The impact of chemotherapy and its timing on survival in malignant peritoneal mesothelioma treated with complete debulking.

Science.gov (United States)

Naffouje, Samer A; Tulla, Kiara A; Salti, George I

2018-04-12

The current standard of treatment for malignant peritoneal mesothelioma (MPM) is cytoreductive surgery when the disease distribution is favorable. The role of chemotherapy, as an adjunct to surgery, remains unclear. The national database of mesothelioma was used to identify MPM patients who were treated with curative intent. Patients were divided into treatment groups: (1) chemotherapy only, (2) surgery only, (3) neoadjuvant chemotherapy + surgery, and (4) surgery + adjuvant chemotherapy. A negative control group of patients who did not receive any treatment was added (group 0). Totally, 1740 patients were included. Mean age was 63.04 ± 14.58 and 60.7% were males. The patients' distribution into the treatment groups was 604, 684, 169, 55, and 228 patients in groups 0-4, respectively, with a median survival of 3.61 ± 0.37, 11.10 ± 0.73, 57.41 ± 11.91, 52.30 ± 7.20, and 55.00 ± 9.19 months. The addition of chemotherapy, in any setting, to surgery provided an improved survival at 1 year (p = 0.006). This survival benefit ceased at the 2-, 3-, and 5-year checkpoints. The multivariate analysis identified age, sarcomatoid/biphasic histologies, nodal and distant metastasis, and offering no treatment or chemotherapy only as poor prognostic factors for overall survival. No difference in overall survival was noted with the addition of chemotherapy to complete debulking regardless of the timing. Complete debulking remains the standard treatment for MPM. The addition of systemic chemotherapy provides a short-term survival improvement at 1 year only and was similar whether given in the neoadjuvant or adjuvant setting. Nevertheless, it did not add a survival benefit beyond the 1-year time point.

A novel index for preoperative, non-invasive prediction of macro-radical primary surgery in patients with stage IIIC-IV ovarian cancer-a part of the Danish prospective pelvic mass study

DEFF Research Database (Denmark)

Karlsen, Mona Aarenstrup; Fagö-Olsen, Carsten Lindberg; Høgdall, Estrid Vilma Solyom

2016-01-01

The purpose of this study was to develop a novel index for preoperative, non-invasive prediction of complete primary cytoreduction in patients with FIGO stage IIIC-IV epithelial ovarian cancer. Prospectively collected clinical data was registered in the Danish Gynecologic Cancer Database. Blood...... samples were collected within 14 days of surgery and stored by the Danish CancerBiobank. Serum human epididymis protein 4 (HE4), serum cancer antigen 125 (CA125), age, performance status, and presence/absence of ascites at ultrasonography were evaluated individually and combined to predict complete tumor...... removal. One hundred fifty patients with advanced epithelial ovarian cancer were treated with primary debulking surgery (PDS). Complete PDS was achieved in 41 cases (27 %). The receiver operating characteristic curves demonstrated an area under the curve of 0.785 for HE4, 0.678 for CA125, and 0...

Organisation and quality of primary surgical intervention for ovarian cancer in Denmark

DEFF Research Database (Denmark)

Marx, Charlotte; Bendixen, Anette; Høgdall, Claus

2007-01-01

The positive effect on survival of maximal primary cytoreductive surgery for ovarian cancer is well established, and the highest rates of optimal cytoreduction are achieved by gynecological oncologists. Danish women have not only one of the highest incidences of ovarian cancer, but also the highest...... mortality rate. From 1981 to 1989, the overall Danish optimal debulking rate was 25% in patients with stage III and IV tumors. The primary aim of the present study was, therefore, to evaluate the organisation and quality of current primary surgical intervention for ovarian cancer in Denmark....

A prospective comparison of perioperative morbidity in advanced epithelial ovarian cancer: Primary versus interval cytoreduction - experience from India

Directory of Open Access Journals (Sweden)

Sheikh Zahoor Ahmad

2015-01-01

Full Text Available Objectives: The objective was to compare perioperative morbidity and mortality of patients with advanced epithelial ovarian cancer (EOC treated with either of the two treatment approaches; neoadjuvant chemotherapy (NACT followed by interval debulking versus upfront surgery. Design: Prospective comparative observational study. Participants: In total, 51 patients were included in the study. All patients with diagnosed advanced EOC (International Federation of Gynecology and Obstetrics IIIC and IV presenting for the 1st time were included in the study. Interventions: Patients were either operated upfront (n = 19 if deemed operable or were subjected to NACT followed by interval debulking (n = 32. Primary and Secondary Outcomes: Intra- and postoperative morbidity and mortality were the primary outcome measures. Results: Patients with interval cytoreduction were noted to have significantly lesser operative time, blood loss, and extent of surgery. Their discharge time was also significantly earlier. However, they did not differ from the other group vis. a vis. postoperative complications or mortality. Conclusions: Neoadjuvant chemotherapy although has a positive impact on various intraoperative adverse events, fails to show any impact on immediate postoperative negative outcomes.

The combined use of surgical debulking and diode laser photocoagulation for limbal melanoma treatment: a retrospective study of 21 dogs.

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Andreani, Valentina; Guandalini, Adolfo; D'Anna, Nunzio; Giudice, Chiara; Corvi, Roberta; Di Girolamo, Nicola; Sapienza, John S

2017-03-01

To evaluate effectiveness and safety of debulking and diode laser photocoagulation (DPC) for the treatment of limbal melanoma (LM). Retrospective multi-institutional case series. Medical records of animals diagnosed with LM at the Centro Veterinario Specialistico (CVS) and at the Long Island Veterinary Specialists from 1994 to 2014 were retrieved. Signalment, location, extent of tumors, recurrence rate, and early and late complications were reported. Patient follow-up information was obtained from veterinary ophthalmologists, primary care veterinarians, and where appropriate, owners. Twenty-one eyes of 21 dogs (13 females and 8 males) were included in this study. The dogs' average age was 6 years (range: 7 months-11 years). The follow-up period ranged from 1-108 months (median 48 months) after the last DPC procedure. Long-term follow-up was obtained by telephone interviews in 6 of 20 cases and by clinical re-evaluations in 14 of 20 cases. The most common early complications were a moderate anterior uveitis and peripheral corneal edema (21/21 eyes). Late complications included corneal fibrosis and/or pigmentation (20/21). In one case, a severe bullous keratopathy associated with extensive corneal fibrosis was observed (1/21). One case was blind due to concurrent Sudden Acquired Retinal Degeneration (SARD). However, after surgery 2 of 20 eyes lost vision and one of these was enucleated. Debulking, in addition to diode laser photocoagulation, was technically straightforward to perform, minimally invasive, well tolerated, and highly successful in this case series. © 2016 American College of Veterinary Ophthalmologists.

The impact of type and number of bowel resections on anastomotic leakage risk in advanced ovarian cancer surgery.

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Grimm, Christoph; Harter, Philipp; Alesina, Pier F; Prader, Sonia; Schneider, Stephanie; Ataseven, Beyhan; Meier, Beate; Brunkhorst, Violetta; Hinrichs, Jakob; Kurzeder, Christian; Heitz, Florian; Kahl, Annett; Traut, Alexander; Groeben, Harald T; Walz, Martin; du Bois, Andreas

2017-09-01

To identify risk factors for anastomotic leakage (AL) in patients undergoing primary advanced ovarian cancer surgery and to evaluate the prognostic implication of AL on overall survival in these patients. We analyzed our institutional database for primary EOC and included all consecutive patients treated by debulking surgery including any type of full circumferential bowel resection beyond appendectomy between 1999 and 2015. We performed logistic regression models to identify risk factors for AL and log-rank tests and Cox proportional hazards models to evaluate the association between AL and survival. AL occurred in 36/800 (4.5%; 95% confidence interval [3%-6%]) of all patients with advanced ovarian cancer and 36/518 (6.9% [5%-9%]) patients undergoing bowel resection during debulking surgery. One hundred fifty-six (30.1%) patients had multiple bowel resections. In these patients, AL rate per patient was only slightly higher (9.0% [5%-13%]) than in patients with rectosigmoid resection only (6.9% [4%-10%]), despite the higher number of anastomosis. No independent predictive factors for AL were identified. AL was independently associated with shortened overall survival (HR 1.9 [1.2-3.4], p=0.01). In the present study, no predictive pre- and/or intraoperative risk factors for AL were identified. AL rate was mainly influenced by rectosigmoid resection and only marginally increased by additional bowel resections. Copyright © 2017 Elsevier Inc. All rights reserved.

A predictive score for optimal cytoreduction at interval debulking surgery in epithelial ovarian cancer: a two- centers experience.

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Ghisoni, Eleonora; Katsaros, Dionyssios; Maggiorotto, Furio; Aglietta, Massimo; Vaira, Marco; De Simone, Michele; Mittica, Gloria; Giannone, Gaia; Robella, Manuela; Genta, Sofia; Lucchino, Fabiola; Marocco, Francesco; Borella, Fulvio; Valabrega, Giorgio; Ponzone, Riccardo

2018-05-30

Optimal cytoreduction (macroscopic Residual Tumor, RT = 0) is the best survival predictor factor in epithelial ovarian cancer (EOC). It doesn't exist a consolidated criteria to predict optimal surgical resection at interval debulking surgery (IDS). The aim of this study is to develop a predictive model of complete cytoreduction at IDS. We, retrospectively, analyzed 93 out of 432 patients, with advanced EOC, underwent neoadjuvant chemotherapy (NACT) and IDS from January 2010 to December 2016 in two referral cancer centers. The correlation between clinical-pathological variables and residual disease at IDS has been investigated with univariate and multivariate analysis. A predictive score of cytoreduction (PSC) has been created by combining all significant variables. The performance of each single variable and PSC has been reported and the correlation of all significant variables with progression free survival (PFS) has been assessed. At IDS, 65 patients (69,8%) had complete cytoreduction with no residual disease (R = 0). Three criteria independently predicted R > 0: age ≥ 60 years (p = 0.014), CA-125 before NACT > 550 UI/dl (p = 0.044), and Peritoneal Cancer Index (PCI) > 16 (p  16, a PSC ≥ 3 and the presence of R > 0 after IDS were all significantly associated with shorter PFS (p  0). The PSC should be prospectively validated in a larger series of EOC patients undergoing NACT-IDS.

Giant morphea-form basal cell carcinoma of the umbilicus: Successful debulking with vismodegib.

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Orduz Robledo, Mariana; Lebas, Eve; Reginster, Marie-Annick; Baghaie, Mahmoud; Groves, Sabine; Nikkels, Arjen F

2018-01-01

Basal cell carcinoma of the umbilicus is very rare. The nodular subtype is the main representative. Giant basal cell carcinomas represent around 1% of all basal cell carcinomas. The hedgehog pathway inhibitor vismodegib is indicated for advanced basal cell carcinoma and CD56-negative immunostaining seems indicative for successful treatment. A 54-year-old man presented a 10 cm × 14 cm large and 4.5 cm deep morphea-form basal cell carcinoma with faint immunohistochemical CD56 expression arising from the umbilicus. A sequential treatment was initiated with debulking using vismodegib 150 mg per day for 4 months, followed by reconstructive surgery. To the best of our knowledge, this is the first report of a giant basal cell carcinoma of the morphea-form type of the umbilicus. The sequential treatment plan reduces the duration of vismodegib inherent adverse effects and significantly reduces the tumor mass prior to surgery. Besides increasing adherence to vismodegib treatment, this approach facilitates the surgical technique and improves cosmetic outcome.

Neoadjuvant chemotherapy as ovarian cancer treatment: ever more used with major regional differences

DEFF Research Database (Denmark)

Fagö-Olsen, Carsten L; Ottesen, Bent; Kehlet, Henrik

2012-01-01

The traditional first-line treatment for patients with advanced ovarian cancer with primary debulking surgery (PDS) and adjuvant chemotherapy is controversial as some authors report a potential benefit from the alternative treatment with neoadjuvant chemotherapy (NACT) and interval debulking...

Laser surgery combined with radiotherapy for T1/T2 hypopharyngeal squamous cell carcinomas

International Nuclear Information System (INIS)

Sakamoto, Kikuo; Nakashima, Tadashi

2006-01-01

We analyzed the results and clinical features of 41 patients with T1 or T2 squamous cell carcinoma of the hypopharynx who received the treatment of laser surgery combined with radiotherapy at the Kurume University Hospital between 1989 and 2003. The patients consisted of 38 males and 3 females (mean age: 64 years); T classification was 8 T1 cases and 33 T2 cases. N classification of the patients was 20 N0 cases, 9 N1 cases, 10 N2 cases, and 2 N3 cases. Three were stage I, 17 were stage II, 9 were stage III, and 12 were stage IV. Sub-sites of the tumor were 33 of piriform sinus type, 6 of post-cricoid type and 2 of poterior wall type. The primary disease was treated by laser debulking surgery combined with radiotherapy. Local recurrence was recognized in 4 cases and laryngectomy was performed in 3 cases. As a result, 38 (92.6%) cases were treated by preserving the larynx. All patients could eat a meal from the day following the operation. Tracheostomy was performed in six cases, but the tracheal stoma could be closed in five. The disease-specific 5-year survival rate was 87.7%. The 5-year local control rate was 90.2%. The overall 5-year survival rate was 49.2%. Four patients died of the primary disease (lymph node death: 3, distant metastasis death: 1). This retrospective review indicates that laser debulking surgery combined with radiotherapy is a successful treatment for T1/T2 hypopharyngeal carcinoma. (author)

Initial incomplete surgery modifies prognosis in advanced ovarian cancer regardless of subsequent management.

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Bacalbasa, Nicolae; Balescu, Irina; Dima, Simona; Herlea, Vlad; David, Leonard; Brasoveanu, Vladislav; Popescu, Irinel

2015-04-01

Prognosis in ovarian cancer is determined by completeness of cytoreduction and proper management by specialized oncological gynecologists. Incomplete initial debulking surgery in non-specialized Centers is, however, a reality and there is ongoing discussion about the best subsequent management of such patients. Patients with advanced ovarian cancer (International Federation of Gynecology and Obstetrics--FIGO FIGO stages IIIC-IV) who had biopsy by laparotomy or incomplete cytoreduction followed or not by chemotherapy further referred to our Institution between January 2002 and May 2014 were included. The two groups of incomplete cytoreduction [followed by upfront surgery or followed by chemotherapy and interval debulking surgery (IDS)] were compared and also compared against a cohort of 197 patients with similar characteristics who underwent upfront maximal surgery according to the standard at our Iinstitution during the same period. A total of 99 eligible patients were identified. Sixty-seven of them underwent biopsies by laparotomy and 32 underwent incomplete cytoreduction in other institutions. Twenty-eight patients underwent direct re-operation while 71 patients underwent neoadjuvant chemotherapy followed by IDS. The mean overall survival duration for patients with upfront reoperation was 31 months and 54 months for patients with neoadjuvant chemotherapy and IDS, considerably lower than the 72 months obtained for the group of 197 patients with maximal up-front complete cytoreduction at our Institution. Primary biopsy or incomplete cytoreduction reduces survival regardless of the subsequent approach. However, if incomplete cytoreduction has occurred, neoadjuvant chemotherapy followed by IDS is preferable to up-front reoperation. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

Prognosis for advanced-stage primary peritoneal serous papillary carcinoma and serous ovarian cancer in Taiwan.

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Chao, Kuan-Chong; Chen, Yi-Jen; Juang, Chi-Mou; Lau, Hei-Yu; Wen, Kuo-Chang; Sung, Pi-Lin; Fang, Feng-Ying; Twu, Nae-Fang; Yen, Ming-Shyen

2013-03-01

To compare the prognosis of patients with advanced-stage primary peritoneal serous papillary carcinoma (PSPC) or papillary serous ovarian cancer (PSOC). This was a retrospective case-control study and included two study groups: one with stage III/IV PSPC (n = 38) patients and the other with PSOC (n = 53) patients. Patients were matched for histologic subtype (serous tumor), tumor stage, tumor grade, residual disease at the end of debulking surgery (primary or interval), and age (±5 years). Mean age was significantly greater for patients with PSPC (63.03 ± 11.88 years) than for patients with PSOC (55.92 ± 12.56 years, p = 0.008). Optimal debulking surgery was performed initially in 71.9% of PSPC patients and 66.0% of PSOC patients. In addition, 93.9% of PSPC patients and 92.3% of PSOC patients were treated with platinum-paclitaxel chemotherapy. The frequency of high-grade tumors was significantly higher in the PSPC (100%) than in the PSOC group (68.3%; p statistic). PFS was similar for advanced-stage PSPC and PSOC patients. Since the PSPC patients tended to be older and have more high-grade tumors, OS was shorter for PSPC than for POSC patients. Thus, management of the two types of cancer should not differ. Copyright © 2013. Published by Elsevier B.V.

A comparison of revisional and primary bariatric surgery.

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Fulton, Courtney; Sheppard, Caroline; Birch, Daniel; Karmali, Shazeer; de Gara, Christopher

2017-06-01

Revisional surgery is an important component of addressing weight regain and complications following primary bariatric surgery. Owing to provincial need and the complexity of this patient population, a specialized multidisciplinary revision clinic was developed. We sought to characterize patients who undergo revision surgery and compare their outcomes with primary bariatric surgery clinic data. We completed a retrospective chart review of bariatric revision clinic patients compared with primary bariatric surgery patients from December 2009 to June 2014. We reviewed the charts of 2769 primary bariatric clinic patients, 886 of whom had bariatric surgery, and 534 revision bariatric clinic patients, 83 of whom had revision surgery. Fewer revision clinic patients underwent surgery than primary clinic patients (22% v. 32%). The mean preoperative body mass index (BMI) was 44.7 ± 9.5 in revision patients compared with 45.7 ± 7.6 in primary bariatric surgery patients. Most revision patients had a prior vertical banded gastroplasty (VBG; 48%) or a laparoscopic adjustable gastric band (LAGB; 24%). Bands were removed in 36% of all LAGB patients presenting to clinic. Of the 134 procedures performed in the revision clinic, 83 were bariatric weight loss surgeries, and 51 were band removals. Revision clinic patients experienced a significant decrease in BMI (from 44.7 ± 9.5 to 33.8 ± 7.5, p bariatric revision clinic manages a wide variety of complex patients distinct from those seen in a primary clinic. Operative candidates at the revision clinic are chosen based on favourable medical, anatomic and psychosocial factors, keeping in mind the resource constraints of a public health care system.

Classification of Ovarian Cancer Surgery Facilitates Treatment Decisions in a Gynecological Multidisciplinary Team

DEFF Research Database (Denmark)

Bjørn, Signe Frahm; Schnack, Tine Henrichsen; Lajer, Henrik

2017-01-01

multidisciplinary team (MDT) decisions. Materials and Methods Four hundred eighteen women diagnosed with ovarian cancers (n = 351) or borderline tumors (n = 66) were selected for primary debulking surgery from January 2008 to July 2013. At an MDT meeting, women were allocated into 3 groups named "pre-COVA" 1 to 3...... classifying the expected extent of the primary surgery and need for postoperative care. On the basis of the operative procedures performed, women were allocated into 1 of the 3 corresponding COVA 1 to 3 groups. The outcome measure was the predictive value of the pre-COVA score compared with the actual COVA......-COVA classification predicted the actual COVA group in 79 (49%) FIGO stages I to IIIB and in 85 (45%) FIGO stages IIIC to IV. Conclusions The COVA classification system is a simple and useful tool in the MDT setting where specialists make treatment decisions based on advanced technology. The use of pre...

Quality of pathology reports for advanced ovarian cancer: are we missing essential information? An audit of 479 pathology reports from the EORTC-GCG 55971/NCIC-CTG OV13 neoadjuvant trial.

Science.gov (United States)

Verleye, Leen; Ottevanger, Petronella B; Kristensen, Gunnar B; Ehlen, Tom; Johnson, Nick; van der Burg, Maria E L; Reed, Nick S; Verheijen, René H M; Gaarenstroom, Katja N; Mosgaard, Berit; Seoane, Jose M; van der Velden, Jacobus; Lotocki, Robert; van der Graaf, Winette; Penninckx, Björn; Coens, Corneel; Stuart, Gavin; Vergote, Ignace

2011-01-01

To assess the quality of surgical pathology reports of advanced stage ovarian, fallopian tube and primary peritoneal cancer. This quality assurance project was performed within the EORTC-GCG 55971/NCIC-CTG OV13 study comparing primary debulking surgery followed by chemotherapy with neoadjuvant chemotherapy and interval debulking surgery. Four hundred and seventy nine pathology reports from 40 institutions in 11 different countries were checked for the following quality indicators: macroscopic description of all specimens, measuring and weighing of major specimens, description of tumour origin and differentiation. All specimens were macroscopically described in 92.3% of the reports. All major samples were measured and weighed in 59.9% of the reports. A description of the origin of the tumour was missing in 20.5% of reports of the primary debulking group and in 23.4% of the interval debulking group. Assessment of tumour differentiation was missing in 10% of the reports after primary debulking and in 20.8% of the reports after interval debulking. Completeness of reports is positively correlated with accrual volume and adversely with hospital volume or type of hospital (academic versus non-academic). Quality of reports differs significantly by country. This audit of ovarian cancer pathology reports reveals that in a substantial number of reports basic pathologic data are missing, with possible adverse consequences for the quality of cancer care. Specialisation by pathologists and the use of standardised synoptic reports can lead to improved quality of reporting. Further research is needed to better define pre- and post-operative diagnostic criteria for ovarian cancer treated with neoadjuvant chemotherapy. Copyright © 2010 Elsevier Ltd. All rights reserved.

Results of endocapsular phacofracture debulking of hard cataracts.

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Davison, James A

2015-01-01

To present a phacoemulsification technique for hard cataracts and compare postoperative results using two different ultrasonic tip motions during quadrant removal. A phacoemulsification technique which employs in situ fracture and endocapsular debulking for hard cataracts is presented. The prospective study included 56 consecutive cases of hard cataract (LOCS III NC [Lens Opacification Classification System III, nuclear color], average 4.26), which were operated using the Infiniti machine and the Partial Kelman tip. Longitudinal tip movement was used for sculpting for all cases which were randomized to receive longitudinal or torsional/interjected longitudinal (Intelligent Phaco [IP]) strategies for quadrant removal. Measurements included cumulative dissipated energy (CDE), 3 months postoperative surgically induced astigmatism (SIA), and corneal endothelial cell density (ECD) losses. No complications were recorded in any of the cases. Respective overall and longitudinal vs IP means were as follows: CDE, 51.6±15.6 and 55.7±15.5 vs 48.6±15.1; SIA, 0.36±0.2 D and 0.4±0.2 D vs 0.3±0.2 D; and mean ECD loss, 4.1%±10.8% and 5.9%±13.4% vs 2.7%±7.8%. The differences between longitudinal and IP were not significant for any of the three categories. The endocapsular phacofracture debulking technique is safe and effective for phacoemulsification of hard cataracts using longitudinal or torsional IP strategies for quadrant removal with the Infiniti machine and Partial Kelman tip.

Orbital atherectomy as an adjunct to debulk difficult calcified lesions prior to mesenteric artery stenting.

Science.gov (United States)

Manunga, Jesse M; Oderich, Gustavo S

2012-08-01

To describe a technique in which percutaneous orbital atherectomy is used to debulk heavily calcified superior mesenteric artery (SMA) occlusions as an adjunct in patients undergoing angioplasty and stenting. The technique is demonstrated in a 62-year-old woman with a replaced right hepatic artery originating from an SMA occluded by densely calcified lesions. Via a left transbrachial approach, a 7-F MPA guide catheter was used to engage the ostium of the SMA, which was crossed using a catheter and guidewire. The calcified lesion was debulked using the 2-mm Diamondback 360° orbital atherectomy system. The wire was exchanged for a 0.014-inch filter wire and 0.018-inch guidewire. Using a 2-guidewire technique, the SMA was stented with a self-expanding stent for the distal lesion that crossed side branches and a balloon-expandable stent at the ostium. A 0.014-inch guidewire was placed into the replaced hepatic artery through a cell of the self-expanding stent, followed by deployment of a small balloon-expandable stent to address the residual lesion. The use of orbital atherectomy to debulk occluded and heavily calcified SMA lesions may optimize the technical results with angioplasty and stenting.

Peeled Guidewire Coating with Debulked Plaque Obtained by Directional Coronary Atherectomy

Directory of Open Access Journals (Sweden)

Rikuta Hamaya

2017-01-01

Full Text Available Percutaneous directional coronary atherectomy (DCA is a plaque debulking method performed in Japan, and recently a renewed DCA device has been launched. We present a case with a tight left anterior descending lesion undergoing percutaneous coronary intervention with application of DCA. After several sessions of DCA, white plaques accompanied by green, stringed materials were obtained from the device; some materials were considerably long (approximately 15 mm in length. A drug-eluting stent was subsequently implanted, and the procedure was completed successfully without any complications. The extracted plaques and artificial materials were pathologically examined, and no inflammatory changes were detected on plaques adjacent to the material. Assessing pathological findings and structure of the DCA catheter, the obtained artificial materials were considered as peeled guidewire, possibly resulting from the friction between the guidewire and metallic bearing in the housing of DCA catheter. Of note, this phenomenon has been recognized even in other DCA cases in which guidewires of the other kind are used. We report this phenomenon for the first time, warning of theoretically possible distal embolization of artificial materials caused by any debulking devices.

Results of endocapsular phacofracture debulking of hard cataracts

Directory of Open Access Journals (Sweden)

Davison JA

2015-07-01

Full Text Available James A Davison Wolfe Eye Clinic, Marshalltown, IA, USA Purpose/aim of the study: To present a phacoemulsification technique for hard cataracts and compare postoperative results using two different ultrasonic tip motions during quadrant removal.Materials and methods: A phacoemulsification technique which employs in situ fracture and endocapsular debulking for hard cataracts is presented. The prospective study included 56 consecutive cases of hard cataract (LOCS III NC [Lens Opacification Classification System III, nuclear color], average 4.26, which were operated using the Infiniti machine and the Partial Kelman tip. Longitudinal tip movement was used for sculpting for all cases which were randomized to receive longitudinal or torsional/interjected longitudinal (Intelligent Phaco [IP] strategies for quadrant removal. Measurements included cumulative dissipated energy (CDE, 3 months postoperative surgically induced astigmatism (SIA, and corneal endothelial cell density (ECD losses.Results: No complications were recorded in any of the cases. Respective overall and longitudinal vs IP means were as follows: CDE, 51.6±15.6 and 55.7±15.5 vs 48.6±15.1; SIA, 0.36±0.2 D and 0.4±0.2 D vs 0.3±0.2 D; and mean ECD loss, 4.1%±10.8% and 5.9%±13.4% vs 2.7%±7.8%. The differences between longitudinal and IP were not significant for any of the three categories.Conclusion: The endocapsular phacofracture debulking technique is safe and effective for phacoemulsification of hard cataracts using longitudinal or torsional IP strategies for quadrant removal with the Infiniti machine and Partial Kelman tip. Keywords: astigmatism, cataract, corneal endothelium, phacoemulsification, viscoelastic

Cost Implications of Primary Versus Revision Surgery in Adult Spinal Deformity.

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Qureshi, Rabia; Puvanesarajah, Varun; Jain, Amit; Kebaish, Khaled; Shimer, Adam; Shen, Francis; Hassanzadeh, Hamid

2017-08-01

Adult spinal deformity (ASD) is an important problem to consider in the elderly. Although studies have examined the complications of ASD surgery and have compared functional and radiographic results of primary surgery versus revision, no studies have compared the costs of primary procedures with revisions. We assessed the in-hospital costs of these 2 surgery types in patients with ASD. The PearlDiver Database, a database of Medicare records, was used in this study. Mutually exclusive groups of patients undergoing primary or revision surgery were identified. Patients in each group were queried for age, sex, and comorbidities. Thirty-day readmission rates, 30-day and 90-day complication rates, and postoperative costs of care were assessed with multivariate analysis. For analyses, significance was set at P average reimbursement of the primary surgery cohort was $57,078 ± $30,767. Reimbursement of revision surgery cohort was $52,999 ± $27,658. The adjusted difference in average costs between the 2 groups is $4773 ± $1069 (P day and 90-day adjusted difference in cost of care when sustaining any of the major medical complications in primary surgery versus revision surgery was insignificant. Patients undergoing primary and revision corrective procedures for ASD have similar readmission rates, lengths of stays, and complication rates. Our data showed a higher cost of primary surgery compared with revision surgery, although costs of sustaining postoperative complications were similar. This finding supports the decision to perform revision procedures in patients with ASD when indicated because neither outcomes nor costs are a hindrance to correction. Copyright © 2017 Elsevier Inc. All rights reserved.

The Impact of Number of Cycles of Neoadjuvant Chemotherapy on Survival of Patients Undergoing Interval Debulking Surgery for Stage IIIC-IV Unresectable Ovarian Cancer: Results From a Multi-Institutional Study.

Science.gov (United States)

Bogani, Giorgio; Matteucci, Laura; Tamberi, Stefano; Arcangeli, Valentina; Ditto, Antonino; Maltese, Giuseppa; Signorelli, Mauro; Martinelli, Fabio; Chiappa, Valentina; Leone Roberti Maggiore, Umberto; Perotto, Stefania; Scaffa, Cono; Comerci, Giuseppe; Stefanetti, Marco; Raspagliesi, Francesco; Lorusso, Domenica

2017-11-01

Neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS) may be a valuable treatment option in advanced ovarian cancer when primary cytoreduction is not feasible. However, a consensus on the ideal number of NACT cycles is still lacking. In the present investigation, we aimed to evaluate how number of cycles of NACT influenced patients' outcomes. Data of consecutive patients undergoing NACT and IDS were retrospectively reviewed in 4 Italian centers, and survival outcomes were evaluated. Overall, 193 patients were included. Cycles of NACT were 3, 4, and at least 5 in 77 (40%), 74 (38%), and 43 (22%) patients, respectively. Patients undergoing 3 cycles experienced a similar disease-free survival (hazard ratio [HR], 1.12; 95% confidence interval [CI], 0.89-1.65; P = 0.20) but an improved overall survival (HR, 1.64; 95% CI, 1.05-2.4; P = 0.02) in comparison to patients receiving at least 4 cycles. Five-year overall survival was 46% and 31% for patients having 3 and at least 4 cycles. Ten-year overall survival was 26% and 18% for patients having 3 and at least 4 cycles (HR, 1.70; 95% CI, 1.13-2.55; P = 0.009). Using multivariate analysis, we observed that only Eastern Cooperative Oncology Group performance status correlated with overall survival (HR, 1.76; 95% CI, 1.2-2.49; P = 0.001). In addition, a trend toward worse overall survival was observed for patients with residual disease at IDS (HR, 1.29; 95% CI, 0.98-1.70; P = 0.06) and patients receiving at least 4 cycles (HR, 1.76; 95% CI, 0.95-3.22; P = 0.06). Our data underline the potential implication of number of cycles of NACT before IDS. Further prospective studies are warranted to assess this correlation.

Recurrence rate after thoracoscopic surgery for primary spontaneous pneumothorax.

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Dagnegård, Hanna H; Rosén, Alice; Sartipy, Ulrik; Bergman, Per

2017-08-01

There is an on-going discussion regarding the recurrence rate after surgery for primary spontaneous pneumothorax by video assisted thoracic surgery (VATS) or by thoracotomy access. This study aimed to describe the recurrence rate, and to identify a possible learning curve, following surgery for primary spontaneous pneumothorax by VATS. All patients who underwent surgery for primary spontaneous pneumothorax by VATS at Karolinska University Hospital 2004-2013 were reviewed. Preoperative and operative characteristics were obtained from medical records. Patients were followed-up through telephone interviews or questionnaires and by review of medical records. The primary outcome of interest was time to recurrence of pneumothorax requiring intervention. Outcomes were compared between patients operated during 2004-June 2010 and July 2010-2013. 219 patients who underwent 234 consecutive procedures were included. The mean follow-up times were 6.3 and 2.9 years in the early and late period, respectively. The postoperative recurrence rate in the early period was 16% (11%-25%), 18% (12%-27%), and 18% (12%-27%), at 1, 3 and 5 years, compared to 1.7% (0.4%-6.8%), 7.6% (3.7%-15%), and 9.8% (4.8%-19%) at 1, 3 and 5 years, in the late period (p = 0.016). We found that the recurrence rate after thoracoscopic surgery for primary spontaneous pneumothorax decreased significantly during the study period. Our results strongly suggest that thoracoscopic surgery for pneumothorax involve a substantial learning curve.

The influence of sarcopenia on survival and surgical complications in ovarian cancer patients undergoing primary debulking surgery

NARCIS (Netherlands)

Rutten, I.J.; Ubachs, J.; Kruitwagen, R.F.P.M.; Dijk, D.P. van; Beets-Tan, R.G.; Massuger, L.F.A.G.; Oude Damink, S.W.; Gorp, T. Van

2017-01-01

BACKGROUND: Sarcopenia, severe skeletal muscle loss, has been identified as a prognostic factor in various malignancies. This study aims to investigate whether sarcopenia is associated with overall survival (OS) and surgical complications in patients with advanced ovarian cancer undergoing primary

Demographic Clinical and Prognostic Factors of Primary Ovarian Adenocarcinomas of Serous and Clear Cell Histology—A Comparative Study

DEFF Research Database (Denmark)

Schnack, Tine H; Høgdall, Estrid; Nedergaard, Lotte

2016-01-01

-based prospectively collected data on oCCC (n = 179) and oSAC (n = 2363) cases were obtained from the Danish Gynecological Cancer Database. χ, Fischer or Wilcoxon-Mann-Whitney, multivariate logistic regression, univariate Kaplan-Meier, and multivariate Cox regression tests were used. Statistical tests were 2-sided. P......, 0.62; 95% confidence interval, 0.37-0.92).Although more oSAC than oCCC cases diagnosed in stage III or IV were referred to neoadjuvant chemotherapy, a higher proportion of oCCC achieved complete cytoreduction at primary debulking surgery and/or had lymphadenectomy performed; overall survival were...

Quality of pathology reports for advanced ovarian cancer: are we missing essential information? An audit of 479 pathology reports from the EORTC-GCG 55971/NCIC-CTG OV13 neoadjuvant trial

NARCIS (Netherlands)

Verleye, Leen; Ottevanger, Petronella B.; Kristensen, Gunnar B.; Ehlen, Tom; Johnson, Nick; van der Burg, Maria E. L.; Reed, Nick S.; Verheijen, René H. M.; Gaarenstroom, Katja N.; Mosgaard, Berit; Seoane, Jose M.; van der Velden, Jacobus; Lotocki, Robert; van der Graaf, Winette; Penninckx, Björn; Coens, Corneel; Stuart, Gavin; Vergote, Ignace

2011-01-01

To assess the quality of surgical pathology reports of advanced stage ovarian, fallopian tube and primary peritoneal cancer. This quality assurance project was performed within the EORTC-GCG 55971/NCIC-CTG OV13 study comparing primary debulking surgery followed by chemotherapy with neoadjuvant

Quality of pathology reports for advanced ovarian cancer

DEFF Research Database (Denmark)

Verleye, Leen; Ottevanger, Petronella B; Kristensen, Gunnar B

2011-01-01

To assess the quality of surgical pathology reports of advanced stage ovarian, fallopian tube and primary peritoneal cancer. This quality assurance project was performed within the EORTC-GCG 55971/NCIC-CTG OV13 study comparing primary debulking surgery followed by chemotherapy with neoadjuvant...

Quality of pathology reports for advanced ovarian cancer: are we missing essential information? An audit of 479 pathology reports from the EORTC-GCG 55971/NCIC-CTG OV13 neoadjuvant trial

NARCIS (Netherlands)

Verleye, L.I.A.; Ottevanger, P.B.; Kristensen, G.B.; Ehlen, T.; Johnson, N.; Burg, M.E. van der; Reed, N.S.; Verheijen, R.H.; Gaarenstroom, K.N.; Mosgaard, B.; Seoane, J.M.; Velden, J. Van der; Lotocki, R.; Graaf, W.T.A. van der; Penninckx, B.; Coens, C.; Stuart, G.; Vergote, I.

2011-01-01

OBJECTIVE: To assess the quality of surgical pathology reports of advanced stage ovarian, fallopian tube and primary peritoneal cancer. This quality assurance project was performed within the EORTC-GCG 55971/NCIC-CTG OV13 study comparing primary debulking surgery followed by chemotherapy with

Novel deployment of a covered duodenal stent in open surgery to facilitate closure of a malignant duodenal perforation

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Psaila Josephine

2009-10-01

Full Text Available Abstract Background Its a dilemma to attempt a palliative procedure to debulk the tumour and/or prevent future obstructive complications in a locally advanced intra abdominal malignancy. Case presentation A 38 year old Vietnamese man presented with a carcinoma of the colon which had invaded the gallbladder and duodenum with a sealed perforation of the second part of the duodenum. Following surgical exploration, it was evident that primary closure of the perforated duodenum was not possible due to the presence of unresectable residual tumour. Conclusion We describe a novel technique using a covered duodenal stent deployed at open surgery to aid closure of a malignant duodenal perforation.

Outpatient versus Inpatient Primary Cleft Lip and Palate Surgery: Analysis of Early Complications.

Science.gov (United States)

Kantar, Rami S; Cammarata, Michael J; Rifkin, William J; Plana, Natalie M; Diaz-Siso, J Rodrigo; Flores, Roberto L

2018-05-01

Fiscal constraints are driving shorter hospital lengths of stay. Outpatient primary cleft lip surgery has been shown to be safe, but outpatient primary cleft palate surgery remains controversial. This study evaluates outcomes following outpatient versus inpatient primary cleft lip and palate surgery. The American College of Surgeons National Surgical Quality Improvement Program Pediatric database was used to identify patients undergoing primary cleft lip and palate surgery between 2012 and 2015. Patient clinical factors and 30-day complications were compared for outpatient versus inpatient primary cleft lip and palate surgery. Univariate and multivariate analyses were performed. Three thousand one hundred forty-two patients were included in the primary cleft lip surgery group and 4191 in the primary cleft palate surgery group. Patients in the cleft lip surgery group with structural pulmonary abnormalities had a significantly longer hospital length of stay (β, 4.94; p = 0.001). Patients undergoing outpatient surgery had a significantly higher risk of superficial (OR, 1.99; p = 0.01) and deep wound dehiscence (OR, 2.22; p = 0.01), and were at a significantly lower risk of reoperation (OR, 0.36; p = 0.04) and readmission (OR, 0.52; p = 0.02). Outpatient primary cleft lip surgery is safe and has a complication profile similar to that of inpatient surgery. Outpatient primary cleft palate surgery is common practice in many U.S. hospitals and has a significantly higher rate of wound complications, and lower rates of reoperation and readmission. In properly selected patients, outpatient palatoplasty can be performed safely. Therapeutic, III.

Isolated pediatric hemihyperplasia requiring surgical debulking of the thigh

Directory of Open Access Journals (Sweden)

Benjamin D. Schultz

2015-02-01

Full Text Available Isolated Hemihyperplasia (IHH is a rare disorder that results in the enlargement of a portion of a limb, a complete limb or an entire half of an individual's body. We describe an 11 year-old girl with isolated hemihyperplasia of her right upper and lower extremities, breast, and vulvar region. A mass consisting of asymmetric enlargement and fatty infiltration of the right adductor compartment was first noticed at approximately 4 years of life and progressed dramatically to severely affect her gait. We surgically debulked the thigh and resected the excess skin to restore symmetry. The patient did well postoperatively, achieved excellent cosmesis, and restoration of gait.

[Routine fluoroscopic investigations after primary bariatric surgery].

Science.gov (United States)

Gärtner, D; Ernst, A; Fedtke, K; Jenkner, J; Schöttler, A; Reimer, P; Blüher, M; Schön, M R

2016-03-01

Staple line and anastomotic leakages are life-threatening complications after bariatric surgery. Upper gastrointestinal (GI) tract X-ray examination with oral administration of a water-soluble contrast agent can be used to detect leaks. The aim of this study was to evaluate the impact of routine upper GI tract fluoroscopy after primary bariatric surgery. Between January 2009 and December 2014 a total of 658 bariatric interventions were carried out of which 442 were primary bariatric operations. Included in this single center study were 307 sleeve gastrectomies and 135 Roux-en-Y gastric bypasses. Up to December 2012 upper GI tract fluoroscopy was performed routinely between the first and third postoperative days and the detection of leakages was evaluated. In the investigation period 8 leakages (2.6 %) after sleeve gastrectomy, 1 anastomotic leakage in gastrojejunostomy and 1 in jejunojejunostomy after Roux-en-Y gastric bypass occurred. All patients developed clinical symptoms, such as abdominal pain, tachycardia or fever. In one case the leakage was detected by upper GI fluoroscopy and in nine cases radiological findings were unremarkable. No leakages were detected in asymptomatic patients. Routine upper GI fluoroscopy is not recommended for uneventful postoperative courses after primary bariatric surgery.

Complications Following Primary and Revision Transsphenoidal Surgeries for Pituitary Tumors

Science.gov (United States)

Krings, James G.; Kallogjeri, Dorina; Wineland, Andre; Nepple, Kenneth G.; Piccirillo, Jay F.; Getz, Anne E.

2014-01-01

Objective This study aimed to determine the incidence of major complications following both primary and revision transsphenoidal pituitary surgery. Major complications included endocrinopathic, skull base, orbital, hemorrhagic and thromboembolic complications, respiratory failure, and death. Secondarily, this study aimed to examine factors associated with the occurrence of complications. Study Design Retrospective cohort analysis of California and Florida all-payer databases from 2005-2008. Methods The major complication rate following both primary and revision transsphenoidal pituitary surgery was calculated. Bivariate analyses were performed to investigate the relationship of patient characteristics with complication occurrence, and a multivariate model was constructed to determine risk factors associated with these complications. Results 5,277 primary cases and 192 revision cases met inclusion criteria. There was a non-significant absolute difference of 3.09% (95% CI −11.00 to 16.14) between the rate of complications following primary (n=443; 8.39%) and revision (n=22; 11.46%) surgeries. Multivariate analyses showed that patients with Medicare (OR=1.74; 95% CI 1.17 to 2.61), Medicaid (OR=2.13; 95% CI 1.59 to 2.86), or a malignant neoplasm (OR=3.10; 95% CI 1.62 to 5.93) were more likely to have complications. Conclusions The rate of major complications following transsphenoidal pituitary surgery is lower than earlier retrospective reports. The overall complication rate following revision surgery was not significantly different from primary surgery. Insurance status and a diagnosis of a malignant neoplasm were associated with a higher rate of complications. PMID:25263939

Annals of African Surgery July 2011 07.12.2011.indd

African Journals Online (AJOL)

andrew

malignant peripheral nerve sheath tumor -. MPNST Figure 5) (7). Palliative debulking is an option when this ... rather than surgical cure is the primary, achievable goal of most interven- ... school, and could not play with other children because of this de-.

Beta-blocker use and clinical outcomes after primary vascular surgery

DEFF Research Database (Denmark)

Høgh, A.; Lindholt, J.S.; Nielsen, Henrik

2013-01-01

To explore the associations between beta-blocker use and clinical outcomes (death, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction.......To explore the associations between beta-blocker use and clinical outcomes (death, hospitalisation with myocardial infarction (MI) or stroke, major amputation and recurrent vascular surgery) after primary vascular reconstruction....

The mortality after surgery in primary lung cancer

DEFF Research Database (Denmark)

Green, Anders; Hauge, Jacob; Iachina, Maria

2015-01-01

OBJECTIVES: The study has been performed to investigate the mortality within the first year after resection in patients with primary lung cancer, together with associated prognostic factors including gender, age, tumour stage, comorbidity, alcohol abuse, type of surgery and post-surgical complica......OBJECTIVES: The study has been performed to investigate the mortality within the first year after resection in patients with primary lung cancer, together with associated prognostic factors including gender, age, tumour stage, comorbidity, alcohol abuse, type of surgery and post...... included gender, age, comorbidity (Charlson comorbidity index), perioperative stage, type of resection, registered complications to surgery and alcohol abuse. RESULTS: The cumulative deaths after 30 days, 90 days, 180 days and 360 days were 72 (2.1%), 154 (4.6%), 239 (7.1%) and 478 (14.2%), respectively...... resection, which is conventionally considered a time window of relevance for the adverse outcome of surgery. Increased efforts should be made for optimizing the selection of patients suited for resection and for identifying patients at increased risk of death after resection. Furthermore, patients should...

Predictors of mortality within 1 year after primary ovarian cancer surgery

DEFF Research Database (Denmark)

Sjøland, Mette Ørskov; Iachina, Maria; Sørensen, Rikke Guldberg

2016-01-01

System. PARTICIPANTS: 2654 women who underwent surgery due to a diagnosis of primary ovarian cancer. OUTCOME MEASURES: Overall survival and predictors of mortality within 0-180 and 181-360 days after the primary surgery. Examined predictors were age, preoperative American Society of Anesthesiologists...

Primary care physician decision making regarding referral for bariatric surgery

DEFF Research Database (Denmark)

Stolberg, Charlotte Røn; Hepp, Nicola; Juhl, Anna Julie Aavild

2017-01-01

the decision to refer patients for surgery. Only 9% of the respondents indicated that bariatric surgery should be the primary treatment option for severe obesity in the future. Conclusion: Danish PCPs express severe concerns about surgical and medical complications following bariatric surgery. This might...

Two Blades-Up Runs Using the JetStream Navitus Atherectomy Device Achieve Optimal Tissue Debulking of Nonocclusive In-Stent Restenosis: Observations From a Porcine Stent/Balloon Injury Model.

Science.gov (United States)

Shammas, Nicolas W; Aasen, Nicole; Bailey, Lynn; Budrewicz, Jay; Farago, Trent; Jarvis, Gary

2015-08-01

To determine the number of runs with blades up (BU) using the JetStream Navitus to achieving optimal debulking in a porcine model of femoropopliteal artery in-stent restenosis (ISR). In this porcine model, 8 limbs were implanted with overlapping nitinol self-expanding stents. ISR was treated initially with 2 blades-down (BD) runs followed by 4 BU runs (BU1 to BU4). Quantitative vascular angiography (QVA) was performed at baseline, after 2 BD runs, and after each BU run. Plaque surface area and percent stenosis within the treated stented segment were measured. Intravascular ultrasound (IVUS) was used to measure minimum lumen area (MLA) and determine IVUS-derived plaque surface area. QVA showed that plaque surface area was significantly reduced between baseline (83.9%±14.8%) and 2 BD (67.7%±17.0%, p=0.005) and BU1 (55.4%±9.0%, p=0.005) runs, and between BU1 and BU2 runs (50.7%±9.7%, patherectomy. JetStream Navitus achieved optimal tissue debulking after 2 BD and 2 BU runs with no further statistical gain in debulking after the BU2 run. Operators treating ISR with JetStream Navitus may be advised to limit their debulking to 2 BD and 2 BU runs to achieve optimal debulking. © The Author(s) 2015.

Molteno3 Implantation as Primary Glaucoma Surgery

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Juha O. Välimäki

2014-01-01

Full Text Available Purpose. To determine the outcome of Molteno3 implantation as primary glaucoma surgery and to analyze the factors influencing the surgical outcome. Methods. This is a retrospective clinical study of 106 consecutive eyes (97 patients with no previous glaucoma surgery. Surgical failure was defined as an IOP > 21 mmHg or less than a 20% reduction below baseline, or IOP ≤ 5 mmHg, on two consecutive visits after 3 months follow-up, or reoperation for glaucoma or loss of light perception. Results. At the end of the follow-up (mean, 35 months; range, 12–71 months, the mean postoperative IOP (14.2 ± 4.4 mmHg was statistically significantly lower than the preoperative IOP (35.2 ± 9.7 mmHg (P<0.001. Life-table success rates were 97%, 94%, and 91% after follow-up of 12, 24, and 36 months, respectively. Success rate for an IOP ≤ 18 mmHg was 77% at the last visit. Success was not influenced by previous cataract surgery, sex, age, laser trabeculoplasty (LTP, preoperative IOP, or number of antiglaucoma medications. Forty-seven eyes had 66 postoperative complications. Conclusions. The primary Molteno3 implant provided significant IOP lowering with minimal and manageable complications in uncontrolled glaucoma. Neither previous cataract surgery nor LTP had any detrimental effect on surgical success.

Surgery of Primary Melanomas

Energy Technology Data Exchange (ETDEWEB)

Rutkowski, Piotr, E-mail: rutkowskip@coi.waw.pl; Zdzienicki, Marcin; Nowecki, Zbigniew I. [Soft Tissue/Bone Sarcoma and Melanoma Department, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw (Poland); Akkooi, Alexander C. J. van [Erasmus University Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)

2010-05-11

Surgery remains the mainstay of melanoma therapy, regardless of the tumor site. Only the early diagnosis combined with proper surgical therapy currently gives patients affected by this malignancy the chance for a full cure. The main goal of surgical therapy is to provide the local control of the disease and to secure long-term survival of the patient without reasonable functional and esthetic impairment. The recommended method of biopsy—excisional biopsy, as an initial diagnostic and, to some extent, therapeutic procedure—is performed under local anesthesia as an elliptical incision with visual clear margins of 1–3 mm and with some mm of subcutaneous tissue. The extent of radical excision of the primary tumor (or scar after excisional biopsy) is based on the histopathologic characteristics of the primary tumor and usually consists of 1–2 cm margins with primary closure. The philosophy behind conducted randomized clinical trials has been to find the most conservative surgical approach that is able to guarantee the same results as more demolitive treatment. This has been the background of the trials designed to define the correct margins of excision around a primary cutaneous melanoma. Much less definition can be dedicated to the surgical management of patients with non-cutaneous melanomas.

Surgery of Primary Melanomas

International Nuclear Information System (INIS)

Rutkowski, Piotr; Zdzienicki, Marcin; Nowecki, Zbigniew I.; Akkooi, Alexander C. J. van

2010-01-01

Surgery remains the mainstay of melanoma therapy, regardless of the tumor site. Only the early diagnosis combined with proper surgical therapy currently gives patients affected by this malignancy the chance for a full cure. The main goal of surgical therapy is to provide the local control of the disease and to secure long-term survival of the patient without reasonable functional and esthetic impairment. The recommended method of biopsy—excisional biopsy, as an initial diagnostic and, to some extent, therapeutic procedure—is performed under local anesthesia as an elliptical incision with visual clear margins of 1–3 mm and with some mm of subcutaneous tissue. The extent of radical excision of the primary tumor (or scar after excisional biopsy) is based on the histopathologic characteristics of the primary tumor and usually consists of 1–2 cm margins with primary closure. The philosophy behind conducted randomized clinical trials has been to find the most conservative surgical approach that is able to guarantee the same results as more demolitive treatment. This has been the background of the trials designed to define the correct margins of excision around a primary cutaneous melanoma. Much less definition can be dedicated to the surgical management of patients with non-cutaneous melanomas

Surgery of Primary Melanomas

Directory of Open Access Journals (Sweden)

Piotr Rutkowski

2010-05-01

Full Text Available Surgery remains the mainstay of melanoma therapy, regardless of the tumor site. Only the early diagnosis combined with proper surgical therapy currently gives patients affected by this malignancy the chance for a full cure. The main goal of surgical therapy is to provide the local control of the disease and to secure long-term survival of the patient without reasonable functional and esthetic impairment. The recommended method of biopsy—excisional biopsy, as an initial diagnostic and, to some extent, therapeutic procedure—is performed under local anesthesia as an elliptical incision with visual clear margins of 1–3 mm and with some mm of subcutaneous tissue. The extent of radical excision of the primary tumor (or scar after excisional biopsy is based on the histopathologic characteristics of the primary tumor and usually consists of 1–2 cm margins with primary closure. The philosophy behind conducted randomized clinical trials has been to find the most conservative surgical approach that is able to guarantee the same results as more demolitive treatment. This has been the background of the trials designed to define the correct margins of excision around a primary cutaneous melanoma. Much less definition can be dedicated to the surgical management of patients with non-cutaneous melanomas.

Primary Surgery vs Radiotherapy for Early Stage Oral Cavity Cancer.

Science.gov (United States)

Ellis, Mark A; Graboyes, Evan M; Wahlquist, Amy E; Neskey, David M; Kaczmar, John M; Schopper, Heather K; Sharma, Anand K; Morgan, Patrick F; Nguyen, Shaun A; Day, Terry A

2018-04-01

Objective The goal of this study is to determine the effect of primary surgery vs radiotherapy (RT) on overall survival (OS) in patients with early stage oral cavity squamous cell carcinoma (OCSCC). In addition, this study attempts to identify factors associated with receiving primary RT. Study Design Retrospective cohort study. Setting National Cancer Database (NCDB, 2004-2013). Subjects and Methods Reviewing the NCDB from 2004 to 2013, patients with early stage I to II OCSCC were identified. Kaplan-Meier estimates of survival, Cox regression analysis, and propensity score matching were used to examine differences in OS between primary surgery and primary RT. Multivariable logistic regression analysis was performed to identify factors associated with primary RT. Results Of the 20,779 patients included in the study, 95.4% (19,823 patients) underwent primary surgery and 4.6% (956 patients) underwent primary RT. After adjusting for covariates, primary RT was associated with an increased risk of mortality (adjusted hazard ratio [aHR], 1.97; 99% confidence interval [CI], 1.74-2.22). On multivariable analysis, factors associated with primary RT included age ≥70 years, black race, Medicaid or Medicare insurance, no insurance, oral cavity subsite other than tongue, clinical stage II disease, low-volume treatment facilities, and earlier treatment year. Conclusion Primary RT for early stage OCSCC is associated with increased mortality. Approximately 5% of patients receive primary RT; however, this percentage is decreasing. Patients at highest risk for receiving primary RT include those who are elderly, black, with public insurance, and treated at low-volume facilities.

FILAR I AL LYMPHEDEMA LOWER LIMB DEBULKING 34 CASES

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Baburao

2015-10-01

Full Text Available There are various treatment options in the management of filarial lymphedema of the lower extremities. The end point, regardless of the method adopted is a reduction of the girth of the limb, prevention of future increases in limb girth, prevention of recurrent episodes of streptococcal cellulitis; more important the treatment method used should not lead to any secondary problems that may far out shadow the primary co Majority of the methods adopted are mainly of the secondary prevention kind; very few of the procedures to date cure the disease condition. A few of the methods have been historically found to be more effective than the others; this may be real or apparent as the methodology of - reporting swelling in the lower limb may not have been consistent and there are too many variables to consider. This study seeks to evaluate the efficacy of one such treatment protocol for the management of filarial lymphedema of the lower limb 80 patients were admitted for filarial lymphedema of the lower limbs from 2005 to 2015 Of these 42 patients underwent surgical treatment; operative records for 8 of these patients was insufficient to analyse; among the remaining 34 patients 19 patients were unavailable for review. This left us a patient population of 15 for the final analysis . The surgical treatment of all of the 15 patients was identical, after preop preparation by using compression ba n dages to soften the edema along with a period of bed rest debulking of excess skin and subcutaneous tissue and primary closure was done. The intro operative application of Esmarch bandages helped in expelling fluid from the tissues and this ensured that closure was obtained with no tension at the margins. Patients were kept for at least 5 days post op before discharge; the routine use of compression crepe bandages postop along with bed rest ensured that we did not have a single case of skin necrosis or wound disruption in the postop period. All patients were given

Standardized FDG uptake as a prognostic variable and as a predictor of incomplete cytoreduction in primary advanced ovarian cancer

DEFF Research Database (Denmark)

Risum, Signe; Jakobsen, Annika Loft; Høgdall, Claus

2011-01-01

Abstract Introduction. In patients with advanced ovarian cancer undergoing preoperative PET/CT, we investigated the prognostic value of SUV in the primary tumor and we evaluated the value of SUV for predicting incomplete primary cytoreduction (macroscopic residual tumor). Material and methods. From...... debulking (no macroscopic residual tumor); median SUV(max) was 13.5 (range 2.5-39.0). Median follow-up was 30.2 months. At follow-up 57% (34/60) were alive and 43% (26/60) had died from ovarian cancer. SUV(max) in patients alive was not statistically different from SUV(max) in dead patients (p=0.......69), and SUV(max) was not correlated with the amount of residual tumor after surgery (p=0.19). Using univariate Cox regression analysis, residual tumor was a significant prognostic variable (p=0.001); SUV(max) was not a statistically significant prognostic variable (p=0.86). Discussion. FDG uptake (SUV...

Primary care physician decision making regarding referral for bariatric surgery: a national survey.

Science.gov (United States)

Stolberg, Charlotte Røn; Hepp, Nicola; Juhl, Anna Julie Aavild; B C, Deepti; Juhl, Claus B

2017-05-01

Bariatric surgery is the most effective treatment for severe obesity. It results in significant and sustained weight loss and reduces obesity-related co-morbidities. Despite an increasing prevalence of severe obesity, the number of bariatric operations performed in Denmark has decreased during the past years. This is only partly explained by changes in the national guidelines for bariatric surgery. The purpose of the cross-sectional study is to investigate referral patterns and possible reservations regarding bariatric surgery among Danish primary care physicians (PCPs). Primary care physicians in Denmark METHODS: A total of 300 Danish PCPs were invited to participate in a questionnaire survey regarding experiences with bariatric surgery, reservations about bariatric surgery, attitudes to specific patient cases, and the future treatment of severe obesity. Most questions required a response on a 5-point Likert scale (strongly disagree, disagree, neither agree nor disagree, agree, and strongly agree) and frequency distributions were calculated. 133 completed questionnaires (44%) were returned. Most physicians found that they had good knowledge about the national referral criteria for bariatric surgery. With respect to the specific patient cases, a remarkably smaller part of physicians would refer patients on their own initiative, compared with the patient's initiative. Fear of postoperative surgical complications and medical complications both influenced markedly the decision to refer patients for surgery. Only 9% of the respondents indicated that bariatric surgery should be the primary treatment option for severe obesity in the future. Danish PCPs express severe concerns about surgical and medical complications following bariatric surgery. This might, in part, result in a low rate of referral to bariatric surgery. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Major League pitching workload after primary ulnar collateral ligament reconstruction and risk for revision surgery.

Science.gov (United States)

Keller, Robert A; Mehran, Nima; Marshall, Nathan E; Okoroha, Kelechi R; Khalil, Lafi; Tibone, James E; Moutzouros, Vasilios

2017-02-01

Literature has attempted to correlate pitching workload with risk of ulnar collateral ligament (UCL) injury; however, limited data are available in evaluating workload and its relationship with the need for revision reconstruction in Major League Baseball (MLB) pitchers. We identified 29 MLB pitchers who underwent primary UCL reconstruction surgery and subsequently required revision reconstruction and compared them with 121 MLB pitchers who underwent primary reconstruction but did not later require revision surgery. Games pitched, pitch counts, and innings pitched were evaluated and compared for the seasons after returning from primary reconstruction and for the last season pitched before undergoing revision surgery. The difference in workload between pitchers who did and did not require revision reconstruction was not statistically significant in games pitched, innings pitched, and MLB-only pitch counts. The one significant difference in workload was in total pitch counts (combined MLB and minor league), with the pitchers who required revision surgery pitching less than those who did not (primary: 1413.6 pitches vs. revision: 959.0 pitches, P = .04). In addition, pitchers who required revision surgery underwent primary reconstruction at an early age (22.9 years vs. 27.3 years, P risk for injury after primary UCL reconstruction. However, correlations of risk may be younger age and less MLB experience at the time of the primary reconstruction. Copyright © 2017. Published by Elsevier Inc.

Early port-site metastasis during neoadjuvant chemotherapy in advanced stage ovarian cancer: report of two cases

OpenAIRE

Özmen, Batuhan; Şükür, Yavuz Emre; Atabekoglu, Cem Somer; Heper, Aylin Okçu; Sönmezer, Murat; Güngör, Mete

2011-01-01

Port-site metastases in gynecological malignancies subsequent to laparoscopy have been reported with an incidence of 1.1-16%. These metastases tend to be disappearing after primary debulking surgery and subsequent primary chemotherapy. Local resection, chemotherapy and/or radiotherapy have been defined in the management of these metastases with enhanced clinical success. However, in extremely rare cases these metastases were also defined very early during neoadjuvant chemotherapy. Herein, we ...

Feasibility of Helical Tomotherapy for Debulking Irradiation Before Stem Cell Transplantation in Malignant Lymphoma

International Nuclear Information System (INIS)

Chargari, Cyrus; Vernant, Jean-Paul; Tamburini, Jerome; Zefkili, Sofia; Fayolle, Maryse; Campana, Francois; Fourquet, Alain; Kirova, Youlia M.

2011-01-01

Purpose: Preliminary clinical experience has suggested that radiation therapy (RT) may be effectively incorporated into conditioning therapy before transplant for patients with refractory/relapsed malignant lymphoma. We investigated the feasibility of debulking selective lymph node irradiation before autologous and/or allogeneic stem cell transplantation (SCT) using helical tomotherapy (HT). Methods and Materials: Six consecutive patients with refractory malignant lymphoma were referred to our institution for salvage HT before SCT. All patients had been previously heavily treated but had bulky residual tumor despite chemotherapy (CT) intensification. Two patients had received previous radiation therapy. HT delivered 30-40 Gy in the involved fields (IF), using 6 MV photons, 2 Gy per daily fraction. Total duration of treatment was 28 to 35 days. Results: Using HT, doses to critical organs (heart, lungs, esophagu, and parotids) were significantly decreased and highly conformational irradiation could be delivered to all clinical target volumes. HT delivery was technically possible, even in patients with lesions extremely difficult to irradiate in other conditions or in patients with previous radiation therapy. No Grade 2 or higher toxicity occurred. Four months after the end of HT, 5 patients experienced complete clinical, radiologic, and metabolic response and were subsequently referred for SCT. Conclusions: By more effectively sparing critical organs, HT may contribute to improving the tolerance of debulking irradiation before allograft. Quality of life may be preserved, and doses to the heart may be decreased. This is particularly relevant in heavily treated patients who are at risk for subsequent heart disease. These preliminary results require further prospective assessment.

Trabectome surgery for primary and secondary open angle glaucomas.

Science.gov (United States)

Jordan, Jens F; Wecker, Thomas; van Oterendorp, Christian; Anton, Alexandra; Reinhard, Thomas; Boehringer, Daniel; Neuburger, Matthias

2013-12-01

In most forms of open angle glaucoma, the trabecular meshwork is the main barrier for aqueous humor outflow, causing elevated intraocular pressure (IOP). The Trabectome is a minimal invasive device for the surgical treatment of open angle glaucoma, particularly eliminating the juxtacanalicular meshwork. This study was conducted to compare the effectiveness and complication profile among different glaucoma subgroups. Single center prospective observational study. There were 557 consecutive eyes of 487 patients included in this study. Trabectome surgery was performed either alone or in combination with cataract surgery. Intraoperative and postoperative complications were documented systematically. Main outcome measures were IOP reduction over time and the preoperative and postoperative number of IOP-lowering medications. Due to subgroup sizes, only data from eyes with primary open angle glaucoma and pseudoexfoliation glaucoma were processed for statistical analysis. For the 261 eyes classified as primary open angle glaucoma, preoperative IOP was 24 ± 5.5 mmHg (mean ± SD) under 2.1 ± 1.3 IOP-lowering medications. After a mean follow-up of 204 ± 238 days, IOP was reduced to 18 ± 6.1 mmHg, and medication was reduced to 1.2 ± 1.1. For the 173 eyes classified as pseudoexfoliation glaucoma, after a mean follow-up of 200 ± 278 days, IOP was reduced from 25 ± 5.9 mmHg to 18 ± 8.2 mmHg, and medication was reduced from 2.0 ± 1.2 to 1.1 ± 1.1. A Cox proportional hazards model hinted forward superiority of the combined surgery cases (Trabectome + Phaco + intraocular lens) in comparison to Trabectome surgery only in phakic or pseudophakic eyes. No serious complications were observed. Minimal invasive glaucoma surgery with the Trabectome seems to be safe and effective. The subgroup analysis of different kinds of open angle glaucomas presented in this study may help in first-line patient selection. The lack of ocular surface alterations makes it a valuable addition to

Effect of surgery on cardiac structure and function in mild primary hyperparathyroidism

DEFF Research Database (Denmark)

Persson, Anita; Bollerslev, Jens; Rosen, Thord

2011-01-01

The cardiovascular (CV) risk profile is worsened in primary hyperparathyroidism (PHPT), and CV mortality is related to serum calcium levels. It is unknown whether CV mortality is increased in the most common form of PHPT and whether the increased CV risk is reversible after surgery.......The cardiovascular (CV) risk profile is worsened in primary hyperparathyroidism (PHPT), and CV mortality is related to serum calcium levels. It is unknown whether CV mortality is increased in the most common form of PHPT and whether the increased CV risk is reversible after surgery....

Local melanoma recurrences in the scar after limited surgery for primary tumor

DEFF Research Database (Denmark)

Drzewiecki, K T; Andersson, A P

1995-01-01

The clinical and histologic records of 46 consecutive patients were reviewed who during the period 1980-1993 had recurrence from melanoma in the scar after limited surgery for a skin tumor. They constituted about 50% of all patients admitted with local recurrence from melanoma during this period....... At reexamination of the primary tumors, 16 were found to be malignant melanomas and 9 were nevi (four atypical and five benign). Twenty-one were missing, 11 of which had never been set for histologic examination. The median thickness of nine measurable melanomas was 0.66 mm. The recurrences in scar consisted of 34...... recurrences in the form of a new primary in a scar following limited surgery supports the theory of limited field change around a primary melanoma. Furthermore, limited procedures for primary melanoma, if followed by a recurrence in the scar, worsen the prognosis....

Radiation therapy in recurrence of carcinoma of the uterine cervix after primary surgery

International Nuclear Information System (INIS)

Kim, Jin Hee; Kim, Ok Bae

2003-01-01

The purpose of this study was to evaluate treatment results in terms of the survival and failure patterns subsequent to radiation therapy in recurrent cervical cancer, following primary surgery. Between January 1990 and December 1999, 27 patients, with recurrent cervical cancer following primary surgery, were subsequently treated with radiation in the Department of Radiation Oncology, at the Keimyung University Dongsan Medical Center. Their median age was 48, ranging from 31 to 70 years old. With regard to the initial FIGO stage on presentation, 20 and 7 patients were stages I and II, respectively. Twenty three patients had squamous ceH carcinomas and 4 had adenocarcinomas. The time interval from the primary surgery to the recurrence ranged from 2 to 90 months with a median of 29 months. The recurrent sites were the vaginal cuff alone, the pelvic cavity and combined recurrence in 14, 9 and 4 patients, respectively. Radiation was performed, with external and vaginal intracavitary radiation in 13 patients, external radiation alone in 13 and vaginal intracavitary radiation alone in another one. The median follow-up period was 55 months, ranging from 6 to 128 months. The five year disease free survival (5y DFS) and five year overall survival (5y OS) rates were 68.2 and 71.9%, respectively. There was a marginal statistically significant difference in the 5y DFS in relation to the recurrent site (5y DFS, 85.7% in vaginal cuff recurrence alone, 53.3% in pelvic cavity recurrence, p=0.09). There was no difference in the survival according to the time interval between the primary surgery and a recurrence. There was only a 7% local failure rate in the patients with a vaginal cuff recurrence. The major failure patterns were local failure in the patients with pelvic cavity recurrence, and distant failure in the patients with a combined recurrence. There were no complications above grade 3 after the radiation therapy. Radiation therapy was safe and effective treatment for a

REVIEW OF NASA FIBROMYXOMA: Aggressive Behaviour? (Case Report

Directory of Open Access Journals (Sweden)

Rr. Suzy Indharti

2015-12-01

Full Text Available Background: Myxomas are rare benign tumors arising from mesenchymal tissues throughout the body. These tumors are usually seen in the atrium of the heart and the jawbone. Involvement of the skull base with intracranial extension is extremely rare, and only a few cases of primary intracranial myxomas have been described in the literature. This article presents a rare case of primary myxoma of the nasal bone. Methods: The patient underwent a skull base surgery with a pre-diagnosis of possible fibromyxomas. The tumor pathology revealed a diagnosis of myxoma with bone and meningeal involvement. Despite the debulking surgery, the tumor showed a local recurrence in five month. A second debulking surgery in piece meal was required. In the article, the etiology, histological and radiological findings as well as treatment options of this rare entity were briefly discussed under the highlights of the relevant literature. Such a localization and intracranial extension of myxomas is extremely unusual in clinical practice; the diagnosis therefore requires a high degree of suspicion and detailed histopathological examination. The differential diagnosis frequently includes chondrosarcomas, chordoma, metastatic tumors of the skull, hemangiopericytoma, meningioma and other neoplasms of the dura and skull base in this location.

Ovarian Cancer and Comorbidity

DEFF Research Database (Denmark)

Noer, Mette Calundann; Sperling, Cecilie Dyg; Ottesen, Bent

2017-01-01

OBJECTIVES: Comorbidity influences survival in ovarian cancer, but the causal relations between prognosis and comorbidity are not well characterized. The aim of this study was to investigate the associations between comorbidity, system delay, the choice of primary treatment, and survival in Danish...... ovarian cancer patients. METHODS: This population-based study was conducted on data from 5317 ovarian cancer patients registered in the Danish Gynecological Cancer Database. Comorbidity was classified according to the Charlson Comorbidity Index and the Ovarian Cancer Comorbidity Index. Pearson χ test...... and multivariate logistic regression analyses were used to investigate the association between comorbidity and primary outcome measures: primary treatment ("primary debulking surgery" vs "no primary surgery") and system delay (more vs less than required by the National Cancer Patient Pathways [NCPPs]). Cox...

Results of primary versus recurrent surgery to treat stress urinary incontinence in women

NARCIS (Netherlands)

van der Doelen, Maarten J; Withagen, Mariëlla I J; Vierhout, Mark E; Heesakkers, John P F A

INTRODUCTION AND HYPOTHESIS: We compared cure rates and complication rates in patients who had undergone primary or recurrent (secondary) surgery for stress urinary incontinence (SUI). METHODS: A retrospective cohort study that included patients who underwent surgery to treat SUI in a tertiary

Results of primary versus recurrent surgery to treat stress urinary incontinence in women

NARCIS (Netherlands)

Doelen, M.J. van der; Withagen, M.I.J.; Vierhout, M.E.; Heesakkers, J.P.F.A.

2015-01-01

INTRODUCTION AND HYPOTHESIS: We compared cure rates and complication rates in patients who had undergone primary or recurrent (secondary) surgery for stress urinary incontinence (SUI). METHODS: A retrospective cohort study that included patients who underwent surgery to treat SUI in a tertiary

Primary Endoscopic Transnasal Transsphenoidal Surgery for Giant Pituitary Adenoma.

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Kuo, Chao-Hung; Yen, Yu-Shu; Wu, Jau-Ching; Chang, Peng-Yuan; Chang, Hsuan-Kan; Tu, Tsung-Hsi; Huang, Wen-Cheng; Cheng, Henrich

2016-07-01

Giant pituitary adenoma (>4 cm) remains challenging because the optimal surgical approach is uncertain. Consecutive patients with giant pituitary adenoma who underwent endoscopic transnasal transsphenoidal surgery (ETTS) as the first and primary treatment were retrospectively reviewed. Inclusion criteria were tumor diameter ≥4 cm in at least 1 direction, and tumor volume ≥10 cm(3). Exclusion criteria were follow-ups surgery. Residual and recurrent tumors (n = 30) were managed with 1 of the following: Gamma Knife radiosurgery (GKRS), reoperation (redo ETTS), both GKRS and ETTS, medication, conventional radiotherapy, or none. At last follow-up, most of the patients had favorable outcomes, including 8 (21.1%) who were cured and 29 (76.3%) who had a stable residual condition without progression. Only 1 (2.6%) had late recurrence at 66 months after GKRS. The overall progression-free rate was 97.4%, with few complications. In this series of giant pituitary adenoma, primary (ie, the first) ETTS yielded complete resection and cure in 21.1%. Along with adjuvant therapies, including GKRS, most patients (97.4%) were stable and free of disease progression. Therefore, primary ETTS appeared to be an effective surgical approach for giant pituitary adenoma. Copyright © 2016 Elsevier Inc. All rights reserved.

Debulking Atherectomy in the Peripheral Arteries: Is There a Role and What is the Evidence?

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Katsanos, Konstantinos; Spiliopoulos, Stavros; Reppas, Lazaros; Karnabatidis, Dimitris

2017-07-01

Traditional percutaneous balloon angioplasty and stent placement is based on mechanical plaque disruption and displacement within the arterial wall. On the contrary, transcatheter atherectomy achieves atherosclerotic plaque clearance by means of directional plaque excision or rotational plaque removal or laser plaque ablation. Debulking atherectomy may allow for a more uniform angioplasty result at lower pressures with consequently less vessel barotrauma and improved luminal gain, thereby decreasing the risk of plaque recoil and dissection that may require permanent metal stenting. It has been also argued that atherectomy may disrupt the calcium barrier and optimize drug transfer and delivery in case of drug-coated balloon applications. The authors discuss the various types of atherectomy devices available in clinical practice to date and critically appraise their mode of action as well as relevant published data in each case. Overall, amassed randomized and observational evidence indicates that percutaneous atherectomy of the femoropopliteal and infrapopliteal arteries may achieve high technical success rates and seems to lessen the frequency of bailout stenting, however, at the expense of increased risk of peri-procedural distal embolization. Long-term clinical outcomes reported to date do not support the superiority of percutaneous atherectomy over traditional balloon angioplasty and stent placement in terms of vessel patency or limb salvage. The combination of debulking atherectomy and drug-coated balloons has shown promise in early studies, especially in the treatment of more complex lesions. Unanswered questions and future perspectives of this continuously evolving endovascular technology as part of a broader treatment algorithm are discussed.

Risk factors for treatment failure in surgery for primary hyperparathyroidism

DEFF Research Database (Denmark)

Madsen, Anders Rørbæk; Rasmussen, Lars; Godballe, Christian

2016-01-01

Surgery for primary hyperparathyroidism (pHPT) has a high cure-rate and few complications. Preoperative localization procedures have permitted a dramatic shift from routine bilateral exploration to focused, minimally invasive procedures. At Odense University Hospital, Denmark, the introduction...... University hospital, Denmark, was analyzed. A shift in strategy was made in 2006 and at the same time new surgeons started training in parathyroid surgery. Biochemical-, clinical- and follow-up data were analyzed. Overall cure-rate was 90.7 %. Complication rates were 1.1 % for hemorrhage, 1.1 % for wound...

The use of intraoperative computed tomography navigation in pituitary surgery promises a better intraoperative orientation in special cases

Directory of Open Access Journals (Sweden)

Stefan Linsler

2016-01-01

Full Text Available Objective: The safety of endoscopic skull base surgery can be enhanced by accurate navigation in preoperative computed tomography (CT and magnetic resonance imaging (MRI. Here, we report our initial experience of real-time intraoperative CT-guided navigation surgery for pituitary tumors in childhood. Materials and Methods: We report the case of a 15-year-old girl with a huge growth hormone-secreting pituitary adenoma with supra- and perisellar extension. Furthermore, the skull base was infiltrated. In this case, we performed an endonasal transsphenoidal approach for debulking the adenoma and for chiasma decompression. We used an MRI neuronavigation (Medtronic Stealth Air System which was registered via intraoperative CT scan (Siemens CT Somatom. Preexisting MRI studies (navigation protocol were fused with the intraoperative CT scans to enable three-dimensional navigation based on MR and CT imaging data. Intraoperatively, we did a further CT scan for resection control. Results: The intraoperative accuracy of the neuronavigation was excellent. There was an adjustment of <1 mm. The navigation was very helpful for orientation on the destroyed skull base in the sphenoid sinus. After opening the sellar region and tumor debulking, we did a CT scan for resection control because the extent of resection was not credible evaluable in this huge infiltrating adenoma. Thereby, we were able to demonstrate a sufficient decompression of the chiasma and complete resection of the medial part of the adenoma in the intraoperative CT images. Conclusions: The use of intraoperative CT/MRI-guided neuronavigation for transsphenoidal surgery is a time-effective, safe, and technically beneficial technique for special cases.

Dermis-Fat Graft in Children as Primary and Secondary Orbital Implant.

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Quaranta-Leoni, Francesco M; Sposato, Sabrina; Raglione, Pietro; Mastromarino, Angelo

2016-01-01

To report the experience with the use of dermis-fat graft in the pediatric population and to evaluate the outcome of this procedure as a primary or secondary orbital implant. Case series. Analysis of the clinical charts of 22 patients. Age at the time of surgery ranged from 2.1 to 13 years. Three patients affected were submitted to evisceration with primary dermis-fat graft. Six patients had explantation of exposed implants and a replacement with a dermis-fat graft. Three patients had a dermis-fat graft to repair contracted sockets. Ten patients were affected by congenital anophthalmia: 4 patients had a primary dermis-fat graft, 6 patients had a removal of a socket expander, or an orbital spherical expander, or pellet expanders and a replacement with a dermis-fat graft. This study adheres to the principles outlined in the Declaration of Helsinki. The patients' follow up ranged between 2.5 and 8 years. Only 1 child who had a primary dermis-fat graft experienced excessive growth of the implant, managed by surgical debulking. In the end, all the patients showed satisfactory orbital volume along with adequate fornices. The dermis-fat graft as a primary implant may be useful in children with severe scleromalacia or following ocular trauma. It is a suitable option in children affected by congenital anophthalmia as it helps continued socket expansion. It can also be considered in the pediatric population to address the volume deficit following explantation of exposed implants and in contracted sockets.

The value of contrast-enhanced laparoscopic ultrasound during robotic-assisted surgery for primary colorectal cancer

DEFF Research Database (Denmark)

Ellebaek, Signe Bremholm; Fristrup, Claus Wilki; Pless, Torsten

2018-01-01

AIM: The aim of this study was to assess the potential clinical value of contrast enhanced laparoscopic ultrasonography (CE-LUS) as a screening modality for liver metastases during robotic assisted surgery for primary colorectal cancer (CRC). METHOD: A prospective, descriptive (feasibility) study...... including 50 consecutive patients scheduled for robotic assisted surgery for primary CRC. CE-LUS was performed by 2 experienced specialists. Only patients without metastatic disease were included. Follow-up was obtained with contrast-enhanced CT imaging at 3 and 12 months postoperatively. RESULTS: Fifty......-up revealed no liver metastasis in any of the patients. CONCLUSION: CE-LUS did not increase the detection rate of occult liver metastasis during robotic assisted primary CRC surgery. The use of CE-LUS as a screening modality for detection of liver metastasis cannot be recommended based on this study...

Failed anterior cruciate ligament reconstruction: analysis of factors leading to instability after primary surgery.

Science.gov (United States)

Ma, Yong; Ao, Ying-Fang; Yu, Jia-Kuo; Dai, Ling-Hui; Shao, Zhen-Xing

2013-01-01

Revision anterior cruciate ligament (ACL) surgery can be expected to become more common as the number of primary reconstruction keeps increasing. This study aims to investigate the factors causing instability after primary ACL reconstruction, which may provide an essential scientific base to prevent surgical failure. One hundred and ten revision ACL surgeries were performed at our institute between November 2001 and July 2012. There were 74 men and 36 women, and the mean age at the time of revision was 27.6 years (range 16 - 56 years). The factors leading to instability after primary ACL reconstruction were retrospectively reviewed. Fifty-one knees failed because of bone tunnel malposition, with too anterior femoral tunnels (20 knees), posterior wall blowout (1 knee), vertical femoral tunnels (7 knees), too posterior tibial tunnels (12 knees), and too anterior tibial tunnels (10 knees). There was another knee performed with open surgery, where the femoral tunnel was drilled through the medial condyle and the tibial tunnel was too anterior. Five knees were found with malposition of the fixation. One knee with allograft was suspected of rejection and a second surgery had been made to take out the graft. Three knees met recurrent instability after postoperative infection. The other factors included traumatic (48 knees) and unidentified (12 knees). Technical errors were the main factors leading to instability after primary ACL reconstructions, while attention should also be paid to the risk factors of re-injury and failure of graft incorporation.

Electronic brachytherapy management of atypical fibroxanthoma: report of 8 lesions

Directory of Open Access Journals (Sweden)

Stephen Doggett

2017-01-01

Full Text Available Purpose : To evaluate the suitability of treating atypical fibroxanthoma (AFX, an uncommon skin malignancy, with electronic brachytherapy. Material and methods : From Feb 2013 to Sep 2014, we were referred a total of 8 cases of AFX in 7 patients, all involving the scalp. All of them were treated with electronic brachytherapy 50 Kev radiations (Xoft Axxent®, Fremont, California. All lesions received 40 Gy in two fractions per week with 5mm margins. Results : At a median follow-up of 23.7 months, the local recurrence rate is 12.5%. The single lesion that failed was not debulked surgically prior to electronic brachytherapy. Conclusions : To our knowledge, this is the first report in the literature on the use of radiation therapy as curative primary treatment for AFX. No contraindication to the use of radiations is found in the literature, with surgery being the sole treatment for AFX noted. Our recurrence rate is 0% for debulked lesions. Risk of recurrence is mitigated with surgical debulking prior to brachytherapy. Electronic brachytherapy appears to be a safe and effective treatment for debulked AFX. Multiple excisions, skin grafting, and wound care can be avoided in elderly patients by the use of electronic brachytherapy.

Effect of surgery on cardiovascular risk factors in mild primary hyperparathyroidism

DEFF Research Database (Denmark)

Bollerslev, Jens; Rosen, Thord; Mollerup, Charlotte

2009-01-01

CONTEXT: Mild primary hyperparathyroidism (pHPT) seems to have a good prognosis, and indications for active treatment (surgery) are widely discussed. The extraskeletal effects of PTH, such as insulin resistance, arterial hypertension, and cardiovascular (CV) risk, may however be reversible...

Cytoreductive nephrectomy vs medical therapy as initial treatment: a rational approach to the sequence question in metastatic renal cell carcinoma.

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Spiess, Philippe E; Fishman, Mayer N

2010-10-01

Renal cell carcinoma (RCC) can be considered as two distinct entities: localized and metastatic disease. We conducted a review of the scientific literature published within the past decade pertaining to cytoreductive nephrectomy for metastatic RCC. Retrospective data and historical prospective series have demonstrated the survival benefit of debulking nephrectomy in well-selected RCC patients. New medical therapies, including vascular endothelial growth factor and mTOR pathway blocking drugs, are active biological agents, with survival improvement and potential regression of metastatic and primary tumors. Our current therapeutic challenge is the optimal integration of multimodal therapy consisting of systemic therapy and surgery including cytoreductive nephrectomy, debulking, and metastasectomy. Empiric data to guide this decision are limited. The decision concerning whether medical or surgical therapy should be the primary treatment approach selected must be made on an individual basis, taking into account patient performance status, clinical parameters, and physician expertise and recommendations, thus making each case a unique therapeutic challenge.

Dynamic muscle O2 saturation response is impaired during major non-cardiac surgery despite goal-directed haemodynamic therapy.

Science.gov (United States)

Feldheiser, A; Hunsicker, O; Kaufner, L; Köhler, J; Sieglitz, H; Casans Francés, R; Wernecke, K-D; Sehouli, J; Spies, C

2016-03-01

Near-infrared spectroscopy combined with a vascular occlusion test (VOT) could indicate an impairment of microvascular reactivity (MVR) in septic patients by detecting changes in dynamic variables of muscle O2 saturation (StO2). However, in the perioperative context the consequences of surgical trauma on dynamic variables of muscle StO2 as indicators of MVR are still unknown. This study is a sub-analysis of a randomised controlled trial in patients with metastatic primary ovarian cancer undergoing debulking surgery, during which a goal-directed haemodynamic algorithm was applied using oesophageal Doppler. During a 3 min VOT, near-infrared spectroscopy was used to assess dynamic variables arising from changes in muscle StO2. At the beginning of surgery, values of desaturation and recovery slope were comparable to values obtained in healthy volunteers. During the course of surgery, both desaturation and recovery slope showed a gradual decrease. Concomitantly, the study population underwent a transition to a surgically induced systemic inflammatory response state shown by a gradual increase in norepinephrine administration, heart rate, and Interleukin-6, with a peak immediately after the end of surgery. Higher rates of norepinephrine and a higher heart rate were related to a faster decline in StO2 during vascular occlusion. Using near-infrared spectroscopy combined with a VOT during surgery showed a gradual deterioration of MVR in patients treated with optimal haemodynamic care. The deterioration of MVR was accompanied by the transition to a surgically induced systemic inflammatory response state. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

Complete remission of recalcitrant genital warts with a combination approach of surgical debulking and oral isotretinoin in a patient with systemic lupus erythematosus.

Science.gov (United States)

Yew, Yik Weng; Pan, Jiun Yit

2014-01-01

Genital warts in immunocompromised patients can be extensive and recalcitrant to treatment. We report a case of recalcitrant genital warts in a female patient with systemic lupus erythematosus (SLE), who achieved complete remission with a combination approach of surgical debulking and oral isotretinoin at an initial dose of 20 mg/day with a gradual taper of dose over 8 months. She had previously been treated with a combination of topical imiquimod cream and regular fortnightly liquid nitrogen. Although there was partial response, there was no complete clearance. Her condition worsened after topical imiquimod cream was stopped because of her pregnancy. She underwent a combination approach of surgical debulking and oral isotretinoin after her delivery and achieved full clearance for more than 2 years duration. Oral isotretinoin, especially in the treatment of recalcitrant genital warts, is a valuable and feasible option when other more conventional treatment methods have failed or are not possible. It can be used alone or in combination with other local or physical treatment methods. © 2013 Wiley Periodicals, Inc.

Psychological, behavioral, and weight-related aspects of patients undergoing reoperative bariatric surgery after gastric band: comparison with primary surgery patients.

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Conceição, Eva; Pinto-Bastos, Ana; de Lourdes, Marta; Brandão, Isabel; Teixeira, Cristina; Machado, Paulo P P

2018-02-15

Patients experiencing insufficient weight loss or weight regain in their first bariatric surgery may represent a high-risk group with greater problematic eating and general psychopathology levels, which may compromise the success of a reoperative procedure. This study seeks to describe and compare disordered eating-related psychological and behavioral features of primary and reoperative surgery candidates after gastric band. Hospital center and university in Portugal. The baseline (preoperative) data from a longitudinal observational study are presented. Patients were interviewed by trained psychologists to identify binge-eating episodes and grazing and responded to a set of self-report measures: disordered eating, grazing, negative urgency, depression, anxiety, and stress. Two hundred twenty-five patients were undergoing primary surgery, and 166 were undergoing reoperative (REOP group) surgery. The groups did not differ in body mass index preoperatively, but the REOP group had greater weight suppression (t 387 = -5.35, P = .001), higher highest (t 387 = -3.40, P = .001) and lower lowest body mass index (t 381 = 2.22, P = .03). The main reasons for reoperative surgery were weight regain/poor weight loss (42.8%) or medical complications (32.5%). REOP patients with objective binge eating reported a higher frequency of these episodes (t 47 = 2.15, P = .04). No significant difference was found for the self-report measures assessed (only shape concern was higher for REOP group, F 1,216 = 8.30, Psurgeries, the differences in binge eating and weight-related variables may associate with postoperative difficulties. The link between binge eating, weight suppression, and weight gain found in other samples suggests that patients undergoing reoperative surgery may be at increased risk for poor weight outcomes. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Identification of risk factors for postoperative dysphagia after primary anti-reflux surgery.

Science.gov (United States)

Tsuboi, Kazuto; Lee, Tommy H; Legner, András; Yano, Fumiaki; Dworak, Thomas; Mittal, Sumeet K

2011-03-01

Transient postoperative dysphagia is not uncommon after antireflux surgery and usually runs a self-limiting course. However, a subset of patients report long-term dysphagia. The purpose of this study was to determine the risk factors for persistent postoperative dysphagia at 1 year after surgery. All patients who underwent antireflux surgery were entered into a prospectively maintained database. After obtaining institutional review board approval, the database was queried to identify patients who underwent primary antireflux surgery and were at least 1 year from surgery. Postoperative severity of dysphagia was evaluated using a standardized questionnaire (scale 0-3). Patients with scores of 2 or 3 were defined as having significant dysphagia. A total of 316 consecutive patients underwent primary antireflux surgery by a single surgeon. Of these, 219 patients had 1 year postoperative symptom data. Significant postoperative dysphagia at 1 year was reported by 19 (9.1%) patients. Thirty-eight patients (18.3%) required postoperative dilation for dysphagia. Multivariate logistic regression analysis identified preoperative dysphagia (odds ratio (OR), 4.4; 95% confidence interval (CI), 1.2-15.5; p = 0.023) and preoperative delayed esophageal transit by barium swallow (OR, 8.2; 95% CI, 1.6-42.2; p = 0.012) as risk factors for postoperative dysphagia. Female gender was a risk factor for requiring dilation during the early postoperative period (OR, 3.6; 95% CI, 1.3-10.2; p = 0.016). No correlations were found with preoperative manometry. There also was no correlation between a need for early dilation and persistent dysphagia at 1 year of follow-up (p = 0.109). Patients with preoperative dysphagia and delayed esophageal transit on preoperative contrast study were significantly more likely to report moderate to severe postoperative dysphagia 1 year after antireflux surgery. This study confirms that the manometric criteria used to define esophageal dysmotility are not reliable

Early and late physical and psychosocial effects of primary surgery in patients with oral and oropharyngeal cancers

DEFF Research Database (Denmark)

Mortensen, Annelise; Jarden, Mary

2016-01-01

The purpose of this systematic review is to explore early and late physical and psychosocial effects of primary surgery for oral and oropharyngeal cancers and to investigate the factors that influence these effects. PubMed, Cinahl, and PsycInfo were searched for studies concerning patients...... diagnosed with oral and oropharyngeal cancers and treated with primary surgery and which followed the treatment trajectory from time of diagnosis to 10 years after surgery; these studies reported the quantitative assessments and qualitative experiences of the patient's physical and psychosocial well...... in this review was 3386; of these, 1996 were treated by surgery alone and 1390 with combined surgery and adjuvant radiation therapy and/or chemotherapy. The studies showed that because of the nature of their disease, patients are negatively affected by the different types of surgical treatment for oral...

Nomogram for 30-day morbidity after primary cytoreductive surgery for advanced stage ovarian cancer.

Science.gov (United States)

Nieuwenhuyzen-de Boer, G M; Gerestein, C G; Eijkemans, M J C; Burger, C W; Kooi, G S

2016-01-01

Extensive surgical procedures to achieve maximal cytoreduction in patients with advanced stage epithelial ovarian cancer (EOC) are inevitably associated with postoperative morbidity and mortality. This study aimed to identify preoperative predictors of 30-day morbidity after primary cytoreductive surgery for advanced stage EOC and to develop a nomogram for individual risk assessment. Patients in The Netherlands who underwent primary cytoreductive surgery for advanced stage EOC between January 2004 and December 2007. All peri- and postoperative complications within 30 days after surgery were registered and classified. To investigate predictors of 30-day morbidity, a Cox proportional hazard model with backward stepwise elimination was utilized. The identified predictors were entered into a nomogram. The main outcome was to identify parameters that predict operative risk. 293 patients entered the study protocol. Optimal cytoreduction was achieved in 136 (46%) patients. Thirty-day morbidity was seen in 99 (34%) patients. Morbidity could be predicted by age (p = 0.033; OR 1.024), preoperative hemoglobin (p = 0.194; OR 0.843), and WHO performance status (p = 0.015; OR 1.821) with a optimism-corrected c-statistic of 0.62. Determinants co-morbidity status, serum CA125 level, platelet count, and presence of ascites were comparable in both groups. Thirty-day morbidity after primary cytoreductive surgery for advanced stage EOC could be predicted by age, hemoglobin, and WHO performance status. The generated nomogram could be valuable for predicting operative risk in the individual patient.

Timing of surgery with regard to the menstrual cycle in women with primary breast cancer.

Science.gov (United States)

Badwe, R A; Mittra, I; Havaldar, R

1999-10-01

There is sufficient evidence to support both the hormonal influence on the outcome of breast cancer surgery and the SDA hypothesis. The SDA model produces a paradigm shift in the understanding of the natural history of breast cancer. It offers opportunities to try modifying a tumor's biological potential for metastasis (e.g., by tamoxifen, progesterone, antiprotease, or angiostatin) in the neoadjuvant setting. It continues to support the beneficial effects of detection and surgery early in the natural history of disease. It would be worthwhile to plan a trial comparing standard practice (unplanned surgery as the patient enrolls) with surgery during the luteal phase of the menstrual cycle in premenopausal women. Another possibility, based on studies of circulating progesterone, would be to compare primary progesterone treatment (for 4 to 10 days before surgery) with standard practice. Such a trial of primary progesterone is already under way, conducted by the Indian Breast Group. More than 200 patients have enrolled so far. The details of the trial are available from Clinical Research Secretariat, Tata Memorial Centre, Parel, Mumbai, India (e mail: tmho3@bom2.vsnl.in).

Positron emission tomography (PET) and magnetic resonance imaging (MRI) for assessing tumour resectability in advanced epithelial ovarian, fallopian tube and/or primary peritoneal cancer

NARCIS (Netherlands)

Hoogendam, Jacob P.; Roze, Joline F.; van de Wetering, Fleur T.; Spijker, René; Verleye, Leen; Vlayen, Joan; Veldhuis, Wouter B.; Scholten, Rob J P M; Zweemer, RP

2017-01-01

This is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: To assess the diagnostic test accuracy of PET(-CT), conventional and diffusion-weighted MRI as an replacement or an add-on to abdominal CT, for predicting tumour resectability at primary debulking

Sex, race, and consideration of bariatric surgery among primary care patients with moderate to severe obesity.

Science.gov (United States)

Wee, Christina C; Huskey, Karen W; Bolcic-Jankovic, Dragana; Colten, Mary Ellen; Davis, Roger B; Hamel, Marybeth

2014-01-01

Bariatric surgery is one of few obesity treatments to produce substantial weight loss but only a small proportion of medically-eligible patients, especially men and racial minorities, undergo bariatric surgery. To describe primary care patients' consideration of bariatric surgery, potential variation by sex and race, and factors that underlie any variation. Telephone interview of 337 patients with a body mass index or BMI > 35 kg/m(2) seen at four diverse primary care practices in Greater-Boston. Patients' consideration of bariatric surgery. Of 325 patients who had heard of bariatric surgery, 34 % had seriously considered surgery. Men were less likely than women and African Americans were less likely than Caucasian patients to have considered surgery after adjustment for sociodemographics and BMI. Comorbid conditions did not explain sex and racial differences but racial differences dissipated after adjustment for quality of life (QOL), which tended to be higher among African American than Caucasian patients. Physician recommendation of bariatric surgery was independently associated with serious consideration for surgery [OR 4.95 (95 % CI 2.81-8.70)], but did not explain variation in consideration of surgery across sex and race. However, if recommended by their doctor, men were as willing and African American and Hispanic patients were more willing to consider bariatric surgery than their respective counterparts after adjustment. Nevertheless, only 20 % of patients reported being recommended bariatric surgery by their doctor and African Americans and men were less likely to receive this recommendation; racial differences in being recommended surgery were also largely explained by differences in QOL. High perceived risk to bariatric surgery was the most commonly cited barrier; financial concerns were uncommonly cited. Single geographic region; examined consideration and not who eventually proceeded with bariatric surgery. African Americans and men were less likely to

The effect of surgery and radiotherapy on outcome of anaplastic thyroid carcinoma.

Science.gov (United States)

Pierie, Jean-Pierre E N; Muzikansky, Alona; Gaz, Randall D; Faquin, William C; Ott, Mark J

2002-01-01

Anaplastic thyroid carcinoma (ATC) is an aggressive rare tumor. We analyzed our experience for prognosis and the effect of surgery and radiotherapy on patients with ATC. We conducted a retrospective review of all patients (n = 67) with ATC treated at a tertiary care center from 1969 to 1999. Survivor median follow-up was 51 months. Tumor and patient characteristics and therapy were assessed for effect on survival by multivariate analysis. Patients presented with a neck mass (99%), change of voice (51%), dysphagia (33%), and dyspnea (28%). Surgery was performed in 44 of 67 patients, with 12 complete resections. The 6-month and 1- and 3-year survival rates were 92%, 92%, and 83% after complete resection; 53%, 35%, and 0% after debulking; and 22%, 4%, and 0% after no resection, respectively (P 45 Gy improved survival as compared with a lower dose (P = .02). Multivariate analysis showed that age 45 Gy improves outcome.

Red Blood Cell Transfusion Need for Elective Primary Posterior Lumbar Fusion in A High-Volume Center for Spine Surgery

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Ristagno, Giuseppe; Beluffi, Simonetta; Tanzi, Dario; Belloli, Federica; Carmagnini, Paola; Croci, Massimo; D’Aviri, Giuseppe; Menasce, Guido; Pastore, Juan C.; Pellanda, Armando; Pollini, Alberto; Savoia, Giorgio

2018-01-01

(1) Background: This study evaluated the perioperative red blood cell (RBC) transfusion need and determined predictors for transfusion in patients undergoing elective primary lumbar posterior spine fusion in a high-volume center for spine surgery. (2) Methods: Data from all patients undergoing spine surgery between 1 January 2014 and 31 December 2016 were reviewed. Patients’ demographics and comorbidities, perioperative laboratory results, and operative time were analyzed in relation to RBC transfusion. Multivariate logistic regression analysis was performed to identify the predictors of transfusion. (3) Results: A total of 874 elective surgeries for primary spine fusion were performed over the three years. Only 54 cases (6%) required RBC transfusion. Compared to the non-transfused patients, transfused patients were mainly female (p = 0.0008), significantly older, with a higher ASA grade (p = 0.0002), and with lower pre-surgery hemoglobin (HB) level and hematocrit (p < 0.0001). In the multivariate logistic regression, a lower pre-surgery HB (OR (95% CI) 2.84 (2.11–3.82)), a higher ASA class (1.77 (1.03–3.05)) and a longer operative time (1.02 (1.01–1.02)) were independently associated with RBC transfusion. (4) Conclusions: In the instance of elective surgery for primary posterior lumbar fusion in a high-volume center for spine surgery, the need for RBC transfusion is low. Factors anticipating transfusion should be taken into consideration in the patient’s pre-surgery preparation. PMID:29385760

Red Blood Cell Transfusion Need for Elective Primary Posterior Lumbar Fusion in A High-Volume Center for Spine Surgery

Directory of Open Access Journals (Sweden)

Giuseppe Ristagno

2018-01-01

Full Text Available (1 Background: This study evaluated the perioperative red blood cell (RBC transfusion need and determined predictors for transfusion in patients undergoing elective primary lumbar posterior spine fusion in a high-volume center for spine surgery. (2 Methods: Data from all patients undergoing spine surgery between 1 January 2014 and 31 December 2016 were reviewed. Patients’ demographics and comorbidities, perioperative laboratory results, and operative time were analyzed in relation to RBC transfusion. Multivariate logistic regression analysis was performed to identify the predictors of transfusion. (3 Results: A total of 874 elective surgeries for primary spine fusion were performed over the three years. Only 54 cases (6% required RBC transfusion. Compared to the non-transfused patients, transfused patients were mainly female (p = 0.0008, significantly older, with a higher ASA grade (p = 0.0002, and with lower pre-surgery hemoglobin (HB level and hematocrit (p < 0.0001. In the multivariate logistic regression, a lower pre-surgery HB (OR (95% CI 2.84 (2.11–3.82, a higher ASA class (1.77 (1.03–3.05 and a longer operative time (1.02 (1.01–1.02 were independently associated with RBC transfusion. (4 Conclusions: In the instance of elective surgery for primary posterior lumbar fusion in a high-volume center for spine surgery, the need for RBC transfusion is low. Factors anticipating transfusion should be taken into consideration in the patient’s pre-surgery preparation.

Strategies for revision surgery after primary double-bundle anterior cruciate ligament (ACL) reconstruction

NARCIS (Netherlands)

Hofbauer, Marcus; Muller, Bart; Murawski, Christopher D.; Baraga, Michael; van Eck, Carola Franziska; Fu, Freddie H.

2013-01-01

The purpose of this article was to discuss pre- and intra-operative considerations as well as surgical strategies for different femoral and tibial tunnel scenarios in revision surgery following primary double-bundle anterior cruciate ligament (ACL) reconstruction. Based on the current literature of

Primary surgery results in no survival benefit compared to primary radiation for oropharyngeal cancer patients stratified by high-risk human papilloma virus status.

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Lybak, Stein; Ljøkjel, Borghild; Haave, Hilde; Karlsdottir, Àsa; Vintermyr, Olav K; Aarstad, Hans Jørgen

2017-01-01

We changed the primary oropharynx squamous cell carcinoma (OPSCC) treatment recommendation from primary radiation therapy (RT) to tumor surgery and neck dissection, followed by RT around the year 2000 with apparently improved survival. However, high-risk human papilloma virus (hr-HPV)-16-caused OPSCCs have increased during this period. Furthermore, hr-HPV+ OPSCC carry a better prognosis than hr-HPV-negative patients. We have, therefore, evaluated the 5-year survival in the period from 1992 to 1999 versus 2000 to 2008 stratified by hr-HPV tumor infection status. Ninety-six OPSCC patients were treated from 1992 to 1999 compared with 136 patients from 2000 to 2008. The 5-year disease-specific survival (DDS) and overall survival (OS) were recorded, while the health-related quality of life (HRQoL) scores were obtained from some of the cured patients. Thirty-eight (40 %) in the first period and 86 OPSCCs (63 %) in the second period were hr-HPV+. In the first period, 16 versus 62 patients in the last period were treated by neck dissection, primary tumor surgery, and RT. DSS among all the hr-HPV-negative patients in the first period was 51 versus 55 % in the second period, and the corresponding OS was 33 versus 31 %, respectively. The DSS among all the hr-HPV+ patients was 78 % in the first period versus 77 % in the second period, while the OS was 71 versus 69 %, respectively. The HRQoL scores among successfully treated patients were worse following surgery, plus RT than RT only. The hr-HPV-adjusted 5-year survival in OPSCC patients was similar between the two time periods. A decreased HRQoL was associated with surgical therapy, which indicates that hr-HPV+ OPSCC patients may be treated by primary RT followed by major surgery only if RT treatment fails.

Neoadjuvant Chemotherapy for Advanced Epithelial Ovarian Cancer

International Nuclear Information System (INIS)

Avendano Juan; Buitrago, Giancarlo; Ramos, Pedro; Suescun Oscar

2010-01-01

Objective: To describe the experience at the National Cancer Institute (NCI) on the use of neoadjuvant chemotherapy as primary treatment for epithelial ovarian cancer among patients in stages IIIC and IV. Methods: We conducted a descriptive retrospective study (case series type) of patients diagnosed with epithelial ovarian cancer in stages IIIC and IV, treated at the NCI from January 1, 2003 to December 31,2006, who underwent neoadjuvant chemotherapy as primary treatment. Demographic characteristics and clinical outcomes are described. Results: Seventeen patients who fulfilled the above mentioned criteria were selected. Once neoadjuvant chemotherapy ended, 5 patients (29.4%) achieved complete or partial clinical response; 4 (23.8%) remained in stable condition, and 8 (47.6%) showed signs of progressive illness. Interval debulking surgery was performed on objective response patients. Maximum cytoreduction was achieved in 5 patients (100%); first relapse was reported at month 18 of follow-up; 2 disease-free survivors were identified in December, 2007; 8 (49%) reported some degree of non-severe chemotherapy-related toxicity. No mortality was related to chemotherapy, no post surgical complications were observed and no patient required advanced support management. Conclusions: Neoadjuvant chemotherapy, followed by optimal interval debulking surgery among selected patients, can be an alternative treatment for advanced epithelial ovarian cancer among women with irresecability or the critically ill. Further studies with improved design are required to confirm these findings.

Efficacy and Safety of Adjuvant Proton Therapy Combined With Surgery for Chondrosarcoma of the Skull Base: A Retrospective, Population-Based Study

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Feuvret, Loïc, E-mail: loic.feuvret@psl.aphp.fr [Department of Radiation Oncology, Groupe Hospitalier La Pitié-Salpêtrière–Charles Foix (Assistance Publique–Hôpitaux de Paris), Paris (France); Department of Radiation Oncology, Institut Curie–Centre de protonthérapie d' Orsay (CPO), Orsay (France); Bracci, Stefano [Institute of Radiation Oncology, Sapienza University, Sant' Andrea Hospital, Rome (Italy); Calugaru, Valentin [Department of Radiation Oncology, Institut Curie–Centre de protonthérapie d' Orsay (CPO), Orsay (France); Bolle, Stéphanie [Department of Radiation Oncology, Gustave Roussy, Villejuif (France); Mammar, Hamid; De Marzi, Ludovic [Department of Radiation Oncology, Institut Curie–Centre de protonthérapie d' Orsay (CPO), Orsay (France); Bresson, Damien [Department of Neurosurgery, Hôpital Lariboisière (Assistance Publique–Hôpitaux de Paris), Paris (France); Habrand, Jean-Louis [Department of Radiation Oncology, Centre François Baclesse, Caen (France); Mazeron, Jean-Jacques [Department of Radiation Oncology, Groupe Hospitalier La Pitié-Salpêtrière–Charles Foix (Assistance Publique–Hôpitaux de Paris), Paris (France); Dendale, Rémi [Department of Radiation Oncology, Institut Curie–Centre de protonthérapie d' Orsay (CPO), Orsay (France); and others

2016-05-01

Purpose: Chondrosarcoma is a rare malignant tumor of the cartilage affecting young adults. Surgery, followed by charged-particle irradiation, is considered the reference standard for the treatment of patients with grade I to II skull base chondrosarcoma. The present study was conducted to assess the effect of the quality of surgery and radiation therapy parameters on local control (LC) and overall survival (OS). Methods and Materials: From 1996 to 2013, 159 patients (median age 40 years, range 12-83) were treated with either protons alone or a combination of protons and photons. The median total dose delivered was 70.2 Gy (relative biologic effectiveness [RBE]; range 67-71). Debulking and biopsy were performed in 133 and 13 patients, respectively. Results: With a median follow-up of 77 months (range 2-214), 5 tumors relapsed based on the initial gross tumor volume. The 5- and 10-year LC rates were 96.4% and 93.5%, respectively, and the 5- and 10-year OS rates were 94.9% and 87%, respectively. A total of 16 patients died (13 of intercurrent disease, 3 of disease progression). On multivariate analysis, age <40 years and primary disease status were independent favorable prognostic factors for progression-free survival and OS, and local tumor control was an independent favorable predictor of OS. In contrast, the extent of surgery, dosimetric parameters, and adjacent organs at risk were not prognostic factors for LC or OS. Conclusions: Systematic high-dose postoperative proton therapy for skull base chondrosarcoma can achieve a high LC rate with a low toxicity profile. Maximal safe surgery, followed by high-dose conformal proton therapy, is therefore recommended.

Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate

DEFF Research Database (Denmark)

Heliövaara, Arja; Küseler, Annelise; Skaare, Pål

2017-01-01

BACKGROUND AND AIM: Good dentofacial growth is a major goal in the treatment of unilateral cleft lip and palate (UCLP). The aim was to evaluate dental arch relationships at age 5 years after four different protocols of primary surgery for UCLP. DESIGN: Three parallel randomised clinical trials were...... undertaken as an international multi-centre study by 10 cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. METHODS: Three different surgical procedures for primary palatal repair (Arms B, C, D) were tested against a common procedure (Arm A) in the total cohort of 448 children born...

Multi-center evaluation of post-operative morbidity and mortality after optimal cytoreductive surgery for advanced ovarian cancer.

Directory of Open Access Journals (Sweden)

Arash Rafii

Full Text Available PURPOSE: While optimal cytoreduction is the standard of care for advanced ovarian cancer, the related post-operative morbidity has not been clearly documented outside pioneering centers. Indeed most of the studies are monocentric with inclusions over several years inducing heterogeneity in techniques and goals of surgery. We assessed the morbidity of optimal cytoreduction surgery for advanced ovarian cancer within a short inclusion period in 6 referral centers dedicated to achieve complete cytoreduction. PATIENTS AND METHODS: The 30 last optimal debulking surgeries of 6 cancer centers were included. Inclusion criteria included: stage IIIc- IV ovarian cancer and optimal surgery performed at the site of inclusion. All post-operative complications within 30 days of surgery were recorded and graded using the Memorial secondary events grading system. Student-t, Chi2 and non-parametric statistical tests were performed. RESULTS: 180 patients were included. There was no demographic differences between the centers. 63 patients underwent surgery including intestinal resections (58 recto-sigmoid resection, 24 diaphragmatic resections, 17 splenectomies. 61 patients presented complications; One patient died post-operatively. Major (grade 3-5 complications requiring subsequent surgeries occurred in 21 patients (11.5%. 76% of patients with a major complication had undergone an ultraradical surgery (P = 0.004. CONCLUSION: While ultraradical surgery may result in complete resection of peritoneal disease in advanced ovarian cancer, the associated complication rate is not negligible. Patients should be carefully evaluated and the timing of their surgery optimized in order to avoid major complications.

Parathyroid Carcinoma in Patients that Have Undergone Surgery for Primary Hyperparathyroidism.

Science.gov (United States)

Libánský, Petr; Adámek, Svatopluk; Broulík, Petr; Fialová, Martina; Kubinyi, Josef; Lischke, Robert; Naňka, Ondřej; Pafko, Pavel; Šedý, Jiří; Bobek, Vladimír

2017-01-01

Parathyroid carcinoma is a rare clinical entity, which represents one of the main reasons, why surgery should be performed in specialized centres. Preoperatively, it is very difficult to distinguish between benign and malignant hyperparathyroidism. During the years 1996-2016, we performed 2,220 operations in 2,075 patients with a diagnosis of primary hyperparathyroidism. Among these 2,220 operations, there were 16 operations for parathyroid carcinoma. These 16 operations, including reoperations, were performed in four patients. Two patients had no reoperation, but another 2 patients required 14 reoperations in total. Parathyroid carcinoma was described in 0.2% of all patients with a diagnosis of primary hyperparathyroidism. The number of operations was 0.73% of all operations of primary hyperparathyroidism in years 1996-2016. Prognosis of parathyroid carcinoma is quite favourable, patients evidence a long-term survival rate after the primary operation. However, every reoperation increases the number of possible complications, including recurrent laryngeal nerve injury. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Oncological and functional outcomes of salvage renal surgery following failed primary intervention for renal cell carcinoma

Directory of Open Access Journals (Sweden)

Fernando G. Abarzua-Cabezas

2015-02-01

Full Text Available Purpose To assess the oncologic and functional outcomes of salvage renal surgery following failed primary intervention for RCC. Materials and Methods We performed a retrospective review of patients who underwent surgery for suspected RCC during 2004-2012. We identified 839 patients, 13 of whom required salvage renal surgery. Demographic data was collected for all patients. Intraoperative and postoperative data included ischemic duration, blood loss and perioperative complications. Preoperative and postoperative assessments included abdominal CT or magnetic resonance imaging, chest CT and routine laboratory work. Estimated glomerular filtration rate (eGFR was calculated according to the Modification of Diet in Renal Disease equation. Results The majority (85% of the patients were male, with an average age of 64 years. Ten patients underwent salvage partial nephrectomy while 3 underwent salvage radical nephrectomy. Cryotherapy was the predominant primary failed treatment modality, with 31% of patients undergoing primary open surgery. Pre-operatively, three patients were projected to require permanent post-operative dialysis. In the remaining 10 patients, mean pre- and postoperative serum creatinine and eGFR levels were 1.35 mg/dL and 53.8 mL/min/1.73 m2 compared to 1.43 mg/dL and 46.6 mL/min/1.73 m2, respectively. Mean warm ischemia time in 10 patients was 17.4 min and for all patients, the mean blood loss was 647 mL. The predominant pathological stage was pT1a (8/13; 62%. Negative surgical margins were achieved in all cases. The mean follow-up was 32.9 months (3.5-88 months. Conclusion While salvage renal surgery can be challenging, it is feasible and has adequate surgical, functional and oncological outcomes.

Prospective data collection and analysis of perforations and tears of latex surgical gloves during primary endoprosthetic surgeries

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Zaatreh, Sarah

2016-12-01

Full Text Available Introduction: Surgical gloves are used to prevent contamination of the patient and the hospital staff with pathogens. The aim of this study was to examine the actual effectiveness of gloves by examining the damage (perforations, tears to latex gloves during surgery in the case of primary hip and knee prosthesis implantation. Materials and methods: Latex surgical gloves used by surgeons for primary hip and knee replacement surgeries were collected directly after the surgery and tested using the watertightness test according to ISO EN 455-1:2000.Results: 540 gloves were collected from 104 surgeries. In 32.7% of surgeries at least one glove was damaged. Of all the gloves collected, 10.9% were damaged, mainly on the index finger. The size of the perforations ranged from ≤1 mm to over 5 mm. The surgeon’s glove size was the only factor that significantly influenced the occurrence of glove damage. Surgeon training level, procedure duration, and the use of bone cement had no significant influence.Conclusions: Our results highlight the high failure rate of surgical gloves. This has acute implications for glove production, surgical practice, and hygiene guidelines. Further studies are needed to detect the surgical steps, surface structures, and instruments that pose an increased risk for glove damage.

Prospective data collection and analysis of perforations and tears of latex surgical gloves during primary endoprosthetic surgeries.

Science.gov (United States)

Zaatreh, Sarah; Enz, Andreas; Klinder, Annett; König, Tony; Mittelmeier, Lena; Kundt, Günther; Mittelmeier, Wolfram

2016-01-01

Introduction: Surgical gloves are used to prevent contamination of the patient and the hospital staff with pathogens. The aim of this study was to examine the actual effectiveness of gloves by examining the damage (perforations, tears) to latex gloves during surgery in the case of primary hip and knee prosthesis implantation. Materials and methods: Latex surgical gloves used by surgeons for primary hip and knee replacement surgeries were collected directly after the surgery and tested using the watertightness test according to ISO EN 455-1:2000. Results: 540 gloves were collected from 104 surgeries. In 32.7% of surgeries at least one glove was damaged. Of all the gloves collected, 10.9% were damaged, mainly on the index finger. The size of the perforations ranged from ≤1 mm to over 5 mm. The surgeon's glove size was the only factor that significantly influenced the occurrence of glove damage. Surgeon training level, procedure duration, and the use of bone cement had no significant influence. Conclusions: Our results highlight the high failure rate of surgical gloves. This has acute implications for glove production, surgical practice, and hygiene guidelines. Further studies are needed to detect the surgical steps, surface structures, and instruments that pose an increased risk for glove damage.

Prospective data collection and analysis of perforations and tears of latex surgical gloves during primary endoprosthetic surgeries

Science.gov (United States)

Zaatreh, Sarah; Enz, Andreas; Klinder, Annett; König, Tony; Mittelmeier, Lena; Kundt, Günther; Mittelmeier, Wolfram

2016-01-01

Introduction: Surgical gloves are used to prevent contamination of the patient and the hospital staff with pathogens. The aim of this study was to examine the actual effectiveness of gloves by examining the damage (perforations, tears) to latex gloves during surgery in the case of primary hip and knee prosthesis implantation. Materials and methods: Latex surgical gloves used by surgeons for primary hip and knee replacement surgeries were collected directly after the surgery and tested using the watertightness test according to ISO EN 455-1:2000. Results: 540 gloves were collected from 104 surgeries. In 32.7% of surgeries at least one glove was damaged. Of all the gloves collected, 10.9% were damaged, mainly on the index finger. The size of the perforations ranged from ≤1 mm to over 5 mm. The surgeon’s glove size was the only factor that significantly influenced the occurrence of glove damage. Surgeon training level, procedure duration, and the use of bone cement had no significant influence. Conclusions: Our results highlight the high failure rate of surgical gloves. This has acute implications for glove production, surgical practice, and hygiene guidelines. Further studies are needed to detect the surgical steps, surface structures, and instruments that pose an increased risk for glove damage. PMID:28066701

Early Primary Care Provider Follow-up and Readmission After High-Risk Surgery

Science.gov (United States)

Brooke, Benjamin S.; Stone, David H.; Cronenwett, Jack L.; Nolan, Brian; DeMartino, Randall R.; MacKenzie, Todd A.; Goodman, David C.; Goodney, Philip P.

2014-01-01

IMPORTANCE Follow-up with a primary care provider (PCP) in addition to the surgical team is routinely recommended to patients discharged after major surgery despite no clear evidence that it improves outcomes. OBJECTIVE To test whether PCP follow-up is associated with lower 30-day readmission rates after open thoracic aortic aneurysm (TAA) repair and ventral hernia repair (VHR), surgical procedures known to have a high and low risk of readmission, respectively. DESIGN, SETTING, AND PARTICIPANTS In a cohort of Medicare beneficiaries discharged to home after open TAA repair (n = 12 679) and VHR (n = 52 807) between 2003 to 2010, we compared 30-day readmission rates between patients seen and not seen by a PCP within 30 days of discharge and across tertiles of regional primary care use. We stratified our analysis by the presence of complications during the surgical (index) admission. MAIN OUTCOMES AND MEASURES Thirty-day readmission rate. RESULTS Overall, 2619 patients (20.6%) undergoing open TAA repair and 4927 patients (9.3%) undergoing VHR were readmitted within 30 days after surgery. Complications occurred in 4649 patients (36.6%) undergoing open TAA repair and 4528 patients (8.6%) undergoing VHR during their surgical admission. Early follow-up with a PCP significantly reduced the risk of readmission among open TAA patients who experienced perioperative complications, from 35.0% (without follow-up) to 20.4% (with follow-up) (P < .001). However, PCP follow-up made no significant difference in patients whose hospital course was uncomplicated (19.4% with follow-up vs 21.9% without follow-up; P = .31). In comparison, early follow-up with a PCP after VHR did not reduce the risk of readmission, regardless of complications. In adjusted regional analyses, undergoing open TAA repair in regions with high compared with low primary care use was associated with an 18% lower likelihood of 30-day readmission (odds ratio, 0.82; 95% CI, 0.71–0.96; P = .02), whereas no significant

Radical surgery compared with intracavitary cesium followed by radical surgery in cervical carcinoma stage IB

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Tinga, D.J.; Bouma, J.; Aalders, J.G. (Dept. of Obstetrics and Gynaecology, State Univ. Hospital, Groningen (Netherlands)); Hollema, H. (Dept. of Pathology, State Univ. Hospital, Groningen (Netherlands))

1990-01-01

Forty-nine patients aged {le} 45 years, with cervical carcinoma stage IB ({le} 3 cm) were treated with either primary radical surgery (n = 26), or intracavitary irradiation followed by radical surgery (n = 23). With primary surgery, ovarian function had been preserved in 15 of the 25 patients, who were alive and well. Seven of the primary surgery patients were irradiated postoperatively and 2 others with a central recurrence were cured by irradiation. One other patient, who was not irradiated postoperatively, had an intestinal metastasis and died of the disease. If any of the adverse prognostic factors (as reported in the literature) had been considered as an indication for postoperative irradiation, 17 patients instead of 7 would have been irradiated after primary radical surgery. In the comparable group of 23 patients treated by intracavitary irradiation and radical surgery (and in 4 cases postoperative irradiation as well) there was no recurrence. There was no significant statistical difference between the treatment results in the cesium + surgery group and those who underwent primary radical surgery. Young patients with early cervical carcinoma without prognostic indicators for postoperative irradiation can benefit from primary radical surgery, because their ovarian function can be preserved. (authors).

Radical surgery compared with intracavitary cesium followed by radical surgery in cervical carcinoma stage IB

International Nuclear Information System (INIS)

Tinga, D.J.; Bouma, J.; Aalders, J.G.; Hollema, H.

1990-01-01

Forty-nine patients aged ≤ 45 years, with cervical carcinoma stage IB (≤ 3 cm) were treated with either primary radical surgery (n = 26), or intracavitary irradiation followed by radical surgery (n = 23). With primary surgery, ovarian function had been preserved in 15 of the 25 patients, who were alive and well. Seven of the primary surgery patients were irradiated postoperatively and 2 others with a central recurrence were cured by irradiation. One other patient, who was not irradiated postoperatively, had an intestinal metastasis and died of the disease. If any of the adverse prognostic factors (as reported in the literature) had been considered as an indication for postoperative irradiation, 17 patients instead of 7 would have been irradiated after primary radical surgery. In the comparable group of 23 patients treated by intracavitary irradiation and radical surgery (and in 4 cases postoperative irradiation as well) there was no recurrence. There was no significant statistical difference between the treatment results in the cesium + surgery group and those who underwent primary radical surgery. Young patients with early cervical carcinoma without prognostic indicators for postoperative irradiation can benefit from primary radical surgery, because their ovarian function can be preserved. (authors)

The efficacy of postoperative radiotherapy in localized primary soft tissue sarcoma treated with conservative surgery

International Nuclear Information System (INIS)

Zhao, Ru-Ping; Yu, Xiao-Li; Zhang, Zhen; Jia, Li-Juan; Feng, Yan; Yang, Zhao-Zhi; Chen, Xing-Xing; Wang, Jian; Ma, Sheng-Lin; Guo, Xiao-Mao

2016-01-01

To evaluate the efficacy of postoperative radiotherapy (RT) on local failure-free survival (LFFS), distant metastasis-free survival (DMFS) and overall survival (OS) in patients with localized primary soft tissue sarcoma (STS) and to identify prognostic factors. Between January 2000 and July 2010, 220 consecutive patients with localized primary STS, who received conservative surgery with or without postoperative RT, were enrolled in the study. Survival curves were constructed by the Kaplan-Meier method and log-rank test was used to assess statistical significance. Multivariate analysis was applied to identify the prognostic factors. After a median follow-up of 68 months (range, 5–127 months), the 5-year LFFS, DMFS and OS were 70.0, 78.2 and 71.2 %, respectively. Tumor size, histological subtypes, margin status and postoperative RT were independent predictors for OS. Postoperative RT was associated with a significant reduced local recurrence risk versus surgery alone (hazard ratio [HR] = 0.408, 95 % confidence interval [CI] 0.235–0.707, P = 0.001), with 5-year LFFS of 81.1 and 63.6 %, respectively (log-rank, P = 0.004). The log-rank test showed that postoperative RT had a tendency of improving OS compared with surgery alone, with 5-year OS of 74.8 and 65.0 %, respectively (P = 0.089). Multivariate analysis demonstrated that postoperative RT significantly reduced mortality rate compared with surgery alone (HR = 0.512, 95 % CI 0.296–0.886, p = 0.017), especially in patients with liposarcoma (p = 0.034). Postoperative radiotherapy reduce both local recurrence and STS mortality in patients with localized primary STS. The efficacy of RT on survival warrants further prospective study. The online version of this article (doi:10.1186/s13014-016-0605-y) contains supplementary material, which is available to authorized users

Postoperative intra-abdominal collections using a sodium hyaluronate-carboxymethylcellulose (HA-CMC) barrier at the time of laparotomy for uterine or cervical cancers.

Science.gov (United States)

Leitao, Mario M; Byrum, Graham V; Abu-Rustum, Nadeem R; Brown, Carol L; Chi, Dennis S; Sonoda, Yukio; Levine, Douglas A; Gardner, Ginger J; Barakat, Richard R

2010-11-01

A prior analysis of patients undergoing laparotomy for ovarian malignancies at our institution revealed an increased rate of intra-abdominal collections using HA-CMC film during debulking surgery. The primary objective of the current study was to determine whether the use of HA-CMC is associated with the development of postoperative intra-abdominal collections in patients undergoing laparotomy for uterine or cervical malignancies. We retrospectively identified all laparotomies performed for these malignancies from 3/1/05 to 12/31/07. We identified cases involving the use of HA-CMC via billing records and operative reports. Intra-abdominal collections were defined as localized intraperitoneal fluid accumulations in the absence of re-accumulating ascites. We noted incidences of intra-abdominal collections, as well as other complications. Appropriate statistical tests were applied using SPSS 15.0. We identified 169 laparotomies in which HA-CMC was used and 347 in which HA-CMC was not used. The following were statistically similar in both cohorts: age, body mass index (BMI), primary site, surgery for recurrent disease, prior intraperitoneal surgery, and extent of current surgery. Intra-abdominal collections were seen in 6 (3.6%) of 169 HA-CMC cases compared to 10 (2.9%) of 347 non-HA-CMC cases (p=0.7). The rate of infected collections was similar in both groups (1.2% vs. 1.4%). In the subgroup that underwent tumor debulking, intra-abdominal collections were seen in 3 (11.5%) of 26 HA-CMC cases compared to 2 (5.4%) of 37 non-HA-CMC cases (p=0.6). HA-CMC use does not appear to be associated with postoperative intra-abdominal collections in patients undergoing laparotomy for uterine or cervical cancer. Copyright © 2010 Elsevier Inc. All rights reserved.

Surgical management of secondary hyperparathyroidism: how to effectively reduce recurrence at the time of primary surgery.

Science.gov (United States)

Xu, D; Yin, Y; Hou, L; Dai, W

2016-05-01

Successful parathyroidectomy (PTX) often results in a dramatic drop in the parathyroid hormone (PTH) levels, relieves the patient from clinical symptoms, and reduces mortality. Although PTX is generally a successful treatment for progressive secondary hyperparathyroidism (SHPT) patients subjected to surgery, a significant proportion develops recurrent SHPT following PTX. SHPT requiring PTX occurs more commonly in progressive chronic kidney disease and in long-term lithium therapy. Operative approaches include subtotal PTX, total PTX with or without autotransplantation, and possible thymectomy. Each approach has its proponents, advantages, and disadvantages. Although PTX offers the highest percentage cure for SHPT, compared to all other medical and surgical treatment, recurrent hyperparathyroidism can be observed in some patients dependent on follow-up time. A literature review and analysis of recent data regarding how to reduce recurrence of SHPT at the time of primary surgery was performed. The current literature and our own experience in the field have confirmed that pre-operative imaging, thymectomy, stereo magnifier, and surgical procedure may effectively reduce recurrence of SHPT at the time of primary surgery.

A Population-based Study Evaluating the Association between Surgery in Early Life and Child Development at Primary School Entry.

Science.gov (United States)

O'Leary, James D; Janus, Magdalena; Duku, Eric; Wijeysundera, Duminda N; To, Teresa; Li, Ping; Maynes, Jason T; Crawford, Mark W

2016-08-01

It is unclear whether exposure to surgery in early life has long-term adverse effects on child development. The authors aimed to investigate whether surgery in early childhood is associated with adverse effects on child development measured at primary school entry. The authors conducted a population-based cohort study in Ontario, Canada, by linking provincial health administrative databases to children's developmental outcomes measured by the Early Development Instrument (EDI). From a cohort of 188,557 children, 28,366 children who underwent surgery before EDI completion (age 5 to 6 yr) were matched to 55,910 unexposed children. The primary outcome was early developmental vulnerability, defined as any domain of the EDI in the lowest tenth percentile of the population. Subgroup analyses were performed based on age at first surgery (less than 2 and greater than or equal to 2 yr) and frequency of surgery. Early developmental vulnerability was increased in the exposed group (7,259/28,366; 25.6%) compared with the unexposed group (13,957/55,910; 25.0%), adjusted odds ratio, 1.05; 95% CI, 1.01 to 1.08. Children aged greater than or equal to 2 yr at the time of first surgery had increased odds of early developmental vulnerability compared with unexposed children (odds ratio, 1.05; 95% CI, 1.01 to 1.10), but children aged less than 2 yr at the time of first exposure were not at increased risk (odds ratio, 1.04; 95% CI, 0.98 to 1.10). There was no increase in odds of early developmental vulnerability with increasing frequency of exposure. Children who undergo surgery before primary school age are at increased risk of early developmental vulnerability, but the magnitude of the difference between exposed and unexposed children is small.

No. 127-The Evaluation of Stress Incontinence Prior to Primary Surgery.

Science.gov (United States)

Farrell, Scott A

2018-02-01

To provide clinical guidelines for the evaluation of women with stress urinary incontinence prior to primary anti-incontinence surgery. The modalities of evaluation range from basic pelvic examination through to the use of adjuncts including ultrasound and urodynamic testing. These guidelines provide a comprehensive approach to the preoperative evaluation of urinary incontinence to ensure that excessive evaluation is avoided without sacrificing diagnostic accuracy. Published opinions of experts, supplemented by evidence from clinical trials, where appropriate. The quality of the evidence is rated using the criteria described by the Canadian Task Force on the Periodic Health Examination. Comprehensive evaluation of women considering surgery to treat urinary incontinence is essential to rule out causes of incontinence that may not be amenable to surgical treatment. Simplifying the evaluation minimizes the discomfort and embarrassment potentially experienced by women. VALIDATION: These guidelines have been approved by the Urogynaecology Committee and the Executive and Council of The Society of Obstetricians and Gynaecologists of Canada. Copyright © 2018. Published by Elsevier Inc.

Salvage definitive chemo-radiotherapy for locally recurrent oesophageal carcinoma after primary surgery: retrospective review

International Nuclear Information System (INIS)

Baxi, S. H.; Burmeister, B.; Harvey, J. A.; Smithers, M.; Thomas, J.

2008-01-01

Full text: To determine the overall survival and gastrointestinal toxicity for patients treated with salvage definitive chemo-radiotherapy after primary surgery for locoregional relapse of oesophageal carcinoma. A retrospective review of 525 patients who had a resection for oesophageal or oesophagogastric carcinoma at Princess Alexandra Hospital identified 14 patients treated with salvage definitive radiotherapy or chemo-radiotherapy, following localized recurrence of their disease. We analysed the patient and treatment characteristics to determine the median overall survival as the primary end point. Gastrointestinal toxicity was examined to determine if increased toxicity occurred when the stomach was irradiated within the intrathoracic radiotherapy field. The median overall survival for patients treated with curative intent using salvage definitive chemo-radiotherapy was 16 months and the 2-year overall survival is 21%. One patient is in clinical remission more than 5 years after therapy. Age <60 years old and nodal recurrence were favourable prognostic factors. Treatment compliance was 93% with only one patient unable to complete the intended schedule. Fourteen per cent of patients experienced grade 3 or 4 gastrointestinal toxicity. Salvage definitive chemo-radiotherapy should be considered for good performance status patients with oesophageal carcinoma who have a locoregional relapse after primary surgery. The schedule is tolerable with low toxicity and an acceptable median survival

Failed surgery in primary hyperparathyroidism - what has changed with time.

Science.gov (United States)

Wirowski, D; Goretzki, P E; Schwarz, K; Lammers, B J; Dotzenrath, C; Röher, H-D

2013-06-01

Advanced preoperative imaging of parathyroid adenomas and intraoperative parathyroid hormone determination optimized the results in the surgical treatment of primary hyperparathyroidism patients. We asked, whether reasons for failure have changed during the last 25 years.We retrospectively analyzed operations for persistent primary hyperparathyroidism in our department between 2001 and 2011 (n=67), and compared these results to our experience between 1986 and 2001 (n=80).From 2001 to 2011, 765 primary hyperparathyroidism patients were operated on at our department. All but 4 patients were cured (761/765, 99.5%). 67 operations were performed for persistent primary hyperparathyroidism. Main reasons for failure were a misdiagnosed sporadic multiple gland disease in our own patients (18/29, 62.1%), and an undetected solitary adenoma in patients referred to us after -initial operation in another hospital (22/38, 57.9%) (statistically significant). From 1986 to 2001 (1 105 primary hyperparathyroidism patients), main indications for re-operation due to persistent disease were an undiagnosed sporadic multiple gland disease in our own patients (15/24, 62.5%), and a missed solitary adenoma in patients being operated on primarily somewhere else (38/56, 67.9%) (statistically significant).Comparing our experience in 147 patients with persistent primary hyperparathyroidism being operated on between 2001-2011 and 1986-2001, not much has changed with the modern armamentarium of improved preoperative imaging or intraoperative biochemical control. Whereas sporadic multiple gland disease was the most common reason for unsuccessful surgery in experienced hands, other units mainly failed due to an undetected solitary adenoma. Re-operations for persistent primary hyperparathyroidism performed by us were successful in 93.8% (2001-2011) and 96.0% (1986-2001), respectively. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York.

The role of neck surgery in patients with primary oropharyngeal cancer treated by radiotherapy

International Nuclear Information System (INIS)

Peters, Lester J.; Weber, Randal S.; Morrison, William H.; Byers, Robert M.; Garden, Adam S.; Goepfert, Helmuth

1996-01-01

Purpose: The role of neck surgery in node- positive patients whose primary tumours are treated by definitive radiotherapy is controversial. A planned neck dissection following radiotherapy is frequently recommended regardless of response of the neck nodes to treatment. This analysis was undertaken to assess the risk of withholding planned neck dissection in patients who obtain a complete nodal response to irradiation. Materials and Methods: The analysis is based on all 100 patients treated using the concomitant boost protocol described below who presented between 1984 and 1993 with primary squamous cell carcinomas of the oropharynx and clinically positive cervical lymphadenopathy. There were 73 males and 27 females with a median age of 59. Primary disease site was base of tongue 39, tonsil 40, soft palate 14 and pharyngeal wall 7. Nodal stages were N1: 35, N2: 51 and N3: 15. Nodal size varied from 1 - 9 cm with a median of 3 cm. Radiotherapy consisted of 54 Gy in 30 fractions over 6 weeks to large fields with a boost to gross disease of 18 Gy in 12 fractions being delivered as a second daily fraction during the last 2.4 weeks of treatment. Seventy-five patients had their nodal disease treated definitively by radiotherapy; those who had complete clinical resolution of all nodal disease (62) had no planned surgery, while the remaining 13 underwent neck dissection for presumed residual disease. Twenty-five patients had either node excision (8) or neck dissection (17) prior to radiotherapy. Results: There were 8 cases of isolated neck failure of which 3 occurred in the 62 patients who had no planned neck surgery, 0 in the 13 patients who were operated for presumed residual disease (pathologically negative in 7) and 5 in the 25 patients who had initial neck surgery. Of the 62 patients who had a complete response to radiotherapy, the two year probability of neck control was 87% if the initial nodal size was ≤ 3 cm versus 85% for nodes > 3 cm. However the likelihood of

Lifetime risk of primary total hip replacement surgery for osteoarthritis from 2003-2013

DEFF Research Database (Denmark)

Ackerman, Ilana N; Bohensky, Megan A; de Steiger, Richard

2017-01-01

OBJECTIVE: To compare the lifetime risk of total hip replacement surgery (THR) for osteoarthritis (OA) between countries, and over time. METHODS: Data on primary THR procedures performed for OA in 2003 and 2013 were extracted from national arthroplasty registries in Australia, Denmark, Finland, N....... These multi-national risk estimates can inform resource planning for OA service delivery. This article is protected by copyright. All rights reserved....

Surgical management of advanced ocular adnexal amyloidosis.

Science.gov (United States)

Patrinely, J R; Koch, D D

1992-06-01

Ocular adnexal amyloidosis is characterized by amyloid deposition within the deep connective tissue layers of the eyelids, conjunctiva, and anterior orbit. Management of advanced cases has traditionally been unsatisfactory, with either no surgery offered because of fear of hemorrhage or an en bloc resection performed of the entire involved area. We present two cases of advanced periorbital amyloidosis successfully managed by preserving the anatomic planes of the eyelids and meticulously debulking the deposits with a spooned curette. Lax eyelid tendons and aponeuroses were simultaneously repaired, and no sacrifice of eyelid tissues was necessary. One patient remained asymptomatic for 2 years after surgery before developing early reaccumulation in the lower eyelids. The other patient required additional eyelid debulking and ptosis revision 8 months after surgery, but was in stable condition at follow-up 2 years after surgery. This technique offers safe, easily repeatable, nondestructive treatment for advanced periocular amyloidosis.

Primary transoral robotic surgery with concurrent neck dissection for early stage oropharyngeal squamous cell carcinoma implemented at a Danish head and neck cancer center

DEFF Research Database (Denmark)

Rubek, Niclas; Channir, Hani Ibrahim; Charabi, Birgitte Wittenborg

2017-01-01

(RT) with or without concomitant chemotherapy. This is the first study in Scandinavia from a head and neck cancer centre that aims to demonstrate the feasibility of performing primary transoral robotic surgery (TORS) and concurrent neck dissection for patients with early stage OPSCC. Between September...... bilateral neck dissection. Due to an upstaging following surgery, 13 patients were referred to adjuvant therapy. Four of these patients received RT and two patients received concomitant chemo-radiation (CCR) therapy. Seven patients declined the recommended adjuvant therapy one of whom later developed an N......-site recurrence and received salvage surgery with postoperative RT. In summary, 43% of the patients were referred to adjuvant therapy following primary surgery which was mainly due to N-site stage migration and ECE. Primary TORS and concurrent neck dissection is a safe and feasible procedure that may...

Changes of visual-field global indices after cataract surgery in primary open-angle glaucoma patients.

Science.gov (United States)

Seol, Bo Ram; Jeoung, Jin Wook; Park, Ki Ho

2016-11-01

To determine changes of visual-field (VF) global indices after cataract surgery and the factors associated with the effect of cataracts on those indices in primary open-angle glaucoma (POAG) patients. A retrospective chart review of 60 POAG patients who had undergone phacoemulsification and intraocular lens insertion was conducted. All of the patients were evaluated with standard automated perimetry (SAP; 30-2 Swedish interactive threshold algorithm; Carl Zeiss Meditec Inc.) before and after surgery. VF global indices before surgery were compared with those after surgery. The best-corrected visual acuity, intraocular pressure (IOP), number of glaucoma medications before surgery, mean total deviation (TD) values, mean pattern deviation (PD) value, and mean TD-PD value were also compared with the corresponding postoperative values. Additionally, postoperative peak IOP and mean IOP were evaluated. Univariate and multivariate logistic regression analyses were performed to identify the factors associated with the effect of cataract on global indices. Mean deviation (MD) after cataract surgery was significantly improved compared with the preoperative MD. Pattern standard deviation (PSD) and visual-field index (VFI) after surgery were similar to those before surgery. Also, mean TD and mean TD-PD were significantly improved after surgery. The posterior subcapsular cataract (PSC) type showed greater MD changes than did the non-PSC type in both the univariate and multivariate logistic regression analyses. In the univariate logistic regression analysis, the preoperative TD-PD value and type of cataract were associated with MD change. However, in the multivariate logistic regression analysis, type of cataract was the only associated factor. None of the other factors was associated with MD change. MD was significantly affected by cataracts, whereas PSD and VFI were not. Most notably, the PSC type showed better MD improvement compared with the non-PSC type after cataract surgery

Incidence and types of complications after ablative oral cancer surgery with primary microvascular free flap reconstruction

NARCIS (Netherlands)

Lodders, J.N.; Parmar, S.; Stienen, N.-L.M.; Martin, T.J.; Karagozoglu, K.H.; Heymans, M.W.; Nandra, B.; Forouzanfar, T.

2015-01-01

Background: The aims of the study were 1) to evaluate the incidence and types of postoperative complications after ablative oral cancer surgery with primary free flap reconstruction and 2) identify prognostic variables for postoperative complications. Material and Methods: Desired data was retrieved

Incidence and types of complications after ablative oral cancer surgery with primary microvascular free flap reconstruction

NARCIS (Netherlands)

Lodders, J.N.; Parmar, S.; Stienen, N.L.M.; Martin, T.J.; Karagozoglu, K.H.; Heymans, M.W.; Nandra, B.; Forouzanfar, T.

2015-01-01

BACKGROUND: The aims of the study were 1) to evaluate the incidence and types of postoperative complications after ablative oral cancer surgery with primary free flap reconstruction and 2) identify prognostic variables for postoperative complications. MATERIAL AND METHODS: Desired data was retrieved

Second-line treatment of recurrent HNSCC: tumor debulking in combination with high-dose-rate brachytherapy and a simultaneous cetuximab-paclitaxel protocol

International Nuclear Information System (INIS)

Ritter, M.; Teudt, I. U.; Meyer, J. E.; Schröder, U.; Kovács, G.; Wollenberg, B.

2016-01-01

After the failure of first-line treatment, the clinical prognosis in head and neck cancer (HNSCC) deteriorates. Effective therapeutic strategies are limited due to the toxicity of previous treatments and the diminished tolerance of surrounding normal tissue. This study demonstrates a promising second-line regimen, with function preserving surgical tumor debulking, followed by a combination of postoperative interstitial brachytherapy and a simultaneous protocol of cetuximab and taxol. From January 2006 to May 2013, 197 patients with HNSCC were treated with brachytherapy at the University Hospital Schleswig-Holstein Campus Lübeck, including 94 patients due to recurrent cancer. Within these, 18 patients were referred to our clinic because of early progressive disease following first- or second-line treatment failure. They received the new palliative regimen. A matched-pair analysis including recurrent tumor stage, status of resection margins, tissue invasion and previous therapy was performed to evaluate this treatment retrospectively. Overall survival (OS), disease-free survival (DFS), functional outcome and treatment toxicity was analyzed on the basis of medical records and follow-up data. DFS and OS of the study group were 8.7 and 14.8 months. Whereas, DFS and OS of the control group, treated only by function preserving tumor debulking and brachytherapy, was 3.9 and 6.1 months respectively. This demonstrates a positive trend through the additional use of the cetuximab-taxane protocol. Furthermore, no increase of therapy induced toxicities was displayed. Pre-treated patients with a further relapse benefit from the ‘cetuximab-taxane recurrency scheme’. It seems to be a valuable complement to interdisciplinary and multimodal tumor therapy, which improves OS and results in acceptable toxicity. The online version of this article (doi:10.1186/s13014-016-0583-0) contains supplementary material, which is available to authorized users

Extended upper abdominal resections as part of debulking surgery at the time of tertiary cytoreduction for relapsed ovarian cancer; case report and literature review

OpenAIRE

Nicolae Bacalbașa; Irina Balescu

2017-01-01

Ovarian cancer remains one of the most aggressive gynecologic malignancies with high capacity to recur even in cases submitted to surgery with curative intent. However, even in these cases the best therapeutic option in order to achieve a good control of the disease remains radical surgery. We present the case of a 65-year-old patient diagnosed submitted to surgery for stage IIIC ovarian cancer five years before. At two years follow up she was diagnosed with an isolated recurrence at the leve...

Intraperitoneal cisplatin versus no further treatment : 8-year results of EORTC 55875, a randomized phase III study in ovarian cancer patients with a pathologically complete remission after platinum-based intravenous chemotherapy

NARCIS (Netherlands)

Piccart, MJ; Floquet, A; Scarfone, G; Willemse, PHB; Emerich, J; Vergote, [No Value; Giurgea, L; Coens, C; Awada, A; Vermorken, JB

2003-01-01

First-line intravenous chemotherapy (CT) following debulking surgery is associated with prolonged survival, in particular in patients who achieve a pathological complete remission (pCR) at second-look surgery but in whom a high rate of relapses still occurs. Between 1988 and 1997, 153 patients in

Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate

DEFF Research Database (Denmark)

Lohmander, Anette; Persson, Christina; Willadsen, Elisabeth

2017-01-01

BACKGROUND AND AIM: Adequate velopharyngeal function and speech are main goals in the treatment of cleft palate. The objective was to investigate if there were differences in velopharyngeal competency (VPC) and hypernasality at age 5 years in children with unilateral cleft lip and palate (UCLP...... cleft teams in five countries: Denmark, Finland, Sweden, Norway, and the UK. METHODS: Three different surgical protocols for primary palatal repair were tested against a common procedure in the total cohort of 448 children born with a non-syndromic UCLP. Speech audio and video recordings of 391 children......) operated on with different surgical methods for primary palatal repair. A secondary aim was to estimate burden of care in terms of received additional secondary surgeries and speech therapy. DESIGN: Three parallel group, randomised clinical trials were undertaken as an international multicentre study by 10...

Prognostic value of miliary versus non-miliary sub-staging in advanced ovarian cancer.

Science.gov (United States)

Eng, Kevin H; Morrell, Kayla; Starbuck, Kristen; Spring-Robinson, Chandra; Khan, Aalia; Cleason, Dana; Akman, Levent; Zsiros, Emese; Odunsi, Kunle; Szender, J Brian

2017-07-01

The presence of miliary disease during initial ovarian cancer debulking may reflect a distinct mode of peritoneal spread independent from size-based tumor staging and may explain variation in response to treatment and survival outcomes. To infer the prevalence, presentation and clinical implications of miliary disease we reviewed existing surgical records. Reports were available for 1008 primary debulking surgeries for ovarian, primary peritoneal or fallopian tube cancer between 2001 and 2015 (685 reports from 2005 to 2015). Clinical outcome data was available for 938 patients. We analyzed a high-stage sub-cohort for survival (N=436). Most records were evaluable for miliary disease (761/938); for these, the miliary phenotype was highly prevalent (249/761, 32.7%) and often accompanied by ascites (185/249, 74%). While optimal debulking rates were unaffected by miliary disease, total resection (R0) rates were poorer. Liver, stomach, spleen or bladder appeared to be sporadically involved while the omentum, mesentery, bowel, peritoneum and diaphragm were affected simultaneously (Spearman rho>0.5). Overall, miliary disease was associated with worse progression free survival, overall survival, and time from relapse to death independent of stage. Survival effects were particularly strong for Stage IV disease where median overall survival varied by over 30months (log-rank p=0.002). Miliary disease is an identifiable surgical phenotype reflecting a distinct clinical trajectory that adds prognostic information to standard disease burden-based staging. These findings should permit further retrospective investigation in a wider cohort and prompt the consideration of prospective structured operative reporting standards and treatment strategies. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

COMPARATIVE STUDY OF EFFICACY OF INJECTION SCLEROTHERAPY VERSUS SURGERY AS PRIMARY MODALITY THERAPY IN PRIMARY VAGINAL HYDROCOELE : A RANDOMISED CONTROL STUDY

OpenAIRE

Jayakarthik; Patil

2015-01-01

CONTEXT (BACKGROUND): Primary/Idiopathic hydrocele is defined as an abnormal collection of serous fluid in tunica vaginalis whose cause is not known as it is neither associated with the disease of testis or epididymis. Surgery is considered as a definitive treatment, though th e reason of injection treatment falling out of favour is ill understood as studies have shown this technique to be efficacious, safe, cost effective treatment modality in idiopathic hydroceles. This...

Recurrence-free survival, but not surgical therapy per se, determines 583 patients' long-term satisfaction following primary pilonidal sinus surgery.

Science.gov (United States)

Doll, Dietrich; Luedi, Markus M; Evers, Theo; Kauf, Peter; Matevossian, Edouard

2015-05-01

With pilonidal sinus disease (PSD) incidence increasing and patients freely choosing their surgeon, patients' interest issues have been brought forward estimating patient satisfaction following pilonidal sinus surgery. The influence of wound healing time and long-term recurrence rate on patient satisfaction in primary PSD surgery has not been investigated yet. Five hundred eighty-three patients (German military cohort) were interviewed, compiling wound healing time, aesthetic satisfaction, long-term recurrence-free survival and patient satisfaction having undergone primary open (PO) treatment, marsupialization (MARS) or primary midline closure (PMC) treatment. Recurrence rate was determined by Kaplan-Meier calculation following up to 20 years after primary PSD surgery. Patient satisfaction ranking from 1 to 10 (10 = max. satisfied) showed an average satisfaction of 8.2 (range 0-10; 95% confidence interval (CI) 7891-8250). In-hospital stay time was significantly longer in primary open (PO) and marsupialization (MARS) group as compared to primary midline closure (PMC; p < 0.0001, Kruskal-Wallis test). Satisfaction was comparable between treatment groups, and was neither linked to in-hospital stay time nor to longer outpatient wound care period or total treatment time. Recurrence-free survival, as seen in the PO and PMC treatment group, revealed a highly significant difference for all patients. Improvement in MARS patients with versus without recurrence was low, as satisfaction with primary treatment was lower as the other groups. Neither choice of surgical treatment nor treatment duration within hospital or after hospital influences patient satisfaction, as long as recurrence-free survival can be provided. Marsupialization was ranked lower in both groups (with or without recurrence), and should be abandoned, as patients are significantly less satisfied with either results, independent of recurrence.

Ipsilateral Irradiation for Oral and Oropharyngeal Carcinoma Treated With Primary Surgery and Postoperative Radiotherapy

International Nuclear Information System (INIS)

Vergeer, Marije R.; Doornaert, Patricia; Jonkman, Anja; Kaanders, Johannes H.A.M.; Ende, Piet L.A. van den; Jong, Martin A. de; Leemans, C. Rene; Slotman, Ben J.; Langendijk, Johannes A.

2010-01-01

Purpose: The purpose was to evaluate the contralateral nodal control (CLNC) in postoperative patients with oral and oropharyngeal cancer treated with ipsilateral irradiation of the neck and primary site. Late radiation-induced morbidity was also evaluated. Methods and Materials: The study included 123 patients with well-lateralized squamous cell carcinomas treated with surgery and unilateral postoperative irradiation. Most patients had tumors of the gingiva (41%) or buccal mucosa (21%). The majority of patients underwent surgery of the ipsilateral neck (n = 102 [83%]). The N classification was N0 in 73 cases (59%), N1 or N2a in 23 (19%), and N2b in 27 cases (22%). Results: Contralateral metastases developed in 7 patients (6%). The 5-year actuarial CLNC was 92%. The number of lymph node metastases was the only significant prognostic factor with regard to CLNC. The 5-year CLNC was 99% in N0 cases, 88% in N1 or N2a cases, and 73% in N2b cases (p = 0.008). Borderline significance (p = 0.06) was found for extranodal spread. Successful salvage could be performed in 71% of patients with contralateral metastases. The prevalence of Grade 2 or higher xerostomia was 2.6% at 5 years. Conclusions: Selected patients with oral or oropharyngeal carcinoma treated with primary surgery and postoperative ipsilateral radiotherapy have a very high CLNC with a high probability of successful salvage in case of contralateral metastases. However, bilateral irradiation should be applied in case of multiple lymph node metastases in the ipsilateral neck, particularly in the presence of extranodal spread. The incidence of radiation-induced morbidity is considerably lower as observed after bilateral irradiation.

Nomogram for suboptimal cytoreduction at primary surgery for advanced stage ovarian cancer.

Science.gov (United States)

Gerestein, Cornelis G; Eijkemans, Marinus J; Bakker, Jeanette; Elgersma, Otto E; van der Burg, Maria E L; Kooi, Geertruida S; Burger, Curt W

2011-11-01

Maximal cytoreduction to minimal residual tumor is the most important determinant of prognosis in patients with advanced stage epithelial ovarian cancer (EOC). Preoperative prediction of suboptimal cytoreduction, defined as residual tumor >1 cm, could guide treatment decisions and improve counseling. The objective of this study was to identify predictive computed tomographic (CT) scan and clinical parameters for suboptimal cytoreduction at primary cytoreductive surgery for advanced stage EOC and to generate a nomogram with the identified parameters, which would be easy to use in daily clinical practice. Between October 2005 and December 2008, all patients with primary surgery for suspected advanced stage EOC at six participating teaching hospitals in the South Western part of the Netherlands entered the study protocol. To investigate independent predictors of suboptimal cytoreduction, a Cox proportional hazard model with backward stepwise elimination was utilized. One hundred and fifteen patients with FIGO stage III/IV EOC entered the study protocol. Optimal cytoreduction was achieved in 52 (45%) patients. A suboptimal cytoreduction was predicted by preoperative blood platelet count (p=0.1990; odds ratio (OR)=1.002), diffuse peritoneal thickening (DPT) (p=0.0074; OR=3.021), and presence of ascites on at least two thirds of CT scan slices (p=0.0385; OR=2.294) with a for-optimism corrected c-statistic of 0.67. Suboptimal cytoreduction was predicted by preoperative platelet count, DPT and presence of ascites. The generated nomogram can, after external validation, be used to estimate surgical outcome and to identify those patients, who might benefit from alternative treatment approaches.

A comparison of high-dose and low-dose tranexamic acid antifibrinolytic protocols for primary coronary artery bypass surgery

Directory of Open Access Journals (Sweden)

Stephen M McHugh

2016-01-01

Full Text Available Background and Aims: Tranexamic acid (TA is used for prophylactic antifibrinolysis in coronary artery bypass surgeries to reduce bleeding. We evaluated the efficacy of two different doses of TA for prophylactic antifibrinolysis in patients undergoing primary coronary artery bypass grafting (CABG surgery in this retrospective cohort study at a tertiary care referral centre. Methods: One-hundred eighty-four patients who underwent primary CABG with cardiopulmonary bypass (CPB via sternotomy between January 2009 and June 2011 were evaluated. Pre-operative patient characteristics, intraoperative data, post-operative bleeding, transfusions, organ dysfunction and 30-day mortality were compared between high-dose TA (30 mg/kg loading dose followed by infusion of 15 mg/kg/h until the end of surgery along with 2 mg/kg priming dose in the bypass circuit and low-dose TA (15 mg/kg loading dose followed by infusion of 6 mg/kg/h until the end of surgery along with 1 mg/kg priming dose in the bypass circuit groups. Univariate comparative analysis of all categorical and continuous variables was performed between the two groups by appropriate statistical tests. Linear and logistic regression analyses were performed to control for the effect of confounding on the outcome variables. Results: Chest tube output, perioperative transfusion of blood products and incidence of re-exploration for bleeding did not differ significantly (P> 0.05 between groups. Post-operative complications and 30-day mortality were comparable between the groups. The presence of cardiogenic shock and increased pre-operative creatinine were found to be associated with increased chest tube output on the post-operative day 2 by multivariable linear regression model. Conclusions: Low-dose TA protocol is as effective as high-dose protocol for antifibrinolysis in patients undergoing primary CABG with CPB.

Extended upper abdominal resections as part of debulking surgery at the time of tertiary cytoreduction for relapsed ovarian cancer; case report and literature review

Directory of Open Access Journals (Sweden)

Nicolae Bacalbașa

2017-11-01

Full Text Available Ovarian cancer remains one of the most aggressive gynecologic malignancies with high capacity to recur even in cases submitted to surgery with curative intent. However, even in these cases the best therapeutic option in order to achieve a good control of the disease remains radical surgery. We present the case of a 65-year-old patient diagnosed submitted to surgery for stage IIIC ovarian cancer five years before. At two years follow up she was diagnosed with an isolated recurrence at the level of the hepatic pedicle which was successfully removed. At 18 months follow up she was diagnosed with a large recurrence in the left superior abdominal quadrant and a liver metastasis which were resected. At 18 months follow up she is free of recurrent disease.

Penile-preserving surgery for primary urothelial carcinoma of male urethra

Directory of Open Access Journals (Sweden)

Haoping Tai

2015-06-01

Full Text Available Primary urethral carcinoma is a rare cancer, comprising <1% of all malignancies. The location of this lesion presents a certain dilemma of treatment between efficacy and quality of life. We report an 84-year-old male patient, with a history of chronic hepatitis C, hypertension, and transient ischemic accident, who presented with dysuria and acute urinary retention. The intravenous urography showed mild prostatic enlargement, but no stone or filling defect was noted in the upper urinary tract. On urethrocystoscopy, multiple papillary tumors were found at the pendulous urethra, and the pathology of biopsy confirmed urothelial carcinoma. The patient was admitted, and electroresection with fulguration of urethral tumors was performed owing to the patient's old age and poor performance status. Intraurethral and intravesical chemotherapy with mitomycin C was regularly given at the outpatient clinic. Recurrent urothelial carcinomas were noted twice in the first 2 years of follow up, and repeated transurethral resections were done. Unfortunately, liver cirrhosis with hepatocellular carcinoma was diagnosed last June, for which he received transcatheter arterial chemoembolization. No recurrence of urethral cancer has been found on semiannual cystoscopy in the past 3 years. Penile-preserving surgery is a reasonable surgical option for elderly primary urethral carcinoma patients with acceptable oncological outcome and good quality of life.

Health-related quality of life after surgery for primary advanced rectal cancer and recurrent rectal cancer a review

DEFF Research Database (Denmark)

Thaysen, Henriette Vind

2012-01-01

, physical, social, role and sexual function seemed to be impaired for a varying time after surgery. All the studies had methodical problems due to small sample size (12-44 patients) and different points of time for the assessment of HRQoL (12.3-47 months) which made it difficult to determine the period...... studies concerning surgery for primary advanced or recurrent rectal cancer and describing methods used for measuring HRQoL were considered. Results Seven studies were identified including two prospective longitudinal, three cross-sectional and two based on qualitative data. Global quality of life...

Sacral chordomas: Impact of high-dose proton/photon-beam radiation therapy combined with or without surgery for primary versus recurrent tumor

International Nuclear Information System (INIS)

Park, Lily; De Laney, Thomas F.; Liebsch, Norbert J.; Hornicek, Francis J.; Goldberg, Saveli; Mankin, Henry; Rosenberg, Andrew E.; Rosenthal, Daniel I.; Suit, Herman D.

2006-01-01

Purpose: To assess the efficacy of definitive treatment of sacral chordoma by high-dose proton/photon-beam radiation therapy alone or combined with surgery. Methods and Materials: The records of 16 primary and 11 recurrent sacral chordoma patients treated from November 1982 to November 2002 by proton/photon radiation therapy alone (6 patients) or combined with surgery (21 patients) have been analyzed for local control, survival, and treatment-related morbidity. The outcome analysis is based on follow-up information as of 2005. Results: Outcome results show a large difference in local failure rate between patients treated for primary and recurrent chordomas. Local control results by surgery and radiation were 12/14 vs. 1/7 for primary and recurrent lesions. For margin-positive patients, local control results were 10 of 11 and 0 of 5 in the primary and recurrent groups, respectively; the mean follow-up on these locally controlled patients was 8.8 years (4 at 10.3, 12.8, 17, and 21 years). Radiation alone was used in 6 patients, 4 of whom received ≥73.0 Gy (E); local control was observed in 3 of these 4 patients for 2.9, 4.9, and 7.6 years. Conclusion: These data indicate a high local control rate for surgical and radiation treatment of primary (12 of 14) as distinct from recurrent (1 of 7) sacral chordomas. Three of 4 chordomas treated by ≥73.0 Gy (E) of radiation alone had local control; 1 is at 91 months. This indicates that high-dose proton/photon therapy offers an effective treatment option

Implementation of Extensive Cytoreduction Resulted in Improved Survival Outcomes for Patients with Newly Diagnosed Advanced-Stage Ovarian, Tubal, and Peritoneal Cancers.

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Raspagliesi, Francesco; Bogani, Giorgio; Ditto, Antonino; Martinelli, Fabio; Chiappa, Valentina; Borghi, Chiara; Scaffa, Cono; Morano, Federica; Maltese, Giuseppa; Lorusso, Domenica

2017-10-01

Residual disease (RD) after primary debulking surgery (PDS) is one of the main factors driving ovarian cancer prognosis. The primary end point of this study was assessment of the impact that surgery had on survival outcomes for patients with advanced ovarian cancer. Data on the effect of newly diagnosed advanced-stage ovarian, tubal, and peritoneal cancers were analyzed during two study periods (T1: 2001-2006 and T2: 2007-2012), in which the concepts of optimal and complete cytoreduction were introduced and implemented. In this study, 260 patients (36%) had surgery during T1 and 462 patients (64%) had surgery during T2. The rate of PDS increased, from 55.4% (144/260) during T1 to 85.5% (395/462) during T2 (p < 0.001). At the time of PDS, complete resection (RD0) was achieved for 45.1% of the patients during T1 and 76.7% of the patients during T2 (p < 0.001), whereas optimal resection (RD < 1 cm) was achieved for 60.4% of the patients during T1 and 85.3% of the patients during T2 (p < 0.001). Disease-free survival improved during the study periods (p = 0.006). Overall survival was similar in T1 and T2 (p = 0.18). The preoperative CA125 level, disease stage, and RD remained independently associated with disease-free survival (p ≤ 0.05). The performance of interval debulking surgery (IDS) instead of PDS correlated with worse survival outcomes (hazard ratio [HR] 1.47; 95% confidence interval [CI] 1.24-1.92; p = 0.02), whereas achievement of RD0 and RD < 1 cm independently improved overall survival (HR 0.45; 95% CI 0.22-0.91; p = 0.02 for RD0 and HR 0.47; 95% CI 0.23-0.96; p = 0.03 for RD0). The implementation of extensive cytoreduction allows improvement of patient outcomes. Further studies are needed to assess the risk-to-benefit ratio between PDS and IDS and to identify patients who benefit much more from one treatment method than from another.

Impact on regional recurrence and survival of axillary surgery in women with node-negative primary breast cancer

DEFF Research Database (Denmark)

Axelsson, C K; Düring, M; Christiansen, P M

2009-01-01

-negative primary breast cancer treated solely by surgery. Median follow-up was 9 years. RESULTS: The number of lymph nodes removed correlated with a reduction in the rate of subsequent axillary recurrence (from 2.1 to 0.4 per cent; P = 0.037), local recurrence (from 7.4 to 3.8 per cent; P

A predictive model of suitability for minimally invasive parathyroid surgery in the treatment of primary hyperparathyroidism [corrected].

LENUS (Irish Health Repository)

Kavanagh, Dara O

2012-05-01

Improved preoperative localizing studies have facilitated minimally invasive approaches in the treatment of primary hyperparathyroidism (PHPT). Success depends on the ability to reliably select patients who have PHPT due to single-gland disease. We propose a model encompassing preoperative clinical, biochemical, and imaging studies to predict a patient\\'s suitability for minimally invasive surgery.

Lack of evidence of the effectiveness of primary brachial plexus surgery for infants (under the age of two years) diagnosed with obstetric brachial plexus palsy.

Science.gov (United States)

Bialocerkowski, Andrea; Gelding, Bronwyn

2006-12-01

Background  Obstetric brachial plexus palsy, which occurs in 1-3 per 1000 live births, results from traction and/or compression of the brachial plexus in utero, during descent through the birth canal or during delivery. This results in a spectrum of injuries that range in extent of damage and severity and can lead to a lifelong impairment and functional difficulties associated with the use of the affected upper limb. Most infants diagnosed with obstetric brachial plexus palsy receive treatment, such as surgery to the brachial plexus, physiotherapy or occupational therapy, within the first months of life. However, there is controversy regarding the most effective form of management. This review follows on from our previous systematic review which investigated the effectiveness of primary conservative management in infants with obstetric brachial plexus palsy. This systematic review focuses on the effects of primary surgery. Objectives  The objective of this review was to systematically assess and collate all available evidence on effectiveness of primary brachial plexus surgery for infants with obstetric brachial plexus palsy. Search strategy  A systematic literature search was performed using 13 databases: TRIP, MEDLINE, CINAHL, Web of Science, Proquest 5000, Evidence Based Medicine Reviews, Expanded Academic ASAP, Meditext, Science Direct, the Physiotherapy Evidence Database, Proquest Digital Dissertations, Open Archives Initiative Search Engine, the Australian Digital Thesis program. Those studies that were reported in English and published between July 1992 to June 2004 were included in this review. Selection criteria  Quantitative studies that investigated the effectiveness of primary brachial plexus surgery for infants with obstetric brachial plexus palsy were eligible for inclusion into this review. This excluded studies where infants were solely managed conservatively or with pharmacological agents, or underwent surgery for the management of

Number of Blades-up Runs Using JetStream XC Atherectomy for Optimal Tissue Debulking in Patients with Femoropopliteal Artery In-Stent Restenosis.

Science.gov (United States)

Shammas, Nicolas W; Shammas, Gail A; Aasen, Nicole; Jarvis, Gary

2015-12-01

Rotational atherectomy with the use of the JetStream XC device is indicated for treatment of infrainguinal arterial obstructive disease. The number of blades-up (BU) runs needed for optimal tissue debulking in femoropopliteal in-stent restenosis (ISR) is unknown. In the present series, 6 patients (15 lesions) were treated for femoropopliteal ISR with the JetStream XC device. Minimal luminal diameter or percent stenosis improved significantly from baseline after 2 BU runs, but no further gain was seen between 2 and 4 BU runs (P > .05). However, adjunctive balloon angioplasty reduced percent stenosis significantly following BU runs. In conclusion, the JetStream XC device achieved optimal acute angiographic results in treating femoropopliteal ISR following 2 BU runs and adjunctive balloon angioplasty. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

AngioVac System Used for Vegetation Debulking in a Patient with Tricuspid Valve Endocarditis: A Case Report and Review of the Literature

Directory of Open Access Journals (Sweden)

Hossam Abubakar

2017-01-01

Full Text Available AngioVac is a vacuum-based device approved in 2014 for percutaneous removal of undesirable materials from the intravascular system. Although numerous reports exist with regard to the use of the AngioVac device in aspiration of iliocaval, pulmonary, upper extremity, and right-sided heart chamber thrombi, very few data are present demonstrating its use in treatment of right-sided endocarditis. In this case report, we describe the novel device used in debulking a large right-sided tricuspid valve vegetation reducing the occurrence of septic embolisation and enhancing the efficacy of antibiotics in clearance of bloodstream infection. Further research is needed in larger RSIE patient populations to confirm the benefits and the potential of improved outcomes associated with the AngioVac device as well as identify its potential complications.

Genome-wide assessment for genetic variants associated with ventricular dysfunction after primary coronary artery bypass graft surgery.

Directory of Open Access Journals (Sweden)

Amanda A Fox

Full Text Available BACKGROUND: Postoperative ventricular dysfunction (VnD occurs in 9-20% of coronary artery bypass graft (CABG surgical patients and is associated with increased postoperative morbidity and mortality. Understanding genetic causes of postoperative VnD should enhance patient risk stratification and improve treatment and prevention strategies. We aimed to determine if genetic variants associate with occurrence of in-hospital VnD after CABG surgery. METHODS: A genome-wide association study identified single nucleotide polymorphisms (SNPs associated with postoperative VnD in male subjects of European ancestry undergoing isolated primary CABG surgery with cardiopulmonary bypass. VnD was defined as the need for ≥2 inotropes or mechanical ventricular support after CABG surgery. Validated SNPs were assessed further in two replication CABG cohorts and meta-analysis was performed. RESULTS: Over 100 SNPs were associated with VnD (P2.1 of developing in-hospital VnD after CABG surgery. However, three genetic loci identified by meta-analysis were more modestly associated with development of postoperative VnD. Studies of larger cohorts to assess these loci as well as to define other genetic mechanisms and related biology that link genetic variants to postoperative ventricular dysfunction are warranted.

Efficacy and Safety of Adjuvant Proton Therapy Combined With Surgery for Chondrosarcoma of the Skull Base: A Retrospective, Population-Based Study.

Science.gov (United States)

Feuvret, Loïc; Bracci, Stefano; Calugaru, Valentin; Bolle, Stéphanie; Mammar, Hamid; De Marzi, Ludovic; Bresson, Damien; Habrand, Jean-Louis; Mazeron, Jean-Jacques; Dendale, Rémi; Noël, Georges

2016-05-01

Chondrosarcoma is a rare malignant tumor of the cartilage affecting young adults. Surgery, followed by charged-particle irradiation, is considered the reference standard for the treatment of patients with grade I to II skull base chondrosarcoma. The present study was conducted to assess the effect of the quality of surgery and radiation therapy parameters on local control (LC) and overall survival (OS). From 1996 to 2013, 159 patients (median age 40 years, range 12-83) were treated with either protons alone or a combination of protons and photons. The median total dose delivered was 70.2 Gy (relative biologic effectiveness [RBE]; range 67-71). Debulking and biopsy were performed in 133 and 13 patients, respectively. With a median follow-up of 77 months (range 2-214), 5 tumors relapsed based on the initial gross tumor volume. The 5- and 10-year LC rates were 96.4% and 93.5%, respectively, and the 5- and 10-year OS rates were 94.9% and 87%, respectively. A total of 16 patients died (13 of intercurrent disease, 3 of disease progression). On multivariate analysis, age chondrosarcoma can achieve a high LC rate with a low toxicity profile. Maximal safe surgery, followed by high-dose conformal proton therapy, is therefore recommended. Copyright © 2016 Elsevier Inc. All rights reserved.

Unusual Origin and Rare Presentation of Primary Cardiac Lymphoma

Science.gov (United States)

Mohamed, Amir; Cherian, Sanjay; El-Ashmawy, Ahmed; Abdelmoneim, Salah Eldin; Soliman, Maher; Abu-Rayan, Mohamed; Kalangos, Afksendyios

2011-01-01

Non-Hodgkin lymphoblastic lymphomas are very uncommon tumors that rarely involve the heart; however, when they do, they typically cause cardiac symptoms. Herein, we describe the case of a young woman who presented with respiratory symptoms. These were caused by a high-grade lymphoblastic lymphoma, which originated in the left inferior pulmonary vein and extended into the left atrium. The tumor was surgically debulked, but it recurred in 1 month, and the patient underwent chemotherapy. Six months later, she had recurrent respiratory symptoms, and echocardiography revealed a persistent mass in the left lower lobar vein. A modified chemotherapy regimen led to complete resolution of the tumor within 2 months. We are unaware of other reports of a primary cardiac non-Hodgkin lymphoblastic lymphoma with this unusual site of origin and rare manifestation of symptoms. PMID:21841872

Prevention and control of proliferative vitreoretinopathy: primary retinal detachment surgery using silicone oil as a planned two-stage procedure in high-risk cases.

Science.gov (United States)

Alexander, P; Prasad, R; Ang, A; Poulson, A V; Scott, J D; Snead, M P

2008-06-01

For rhegmatogenous retinal detachment, reattachment with a single procedure is associated with better visual outcomes. In the past, silicone oil has been used mostly as a last resort following failed primary surgery. This study evaluates a novel approach to patients at high risk of primary failure, using silicone tamponade as the primary stage of a planned two-stage procedure. We report a series of 140 eyes that underwent primary surgery for rhegmatogenous retinal detachment. Patients at higher risk of surgical failure (eg giant retinal tear, inability to posture, poor view, uncertainty of location of primary break, primary proliferative vitreoretinopathy (PVR), multiple tears with rolled posterior edges, retinoschisis/detachment, staphyloma with macular hole) were managed by a planned staged procedure using primary silicone oil tamponade. This was followed by silicone removal at a later date. Fifty-four eyes underwent scleral buckling alone, with primary success in 52/54 (96%). Fifty-three eyes underwent vitrectomy and gas, achieving primary success in 50/53 (94%). Thirty-three eyes were classified high risk and managed with primary silicone. Silicone was safely removed in 22/25. In eight eyes, silicone was retained without attempt at removal. In total, primary retinal reattachment was achieved in 128 of 140 eyes (91.4%). Of these, 124 (97%) did not require long-term tamponade. Only four eyes (2.9%) developed PVR. A planned two-stage approach to highrisk cases of retinal detachment using primary silicone oil tamponade followed by silicone removal can achieve a high primary reattachment rate with less than 3% incidence of PVR.

Acute normovolemic hemodilution is not beneficial in patients undergoing primary elective valve surgery

Directory of Open Access Journals (Sweden)

Virmani Sanjula

2010-01-01

Full Text Available The objective of this study was to evaluate the effectiveness of acute normovolemic hemodilution (ANH as a sole method of reducing allogenic blood requirement in patients undergoing primary elective valve surgery. One hundred eighty eight patients undergoing primary elective valve surgery were prospectively randomized into two groups: Group I (n=100 acted as control and in Group II (n=88 autologous blood was removed (10% of estimated blood volume in patients with hemoglobin (Hb > 12g% and 7% when the Hb was < 12g% in the pre-cardiopulmonary bypass (CPB period for subsequent re-transfusion after protamine administration. The autologous blood withdrawn was replaced simultaneously with an equal volume of hydroxyl-ethyl starch solution. Banked blood was transfused in both the groups when Hb was ≤6g % on CPB and ≤8g% after CPB. Platelets were transfused when the count fell to < 100´10 9 /L and fresh frozen plasma (FFP was transfused whenever there was diffuse bleeding with laboratory evidence of coagulopathy. The two groups were comparable as regards demographic data, type of surgical procedures performed, duration of CPB and ischemia, duration of elective ventilation and re-exploration for excessive bleeding. The autologous blood withdrawn in patients with Hb≥12g% was 288.3±69.4 mL and 244.4±41.3 mL with Hb < 12g% (P=NS. The Hb concentration (g % was comparable pre-operatively (Group I= 12.1±1.6, Group II= 12.4±1.4, on postoperative day 1 (Group I =10.3±1.1, Group II= 10.6±1.2 and day 7 (Group I = 10.9±1.5, Group II=10.4±1.5. However, the lowest Hb recorded on CPB was significantly lower in Group II (Group I =7.7±1.2, Group II=6.7±0.9, P < 0.05. There was no difference in the chest tube drainage (Group I =747.2±276.5 mL, Group II=527.6±399.5 mL, blood transfusion (Group I=1.1±1.0 units vs. Group II=1.3±1.0 units intra-operatively and Group I=1.7±1.2 units vs. Group II=1.7±1.4 units post-operatively and FFP transfusion (Group I

Clinical study of anti-reflux surgery for pediatric patients with primary vesico-ureteral reflux

International Nuclear Information System (INIS)

Miyamae, Koichi; Kitani, Kosuke; Miyamoto, Kenji; Nakakuma, Kensuke; Hamada, Yasuyuki; Nagano, Koji; Kawano, Tomoyasu; Nakamura, Toshiro

2012-01-01

We reviewed the characteristics of 25 pediatric patients (41 ureters) with primary vesico-ureteral reflux (VUR) who underwent anti-reflux surgery. The patients comprised 14 males and 11 females. The median age at diagnosis and at operation was 5 years 3 months and 6 years 5 months, respectively. VUR grade comprised grade I, 4 cases, grade II, 3 cases, grade III, 11 cases, grade IV, 11 cases and grade V, 12 cases. We utilized the Cohen method as the anti-reflux surgery technique. VUR recurrence was detected in 1 case (2.9%) during follow-up. Moreover, there were no cases with progressive renal dysfunction or breakthrough infection. The rate of kidney with renal scar on scintigraphy before the operation was 48.9%, and the rate of kidney with renal dysfunction before the operation was 60.0%. As a result of Fisher's exact probability test, the risk factors of breakthrough infection (BTI) were high grade VUR and renal scar on scintigraphy. Based on our clinical results, our future strategy for the management of pediatric patients with primary VUR is proposed as follows. In all patients younger than 1 year old, antibacterial prophylaxis should be applied. For patients younger than 6 years old, the initial treatment should be antibacterial prophylaxis, but for patients with VUR of grade III or more, in cases of breakthrough infection or in cases with progressive renal dysfunction, surgical treatment should be considered. For patients older than 6 years with VUR of grade III or more, surgical treatment is strongly recommended. (author)

Incidence and Timing of Thromboembolic Events in Patients With Ovarian Cancer Undergoing Neoadjuvant Chemotherapy.

Science.gov (United States)

Greco, Patricia S; Bazzi, Ali A; McLean, Karen; Reynolds, R Kevin; Spencer, Ryan J; Johnston, Carolyn M; Liu, J Rebecca; Uppal, Shitanshu

2017-06-01

To identify the incidence and timing of venous thromboembolism as well as any associated risk factors in patients with ovarian, fallopian tube, or primary peritoneal cancer undergoing neoadjuvant chemotherapy. We conducted a retrospective cohort study of patients diagnosed with ovarian, fallopian tube, and primary peritoneal cancer and receiving neoadjuvant chemotherapy from January 2009 to May 2014 at a single academic institution. The timing and number of venous thromboembolic events for the entire cohort were categorized as follows: presenting symptom, during neoadjuvant chemotherapy treatment, after debulking surgery, and during adjuvant chemotherapy. Of the 125 total patients with ovarian cancer undergoing neoadjuvant chemotherapy, 13 of 125 patients (10.4%, 95% confidence interval [CI] 6.1-17.2%) had a venous thromboembolism as a presenting symptom and were excluded from further analysis. Of the 112 total patients at risk, 30 (26.8%, 95% CI 19.3-35.9%) experienced a venous thromboembolism. Based on the phase of care, 13 (11.6%, 95% CI 6.8-19.1%) experienced a venous thromboembolism during neoadjuvant chemotherapy, six (5.4%, 95% CI 2.4-11.5%) developed a postoperative venous thromboembolism, and 11 (9.9%, 95% CI 5.5-17%) developed a venous thromboembolism during adjuvant chemotherapy. Two of the four patients with clear cell histology developed a venous thromboembolism in this cohort. Overall new diagnosis of venous thromboembolism was associated with one fourth of the patients undergoing neoadjuvant chemotherapy for ovarian cancer with nearly half of these diagnosed during chemotherapy cycles before interval debulking surgery. Efforts to reduce venous thromboembolism so far have largely focused on the postoperative period. Additional attention to venous thromboembolic prophylaxis during chemotherapy (neoadjuvant and adjuvant) in this patient population is warranted in an effort to decrease the rates of venous thromboembolism.

A diagnostic dilemma following risk-reducing surgery for BRCA1 mutation – a case report of primary papillary serous carcinoma presenting as sigmoid cancer

Directory of Open Access Journals (Sweden)

Nash Guy F

2007-09-01

Full Text Available Abstract Background Women that carry germ-line mutations for BRCA1 or BRCA2 genes are at an increased risk of developing breast, ovarian and peritoneal cancer. Primary peritoneal carcinoma is a rare tumour histologically identical to papillary serous ovarian carcinoma. Risk-reducing surgery in the form of mastectomy and oophorectomy in premenopausal women has been recommended to prevent breast and ovarian cancer occurrence and decrease the risk of developing primary peritoneal cancer. Case presentation We present a case report of a woman with a strong family history of breast cancer who underwent risk-reducing surgery in the form of bilateral salpingo-oophorectomy following a mastectomy for a right-sided breast tumour. Following the finding of a BRCA1 mutation, a prophylactic left-sided mastectomy was performed. After remaining well for twenty-seven years, she presented with rectal bleeding and altered bowel habit, and was found to have a secondary cancer of the sigmoid colon. She was finally diagnosed with primary papillary serous carcinoma of the peritoneum (PSCP. Conclusion PSCP can present many years after risk-reducing surgery and be difficult to detect. Surveillance remains the best course of management for patients with known BRCA mutations.

Randomized study of control of the primary tumor and survival using preoperative radiation, radiation alone, or surgery alone in head and beck carcinomas

International Nuclear Information System (INIS)

Hintz, B.; Charyulu, K.; Chandler, J.R.; Sudarsanam, A.; Garciga, C.

1979-01-01

Fifty-five selected patients with previously untreated squamous cell carcinoma of the head and neck regions were studied in a randomized, prospective manner. The three treatment categories were primary radiation (Gp R), primary surgery (Gp S), and preoperative radiation of 4000 rads in four weeks (Gp R/S). The local control rates for the 44 evaluable patients with a two-year minimum followup were 24%, 39%, and 43%, respectively. Further treatment attempts in patients failing initial therapy yielded local control rates of 35%, 39%, and 43% for Gp R, Gp S, and Gp R/S, respectively. None of the local control rates nor the corresponding survival curves were significantly different at P < 0.10. However, the group sizes were sufficiently small that true differences might not have been detected. Postoperative complications were higher in the primary radiation failures subsequently operated upon compared to the primary surgery group (P = 0.07). A table is included in which the types of postoperative complications are listed and enumerated according to treatment regime

Radiotherapy With or Without Surgery for Patients With Idiopathic Sclerosing Orbital Inflammation Refractory or Intolerant to Steroid Therapy

International Nuclear Information System (INIS)

Lee, Jong Hoon; Kim, Yeon-Sil; Yang, Suk Woo; Cho, Won-Kyung; Lee, Sang Nam; Lee, Kyung Ji; Ryu, Mi-Ryeong; Jang, Hong Seok

2012-01-01

Purpose: To evaluate the outcomes of patients with idiopathic sclerosing orbital inflammation (ISOI) treated with radiotherapy with or without surgery. Methods and Materials: We retrospectively reviewed 22 patients with histopathologically confirmed ISOI who had been refractory or intolerant to steroid therapy and treated with radiation with or without surgery. The radiation dose ranged from 20 to 40 Gy (median, 20 Gy) at 2 Gy per fraction. Presenting signs and treatment outcomes were assessed. Results: Proptosis was the most common sign at presentation, seen in 19 (86.3%) patients, followed by restriction of extraocular movements in 10 (45.4%) patients. Response to radiotherapy was complete in 15 (68.1%) patients, partial in 3 (13.6%) patients, and none in 4 (18.2%) patients. At the median follow-up of 34 months, 14 (63.6%) patients had progression-free state of symptoms and signs, with the progression-free duration ranging from 3 to 75 months (median, 41.5 months), whereas 8 (36.4%) patients had recurrent or persistent disease although they had received radiotherapy. Of the 14 progression-free patients, 6 underwent a bimodality treatment of debulking surgery of ocular disease and radiotherapy. They had had no recurrent disease. Cataract was the most common late complications, and 2 patients experienced a Grade 3 cataract. Conclusion: Our study suggests that for patients with ISOI who are refractory or intolerant to steroid therapy, 20 Gy of radiotherapy appears to be effective for the control of disease with acceptable complications, especially when it is combined with surgery.

[Ovarian carcinoma: new prognostic and therapeutic viewpoints].

Science.gov (United States)

Goldhirsch, A; Joss, R; Greiner, R; Brunner, K W

1980-11-01

Some recently developed concepts concerning the management of ovarian cancer are discussed. Cytoreductive surgery to debulk the tumor to a minimum, even in those cases which were considered inoperable in the past, improves the chances for cure. Adjuvant radiotherapy or combination chemotherapy with new drugs have proved highly effective in inducing complete remission and potential cures in these patients. The definition and better understanding of prognostic criteria play a primary role in the selection of treatment. In designing the strategy for adequate treatment, the following points are of major importance: (1) exact definition of tumor spread as determined by accurate surgical staging; (2) histologic and cytologic grading; and (3) evaluation of response.

Analysis of Survival Rates Following Primary Surgery of 178 Consecutive Patients with Oral Cancer in a Large District General Hospital.

Science.gov (United States)

Stathopoulos, Panagiotis; Smith, William P

2017-06-01

The aim of this study is to present the survival rates in patients treated for oral cancer with primary surgery in a large district general hospital. We discuss the influence of the most significant prognostic factors on survival and compare our results with larger centres specializing in the management of oral cancer. All patients diagnosed with oral cancer from 1995 to 2006 and were treated in the Department had their details entered prospectively onto a computerized database. Demographic details of patients, type of treatment, pathological stage of tumor (TNM), local and regional recurrence rate, overall survival, disease specific survival and incidence of involved margins were recorded and calculated. Of the 178 patients, 96 (54 %) were alive and free of oral cancer 5 years after surgery. Forty-four patients died of oral cancer (24.7 %) but 38 (21.3 %) died of other causes. The overall survival rate after primary surgery in relation to stage was: I 84 %, II 71 %, III 36 % and IV 28 %. As almost half of our patients presented with advanced cancer and had discouraging survival rates, we emphasize the need for early recognition of the disease. Advanced disease signifies difficulty in obtaining clear margins which actually indicates a higher recurrence rate. 25 % of our patients died of oral cancer within 5 years of surgery which highlights the poor prognosis that recurrence carries after treatment. Effective educational campaign with purpose to raise oral cancer awareness and earlier referral may result in improvement of survival.

Surgery under general anaesthesia in severe hidradenitis suppurativa: a study of 363 primary operations in 113 patients.

Science.gov (United States)

Blok, J L; Boersma, M; Terra, J B; Spoo, J R; Leeman, F W J; van den Heuvel, E R; Huizinga, J; Jonkman, M F; Horváth, B

2015-08-01

Treatment of hidradenitis suppurativa (HS) is a difficult undertaking, especially as there is no consensus on what surgical technique is preferred. At our centre severe HS (Hurley II/III) is operated under general anaesthesia, mostly with the STEEP procedure. To investigate characteristics, surgical outcomes and patient satisfaction of HS patients who underwent deroofing or STEEP under general anaesthesia. A clinical records-based retrospective analysis was conducted of all patients who had surgery under general anaesthesia between 1999 and 2013. Patient satisfaction was retrospectively investigated with questionnaires. A total of 482 operations (363 primary operations and 119 re-operations) were performed during the study period. The proportion of women in the included population was 68%. The median diagnostic delay (patient's and doctor's delay) was 6.5 years. Relapses occurred after 29.2% of primary operations. Women had higher relapse rates than men [odds ratio 2.85 (1.07;7.61)]. Hypergranulation of the wound was the most common complication and occurred in 7% of all operations. The median score patients attributed to the medical effect of surgery was eight of 10 (zero corresponding to very dissatisfied and 10 to very satisfied). The diagnostic delay in HS is long due to a lack of knowledge in both patients and health care professionals, indicating that there is a need for education. Deroofing and the STEEP are effective surgical procedures in severe cases of HS and lead to a relatively high patient satisfaction. The postoperative relapse risk is higher in women. Prospective studies are required for the development of clear guidelines on the appropriate choice of surgery. © 2015 European Academy of Dermatology and Venereology.

Disseminated bone metastases from occult thyroid cancer effectively treated with debulking surgery and a single dosimetry-guided administration of radioiodine.

Science.gov (United States)

Borsò, Elisa; Boni, Giuseppe; Mazzarri, Sara; Cocciaro, Ardico; Gambacciani, Carlo; Traino, Antonio C; Manca, Giampiero; Grosso, Mariano; Scatena, Cristian; Ortenzi, Valerio; Vannozzi, Riccardo; Marzola, Maria Cristina; Rubello, Domenico; Mariani, Giuliano

2015-01-01

In this paper we report on a successful management of multiple bone metastases from differentiated thyroid cancer. In 2007, a 75-year-old female patient, previously referred for thyroidectomy for multinodular goiter, underwent surgical removal of a lumbar mass with histological findings of metastasis from well differentiated thyroid cancer. After surgery, serum thyroglobulin (sTg) was 204.4 ng/mL. A diagnostic/dosimetric (123)I WBS was performed, following stimulation by rTSH. Serial WBSs were acquired, along with SPECT/CT and bone scan for localization of lesions. sTg raised to 3.810 ng/mL, and (123)I WBS showed thyroid remnants and numerous areas with high iodine-uptake corresponding to skeletal sites, the two largest loading on the skull, with osteolytic pattern. Calculated radiation absorbed dose for skull lesions, determined by mean of MIRD methodology, was 63.5 mGy/MBq. The patient underwent surgical removal of the two major skull lesions. Successively, 100 mCi (131)I was administered after stimulation by rTSH, with stimulated sTg 297 ng/mL. After 8 months, diagnostic WBS was negative both for remnants and metastases and rTSH-stimulated Tg was 0.6 ng/mL. To date, the patient has maintained sTg values <1 ng/mL during L-T4 suppressive therapy and after rTSH stimulations. In this unusual case of extensive bone cancerous involvement with high iodine avidity, a multidisciplinary approach based on surgery and dosimetry-guided radiometabolic therapy allowed to accurately assess the patient, execute a small number of treatments and achieve a complete remission of the disease in a very short time, with no additive morbidity. Copyright © 2014 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

Laser Eye Surgery: MedlinePlus Health Topic

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... corneal surgery - discharge (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Laser Eye Surgery ... surgery - what to ask your doctor Related Health Topics Refractive Errors National Institutes of Health The primary ...

Fractionated stereotactic conformal radiotherapy following conservative surgery in the control of craniopharyngiomas

International Nuclear Information System (INIS)

Minniti, Giuseppe; Saran, Frank; Traish, Daphne; Soomal, Rubin; Sardell, Susan; Gonsalves, Adam; Ashley, Susan; Warrington, Jim; Burke, Kevin; Mosleh-Shirazi, Amin; Brada, Michael

2007-01-01

Purpose: To describe the technique and results of stereotactically guided conformal radiotherapy (SCRT) in patients with craniopharyngioma after conservative surgery. Methods and materials: Thirty-nine patients with craniopharyngioma aged 3-68 years (median age 18 years) were treated with SCRT between June 1994 and January 2003. All patients were referred for radiotherapy after undergoing one or more surgical procedures. Treatment was delivered in 30-33 daily fractions over 6-6.5 weeks to a total dose of 50 Gy using 6 MV photons. Outcome was assessed prospectively. Results: At a median follow-up of 40 months (range 3-88 months) the 3- and 5-year progression-free survival (PFS) was 97% and 92%, and 3- and 5-year survival 100%. Two patients required further debulking surgery for progressive disease 8 and 41 months after radiotherapy. Twelve patients (30%) had acute clinical deterioration due to cystic enlargement of craniopharyngioma following SCRT and required cyst aspiration. One patient with severe visual impairment prior to radiotherapy had visual deterioration following SCRT. Seven out of 10 patients with a normal pituitary function before SCRT had no endocrine deficits following treatment. Conclusion: SCRT as a high-precision technique of localized RT is suitable for the treatment of incompletely excised craniopharyngioma. The local control, toxicity and survival outcomes are comparable to results reported following conventional external beam RT. Longer follow-up is required to assess long-term efficacy and toxicity, particularly in terms of potential reduction in treatment related late toxicity

Effect of neurological monitoring in postoperative 5-15 days residual thyroidectomy after primary thyroid cancer surgery.

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Long, Miao-Yun; Diao, Fei-Yu; Peng, Li-Na; Tan, Lang-Ping; Zhu, Yue; Huang, Kai; Li, Hong-Hao

2018-05-16

To explore the application of intraoperative neurological monitoring in residual thyroidectomy 5-15 days after thyroid cancer operation and the influence on postoperative serum thyroglobulin (Tg), recurrent laryngeal nerve and function of parathyroid glands. Material of patients receiving thyroid surgery from January 2010 to December 2016 was retrospectively analyzed. Cases meeting with standards were enrolled for analysis and the patients were divided into neurological monitoring group and non-neurological monitoring group in line with the use of neurological monitoring during the operation. Recurrent laryngeal nerve-injured hoarseness, hypoparathyroidism and concentration of serum Tg before and after the surgery were collected and analyzed. Four-hundred and thirty-five patients met with standards, among which 227 from neurological monitoring group and 208 from non-neurological monitoring group. Temporary hoarseness rate of non-neurological monitoring group and neurological monitoring group was 8.67% and 2.2%. Permanent hoarseness rate of non-neurological monitoring group and neurological monitoring group was 1.92% and 0.44%. Temporary hypoparathyroidism rate of non-neurological monitoring group and neurological monitoring group was 18.75% and 7.48%. Permanent hypoparathyroidism rate of non-neurological monitoring group and neurological monitoring group was 1.92% and 0.88%. Average Tg concentration 1 month after the surgery in non-neurological monitoring group and neurological monitoring group was 2.82 and 1.37 ng/mL, respectively. Rate of average Tg concentration less than 1 ng/mL 1 month after the surgery in non-neurological monitoring group and neurological monitoring group was 45.06% and 67.4%. Intraoperative neurological monitoring can be adopted in residual thyroidectomy in postoperative 5-15 days after primary thyroid cancer surgery, as to reduce incidence rate of recurrent laryngeal nerve injury and hypoparathyroidism and to enhance thorough removal of

Drainage or Packing of the Sella? Transsphenoidal Surgery for Primary Pituitary Abscess: Report of Two Cases

Directory of Open Access Journals (Sweden)

Soichi Oya

2009-01-01

Full Text Available The detailed surgical procedure of the transsphenoidal surgery for pituitary abscess has scarcely been described previously because it is a very rare clinical entity. The authors reported two cases of primary pituitary abscess. In case 1, the anterior wall of the sella turcica was reconstructed with the vomer bone after irrigating the abscess cavity, but the sella was not packed by fat for fear of the persistent infection by devascularized tissues. This led to the postoperative meningocele, the cerebrospinal fluid leak, and bacterial meningitis despite the successful abscess drainage. In case 2, tight sellar packing and reconstruction of the sellar wall were performed to avoid these postoperative complications, which resulted in complete drainage and uneventful postoperative course. Although accumulation of more cases is obviously needed to establish the definitive surgical technique in pituitary abscess surgery, our experience might suggest that packing of the sella is not impeditive for postoperative sufficient drainage.

Outcomes of cataract surgery with residents as primary surgeons in the Veterans Affairs Healthcare System.

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Payal, Abhishek R; Gonzalez-Gonzalez, Luis A; Chen, Xi; Cakiner-Egilmez, Tulay; Chomsky, Amy; Baze, Elizabeth; Vollman, David; Lawrence, Mary G; Daly, Mary K

2016-03-01

To explore visual outcomes, functional visual improvement, and events in resident-operated cataract surgery cases. Veterans Affairs Ophthalmic Surgery Outcomes Database Project across 5 Veterans Affairs Medical Centers. Retrospective data analysis of deidentified data. Cataract surgery cases with residents as primary surgeons were analyzed for logMAR corrected distance visual acuity (CDVA) and vision-related quality of life (VRQL) measured by the modified National Eye Institute Vision Function Questionnaire and 30 intraoperative and postoperative events. In some analyses, cases without events (Group A) were compared with cases with events (Group B). The study included 4221 cataract surgery cases. Preoperative to postoperative CDVA improved significantly in both groups (P < .0001), although the level of improvement was less in Group B (P = .03). A CDVA of 20/40 or better was achieved in 96.64% in Group A and 88.25% in Group B (P < .0001); however, Group B had a higher prevalence of preoperative ocular comorbidities (P < .0001). Cases with 1 or more events were associated with a higher likelihood of a postoperative CDVA worse than 20/40 (odds ratio, 3.82; 95% confidence interval, 2.92-5.05; P < .0001) than those who did not experience an event. Both groups had a significant increase in VRQL from preoperative levels (both P < .0001); however, the level of preoperative to postoperative VRQL improvement was significantly less in Group B (P < .0001). Resident-operated cases with and without events had an overall significant improvement in visual acuity and visual function compared with preoperatively, although this improvement was less marked in those that had an event. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Decreased risk of surgery for small bowel obstruction after laparoscopic colon cancer surgery compared with open surgery

DEFF Research Database (Denmark)

Jensen, Kristian Kiim; Andersen, Peter; Erichsen, Rune

2016-01-01

cancer resection. METHODS: This was a nationwide cohort study of patients undergoing elective colonic cancer resection with primary anastomosis in Denmark between 2001 and 2008. All included patients were operated with curative intent. Patients were identified in the Danish Colorectal Cancer Group....... The HR for mortality after colonic resection was 2.54 (CI 1.91 to 3.38, P ... surgery. Further, subsequent SBO surgery was associated with increased mortality after colonic cancer resection....

Post-operative therapy following transoral robotic surgery for unknown primary cancers of the head and neck.

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Patel, Sapna A; Parvathaneni, Aarthi; Parvathaneni, Upendra; Houlton, Jeffrey J; Karni, Ron J; Liao, Jay J; Futran, Neal D; Méndez, Eduardo

2017-09-01

Our primary objective is to describe the post- operative management in patients with an unknown primary squamous cell carcinoma of the head and neck (HNSCC) treated with trans-oral robotic surgery (TORS). We conducted a retrospective multi-institutional case series including all patients diagnosed with an unknown primary HNSCC who underwent TORS to identify the primary site from January 1, 2010 to June 30, 2016. We excluded those with recurrent disease, ≤6months of follow up from TORS, previous history of radiation therapy (RT) to the head and neck, or evidence of primary tumor site based on previous biopsies. Our main outcome measure was receipt of post-operative therapy. The tumor was identified in 26/35 (74.3%) subjects. Post-TORS, 2 subjects did not receive adjuvant therapy due to favorable pathology. Volume reduction of RT mucosal site coverage was achieved in 12/26 (46.1%) subjects who had lateralizing tumors, ie. those confined to the palatine tonsil or glossotonsillar sulcus. In addition, for 8/26 (30.1%), the contralateral neck RT was also avoided. In 9 subjects, no primary was identified (pT0); four of these received RT to the involved ipsilateral neck nodal basin only without pharyngeal mucosal irradiation. Surgical management of an unknown primary with TORS can lead to deintensification of adjuvant therapy including avoidance of chemotherapy and reduction in RT doses and volume. There was no increase in short term treatment failures. Treatment after TORS can vary significantly, thus we advocate adherence to NCCN guideline therapy post-TORS to avoid treatment-associated variability. Published by Elsevier Ltd.

Application of fast track surgery strategy in perioperative period of primary suture of laparoscopic choledocholithotomy

Directory of Open Access Journals (Sweden)

LIU Jinheng

2016-11-01

Full Text Available ObjectiveTo investigate the clinical application value of fast track surgery strategy (EARS in the perioperative period of primary suture of laparoscopy in the treatment of common bile duct stones. MethodsA total of 64 patients with gallstones complicated by common bile duct stones who were hospitalized in Department of Hepatobiliary Surgery in The Second People′s Hospital of Chengdu from October 2015 to February 2016 were enrolled, and according to the treatment in the perioperative period, the patients were divided into EARS group (32 patients and control group (32 patients. Clinical indices and complications were compared between the two groups. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsCompared with the control group, the ERAS group had significantly shortened time of extraction of drainage tube (1.6±0.9 d vs 2.7±1.0 d, t=-5.675, P＜0.01 and length of hospital stay (5.1±1.0 d vs 6.8±1.1 d, t=-5.910, P＜0.01, significantly shorter time to first ambulation (1.0±0.3 d vs 1.6±0.7 d, t=-4.313, P＜0.01 and time to intestinal functional recovery (1.1±0.4 d vs 1.8±0.6 d, t=-4.842, P＜0.01, a significantly shortened time to stopping infusion after surgery (3.8±1.0 d vs 4.9±1.2 d, t=-3.923, P＜0.01, significantly reduced total hospital costs (17 433.5±1411.3 ten thousand yuan vs 26 651.6±2945.8 ten thousand yuan, t=-15.942, P＜0.001, a significantly lower proportion of patients who experienced pain after surgery ［4 (12.5% vs 13 (40.6%, χ2=6.490, P=0.011］, and significantly lower levels of alanine aminotransferase (105.25±35.34 U/L vs 179.00±48.64 U/L, t=-5.973, P＜0.05 and total bilirubin (50.78±12.60 μmol/L vs 79.70±18.56 μmol/L, t=-7.090, P＜0.05 after surgery. ConclusionEARS is highly practical in the perioperative period of laparoscopic surgery and can promote patients′ rapid recovery. Therefore

Primary management of esophageal carcinoma with radiation therapy and surgery and correlation of failure pattern based on autopsy findings

International Nuclear Information System (INIS)

Ali, M.M.; Goertz, S.R.

1989-01-01

This paper reports a study of forty-seven patients with esophageal carcinoma who were treated definitively with radiation therapy (n = 18) and radical surgery (n = 18) or received palliative treatment (n = 11) at the Medical College of Virginia between 1967 and 1982. The average intervals between diagnosis and death were 5, 7, and 4 months, respectively. Autopsy revealed that 80% with radiation therapy and 50% in the surgery group had persistent local-regional disease. Eleven of 36 had adrenal metastasis and eight of 36 had a second primary in the head, neck, lung or prostate. The data show a significant incidence of persistent disease in spite of negative surgical margins. Additional treatment with chemotherapy or postoperative radiation therapy should be considered

Long-term effectiveness and safety of stereotactic gamma knife surgery as a primary sole treatment in the management of glomus jagulare tumor.

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Hafez, Raef F A; Morgan, Magad S; Fahmy, Osama M; Hassan, Hamdy T

2018-05-01

This study aims to report and confirm long-term effectiveness and safety of stereotactic Gamma Knife Surgery as a primary sole treatment in the management of 40 glomus jagulare tumors patients. Retrospective analysis of clinical and radiological outcomes of 40 GJTs consecutive patients treated with GKS as primary sole treatment at International Medical Center (IMC), Cairo-Egypt from the beginning of 2005 till the end of 2014,with mean follow-up period of 84 months (range 36-156 months), mean tumor volume was 6.5 cc, and mean peripheral radiation dose of 15 Gy, to mean isodose curve of 38%. The most common neurological deficit at initial evaluation was bulbar symptoms in 24 patients, followed by pulsatile tinnitus in 22, deterioration of hearing in 20 patients. The overall clinical control achieved in 92.5% of patients, while actuarial tumor size control rate post- GKS was 97.5% at 3 years, 97% at 5 years and 92% at 10 years of follow-up period. Gamma knife surgery could be used effectively and safely as a primary sole treatment tool in the management of glomus jugulare tumors. Copyright © 2018 Elsevier B.V. All rights reserved.

Current integrated cardiothoracic surgery residents: a Thoracic Surgery Residents Association survey.

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Tchantchaleishvili, Vakhtang; LaPar, Damien J; Stephens, Elizabeth H; Berfield, Kathleen S; Odell, David D; DeNino, Walter F

2015-03-01

After approval by the Thoracic Surgery Residency Review Committee in 2007, 6-year integrated cardiothoracic surgery (I-6) residency programs have gained in popularity. We sought to assess and objectively quantify the level of satisfaction I-6 residents have with their training and to identify areas of improvement for future curriculum development. A completely anonymous, electronic survey was created by the Thoracic Surgery Residents Association that asked the responders to provide demographic information, specialty interest, and lifestyle priorities, and to rate their experience and satisfaction with I-6 residency. The survey was distributed nationwide to all residents in I-6 programs approved by the Accreditation Council for Graduate Medical Education. Of a total of 88 eligible I-6 residents, 49 completed the survey (55.7%). Career choice satisfaction was high (75.5%), as was overall satisfaction with integrated training (83.7%). The majority (77.6%) were interested in cardiac surgery. Overall, the responders reported sufficient time for life outside of the hospital (57.1%), but experienced conflicts between work obligations and personal life at least sometimes (75.5%). Early exposure to cardiothoracic surgery was reported as the dominant advantage of the I-6 model, whereas variable curriculum structure and unclear expectations along with poor integration with general surgery training ranked highest among perceived disadvantages. Current I-6 residents are largely satisfied with the integrated training model and report a reasonable work/life balance. The focused nature of training is the primary perceived advantage of the integrated pathway. Curriculum variability and poor integration with general surgery training are identified by residents as primary areas of concern. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Preoperative radiochemotherapy and radical surgery in comparison with radical surgery alone

International Nuclear Information System (INIS)

Mohr, C.; Schettler, D.; Bohndorf, W.

1994-01-01

A multicentric, randomized study of squamous cell carcinoma (SCC) of the oral cavity and the oropharynx has been undertaken by DOeSAK. The results after radical surgery alone have been compared with the results of combined preoperative radiochemotherapy followed by radical surgery. Patients with primary (biopsy proven) SCC of the oral cavity or the oropharynx with tumor nodes metastasis (TNM) stages T2-4, N0-3, M0 were included in the study. A total of 141 patients were treated by radical surgery alone, whereas 127 patients were treated by radical surgery preceded by preoperative radiochemotherapy. The pre-operative treatment consisted of conventionally fractioned irradiation on the primary and the regional lymph nodes with a total dose of 36 Gy (5 x 2 Gy per week) and low-dose cisplatin chemotherapy with 5 x 12.5 mg cisplatin per m 2 of body surface during the first week of treatment. Radical surgery according to be DOeSAK definitions (DOeSAK, 1982) was performed after a delay of 10-14 days. During the follow-up period, 28.2% of all patients suffered from locoregional recurrence, and 27.2% of the patients died. The percentages were higher after radical surgery alone for locoregional recurrence (31% and 15.6%) and for death (28% and 18.6%). The life-table analysis showed improved survival rates of 4.5% after 1 year and 8.3% after 2 years in the group of patients treated with combined therapy. The demonstrated improvement appeared to be significant with the Gehan-Wilcoxon test as well as with the log rank test below a P value of 5%. (au) (29 refs.)

Which patients benefit most from primary surgery or neoadjuvant chemotherapy in stage IIIC or IV ovarian cancer? An exploratory analysis of the European Organisation for Research and Treatment of Cancer 55971 randomised trial.

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van Meurs, Hannah S; Tajik, Parvin; Hof, Michel H P; Vergote, Ignace; Kenter, Gemma G; Mol, Ben Willem J; Buist, Marrije R; Bossuyt, Patrick M

2013-10-01

To investigate whether biomarkers consisting of baseline characteristics of advanced stage ovarian cancer patients can help in identifying subgroups of patients who would benefit more from primary surgery or neoadjuvant chemotherapy. We used data of the European Organisation for Research and Treatment of Cancer (EORTC) 55971 trial in which 670 patients were randomly assigned to primary surgery or neoadjuvant chemotherapy. The primary outcome was overall survival. Ten baseline clinical and pathological characteristics were selected as potential biomarkers. Using Subpopulation Treatment Effect Pattern Plots (STEPP), biomarkers with a statistically significant qualitative additive interaction with treatment were considered as potentially informative for treatment selection. We also combined selected biomarkers to form a multimarker treatment selection rule. The size of the largest metastatic tumour and clinical stage were significantly associated with the magnitude of the benefit from treatment, in terms of five-year survival (p for interaction: 0.008 and 0.016, respectively). Stage IIIC patients with metastatic tumours ⩽45 mm benefited more from primary surgery while stage IV patients with metastatic tumours >45 mm benefited more from neoadjuvant chemotherapy. In stage IIIC patients with larger metastatic tumours and in stage IV patients with less extensive metastatic tumours both treatments were equally effective. We estimated that by selecting treatments for patients based on largest metastatic tumour and clinical stage, the potential five-year survival rate in the population of treated patients would be 27.3% (95% confidence interval (CI) 21.9-33.0), 7.8% higher than if all were treated with primary surgery, and 5.6% higher if all were treated with neoadjuvant chemotherapy. Although survival was comparable after primary surgery and neoadjuvant chemotherapy in the overall group of patients with ovarian cancer in the EORTC 55971 trial, we found in this exploratory

Vulvar Asymmetry Due to Silicone Migration and Granulomatous Immune Response Following Injection for Buttock Augmentation

OpenAIRE

Harker, David B.; Turrentine, Jake E.; Desai, Seemal R.

2017-01-01

A 34-year-old woman was referred to the authors? dermatology clinic for evaluation of right labial swelling and dyspareunia. Her symptoms began after receiving a liquid silicone injection into the buttocks at a cosmetic plastic surgery clinic that was operating illegally by an unlicensed provider. A single prior debulking surgery had produced only temporary relief of symptoms, and the swelling returned. Work-up including magnetic resonance imaging and skin biopsy revealed migration of the inj...

Risk of Post-Discharge Venous Thromboembolism and Associated Mortality in General Surgery: A Population-Based Cohort Study Using Linked Hospital and Primary Care Data in England.

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Bouras, George; Burns, Elaine Marie; Howell, Ann-Marie; Bottle, Alex; Athanasiou, Thanos; Darzi, Ara

2015-01-01

Trends towards day case surgery and enhanced recovery mean that postoperative venous thromboembolism (VTE) may increasingly arise after hospital discharge. However, hospital data alone are unable to capture adverse events that occur outside of the hospital setting. The National Institute for Health and Care Excellence has suggested the use of primary care data to quantify hospital care-related VTE. Data in surgical patients using these resources is lacking. The aim of this study was to measure VTE risk and associated mortality in general surgery using linked primary care and hospital databases, to improve our understanding of harm from VTE that arises beyond hospital stay. This was a longitudinal cohort study using nationally linked primary care (Clinical Practice Research Datalink, CPRD), hospital administrative (Hospital Episodes Statistics, HES), population statistics (Office of National Statistics, ONS) and National Cancer Intelligence Network databases. Routinely collected information was used to quantify 90-day in-hospital VTE, 90-day post-discharge VTE and 90-day mortality in adults undergoing one of twelve general surgical procedures between 1st April 1997 and 31st March 2012. The earliest postoperative recording of deep vein thrombosis or pulmonary embolism in CPRD, HES and ONS was counted in each patient. Covariates from multiple datasets were combined to derive detailed prediction models for VTE and mortality. Limitation included the capture of VTE presenting to healthcare only and the lack of information on adherence to pharmacological thromboprophylaxis as there was no data linkage to hospital pharmacy records. There were 981 VTE events captured within 90 days of surgery in 168005 procedures (23.7/1000 patient-years). Overall, primary care data increased the detection of postoperative VTE by a factor of 1.38 (981/710) when compared with using HES and ONS only. Total VTE rates ranged between 3.2/1000 patient-years in haemorrhoidectomy to 118

Preoperative intestinal stent decompression with primary laparoscopic surgery to treat left-sided colorectal cancer with obstruction: a report of 21 cases

International Nuclear Information System (INIS)

Zheng, Chao; Wu, Yu-Lian; Li, Qing

2013-01-01

This work aimed to study the safety and efficacy of preoperative intestinal stent decompression combined with laparoscopic surgery to treat left-sided colorectal cancer with obstruction (LCCO). Retrospective analysis was conducted on data obtained from 21 LCCO patients admitted to The First Affiliated Hospital of Zhejiang Chinese Medicine University during March 2008 and December 2011. To remove the intestinal obstruction, preoperative intestinal stent placement under colonoscopic guidance was performed. Approximately 7 to 10 days after the operation, laparoscopic radical surgery of colorectal cancer was conducted. Among the 21 cases studied, laparoscopic surgery was successful in 20 patients. Emergent laparotomy was conducted in one patient because of tumor invasion in the ureter. The duration of the operation ranged from 180 to 320 min, and the average time was 220 min. The recovery time for bowel function ranged from 2 to 5 days with an average time of 3 days. Postoperative infection of the incision occurred in one case. No anastomotic leakage was observed in any of the cases. Preoperative intestinal stent decompression, combined with primary stage laparoscopic surgery, is a safe and effective method for the treatment of LCCO

Therapeutic outcomes of transsphenoidal surgery in pediatric patients with craniopharyngiomas: a single-center study.

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Yamada, Shozo; Fukuhara, Noriaki; Yamaguchi-Okada, Mitsuo; Nishioka, Hiroshi; Takeshita, Akira; Takeuchi, Yasuhiro; Inoshita, Naoko; Ito, Junko

2018-03-30

OBJECTIVE The aim of this study was to analyze the outcomes of transsphenoidal surgery (TSS) in a single-center clinical series of pediatric craniopharyngioma patients treated with gross-total resection (GTR). METHODS The authors retrospectively reviewed the surgical outcomes for 65 consecutive patients with childhood craniopharyngiomas (28 girls and 37 boys, mean age 9.6 years) treated with TSS (45 primary and 20 repeat surgeries) between 1990 and 2015. Tumors were classified as subdiaphragmatic or supradiaphragmatic. Demographic and clinical characteristics, including extent of resection, complications, incidence of recurrence, pre- and postoperative visual disturbance, pituitary function, and incidence of diabetes insipidus (DI), as well as new-onset obesity, were analyzed and compared between the primary surgery and repeat surgery groups. RESULTS Of the 45 patients in the primary surgery group, 26 (58%) had subdiaphragmatic tumors and 19 had supradiaphragmatic tumors. Of the 20 patients in the repeat surgery group, 9 (45%) had subdiaphragmatic tumors and 11 had supradiaphragmatic tumors. The only statistically significant difference between the 2 surgical groups was in tumor size; tumors were larger (mean maximum diameter 30 mm) in the primary surgery group than in the repeat surgery group (25 mm) (p = 0.008). GTR was accomplished in 59 (91%) of the 65 cases; the GTR rate was higher in the primary surgery group than in the repeat surgery group (98% vs 75%, p = 0.009). Among the patients who underwent GTR, 12% experienced tumor recurrence, with a median follow-up of 7.8 years, and recurrence tended to occur less frequently in primary than in repeat surgery patients (7% vs 27%, p = 0.06). Of the 45 primary surgery patients, 80% had deteriorated pituitary function and 83% developed DI, whereas 100% of the repeat surgery patients developed these conditions. Among patients with preoperative visual disturbance, vision improved in 62% but worsened in 11%. Visual

Health-related Quality of Life after complex rectal surgery for primary advanced rectal cancer and locally recurrent rectal cancer

DEFF Research Database (Denmark)

Thaysen, Henriette Vind

2013-01-01

postoperative morbidity, Health-related Quality of Life (HRQoL) is an important issue. The overall aim of this thesis was therefore to evaluate HRQoL in patients with PARC and LRRC treated with COMP-RCS and curative intent. In study I a review of the literature was undertaken to provide an overview of HRQo......Advances in the treatment of rectal cancer, have made it possible to perform complex rectal cancer surgery (COMP-RCS) with curative intent in patients with primary advanced rectal caner (PARC) and local recurrent rectal cancer (LRRC). Due to the complexity of the treatment and its high...... in the study was 164 (86%) patients treated with standard rectal cancer surgery (STAN-RCS). The Danish version showed satisfactory psychometric properties for the scales concerning body image, sexual functioning, male sexual problems and defecations problems. Reduced psychometric properties were found...

Advanced laparoscopic bariatric surgery Is safe in general surgery training.

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Kuckelman, John; Bingham, Jason; Barron, Morgan; Lallemand, Michael; Martin, Matthew; Sohn, Vance

2017-05-01

Bariatric surgery makes up an increasing percentage of general surgery training. The safety of resident involvement in these complex cases has been questioned. We evaluated patient outcomes in resident performed laparoscopic bariatric procedures. Retrospective review of patients undergoing a laparoscopic bariatric procedure over seven years at a tertiary care single center. Procedures were primarily performed by a general surgery resident and proctored by an attending surgeon. Primary outcomes included operative volume, operative time and leak rate with perioperative outcomes evaluated as secondary outcomes. A total of 1649 bariatric procedures were evaluated. Operations included laparoscopic bypass (690) and laparoscopic sleeve gastrectomy (959). Average operating time was 136 min. Eighteen leaks (0.67%) were identified. Graduating residents performed an average of 89 laparoscopic bariatric cases during their training. There were no significant differences between resident levels with concern to operative time or leak rate (p 0.97 and p = 0.54). General surgery residents can safely perform laparoscopic bariatric surgery. When proctored by a staff surgeon, a resident's level of training does not significantly impact leak rate. Published by Elsevier Inc.

Applications of navigation for orthognathic surgery.

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Bobek, Samuel L

2014-11-01

Stereotactic surgical navigation has been used in oral and maxillofacial surgery for orbital reconstruction, reduction of facial fractures, localization of foreign bodies, placement of implants, skull base surgery, tumor removal, temporomandibular joint surgery, and orthognathic surgery. The primary goals in adopting intraoperative navigation into these different surgeries were to define and localize operative anatomy, to localize implant position, and to orient the surgical wound. Navigation can optimize the functional and esthetic outcomes in patients with dentofacial deformities by identifying pertinent anatomic structures, transferring the surgical plan to the patient, and verifying the surgical result. This article discusses the principles of navigation-guided orthognathic surgery. Copyright © 2014 Elsevier Inc. All rights reserved.

Mammographic Features of Local Recurrence after Conservative Surgery and Radiation Therapy: Comparison with that of the Primary Tumor

International Nuclear Information System (INIS)

Guenhan-Bilgen, I.; Oktay, A.

2007-01-01

Purpose: To compare the mammographic features of recurrent breast cancer with those of the primary tumor and to determine whether certain mammographic features are associated with a higher risk of local recurrence after breast-conserving therapy. Material and Methods: A retrospective review of mammograms of 421 patients who were treated with conservative surgery and radiotherapy revealed 41 recurrent tumors. Mammographic findings, location, and histopathologic characteristics were retrospectively compared between primary and recurrent tumors. Results: Recurrent tumors were similar in mammographic appearance to primary tumors in 27 (66%) cases. Of 27 primary tumors that occurred as masses without calcifications, 19 (70%) recurred as a mass, and of the six isolated calcifications, five (83%) recurred with calcifications. Ten (53%) of the 19 recurrent masses and five (100%) of the five recurrent calcifications had morphologic features that were similar to those of the primary tumor. Ninety-two percent (11/12) of the recurrences containing microcalcifications (isolated or associated with a mass) had microcalcifications in their primary tumor. Of 27 masses that recurred, the morphology of the primary tumor was obscured in 13 (48%), ill defined in 10 (37%), and spiculated in four (15%) of the masses. Seventy-six percent (31/41) of recurrences were within the lumpectomy quadrant. In 25 (61%) cases, the histologic findings from the primary tumor and the recurrence were identical. Conclusion: The majority of recurrent tumors appear to be mammographically similar to primary tumors. Therefore, it is important to review preoperative mammograms during follow-up of these patients. Although the study population is small, it was noted that mass with spiculated contour is associated with a lower risk for local recurrence

Systemic hypertension and non-cardiac surgery.

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Misra, Satyajeet

2017-09-01

Primary systemic hypertension affects 10%-25% of individuals presenting for surgery and anaesthesia and constitutes an important cause of cancellation of elective surgeries. Much of the fear stems from the fact that hypertension may lead to adverse perioperative outcomes. Although long-standing hypertension increases the risk of stroke, renal dysfunction or major adverse cardiovascular events, the same is usually not seen in the perioperative period if blood pressure is <180/110 mmHg and this has been the overriding theme in the recent guidelines on perioperative blood pressure management. Newer concepts include isolated systolic hypertension and pulse pressure hypertension that are increasingly used to stratify risk. The aim of this review is to focus on the adult patient with chronic primary systemic hypertension posted for elective non-cardiac surgery and outline the perioperative concerns.

The Relationship Between Preoperative and Primary Care Blood Pressure Among Veterans Presenting from Home for Surgery. Is There Evidence for Anesthesiologist-Initiated Blood Pressure Referral?

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Schonberger, Robert B.; Burg, Matthew M.; Holt, Natalie; Lukens, Carrie L.; Dai, Feng; Brandt, Cynthia

2011-01-01

Background American College of Cardiology/American Heart Association guidelines describe the perioperative evaluation as “a unique opportunity to identify patients with hypertension,” however factors such as anticipatory stress or medication noncompliance may induce a bias toward higher blood pressure, leaving clinicians unsure about how to interpret preoperative hypertension. Information describing the relationship between preoperative intake blood pressure and primary care measurements could help anesthesiologists make primary care referrals for improved blood pressure control in an evidence-based fashion. We hypothesized that the preoperative examination provides a useful basis for initiating primary care blood pressure referral. Methods We analyzed retrospective data on 2807 patients who arrived from home for surgery and who were subsequently evaluated within 6 months after surgery in the primary care center of the same institution. After descriptive analysis, we conducted multiple linear regression analysis to identify day-of-surgery (DOS) factors associated with subsequent primary care blood pressure. We calculated the sensitivity, specificity, and positive and negative predictive value of different blood pressure referral thresholds using both a single-measurement and a two-stage screen incorporating recent preoperative and DOS measurements for identifying patients with subsequently elevated primary care blood pressure. Results DOS systolic blood pressure (SBP) was higher than subsequent primary care SBP by a mean bias of 5.5mmHg (95% limits of agreement +43.8 to −32.8). DOS diastolic blood pressure (DBP) was higher than subsequent primary care DBP by a mean bias of 1.5mmHg (95% limits of agreement +13.0 to −10.0). Linear regression of DOS factors explained 19% of the variability in primary care SBP and 29% of the variability in DBP. Accounting for the observed bias, a two-stage SBP referral screen requiring preoperative clinic SBP≥140mmHg and DOS

[Strategy of liver resection during chemotherapy for otherwise unresectable colorectal metastases].

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Tanaka, Kuniya; Kumamoto, Takafumi; Takeda, Kazuhisa; Nojiri, Kazunori; Endo, Itaru

2013-07-01

With multidisciplinary management of patients with effective chemotherapy that can downstage metastases, more patients with previously inoperable disease can benefit from surgery. Surgery in isolation may be approaching technical limits, but now is likely to help more patients because of success of complementary strategies, particularly newer chemotherapy and targeted therapy. Leaving behind disappearing metastases after chemotherapy, margin-positive resection, staged liver resection, and liver-first reversed management permit potentially curative surgery for patients previously unable to survive resection. Further, survival benefit from maximum debulking surgery, like ovarian cancer, for colorectal liver metastases is uncertain at present, but likely. Individualized multidisciplinary treatment planning using such strategies is essential.

Combined therapy for 129 patients with second primary lung cancer

International Nuclear Information System (INIS)

Liang Jun; Feng Qinfu; Wang Luhua; Zhang Yaohong; Zhao Hongfa; Weng Xinran

2004-01-01

Objective: To analyze the clinical characteristics and prognosis of the second primary lung cancer. Methods: The interval between the second primary lung cancer and the previous primary cancer ranged from 10 days to 317 months (median 49 months). Of the 129 patients treated from 1971 to 1997 by surgery only, radiotherapy only and chemotherapy only or combined therapy, 11 (8.5%) patients had stage I, 29 (22.5%) stage II, 75 (58.1%) stage III and 14 (10.9%) stage IV; 30 patients received surgery alone, 54 radiotherapy alone, 8 chemotherapy alone, 12 surgery plus radiotherapy, 20 radiotherapy plus chemotherapy, 4 surgery plus chemotherapy and 1 surgery plus radiotherapy plus chemotherapy. Results: The overall 2-, 3- and 5-year survival rates were 40.2%, 27.2% and 15.3%. The stage I, II, III and IV 2-year survival rates were 71.6%, 60.7%, 32.9% and 0%, respectively (P 49 and ≤49 months of the interval between the second primary lung cancer and the previous primary cancer (P>0.05). Conclusions: Second primary lung cancer are similar to the first primary lung cancer in clinical characteristics and prognosis. The main cause of failure is lung cancer perse. Stage and being able to operation are prognostic factors

An investigation into the variables associated with length of hospital stay related to primary cleft lip and palate surgery and alveolar bone grafting.

Science.gov (United States)

Izadi, N; Haers, P E

2012-10-01

This retrospective study evaluated variables associated with length of stay (LOS) in hospital for 406 admissions of primary cleft lip and palate and alveolus surgery between January 2007 and April 2009. Three patients were treated as day cases, 343 (84%) stayed one night, 48 (12%) stayed 2 nights and 12 (3%) stayed > 2 nights. Poisson regression analysis showed that there was no association between postoperative LOS and age, distance travelled, diagnosis and type of operation, with a p value > 0.2 for all variables. 60/406 patients stayed 2 nights or more postoperatively mostly due to poor pain control and inadequate oral intake. Patients with palate repair were more likely to have postoperative LOS > 1 night, compared to patients with lip repair, p value = 0.011. Four patients (1%), all of whom had undergone cleft palate surgery, were readmitted within 4 weeks of the operation due to respiratory obstruction or haemorrhage. Using logistic regression, evidence showed that these readmissions were related to a longer original postoperative LOS. This study shows that length of stay for primary cleft lip, palate and alveolus surgery can in most cases be limited to one night postoperatively, provided that adequate support can be provided at home. Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Reconstruction after complex facial trauma: achieving optimal outcome through multiple contemporary surgeries.

Science.gov (United States)

Jaiswal, Rohit; Pu, Lee L Q

2013-04-01

Major facial trauma injuries often require complex repair. Traditionally, the reconstruction of such injuries has primarily utilized only free tissue transfer. However, the advent of newer, contemporary procedures may lead to potential reconstructive improvement through the use of complementary procedures after free flap reconstruction. An 18-year-old male patient suffered a major left facial degloving injury resulting in soft-tissue defect with exposed zygoma, and parietal bone. Multiple operations were undertaken in a staged manner for reconstruction. A state-of-the-art free anterolateral thigh (ALT) perforator flap and Medpor implant reconstruction of the midface were initially performed, followed by flap debulking, lateral canthopexy, midface lift with redo canthopexy, scalp tissue expansion for hairline reconstruction, and epidermal skin grafting for optimal skin color matching. Over a follow-up period of 2 years, a good and impressive reconstructive result was achieved through the use of multiple contemporary reconstructive procedures following an excellent free ALT flap reconstruction. Multiple staged reconstructions are essential in producing an optimal outcome in this complex facial injury that would likely not have been produced through a 1-stage traditional free flap reconstruction. Utilizing multiple, sequential contemporary surgeries may substantially improve outcome through the enhancement and refinement of results based on possibly the best initial soft-tissue reconstruction.

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

Science.gov (United States)

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

2017-06-01

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

Feasibility study of red blood cell debulking by magnetic field-flow fractionation with step-programmed flow.

Science.gov (United States)

Moore, Lee R; Williams, P Stephen; Nehl, Franziska; Abe, Koji; Chalmers, Jeffrey J; Zborowski, Maciej

2014-02-01

Emerging applications of rare cell separation and analysis, such as separation of mature red blood cells from hematopoietic cell cultures, require efficient methods of red blood cell (RBC) debulking. We have tested the feasibility of magnetic RBC separation as an alternative to centrifugal separation using an approach based on the mechanism of magnetic field-flow fractionation (MgFFF). A specially designed permanent magnet assembly generated a quadrupole field having a maximum field of 1.68 T at the magnet pole tips, zero field at the aperture axis, and a nearly constant radial field gradient of 1.75 T/mm (with a negligible angular component) inside a cylindrical aperture of 1.9 mm (diameter) and 76 mm (length). The cell samples included high-spin hemoglobin RBCs obtained by chemical conversion of hemoglobin to methemoglobin (met RBC) or by exposure to anoxic conditions (deoxy RBC), low-spin hemoglobin obtained by exposure of RBC suspension to ambient air (oxy RBC), and mixtures of deoxy RBC and cells from a KG-1a white blood cell (WBC) line. The observation that met RBCs did not elute from the channel at the lower flow rate of 0.05 mL/min applied for 15 min but quickly eluted at the subsequent higher flow rate of 2.0 mL/min was in agreement with FFF theory. The well-defined experimental conditions (precise field and flow characteristics) and a well-established FFF theory verified by studies with model cell systems provided us with a strong basis for making predictions about potential practical applications of the magnetic RBC separation.

Results of salvage surgery for mammary recurrence following breast-conserving therapy

International Nuclear Information System (INIS)

Kurtz, J.M.; Amalric, R.; Brandone, H.; Ayme, Y.; Spitalier, J.M.

1988-01-01

A retrospective analysis was performed of 118 surgically treated mammary recurrences, occurring following primary conservative excision and radiation therapy for clinical Stages I and II breast cancer. Actuarial cancer-specific survival following salvage surgery was 72% at 5 years and 58% at 10 years. With a median followup of 7 years, further local-regional recurrences were observed in 20 of the 118 patients, many of whom could be treated by further surgery. Actuarial survival after recurrence was significantly influenced by initial clinical stage, as well as by the disease-free interval following primary therapy, but was similar for both premenopausal and postmenopausal patients and for patients treated by radical or breast-conserving salvage operations. For recurrences after the fifth year, actuarial survival following salvage surgery was 83% and 68% at 5 and 10 years, respectively. Survival for Stage I patients was favorable regardless of disease-free interval. It is concluded that recurrences in the breast following primary treatment with limited surgery and irradiation have a considerably more favorable prognosis than that of local failures after primary radical surgery. Suggestions for the management of these recurrences are presented

Recurrent spine surgery patients in hospital administrative database

Directory of Open Access Journals (Sweden)

M. Sami Walid

2012-02-01

Full Text Available Introduction: Hospital patient databases are typically used by administrative staff to estimate loss-profit ratios and to help with the allocation of hospital resources. These databases can also be very useful in following rehospitalization. This paper studies the recurrence of spine surgery patients in our hospital population based on administrative data analysis. Methods: Hospital data on 4,958 spine surgery patients operated between 2002 and 2009 were retrospectively reviewed. After sorting the cohort per ascending discharge date, the patient official name, consisting of first, middle and last names, was used as the variable determining duplicate cases in the SPSS statistical program, designating the first case in each group as primary. Yearly recurrence rate and change in procedure distribution were studied. In addition, hospital charges and length of stay were compared using the Wilcoxon-Mann-Whitney test. Results: Of 4,958 spine surgery patients 364 (7.3% were categorized as duplicate cases by SPSS. The number of primary cases from which duplicate cases emerged was 327 meaning that some patients had more than two spine surgeries. Among primary patients (N=327 the percentage of excision of intervertebral disk procedures was 33.3% and decreased to 15.1% in recurrent admissions of the same patients (N=364. This decrease was compensated by an increase in lumbar fusion procedures. On the other hand, the rate of cervical fusion remained the same. The difference in hospital charges between primary and duplicate patients was $2,234 for diskectomy, $6,319 for anterior cervical fusion, $8,942 for lumbar fusion – lateral technique, and $12,525 for lumbar fusion – posterior technique. Recurrent patients also stayed longer in hospital, up to 0.9 day in lumbar fusion – posterior technique patients. Conclusion: Spine surgery is associated with an increasing possibility of additional spine surgery with rising invasiveness and cost.

Factors associated with a primary surgical approach for sinonasal squamous cell carcinoma.

Science.gov (United States)

Cracchiolo, Jennifer R; Patel, Krupa; Migliacci, Jocelyn C; Morris, Luc T; Ganly, Ian; Roman, Benjamin R; McBride, Sean M; Tabar, Viviane S; Cohen, Marc A

2018-03-01

Primary surgery is the preferred treatment of T1-T4a sinonasal squamous cell carcinoma (SNSCC). Patients with SNSCC in the National Cancer Data Base (NCDB) were analyzed. Factors that contributed to selecting primary surgical treatment were examined. Overall survival (OS) in surgical patients was analyzed. Four-thousand seven hundred and seventy patients with SNSCC were included. In T1-T4a tumors, lymph node metastases, maxillary sinus location, and treatment at high-volume centers were associated with selecting primary surgery. When primary surgery was utilized, tumor factors and positive margin guided worse OS. Adjuvant therapy improved OS in positive margin resection and advanced T stage cases. Tumor and non-tumor factors are associated with selecting surgery for the treatment of SNSCC. When surgery is selected, tumor factors drive OS. Negative margin resection should be the goal of a primary surgical approach. When a positive margin resection ensues, adjuvant therapy may improve OS. © 2017 Wiley Periodicals, Inc.

Primary thyroid lymphoma: a rare thyroid malignancy

International Nuclear Information System (INIS)

Mukhtar, R.; Khattak, R.; Mateen, A.

2011-01-01

Incidence of thyroidal masses is very high with predominance in females. Most of these masses are benign. Malignancy can be of thyroid or non-thyroid origin. Surgery is treatment of choice in the former but not in latter. Primary thyroid lymphoma (PTL) is a rare cause of thyroid malignancy of non-thyroid origin which is highly treatable without surgery but early diagnosis is important requisite to have better outcome. Fine needle aspiration cytology (FNAC) is an important tool in early diagnosis of PTL, which enables doctors to treat patient better without major surgery and its morbidity. Two cases of primary thyroid lymphoma are hereby presented. The patient diagnosed on FNAC had better outcome than the one who had major surgery. (author)

Approach to Rectal Cancer Surgery

Directory of Open Access Journals (Sweden)

Terence C. Chua

2012-01-01

Full Text Available Rectal cancer is a distinct subset of colorectal cancer where specialized disease-specific management of the primary tumor is required. There have been significant developments in rectal cancer surgery at all stages of disease in particular the introduction of local excision strategies for preinvasive and early cancers, standardized total mesorectal excision for resectable cancers incorporating preoperative short- or long-course chemoradiation to the multimodality sequencing of treatment. Laparoscopic surgery is also increasingly being adopted as the standard rectal cancer surgery approach following expertise of colorectal surgeons in minimally invasive surgery gained from laparoscopic colon resections. In locally advanced and metastatic disease, combining chemoradiation with radical surgery may achieve total eradication of disease and disease control in the pelvis. Evidence for resection of metastases to the liver and lung have been extensively reported in the literature. The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastases is showing promise in achieving locoregional control of peritoneal dissemination. This paper summarizes the recent developments in approaches to rectal cancer surgery at all these time points of the disease natural history.

Revisional Bariatric Surgery.

Science.gov (United States)

Switzer, Noah J; Karmali, Shahzeer; Gill, Richdeep S; Sherman, Vadim

2016-08-01

Revisional bariatric procedures are increasingly common. With more primary procedures being performed to manage severe obesity and its complications, 5% to 8% of these procedures will fail, requiring revisional operation. Reasons for revisional bariatric surgery are either primary inadequate weight loss, defined as less than 25% excess body weight loss, or weight recidivism, defined as a gain of more than 10 kg based on the nadir weight; however, each procedure also has inherit specific complications that can also be indications for revision. This article reviews the history of each primary bariatric procedure, indications for revision, surgical options, and subsequent outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

Nonelective surgery at night and in-hospital mortality

DEFF Research Database (Denmark)

van Zaane, Bas; van Klei, Wilton A; Buhre, Wolfgang F

2015-01-01

BACKGROUND: Evidence suggests that sleep deprivation associated with night-time working may adversely affect performance resulting in a reduction in the safety of surgery and anaesthesia. OBJECTIVE: Our primary objective was to evaluate an association between nonelective night-time surgery and in...

F18-choline PET/CT guided surgery in primary hyperparathyroidism when ultrasound and MIBI SPECT/CT are negative or inconclusive: the APACH1 study.

Science.gov (United States)

Quak, Elske; Blanchard, David; Houdu, Benjamin; Le Roux, Yannick; Ciappuccini, Renaud; Lireux, Barbara; de Raucourt, Dominique; Grellard, Jean-Michel; Licaj, Idlir; Bardet, Stéphane; Reznik, Yves; Clarisse, Bénédicte; Aide, Nicolas

2018-04-01

To evaluate the sensitivity of F18-choline (FCH) PET/CT for parathyroid adenoma detection prior to surgery in patients with primary hyperparathyroidism and negative or inconclusive cervical ultrasound and Tc99m-sestaMIBI SPECT/CT. We conducted a prospective bicentric study (NCT02432599). All patients underwent FCH PET/CT. The result was scored positive, inconclusive or negative. The number of uptakes and their sites were recorded. The FCH PET/CT result guided the surgical procedure (minimally invasive parathyroidectomy, bilateral cervical exploration, or other in case of multiple or ectopic foci). FCH PET/CT results were compared to the surgical and pathological findings and the follow-up. Twenty-five patients were included. Mean calcium and PTH levels prior to surgery were 2.76 ± 0.17 mmol/l and 94.8 ± 37.4 ng/l. Nineteen (76%) FCH PET/CTs were scored positive, 3 (12%) inconclusive and 3 (12%) negative, showing 21 cases of uniglandular disease, including 1 ectopic localization and 1 case of multiglandular (3 foci) disease. Mean lesion size was 13.1 ± 8.6 mm. Twenty-four patients underwent surgery. FCH PET/CT guided surgery in 22 (88%) patients, allowing for 17 minimally invasive parathyroidectomies, 1 bilateral cervical exploration for multifocality and 4 other surgical procedures. Two patients with negative FCH-PET/CT underwent bilateral cervical exploration. When dichotomizing the FCH PET/CT results, thereby classifying the inconclusive FCH PET/CT results as positive, the per lesion and per patient sensitivities were 91.3% (95%CI: 72.0-98.9) and 90.5% (95%CI: 69.6-98.8) and the corresponding positive predictive values were 87.5% (95%CI: 67.6-97.3) and 86.4% (95%CI: 65.1-97.1), respectively. Twenty-one (88%) patients were considered cured after surgery. Their mean calcium level after surgery was 2.36 ± 0.17 mmol/l. Preoperative FCH PET/CT has a high sensitivity and positive predictive value for parathyroid adenoma detection in patients

F18-choline PET/CT guided surgery in primary hyperparathyroidism when ultrasound and MIBI SPECT/CT are negative or inconclusive. The APACH1 study

Energy Technology Data Exchange (ETDEWEB)

Quak, Elske; Lireux, Barbara; Bardet, Stephane [Francois Baclesse Cancer Centre, Department of Nuclear Medicine and Thyroid Unit, Caen (France); Blanchard, David; Raucourt, Dominique de [Francois Baclesse Cancer Centre, Department of Head and Neck Surgery, Caen (France); Houdu, Benjamin [University Hospital, Department of Nuclear Medicine, Caen (France); Le Roux, Yannick [University Hospital, Department of General and Endocrine Surgery, Caen (France); Ciappuccini, Renaud [Francois Baclesse Cancer Centre, Department of Nuclear Medicine and Thyroid Unit, Caen (France); Caen University, INSERM 1086 ANTICIPE, Caen (France); Grellard, Jean-Michel; Licaj, Idlir; Clarisse, Benedicte [Francois Baclesse Cancer Centre, Department of Clinical Research, Caen (France); Reznik, Yves [University Hospital, Department of Endocrinology, Caen (France); Aide, Nicolas [Francois Baclesse Cancer Centre, Department of Nuclear Medicine and Thyroid Unit, Caen (France); University Hospital, Department of Nuclear Medicine, Caen (France); Caen University, INSERM 1086 ANTICIPE, Caen (France)

2018-04-15

To evaluate the sensitivity of F18-choline (FCH) PET/CT for parathyroid adenoma detection prior to surgery in patients with primary hyperparathyroidism and negative or inconclusive cervical ultrasound and Tc99m-sestaMIBI SPECT/CT. We conducted a prospective bicentric study (NCT02432599). All patients underwent FCH PET/CT. The result was scored positive, inconclusive or negative. The number of uptakes and their sites were recorded. The FCH PET/CT result guided the surgical procedure (minimally invasive parathyroidectomy, bilateral cervical exploration, or other in case of multiple or ectopic foci). FCH PET/CT results were compared to the surgical and pathological findings and the follow-up. Twenty-five patients were included. Mean calcium and PTH levels prior to surgery were 2.76 ± 0.17 mmol/l and 94.8 ± 37.4 ng/l. Nineteen (76%) FCH PET/CTs were scored positive, 3 (12%) inconclusive and 3 (12%) negative, showing 21 cases of uniglandular disease, including 1 ectopic localization and 1 case of multiglandular (3 foci) disease. Mean lesion size was 13.1 ± 8.6 mm. Twenty-four patients underwent surgery. FCH PET/CT guided surgery in 22 (88%) patients, allowing for 17 minimally invasive parathyroidectomies, 1 bilateral cervical exploration for multifocality and 4 other surgical procedures. Two patients with negative FCH-PET/CT underwent bilateral cervical exploration. When dichotomizing the FCH PET/CT results, thereby classifying the inconclusive FCH PET/CT results as positive, the per lesion and per patient sensitivities were 91.3% (95%CI: 72.0-98.9) and 90.5% (95%CI: 69.6-98.8) and the corresponding positive predictive values were 87.5% (95%CI: 67.6-97.3) and 86.4% (95%CI: 65.1-97.1), respectively. Twenty-one (88%) patients were considered cured after surgery. Their mean calcium level after surgery was 2.36 ± 0.17 mmol/l. Preoperative FCH PET/CT has a high sensitivity and positive predictive value for parathyroid adenoma detection in patients with primary

F18-choline PET/CT guided surgery in primary hyperparathyroidism when ultrasound and MIBI SPECT/CT are negative or inconclusive. The APACH1 study

International Nuclear Information System (INIS)

Quak, Elske; Lireux, Barbara; Bardet, Stephane; Blanchard, David; Raucourt, Dominique de; Houdu, Benjamin; Le Roux, Yannick; Ciappuccini, Renaud; Grellard, Jean-Michel; Licaj, Idlir; Clarisse, Benedicte; Reznik, Yves; Aide, Nicolas

2018-01-01

To evaluate the sensitivity of F18-choline (FCH) PET/CT for parathyroid adenoma detection prior to surgery in patients with primary hyperparathyroidism and negative or inconclusive cervical ultrasound and Tc99m-sestaMIBI SPECT/CT. We conducted a prospective bicentric study (NCT02432599). All patients underwent FCH PET/CT. The result was scored positive, inconclusive or negative. The number of uptakes and their sites were recorded. The FCH PET/CT result guided the surgical procedure (minimally invasive parathyroidectomy, bilateral cervical exploration, or other in case of multiple or ectopic foci). FCH PET/CT results were compared to the surgical and pathological findings and the follow-up. Twenty-five patients were included. Mean calcium and PTH levels prior to surgery were 2.76 ± 0.17 mmol/l and 94.8 ± 37.4 ng/l. Nineteen (76%) FCH PET/CTs were scored positive, 3 (12%) inconclusive and 3 (12%) negative, showing 21 cases of uniglandular disease, including 1 ectopic localization and 1 case of multiglandular (3 foci) disease. Mean lesion size was 13.1 ± 8.6 mm. Twenty-four patients underwent surgery. FCH PET/CT guided surgery in 22 (88%) patients, allowing for 17 minimally invasive parathyroidectomies, 1 bilateral cervical exploration for multifocality and 4 other surgical procedures. Two patients with negative FCH-PET/CT underwent bilateral cervical exploration. When dichotomizing the FCH PET/CT results, thereby classifying the inconclusive FCH PET/CT results as positive, the per lesion and per patient sensitivities were 91.3% (95%CI: 72.0-98.9) and 90.5% (95%CI: 69.6-98.8) and the corresponding positive predictive values were 87.5% (95%CI: 67.6-97.3) and 86.4% (95%CI: 65.1-97.1), respectively. Twenty-one (88%) patients were considered cured after surgery. Their mean calcium level after surgery was 2.36 ± 0.17 mmol/l. Preoperative FCH PET/CT has a high sensitivity and positive predictive value for parathyroid adenoma detection in patients with primary

Dexamethasone for pain after outpatient shoulder surgery

DEFF Research Database (Denmark)

Bjørnholdt, K. T.; Mønsted, P. N.; Søballe, Kjeld

2014-01-01

Background Dexamethasone has analgesic properties when given intravenously before surgery, but the optimal dose has not been determined. We hypothesised that a dose of 40 mg dexamethasone would improve analgesia after outpatient shoulder surgery compared with 8 mg. Methods A randomised, double...... a dose–response relationship, increasing the dexamethasone dose from 8 to 40 mg did not improve analgesia significantly after outpatient shoulder surgery.......) or placebo (D0) before surgery. The primary outcome was pain intensity 8 h after surgery rated on a numeric rating scale of 0 to 10. Secondary outcomes were pain intensity, analgesic consumption and side effects during the first 3 days after surgery. Results Data from 73 patients were available for analysis...

YouTube™ as an information resource for orthognathic surgery.

Science.gov (United States)

Hegarty, Emmett; Campbell, Ciara; Grammatopoulos, Ektor; DiBiase, Andrew T; Sherriff, Martyn; Cobourne, Martyn T

2017-06-01

To investigate video content on YouTube™ related to orthognathic surgery. YouTube™ was searched using the terms: orthognathic surgery; orthodontic surgery; jaw surgery; jaw corrective surgery. Inclusion criteria included English language; primary content orthognathic surgery and acceptable audio-visual quality. Videos were sorted into the top 50 for each search term by view-count and into an overall top 60 from the four searches. The following parameters were recorded for each video: number of views; likes; dislikes; source; primary intention. Each was classified according to information content as 'excellent', 'moderate' or 'poor'. A pre-determined list of orthognathic surgery-related information domains was also evaluated. The top 60 videos had a combined total of 6,986,141 views. Videos predominantly involved patients describing their personal experience (41.67%) with the majority positively biased (61.67%). Only 9.17% of videos were classified as having excellent general information content and 55.83% were rated as poor. Surgical procedures were described in 45% whilst the need for pre- and post-surgical orthodontics was discussed in 33% and 16%, respectively. Post-operative paraesthesia was discussed in 17.5% of videos outcome. Video content on YouTube™ relating to orthognathic surgery is substandard and patients should be advised to view it with caution.

Public-private partnerships to improve primary healthcare surgeries: clarifying assumptions about the role of private provider activities.

Science.gov (United States)

Mudyarabikwa, Oliver; Tobi, Patrick; Regmi, Krishna

2017-07-01

Aim To examine assumptions about public-private partnership (PPP) activities and their role in improving public procurement of primary healthcare surgeries. PPPs were developed to improve the quality of care and patient satisfaction. However, evidence of their effectiveness in delivering health benefits is limited. A qualitative study design was employed. A total of 25 interviews with public sector staff (n=23) and private sector managers (n=2) were conducted to understand their interpretations of assumptions in the activities of private investors and service contractors participating in Local Improvement Finance Trust (LIFT) partnerships. Realist evaluation principles were applied in the data analysis to interpret the findings. Six thematic areas of assumed health benefits were identified: (i) quality improvement; (ii) improved risk management; (iii) reduced procurement costs; (iv) increased efficiency; (v) community involvement; and (vi) sustainable investment. Primary Care Trusts that chose to procure their surgeries through LIFT were expected to support its implementation by providing an environment conducive for the private participants to achieve these benefits. Private participant activities were found to be based on a range of explicit and tacit assumptions perceived helpful in achieving government objectives for LIFT. The success of PPPs depended upon private participants' (i) capacity to assess how PPP assumptions added value to their activities, (ii) effectiveness in interpreting assumptions in their expected activities, and (iii) preparedness to align their business principles to government objectives for PPPs. They risked missing some of the expected benefits because of some factors constraining realization of the assumptions. The ways in which private participants preferred to carry out their activities also influenced the extent to which expected benefits were achieved. Giving more discretion to public than private participants over critical

Innovations in Bariatric Surgery.

Science.gov (United States)

Zhu, Catherine; Pryor, Aurora D

2015-11-01

Surgery has consistently been demonstrated to be the most effective long-term therapy for the treatment of obesity. However, despite excellent outcomes with current procedures, most patients with obesity- and weight-related comorbidities who meet criteria for surgical treatment choose not to pursue surgery out of fear of operative risks and complications or concerns about high costs. Novel minimally invasive procedures and devices may offer alternative solutions for patients who are hesitant to pursue standard surgical approaches. These procedures may be used for primary treatment of obesity, early intervention for patients approaching morbid obesity, temporary management prior to bariatric surgery, or revision of bypass surgery associated with weight regain. Novel bariatric procedures can in general be divided into four categories: endoluminal space-occupying devices, gastric suturing and restrictive devices, absorption-limiting devices, and neural-hormonal modulating devices. Many of these are only approved as short-term interventions, but these devices may be effective for patients desiring low-risk procedures or a transient effect. We will see the expansion of indications and alternatives for metabolic surgery as these techniques gain approval.

Breast conserving surgery following primary irradiation in 3-7 cm breast cancer: pathologic response and outcome

International Nuclear Information System (INIS)

Saint-Gaudens, Anne Bareille; Vilcoq, Jacques R.; Campana, Francois; Gautier, Chantal; Asselain, Bernard; Rocherfordiere, Anne de la; Clough, Krishna B.; Fourquet, Alain

1997-01-01

Purpose: To retrospectively evaluate histologic response and outcome of patients treated by primary irradiation followed by conservative surgery. Materials and Methods: Between 1981 and 1993, 1742 patients (pts.) with large 3-7 cm invasive breast cancer were treated by primary breast and nodes irradiation in our institution. Of these, 311 pts. (18%) further underwent a wide excision of the residual tumor. Median age was 55 years (yrs.) (29 - 79 yrs.). Median breast tumor size was 40 mm (35 - 70mm). 149 pts. (48%) were premenopausal. 142 pts (46%) had clinically palpable axillary nodes. Diagnosis of invasive breast cancer was performed in all patients by drill biopsy. Following diagnosis, all 311 patients were treated by external irradiation to the breast and regional nodes. Median dose to the breast was 55 Gy (50 - 64 Gy) over 5.5 weeks. Following this irradiation, all patients underwent a wide surgical excision with (140 pts; 45%) or without (171 pts; 55%) axillary node dissection. In addition, 70 pts (22.5%) received adjuvant chemotherapy and 70 pts. received hormone therapy after local treatment. All patients were then regularly followed. Results: Median residual breast tumor size after completion of irradiation was 20 mm (0 - 50mm). On pathologic examination, 34 (11%) tumors had no residual malignant cells (complete response), 137 tumors (44%) had residual fibrosis with clusters of viable cells (partial response), and 138 tumors (45%) had residual viable malignant cells (no response). Median follow up was 106 months (10 - 188 months). Actuarial 9-year overall survival rate was 69 % ± 6%. The 9-year metastasis-free interval was 58 % ± 6%. The 9-year breast recurrence rate was 22 % ± 5 %. The 9-year breast preservation rate was 84% ± 5%. Pathologic response was not predictive of outcome, either distant or local. Conclusion: This retrospective study showed that in patients with tumors too large to be treated by upfront breast-conserving surgery, primary breast

Parental Decisional Regret after Primary Distal Hypospadias Repair: Family and Surgery Variables, and Repair Outcomes.

Science.gov (United States)

Ghidini, Filippo; Sekulovic, Sasa; Castagnetti, Marco

2016-03-01

Decisional regret is defined as distress after making a health care choice and can be an issue for parents electing distal hypospadias repair for their sons. We assessed the influence on decisional regret of variables related to the family, surgery and outcomes. Charts for 372 patients undergoing primary distal hypospadias repair between 2005 and 2012 were reviewed, and validated questionnaires, including the Decisional Regret Scale, Pediatric Penile Perception Score and Dysfunctional Voiding and Incontinence Scoring System, were administered to parents. Data were available for 172 of 372 families (response rate 46.2%). Of 323 parents 128 (39.6%) presented with moderately strong decisional regret, with good agreement within couples. Predictors of decisional regret included intermediate parental educational level (OR 3.19, 95% CI 1.52-6.69), patient not being the first born (OR 2.01, 95% CI 1.07-3.78), family history of hypospadias (OR 4.42, 95% CI 1.96-9.97), initial desire to avoid surgery (OR 2.07, 95% CI 1.04-4.12), younger age at followup (OR 0.81, 95% CI 0.72-0.91), presence of lower urinary tract symptoms (OR 4.92, 95% CI 1.53-15.81) and lower Pediatric Penile Perception Score (OR 0.86, 95% CI 0.75-0.99). Decisional regret was unrelated to parental desire to avoid circumcision, surgical variables, development of complications and duration of followup. Decisional regret is a problem in a significant proportion of parents electing distal hypospadias repair for their sons. In our experience family variables seemed to be predictors of decisional regret, while surgical variables did not. Predictors of decisional regret included worse parental perception of penile appearance and the presence of lower urinary tract symptoms. However, the latter could be unrelated to surgery. Irrespective of the duration of followup, decisional regret seems decreased in parents of older patients. Copyright © 2016 American Urological Association Education and Research, Inc

High-dose methylprednisolone in video-assisted thoracoscopic surgery lobectomy

DEFF Research Database (Denmark)

Bjerregaard, Lars S; Jensen, Per F; Bigler, Dennis R

2018-01-01

equally to 125 mg MP or placebo before the start of their elective video-assisted thoracoscopic surgery lobectomy. Group allocation was blinded to patients, investigators and caregivers, and all patients received standardized multimodal, opioid-sparing analgesia. Our primary outcome was area under...... the curve on a numeric rating scale from 0 to 10, for pain scores on the day of surgery and on postoperative days 1 and 2. Clinical follow-up was 2-3 weeks, and telephone follow-up was 12 weeks after surgery. RESULTS: Ninety-six patients were included in the primary analysis. Methylprednisolone...... significantly reduced pain at rest and after mobilization to a sitting position on the day of surgery, without later analgesic effects. Nausea and fatigue were improved without side effects, except transient higher postoperative blood glucose levels. CLINICAL TRIAL REGISTRATION: Registered...

Ergonomic analysis of primary and assistant surgical roles.

Science.gov (United States)

Zihni, Ahmed M; Cavallo, Jaime A; Ray, Shuddhadeb; Ohu, Ikechukwu; Cho, Sohyung; Awad, Michael M

2016-06-15

Laparoscopic surgery is associated with a high degree of ergonomic stress. However, the stress associated with surgical assisting is not known. In this study, we compare the ergonomic stress associated with primary and assistant surgical roles during laparoscopic surgery. We hypothesize that higher ergonomic stress will be detected in the primary operating surgeon when compared with the surgical assistant. One right-hand dominant attending surgeon performed 698 min of laparoscopic surgery over 13 procedures (222 min primary and 476 min assisting), whereas electromyography data were collected from bilateral biceps, triceps, deltoids, and trapezius muscles. Data were analyzed in 1-min segments. Average muscle activation as quantified by maximal voluntary contraction (%MVC) was calculated for each muscle group during primary surgery and assisting. We compared mean %MVC values with unpaired t-tests. Activation of right (R) biceps and triceps muscle groups is significantly elevated while operating when compared with assisting (R biceps primary: 5.47 ± 0.21 %MVC, assistant: 3.93 ± 0.11, P ergonomic differences between operating and assisting. Surgical assisting was associated with similar and occasionally higher levels of muscle activation compared with primary operating. These findings suggest that surgical assistants face significant ergonomic stress, just as operating surgeons do. Steps must be taken to recognize and mitigate this stress in both operating surgeons and assistants. Copyright © 2016 Elsevier Inc. All rights reserved.

[A Case of an Abdominal Desmoplastic Small Round Cell Tumor with Metastasis in the Medulla Oblongata].

Science.gov (United States)

Azami, Ayaka; Takano, Yoshinao; Honda, Michitaka; Todate, Yukitoshi; Tada, Takeshi; Waragai, Mitsuru; Fukushima, Daizo; Suzuki, Nobuyasu; Sato, Atai; Abe, Tsuyoshi; Teranishi, Yasushi; Sakuma, Hideo

2016-11-01

A desmoplastic small round cell tumor(DSRCT)is a very rare malignant tumor that mainly occurs in the intra-abdominal cavity in young adults.This neoplasm has an extremely poor prognosis, with a clinical course characterized by rapid progression and metastasis.We present a 31-year-old man who presented with chief complaints of dysphagia, ataxic gait, and hoarseness.He first underwent surgical resection of a tumor in the medulla oblongata; however, the lesion was suspected to be a metastatic neoplasm.Following a thorough medical examination, the patient was diagnosed with retroperitoneal DSRCT with multiple metastatic lesions.He received multidisciplinary treatment including debulking surgery for the primary lesion; radiotherapy for metastatic lesions in the brain, abdomen, and cervical lymph nodes; hepatic artery embolization for liver metastasis; and systemic chemotherapy.The patient died of progressive disease 17 months after the initial diagnosis.

Perioperative Rosuvastatin in Cardiac Surgery.

Science.gov (United States)

Zheng, Zhe; Jayaram, Raja; Jiang, Lixin; Emberson, Jonathan; Zhao, Yan; Li, Qi; Du, Juan; Guarguagli, Silvia; Hill, Michael; Chen, Zhengming; Collins, Rory; Casadei, Barbara

2016-05-05

Complications after cardiac surgery are common and lead to substantial increases in morbidity and mortality. Meta-analyses of small randomized trials have suggested that perioperative statin therapy can prevent some of these complications. We randomly assigned 1922 patients in sinus rhythm who were scheduled for elective cardiac surgery to receive perioperative rosuvastatin (at a dose of 20 mg daily) or placebo. The primary outcomes were postoperative atrial fibrillation within 5 days after surgery, as assessed by Holter electrocardiographic monitoring, and myocardial injury within 120 hours after surgery, as assessed by serial measurements of the cardiac troponin I concentration. Secondary outcomes included major in-hospital adverse events, duration of stay in the hospital and intensive care unit, left ventricular and renal function, and blood biomarkers. The concentrations of low-density lipoprotein cholesterol and C-reactive protein after surgery were lower in patients assigned to rosuvastatin than in those assigned to placebo (PSTICS ClinicalTrials.gov number, NCT01573143.).

Appendectomy with cytoreductive surgery for ovarian and type 2 endometrial carcinoma.

Science.gov (United States)

Wong, L F A; Wahab, N A; Gleeson, N

2014-01-01

There is considerable variation within and between cancer centers in the practice of appendectomy as part of cytoreductive surgery for ovarian carcinoma and in the surgical staging of endometrial carcinoma. The purpose of this study was to determine the prevalence and the type of appendiceal pathology, the morbidity associated with appendectomy in gynaecologic cancer surgery. This is a retrospective review of all cytoreductive surgery for ovarian carcinoma and surgical staging for endometrial carcinoma with appendectomy over a four year period. Two hundred and fifty-one patients (38 patients for endometrial carcinoma surgery and 213 patients for ovarian cytoreduction) had an appendectomy performed. Metastases to the appendix was present in 46 (23.2%) of primary ovarian carcinoma and one (2.6%) primary endometrial carcinosarcoma. The appendix was more likely to be involved in advanced stage ovarian cancer with positive peritoneal washings, omental deposits, grade 3 differentiation, and papillary serous histology. Sixteen (6.4%) co-incidental primary appendiceal tumours were detected. No postoperative morbidity specific to appendectomy was identified. One case of ovarian carcinoma was upstaged from IC to IIIA by the appendiceal metastases. There was no upstaging of disease in the endometrial carcinoma group. Appendectomy is an integral part of ovarian cytoreductive surgery but the authors found it did not upstage the disease in a clinically significant manner. The incidence of co-incidental appendiceal primary tumours was high in this series and may add value to the procedure in preventing further surgeries. The absence of procedure related morbidity is reassuring. The authors recommend appendectomy for all ovarian staging surgery and its consideration in type 2 endometrial cancer.

Irradiation followed by muscle surgery for dysthyroid ophthalmopathy with diplopia

Energy Technology Data Exchange (ETDEWEB)

Nakajima, Satoko; Asakura, Akiko [Iwate Prefectural Central Hospital, Morioka (Japan); Ogasawara, Kosuke; Mori, Toshiro; Shibuya, Masako; Kurihara, Hideo; Tazawa, Yutaka

1995-10-01

We obtained favorable therapeutic outcome in 12 cases of dysthyroid ophthalmopathy with diplopia. All the patients underwent Lineac irradiation to the retrobulbar tissue totalling 15 to 20 Gy over 10 days. Extraocular muscle surgery was performed 30 days after irradiation. Diplopia at the primary position almost disappeared one day after surgery. An additional surgery was necessary in one case. The interval between onset of diplopia and surgery averaged 6.1 months. Irradiation prior to muscle surgery appeared to be beneficial in allowing an early surgery and in avoiding surgical overcorrection. (author).

Variation among cleft centres in the use of secondary surgery for children with cleft palate: a retrospective cohort study

Science.gov (United States)

Sitzman, Thomas J; Hossain, Monir; Carle, Adam C; Heaton, Pamela C; Britto, Maria T

2017-01-01

Objectives To test whether cleft centres vary in their use of secondary cleft palate surgery, also known as revision palate surgery, and if so to identify modifiable hospital factors and surgeon factors that are associated with use of secondary surgery. Design Retrospective cohort study. Setting Forty-three paediatric hospitals across the USA. Patients Children with cleft lip and palate who underwent primary cleft palate repair from 1999 to 2013. Main outcome measures Time from primary cleft palate repair to secondary palate surgery. Results We identified 4939 children who underwent primary cleft palate repair. At 10 years after primary palate repair, 44% of children had undergone secondary palate surgery. Significant variation existed among hospitals (ppalate repair before 9 months of age was associated with an increased hazard of secondary palate surgery (initial HR 6.74, 95% CI 5.30 to 8.73). Postoperative antibiotics, surgeon procedure volume and hospital procedure volume were not associated with time to secondary surgery (p>0.05). Of the outcome variation attributable to hospitals and surgeons, between-hospital differences accounted for 59% (ppalate surgery exists depending on a child’s age at primary palate repair and the hospital and surgeon performing their repair. Performing primary palate repair before 9 months of age substantially increases the hazard of secondary surgery. Further research is needed to identify other factors contributing to variation in palate surgery outcomes among hospitals and surgeons. PMID:29479567

Acute recurrent seizures in a dog

International Nuclear Information System (INIS)

Wheeler, S.J.

1990-01-01

A detailed account is given, in question and answer format, of the diagnosis of meningioma in the left cerebral cortex of a 9-year-old male Shetland sheepdog with a history of sudden onset of seizures. The seizures were controlled by phenobarbital. Surgery was also performed to debulk the tumour. One year later the dog's neurological condition deteriorated again. Meningioma was confirmed by PM examination

Hypotensive Anesthesia Is Associated With Shortened Length of Hospital Stay Following Orthognathic Surgery.

Science.gov (United States)

Ettinger, Kyle S; Yildirim, Yavuz; Weingarten, Toby N; Van Ess, James M; Viozzi, Christopher F; Arce, Kevin

2016-01-01

To evaluate the impact of induced hypotensive anesthesia on length of hospital stay (LOS) for patients undergoing maxillary Le Fort I osteotomy in isolation or in combination with mandibular orthognathic surgery. A retrospective cohort study design was implemented and patients undergoing a Le Fort I osteotomy as a component of orthognathic surgery at the Mayo Clinic from 2010 through 2014 were identified. The primary predictor variable was the presence of induced hypotensive anesthesia during orthognathic surgery. Hypotensive anesthesia was defined as at least 10 consecutive minutes of a mean arterial pressure no higher than 60 mmHg documented within the anesthetic record. The primary outcome variable was LOS in hours after completion of orthognathic surgery. The secondary outcome variable was the duration of surgery in hours. Multiple covariates also abstracted included patient age, patient gender, American Society of Anesthesiologists score, complexity of surgical procedure, and volume of intraoperative fluids administered during surgery. Univariable and multivariable models were developed to evaluate associations between the primary predictor variable and covariates relative to the primary and secondary outcome variables. A total of 117 patients were identified undergoing Le Fort I orthognathic surgery in isolation or in combination with mandibular surgery. Induced hypotensive anesthesia was significantly associated with shortened LOS (odds ratio [OR] = 0.33; 95% confidence interval [CI], 0.12-0.88; P = .026) relative to patients with normotensive regimens. This association between hypotensive anesthesia and LOS remained statistically significant in a subgroup analysis of 47 patients in whom isolated Le Fort I surgery was performed (OR = 0.13; 95% CI, 0.03-0.62; P = .010). Induced hypotensive anesthesia was not statistically associated with shorter duration of surgery. Induced hypotensive anesthesia represents a potential factor that minimizes

Surgery vs. primary radiotherapy in early-stage oropharyngeal cancer

Directory of Open Access Journals (Sweden)

Catia Pedro

2018-02-01

Conclusions: Longer follow-up still does not show a significant difference in OS and LRFS between both treatments. Because most patients submitted to surgery required adjuvant RT and since its side-effects were not negligible, further studies are warranted to better suit the first treatment for each patient and to prevent the need for adjuvant treatment and the risk of toxicity.

Radioguided surgery of primary hyperparathyroidism in a population with a high prevalence of thyroid pathology

Energy Technology Data Exchange (ETDEWEB)

Garcia-Talavera, Paloma [University Hospital of Valladolid, Department of Nuclear Medicine, Valladolid (Spain); Gonzalez, Carmen; Gomez, Alberto [University Hospital of Salamanca, Department of Surgery, Salamanca (Spain); Garcia-Talavera, Jose Ramon; Martin, Esther; Martin, Mariano [University Hospital of Salamanca, Department of Nuclear Medicine, Salamanca (Spain)

2010-11-15

Patients with concomitant thyroid pathology are usually excluded from minimally invasive radioguided parathyroidectomy (MIRP). We assessed the value in these patients of the gamma probe, alone or in combination with other techniques, in MIRP and unilateral or bilateral approaches. We evaluated its performance in association with intraoperative determination of intact parathyroid hormone (ioPTHi) and preoperative {sup 99m}Tc-MIBI dual phase scintigraphy. Included in the study were 87 patients with a diagnosis of primary hyperparathyroidism who underwent radioguided surgery. They were divided into two groups depending on the presence of concomitant thyroid pathology (TP group, 33 patients) or absence of concomitant thyroid pathology (NTP group, 54 patients). In the TP group, ioPTHi achieved the highest accuracy (90.9%), followed by the gamma probe (81.8%) and scintigraphy (69.7%). In the NTP group, the probe (94.4%) performed better than ioPTH and scintigraphy (both 85.2%). In the TP group, scintigraphy in combination with the gamma probe had a success rate of 90.9%, and 94% in combination with ioPTHi. The three techniques are applied together had a success rate of 97%. For all patients undergoing MIRP, the probe alone worked well, irrespective of the presence or absence of concomitant thyroid pathology. Patients with concomitant thyroid pathology should not be a priori excluded from a MIRP, as long as other adjuvant techniques (scintigraphy or ioPTHi) are used in conjunction with the gamma probe. In these patients, the probe can also be helpful in unilateral or bilateral surgery. (orig.)

Radioguided surgery of primary hyperparathyroidism in a population with a high prevalence of thyroid pathology

International Nuclear Information System (INIS)

Garcia-Talavera, Paloma; Gonzalez, Carmen; Gomez, Alberto; Garcia-Talavera, Jose Ramon; Martin, Esther; Martin, Mariano

2010-01-01

Patients with concomitant thyroid pathology are usually excluded from minimally invasive radioguided parathyroidectomy (MIRP). We assessed the value in these patients of the gamma probe, alone or in combination with other techniques, in MIRP and unilateral or bilateral approaches. We evaluated its performance in association with intraoperative determination of intact parathyroid hormone (ioPTHi) and preoperative 99m Tc-MIBI dual phase scintigraphy. Included in the study were 87 patients with a diagnosis of primary hyperparathyroidism who underwent radioguided surgery. They were divided into two groups depending on the presence of concomitant thyroid pathology (TP group, 33 patients) or absence of concomitant thyroid pathology (NTP group, 54 patients). In the TP group, ioPTHi achieved the highest accuracy (90.9%), followed by the gamma probe (81.8%) and scintigraphy (69.7%). In the NTP group, the probe (94.4%) performed better than ioPTH and scintigraphy (both 85.2%). In the TP group, scintigraphy in combination with the gamma probe had a success rate of 90.9%, and 94% in combination with ioPTHi. The three techniques are applied together had a success rate of 97%. For all patients undergoing MIRP, the probe alone worked well, irrespective of the presence or absence of concomitant thyroid pathology. Patients with concomitant thyroid pathology should not be a priori excluded from a MIRP, as long as other adjuvant techniques (scintigraphy or ioPTHi) are used in conjunction with the gamma probe. In these patients, the probe can also be helpful in unilateral or bilateral surgery. (orig.)

Multiple Primary Tumors

African Journals Online (AJOL)

2018-02-07

Feb 7, 2018 ... breast and ascending colon. KEYWORDS: Carcinoid, colorectal cancer, metachronous, synchronous. Multiple Primary Tumors. MA Adeyanju, AA Ilori. Address for correspondence: Dr. MA Adeyanju,. Department of Surgery, Federal Medical Centre, Ebute Metta,. Lagos, Nigeria. E-mail: mbadeyanju@yahoo.

Peritoneal drainage for newborn intestinal perforation: primary ...

African Journals Online (AJOL)

Keywords: intestinal perforation in newborn, necrotizing enterocolitis, primary peritoneal drainage. Department of Surgery, Paul L. Foster School of Medicine, Texas Tech University. HSC, El Paso, Texas, USA. Correspondence to Donald E. Meier, MD, Department of Surgery, Paul L. Foster. School of Medicine, Texas Tech ...

Postradiation sarcomas: importance of surgery

International Nuclear Information System (INIS)

Lagrange, J.L.; Ramaioli, A.; Chateau, M.C.; Pignol, J.P.; Marchal, C.; Resbeut, M.; Richaud, P.; Rambert, P.; Tortechaux, J.; Seng, S.H.; La Fontan, B. de; Reme-Saumon, M.; Roullet, B.; Bof, J.; Coindre, J.M.

1997-01-01

Purpose: To evaluate the role of surgery in the treatment of Post-radiation sarcomas Materials. Post-radiation sarcomas is a rare entity and large series have rarely been reported. In order to improve knowledge about this entity the Radiotherapist group of the French Cancer Centres (FNCLCC) decided to collect retrospectively the cases treated in their institutions. In order to be sure of the histology, all the cases were reviewed by a panel of pathologists of the FNCLCC Pathologist group. A total of 129 cases of sarcomas, and 108 were reviewed; analysis of 8 is in progress, and no material was obtained in the other 11 cases. The diagnosis of sarcomas was confirmed in 80 cases. All patients (60 F, 20 M) have received radiation therapy (median dose 50 Gy; 9-110 Gy) for the treatment of the primary tumor. At this time the age was 44 years (6-83 y). Diagnoses included: breast C. 42%, Lymphomas 11.5%, gynaecological C. 10% benign lesions 5% miscellaneous. Sarcomas developed after a mean interval of 12 years (3-64 y), in bone in 30% of the cases and in soft tissue in 70%. The majority of lesions (90%) developed in the irradiated field (dose received was between 50 Gy and 60 Gy). Histologically there were 29% Malignant HistiocytofibroSarcomas, 19% OsteoSarcomas, 15% FibroSarcomas, 9% LipoSarcomas, 6% LeiomyoSarcomas, miscellaneous sarcomas 22%. Treatment included: Surgery 28 cases, Surgery+Chemotherapy 17 cases, Chemotherapy only 16 cases, Radiation therapy only 1 case, surgery + Radiation therapy 5 cases, Radiation therapy +chemotherapy 6 cases, Surgery + Radiation therapy + Chemotherapy 7 cases, no treatment 5 cases. Results. The outcome is known for all but 3 patients. 51 patients have died (44 of their sarcoma, 4 of the primary tumour, 2 of other cause and 1 iatrogenic). Median survival is 23 months (95% confidence interval 16-29 mo) but 9 patients survived 5 yr or more. Median survival was 43 mo for patients treated by surgery (28p), 6 mo for chemotherapy group (16 p

A primary intestinal lymphangiectasia patient diagnosed by capsule endoscopy and confirmed at surgery: a case report.

Science.gov (United States)

Fang, You-Hong; Zhang, Bing-Ling; Wu, Jia-Guo; Chen, Chun-Xiao

2007-04-21

Intestinal lymphangiectasia (IL) is a rare disease characterized by dilated lymphatic vessles in the intestinal wall and small bowel mesentery which induce loss of protein and lymphocytes into bowel lumen. Because it most often occurs in the intestine and cannot be detected by upper gastroendoscopy or colonoscopy, and the value of common image examinations such as X-ray and computerized tomography (CT) are limited, the diagnosis of IL is difficult, usually needing the help of surgery. Capsule endoscopy is useful in diagnosing intestinal diseases, such as IL. We here report a case of IL in a female patient who was admitted for the complaint of recurrent edema accompanied with diarrhea and abdominal pain over the last twenty years, and aggravated ten days ago. She was diagnosed by M2A capsule endoscopy as a primary IL and confirmed by surgical and pathological examination.

Primary Angiosarcoma of the Breast after Bilateral Breast Reduction

Directory of Open Access Journals (Sweden)

Justus Philip

2018-01-01

Full Text Available Angiosarcoma of the breast is a rare malignancy of endothelial cell origin, representing less than 1% of all breast malignancy. Primary angiosarcomas can occur in the setting of chronic lymphedema, but it also may occur spontaneously without any preceding treatment. Surgery is the primary therapeutic intervention for breast angiosarcomas with radiation and chemotherapy as adjuvant treatment. Angiosarcomas are aggressive and tend to have a high risk of local and metastatic recurrence. We present a case of primary angiosarcoma that developed in a patient who had bilateral breast reduction surgery in the past.

Introduction of staging laparoscopy in the management of advanced epithelial ovarian, tubal and peritoneal cancer: impact on prognosis in a single institution experience.

Science.gov (United States)

Fagotti, A; Vizzielli, G; Fanfani, F; Costantini, B; Ferrandina, G; Gallotta, V; Gueli Alletti, S; Tortorella, L; Scambia, G

2013-11-01

To evaluate the prognostic impact of routinely use of staging laparoscopy (S-LPS) in patients with primary advanced epithelial ovarian cancer (AEOC). All women were submitted to S-LPS before receiving primary debulking surgery (PDS) or neoadjuvant treatment (NACT). The surgical and survival outcome were evaluated by univariate and multivariate analysis. Among 300 consecutive patients submitted to S-LPS no complications related to the surgical procedure were registered. The laparoscopic evaluation showed that almost half of the patients (46.3%) had a high tumor load. One-hundred forty-eight (49.3%) women were considered suitable for PDS and the remaining 152 (50.7%) were submitted to NACT. The percentages of complete (residual tumor, RT=0) and optimal (RTperformance status (p=0.016) maintained an independent association with the PFS. Including S-LPS in a tertiary referral center for the management AEOC does not appear to have a negative impact in terms of survival and it may be helpful to individualize the treatment avoiding unnecessary laparotomies and surgical complications. © 2013.

Endoscopic Endonasal Transsphenoidal Surgery, A Reliable Method for Treating Primary and Recurrent/Residual Craniopharyngiomas: Nine Years of Experience.

Science.gov (United States)

Bal, Ercan; Öge, Kamil; Berker, Mustafa

2016-10-01

Craniopharyngioma resection is one of the most challenging surgical procedures. Herein, we describe our extended endoscopic endonasal transsphenoidal surgery (EETS) technique, and the results of 9 years of use on primary and recurrent/residual craniopharyngiomas. This study reviewed 28 EETSs in 25 patients with craniopharyngiomas between January 2006 and September 2015. The patients were divided into 2 groups, newly diagnosed patients (group A, n = 15), and patients having residual or recurrent tumors (group B, n = 10). There was no significant difference between the groups in terms of the largest tumor diameter (P = 0.495), and all patients underwent EETS. The clinical and ophthalmologic examinations, imaging studies, endocrinologic studies, and operative findings for these cases were reviewed retrospectively. The number of gross total resections in group A was 13/15, and 7/10 in group B. Three of the patients developed postoperative cerebrospinal fluid leakage (all in group A). There were no neurovascular or ophthalmologic complications, and no meningitis or mortality was observed. There has been a notable increase in the use of EETS in the treatment of craniopharyngiomas during the last decade. Despite its increased use in the treatment of primary craniopharyngiomas, its implementation for recurrent or residual craniopharyngiomas has been viewed with suspicion. In this study, the results have been presented separately for primary and recurrent/residual craniopharyngiomas, so that the results can be compared. Overall, EETS is a reliable and successful surgical treatment method for primary and recurrent/residual craniopharyngiomas. Copyright © 2016 Elsevier Inc. All rights reserved.

Breast conserving surgery versus mastectomy

DEFF Research Database (Denmark)

Christiansen, Peer; Carstensen, Stina Lyck; Ejlertsen, Bent

2018-01-01

Background: Observational studies have pointed at a better survival after breast conserving surgery (BCS) compared with mastectomy. The aim of the present study was to evaluate whether this remains true when more extensive tumor characteristics and treatment data were included. Methods: The cohort...... included patients registered after primary surgery for early invasive breast cancer in the database of the Danish Breast Cancer Cooperative Group, in the period 1995–2012. The cohort was divided into three groups: (i) patients who primarily had a mastectomy, (ii) patients treated by BCS, and (iii) patients...

Human error in strabismus surgery: Quantification with a sensitivity analysis

NARCIS (Netherlands)

S. Schutte (Sander); J.R. Polling (Jan Roelof); F.C.T. van der Helm (Frans); H.J. Simonsz (Huib)

2009-01-01

textabstractBackground: Reoperations are frequently necessary in strabismus surgery. The goal of this study was to analyze human-error related factors that introduce variability in the results of strabismus surgery in a systematic fashion. Methods: We identified the primary factors that influence

Metabolic response to surgery in the cancer patient

International Nuclear Information System (INIS)

Brennan, M.F.

1979-01-01

The metabolic response to uncomplicated surgery in the patient undergoing primary therapy for malignancy is no different than the response to surgery of similar magnitude for benign disease. Hemodynamic, nutritional-endocrine, and convalescent changes are similar. However, with current aggressive approaches to the management of cancer, the patient often comes to surgery with evidence of major debilitating side effects from his progressive malignancy or from aggressive multimodality therapy. The surgeon must be aware of the consequences of the use of combination therapies on the expected metabolic response to surgery. Awareness of such problems such as the nutritional deficit will allow preventive methods to supercede mtabolic salvage procedures

Overproduction of an amino-terminal form of PTH distinct from human PTH(1-84) in a case of severe primary hyperparathyroidism: influence of medical treatment and surgery.

Science.gov (United States)

Räkel, Agnès; Brossard, Jean-Hugues; Patenaude, Jean-Victor; Albert, Caroline; Nassif, Edgard; Cantor, Tom; Rousseau, Louise; D'Amour, Pierre

2005-06-01

Rare patients with severe primary hyperparathyroidism present with large parathyroid tumours, severe hypercalcaemia, very high PTH levels and osteitis fibrosa cystica. Some of these patients display a large amount of C-PTH fragments in circulation and present with a higher C-PTH/I-PTH ratio than seen in less severe cases of primary hyperparathyroidism. We wanted to determine how PTH levels and circulating PTH high-performance liquid chromatography (HPLC) profiles analysed with PTH assays having different epitopes could be affected by medical and surgical treatment in such patients. A 55-year-old man with severe hypercalcaemia (Ca(2+): 2.01 mmol/l), very high PTH levels (CA-PTH 82.1 and T-PTH 72 pmol/l) caused by a large parathyroid tumour (7.35 g) and accompanied by significant bone involvement (alkaline phosphatase of 185 UI/l and subperiostal bone resorption of hands) was referred to us. Blood was obtained at various time points during his medical treatment, before and after surgery, to measure parameters of calcium and phosphorus metabolism, and of bone turnover. HPLC separations of circulating PTH molecular forms were performed and analysed with PTH assays having 1-4 (CA), 12-18 (T), 26-32 (E) and 65-84 (C) epitopes. Before surgery, serum Ca2+ was nearly normalized with hydratation, intravenous (IV) pamidronate and oral vitamin D administration. Despite a decrease in Ca2+ to 1.31 mmol/l, CA-PTH and T-PTH levels decreased by half in relation to a threefold increase in basal 1,25-dihydroxyvitamin D [1,25(OH)2D] level (94 to 337 pmol/l). After this initial positive response, hypercalcaemia and elevated CA- and T-PTH levels recurred even if 1,25(OH)2D levels remained elevated. The tumour was removed surgically and proved to be poorly differentiated with nuclear atypia and mitosis. After surgery, the Ca2+ level and PTH secretion normalized. The higher CA-PTH level relative to the T-PTH level observed before surgery in this patient was related to the oversecretion of

Clinical presentation and treatment of primary and secondary paranasal mucoceles

Directory of Open Access Journals (Sweden)

Jih-Chin Lee

2014-01-01

Full Text Available Background: This retrospective study was conducted to describe and compare the clinical characteristics of primary mucoceles occurring in patients without a previous history of sinus surgery, the cause of mucoceles and secondary mucoceles resulting as a complication following endoscopic sinus surgery, and the Caldwell-Luc operation. Materials and Methods: This study reviewed 18 cases of primary mucoceles and 21 cases of secondary mucoceles, who were diagnosed and had received surgical intervention between 1995 and 2012. Results: The most common presenting symptoms in primary mucoceles were: Visual disturbance (18.6%, nasal obstruction (12.5%, and headache (12.5%. In secondary mucoceles, the most common symptoms were: Nasal obstruction (27.5%, rhinorrhea (15%, and postnasal drip (12.5%. The most common sites of origin for primary mucoceles were the ethmoid sinus (31.5% and sphenoid sinus (31.5%. In secondary mucoceles, the maxillary sinus was the most common site of origin (40.7%, followed by the ethmoid sinus (29.6%. All patients with secondary mucoceles had a history of sinus surgery. Conclusions: Mucoceles are benign lesions of the paranasal sinus. Cases of secondary mucoceles that occur following sinus endoscopic surgery develop more frequently in the ethmoid sinus compared to those following the Caldwell-Luc procedure. Endoscopic intranasal surgery of mucoceles is a reliable therapeutic measure with a favorable long-term outcome.

Human error in strabismus surgery : Quantification with a sensitivity analysis

NARCIS (Netherlands)

Schutte, S.; Polling, J.R.; Van der Helm, F.C.T.; Simonsz, H.J.

2008-01-01

Background- Reoperations are frequently necessary in strabismus surgery. The goal of this study was to analyze human-error related factors that introduce variability in the results of strabismus surgery in a systematic fashion. Methods- We identified the primary factors that influence the outcome of

Global patient outcomes after elective surgery

DEFF Research Database (Denmark)

2016-01-01

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective...... adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration...... to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low...

Adding left atrial appendage closure to open heart surgery provides protection from ischemic brain injury six years after surgery independently of atrial fibrillation history: the LAACS randomized study.

Science.gov (United States)

Park-Hansen, Jesper; Holme, Susanne J V; Irmukhamedov, Akhmadjon; Carranza, Christian L; Greve, Anders M; Al-Farra, Gina; Riis, Robert G C; Nilsson, Brian; Clausen, Johan S R; Nørskov, Anne S; Kruuse, Christina R; Rostrup, Egill; Dominguez, Helena

2018-05-23

Open heart surgery is associated with high occurrence of atrial fibrillation (AF), subsequently increasing the risk of post-operative ischemic stroke. Concomitant with open heart surgery, a cardiac ablation procedure is commonly performed in patients with known AF, often followed by left atrial appendage closure with surgery (LAACS). However, the protective effect of LAACS on the risk of cerebral ischemia following cardiac surgery remains controversial. We have studied whether LAACS in addition to open heart surgery protects against post-operative ischemic brain injury regardless of a previous AF diagnosis. One hundred eighty-seven patients scheduled for open heart surgery were enrolled in a prospective, open-label clinical trial and randomized to concomitant LAACS vs. standard care. Randomization was stratified by usage of oral anticoagulation (OAC) planned to last at least 3 months after surgery. The primary endpoint was a composite of post-operative symptomatic ischemic stroke, transient ischemic attack or imaging findings of silent cerebral ischemic (SCI) lesions. During a mean follow-up of 3.7 years, 14 (16%) primary events occurred among patients receiving standard surgery vs. 5 (5%) in the group randomized to additional LAACS (hazard ratio 0.3; 95% CI: 0.1-0.8, p = 0.02). In per protocol analysis (n = 141), 14 (18%) primary events occurred in the control group vs. 4 (6%) in the LAACS group (hazard ratio 0.3; 95% CI: 0.1-1.0, p = 0.05). In a real-world setting, LAACS in addition to elective open-heart surgery was associated with lower risk of post-operative ischemic brain injury. The protective effect was not conditional on AF/OAC status at baseline. LAACS study, clinicaltrials.gov NCT02378116 , March 4th 2015, retrospectively registered.

Postoperative glaucoma following infantile cataract surgery: an individual patient data meta-analysis.

Science.gov (United States)

Mataftsi, Asimina; Haidich, Anna-Bettina; Kokkali, Stamatia; Rabiah, Peter K; Birch, Eileen; Stager, David R; Cheong-Leen, Richard; Singh, Vineet; Egbert, James E; Astle, William F; Lambert, Scott R; Amitabh, Purohit; Khan, Arif O; Grigg, John; Arvanitidou, Malamatenia; Dimitrakos, Stavros A; Nischal, Ken K

2014-09-01

Infantile cataract surgery bears a significant risk for postoperative glaucoma, and no consensus exists on factors that may reduce this risk. To assess the effect of primary intraocular lens implantation and timing of surgery on the incidence of postoperative glaucoma. We searched multiple databases to July 14, 2013, to identify studies with eligible patients, including PubMed, MEDLINE, EMBASE, ISI Web of Science, Scopus, Central, Google Scholar, Intute, and Tripdata. We also searched abstracts of ophthalmology society meetings. We included studies reporting on postoperative glaucoma in infants undergoing cataract surgery with regular follow-up for at least 1 year. Infants with concurrent ocular anomalies were excluded. Authors of eligible studies were invited to contribute individual patient data on infants who met the inclusion criteria. We also performed an aggregate data meta-analysis of published studies that did not contribute to the individual patient data. Data were pooled using a random-effects model. Time to glaucoma with the effect of primary implantation, additional postoperative intraocular procedures, and age at surgery. Seven centers contributed individual patient data on 470 infants with a median age at surgery of 3.0 months and median follow-up of 6.0 years. Eighty patients (17.0%) developed glaucoma at a median follow-up of 4.3 years. Only 2 of these patients had a pseudophakic eye. The risk for postoperative glaucoma appeared to be lower after primary implantation (hazard ratio [HR], 0.10 [95% CI, 0.01-0.70]; P = .02; I(2) = 34%), higher after surgery at 4 weeks or younger (HR, 2.10 [95% CI, 1.14-3.84]; P = .02; I(2) = 0%), and higher after additional procedures (HR, 2.52 [95% CI, 1.11-5.72]; P = .03; I(2) = 32%). In multivariable analysis, additional procedures independently increased the risk for glaucoma (HR, 2.25 [95% CI, 1.20-4.21]; P = .01), and primary implantation independently reduced it (HR, 0.10 [95% CI, 0.01-0.76]; P =�

Diabetic retinopathy and complexity of retinal surgery in a general hospital.

Science.gov (United States)

Mijangos-Medina, Laura Fanny; Hurtado-Noriega, Blanca Esmeralda; Lima-Gómez, Virgilio

2012-01-01

Usual retinal surgery (vitrectomy or surgery for retinal detachment) may require additional procedures to deal with complex cases, which increase time and resource use and delay access to treatment. We undertook this study to identify the proportion of primary retinal surgeries that required complex procedures and the associated causes. We carried out an observational, descriptive, cross-sectional, retrospective study. Patients with primary retinal surgery were evaluated (January 2007-December 2010). The proportion and 95% confidence intervals (CI) of preoperative diagnosis and cause of the disease requiring retinal surgery as well as the causes for complex retinal surgery were identified. Complex retinal surgery was defined as that requiring lens extraction, intraocular lens implantation, heavy perfluorocarbon liquids, silicone oil tamponade or intravitreal drugs, in addition to the usual surgical retinal procedure. The proportion of complex retinal surgeries was compared among preoperative diagnoses and among causes (χ(2), odds ratio [OR]). We studied 338 eyes. Mean age of subjects was 53.7 years, and there were 49% females. The most common diagnoses were vitreous hemorrhage (27.2%) and rhegmatogenous retinal detachment (24.6%). The most common cause was diabetes (50.6%); 273 eyes required complex surgery (80.8%, 95% CI: 76.6-85). The proportion did not differ among diagnoses but was higher in diabetic retinopathy (89%, p diabetic retinopathy increased by 3-fold the probability of requiring these complex procedures. Early treatment of diabetic retinopathy may reduce the proportion of complex retinal surgery by 56%.

Adolescent Bariatric Surgery — Thoughts and Perspectives from the UK

OpenAIRE

Penna, Marta; Markar, Sheraz; Hewes, James; Fiennes, Alberic; Jones, Niall; Hashemi, Majid

2013-01-01

Opinions of healthcare professionals in the United Kingdom regarding bariatric surgery in adolescents are largely unknown. This study aims to explore the perspectives of medical professionals regarding adolescent bariatric surgery. Members of the British Obesity and Metabolic Surgery Society and groups of primary care practitioners based in London were contacted by electronic mail and invited to complete an anonymous online survey consisting of 21 questions. Ninety-four out of 324 questionnai...

Do Patients Prefer a Pessary or Surgery as Primary Treatment for Pelvic Organ Prolapse

NARCIS (Netherlands)

Thys, S. D.; Roovers, J. P.; Geomini, P. M.; Bongers, M. Y.

2012-01-01

Background/Aims: To assess whether patients prefer surgery or a pessary as treatment for pelvic organ prolapse (POP). Methods: A structured interview was performed among treated and untreated women with POP. We conducted fictive scenarios of potential disadvantages of surgery and pessary use. Our

Appendectomy in the surgical staging of ovarian carcinoma.

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Beşe, T; Kösebay, D; Kaleli, S; Oz, A U; Demirkiran, F; Gezer, A

1996-06-01

Extensive debulking is accepted as the primary method of operative management for carcinoma of the ovary. However, there is no consensus regarding the role of appendectomy in primary surgical treatment. The aim of this study was to assess the role of appendectomy in the surgical staging and cytoreduction of ovarian carcinoma. The study was a retrospective review of 90 primary malignant ovarian carcinoma patients who had an appendectomy in addition to primary cytoreductive surgery. Out of 90 patients, 10 (11.1%) had metastasis to the appendix. The rate of metastasis to the appendix was 11.5% (9/78) in malignant epithelial ovarian carcinomas and 8.3% (1/12) in non-epithelial ovarian tumors. Of the patients with metastasis in the appendix, malignant epithelial ovarian tumors were identified in 90% (serous: 70%; clear cell: 20%), and non-epithelial malignant ovarian tumor were disclosed in 10% (granulosa cell carcinoma). There were no metastases to the appendix in the other histological types. Although metastasis to the appendix was not observed in early stage ovarian carcinomas, it was detected in 21.4% (9/42) of stage III and 50% (1/2) of stage IV. Macroscopic tumor metastasis in the abdomen was noted in all patients with metastasis to the appendix. Appendectomy for stage I and II patients was not beneficial and did not affect final staging. As a result, for the proper staging of ovarian carcinoma there is no advantage to the addition of routine appendectomy to primary cytoreductive surgery in early stage (stage I and II) malignant epithelial ovarian tumors. Appendectomy would contribute to the cytoreduction of advanced stage disease if it is macroscopically involved.

One Step Melanoma Surgery for Patient with Thick Primary Melanomas: "To Break the Rules, You Must First Master Them!"

Science.gov (United States)

Tchernev, Georgi

2018-02-15

We present to the attention of the medical, dermatological and oncosurgical community data that serves to indicate the indispensability of optimisation of the algorithm and recommendations for diagnosis and surgical treatment of cutaneous melanoma. These recommendations could be referred to different subgroups of patients in different clinical stages as well as to patients with different initial characterisation (histological morphology) of the primary tumours. One step surgery is not a myth, even more, it could prove to be one of the best solutions for some patient collectives with advanced stages of melanoma. We present a case of a 74 - year old patient with a congenital medium sized melanocytic nevus, located directly above the lateral part of the elbow joint. In one month and a half, an achromatic nodular formation evolves with a diameter of 2.7 x 2.3 cm, prominent over the skin level, painful by palpation and spontaneously bleeding. By the anamnestic, clinical and dermoscopic findings the patient was diagnosed with nodular melanoma associated with a congenital medium sized melanocytic nevus. A primary excision with a field of safety 0.5 cm in all directions was performed. After confirmation of the primary diagnosis (tumour thickness 8 mm with no ultrasonographic detection of enlarged lymph nodes), seven days later are - excision was performed with an additional field of surgical safety of 1.5 cm in all directions. In this case remains unclear the following question: For what reason a preoperative high - frequent ultrasonography (HFUS) is not recommended to be used as it will allow only one surgical excision with the elimination of a tumour with a safety field of 2cm in all directions? The enigma about the obstacles preventing such a rational optimisation of the current diagnostic and therapeutic algorithm in patients with melanomas remains unresolved. One step surgery for cutaneous melanoma is widely used in many countries although it continues to be

Antibiotic prophylaxis in orthognathic surgery: A complex systematic review

Science.gov (United States)

Hultin, Margareta; Klinge, Anna; Klinge, Björn; Tranæus, Sofia; Lund, Bodil

2018-01-01

Objective In orthognathic surgery, antibiotics are prescribed to reduce the risk of postoperative infection. However, there is lack of consensus over the appropriate drug, the dose and duration of administration. The aim of this complex systematic review was to assess the effect of antibiotics on postoperative infections in orthognathic surgery. Methods Both systematic reviews and primary studies were assessed. Medline (OVID), The Cochrane Library (Wiley) and EMBASE (embase.com), PubMed (non-indexed articles) and Health Technology Assessment (HTA) publications were searched. The primary studies were assessed using GRADE and the systematic reviews by AMSTAR. Results Screening of abstracts yielded 6 systematic reviews and 36 primary studies warranting full text scrutiny. In total,14 primary studies were assessed for risk of bias. Assessment of the included systematic reviews identified two studies with a moderate risk of bias, due to inclusion in the meta-analyses of primary studies with a high risk of bias. Quality assessment of the primary studies disclosed one with a moderate risk of bias and one with a low risk. The former compared a single dose of antibiotic with 24 hour prophylaxis using the same antibiotic; the latter compared oral and intravenous administration of antibiotics. Given the limited number of acceptable studies, no statistical analysis was undertaken, as it was unlikely to contribute any relevant information. Conclusion With respect to antibiotic prophylaxis in orthognathic surgery, most of the studies to date have been poorly conducted and reported. Thus scientific uncertainty remains as to the preferred antibiotic and the optimal duration of administration. PMID:29385159

Young infants with severe tetralogy of Fallot: Early primary surgery versus transcatheter palliation.

Science.gov (United States)

Wilder, Travis J; Van Arsdell, Glen S; Benson, Lee; Pham-Hung, Eric; Gritti, Michael; Page, Alexandra; Caldarone, Christopher A; Hickey, Edward J

2017-11-01

Infants with severe tetralogy of Fallot may undergo (1) early primary surgical repair (EARLY) or (2) early transcatheter palliation (CATH) before delayed surgical repair. We compared these strategies with (3) elective single-stage tetralogy of Fallot repair (IDEAL). From 2000 to 2012, 453 children underwent tetralogy of Fallot repair (excluding systemic-pulmonary shunts), including 383 in the IDEAL (75%), 42 in the EARLY (9%), and 28 in the CATH (6%) groups. IDEAL repair at The Hospital for Sick Children occurs after 3 months. Risk-adjusted hazard analysis compared freedom from surgical or catheter reintervention. Somatic size, branch pulmonary artery size, and right ventricle systolic pressure were modeled using 2780 echocardiogram reports via mixed-model regression. CATH involved right ventricular outflow tract stent in 18 patients, right ventricular outflow tract balloon in 9 patients, and ductal-stent in 1 patient. Three patients died (1 per group). Risk-adjusted freedom from surgical reoperation was 89% ± 4%, 88% ± 5%, and 85% ± 6% for the IDEAL, EARLY, and CATH groups, respectively, at 10 years. Patients in the EARLY and CATH groups had similar reoperation rates, except for neonates (tetralogy of Fallot. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Information needs and decision-making preferences of older women offered a choice between surgery and primary endocrine therapy for early breast cancer.

Science.gov (United States)

Burton, Maria; Kilner, Karen; Wyld, Lynda; Lifford, Kate Joanna; Gordon, Frances; Allison, Annabel; Reed, Malcolm; Collins, Karen Anna

2017-12-01

To establish older women's (≥75 years) information preferences regarding 2 breast cancer treatment options: surgery plus adjuvant endocrine therapy versus primary endocrine therapy. To quantify women's preferences for the mode of information presentation and decision-making (DM) style. This was a UK multicentre survey of women, ≥75 years, who had been offered a choice between PET and surgery at diagnosis of breast cancer. A questionnaire was developed including 2 validated scales of decision regret and DM preferences. Questionnaires were sent to 247 women, and 101 were returned (response rate 41%). The median age of participants was 82 (range 75 to 99), with 58 having had surgery and 37 having PET. Practical details about the impact, safety, and efficacy of treatment were of most interest to participants. Of least interest were cosmetic outcomes after surgery. Information provided verbally by doctors and nurses, supported by booklets, was preferred. There was little interest in technology-based sources of information. There was equal preference for a patient- or doctor-centred DM style and lower preference for a shared DM style. The majority (74%) experienced their preferred DM style. Levels of decision regret were low (15.73, scale 0-100). Women strongly preferred face to face information. Written formats were also helpful but not computer-based resources. Information that was found helpful to women in the DM process was identified. The study demonstrates many women achieved their preferred DM style, with a preference for involvement, and expressed low levels of decision regret. Copyright © 2017 John Wiley & Sons, Ltd.

Clinical presentation, diagnosis, therapy and outcome of alveolar echinococcosis in dogs.

Science.gov (United States)

Corsini, M; Geissbühler, U; Howard, J; Gottstein, B; Spreng, D; Frey, C F

2015-12-05

Alveolar echinococcosis (AE), a parasitic disease primarily of the liver caused by the larval stage of Echinococcus multilocularis, is highly endemic in Switzerland. In contrast to well-established management protocols in people, little is known with regard to optimal treatment strategies in dogs. The objective of this study was to describe the clinical signs and diagnostic procedures in dogs with AE and to evaluate outcome following medical treatment alone or surgery and medical treatment. Of 23 putative AE cases between 2004 and 2014, 20 were classified as confirmed (n=18) or probable (n=2) AE, based on abdominal ultrasound, serology, cytology, histology and/or PCR. Most dogs presented with abdominal distension in an advanced stage of disease. Dogs receiving specific treatment (radical or debulking surgery together with medical treatment, or medical treatment alone) survived longer than dogs left untreated, but no difference was found between treatment types. Survival at one year was associated with absence of free abdominal fluid, absence of abdominal distension and treatment of any type. However, dogs treated with debulking surgery all faced relapse. Findings of this study suggest that in AE-affected dogs for which a therapeutic approach is regarded appropriate by owners and veterinarians, radical surgical resection and medical treatment or, if total resection is not possible, medical treatment alone should be considered. However, studies on larger numbers of dogs are necessary before definitive treatment recommendations can be made. British Veterinary Association.

Primary small intestinal volvulus after laparoscopic rectopexy for rectal prolapse.

Science.gov (United States)

Koizumi, Michihiro; Yamada, Takeshi; Shinji, Seiichi; Yokoyama, Yasuyuki; Takahashi, Goro; Hotta, Masahiro; Iwai, Takuma; Hara, Keisuke; Takeda, Kohki; Kan, Hayato; Takasaki, Hideaki; Ohta, Keiichiro; Uchida, Eiji

2018-02-01

Primary small intestinal volvulus is defined as torsion in the absence of congenital malrotation, band, or postoperative adhesions. Its occurrence as an early postoperative complication is rare. A 40-year-old woman presented with rectal prolapse, and laparoscopic rectopexy was uneventfully performed. She could not have food on the day after surgery. She started oral intake on postoperative day 3 but developed abdominal pain after the meal. Contrast-enhanced CT revealed torsion of the small intestinal mesentery. An emergent laparotomy showed small intestinal volvulus, without congenital malformation or intestinal adhesions. We diagnosed it as primary small intestinal volvulus. The strangulated intestine was resected, and reconstruction was performed. The patient recovered uneventfully after the second surgery. To the best of our knowledge, this is the first report of primary small intestinal volvulus occurring after rectopexy for rectal prolapse. Primary small intestinal volvulus could be a postoperative complication after laparoscopy. © 2018 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

Risk of Post-Discharge Venous Thromboembolism and Associated Mortality in General Surgery: A Population-Based Cohort Study Using Linked Hospital and Primary Care Data in England.

Directory of Open Access Journals (Sweden)

George Bouras

Full Text Available Trends towards day case surgery and enhanced recovery mean that postoperative venous thromboembolism (VTE may increasingly arise after hospital discharge. However, hospital data alone are unable to capture adverse events that occur outside of the hospital setting. The National Institute for Health and Care Excellence has suggested the use of primary care data to quantify hospital care-related VTE. Data in surgical patients using these resources is lacking. The aim of this study was to measure VTE risk and associated mortality in general surgery using linked primary care and hospital databases, to improve our understanding of harm from VTE that arises beyond hospital stay.This was a longitudinal cohort study using nationally linked primary care (Clinical Practice Research Datalink, CPRD, hospital administrative (Hospital Episodes Statistics, HES, population statistics (Office of National Statistics, ONS and National Cancer Intelligence Network databases. Routinely collected information was used to quantify 90-day in-hospital VTE, 90-day post-discharge VTE and 90-day mortality in adults undergoing one of twelve general surgical procedures between 1st April 1997 and 31st March 2012. The earliest postoperative recording of deep vein thrombosis or pulmonary embolism in CPRD, HES and ONS was counted in each patient. Covariates from multiple datasets were combined to derive detailed prediction models for VTE and mortality. Limitation included the capture of VTE presenting to healthcare only and the lack of information on adherence to pharmacological thromboprophylaxis as there was no data linkage to hospital pharmacy records.There were 981 VTE events captured within 90 days of surgery in 168005 procedures (23.7/1000 patient-years. Overall, primary care data increased the detection of postoperative VTE by a factor of 1.38 (981/710 when compared with using HES and ONS only. Total VTE rates ranged between 3.2/1000 patient-years in haemorrhoidectomy to 118

Phase II/III multicentre randomised controlled trial evaluating a strategy of primary surgery and adjuvant chemotherapy versus peri-operative chemotherapy for resectable gastric signet ring cell adenocarcinomas – PRODIGE 19 – FFCD1103 – ADCI002

International Nuclear Information System (INIS)

Piessen, Guillaume; Mariette, Christophe; Messager, Mathieu; Le Malicot, Karine; Robb, William B; Di Fiore, Frédéric; Guilbert, Marie; Moreau, Marie; Christophe, Véronique; Adenis, Antoine

2013-01-01

A dramatic increase in the incidence of the diffuse form of gastric adenocarcinomas and particularly signet ring cell carcinomas has been observed in Western countries. Evidence is accruing that signet ring cell carcinomas may have inherent chemo resistance leaving many clinicians unsure of the benefits of delaying surgery to pursue a neoadjuvant approach. PRODIGE-19-FFCD1103-ADCI002 is a prospective multicentre controlled randomised phase II/III trial comparing current standard of care of perioperative chemotherapy (2x3 cycles of Epirubicin, cisplatin, 5-fluorouracil) with a strategy of primary surgery followed by adjuvant chemotherapy (6 cycles of Epirubicin, cisplatin, 5-fluorouracil) in patients with a stage IB-III gastric signet ring cell tumour. The principal objective of the phase II study (84 patients) is to determine if the experimental arm (primary surgery followed by adjuvant chemotherapy) has sufficient interest in terms of percentage of living patients at 24 months to be evaluated in a phase III trial. If 7 or less patients in the experimental arm are alive at 24 months, phase III will not be initiated. The primary objective of phase III (230 additional patients) is to demonstrate superiority of the experimental arm in terms of overall survival. Secondary endpoints include overall survival at 36 months, disease free survival at 24 and 36 months, R0 resection rates, treatment tolerance, postoperative mortality and morbidity evaluated by Clavien-Dindo severity index, the prognostic impact of positive peritoneal cytology and the assessment of quality of life. An ancillary study will assess the emotional and cognitive impact of surgery and perioperative chemotherapy for both the patient and their partner. As inherent chemo resistance of signet ring cell tumours and delay in definitive surgery may favour tumour progression we hypothesise that a policy of primary surgery followed by adjuvant chemotherapy will improve overall survival compared to a standard

Laparoscopic Surgery for Recurrent Crohn's Disease

Directory of Open Access Journals (Sweden)

Antonino Spinelli

2012-01-01

Full Text Available In spite of the recent improvements in drug therapy, surgery still represents the most frequent treatment for Crohn's disease (CD complications. Laparoscopy has been widely applied over the last twenty years in colorectal surgery and was associated with lower postoperative pain, shorter hospitalization, faster return to daily activities, and better cosmetic results. Laparoscopy experienced a slower diffusion in inflammatory bowel disease surgery than in oncologic colorectal surgery, but proved to be safe and effective, and is currently considered the gold standard for the treatment of primary uncomplicated ileocolic CD. Indications for laparoscopy in CD have recently been widened to embrace more complicated or recurrent CD. This paper reviews the available data on the subset of recurrent CD patients. The reported results indicate that laparoscopy may be safely applied even in selected recurrent CD cases in hands of IBD surgeons with broad laparoscopic experience.

A approach for differential diagnosis of primary lung cancer and breast cancer relapse presenting as a solitary pulmonary nodule in patients after breast surgery

International Nuclear Information System (INIS)

Fujita, Takashi; Iwata, Hiroharu; Yatabe, Yasushi

2009-01-01

The differential diagnosis of primary lung cancer from metastatic breast cancer is crucial in patients presenting with a solitary pulmonary nodule after breast surgery. However definitive diagnosis of these nodules is often difficult due to similar radiological and pathological features in primary lung and metastatic breast cancer nodules. We assessed the feasibility of our diagnostic approach for these nodules by morphopathological and immunohistochemical examination (thyroid transcription factor-1 (TTF-1), surfactant pro-protein B (SPPB), estrogen receptor (ER), mammaglobin-1 (MGB1)), and estimated the frequency of primary lung cancer occurrence in 23 breast cancer patients. Biopsy specimens were obtained using CT-guided needle biopsy (NB) and transbronchial lung biopsy (TBLB) in 21 patients (91.3%). Surgical resection was performed for diagnosis and treatment in two patients. Differential diagnosis was obtained by morphopathological methods alone in 17 patients (73.9%, primary lung cancer: 6 cases, metastatic breast cancer: 11 cases) and by immunohistochemical examination in the remaining 6 (26.1%, primary lung cancer: 1 case, metastatic breast cancer: 5 cases). Our results show the clinical feasibility of our approach to the differential diagnosis of breast cancer relapse and primary lung cancer presenting as a solitary nodule in breast cancer patients. (author)

The psychological impact of body contouring surgery

DEFF Research Database (Denmark)

Mikkelsen Lorenzen, Mike; Poulsen, Lotte; Poulsen, Signe

2018-01-01

INTRODUCTION: Body contouring surgery is associated with changes in body image and identity. The primary aim of the study was to investigate a multidisciplinary assessment of potential psychological challenges before and after body contouring surgery. METHODS: Eight pre- and post-operative patients...... relevant codes had been extracted. RESULTS: A total of seven psychological themes were iden- tified, indicating that surgery alone cannot improve the pa- tients’ psychological difficulties and that psychological care and management of the expected discomfort and body im- age is of considerable importance...... in providing continuity of care. CONCLUSIONS: The reported quality of life is of consider- able importance to patients undergoing body contouring surgery after massive weight loss. Our findings may provide useful information for surgeons and healthcare profes- sionals allowing them to develop patient education...

Response of the primary tumor in symptomatic and asymptomatic stage IV colorectal cancer to combined interventional endoscopy and palliative chemotherapy

International Nuclear Information System (INIS)

Cameron, Silke; Hünerbein, Diana; Mansuroglu, Tümen; Armbrust, Thomas; Scharf, Jens-Gerd; Schwörer, Harald; Füzesi, László; Ramadori, Giuliano

2009-01-01

The treatment of the primary tumor in advanced metastatic colorectal cancer (CRC) is still a matter of discussion. Little attention has thus far been paid to the endoscopically observable changes of the primary in non-curatively resectable stage IV disease. 20 patients [14 men, 6 women, median age 67 (39–82) years] were observed after initial diagnosis of non-curatively resectable metastasized symptomatic (83%) or asymptomatic (17%) CRC, from June 2002 to April 2009. If necessary, endoscopic tumor debulking was performed. 5-FU based chemotherapy was given immediately thereafter. In 10 patients, chemotherapy was combined with antibody therapy. Response of the primary was observed in all patients. Local symptoms were treated endoscopically whenever necessary (obstruction or bleeding), and further improved after chemotherapy was started: Four patients showed initial complete endoscopic disappearance of the primary. In an additional 6 patients, only adenomatous tissue was histologically detected. In both these groups, two patients revealed local tumor relapse after interruption of therapy. Local tumor regression or stable disease was achieved in the remaining 10 patients. 15 patients died during the observation time. In 13 cases, death was related to metastatic disease progression. The mean overall survival time was 19.6 (3–71) months. No complications due to the primary were observed. This study shows that modern anti-cancer drugs combined with endoscopic therapy are an effective and safe treatment of the symptomatic primary and ameliorate local complaints without the need for surgical intervention in advanced UICC stage IV CRC

Primary Diffuse Large B-Cell Lymphoma in a Patient with Rubinstein-Taybi Syndrome: Case Report and Review of the Literature.

Science.gov (United States)

Sy, Christopher; Henry, James; Kura, Bhavani; Brenner, Andrew; Grandhi, Ramesh

2018-01-01

Rubinstein-Taybi syndrome (RSTS) is a rare, congenital syndrome that is known to be associated with neoplasms of various organ systems. Evaluation and treatment of such patients is challenging, given the cognitive delay and heterogeneity of pathologic presentations that define this syndrome. Presented here is a case of a patient with RSTS, diagnosed at birth, who presented with subtle symptoms of lethargy and a change in behavior. He was found to have a large (7.0-cm × 4.7-cm), right-sided brain mass that was eventually diagnosed as a primary central nervous system lymphoma. To the best of our knowledge, this is the first reported case of a primary central nervous system lymphoma presenting in a patient with RSTS. This was confirmed through microscopic and histologic studies. The large size attained by this mass in our patient highlights the increased scrutiny and surveillance needed to provide the best care for these patients. A multidisciplinary team approach is ideal as successful treatment of our patient using surgical debulking, appropriate chemotherapy, and close postoperative follow-up has resulted in an excellent clinical outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

Network Centrality of Resting-State fMRI in Primary Angle-Closure Glaucoma Before and After Surgery.

Directory of Open Access Journals (Sweden)

Fengqin Cai

Full Text Available Using voxel-wise degree centrality (DC, as measured by resting-state fMRI, we aimed to study alterations in the brain functional networks in patients with primary angle-closure glaucoma (PACG and to reveal the plastic trajectories of surgery.A total of 23 preoperative PACG patients (49.48 ± 14.37 years old were recruited to undergo a resting-state fMRI scan, and 9 of them were rescanned 3 months after surgery. All PACG patients underwent a complete ophthalmologic examination, including intraocular pressure (IOP, retinal nerve fiber layer (RNFL thickness, vertical cup to disc ratio (V C/D, and average cup to disc ratio (A C/D. Another 23 gender- and age-matched healthy controls (48.18 ± 9.40 years old underwent scanning once for comparison. The group difference in DC was calculated in each voxel, and the correlations between the DC value and each of the clinical variables were analyzed in the PACG patients.Preoperative PACG (pre-PACG patients showed significantly decreased DC in the bilateral visual cortices but increased DC in the left anterior cingulate cortex (ACC and caudate (p < 0.05, corrected compared with the controls. Statistical analysis showed a significantly negative correlation between DC in the bilateral visual cortices and the IOP score and between DC in the anterior cingulate cortex (ACC and both the A C/D and V C/D scores in the pre-PACG patients. Three months after surgery, these postoperative PACG (post-PACG patients showed a significantly increased DC in both the bilateral visual cortices and the left precentral gyrus compared with the pre-PACG patients.Our results suggest that PACG may contribute to decreased functional centrality in the visual system and to increased degree centrality in cognition-emotional processing regions. Alterations in visual areas seem to parallel the cup to disc ratio, but not the duration of angle closure. The changes of functional centrality in PACG patients after operation may reveal the

Magnetic resonance imaging of elephantiasis neuromatosa

Energy Technology Data Exchange (ETDEWEB)

Stevens, K.J.; Sully, L.; Preston, B.J. [Department of Radiology, University Hospital, Queen`s Medical Centre, Nottingham (United Kingdom); Ludman, C.N. [Department of Radiology, University Hospital, Queen`s Medical Centre, Nottingham (United Kingdom)]|[Division of Academic Radiology, University Hospital, Queen`s Medical Centre, Nottingham (United Kingdom)

1998-12-01

We present the case of a 43-year-old man with neurofibromatosis type 1 who developed elephantiasis neuromatosa of his left leg. The gross limb enlargement was extremely disfiguring, and resulted in such severe disability that he was only able to walk a very short distance using crutches. Previous debulking procedures had resulted in massive blood loss, and prior to attempting further surgical intervention MRI studies were requested. Taking advantage of the excellent tissue characterisation and multiplanar imaging capabilities of MRI, we were able to assess the extent of soft tissue and osseous involvement. The use of recently developed MR angiographic sequences enabled us to non-invasively provide detailed images to assess the relationship of the lesions to the major vessels, as well as the vascular supply and angiographic features of the lesions themselves. This article describes our MRI-based findings, which precluded debulking surgery in this unusual manifestation of neurofibromatosis. (orig.) With 6 figs., 23 refs.

Magnetic resonance imaging of elephantiasis neuromatosa

International Nuclear Information System (INIS)

Stevens, K.J.; Sully, L.; Preston, B.J.; Ludman, C.N.

1998-01-01

We present the case of a 43-year-old man with neurofibromatosis type 1 who developed elephantiasis neuromatosa of his left leg. The gross limb enlargement was extremely disfiguring, and resulted in such severe disability that he was only able to walk a very short distance using crutches. Previous debulking procedures had resulted in massive blood loss, and prior to attempting further surgical intervention MRI studies were requested. Taking advantage of the excellent tissue characterisation and multiplanar imaging capabilities of MRI, we were able to assess the extent of soft tissue and osseous involvement. The use of recently developed MR angiographic sequences enabled us to non-invasively provide detailed images to assess the relationship of the lesions to the major vessels, as well as the vascular supply and angiographic features of the lesions themselves. This article describes our MRI-based findings, which precluded debulking surgery in this unusual manifestation of neurofibromatosis. (orig.)

Fetal Primary Cardiac Tumors During Perinatal Period

Directory of Open Access Journals (Sweden)

Shi-Min Yuan

2017-06-01

Full Text Available Fetal primary cardiac tumors are rare, but they may cause complications, which are sometimes life threatening, including arrhythmias, hydrops fetalis, ventricular outflow/inflow obstruction, cardiac failure, and even sudden death. Among fetal primary cardiac tumors, rhabdomyomas are most common, followed by teratomas, fibromas, hemangiomas, and myxomas. Everolimus, a mammalian target of rapamycin inhibitor, has been reported to be an effective drug to cause tumor remission in three neonates with multiple cardiac rhabdomyomas. Neonatal cardiac surgery for the resection of primary cardiac tumors found by fetal echocardiography has been reported sporadically. However, open fetal surgery for pericardial teratoma resection, which was performed successfully via a fetal median sternotomy in one case report, could be a promising intervention to rescue these patients with large pericardial effusions. These recent achievements undoubtedly encourage further development in early management of fetal cardiac tumors. Owing to the rarity of fetal primary cardiac tumors, relevant information in terms of prenatal diagnosis, treatment, and prognosis remains to be clarified.

[Emergency Surgery and Treatments for Pneumothorax].

Science.gov (United States)

Kurihara, Masatoshi

2015-07-01

The primary care in terms of emergency for pneumothorax is chest drainage in almost cases. The following cases of pneumothorax and the complications need something of surgery and treatments. Pneumothorax with subcutaneous emphysema often needs small skin incisions around the drainage tube. Tension pneumothorax often needs urgent chest drainage. Pneumothorax with intractable air leakage often needs interventional treatments like endobroncheal occlusion (EBO) or thoracographic fibrin glue sealing method (TGF) as well as urgent thoracoscopic surgery. Pneumothorax with acute empyema also often needs urgent thoracoscopic surgery within 2 weeks if chest drainage or drug therapy are unsuccessful. It will probably become chronic empyema of thorax after then. Pneumothorax with bleeding needs urgent thoracoscopic surgery in case of continuous bleeding over 200 ml/2 hours. In any cases of emergency for pneumothorax, respiratory physicians should collaborate with respiratory surgeons at the 1st stage because it is important to timely judge conversion of surgical treatments from medical treatments.

Radiation therapy for primary spinal cord tumors in adults

International Nuclear Information System (INIS)

Jeremic, B.; Grujicic, D.; Jovanovic, D.; Djuric, L.; Mijatovic, L.

1990-01-01

This paper evaluates the role of radiation therapy in management of primary spinal cord tumors in adults. Records of 21 patients with primary spinal cord tumors treated with radiation therapy after surgery were retrospectively reviewed. Histologic examination showed two diffuse and 10 localized ependymomas, six low-grade gliomas, and three malignant gliomas. Surgery consisted of gross tumor resection in six patients, subtotal resection in three patients, and biopsy in 12 patients. Three patients also received chemotherapy. Radiation dose range from 45 to 55 Cy

The role of minimally invasive spine surgery in the management of pyogenic spinal discitis

Directory of Open Access Journals (Sweden)

Mazda K Turel

2017-01-01

Conclusions: MIS surgery provides an opportunity for early pain relief in patients with discitis, osteomyelitis, spondylodiscitis, and/or epidural abscess by directly addressing the primary cause of pain. MIS surgery for discitis provides a higher diagnostic yield to direct antibiotic treatment. MIS surgery results in good long-term recovery.

Preoperative immobility significantly impacts the risk of postoperative complications in bariatric surgery patients.

Science.gov (United States)

Higgins, Rana M; Helm, Melissa; Gould, Jon C; Kindel, Tammy L

2018-03-05

Preoperative immobility in general surgery patients has been associated with an increased risk of postoperative complications. It is unknown if immobility affects bariatric surgery outcomes. The aim of this study was to determine the impact of immobility on 30-day postoperative bariatric surgery outcomes. This study took place at a university hospital in the United States. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2015 data set was queried for primary minimally invasive bariatric procedures. Preoperative immobility was defined as limited ambulation most or all the time. Logistic regression analysis was performed to determine if immobile patients are at increased risk (odds ratio [OR]) for 30-day complications. There were 148,710 primary minimally invasive bariatric procedures in 2015. Immobile patients had an increased risk of mortality (OR 4.59, Pbariatric surgery outcomes. Immobile patients have a significantly increased risk of morbidity and mortality. This study provides an opportunity for the development of multiple quality initiatives to improve the safety and perioperative complication profile for immobile patients undergoing bariatric surgery. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Incidence of Speech-Correcting Surgery in Children With Isolated Cleft Palate.

Science.gov (United States)

Gustafsson, Charlotta; Heliövaara, Arja; Leikola, Junnu; Rautio, Jorma

2018-01-01

Speech-correcting surgeries (pharyngoplasty) are performed to correct velopharyngeal insufficiency (VPI). This study aimed to analyze the need for speech-correcting surgery in children with isolated cleft palate (ICP) and to determine differences among cleft extent, gender, and primary technique used. In addition, we assessed the timing and number of secondary procedures performed and the incidence of operated fistulas. Retrospective medical chart review study from hospital archives and electronic records. These comprised the 423 consecutive nonsyndromic children (157 males and 266 females) with ICP treated at the Cleft Palate and Craniofacial Center of Helsinki University Hospital during 1990 to 2016. The total incidence of VPI surgery was 33.3% and the fistula repair rate, 7.8%. Children with cleft of both the hard and soft palate (n = 300) had a VPI secondary surgery rate of 37.3% (fistula repair rate 10.7%), whereas children with only cleft of the soft palate (n = 123) had a corresponding rate of 23.6% (fistula repair rate 0.8%). Gender and primary palatoplasty technique were not considered significant factors in need for VPI surgery. The majority of VPI surgeries were performed before school age. One fifth of patients receiving speech-correcting surgery had more than one subsequent procedure. The need for speech-correcting surgery and fistula repair was related to the severity of the cleft. Although the majority of the corrective surgeries were done before the age of 7 years, a considerable number were performed at a later stage, necessitating long-term observation.

Soft tissue sarcomas of the extremities: survival and patterns of failure with conservative surgery and postoperative irradiation compared to surgery alone

International Nuclear Information System (INIS)

Leibel, S.A.; Tranbaugh, R.F.; Wara, W.M.; Beckstead, J.H.; Bovill, E.G.; Phillips, T.L.

1982-01-01

Between 1960 and 1978, 81 patients received their primary treatment for localized soft tissue sarcomas of the extremities, buttock and shoulder at the University of California, San Francisco. Initial treatment consisted of surgery alone in 47 patients, planned conservative surgery followed by radiation therapy in 29 patients, and irradiation alone in five patients. The two- and five-year determinate survival for all cases was 86% and 73%, respectively. The local control rate achieved with surgery alone was related to the extent of surgery. Eighty-seven percent (14/16) of the patients undergoing amputation were locally controlled. Seventy-two percent (8/11) were treated with wide en bloc resection and had local tumor control while only 30% (6/20) having simple excision were controlled. The local control rate with surgery and postoperative irradiation was 90% (26/29). No patients treated with irradiation therapy alone were controlled. This review suggests that local tumor control achieved with limb preserving conservative surgery and postoperative irradiation is superior to limited surgery alone. The survival and patterns of failure of patients undergoing radical surgery is comparable to combined treatment with the risk-benefit ratio favoring the latter

Emergency general surgery: definition and estimated burden of disease.

Science.gov (United States)

Shafi, Shahid; Aboutanos, Michel B; Agarwal, Suresh; Brown, Carlos V R; Crandall, Marie; Feliciano, David V; Guillamondegui, Oscar; Haider, Adil; Inaba, Kenji; Osler, Turner M; Ross, Steven; Rozycki, Grace S; Tominaga, Gail T

2013-04-01

Acute care surgery encompasses trauma, surgical critical care, and emergency general surgery (EGS). While the first two components are well defined, the scope of EGS practice remains unclear. This article describes the work of the American Association for the Surgery of Trauma to define EGS. A total of 621 unique International Classification of Diseases-9th Rev. (ICD-9) diagnosis codes were identified using billing data (calendar year 2011) from seven large academic medical centers that practice EGS. A modified Delphi methodology was used by the American Association for the Surgery of Trauma Committee on Severity Assessment and Patient Outcomes to review these codes and achieve consensus on the definition of primary EGS diagnosis codes. National Inpatient Sample data from 2009 were used to develop a national estimate of EGS burden of disease. Several unique ICD-9 codes were identified as primary EGS diagnoses. These encompass a wide spectrum of general surgery practice, including upper and lower gastrointestinal tract, hepatobiliary and pancreatic disease, soft tissue infections, and hernias. National Inpatient Sample estimates revealed over 4 million inpatient encounters nationally in 2009 for EGS diseases. This article provides the first list of ICD-9 diagnoses codes that define the scope of EGS based on current clinical practices. These findings have wide implications for EGS workforce training, access to care, and research.

Simulation-based certification for cataract surgery

DEFF Research Database (Denmark)

Thomsen, Ann Sofia Skou; Kiilgaard, Jens Folke; Kjaerbo, Hadi

2015-01-01

PURPOSE: To evaluate the EyeSi(™) simulator in regard to assessing competence in cataract surgery. The primary objective was to explore all simulator metrics to establish a proficiency-based test with solid evidence. The secondary objective was to evaluate whether the skill assessment was specific...

Lack of relationship between TIMP-1 tumour cell immunoreactivity, treatment efficacy and prognosis in patients with advanced epithelial ovarian cancer

International Nuclear Information System (INIS)

Steffensen, Karina Dahl; Waldstrøm, Marianne; Christensen, Rikke Kølby; Bartels, Annette; Brünner, Nils; Jakobsen, Anders

2010-01-01

Tissue inhibitor of metalloproteinase 1 (TIMP-1) is a natural inhibitor of the matrix metalloproteinases (MMPs) which are proteolytic enzymes involved in degradation of extracellular matrix thereby favoring tumour cell invasion and metastasis. TIMP-1 activity in tumour tissue may therefore play an essential role in the progression of a malignant tumour. The primary aim of the present study was to evaluate TIMP-1 protein immunoreactivity in tissue from primary ovarian cancer patients and associate these findings with the course of the disease including response to treatment in the individual patient. TIMP-1 was assessed by immunohistochemistry (in tissue micro arrays) in a total of 163 ovarian cancer specimens obtained from primary debulking surgery during 1991-1994 as part of a randomized clinical protocol. Positive TIMP-1 immunoreactivity was found in 12.3% of the tumours. The median survival time for the 143 patients with TIMP-1 negative tumours was 23.7 months [19.0-29.4] 95% CI, while the median survival time for the 20 patients with TIMP-1 positive tumours was 15.9 months [12.3-27.4] 95% CI. Although a difference of 7.8 months in median overall survival in favor of the TIMP-1 tumour negative patients was found, this difference did not reach statistical significance (p = 0.28, Kaplan-Meier, log-rank test). Moreover, TIMP-1 immunoreactivity was not associated with CA125 response (p = 0.53) or response at second look surgery (p = 0.72). TIMP-1 immunoreactivity in tumour tissue from patients with primary epithelial ovarian cancer did not correlate with patient survival or response to combination platinum/cyclophosphamide therapy

[Diagnosis and treatment of strabismus caused by nasal endoscopic surgery].

Science.gov (United States)

Ai, L K; Wu, X; Wang, J N; Li, J; Wu, Y; Zhou, J; Song, W X; Guo, R L

2017-12-11

Objective: Strabismus with diplopia is the main orbital complication of functional endoscopic sinus surgery (FESS). This study was to analyze clinical findings, treatment and outcomes of such cases. Methods: Retrospective case series. Twenty-three cases were divided into 3 groups based on the disease severity: group A, partial transection of the medial rectus muscle, group B, complete transection of the medical rectus, group C, transection of the medial rectus combined with the other orbital injuries. Complete ophthalmology examinations, including eye alignment, eye motility, force duction test, force generation test, general eye exam, and medical imaging (orbital CT or MRI), were performed for each case. The treatment included botulinum toxin (Botox) injection to the lateral rectus muscle, transposition of the vertical rectus muscle, and orbital surgery if needed. Results: In group A with Botox injection, all the cases achieved single vision in primary position, but still remained some adduction weakness. In group B treated by vertical transposition surgery combined with Botox, 22% of the cases got single vision in primary gaze. In group C, even with more efforts of treatment, the cases with orbital injury can only get cosmetic improvement, and diplopia and adduction dysfunction were found in most cases. Conclusions: Due to the variety of the complications of FESS, force duction test is a crucial exam to detect the direction and severity of synechia in the orbit, which will give solid information to surgery approach as well as prognosis. Botox injection at early stage will minimize the contraction of antagonist lateral rectus, helping to postpone the transposition surgery which may cause anterior segment ischemia when performed right after the medial rectus transection injury. Botox may even reduce the synechia by minimizing the scarring process. Partial vertical rectus transposition combined with muscle resection may effectively correct the eye misalignment in

Enhancement of liver regeneration and liver surgery

NARCIS (Netherlands)

Olthof, P.B.

2017-01-01

Liver regeneration allows surgical resection of up to 75% of the liver and enables curative treatment potential for patients with primary or secondary hepatic malignancies. Liver surgery is associated with substantial risks, reflected by considerable morbidity and mortality rates. Optimization of

Diode laser surgery. Ab interno and ab externo versus conventional surgery in rabbits.

Science.gov (United States)

Karp, C L; Higginbotham, E J; Edward, D P; Musch, D C

1993-10-01

Fibroblastic proliferation of subconjunctival tissues remains a primary mechanism of failure in filtration surgery. Minimizing the surgical manipulation of episcleral tissues may reduce scarring. Laser sclerostomy surgery involves minimal tissue dissection, and is gaining attention as a method of potentially improving filter duration in high-risk cases. Twenty-five New Zealand rabbits underwent filtration surgery in one eye, and the fellow eye remained as the unoperated control. Ten rabbits underwent ab externo diode laser sclerostomy surgery, ten underwent ab interno diode sclerostomy surgery, and five had posterior sclerostomy procedures. Filtration failure was defined as a less-than-4-mmHg intraocular pressure (IOP) difference between the operative and control eyes. The mean time to failure for the ab externo, ab interno, and conventional posterior sclerostomy techniques measured 17.4 +/- 11.5, 13.1 +/- 6.7, and 6.0 +/- 3.1 days, respectively. In a comparison of the laser-treated groups with the conventional procedure, the time to failure was significantly longer (P = 0.02) for the ab externo filter. The mean ab interno sclerostomy duration was longer than the posterior lip procedure, but this difference was not statistically significant (P = 0.15). The overall level of IOP reduction was similar in the three groups. These data suggest that diode laser sclerostomy is a feasible technique in rabbits, and the ab externo approach resulted in longer filter duration than the conventional posterior lip procedure in this model.

Role of Surgery in Stages II and III Pediatric Abdominal Non-Hodgkin Lymphoma: A 5-Years Experience.

Science.gov (United States)

Ali, Amany M; Sayd, Heba A; Hamza, Hesham M; Salem, Mohamed A

2011-03-29

Abdominal Non-Hodgkin lymphomas (NHL) are the most common extra nodal presentation of pediatric NHL. Our aim is to assess the role of surgery as a risk factor and to evaluate the impact of risk-adjusted systemic chemotherapy on survival of patients with stages II and III disease. This study included 35 pediatric patients with abdominal NHL treated over five years at South Egypt Cancer Institute (SECI), Assiut University, between January 2005 and January 2010. The data of every patient included: Age, sex, and presentation, staging work up to determine extent of the disease and the type of resection performed, histopathological examination, details of chemotherapy, disease free survival and overall survival. The study included 25 boys and 10 girls with a median age of six years (range: 2.5:15). Thirty patients (86%) presented with abdominal pain, 23 patients (66%) presented with abdominal mass and distention, 13 patients (34%) presented with weight loss, and intestinal obstruction occurred in six patients (17%). The ileo-cecal region and abdominal lymph nodes were the commonest sites (48.5%, 21% respectively). Burkitt's lymphoma was the most common histological type in 29 patients (83%). Ten (28.5%) stage II (group A) and 25 (71.5%) stage III (group B). Complete resections were performed in 10 (28.5%), debulking in 6 (17%) and imaging guided biopsy in 19 (54%). A11 patients received systemic chemotherapy. The median follow up duration was 63 months (range 51-78 months). The parameters that significantly affect the overall survival were stage at presentation complete resection for localized disease. In conclusion, the extent of disease at presentation is the most important prognostic factor in pediatric abdominal NHL. Surgery is restricted to defined situations such as; abdominal emergencies, diagnostic biopsy and total tumor extirpation in localized disease. Chemotherapy is the cornerstone in the management of pediatric abdominal NHL.

Role of Surgery in Stages II and III Pediatric Abdominal Non-Hodgkin Lymphoma: A 5-Years Experience

Directory of Open Access Journals (Sweden)

Mohamed A. Salem

2011-03-01

Full Text Available Abdominal Non-Hodgkin lymphomas (NHL are the most common extra nodal presentation of pediatric NHL. Our aim is to assess the role of surgery as a risk factor and to evaluate the impact of risk-adjusted systemic chemotherapy on survival of patients with stages II and III disease. This study included 35 pediatric patients with abdominal NHL treated over five years at South Egypt Cancer Institute (SECI, Assiut University, between January 2005 and January 2010. The data of every patient included: Age, sex, and presentation, staging work up to determine extent of the disease and the type of resection performed, histopathological examination, details of chemotherapy, disease free survival and overall survival. The study included 25 boys and 10 girls with a median age of six years (range: 2.5:15. Thirty patients (86% presented with abdominal pain, 23 patients (66% presented with abdominal mass and distention, 13 patients (34% presented with weight loss, and intestinal obstruction occurred in six patients (17%. The ileo-cecal region and abdominal lymph nodes were the commonest sites (48.5%, 21% respectively. Burkitt's lymphoma was the most common histological type in 29 patients (83%. Ten (28.5% stage II (group A and 25 (71.5% stage III (group B. Complete resections were performed in 10 (28.5%, debulking in 6 (17% and imaging guided biopsy in 19 (54%. A11 patients received systemic chemotherapy. The median follow up duration was 63 months (range 51-78 months. The parameters that significantly affect the overall survival were stage at presentation complete resection for localized disease. In conclusion, the extent of disease at presentation is the most important prognostic factor in pediatric abdominal NHL. Surgery is restricted to defined situations such as; abdominal emergencies, diagnostic biopsy and total tumor extirpation in localized disease. Chemotherapy is the cornerstone in the management of pediatric abdominal NHL.

Indications for radiation therapy and surgery in the treatment of fibromatosis

International Nuclear Information System (INIS)

Spear, M.A.; Jennings, L.C.; Efird, J.T.; Mankin, H.J.; Springfield, D.S.; Gebhardt, M.C.; Spiro, I.J.; Rosenberg, A.E.; Suit, H.D.

1995-01-01

Purpose: To determine the roles of radiation and surgery in treating fibromatosis (desmoid tumors). Methods and Materials: Records of 92 patients treated at the Massachusetts General Hospital between 1971 and 1992 were analyzed. Treatment consisted of: radiation, 15 tumors; surgery, 37 tumors; radiation plus surgery, 40 tumors. Radiation doses ranged from 10 Gy to 72 Gy, and were delivered as megavoltage external beam, brachytherapy or a combination. Minimum follow up was 1 year (median 6.2 yrs). The margin status of resected specimens included: 14 negative, 11 negative at 18 yrs and 0% for age <18 yrs. Conclusions: Surgery remains the primary treatment of choice for fibromatosis. Radiation therapy, however, is also effective either as a primary treatment or a surgical adjuvent. Additional advantage in recurrence free survival with peri-operative treatment was seen in patients for whom negative margins were not achieved. Thus, radiation might be recommended to these patients, particularly if the lesion is located such that further recurrence and resection could result in a significant functional or cosmetic defect. Radiation would also be recommended as a primary therapy for those in which a primary resection could not be expected without such deficits. It should also be noted when considering the potential consequences of recurrence that these lesions may often fail locally even with negative margins. Of further interest lesions located in the planter or palmer regions appear as a different disease entity, with a very benign course in adults and an extremely aggressive course in children

Segmental thoracic spinal has advantages over general anesthesia for breast cancer surgery

OpenAIRE

Elakany, Mohamed Hamdy; Abdelhamid, Sherif Ahmed

2013-01-01

Background: Thoracic spinal anesthesia has been used for laparoscopic cholecystectomy and abdominal surgeries, but not in breast surgery. The present study compared this technique with general anesthesia in breast cancer surgeries. Materials and Methods: Forty patients were enrolled in this comparative study with inclusion criteria of ASA physical status I-III, primary breast cancer without known extension beyond the breast and axillary nodes, scheduled for unilateral mastectomy with axillary...

Can intermittent pneumatic compression (IPC) reduce time to surgery for malleolar fractures?

DEFF Research Database (Denmark)

Arndt, K B; Jordy, A; Viberg, Bjarke

2017-01-01

BACKGROUND: Surgery of malleolar fractures are often delayed due to oedema of the ankle. The use of intermittent pneumatic compression (IPC) is thought to reduce oedema of the fracture site and thereby time to surgery in patients with malleolar fractures. PURPOSE: To investigate the influence...... of IPC on the time from admission to surgery in adult patients with internal fixated primary malleolar fractures. METHODS: February 1st 2013 IPC was introduced as a standard treatment for all patients admitted with a malleolar fracture. Data was retrieved from the hospital database 2 years prior...... for patients operated after 24h was 21.5 (4.1-57.0) hours for the control group and 18.4 (7.4-32.3) hours in the IPC group (p=0.353). INTERPRETATION: There was no benefit from IPC on time to surgery in patients with acute primary malleolar fracture in a cohort with a mean surgical delay less than 24h....

Rectal surgery for endometriosis--should we be aggressive?

Science.gov (United States)

Varol, Nesrin; Maher, Peter; Healey, Martin; Woods, Rod; Wood, Carl; Hill, David; Lolatgis, Nick; Tsaltas, Jim

2003-05-01

To assess the outcome of aggressive but conservative laparoscopic surgery in the treatment of severe endometriosis involving the rectum. Retrospective study (Canadian Task Force classification III). Endosurgery unit of a tertiary referral center. One hundred sixty-nine women. Laparoscopy or laparotomy. The procedure was completed successfully laparoscopically in 145 (86%) and by laparotomy in 24 women (14%). The rate of preoperative symptoms was higher in 25 women who underwent bowel resection compared with those who had other bowel surgery. In addition to bowel surgery, excision of uterosacral ligaments, adhesiolysis, excision of endometrioma, and oophorectomy were the four most commonly performed procedures. At 35-month follow-up 61 patients (36%) required further surgery for pain. The average time between primary and repeat surgery was 16 months. This second operation was performed by laparoscopy in over three-fourths of the women. Overall recurrent endometriosis was found in 26 patients (15%). Overall morbidity associated with all surgery was 12.4%. Surgery for endometriosis of the cul-de-sac and bowel involves some of the most difficult dissections encountered, but it can be accomplished successfully with the low postoperative morbidity typical of laparoscopy.

Pectoral nerve block (Pecs block) with sedation for breast conserving surgery without general anesthesia.

Science.gov (United States)

Moon, Eun-Jin; Kim, Seung-Beom; Chung, Jun-Young; Song, Jeong-Yoon; Yi, Jae-Woo

2017-09-01

Most regional anesthesia in breast surgeries is performed as postoperative pain management under general anesthesia, and not as the primary anesthesia. Regional anesthesia has very few cardiovascular or pulmonary side-effects, as compared with general anesthesia. Pectoral nerve block is a relatively new technique, with fewer complications than other regional anesthesia. We performed Pecs I and Pec II block simultaneously as primary anesthesia under moderate sedation with dexmedetomidine for breast conserving surgery in a 49-year-old female patient with invasive ductal carcinoma. Block was uneventful and showed no complications. Thus, Pecs block with sedation could be an alternative to general anesthesia for breast surgeries.

Video-assisted Thoracoscopic surgery (VATS) lobectomy for lung cancer does not induce a procoagulant state

DEFF Research Database (Denmark)

Christensen, Thomas Decker; Vad, Henrik; Pedersen, Søren

2017-01-01

Background: Changes in the coagulation system in patients undergoing surgery for lung cancer have been sparsely investigated and the impact of the surgical trauma on the coagulation system is largely unknown in these patients. An increased knowledge could potentially improve the thromboprophylaxis...... regimes. The aim of this study was to assess the coagulation profile evoked in patients undergoing curative surgery by Video-Assisted Thoracoscopic Surgery (VATS) lobectomy for primary lung cancer. Methods: Thirty-one patients diagnosed with primary lung cancer undergoing VATS lobectomy were prospectively...... thrombography. Patients did not receive thromboprophylactic treatment. Data was analyzed using repeated measures one-way ANOVA. Results: The standard coagulation parameters displayed only subtle changes after surgery and the ROTEM® and thrombin generation results remained largely unchanged. Conclusions...

Which patients benefit most from primary surgery or neoadjuvant chemotherapy in stage IIIC or IV ovarian cancer? An exploratory analysis of the European Organisation for Research and Treatment of Cancer 55971 randomised trial

NARCIS (Netherlands)

van Meurs, Hannah S.; Tajik, Parvin; Hof, Michel H. P.; Vergote, Ignace; Kenter, Gemma G.; Mol, Ben Willem J.; Buist, Marrije R.; Bossuyt, Patrick M.

2013-01-01

To investigate whether biomarkers consisting of baseline characteristics of advanced stage ovarian cancer patients can help in identifying subgroups of patients who would benefit more from primary surgery or neoadjuvant chemotherapy. We used data of the European Organisation for Research and

Childhood glaucoma surgery in the 21st Century

Science.gov (United States)

Papadopoulos, M; Edmunds, B; Fenerty, C; Khaw, P T

2014-01-01

Most children with glaucoma will require surgery in their lifetime, often in their childhood years. The surgical management of childhood glaucoma is however challenging, largely because of its greater potential for failure and complications as compared with surgery in adults. The available surgical repertoire for childhood glaucoma has remained relatively unchanged for many years with most progress owing to modifications to existing surgery. Although the surgical approach to childhood glaucoma varies around the world, angle surgery remains the preferred initial surgery for primary congenital glaucoma and a major advance has been the concept of incising the whole of the angle (circumferential trabeculotomy). Simple modifications to the trabeculectomy technique have been shown to considerably minimise complications. Glaucoma drainage devices maintain a vital role for certain types of glaucoma including those refractory to other surgery. Cyclodestruction continues to have a role mainly for patients following failed drainage/filtering surgery. Although the prognosis for childhood glaucoma has improved significantly since the introduction of angle surgery, there is still considerable progress to be made to ensure a sighted lifetime for children with glaucoma all over the world. Collaborative approaches to researching and delivering this care are required, and this paper highlights the need for more high-quality prospective surgical trials in the management of the childhood glaucoma. PMID:24924446

Primary urachal adenocarcinoma: A case report

Directory of Open Access Journals (Sweden)

I. Ziouziou

2014-06-01

Full Text Available Primary urachal adenocarcinoma is an aggressive rare cancer that often presents at advanced stages with poor prognosis. We report this case of a 52-year-old patient with a stage-I (Mayo Clinic primary urachal adenocarcinoma with good outcomes after surgery in a 2-year follow-up period. We analyze epidemiological, clinical and therapeutic features of this disease in the literature review.

Fotemustine: A Third-Generation Nitrosourea for the Treatment of Recurrent Malignant Gliomas

International Nuclear Information System (INIS)

Beauchesne, Patrick

2012-01-01

Malignant gliomas account for approximately 60% of all primary brain tumors in adults. The prognosis for patients with malignant glioma has not changed significantly in recent years. Despite debulking surgery, radiotherapy and cytotoxic chemotherapy, the median survival time is nine to 12 months, and very few, if any, patients are cured from this illness. Fotemustine is an alkylating agent characterized by the grafting of a phosphonoalanine group onto the nitrosourea radical with consequent high lipophilicity and improved diffusion through the cell membrane and the blood-brain barrier. Fotemustine has been registered for use in two indications: disseminated malignant melanoma, including cerebral metastases, and primary brain tumors. Fotemustine is currently used in Europe, particularly in France and Italy, as a salvage therapy for recurrent malignant gliomas. Myelosuppression, leucopenia and thrombocytopenia are the most frequent side effects of treatment with fotemustine. The objective response to this treatment is between 26% and 70%, and the reported median survival time is 10 months. New drug combinations containing fotemustine and angiogenesis inhibitors, such as bevacizumab, are currently under development. In this review, we describe all the combinations of fotemustine currently used in clinical practice for recurrent malignant gliomas

Fotemustine: A Third-Generation Nitrosourea for the Treatment of Recurrent Malignant Gliomas

Directory of Open Access Journals (Sweden)

Patrick Beauchesne

2012-02-01

Full Text Available Malignant gliomas account for approximately 60% of all primary brain tumors in adults. The prognosis for patients with malignant glioma has not changed significantly in recent years. Despite debulking surgery, radiotherapy and cytotoxic chemotherapy, the median survival time is nine to 12 months, and very few, if any, patients are cured from this illness. Fotemustine is an alkylating agent characterized by the grafting of a phosphonoalanine group onto the nitrosourea radical with consequent high lipophilicity and improved diffusion through the cell membrane and the blood-brain barrier. Fotemustine has been registered for use in two indications: disseminated malignant melanoma, including cerebral metastases, and primary brain tumors. Fotemustine is currently used in Europe, particularly in France and Italy, as a salvage therapy for recurrent malignant gliomas. Myelosuppression, leucopenia and thrombocytopenia are the most frequent side effects of treatment with fotemustine. The objective response to this treatment is between 26% and 70%, and the reported median survival time is 10 months. New drug combinations containing fotemustine and angiogenesis inhibitors, such as bevacizumab, are currently under development. In this review, we describe all the combinations of fotemustine currently used in clinical practice for recurrent malignant gliomas.

Fotemustine: A Third-Generation Nitrosourea for the Treatment of Recurrent Malignant Gliomas

Energy Technology Data Exchange (ETDEWEB)

Beauchesne, Patrick [Neuro-oncology/Neurology, University Hospital of Nancy, Hôpital CENTRAL, CO N 34,54035 Nancy cedex (France)

2012-02-01

Malignant gliomas account for approximately 60% of all primary brain tumors in adults. The prognosis for patients with malignant glioma has not changed significantly in recent years. Despite debulking surgery, radiotherapy and cytotoxic chemotherapy, the median survival time is nine to 12 months, and very few, if any, patients are cured from this illness. Fotemustine is an alkylating agent characterized by the grafting of a phosphonoalanine group onto the nitrosourea radical with consequent high lipophilicity and improved diffusion through the cell membrane and the blood-brain barrier. Fotemustine has been registered for use in two indications: disseminated malignant melanoma, including cerebral metastases, and primary brain tumors. Fotemustine is currently used in Europe, particularly in France and Italy, as a salvage therapy for recurrent malignant gliomas. Myelosuppression, leucopenia and thrombocytopenia are the most frequent side effects of treatment with fotemustine. The objective response to this treatment is between 26% and 70%, and the reported median survival time is 10 months. New drug combinations containing fotemustine and angiogenesis inhibitors, such as bevacizumab, are currently under development. In this review, we describe all the combinations of fotemustine currently used in clinical practice for recurrent malignant gliomas.

Extra-Neural Metastases of Malignant Gliomas: Myth or Reality?

Energy Technology Data Exchange (ETDEWEB)

Beauchesne, Patrick [Neuro-Oncology, CHU de NANCY, Hôpital Central, CO n°34, 54035 Nancy Cedex (France)

2011-01-27

Malignant gliomas account for approximately 60% of all primary brain tumors in adults. Prognosis for these patients has not significantly changed in recent years— despite debulking surgery, radiotherapy and cytotoxic chemotherapy—with a median survival of 9–12 months. Virtually no patients are cured of their illness. Malignant gliomas are usually locally invasive tumors, though extra-neural metastases can sometimes occur late in the course of the disease (median of two years). They generally appear after craniotomy although spontaneous metastases have also been reported. The incidence of these metastases from primary intra-cranial malignant gliomas is low; it is estimated at less than 2% of all cases. Extra-neural metastases from gliomas frequently occur late in the course of the disease (median of two years), and generally appear after craniotomy, but spontaneous metastases have also been reported. Malignant glioma metastases usually involve the regional lymph nodes, lungs and pleural cavity, and occasionally the bone and liver. In this review, we present three cases of extra-neural metastasis of malignant gliomas from our department, summarize the main reported cases in literature, and try to understand the mechanisms underlying these systemic metastases.

Extra-Neural Metastases of Malignant Gliomas: Myth or Reality?

International Nuclear Information System (INIS)

Beauchesne, Patrick

2011-01-01

Malignant gliomas account for approximately 60% of all primary brain tumors in adults. Prognosis for these patients has not significantly changed in recent years— despite debulking surgery, radiotherapy and cytotoxic chemotherapy—with a median survival of 9–12 months. Virtually no patients are cured of their illness. Malignant gliomas are usually locally invasive tumors, though extra-neural metastases can sometimes occur late in the course of the disease (median of two years). They generally appear after craniotomy although spontaneous metastases have also been reported. The incidence of these metastases from primary intra-cranial malignant gliomas is low; it is estimated at less than 2% of all cases. Extra-neural metastases from gliomas frequently occur late in the course of the disease (median of two years), and generally appear after craniotomy, but spontaneous metastases have also been reported. Malignant glioma metastases usually involve the regional lymph nodes, lungs and pleural cavity, and occasionally the bone and liver. In this review, we present three cases of extra-neural metastasis of malignant gliomas from our department, summarize the main reported cases in literature, and try to understand the mechanisms underlying these systemic metastases

Hyperfractionated-accelerated radiotherapy followed by radical surgery in locally advanced tumors of the oral cavity

International Nuclear Information System (INIS)

Hoeller, U.; Biertz, I.; Tribius, S.; Alberti, W.; Flinzberg, S.; Schmelzle, R.

2006-01-01

Purpose: to evaluate the outcome of hyperfractionated-accelerated radiotherapy and subsequent planned primary tumor resection and radical neck dissection in locally advanced tumors of the oral cavity. Patients and Methods: this retrospective analysis evaluates 126 subsequent patients who were treated between 1988 and 1997 for locally advanced tumors of the oral cavity (with extension into the oropharynx in 17 patients), 34 (27%) AJCC stage III and 92 (73%) stage IV. Primary tumor and nodal metastases were irradiated with 1.4 Gy bid to a median total dose of 72.8 Gy (range 58.8-75.6 Gy). Then, planned radical surgery of the primary site according to the initial tumor extent and cervical nodes was performed. Median follow-up of living patients was 6 years (range 1-11 years). Results: 4 weeks after radiotherapy, 14 patients (11%) had complete tumor remission, 92 (73%) partial remission, 15 (12%) no change, and five (4%) progressive disease. Complete resection was achieved in 117 (93%) patients (nine incomplete resections). 5-year locoregional control rate was 62 ± 9%, overall survival 36 ± 9%. Surgery-related morbidity occurred in 42 patients (33%; mainly delayed wound healing and fistulae), overall severe treatment-related morbidity in 46 patients (36%). 24/84 relapse-free patients (29%) required a percutaneous gastrostomy or nasal tube ≥ 1 year after therapy. Conclusion: in this study, the outcome of combined curative radiotherapy and planned surgery of the primary tumor and neck nodes was comparable to reported results of hyperfractionated radiotherapy with or without salvage surgery of the neck nodes with respect to locoregional control and overall survival. Planned surgery carries a substantial risk of morbidity and seems to offer no benefit in comparison to salvage surgery of the neck nodes only. Therefore, salvage surgery is preferred. (orig.)

Tranexamic Acid in Patients Undergoing Coronary-Artery Surgery.

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Myles, Paul S; Smith, Julian A; Forbes, Andrew; Silbert, Brendan; Jayarajah, Mohandas; Painter, Thomas; Cooper, D James; Marasco, Silvana; McNeil, John; Bussières, Jean S; McGuinness, Shay; Byrne, Kelly; Chan, Matthew T V; Landoni, Giovanni; Wallace, Sophie

2017-01-12

Tranexamic acid reduces the risk of bleeding among patients undergoing cardiac surgery, but it is unclear whether this leads to improved outcomes. Furthermore, there are concerns that tranexamic acid may have prothrombotic and proconvulsant effects. In a trial with a 2-by-2 factorial design, we randomly assigned patients who were scheduled to undergo coronary-artery surgery and were at risk for perioperative complications to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary outcome was a composite of death and thrombotic complications (nonfatal myocardial infarction, stroke, pulmonary embolism, renal failure, or bowel infarction) within 30 days after surgery. Of the 4662 patients who were enrolled and provided consent, 4631 underwent surgery and had available outcomes data; 2311 were assigned to the tranexamic acid group and 2320 to the placebo group. A primary outcome event occurred in 386 patients (16.7%) in the tranexamic acid group and in 420 patients (18.1%) in the placebo group (relative risk, 0.92; 95% confidence interval, 0.81 to 1.05; P=0.22). The total number of units of blood products that were transfused during hospitalization was 4331 in the tranexamic acid group and 7994 in the placebo group (Ptranexamic acid group and in 2.8% of the patients in the placebo group (P=0.001), and seizures occurred in 0.7% and 0.1%, respectively (P=0.002 by Fisher's exact test). Among patients undergoing coronary-artery surgery, tranexamic acid was associated with a lower risk of bleeding than was placebo, without a higher risk of death or thrombotic complications within 30 days after surgery. Tranexamic acid was associated with a higher risk of postoperative seizures. (Funded by the Australian National Health and Medical Research Council and others; ATACAS Australia New Zealand Clinical Trials Registry number, ACTRN12605000557639 .).

Results of revision anterior shoulder stabilization surgery in adolescent athletes.

Science.gov (United States)

Blackman, Andrew J; Krych, Aaron J; Kuzma, Scott A; Chow, Roxanne M; Camp, Christopher; Dahm, Diane L

2014-11-01

The purpose of this study was to determine failure rates, functional outcomes, and risk factors for failure after revision anterior shoulder stabilization surgery in high-risk adolescent athletes. Adolescent athletes who underwent primary anterior shoulder stabilization were reviewed. Patients undergoing subsequent revision stabilization surgery were identified and analyzed. Failure rates after revision surgery were assessed by Kaplan-Meier analysis. Failure was defined as recurrent instability requiring reoperation. Functional outcomes included the Marx activity score; American Shoulder and Elbow Surgeons score; and University of California, Los Angeles score. The characteristics of patients who required reoperation for recurrent instability after revision surgery were compared with those of patients who required only a single revision to identify potential risk factors for failure. Of 90 patients who underwent primary anterior stabilization surgery, 15 (17%) had failure and underwent revision surgery (mean age, 16.6 years; age range, 14 to 18 years). The mean follow-up period was 5.5 years (range, 2 to 12 years). Of the 15 revision patients, 5 (33%) had recurrent dislocations and required repeat revision stabilization surgery at a mean of 50 months (range, 22 to 102 months) after initial revision. No risk factors for failure were identified. The Kaplan-Meier reoperation-free estimates were 86% (95% confidence interval, 67% to 100%) at 24 months and 78% (95% confidence interval, 56% to 100%) at 48 months after revision surgery. The mean final Marx activity score was 14.8 (range, 5 to 20); American Shoulder and Elbow Surgeons score, 82.1 (range, 33 to 100); and University of California, Los Angeles score, 30.8 (range, 16 to 35). At 5.5 years' follow-up, adolescent athletes had a high failure rate of revision stabilization surgery and modest functional outcomes. We were unable to convincingly identify specific risk factors for failure of revision surgery. Level IV

Pediatric endocrine surgery development

Directory of Open Access Journals (Sweden)

Ivan I. Dedov

2017-12-01

Full Text Available Department of pediatric surgery at the Endocrinology Research Centre has been around for nearly two years. During operation, surgical treatment has received more than 500 patients with various endocrine disorders. The article discusses modern diagnostic approaches and surgical options for diseases included in the new direction of pediatric surgery – endocrine surgery in children. There are discussions about options for radical treatment of Graves disease in children, positive and negative aspects of surgical and radioactive iodine treatment. Is own stats of postoperative hyperparathyroidism. Is proposed to optimize the algorithm of actions in identifying thyroid nodules in children. In primary hyperparathyroidism, the emphasis is on the complexity of the postoperative management of patients related to the feature of children’s age in determining the severity of the reactions on the water-electrolyte disorders. Separately reviewed the literature of the adrenal glands diseases in children, demonstrating their own clinical cases which required surgical intervention. The authors describe the possibilities of modern neurosurgical equipment in the Endocrinology Research Centre in operations on the pituitary gland in children. Patients of different age groups performed transnasal transsphenoidal removal of tumors of the chiasm-sellar region using endoscopic assistance. The article also cited research data of pancreas diseases and their surgical treatment. Much attention is paid to the gender section of endocrine surgery in children. Discusses the tactics in disorders of sex development, gonadal tumors in children, diseases of the breast. In conclusion outlines the prospects for the development of endocrine surgery in children.

How traumatic is breast cancer? Posttraumatic stress symptoms (PTSS) and risk factors for severe PTSS at 3 and 15 months after surgery in a nationwide cohort of Danish women treated for primary breast cancer

DEFF Research Database (Denmark)

O'Connor, Maja; Christensen, Søren; Jensen, Anders Bonde

2011-01-01

for primary breast cancer. Methods: Sixty-eight percent of all Danish women receiving surgery for primary breast cancer between October 2001 to March 2004 completed a questionnaire 3 months post-surgery (n=3343), which included the Impact of Event Scale (IES). Ninety-four percent of the disease-free women......The literature shows considerable between-study variation in the prevalence of Post-traumatic Stress Symptoms (PTSS) among women with breast cancer. Our aim was therefore to explore the prevalence of and risk factors for cancer-related PTSS in a nationwide inception cohort of women treated...... physical and mental illness, axillary lymph node involvement (>3), and reduced physical functioning at 3 months. Conclusion: The results confirm that receiving a breast cancer diagnosis can be a significant traumatic experience, and that many women experience persistent cancer-related PTSS. Low social...

Primary radical ablative surgery and fibula free-flap reconstruction for T4 oral cavity squamous cell carcinoma with mandibular invasion: oncologic and functional results and their predictive factors.

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Camuzard, Olivier; Dassonville, Olivier; Ettaiche, Marc; Chamorey, Emmanuel; Poissonnet, Gilles; Berguiga, Riadh; Leysalle, Axel; Benezery, Karen; Peyrade, Frédéric; Saada, Esma; Hechema, Raphael; Sudaka, Anne; Haudebourg, Juliette; Demard, François; Santini, José; Bozec, Alexandre

2017-01-01

The aims of this study were to evaluate clinical outcomes and to determine their predictive factors in patients with oral cavity squamous cell carcinoma (OCSCC) invading the mandibular bone (T4) who underwent primary radical surgery and fibula free-flap reconstruction. Between 2001 and 2013, all patients who underwent primary surgery and mandibular fibula free-flap reconstruction for OCSCC were enrolled in this retrospective study. Predictive factors of oncologic and functional outcomes were assessed in univariate and multivariate analysis. 77 patients (55 men and 22 women, mean age 62 ± 10.6 years) were enrolled in this study. Free-flap failure and local and general complication rates were 9, 31, and 22 %, respectively. In multivariate analysis, ASA score (p = 0.002), pathologic N-stage (p = 0.01), and close surgical margins (p = 0.03) were independent predictors of overall survival. Six months after therapy, oral diet, speech intelligibility, and mouth opening functions were normal or slightly impaired in, respectively, 79, 88, and 83 % of patients. 6.5 % of patients remaining dependent on enteral nutrition 6 months after therapy. With acceptable postoperative outcomes and satisfactory oncologic and functional results, segmental mandibulectomy with fibula free-flap reconstruction should be considered the gold standard primary treatment for patients with OCSCC invading mandible bone. Oncologic outcomes are dependent on three main factors: ASA score, pathologic N-stage, and surgical margin status.

Mechanical disruption of tumors by iron particles and magnetic field application results in increased anti-tumor immune responses.

Directory of Open Access Journals (Sweden)

Myriam N Bouchlaka

Full Text Available The primary tumor represents a potential source of antigens for priming immune responses for disseminated disease. Current means of debulking tumors involves the use of cytoreductive conditioning that impairs immune cells or removal by surgery. We hypothesized that activation of the immune system could occur through the localized release of tumor antigens and induction of tumor death due to physical disruption of tumor architecture and destruction of the primary tumor in situ. This was accomplished by intratumor injection of magneto-rheological fluid (MRF consisting of iron microparticles, in Balb/c mice bearing orthotopic 4T1 breast cancer, followed by local application of a magnetic field resulting in immediate coalescence of the particles, tumor cell death, slower growth of primary tumors as well as decreased tumor progression in distant sites and metastatic spread. This treatment was associated with increased activation of DCs in the draining lymph nodes and recruitment of both DCs and CD8(+T cells to the tumor. The particles remained within the tumor and no toxicities were observed. The immune induction observed was significantly greater compared to cryoablation. Further anti-tumor effects were observed when MRF/magnet therapy was combined with systemic low dose immunotherapy. Thus, mechanical disruption of the primary tumor with MRF/magnetic field application represents a novel means to induce systemic immune activation in cancer.

Depression and Geographic Status as Predictors for Coronary Artery Bypass Surgery Outcomes

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Dao, Tam K.; Chu, Danny; Springer, Justin; Hiatt, Emily; Nguyen, Quang

2010-01-01

Purpose: To examine the relationships between depression, geographic status, and clinical outcomes following a coronary artery bypass grafting (CABG) surgery. Methods: Using the 2004 Nationwide Inpatient Sample database, we identified 63,061 discharge records of patients who underwent a primary CABG surgery (urban 57,247 and rural 5,814). We…

Timing of surgery for primary exotropia in children.

NARCIS (Netherlands)

Asjes-Tydeman, W.L.; Groenewoud, H.; Wilt, G.J. van der

2007-01-01

OBJECTIVE: To compare the postoperative alignment and sensory functions in patients with primary exotropia who had been operated at an early age (< 7 years) with those in patients who had been operated at an older age (> 7 years). METHODS: In a consecutive retrospective cohort study, 112 patients

External-beam radiation therapy combined with limb-sparing surgery in elderly patients (>70 years) with primary soft tissue sarcomas of the extremities : A retrospective analysis.

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Andrä, Claudia; Klein, Alexander; Dürr, Hans Roland; Rauch, Josefine; Lindner, Lars Hartwin; Knoesel, Thomas; Angele, Martin; Baur-Melnyk, Andrea; Belka, Claus; Roeder, Falk

2017-08-01

To report our experience with EBRT combined with limb-sparing surgery in elderly patients (>70 years) with primary extremity soft tissue sarcomas (STS). Retrospectively analyzed were 35 patients (m:f 18:17, median 78 years) who all presented in primary situation without nodal/distant metastases (Charlson score 0/1 in 18 patients; ≥2 in 17 patients). Median tumor size was 10 cm, mainly located in lower limb (83%). Stage at presentation (UICC7th) was Ib:3%, 2a:20%, 2b:20%, and 3:57%. Most lesions were high grade (97%), predominantly leiomyosarcoma (26%) and undifferentiated pleomorphic/malignant fibrous histiocytoma (23%). Limb-sparing surgery was preceded (median 50 Gy) or followed (median 66 Gy) by EBRT. Median follow-up was 37 months (range 1-128 months). Margins were free in 26 patients (74%) and microscopically positive in 9 (26%). Actuarial 3‑ and 5‑year local control rates were 88 and 81% (4 local recurrences). Corresponding rates for distant control, disease-specific survival, and overall survival were 57/52%, 76/60%, and 72/41%. The 30-day mortality was 0%. Severe postoperative complications were scored in 8 patients (23%). Severe acute radiation-related toxicity was observed in 2 patients (6%). Patients with Charlson score ≥2 had a significantly increased risk for severe postoperative complications and acute radiation-related side effects. Severe late toxicities were found in 7 patients (20%), including fractures in 3 (8.6%). Final limb preservation rate was 97%. Combination of EBRT and limb-sparing surgery is feasible in elderly patients with acceptable toxicities and encouraging but slightly inferior outcome compared to younger patients. Comorbidity correlated with postoperative complications and acute toxicities. Late fracture risk seems slightly increased.

Laser surgery in ear, nose and throat

International Nuclear Information System (INIS)

Winter, F.Oe.; Teig, E.; Haye, R.

1991-01-01

This survey is based on own experiences and a study of the literature. The CO 2 laser has certain advantages in the surgical treatment of otosclerosis, both in the primary operation and in reoperation. In rhinal surgery the argon laser has been used with good results in Osler's disease. Laser surgery is not recommended for vasomotoric rhinitis and polyposis. The CO-2 laser has improved the quality of treatment of laryngeal papilloma. With high precision and minimal bleeding the postoperative voice is better than with conventional surgery. The CO 2 laser can also be used to exstirpate small malignant tumours of the tongue and leukoplasia of the oral mucosa. Healing is rapid and involves relatively little pain. The postoperative functional results is usually good, due to moderate formation of scars. 11 refs., 2 tabs

Surgery for necrotising enterocolitis : primary anastomosis or enterostomy?

NARCIS (Netherlands)

Hofman, FN; Bax, NMA; van der Zee, DC

The ideal surgical management of neonates with necrotising enterocolitis (NEC) is still a matter of debate. The purpose of this study was to compare the results of bowel resection with primary anastomosis with the results of bowel resection with enterostomy. Sixty-three neonates with NEC had a bowel

Is there a role for segmental adrenal venous sampling and adrenal sparing surgery in patients with primary aldosteronism?

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Satoh, Fumitoshi; Morimoto, Ryo; Seiji, Kazumasa; Satani, Nozomi; Ota, Hideki; Iwakura, Yoshitsugu; Ono, Yoshikiyo; Kudo, Masataka; Nezu, Masahiro; Omata, Kei; Tezuka, Yuta; Kawasaki, Yoshihide; Ishidoya, Shigeto; Arai, Yoichi; Takase, Kei; Nakamura, Yasuhiro; McNamara, Keely; Sasano, Hironobu; Ito, Sadayoshi

2015-10-01

Adrenal venous sampling (AVS) is critical to determine the subtype of primary aldosteronism (PA). Central AVS (C-AVS)--that is, the collection of effluents from bilateral adrenal central veins (CV)--sometimes does not allow differentiation between bilateral aldosterone-producing adenomas (APA) and idiopathic hyperaldosteronism. To establish the best treatment course, we have developed segmental AVS (S-AVS); that is, we collect effluents from the tributaries of CV to determine the intra-adrenal sources of aldosterone overproduction. We then evaluated the clinical utility of this novel approach in the diagnosis and treatment of PA. We performed C-AVS and/or S-AVS in 297 PA patients and assessed the accuracy of diagnosis based on the results of C-AVS (n=138, 46.5%) and S-AVS (n=159, 53.5%) by comparison with those of clinicopathological evaluation of resected specimens. S-AVS demonstrated both elevated and attenuated secretion of aldosterone from APA and non-tumorous segments, respectively, in patients with bilateral APA and recurrent APA. These findings were completely confirmed by detailed histopathological examination after surgery. S-AVS, but not C-AVS, also served to identify APA located distal from the CV. Compared to C-AVS, S-AVS served to identify APA in some patients, and its use should expand the pool of patients eligible for adrenal sparing surgery through the identification of unaffected segments, despite the fact that S-AVS requires more expertise and time. Especially, this new technique could enormously benefit patients with bilateral or recurrent APA because of the preservation of non-tumorous glandular tissue. © 2015 European Society of Endocrinology.

Deep lateral wall orbital decompression following strabismus surgery in patients with Type II ophthalmic Graves' disease.

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Ellis, Michael P; Broxterman, Emily C; Hromas, Alan R; Whittaker, Thomas J; Sokol, Jason A

2018-01-10

Surgical management of ophthalmic Graves' disease traditionally involves, in order, orbital decompression, followed by strabismus surgery and eyelid surgery. Nunery et al. previously described two distinct sub-types of patients with ophthalmic Graves' disease; Type I patients exhibit no restrictive myopathy (no diplopia) as opposed to Type II patients who do exhibit restrictive myopathy (diplopia) and are far more likely to develop new-onset worsening diplopia following medial wall and floor decompression. Strabismus surgery involving extra-ocular muscle recession has, in turn, been shown to potentially worsen proptosis. Our experience with Type II patients who have already undergone medial wall and floor decompression and strabismus surgery found, when additional decompression is necessary, deep lateral wall decompression (DLWD) appears to have a low rate of post-operative primary-gaze diplopia. A case series of four Type II ophthalmic Graves' disease patients, all of whom had already undergone decompression and strabismus surgery, and went on to develop worsening proptosis or optic nerve compression necessitating further decompression thereafter. In all cases, patients were treated with DLWD. Institutional Review Board approval was granted by the University of Kansas. None of the four patients treated with this approach developed recurrent primary-gaze diplopia or required strabismus surgery following DLWD. While we still prefer to perform medial wall and floor decompression as the initial treatment for ophthalmic Graves' disease, for proptosis following consecutive strabismus surgery, DLWD appears to be effective with a low rate of recurrent primary-gaze diplopia.

Fluorescent imaging of cancerous tissues for targeted surgery

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Bu, Lihong; Shen, Baozhong; Cheng, Zhen

2014-01-01

To maximize tumor excision and minimize collateral damage is the primary goal of cancer surgery. Emerging molecular imaging techniques have to “image-guided surgery” developing into “molecular imaging-guided surgery”, which is termed “targeted surgery” in this review. Consequently, the precision of surgery can be advanced from tissue-scale to molecule-scale, enabling “targeted surgery” to be a component of “targeted therapy”. Evidence from numerous experimental and clinical studies has demonstrated significant benefits of fluorescent imaging in targeted surgery with preoperative molecular diagnostic screening. Fluorescent imaging can help to improve intraoperative staging and enable more radical cytoreduction, detect obscure tumor lesions in special organs, highlight tumor margins, better map lymph node metastases, and identify important normal structures intraoperatively. Though limited tissue penetration of fluorescent imaging and tumor heterogeneity are two major hurdles for current targeted surgery, multimodality imaging and multiplex imaging may provide potential solutions to overcome these issues, respectively. Moreover, though many fluorescent imaging techniques and probes have been investigated, targeted surgery remains at a proof-of-principle stage. The impact of fluorescent imaging on cancer surgery will likely be realized through persistent interdisciplinary amalgamation of research in diverse fields. PMID:25064553

Minimal impairment in pulmonary function following laparoscopic surgery

DEFF Research Database (Denmark)

Staehr-Rye, Anne K; Rasmussen, L S; Rosenberg, J

2014-01-01

BACKGROUND: Pulmonary function may be impaired in connection with laparoscopic surgery, especially in the head-down body position, but the clinical importance has not been assessed in detail. The aim of this study was to assess pulmonary function after laparoscopic hysterectomy and laparoscopic...... cholecystectomy in the 20° head-up position or hysterectomy in the 30° head-down position. The primary outcome was the difference between arterial oxygenation (PaO2 ) 2 h postoperatively and the preoperative value. Two hours and 24 h after surgery, pulmonary shunt and ventilation-perfusion mismatch were assessed.......88). Shunt was significantly greater in the cholecystectomy group 24 h after surgery compared to the hysterectomy group [4%, 95% CI 0 to 9 vs. 0%, 95% CI 0 to 7, P = 0.02]. CONCLUSIONS: Minimal impairment in pulmonary gas exchange was found after laparoscopic surgery. Pulmonary shunt was larger after...

Carcinoma of Unknown Primary Treatment (PDQ®)—Health Professional Version

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Carcinoma of unknown primary (CUP) treatment depends on the best determination of the primary site, if possible. Treatment options may include surgery, radiation therapy, and systemic treatment. Get detailed information about diagnosis and treatment of CUP in this summary for clinicians.

Brief smoking cessation intervention in relation to breast cancer surgery: a randomized controlled trial

DEFF Research Database (Denmark)

Thomsen, Thordis; Tønnesen, Hanne; Okholm, Mette

2010-01-01

Smokers are more prone to develop postoperative complications. Smoking cessation intervention beginning 4-8 weeks prior to surgery improves the postoperative outcome. Cancer patients, however, often undergo surgery less than 4 weeks after diagnosis. The primary objective of this study was therefo...

Prenatal surgery for myelomeningocele and the need for cerebrospinal fluid shunt placement

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Tulipan, Noel; Wellons, John C.; Thom, Elizabeth A.; Gupta, Nalin; Sutton, Leslie N.; Burrows, Pamela K.; Farmer, Diana; Walsh, William; Johnson, Mark P.; Rand, Larry; Tolivaisa, Susan; D’Alton, Mary E.; Adzick, N. Scott

2016-01-01

Object The Management of Myelomeningocele Study (MOMS) was a multicenter randomized trial comparing the safety and efficacy of prenatal and postnatal closure of myelomeningocele. The trial was stopped early because of the demonstrated efficacy of prenatal surgery, and outcomes on 158 of 183 pregnancies were reported. Here, the authors update the 1-year outcomes for the complete trial, analyze the primary and related outcomes, and evaluate whether specific prerandomization risk factors are associated with prenatal surgery benefit. Methods The primary outcome was a composite of fetal loss or any of the following: infant death, CSF shunt placement, or meeting the prespecified criteria for shunt placement. Primary outcome, actual shunt placement, and shunt revision rates for prenatal versus postnatal repair were compared. The shunt criteria were reassessed to determine which were most concordant with practice, and a new composite outcome was created from the primary outcome by replacing the original criteria for CSF shunt placement with the revised criteria. The authors used logistic regression to estimate whether there were interactions between the type of surgery and known prenatal risk factors (lesion level, gestational age, degree of hindbrain herniation, and ventricle size) for shunt placement, and to determine which factors were associated with shunting among those infants who underwent prenatal surgery. Results Ninety-one women were randomized to prenatal surgery and 92 to postnatal repair. The primary outcome occurred in 73% of infants in the prenatal surgery group and in 98% in the postnatal group (p < 0.0001). Actual rates of shunt placement were only 44% and 84% in the 2 groups, respectively (p < 0.0001). The authors revised the most commonly met criterion to require overt clinical signs of increased intracranial pressure, defined as split sutures, bulging fontanelle, or sunsetting eyes, in addition to increasing head circumference or hydrocephalus. Using

Image guided, minimally invasive adenomectomy for solitary gland disease in primary hyperparathyroidism

NARCIS (Netherlands)

Smit, Pieter Casper

2001-01-01

Introduction: Since the introduction in the 1970s of the unilateral approach in surgery for primary hyperparathyroidism by Wang, authors have increasingly been recommending limited forms of parathyroid surgery. Although unilateral explorations reduce operation time and admission days, decrease

Clinical outcome of combined conjunctival autograft transplantation and amniotic membrane transplantation in pterygium surgery

Science.gov (United States)

Malla, Tejsu; Jiang, Jing; Hu, Kai

2018-01-01

AIM To compare long-term outcome of primary and recurrent pterygium surgery with three different techniques: combined conjunctival autograft and overlay amniotic membrane transplantation (CAT with AMT), conjunctival autograft transplantation (CAT) alone and amniotic membrane transplantation (AMT) alone. METHODS In this retrospective study, 142 eyes of 142 pterygium patients (104 primary, 38 recurrent) who underwent CAT (group A), AMT (group B) or CAT with AMT (group C) respectively following surgical excision were reviewed and compared based on the recurrences and post-operative complications. RESULTS The number of recurrence post-surgery were 17 (9 from primary, 8 from recurrent; the same description below), 18 (10, 8) and 2 (1, 1) in groups A, B, and C respectively; dry eyes were 22 (16, 6), 27 (18, 9) and 7 (3, 4); conjunctival inflammations were 30 (17, 13), 27 (16, 11) and 11 (6, 5). Patients in group C (either primary or recurrent or both) mainly showed significantly better results than those in group A or B (P<0.05) regarding above-mentioned clinical effects. CONCLUSION Combined CAT and overly AMT have significantly lower rates of recurrence and postoperative complications for primary and recurrent pterygium surgery than CAT or AMT alone. PMID:29600172

Clinical outcome of combined conjunctival autograft transplantation and amniotic membrane transplantation in pterygium surgery

Directory of Open Access Journals (Sweden)

Tejsu Malla

2018-03-01

Full Text Available AIM: To compare long-term outcome of primary and recurrent pterygium surgery with three different techniques: combined conjunctival autograft and overlay amniotic membrane transplantation (CAT with AMT, conjunctival autograft transplantation (CAT alone and amniotic membrane transplantation (AMT alone. METHODS: In this retrospective study, 142 eyes of 142 pterygium patients (104 primary, 38 recurrent who underwent CAT (group A, AMT (group B or CAT with AMT (group C respectively following surgical excision were reviewed and compared based on the recurrences and post-operative complications. RESULTS: The number of recurrence post-surgery were 17 (9 from primary, 8 from recurrent; the same description below, 18 (10, 8 and 2 (1, 1 in groups A, B, and C respectively; dry eyes were 22 (16, 6, 27 (18, 9 and 7 (3, 4; conjunctival inflammations were 30 (17, 13, 27 (16, 11 and 11 (6, 5. Patients in group C (either primary or recurrent or both mainly showed significantly better results than those in group A or B (P<0.05 regarding above-mentioned clinical effects. CONCLUSION: Combined CAT and overly AMT have significantly lower rates of recurrence and postoperative complications for primary and recurrent pterygium surgery than CAT or AMT alone.

Primary benign brachial plexus tumors: an experience of 115 operated cases.

Science.gov (United States)

Desai, Ketan I

2012-01-01

Primary benign brachial plexus tumors are rare. They pose a great challenge to the neurosurgeon, because the majority of patients present with minimal or no neurological deficits. Radical to complete excision of the tumor with preservation of neurological function of the involved nerve is an ideal surgical treatment option with benign primary brachial plexus tumor surgery. We present a review article of our 10-year experience with primary benign brachial plexus tumors surgically treated at King Edward Memorial Hospital and P.D. Hinduja National Hospital from 2000 to 2009. The clinical presentations, radiological features, surgical strategies, and the eventual outcome following surgery are analyzed, discussed, and compared with available series in the world literature. Various difficulties and problems faced in the management of primary benign brachial plexus tumors are analyzed. Irrespective of the tumor size, the indications for surgical intervention are also discussed. The goal of our study was to optimize the treatment of patients with benign brachial plexus tumors with minimal neurological deficits. It is of paramount importance that brachial plexus tumors be managed by a peripheral nerve surgeon with expertise and experience in this field to minimize the neurological insult following surgery.

The Effect of Cataract Surgery on Circadian Photoentrainment

DEFF Research Database (Denmark)

Brøndsted, Adam Elias; Sander, Birgit; Haargaard, Birgitte

2015-01-01

of cataract surgery on circadian photoentrainment and to determine any difference between blue-blocking and neutral intraocular lenses (IOLs). DESIGN: The study was a single-center, investigator-driven, double-masked, block-randomized clinical trial. PARTICIPANTS: One eye in 76 patients with bilateral age......PURPOSE: Cataract decreases blue light transmission. Because of the selective blue light sensitivity of the retinal ganglion cells governing circadian photoentrainment, cataract may interfere with normal sleep-wake regulation and cause sleep disturbances. The purpose was to investigate the effect......-related cataract eligible for cataract surgery was included. METHODS: Intervention was cataract surgery by phacoemulsification. Patients were randomized to receive a blue-blocking or neutral IOL. MAIN OUTCOME MEASURES: Primary outcome was activation of intrinsic photosensitive ganglion cells using post...

Femtosecond laser cataract surgery: technology and clinical practice.

Science.gov (United States)

Roberts, Timothy V; Lawless, Michael; Chan, Colin Ck; Jacobs, Mark; Ng, David; Bali, Shveta J; Hodge, Chris; Sutton, Gerard

2013-03-01

The recent introduction of femtosecond lasers to cataract surgery has generated much interest among ophthalmologists around the world. Laser cataract surgery integrates high-resolution anterior segment imaging systems with a femtosecond laser, allowing key steps of the procedure, including the primary and side-port corneal incisions, the anterior capsulotomy and fragmentation of the lens nucleus, to be performed with computer-guided laser precision. There is emerging evidence of reduced phacoemulsification time, better wound architecture and a more stable refractive result with femtosecond cataract surgery, as well as reports documenting an initial learning curve. This article will review the current state of technology and discuss our clinical experience. © 2012 The Authors. Clinical and Experimental Ophthalmology © 2012 Royal Australian and New Zealand College of Ophthalmologists.

Predictors of not regaining basic mobility after hip fracture surgery

DEFF Research Database (Denmark)

Hulsbæk, Signe; Larsen, Rikke Faebo; Troelsen, Anders

2015-01-01

PURPOSE: Regaining basic mobility after hip fracture surgery is a milestone in the in-hospital rehabilitation. The aims were to investigate predictors for not regaining basic mobility at the fifth post-operative day and at discharge after undergoing hip fracture surgery. METHOD: In a prospective...... on first post-operative day (OR = 3.3) (p values: 0.009-surgery, who are not able to complete physiotherapy on first post-operative day, are at a greater risk of not regaining basic mobility during hospitalization....... This highlights the importance of physiotherapy as part of the interdisciplinary treatment. IMPLICATIONS FOR REHABILITATION: Regaining abilities in basic mobility after hip fracture surgery is a primary goal of rehabilitation during hospitalization in the acute ward. The following factors are indentified...

Impact of surgical complications on length of stay after hip fracture surgery

DEFF Research Database (Denmark)

Foss, Nicolai Bang; Palm, Henrik; Krasheninnikoff, Michael

2006-01-01

BACKGROUND: Rehabilitation after hip fracture may be lengthy, with bed-day consumption accounting for up to 85% of the total cost of admission to hospital. Data suggest that surgical complications requiring reoperation may lead to an excessively long in-patient stays. However, the overall impact...... of surgical complications has not been examined in detail. METHODS: All 600 consecutive patients included were admitted with primary hip fracture and received primary surgical intervention with multimodal rehabilitation. Surgical complications were audited and classified as being due to a patient fall...... showed that 64 complications (55%) were due to suboptimal surgery, 18 (16%) to infection, 6 (5%) to falls and 28 (24%) to no obvious cause. CONCLUSION: Surgical complications secondary to primary hip fracture surgery account for 27.1% of total hospital bed consumption within 6 months. Approximately, 50...

Extended maxillotomy for skull base access in contemporary management of chordomas: Rationale and technical aspect.

Science.gov (United States)

Abdul Jalil, Muhammad Fahmi; Story, Rowan D; Rogers, Myron

2017-05-01

Minimally invasive approaches to the central skull base have been popularized over the last decade and have to a large extent displaced 'open' procedures. However, traditional skull base surgery still has its role especially when dealing with a large clival chordoma where maximal surgical resection is the principal goal to maximize patient survival. In this paper, we present a case of a 25year-old male patient with chordoma in the inferior clivus which was initially debulked via a transnasal endoscopic approach. He unfortunately had a large recurrence of tumor requiring re-do resection. With the aim to achieve maximal surgical resection, we then chose the technique of a transoral approach with Le Fort 1 maxillotomy and midline palatal split. Post-operative course for the patient was uneventful and post-operative MRI confirmed significant debulking of the clival lesion. The technique employed for the surgical procedure is presented here in detail as is our experience over two decades using this technique for tumors, inflammatory lesions and congenital abnormalities at the cranio-cervical junction. Copyright © 2017 Elsevier Ltd. All rights reserved.

A Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 1. Planning and management.

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Semb, Gunvor; Enemark, Hans; Friede, Hans; Paulin, Gunnar; Lilja, Jan; Rautio, Jorma; Andersen, Mikael; Åbyholm, Frank; Lohmander, Anette; Shaw, William; Mølsted, Kirsten; Heliövaara, Arja; Bolund, Stig; Hukki, Jyri; Vindenes, Hallvard; Davenport, Peter; Arctander, Kjartan; Larson, Ola; Berggren, Anders; Whitby, David; Leonard, Alan; Neovius, Erik; Elander, Anna; Willadsen, Elisabeth; Bannister, R Patricia; Bradbury, Eileen; Henningsson, Gunilla; Persson, Christina; Eyres, Philip; Emborg, Berit; Kisling-Møller, Mia; Küseler, Annelise; Granhof Black, Birthe; Schöps, Antje; Bau, Anja; Boers, Maria; Andersen, Helene Søgaard; Jeppesen, Karin; Marxen, Dorte; Paaso, Marjukka; Hölttä, Elina; Alaluusua, Suvi; Turunen, Leena; Humerinta, Kirsti; Elfving-Little, Ulla; Tørdal, Inger Beate; Kjøll, Lillian; Aukner, Ragnhild; Hide, Øydis; Feragen, Kristin Billaud; Rønning, Elisabeth; Skaare, Pål; Brinck, Eli; Semmingsen, Ann-Magritt; Lindberg, Nina; Bowden, Melanie; Davies, Julie; Mooney, Jeanette; Bellardie, Haydn; Schofield, Nina; Nyberg, Jill; Lundberg, Maria; Karsten, Agneta Linder-Aronson; Larson, Margareta; Holmefjord, Anders; Reisæter, Sigvor; Pedersen, Nina-Helen; Rasmussen, Therese; Tindlund, Rolf; Sæle, Paul; Blomhoff, Reidunn; Jacobsen, Gry; Havstam, Christina; Rizell, Sara; Enocson, Lars; Hagberg, Catharina; Najar Chalien, Midia; Paganini, Anna; Lundeborg, Inger; Marcusson, Agneta; Mjönes, Anna-Britta; Gustavsson, Annica; Hayden, Christine; McAleer, Eilish; Slevan, Emma; Gregg, Terry; Worthington, Helen

2017-02-01

Longstanding uncertainty surrounds the selection of surgical protocols for the closure of unilateral cleft lip and palate, and randomised trials have only rarely been performed. This paper is an introduction to three randomised trials of primary surgery for children born with complete unilateral cleft lip and palate (UCLP). It presents the protocol developed for the trials in CONSORT format, and describes the management structure that was developed to achieve the long-term engagement and commitment required to complete the project. Ten established national or regional cleft centres participated. Lip and soft palate closure at 3-4 months, and hard palate closure at 12 months served as a common method in each trial. Trial 1 compared this with hard palate closure at 36 months. Trial 2 compared it with lip closure at 3-4 months and hard and soft palate closure at 12 months. Trial 3 compared it with lip and hard palate closure at 3-4 months and soft palate closure at 12 months. The primary outcomes were speech and dentofacial development, with a series of perioperative and longer-term secondary outcomes. Recruitment of 448 infants took place over a 9-year period, with 99.8% subsequent retention at 5 years. The series of reports that follow this introductory paper include comparisons at age 5 of surgical outcomes, speech outcomes, measures of dentofacial development and appearance, and parental satisfaction. The outcomes recorded and the numbers analysed for each outcome and time point are described in the series. ISRCTN29932826.

[Initial experience in robot-assisted colorectal surgery in Mexico].

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Villanueva-Sáenz, Eduardo; Ramírez-Ramírez, Moisés Marino; Zubieta-O'Farrill, Gregorio; García-Hernández, Luis

Colorectal surgery has advanced notably since the introduction of the mechanical suture and the minimally invasive approach. Robotic surgery began in order to satisfy the needs of the patient-doctor relationship, and migrated to the area of colorectal surgery. An initial report is presented on the experience of managing colorectal disease using robot-assisted surgery, as well as an analysis of the current role of this platform. A retrospective study was conducted in order to review five patients with colorectal disease operated using a robot-assisted technique over one year in the initial phase of the learning curve. Gender, age, diagnosis and surgical indication, surgery performed, surgical time, conversion, bleeding, post-operative complications, and hospital stay, were analysed and described. A literature review was performed on the role of robotic assisted surgery in colorectal disease and cancer. The study included 5 patients, 3 men and 2 women, with a mean age of 62.2 years. Two of them were low anterior resections with colorectal primary anastomoses, one of them extended with a loop protection ileostomy, a Frykman-Goldberg procedure, and two left hemicolectomies with primary anastomoses. The mean operating time was 6hours and robot-assisted 4hours 20minutes. There were no conversions and the mean hospital stay was 5 days. This technology is currently being used worldwide in different surgical centres because of its advantages that have been clinically demonstrated by various studies. We report the first colorectal surgical cases in Mexico, with promising results. There is enough evidence to support and recommend the use of this technology as a viable and safe option. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

Surgery for failed cervical spine reconstruction.

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Helgeson, Melvin D; Albert, Todd J

2012-03-01

Review article. To review the indications, operative strategy, and complications of revision cervical spine reconstruction. With many surgeons expanding their indications for cervical spine surgery, the number of patients being treated operatively has increased. Unfortunately, the number of patients requiring revision procedures is also increasing, but very little literature exists reviewing changes in the indications or operative planning for revision reconstruction. Narrative and review of the literature. In addition to the well-accepted indications for primary cervical spine surgery (radiculopathy, myelopathy, instability, and tumor), we have used the following indications for revision surgery: pseudarthrosis, adjacent segment degeneration, inadequate decompression, iatrogenic instability, and deformity. Our surgical goal for pseudarthrosis is obviously to obtain a fusion, which can usually be performed with an approach not done previously. Our surgical goals for instability and deformity are more complex, with a focus on decompression of any neurologic compression, correction of deformity, and stability. Revision cervical spine reconstruction is safe and effective if performed for the appropriate indications and with proper planning.

Acute care surgery: defining mortality in emergency general surgery in the state of Maryland.

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Narayan, Mayur; Tesoriero, Ronald; Bruns, Brandon R; Klyushnenkova, Elena N; Chen, Hegang; Diaz, Jose J

2015-04-01

Emergency general surgery (EGS) is a major component of acute care surgery, however, limited data exist on mortality with respect to trauma center (TC) designation. We hypothesized that mortality would be lower for EGS patients treated at a TC vs non-TC (NTC). A retrospective review of the Maryland Health Services Cost Review Commission database from 2009 to 2013 was performed. The American Association for the Surgery of Trauma EGS ICD-9 codes were used to identify EGS patients. Data collected included demographics, TC designation, emergency department admissions, and All Patients Refined Severity of Illness (APR_SOI). Trauma center designation was used as a marker of a formal acute care surgery program. Primary outcomes included in-hospital mortality. Multivariable logistic regression analysis was performed controlling for age. There were 817,942 EGS encounters. Mean ± SD age of patients was 60.1 ± 18.7 years, 46.5% were males; 71.1% of encounters were at NTCs; and 75.8% were emergency department admissions. Overall mortality was 4.05%. Mortality was calculated based on TC designation controlling for age across APR_SOI strata. Multivariable logistic regression analysis did not show statistically significant differences in mortality between hospital levels for minor APR_SOI. For moderate APR_SOI, mortality was significantly lower for TCs compared with NTCs (p surgery patients treated at TCs had lower mortality for moderate APR_SOI, but increased mortality for extreme APR_SOI when compared with NTCs. Additional investigation is required to better evaluate this unexpected finding. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Predicting outcome of rethoracotomy for suspected pericardial tamponade following cardio-thoracic surgery in the intensive care unit

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Beishuizen Albertus

2011-05-01

Full Text Available Abstract Objectives Pericardial tamponade after cardiac surgery is difficult to diagnose, thereby rendering timing of rethoracotomy hard. We aimed at identifying factors predicting the outcome of surgery for suspected tamponade after cardio-thoracic surgery, in the intensive care unit (ICU. Methods Twenty-one consecutive patients undergoing rethoracotomy for suspected pericardial tamponade in the ICU, admitted after primary cardio-thoracic surgery, were identified for this retrospective study. We compared patients with or without a decrease in severe haemodynamic compromise after rethoracotomy, according to the cardiovascular component of the sequential organ failure assessment (SOFA score. Results A favourable haemodynamic response to rethoracotomy was observed in 11 (52% of patients and characterized by an increase in cardiac output, and less fluid and norepinephrine requirements. Prior to surgery, the absence of treatment by heparin, a minimum cardiac index 2 and a positive fluid balance (> 4,683 mL were predictive of a beneficial haemodynamic response. During surgery, the evacuation of clots and > 500 mL of pericardial fluid was associated with a beneficial haemodynamic response. Echocardiographic parameters were of limited help in predicting the postoperative course, even though 9 of 13 pericardial clots found at surgery were detected preoperatively. Conclusion Clots and fluids in the pericardial space causing regional tamponade and responding to surgical evacuation after primary cardio-thoracic surgery, are difficult to diagnose preoperatively, by clinical, haemodynamic and even echocardiographic evaluation in the ICU. Only absence of heparin treatment, a large positive fluid balance and low cardiac index predicted a favourable haemodynamic response to rethoracotomy. These data might help in deciding and timing of reinterventions after primary cardio-thoracic surgery.

Patients' perspectives on urethral bulk injection therapy and mid-urethral sling surgery for stress urinary incontinence.

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Casteleijn, Fenne M; Zwolsman, Sandra E; Kowalik, Claudia R; Roovers, Jan-Paul P W R

2018-04-19

The aim of this study was to identify all treatment decision factors that determined the preference for peri-urethral bulk injection therapy (PBI) or mid-urethral sling (MUS) surgery in patients with primary stress urinary incontinence (SUI). Second, we explored what patients expect from treatment for SUI and whether patients would consider PBI as a primary treatment option. In a qualitative design, 20 semi-structured, face-to-face interviews were conducted in women with primary SUI. Exclusion criteria were: previous PBI or MUS surgery; predominating urgency. Interviews were guided by three open-ended questions and a topic list. PBI treatment and MUS surgery were described in detail, and the efficacy was stated as 70% and 90%, respectively. Data saturation was reached when no new treatment decision factors were identified in three consecutive interviews. Interviews were audiotaped and fully transcribed. Thematic analysis by a coding process was done independently by two researchers. Sixteen procedural, personal, professional, social and external treatment decision factors were identified. Regarding expectations about treatment for SUI, women believed 'becoming dry' was wishful thinking. The majority of patients accepted a small degree of persistent urinary incontinence after treatment. Regardless of their treatment preference, patients indicated that women should be informed about PBI as a primary treatment option. Patients with primary SUI are open to PBI as an alternative treatment option even with lower cure rates compared with MUS surgery performed under general or spinal anesthesia. Patients indicated that women with primary SUI seeking treatment should be informed about PBI as a treatment option.

The Danish Fracture Database can monitor quality of fracture-related surgery, surgeons' experience level and extent of supervision

DEFF Research Database (Denmark)

Andersen, M. J.; Gromov, K.; Brix, M.

2014-01-01

INTRODUCTION: The importance of supervision and of surgeons' level of experience in relation to patient outcome have been demonstrated in both hip fracture and arthroplasty surgery. The aim of this study was to describe the surgeons' experience level and the extent of supervision for: 1) fracture-related...... surgery in general; 2) the three most frequent primary operations and reoperations; and 3) primary operations during and outside regular working hours. MATERIAL AND METHODS: A total of 9,767 surgical procedures were identified from the Danish Fracture Database (DFDB). Procedures were grouped based...... procedures by junior residents grew from 30% during to 40% (p related surgery. The extent of supervision was generally high; however, a third of the primary procedures performed by junior...

Incisional hernia in pediatric surgery - experience at a single UK tertiary centre.

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Mullassery, Dhanya; Pedersen, Ami; Robb, Andrew; Smith, Nicola

2016-11-01

Incisional hernia (IH) is a recognized complication of open and laparoscopic visceral surgery, with reported rates of 10-50% in adult surgical literature. There is a paucity of data relating to incisional hernias in children. The aim of our study was to analyze the incidence and treatment of IH in children. Retrospective review of all patients admitted for incisional hernia repair at a tertiary pediatric surgical centre in the UK more than a 7-year period was performed. Data collected included age at initial surgery, time to IH repair, and type of IH repair and postoperative complications. Twenty one patients (14 male) underwent IH repair during the study period. The incidence of IH among children who had primary abdominal surgery in our institution less than the age of 6months was 2.3%. Median age at repair was 7.9months (range: 18days-5years). Median time from primary surgery to diagnosis of IH was 2months (range 0day-3years), with 81% (17/21) diagnosed within 1year of the preceding abdominal procedure. The most common pathology necessitating the primary operative procedure was necrotising enterocolitis (n=9) in babies of gestational age less than 30weeks. The highest rates of IH were noted in infants following closure of stoma (7.5%) and pyloromyotomy (2.52%). Primary closure was undertaken in all cases. Two children had recurrence of IH, one of which underwent surgical repair. Incidence of IH in children is low but significant. IH was most commonly diagnosed following closure of stoma for NEC in this study. Copyright © 2016. Published by Elsevier Inc.

Humanitarian Cleft Lip/Palate Surgeries in Buddhist Thailand and Neighboring Countries.

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Uemura, Tetsuji; Preeyanont, Piyoros; Udnoon, Sopridee

2015-06-01

This study evaluates surgeries done on patients with cleft lip and/or palate in Thailand and its neighboring countries from 1988 to 2008. This 21-year-long volunteer surgical mission was sponsored by Duang-Kaew Foundation, a volunteer organization. Countries involved, besides Thailand, were Vietnam, Myanmar, Laos, Cambodia, China, Sri Lanka, Bhutan, and India. The same surgical method for primary and secondary repair of lip and/or palate was used throughout: Onizuka method by single surgeon, the second author mainly. We assessed, by way of the patients' medical records including their background, the results of surgeries. The healing rates and complication rates associated with patients for primary and secondary repair of lip and/or palate. The study consisted of a total of 6832 patients: 3120 with cleft lip (CL); 2190 with cleft palate (CP); and 1522 with cleft lip and palate (CLP). Their primary cases were 675 (CL), 799 (CP), and 301 (CLP). All CP operations were done under general anesthesia. Of the CL surgeries, 10% of adult cases were done under local anesthesia. Of all the patients, 78%, or 5329, had one surgery; and 22%, or 1503, had 2 or more surgeries. Good healing was seen in 73.3%, whereas wound infection was noted in 2.0% and healing by second intention was in 1.2% of all cases. It is important that the Onizuka method was the only method used in all the countries throughout the mission period. The method has an advantage over other methods in that its design is simple enough so that even a beginning plastic surgeon can easily master, and operative results are constantly good regardless of who did the operation. The Duang-Kaew Foundation's long-term surgical program helped reduce the number of untreated patients to manageable levels for local health care providers in Thailand and neighboring countries for as long as 21 years.

Arthroscopic surgery for degenerative knee

DEFF Research Database (Denmark)

Thorlund, J B; Juhl, C B; Roos, E M

2015-01-01

OBJECTIVE: To determine benefits and harms of arthroscopic knee surgery involving partial meniscectomy, debridement, or both for middle aged or older patients with knee pain and degenerative knee disease. DESIGN: Systematic review and meta-analysis. MAIN OUTCOME MEASURES: Pain and physical function....... RESULTS: The search identified nine trials assessing the benefits of knee arthroscopic surgery in middle aged and older patients with knee pain and degenerative knee disease. The main analysis, combining the primary endpoints of the individual trials from three to 24 months postoperatively, showed a small...... included symptomatic deep venous thrombosis (4.13 (95% confidence interval 1.78 to 9.60) events per 1000 procedures), pulmonary embolism, infection, and death. CONCLUSIONS: The small inconsequential benefit seen from interventions that include arthroscopy for the degenerative knee is limited in time...

Clinical results of Trabectome surgery for open-angle glaucoma

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Mizoguchi T

2015-10-01

Full Text Available Takanori Mizoguchi,1 Shiro Nishigaki,2 Tomoki Sato,3 Harumi Wakiyama,4 Nobuchika Ogino2 1Mizoguchi Eye Clinic, Ophthalmology, Sasebo, 2Nishigaki Eye Clinic, Ophthalmology, Nagoya, 3Sato Eye Clinic, Ophthalmology, Arao, 4Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan Background: The purpose of this study was to determine outcomes when using Trabectome surgery and to evaluate factors associated with its effects in primary open-angle glaucoma (POAG and exfoliation glaucoma (EXG. Methods: This was a prospective, non-randomized, observational, comparative cohort study in which Trabectome surgery was used alone in patients with POAG or EXG. Trabectome surgery was considered to have failed when at least one of the following three criteria was fulfilled: intraocular pressure (IOP ≥21 mmHg and a <20% reduction below the baseline IOP on two consecutive follow-up visits 3 months or more after surgery; need for additional glaucoma surgery; and an increase in number of medications compared with baseline. Results: The subjects were 32 males (34 eyes and 46 females (48 eyes. POAG was observed in 43 eyes and EXG in 39 eyes. IOP after Trabectome surgery decreased significantly from 22.3±6.8 mmHg at baseline to 14.0±3.9 mmHg (23.0% reduction at month 24 in all cases (P<0.0000. The success rate at 2 years was 51.2% for all cases (POAG, 50.9%; EXG, 49.2%. There was no significant difference in success rate between POAG and EXG (P=0.91. Preoperative IOP (P=0.033 and number of medications (P=0.041 were significant factors for surgical success/failure in multivariate logistic regression. No serious complications were observed. Conclusion: Trabectome surgery achieved favorable IOP control and was equally effective in patients with POAG and those with EXG. Its effects were influenced by preoperative IOP and number of preoperative medications. Keywords: Trabectome, primary open-angle glaucoma, exfoliation glaucoma, success rate, risk factors 

Factors predicting the duration of adrenal insufficiency in patients successfully treated for Cushing disease and nonmalignant primary adrenal Cushing syndrome.

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Prete, Alessandro; Paragliola, Rosa Maria; Bottiglieri, Filomena; Rota, Carlo Antonio; Pontecorvi, Alfredo; Salvatori, Roberto; Corsello, Salvatore Maria

2017-03-01

Successful treatment of Cushing syndrome causes transient or permanent adrenal insufficiency deriving from endogenous hypercortisolism-induced hypothalamus-pituitary-adrenal-axis suppression. We analyzed pre-treatment factors potentially affecting the duration of adrenal insufficiency. We conducted a retrospective analysis on patients successfully treated for Cushing disease (15 patients) who underwent transsphenoidal surgery, and nonmalignant primary adrenal Cushing syndrome (31 patients) who underwent unilateral adrenalectomy, divided into patients with overt primary adrenal Cushing syndrome (14 patients) and subclinical primary adrenal Cushing syndrome (17 patients). Epidemiological data, medical history, and hormonal parameters depending on the etiology of hypercortisolism were collected and compared to the duration of adrenal insufficiency. The median duration of follow-up after surgery for Cushing disease and primary adrenal Cushing syndrome was 70 and 48 months, respectively. In the Cushing disease group, the median duration of adrenal insufficiency after transsphenoidal surgery was 15 months: younger age at diagnosis and longer duration of signs and symptoms of hypercortisolism before diagnosis and surgery were associated with longer duration of adrenal insufficiency. The median duration of adrenal insufficiency was 6 months for subclinical primary adrenal Cushing syndrome and 18.5 months for overt primary adrenal Cushing syndrome. The biochemical severity of hypercortisolism, the grade of hypothalamus-pituitary-adrenal-axis suppression, and treatment with ketoconazole before surgery accounted for longer duration of adrenal insufficiency. In patients with Cushing disease, younger age and delayed diagnosis and treatment predict longer need for glucocorticoid replacement therapy after successful transsphenoidal surgery. In patients with primary adrenal Cushing syndrome, the severity of hypercortisolism plays a primary role in influencing the duration of

The Effects of Anesthetic Technique on Postoperative Opioid Consumption in Ankle Fracture Surgery

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Christensen, Kristian P; Møller, Ann M.; Nielsen, Jesper K.

2016-01-01

OBJECTIVES: To investigate the impact of common anesthetic techniques on postoperative opioid consumption in ankle fracture surgery. MATERIALS AND METHODS: We performed a retrospective cohort study on 622 patients with isolated ankle fractures undergoing primary reconstructive surgery. Patients...... anesthesia modalities reduce postoperative opioid consumption in ankle fracture surgery in comparison with GA. A benefit of PNBs is possibly due to an improved pain profile. Our study is retrospective and cannot predict the exact magnitude of this benefit....

The Importance of Appendectomy in Surgery for Mucinous Adenocarcinoma of the Ovary

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Rosendahl, Mikkel; Haueberg Oester, Laura Amalie; Høgdall, Claus Kim

2017-01-01

Objective: The aim of this study was to assess the importance of appendectomy during surgery for mucinous ovarian cancer. It can be difficult to distinguish between primary ovarian and primary appendiceal cancers clinically, histologically, and immunohistochemically. Removal of the appendix may...... metastases from ovarian cancer. Three of the cases were macroscopically normal, and metastases were discovered only during microscopic evaluation. Patients with metastatic disease to the appendix had significantly worse 5-year survival (22%) compared with patients without metastases (73%) (χ2 = 31.998, P ... metastatic disease, and because appendectomy is easily performed and does not increase morbidity, it should be performed during surgery for suspected mucinous ovarian cancer....

Atherectomy in complex infrainguinal lesions: a review.

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Engelberger, S; van den Berg, J C

2015-02-01

In the femoropopliteal segment, endovascular revascularization techniques have gained the role as a first line treatment strategy. Nitinol stent placement has improved the short- and mid-term primary patency rates in most lesion types and is therefore widely applied. Stenting has several shortcomings as in-stent restenosis, stent fractures and foreign material being left behind in the vessel. The concept of atherectomy is plaque debulking. This results in a potential reduction of inflation pressure requirements in angioplasty. Stent placement and consecutive in-stent restenosis may be avoided. In this non systematic literature review, the performance of different atherectomy techniques, such as direct atherectomy, orbital atherectomy, laser debulking and rotational atherectomy in the treatment of complex femoropopliteal lesions, including long lesions, moderately to heavily calcified lesions as well as occlusions and in-stent restenosis, has been analyzed.

Acromegaly associated with gangliocytoma.

LENUS (Irish Health Repository)

Crowley, R K

2009-09-30

BACKGROUND: Acromegaly secondary to growth hormone-releasing hormone (GHRH) excess is rare. AIMS\\/CASE DESCRIPTION: We report two patients with acromegaly who were diagnosed with sellar gangliocytomas that were immunopositive for GHRH. Tumour tissue persisted after debulking surgery and in the second case this was associated with persistent growth hormone hypersecretion, successfully suppressed by a somatostatin analogue. CONCLUSIONS: The development of functional pituitary adenomas in association with sellar gangliocytomas is poorly understood. We present a brief discussion of the possible aetiology of these unusual pituitary tumours.

Salvage surgery following radiation failure in squamous cell carcinoma of the supraglottic larynx

International Nuclear Information System (INIS)

Parsons, James T.; Mendenhall, William M.; Stringer, Scott P.; Cassisi, Nicholas J.; Million, Rodney R.

1995-01-01

Purpose: We analyzed the clinical course of patients who developed local (primary) recurrence following high-dose irradiation of squamous cell carcinoma of the supraglottic larynx. Methods and Materials: Between October 1964 and July 1991, 206 patients with previously untreated squamous cell carcinoma of the supraglottic larynx underwent radiotherapy with curative intent. Local failure occurred in 46 (22%) patients. Successful surgical salvage was defined as no evidence of recurrent cancer for at least 2 years after salvage surgery and continuously thereafter. Results: Sixteen patients did not undergo salvage surgery because of refusal (7 patients), severe medical illness (2 patients), concurrent distant metastasis (5 patients), or unresectable neck disease (2 patients). Twenty-six patients underwent total laryngectomy, and 4 patients had a voice-sparing procedure. Successful salvage was achieved in 50% of patients who underwent surgery. The rate of successful salvage did not correlate with preirradiation T-stage or time to failure after irradiation. Most of the failures after surgery were because of failure to control the primary cancer. The overall rate of postsurgical complications was 37%. No operative or perioperative deaths occurred. The 5-year survival rate for all 46 patients, calculated from the date of irradiation failure, was 20%, while the 5-year survival rate after salvage surgery for the 30 patients who underwent the procedure was 29%. Conclusion: There are few data in the literature regarding the clinical outcome in patients whose tumors are not controlled by initial radiotherapy. In the current and previous series, one-half to two-thirds of patients who developed primary failure underwent salvage surgery, which was successful in approximately half of the operated patients, leading to a 25-30% rate of long-term disease-free survival among the entire group of patients who developed failure

Metastatic Squamous Neck Cancer with Occult Primary Treatment (PDQ®)—Patient Version

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Metastatic squamous neck cancer with occult primary (unknown primary) treatment options include surgery, radiation therapy, or a combination of both. Learn more about the diagnosis and treatment of these tumors in this expert-reviewed summary.

INSIST-ED: Italian Society of Andrology registry on penile prosthesis surgery. First data analysis

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Edoardo Pescatori

2016-07-01

Full Text Available Objectives: The Italian Society of Andrology, i.e. “Società Italiana di Andrologia” (S.I.A., launched on December 2014 a prospective, multicenter, monitored and internal review board approved Registry for penile implants, the “INSIST-ED” (Italian Nationwide Systematic Inventarisation of Surgical Treatment for ED Registry. Purpose of this first report is to present a baseline data analysis of the characteristics of penile implant surgery in Italy. Material and methods: The INSIST-ED Registry is open to all surgeons implanting penile prostheses (all brands, all models in Italy, providing anonymous patient, device, surgical procedure, outcome, follow-up data, for both first and revision surgeries. A Registry project Board overviews all the steps of the project, and a Registry Monitor interacts with the Registry implanting surgeons. Results: As by April 8, 2016, 31 implanting surgeons actively joined the Registry, entering 367 surgical procedures in its database, that comprise: 310 first implants, 43 prosthesis substitutions, 14 device explants without substitution. Implanted devices account for: 288 three-component devices (81,3%, 20 two-component devices (5,4%, 45 non-hydraulic devices (12,3%. Leading primary ED etiologies in first implant surgeries resulted: former radical pelvic surgery in 111 cases (35,8%, Peyronie’s disease in 66 cases (21,3%, diabetes in 39 cases (12,6%. Two intraoperative complications have been recorded. Main reasons for 57 revision surgeries were: device failure (52,6%, erosion (19,3%, infection (12,3%, patient dissatisfaction (10,5%. Surgical settings for patients undergoing a first penile implant were: public hospitals in 251 cases (81%, private environments in 59 cases (19%. Conclusions: The INSIST-ED Registry represents the first European experience of penile prosthesis Registry. This baseline data analysis shows that: three-pieces inflatable prosthesis is the most implanted device, leading etiology of

Adolescent bariatric surgery--thoughts and perspectives from the UK.

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Penna, Marta; Markar, Sheraz; Hewes, James; Fiennes, Alberic; Jones, Niall; Hashemi, Majid

2013-12-31

Opinions of healthcare professionals in the United Kingdom regarding bariatric surgery in adolescents are largely unknown. This study aims to explore the perspectives of medical professionals regarding adolescent bariatric surgery. Members of the British Obesity and Metabolic Surgery Society and groups of primary care practitioners based in London were contacted by electronic mail and invited to complete an anonymous online survey consisting of 21 questions. Ninety-four out of 324 questionnaires were completed. 66% of professionals felt that adolescents with a body mass index (BMI) >40 or BMI >35 with significant co-morbidities can be offered surgery. Amongst pre-requisites, parental psychological counseling was chosen most frequently. 58% stated 12 months as an appropriate period for weight management programs, with 24% regarding 6 months as sufficient. Most participants believed bariatric surgery should only be offered ≥ 16 years of age. However, 17% of bariatric surgeons marked no minimum age limit. Over 80% of the healthcare professionals surveyed consider bariatric surgery in adolescents to be acceptable practice. Most healthcare professionals surveyed feel that adolescent bariatric surgery is an acceptable therapeutic option for adolescent obesity. These views can guide towards a consensus opinion and further development of selection criteria and care pathways.

Patch in Cardiac Surgery

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Alireza Alizadeh Ghavidel

2014-06-01

Full Text Available Introduction: Excessive bleeding presents a risk for the patient in cardiovascular surgery. Local haemostatic agents are of great value to reduce bleeding and related complications. TachoSil (Nycomed, Linz, Austria is a sterile, haemostatic agent that consists of an equine collagen patchcoated with human fibrinogen and thrombin. This study evaluated the safety and efficacy of TachoSil compared to conventional technique.Methods: Forty-two patients scheduled for open heart surgeries, were entered to this study from August 2010 to May 2011. After primary haemostatic measures, patients divided in two groups based on surgeon’s judgment. Group A: 20 patients for whom TachoSil was applied and group B: 22 patients that conventional method using Surgicel (13 patients or wait and see method (9 cases, were performed in order to control the bleeding. In group A, 10 patients were male with mean age of 56.95±15.67 years and in group B, 9 cases were male with mean age of 49.95±14.41 years. In case group 70% (14/20 of the surgeries were redo surgeries versus 100% (22/22 in control group.Results: Baseline characteristics were similar in both groups. In TachoSil group 75% of patients required transfusion versus 90.90% in group B (P=0.03.Most transfusions consisted of packed red blood cell; 2±1.13 units in group A versus 3.11±1.44 in group B (P=0.01, however there were no significant differences between two groups regarding the mean total volume of intra and post-operative bleeding. Re-exploration was required in 10% in group A versus 13.63% in group B (P=0.67.Conclusion: TachoSil may act as a superior alternative in different types of cardiac surgery in order to control the bleeding and therefore reducing transfusion requirement.

Risk reduction before surgery. The role of the primary care provider in preoperative smoking and alcohol cessation

DEFF Research Database (Denmark)

Tønnesen, Hanne; Faurschou, Pernille; Ralov, Helge

2010-01-01

Daily smokers and hazardous drinkers are high-risk patients, developing 2-4 times more complications after surgery. Preoperative smoking and alcohol cessation for four to eight weeks prior to surgery halves this complication rate. The patients' preoperative contact with the surgical departments...

Small-incision cataract extraction combined trabeculectomy for primary angle-closure glaucoma with cataract

Directory of Open Access Journals (Sweden)

Yu-Feng Wu

2014-09-01

Full Text Available AIM: To observe the curative effect of treating small-incision cataract extraction by intraocular lens implantation combined with trabeculectomy for primary angle-closure glaucoma with cataract. METHODS: Totally 44 cases(52 eyesof primary angle-closure glaucoma combined with cataract were selected to undergo the combined surgery, in order to observe the patients' pre- and postoperative eyesights, intraocular pressures and the postoperative complications.RESULTS: The postoperative eyesight was improved significantly as compared with the preoperative eyesight. The intraocular pressure was declined dramatically. The result was of statistical significance(P0.05. All the 52 cases' surgeries were performed by the same surgeon. The surgeries were processed smoothly, with 6 postoperative eyes of anterior chamber inflammation cell response, 3 eyes of anterior chamber fibrinoid exudate, 2 eyes of shallow anterior chamber through mydriasis and treatment with glucocorticoids and non-steroidal eyedrops before absorption, and no complications like malignant glaucoma, cyclodialysis, etc. were reported through mydriasis and pressure bandaging before recovery.CONCLUSION: Treating the primary angle-closure glaucoma combined with cataract through the combined surgery has high reliability and desirable curative effect. The surgical method is simple to learn and applicable for promotion on the basic level.

Multiple primary cancer

International Nuclear Information System (INIS)

Jung, Gyu Sik; Lee, Ouk; Kim, So Sun; Kim, Ho Joon; Chun, Byung Hee; Joh, Young Duck

1989-01-01

It is rare for one human being to be afflicted with more than one cancer. However with further advances in therapeutic regimens, histopathologic observation, diagnostic modalities, and increased curiosity, there are increasing number of case reports of multiple primary cancer. The present study evaluates 25 histologically confirmed cases of multiple primary cancer from 1974 to 1988 at Kosin Medical Center. The most frequent site of the first primary cancer in male was stomach and in female, uterine cervix. The first primary cancer in female occurred in endocrine-related organs (breast, uterus and thyroid) in 63.6 percent. Synchronous cancers are diagnosed simultaneously or within an interval of about six months and synchronous cancers were 16 out of 25 cases. Metachronous cancers are diagnosed at interval of more than six months. There were 9 metachronous cancers and average interval between the first and second primary cancer was 22.8 months. The incidence of multiple primary cancer was 0.11 percent. The average age was 51.9 years at the time of the first primary cancer (53.1 years in male and 50.3 years in female). CT scan was most helpful in early detection of multiple primary cancers facilitating biopsy and surgery. Multiple primary cancers are beyond the medical curiosity. Early diagnosis of the disease and careful follow-up study, based on an awareness of the possibility of second cancers, will substantially increase the survival of these patients

Synergistic Utility of Brain Natriuretic Peptide and Left Ventricular Global Longitudinal Strain in Asymptomatic Patients With Significant Primary Mitral Regurgitation and Preserved Systolic Function Undergoing Mitral Valve Surgery.

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Alashi, Alaa; Mentias, Amgad; Patel, Krishna; Gillinov, A Marc; Sabik, Joseph F; Popović, Zoran B; Mihaljevic, Tomislav; Suri, Rakesh M; Rodriguez, L Leonardo; Svensson, Lars G; Griffin, Brian P; Desai, Milind Y

2016-07-01

In asymptomatic patients with ≥3+ mitral regurgitation and preserved left ventricular (LV) ejection fraction who underwent mitral valve surgery, we sought to discover whether baseline LV global longitudinal strain (LV-GLS) and brain natriuretic peptide provided incremental prognostic utility. Four hundred and forty-eight asymptomatic patients (61±12 years and 69% men) with ≥3+ primary mitral regurgitation and preserved left ventricular ejection fraction, who underwent mitral valve surgery (92% repair) at our center between 2005 and 2008, were studied. Baseline clinical and echocardiographic data (including LV-GLS using Velocity Vector Imaging, Siemens, PA) were recorded. The Society of Thoracic Surgeons score was calculated. The primary outcome was death. Mean Society of Thoracic Surgeons score, left ventricular ejection fraction, mitral effective regurgitant orifice, indexed LV end-diastolic volume, and right ventricular systolic pressure were 4±1%, 62±3%, 0.55±0.2 cm(2), 58±13 cc/m(2), and 37±15 mm Hg, respectively. Forty-five percent of patients had flail. Median log-transformed BNP and LV-GLS were 4.04 (absolute brain natriuretic peptide: 60 pg/dL) and -20.7%. At 7.7±2 years, death occurred in 41 patients (9%; 0% at 30 days). On Cox analysis, a higher Society of Thoracic Surgeons score (hazard ratio 1.55), higher baseline right ventricular systolic pressure (hazard ratio 1.11), more abnormal LV-GLS (hazard ratio 1.17), and higher median log-transformed BNP (hazard ratio 2.26) were associated with worse longer-term survival (all Pright ventricular systolic pressure) provided incremental prognostic utility (χ(2) for longer-term mortality increased from 31-47 to 61; Pleft ventricular ejection fraction who underwent mitral valve surgery, brain natriuretic peptide and LV-GLS provided synergistic risk stratification, independent of established factors. © 2016 American Heart Association, Inc.

Outcomes of Primary Transsphenoidal Surgery in Cushing Disease: Experience of a Tertiary Center.

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Keskin, Fatma Ela; Ozkaya, Hande Mefkure; Bolayirli, Murat; Erden, Secil; Kadioglu, Pınar; Tanriover, Necmettin; Gazioglu, Nurperi

2017-10-01

To report the initial and long-term remission rates and related factors, secondary treatments, and outcomes of a series of patients with Cushing disease (CD). We included 147 consecutive adult patients with CD who underwent primary transsphenoidal surgery (TSS) between 1998 and 2014 in this study. Eighty-two were followed up in the Cerrahpasa Medical Faculty Endocrinology and Metabolism outpatient clinic. Patients were requested to attend a long-term remission assessment; 55 could be contacted, and data for the remaining 27 patients' last visit to the outpatient clinics were reviewed for early and late remission. Six patients were excluded from the study. Magnetic resonance imaging (MRI) findings and pathologic results including mitosis, Ki-67 levels, and P53 in immunostaining of all patients were evaluated. Data of 82 patients with CD with an average age of 36 years [interquartile range: 29-47] were analyzed with a mean follow-up of 7.5 years [interquartile range: 5-10]. Overall initial remission rates were 72.3% after TSS. Among the 82 patients, 16 patients had Gamma Knife radiosurgery and 7 patients underwent adrenalectomy. After these additional treatments, the long-term remission rate was found as 69.7%. The highest remission rates were with microadenomas. Recurrence was most frequently seen in patients without tumor evidence on MRI. Patients with high Ki-67 levels had higher recurrence rates in long-term follow-up (P = 0.02). Life-long follow-up for patients with CD seems essential. Undetectable tumors on MRI before TSS and high Ki-67 immunopositivity were found as risk factors for tumor recurrence. Copyright © 2017 Elsevier Inc. All rights reserved.

American Thyroid Association statement on preoperative imaging for thyroid cancer surgery.

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Yeh, Michael W; Bauer, Andrew J; Bernet, Victor A; Ferris, Robert L; Loevner, Laurie A; Mandel, Susan J; Orloff, Lisa A; Randolph, Gregory W; Steward, David L

2015-01-01

The success of surgery for thyroid cancer hinges on thorough and accurate preoperative imaging, which enables complete clearance of the primary tumor and affected lymph node compartments. This working group was charged by the Surgical Affairs Committee of the American Thyroid Association to examine the available literature and to review the most appropriate imaging studies for the planning of initial and revision surgery for thyroid cancer. Ultrasound remains the most important imaging modality in the evaluation of thyroid cancer, and should be used routinely to assess both the primary tumor and all associated cervical lymph node basins preoperatively. Positive lymph nodes may be distinguished from normal nodes based upon size, shape, echogenicity, hypervascularity, loss of hilar architecture, and the presence of calcifications. Ultrasound-guided fine-needle aspiration of suspicious lymph nodes may be useful in guiding the extent of surgery. Cross-sectional imaging (computed tomography with contrast or magnetic resonance imaging) may be considered in select circumstances to better characterize tumor invasion and bulky, inferiorly located, or posteriorly located lymph nodes, or when ultrasound expertise is not available. The above recommendations are applicable to both initial and revision surgery. Functional imaging with positron emission tomography (PET) or PET-CT may be helpful in cases of recurrent cancer with positive tumor markers and negative anatomic imaging.

Surgery for Drug-Resistant Epilepsy in Children.

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Dwivedi, Rekha; Ramanujam, Bhargavi; Chandra, P Sarat; Sapra, Savita; Gulati, Sheffali; Kalaivani, Mani; Garg, Ajay; Bal, Chandra S; Tripathi, Madhavi; Dwivedi, Sada N; Sagar, Rajesh; Sarkar, Chitra; Tripathi, Manjari

2017-10-26

Neurosurgical treatment may improve seizures in children and adolescents with drug-resistant epilepsy, but additional data are needed from randomized trials. In this single-center trial, we randomly assigned 116 patients who were 18 years of age or younger with drug-resistant epilepsy to undergo brain surgery appropriate to the underlying cause of epilepsy along with appropriate medical therapy (surgery group, 57 patients) or to receive medical therapy alone (medical-therapy group, 59 patients). The patients in the medical-therapy group were assigned to a waiting list for surgery. The primary outcome was freedom from seizures at 12 months. Secondary outcomes were the score on the Hague Seizure Severity scale, the Binet-Kamat intelligence quotient, the social quotient on the Vineland Social Maturity Scale, and scores on the Child Behavior Checklist and the Pediatric Quality of Life Inventory. At 12 months, freedom from seizures occurred in 44 patients (77%) in the surgery group and in 4 (7%) in the medical-therapy group (Pchildren and adolescents with drug-resistant epilepsy who had undergone epilepsy surgery had a significantly higher rate of freedom from seizures and better scores with respect to behavior and quality of life than did those who continued medical therapy alone at 12 months. Surgery resulted in anticipated neurologic deficits related to the region of brain resection. (Funded by the Indian Council of Medical Research and others; Clinical Trial Registry-India number, CTRI/2010/091/000525 .).

Population-based study of survival for women with serous cancer of the ovary, fallopian tube, peritoneum or undesignated origin - on behalf of the Swedish gynecological cancer group (SweGCG).

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Dahm-Kähler, Pernilla; Borgfeldt, Christer; Holmberg, Erik; Staf, Christian; Falconer, Henrik; Bjurberg, Maria; Kjölhede, Preben; Rosenberg, Per; Stålberg, Karin; Högberg, Thomas; Åvall-Lundqvist, Elisabeth

2017-01-01

The aim of the study was to determine survival outcome in patients with serous cancer in the ovary, fallopian tube, peritoneum and of undesignated origin. Nation-wide population-based study of women≥18years with histologically verified non-uterine serous cancer, included in the Swedish Quality Registry for primary cancer of the ovary, fallopian tube and peritoneum diagnosed 2009-2013. Relative survival (RS) was estimated using the Ederer II method. Simple and multivariable analyses were estimated by Poisson regression models. Of 5627 women identified, 1246 (22%) had borderline tumors and 4381 had malignant tumors. In total, 2359 women had serous cancer; 71% originated in the ovary (OC), 9% in the fallopian tube (FTC), 9% in the peritoneum (PPC) and 11% at an undesignated primary site (UPS). Estimated RS at 5-years was 37%; for FTC 54%, 40% for OC, 34% for PPC and 13% for UPS. In multivariable regression analyses restricted to women who had undergone primary or interval debulking surgery for OC, FTC and PPC, site of origin was not independently associated with survival. Significant associations with worse survival were found for advanced stages (RR 2.63, Pcancer at UPS than for ovarian, fallopian tube and peritoneal cancer. Serous cancer at UPS needs to be addressed when reporting and comparing survival rates of ovarian cancer. Copyright © 2016 Elsevier Inc. All rights reserved.

Technological innovations in tissue removal during rhinologic surgery.

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Sindwani, Raj; Manz, Ryan

2012-01-01

The modern rhinologist has a wide variety of technological innovations at his/her disposal for the removal of soft tissue and bone during endoscopic surgery. We identified and critically evaluated four leading tissue removal technologies that have impacted, or are poised to impact, rhinological surgery. A literature review was conducted. Technological functions, strengths and limitations of microdebriders, radio frequency ablation, endoscopic drills, and ultrasonic aspirators were explored. The primary drawback of powered instruments continues to be the higher costs associated with their use, and their main advantage is the ability to accomplish multiple functions such as tissue removal, suction, and irrigation, all with one tool. The effective and safe use of any powered instrument requires an intimate understanding of its function, capabilities, and limitations. Powered instrumentation continues to play a significant and evolving role in soft tissue and bone removal during rhinologic surgery.

YouTube videos in the English language as a patient education resource for cataract surgery.

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Bae, Steven S; Baxter, Stephanie

2017-08-28

To assess the quality of the content of YouTube videos for cataract surgery patient education. Hotel Dieu Hospital, Kingston, Ontario, Canada. Observational study. "Cataract surgery," "cataract surgery for patients," and "cataract surgery patient education" were used as search terms. The first two pages of search results were reviewed. Descriptive statistics such as video length and view count were obtained. Two cataract surgeons devised 14 criteria important for educating patients about the procedure. Videos were analyzed based on the presence or absence of these criteria. Videos were also assessed for whether they had a primary commercial intent. Seventy-two videos were analyzed after excluding 48 videos that were duplicate, irrelevant, or not in English. The majority of videos came from a medical professional (71%) and many depicted a real cataract surgery procedure (43%). Twenty-one percent of the videos had a primary commercial intent to promote a practice or product. Out of a total possible 14 points, the mean number of usefulness criteria satisfied was only 2.28 ± 1.80. There was no significant difference in view count between the most useful videos and other videos (p = 0.94). Videos from medical organizations such as the National Health Service were more useful (p YouTube, but most are not adequately educational. Patients may be receiving biased information from videos created with primary commercial intent. Physicians should be aware of the type of information patients may be accessing on YouTube.

Surgery versus physiotherapy for stress urinary incontinence.

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Labrie, Julien; Berghmans, Bary L C M; Fischer, Kathelijn; Milani, Alfredo L; van der Wijk, Ileana; Smalbraak, Dina J C; Vollebregt, Astrid; Schellart, René P; Graziosi, Giuseppe C M; van der Ploeg, J Marinus; Brouns, Joseph F G M; Tiersma, E Stella M; Groenendijk, Annette G; Scholten, Piet; Mol, Ben Willem; Blokhuis, Elisabeth E; Adriaanse, Albert H; Schram, Aaltje; Roovers, Jan-Paul W R; Lagro-Janssen, Antoine L M; van der Vaart, Carl H

2013-09-19

Physiotherapy involving pelvic-floor muscle training is advocated as first-line treatment for stress urinary incontinence; midurethral-sling surgery is generally recommended when physiotherapy is unsuccessful. Data are lacking from randomized trials comparing these two options as initial therapy. We performed a multicenter, randomized trial to compare physiotherapy and midurethral-sling surgery in women with stress urinary incontinence. Crossover between groups was allowed. The primary outcome was subjective improvement, measured by means of the Patient Global Impression of Improvement at 12 months. We randomly assigned 230 women to the surgery group and 230 women to the physiotherapy group. A total of 49.0% of women in the physiotherapy group and 11.2% of women in the surgery group crossed over to the alternative treatment. In an intention-to-treat analysis, subjective improvement was reported by 90.8% of women in the surgery group and 64.4% of women in the physiotherapy group (absolute difference, 26.4 percentage points; 95% confidence interval [CI], 18.1 to 34.5). The rates of subjective cure were 85.2% in the surgery group and 53.4% in the physiotherapy group (absolute difference, 31.8 percentage points; 95% CI, 22.6 to 40.3); rates of objective cure were 76.5% and 58.8%, respectively (absolute difference, 17.8 percentage points; 95% CI, 7.9 to 27.3). A post hoc per-protocol analysis showed that women who crossed over to the surgery group had outcomes similar to those of women initially assigned to surgery and that both these groups had outcomes superior to those of women who did not cross over to surgery. For women with stress urinary incontinence, initial midurethral-sling surgery, as compared with initial physiotherapy, results in higher rates of subjective improvement and subjective and objective cure at 1 year. (Funded by ZonMw, the Netherlands Organization for Health Research and Development; Dutch Trial Register number, NTR1248.).

Long-term follow-up after bariatric surgery in a national cohort.

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Thereaux, J; Lesuffleur, T; Païta, M; Czernichow, S; Basdevant, A; Msika, S; Millat, B; Fagot-Campagna, A

2017-09-01

Lifelong medical follow-up is mandatory after bariatric surgery. The aim of this study was to assess the 5-year follow-up after bariatric surgery in a nationwide cohort of patients. All adult obese patients who had undergone primary bariatric surgery in 2009 in France were included. Data were extracted from the French national health insurance database. Medical follow-up (medical visits, micronutrient supplementation and blood tests) during the first 5 years after bariatric surgery was assessed, and compared with national and international guidelines. Some 16 620 patients were included in the study. The percentage of patients with at least one reimbursement for micronutrient supplements decreased between the first and fifth years for iron (from 27.7 to 24.5 per cent; P bariatric surgery is poor, especially for young men with poor early follow-up. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

Audit of accuracy of clinical coding in oral surgery.

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Naran, S; Hudovsky, A; Antscherl, J; Howells, S; Nouraei, S A R

2014-10-01

We aimed to study the accuracy of clinical coding within oral surgery and to identify ways in which it can be improved. We undertook did a multidisciplinary audit of a sample of 646 day case patients who had had oral surgery procedures between 2011 and 2012. We compared the codes given with their case notes and amended any discrepancies. The accuracy of coding was assessed for primary and secondary diagnoses and procedures, and for health resource groupings (HRGs). The financial impact of coding Subjectivity, Variability and Error (SVE) was assessed by reference to national tariffs. The audit resulted in 122 (19%) changes to primary diagnoses. The codes for primary procedures changed in 224 (35%) cases; 310 (48%) morbidities and complications had been missed, and 266 (41%) secondary procedures had been missed or were incorrect. This led to at least one change of coding in 496 (77%) patients, and to the HRG changes in 348 (54%) patients. The financial impact of this was £114 in lost revenue per patient. There is a high incidence of coding errors in oral surgery because of the large number of day cases, a lack of awareness by clinicians of coding issues, and because clinical coders are not always familiar with the large number of highly specialised abbreviations used. Accuracy of coding can be improved through the use of a well-designed proforma, and standards can be maintained by the use of an ongoing data quality assurance programme. Copyright © 2014. Published by Elsevier Ltd.

Surgery cancellations at a public hospital

Directory of Open Access Journals (Sweden)

Erika Pittelkow

2008-12-01

Full Text Available Objective: To determine the frequency of cancellation of scheduledsurgeries at a public hospital in the city of São Paulo, and to identifythe reasons of cancellation. Methods: A descriptive, exploratory,retrospective study, with quantitative analysis, of records ofprocedures cancelled and medical charts of patients whose surgerieswere cancelled, between January 2006 and July 2007. Results: Ofthe 6,149 (100% surgeries scheduled for the period surveyed, 701(11.4% were canceled and 5,448 (88.6% conducted; among thesurgeries cancelled, most were general surgeries (237/33.8% andorthopedic surgery (200/28.5%; surgeons or assistant surgeons(518/73.9% and anesthesiologists (183/26.1% were responsible forcancellations. The primary reasons for cancellation were unfavorableclinical status of patients (225/32.1%, no show up of patients(119/17.0%, change in medical management (79/11.3%, patientnot appropriately prepared (53/7.5% and lack of material (52/7.4%.Conclusions: This study enabled identifying the frequency and causesof surgical cancellations at a public hospital, so as to contribute toimproving professional performance in this area.

Surgery for post-operative entero-cutaneous fistulas: is bowel resection plus primary anastomosis without stoma a safe option to avoid early recurrence? Report on 20 cases by a single center and systematic review of the literature.

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Lauro, A; Cirocchi, R; Cautero, N; Dazzi, A; Pironi, D; Di Matteo, F M; Santoro, A; Faenza, S; Pironi, L; Pinna, A D

2017-01-01

A review was performed on entero-cutaneous fistula (ECF) repair and early recurrence, adding our twenty adult patients (65% had multiple fistulas). The search yielded 4.098 articles but only 15 were relevant: 1.217 patients underwent surgery. The interval time between fistula's diagnosis and operative repair was between 3 months and 1 year. A bowel resection with primary anastomosis was performed in 1.048 patients, 192 (18.3%) underwent a covering stoma: 856 patients (81.7%) had a fistula takedown in one procedure. The patients had 14.3% recurrence and 13.1% mortality rate. In our experience 75% were surgically treated after a period equal or above one year from fistula occurrence: surgery was very demolitive (in 40% remnant small bowel was less than 100 cm). We performed a bowel resection with a hand-sewn anastomosis (95%) without temporary stoma. In-hospital mortality was 0% and at discharge all were back to oral intake with 0% early re-fistulisation. Literature supports our experience: ECF takedown could be safely performed after an adequate period of recovery from 3 months to one year from fistula occurrence. In our series primary repair (bowel resection plus reconnection surgery without temporary stoma) avoided an early recurrence without mortality.

Enhanced recovery after vascular surgery: protocol for a systematic review

Directory of Open Access Journals (Sweden)

Gotlib Conn Lesley

2012-11-01

Full Text Available Abstract Background The enhanced recovery after surgery (ERAS programme is a multimodal evidence-based approach to surgical care which begins in the preoperative setting and extends through to patient discharge in the postoperative period. The primary components of ERAS include the introduction of preoperative patient education; reduction in perioperative use of nasogastric tubes and drains; the use of multimodal analgesia; goal-directed fluid management; early removal of Foley catheter; early mobilization, and early oral nutrition. The ERAS approach has gradually evolved to become the standard of care in colorectal surgery and is presently being used in other specialty areas such as vascular surgery. Currently there is little evidence available for the implementation of ERAS in this field. We plan to conduct a systematic review of this literature with a view to incorporating ERAS principles into the management of major elective vascular surgery procedures. Methods We will search EMBASE (OVID, 1947 to June 2012, Medline (OVID, 1948 to June 2012, and Cochrane Central Register of Controlled Trials (Wiley, Issue 1, 2012. Searches will be performed with no year or language restrictions. For inclusion, studies must look at adult patients over 18 years. Major elective vascular surgery includes carotid, bypass, aneurysm and amputation procedures. Studies must have evaluated usual care against an ERAS intervention in the preoperative, perioperative or postoperative period of care. Primary outcome measures are length of stay, decreased complication rate, and patient satisfaction or expectations. Only randomized controlled trials will be included. Discussion Most ERAS approaches have been considered in the context of colorectal surgery. Given the increasing use of multiple yet different aspects of this pathway in vascular surgery, it is timely to systematically review the evidence for their independent or combined outcomes, with a view to implementing

Does Certification as Bariatric Surgery Center and Volume Influence the Outcome in RYGB-Data Analysis of German Bariatric Surgery Registry.

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Stroh, Christine; Köckerling, F; Lange, V; Wolff, S; Knoll, C; Bruns, C; Manger, Th

2017-02-01

To examine the association between the certification as bariatric surgery center and volume and patient outcome, data collected in the German Bariatric Surgery Registry were evaluated. All data were registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at Otto-von-Guericke University Magdeburg. Data collection began in 2005 for all bariatric procedures in an online database. Participation in the quality assurance study is required for all certified bariatric surgery centers in Germany. Descriptive evaluation and matched pairs analysis were performed. Patients were matched via propensity score taking into account BMI, age, and incidence of comorbidities. During the period from 2005 to 2013, 3083 male and 10,639 female patients were operated on with the RYGB primary approach. In Centers of Competence (77.2 %) and non-accredited hospitals (76.3 %), the proportion of female patients was significantly lower than in Centers of Reference/Excellence (78.7 %; p = 0.002). The mean age in Centers of Reference/Excellence (41.2 years) was significantly lower than in Centers of Competence (43.2 years; p bariatric surgery centers with higher volume. The study supports the concept of certification. There are different factors which can and cannot be preoperatively modified and influence the perioperative outcome.

Medical tourism and bariatric surgery: who pays?

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Sheppard, Caroline E; Lester, Erica L W; Chuck, Anderson W; Kim, David H; Karmali, Shahzeer; de Gara, Christopher J; Birch, Daniel W

2014-12-01

The objective of this study was to determine the short-term cost impact that medical tourism for bariatric surgery has on a public healthcare system. Due to long wait times for bariatric surgery services, Canadians are venturing to private clinics in other provinces/countries. Postoperative care in this population not only burdens the provincial health system with intervention costs required for complicated patients, but may also impact resources allotted to patients in the public clinic. A chart review was performed from January 2009 to June 2013, which identified 62 medical tourists requiring costly interventions related to bariatric surgery. Secondarily, a survey was conducted to estimate the frequency of bariatric medical tourists presenting to general surgeons in Alberta, necessary interventions, and associated costs. A threshold analysis was used to compare costs of medical tourism to those from our institution. A conservative cost estimate of $1.8 million CAD was calculated for all interventions in 62 medical tourists. The survey established that 25 Albertan general surgeons consulted 59 medical tourists per year: a cost of approximately $1 million CAD. Medical tourism was calculated to require a complication rate ≤ 28% (average intervention cost of $37,000 per patient) to equate the cost of locally conducted surgery: a rate less than the current supported evidence. Conducting 250 primary bariatric surgeries in Alberta is approximately $1.9 million less than the modeled cost of treating 250 medical tourists returning to Alberta. Medical tourism has a substantial impact on healthcare costs in Alberta. When compared to bariatric medical tourists, the complication rate for locally conducted surgery is less, and the cost of managing the complications is also much less. Therefore, we conclude that it is a better use of resources to conduct bariatric surgery for Albertan residents in Alberta than to fund patients to seek surgery out of province/country.

Carcinoma of Unknown Primary Treatment (PDQ®)—Patient Version

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Carcinoma of unknown primary (CUP), treatment can include surgery, radiation therapy, chemotherapy, or hormone therapy. Get detailed information about the diagnosis and treatment of CUP in this expert-reviewed summary.

Cardiac surgery in the parturient.

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Chandrasekhar, Shobana; Cook, Christopher R; Collard, Charles D

2009-03-01

Heart disease is the primary cause of nonobstetric mortality in pregnancy, occurring in 1%-3% of pregnancies and accounting for 10%-15% of maternal deaths. Congenital heart disease has become more prevalent in women of childbearing age, representing an increasing percentage (up to 75%) of heart disease in pregnancy. Untreated maternal heart disease also places the fetus at risk. Independent predictors of neonatal complications include a maternal New York Heart Association heart failure classification >2, anticoagulation use during pregnancy, smoking, multiple gestation, and left heart obstruction. Because cardiac surgical morbidity and mortality in the parturient is higher than nonpregnant patients, most parturients with cardiac disease are first managed medically, with cardiac surgery being reserved when medical management fails. Risk factors for maternal mortality during cardiac surgery include the use of vasoactive drugs, age, type of surgery, reoperation, and maternal functional class. Risk factors for fetal mortality include maternal age >35 yr, functional class, reoperation, emergency surgery, type of myocardial protection, and anoxic time. Nonetheless, acceptable maternal and fetal perioperative mortality rates may be achieved through such measures as early preoperative detection of maternal cardiovascular decompensation, use of fetal monitoring, delivery of a viable fetus before the operation and scheduling surgery on an elective basis during the second trimester. Additionally, fetal morbidity may be reduced during cardiopulmonary bypass by optimizing maternal oxygen-carrying capacity and uterine blood flow. Current maternal bypass recommendations include: 1) maintaining the pump flow rate >2.5 L x min(-1) x m(-2) and perfusion pressure >70 mm Hg; 2) maintaining the hematocrit > 28%; 3) using normothermic perfusion when feasible; 4) using pulsatile flow; and 5) using alpha-stat pH management.

Macrodystrophia lipomatosa: a reconstructive approach to gigantism of the foot.

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Watt, Andrew J; Chung, Kevin C

2004-01-01

Localized gigantism poses a challenging surgical dilemma, and it may be treated with amputation. This case report documents the application of a reconstructive approach to a severe case of pedal macrodystrophia lipomatosa in a 1-year-old girl. A series of 3 surgeries were designed to reduce the length, width, height, and overall bulk of the congenitally enlarged foot. The 3 procedures debulked the foot for normal ambulation and same-size shoe wear for both feet. The resulting functional and aesthetic improvements achieved through reconstructive treatment provided a desirable alternative to amputation.

Re-resection rates and risk characteristics following breast conserving surgery for breast cancer and carcinoma in situ

DEFF Research Database (Denmark)

Kryh, C G; Pietersen, C A; Rahr, Hans

2014-01-01

OBJECTIVES: To examine the frequency of re-resections and describe risk characteristics: invasive carcinoma or carcinoma in situ (CIS), palpability of the lesion, and neoadjuvant chemotherapy. RESULTS: 1703 breast conserving surgeries were performed: 1575 primary breast conserving surgeries (BCS...

The Danish Fracture Database can monitor quality of fracture-related surgery, surgeons' experience level and extent of supervision

DEFF Research Database (Denmark)

Andersen, Morten Jon; Gromov, Kirill; Brix, Michael

2014-01-01

INTRODUCTION: The importance of supervision and of surgeons' level of experience in relation to patient outcome have been demonstrated in both hip fracture and arthroplasty surgery. The aim of this study was to describe the surgeons' experience level and the extent of supervision for: 1) fracture......-related surgery in general; 2) the three most frequent primary operations and reoperations; and 3) primary operations during and outside regular working hours. MATERIAL AND METHODS: A total of 9,767 surgical procedures were identified from the Danish Fracture Database (DFDB). Procedures were grouped based...... on the surgeons' level of experience, extent of supervision, type (primary, planned secondary or reoperation), classification (AO Müller), and whether they were performed during or outside regular hours. RESULTS: Interns and junior residents combined performed 46% of all procedures. A total of 90% of surgeries...

The Danish Fracture Database can monitor quality of fracture-related surgery, surgeons' experience level and extent of supervision

DEFF Research Database (Denmark)

Andersen, M. J.; Gromov, K.; Brix, M.

2014-01-01

INTRODUCTION: The importance of supervision and of surgeons' level of experience in relation to patient outcome have been demonstrated in both hip fracture and arthroplasty surgery. The aim of this study was to describe the surgeons' experience level and the extent of supervision for: 1) fracture......-related surgery in general; 2) the three most frequent primary operations and reoperations; and 3) primary operations during and outside regular working hours. MATERIAL AND METHODS: A total of 9,767 surgical procedures were identified from the Danish Fracture Database (DFDB). Procedures were grouped based...... on the surgeons' level of experience, extent of supervision, type (primary, planned secondary or reoperation), classification (AO Muller), and whether they were performed during or outside regular hours. RESULTS: Interns and junior residents combined performed 46% of all procedures. A total of 90% of surgeries...

[18F]DOPA PET/ceCT in diagnosis and staging of primary medullary thyroid carcinoma prior to surgery.

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Rasul, Sazan; Hartenbach, Sabrina; Rebhan, Katharina; Göllner, Adelina; Karanikas, Georgios; Mayerhoefer, Marius; Mazal, Peter; Hacker, Marcus; Hartenbach, Markus

2018-05-15

Medullary thyroid carcinoma (MTC) is characterized by a high rate of metastasis. In this study we evaluated the ability of [ 18 F]DOPA PET/ceCT to stage MTC in patients with suspicious thyroid nodules and pathologically elevated serum calcitonin (Ctn) levels prior to total thyroidectomy and lymph node (LN) dissection. A group of 32 patients with sonographically suspicious thyroid nodules and pathologically elevated basal Ctn (bCtn) and stimulated Ctn (sCtn) levels underwent DOPA PET/ceCT prior to surgery. Postoperative histology served as the standard of reference for ultrasonography and DOPA PET/ceCT region-based LN staging. Univariate and multivariate regression analyses as well as receiver operating characteristic analysis were used to evaluate the correlations between preoperative and histological parameters and postoperative tumour persistence or relapse. Primary MTC was histologically verified in all patients. Of the 32 patients, 28 showed increased DOPA decarboxylase activity in the primary tumour (sensitivity 88%, mean SUVmax 10.5). Undetected tumours were exclusively staged pT1a. The sensitivities of DOPA PET in the detection of central and lateral metastatic neck LN were 53% and 73%, in contrast to 20% and 39%, respectively, for neck ultrasonography. Preoperative bCtn and carcinoembryonic antigen levels as well as cN1b status and the number of involved neck regions on DOPA PET/ceCT were predictive of postoperative tumour persistence/relapse in the univariate regression analysis (P PET/ceCT cN1b status remained significant in the multivariate analysis (P = 0.016, relative risk 4.02). This study revealed that DOPA PET/ceCT has high sensitivity in the detection of primary MTC and superior sensitivity in the detection of LN metastases compared to ultrasonography. DOPA PET/ceCT identification of N1b status predicts postoperative tumour persistence. Thus, implementation of a DOPA-guided LN dissection might improve surgical success.

Race/ethnicity and socio-economic differences in colorectal cancer surgery outcomes: analysis of the nationwide inpatient sample.

Science.gov (United States)

Akinyemiju, Tomi; Meng, Qingrui; Vin-Raviv, Neomi

2016-09-05

The purpose of this study was to examine racial and socio-economic differences in the receipt of laparoscopic or open surgery among patients with colorectal cancer, and to determine if racial and socio-economic differences exist in post-surgical complications, in-hospital mortality and hospital length of stay among patients who received surgery. We conducted a cross-sectional analysis of hospitalized patients with a primary diagnosis of colorectal cancer between 2007 and 2011 using data from Nationwide Inpatient Sample. ICD-9 codes were used to capture primary diagnosis, surgical procedures, and health outcomes during hospitalization. We used logistic regression analysis to determine racial and socio-economic predictors of surgery type, post-surgical complications and mortality, and linear regression analysis to assess hospital length of stay. A total of 122,631 patients were admitted with a primary diagnosis of malignant colorectal cancer between 2007 and 2011. Of these, 17,327 (14.13 %) had laparoscopic surgery, 70,328 (57.35 %) received open surgery, while 34976 (28.52 %) did not receive any surgery. Black (36 %) and Hispanic (34 %) patients were more likely to receive no surgery compared with Whites (27 %) patients. However, among patients that received any surgery, there were no racial differences in which surgery was received (laparoscopic versus open, p = 0.2122), although socio-economic differences remained, with patients from lower residential income areas significantly less likely to receive laparoscopic surgery compared with patients from higher residential income areas (OR: 0.74, 95 % CI: 0.70-0.78). Among patients who received any surgery, Black patients (OR = 1.07, 95 % CI: 1.01-1.13), and patients with Medicare (OR = 1.16, 95 % CI: 1.11-1.22) and Medicaid (OR = 1.15, 95 % CI: 1.07-1.25) insurance experienced significantly higher post-surgical complications, in-hospital mortality (Black OR = 1.18, 95 % CI: 1.00-1.39), and

Use of CT in the management of anterior cruciate ligament revision surgery

International Nuclear Information System (INIS)

Groves, C.; Chandramohan, M.; Chew, C.; Subedi, N.

2013-01-01

Anterior cruciate ligament (ACL) injuries occur most commonly in individuals between 18 and 29 years of age and are strongly correlated with sporting activity, with female athletes being at higher risk of ACL rupture than their male counterparts. ACL reconstruction is one of the most frequently performed procedures in orthopaedic surgery, having a reported incidence of 85 per 100,000 head of population in the at-risk age group. Subsequent graft failure is most commonly caused by recurrent trauma, followed by tunnel malpositioning, although the choice of graft type does not appear to affect outcome. The Danish ACL registry reported that ACL revisions accounted for 7.5% of all ACL reconstruction surgery performed between 2005 and 2008. Revision of ACL reconstruction is recognized to carry a worse outcome than primary reconstruction. Preoperative imaging has become a crucial part of surgical planning in these patients, with great reliance placed on computed tomography (CT). The radiologist should be able to recognize the types of primary repair and must be able to assess for the complications of primary surgery, such as tunnel malpositioning, tunnel widening, and fixation device failure. Revision is commonly a two-stage procedure with bone grafting of the tunnels prior to the definitive ligament repair. The radiologist should be able to asses for adequate bone graft incorporation. The purpose of this article is to present a review of the use of CT in the management of ACL revision surgery with examples of commonly used fixation devices; complications, such as tunnel widening and tunnel malpositioning; and bone graft incorporation

A prospective randomized clinical study of the influence of primary closure or dressing on post-operative morbidity after mandibular third molar surgery

Directory of Open Access Journals (Sweden)

Peter E Egbor

2014-01-01

Full Text Available Objective: The aim of the following study is to determine the effect of primary closure or dressing on post-operative morbidity after impacted lower third molar surgery. Materials and Methods: This was a randomized clinical study of 72 patients who had surgical extraction of impacted mandibular third molars. The subjects were divided into two groups of A and B. Group A had total closure (primary closure and Group B had whitehead varnish dressing of the socket. Pain, swelling and trismus were evaluated pre-operatively using visual analogue scale, flexible tape measuring method and inter-incisal distance measurement with Vernier Callipers respectively as well as post-operatively on 1 st , 2 nd , 3 rd , 5 th and 7 th day. Results: The study participants consisted of 27 males and 45 females in a ratio 1:1.7. With a mean age of 24.7 ± 4.9 years (range 19-33 years for Group A and 25.5 ± 4.3 years (range 20-39 years for Group B. Post-operative pain was not significantly affected by the closure techniques (P > 0.05. Dressing was found to significantly reduce the degree of swelling and trismus peaking on the 2 nd day (P = 0.0207 and P = 0.010 respectively. Conclusion: The use of dressing was more effective than primary closure to reduce the degree of swelling and trismus though its effect on post-operative pain reduction was not significant.

Minimal incision surgery in strabismus: Modified fornix-based approach.

Science.gov (United States)

Pérez-Flores, I

2016-07-01

To evaluate the modified fornix-based technique as an approach for minimal incision surgery in strabismus. The medical records of all consecutive patients that underwent strabismus surgery with fornix-based conjunctival incision between 2007 and 2012 were retrospectively reviewed. As a primary variable, an analysis was made of the wound size depending on the number of stitches. A descriptive study was performed on the variables related to patients and to the type of strabismus and surgery. Out of 153patients identified, 138 with 294 surgeries were included. In 200 (68%) interventions, the incision was sutured with one stitch, in 77 (26.2%) with 2, in 13 (4.4%) with 3, and in 4 (1.4%) with 4, with the mean number of stitches being 1.39±0.64. The mean age of the patients was 39years (2-80), and 36 (26.1%) had previous strabismus surgery, with topical anaesthesia being used in 35 (25.4%) cases. At 3months after surgery deviation was ≤10DP in 114 (82.6%) patients. There were no wound-related complications. The modified fornix-based technique is an effective and safe approach for minimal incision surgery in strabismus, in patients at all ages, with previous history of strabismus surgery and with topical anaesthesia. Copyright © 2015 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

Remifentanil Reduces Blood Loss During Orthognathic Surgery.

Science.gov (United States)

Matsuura, Nobuyuki; Okamura, Taiki; Ide, Satoko; Ichinohe, Tatsuya

2017-01-01

Remifentanil is reported to reduce oral tissue blood flow. We performed a retrospective investigation using logistic regression analysis of anesthesia records to investigate whether the use of remifentanil infusion in a balanced anesthesia technique was useful as a primary technique to reduce blood loss during orthognathic surgery. Subjects were 80 patients who underwent Le Fort I osteotomy and sagittal split ramus osteotomy of the mandible. The variables included gender, age, weight, type of maintenance anesthetic, type and dose or infusion rate of opioid, mean systolic blood pressure (SBP-mean), coefficient of variation of systolic blood pressure (CVSBP) during surgery, mean heart rate (HR-mean), duration of surgery, total blood loss, volume of infusion used, amount of local anesthetic used, body temperature, and urine output. Gender, type of maintenance anesthetic, type of opioid, SBP-mean, CVSBP, HR-mean, and duration of surgery were used as candidates for independent variables. Logistic regression analysis was performed for the selected independent variables with the total blood loss as the dependent variable. The factors associated with the reduction of blood loss were the use of remifentanil (odds ratio, 3.112; 95% CI, 1.166-8.307; P = .023) and smaller CVSBP (odds ratio, 2.747; 95% CI, 1.07-7.053; P = .036). Use of remifentanil and smaller CVSBP were associated with a reduction of blood loss during orthognathic surgery.

4. Primary Malignant Bone Tumours at the University Teaching ...

African Journals Online (AJOL)

46987.2

1Orthopaedic Unit Department of Surgery, University Teaching Hospital, Lusaka, Zambia. 2Department of ... primary malignant bone tumours at UTH and the hospital ..... unavailable resources. ... bone tumors in Mexico City: retrospective.

30-Day, 90-day and 1-year mortality after emergency colonic surgery

DEFF Research Database (Denmark)

Pedersen, T; Watt, S K; Tolstrup, M-B

2017-01-01

PURPOSE: Emergency surgery is an independent risk factor in colonic surgery resulting in high 30-day mortality. The primary aim of this study was to report 30-day, 90-day and 1-year mortality rates after emergency colonic surgery, and to report factors associated with 30-day, 90-day and 1-year...... mortality. Second, the aim was to report 30-day postoperative complications and their relation to in-hospital mortality. METHODS: All patients undergoing acute colonic surgery in the period from May 2009 to April 2013 at Copenhagen University Hospital Herlev, Denmark, were identified. Perioperative data...... postoperative deaths. CONCLUSION: Mortality and complication rates after emergency colonic surgery are high and associated with patient related risk factors that cannot be modified, but also treatment related outcomes that are modifiable. An increased focus on medical and other preventive measures should...

Nonelective surgery at night and in-hospital mortality Prospective observational data from the European Surgical Outcomes Study

NARCIS (Netherlands)

van Zaane, Bas; van Klei, Wilton A.; Buhre, Wolfgang F.; Bauer, Peter; Boerma, E. Christiaan; Hoeft, Andreas; Metnitz, Philipp; Moreno, Rui P.; Pearse, Rupert; Pelosi, Paolo; Sander, Michael; Vallet, Benoit; Pettilä, Ville; Vincent, Jean-Louis; Rhodes, Andrew; Moreno, Rui; Spies, Claudia; Hoste, Eric; Huyghens, Luc; Jacobs, Rita; van Mossevelde, Veerle; Opdenacker, Godelieve; Poelaert, Jan; Spapen, Herbert; Leleu, Kris; Rijckaert, Dirk; de Decker, Koen; Foubert, Luc; de Neve, Nikolaas; Biston, Patrick; Piagnerelli, Michael; Collin, Vincent; den Blauwen, Nadia; Clauwaert, Charlotte; de Crop, Luc; Verbeke, An; Derumeaux, Pieter; Gardin, Christophe; Kindt, Sebastiaan; Louage, Sofie; Verhamme, Bruno; Druwé, Patrick; Lahaye, Ingrid; Rosseel, Francis; Rutsaert, Robert; Vanlinthout, Luc; de Kock, Marc; Forget, Patrice; Georges, Pascal; Grosu, Irina; Kahn, David; Lois, Fernande; Momeni, Mona; Yemnga, Audrey Pospiech Bernadette; Jadoul, Jean-Luc; Malbrain, Manu; Bosinceanu, Dana; Collard, Edith; Jorens, Philippe; Reyntiens, Dirk; Smitz, Carine; Vercauteren, Marcel; Fagnoul, David; van Obbergh, Luc; Goranović, Tatjana; Mazul-Sunko, Branka; Toplice, Krapinske; Oremuš, Krešimir; Bešlić, Gabrijela; Duzel, Viktor; Hauptman, Ada; Peremin, Sanja; Šribar, Andrej; Župčić, Miroslav; Benčević, Josip; Brod, Slavonski; Mirković, Ivan; Šarić Bauer, Zlata; Belavić, Matija; Blažanin, Božidar; Lončarić Katušin, Mirjana; Brozović Krijan, Antonija; Mišković, Petar; Šimić-Korać, Nataša; Topić, Jasna; Žilić, Antonio; Žunić, Josip; Acan, Ivana; Adanić, Mirta; Ivanov, Nikola; Pavičić Šarić, Jadranka; Tomulić, Katarina; Visković, Nataša; Bošnjak, Silvana; Haršanji Drenjančevic, Ivana; Kristek, Gordana; Kvolik, Slavica; Markić, Stela; Stojanovic Rakipovic, Andreja; Tot, Ozana Katarina; Venzera-Azenic, Darija; Fabris, Lada Kalagac; Bačak-Kocman, Iva; Balenović, Igor; Bandić, Daniela; Deutsch, Patricia Adrianne Judith; Divjak, Loredana; Grčić Filipović, Ina; Gužvinec, Zvonka; Krznarić, Zrinka; Lončarić, Yvonne; Magaš, Jelena Vadlja; Mitrović, Marek; Okić, Marija; Pavlek, Mario; Ramov, Elza; Rezek, Karolina; Sekulić, Ante; Tomasevic, Boris; Mirić, Mirjana; Tomašević, Anita; Tomić Mahečić, Tina; Vrbanović, Vilena; Bobinac, Mirna; Božić, Alfred; Debelic, Danijela; Frkovic, Vedran; Mladić Batinica, Inga; Baranović, Senka; Gavranović, Željka; Kikec, Mirna; Maldini, Branka; Marić, Stela; Agnić, Ivan; Delić, Nikola; Dropulić, Nataša; Kljaković Gašpić, Toni; Ilić, Darko; Ivančev, Božena; Karanović, Nenad; Kuščević, Dorjan; Marović, Zlatko; Milić, Matija; Nevešćanin, Ana; Petković, Tatjana; Smoje, Mario; Brozović, Gordana; Jelisavac, Milana; Matolić, Martina; Oberhofer, Dagmar; Pavičić, Ana Marija; Šakić, Kata; Bozovic, Margarita Delija; Krecek, Zvjezdana Kotorac; Krobot, Renata; Andabaka, Tatjana; Bratanić, Mislav; Dzepina, Orjana; Kraljev, Martina; Šeric, Julija; Šimurina, Tatjana; Grujić, Rosa; Nacevski-Bulaja, Biljana; Barižon, Mirna; Danira, Vrančić; Dražen, Bulaja; Dušanka, Kimer; Bašić Halužan, Marijana; Joško, Žaja; Katica, Roca; Labor, Magda; Grgurević Marinković, Tea; Mihovilčević, Danči; Marija, Bego; Srečko, Marinković; Vranković, Srđan; Kyprianou, Theodoros; Neophytou, Kyriakos; Cerny, Vladimir; Cvachovec, Karel; Belikova, Barbora; Drab, Michal; Hudacek, Kamil; Krikava, Ivo; Stourac, Petr; Zadrazilova, Katarina; Bicek, Vladimír; Brabcová, Milena; Klozová, Radka; Vajter, Jaromír; Vymazal, Tomáš; Toft, Palle; Blichfeldt, Louise; Hansen, Bo Dilling; Moller, Kirsten; Nielsen, Jeppe Sylvest; Frederiksen, Joachim; Dohn Andersen, Johnny; Kühne, Jan Peter; Leivdal, Siv; Stendell, Line; Simonsen, Martin; Zoltowski, Marcin Konrad; Ali, Zahida Salman; Freundlich, Morten; Pilypaite, Jurgita; Clausen, Nicola Groes; Thorup, Line; Hansen, Frank; Bestle, Morten; Hansen, Christian Steen; Afshari, Arash; Bastholm Bille, Anders; Lefort, Michele; Secher, Erik L.; Liboriussen, Lisbeth; Herodes, Veiko; Marvet, Kadri; Pool, Kristiina; Kallas, Pille; Mägi, Triinu-Kreete; Sütt, Jaan; Vijar, Kerli; Visk, Evelin; Vinnal, Mare; Ellermaa, Jaanus; Liibusk, Liia; Tikkerberi, Artur; Falk, Ilme; Mällo, Esta; Talving, Jaak; Pettila, Ville; Hovilehto, Seppo; Kirsi, Anne; Mustola, Seppo; Tiainen, Pekka; Toivonen, Juhani; Dabnell, Sandra; Kaminski, Tadeusz; Kaukonen, Maija; Silvasti, Päivi; Vainio, Kaisa; Lund, Vesa; Sjövall, Sari; Saarinen, Kari; Viitanen, Matti; Ahonen, Tommi; Alaspää, Ari; Zittling, Ritva; Aarne, Saarikoski; Annette, Moisander; Bodo, Wagner; Laru-Sompa, Raili; Elomaa, Esa; Lavonen, Leena; Nevantaus, Juha; Geier, Klaus; Kavasmaa, Tomi; Koorits, Ursula; Kubjas, Mari; Lauritsalo, Seppo; Ottelin, Lauri; Palve, Markki; Pynnönen, Jari; Raabis, Inga; Saarelainen, Minna; Heikkilä, Tapani; Kontula, Timo; Lehtimäki, Markku; Liimatainen, Jari; Moilanen-Oikarinen, Mari; Pakarinen, Marika; Palanne, Riku; Seppänen, Hanna; Pulkkinen, Anni; Vääräniemi, Heikki; Kainuun Keskussairaala, Kajaani; Paananen, Sami; Koskenkari, Juha; Sälkiö, Sinikka; Vakkala, Merja; Koskue, Talvikki; Loisa, Pekka; Ruut, Laitio; Hautamäki, Raku; Koivisto, Simo-Pekka; Futier, Emmanuel; Lefrant, Jean-Yves; Leon, Alain; Bonnet, Francis; Marret, Emmanuel; Spielvogel, Catherine; Papageorgiou, Chryssa; Szymkiewicz, Olga; Tounou-Akue, Felix; Aubrun, Frederic; Bonnet, Aurélie; Gazon, Mathieu; Guiraud, Michel; Laurent, Virginie; Béclère, Antoine; Tachon, Guillaume; Demars, Nadège; Dumenil, Anne-Sylvie; Mercier, Frederic J.; Landais, Alain; Mentec, Herve; Bazin, Marie; Gonnu, Sophie; Petit, Antoine; Albaladejo, Pierre; Almeras, Luc; Bataillard, Amélie; Rossi-Blancher, Marine; Lefrant, Jean Yves; Barthel, Florian; Hallel, Dan; Sbai, Hicham; Khalifeh, Pamela; Lidzborski, Lionel; Jully, Marion; Platon, Ecaterina; Pottecher, Julien; Baumgarten, Romain; Schultz, Christel; ElMiloudi, Fayçal; Lefebvre, Julie; Waton, Karen; Sprunck, Adrien; Steib, Annick; Thibaud, Adrien; Thuet, Vincent; Kieffer, Vianney; Dubois-Vallaud, Delphine; Jacob, Laurent; Becanne, Xavier; Cherfaoui, Salim; Gauzit, Remy; Godier, Anne; Lakhdari, Mourad; Samma, Charles Marc; Bigeon, Jean Yves; Burtin, Philippe; Halchini, Constantin; Lacroix, Magali; Pinna, Frederic; Barbes, Aurélie; Just, Bernard; Mateu, Philippe; Benayoun, Laurent; Berger, Philippe; Granier, Nathalie; Perrigault, Pierre Francois; Libert, Nicolas; de Rudnicki, Stephan; Merat, Stéphane; Bourdet, Benoit; Ferré, Fabrice; Minville, Vincent; Piriou, Vincent; Rague, Philippe; Wallet, Florent; Lebuffe, Gilles; Desbordes, Jacques; Robin, Emmanuel; Ichai, Carole; Orban, Jean-Christophe; Marx, Gernot; Gottschalk, André; Piontek, André; Unterberg, Matthias; Hilpert, Justus; Kees, Martin; Triltsch, Andreas; Wiegand-Löhnert, Carola; Glöckner, Christiane; Hohn, Andreas; Rose, Elmar; Schröder, Stefan; Wiese, Oliver; Awlakpui, Eli; Scheidemann, Mona; Wittmann, Maria; Ramminger, Axel; Gama de Abreu, Marcelo; Heller, Axel R.; Marx, Christine; Neidel, Julia; Goldmann, Anton; von Heymann, Christian; Laetsch, Beatrix; Maahs, Esther; Scholz, Lars; Frenzel, Dirk; Massarat, Kyros; Lenhart, Franz-Peter; Reichle, Florian; Rudlof, Kristina; Borchers, Friedrich; Buettner, Christoph; Schmutzler, Martin; Burgard, Gerald; Lucht, Alexander; Wagner, Jan; Pilge, Stefanie; Schneider, Gerhard; Untergehrer, Gisela; Bis, Beata; Krassler, Jens; Dittmann, Jan; Haberkorn, Jörg; Eberitsch, Jürgen; Eberitsch, Karola; Nippraschk, Thomas; Wepler, Ulrich; Engelen, Wolf-Christian; Nau, Carla; Scholler, Axel; Schüttler, Jürgen; Wintzheimer, Simone; Bloos, Frank; Braune, Anke; Fergen, Daniela; Ludewig, Katrin; Paxian, Markus; Reinhart, Konrad; Graf, Nikolaus; Schwarzkopf, Konrad; Berger, Katharina; Habicher, Marit; Kasperiunaite, Ruta; Savelsberg, Sabine; Krep, Henning; Reindl, Michael; Weber, Matthias; Bauer, Wolfgang; Bingold, Florian; Christ, Saskia; Friederich, Patrick; Kaviani, Reza; Auer, Patrick; Bonnländer, Georg; Drescher, Jürgen; Braun, Roland; Eichenauer, Tim; Kerner, John; Bierbaum, Kathrin; Brünner, Horst; Grond, Stefan; Perez-Platz, Ursula; Andresen, Bent; Linstedt, Ulf; Stegmann, Nils; Erkens, Uwe; Kopcke, Jens; Meyer, Andreas; Brestrich, Hartmut; Ernst, Sandra; Merkel, Stella; Krieger, Lena; Luers, Frank; Weyland, Andreas; Noeldge-Schomburg, Gabriele; Menckie, Thomas; Wasmund, Christina; Bredtmann, Ralph-Dieter; Erler, Ines; Haumann, Christine; Möllemann, Angela; Oehmichen, Uwe; Sergejewa, Olga; Lehning, Brigitte; Czeslick, Elke; Geyer, Michaela; Malcharek, Michael; Sablotzki, Armin; Stier, Marina; Feld, Florian; Rossaint, Rolf; Simon, Verena; Armaganidis, Apostolos; Koulenti, Despoina; Kotanidou, Anastasia; Nanas, Serafim; Papastylianou, Androula; Psevdi, Aikaterini; Stathopoulos, Anastasios; Voulas, Asklepieion; Kanna, Efthymia; Koutsikou, Anastasia; Moustaka, Alexandra; Chovas, Achilleas; Komnos, Apostolos; Zafiridis, Tilemachos; Franses, Josef; Lavrentieva, Athena; Koraki, Eleni; Katsenos, Chrysostomos; Kasianidou, Maria Flora; Nasopoulou, Pantelia; Spyropoulou, Eleni; Gousia, Chrysoula; Katsanoulas, Constantine; Lathyris, Dimitrios; Kyriazopoulos, George; Sfyras, Dimitrios; Tsirogianni, Athanasia; Kostopanagiotou, Georgia; Lignos, Mihail; Matsota, Paraskevi; Christopoulos, Christos; Mouratidou, Alexandra; Vrettou, Efstratia; Boufidis, Spyros; Moka, Eleni; Arnaoutoglou, Eleni; Koulouras, Vasileios; Nakos, George; Papathanakos, Georgios; Anthopoulos, Georgios; Choutas, Georgios; Karapanos, Dimitrios; Tzani, Vaso; Gkiokas, Georgios; Nastos, Konstantinos; Nikolakopoulos, Fotios; Dragoumanis, Christos; Nikitidis, Nikos; Pneumatikos, Ioannis; Theodorou, Vassiliki; Zacharouli, Danai; Kandi, Stella; Tasopoulos, Konstantinos; Arvaniti, Kostoula; Matamis, Dimitrios; Mplougoura, Eva; Petropoulou, Polixeni; Soumpasis, Ioannis; Amaniti, Ekaterini; Giannakou-Peftoulidou, Maria; Gkeka, Eleni; Soultati, Ioanna; Kokinou, Maria; Papatheodorou, Lambrini; Stafylaraki, Maria; Giasnetsova, Tatiana; Gritsi-Gerogianni, Nikoleta; Kydona, Christina; Kiskira, Olga; Koulentis, Ioannis; Apsokardos, Alexandros; Dimitropoulos, Konstantinos; Soldatou, Ourania; Nathanail, Christodoulos; Papazotos, Alexios; Kolotoura, Athina; Sartzi, Monika; Papanikolaou, Spiros; Polakis, Pavlos; Karatzas, Stylianos; Kyparissi, Aikaterini; Papavasilopoulou, Theonymfi; Koukoubani, Triantafillia; Mastora, Evangelia; Spyropoulou, Kyriaki; Papaioannou, Alexandra; Maragkou, Elisavet; Spring, Anna; Ioakeimidou, Stavros Evagelatos Aikaterini; Noulas, Nikos; Molnár, Zsolt; Csüllög, Emese; Elekes, Enikő; Katona, Zsuzsana; Kremer, Ildiko; Miko, Angela; Csomos, Akos; Galambos, Zsuzsanna; Szucs, Akos; Nyikos, Gyorgy; Szekeres, Gabor; Szabo, Ervin; Kranitz, Katalin; Simon, Melinda; Szigeti, Janos; Gaál, Emánuel; Havas, Attila; Ille, Alexandru; Bráz, Krisztina; Nagy, Geza; Sigurdsson, Gisli; Sigurbjörnsson, Fridrik T.; Sigurdsson, Gisli H.; Sigurdardottir, Elin Edda; Gunnarsson, Björn; Westbrook, Andrew; Broderick, Alan; Hafeez, Parvaiz; Hanumanthaiah, Deepak; Brohan, Janette; O'Chroinin, Donal; Bailey, Kevin; Ramamoorthy, Karthik G.; Doyle, Yvonne; Freir, Noelle; O'Rourke, James; Jonson, Philip; Saeed, Sabir; Hayes, Ivan; Loughrey, John; Frohlich, Stephen; McCauley, Nuala; Ryan, Donal; Fitzpatrick, Gerry; Kevin, Leo; Thomas, Jubil; Warde, Barry; Woolhead, Alan; Duggan, Michelle; Egan, Cara; Crowley, Seamus; Lebese, Soloman; Bergin, Anne; Page, Rory; Collins, Daniel; McKenny, Michael; Della Rocca, Giorgio; Grasso, Salvatore; Bresciani, Anna; Carmino, Livio; Ghelfi, Silvia; Lorenzelli, Laura; Novelli, Maria Teresa; Pescarmona, Chiara; Roasio, Agostino; Gatta, Alessandro; Nastasi, Mauro; Sanseverino, Manlio; Tinti, Carla; Bianchin, Andrea; Tormena, Maria Paola; Franco, Antonio; Marini, Federica; Rapido, Francesca; Bellotti, Ferdinando; Boninsegna, Daniele; Castellani, Gianluca; Sances, Daniele; Spano, Gianluca; Tredici, Stefano; Vezzoli, Dario; Fucecchio, Igneo; Bacci, Alessandro; Coppini, Roberta; Dell'unto, Sandro; Mori, Emanuele; Stanzani, Maria Rosa; Tosi, Monica; Collareta, Michele; Forfori, Francesco; Franchi, Matteo; Mancino, Giuseppe; Battistella, Massimo; Baricocchi, Elisa; Bona, Francesco; Debernardi, Felicino; Giacoletto, Gianmarco; Iacobellis, Antonio; Massucco, Paolo; Moselli, Nora; Muratore, Andrea; Palomba, Graziella; Sardo, Elena; de Simone, Michele; Suita, Luisa; Zocca, Edoardo; Bucci, Barbara; Corte, Francesco Della; Piciucco, Tiziana; Viarengo, Valeria; Pugliese, Francesco; Ruberto, Franco; Bettelli, Gabriella; Cantarini, Eugenia; Giampieri, Marina; Tanfani, Alessandra; Recchia, Eugenio; Milano, S. Raffaele; Bignami, Elena; Bruno, Giovanna; Costagliola, Roberto; Gandolfi, Azzurra; Greco, Massimiliano; Lembo, Rosalba; Monti, Giacomo; Nicelli, Elisa; Pasculli, Nicola; Turi, Stefano; Baroselli, Antonio; Brazzoni, Marcella; Buttazzoni, Mattia; Buttera, Stefania; Centonze, Carlo; Serena, Giovanni; Spagnesi, Lorenzo; Toretti, Ilaria; Vilardi, Anna; Zearo, Ester; Arpino, Ines; Baraldi, Sara; Guarnerio, Chiara; Molene, Vincenzo; Monea, Maria Concetta; Vaccarisi, Enrico; Vicari, Luigi; Albante, Alida; Aversano, Marco; Loiacono, Cinzia; Marandola, Maurizio; Fusari, Maurizio; Petrucci, Nicola; Galla, Amerigo; Mascia, Antonio; Primieri, Paolo; Di Noto, Anna; Gratarola, Angelo; Molin, Alessandro; Spagnolo, Luigi; Spena, Claudio; Bussolengo, Orlandi; Calligaro, Plinio; Marchiotto, Simonetta; Merlini, Alberto; Pedrazzoli, Eleonora; Perina, Giulia; Visentin, Renea; Fumagalli, Roberto; Garbagnati, Andrea; Manetti, Bruna; Snaier, Chiara; Somaini, Marta; Farnia, Antonio; Nani, Roberto; Pierantonio, Novello; de Michele, Michele; Gazzanelli, Sergio; Bergamini, Elena; Tassinati, Tania; Capuzzo, Maurizia; Cirillo, Vera; Tufano, Rosalba; Oggioni, Roberto; Parrini, Vieri; Brunori, Emanuela; Capone, Micaela; Carbone, Luigi; Corradetti, Francesco; Elisei, Daniele; Fiorentino, Stefano; Francesconi, Maurizio; Gattari, Diego; Gorgoglione, Maria; Iacobone, Emanuele; Minnucci, Francesco; Montironi, Claudio; Riccioni, Gianrenato; Tappata, Giuseppe; Zompanti, Valeria; Verdenelli, Paola; Cerutti, Elisabetta; Ranieri, Vito Marco; Golubovska, Iveta; Grigorjevs, Sergejs; Rikmane, Maija; Rozkalne, Daina; Stepanovs, Jevgenijs; Suba, Olegs; Kazune, Sigita; Miscuk, Aleksej; Nemme, Janis; Oss, Peteris; Sipylaite, Jurate; Macas, Andrius; Ragaisis, Vytautas; Kontrimaviciute, Egle; Tomkute, Gabija; Kramer, Irene Fleur; Poeze, Martijn; Ziekenhuis, Antonius; Maria, John; Pelzer, Gerardus; Winsser, Lex J. A.; Nijsten, Maarten; Schoorl, Michiel; Spanjersberg, Rob; Dieleman, Stefan; Koopman-van Gemert, A. W. M. M.; Bouw, Martijn; Pickkers, Peter; van der A, Marieke; Capelle, Ziekenhuis; Schreiner, Frodo; van den Berg, Roy; de Wit, Esther; Keijzer, Christaan; Hollmann, Markus W.; Preckel, Benedikt; van Acker, Gijs J. D.; Dennesen, Paul J. W.; Kuijpers-Visser, Agnes Gerda; Inan, T.; Ponssen, Huibert Hendrik; Brouwer, Tammo; Koopmans, Matty; van Bommel, Jasper; van Duijn, Ditty; van der Hoven, Ben; Ormskerk, Patricia; Beck, Oliver; Schiere, Sjouke; Reidinga, C.; Venema, Allart; Olthof, Kees; Flaatten, Hans; Jammer, Ib; Dokka, Vegard; Monsen, Svein Arne; Ytrebo, Lars Marius; Noursadeghi, Mostafa; Shahzad, Ahmed; Boksasp, Dagfinn; Roiss, Christoph; Strietzel, Hans Frank; Berntsen, Anne Gina Schie; Haugland, Helge; Vingsnes, Svein Ove; Axelsson, Patric; Risom Olsen, Thomas C.; Katre, Sanjay; Aakeroey, Kristin; Mikstacki, Adam; Tamowicz, Barbara; Bożiłow, Dominika; Goch, Robert; Grabowski, Piotr; Kupisiak, Jacek; Małłek, Małgorzata; Szyca, Robert; Jankowski, Grzegorz; Kościelniak, Władysław; Pietraszek, Paweł; Szarowar, Bartosz; Matos, Ricardo; França, Carlos; Lacerda, António Pais; Ormonde, Lucindo; Rosa, Rosário; Pereira, Inês; Vitor, Paula; Valente, Pulido; Lopes Marques Carvalho, Maria Raquel; Faria, Manuela; Almeida, Eduardo; Mealha, Rui; Vicente, Rachel; Monte, Raquel; Rua, Fernando; Barros, Nelson; Esteves, Francisco; Gouveia Pinheiro, Célia Maria; Oliveira, Vítor Miguel; Oliveira, Maria Fátima; Martins, Isabel; Saraiva, José Pedro; Assunção, José Pedro; Bártolo, Anabela; Carvalho, Anabela; Correia, Carlos; Martins, Salomé; Milheiro, Ruth; Diaz, Alejandro; Gonçalves, Maria Imelda; Ribeiro, Rosa; Estilita, Joana; Glória, Carlos; de Almeida, José; Barros, Filipa; Ramos, Armindo; Camara, Margarida; Maul, Edward Richard; Nobrega, Julio; Langner, Anuscka; Maia, Dionísio Faria; Afonso, Ofélia; Faria, Filomena; Cabral, Curry; Botelho, Maria Manuela; Ferreira, Pedro; Mourão, Luís; Oliveira, Ana Vintém; Resende, Margarida; Aleman, Miguel; Fonseca, Jorge; Isidoro, Marta; de Meneses, Helena; Pêgas, António; Pereira, José; Pereira, Luis; Ramos, Bárbara; Matos, Francisco; Martins, Ana; Ramos, Cristina; de Sousa, Manuel; Bento, Luís; Botas, Conceição; Lopes, Vitor; Mendes, Rosa; Grigoras, Ioana; Blaj, Mihaela; Damian, Mihaela; Lupusoru, Andreea; Ristescu, Irina; Codreanu, Monica; Diaconescu, Ciresica; Nistor, Alina; Stanescu Stelian, Dorin; Streanga, Livia; Berneanu, Maria; Bordeianu, Cristina; Florenta, Calarasu; Iacob, Alina; Lupu, Mary Nicoleta; Mocanu, Iulian; Moraru, Coca; Meran, Carleta; Nicolae, Bacalbasa; Sandu, Madalina; Turcanu, Roxana; Grigore, Monica; Hotaranu, Cristina; Popescu, Nicoleta; Baban, Oleg; Baciu, Manuela; Ciobanu, Aurica; Denciu, Catalin Ioan; Gurau, Vitalie; Maftei, Ion; Ungureanu, Liviu; Bogdan, Prodan; Corneci, Dan; Dinu, Melania; Madalina, Dutu; Silvius, Negoita; Tomescu, Dana; Gabriela, Droc; Dinescu, Stelian Adrian; Calin, Mitre; Ionescu, Daniela; Margarit, Simona; Vasian, Horatiu; Albu, Corina; Balasa, Carmen; Cadrigati, Alina; Dragulescu, Dorian; Gavra, Loredana; Hentia, Ciprian; Macarie, Claudiu; Manescu, Mihaela; Nediglea, Ioan; Ocica, Dana; Ovidiu, Bedreag; Papurica, Marius; Plavat, Cosmin; Popa, Claudia; Ramneantu, Mihaela; Sandici, Zoran; Sarandan, Mihaela; Belciu, Ioana; Tincu, Eugen; Ursu, Irina; Aignatoaie, Mariana; Huzuneanu, Mariana; Cocu, Simona; Hagau, Natalia; Ciubotaru, Roxana; Copotoiu, Ruxandra; Ioana, Ghitescu; Kovacs, Judit; Leonard, Azamfirei; Szederjesi, Ianos; Genoveva, Vanvu; Mosnegutu, Simona; Surbatovic, Maja; Djordjevic, Dragan; Djordjevic, Biljana; Grujic, Krasimirka; Jovanovic, Dusko; Krstic, Ivana; Zeba, Snjezana; Jevdjic, Jasna; Miletic, Milos; Zunic, Filip; Bulasevic, Aleksandra; Brko, Radoslava; Gazibegovic, Narcisa; Kendrisic, Mirjana; Vojinovic, Radisa; Firment, Jozef; Capková, Judita; Grochova, Monika; Trenkler, Stefan; Griger, Martin; Bakosova, Erika; Kvasnica, Martin; Saniova, Beata; Sulaj, Miroslav; Zacharovska, Andrea; Simkova, Alexandra; Číková, Andrea; Gebhardtova, Andrea; Hanuljaková, Slávka; Koutun, Juraj; Martonová, Andrea; Žilinčárová, Veronika; Galkova, Katarína; Krbila, Stefan; Sobona, Viliam; Ocenasova, Marieta; Novak-Jankovic, Vesna; Grynyuk, Andriy; Damjanovska, Marija; Kostadinov, Ivan; Knezevic, Mile; Malivojevic, Marko; Borovsak, Zvonko; Kamenik, Mirt; Mekiš, Dušan; Osojnik, Irena; Kosec, Lučka; Kapš, Silva Ostojič; Aleksic, Dragoslav; Gerjevič, Božena; Kalan, Katja; Ursic, Tomaz; Aldecoa, Cesar; Montejo González, Juan C.; Artigas, Anna; Garcia, Andres; Lisi, Alberto; Perez, Isabel; Perez, Gisela; Poch, Nuria; Vaquer, Sergi; Balciscueta, Goiatz; Barrasa, Helena; Cabanes, Sara; Maynar, Javier; Poveda, Yolanda; Rodero, Amaia Quintano; Garcia-Bunger, Beatriz; Elvira, Maria Adoracion; Lajara, Ana María; Palencia, María; Ramos, Rafael; Fernandez, Ana Saez; Tirapu León, Juan Pedro; López, Jaione Iza; Yoldi Murillo, Francisco Javier; Ramirez, Eva Turumbay; Rico, Patricia Unzué; Patricia, Marta; Vizcaíno, Martín; Bernat Álvarez, Maria José; Real, Kenneth Planas; Aracil, Norma; Menendez Bodega, Begoña; Fernández García, Raquel; Álvarez García, Marivi; Gordon, Quintana; Gutiérrez Jodrá, Alicia; de Santos López, Angela; Ros, Juan José Llavador; Soto, Rocío Ayala; Sepúlveda, Isabel; Díez, Esperanza Pascual; Fernández Fernández, Luisa; Gulina, Carlos Soria; Pérez Arviza, Laura; Mouriz Fernandez, Lorena; Gómez, Antía Río; Alonso Martínez, Concepción; Mouriz Rodríguez, Ana Belén; Lopez Soto, Carmen; Garcia, Clara; Lorenzo, Mario; Pinilla, Elena; Rico, Jesus; Ruperez, Irene; Alonso, Eduardo; Leira, Fernando; Maseda, David Pestaña Emilio; Royo, Concepcion; Villagran, Jose; Murillo Candi, Giralt; Esteva, Garcia Eduardo; Folgado, Raquel Mansilla; Fornaguera, Nadal Joan; Calonge Montse, Pijoan; Prat, Anna Sape; Sintes, Dolores; Arteta, Donaldo Arteta; García Delgado, Horacio; López-Cuervo, Juan Fajardo; López, Mikel Celaya; Ramírez, Alejandro; Saldaña, Francisco José; Aliste, Pilar; Anchuelo, Ana Hermira; García Campos, Ascensión; Catalán, Mercedes; García Gómez, Mónica; Gonzalez Gonzalaez, Olga; López López, Eloísa; Arlanzón de Quevedo, Sara; Gonzalez Serrano, Matilde; Perez-Cerdá Silvestre, Francisco; Martinez Torrente, Francisco; Arocas, Blanca; Soro, Marina; Maroto, Fernando; Robledo Algarra, Ruth; Aleixandre, Inés Silla; Rodriguez Argente, Gemma; Broseta Lleó, Ana; Rubio, Antonio Vela; Vicente Sánchez, José Luis; Enríquez Valcárcel, Irene; Balust, Clara; Balust, Jaume; Borrat, Xavier; Carretero, Maria Jose; Gracia, Isabel; Matute, Purificacion; Mercadal, Jordi; Pujol, Roger; Tena, Beatriz; Ubre, Marta; Albalad, Dolores Dorda; Muñoz Alcaide, Concepción; Caballero, Jesus; Montferrer Estruch, Nuria; Ferrer, Mercè Ballvé; Lacasta Fornells, Albert; Terrer Galera, Eduard; Garcia Martinez, Irene; Manrique Muñoz, Susana; Pelavski, Andres; Perez, Pilar Tormos; Gonzalez Posada, Miguel Angel; Chocron de Prat, Ivette; Rello, Jordi; Garcia Serrano, Llum; Naya Sieiro, José Manuel; Silva, Lorena; Colomina Sole, Maria Jose; Biarnes Suñé, Alfons; Rochera Villach, Isabel; Gómez Herreras, José Ignacio; Poves, Rodrigo; Martinez Rafael, Beatriz; Martinez Almeida, Icier; Fernandez Collates, Angel; Bartolomé, Maria Jose; Cimadevilla, Bonifacio; González González, Antonio Manuel; Rabanal Llevot, Jose Manuel; de Terán Mira, Juan Carlos Diaz; González Molina, Begoña; Pardo, Sara; Sánchez, Carlos López; Williams, Monica; Muñoz Corsini, Lourdes; Rodríguez Fraile, José Ramón; de la Lastra, Maria; Sacramento, Monir Kabiri; López Saña, Francisco Javier; Trenado Ålvarez, Josep; Cantón Bulnes, Maria Luisa; Carrasco, Violeta Gándara; Cubillos, Diana Narváez; Seisdedos, Ángel Arenzana; Torres, Bartolomé Fernández; Ampuero, Marian Santos; Llano, Marta Chicot; Munoz, Manuel; Orts, Mar; Planas, Antonio; Ramasco, Fernando; Roman, Carlos; Durán, Marina Varela; del Río Fernandez, Sabela; Sanduende Otero, Yolanda; Lopez Pineiro, Susana; Barreiro Pardal, Cristina; Fernández Alcantud, Jesús; Antolinos, Mercedes Ayuso; Barrios, Francisco; Casanova, Ana Collantes; Castro, Manuel Ruiz; Crespo, Beatriz Infantes; Felipe, Uzuri Lancha; Fuster, Marta Liceras; García, Máximo Sanz; Garrote, Begoña Herrero; Gonzalez, Ricardo Moreno; Granero, Maria José Montes; Lloreda de la Guia, Carlos; López, Raquel Chaves; de Frutos López, Santiago; Martinez, Jose Javier Marco; Mostaza, Angel Garcia; Moreno, Antonio Jiménez; Osado, Irene Riquelme; Pastor, Ana Bardina; Peña, Rosa; Pérez, Mónica Rustarazo; Piña, María Aliaño; Romero, Carlos Aranda; Rodríguez, Elena Rodríguez; Sáez, Vicente Pedroviejo; Safatle, Fernando; Salvan, Javier Hernández; Sampedro, Mar Galán; de la Torre, Patricia Alfaro; Toro, Jonatan Pérez; Unzúe, Crsitina Lasa; Vargas, Maria José; Bernal, David Garcia; Echevarria, Mercedes; Iglesias, Alejandro Ubeda; Loza, Ana; Rodriguez Morillo, Araceli; Serrano, Pedro Diaz; Barrientos Sevilla, Fernando Caba; Cacho, Elena; Calderón, Ricardo; Dufur, Mercedes; Marginet, Carolina; Monedero, Pablo; Yepes, Maria José; Alvarez, Luzdivina Rellán; Carballal, Francisca Fernández; Castiñeiras, Alberto Pensado; García, Paula Dieguez; López, Lorena Ramos; Maceiras, Pablo Rama; Puente, María Socorro Martínez; Rilo, Maria Teresa Rey; Alonso, Esther Trujillo; Fernández, Sonia Rodríguez; García, Rafael Omaña; García, Aníbal Pérez; Puentes, Rafael Bello; Aguado, Domingo Nunez; Carballo, Carlos Lopez; Fernandez, Ricardo Fernandez; Presedo, Amadeo Toledo; de Rabago, Ricardo Bermejo Diaz; Velasco, Ana Rodriguez; Capel, Yolanda Jiménez; Cortés, Ana Fernández; García, Esther Martínez; Gimeno, Laura Martinez; Klamburg, Jordi; Omedas, Rosa Castillo; Núñez, Miriam González; Maristany, Clara Llubià; Ruiz, Enrique Moret; Artigas, Xavier; Castrillón, Sebastian; Espinosa, Nieves; Gomez-Caro, Ana Maria; Illa, Susana; Martín-Huerta, Beatriz; Moreno, Marisa; Fernández, Cristina Iglesias; García, Violeta Fernández; Hernández, Pedro Picatto; Checa, Alberto Honrubia; Diaz, David Salvatierra; Noguera, Manuel Linero; Varela, Ignacio Pujol; Gallego, Miguel A. González; García, Oscar Martínez; Irujo, José Javier Ariño; Perrino, Carlos González; Picazo, Julio Rey; Timoneda, Francisco López; Arroyo, María Manzanero; Blanco, Isabel Albalá; Borja, Marcos Martínez; Burcio, Sara Martín; Castro, Nilda Martinez; Cerdeiriña, Aránzazu Puente; Cristina, Medrano Viñas; Dorado Díaz, Trinidad; Esteruelas, Juan Avellanosa; Ingelmo, Ildefonso Ingelmo; Insuga, Paco Duran; Llamas, Elisabeth Claros; Lopez, Jose Juan Martín; Martín, María Beltran; Martín, Elena Elías; Mesa, Eva Ureta; Monterde, Manuela Loren; Montoiro, Paloma Alonso; Móstoles, Maria Luisa Gonzalez; Olarte, Eva Velasco; Pérez, Adolfo Martínez; Perez, Fernando Domínguez; Romero, Ana Serrano; Rous, Diego Parise; Ruiz, Nuria Mané; Ruiz, Jose Angel Palomo; Saiz, Alvaro Ruigomez; Toha, Angel Candela; Utrera, Fernando Alvarez; Alberdi, Fermín; Elósegui, Itxaso; García, Javier; Garde, Pilar Marco; Mintegui, Escudero Itziar; Sáez, Iker García; Salas, Estibaliz; Camil, Sant; Diaz-Boladeras, Rosa-Maria; Mora-Guevara, Emilio; Zamora, Julia Ferreras; Bonet, Alfons; Salo, Lidia; Salinas, Unai; Zaballos, Juan M.; Alvarez, Ana Abella; Garrido, Carlos Jimenez; Roa, Juan Ramón Hita; Vidal, Federico Gordo; Garcia-Egea, Jorge; Elson, Monica Zamora; Asensio, Miguel Angel Mendiola; Simeón, Rosa Gastaldo; Alameda, Luis Enrique Muñoz; Angulo, Guillermo Oeding; Aranzubia, Monserrat; Arcas, Jose Juan; Arevalo, Julian; Belvert, Belén Quesada; Calvo, César Pérez; Cremades, Marta; Crespo, Pascual; Cuarental, Ana; Fernández, Pablo Turrión; Herrera, Elena; Llorente, Miguel Angel Alcala; Rabes, Cecilia Martin; de Maeyer, Ana Gamo; Marquez, Manuel Pérez; Mendoza, Diego López; Muñoz, José María Milicua; Martínez, Natividad Arias; Ferrandiz, Sergi Tormo; Sanchez-Morcillo, Silvia; Sánchez, Matilde Lafuente; Parra, Asunción Marqués; Vidal, Sonia Gomar; Allué, Raquel Montoiro; Etayo, Begoña Zalba; Rodriguez, Raquel Bustamante; Villen, Luis Martin; Jimenez, Cristina Molla; de Zayas, Ricardo Salas; Moreno, Cristina Dolera; Pacheco, Fernando SanJose; Pascual, Jose Luis Anton; Parla, Infanta Cristina; Gude, Fernando Tejera; Riestra, Eva Manteiga; Delgado, Francisco Cota; de Vilanova, Arnau; Barrios, Javier; García-Sanz, Mercedes; García, Vicente; Sanmiguel, Guillermo; Álvaro, Julian López; Barrachima, Beatriz Bornay; Bermejo, Francisco Jose Romero; Garcia, Alberto Garcia Fernandez Pilar Martinez; Ramírez, Carolina Navarro; Ramos, Jorge Gómez; Samaniego, Luis Angel; Belenguer-Muncharaz, Alberto; Mateu-Campos, Maria-Lidon; Domínguez, David; Espinosa, Elena; León, Teresa; Betancor, Nazario Ojeda; Cortes, Javier Garcia; Díaz, Juan José Díaz; Canalechevarria, Ana Manzano; Novales, Beatriz Fores; Peña, Jose Manuel Garcia; Delgado, Tomas Rodriguez; Roquerio, Beatriz Santamaria; Sainz, Juan Jose Gomez; Soto, Teresa Tebar; Chew, Michelle; Dahm, Peter; Odenstedt Hergès, Helena; Lundborg, Christoffer; Söndergaard, Sören; Rylander, Christian; Sari, Ferenc; Oscarsson Tibblin, Anna; Adolfsson, Anne; Klarin, Bengt; Schrey, Susann; Chew, Michelle S.; Merisson, Edyta; Ryde, Jörgen; Divander, Mona Britt; Hedin, Annika; Hedlund, Daniel; Jawad, Monir; Layous, Lona; Brattström, Olof; Olheden, Staffan; Oldner, Anders; Sellden, Eva; Walder, Bernhard; Wickboldt, Nadine; Rossi, Ariane; Steiner, Luzius; Djurdjevic, Mirjana; Lussmann, Roger; Geisen, Martin; Hofer, Christoph; Turina, Matthias; Grocott, Mike; Goldhill, David; Everett, Lynn; Harris, Katy; Wright, Maggie; Adams, David; Alderson, Lorraine; Baker, Julie; Christie, Iain; Ferguson, Colin; Hill, Matthew; Holmes, Kate; Hutton, Andrew; Minto, Gary; Moor, Paul; Porter, Andrew; Struthers, Richard; Akotia, Niven; Belhaj, Alaa; Chang, Serene; Collantes, Enrique; Eigener, Katrin; Husband, Michael; Khan, Ahsun; McAlees, Eleanor Jane; MacDonald, Neil; Niebrzegowska, Edyta; Parnell, Wendy; Smith, Amanda; Chhatwal, Ally; Jhingan, Smriti; Muswell, Richard; Poon, Yoyo; Singh, Nidhita; Stephens, Robert; Vasan, Robin; Waife, Nicola; Weda, Tahmina; Clarke, Adrian; Szakmany, Tamas; Fletcher, Simon; Rosbergen, Melissa; Prince, Liz; Wong, Kate; Kumar, Ram; Stilwell, Sarah; Couper, Keith; Crooks, Neil; Gao-Smith, Fang; Melody, Teresa; Snaith, Catherine; Patel, Jaimin; Parekh, Dhruv; Yeung, Joyce; Loughnan, Bernadette; Rope, Tamsin; Dawson, Julie; Hadfield, Daniel; Hopkins, Phil; McDonald, Lisa; Willars, Chris; Campbell, Gillian; Craig, Jayne; Smith, Andrew; Ladipo, Karleen; Lockwood, Geoff; Moreno, Juan; Ballington, Ruth; Hamandishe, Sibongilele; Rogerson, David; Cowman, Sarah; Hayden, Paul; Pinto, Nuno; Arawwawala, Dilshan; Brotherston, Lauren; Mitchell-Inwang, Christine; Walsh, Helena; Alagarsamy, Famila; Goon, Serena; Karcheva, Sylvia; Krepska, Amy; McKinney, Brian; Patil, Vishal; Devon, Royal; Batchelor, Nicholas; Finch, Louise; Gibson, Charlie; Grayling, Matthew; Hubble, Sheena; Key, William; Knight, Thomas; Loosley, Alexander; Margetts, Paul; Stewart, Hannah; Bewley, Jeremy; Hurley, Katrina; Murphy, Ruth; Philpott, Catherine; Pollock, Kathryn; Sweet, Katie; Thomas, Matthew; Tucker, Katy; Windsor, David; Conway, Daniel; Gold, Steve; Quraishi, Tanviha; Cupitt, Jason; Baddeley, Sally; Brown, John David; Mantle, Damien; Carvalho, Peter; Huddart, Sam; Kirk-Bayley, Justin; Smith, Rebecca-Lea; Milligan, Lisa; Poulose, Sonia; Sarkar, Som; Nolan, Jerry; Pedley, Emma; Padkin, Andrew; Pesian, Siamak; Rajamanickam, Satish; Ramkumar, Konnur; Thomas, Jerry; Crayford, Alison; Turner, Angus; Bottrill, Fiona; Webb, Stephen; Jhanji, Shaman; MacCallum, Niall; Wessels, Kate; Wigmore, Tim; Meikle, Alistair; Wilson, Stephen; White, Stuart; Bonnett, Andrew; Rushton, Andrew; Williams, Colin; Zuzan, Oliver; Hall, Andrew; Montgomery, Jane; Piggot, Ailie; Read, Richard; Stocker, Mary; Tamm, Tiina; Agarwal, Banwari; Ward, Stephen; Brown, Lucy; Joy, Manju; Venkatesh, Suresh; Hughes, Thomas; Zsisku, Lajos; Roy, Alistair; Hooper, Victoria; Mouland, Johanna; Nightingale, Jeremy; Rose, Steve; Chiam, Patrick; Chohan, Harnita; Dickson, Chris; Gibb, Sarah; Higham, Charley; Harvey, Caroline; Janarthanan, Chandra; Jones, Laura; Kapoor, Avinash; Moll, Mark; Roberts, Louise; Saunders, David; Arnold, Glenn; Gibbs, Claire; Jhurgursing, Mhairi; Pritchard, Frances; Doyle, Patrick; Templeton, Maie; Wilson, Robert; Zantua, Kim; Collyer, Thomas; Featherstone, James; Worton, Rachael; Bruce, Jean; McGuigan, Kate; Moreton, Sarah; Pulletz, Mark; Anderson, Helen; Baxter, Ian; Beckingsale, Alex; Callaghan, Mark; Datta, Ansu; Dawson, Jo; Gollogly, Jackit; Izod, Chris; Lobaz, Steve; MacFie, Caroline; Patel, Manju; Payne, Heather; Singh, Raj; Timms, Gemma; McLeod, Shaun; O'Brian, Peter; Horner, Elspeth; Joshi, Vivekananda; Stuart-Smith, Karen; Seale, Tania; Bolger, Clare; Collins, Hannah; Ekins, Emma; Golder, Kim; Hawkins, Lesley; Jonas, Max; Linford, Karen; Wadams, Beverley; Vizcaychipi, Marcela; Jewsbury, William; Davies, Simon; Kangaraj, Muthuraj; Pissay, Nagesh; Smith, Neil; Gopalakrishnan, Senthilkumar; MacKinnon, John; Strandvik, Gustav; Francis, Ruth; Jennings, Adrian; Keating, Matthew; Kumar, Sajith; Leese, Sarah; Magee, Cliona; Pilsbury, Jane; Ralph, James; Riddington, David; Sachdeva, Rajneesh; Snelson, Catherine; Vasanth, Suresh; Wilde, Judith; Lavender, Beth; Lyons, Rachel; Watters, Malcolm; Adams, Tim; Dyer, Simon; Tindall, Lucy; Claxton, Andrew; Netke, Meenu; Princess, Diana; Akouds, Esam; Bates, Debrah; Gallagher, Heather; Hatton, Jonathan; Holroyd, William; Mitra, Atideb; Nurse, Trudy; Reed, Deborah; Barber, Russell; Childs, Sophie; O'Carroll-Kuehn, Britta; Wyldbore, Mark; Al-Abdaly, Ayad; Amatya, Suman; Bhaskaran, Sherly; Chandan, Garud; Chaudhry, Suman; Chikungwa, Moses; Earnshaw, Greg; Grewal, Moni; Haque, Shamimul; Hawkins, John; Javaid, Ahmed; Jackson, Clare; Kamel, Miriam; Marla, Ruchira; Mculloch, Dori-Ann; Parker, Tom; Salib, Yussof; Saravanmuthu, Ramesh; Secker, Chris; Sockalingam, Siva; Taylor, Anne; Austine, Pauline; Kanade, Vrushali; Paal, Dora; Mok, Sam; Burtenshaw, Andrew; Davis, Laura; Ellahee, Parvez; Freeman, David; Pierson, Richard; Wollaston, Julie; Karmarkar, Amara; Ball, Clare; Calton, Emily; Maxwell, Louise; Walker, Rachel; Bland, Martin; Bullock, Lynne; Harrison-Briggs, Donna; Hodge, Paul; Krige, Anton; Dempsey, Ged; Hammell, Claire; Loveridge, Robert; Parker, Robert; Snell, Jane; Wright, Carl; Baker, Andy; Barr, Katharine; Belcher, Alex; Bonnington, Sam; Bougeard, Anne-Marie; Fitzgerald, Emma; Ford, Rachael; Gillard, Chantal; Griffiths, Liz; Greenberg, Lizzie; Huber, Jonathan; Mathieu, Steve; Richardson, Neil; Tompsett, Laura; White, Nigel; Patel, Santosh; Thomas, Richard; Wilson, Jennifer; Copley, Ed; Flutter, Laura; Hulme, Jonathan; Susarla, Jay; Thwaites, Alison; Infirmary, Albert Edward; Jayasundera, Suraj; McAfee, Sean; Chantler, Jonathan; McKechnie, Stuart; Neely, Julia; Mouton, Ronelle; Scarth, Edward; Buss, Joanne; Currie, Vicki; Sange, Mansoor; Kuttler, Anja; Power, Fiona; Alexander, David; Dunne, Kevin; Shinner, Guy; Black, Euan; Haldane, Grant; Kerr, Jennie; Saran, Taj; Ward, Geraldine; Jefferies, Fiona; Alexander, Peter; Royle, Alison; Nahla, Farid; Bowles, Tim; Gregory, Maggie; Ahern, Rebecca; Cartlidge, David; Craker, Lloyd; Thompson, Christopher; Bidd, Heena; Giles, Julian; Manser, Amanda; Parry, Gareth; Chan, Peter; Das, Dinesh; Fahmy, Nisreen; Higgins, David; Khader, Ahamed Abdul; Stone, Alex; Leonardi, Silvia; Rose, Oliver; Ercole, Ari; Rafi, Muhammed Amir; Ramasamy, Radhika; Sheshgiri, Bengeri; Merrill, Colin; Page, Valerie; Walker, Elaine; Harris, Stephen; Hughes, Sarah; Morrison, Alan; Razouk, Khaled; Ayman, Mustafa; al-Subaie, Nawaf; Arif, Fuhazia; Cashman, Jeremy; Cecconi, Maurizio; Edsell, Mark; Fossati, Nicoletta; Hammond, Sarah Jane; Hamilton, Mark; Lonsdale, Dagan; Moran, Carl; Siegmueller, Claas; Velzeboer, Freya; Wong, Patrick; Jakeman, Alicia; Mowatt, Chris; Tsakas, Pirros; Clouva-Molyvdas, Phyllis-Maria; Nyktari, Vasileia; Malliotakis, Polychronis; Bekos, Vasileios; Molnar, Tamas; Karason, Sigurbergur; Blondal, Asbjorn; Di Mauro, Piero; Tommasino, Concezione; Zandvliet, Ria; in't Veld, Bas A.; Reidinga, Auke C.; Dagfinn Boksasp, Ola; Kostryka, Wlodzimierz; Choma, Robert; de Sousa Pereira de Freitas, Ana Claudia; de la Quintana Gordon, Borja; Serra, Sofia; Goncalves Castro, Maria de Lurdes; Botas, Concecao; Maldovan, Ion; Rely, Manolescu; Sandesc, Dorel; Copotoiu, Sanda-Maria; Obradovic, Jovana; Zahorec, Roman; Stecher, Adela; Stivan, Feri; Vallejo, Ana; Mas Serra, Arantxa; Real Navacerrada, Isabel; Pastor Martinez, Ernesto; Camps Cervantes, Angel; de Nadal Clanchet, Miriam; Zaldibar, Estibaliz; Miguez Crespo, Maria del Rocio; Laza Laza, Enrique; Heredia Perez, Maria del Pino; India, Inmaculada; Moral, Victoria; Concostrina, Maria de la Torre; de la Vega Terol, Alvaro; Zabarte, Mercedes; Seron-Arbeloa, Carlos; del Olmo, Mercedes; Franqueza Garcia Isabel Garcia Vega, Jose Luis; Santos Oveido, Arnoldo; Inigo, Jose Alonso; de la Torre Prados, Maria Victoria; Ferrandiz-Selles, Amparo; Seeman-Lodding, Helene; Ryde'n, Jorgen; Wernerman, Jan; Bjorne, Hakan; Kong, Ming-Li; Blunt, Mark; Moosajee, Vas; Edger, Lliam; Sandhar, Taj; Day, Christopher; Foo, Irwin; Pierro, Dena; Price, Grant; Desikan, Somi; Mok, May Un Sam; Trodd, Dawn; Soar, Jasmeet; Bright, Elizabeth

2015-01-01

BACKGROUND Evidence suggests that sleep deprivation associated with night-time working may adversely affect performance resulting in a reduction in the safety of surgery and anaesthesia. OBJECTIVE Our primary objective was to evaluate an association between nonelective night-time surgery and

Primary closure in colon trauma.

Science.gov (United States)

Salinas-Aragón, Luis Enrique; Guevara-Torres, Lorenzo; Vaca-Pérez, Enrique; Belmares-Taboada, Jaime Arístides; Ortiz-Castillo, Fátima de Guadalupe; Sánchez-Aguilar, Martín

2009-01-01

Primary repair of colon injuries is an accepted therapeutic option; however, controversy persists regarding its safety. Our objective was to report the evolution and presence of complications in patients with colon injury who underwent primary closure and to determine if the time interval (>6 h), degree of injury, contamination, anatomic site injured, PATI (Penetrating Abdominal Trauma Index) >25, and the presence of other injuries in colon trauma are associated with increased morbidity and mortality. This was a prospective, observational, longitudinal and descriptive study conducted at the Central Hospital "Dr. Ignacio Morones Prieto," San Luis Potosí, Mexico, from January 1, 2003 to December 31, 2007. We included patients with abdominal trauma with colon injury subjected to surgical treatment. chi(2) was used for basic statistical analysis. There were 481 patients with abdominal trauma who underwent surgery; 77(16.1%) had colon injury. Ninety percent (n = 69) were treated in the first 6 h; 91% (n = 70) were due to penetrating injuries, and gunshot wound accounted for 48% (n = 37). Transverse colon was the most frequently injured (38%) (n = 29). Grade I and II injuries accounted for 75.3% (n = 58). Procedures included primary repair (76.66 %) (n = 46); resection with anastomosis (8.3%) (n = 5); and colostomy (15%) (n = 9). Associated injuries were present in 76.6% (n = 59). There was some degree of contamination in 85.7% (n = 66); 82.8% (58) had PATI colon injury. Primary repair is a safe procedure for treatment of colon injuries. Patients with primary repair had lower morbidity (p <0.009). Surgery during the first 6 h (p <0.006) and in hemodynamically stable patients (p <0.014) had a lower risk of complications.

Minimally invasive surgery for esophageal achalasia

OpenAIRE

Bonavina, Luigi

2006-01-01

Esophageal achalasia is the most commonly diagnosed primary esophageal motor disorder and the second most common functional esophageal disorder. Current therapy of achalasia is directed toward elimination of the outflow resistance caused by failure of the lower esophageal sphincter to relax completely upon swallowing. The advent of minimally invasive surgery has nearly replaced endoscopic pneumatic dilation as the first-line therapeutic approach. In this editorial, the rationale and the evide...

Adolescent Bariatric Surgery — Thoughts and Perspectives from the UK

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Penna, Marta; Markar, Sheraz; Hewes, James; Fiennes, Alberic; Jones, Niall; Hashemi, Majid

2013-01-01

Opinions of healthcare professionals in the United Kingdom regarding bariatric surgery in adolescents are largely unknown. This study aims to explore the perspectives of medical professionals regarding adolescent bariatric surgery. Members of the British Obesity and Metabolic Surgery Society and groups of primary care practitioners based in London were contacted by electronic mail and invited to complete an anonymous online survey consisting of 21 questions. Ninety-four out of 324 questionnaires were completed. 66% of professionals felt that adolescents with a body mass index (BMI) >40 or BMI >35 with significant co-morbidities can be offered surgery. Amongst pre-requisites, parental psychological counseling was chosen most frequently. 58% stated 12 months as an appropriate period for weight management programs, with 24% regarding 6 months as sufficient. Most participants believed bariatric surgery should only be offered ≥16 years of age. However, 17% of bariatric surgeons marked no minimum age limit. Over 80% of the healthcare professionals surveyed consider bariatric surgery in adolescents to be acceptable practice. Most healthcare professionals surveyed feel that adolescent bariatric surgery is an acceptable therapeutic option for adolescent obesity. These views can guide towards a consensus opinion and further development of selection criteria and care pathways. PMID:24384777

Adolescent Bariatric Surgery — Thoughts and Perspectives from the UK

Directory of Open Access Journals (Sweden)

Marta Penna

2013-12-01

Full Text Available Opinions of healthcare professionals in the United Kingdom regarding bariatric surgery in adolescents are largely unknown. This study aims to explore the perspectives of medical professionals regarding adolescent bariatric surgery. Members of the British Obesity and Metabolic Surgery Society and groups of primary care practitioners based in London were contacted by electronic mail and invited to complete an anonymous online survey consisting of 21 questions. Ninety-four out of 324 questionnaires were completed. 66% of professionals felt that adolescents with a body mass index (BMI >40 or BMI >35 with significant co-morbidities can be offered surgery. Amongst pre-requisites, parental psychological counseling was chosen most frequently. 58% stated 12 months as an appropriate period for weight management programs, with 24% regarding 6 months as sufficient. Most participants believed bariatric surgery should only be offered ≥16 years of age. However, 17% of bariatric surgeons marked no minimum age limit. Over 80% of the healthcare professionals surveyed consider bariatric surgery in adolescents to be acceptable practice. Most healthcare professionals surveyed feel that adolescent bariatric surgery is an acceptable therapeutic option for adolescent obesity. These views can guide towards a consensus opinion and further development of selection criteria and care pathways.

Initial experience of Da Vinci robotic thoracic surgery at the First Affiliated Hospital of Zhejiang University

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He, Zhehao; Zeng, Liping; Zhang, Chong; Wang, Luming; Wang, Zhitian; Rustam, Azmat; Du, Chengli; Lv, Wang

2017-01-01

Robot-assisted thoracic surgery (RATS) is a relatively new but rapidly adopted technique, pioneered by the urological and gynecological departments. The primary objective of this study is to present the current status, a series of improvement and innovation of Da Vinci robotic surgery in the Department of Thoracic Surgery at First Affiliated Hospital of Zhejiang University. In addition, we discuss the prospect of robotic surgical technology. PMID:29302429

The number of cycles of neoadjuvant chemotherapy is associated with prognosis of stage IIIc-IV high-grade serous ovarian cancer.

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Xu, Xia; Deng, Fei; Lv, Mengmeng; Chen, Xiaoxiang

2017-02-01

No consensus exists on the number of chemotherapy cycles to be administered before and after interval debulking surgery (IDS) in patients with advanced stage epithelial ovarian cancer. The present study aims to explore the optimal number of cycles of neoadjuvant chemotherapy (NAC) and post-operation chemotherapy to treat the International Federation of Gynecology and Obstetrics stage IIIc-IV high-grade serous ovarian cancer (HG-SOC). A total of 129 IIIc-IV stage HG-SOC cases were retrospectively analyzed. Cases were comprised of patients who underwent NAC followed by IDS and who achieved clinical complete response (CCR) at the end of primary therapy. Patients were recruited from the Jiangsu Institute of Cancer Research between 1993 and 2013. Optimal IDS-associated factors were explored with logistic regression. The association between progression-free survival (PFS), overall survival (OS) duration, and covariates was assessed by Cox proportional hazards model and log-rank test. The median number of NAC cycle was 3 (range 1-8). CA-125 decreasing kinetics (p = 0.01) was independently associated with optimal IDS. CA-125 decreasing kinetics, optimal IDS, and NAC cycles was independently associated with OS (p cycles was shorter than those of patients who underwent cycles (12.3 versus 17.2 months). The PFS and OS of patients who underwent cycles of adjuvant chemotherapy post-IDS were shorter than those of patients who underwent ≥5 cycles (14.2 and 20.3 versus 21.2 and 28.8 months). NAC cycles, CA-125 decreasing kinetics, and optimal debulking are independently associated with the prognosis of patients with advanced stage HG-SOC who underwent NAC/IDS and achieved CCR. The number of administered NAC cycles should not exceed 4.

Cohort profile: the Nordic Antireflux Surgery Cohort (NordASCo).

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Maret-Ouda, John; Wahlin, Karl; Artama, Miia; Brusselaers, Nele; Färkkilä, Martti; Lynge, Elsebeth; Mattsson, Fredrik; Pukkala, Eero; Romundstad, Pål; Tryggvadóttir, Laufey; Euler-Chelpin, My von; Lagergren, Jesper

2017-06-08

To describe a newly created all-Nordic cohort of patients with gastro-oesophageal reflux disease (GORD), entitled the Nordic Antireflux Surgery Cohort (NordASCo), which will be used to compare participants having undergone antireflux surgery with those who have not regarding risk of cancers, other diseases and mortality. Included were individuals with a GORD diagnosis recorded in any of the nationwide patient registries in the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) in 1964-2014 (with various start and end years in different countries). Data regarding cancer, other diseases and mortality were retrieved from the nationwide registries for cancer, patients and causes of death, respectively. The NordASCo includes 945 153 individuals with a diagnosis of GORD. Of these, 48 433 (5.1%) have undergone primary antireflux surgery. Median age at primary antireflux surgery ranged from 47 to 52 years in the different countries. The coding practices of GORD seem to have differed between the Nordic countries. The NordASCo will initially be used to analyse the risk of developing known or potential GORD-related cancers, that is, tumours of the oesophagus, stomach, larynx, pharynx and lung, and to evaluate the mortality in the short-term and long-term perspectives. Additionally, the cohort will be used to evaluate the risk of non-malignant respiratory conditions that might be caused by aspiration of gastric contents. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Use of antibiotics for urinary tract infection in women undergoing surgery for urinary incontinence: a cohort study.

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Guldberg, Rikke; Kesmodel, Ulrik Schiøler; Brostrøm, Søren; Kærlev, Linda; Hansen, Jesper Kjær; Hallas, Jesper; Nørgård, Bente Mertz

2014-02-04

To describe the use of antibiotics for urinary tract infection (UTI) before and after surgery for urinary incontinence (UI); and for those with use of antibiotics before surgery, to estimate the risk of treatment for a postoperative UTI, relative to those without use of antibiotics before surgery. A historical population-based cohort study. Denmark. Women (age ≥18 years) with a primary surgical procedure for UI from the county of Funen and the Region of Southern Denmark from 1996 throughout 2010. Data on redeemed prescriptions of antibiotics ±365 days from the date of surgery were extracted from a prescription database. Use of antibiotics for UTI in relation to UI surgery, and the risk of being a postoperative user of antibiotics for UTI among preoperative users. A total of 2151 women had a primary surgical procedure for UI; of these 496 (23.1%) were preoperative users of antibiotics for UTI. Among preoperative users, 129 (26%) and 215 (43.3%) also redeemed prescriptions of antibiotics for UTI within 0-60 and 61-365 days after surgery, respectively. Among preoperative non-users, 182 (11.0%) and 235 (14.2%) redeemed prescriptions within 0-60 and 61-365 days after surgery, respectively. Presurgery exposure to antibiotics for UTI was a strong risk factor for postoperative treatment for UTI, both within 0-60 days (adjusted OR, aOR=2.6 (95% CI 2.0 to 3.5)) and within 61-365 days (aOR=4.5 (95% CI 3.5 to 5.7)). 1 in 4 women undergoing surgery for UI was treated for UTI before surgery, and half of them had a continuing tendency to UTIs after surgery. Use of antibiotics for UTI before surgery was a strong risk factor for antibiotic use after surgery. In women not using antibiotics for UTI before surgery only a minor proportion initiated use after surgery.

A nationwide study on anastomotic leakage after colonic cancer surgery

DEFF Research Database (Denmark)

Krarup, Peter-Martin; Jorgensen, L N; Andreasen, A H

2012-01-01

Aim: Anastomotic leakage (AL) is a major challenge in colorectal cancer surgery due to increased morbidity and mortality. Possible risk factors should be investigated differentially, distinguishing between rectal and colonic surgery in large-scale studies to avoid selection bias and confounding....... Method: The incidence and risk factors associated with AL were analysed in an unselected nation-wide prospective cohort of patient subjected to curative colonic cancer surgery with primary anastomosis and entered into The Danish Colorectal Cancer Group database between May 2001 and December 2008. Results......: AL occurred in 593 (6.4%) of 9333 patients. Laparoscopic surgery (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.05-1.70; P = 0.03); left hemicolectomy (OR, 2.02; 95% CI, 1.50-2.72) or sigmoid colectomy (OR, 1.69; 95% CI, 1.32-2.17; P = 0.01); intraoperative blood loss (OR, 1.04; 95% CI, 1...

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

Science.gov (United States)

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

2012-11-27

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

Agressive fibromatosis involving the mandible--case report and review of the literature.

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Seper, László; Bürger, Horst; Vormoor, Josef; Joos, Ulrich; Kleinheinz, Johannes

2005-01-01

Aggressive fibromatosis (AF) involving the mandible is rare, and surgery is often complicated by a high recurrence rate. A 4-year-old boy was referred because of a fast growing painless mass which involved the entire left angle of the mandible. Excisional biopsy revealed AF, and local excision of the tumor was performed. Six months after surgery a recurrence was detected. The tumor was determined to be unresectable and the boy was treated with low-dose chemotherapy including methotrexate and vinblastine for 1 year. With combined chemotherapy and surgical debulking, mutilating surgical resection will be delayed as long as possible or until completion of facial growth. According to the literature, surgery is the most common treatment of AF in the head and neck region. However, particularly in children, alternative modes of therapy must be considered because of the high recurrence rate and to avoid mutilating operations.

Optimal primary surgical treatment for advanced epithelial ovarian cancer.

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Elattar, Ahmed; Bryant, Andrew; Winter-Roach, Brett A; Hatem, Mohamed; Naik, Raj

2011-08-10

Ovarian cancer is the sixth most common cancer among women. In addition to diagnosis and staging, primary surgery is performed to achieve optimal cytoreduction (surgical efforts aimed at removing the bulk of the tumour) as the amount of residual tumour is one of the most important prognostic factors for survival of women with epithelial ovarian cancer. An optimal outcome of cytoreductive surgery remains a subject of controversy to many practising gynae-oncologists. The Gynaecologic Oncology group (GOG) currently defines 'optimal' as having residual tumour nodules each measuring 1 cm or less in maximum diameter, with complete cytoreduction (microscopic disease) being the ideal surgical outcome. Although the size of residual tumour masses after surgery has been shown to be an important prognostic factor for advanced ovarian cancer, it is unclear whether it is the surgical procedure that is directly responsible for the superior outcome that is associated with less residual disease. To evaluate the effectiveness and safety of optimal primary cytoreductive surgery for women with surgically staged advanced epithelial ovarian cancer (stages III and IV).To assess the impact of various residual tumour sizes, over a range between zero and 2 cm, on overall survival. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 3) and the Cochrane Gynaecological Cancer Review Group Trials Register, MEDLINE and EMBASE (up to August 2010). We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. Retrospective data on residual disease from randomised controlled trials (RCTs) or prospective and retrospective observational studies which included a multivariate analysis of 100 or more adult women with surgically staged advanced epithelial ovarian cancer and who underwent primary cytoreductive surgery followed by adjuvant platinum

Thyroid storm following anterior cervical spine surgery for tuberculosis of cervical spine

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Sanjiv Huzurbazar

2014-01-01

Full Text Available Objective: The primary objective was to report this rare case and discuss the probable mechanism of thyroid storm following anterior cervical spine surgery for Kochs cervical spine.

Factors Associated With Surgery Clerkship Performance and Subsequent USMLE Step Scores.

Science.gov (United States)

Dong, Ting; Copeland, Annesley; Gangidine, Matthew; Schreiber-Gregory, Deanna; Ritter, E Matthew; Durning, Steven J

2018-03-12

We conducted an in-depth empirical investigation to achieve a better understanding of the surgery clerkship from multiple perspectives, including the influence of clerkship sequence on performance, the relationship between self-logged work hours and performance, as well as the association between surgery clerkship performance with subsequent USMLE Step exams' scores. The study cohort consisted of medical students graduating between 2015 and 2018 (n = 687). The primary measures of interest were clerkship sequence (internal medicine clerkship before or after surgery clerkship), self-logged work hours during surgery clerkship, surgery NBME subject exam score, surgery clerkship overall grade, and Step 1, Step 2 CK, and Step 3 exam scores. We reported the descriptive statistics and conducted correlation analysis, stepwise linear regression analysis, and variable selection analysis of logistic regression to answer the research questions. Students who completed internal medicine clerkship prior to surgery clerkship had better performance on surgery subject exam. The subject exam score explained an additional 28% of the variance of the Step 2 CK score, and the clerkship overall score accounted for an additional 24% of the variance after the MCAT scores and undergraduate GPA were controlled. Our finding suggests that the clerkship sequence does matter when it comes to performance on the surgery NBME subject exam. Performance on the surgery subject exam is predictive of subsequent performance on future USMLE Step exams. Copyright © 2018 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Frequent occurrence of the triphasic response (diabetes insipidus/hyponatremia/diabetes insipidus) after surgery for craniopharyngioma in childhood

NARCIS (Netherlands)

Finken, Martijn J. J.; Zwaveling-Soonawala, Nitash; Walenkamp, Marie J. E.; Vulsma, Thomas; van Trotsenburg, A. S. Paul; Rotteveel, Joost

2011-01-01

It is not exactly known how many children develop the triphasic response (diabetes insipidus (DI)/hyponatremia/DI) immediately after surgery for childhood craniopharyngioma; neither is it known which factors predict this. We studied the occurrence of the triphasic response after primary surgery for

Forty years of shunt surgery at Rigshospitalet, Denmark

DEFF Research Database (Denmark)

Mansson, Philip Kofoed; Johansson, Sofia; Ziebell, Morten

2017-01-01

Objective The objective of this study is to review our experience of shunt surgery by investigating 40years of development in terms of rates of revision and infection, shunt survival and risk factors. Design and participants Medical records and operative reports were reviewed retrospectively...... for all patients who underwent primary shunt surgery at our department in the years 2010 to 2012. All results were compared with a previous study from our department. A mixed population consisting of 434 patients was included. Adults (≥15years) accounted for 89.9% of all patients and the mean follow.......1-54.9). Within 4weeks postoperatively, 3.2% had an infection and overall infection rate was 5.5%. Short duration of surgery and the use of antibiotic prophylaxis were associated with a lower risk of infection. The most frequent causes of revision were valve defects (18.4%) and proximal defects or obstructions...

A COMPARISON OF TWO DIFFERENT DOSES OF DEXMEDETOMIDINE INFUSION DURING MAINTENANCE OF GENERAL ANAESTHESIA IN PATIENTS UNDERGOING SPINE SURGERIES, FUNCTIONAL ENDOSCOPIC SINUS SURGERY AND MIDDLE EAR SURGERIES

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Bijay

2016-03-01

Full Text Available BACKGROUND This study is undertaken to compare the hemodynamic effects and reduction in the doses of volatile anaesthetics and muscle relaxants using two different doses of dexmedetomidine infusion during maintenance of anaesthesia in spine, functional endoscopic sinus surgery and middle ear surgeries. METHODS Sixty patients are randomly divided into 2 groups of 30 each. After shifting to the operation theatre baseline vitals were recorded. Anesthesia induced with thiopentone sodium and intubation done with the help of succinylcholine and maintained with oxygen, nitrous oxide and isoflurane. After 1 min of intubation, maintenance infusion of dexmedetomidine (0.4 mcg/kg/hr and 0.7 mcg/kg/hr for patients allotted in 2 separate groups was started and stopped 15 min before end of surgery. Hemodynamic parameters and any reduction in the doses of volatile anaesthetics and muscle relaxants was noted. RESULTS Dexmedetomidine infusion (0.4 mcg/kg/hr and 0.7 mcg/kg/hr in both groups reduced the requirements of muscle relaxants and volatile anaesthetics. Hemodynamic stability was better in the group receiving 0.4 mcg/kg/hr. Patients receiving 0.7 mcg/kg/hr had higher incidence of hypotension, bradycardia and delayed emergence from anaesthesia. CONCLUSION Dexmedetomidine infusion at 0.4 mcg/kg/hr during maintenance of anaesthesia in spine surgery, FESS and middle ear surgery would be good option to reduce the requirements of volatile anaesthetics, muscle relaxants and for better hemodynamic stability. OBJECTIVE OF STUDY: Primary Objective To compare and evaluate the hemodynamic effects and reduction in requirements of volatile anaesthetics and muscle relaxants with two different doses of dexmedetomidine infusion during maintenance of general anaesthesia in patients undergoing spine, FESS and middle ear surgeries.

Examinations on cases of surgery for radiation-induced disorders of large intestine

Energy Technology Data Exchange (ETDEWEB)

Shiba, Tadaaki [Toho Univ., Tokyo (Japan). School of Medicine

1996-11-01

Author`s experience of surgery for radiation colitis was examined and discussed on the primary disease, radiation dose, major symptoms, surgical techniques, results and post-operative complication. Patients were 1 male and 21 females of the average age of 59.5 y. The primary diseases were bladder cancer for the male and uterine cancer for the females. The radiation dose ranged from 35-120 Gy and was 63.4 Gy in a mean. The symptoms for surgery were 14 ileuses, 4 intestinal hemorrhages, 1 perforation and 3 burrows. Colostomy was performed for 18 cases; enterostomy, 2; anastomosis, 1; and enterectomy, 1, which resulted in improvement of symptoms in 5 cases, 0, 1 and 1, respectively. The author concluded that radiation colitis should be treated preventively. (K.H.)

Consensus statement on anaesthesia for day care surgeries

Directory of Open Access Journals (Sweden)

Satish Kulkarni

2017-01-01

Full Text Available The primary aim of day-care surgery units is to allow for early recovery of the patients so that they can return to their familiar 'home' environment; the management hence should be focused towards achieving these ends. The benefits could include a possible reduction in the risk of thromboembolism and hospital-acquired infections. Furthermore, day-care surgery is believed to reduce the average unit cost of treatment by up to 70% as compared to inpatient surgery. With more than 20% of the world's disease burden, India only has 6% of the world's hospital beds. Hence, there is an immense opportunity for expansion in day-care surgery in India to ensure faster and safer, cost-effective patient turnover. For this to happen, there is a need of change in the mindset of all concerned clinicians, surgeons, anaesthesiologists and even the patients. A group of nine senior consultants from various parts of India, a mix of private and government anaesthesiologists, assembled in Mumbai and deliberated and discussed on the various aspects of day-care surgery. They formulated a consensus statement, the first of its kind in the Indian scenario, which can act as a guidance and tool for day-care anaesthesia in India. The statements are derived from the available published evidence in peer-reviewed literature including guidelines of several bodies such as the American Society of Anesthesiologists, British Association of Day Surgery and International Association of Ambulatory Surgery. The authors also offer interpretive comments wherever such evidence is inadequate or contradictory.

Evaluation of aesthetic and functional outcomes in rhinoplasty surgery: a prospective study.

Science.gov (United States)

Sena Esteves, Sara; Gonçalves Ferreira, Miguel; Carvalho Almeida, João; Abrunhosa, José; Almeida E Sousa, Cecília

Evaluation of surgery outcome measured by patient satisfaction or quality of life is very important, especially in plastic surgery. There is increasing interest in self-reporting outcomes evaluation in plastic surgery. The aim of our study was to determine patient satisfaction in regard to nose appearance and function with the use of a validated questionnaire, before and after rhinoplasty surgery. A prospective study was realized at a tertiary centre. All rhinoplasty surgeries performed in adults between February 2013 and August 2014 were included. Many patients underwent additional nasal surgery such as septoplasty or turbinoplasty. The surgical procedures and patients' characteristics were also recorded. Among 113 patients, 107 completed the questionnaires and the follow-up period. Analysis of pre-operative and post-operative Rhinoplasty Evaluation Outcome showed a significant improvement after 3 and 6 months in functional and aesthetic questions (pprocedures, primary or revision surgery and open versus closed approach. We found that patients with lower literacy degree were more satisfied with the procedure. Rhinoplasty surgery significantly improved patient quality of life regarding nose function and appearance. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Salvage surgery for local failure of oral squamous cell carcinoma

International Nuclear Information System (INIS)

Omura, Ken; Harada, Hiroyuki; Shimamoto, Hiroaki

2003-01-01

Local failure rates following treatment for squamous cell carcinoma of the oral cavity have been reported to be in the range of 25%-48%. This study investigated the pattern of failure for squamous cell carcinoma (SCC) of the oral cavity and evaluated salvage surgery for local recurrent disease. The tumor files of 549 patients undergoing treatment for SCC of the oral cavity between 1980 and 2000 at Chiba Cancer Center Hospital were reviewed. Of 549 patients, 289 were initially treated with radiation therapy for their primary tumor, and 260 with surgery, either with or without radiation therapy. One hundred and sixty-one patients developed failures, yielding a failure rate of 29.3%. The site of recurrent tumor was local in 72 (13.1%) patients, regional in 89 (16.2%) patients, and distant in 5 (0.9%) patients. Local failure developed in 49 (17.0%) patients with radiation therapy and in 23 (8.8%) patients with surgery. Out of these 72 patients with local failure, 41 (56.9%) patients had salvage surgery for their disease. Twenty-five (73.5%) of the 34 patients initially treated with radiation therapy were salvaged with surgery, and 4 (57.1%) of the 7 patients initially treated with surgery were cured with further surgery. For the treatment of patients with local failure, the disease should be diagnosed more carefully than untreated disease. The disease that has recurred after radiation therapy may be more likely to be salvaged by surgery, however, the disease that has developed after surgery may have a limited indication for re-surgery. (author)

An evaluation of surgical outcome of bilateral cleft lip surgery using a modified Millard′s (Fork Flap technique

Directory of Open Access Journals (Sweden)

W L Adeyemo

2013-01-01

Full Text Available Background: The central third of the face is distorted by the bilateral cleft of the lip and palate and restoring the normal facial form is one of the primary goals for the reconstructive surgeons. The history of bilateral cleft lip repair has evolved from discarding the premaxilla and prolabium and approximating the lateral lip elements to a definitive lip and primary cleft nasal repair utilising the underlying musculature. The aim of this study was to review surgical outcome of bilateral cleft lip surgery (BCLS done at the Lagos University Teaching Hospital. Materials and Methods: A review of all cases of BCLS done between January 2007 and December 2012 at the Lagos University Teaching Hospital was done. Data analysis included age and sex of patients, type of cleft deformity and type of surgery (primary or secondary and whether the cleft deformity was syndromic and non-syndromic. Techniques of repair, surgical outcome and complications were also recorded. Results: A total of 39 cases of BCLS involving 21 males and 18 females were done during the period. This constituted 10% (39/390 of all cases of cleft surgery done during the period. There were 5 syndromic and 34 non-syndromic cases. Age of patients at time of surgery ranged between 3 months and 32 years. There were 24 bilateral cleft lip and palate deformities and 15 bilateral cleft lip deformities. Thirty-one of the cases were primary surgery, while 8 were secondary (revision surgery. The most common surgical technique employed was modified Fork flap (Millard technique, which was employed in 37 (95% cases. Conclusion: Bilateral cleft lip deformity is a common cleft deformity seen in clinical practice, surgical repair of which can be a challenge to an experienced surgeon. A modified Fork flap technique for repair of bilateral cleft lip is a reliable and versatile technique associated with excellent surgical outcome.

Lawsuits After Primary and Revision Total Hip Arthroplasties: A Malpractice Claims Analysis.

Science.gov (United States)

Patterson, Diana C; Grelsamer, Ronald P; Bronson, Michael J; Moucha, Calin S

2017-10-01

As the prevalence of total hip arthroplasty (THA) expands, so too will complications and patient dissatisfaction. The goal of this study was to identify the common etiologies of malpractice suits and costs of claims after primary and revision THAs. Analysis of 115 malpractice claims filed for alleged neglectful primary and revision THA surgeries by orthopedic surgeons insured by a large New York state malpractice carrier between 1983 and 2011. The incidence of malpractice claims filed for negligent THA procedures is only 0.15% per year in our population. In primary cases, nerve injury ("foot drop") was the most frequent allegation with 27 claims. Negligent surgery causing dislocation was alleged in 18 and leg length discrepancy in 14. Medical complications were also reported, including 3 thromboembolic events and 6 deaths. In revision cases, dislocation and infection were the most common source of suits. The average indemnity payment was $386,153 and the largest single settlement was $4.1 million for an arterial injury resulting in amputation after a primary hip replacement. The average litigation cost to the insurer was $61,833. Nerve injury, dislocation, and leg length discrepancy are the most common reason for malpractice after primary THA. Orthopedic surgeons should continue to focus on minimizing the occurrence of these complications while adequately incorporating details about the risks and limitations of surgery into their preoperative education. Copyright © 2017 Elsevier Inc. All rights reserved.

Influence of postsurgical residual tumor volume on local control in radiotherapy for maxillary sinus cancer

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Kawashima, Mitsuhiko; Ogino, Takashi; Hayashi, Ryuichi; Ishikura, Satoshi; Nihei, Keiji; Ito, Yoshinori; Ikeda, Hiroshi; Ebihara, Satoshi [National Cancer Center, Kashiwa, Chiba (Japan). Hospital East; Itai, Yuji

2001-05-01

The aim was to study the influence of postsurgical gross residual tumor volume on local control of maxillary sinus cancer treated with radiotherapy combined with debulking surgery. Forty-three patients who underwent combined surgery and radiotherapy (50-72 Gy, median 60 Gy) for squamous cell carcinoma of the maxillary sinus were reviewed. Gross residual tumor volume (GRTV) after surgery was measured on computed tomograms obtained during the radiotherapy planning. Patients were classified according to GRTV as follows: group AA, GRTV=0 (microscopic residual, n=2); group A, GRTV <10 cm{sup 3} (n=24); group B, 10-40 cm{sup 3} (n=9); and group C, {>=}40 cm{sup 3} (n=8). The relationship between local control and GRTV was analyzed using univariate and multivariate analysis. The 2-year local control rate for all patients was 62%. The differences in local control rates between groups AA, A and B were not significant (P<0.05), but the rate was significantly lower in group C than in the other groups (69% at 2 years vs 31% at 1 year, P<0.001). Multivariate analysis showed that GRTV (P=0.002) and histological differentiation (poorly differentiated histology was favorable, P=0.035) were independent prognostic factors and that intraarterial chemotherapy and administered total dose were not. Local control in groups A and B significantly depended on the total dose of radiotherapy, with 2-year control rates of patients receiving 50 Gy (n=6) and {>=}60 Gy (n=27) of 17% vs 79%, respectively (P<0.001). Our data suggest that adequate, not complete, debulking associated with a total radiotherapy dose of {>=}60 Gy can provide satisfactory local control for patients with squamous cell carcinoma of the maxillary sinus. (author)

The surgery of peripheral nerves (including tumors)

DEFF Research Database (Denmark)

Fugleholm, Kåre

2013-01-01

Surgical pathology of the peripheral nervous system includes traumatic injury, entrapment syndromes, and tumors. The recent significant advances in the understanding of the pathophysiology and cellular biology of peripheral nerve degeneration and regeneration has yet to be translated into improved...... surgical techniques and better outcome after peripheral nerve injury. Decision making in peripheral nerve surgery continues to be a complex challenge, where the mechanism of injury, repeated clinical evaluation, neuroradiological and neurophysiological examination, and detailed knowledge of the peripheral...... nervous system response to injury are prerequisite to obtain the best possible outcome. Surgery continues to be the primary treatment modality for peripheral nerve tumors and advances in adjuvant oncological treatment has improved outcome after malignant peripheral nerve tumors. The present chapter...

Primary medulla oblongata germinoma in a male patient.

Science.gov (United States)

Shuto, Takashi; Ohtake, Makoto; Matsunaga, Shigeo; Hasegawa, Naoki

2012-05-01

Germinoma mainly occurs in the pituitary stalk, pineal region, and basal ganglia. Sex predominance of the tumor in males in the pineal region and basal ganglia is well known. Primary germinoma of the medulla oblongata is rare, with only eight reports, mostly in females. We report the second male patient with primary medulla oblongata germinoma, without chromosomal abnormality, who was successfully treated with surgery, chemotherapy, and radiotherapy. Copyright © 2011 Elsevier Ltd. All rights reserved.

The Safety of Aesthetic Labiaplasty: A Plastic Surgery Experience.

Science.gov (United States)

Lista, Frank; Mistry, Bhavik D; Singh, Yashoda; Ahmad, Jamil

2015-08-01

The demand for female aesthetic labiaplasty surgery continues to rapidly increase. Several questions have been raised regarding the safety and effectiveness of female aesthetic genital surgery. The purpose of this study is to review our experience with aesthetic labiaplasty and describe the type and frequency of complications that have been experienced. A retrospective chart review was performed on all patients who had primary aesthetic labia minora reduction surgery from August 2007 to April 2014. A chart review of the electronic medical record was performed to examine demographic, procedural, and outcome data. In the study period, 113 patients underwent aesthetic labiaplasty. Of these, 29 patients (25.6%) had labiaplasty performed in combination with another procedure. A total of 15 patients (13.3%) reported transient symptoms, including swelling, bruising, and pain. There was one patient (0.8%) that experienced bleeding. Four patients (3.5%) required revision surgery. All revisions were performed to excise further tissue to address persistent redundancy or asymmetry. No major complications were reported. In our experience, aesthetic surgery of the labia minora using an edge excision technique has a very low complication rate and provides satisfactory aesthetic outcomes for our patients. More studies examining the impact of labiaplasty on a woman's self-image and quality of life would add to our understanding of the motivations and expectations of women undergoing this aesthetic surgery. This information will allow us to help our patients make well-informed decisions when considering this aesthetic genital surgery. 4 Risk. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

Resident operative experience in general surgery, plastic surgery, and urology 5 years after implementation of the ACGME duty hour policy.

Science.gov (United States)

Simien, Christopher; Holt, Kathleen D; Richter, Thomas H; Whalen, Thomas V; Coburn, Michael; Havlik, Robert J; Miller, Rebecca S

2010-08-01

Resident duty hour restrictions were implemented in 2002-2003. This study examines changes in resident surgical experience since these restrictions were put into place. Operative log data for 3 specialties were examined: general surgery, urology, and plastic surgery. The academic year immediately preceding the duty hour restrictions, 2002-2003, was used as a baseline for comparison to subsequent academic years. Operative log data for graduating residents through 2007-2008 were the primary focus of the analysis. Examination of associated variables that may moderate the relationship between fewer duty hours and surgical volume was also included. Plastic surgery showed no changes in operative volume following duty hour restrictions. Operative volume increased in urology programs. General surgery showed a decrease in volume in some operative categories but an increase in others. Specifically the procedures in vascular, plastic, and thoracic areas showed a consistent decrease. There was no increase in the percentage of programs' graduates falling below minimum requirements. Procedures in pancreas, endocrine, and laparoscopic areas demonstrated an increase in volume. Graduates in larger surgical programs performed fewer procedures than graduates in smaller programs; this was not the case for urology or plastic surgery programs. The reduction of duty hours has not resulted in an across the board decrease in operative volume. Factors other than duty hour reforms may be responsible for some of the observed findings.

Use of Vagus Nerve Stimulator on Children With Primary Generalized Epilepsy.

Science.gov (United States)

Welch, William P; Sitwat, Bilal; Sogawa, Yoshimi

2018-06-01

To describe the response to vagus nerve stimulator (VNS) in otherwise neurotypical children with medically intractable primary generalized epilepsy. Retrospective chart review of patients who underwent vagus nerve stimulator surgery between January 2011 and December 2015. Eleven patients were identified. Median follow-up duration was 2.5 years (1.2-8.4 years). Prior to vagus nerve stimulator surgery, all patients had at least 1 seizure per week, and 7/11 (64%) had daily seizures. At 1-year follow-up after vagus nerve stimulator, 7/11 (64%) reported improved seizure frequency and 6/11 (55%) reported fewer than 1 seizure per month. Three patients (27%) reported complications related to vagus nerve stimulator surgery, and no patients required device removal. In children with medically intractable primary generalized epilepsy, vagus nerve stimulator is well tolerated and appears to lead to improvement in seizure frequency. Improvement was not attributable to epilepsy classification, age at vagus nerve stimulator implantation, output current, duty cycle, or follow-up duration.

Primary Ewing's Sarcoma of the temporal bone in an infant.

Science.gov (United States)

Goudarzipour, Kourosh; Shamsian, Shahin; Alavi, Samin; Nourbakhsh, Kazem; Aghakhani, Roxana; Eydian, Zahra; Arzanian, Mohammad Taghi

2015-04-01

Introduction : Ewing's sarcoma is the second most common primary malignant tumor of bone found in children after Osteosarcoma. It accounts for 4-9% of primary malignant bone tumors and it affects bones of the skull or face in only 1-4% of cases. Hence it rarely affects the head and neck. Subject and Method : In this case report, we describe a case of primary Ewing's sarcoma occurring in the temporal bone. The tumor was surgically excised, and the patient underwent chemotherapy for ten months. Results : Neither recurrence nor distant metastasis was noted in these 10 months after surgery but about 18 months after surgery our patient was expired. Conclusion : Although the prognosis of Ewing's sarcoma is generally poor because of early metastasis to the lungs and to other bones, a review of the article suggested that Ewing's sarcoma occurring in the skull can often be successfully managed by intensive therapy with radical excision and chemotherapy. This result was supported by the case reported here.

The efficacy of adductor canal blockade after minor arthroscopic knee surgery

DEFF Research Database (Denmark)

Espelund, M; Fomsgaard, J S; Haraszuk, J

2014-01-01

for minor knee surgery were enrolled in this placebo-controlled, blinded trial. The patients were randomised to receive an ACB with either 30 ml ropivacaine 7.5 mg/ml (n = 36) or saline (n = 35) in addition to a basic analgesic regimen with paracetamol and ibuprofen. Primary outcome measure was pain during...... standing at 2 h after surgery. Secondary outcomes were pain at rest, while standing and after a 5-m walk; opioid consumption and opioid-related side effects 0-24 h after surgery. RESULTS: Pain scores {median [interquartile range (IQR)]}, regarding primary outcome were 15 (0-26) mm in the ropivacaine vs. 17...... (5-28) mm in the control group, 95% confidence interval (CI) (-10 to 4) mm, P = 0.41. Ketobemidone consumption 0-2 h post-operatively [median (IQR)] was lower in the ropivacaine vs. the control group: 0.0 (0.0-2.5) mg vs. 2.5 (0.0-5.0) mg, 95% CI: -2.5 to 0 mg, P = 0.01. No differences were observed...

The resection angle in apical surgery

DEFF Research Database (Denmark)

von Arx, Thomas; Janner, Simone F M; Jensen, Simon S

2016-01-01

OBJECTIVES: The primary objective of the present radiographic study was to analyse the resection angle in apical surgery and its correlation with treatment outcome, type of treated tooth, surgical depth and level of root-end filling. MATERIALS AND METHODS: In the context of a prospective clinical...... study, cone beam computed tomography (CBCT) scans were taken before and 1 year after apical surgery to measure the angle of the resection plane relative to the longitudinal axis of the root. Further, the surgical depth (distance from the buccal cortex to the most lingual/palatal point of the resection...... or with the retrofilling length. CONCLUSIONS: Statistically significant differences were observed comparing resection angles of different tooth groups. However, the angle had no significant effect on treatment outcome. CLINICAL RELEVANCE: Contrary to common belief, the resection angle in maxillary anterior teeth...

Renal manifestations of primary hyperparathyroidism

OpenAIRE

Lila, Anurag Ranjan; Sarathi, Vijaya; Jagtap, Varsha; Bandgar, Tushar; Menon, Padma S.; Shah, Nalini Samir

2012-01-01

Primary hyperparathyroidism (PHPT) is associated with nephrolithiasis and nephrocalcinosis. Hypercalciuria is one of the multiple factors that is implicated in the complex pathophysiology of stone formation. The presence of a renal stone (symptomatic or asymptomatic) categorizes PHPT as symptomatic and is an indication for parathyroid adenomectomy. Progression of nephrocalcinosis is largely reversible after successful surgery, but the residual risk persists. PHPT is also associated with decli...

Management of low anal fistula: fistulectomy alone versus fistulectomy with primary closure

International Nuclear Information System (INIS)

Shahid, M.; Malik, S.; Ahmed, Z.

2017-01-01

To compare fistulectomy with primary closure of the wound and fistulectomy alone in the treatment of low anal fistula in terms of healing time. Study Design: Randomized control trial. Place and Duration of Study: Department of General Surgery Combined Military Hospital (CMH) Rawalpindi, from Nov 2006 to May 2007. Material and Methods: Total 60 patients of low anal fistula were enrolled in this study after informed consent and ethical approval. Patients were divided in two groups (A and B) each containing 30 patients. Patient of group A underwent fistulectomy alone whereas patients of group B underwent fistulectomy with primary closure of wound. All the patients were followed two weekly for 06 weeks. On each visit, healing was assessed by naked eye examination of epithelialization and noted on a Proforma. SPSS 17 was used to analyze the results. A p-value of <0.005 was considered statistically significant. Results: At 02 weeks after surgery, none of the patient in group A and 6.6% of group B patients showed wound healing, p-value was not significant i.e. 0.492. At 04 weeks after surgery, 23.3% of group A and 86.6% of group B patients showed wound healing p-value <0.001. At 06 weeks after surgery, 93.3% of group A and 100% of group B patients showed wound healing, p-value was not significant i.e. 0.492. Healing of wound was found more rapid in group B patients who underwent fistulectomy with primary closure of wound. Conclusion: Fistulectomy with primary repair was a better treatment as compared to fistulectomy alone in terms of healing time of wound. (author)

Is single port enough in minimally surgery for pneumothorax?

Science.gov (United States)

Ocakcioglu, Ilhan; Alpay, Levent; Demir, Mine; Kiral, Hakan; Akyil, Mustafa; Dogruyol, Talha; Tezel, Cagatay; Baysungur, Volkan; Yalcinkaya, Irfan

2016-01-01

Video-assisted thoracoscopic surgery is a widespread used procedure for treatment of primary spontaneous pneumothorax patients. In this study, the adaptation of single-port video-assisted thoracoscopic surgery approach to primary spontaneous pneumothorax patients necessitating surgical treatment, with its pros and cons over the traditional two- or three-port approaches are examined. Between January 2011 and August 2013, 146 primary spontaneous pneumothorax patients suitable for surgical treatment are evaluated prospectively. Indications for surgery included prolonged air leak, recurrent pneumothorax, or abnormal findings on radiological examinations. Visual analog scale and patient satisfaction scale score were utilized. Forty triple-port, 69 double-port, and 37 single-port operations were performed. Mean age of 146 (126 male, 20 female) patients was 27.1 ± 16.4 (range 15-42). Mean operation duration was 63.59 ± 26 min; 61.7 for single, 64.2 for double, and 63.8 min for triple-port approaches. Total drainage was lower in the single-port group than the multi-port groups (P = 0.001). No conversion to open thoracotomy or 30-day hospital mortality was seen in our group. No recurrence was seen in single-port group on follow-up period. Visual analog scale scores on postoperative 24th, 48th, and 72nd hours were 3.42 ± 0.94, 2.46 ± 0.81, 1.96 ± 0.59 in the single-port group; significantly lower than the other groups (P = 0.011, P = 0.014, and P = 0.042, respectively). Patient satisfaction scale scores of patients in the single-port group on 24th and 48th hours were 1.90 ± 0.71 and 2.36 ± 0.62, respectively, indicating a significantly better score than the other two groups (P = 0.038 and P = 0.046). This study confirms the competency of single-port procedure in first-line surgical treatment of primary spontaneous pneumothorax.

Corrective Jaw Surgery

Medline Plus

Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

Primary Volvulus of the Small Intestine Exhibiting Chylous Ascites: A Case Report.

Science.gov (United States)

Hayama, Tamuro; Shioya, Takeshi; Hankyo, Meishi; Shimizu, Takao; Shibuya, Hajime; Komine, Osamu; Watanabe, Yoshimasa; Nanbu, Kotaro; Yamada, Taro

2017-01-01

Primary volvulus of the small intestine associated with chylous ascites is very rare, with only four reported cases. In this paper, we report a new case of primary volvulus associated with chylous ascites. The patient was a 70-year-old man. After experiencing bloating and abdominal pain for several hours, he called an ambulance and underwent an emergency examination at our hospital. Abdominal distension, pressure pain, and rebound tenderness were observed throughout his entire abdomen. The patient had a history of hypertension for which he was receiving oral treatment. Abdominal contrast-enhanced computed tomography (CT) revealed an edematous change in the intestinal membrane and volvulus of the small intestine. As findings suggestive of ischemia were observed in part of the intestines, emergency surgery was performed on the day of admission. Open surgery revealed approximately 500 mL of chylous ascites in the abdominal cavity. The small intestine had twisted 180° in a counter-clockwise direction at the root of the superior mesenteric artery, and the mesentery appeared milky white with edematous changes extending 75 to 240 cm from the ligament of Treitz. There was no evidence of intestinal necrosis; therefore intestinal resection was not performed. The volvulus of the small intestine was corrected. Moreover, because there was no other underlying disease observed, surgery was completed. The ascites collected during surgery revealed high levels of triglycerides at 332 mg/dL, and chylous ascites was diagnosed. An abdominal CT performed on the third day after surgery showed an improvement in intestinal edema, and primary volvulus of the small intestine associated with chylous ascites was diagnosed. Postoperative progress was good, and the patient was discharged on hospital day 10.

Palliative radiation in primary squamous cell carcinoma of thyroid: A rare case report

Directory of Open Access Journals (Sweden)

Sushmita Ghoshal

2013-01-01

Full Text Available Primary squamous cell carcinoma of the thyroid is an extremely rare neoplasm with aggressive behavior. Until date, only around 60 cases have been reported in the literature. Primary treatment of the patient is radical surgery. With optimum treatment survival is not more than 6 months in this aggressive malignancy. However in our patient surgery it was not possible because of unresectability of the mass due to encroachment of major vessels. Hence, we have delivered radiotherapy alone, with which effective palliation could be achieved and patient is leading a good quality-of-life for last 1 year.

Diagnosis and prognosis of primary breast cancer

International Nuclear Information System (INIS)

Robertson, J. F. R.; Evans, A. J.

1997-01-01

The diagnosis of breast cancer should be made in the context of a multidisciplinary team: preoperative diagnosis can be made in over 90 % of patients with symptomatic and screen-detected cancers. A preoperative diagnosis allows patients the opportunity to come to terms with the diagnosis of breast cancer and to consider their treatment options before progressing to therapeutic surgery. Surgery remains the primary therapeutic treatment for operable breast cancer with radiotherapy and systemic therapies as adjuvant treatments. Surgery in addition provides pathological specimens from which important prognostic information may be obtained. The traditional TNM classification in itself is no longer sufficient although there is still c considerable prognostic information to be gained in staging patients. Markers of tumour biology provide prognostic data independent of TNM staging. Both need to be considered in any overall assessment of patient prognosis

Left Transperitoneal Adrenalectomy with a Laparoendoscopic Single-Site Surgery Combined Technique: Initial Case Reports

Directory of Open Access Journals (Sweden)

Yasuhiro Sumino

2011-01-01

Full Text Available Laparoendoscopic single-site surgery (LESS is a step toward the development of minimally invasive surgery. It is initially difficult for surgeons with limited experience to perform the surgery. We describe two cases of left adrenalectomy with a LESS combined with the addition of an accessory port. After a 2.5-cm skin incision was made at the level of the paraumbilicus to insert the primary 12-mm trocar for the laparoscope, a 5-mm nonbladed trocar was placed through the skin incision side-by-side with the primary trocar. A second 3-mm nonbladed trocar was then placed along the anterior axillary line; a multichannel trocar was not used as a single port. Both adrenalectomies were completed successfully. In patients with a minor adrenal tumor, a combined technique using LESS and an additional port is easier than LESS alone and may, therefore, be a bridge between the conventional laparoscopic approach and LESS.

Do prophylactic antibiotics in gynecologic surgery prevent postoperative inflammatory complications? A systematic review.

Science.gov (United States)

Boesch, Cedric Emanuel; Pronk, Roderick Franziskus; Medved, Fabian; Hentschel, Pascal; Schaller, Hans-Eberhard; Umek, Wolfgang

2017-06-01

The aim of this study was to systematically review the literature on antibiotic prophylaxis in gynaecologic surgeries to prevent inflammatory complications after gynaecological operations. The study was carried out as a systematic review. Only randomised controlled trials of women undergoing gynaecological surgery were included. The Medline and the Cochrane library databases were searched from 1966 to 2016. The trials must have investigated an antibiotic intervention to prevent an inflammatory complication after gynaecological surgery. Trials were excluded if they were not randomised, uncontrolled or included obstetrical surgery. Prophylactic antibiotics prevent inflammatory complications after gynaecological surgery. Prophylactic antibiotics are more effective in surgery requiring access to the peritoneal cavity or the vagina. Cefotetan appears to be more capable in preventing the overall inflammatory complication rate than cefoxitin or cefazolin. No benefit has been shown for the combination of antibiotics as prophylaxis. No difference has been shown between the long-term and short-term use of antibiotics. There is no need for the primary use of an anaerobic antibacterial agent. Antibiotics help to prevent postoperative inflammatory complications after major gynecologic surgeries.

Accounting for graduate medical education production of primary care physicians and general surgeons: timing of measurement matters.

Science.gov (United States)

Petterson, Stephen; Burke, Matthew; Phillips, Robert; Teevan, Bridget

2011-05-01

Legislation proposed in 2009 to expand GME set institutional primary care and general surgery production eligibility thresholds at 25% at entry into training. The authors measured institutions' production of primary care physicians and general surgeons on completion of first residency versus two to four years after graduation to inform debate and explore residency expansion and physician workforce implications. Production of primary care physicians and general surgeons was assessed by retrospective analysis of the 2009 American Medical Association Masterfile, which includes physicians' training institution, residency specialty, and year of completion for up to six training experiences. The authors measured production rates for each institution based on physicians completing their first residency during 2005-2007 in family or internal medicine, pediatrics, or general surgery. They then reassessed rates to account for those who completed additional training. They compared these rates with proposed expansion eligibility thresholds and current workforce needs. Of 116,004 physicians completing their first residency, 54,245 (46.8%) were in primary care and general surgery. Of 683 training institutions, 586 met the 25% threshold for expansion eligibility. At two to four years out, only 29,963 physicians (25.8%) remained in primary care or general surgery, and 135 institutions lost eligibility. A 35% threshold eliminated 314 institutions collectively training 93,774 residents (80.8%). Residency expansion thresholds that do not account for production at least two to four years after completion of first residency overestimate eligibility. The overall primary care production rate from GME will not sustain the current physician workforce composition. Copyright © by the Association of American medical Colleges.

[The experimental surgery and your relation with the university: an experience report].

Science.gov (United States)

Yamaki, Vitor Nagai; Teixeira, Renan Kleber Costa; Feijo, Daniel Haber; Silva, José Antonio Cordero da; Botelho, Nara Macedo; Henriques, Marcus Vinicius

2014-01-01

The laboratory of experimental surgery represents one of the key points for the university, especially in the biomedical area. This focuses on the university's tripod of primary structure that are teaching, research and extension, which are essential for formation of humanistic and practice of a good doctor that is based, first of all, on scientific evidence and critical knowledge. The importance of a laboratory of experimental surgery centers for medical education was regulated from the new curriculum guidelines of the Ministério da Educação e Cultura, establishing a mandatory laboratory within college centers. Therefore, it is of great importance to the contribution of the laboratories of experimental surgery in the curriculum, both in the discipline of surgical technics and experimental surgery, and an incentive for basic research. Thus, the study presents the experience of 15 years of the Laboratory of Experimental Surgery from Universidade do Estado do Pará, with the goal show the importance of this to medical graduation and the university.

[Penis-preserving surgery in patients with primary penile urethral cancer].

Science.gov (United States)

Maek, M; Musch, M; Arnold, G; Kröpfl, D

2014-12-01

Primary urethral cancer in males is a rare entity with only approximately 800 cases described, which is why it is difficult to formulate evidence-based guidelines for treatment. For tumors in the pT2 stage with a localization distal to the membranous urethra, a penis-preserving operation can be carried out. In the period from November 2006 to February 2014 a total of 4 patients with primary urethral cancer underwent a penis-preserving urethral resection. The tumor characteristics and treatment results were collated retrospectively. Of the four patients one had a transitional cell carcinoma of the mid-penile urethra in stage pT2 G2. In two out of the four patients a squamous cell carcinoma (PEC) was present in the mid-penile urethra in stages pT2 G2 and pT2 G3, respectively, with concomitant carcinoma in situ (CIS). The fourth patient had a PEC of the fossa terminalis in stage pT2 G2. Initially all patients underwent a penis-preserving resection. In one case, despite an initial R0 resection a local recurrence occurred and a complete penectomy was performed. Irradiation and lymphadenectomy were not carried out. At a mean follow-up of 37 months all patients are currently in complete remission. Primary penile urethral cancer can be treated by a penis-preserving operation. Close follow-up is essential because recurrence can arise despite an initial R0 resection.

Intravesical midurethral sling mesh erosion secondary to transvaginal mesh reconstructive surgery

Directory of Open Access Journals (Sweden)

Sukanda Bin Jaili

2015-05-01

Conclusion: Repeated vaginal reconstructive surgery may jeopardize a primary mesh or sling, and pose a high risk of mesh erosion, which may be delayed for several years. Removal of the mesh erosion and bladder repair are feasible pervaginally with good outcome.

Allograft in bone tumour surgery

International Nuclear Information System (INIS)

Sengupta, S.

1999-01-01

In the last twenty years, there has been a vast improvement in the prognosis of primary malignant tumours of bone. This is due to many factors including early detection, staging and classification of tumours as a result of better staining and imaging techniques, better surgical technology, e.g. endoprosthesis and most importantly adjuvant treatment with cytotoxic drugs. As a result of long term survival, amputation of limb has more or less been replaced by limb salvage surgery. This procedure consists of two parts. Primary objective is of course complete removal of the tumour by adequate soft tissue cover and secondarily by reconstruction of the locomotor system, If possible with retention of the function of the limb. These procedures include endo-prosthetic replacement or arthroplasty and arthrodesis using autologus grafts, allograft or combination. With the development of bone banks and assured safety of preserved bones, reconstructive limb salvage surgery using massive allograft is gradually replacing prosthetic implants. The advantages include replacement of articular surfaces, incorporation of the graft to the host bone, attachment of bone tissue and increased probably permanent survival. Allograft can be used for intercalary replacement, osteo-articular arthroplasty arthrodesis or filling large cavities. Inherent complication of massive allograft are disease transmission, infection, delayed and non-union, pathological fractures, mechanical failure and joint destruction. Several limb salvage procedures using allografts have been carried out in our institution with one failure due to infection. Paucity of available allograft has restricted more such procedures to be carried out

Benign metastasizing leiomyoma: A review of current literature in respect to the time and type of previous gynecological surgery

Science.gov (United States)

Barnaś, Edyta; Książek, Mariusz; Raś, Renata; Skręt, Andrzej; Skręt- Magierło, Joanna; Dmoch- Gajzlerska, Ewa

2017-01-01

Introduction Benign metastasizing leiomyoma (BML) is a rare disorder that affects women with a history of uterine leiomyoma, which is found to metastasise within extrauterine sites. The aetiology of BML remains unexplained. Because BML is rare, and most publications contain descriptions of single cases, no statistically determined time relations were found between the primary and secondary surgeries, which may have aetiological implications. Objectives To determine age before BML surgery, age during diagnosis of BML, type of prior surgery, and location of metastasis based on the literature. Methods A systematic review of four databases (Medline/PubMed, Embase, Web of Science, and Cochrane) covering articles published from 1 January 1965 to 10 April 2016. The inclusion criteria were full-text articles in English and articles containing case reports. Articles in languages other than English (39), articles containing incomplete data (14), i.e. no information regarding the time of surgery and/or the site of metastasis, articles bereft of case studies (25), and articles with access only to summaries, without access to the complete text (10) were excluded. Of 321 titles identified, only 126 articles met the aforementioned criteria. Results and conclusions The mean age during primary surgery and BML diagnosis was 38.5 years and 47.3 years, respectively. The most common surgery was total hysterectomy. The most frequent site of metastasis was the lungs; other organs were affected less frequently.The site of metastases and their number were not related to the longer time span between the patient’s initial surgery and occurrence of metastasis. The analysed data, such as the age during primary surgery, age during BML diagnosis, site and type of metastasis, do not provide us a clear answer. Thus, BML pathogenesis is most probably complex in nature and requires further multidirectional research. PMID:28426767

[Quality perceived by users of minor surgery according to care level and the professionals that carried it out].

Science.gov (United States)

Oltra Rodríguez, Enrique; Fernández García, Benjamín; Cabiedes Miragaya, Laura; Riestra Rodríguez, Rosario; González Aller, Cristina; Osorio Álvarez, Sofía

2018-04-26

Nowadays minor surgery is performed by di- fferent professionals at primary as well as specialized care. Being a healthcare technology, minor surgery must be assessed in order to achieve an organizational efficiency. User's satisfaction must be one of the quality criteria. That is why an analysis of the quality perceived by users according to where minor surgery takes place and who carries it out is made. This study explores, conducting telephone surveys, the satisfaction of a sample of 275 minor surgery patients of two hospitals and three primary healthcare areas of Asturias. The survey is based on the SERVQUAL model adapting the one used by the Spanish Ministry of Health in 1977. A behavior pattern of satisfaction was established in terms of the variables that increase or diminish it. In every item, satisfaction was perceived as good or very good at least in 84% of the survey users and in the majority was over 95%. There was a significant difference in favour of primary care with respect to waiting time (p less than 0,001), explanations received (p=0,002) and security perceived (p=0,015). The more explanatory variables of excellent satisfaction were the sense of security and the staff attention. The kind of professional did not represent a conditioning factor and the level of healthcare only appeared to be so among those who did not feel safe showing to be less satisfied those treated in primary care. Good quality perceived by users does not seem to be penalized by the fact that minor surgery can be carried out at different healthcare levels or which specialist performs it.

Factors Associated with Gender-Affirming Surgery and Age of Hormone Therapy Initiation Among Transgender Adults

Science.gov (United States)

Beckwith, Noor; Reisner, Sari L.; Zaslow, Shayne; Mayer, Kenneth H.; Keuroghlian, Alex S.

2017-01-01

Abstract Purpose: Gender-affirming surgeries and hormone therapy are medically necessary treatments to alleviate gender dysphoria; however, significant gaps exist in the research and clinical literature on surgery utilization and age of hormone therapy initiation among transgender adults. Methods: We conducted a retrospective review of electronic health record data from a random sample of 201 transgender patients of ages 18–64 years who presented for primary care between July 1, 2010 and June 30, 2015 (inclusive) at an urban community health center in Boston, MA. Fifty percent in our analyses were trans masculine (TM), 50% trans feminine, and 24% reported a genderqueer/nonbinary gender identity. Regression models were fit to assess demographic, gender identity-related, sexual history, and mental health correlates of gender-affirming surgery and of age of hormone therapy initiation. Results: Overall, 95% of patients were prescribed hormones by their primary care provider, and the mean age of initiation of masculinizing or feminizing hormone prescriptions was 31.8 years (SD=11.1). Younger age of initiation of hormone prescriptions was associated with being TM, being a student, identifying as straight/heterosexual, having casual sexual partners, and not having past alcohol use disorder. Approximately one-third (32%) had a documented history of gender-affirming surgery. Factors associated with increased odds of surgery were older age, higher income levels, not identifying as bisexual, and not having a current psychotherapist. Conclusion: This study extends our understanding of prevalence and factors associated with gender-affirming treatments among transgender adults seeking primary care. Findings can inform future interventions to expand delivery of clinical care for transgender patients. PMID:29159310

Urgent surgery for complicated colonic diverticula.

Science.gov (United States)

Funariu, Gheorghe; Binţinţan, Vasile; Seicean, Radu

2006-03-01

The AIM of this retrospective study was to evaluate the emergency surgical treatment of life-threatening complications of colonic diverticula. In the last 11 years, 22 of 101 patients with colonic diverticula (22.1%) underwent urgent surgery for acute complications: perforated gangrenous diverticulitis with generalized peritonitis (n=8) or pericolic abscess (n=8), acute bowel obstruction (n=4) and severe diverticular bleeding (n=2). In all patients with diffuse peritonitis or acute obstruction the indication for surgery was decided on clinical basis and the complicated diverticula were recognized only intra-operatively. Emergency surgical strategy differed according to the type of complication and the biologic condition of the patient: segmental colectomy and primary anastomosis for diverticular perforation (n=4), colonic stenosis (n=3) or diverticular bleeding (n=2); Hartmann resection with late reconnecting anastomosis in patients with diverticular perforation (n=5) or colonic obstruction (n=1); diverticulectomy with peritoneal drainage (n=2) and colostomy and drainage followed by secondary colectomy (n=5) for diverticular perforations in patients with poor general condition. Only one patient (4.5%) died post-operatively of multiple organ failure from generalized peritonitis. There was no anastomotic leakage in patients with primary anastomosis. Six patients (27.2%) developed wound infection. Hospital stay ranged between 11 and 60 days, significantly longer in cases with two-stage operations. Primary colectomy with immediate or delayed anastomosis is the best surgical procedure for acute divericular complications in patients with good biologic status. Two-stage operations such as colostomy and drainage coupled with late colectomy remain the viable alternative in patients with advanced disease and critical biologic condition.

[History of cranial surgery, cerebral tumor surgery and epilepsy surgery in Mexico].

Science.gov (United States)

Chico-Ponce de León, F

2009-08-01

The first report of intra-cerebral tumor surgery was provided by Bennett & Goodle, in London, 1884. Worldwide this kind of surgery was performed in France by Chipault, in Italy by Durante, in the United States by Keen and in Deutchland by Krause & Oppenheim. Lavista in Mexico City operated on intra-cerebral tumor in 1891, and the report was printed in 1892. In the same publication, Lavista exhibited the first cases of epilepsy surgery. Since now, it is the first report of this kind of surgery in the Spanish-speaking world.

Mechanical bowel preparation for elective colorectal surgery

DEFF Research Database (Denmark)

Guenaga, Katia K F G; Matos, Delcio; Wille-Jørgensen, Peer

2009-01-01

BACKGROUND: The presence of bowel contents during surgery has been related to anastomotic leakage, but the belief that mechanical bowel preparation (MBP) is an efficient agent against leakage and infectious complications is based on observational data and expert opinions only. OBJECTIVES...... with no MBP. Primary outcomes included anastomosis leakage - both rectal and colonic - and combined figures. Secondary outcomes included mortality, peritonitis, reoperation, wound infection, extra-abdominal complications, and overall surgical site infections. DATA COLLECTION AND ANALYSIS: Data were......: Four new trials were included at this update (total 13 RCTs with 4777 participants; 2390 allocated to MBP (Group A), and 2387 to no preparation (Group B), before elective colorectal surgery) .Anastomotic leakage occurred:(i) in 10.0% (14/139) of Group A, compared with 6.6% (9/136) of Group B for low...

Long-term surgical outcomes of primary congenital glaucoma in China

Directory of Open Access Journals (Sweden)

Xiulan Zhang

2009-06-01

Full Text Available OBJECTIVE: To evaluate the long-term outcomes of three surgical procedures for the treatment of primary congenital glaucoma (PCG. INTRODUCTION: PCG is one of the main causes of blindness in children. There is a paucity of contemporary data on PCG in China. METHODS: A retrospective study of 48 patients (81 eyes with PCG who underwent primary trabeculectomy, trabeculotomy, or combined trabeculotomy and trabeculectomy (CTT. RESULTS: All patients were less than 4 years (yrs of age, with a mean age of 2.08 ± 1.23 yrs. The mean duration of follow-up was 5.49 ± 3.09 yrs. The difference in success rates among the three surgical procedures at 1, 3, 6 and 9 yrs was not statistically significant (p = 0.492. However, in patients with over 4 yrs of follow-up, Kaplan-Meier survival analysis revealed that the success rates of trabeculectomy and CTT declined more slowly than that of trabeculotomy. Among the patients, 66.22% acquired good vision (VA > 0.4, 17.57% acquired fair vision (VA = 0.1 - 0.3, and 16.22% acquired poor vision (VA < 0.1. The patients with good vision were mostly in the successful surgery group. Myopia was more prevalent postoperatively (p = 0.009. Reductions in the cup-disc ratio and corneal diameter were only seen in the successful surgery group (p = 0.000. In addition, the successful surgery group contained more patients that complied with a regular follow-up routine (p = 0.002. DISCUSSION: Our cases were all primary surgeries. Primary trabeculectomy was performed in many cases because no treatment was sought until an advanced stage of disease had been reached. CONCLUSIONS: In contrast to most reports, in the present study, trabeculectomy and CTT achieved higher long-term success rates than trabeculotomy. The patients with successful surgical results had better vision. Compliance with a routine of regular follow-up may increase the chances of a successful surgical outcome.

CT findings of benign omental lesions following abdominal cancer surgery

Energy Technology Data Exchange (ETDEWEB)

Lee, Sang Yun; Kim, Dong Won; Cho, Jin Han; Kwon, Hee Jin; Ha, Dong Ho; Oh, Jong Young [Diagnostic Radiology, Dong-A University College of Medicine, Busan (Korea, Republic of)

2016-07-15

The greater omentum is the largest peritoneal fold and can be the origin of primary pathologic conditions, as well as a boundary and conduit for disease processes. Most diseases involving the omentum manifest with nonspecific and overlapping features on computed tomography (CT). In particular, varying benign disease processes of traumatic, inflammatory, vascular, or systemic origin can occur in the omentum during the follow-up period after surgery for intra-abdominal malignancy. It can be challenging for radiologists due to various spectrum of CT findings. Thus, we reviewed the CT findings of various benign omental lesions after surgery for intra-abdominal malignancy.

Excisional surgery for cancer cure: therapy at a cost.

LENUS (Irish Health Repository)

Coffey, J C

2012-02-03

Excisional surgery is one of the primary treatment modalities for cancer. Minimal residual disease (MRD) is the occult neoplastic disease that remains in situ after curative surgery. There is increasing evidence that tumour removal alters the growth of MRD, leading to perioperative tumour growth. Because neoplasia is a systemic disease, this phenomenon may be relevant to all patients undergoing surgery for cancer. In this review we discuss the published work that addresses the effects of tumour removal on subsequent tumour growth and the mechanisms by which tumour excision may alter residual tumour growth. In addition, we describe therapeutic approaches that may protect patients against any oncologically adverse effects of tumour removal. On the basis of the evidence presented, we propose a novel therapeutic paradigm; that the postoperative period represents a window of opportunity during which the patient may be further protected against the oncological effects of tumour removal.

Primary hypothyroidism masquerading pituitary macroadenoma

OpenAIRE

Agrawal Amit; Reddy Amareesh P.; Malleswara Rao G.; Reddy V. Umamaheswara

2014-01-01

Diffuse and reactive pituitary gland enlargement secondary to primary hypothyroidism is an uncommon occurrence and that can masquerade many pituitary disorders. In present article, we report a case of 19 year female severe hypothyroidism presenting with diffuse enlargement of pituitary gland and hyperprolactinemia and review the clinical importance of this entity. Knowledge of this entity is very important to avoid unnecessary surgery and irreversible complications in this sub-group of patients.

A novel hyper-viscoelastic model for consolidation of toughened prepregs under processing conditions

OpenAIRE

Belnoue, J.P.-H.; Nixon-Pearson, O.J.; Ivanov, D.; Hallett, S.R.

2016-01-01

The paper presents a new modelling concept for describing the compressibility of toughened uncured prepregs over a wide range of processing conditions (i.e. automatic fibre deposition, hot debulking and pre-curing consolidation). The primary challenge of the work is to simulate the material response due complex flow and deformation mechanisms. This generation of prepreg systems exhibits both percolation (bleeding) flow typical for conventional thermosets, where the pressure gradient causes re...

Predictive factors for the development of persistent pain after breast cancer surgery

DEFF Research Database (Denmark)

Andersen, Kenneth Geving; Duriaud, Helle Molter; Jensen, Helle Elisabeth

2015-01-01

Previous studies have reported that 15% to 25% of patients treated for breast cancer experience long-term moderate-to-severe pain in the area of surgery, potentially lasting for several years. Few prospective studies have included all potential risk factors for the development of persistent pain...... after breast cancer surgery (PPBCS). The aim of this prospective cohort study was to comprehensively identify factors predicting PPBCS. Patients scheduled for primary breast cancer surgery were recruited. Assessments were conducted preoperatively, the first 3 days postoperatively, and 1 week, 6 months...... were included, and 475 (88%) were available for analysis at 1 year. At 1-year follow-up, the prevalence of moderate-to-severe pain at rest was 14% and during movement was 7%. Factors associated with pain at rest were age breast conserving surgery (OR: 2.0, P...

Criticism of conservative surgery for primary operable breast cancer

International Nuclear Information System (INIS)

Urban, J.A.

1977-01-01

A critical evaluation about the adoption of a less adequate primary surgical procedure is done with respect to patients with similar extent of disease. A comparison is done between the results obtained for groups of patients submitted to conservative surgical treatment and to radical mastectomy, both accompanied by radiotherapy. Emphasis is given to the need for removing all disease in breast and regional nodes at the time of original surgical treatment. (M.A.) [pt

Understanding the "Weekend Effect" for Emergency General Surgery.

Science.gov (United States)

Hoehn, Richard S; Go, Derek E; Dhar, Vikrom K; Kim, Young; Hanseman, Dennis J; Wima, Koffi; Shah, Shimul A

2018-02-01

Several studies have identified a "weekend effect" for surgical outcomes, but definitions vary and the cause is unclear. Our aim was to better characterize the weekend effect for emergency general surgery using mortality as a primary endpoint. Using data from the University HealthSystem Consortium from 2009 to 2013, we identified urgent/emergent hospital admissions for seven procedures representing 80% of the national burden of emergency general surgery. Patient characteristics and surgical outcomes were compared between cases that were performed on weekdays vs weekends. Hospitals varied widely in the proportion of procedures performed on the weekend. Of the procedures examined, four had higher mortality for weekend cases (laparotomy, lysis of adhesions, partial colectomy, and small bowel resection; p < 0.01), while three did not (appendectomy, cholecystectomy, and peptic ulcer disease repair). Among the four procedures with increased weekend mortality, patients undergoing weekend procedures also had increased severity of illness and shorter time from admission to surgery (p < 0.01). Multivariate analysis adjusting for patient characteristics demonstrated independently higher mortality on weekends for these same four procedures (p < 0.01). For the first time, we have identified specific emergency general surgery procedures that incur higher mortality when performed on weekends. This may be due to acute changes in patient status that require weekend surgery or indications for urgent procedures (ischemia, obstruction) compared to those without a weekend mortality difference (infection). Hospitals that perform weekend surgery must acknowledge and identify ways to manage this increased risk.

Localisation of cancer of the ovary and metastases using 123I-labelled monoclonal antibody HMFG-2 compared to surgical findings

International Nuclear Information System (INIS)

Britton, K.E.; Granowska, M.; Shepherd, J.

1985-01-01

Ovarian cancer is the second most common cause of death due to cancer in women. It often presents late and then requires radical surgery and repeated courses of chemotherapy. Because the deposits are often in the form of peritoneal seedlings or matted to bowel or omentum, the use of ultrasound and X-ray computed tomography is not very successful in staging or in judging response to chemotherapy or recurrence. Therefore a 'second-look' or even 'third-look' operation with, if necessary, further debulking surgery is performed. The clinical requirements are for, first, and imaging technique that would diagnose whether or not any pelvic mass is due to ovarian cancer before surgery; and second, an imaging technique that would help to demonstrate the distribution of metastases and their response to chemotherapy and their recurrence or not, so as to avoid the need for the 'second-look' operation. This chapter summarises the use of radioimmunoscintigraphy in this context

Value of internal limiting membrane peeling in surgery for idiopathic macular hole and the correlation between function and retinal morphology

DEFF Research Database (Denmark)

Christensen, Ulrik Correll

2009-01-01

conducted a randomized clinical trial including 78 pseudophakic patients with idiopathic macular hole stages 2 and 3. Patients were randomly assigned to macular hole surgery consisting of (i) vitrectomy alone without instrumental retinal surface contact (non-peeling), (ii) vitrectomy plus 0.05% isotonic ICG...... rate than surgery without ILM peeling (95% versus 45%). The overall functional results confirm that surgery for macular hole generally leads to favourable visual results, with two-thirds of eyes regaining reading vision (>or=20/40). Macular hole surgery can be considered a safe procedure with a low...... incidence of sight-threatening adverse events; the retinal detachment rate was 2.2%. Visual outcomes in eyes with primary hole closure were not significantly different between the intervention groups; however, for the stage 2 subgroup with primary macular hole closure, there was a trend towards a better...

Bariatric surgery insurance requirements independently predict surgery dropout.

Science.gov (United States)

Love, Kaitlin M; Mehaffey, J Hunter; Safavian, Dana; Schirmer, Bruce; Malin, Steven K; Hallowell, Peter T; Kirby, Jennifer L

2017-05-01

Many insurance companies have considerable prebariatric surgery requirements despite a lack of evidence for improved clinical outcomes. The hypothesis of this study is that insurance-specific requirements will be associated with a decreased progression to surgery and increased delay in time to surgery. Retrospective data collection was performed for patients undergoing bariatric surgery evaluation from 2010-2015. Patients who underwent surgery (SGY; n = 827; mean body mass index [BMI] 49.1) were compared with those who did not (no-SGY; n = 648; mean BMI: 49.4). Univariate and multivariate analysis were performed to identify specific co-morbidity and insurance specific predictors of surgical dropout and time to surgery. A total of 1475 patients using 12 major insurance payors were included. Univariate analysis found insurance requirements associated with surgical drop out included longer median diet duration (no-SGY = 6 mo; SGY = 3 mo; Psurgery dropout. Additionally, surgical patients had an average interval between initial visit and surgery of 5.8±4.6 months with significant weight gain (2.1 kg, Psurgery insurance requirements were associated with lack of patient progression to surgery in this study. In addition, delays in surgery were associated with preoperative weight gain. Although prospective and multicenter studies are needed, these findings have major policy implications suggesting insurance requirements may need to be reconsidered to improve medical care. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Sources of federal funding in plastic and reconstructive surgery research.

Science.gov (United States)

Larson, Kelsey E; Gastman, Brian

2014-05-01

In the last several years, federal funding has become increasingly difficult to obtain. The purpose of this project was to define the level of federal funding among plastic surgeons in the modern era. The authors evaluated members of the Plastic Surgery Research Council because of their expected invested interested in research. The authors collected information from 1998 to 2012 on funding using curricula vitae and publically available online tools. Data on Plastic Surgery Foundation funding was also collected to determine its role in supporting federally funded investigators. Of 256 individuals, the authors found 41 to be primary investigators on federally funded grants, with the majority receiving one to two awards. Common subtypes of awards included National Institutes of Health R01 (n = 15), K08 (n = 9), and R21 (n = 6). Limited funding from the National Science Foundation and the Department of Defense was identified. Despite a steady number of available National Institutes of Health awards, plastic surgery recipients have grown in number over the past 15 years. In a review of 20 years of Plastic Surgery Foundation awards, 113 Plastic Surgery Research Council members (44.1 percent) were awardees, averaging 1.8 awards per person. Twenty-nine Plastic Surgery Foundation awardees were also recipients of federal funding; 12 individuals received federal funding without prior Plastic Surgery Foundation funding. A search of plastic surgeons indicates a limited but increasing number of individuals receive federal funding. Plastic Surgery Foundation awards appear to be helpful in supporting investigators as they move to larger federal awards.

Reoperative bariatric surgery for treatment of type 2 diabetes mellitus.

Science.gov (United States)

Yan, Jingliang; Cohen, Ricardo; Aminian, Ali

2017-08-01

Primary bariatric surgery has been proven to be effective in weight loss and improvement of weight-related metabolic co-morbidities. However, a small proportion of patients after bariatric surgery either have persistent hyperglycemia or relapse after initial remission of their metabolic disease. Revisional bariatric surgery has been evaluated extensively for weight recidivism and postoperative complications. However, there has not been any high-level evidence validating the utility of revisional bariatric surgery on recurrent metabolic diseases, especially diabetes. In this review of 30 studies, we aimed to summarize the evidence and determine whether revisional surgery can have a positive impact on metabolic diseases that were not reversed by initial bariatric intervention. Overall, 14-38% of patients had residual diabetes at the time of revisional surgery. Depending on the index surgery and subsequent reconstruction, revisions induced 20-80% additional excess weight loss, or further decrease of body mass index by 10-30%. Improvement of diabetes was seen in 65-100% of patients. Specifically, conversion to Roux-en-Y gastric bypass (RYGB) yielded improvement of diabetes in 79%, 72%, and 62% of patients who previously had vertical banded gastroplasty (VBG), adjustable gastric banding (AGB), or sleeve gastrectomy (SG), respectively. Converting AGB to SG improved diabetes in 65% of patients, and SG to duodenal switch improved diabetes in 79% of patients. Revision of the gastric pouch or stoma in RYGB yielded improvement of diabetes in 79% of patients. Further clinical and mechanistic research is needed to better delineate the role of revisional bariatric surgery in patients with residual metabolic disease. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Benign meningiomas: primary treatment selection affects survival

International Nuclear Information System (INIS)

Condra, Kellie S.; Buatti, John M.; Mendenhall, William M.; Friedman, William A.; Marcus, Robert B.; Rhoton, Albert L.

1997-01-01

Purpose: To examine the effect of primary treatment selection on outcomes for benign intracranial meningiomas at the University of Florida. Methods and Materials: For 262 patients, the impact of age, Karnofsky performance status, pathologic features, tumor size, tumor location, and treatment modality on local control and cause-specific survival was analyzed (minimum potential follow-up, 2 years; median follow-up, 8.2 years). Extent of surgery was classified by Simpson grade. Treatment groups: surgery alone (n = 229), surgery and postoperative radiotherapy (RT) (n = 21), RT alone (n = 7), radiosurgery alone (n = 5). Survival analysis: Kaplan-Meier method with univariate and multivariate analysis. Results: At 15 years, local control was 76% after total excision (TE) and 87% after subtotal excision plus RT (SE+RT), both significantly better (p = 0.0001) than after SE alone (30%). Cause-specific survival at 15 years was reduced after treatment with SE alone (51%), compared with TE (88%) or SE+RT (86%) (p = 0.0003). Recurrence after primary treatment portended decreased survival, independent of initial treatment group or salvage treatment selection (p = 0.001). Atypical pathologic features predicted reduced 15-year local control (54 vs. 71%) and cause-specific survival rates (57 vs. 86%). Multivariate analysis for cause-specific survival revealed treatment group (SE vs. others; p = 0.0001), pathologic features (atypical vs. typical; p = 0.0056), and Karnofsky performance status (≥80 vs. <80; p = 0.0153) as significant variables. Conclusion: Benign meningiomas are well managed by TE or SE+RT. SE alone is inadequate therapy and adversely affects cause-specific survival. Atypical pathologic features predict a poorer outcome, suggesting possible benefit from more aggressive treatment. Because local recurrence portends lower survival rates, primary treatment choice is important

A fatal case of primary basaloid squamous cell carcinoma in the intrahepatic bile ducts

DEFF Research Database (Denmark)

Kirkegaard, Johan; Grunnet, Mie; Hasselby, Jane Preuss

2014-01-01

of diagnosis but expired 20 months after surgery with epidural, lung, and spine metastasis. In addition to the unusual clinical presentation, the diagnosis of the liver tumor was that of a primary basaloid squamous cell carcinoma of the intrahepatic bile ducts, an entity with only one previous report......Primary squamous cholangiocellular carcinomas are very rare. We describe a case of a 67-year-old man, who underwent chemotherapy and surgery for a right-sided liver tumor with an unusual presentation of metastasis to a lymph node in the left armpit. The patient was asymptomatic at the time...

Corrective Jaw Surgery

Medline Plus

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

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.

FNAB cytology of extra-cranial metastasis of glioblastoma multiforme may resemble a lung primary: A diagnostic pitfall

Directory of Open Access Journals (Sweden)

Dincer HE

2005-01-01

Full Text Available Abstract Background As extra-cranial metastasis of glioblastoma multiforme (GBM is rare, it may create a diagnostic dilemma especially during interpretation of fine needle aspiration biopsy (FNAB cytology. Case presentation We present transbronchial FNAB findings in a 62-year-old smoker with lung mass clinically suspicious for a lung primary. The smears of transbronchial FNAB showed groups of cells with ill-defined cell margins and cytological features overlapping with poorly differentiated non-small cell carcinoma. The tumor cells demonstrated lack of immunoreactivity for cytokeratin, thyroid transcription factor-1, and usual neuroendocrine markers, synaptophysin and chromogranin in formalin-fixed cellblock sections. However, they were immunoreactive for the other neuroendocrine immunomarker, CD56, suggesting neural nature of the cells. Further scrutiny of clinical details revealed a history of GBM, 13 months status-post surgical excision with radiation therapy and systemic chemotherapy. The tumor recurred 7 months earlier and was debulked surgically and with intra-cranial chemotherapy. Additional evaluation of tumor cells for glial fibrillary acidic protein (GFAP immunoreactivity with clinical details resulted in final interpretation of metastatic GBM. Conclusion Lack of clinical history and immunophenotyping may lead to a diagnostic pitfall with possible misinterpretation of metastatic GBM as poorly differentiated non-small cell carcinoma of lung in a smoker.

Locally Advanced Oncocytic Carcinoma of the Nasal Cavity Treated With Surgery and Intensity-modulated Radiotherapy

Directory of Open Access Journals (Sweden)

Yu-Wen Hu

2010-03-01

Full Text Available Oncocytic carcinomas of the nasal cavity are extremely rare. We report 1 patient whose primary tumor and neck lymphadenopathies were under control nearly 2 years after combined surgery and radiotherapy. An 80-year-old man with a history of nasal oncocytoma had received excision twice previously. Computed tomography demonstrated locally advanced recurrent tumor invading the paranasal sinuses and orbit with lymphadenopathies in the right neck. Skull base surgery was performed. Pathological examination revealed oncocytic carcinoma. Positron emission tomography showed hypermetabolic lesions in the surgical bed and right neck. The patient subsequently received intensity-modulated radiotherapy to the primary site and the whole neck. Follow-up computed tomography 4 months later showed marked shrinkage of the neck lymphadenopathies. There was no progression after nearly 2 years. Although these tumors have historically been regarded as radioresistant, the combined treatment of surgery followed by radiotherapy may offer the best chance for control of locally advanced disease.

Factors affecting the referral of primary health care doctors toward ...

African Journals Online (AJOL)

Hend Al-Namash

2011-06-08

Jun 8, 2011 ... There is a worldwide epidemic of overweight, obesity, and morbid obesity ... the evolution of bariatric surgery.4 Controversy exists regard- ing the best ..... attitudes and practices among Israeli primary care physicians. Int J.

Safety in the operating room during orthopedic trauma surgery-incidence of adverse events related to technical equipment and logistics

NARCIS (Netherlands)

van Delft, E. A. K.; Schepers, T.; Bonjer, H. J.; Kerkhoffs, G. M. M. J.; Goslings, J. C.; Schep, N. W. L.

2017-01-01

Safety in the operating room is widely debated. Adverse events during surgery are potentially dangerous for the patient and staff. The incidence of adverse events during orthopedic trauma surgery is unknown. Therefore, we performed a study to quantify the incidence of these adverse events. Primary

Minority and Public Insurance Status: Is There a Delay to Alveolar Bone Grafting Surgery?

Science.gov (United States)

Silvestre, Jason; Basta, Marten N; Fischer, John P; Lowe, Kristen M; Mayro, Rosario; Jackson, Oksana

2017-01-01

  This study sought to determine the timing of alveolar bone grafting (ABG) surgery among children with cleft lip with or without cleft palate (CL±P) with regard to race and insurance status.   A retrospective chart review of consecutive patients receiving ABG surgery was conducted. A multivariate regression model was constructed using predetermined clinical and demographic variables.   A large, urban cleft referral center.   Nonsyndromic patients with CL±P were eligible for study inclusion.   ABG surgery using autogenous bone harvested from the anterior iliac crest.   The primary outcome of interest was age at ABG surgery.   A total of 233 patients underwent ABG surgery at 8.1 ± 2.3 years of age. African American and Hispanic patients received delayed ABG surgery compared with Caucasian patients by approximately 1 year (P .05).   The timing of ABG surgery varied by race but not by insurance status. Greater resources may be needed to ensure timely delivery of cleft care to African American and Hispanic children.

Risk of Acute Kidney Injury in Patients Randomized to a Restrictive Versus Liberal Approach to Red Blood Cell Transfusion in Cardiac Surgery: A Substudy Protocol of the Transfusion Requirements in Cardiac Surgery III Noninferiority Trial.

Science.gov (United States)

Garg, Amit X; Shehata, Nadine; McGuinness, Shay; Whitlock, Richard; Fergusson, Dean; Wald, Ron; Parikh, Chirag; Bagshaw, Sean M; Khanykin, Boris; Gregory, Alex; Syed, Summer; Hare, Gregory M T; Cuerden, Meaghan S; Thorpe, Kevin E; Hall, Judith; Verma, Subodh; Roshanov, Pavel S; Sontrop, Jessica M; Mazer, C David

2018-01-01

When safe to do so, avoiding blood transfusions in cardiac surgery can avoid the risk of transfusion-related infections and other complications while protecting a scarce resource and reducing costs. This protocol describes a kidney substudy of the Transfusion Requirements in Cardiac Surgery III (TRICS-III) trial, a multinational noninferiority randomized controlled trial to determine whether the risk of major clinical outcomes in patients undergoing planned cardiac surgery with cardiopulmonary bypass is no greater with a restrictive versus liberal approach to red blood cell transfusion. The objective of this substudy is to determine whether the risk of acute kidney injury is no greater with a restrictive versus liberal approach to red blood cell transfusion, and whether this holds true in patients with and without preexisting chronic kidney disease. Multinational noninferiority randomized controlled trial conducted in 73 centers in 19 countries (2014-2017). Patients (~4800) undergoing planned cardiac surgery with cardiopulmonary bypass. The primary outcome of this substudy is perioperative acute kidney injury, defined as an acute rise in serum creatinine from the preoperative value (obtained in the 30-day period before surgery), where an acute rise is defined as ≥26.5 μmol/L in the first 48 hours after surgery or ≥50% in the first 7 days after surgery. We will report the absolute risk difference in acute kidney injury and the 95% confidence interval. We will repeat the primary analysis using alternative definitions of acute kidney injury, including staging definitions, and will examine effect modification by preexisting chronic kidney disease (defined as a preoperative estimated glomerular filtration rate [eGFR] blood cell transfusion in the presence of anemia during cardiac surgery done with cardiopulmonary bypass. www.clinicaltrials.gov; clinical trial registration number NCT 02042898.