breast ratio of Asian patients will be a helpful reference point for determining the most appropriate oncoplastic surgical technique.

  8. A Study of Patients with Primary Mediastinal Germ Cell Tumors Treated Using Multimodal Therapy

    Directory of Open Access Journals (Sweden)

    Yutaro Tanaka

    2017-01-01

    Full Text Available Objectives. Primary mediastinal germ cell tumors (PMGCTs are rare, which often makes them difficult to treat. Herein, we examined patients with PMGCTs who underwent multimodal treatment. Methods. We examined 6 patients (median age: 25 years, range: 19–27 years with PMGCTs who underwent multimodal treatment between April 2001 and March 2015. Three patients had seminomas, 2 patients had yolk sac tumors, and 1 patient had choriocarcinoma. The median observation period was 32.5 months (range: 8–84 months. Results. Three of the 6 patients received initial operation followed by 3-4 courses of chemotherapy (bleomycin, etoposide, and cisplatin (BEP or etoposide and cisplatin (EP. One patient developed multiple lung metastases 17 months after surgery; received salvage chemotherapy with vinblastine, ifosfamide, and cisplatin; and achieved complete remission. The remaining 3 patients received initial BEP and EP chemotherapy. Multiple lung metastases and supraclavicular lymph node metastases were detected in 2 of these patients at the initial diagnosis. The patients underwent resections to remove residual tumor after treatment, and no viable tumor cells were found. Conclusions. Reliable diagnosis and immediate multimodal treatments are necessary for patients with PMGCTs. The 6 patients treated in our hospital have never experienced recurrence after the multimodal treatment.

  9. Percutaneous nephrolithotomy in ectopically located kidneys and in patients with musculoskeletal deformities.

    Science.gov (United States)

    Srivastava, A; Gupta, P; Chaturvedi, S; Singh, P; Kapoor, R; Dubey, D; Kumar, A

    2010-01-01

    To assess the feasibility, safety and results of percutaneous nephrolithotomy (PNL) in ectopically located kidneys and in patients with musculoskeletal deformities. Thirteen such patients underwent PNL between June 2005 and May 2008. Mean stone size was 27.4 mm (16-37 mm). Six patients had severe kyphoscoliosis, 2 patients each had achondroplasia, cross-fused ectopia and pelvic ectopic kidney, and 1 patient had thoracic kidney. All had a preoperative CT scan of the abdomen. Preoperative ultrasound- or CT-guided percutaneous nephrostomy (PCN) was done in 10 patients. Three patients underwent laparoscopic-assisted PNL. All underwent standard PNL. The stone-free rate, complication rate and need for secondary intervention were evaluated. PNL was successfully completed in all. A second ultrasound-guided intraoperative puncture was required in 2 patients. Re-look PNL was required in 1 patient and the same patient later required shock wave lithotripsy for complete stone clearance. The remaining 12 patients (92.3%) were rendered stone-free in a single sitting. PNL is a feasible and effective modality in anomalous kidneys. Preoperative planning with CT and image-guided PCN is helpful in these situations. Laparoscopic-assisted PNL can be safely performed in patients where access to a renal collecting system by fluoroscopy or image-guided assistance (ultrasound or CT scan) is not possible. Copyright (c) 2010 S. Karger AG, Basel.

  10. [Long-term effects of combined therapy in patients with beta-thalassemia major].

    Science.gov (United States)

    Bagnulo, S; Giannini, A M; Moscatelli, F; Stragapede, L; Acquafredda, A; Dammacco, A

    1998-01-01

    We evaluated therapy complications in 19 beta-thalassemia major patients (mean age from 3 years/5 months and 1 years/6 months) who were followed at II Pediatric Department-University of Bari. 3 out of 19 patients underwent allogenic BMT from matched related donor; 2 out of 19 underwent splenectomy. All of them were receiving hypertransfusion therapy and continuous chelation with DFO. In all patients we performed physical examination, laboratory assays, cardiac and endocrinologic function tests, serum HBV-HCV-HIV antibodies, otoscopy and audiometric test, fundus oculi, skeletal x-ray. 1 out of 19 patients, who was under 15, had a slight dilatation of left ventricle and arythmia. All patients were HBsAb positive. 4/19 patients were HCV Ab positive (ELISA test) with an increase in ALT-AST serum levels since at least 6 months. In 3 of them we assessed RIBA test, always positive. 3 of them underwent liver biopsy (1 iron overload 2 chronic active hepatitis). All patients were HIV Ab negative. 4/15 patients revealed low GH levels after Arginina test. 13 pre-pubescent patients had normal results with GNRH test but lower results after FSH test. 1 pubescent patient had gonadotropic hypophyseal deficit. 4 patients had subclinic hypothiroidism. We couldn't find any sequelas in bone-eyes-ears. Hypertransfusion therapy, chelation, profilaxis of infections improved length and quality of life in thalassemic patients. Hypogonadotropic hypogonadism remains a serious sequela and we think it needs to be treated.

  11. Graded Aerobic Treadmill Testing in Adolescent Traumatic Brain Injury Patients.

    Science.gov (United States)

    Cordingley, Dean M; Girardin, Richard; Morissette, Marc P; Reimer, Karen; Leiter, Jeff; Russell, Kelly; Ellis, Michael J

    2017-11-01

    To examine the safety and tolerability of clinical graded aerobic treadmill testing in recovering adolescent moderate and severe traumatic brain injury (TBI) patients referred to a multidisciplinary pediatric concussion program. We completed a retrospective case series of two moderate and five severe TBI patients (mean age, 17.3 years) who underwent initial Buffalo Concussion Treadmill Testing at a mean time of 71.6 days (range, 55-87) postinjury. Six patients completed one graded aerobic treadmill test each and one patient underwent initial and repeat testing. There were no complications. Five initial treadmill tests were completely tolerated and allowed an accurate assessment of exercise tolerance. Two initial tests were terminated early by the treatment team because of neurological and cardiorespiratory limitations. As a result of testing, two patients were cleared for aerobic exercise as tolerated and four patients were treated with individually tailored submaximal aerobic exercise programs resulting in subjective improvement in residual symptoms and/or exercise tolerance. Repeat treadmill testing in one patient performed after 1 month of treatment with submaximal aerobic exercise prescription was suggestive of improved exercise tolerance. One patient was able to tolerate aerobic exercise following surgery for posterior glottic stenosis. Preliminary results suggest that graded aerobic treadmill testing is a safe, well tolerated, and clinically useful tool to assess exercise tolerance in appropriately selected adolescent patients with TBI. Future prospective studies are needed to evaluate the effect of tailored submaximal aerobic exercise prescription on exercise tolerance and patient outcomes in recovering adolescent moderate and severe TBI patients.

  12. Acupuncture in patients with valvular heart disease and prosthetic valves.

    Science.gov (United States)

    Stellon, Anthony

    2003-09-01

    Endocarditis has been reported in patients with valvular heart disease who have undergone acupuncture treatment, although most have been associated with the use of semi-permanent needles. This has led reviewers to suggest that acupuncture may not only be contraindicated in such patients but that prophylactic antibiotics should be given. This study investigated the use of acupuncture treatment in patients with proven valvular heart disease and observed whether endocarditis developed in such patients. All patients in a single-handed GP practice with proven valvular heart disease, including those with prosthetic valves, were identified over a ten-year period. Those who had undergone acupuncture treatment underwent a clinical examination and diagnostic tests, which focused on the signs, symptoms and laboratory criteria for the diagnosis of endocarditis and included a transthoracic echocardiogram. Autopsy findings were reviewed in any patient who died. Based on these clinical and laboratory data, using the modified Duke's criteria for the diagnosis of endocarditis, patients were identified as having definite or possible endocarditis, or the diagnosis was rejected. All patients underwent brief acupuncture with no skin disinfectant and no prophylactic antibiotics were given. Semi-permanent needles were avoided. Thirty-six patients with valvular heart disease underwent a total of 479 acupuncture treatments over a ten-year period. The median number of treatments was 9 (range 1-72), with a follow-up after treatment of 5.75 years (range 0.5-10 years). Definite endocarditis was not found in any patient, but two patients had possible endocarditis, eventually discounted by both negative blood cultures and echocardiography. In conclusion, brief acupuncture was safe in this small cohort of valvular heart disease patients and no case of endocarditis was detected over a ten-year period.

  13. Characterizing mortality in pediatric tracheostomy patients.

    Science.gov (United States)

    Funamura, Jamie L; Yuen, Sonia; Kawai, Kosuke; Gergin, Ozgul; Adil, Eelam; Rahbar, Reza; Watters, Karen

    2017-07-01

    To assess the longitudinal risk of death following tracheostomy in the pediatric age group. Retrospective cohort study. Hospital records of 513 children (≤18 years) at a tertiary care children's hospital who underwent tracheostomy between 1984 and 2015 were reviewed. The primary outcome measure was time from tracheostomy to death. Secondary patient demographic and clinical characteristics were assessed, with likelihood of death using χ 2 tests and the Cox proportional hazards model. Median age at time of tracheostomy was 0.8 years (interquartile range, 0.3-5.2 years).The highest mortality rate (27.8%) was observed in patients in the 13- to 18-year-old age category; their mortality rate was significantly higher when compared to the lowest mortality risk group patients (age 1-4 years, P = .031). Timing of death was evenly distributed: 1 year after tracheostomy (35.3%). Patients who underwent tracheostomy for cardiopulmonary disease had an increased risk of mortality compared with airway obstruction (adjusted hazard ratio: 3.53, 95% confidence interval: 1.72-7.24, P tracheostomy have a high mortality rate, with an increased risk of death associated with a cardiopulmonary indication for undergoing tracheostomy. The majority of deaths occur after the index hospitalization during which the tracheostomy was performed. BPD and CHD are independent predictors of mortality in pediatric tracheostomy patients. 4 Laryngoscope, 127:1701-1706, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  14. Troponin elevation in patients with various tachycardias and normal epicardial coronaries

    Directory of Open Access Journals (Sweden)

    Yousuf Kanjwal

    2008-08-01

    Full Text Available Troponin elevation is usually synonymous with acute coronary syndrome (ACS. Although sensitive for ACS, the elevation of serum troponin, in the absence of clinical evidence of ischemia, should prompt a search for other etiologies of myocardial necrosis. In fact, elevated values of troponin are correlated with myocardial necrosis even though it does not discriminate the mechanism involved. We report a series of seven patients (age range 18-67 years, who presented with complaints of chest discomfort and were found to have regular supraventricular tachycardia (5 patients and one patient each with atrial fibrillation and ventricular tachycardia. All these patients had elevated troponin I and underwent coronary angiography that revealed normal epicardial coronary arteries. This is first case series in which all patients underwent coronary angiography and none of the patients was hemodynamically unstable at the time of presentation. Patients with elevated troponin due to conditions other than ACS can receive inappropriate and delayed definitive diagnosis and treatment.

  15. Transjugular intrahepatic portosystemic shunt for severe jaundice in patients with acute Budd-Chiari syndrome.

    Science.gov (United States)

    He, Fu-Liang; Wang, Lei; Zhao, Hong-Wei; Fan, Zhen-Hua; Zhao, Meng-Fei; Dai, Shan; Yue, Zhen-Dong; Liu, Fu-Quan

    2015-02-28

    To evaluate the feasibility of transjugular intrahepatic portosystemic shunt (TIPS) for severe jaundice secondary to acute Budd-Chiari syndrome (BCS). From February 2009 to March 2013, 37 patients with severe jaundice secondary to acute BCS were treated. Sixteen patients without hepatic venule, hepatic veins (HV) obstruction underwent percutaneous angioplasty of the inferior vena cava (IVC) and/or HVs. Twenty-one patients with HV occlusion underwent TIPS. Serum bilirubin, liver function, demographic data and operative data of the two groups of patients were analyzed. Twenty-one patients underwent TIPS and the technical success rate was 100%, with no technical complications. Sixteen patients underwent recanalization of the IVC and/or HVs and the technical success rate was 100%. The mean procedure time for TIPS was 84.0±12.11 min and angioplasty was 44.11±5.12 min (Pjaundice in either group. Severe jaundice is not a contraindication for TIPS in patients with acute BCS and TIPS is appropriate for severe jaundice due to BCS.

  16. Breast reconstruction rate and profile in a Singapore patient population: a National University Hospital experience.

    Science.gov (United States)

    Sim, Nadia; Soh, Sharon; Ang, Chuan Han; Hing, Chor Hoong; Lee, Han Jing; Nallathamby, Vigneswaran; Yap, Yan Lin; Ong, Wei Chen; Lim, Thiam Chye; Lim, Jane

    2017-05-15

    Breast reconstruction is an integral part of breast cancer management, with the aim of restoring a breast to its natural form. There is increasing awareness among women that it is a safe procedure and its benefits extend beyond aesthetics. Our aim was to establish the rate of breast reconstruction and provide an overview of the patients who underwent breast reconstruction at National University Hospital (NUH), Singapore. We evaluated factors, such as ethnicity, age, time and type of implant, for their impact on a patient's decision to proceed with breast reconstruction. We retrospectively reviewed the medical records of women who had breast cancer and underwent breast surgery at NUH between 2001 and 2010. The breast reconstruction rate in this study was 24.3%. There were 241 patients who underwent breast reconstruction surgeries (including delayed and immediate procedures) among 993 patients for whom mastectomies were done for breast cancer. Chinese patients were the largest ethnic group who underwent breast reconstruction after mastectomy (74.3%). Within a single ethnic patient group, Malay women had the largest proportion of women undergoing breast reconstruction (60.0%). The youngest woman in whom cancer was detected in our study was aged 20 years. Malay women showed the greatest preference for autologous tissue breast reconstruction (92.3%). The median age at cancer diagnosis of our cohort was 46 years. We noted increases in the age of patients undergoing breast reconstruction and the proportion of breast reconstruction cases over the ten-year study period.

  17. Utero-vaginal abnormalities: MR imaging in pediatric patients

    International Nuclear Information System (INIS)

    Bailez, Marcela; Daneff, Monica; Balestrini, Maria A.; Gomez Zanetta, Santiago; Rabellino, Martin; Bruno, Claudio H.

    2003-01-01

    Purpose: To correlate the pre-surgical findings in MRI with the surgical results in Muellerian malformations. Material and methods: 14 pediatric patients were studied by MRI. MRI findings were divided in 4 groups according to the classification of the American Fertility Society (modified by Rock). Patient's age ranged between 12-17 years. Results: In our series 4 patients were included in Group I, 4 cases in Group II, 4 in Group III and only 2 in Group IV. All patients underwent reconstructive surgery based on MRI findings. Conclusions: In our series MRI was a useful method for the pre-surgical evaluation of Muellerian malformations. (author)

  18. Striatal Reward Activity and Antipsychotic-Associated Weight Change in Patients With Schizophrenia Undergoing Initial Treatment

    DEFF Research Database (Denmark)

    Nielsen, Mette Ødegaard; Rostrup, Egill; Wulff, Sanne

    2016-01-01

    -nine antipsychotic-naive inpatients and outpatients with schizophrenia were included in a multimodal longitudinal cohort study from December 16, 2008, to December 11, 2013. Fifty-eight patients underwent functional magnetic resonance imaging (fMRI) while performing a monetary reward task. After 6 weeks of treatment...... with amisulpride, a relatively selective dopamine D2 antagonist, 39 patients underwent a second fMRI scan and measurement of change in body weight. Final follow-up was completed on January 14, 2014, and data were analyzed from October 25, 2014, to June 15, 2015 and August 31 to September 19, 2015. Exposures: Six...... weeks of individually dosed amisulpride treatment. Main Outcomes and Measures: Reward-anticipation activity in the striatum before and after treatment and weight change. Results: Of the 69 patients who consented to the study, 39 underwent the follow-up fMRI and weight measurement (age range, 18-45 years...

  19. Patient opinion

    DEFF Research Database (Denmark)

    Zurita, Laura; Nøhr, Christian

    2004-01-01

    The paper is based upon a case study and aims to provide information abouit patients values and communication that will be useful in the design of more patient friendly health system.......The paper is based upon a case study and aims to provide information abouit patients values and communication that will be useful in the design of more patient friendly health system....

  20. The Comparison of Intrathecal Morphine and IV Morphine PCA on Pain Control, Patient Satisfaction, Morphine Consumption, and Adverse Effects in Patients Undergoing Reduction Mammoplasty

    OpenAIRE

    Karamese, Mehtap; Akda?, Osman; Kara, ?nci; Y?ld?ran, Gokce Unal; Tosun, Zekeriya

    2015-01-01

    Background: Following breast reduction procedures, the level of postoperative pain can be severe, and sufficient pain control influences a patient's physiological, immunological, and psychological status. Objective: The aim of this study was to examine the use of intrathecal morphine (ITM) in breast reduction surgery with patient-controlled analgesia (PCA). Methods: Sixty-two female patients who underwent breast reductions with the same technique participated in this study. The study group (I...

  1. The utility of neck ultrasound and sestamibi scans in patients with secondary and tertiary hyperparathyroidism.

    Science.gov (United States)

    Alkhalili, Eyas; Tasci, Yunus; Aksoy, Erol; Aliyev, Shamil; Soundararajan, Saranya; Taskin, Eren; Siperstein, Allan; Berber, Eren

    2015-03-01

    Secondary hyperparathyroidism (SHPT) and tertiary hyperparathyroidism (THPT) are disease entities in patients with chronic kidney disease that are caused by parathyroid hyperplasia. The role of preoperative localization studies in patients undergoing parathyroidectomy for these conditions remains poorly defined. To evaluate the utility of surgeon-performed neck ultrasound (US) as well as sestamibi scans in the localization of parathyroid glands in patients with SHPT/THPT. A retrospective analysis of patients with SHPT/THPT who underwent parathyroidectomy at a single institution. Results of preoperative localization studies were compared to intraoperative findings. One hundred and three patients underwent parathyroidectomy for SHPT/THPT. All patients underwent surgeon-performed neck US, while 92 (89%) underwent sestamibi scans. US failed to localize any of the parathyroids in 4 patients (3.8%), while sestamibi was negative in 11 (12%). Forty-seven ectopic glands were identified in 38 patients in whom sestamibi was performed. In five patients (13%), ectopic glands were identified by both modalities, by US only in 6 (16%), by sestamibi only in 8 (21%), and by neither study in 19 patients (50%). US showed new thyroid nodules in 19 patients (18.4 %), leading to lobectomy or thyroidectomy at the time of parathyroidectomy in 16 patients (15.5%). Pathology showed malignancy in 7 patients (6.8%). US and MIBI offer little benefit in localizing ectopic glands and rarely change the conduct of a standard four-gland exploration. Although there was a benefit of US in the assessment of thyroid nodules, in only 8.7% of patients was sestamibi of benefit in identifying ectopic glands.

  2. The outcome of early laparoscopic cholecystectomy in patients with acute biliary pancreatitis

    Directory of Open Access Journals (Sweden)

    Yusuf Yağmur

    2010-05-01

    Full Text Available Objectives: It is still controversial to perform a laparoscopic cholecystectomy (LC for the management of acute biliary pancreatitis (ABP at the early hospitalization period, because of adhesions and dissection difficulties. The aim of this study was to evaluate the outcome of the patients with ABP who underwent LC prior to hospital discharge.Methods: A total of 43 patients with ABP, that underwent LC after clinical and laboratory improvement, were retrospectively evaluated. Patient’s age, gender, laboratory findings; ultrasonography (USG, magnetic resonance and other imaging results, surgical operation duration, complications, mortality and postoperative hospital stay days were recorded and statistically analyzed.Results: The median age of patients was 51.8 (20-83 years. A total of 29 (67.4% patients were women and 14 (32.6% were male. The cause was gallstone in all patients. In addition, hyperparathyroidism was found in one patient and hyperlipidemia was present in the other one. Gallbladder stones were determined in all patients. Common bile duct enlargement and stones were detected in 7 patients. Three patients underwent sphyncterectomy and stone extraction according to clinical status. Operations were performed at the mean hospitalization day of 11.4 (3-23. LC was performed to 39 (%90.6 of patients. However, 4 (9.4% patients had intra-abdominal adhesions secondary to infection and were switched to open surgery. The mean operation time was 70 (25-160 minutes and the mean duration of postoperative hospital stay was 3 (1-6 days. In a patient who underwent LC and ERCP preoperatively complication occurred. A second drainage operation was performed and due to development of necrotizing pancreatitis, the patient was lost at the postoperative 7th day secondary to adult type respiratory distress syndrome.Conclusions: In patients with ABP whose clinical and laboratory findings were improved, late LC can be performed safely during their first

  3. Benign and Malignant Thyroid Gland Diseases in the Patients with Primary Hyperparathyroidism.

    Science.gov (United States)

    Celik, Mehmet; Guldiken, Sibel; Ayturk, Semra; Bulbul, Buket Yilmaz; Tastekin, Ebru; Can, Nuray; Sezer, Atakan; Ustun, Funda; Kucukarda, Ahmet

    2017-01-01

    This study aimed to evaluate concurrently detected thyroid pathologies in the patients who underwent surgery for primary hyperparathyroidism (PHPT). In this study, we retrospectively analyzed the files of the patients who underwent surgery for PHPT between 2012 and 2015. Pre- and post-operative laboratory examination results and preoperative radiological and nuclear medicine findings of the patients were retrospectively recorded. A total number of 41 patients with PHPT were divided into two groups as the Group 1 with PHPT and benign thyroid pathology (21 patients) and the Group 2 with PHPT and malignant thyroid pathology (20 patients). In Group 1, 18 and 3 of 21 patients were females and males, respectively. Group 2 included 15 male and 5 female patients. The mean age of the patients was found to be 55.6 and 53.9 years in Group 1 and Group 2, respectively. Both groups were matched for age and gender. In terms of thyroid pathology, 20 of 41 patients (48.7%) who underwent total thyroidectomy for PHPT were found to have thyroid papillary carcinoma while benign pathologic conditions were detected in 21 (51.3%) individuals. Cooccurrence of thyroid diseases and PHPT is common. Therefore, all the patients should preoperatively be evaluated for the presence of thyroid pathology to determine the technique of parathyroid surgery.

  4. Percutaneous nephrolithotomy in pediatric patients: is computerized tomography a must?

    Science.gov (United States)

    Gedik, Abdullah; Tutus, Ali; Kayan, Devrim; Yılmaz, Yakup; Bircan, Kamuran

    2011-02-01

    The aim of this study was to retrospectively evaluate the results of pediatric percutaneous nephrolithotomy (PNL) cases, and discuss the results and necessity of non-contrast computerized tomography (CT) in these cases. In all, 48 pediatric patients who underwent PNL were retrospectively evaluated. Before PNL, either intravenous urography or CT was performed. In all patients, we evaluated the PNL time, scopy time with stone burden, and complications. During the PNL procedure, we switched to open surgery in two cases: in one because of renal pelvis perforation and in the other because of transcolonic access. In one patient who was scheduled to undergo PNL, we performed open surgery, primarily because we detected a retrorenal colon with CT. The stone burden in 45 patients who underwent PNL was 445 ± 225 mm(2), the PNL time was 51 ± 23 min, and the scopy time was 6.1 ± 2.7 min. We removed nephrostomy tubes 1-4 days after the procedure. In two patients, 24 h after removal of nephrostomy tubes, we inserted double J stents because of prolonged urine extravasation from the tract. In all, 34 of the 45 patients were stone-free, 5 patients had clinically insignificant stone fragments, and 6 patients had residual stones. PNL is a safe and effective method in the treatment of pediatric patients with kidney stones. Clinical experience is the most important factor in obtaining stone-free results. CT should be performed in all pediatric patients in order to prevent colon perforation.

  5. Ultrasonographic patterns in patients with obstructed defaecation.

    Science.gov (United States)

    Brusciano, L; Limongelli, P; Pescatori, M; Napolitano, V; Gagliardi, G; Maffettone, V; Rossetti, G; del Genio, G; Russo, G; Pizza, F; del Genio, A

    2007-08-01

    Anal ultrasound is helpful in assessing organic anorectal lesions, but its role in functional disease is still questionable. The purpose of the present study is to assess anal-vaginal-dynamic perineal ultrasonographic findings in patients with obstructed defecation (OD) and healthy controls. Ninety-two consecutive patients (77 women; mean age 51 years; range 21-71) with symptoms of OD were retrospectively evaluated. All patients underwent digital exploration, endoanal and endovaginal ultrasound (US) with rotating probe. Forty-one patients underwent dynamic perineal US with linear probe. Anal manometry and defaecography were performed in 73 and 43 patients, respectively. Ultrasonographic findings of 92 patients with symptoms of OD were compared to 22 healthy controls. Anismus was defined on US when the difference in millimetres between the distance of the inner edge of the puborectalis muscle posteriorly and the probe at rest and on straining was less then 5 mm. Sensitivity and specificity were calculated by assuming defaecography as the gold standard for intussusception and rectocele and proctoscopy for rectal internal mucosal prolapse. Since no gold standard for the diagnosis of anismus was available in the literature, the agreement between anal US and all other diagnostic procedures was evaluated. The incidence of anismus resulted significantly higher (P anismus, anal ultrasonography resulted in agreement with perineal and vaginal US, manometry, defaecography, and digital exam (P < 0.05). Other lesions detected by US in patients with OD include solitary rectal ulcer, rectocele and enterocele. Damage of internal and/or external sphincter was diagnosed at anal US in 19/92 (20%) patients, all continent and with normal manometric values. Anal, vaginal and dynamic perineal ultrasonography can diagnose or confirm many of the abnormalities seen in patients with OD. The value of the information obtained by this non-invasive test and its role in the diagnostic algorithm

  6. Surgical treatment of pain in patients with chronic pancreatitis.

    Science.gov (United States)

    Prochorov, Alexandermiddle Victorovich; Oldhafer, Karl-Jurgen; Tretyak, Stanislaw Ivanovich; Rashchynski, Siarhei Markovich; Donati, Marcello; Rashchynskaya, Nina Timofeevna; Audzevich, Dzmitry Anatolyevich

    2012-06-01

    The objectives of the research were to compare the outcomes of pancreatoduodenectomy (PD) (Kausch-Whipple or Traverso-Longmire) and resection with drainage operations (RDO) (Frey or Partingtone-Rochelle) in patients suffering from chronic pancreatitis (CP), in management of pain syndrome and quality of life provided by these kinds of surgical procedures. From 2002 to 2008 sixteen patients suffering from CP underwent PD and 16 underwent RDO. Treatment results for the two groups were analyzed with respect to postoperative complications and results of the questionnaire MOS SF-36 v.2(TM). In the immediate postoperative period more complications were observed in the PD group (a<0.05). In both groups a positive effect on removing the painful syndrome and improvement of the quality of life (p<0.01) were observed. In the PD group there were the best results of management by General Health difference criterion (a<0.01). A greater improvement of Physical Functiong value (a<0.01) was noticed in patients who underwent RDO. Both PD and RDO adequately remove pain syndrome and improve the quality of life in patients suffering from CP. Under equal conditions the preference should be given to RDO, as improvement in life quality of operated patients is greater.

  7. Meniscus suture repair: minimum 10-year outcomes in patients younger than 40 years compared with patients 40 and older.

    Science.gov (United States)

    Steadman, J Richard; Matheny, Lauren M; Singleton, Steven B; Johnson, Nicholas S; Rodkey, William G; Crespo, Bernardo; Briggs, Karen K

    2015-09-01

    Few studies have compared outcomes after meniscus suture repair in patients younger than 40 years versus patients 40 years and older. To document failure rates and long-term outcomes after meniscus suture repair by a single surgeon, using the inside-out technique, at a minimum 10-year follow-up in patients younger than 40 years versus those 40 years and older. Cohort study; Level of evidence, 3. This study included all patients 18 years or older who underwent meniscus suture repair with the inside-out technique by a single surgeon between January 1992 and December 2003. Patients were divided into 2 cohorts according to age: meniscus as repaired in the index surgery. Patients completed a subjective questionnaire at minimum of 10 years after arthroscopy. Outcomes measures included Lysholm, Tegner, and patient satisfaction with outcome. All data were collected prospectively. The surgeon performed 339 meniscus repairs between 1992 and 2003. The study included 181 knees in 178 patients, who had a mean age of 33 years (range, 18-70 years). Cohort 1 contained 136 knees; 16 patients (12%) were lost to follow-up and 47 (35%) underwent a subsequent knee arthroscopy. Cohort 2 contained 45 knees; 2 patients (4.4%) were lost to follow-up, 3 patients had a total knee arthroplasty, and 12 patients (28%) underwent a subsequent knee arthroscopy. In cohort 1, the meniscus repair failure rate was 5.5% (6/110), and in cohort 2 it was 5.3% (2/38) (P = .927). There was no significant difference in failure rate based on which meniscus was repaired (P = .257), concomitant anterior cruciate ligament (ACL) reconstruction (P = .092), or microfracture (P = .674). Average follow-up time for cohort 1 was 16.1 years (range, 10.0-21.9 years), with 82% follow-up (n = 73/89); average follow-up time for cohort 2 was 16.2 years (range, 10.1-21.0 years), with 93% follow-up (n = 28/30). There were no significant differences in outcomes scores after meniscus suture repair based on age cohort or meniscus

  8. Hyperbaric oxygen therapy in spontaneous brain abscess patients

    DEFF Research Database (Denmark)

    Bartek, Jiri; Jakola, Asgeir S; Skyrman, Simon

    2016-01-01

    BACKGROUND: There is a need to improve outcome in patients with brain abscesses and hyperbaric oxygen therapy (HBOT) is a promising treatment modality. The objective of this study was to evaluate HBOT in the treatment of intracranial abscesses. METHOD: This population-based, comparative cohort...... study included 40 consecutive adult patients with spontaneous brain abscess treated surgically between January 2003 and May 2014 at our institution. Twenty patients received standard therapy with surgery and antibiotics (non-HBOT group), while the remaining 20 patients also received adjuvant HBOT (HBOT...... group). RESULTS: Resolution of brain abscesses and infection was seen in all patients. Two patients had reoperations after HBOT initiation (10 %), while nine patients (45 %) in the non-HBOT group underwent reoperations (p = 0.03). Of the 26 patients who did not receive HBOT after the first surgery, 15...

  9. Cancer Patients' Informational Needs: Qualitative Content Analysis.

    Science.gov (United States)

    Heidari, Haydeh; Mardani-Hamooleh, Marjan

    2016-12-01

    Understanding the informational needs of cancer patients is a requirement to plan any educative care program for them. The aim of this study was to identify Iranian cancer patients' perceptions of informational needs. The study took a qualitative approach. Semi-structured interviews were held with 25 cancer patients in two teaching hospitals in Iran. Transcripts of the interviews underwent conventional content analysis, and categories were extracted. The results came under two main categories: disease-related informational needs and information needs related to daily life. Disease-related informational needs had two subcategories: obtaining information about the nature of disease and obtaining information about disease prognosis. Information needs related to daily life also had two subcategories: obtaining information about healthy lifestyle and obtaining information about regular activities of daily life. The findings provide deep understanding of cancer patients' informational needs in Iran.

  10. [Social characteristics of patients in penitentiaries++].

    Science.gov (United States)

    Sannikov, A L; Kuznetsov, A A

    1998-01-01

    Three hundred and forty five convicted patients with tuberculosis underwent sociohygienic examinations. Among the examinees, the disease was first detected in 74.2% in a reformatory, in 25.8% in an investigating cell. The persons who fell ill with tuberculosis in places of confinement were mainly young, their ages ranged from 20 to 39 years. Only every 4 patients with tuberculosis are condemned for the first time, more than half the patients have over 3 convictions and every 5 patients have over 5 convictions. The most socially disadapted individuals fall ill with tuberculosis in the reformatory; among the examinees, 7.6% were homeless before conviction. The overwhelming majority of the convicts had no social contacts: 52.2% were never married. The study ascertained that in addition to the negative social environment, some criminogenic, personal, and behavioral factors of this contingent predispose to tuberculosis.

  11. Mitral valve disease in patients with Marfan syndrome undergoing aortic root replacement.

    Science.gov (United States)

    Kunkala, Meghana R; Schaff, Hartzell V; Li, Zhuo; Volguina, Irina; Dietz, Harry C; LeMaire, Scott A; Coselli, Joseph S; Connolly, Heidi

    2013-09-10

    Cardiac manifestations of Marfan syndrome include aortic root dilation and mitral valve prolapse (MVP). Only scant data exist describing MVP in patients with Marfan syndrome undergoing aortic root replacement. We retrospectively analyzed data from 166 MFS patients with MVP who were enrolled in a prospective multicenter registry of patients who underwent aortic root aneurysm repair. Of these 166 patients, 9% had mitral regurgitation (MR) grade >2, and 10% had MR grade 2. The severity of MVP and MR was evaluated by echocardiography preoperatively and ≤ 3 years postoperatively. Forty-one patients (25%) underwent composite graft aortic valve replacement, and 125 patients (75%) underwent aortic valve-sparing procedures; both groups had similar prevalences of MR grade >2 (P=0.7). Thirty-three patients (20%) underwent concomitant mitral valve (MV) intervention (repair, n=29; replacement, n=4), including all 15 patients with MR grade >2. Only 1 patient required MV reintervention during follow-up (mean clinical follow-up, 31 ± 10 months). Echocardiography performed 21 ± 13 months postoperatively revealed MR >2 in only 3 patients (2%). One early death and 2 late deaths occurred. Although the majority of patients with Marfan syndrome who undergo elective aortic root replacement have MVP, only 20% have concomitant MV procedures. These concomitant procedures do not seem to increase operative risk. In patients with MR grade ≤ 2 who do not undergo a concomitant MV procedure, the short-term incidence of progressive MR is low; however, more follow-up is needed to determine whether patients with MVP and MR grade ≤ 2 would benefit from prophylactic MV intervention.

  12. Fracture of fusion mass after hardware removal in patients with high sagittal imbalance.

    Science.gov (United States)

    Sedney, Cara L; Daffner, Scott D; Stefanko, Jared J; Abdelfattah, Hesham; Emery, Sanford E; France, John C

    2016-04-01

    As spinal fusions become more common and more complex, so do the sequelae of these procedures, some of which remain poorly understood. The authors report on a series of patients who underwent removal of hardware after CT-proven solid fusion, confirmed by intraoperative findings. These patients later developed a spontaneous fracture of the fusion mass that was not associated with trauma. A series of such patients has not previously been described in the literature. An unfunded, retrospective review of the surgical logs of 3 fellowship-trained spine surgeons yielded 7 patients who suffered a fracture of a fusion mass after hardware removal. Adult patients from the West Virginia University Department of Orthopaedics who underwent hardware removal in the setting of adjacent-segment disease (ASD), and subsequently experienced fracture of the fusion mass through the uninstrumented segment, were studied. The medical records and radiological studies of these patients were examined for patient demographics and comorbidities, initial indication for surgery, total number of surgeries, timeline of fracture occurrence, risk factors for fracture, as well as sagittal imbalance. All 7 patients underwent hardware removal in conjunction with an extension of fusion for ASD. All had CT-proven solid fusion of their previously fused segments, which was confirmed intraoperatively. All patients had previously undergone multiple operations for a variety of indications, 4 patients were smokers, and 3 patients had osteoporosis. Spontaneous fracture of the fusion mass occurred in all patients and was not due to trauma. These fractures occurred 4 months to 4 years after hardware removal. All patients had significant sagittal imbalance of 13-15 cm. The fracture level was L-5 in 6 of the 7 patients, which was the first uninstrumented level caudal to the newly placed hardware in all 6 of these patients. Six patients underwent surgery due to this fracture. The authors present a case series of 7

  13. The Turner syndrome in patient with 45X/47XXX mosaic karyotype--case report.

    Science.gov (United States)

    Maciejewska-Jeske, Marzena; Czyzyk, Adam; Meczekalski, Blazej

    2015-07-01

    Turner syndrome (TS) is a gonadal dysgenesis related to partial or total lack of one of the X chromosomes. It this report we describe a young patient presenting some somatic features of TS, who underwent spontaneous puberty and was eumenoorheic up to the age of 23. Using fluorescent in situ hybridization (FISH) mosaic karyotype (45X[131]/47XXX[9]) of TS and triple X syndrome was found. She presented uncommon for TS somatic hemihypotrophy and underwent growth hormone and surgical therapy. The patient was diagnosed with premature ovarian failure when she was 23, with absent follicular reserve. Clinical features of this case and a few published cases will be reviewed briefly.

  14. Hodgkin's disease: Analysis of 75 patients

    International Nuclear Information System (INIS)

    Akram, M.; Cheema, M. H.; Sana, S.; Aziz, Z.

    2001-01-01

    Objective: To evaluate patients suffering from Hodgkin's disease to identify its epidemiological characteristics, modalities of treatment and features of survival. Place and Duration of Study: The study was conducted between July 1997 to June 1999 at the Oncology Department of Jinnah Hospital, Lahore. Subjects and Methods: A total 75 patient with Hodgkin's disease underwent Cotswold staging classification, complete hematological, renal and hepatic profile, LDH and uric acid. Chest radiograph abdominal and pelvic ultrasonography and CT scan/MRI bone marrow biopsies. All the patients received combination chemotherapy. Patients with bulky disease received field radiation. Results: Median age was eight ( 18 years). Male to female ratio was 3.5:1, advanced disease accounted for 68%, mixed cellularity was documented in 61% of patients. Eighty-two percent of patients belonged to lower socioeconomic strata. Forty-six patients (65.4%) achieved complete remission (CR) Major toxicities were hematological with febrile neutropenia in 14.6% patients. OS of patients achieving CR with good socioeconomic status was superior compared to patients with lower socioeconomic status (p<0.02). Treatment delays were due to economic constraints, illiteracy, malnutrition and co-morbid conditions. Conclusion: Advanced disease, mixed cellularity and male predominance was common. Socioeconomic status had a significant impact on the presentation of the disease. Poor tolerance to chemotherapy and enhanced toxicities are especially seen in the low socioeconomic group. (author)

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

    Science.gov (United States)

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

    2013-01-01

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

  16. Prognostic value of primary tumour resection in synchronous metastatic colorectal cancer: Individual patient data analysis of first-line randomised trials from the ARCAD database

    NARCIS (Netherlands)

    van Rooijen, K. L.; Shi, Q.; Goey, K. K. H.; Meyers, J.; Heinemann, V.; Diaz-Rubio, E.; Aranda, E.; Falcone, A.; Green, E.; de Gramont, A.; Sargent, D. J.; Punt, C. J. A.; Koopman, M.

    2018-01-01

    Indication for primary tumour resection (PTR) in asymptomatic metastatic colorectal cancer (mCRC) patients is unclear. Previous retrospective analyses suggest a survival benefit for patients who underwent PTR. The aim was to evaluate the prognostic value of PTR in patients with synchronous mCRC by

  17. In vivo measurements of the T1 relaxation processes in the bone marrow in patients with myelodysplastic syndrome. A magnetic resonance imaging study

    DEFF Research Database (Denmark)

    Jensen, K E; Nielsen, H; Thomsen, C

    1989-01-01

    Nine patients with myelodysplastic syndrome (MDS) were examined with magnetic resonance imaging and in vivo T1 relaxation time measurements of the vertebral bone marrow in a 1.5 tesla whole body scanner. Two patients underwent transformation to acute myeloid leukemia and were evaluated at follow-...... not differ from patients with polycythemia vera....

  18. Limb Lengthening in Patients with Achondroplasia.

    Science.gov (United States)

    Park, Kwang-Won; Garcia, Rey-an Niño; Rejuso, Chastity Amor; Choi, Jung-Woo; Song, Hae-Ryong

    2015-11-01

    Although bilateral lower-limb lengthening has been performed on patients with achondroplasia, the outcomes for the tibia and femur in terms of radiographic parameters, clinical results, and complications have not been compared with each other. We proposed 1) to compare the radiological outcomes of femoral and tibial lengthening and 2) to investigate the differences of complications related to lengthening. We retrospectively reviewed 28 patients (average age, 14 years 4 months) with achondroplasia who underwent bilateral limb lengthening between 2004 and 2012. All patients first underwent bilateral tibial lengthening, and at 9-48 months (average, 17.8 months) after this procedure, bilateral femoral lengthening was performed. We analyzed the pixel value ratio (PVR) and characteristics of the callus of the lengthened area on serial radiographs. The external fixation index (EFI) and healing index (HI) were computed to compare tibial and femoral lengthening. The complications related to lengthening were assessed. The average gain in length was 8.4 cm for the femur and 9.8 cm for the tibia. The PVR, EFI, and HI of the tibia were significantly better than those of the femur. Fewer complications were found during the lengthening of the tibia than during the lengthening of the femur. Tibial lengthening had a significantly lower complication rate and a higher callus formation rate than femoral lengthening. Our findings suggest that bilateral limb lengthening (tibia, followed by femur) remains a reasonable option; however, we should be more cautious when performing femoral lengthening in selected patients.

  19. Salvage liver transplantation for patients with recurrent hepatocellular carcinoma after curative resection.

    Directory of Open Access Journals (Sweden)

    LinWei Wu

    Full Text Available OBJECTIVE: To summarize the experience with salvage liver transplantation (SLT for patients with recurrent hepatocellular carcinoma (HCC after primary hepatic resection in a single center. METHODS: A total of 376 adult patients with HCC underwent orthotopic liver transplantation (OLT at Organ Transplantation Center, the First Affiliated Hospital of Sun Yat-sen University, between 2004 and 2008. Among these patients, 36 underwent SLT after primary liver curative resection due to intrahepatic recurrence. During the same period, one hundred and forty-seven patients with HCC within Milan criteria underwent primary OLT (PLTW group, the intra-operative and post-operative parameters were compared between these two groups. Furthermore, we compared tumor recurrence and patient survival of patients with SLT to 156 patients with HCC beyond Milan criteria (PLTB group. Cox Hazard regression was made to identify the risk factors for tumor recurrence. RESULTS: The median interval between initial liver resection and SLT was 35 months (1-63 months. The intraoperative blood loss (P0.05. When compared to those patients with HCC beyond Milan criteria undergoing primary OLT, patients undergoing SLT achieved a better survival and a lower tumor recurrence. Cox Proportional Hazards model showed that vascular invasion, including macrovascular and microvascular invasion, as well as AFP level >400 IU/L were risk factors for tumor recurrence after LT. CONCLUSIONS: In comparison with primary OLT, although SLT is associated with increased operation difficulties, it provides a good option for patients with HCC recurrence after curative resection.

  20. Investigating hyperventilation syndrome in patients suffering from empty nose syndrome.

    Science.gov (United States)

    Mangin, David; Bequignon, Emilie; Zerah-Lancner, Francoise; Isabey, Daniel; Louis, Bruno; Adnot, Serge; Papon, Jean-François; Coste, André; Boyer, Laurent; Devars du Mayne, Marie

    2017-09-01

    Patients with empty nose syndrome (ENS) following turbinate surgery often complain about breathing difficulties. We set out to determine if dyspnea in patients with ENS was associated with hyperventilation syndrome (HVS). We hypothesized that lower airway symptoms in ENS could be explained by HVS. Observational prospective study. All consecutive patients referred to our center for ENS over 1 year were invited to participate. Patients completed the Nijmegen score and underwent a hyperventilation provocation test (HVPT) and arterial blood gas and cardiopulmonary tests. HVS was defined by a delayed return of the end-tidal partial pressure of carbon dioxide in the expired gas to baseline during HVPT. Patients with HVS were asked to complete the Sinonasal Outcome Test (SNOT)-16 questionnaire before and after a specific eight-session respiratory rehabilitation program. Twenty-two of the 29 patients referred for ENS during the study period were eligible for inclusion and underwent a complete workup. HVS was diagnosed in 17 of these patients (77.3%). In the five patients who completed the SNOT-16, the score was significantly lower after rehabilitation. This study suggests that HVS is frequent in patients with ENS, and that symptoms can be improved by respiratory rehabilitation. Pathophysiological links between ENS and HVS deserve to be further explored. 2b Laryngoscope, 127:1983-1988, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  1. Reoperations following combat-related upper-extremity amputations.

    Science.gov (United States)

    Tintle, Scott M; Baechler, Martin F; Nanos, George P; Forsberg, Jonathan A; Potter, Benjamin K

    2012-08-15

    Amputation revision rates following major upper-extremity amputations have not been previously reported in a large cohort of patients. We hypothesized that the revision rates following major upper-extremity amputation were higher than the existing literature would suggest, and that surgical treatment of complications and persistent symptoms would lead to improved outcomes. We performed a retrospective analysis of a consecutive series of ninety-six combat-wounded personnel who had sustained a total of 100 major upper-extremity amputations in Operation Iraqi Freedom and Operation Enduring Freedom. Prerevision and postrevision outcome measures, including prosthesis use and type, the presence of phantom and residual limb pain, pain medication use, and return to active military duty, were identified for all patients. All amputations resulted from high-energy trauma, with 87% occurring secondary to a blast injury. Forty-two residual limbs (42%) underwent a total of 103 repeat surgical interventions. As compared with patients with all other levels of amputation, those with a transradial amputation were 4.7 (95% confidence interval [CI]: 1.75 to 12.46) times more likely to have phantom limb pain and 2.8 (95% CI: 1.04 to 7.39) times more likely to require neuropathic pain medications. In the group of patients who underwent revision surgery, regular prosthesis use increased from 19% before the revision to 87% after it (p < 0.0001). In our cohort, revision amputation to address surgical complications and persistently symptomatic residual limbs improved the patient's overall acceptance of the prosthesis and led to outcomes equivalent to those following amputations that did not require revision.

  2. Near patient cholesterol testing in patients with peripheral arterial disease.

    Science.gov (United States)

    Hobbs, S D; Jones, A; Wilmink, A B; Bradbury, A W

    2003-09-01

    To assess the bias, precision and utility of the Bioscanner 2000 for near patient testing of total cholesterol (NPTC) in patients with peripheral arterial disease (PAD). One hundred consecutive patients attending a hospital-based clinic with symptomatic PAD underwent non-fasting NPTC using finger prick blood sample and a laboratory total cholesterol (TC) using blood drawn from an antecubital fossa vein. The Bioscanner 2000 showed good precision with a coefficient of variation of 1.8-3.8%. NPTC was significantly lower than laboratory TC (mean (S.D.) 4.67 (1.1) vs. 5.12 (1.2) mmol/l), p Bioscanner 2000 compared to laboratory testing, which was demonstrated to be a systematic bias using a Bland-Altman plot. Almost half (46%) of the readings differed by > 0.5 mmol/l, 16% by > 1.0 mmol/l and 3% by > 2 mmol/l. This means that if the cut-off for statin treatment were taken as a TC of 5.0 or 3.5 mmol/l then, based on NPTC, alone 18 and 6% of patients, respectively, would not have received a statin. In the present study, NPTC significantly under-estimated TC when compared to laboratory testing. However, in the majority of cases, this would not have affected the decision to prescribe a statin and NPTC testing allows the immediate institution or titration of statin treatment.

  3. ARTHROSCOPIC TREATMENT OF PATIENTS WITH LATERAL HUMERAL EPICONDYLITIS (TENNIS ELBOW

    Directory of Open Access Journals (Sweden)

    M. R. Salikhov

    2017-01-01

    Full Text Available In the past decade the clinical and anatomical studies proved that lateral humeral epicondylitis can be successfully treated arthroscopically.Purpose of the study is to identify the optimal method of surgical treatment for patients with lateral humeral epicondylitis.Material and methods. The authors conducted an integral study consisting of two sections: clinical and anatomical. Anatomical section included precision preparation of extensor muscles of the forearm. Clinical section was dedicated to comparative analysis of statistically valid and matched by lesion severity groups of patients who underwent open and arthroscopic procedures. All patients were divided into three groups. Patients of Group I underwent arthroscopic release of extensor carpi radialis brevis tendon (ECRB without decorticating of the lateral humeral epicondyle. Patients of Group II underwent arthroscopic release of ECRB in combination with decortication of the lateral humeral epicondyle. Patients in Group III underwent an open release of ECRB.Results. Patients who underwent arthroscopic release of ECRB demonstrated less pronounced pain syndrome as compared to patients after ECRB release along with decortication of epicondyle or after open release (р<0,05. VAS pain score in Group I decreased from 7 to 1 point, in Group II — from 7 to 3 points, in Group III — from 7 to 4 points. Mean time until full recovery after the surgery was 24,2±7,8 days in Group I, 39,4±5,6 days in Group II and 60,2±15,6 days in Group III (р<0,05. Functional outcomes were assessed by Mayo Elbow Performance Score (MEPS in 9 weeks postoperatively: Group I — improvement from 60 to 79 points, Group II — from 62 to 75 points, Group III — from 60 to 75 points.Conclusion. Drilling or removal of periosteum of the damaged epicondyle does not provide a positive effect. Decortication also has certain disadvantages like postoperative pain intensification leading to lesser range of motion in elbow and

  4. Radiation therapy for patients with obstructive jaundice caused by carcinoma of the extrahepatic biliary system

    International Nuclear Information System (INIS)

    Kawamura, Masashi; Nakagawa, Hirofumi; Kataoka, Masaaki

    1992-01-01

    From February 1980 through September 1990, 92 patients with obstructive jaundice resulting from biliary tract cancer were registered at Shikoku Cancer Center Hospital or Ehime University Hospital. Radiation therapy (RT) was used to treat 38 of these patients (30 with carcinoma of the extrahepatic bile duct, excluding ampulla of Vater, and eight patients with carcinoma of the gallbladder). Of 38 patients, 11 underwent intraoperative radiation therapy (IORT), and 27 were treated by external radiation therapy (ERT) alone. In contrast, 54 patients (39 with carcinoma of the extrahepatic bile duct and eight with carcinoma of the gallbladder) were not treated by RT. All jaundiced patients received external and/or internal biliary drainage of some kind. Among patients undergoing biliary drainage with a catheter, 21 patients who underwent RT (four with IORT) survived significantly longer than 19 patients who did not (generalized Wilcoxon test: p<0.05). There were no significant differences in survival between 7 patients with recanalization and 11 patients with no recanalization. Concerning the survival of laparotomized patients, excluding those with complete resection or perioperative death, eight patients treated with postoperative ERT survived longer than 12 patients who did not have postoperative ERT (not significant). Eleven patients underwent IORT. A patient with unresectable carcinoma of the hilar bile duct survived 2 years and 3 months after a combination treatment of ERT and IOTR. In four of eight autopsied patients, radiation effects of Grade II were observed (Oboshi and Shimosato's evaluation system for the histological effects of radiation therapy). Our experience suggests that RT is effective in patients with obstructive jaundice caused by carcinoma of the biliary system. (author)

  5. Profile of women with urinary incontinence who underwent surgical procedure in a teaching hospital in the southern Country Perfil de mulheres com incontinência urinária submetidas a procedimento cirúrgico em um hospital de ensino do sul do país

    Directory of Open Access Journals (Sweden)

    Juliana Cristina Frare

    2011-12-01

    Full Text Available Urinary incontinence (UI is defined as any involuntary loss of urine that may characterize a social and/or hygienic problem. The treatment of UI can be performed surgically or by conservative techniques such as physiotherapy, behavioral therapy and drug therapy. The research aim was to identify the sociodemographic and clinical profile of women who performed surgery procedure for correction of UI at the Western University Hospital of Paraná (HUOP. All records of patients treated at the gynecology sector diagnosed with UI undergoing surgery in the years 2008 and 2009 were analyzed. Data was entered into a spreadsheet and analyzed in terms of relative and absolute frequencies. The results demonstratethat the average was observed in 52.41 years (± 12.11, 128 (58.99% patients were aged between 40 and 59 years old. The stress urinary incontinence (UI was the most prevalent disease, observed in 193(88.94% of 217 records analyzed. The surgical techniques used in most cases was pubovaginal sling associated of colpoperineoplastia (CPP, realized in 117 (53.92% patients. Only six (2.76% recordsreported the physiotherapy performance in women with UI submitted to surgery treatment. A incontinência urinária (IU é definida como qualquer perda involuntária de urina pela uretra, possívelde ser caracterizada como um problema social e/ou higiênico. O tratamento da IU pode ser realizado cirurgicamente ou por meio de técnicas conservadoras como a fisioterapia, a terapia comportamental e medicamentosa. O objetivo da pesquisa foi identificar o perfil sociodemográfico e clínico de mulheres que realizaram procedimento cirúrgico para correção de IU no Hospital Universitário do Oeste doParaná (HUOP. Foram analisados todos os prontuários das pacientes atendidas no setor de ginecologia com diagnóstico de IU submetidas a tratamento cirúrgico nos anos de 2008 e 2009. Os dados foramlançados em uma planilha do programa Excel 7.0 (Microsoft®, e

  6. The behavior of Troponin I and CKMB mass in children who underwent surgical correction of congenital heart malformations Comportamento da troponina I e CK-MB massa em crianças submetidas a correção cirúrgica das cardiopatias congênitas

    Directory of Open Access Journals (Sweden)

    Pedro Rafael Salerno

    2003-09-01

    Full Text Available OBJECTIVE: To analyze the behavior of troponin (TROP I and CKMB mass (CKMBm in regards to the addition of magnesium in cardioplegic solutions; and also the influence of per-operative factors. METHOD: A total of 28 children with ages ranging from 3 to 108 months were studied. The mean weight was 11.8 kg. Eighteen were male. The patients were divided into two groups. Sixteen children in group I (GI and 12 in group II (GII. The patients in GI received cold blood cardioplegic solution with magnesium (12 mEq/L and potassium chloride (20 mEq/L at 20 mL/kg. The patients in GII received the same solution without magnesium. Six blood samples were collected for serum analysis of the concentration of TROP I and CKMBm. The blood samples were collected before clamping the aorta and at 1, 6, 24, 48 and 72 hours after aorta clamping termination. RESULTS: There were no statistical differences in the TROP I and CKMBm levels between the two groups. Among the per-operative factors cyanosis influenced the TROP I and CKMBm levels. Additionally, the aorta clamping time influenced the TROP I levels. CONCLUSIONS: The addition of magnesium in the cardioplegic solution was not associated with different levels of TROP I and CKMBm. Cyanosis and aorta clamping time interfered with peak TROP I levels.OBJETIVO: Analisar o comportamento da troponina I (TROP I e CKMB massa (CKMBm conforme a adição ou não de magnésio (Mg na cardioplegia e a influência dos fatores operatórios. MÉTODO: Foram estudadas 28 crianças com a idade de 3 a 108 meses, peso médio de 11,8 kg, sendo 18 do sexo masculino, divididas em dois grupos, 16 no grupo I (GI e 12 no grupo II (GII. O GI recebeu solução cardioplégica sangüínea fria com Mg 12 mEq/L e cloreto de potássio 20 mEq/L na dose de 20 mL/kg. O GII recebeu a mesma solução sem o (Mg. Foram coletadas seis amostras de sangue para a dosagem sérica de TROP I e CKMBm: pré-pinçamento da aorta e com 1, 6, 24, 48 e 72 horas após o t

  7. Clinical and Economic Burden of Peristomal Skin Complications in Patients With Recent Ostomies

    Science.gov (United States)

    Taneja, Charu; Netsch, Debra; Rolstad, Bonnie Sue; Inglese, Gary; Lamerato, Lois

    2017-01-01

    PURPOSE: The purpose of this study was to estimate the risk and economic burden of peristomal skin complications (PSCs) in a large integrated healthcare system in the Midwestern United States. DESIGN: Retrospective cohort study. SUBJECTS AND SETTING: The sample comprised 128 patients; 40% (n = 51) underwent colostomy, 50% (n = 64) underwent ileostomy, and 10% (n = 13) underwent urostomy. Their average age was 60.6 ± 15.6 years at the time of ostomy surgery. METHODS: Using administrative data, we retrospectively identified all patients who underwent colostomy, ileostomy, or urostomy between January 1, 2008, and November 30, 2012. Trained medical abstractors then reviewed the clinical records of these persons to identify those with evidence of PSC within 90 days of ostomy surgery. We then examined levels of healthcare utilization and costs over a 120-day period, beginning with date of surgery, for patients with and without PSC, respectively. Our analyses were principally descriptive in nature. RESULTS: The study cohort comprised 128 patients who underwent ostomy surgery (colostomy, n = 51 [40%]; ileostomy, n = 64 [50%]; urostomy, n = 13 [10%]). Approximately one-third (36.7%) had evidence of a PSC in the 90-day period following surgery (urinary diversion, 7.7%; colostomy, 35.3%; ileostomy, 43.8%). The average time from surgery to PSC was 23.7 ± 20.5 days (mean ± SD). Patients with PSC had index admissions that averaged 21.5 days versus 13.9 days for those without these complications. Corresponding rates of hospital readmission within the 120-day period following surgery were 47% versus 33%, respectively. Total healthcare costs over 120 days were almost $80,000 higher for patients with PSCs. CONCLUSIONS: Approximately one-third of ostomy patients over a 5-year study period had evidence of PSCs within 90 days of surgery. Costs of care were substantially higher for patients with these complications. PMID:28574928

  8. Operating times and bleeding complications in percutaneous nephrolithotomy: a comparison of tract dilation methods in 5,537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study

    NARCIS (Netherlands)

    Yamaguchi, Akito; Skolarikos, Andreas; Buchholz, Niels-Peter Noor; Chomón, Gonzalo Bueno; Grasso, Michael; Saba, Pietro; Nakada, Stephen; de la Rosette, Jean

    2011-01-01

    The study investigated factors that affect operating times and bleeding complications associated with percutaneous nephrolithotomy (PCNL) in the PCNL Global Study. All patients who underwent PCNL for primary or secondary treatment of kidney stone indications during the study period (November

  9. Role of RENAL nephrometry scoring system in planning surgical intervention in patients with localized renal mas

    OpenAIRE

    Mohamed Samir Shaaban; Tamer Mohammed Abou Youssif; Ahmed Mostafa; Hossam Eldin Hegazy; Mohammed Adel Atta

    2015-01-01

    Purpose: The study was designed to validate the value of preoperative planning using RENAL nephrometry scoring system in patients having organ confined renal tumors and undergoing surgical intervention and to assess its correlation with the surgical technique. Patient and methods: Forty patients with organ-confined renal masses underwent RENAL nephrometry scoring which was correlated with the surgical technique either radical or nephron-sparing surgery. Result: RENAL nephrometry scoring...

  10. Clinical Significance of the Edema Index in Incident Peritoneal Dialysis Patients

    OpenAIRE

    Kang, Seok Hui; Choi, Eun Woo; Park, Jong Won; Cho, Kyu Hyang; Do, Jun Young

    2016-01-01

    Background Proper monitoring for volume overload is important to improve prognosis in peritoneal dialysis (PD) patients. The association between volume status and residual renal function (RRF) remains an unresolved issue. The aim of the present study was to evaluate the association between the edema index and survival or RRF in incident PD patients. Patients and Methods We identified all adults who underwent PD. The edema index was defined as the ratio of extracellular fluid to total body flu...

  11. Epithelioid inflammatory myofibroblastic sarcoma responsive to surgery and an ALK inhibitor in a patient with panhypopituitarism.

    Science.gov (United States)

    Kurihara-Hosokawa, Kotomi; Kawasaki, Isao; Tamai, Anna; Yoshida, Yoko; Yakushiji, Yosuke; Ueno, Hiroki; Fukumoto, Mariko; Fukushima, Hiroko; Inoue, Takeshi; Hosoi, Masayuki

    2014-01-01

    We encountered a case of epithelioid inflammatory myofibroblastic sarcoma (EIMS) originating from an abdominal organ that rapidly regrew twice. The patient underwent two surgeries. Large tumors grew within three months after the second surgery. The patient subsequently received chemotherapy with an anaplastic lymphoma kinase (ALK) inhibitor. Although EIMS has a poor prognosis, the patient continues to be alive with disease 14 months after surgical treatment and the administration of the ALK inhibitor.

  12. Successful enteral nutrition in the treatment of esophagojejunal fistula after total gastrectomy in gastric cancer patients

    OpenAIRE

    Portanova Michel

    2010-01-01

    Abstract Background Esophagojejunal fistula is a serious complication after total gastrectomy in gastric cancer patients. This study describes the successful conservative management in 3 gastric cancer patients with esophagojejunal fistula after total gastrectomy using total enteral nutrition. Methods Between January 2004 to December 2008, 588 consecutive patients with a proven diagnosis of gastric cancer were taken to the operation room to try a curative treatment. Of these, 173 underwent to...

  13. Gait dynamics to optimize fall risk assessment in geriatric patients admitted to an outpatient diagnostic clinic

    OpenAIRE

    Kikkert, Lisette H. J.; de Groot, Maartje H; van Campen, Jos P.; Beijnen, Jos H.; Hortobagyi, Tibor; Vuillerme, Nicolas; Lamoth, Claudine C. J.

    2017-01-01

    Fall prediction in geriatric patients remains challenging because the increased fall risk involves multiple, interrelated factors caused by natural aging and/or pathology. Therefore, we used a multi-factorial statistical approach to model categories of modifiable fall risk factors among geriatric patients to identify fallers with highest sensitivity and specificity with a focus on gait performance. Patients (n = 61, age = 79; 41% fallers) underwent extensive screening in three categories: (1)...

  14. Is prevalence of colorectal polyps higher in patients with family history of colorectal cancer?

    OpenAIRE

    Murad-Regadas, Sthela Maria; Bezerra, Carla Camila Rocha; Peixoto, Ana Ligia Rocha; Regadas, Francisco Sérgio Pinheiro; Rodrigues, Lusmar Veras; Siebra, José Airton Gonçalves; da Silva Fernandes, Graziela Olivia; Vasconcelos, Rafael Aragão

    2015-01-01

    ABSTRACTObjectives:To assess the prevalence of polyps in patients with a family history of colorectal cancer, in comparison to asymptomatic individuals with indication for screening.Methods:A prospective study in a group of patients who underwent colonoscopy between 2012 and 2014. Patients were divided into two groups: Group I: no family history of colorectal cancer, and Group II: with a family history in first-degree relatives. Demographic characteristics, findings on colonoscopy...

  15. Effectiveness of transcutaneous electrical nerve stimulation on saliva production in post-radiated oral cancer patients

    OpenAIRE

    Sakshi Ojha; Thimmarasa V Bhovi; Prashant P Jaju; Manas Gupta; Neha Singh; Kriti Shrivastava

    2016-01-01

    Aims and Objectives: To determine the effectiveness of transcutaneous electrical nerve stimulation (TENS) in stimulating salivary flow in post-radiated oral cancer patients, and to compare the salivary flow rate between unstimulated saliva and saliva stimulated with TENS in post-radiated oral cancer patients. Materials and Methods: In 30 patients who underwent radiotherapy for oral cancer, unstimulated saliva was collected every minute for 5 min in a graduated test tube. The TENS unit was act...

  16. Cognitive performance and psychosocial functioning in patients with bipolar disorder, unaffected siblings, and healthy controls

    OpenAIRE

    Vasconcelos-Moreno, Mirela P.; Bücker, Joana; Bürke, Kelen P.; Czepielewski, Leticia; Santos, Barbara T.; Fijtman, Adam; Passos, Ives C.; Kunz, Mauricio; Bonnín, Caterina del Mar; Vieta i Pascual, Eduard, 1963-; Kapczinski, Flávio; Rosa, Adriane R.; Kauer-Sant'Anna, Marcia

    2016-01-01

    Objective: To assess cognitive performance and psychosocial functioning in patients with bipolar disorder (BD), in unaffected siblings, and in healthy controls. Methods: Subjects were patients with BD (n=36), unaffected siblings (n=35), and healthy controls (n=44). Psychosocial functioning was accessed using the Functioning Assessment Short Test (FAST). A sub-group of patients with BD (n=21), unaffected siblings (n=14), and healthy controls (n=22) also underwent a battery of neuropsychologic...

  17. Effects of exercise training in patients with idiopathic pulmonary arterial hypertension

    OpenAIRE

    de Man, F.S.; Handoko, M.L.; Groepenhoff, H.; van 't Hul, A.J.; Abbink, J.; Koppers, R.J.H.; Grotjohan, H.P.; Twisk, J.W.R.; Bogaard, H.J.; Boonstra, A.; Postmus, P.E.; Westerhof, N.; van der Laarse, W.J.; Vonk Noordegraaf, A.

    2009-01-01

    We determined the physiological effects of exercise training on exercise capacity and quadriceps muscle function in patients with idiopathic pulmonary arterial hypertension (iPAH). In total, 19 clinically stable iPAH patients (New York Heart Association II-III) underwent a supervised exercise training programme for the duration of 12 weeks. Maximal capacity, endurance capacity and quadriceps function were assessed at baseline and after 12 weeks. In 12 patients, serial quadriceps muscle biopsi...

  18. Cardiac surgery in a patient with immunological thrombocytopenic purpura: Complications and precautions

    Directory of Open Access Journals (Sweden)

    Vivek Chowdhry

    2013-01-01

    Full Text Available Immune thrombocytopenic purpura (ITP patients are at high-risk for bleeding complications during and after cardiac surgeries involving cardiopulmonary bypass. We report a patient with ITP with severe coronary artery disease and mitral valve regurgitation who underwent uncomplicated coronary artery bypass grafting and mitral valve replacement. Three weeks later, the patient was readmitted in a very low general condition with signs of pericardial tamponade. We describe our experience of managing the case.

  19. Neuropathic pain and use of PainDETECT in patients with fibromyalgia: a cohort study

    OpenAIRE

    Gauffin, Jarno; Hankama, Tiina; Kautiainen, Hannu; Hannonen, Pekka; Haanp??, Maija

    2013-01-01

    Abstract Backround Fibromyalgia has a plethorae of symptoms, which can be confusing and even misleading. Accurate evaluation is necessary when patients with fibromyalgia are treated. Different types of instruments are available for the clinicians to supplement evaluation. Our objective was to study the applicability of the PainDETECT instrument to screen neuropathic pain in patients with fibromyalgia. Methods 158 patients with primary fibromyalgia underwent a neurological examination includin...

  20. Novel Use of a Pneumatic Compression Device for Haemostasis of Haemodialysis Fistula Access Catheterisation Sites

    Energy Technology Data Exchange (ETDEWEB)

    O’Reilly, Michael K., E-mail: moreilly1@mater.ie; Ryan, David; Sugrue, Gavin; Geoghegan, Tony; Lawler, Leo P.; Farrelly, Cormac T. [Mater Misericordiae University Hospital, Department of Interventional Radiology (Ireland)

    2016-12-15

    PurposeTransradial pneumatic compression devices can be used to achieve haemostasis following radial artery puncture. This article describes a novel technique for acquiring haemostasis of arterio-venous haemodialysis fistula access sites without the need for suture placement using one such compression device.Materials and MethodsA retrospective review of fistulograms with or without angioplasty/thrombectomy in a single institution was performed. 20 procedures performed on 12 patients who underwent percutaneous intervention of failing or thrombosed arterio-venous fistulas (AVF) had 27 puncture sites. Haemostasis was achieved using a pneumatic compression device at all access sites. Procedure details including size of access sheath, heparin administration and complications were recorded.ResultsTwo diagnostic fistulograms, 14 fistulograms and angioplasties and four thrombectomies were performed via access sheaths with an average size (±SD) of 6 Fr (±1.12). IV unfractionated heparin was administered in 11 of 20 procedures. Haemostasis was achieved in 26 of 27 access sites following 15–20 min of compression using the pneumatic compression device. One case experienced limited bleeding from an inflow access site that was successfully treated with reinflation of the device for a further 5 min. No other complication was recorded.ConclusionsHaemostasis of arterio-venous haemodialysis fistula access sites can be safely and effectively achieved using a pneumatic compression device. This is a technically simple, safe and sutureless technique for acquiring haemostasis after AVF intervention.

  1. C-reactive protein in patients with advanced metastatic renal cell carcinoma: Usefulness in identifying patients most likely to benefit from initial nephrectomy

    International Nuclear Information System (INIS)

    Ito, Hiroki; Kishida, Takeshi; Miura, Takeshi; Kubota, Yoshinobu; Yao, Masahiro; Shioi, Koichi; Murakami, Takayuki; Takizawa, Akitoshi; Sano, Futoshi; Kawahara, Takashi; Mizuno, Nobuhiko; Makiyama, Kazuhide; Nakaigawa, Noboru

    2012-01-01

    C-reactive protein (CRP) is considered a useful serum marker for patients with RCC. However, its clinical utility in advanced metastatic renal cell carcinoma (AM-RCC), particularly in deciding whether to perform nephrectomy at the onset, is not well studied. We retrospectively evaluated 181 patients with AM-RCC, including 18 patients underwent potentially curative surgery, 111 underwent cytoreductive nephrectomy, and 52 received medical treatment only. CRP cutoff points were determined by receiver operating characteristic (ROC) curve analysis. Kaplan-Meier and Cox regression analyses were used for survival tests. ROC analysis suggested that grouping patients according to 3 CRP ranges was a rational model. Patients with highly elevated CRP (≥67.0 mg/L) presented remarkably poor prognosis despite treatment (nephrectomy or medical treatment only). Cox regression models demonstrated that risk factors of overall survival for patients who underwent nephrectomy were the CRP ranges defined in this study (≤18.0 mg/L, >18.0 and <67.0 mg/L, and ≥67.0 mg/L), ECOG PS (0, 1, and ≥2), and number of metastatic organ sites (0–1 and ≥2). The retrospective design is a limitation of this study. Our study demonstrated that the serum CRP level is a statistically significant prognostic parameter for patients with AM-RCC. The data also indicated that pretreatment serum CRP level provides useful prognostic information that helps in deciding whether to perform initial nephrectomy for patients with AM-RCC

  2. Fiber type specific response of skeletal muscle satellite cells to high-intensity resistance training in dialysis patients

    DEFF Research Database (Denmark)

    Molsted, Stig; Andersen, Jesper Løvind; Harrison, Adrian Paul

    2015-01-01

    Introduction. The aim was to investigate the effect of high-intensity resistance training on satellite cell (SC) and myonuclear number in the muscle of patients undergoing dialysis. Methods. Patients (n=21) underwent a 16-week control period, followed by 16 weeks of resistance training thrice...

  3. Impact of splenectomy on surgical outcome in patients with cancer of the distal esophagus and gastro-esophageal junction

    NARCIS (Netherlands)

    Pultrum, B. B.; van Bastelaar, J.; Schreurs, Liesbeth; van Dullemen, H. M.; Groen, H.; Nijsten, M. W. N.; van Dam, G. M.; Plukker, J. T. H. M.

    We aim to determine the effect of splenectomy on clinical outcome in patients with cancer of the distal esophagus and gastro-esophageal junction (GEJ) after a curative intended resection. From January 1991 to July 2004, 210 patients underwent a potentially curative gastroesophageal resection with an

  4. Clinical outcome and health-related quality-of-life following microsurgical reconstruction in patients with oral and oropharyngeal cancer

    DEFF Research Database (Denmark)

    Al-Hayder, Shems; Elberg, Jens Jørgen; Charabi, Birgitte

    2017-01-01

    L in patients with oral or oropharyngeal cancer following free flap reconstruction. Methods: A retrospective review of medical records and self-administered HRQoL questionnaires, EORTC QLQ-C30, and -H&N35. All patients who underwent surgery for oral or oropharyngeal cancer followed by primary reconstruction...

  5. Circulating Candida-specific anti-mannan antibodies precede invasive candidiasis in patients undergoing myelo-ablative chemotherapy.

    NARCIS (Netherlands)

    Verduyn Lunel, F.M.; Donnelly, J.P.; Lee, H.A.L. van der; Blijlevens, N.M.A.; Verweij, P.E.

    2009-01-01

    The kinetics of circulating Candida mannan and anti-mannan antibodies were studied in consecutive plasma samples, obtained upon hospital admission, of 21 patients with microbiologically proven invasive candidiasis and 30 control patients who underwent myelo-ablative chemotherapy. The detection of

  6. IgM response to a human Pneumocystis carinii surface antigen in HIV-infected patients with pulmonary symptoms

    DEFF Research Database (Denmark)

    Lundgren, Bettina; Kovacs, J A; Mathiesen, Lars Reinhardt

    1993-01-01

    We have developed an ELISA to detect IgM antibodies to a major human Pneumocystis carinii surface antigen (gp95), and investigated the IgM response in 128 HIV-infected patients who underwent bronchoscopy for evaluation of pulmonary symptoms. Only 5 (4%) patients had IgM antibodies to P. carinii g...

  7. Hepatic Steatosis in Morbidly Obese Patients Undergoing Gastric Bypass Surgery: Assessment With Open-System 1H-MR Spectroscopy

    NARCIS (Netherlands)

    van Werven, Jochem R.; Schreuder, Tim C. M. A.; Aarts, Edo O.; Nederveen, Aart J.; Meijer, Jos W. R.; Berends, Frits J.; Janssen, Ignace M. C.; Mulder, Chris J.; Jansen, Peter L. M.; Stoker, Jaap

    2011-01-01

    The purpose of this study was to assess, with histopathologic control, the use of open-system 1-T (1)H MR spectroscopy for the evaluation of hepatic steatosis in morbidly obese patients undergoing gastric bypass surgery. Patients underwent (1)H MR spectroscopy (MRS) for the assessment of steatosis

  8. NT-pro-BNP is associated with inducible myocardial ischemia in mildly symptomatic type 2 diabetic patients

    NARCIS (Netherlands)

    Wiersma, Jacobijne J.; van der Zee, P. Marc; van Straalen, Jan P.; Fischer, Johan C.; van Eck-Smit, Berthe L. F.; Tijssen, Jan G. P.; Trip, Mieke D.; Piek, Jan J.; Verberne, Hein J.

    2010-01-01

    Baseline levels of N-terminal fragment of the brain natriuretic peptide prohormone (NT-pro-BNP) are associated with myocardial ischemia in non-diabetic patients with stable angina pectoris. A total of 281 patients with diabetes mellitus type 2 and stable angina pectoris underwent myocardial

  9. Prostatic Artery Embolization After Failed Urological Interventions for Benign Prostatic Obstruction: A Case Series of Three Patients

    Energy Technology Data Exchange (ETDEWEB)

    Bhatia, Shivank S., E-mail: sbhatia1@med.miami.edu; Dalal, Ravi, E-mail: rdalal@med.miami.edu [University of Miami – Miller School of Medicine, Department of Radiology (United States); Gomez, Christopher, E-mail: Cgomez7@med.miami.edu [University of Miami – Miller School of Medicine, Department of Urology (United States); Narayanan, Govindarajan, E-mail: gnarayanan@med.miami.edu [University of Miami – Miller School of Medicine, Department of Radiology (United States)

    2016-08-15

    Benign prostate obstruction with associated lower urinary tract symptoms is a common diagnosis with multiple minimally invasive treatment options available. Herein, the authors describe three patients who failed prior different urological interventions who underwent prostate artery embolization with a subsequent improvement in symptoms. The positive response suggests that embolization may be an effective treatment alternative in this subset of patients.

  10. Upper gastrointestinal endoscopy in patients aged 85 years or more. Results of a feasibility study in a district general hospital.

    NARCIS (Netherlands)

    Kouwen, M.C.A. van; Drenth, J.P.H.; Verhoeven, H.M.; Bos, L.P.; Engels, L.G.

    2003-01-01

    We performed a cross sectional analysis of the feasibility and yield of upper gastrointestinal endoscopy (UGE) in a cohort of patients aged 85 years or more. The study involved 218 patients who underwent diagnostic upper gastrointestinal endoscopy in a district general hospital between 1994 and

  11. Faecal microbiota transplantation for recurring Clostridium difficile infection in a patient with Crohn's disease and ileorectal anastomosis

    DEFF Research Database (Denmark)

    Oppfeldt, Asser Mathiassen; Dahlerup, Jens F; Christensen, Lisbet A

    2016-01-01

    disease (IBD) who are on immunomodulating therapies is controversial. In particular, patients who have undergone colectomy may have different treatment responses to FMT. In this case report, we describe the successful use of FMT in a female patient aged 19 years with Crohn's disease who underwent...

  12. Isotope selection for patients undergoing prostate brachytherapy

    International Nuclear Information System (INIS)

    Cha, Christine M.; Potters, Louis; Ashley, Richard; Freeman, Katherine; Wang Xiaohong; Waldbaum, Robert; Leibel, Steven

    1999-01-01

    Purpose: Ultrasound-guided trans perineal interstitial permanent prostate brachytherapy (TIPPB) is generally performed with either 103 Pd or 125 I. The use of 125 I for low Gleason score tumors and 103 Pd for higher Gleason scores has been suggested based on isotope dose rate and cell doubling time observed in in vitro studies. While many centers follow these isotope selection criteria, other centers have elected to use only a single isotope, regardless of Gleason score. No clinical data have been published comparing these isotopes. This study was undertaken to compare outcomes between 125 I and 103 Pd in a matched pair analysis for patients undergoing prostate brachytherapy. Methods and Materials: Six hundred forty-eight consecutively treated patients with clinically confined prostate cancer underwent TIPPB between June 1992 and February 1997. Five hundred thirty-two patients underwent TIPPB alone, whereas 116 received pelvic external beam irradiation and TIPPB. Ninety-three patients received androgen deprivation therapy prior to TIPPB. The prescribed doses for TIPPB were 160 Gy for 125 I (pre-TG43) and 120 Gy for 103 Pd. Patients treated with combination therapy received 41.4 or 45 Gy (1.8 Gy/fraction) external beam irradiation followed by a 3- to 5-week break and then received either a 120-Gy 125 I or a 90-Gy 103 Pd implant. Until November 1994, all patients underwent an 125 I implant after which the isotope selection was based on either Gleason score (Gleason score 2-5: 125 I; Gleason 5-8: 103 Pd) or isotope availability. A matched pair analysis was performed to assess any difference between isotopes. Two hundred twenty-two patients were matched according to Gleason score, prostate-specific antigen (PSA), and stage. PSA relapse-free survival (PSA-RFS) was calculated based on the American Society for Therapeutic Radiology and Oncology (ASTRO) Consensus Group definition of failure. Kaplan-Meier actuarial survival curves were compared to assess differences in

  13. Patient doses in interventional cardiology

    International Nuclear Information System (INIS)

    Carrera, F.; Ojeda, C.; Ruiz-Cruces, R.; Francisco Diaz, J.; Sanchez, A.; Tort, I.

    2001-01-01

    Cardiovascular diseases are the first cause of death in Spain. The most usual procedures in interventional cardiology are coronariography and PTCA. The first is a diagnostic technique, and the second one is interventional. Our goal has been to study procedures made during the first six months in the Interventional Cardiology Unit of the Juan Ramon Jimenez Hospital (Huelva-Spain), taking into account radiation protection issues. We have studied 178 patients; 145 of them underwent coronariography, and 33 of the patients had PTCA too. Every case was analyzed taking into account technical and dosimetric parameters. We show parameters values gathered: Diagnostic techniques (valvular and non-valvular patients), and interventional techniques (coronariography and PTCA in different or in the same intervention). Higher doses were obtained with valvular patients, although the number of frames was similar. Attending to therapeutic procedures, the highest values were gotten with the 'double' interventions. Interventional procedures exceed in 60% doses gotten in diagnostic studies: this is because of the number of series and number of frames per series. Similar values obtained by other authors have been gotten. (author)

  14. Abdominal ultrasound in AIDS patients

    International Nuclear Information System (INIS)

    Escribano, J.; Gonzalez, J.; Alvarez, M.; Rivero, S.; Raya, J.L.; Ruza, M.

    1998-01-01

    To analyze the ultrasonography findings in abdomen in the AIDS patients in our hospital, as well as the indications for this exploration, assessing the role of abdominal ultrasound (AU). The ultrasonographic and clinical findings in 527 patients who underwent a total of 715 explorations between 1992 and 1996 were studied. Hepatomegaly and/or splenomegaly, usually homogeneous, were observed in nearly half of the studies (45%); one third of the patients with marked splenomegaly presented visceral leishmaniasis. Focal lesions in liver and/or spleen, corresponding to angiomas, abscesses, lymphomatous lesions and metastasis, were detected in 5.7% of the explorations. Thirty-five percent of the AU revealed the presence of lymphadenopathy; nodes measuring over 2.5 cm were usually related to potential treatable infection or neoplasm. Thickening of the gallbladder wall did not usually indicate the presence of acute cholecystitis unless Murphy''s sign was also detected. Bile duct dilation and wall thickening was related to opportunistic cholangitis, and the increase in the echogenicity of the renal parenchyma was linked to AIDS-related nephropathy. Despite the fact that many of findings with AU are nonspecific, we consider that this approach should be the principal diagnostic technique in AIDS patients with suspected abdominal pathology or fever of unknown origin. (Author) 43 refs,

  15. Anatomical success in patients after retinectomy for complex retinal detachment

    International Nuclear Information System (INIS)

    Mukhtar, A.; Ishaq, M.; Islam, Q.U.

    2015-01-01

    To evaluate the efficacy of primary and redo retinectomy in eyes with complex retinal detachment. Study Design: Quasi-experimental study. Place and Duration of Study: Armed Forces Institute of Ophthalmology Rawalpindi from Jan 2012 to June 2013. Patients and Methods: Fifty eight eyes (patients) underwent relaxing retinectomies for complex retinal detachment with proliferative vitreoretinopathy or intrinsic retinal shortening. Operative technique included pars plana vitrectomy, proliferative vitreoretinopathy management, use of intraoperative perfluorocarbon liquid, retinectomy, endolaser and intraocular temponade. The main outcome was anatomic success, defined as complete retinal reattachment at four months follow up. Eighteen eyes out of the same primary group underwent second retinectomy because of anatomical failure. Results: Mean age of study population was 53.78 ± 15.11 years, 56.9% of patients were male(s). Anatomic success rate after 1st retinectomy was achieved in 68.96% (40 eyes out of 58). In eighteen eyes that underwent 2nd retinectomy, anatomic success rate was 72.22% (13 eyes out of 18). Overall success rate was 91.3% (53 eyes out of 58) in our study. Conclusions: Relaxing retinectomies for retinal shortening can improve the anatomical success rate in patients with complex RD. (author)

  16. Coexistence of Single Coronary Artery Anomaly and Aortic Arch Anomaly

    OpenAIRE

    Yilmaz Omur Otlu

    2014-01-01

    A 74-year-old male patient was admitted to our hospital for evaluation of recent onset atypical chest pain. His medical history included hypertension, dislipidemia and smoking. Physical examination was unremarkable. The resting electrocardiogram was demonstrated biphasic T waves on lateral derivations. Transthoracic echocardiography showed normal left and right ventricular dimensions and functions. Coronary angiography was planned for the patient. First, right transradial approach tried; but ...

  17. Surgical Management of Mitral Regurgitation in Patients with Marfan Syndrome during Infancy and Early Childhood

    Directory of Open Access Journals (Sweden)

    Eung Re Kim

    2015-02-01

    Full Text Available Background: Mitral regurgitation is one of the leading causes of cardiovascular morbidity in pediatric patients with Marfan syndrome. The purpose of this study was to contribute to determining the appropriate surgical strategy for these patients. Methods: From January 1992 to May 2013, six patients with Marfan syndrome underwent surgery for mitral regurgitation in infancy or early childhood. Results: The median age at the time of surgery was 47 months (range, 3 to 140 months and the median follow-up period was 3.6 years (range, 1.3 to 15.5 years. Mitral valve repair was performed in two patients and four patients underwent mitral valve replacement with a mechanical prosthesis. There was one reoperation requiring valve replacement for aggravated mitral regurgitation two months after repair. The four patients who underwent mitral valve replacement did not experience any complications related to the prosthetic valve. One late death occurred due to progressive emphysema and tricuspid regurgitation. Conclusion: Although repair can be an option for some patients, it may not be durable in infantile-onset Marfan syndrome patients who require surgical management during infancy or childhood. Mitral valve replacement is a feasible treatment option for these patients.

  18. Usefulness Of Three-Dimensional Printing Models for Patients with Stoma Construction

    Directory of Open Access Journals (Sweden)

    Tetsuro Tominaga

    2016-04-01

    Full Text Available The use of patient-specific organ models in three-dimensional printing systems could be helpful for the education of patients and medical students. The aim of this study was to clarify whether the use of patient-specific stoma models is helpful for patient education. From January 2014 to September 2014, 5 patients who underwent colorectal surgery and for whom a temporary or permanent stoma had been created were involved in this study. Three-dimensional stoma models and three-dimensional face plates were created. The patients’ ages ranged from 59 to 81 years. Four patients underwent stoma construction because of rectal cancer, and 1 underwent stoma construction because of colon stenosis secondary to recurrent cancer. All patients were educated about their stoma and potential stoma-associated problems using three-dimensional stoma models, and all practiced cutting face plates using three-dimensional face plates. The models were also used during medical staff conferences to discuss current issues. All patients understood their problems and finally became self-reliant. The recent availability of three-dimensional printers has enabled the creation of many organ models, and full-scale stoma and face plate models are now available for patient education on cutting an appropriately individualized face plate. Thus, three-dimensional printers could enable fewer skin problems than are currently associated with daily stomal care.

  19. Sending family history questionnaires to patients before a colonoscopy improves genetic counseling for hereditary colorectal cancer.

    Science.gov (United States)

    Kessels, Koen; Eisinger, Joey D; Letteboer, Tom G; Offerhaus, G Johan A; Siersema, Peter D; Moons, Leon M G

    2017-06-01

    To investigate whether sending a family history questionnaire to patients prior to undergoing colonoscopy results in an increased availability of family history and better genetic counseling. A questionnaire was mailed to patients before they underwent outpatient colonoscopy at a university hospital in 2013. These patients' additional characteristics and referral for genetic evaluation were retrieved from the electronic medical records. Patients undergoing inpatient coloboscopy, with confirmed hereditary colorectal cancer (CRC) or inflammatory bowel disease were excluded. All study patients from 2010 to 2013 were matched with the database of the genetics department to determine who consulted a geneticist. A total of 6163 patients underwent colonoscopy from 2010 to 2013. Of 1421 who underwent colonoscopy in 2013, 53 (3.7%) consulted a geneticist, while 75 (1.6%) of 4742 patients undergoing colonoscopy between 2010 and 2012 did so (P history was not recorded in the electronic medical records of 393 (40.3%). In 129 (32.8%), family history was obtained from the completed questionnaire. In 2013, 49 (60.5%) out of 81 patients referred for genetic counseling were referred based on their family history. Eight (9.9%) patients were referred based on the completed questionnaire. Screening for hereditary CRC in a population undergoing outpatient colonoscopy with a questionnaire sent by mail resulted in an increased availability of family histories and genetic counseling. © 2017 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.

  20. Hepatobiliary scanning in cardiac transplant patients maintained on cyclosporine

    International Nuclear Information System (INIS)

    Dhekne, R.D.; Long, S.E.; Moore, W.H.; Frazier, O.H.

    1987-01-01

    Many patients receiving cyclosporine (CSA) develop hepatic dysfunction or pancreatitis. The authors reviewed 106 records of cardiac transplant patients maintained on CSA. Eleven patients underwent 16 hepatobiliary scans (HBSs) for abdominal pain and/or abnormal liver function. Of 16 HBSs, ten demonstrated normal gallbladder visualization. Follow-up in all cases confirmed scan findings. Five patients had no gallbladder visualization; confirmation of acute cholecystitis was obtained by surgery in two and by autopsy in three. One patient had previous cholecystectomy. The authors found HPS useful for evaluating acute cholecystitis in patients receiving CSA with or without associated drug-related pancreatitis and hepatic insufficiency and suggest that HBS can assist in the