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Sample records for repair patients group

  1. Excision Repair Cross-complementation Group 1 is a Prognostic Biomarker in Patients with Colorectal Cancer Receiving Chemotherapy

    Institute of Scientific and Technical Information of China (English)

    Mu-Xing Li; Xin-Yu Bi; Hong Zhao; Zhen Huang; Yue Han; Dong-Bin Zhao; Jian-Jun Zhao

    2016-01-01

    Background:Conflicting results about the association between expression level of excision repair cross-complementation group 1 (ERCC1) and clinical outcome in patients with colorectal cancer (CRC) receiving chemotherapy have been reported.Thus,we searched the available articles and performed the meta-analysis to elucidate the prognostic role of ERCC1 expression in patients with CRC.Methods:A thorough literature search using PubMed (Medline),Embase,Cochrane Library,Web of Science databases,and Chinese Science Citation Database was conducted to obtain the relevant studies.Pooled hazard ratios (HRs) or odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to estimate the results.Results:A total of 11 studies were finally enrolled in this meta-analysis.Compared with patients with lower ERCC1 expression,patients with higher ERCC1 expression tended to have unfavorable overall survival (OS) (HR =2.325,95% CI:1.720-3.143,P < 0.001),progression-free survival (PFS) (HR =1.917,95% CI:1.366-2.691,P < 0.001) and poor response to chemotherapy (OR =0.491,95% CI:0.243-0.990,P =0.047).Subgroup analyses by treatment setting,ethnicity,HR extraction,detection methods,survival analysis,and study design demonstrated that our results were robust.Conclusions:ERCC1 expression may be taken as an effective prognostic factor predicting the response to chemotherapy,OS,and PFS.Further studies with better study design and longer follow-up are warranted in order to gain a deeper understanding of ERCC 1's prognostic value.

  2. Different impact of excision repair cross-complementation group 1 on survival in male and female patients with inoperable non-small-cell lung cancer treated with carboplatin and gemcitabine

    DEFF Research Database (Denmark)

    Holm, Bente; Mellemgaard, Anders; Skov, Torsten;

    2009-01-01

    PURPOSE: The excision repair cross-complementation group 1 (ERCC1) status was assessed in patients receiving carboplatin and gemcitabine for inoperable non-small-cell lung cancer (NSCLC). We analyzed the association between the ERCC1 status and the overall survival after the chemotherapy. PATIENTS...

  3. Laparoscopic Incisional Hernia Repair in Obese Patients

    Science.gov (United States)

    2005-01-01

    Background and Objectives: Laparoscopic incisional hernia repair is coming to the forefront as a preferred method of repair due to the advantages offered by minimally invasive techniques. To evaluate safety and feasibility of this approach in obese patients when performed by a general surgeon trained in basic laparoscopy with no prior experience in this technique, we reviewed our early experience in the first 18 patients. Methods: All patients with incisional hernias presenting to a single surgeon from 2000 to 2002 were offered laparoscopic repair. Patients were informed about the limited experience of the surgeon in this particular field. Those who consented were repaired laparoscopically using a standard 4-port technique, one 12-mm port and three 5-mm ports. All patients with body mass index ≥30 were included in this review. A retrospective review of the data included demographics, operative time, blood loss, hospital stay, postoperative complications, and patient satisfaction. Results: Nineteen laparoscopic repairs were completed in 18 patients. No conversions to open repair were necessary. All patients were females except for 2. All hernia sacs were left in place, some of which were empty while others required extensive lysis of adhesions to release sac contents. Mean fascial defect was 102.5 cm2. One defect was closed primarily without mesh, while the rest were closed using Composix mesh in 1 and Dual Plus Gore-Tex mesh in the rest. Three patients were discharged from the recovery room. Mean follow-up was 24 months. No wound or mesh infections occurred. Eight patients had no complications. Eight patients had asymptomatic seromas. Two patients had hematomas; none of them required drainage. One patient had nonspecific dizziness. One patient presented with bowel obstruction secondary to early recurrence (within a week). The repair was salvaged laparoscopically. Upon evaluation by telephone calls, all patients indicated extreme satisfaction with the results

  4. Umbilical hernia in cirrhotic patients: outcome of elective repair.

    Science.gov (United States)

    Lasheen, Adel; Naser, Hatem M; Abohassan, Ahmed

    2013-12-01

    Cirrhotic patients with umbilical hernia have an increased likelihood of complications following repair. The aim of this study was to assess the outcomes of elective umbilical hernia repair in cirrhotic patients. Fifty patients having uncomplicated umbilical hernia with a cirrhotic liver were studied prospectively. These patients divided into three groups' according to Child-Turcotte-Pugh (CTP) classification. After management of coagulopathy, correction of hypoalbuminaemia and electrolytes imbalance, and control of ascites, all patients underwent elective hernia repair under regional anesthesia. A comparison was made between the three groups as regard the size of the defect in the linea Alba, operative time, postoperative morbidity and mortality, length of hospital stay, time of return to daily life and postoperative changes in liver function tests (LFTs) in relation to the regional anesthesia applied. hernioplasty was done under spinal anesthesia in 13 patients (26%), under epidural anesthesia in 10 patients (20%), under intercostal nerve block in 7 patients (14%), and under local anesthesia in 20 patients (40%). There was an increased safety (less changes in LFTs) in cases done under local anesthesia and intercostal nerve block. The overall complications rate was 30%. There was an increased complications rate towards the decompensated cases. The differences in the mean length of hospital stay and mean time of return to daily life are statistically significant between the three groups. Umbilical hernia recurrence rate was 2% and no mortality was reported in the study groups.

  5. Molecular and cellular analysis of the DNA repair defect in a patient in Xeroderma pigmentosum complementation group D who has the clinical features of Xeroderma pigmentosum and Cockayne syndrome

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    Broughton, B.C.; Thompson, A.F.; Harcourt, S.A.; Cole, J.; Arlett, C.F.; Lehmann, A.R. [Univ. of Sussex, Brighton (United Kingdom); Vermeulen, W.; Hoeijmakers, J.H.J. [Erasmus Univ., Rotterdam (United Kingdom); Botta, E.; Stefanini, M. [Istituto di Genetica, Pavia (Italy)] [and others

    1995-01-01

    Xeroderma pigmentosum (XP) and Cockayne syndrome (CS) are quite distinct genetic disorders that are associated with defects in excision repair of UV-induced DNA damage. A few patients have been described previously with the clinical features of both disorders. In this paper we describe an individual in this category who has unusual cellular responses to UV light. We show that his cultured fibroblasts and lymphocytes are extremely sensitive to irradiation with UV-C, despite a level of nucleotide excision repair that is 30%-40% that of normal cells. The deficiency is assigned to the XP-D complementation group, and we have identified two causative mutations in the XPD gene: a gly{yields}arg change at amino acid 675 in the allele inherited from the patient`s mother and a -1 frameshift at amino acid 669 in the allele inherited from his father. These mutations are in the C-terminal 20% of the 760-amino-acid XPD protein, in a region where we have recently identified several mutations in patients with trichothiodystrophy. 44 refs., 5 figs., 2 tabs.

  6. High Mobility Group Box Protein-1 in Wound Repair

    Directory of Open Access Journals (Sweden)

    Mauro Patrone

    2012-09-01

    Full Text Available High-mobility group box 1 protein (HMGB1, a member of highly conserved non-histone DNA binding protein family, has been studied as transcription factor and growth factor. Secreted extracellularly by activated monocytes and macrophages or passively released by necrotic or damaged cells, extracellular HMGB1 is a potent mediator of inflammation. Extracellular HMGB1 has apparently contrasting biological actions: it sustains inflammation (with the possible establishment of autoimmunity or of self-maintaining tissue damage, but it also activates and recruits stem cells, boosting tissue repair. Here, we focus on the role of HMGB1 in physiological and pathological responses, the mechanisms by which it contributes to tissue repair and therapeutic strategies base on targeting HMGB1.

  7. Tubularized incised plate urethroplasty repair in adult hypospadias patients. Are results similar to those reported in the pediatric age group? A prospective study

    Directory of Open Access Journals (Sweden)

    A. Bhat

    2016-06-01

    Conclusions: Complications encountered in the present study were urethral fistula and meatal stenosis with a higher incidence in patients with proximal hypospadias than reported in the literature. The important factors for the outcome of TIPU were the severity of hypospadias, the degree of curvature and the development of the spongiosum and urethral plate. Proximal hypospadias with a poor urethral plate and severe curvature in adults is not suitable for TIPU. In such cases, single-stage flap urethroplasty or two-stage buccal mucosal urethroplasty should be considered instead.

  8. Hypertrophic scarring in cleft lip repair: a comparison of incidence among ethnic groups

    Directory of Open Access Journals (Sweden)

    Soltani AM

    2012-07-01

    Full Text Available Ali M Soltani, Cameron S Francis, Arash Motamed, Ashley L Karatsonyi, Jeffrey A Hammoudeh, Pedro A Sanchez-Lara, John F Reinisch, Mark M UrataDivision of Plastic and Maxillofacial Surgery at Children's Hospital Los Angeles, CA, USA; The Division of Plastic and Reconstructive Surgery at the Keck School of Medicine of the University of Southern California, Los Angeles, CA, USABackground: Although hypertrophic scar (HTS formation following cleft lip repair is relatively common, published rates vary widely, from 1% to nearly 50%. The risk factors associated with HTS formation in cleft patients are not well characterized. The primary aim of this retrospective study of 180 cleft lip repairs is to evaluate the frequency of postoperative HTS among various ethnic groups following cleft lip repair.Methods: A retrospective chart view of patients undergoing primary cleft lip repair over a 16-year period (1990–2005 by the senior surgeon was performed. The primary outcome was the presence of HTS at 1 year postoperatively. Bivariate analysis and multivariable logistic regression were used to evaluate potential risk factors for HTS, including ethnicity, type and laterality of cleft, and gender.Results: One hundred and eighty patients who underwent cleft lip repair were included in the study. The overall rate of postoperative HTS formation was 25%. Ethnicity alone was found to be an independent predictor of HTS formation. Caucasian patients had the lowest rate of HTS formation (11.8% and were used as the reference group. HTS rates were significantly higher in the other ethnicities, 32.2% in Hispanic patients (odds ratio [OR]: 3.51; 95% confidence interval [CI]: 1.53–8.85, and 36.3% for Asian patients (OR 4.27; 95% CI: 1.36–13.70. Sex, cleft type, and cleft laterality were not associated with increased rates of HTS.Conclusions: Differences in ethnic makeup of respective patient populations may be a major factor influencing the wide variability of reported

  9. Outpatient repair for inguinal hernia in elderly patients: still a challenge?

    Science.gov (United States)

    Palumbo, Piergaspare; Amatucci, Chiara; Perotti, Bruno; Zullino, Antonio; Dezzi, Claudia; Illuminati, Giulio; Vietri, Francesco

    2014-01-01

    Elective inguinal hernia repair as a day case is a safe and suitable procedure, with well-recognized feasibility. The increasing number of elderly patients requiring inguinal hernia repair leads clinicians to admit a growing number of outpatients. The aim of the current study was to analyze the outcomes (feasibility and safety) of day case treatment in elderly patients. Eighty patients >80 years of age and 80 patients ≤55 years of age underwent elective inguinal hernia repairs under local anesthesia. There were no mortalities or major complications in the elderly undergoing inguinal herniorraphies as outpatients, and only one unanticipated admission occurred in the younger age group. Elective inguinal hernia repair in the elderly has a good outcome, and age alone should not be a drawback to day case treatment. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  10. Xeroderma pigmentosum group F caused by a defect in a structure-specific DNA repair endonuclease.

    NARCIS (Netherlands)

    A.M. Sijbers (Anneke); W.L. de Laat (Wouter); R.A. Ariza (Rafael); M. Biggerstaff (Maureen); Y-F. Wei; J.G. Moggs (Jonathan); K.C. Carter (Kenneth); B.K. Shell (Brenda); E. Evans (Elizabeth); M.C. de Jong (Mariska); S. Rademakers (Suzanne); J.D. de Rooij (Johan); N.G.J. Jaspers (Nicolaas); J.H.J. Hoeijmakers (Jan); R.D. Wood (Richard)

    1996-01-01

    textabstractNucleotide excision repair, which is defective in xeroderma pigmentosum (XP), involves incision of a DNA strand on each side of a lesion. We isolated a human gene homologous to yeast Rad1 and found that it corrects the repair defects of XP group F as well as rodent groups 4 and 11. Causa

  11. The prognostic and predictive value of excision repair cross-complementation group 1 (ERCC1) protein in 1288 patients with head and neck squamous cell carcinoma treated with platinum-based therapy: a meta-analysis.

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    Bišof, Vesna; Zajc Petranović, Matea; Rakušić, Zoran; Samardžić, Kristina Ruža; Juretić, Antonio

    2016-09-01

    Excision repair cross-complementation group 1 (ERCC1) protein has been extensively investigated as a prognostic and predictive factor for platinum-based treatment in head and neck squamous cell carcinoma (HNSCC) but with inconsistent results. We performed the present meta-analysis to better elucidate this issue in advanced HNSCC. A literature search was conducted using the PubMed and Web of Science databases. The inclusion criteria were head and neck cancer patients with platinum-based treatment and evaluation of the correlation between ERCC1 expression and clinical outcomes [objective response rate (ORR), progression-free survival (PFS), and overall survival (OS), both unadjusted and adjusted estimates]. In high vs. low pooled analyses, high ERCC1 expression was associated with unfavorable OS [hazard ratio (HR) = 1.95, 95 % confidence interval (CI) 1.18-3.21, p = 0.009], PFS (HR = 2.39, 95 % CI 1.74-3.28, p = 0.000) and ORR (odds ratio = 0.48, 95 % CI 0.23-0.98, p = 0.044). In the subgroup analysis of adjusted OS estimates, ERCC1 was a predictor of shorter survival in Asians (HR = 3.13, 95 % CI 2.09-4.70, p = 0.000) and Caucasians (HR = 2.02, 95 % CI 1.32-3.07, p = 0.001) but of longer survival in South Americans (HR = 0.17, 95 % CI 0.07-0.40, p = 0.000). Immunohistochemistry proved to be of predictive value irrespective of used antibody (p = 0.009). In the stratified analysis according to the tumor site, ERCC1 expression was associated with OS in nasopharyngeal cancer (HR = 2.72, 95 % CI 1.79-4.13, p = 0.000). ERCC1 has a potential to become predictive and prognostic factor enabling treatment tailoring in HNSCC patients.

  12. 4. DNA REPAIR CAPACITY IN LUNG CANCER PATIENTS

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    @@The ability for DNA repair is an important host factor which influences the individual susceptibility to genotoxic carcinogen exposures. It has been shown in different case-control studies that DNA repair capacity (DRC) can be reduced in lung cancer patients.We have used an alkaline comet assay to measure the cellular DRC in peri-pheral blood lymphocytes of lung cancer patients and tumor-free control

  13. Outcomes of thoracic endovascular aortic repair in adult coarctation patients.

    Science.gov (United States)

    Lala, Salim; Scali, Salvatore T; Feezor, Robert J; Chandrekashar, Satish; Giles, Kristina A; Fatima, Javairiah; Berceli, Scott A; Back, Martin R; Huber, Thomas S; Beaver, Thomas M; Beck, Adam W

    2017-09-22

    Aortic coarctation (AC) is most commonly identified in pediatric patients; however, adults can present with late sequelae of untreated coarctation or complications of prior open repair. To date, there are limited data about the role of thoracic endovascular aortic repair (TEVAR) in this group of patients. The purpose of this analysis was to describe our experience with management of adult coarctation patients using TEVAR. All TEVAR patients treated for primary coarctation or late sequelae of previous open repair (eg, pseudoaneurysm, recurrent coarctation or anastomotic stenosis related to index open coarctation repair) were reviewed. Demographics, comorbidities, procedure-related variables, postoperative outcomes, and reintervention were recorded. Computed tomography centerline assessments of endograft morphology were completed to delineate stent anatomy at the coarctation site. Survival and reintervention were estimated using life-table analysis. A total of 21 patients were identified (median age, 46 years [range, 33-71 years]; 67% male [n = 14]). Nine patients (43%) were treated for symptomatic primary (n = 6) or recurrent (n = 3) coarctation. Other indications included degenerative thoracic aneurysm (n = 6), pseudoaneurysm (n = 4), and dissection (n = 2). Technical success was 100% (95% confidence interval [CI], 84%-100%). No 30-day mortality or paraplegia events occurred; however, two patients (10%) experienced postoperative nondisabling stroke. In primary or recurrent coarctation patients with available computed tomography imaging (n = 8 of 9), nominal stent graft diameters were achieved proximal and distal to the coarctation (range, -0.4 to -1.2 mm of desired final stent diameter). Specific to the coarctation site, there was a significant increase in aortic diameter after TEVAR (before stenting, 11.5 [95% CI, 6.8-12.3] mm; after stenting, 15 [95% CI, 13.7-15.7] mm; P = .004). Concurrently, systolic arterial blood pressure at time of discharge was

  14. Comparison of arthroscopic rotator cuff repair in healthy patients over and under 65 years of age.

    Science.gov (United States)

    Osti, Leonardo; Papalia, Rocco; Del Buono, Angelo; Denaro, Vincenzo; Maffulli, Nicola

    2010-12-01

    We compared the outcomes of arthroscopically repaired rotator cuff tears in 28 patients older than 65 years (the over 65 group: median age 70 years) with a control group of 28 patients younger than 65 years (the under 65 group: median age 57 years). The groups were similar in regard to sex distribution, surgical technique, and post-operative rehabilitation programmes, but different in age. After careful arthroscopic evaluation of the full-thickness rotator cuff tear, rotator cuff repair and biceps tenotomy were performed in all patients. Pre- and post-operatively, each patient was evaluated for range of motion, shoulder score (UCLA), and SF-36 self-administered questionnaire. Comparing pre- versus post-operative status at a minimum 24 months follow-up, forward elevation, internal and external rotation, modified UCLA rating system scores, and SF-36 scores improved significantly in both groups, with no significant difference between the groups. At the last follow-up, strength improved significantly in both groups, with non-significant intergroup difference. The Popeye sign was detected in 13/28 (46%) of the patients in the over 65 group and in 11/28 (39%) in the under 65 group (χ = 0.29) with non-significant difference between the two groups. In selected active patients older than 65, arthroscopic rotator cuff repair associated with biceps tenotomy (when necessary) can yield clinical and related quality of life outcomes similar to those of patients younger than 65 years.

  15. Morbidity and mortality among patients with hip fractures surgically repaired within and after 48 hours.

    Science.gov (United States)

    Sircar, Padmini; Godkar, Darshan; Mahgerefteh, Shmuel; Chambers, Karinn; Niranjan, Selva; Cucco, Robert

    2007-01-01

    The objectives were (1) to compare the morbidity and mortality of patients with hip fractures surgically repaired within and after 48 hours of the occurrence of fracture and (2) to establish whether timing of repair alone had a major role in determining how the patients fared after the surgical repair or whether comorbidities also affected outcomes. The study involved the medical records of 49 patients (aged 51 to 99 years) admitted to Coney Island Hospital between January 2003 and January 2004 with a primary diagnosis of hip fracture who underwent surgical repair. Analysis of data was done by retrospective chart review of patients admitted with the diagnosis of hip fracture to an acute care hospital setting. Follow-up continued until the patients were transferred to a rehabilitation facility for physical or occupational therapy after surgery. The preoperative health status of each patient was assessed by cardiopulmonary risk index score, based on comorbid conditions, and postoperative outcome was determined by complications (such as bed sores, pneumonia, urinary tract infection, deep vein thrombosis, or pulmonary embolism) or death. Patients who underwent early surgical repair (within 48 hours) had fewer postoperative complications (14.7%, as compared with 33.3% in the group undergoing surgery >48 hours after fracture). CPRI scores in the early and delayed surgery groups were also compared with regard to postoperative mortality and morbidity. It appeared that there was a higher statistical correlation between CPRI scores and complications among patients in the early surgery group (P=0.39) and an insignificant correlation among patients in the delayed surgery group (P=0.07). Surgical repair of hip fractures within the first 48 hours was associated with better health outcomes in a nationally representative sample, as observed in an acute care facility, irrespective of comorbid conditions.

  16. Are valve repairs associated with better outcomes than replacements in patients with native active valve endocarditis?

    Science.gov (United States)

    Zhao, Dong; Zhang, Benqing

    2014-12-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether valve replacement was associated with higher morbidity and mortality rates than valve repair in patients with native active valve endocarditis. Altogether 662 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Traditionally, valve replacement has been the standard therapy for valve endocarditis when surgical treatment is indicated. But now valve repair is increasingly used as an alternative, which may avoid disadvantages of anticoagulation, lower the risk of prosthetic infection and improve postoperative survival. To compare outcomes of these two treatments between studies can be difficult because most of related papers contain raw data on prosthetic valve endocarditis or healed endocarditis, which were excluded from our manuscript. Studies only analysing the outcomes of either of these treatments without the comparison of valve repair and replacement were also excluded. Finally, seven papers were identified. The American Heart Association/American College of Cardiology 2006 valvular guidelines recommended that mitral valve repair should be performed instead of replacement when at all possible. In three of the seven studies, there were significant differences between valve repair and replacement in long-term survival. One study found that aortic valve repair offered better outcomes in freedom from reoperation at 5 years (P = 0.021) and in survival at 4 years (repair vs replacement 88 vs 65%; P = 0.047). One study reported that there was improved event-free survival at 10 years in the mitral valve repair group (P = 0.015), although there was more previous septic embolization in this group. In one study, early and late mortality

  17. Transfection of the cloned human excision repair gene ERCC-1 to UV-sensitive CHO mutants only corrects the repair defect in complementation group 2 mutants.

    NARCIS (Netherlands)

    M. van Duin (Mark); J.H. Janssen; J. de Wit (Jan); J.H.J. Hoeijmakers (Jan); L.H. Thompson; D. Bootsma (Dirk); A. Westerveld (Andries)

    1988-01-01

    textabstractThe human DNA-excision repair gene ERCC-1 is cloned by its ability to correct the excision-repair defect of the ultraviolet light- and mitomycin-C-sensitive CHO mutant cell line 43-3B. This mutant is assigned to complementation group 2 of the excision-repair-deficient CHO mutants. In ord

  18. Patient profiles and outcomes following repair of irreducible and reducible Ventral Wall Hernias.

    Science.gov (United States)

    Danzig, M R; Stey, A M; Yin, S S; Qiu, S; Divino, C M

    2016-04-01

    The belief that irreducible hernias are repaired less successfully and with higher morbidity drives patients to seek elective repair. The aims of this study were threefold. First, this study sought to compare characteristics of patients undergoing irreducible and reducible ventral hernia repair. Second, to compare morbidity rates. Third, to determine which factors, including irreducibility, might be associated with recurrence. This observational study was a retrospective review of 252 consecutive ventral hernia patients divided into two cohorts: 101 patients who underwent repair of an irreducible ventral hernia, and 152 patients underwent repair of a reducible ventral hernia. The mean follow-up time was approximately 4 years in both groups. Patients undergoing repair of irreducible hernias had higher median BMI (31 vs. 27 kg/m2, p = 0.005), had their hernias longer (median 34 months compared to 12 months, p = 0.043), had more defects on average (mean 1.8 vs. 1.4, p hernia size (p = 0.821), nor the location of hernia (p = 0.261) differed significantly between the two groups. Morbidity rates, including rates of surgical site infection, obstruction, and recurrence, did not differ significantly; nor did recurrence-free survival (RFS) distributions. Risk factors for hernia recurrence on multivariate analysis included the repaired hernia being itself recurrent (HR = 2.06, 95% CI = 1.07-3.99, p = 0.031), the occurrence of post-operative surgical site infection (HR = 5.10, 95% CI = 2.18-11.91, p hernias did not have statistically significant differences in morbidity. Recurrence was not observed to be associated with irreducibility but was found to be associated with other post-operative complications.

  19. Use of tubularized incised plate urethroplasty for secondary hypospadias repair or repair in circumcised patients

    OpenAIRE

    2008-01-01

    PURPOSE: To retrospectively review our experience of the tubularized incised plate (TIP) urethroplasty in a series of re-operative hypospadias repairs or circumcised children. MATERIALS AND METHODS: Between September 2001 and September 2007, 17 children (mean 4.6 years, range 7 months to 15 years), were referred for hypospadias re-operation. Some of these patients had previously undergone circumcision and missed hypospadias. In all cases, the TIP urethroplasty was covered with an additional l...

  20. Arthroscopic biceps tenodesis compared with repair of isolated type II SLAP lesions in patients older than 35 years.

    Science.gov (United States)

    Denard, Patrick J; Lädermann, Alexandre; Parsley, B K; Burkhart, Stephen S

    2014-03-01

    This study compared arthroscopic biceps tenodesis with biceps repair for isolated type II superior labrum anterior and posterior (SLAP) lesions in patients older than 35 years. The authors identified isolated type II SLAP lesions that were surgically managed over a 5-year period. Minimum 2-year follow-up data were available for 22 patients who underwent biceps repair (repair group) and for 15 patients who underwent a primary biceps tenodesis (tenodesis group). Mean age at surgery was 45.2±5.5 years in the repair group and 52.0±8.0 years in the tenodesis group. In the repair group, functional outcome improved from baseline to final follow-up using the American Shoulder and Elbow Surgeons (ASES) (47.5 to 87.4, respectively; PSLAP lesion had a shorter postoperative recovery, a more predictable functional outcome, and a higher rate of satisfaction and return to activity with a biceps tenodesis compared with a biceps repair. Based on these observations, biceps tenodesis is preferable to biceps repair for isolated type II SLAP lesions in nonoverhead athletes older than 35 years.

  1. Functional evaluation of patient after arthroscopic repair of rotator cuff tear.

    Science.gov (United States)

    Kumar, Rohit; Jadhav, Umesh

    2014-06-01

    Rotator cuff tear is a common problem either after trauma or after degenerative tear in old age group. Arthroscopic repair is the current concept of rotator cuff repair. Here, we are trying to evaluate the functional outcome after arthroscopic repair of full thickness rotator cuff tear (single row) in Indian population. Twenty five patients (14 males and 11 females) who underwent arthroscopic repair of full thickness rotator cuff tear at a single institution were included in the study. Postoperatively patient's shoulder was rated according to UCLA score, pain was graded according to the visual analog score. The range of motion was analysed and documented. The mean age of the patients were 50.48 years. The preoperative VAS score mode was 7 and post operative VAS was 1 (p value fair in 12% (n = 3), excellent in 8% (n = 2) and poor results were seen in none of the patients. The mean UCLA improved from a score of 15.84 to 30.28 with a p value <0.001. Mean postoperative forward flexion was 161.6°, mean abduction was 147.6° and mean external rotation was 45.4°. Arthroscopic repair is a good procedure for full thickness rotator cuff tear with minimal complications. The newer double row repair claims to be biomechanically superior with faster healing rates without functional advantages, hence we used a single row repair considering the Indian population and the cost effectiveness of the surgery with good to excellent results.

  2. Principles of protein group SUMO modification substantiated in DNA repair

    OpenAIRE

    Psakhye, Ivan

    2013-01-01

    Posttranslational modifications (PTMs) of proteins by covalent attachment of functional groups (like phosphorylation, acetylation, methylation, glycosylation, etc.) are of key importance for the cell as they regulate various aspects of protein behavior after its synthesis, e.g., dictate protein interaction properties, change catalytic activity of enzymes, induce conformational changes, guide subcellular localization and determine protein stability. A special class of protein PTMs is the conju...

  3. A Pain Education Intervention for Patients Undergoing Ambulatory Inguinal Hernia Repair: A Randomized Controlled Trial.

    Science.gov (United States)

    Sawhney, Monakshi; Watt-Watson, Judy; McGillion, Michael

    2017-09-01

    Background Inguinal hernia repair is a common ambulatory surgery after which many patients experience moderate to severe post-operative pain. Limited research has examined the effect of education interventions to reduce pain after ambulatory surgery. Purpose This trial evaluated the effectiveness of an individualized Hernia Repair Education Intervention (HREI) for patients following inguinal hernia repair. Method Pre-operatively, participants (N = 82) were randomized to either the intervention (HREI) or the usual care group. The HREI included written and verbal information regarding managing pain and two telephone support calls (before and after surgery). The primary outcome was WORST 24-h pain intensity on movement on post-operative day 2. Secondary outcomes included pain intensity at rest and movement, pain-related interference with activities, pain quality, analgesics consumed, and adverse effects at post-operative days 2 and 7. Results At day 2, the intervention group reported significantly lower scores across pain intensity outcomes, including WORST 24-h pain on movement and at rest (p pain NOW on movement and at rest (p = 0.001). Conclusion These findings suggest that the HREI may improve patients' pain and function following ambulatory inguinal hernia repair. Further research should examine the effectiveness of an education intervention over a longer period of time.

  4. Patient Compliance with Surveillance Following Elective Endovascular Aneurysm Repair

    Energy Technology Data Exchange (ETDEWEB)

    Godfrey, Anthony D., E-mail: deangodfrey@yahoo.co.uk; Morbi, Abigail H. M., E-mail: a.morbi@soton.ac.uk; Nordon, Ian M., E-mail: ian.nordon@uhs.nhs.uk [University Hospital Southampton NHS Foundation Trust, Unit of Cardiac Vascular and Thoracic Surgery - CV& T, Department of Vascular Surgery (United Kingdom)

    2015-10-15

    PurposeIntegral to maintaining good outcomes post-endovascular aneurysm repair (EVAR) is a robust surveillance protocol. A significant proportion of patients fail to comply with surveillance, exposing themselves to complications. We examine EVAR surveillance in Wessex (UK), exploring factors that may predict poor compliance.MethodsRetrospective analysis of 179 consecutive elective EVAR cases [2008–2013] was performed. 167 patients were male, with the age range of 50–95. Surveillance was conducted centrally (tertiary referral trauma centre) and at four spoke units. Surveillance compliance and predictors of non-compliance including age, gender, co-morbid status, residential location and socioeconomic status were analysed for univariate significance.ResultsFifty patients (27.9 %) were non-compliant with surveillance; 14 (8.1 %) had no imaging post-EVAR. At 1 year, 56.1 % (of 123 patients) were compliant. At years 2 and 3, 41.5 and 41.2 % (of 65 and 34 patients, respectively) were compliant. Four years post-EVAR, only one of eight attended surveillance (12.5 %). There were no statistically significant differences in age (p = 0.77), co-morbid status or gender (p = 0.64). Distance to central unit (p = 0.67) and surveillance site (p = 0.56) was non-significant. While there was a trend towards compliance in upper-middle-class socioeconomic groups (ABC1 vs. C1C2D), correlating with >50 % of non-compliant patients living within <10 mile radius of the central unit, overall predictive value was not significant (p = 0.82).ConclusionsCompliance with surveillance post-EVAR is poor. No independent predictor of non-compliance has been confirmed, but socioeconomic status appears to be relevant. There is a worrying drop-off in attendance beyond the first year. This study highlights a problem that needs to be addressed urgently, if we are to maintain good outcomes post-EVAR.

  5. Revision Arthroscopic Repair Versus Latarjet Procedure in Patients With Recurrent Instability After Initial Repair Attempt: A Cost-Effectiveness Model.

    Science.gov (United States)

    Makhni, Eric C; Lamba, Nayan; Swart, Eric; Steinhaus, Michael E; Ahmad, Christopher S; Romeo, Anthony A; Verma, Nikhil N

    2016-09-01

    To compare the cost-effectiveness of arthroscopic revision instability repair and Latarjet procedure in treating patients with recurrent instability after initial arthroscopic instability repair. An expected-value decision analysis of revision arthroscopic instability repair compared with Latarjet procedure for recurrent instability followed by failed repair attempt was modeled. Inputs regarding procedure cost, clinical outcomes, and health utilities were derived from the literature. Compared with revision arthroscopic repair, Latarjet was less expensive ($13,672 v $15,287) with improved clinical outcomes (43.78 v 36.76 quality-adjusted life-years). Both arthroscopic repair and Latarjet were cost-effective compared with nonoperative treatment (incremental cost-effectiveness ratios of 3,082 and 1,141, respectively). Results from sensitivity analyses indicate that under scenarios of high rates of stability postoperatively, along with improved clinical outcome scores, revision arthroscopic repair becomes increasingly cost-effective. Latarjet procedure for failed instability repair is a cost-effective treatment option, with lower costs and improved clinical outcomes compared with revision arthroscopic instability repair. However, surgeons must still incorporate clinical judgment into treatment algorithm formation. Level IV, expected value decision analysis. Copyright © 2016. Published by Elsevier Inc.

  6. Contribution of DNA Repair Xeroderma Pigmentosum Group D Genotypes to Colorectal Cancer Risk in Taiwan.

    Science.gov (United States)

    Chang, Wen-Shin; Yueh, Te-Cheng; Tsai, Chia-Wen; Ji, Hong-Xue; Wu, Cheng-Nan; Wang, Shou-Cheng; Lai, Yi-Liang; Hsu, Shih-Wei; Hsieh, Ming-Hao; Hsiao, Chieh-Lun; Hung, Yi-Wen; Shih, Tzu-Ching; Bau, Da-Tian

    2016-04-01

    It has been previously proposed that genetic variations on DNA repair genes confer susceptibility to cancer and the DNA repair gene Xeroderma Pigmentosum Group D (XPD) is thought to play the role of a helicase during excision repair and transcription. We investigated three genotypes of XPD, at promoter -114 (rs3810366), Asp312Asn (rs1799793) and Lys751Gln (rs13181), regarding their association with colorectal cancer susceptibility in a Taiwanese population. In total, 362 patients with colorectal cancer and 362 gender- and age-matched healthy controls were genotyped by polymerase chain reaction-based restriction fragment length polymorphism (PCR-RFLP), and their XPD genotypes' association with colorectal cancer risk was investigated. The genotypes of XPD Asp312Asn (p=0.2493), Lys751Gln (p=0.7547) and promoter -114 (p=0.8702), were not associated with susceptibility for colorectal cancer. The Chi-square test revealed that the variant alleles of XPD Asp312Asn, Lys751Gln and promoter -114 was not associated with susceptibility for colorectal cancer either [p=0.1330, 0.3888 and 0.8740; odds ratio (OR)=1.20, 0.83 and 0.98; 95% confidence interval (95%CI)=0.95-1.52, 0.54-1.27 and 0.80-1.21, respectively]. The risk of A/G and A/A genotypes have no association with cancer risk among non-alcohol drinkers (OR=1.24, 95%, CI=0.90-1.72, p=0.2103) or alcohol drinkers (OR=1.51, 95% CI=0.64-3.55, p=0.4648). There exists no obvious contribution of XPD genotypes to tumor size (p=0.3531), location (p=0.3006) and lymph node metastasis (p=0.1061). Asp312Asn, Lys751Gln and promoter -114 of the XPD gene were not found to be adequate predictive markers for colorectal cancer risk in Taiwan. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  7. Echocardiographic assessment of the aortic root dilatation in adult patients after tetralogy of Fallot repair.

    Science.gov (United States)

    Cruz, Cristina; Pinho, Teresa; Lebreiro, Ana; Silva Cardoso, José; Maciel, Maria Júlia

    2013-06-01

    Transthoracic echocardiography is an important tool after tetralogy of Fallot repair, of which aortic root dilatation is a recognized complication. In this study we aimed to assess its prevalence and potential predictors. We consecutively assessed adult patients by transthoracic echocardiography after tetralogy of Fallot repair, and divided them into two groups based on the maximum internal aortic diameter at the sinuses of Valsalva in parasternal long-axis view: group 1 with aortic root dilatation (≥38 mm) and group 2 without dilatation (<38 mm). A total of 53 patients were included, mean age 32±10 years, with a mean time since surgery of 23±7 years. An aortopulmonary shunt had been performed prior to complete repair in 25 patients, and a transannular patch was used in 19 patients. Aortic root measurement was possible in all patients. Aortic root dilatation was identified in eight patients (15%), all male. Male gender (p=0.001), body surface area (1.93±0.10 vs. 1.70±0.20 m(2), p=0.03) and increased left ventricular end-diastolic diameter (p=0.005) were predictors of aortic root dilatation. None of the surgical variables studied were predictors of aortic root dilatation. The prevalence of aortic root dilatation in this cohort was low and male gender was a predictor of its occurrence. The type of repair and time to surgery did not influence its occurrence. Quantification of aortic root diameter is possible by transthoracic echocardiography; we suggest indexing it to body surface area in clinical practice. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  8. [Productive films in patient groups].

    Science.gov (United States)

    Allahyari, H

    1975-01-01

    For 3 years I have been trying to establish creative teamwork with a group of drug-addicted adolescents with the aim of stimulating imagination by visual means, thus enlightening hidden problems, and showing a way to self-representation. Especially with these patients an attitude of mistrust makes verbal access difficult. The group consists of some eight adolescents of about the same age, with whom I in no way try to interfere through provocation. We meet twice a week. On one day we discuss ideas, scripts and technical problems, the other day being dedicated to the practical side. My position in the group equals that of the hierarchic dynamic basic formula according to Raoul Schindler. The group is allocentric, work being aimed at common achievement. We try to create a feeling of solidarity, reduce tensions, and encourage individual relationships. So far we have accomplished four films. Teamwork has helped us to come to know each other better. The interpersonal relationships have improved. The barrier between doctor and patient has been completely obliterated.

  9. DNA repair capacity and acute radiotherapy adverse effects in Italian breast cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Sterpone, Silvia; Cornetta, Tommaso [Department of Biology, University of ' Roma TRE' , V.le G. Marconi 446, Rome 00146 (Italy); Padua, Luca [' Don Carlo Gnocchi' Foundation, Rome (Italy); Mastellone, Valeria [Department of Biology, University of ' Roma TRE' , V.le G. Marconi 446, Rome 00146 (Italy); Giammarino, Daniela [' S. Camillo-Forlanini' Hospital, Radiation Oncology Unit, Rome (Italy); Testa, Antonella; Tirindelli, Donatella [Toxicology and Biomedical Sciences Section, ENEA, Casaccia, Rome (Italy); Cozzi, Renata, E-mail: cozzi@uniroma3.it [Department of Biology, University of ' Roma TRE' , V.le G. Marconi 446, Rome 00146 (Italy); Donato, Vittorio [' S. Camillo-Forlanini' Hospital, Radiation Oncology Unit, Rome (Italy)

    2010-02-03

    Therapeutic exposure to ionising radiation can induce normal tissue side effects which consistently differ among individuals suggesting a possible genetic control. One approach to elucidate the underlying mechanisms is to analyse the relation between genetic traits, biomarkers of in vitro DNA damage and side toxicity in vivo. 43 breast cancer (BC) patients receiving radiotherapy after a breast-conserving surgery were recruited together with 34 age- and sex-matched healthy controls. Adverse tissue reactions were recorded as indicators of radiotherapy susceptibility. All blood samples from both patients (35) and controls (34) were irradiated in vitro and DNA primary damage and repair kinetic were measured through Comet assay. All study subjects were genotyped for XRCC1, OGG1 and XRCC3 gene polymorphisms. In our small groups we found a positive association between XRCC1 variant allele (399Gln) and the occurrence of breast cancer [p = 0.01; OR = 2.41, 95%CI (1.24-4.66)]. BC patients showed a higher degree of basal (p < 0.001) and X-ray induced DNA damage (p < 0.01) when compared to healthy controls. A reduced repair ability was found in BC patients showing high degrees of tissue side effects as classified by Radiation Morbidity Scoring Scheme. BC patients showed an impairment of their DNA repair capacity associated with the development of radiation sensitivity but not with polymorphisms in any of the considered genes.

  10. Use of tubularized incised plate urethroplasty for secondary hypospadias repair or repair in circumcised patients

    Directory of Open Access Journals (Sweden)

    Seyed A. Mousavi

    2008-10-01

    Full Text Available PURPOSE: To retrospectively review our experience of the tubularized incised plate (TIP urethroplasty in a series of re-operative hypospadias repairs or circumcised children. MATERIALS AND METHODS: Between September 2001 and September 2007, 17 children (mean 4.6 years, range 7 months to 15 years, were referred for hypospadias re-operation. Some of these patients had previously undergone circumcision and missed hypospadias. In all cases, the TIP urethroplasty was covered with an additional layer of subcutaneous tissue or dartos flap. The original location, associated complications and results were recorded. RESULTS: There were 4 (30.7%, incidences of complications of TIP re-operation, 2 meatal stenosis, one stenosis with small fistula and one dehiscence. Re-operation was necessary in only one patient of our series (7.6% and the others were cured by dilatation. No complications occurred in the circumcised patents. CONCLUSION: Using TIP urethroplasty as described by Snodgrass, is a suitable method for treating primary and re-operative cases. It can also be used successfully in patients, who do not have a healthy skin flap and in circumcised patients when there is a lack of foreskin.

  11. Transperitoneal laparoscopic repair of vesicovaginal fistula for patients with supratrigonal fistula: comparison with open transperitoneal technique.

    Science.gov (United States)

    Xiong, Yang; Tang, Yunhua; Huang, Fang; Liu, Longfei; Zhang, Xiangyang

    2016-09-01

    We investigated the treatment outcomes of laparoscopic vesicovaginal fistula repair (LVVFR) in patients with supratrigonal vesicovaginal fistula (VVF) in contrast with open transperitoneal vesicovaginal fistula repair (OVVFR). We analyzed 58 VVF repairs from June 2005 to July 2014, with 22 patients in the LVVFR group and 36 in the OVVFR group. Demographic parameters, operative variables, and perioperative outcomes were retrospectively collected and analyzed. The chi-square test, Fisher's exact test, Student's t test and the Mann-Whitney U test were used for statistical analysis. Patients in both groups had comparable preoperative characteristics. Significantly shorter hospital stay (5.6 vs. 13.2 days, p  0.05) and recurrent VVF success rate (90.0 % vs. 75.0 %, p > 0.05) than OVVFR group, but it was not statistically significant. Patients who underwent OVVFR experienced more postoperative symptomatic bladder spasms (8.3 % vs. 4.5 %, p > 0.05), urinary tract infections (UTIs) (5.6 % vs. 0.0 %, p > 0.05), and stress urinary incontinence (SUI) (5.6 % vs. 4.5 %, p > 0.05), but fewer incidents of postoperative ileus (0.0 % vs. 4.5 %, p > 0.05) than the LVVFR group; differences were not significant. Judging from this initial trial, LVVFR should be recommended as the primary intervention to treat supratrigonal VVF patients in view of its reduced blood loss and hospital stay.

  12. RAD25(SSL2), a yeast homolog of the human xeroderma pigmentosum group B DNA repair gene, is essential for viability.

    NARCIS (Netherlands)

    E. Park (Robert); S.N. Guzder; M.H.M. Koken (Marcel); I. Jaspers-Dekker (Iris); G. Weeda (Geert); J.H.J. Hoeijmakers (Jan); S. Prakash; L. Prakash

    1992-01-01

    textabstractXeroderma pigmentosum (XP) patients are extremely sensitive to ultraviolet (UV) light and suffer from a high incidence of skin cancers, due to a defect in nucleotide excision repair. The disease is genetically heterogeneous, and seven complementation groups, A-G, have been identified. Ho

  13. The Polycomb Group Protein EZH2 Impairs DNA Repair in Breast Epithelial Cells

    Directory of Open Access Journals (Sweden)

    Michael Zeidler

    2005-11-01

    Full Text Available The Polycomb group protein EZH2 is a transcriptional repressor involved in controlling cellular memory and has been linked to aggressive and metastatic breast cancer. Here we report that EZH2 decreased the expression of five RAD51 paralog proteins involved in homologous recombination (HR repair of DNA doublestrand breaks (RAD51B/RAD51L1, RAD51C/RAD51L2, RAD51D/RAD51L3, XRCC2, and XRCC3, but did not affect the levels of DMC1, a gene that only functions in meiosis. EZH2 overexpression impaired the formation of RAD51 repair foci at sites of DNA breaks. Overexpression of EZH2 resulted in decreased cell survival and clonogenic capacity following DNA damage induced independently by etoposide and ionizing radiation. We suggest that EZH2 may contribute to breast tumorigenesis by specific downregulation of RAD51-like proteins and by impairment of HR repair. We provide mechanistic insights into the function of EZH2 in mammalian cells and uncover a link between EZH2, a regulator of homeotic gene expression, and HR DNA repair. Our study paves the way for exploring the blockade of EZH2 overexpression as a novel approach for the prevention and treatment of breast cancer.

  14. DNA repair in lymphocytes from patients with secondary leukemia as measured by strand rejoining and unscheduled DNA synthesis

    DEFF Research Database (Denmark)

    Bohr, V; Køber, L

    1985-01-01

    deficiencies as measured by their ability to rejoin strand breaks, and 5 out of 7 had increased unscheduled DNA synthesis compared to treated and normal controls. All patients with SL and 4 out of 8 treated controls had inherent strand breaks in their DNA as compared to the normal controls when measured...... in isolated peripheral lymphocytes from the patients by measuring the rejoining of strand breaks following alkylation damage to the lymphocytes or by measuring unscheduled DNA synthesis. Day-to-day variability in the assays was considerable, but findings were that 5 out of 7 SL patients had repair......The ability to repair damage to DNA was compared in 2 groups of patients having undergone treatment for leukemia, one of which developed secondary leukemia (SL), and the other without signs of secondary malignancy (treated controls). Both were related to normal controls. DNA repair was assessed...

  15. Large Hill-Sachs Lesion: a Comparative Study of Patients Treated with Arthroscopic Bankart Repair with or without Remplissage.

    Science.gov (United States)

    Garcia, Grant H; Park, Min Jung; Zhang, Clare; Kelly, John D; Huffman, G Russell

    2015-07-01

    There is little comparative long-term clinical data comparing Bankart repair alone to the addition of remplissage. Our purpose was to compare results of patients with significant humeral head lesions and who underwent either isolated arthroscopic Bankart repair or remplissage. This is a retrospective cohort study of 14 isolated arthroscopic Bankart and 10 remplissage repairs all with large engaging Hill-Sachs (HS) lesions. Average follow-up was 40.72 months (26.3-51.1) in the Bankart group and 31.55 months (24.1-39.9) in the remplissage group. Surgical failure was defined as a dislocation or subluxation. Groups were matched on handedness, age within 3 years, and HS lesion size. Glenoid bone loss and HS size were measured on MRI. Additionally, WOSI and DASH scores were obtained. The average age at surgery was 26.0 years (17.8-41.1) of the isolated Bankart patient and 24.4 years (16.4-38.3) in the remplissage group. The average HS lesion volume was 310.22 mm(3) in the Bankart group and 283.79 mm(3) in the remplissage group. The failure rate for the Bankart group was 8 out of 14 patients (57.14%). For the remplissage group, the failure rate was 2 out of 10 patients (20.0%). Average WOSI scores were 73.72 in the Bankart group and 79.54 in the remplissage group. For DASH scores, the average Disability/Symptoms Scores were 16.23 for the Bankart group and 12.05 for the remplissage patients. In comparison to isolated Bankart repair, remplissage was a superior option for recurrent instability patients with large Hill-Sachs lesions as seen by diminished failure rates and improved outcome scores.

  16. Response shift of the Western Ontario Rotator Cuff index in patients undergoing arthroscopic rotator cuff repair.

    Science.gov (United States)

    Hollman, Freek; Wessel, Ronald N; Wolterbeek, Nienke

    2016-12-01

    This study determined the response shift in patients undergoing rotator cuff repair using the Western Ontario Rotator Cuff index (WORC), a disease-specific quality of life questionnaire. We hypothesized there would be a response shift with a positive recalibration (overestimated their preoperative disability) on the WORC and increases over time. The study prospectively included 36 patients undergoing arthroscopic rotator cuff repair. At baseline, 3 months (T1), and 1 year (T2) after surgery the WORC, EuroQol (EQ)-5D-3L, and the patient's level of satisfaction after surgery were scored. To evaluate the response shift, patients also completed the WORC at 3 months (Pre-T1) and 1 year (Pre-T2) as how they perceived themselves to have been before surgery. The result on Pre-T1 and Pre-T2 results revealed that patients retrospectively rated their overall WORC score comparable with the baseline WORC score (Pre-T0; T0 = 40.5 ± 18.4, Pre-T1 = 45.0 ± 22.7, Pre-T2 = 34.3 ± 21.3). No response shift was observed on all domains except a negative recalibrated response shift for emotional disability on T1 (P = .04). No significant group-level response shift was observed using the WORC, except for the subdomain emotional disability at 3 months after arthroscopic rotator cuff repair. With the absence of any shift in patient's perception on the self-administered quality of life-related WORC questionnaire, this study suggests one could retrospectively reliably conduct group-level preoperative baseline information on quality of life up to 1 year after surgery. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  17. Excision repair cross complementation group 1 polymorphisms and lung cancer risk: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    CAO Chao; DENG Zai-chun; ZHANG Yan-mei; WANG Ran; SUN Shi-fang; CHEN Zhong-bo; MA Hong-ying; YU Yi-ming; DING Qun-li; SHU Li-hua

    2011-01-01

    Background Several studies have evaluated the association between polymorphisms of encoding excision repair cross complementation group 1 (ERCC1) enzyme and lung cancer risk in diverse populations but with conflicting results.By pooling the relatively small samples in each study, it is possible to perform a meta-analysis of the evidence by rigorous methods.Methods Embase, Ovid, Medline and Chinese National Knowledge Infrastructure were searched. Additional studies were identified from references in original studies or review articles. Articles meeting the inclusion criteria were reviewed systematically, and the reported data were aggregated using the statistical techniques of meta-analysis.Results We found 3810 cases with lung cancer and 4332 controls from seven eligible studies. T19007C polymorphism showed no significant effect on lung cancer risk (C allele vs. T allele: odds ratio (OR)=0.91, 95% confidence interval (CI)=0.80-1.04; CC vs. TT: OR=0.76, 95% CI=0.56-1.02; CC vs. (CT+TT): OR=0.96, 95% CI=-0.84-1.10). Similarly,there was no significant main effects for T19007C polymorphism on lung cancer risk when stratified analyses by ethnicity (Chinese or Caucasian). No significant association was found between C8092A polymorphism (3060 patients and 2729 controls) and the risk of lung cancer (A allele vs. C allele: OR=1.03, 95% CI=0.95-1.11; AA vs. CC: OR=1.08, 95% CI=-0.88-1.33; AA vs. (AC+CC): OR=1.08, 95% CI=-0.88-1.31).Conclusion We found little evidence of an association between the T1900C or C8092A polymorphisms of ERCC 1 and the risk of lung cancer in Caucasian or Han Chinese people.

  18. Dissecting DNA repair in adult high grade gliomas for patient stratification in the post-genomic era

    Science.gov (United States)

    Perry, Christina; Agarwal, Devika; Abdel-Fatah, Tarek M.A.; Lourdusamy, Anbarasu; Grundy, Richard; Auer, Dorothee T.; Walker, David; Lakhani, Ravi; Scott, Ian S.; Chan, Stephen; Ball, Graham; Madhusudan, Srinivasan

    2014-01-01

    Deregulation of multiple DNA repair pathways may contribute to aggressive biology and therapy resistance in gliomas. We evaluated transcript levels of 157 genes involved in DNA repair in an adult glioblastoma Test set (n=191) and validated in ‘The Cancer Genome Atlas’ (TCGA) cohort (n=508). A DNA repair prognostic index model was generated. Artificial neural network analysis (ANN) was conducted to investigate global gene interactions. Protein expression by immunohistochemistry was conducted in 61 tumours. A fourteen DNA repair gene expression panel was associated with poor survival in Test and TCGA cohorts. A Cox multivariate model revealed APE1, NBN, PMS2, MGMT and PTEN as independently associated with poor prognosis. A DNA repair prognostic index incorporating APE1, NBN, PMS2, MGMT and PTEN stratified patients in to three prognostic sub-groups with worsening survival. APE1, NBN, PMS2, MGMT and PTEN also have predictive significance in patients who received chemotherapy and/or radiotherapy. ANN analysis of APE1, NBN, PMS2, MGMT and PTEN revealed interactions with genes involved in transcription, hypoxia and metabolic regulation. At the protein level, low APE1 and low PTEN remain associated with poor prognosis. In conclusion, multiple DNA repair pathways operate to influence biology and clinical outcomes in adult high grade gliomas. PMID:25026297

  19. Single-centre experience with mitral valve repair in asymptomatic patients with severe mitral valve regurgitation

    NARCIS (Netherlands)

    W.J. van Leeuwen (Wouter); S.J. Head (Stuart); L.E. de Groot-de Laat (Lotte); M.L. Geleijnse (Marcel); A.J.J.C. Bogers (Ad); L.A. van Herwerden (Lex); A.P. Kappetein (Arie Pieter)

    2013-01-01

    textabstractOBJECTIVES: Guidelines recommend surgical mitral valve repair in selected patients with asymptomatic severe mitral valve regurgitation (MR), but the role of repair remains a matter of debate. Survival analyses of operated asymptomatic patients have been reported, but long-term haemodynam

  20. Evaluation of radioinduced damage and repair capacity in blood lymphocytes of breast cancer patients

    Directory of Open Access Journals (Sweden)

    P.A. Nascimento

    2001-02-01

    Full Text Available Genetic damage caused by ionizing radiation and repair capacity of blood lymphocytes from 3 breast cancer patients and 3 healthy donors were investigated using the comet assay. The comets were analyzed by two parameters: comet tail length and visual classification. Blood samples from the donors were irradiated in vitro with a 60Co source at a dose rate of 0.722 Gy/min, with a dose range of 0.2 to 4.0 Gy and analyzed immediately after the procedure and 3 and 24 h later. The basal level of damage and the radioinduced damage were higher in lymphocytes from breast cancer patients than in lymphocytes from healthy donors. The radioinduced damage showed that the two groups had a similar response when analyzed immediately after the irradiations. Therefore, while the healthy donors presented a considerable reduction of damage after 3 h, the patients had a higher residual damage even 24 h after exposure. The repair capacity of blood lymphocytes from the patients was slower than that of lymphocytes from healthy donors. The possible influence of age, disease stage and mutations in the BRCA1 and BRCA2 genes are discussed. Both parameters adopted proved to be sensitive and reproducible: the dose-response curves for DNA migration can be used not only for the analysis of cellular response but also for monitoring therapeutic interventions. Lymphocytes from the breast cancer patients presented an initial radiosensitivity similar to that of healthy subjects but a deficient repair mechanism made them more vulnerable to the genotoxic action of ionizing radiation. However, since lymphocytes from only 3 patients and 3 normal subjects were analyzed in the present paper, additional donors will be necessary for a more accurate evaluation.

  1. Operator Semi-group of Density Evolution Equation for a Repairable Redundnt System with Two Same Components

    Institute of Scientific and Technical Information of China (English)

    史定华; 徐洪; 等

    2002-01-01

    For a repairable redundant system consisting of two same components with exponential lifetime and general repair time distribution,the probability densities of the system in some state at time t were determined by a group of ordinary and partial differential equations,called density evolution equations.It was proved that the time-dependent solution of the density evolution equations uniquely exists and strongly converges to its steady state density solution by a semi-group method.In this proof,it is not necessary to suppose that the repair rate function is bounded.The technique of the proof is valuable for many density evolution equatons.

  2. Undescended testicle repair

    Science.gov (United States)

    Orchidopexy; Inguinal orchidopexy; Orchiopexy; Repair of undescended testicle; Cryptorchidism repair ... first year of life without treatment. Undescended testicle repair surgery is recommended for patients whose testicles do ...

  3. The EWMA Patient Outcome Group

    DEFF Research Database (Denmark)

    Gottrup, F

    2009-01-01

    Across Europe, clinical experts in wound care and industry representatives have joined forces to propose recommendations for clinical data collection on chronic wound management. Here, the chair of the group, Finn Gottrup, outlines its main objectives.......Across Europe, clinical experts in wound care and industry representatives have joined forces to propose recommendations for clinical data collection on chronic wound management. Here, the chair of the group, Finn Gottrup, outlines its main objectives....

  4. Targeting DNA-repair systems brings hopes to cancer patients

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ CAS researchers have recently raised a hypothesis to circumvent tumor resistance to radio- and chemo-therapy and to enhance the efficacy of DNAdamaging agents by interfering with DNA repair. "There are emerging anticancer therapeutic opportunities in targeting DNA-repair systems," they asserted.

  5. Outcome of pregnancy in patients after repair of aortic coarctation

    NARCIS (Netherlands)

    Vriend, JWJ; Drenthen, W; Pieper, PG; Roos-Hesselink, JW; Zwinderman, AH; van Veldhuisen, DJ; Mulder, BJM

    2005-01-01

    Aims Nowadays, most women born with aortic coarctation reach childbearing age. However, data on outcome of pregnancy in women after repair of aortic coarctation are scarce. The aim of this study was to report on maternal and neonatal outcome of pregnancy in women after aortic coarctation repair. Met

  6. Technique of laparoscopic ventral hernia repair can be modified to successfully repair large defects in patients with loss of domain.

    Science.gov (United States)

    Baghai, Mercedeh; Ramshaw, Bruce J; Smith, C Daniel; Fearing, Nicole; Bachman, Sharon; Ramaswamy, Archana

    2009-03-01

    Laparoscopic ventral hernia repair (LVHR) can be challenging in patients with large abdominal wall defects and loss of domain (LOD). When hernia contents are reduced, the pneumoperitoneum preferentially fills the sac, leaving no space for mesh manipulation. This study presents a modification for LVHR in LOD patients, as well as outcomes for a series of patients. Between September 2002 and August 2004, 10 patients with large ventral hernias and LOD underwent attempts at LVHR. The technique is modified by placing additional trocars to allow for fixation from above the mesh. Patient data were harvested from a prospective database and analyzed. All hernias were recurrent in nature. Mean defect size was 626 cm(2), requiring 1 to 4 pieces of sutured Gore Dualmesh for a tension-free repair. Three patients' procedures were aborted after adhesiolysis, with concerns about missed enterotomies. All 3 underwent delayed mesh placement within the same hospitalization. Only 2 were successful. The third patient had significant bowel edema precluding mesh placement. Two patients were converted to open repairs (Rives-Stoppa and component separation). There were no mortalities, but there were 2 major complications: inferior vena cava thrombosis and transient abdominal compartment syndrome. In follow-up (7.7 months) there were 2 recurrences secondary to excision of infected mesh. It is possible to obtain a successful LVHR in patients with large defects and LOD. The technique is complex and is modified to allow for mesh fixation from above the mesh. Frequent change in patient positioning allows for visualization below the fascial defect.

  7. Postoperative Comparison In Open Vs. Laparoscopic Ventral Hernia Repair In Obese Patients

    Directory of Open Access Journals (Sweden)

    Dogaru Iuliana

    2017-02-01

    Full Text Available Introduction: Obesity is an important problem in our society. Recent studies shows that laparoscopic ventral hernia repair has advantages in obese patients comparing with the standard open approach. This study wants to compare length of stay (LOS, hospitalization costs (HC and operative time (OT in laparoscopic and open ventral hernia repair.

  8. Difficulties and Problematic Steps in Teaching the Onstep Technique for Inguinal Hernia Repair, Results from a Focus Group Interview

    DEFF Research Database (Denmark)

    Andresen, Kristoffer; Laursen, Jannie; Rosenberg, Jacob

    2016-01-01

    Background. When a new surgical technique is brought into a department, it is often experienced surgeons that learn it first and then pass it on to younger surgeons in training. This study seeks to clarify the problems and positive experiences when teaching and training surgeons in the Onstep...... technique for inguinal hernia repair, seen from the instructor's point of view. Methods. We designed a qualitative study using a focus group to allow participants to elaborate freely and facilitate a discussion. Participants were surgeons with extensive experience in performing the Onstep technique from...... Germany, UK, France, Belgium, Italy, Greece, and Sweden. Results. Four main themes were found, with one theme covering three subthemes: instruction of others (experience, patient selection, and tailored teaching), comfort, concerns/fear, and anatomy. Conclusion. Surgeons receiving a one-day training...

  9. Do patients with isolated Pierre Robin Sequence have worse outcomes after cleft palate repair: A systematic review.

    Science.gov (United States)

    Wan, Teng; Chen, Yang; Wang, Guomin

    2015-08-01

    Cleft palate repair for Pierre Robin Sequence (PRS) patients has always been a challenge for surgeons and anesthetists. The aim of this systematic review is to investigate the outcome of cleft palate repair for PRS patients compared with cleft palate-only patients. All papers published before October 2014 were searched in the databases PubMed and MEDLINE. Search terms included "Pierre Robin Sequence," "cleft palate repair," and "speech result." Additional studies were identified by hand searching the reference lists of the papers retrieved from electronic search. Two independent reviewers assessed the eligibility of studies for inclusion, extracted the data, and assessed the quality of the studies. Six studies met the inclusion criteria. All but one study had multiple deficiencies in study designs. Four studies assessed the fistula rate of both groups, and all studies assessed some aspect of the speech results. Conflicting results and a lack of high-quality and long-term outcomes of reviewed studies provided no conclusive scientific evidence about whether the outcome of cleft palate repair for PRS patients was better or worse than cleft palate-only patients. Further well-designed, well-controlled, and long-term studies are needed.

  10. Medial Gastrocnemius Myotendinous Junction Displacement and Plantar-Flexion Strength in Patients Treated With Immediate Rehabilitation After Achilles Tendon Repair.

    Science.gov (United States)

    De la Fuente, Carlos I; Lillo, Roberto Peña Y; Ramirez-Campillo, Rodrigo; Ortega-Auriol, Pablo; Delgado, Mauricio; Alvarez-Ruf, Joel; Carreño, Gabriel

    2016-12-01

    Pathologic plantar flexion frequently occurs after operative repair of the Achilles tendon (AT) because of immobilization and non-weight bearing in the first weeks of traditional rehabilitation. Novel rehabilitation strategies that apply mobilization and weight bearing have been proposed, but their effects on medial gastrocnemius myotendinous junction displacement (MJD) and isometric plantar-flexion strength (PFS) are unknown. To compare the effects of 12 weeks of immediate versus traditional rehabilitation on MJD and PFS in patients with percutaneous AT repair and to compare AT rupture scores (ATRSs) during follow-up. Controlled laboratory study. Human performance laboratory. A total of 26 amateur soccer players (age = 42.3 ± 9.7 years, body mass index = 29.5 ± 3.9 kg/m(2)) with percutaneous AT repair. Athletes were randomly divided into 2 groups: an immediate group, given physical therapy from day 1 to day 84, and a traditional group, given physical therapy from day 29 to day 84. We used repeated-measures analysis of variance to compare the data. We measured MJD and PFS at days 28 (fourth week), 56 (eighth week), and 84 (12th week) after AT repair. After 12 weeks of rehabilitation, we observed a large clinically meaningful effect and statistical difference between groups. At day 28, the immediate group showed higher values for PFS (P = .002), MJD (P = .02), and ATRS (P = .002) than the traditional group. At day 56, the immediate group presented higher values for MJD (P = .02) and ATRS (P = .009). At day 84, the immediate group registered more MJD (P = .001). Compared with traditional rehabilitation, 12 weeks of immediate rehabilitation after percutaneous AT repair resulted in better MJD, PFS, and ATRS after 4 weeks; better MJD and ATRS after 8 weeks; and better MJD after 12 weeks.

  11. Postoperative pain management in pediatric patients undergoing minimally invasive repair of pectus excavatum: the role of intercostal block.

    Science.gov (United States)

    Lukosiene, Laura; Rugyte, Danguole Ceslava; Macas, Andrius; Kalibatiene, Lina; Malcius, Dalius; Barauskas, Vidmantas

    2013-12-01

    There are no published data regarding value of intercostal block following pectus excavatum repair. Our aim was to evaluate the efficacy of intercostal block in children following minimally invasive repair of pectus excavatum (MIRPE). Forty-five patients given patient-controlled analgesia (PCA) with morphine postoperatively were studied. Twenty-six patients were given bilateral intercostal blocks after induction of anesthesia (PCA-IB group), and nineteen patients were retrospective controls without regional blockade (PCA group). All patients were followed up 24 h postoperatively. A loading dose of morphine (0,1±0,49 mg/kg) before starting PCA was used in seventeen patients in PCA group vs. no patient in PCA-IB group. Cumulative used morphine doses were lower up to 12 h after surgery in PCA-IB group (0,29±0,08 μg/kg) than in the PCA group (0,46±0,18 μg/kg), pintercostal blocks were observed. Bilateral intercostal blocks following MIRPE are safe and easy to perform and can diminish postoperative opioid requirement. Double-blind randomized study is required to confirm the potential to diminish opioid related side effects. © 2013 Elsevier Inc. All rights reserved.

  12. Complex Tricuspid Valve Repair in Patients With Pacer Defibrillator-Related Tricuspid Regurgitation.

    Science.gov (United States)

    Raman, Jaishankar; Sugeng, Lissa; Lai, David T M; Jeevanandam, Valluvan

    2016-04-01

    Tricuspid valve regurgitation in patients with heart failure or in those undergoing complex cardiac operations is associated with increased morbidity and mortality. We report our results with a technique of repairing the tricuspid valves while retaining the pacer defibrillator lead. Patients had tricuspid valve repairs that included repositioning of the pacer defibrillator lead, approximation of septal and inferior/posterior leaflets in a modified cleft repair, and implantation of a tricuspid annuloplasty ring. This procedure was performed in more than 42 patients with good success.

  13. Assessment of nasalance and nasality in patients with a repaired cleft palate.

    Science.gov (United States)

    Sinko, Klaus; Gruber, Maike; Jagsch, Reinhold; Roesner, Imme; Baumann, Arnulf; Wutzl, Arno; Denk-Linnert, Doris-Maria

    2017-03-15

    In patients with a repaired cleft palate, nasality is typically diagnosed by speech language pathologists. In addition, there are various instruments to objectively diagnose nasalance. To explore the potential of nasalance measurements after cleft palate repair by NasalView(®), we correlated perceptual nasality and instrumentally measured nasalance of eight speech items and determined the relationship between sensitivity and specificity of the nasalance measures by receiver-operating characteristics (ROC) analyses and AUC (area under the curve) computation for each single test item and specific item groups. We recruited patients with a primarily repaired cleft palate receiving speech therapy during follow-up. During a single day visit, perceptive and instrumental assessments were obtained in 36 patients and analyzed. The individual perceptual nasality was assigned to one of four categories; the corresponding instrumental nasalance measures for the eight specific speech items were expressed on a metric scale (1-100). With reference to the perceptual diagnoses, we observed 3 nasal and one oral test item with high sensitivity. However, the specificity of the nasality indicating measures was rather low. The four best speech items with the highest sensitivity provided scores ranging from 96.43 to 100%, while the averaged sensitivity of all eight items was below 90%. We conclude that perceptive evaluation of nasality remains state of the art. For clinical follow-up, instrumental nasalance assessment can objectively document subtle changes by analysis of four speech items only. Further studies are warranted to determine the applicability of instrumental nasalance measures in the clinical routine, using discriminative items only.

  14. RAD25 (SSL2), the yeast homolog of the human xeroderma pigmentosum group B DNA repair gene, is essential for viability

    Energy Technology Data Exchange (ETDEWEB)

    Park, E.; Prakash, L. (Univ. of Rochester School of Medicine, NY (United States)); Guzder, S.N.; Prakash, S. (Univ. of Rochester, NY (United States)); Koken, M.H.M.; Jaspers-Dekker, I.; Weeda, G.; Hoeijmakers, H.J. (Erasmus Univ., Rotterdam (Netherlands))

    1992-12-01

    Xeroderma pigmentosum (XP) patients are extremely sensitive to ultraviolet (UV) light and suffer from a high incidence of skin cancers, due to a defect in nucleotide excision repair. The disease is genetically heterogeneous, and seven complementation groups, A-G, have been identified. Homologs of human excision repair genes ERCC1, XPDC/ERCC2, and XPAC have been identified in the yeast Saccharomyces cerevisiae. Since no homolog of human XPBC/ERCC3 existed among the known yeast genes, we cloned the yeast homolog by using XPBC cDNA as a hybridization probe. The yeast homolog, RAD25 (SSL2), encodes a protein of 843 amino acids (M[sub r] 95,356). The RAD25 (SSL2)- and XPCX-encoded proteins share 55% identical and 72% conserved amino acid residues, and the two proteins resemble one another in containing the conserved DNA helicase sequence motifs. A nonsense mutation at codon 799 that deletes the 45 C-terminal amino acid residues in RAD25 (SSL2) confers UV sensitivity. This mutation shows epistasis with genes in the excision repair group, whereas a synergistic increase in UN sensitivity occurs when it is combined with mutations in genes in other DNA repair pathways, indicating that RAD25 (SSL2) functions in excision repair but not in other repair pathways. We also show that RAD25 (SSL2) is an essential gene. A mutation of the Lys[sup 392] residue to arginine in the conserved Walker type A nucleotide-binding motif is lethal, suggesting an essential role of the putative RAD 25 (SSL2) ATPase/DNA helicase activity in viability. 40 refs., 3 figs., 1 tab.

  15. A prospective clinical, economic, and quality-of-life analysis comparing endovascular aneurysm repair (EVAR), open repair, and best medical treatment in high-risk patients with abdominal aortic aneurysms suitable for EVAR: the Irish patient trial.

    LENUS (Irish Health Repository)

    Hynes, Niamh

    2007-12-01

    To report the results of a trial comparing endovascular aneurysm repair (EVAR) to open repair (OR) and best medical therapy (BMT) involving high-risk patients with abdominal aortic aneurysms (AAA) suitable for EVAR.

  16. Effects of lip repair on maxillofacial morphology in patients with unilateral cleft lip with or without cleft palate.

    Science.gov (United States)

    Shao, Qinghua; Chen, Zhengxi; Yang, Yang; Chen, Zhenqi

    2014-11-01

    Objective : To evaluate the effects of lip repair on maxillofacial development of patients with unilateral cleft lip with or without cleft palate. Design : Retrospective. Patients : A total of 75 patients were recruited, including 38 surgical patients with complete unilateral cleft lip and alveolus and 37 patients with complete unilateral cleft lip and palate who had lip but not palate repair. As controls, 38 patients with no cleft were selected. All subjects were divided according to two growth stages: before the pubertal peak (GS1) and after the pubertal peak (GS2). Interventions : Lateral cephalograms of all subjects were obtained. Main Outcome Measures : Cephalograms were analyzed and compared in the study and control groups. Results : The patients with unilateral cleft lip and palate in both GS1 and GS2 demonstrated an almost normal maxillary and mandibular growth with retroclined maxillary incisors. The patients with unilateral cleft lip and palate showed a shorter length of maxilla, a more clockwise-rotated mandible, and retroclined maxillary incisors. Conclusions : There was an almost normal maxillary and mandibular growth but retroclined maxillary incisors in patients with cleft lip with or without cleft palate who had received lip repair only, indicating that lip repair may not have a negative impact on the maxillofacial development and influences only the inclination of the maxillary incisors. The shorter anterior-posterior maxillary length and larger gonial angle in patients with unilateral cleft lip and palate compared with those in patients with unilateral cleft lip and alveolus suggest that these variations in maxillary and mandibular growth may be a consequence of the cleft itself.

  17. Comparison of functional gains after arthroscopic rotator cuff repair in patients over 70 years of age versus patients under 50 years of age: a prospective multicenter study.

    Science.gov (United States)

    Moraiti, Constantina; Valle, Pablo; Maqdes, Ali; Boughebri, Omar; Dib, Chourky; Giakas, Giannis; Kany, Jean; Elkholti, Kamil; Garret, Jérôme; Katz, Denis; Leclère, Franck Marie; Valenti, Philippe

    2015-02-01

    To assess rotator cuff rupture characteristics and evaluate healing and the functional outcome after arthroscopic repair in patients older than 70 years versus patients younger than 50 years. We conducted a multicenter, prospective, comparative study of 40 patients younger than 50 years (group A) and 40 patients older than 70 years (group B) treated with arthroscopic rotator cuff repair. Patients older than 70 years were operated on only if symptoms persisted after 6 months of conservative treatment, whereas patients younger than 50 years were operated on regardless of any persistent symptoms. Imaging consisted of preoperative magnetic resonance imaging and postoperative ultrasound. Preoperative and postoperative function was evaluated with Constant and modified Constant scores. Patient satisfaction was also assessed. The evaluations were performed at least 1 year postoperatively. No patient was lost to follow-up. The incidence of both supraspinatus and infraspinatus tears was greater in group B. Greater retraction in the frontal plane and greater fatty infiltration were observed in group B. The Constant score was significantly improved in both groups (51 ± 12.32 preoperatively v 77.18 ± 11.02 postoperatively in group A and 48.8 ± 10.97 preoperatively v 74.6 ± 12.02 postoperatively in group B, P Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  18. Resultados da valvoplastia por balão do grupo submetido a plastia mitral percutânea ou cirúrgica prévias com o tratado pela primeira vez: evolução do grupo com plastia prévia Balloon valvuloplasty outcome of a group previously submitted to mitral percutaneous or surgical valve repair versus first-time valvuloplasty patients: evolution of the group previously submitted to valve repair procedures

    Directory of Open Access Journals (Sweden)

    Edison Carvalho S. Peixoto

    2006-05-01

    Full Text Available OBJETIVO: Avaliar 501 procedimentos de valvoplastia mitral e as diferenças entre um grupo já submetido a plastia valvar prévia por balão ou cirúrgica, com 59 procedimentos e um grupo sem intervenção prévia, com 442 procedimentos. MÉTODOS: Foi utilizado balão único em 406 procedimentos, balão de Inoue em 89, e duplo balão em seis, não havendo diferença entre os balões utilizados nos dois grupos (p=0,6610. Estudou-se a evolução a longo prazo dos pacientes com plastia prévia. RESULTADOS: O grupo submetido a plastia valvar prévia era mais velho, com maior escore ecocardiográfico, maior porcentual de pacientes em fibrilação atrial, e dos seus 59 pacientes, 48 tinham sido submetidos à comissurotomia cirúrgica, oito a valvoplastia com balão e três à comissurotomia cirúrgica e à valvoplastia com balão. Os grupos da valvoplastia com plastia valvar prévia e da valvoplastia sem intervenção prévia apresentaram pré-valvoplastia: área valvar mitral ecocardiográfica de 0,99±0,21 e 0,94±0,21 cm² (p=0,0802 e área valvar mitral (Gorlin 0,94±0,18 e 0,91±0,21 cm² (p=0,2518 e área valvar mitral pós-valvoplastia mitral de 1,95±0,44 e 2,05±0,42 cm² (p=0,1059. CONCLUSÕES: O grupo com plastia valvar prévia apresentou o mesmo resultado imediato do grupo sem intervenção prévia. O subgrupo com plastia prévia seguido a longo prazo, apresentou evolução satisfatória.OBJECTIVE: To evaluate 501 procedures of mitral balloon valvuloplasty and the differences among the group already submitted the prior surgical or balloon valvuloplasty, with 59 procedures and the group without previous intervention, with 442 procedures. METHODS: It was used the single balloon in 403, Inoue balloon in 89 and a double balloon in six, with no difference between the 2 groups (p=0.6610. RESULTS: The prior surgical or balloon valvuloplasty group was older, with higher echo score and higher atrial fibrillation rate and of its 59 patients, 48 had

  19. Surgical repair of pectus excavatum not requiring exogenous implants in 113 patients.

    Science.gov (United States)

    Iida, Hiroshi; Sunazawa, Toru; Ishida, Keiichi; Doi, Atsuo

    2010-02-01

    Pectus excavatum is relatively common congenital chest deformity that is often accompanied by physical and psychological impairment. The surgical methods for pectus excavatum repair are the subject of some controversy. We review our experience using a procedure in which the introduction of exogenous material is unnecessary. From July 1993 to March 2008, 113 patients underwent surgical repair of pectus excavatum. Sterno-costal elevation was adopted for 102 patients, including all of the paediatric patients and most of the adults. Sternal turnover was employed for 11 adult patients with severe asymmetric deformities. In sterno-costal elevation, a section of the third or fourth to the seventh costal cartilages as well as the lower tip of the sternum below the sixth cartilage junction are resected, and all of the cartilage stumps are re-sutured to the sternum. The secured ribs generate 0.5-10 kg of tension, pulling the sternum bilaterally, such that the resultant force causes the sternum to rise anteriorly. These forces are sufficient to correct the deformities and to prevent flail chest. In sternal turnover, the sternum is cut at the third intercostal space. The lower part of the sternum is turned over and fixed to the upper sternum with an overlap of 1cm. Sections of the third to the seventh rib cartilages are resected and affixed in the same fashion as in sterno-costal elevation. There were no operative deaths, and in all cases the deformities were corrected satisfactorily. Ninety-nine patients (88%) were graded as Excellent, and the remaining 14 (12%) were graded Good. None of the patients developed any life-threatening complications. No patient reported residual pain. No re-operations were required for any reasons. The patients resumed daily activities of all types, including contact sports, within 3 months after surgery. We believe that morbidity is one of the most important factors to be considered in operative invasions. Our technique represents a less

  20. Adipose-Derived Mesenchymal Stem Cells from Ventral Hernia Repair Patients Demonstrate Decreased Vasculogenesis

    Directory of Open Access Journals (Sweden)

    Jeffrey Lisiecki

    2014-01-01

    Full Text Available Introduction. In adipose tissue healing, angiogenesis is stimulated by adipose-derived stromal stem cells (ASCs. Ventral hernia repair (VHR patients are at high risk for wound infections. We hypothesize that ASCs from VHR patients are less vasculogenic than ASCs from healthy controls. Methods. ASCs were harvested from the subcutaneous fat of patients undergoing VHR by the component separation technique and from matched abdominoplasty patients. RNA and protein were harvested on culture days 0 and 3. Both groups of ASCs were subjected to hypoxic conditions for 12 and 24 hours. RNA was analyzed using qRT-PCR, and protein was used for western blotting. ASCs were also grown in Matrigel under hypoxic conditions and assayed for tubule formation after 24 hours. Results. Hernia patient ASCs demonstrated decreased levels of VEGF-A protein and vasculogenic RNA at 3 days of growth in differentiation media. There were also decreases in VEGF-A protein and vasculogenic RNA after growth in hypoxic conditions compared to control ASCs. After 24 hours in hypoxia, VHR ASCs formed fewer tubules in Matrigel than in control patient ASCs. Conclusion. ASCs derived from VHR patients appear to express fewer vasculogenic markers and form fewer tubules in Matrigel than ASCs from abdominoplasty patients, suggesting decreased vasculogenic activity.

  1. Effects of Aspirin and Intrauterine Balloon on Endometrial Repair and Reproductive Prognosis in Patients with Severe Intrauterine Adhesion: A Prospective Cohort Study

    Science.gov (United States)

    Liu, Lixiang; Luo, Yuanna; Chen, Minghui; Fang, Ruili

    2017-01-01

    This study aimed to investigate the effects of estrogen in combination with aspirin and intrauterine balloon on the uterine endometrial repair and reproductive prognosis in patients after surgery for severe intrauterine adhesion (sIUA). We prospectively recruited 114 patients with sIUA. Intrauterine device (IUD) was placed and oral estrogen was administered after surgery. Patients were divided into control group and aspirin group. In addition, patients in aspirin group were subdivided into nonballoon group and balloon group. Results showed that, after therapy, the increase in endometrial thickness of aspirin groups was superior to control group (P 0.05). Thus, aspirin may promote the uterine endometrial growth and repair after surgery for sIUA, and IUD in combination with intrauterine balloon may reduce the recurrence of intrauterine adhesion, but their effect on the reproductive prognosis is required to be further studied.

  2. Feasibility of exercise stress echocardiography and myocardial response in patients with repaired congenital heart disease.

    Science.gov (United States)

    Hasan, Babar S; Lunze, Fatima I; Alvi, Najveen; Shafer, Keri M; Rhodes, Jonathan

    2017-06-01

    Exercise stress echocardiography (ESE) can unmask ventricular dysfunction in asymptomatic patients with congenital heart disease (CHD), but its acquisition and interpretation is often challenging, and the method has not been validated in CHD. This study aimed to evaluate the feasibility of ESE using Doppler imaging and to assess myocardial response to exercise in patients with biventricular (BiV) and univentricular (UniV) circulation after CHD repair. In this single-center prospective study, we recruited 55 participants (17 females), median age 14 years (8-22 years). Our analysis categorized participants in these three groups: with structurally normal hearts as controls (n=21), with BiV circulation (n=20) and with UniV circulation (n=14). We acquired ESE images of the systemic ventricle including pulsed-wave flow and spectral tissue Doppler imaging (TDI) of lateral free wall before and immediately after standard, symptom-limited exercise tests on an electronically braked cycle ergometer. During ESE we obtained inflow E-wave and TDI systolic (S') and early diastolic (E') velocities in 93% to 100% of participants at rest and in 90% to 100% of participants post exercise. Feasibility to obtain Doppler imaging parameter was the same across study groups. The myocardial response to exercise was increase in heart rate (HR), S' and inflow E-wave velocity in all participants. Patients with BiV circulation had preserved ventricular function at rest. While patients with UniV circulation had low S', E', and E-wave velocities at rest in comparison to controls and to BiV group (all Pincreases in HR, S' velocity and inflow E-wave velocity post exercise, with magnitudes of these increases higher in controls than in the BiV and UniV group. The S' and E' velocities were strongly associated with lower percent predicted peak oxygen consumption VO2 (rs=0.614 and rs=0.64, respectively, both Pexercise in patients after biventricular and univentricular CHD repair. Although patients with Bi

  3. SNPs in DNA repair or oxidative stress genes and late subcutaneous fibrosis in patients following single shot partial breast irradiation

    OpenAIRE

    2012-01-01

    Abstract Background The aim of this study was to evaluate the potential association between single nucleotide polymorphisms related response to radiotherapy injury, such as genes related to DNA repair or enzymes involved in anti-oxidative activities. The paper aims to identify marker genes able to predict an increased risk of late toxicity studying our group of patients who underwent a Single Shot 3D-CRT PBI (SSPBI) after BCS (breast conserving surgery). Methods A total of 57 breast cancer pa...

  4. The feasibility, safety and cost of infiltration anaesthesia for hernia repair. Hvidovre Hospital Hernia Group

    DEFF Research Database (Denmark)

    Callesen, T; Bech, K; Kehlet, H

    1998-01-01

    reductions for such a technique. The median age of the patients was 59 years, and 29 operations were performed in ASA group III patients. The median postoperative hospital stay was 85 min. Conversion to general anaesthesia was necessary only in two cases, and nine patients needed overnight admission. One...... with general/regional anaesthesia. We conclude that elective inguinal herniorrhaphy may be performed routinely under unmonitored local anaesthesia with a low postoperative morbidity, a high satisfaction rate and significant cost reductions....

  5. Expression of xeroderma pigmentosum complementation group C protein predicts cisplatin resistance in lung adenocarcinoma patients.

    Science.gov (United States)

    Lai, Tan-Chen; Chow, Kuan-Chih; Fang, Hsin-Yuan; Cho, Hsin-Ching; Chen, Chih-Yi; Lin, Tze-Yi; Chiang, I-Ping; Ho, Shu-Peng

    2011-05-01

    DNA repair has been suggested to be a major cause of spontaneous drug resistance in patients with lung adenocarcinomas (LADC). Among the DNA repair-related proteins, excision repair cross-complementation group 1 (ERCC1) has been shown to be essential for repairing cisplatin-induced interstrand cross-linkage. However, the role of other DNA repair-related proteins in drug resistance has not been clearly elucidated. In this study, we used suppression subtractive hybridization and microarray analysis to identify the DNA repair-related genes associated with cisplatin resistance. We focused on the association of XPC protein expression, which plays a pivotal role in the earliest response to global genomic repair, with the survival of LADC patients. Using suppression subtractive hybridization and a microarray analysis to identify drug resistance-associated DNA repair-related genes, we found that the mRNA levels of ERCC1, MSH-3, MSH-6 and XPC were significantly increased in LADC patients. Since the results of ERCC1 mRNA expression corresponded well with those in previous reports, in this study we focused on the clinical correlation between XPC expression and patient survival. The level of XPC protein was determined by immunohistochemical and immunoblotting analyses. We detected the XPC protein in 46 (43%) of 107 pathological LADC samples. XPC protein expression correlated with tumor stage, cigarette smoking and poor survival. In the in vitro experiments with LADC cell lines, increased XPC expression was associated with elevated drug resistance, and silencing of XPC expression reduced cisplatin resistance. Our results suggest that XPC expression predicts drug resistance in LADC.

  6. [A Case of Mitral Valvular Re-repair in a Patient with Hemolytic Anemia after Mitral Valvular Repair].

    Science.gov (United States)

    Tomino, Mikiko; Miyata, Kazuto; Takeshita, Yuji; Kaneko, Koki; Kanazawa, Hiroko; Uchino, Hiroyuki

    2015-07-01

    A 54-year-old woman was admitted for mitral valvular repair. After folding plasty to A3, a 30 mm Cosgrove-Edwards ring was placed. There was no mitral regurgitation jet observed by transesophageal echocardiography (TEE) during the operation. However, high blood pressure was monitored and treated in the intensive care unit, hemolytic anemia developed, and the serum lactate dehydrogenase level was elevated. Two weeks after the operation, serum lactate dehydrogenase was again elevated. TEE showed mild mitral regurgitation and the regurgitation jet colliding with the annuloplasty ring. Multiple transfusions of red blood cells were required. Repeat surgery was therefore undertaken. Lam and associates previously studying patients on hemolysis after mitral valvular repair noted high grade mitral regurgitation jets fragmented or accelerated. In the present case, mitral regurgitation was mild, but the high velocity and manner of regurgitation (collision with the annuloplasty ring) could cause hemolytic anemia. In the present case, high blood pressure might have caused chordae rupture. Furthermore, a flexible ring, such as the Cosgrove-Edwards ring, is likely to cause hemolytic anemia. As contributing factors to hemolysis after mitral valvular repair, perioperative blood pressure management and type of ring are significant.

  7. The results of Bankart repair without capsular plication in patients with recurrent traumatic anterior shoulder dislocation.

    Science.gov (United States)

    Kalkar, İsmail; Esenyel, Cem Zeki; Saygılı, Mehmet Selçuk; Esenyel, Ayşın; Gürbüz, Hakan

    2017-01-01

    The aim of this study was to evaluate the results of patients with recurrent anterior shoulder dislocation, who had been treated with repair of the Bankart lesion without capsuler plication. The study included 22 shoulders of 22 patients (16 males and 6 females) with a mean age of 28 years, who underwent Bankart repair between 2011 and 2014. Patients with bilateral shoulder instability, multiple instability, >25% glenoid bone loss, and those with a history of shoulder surgery were not included in the study. The average follow-up time was 21.2 months. Evaluation was made of the preoperative number of dislocations, postoperative recurrence, functional status, and daily activity performance of the patients. Shoulder range of motion was measured. The results were evaluated using the Rowe shoulder score and the Oxford shoulder instability score. Recurrence was observed in only one patient who had a shoulder dislocation after trauma, thus giving a recurrence rate of 4.5%. Shoulder range of motion was full in all except that one patient. The mean Rowe shoulder score was 95.5 (excellent) and Oxford shoulder stability score was 44.6 (excellent). No recurrent shoulder dislocation was observed in patients who underwent Bankart repair surgery. Plication was not performed with the Bankart repair. Close to full range of motion was obtained in all patients. In conclusion, Bankart repair alone can be considered to be sufficient for the treatment of traumatic recurrent anterior shoulder instability.

  8. Speech and Speech-Related Quality of Life After Late Palate Repair: A Patient's Perspective.

    Science.gov (United States)

    Schönmeyr, Björn; Wendby, Lisa; Sharma, Mitali; Jacobson, Lia; Restrepo, Carolina; Campbell, Alex

    2015-07-01

    Many patients with cleft palate deformities worldwide receive treatment at a later age than is recommended for normal speech to develop. The outcomes after late palate repairs in terms of speech and quality of life (QOL) still remain largely unstudied. In the current study, questionnaires were used to assess the patients' perception of speech and QOL before and after primary palate repair. All of the patients were operated at a cleft center in northeast India and had a cleft palate with a normal lip or with a cleft lip that had been previously repaired. A total of 134 patients (7-35 years) were interviewed preoperatively and 46 patients (7-32 years) were assessed in the postoperative survey. The survey showed that scores based on the speech handicap index, concerning speech and speech-related QOL, did not improve postoperatively. In fact, the questionnaires indicated that the speech became more unpredictable (P after surgery. A total of 78% of the patients were still satisfied with the surgery and all of the patients reported that their self-confidence had improved after the operation. Thus, the majority of interviewed patients who underwent late primary palate repair were satisfied with the surgery. At the same time, speech and speech-related QOL did not improve according to the speech handicap index-based survey. Speech predictability may even become worse and nasal regurgitation may increase after late palate repair, according to these results.

  9. Genetic characterization of cells of homocystinuria patients with disrupted DNA repair system

    Energy Technology Data Exchange (ETDEWEB)

    Sinel' shchikova, T.A.; L' vova, G.N.; Shoniya, N.N.; Zasukhina, G.D.

    1986-08-01

    Fibroblasts obtained from biopsy material and lymphocytes of patients with homocystinuria were investigated for repair activity according to the following criteria: rejoined DNA breaks, induced by 4-nitroquinoline-1-oxide and ..gamma..-radiation; indices of reactivation and induced mutagenesis of smallpox vaccine virus treated with these mutagens. In lymphocytes a defect of DNA repair was observed according to all criteria investigated. During passage of fibroblast cultures, inhibition of repair activity of cells was preserved according to ..gamma..-type. Increase in the number of spontaneous and ..gamma..-induced mutations of virus was noted according to degree of passage of fibroblasts.

  10. Efficacy of ultrasound-guided transversus abdominis plane block for postoperative analgesia in patients undergoing inguinal hernia repair

    Directory of Open Access Journals (Sweden)

    Venkatraman R

    2016-01-01

    Full Text Available Rajagopalan Venkatraman, Ranganathan Jothi Abhinaya, Ayyanar Sakthivel, Govindarajan Sivarajan Department of Anaesthesia, SRM Medical College Hospital and Research Centre, Chennai, Tamil Nadu, India Background and aim: Transversus abdominis plane block (TAP block is a novel procedure to provide postoperative analgesia following inguinal hernia surgery. The utilization of ultrasound has greatly augmented the success rate of this block and additionally avoiding complications. The aim of our study was to gauge the analgesic efficacy of ultrasound-guided TAP block in patients undergoing unilateral inguinal hernia repair. Materials and methods: Sixty patients scheduled for elective inguinal hernia repair were selected for the study. At the end of the surgical procedure, they were randomly divided into two groups. Ultrasound-guided TAP block was performed with 20 mL of ropivacaine 0.2% (group A or normal saline (group B. Visual analog scale (VAS scores were used to assess pain. Paracetamol was given if VAS >3 and tramadol was used when VAS >6. Patients were monitored for VAS scores and total analgesic consumption for the 24-hour period. Results: The TAP block with ropivacaine (group A reduced VAS scores at 4, 6, and 12 hours. There was no distinction in VAS scores at 0, 2, and 24 hours between the two groups. The duration of analgesia for TAP block with ropivacaine lasted for 390 minutes. Total analgesics consumption was also significantly reduced in group A than group B. No complication was reported to TAP block in both the groups. Conclusion: The ultrasound-guided TAP block provides good postoperative analgesia, reduces analgesic requirements, and provides good VAS scores with fewer complications following inguinal hernia surgery. Keywords: inguinal hernia repair, postoperative analgesia, ropivacaine, transversus abdominis block, ultrasound

  11. Ventricular kinetic energy may provide a novel noninvasive way to assess ventricular performance in patients with repaired tetralogy of Fallot.

    Science.gov (United States)

    Jeong, Daniel; Anagnostopoulos, Petros V; Roldan-Alzate, Alejandro; Srinivasan, Shardha; Schiebler, Mark L; Wieben, Oliver; François, Christopher J

    2015-05-01

    Ventricular kinetic energy measurements may provide a novel imaging biomarker of declining ventricular efficiency in patients with repaired tetralogy of Fallot. Our purpose was to assess differences in ventricular kinetic energy with 4-dimensional flow magnetic resonance imaging between patients with repaired tetralogy of Fallot and healthy volunteers. Cardiac magnetic resonance, including 4-dimensional flow magnetic resonance imaging, was performed at rest in 10 subjects with repaired tetralogy of Fallot and 9 healthy volunteers using clinical 1.5T and 3T magnetic resonance imaging scanners. Right and left ventricular kinetic energy (KERV and KELV), main pulmonary artery flow (QMPA), and aortic flow (QAO) were quantified using 4-dimensional flow magnetic resonance imaging data. Right and left ventricular size and function were measured using standard cardiac magnetic resonance techniques. Differences in peak systolic KERV and KELV in addition to the QMPA/KERV and QAO/KELV ratios between groups were assessed. Kinetic energy indices were compared with conventional cardiac magnetic resonance parameters. Peak systolic KERV and KELV were higher in patients with repaired tetralogy of Fallot (6.06 ± 2.27 mJ and 3.55 ± 2.12 mJ, respectively) than in healthy volunteers (5.47 ± 2.52 mJ and 2.48 ± 0.75 mJ, respectively), but were not statistically significant (P = .65 and P = .47, respectively). The QMPA/KERV and QAO/KELV ratios were lower in patients with repaired tetralogy of Fallot (7.53 ± 5.37 mL/[cycle mJ] and 9.65 ± 6.61 mL/[cycle mJ], respectively) than in healthy volunteers (19.33 ± 18.52 mL/[cycle mJ] and 35.98 ± 7.66 mL/[cycle mJ], respectively; P kinetic energy is necessary to generate flow in the pulmonary and aortic circulations in repaired tetralogy of Fallot. Quantification of ventricular kinetic energy in patients with repaired tetralogy of Fallot is a new observation. Future studies are needed to determine whether changes in ventricular kinetic

  12. Conservation of the nucleotide excision repair pathway: characterization of hydra Xeroderma Pigmentosum group F homolog.

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    Apurva Barve

    Full Text Available Hydra, one of the earliest metazoans with tissue grade organization and nervous system, is an animal with a remarkable regeneration capacity and shows no signs of organismal aging. We have for the first time identified genes of the nucleotide excision repair (NER pathway from hydra. Here we report cloning and characterization of hydra homolog of xeroderma pigmentosum group F (XPF gene that encodes a structure-specific 5' endonuclease which is a crucial component of NER. In silico analysis shows that hydra XPF amino acid sequence is very similar to its counterparts from other animals, especially vertebrates, and shows all features essential for its function. By in situ hybridization, we show that hydra XPF is expressed prominently in the multipotent stem cell niche in the central region of the body column. Ectoderm of the diploblastic hydra was shown to express higher levels of XPF as compared to the endoderm by semi-quantitative RT-PCR. Semi-quantitative RT-PCR analysis also demonstrated that interstitial cells, a multipotent and rapidly cycling stem cell lineage of hydra, express higher levels of XPF mRNA than other cell types. Our data show that XPF and by extension, the NER pathway is highly conserved during evolution. The prominent expression of an NER gene in interstitial cells may have implications for the lack of senescence in hydra.

  13. Repaired supraspinatus tendons in clinically improving patients: Early postoperative findings and interval changes on MRI

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    Lee, Jung Eun; Park, Ji Seon; Ryu, Kyung Nam; Rhee, Yong Girl [Kyung Hee University Hospital, Seoul (Korea, Republic of); Yoon, So Hee; Park, So Young; Jin Wook [Dept. of Radiology, Kyung Hee University Hospital at Gangdong, Seoul (Korea, Republic of)

    2015-04-15

    To demonstrate and further determine the incidences of repaired supraspinatus tendons on early postoperative magnetic resonance imaging (MRI) findings in clinically improving patients and to evaluate interval changes on follow-up MRIs. Fifty patients, who showed symptomatic and functional improvements after supraspinatus tendon repair surgery and who underwent postoperative MRI twice with a time interval, were included. The first and the second postoperative MRIs were obtained a mean of 4.4 and 11.5 months after surgery, respectively. The signal intensity (SI) patterns of the repaired tendon on T2-weighted images from the first MRI were classified into three types of heterogeneous high SI with fluid-like bright high foci (type I), heterogeneous high SI without fluid-like bright high foci (type II), and heterogeneous or homogeneous low SI (type III). Interval changes in the SI pattern, tendon thickness, and rotator cuff interval thickness between the two postoperative MRIs were evaluated. The SI patterns on the first MRI were type I or II in 45 tendons (90%) and type III in five (10%). SI decreased significantly on the second MRI (p < 0.050). The mean thickness of repaired tendons and rotator cuff intervals also decreased significantly (p < 0.050). Repaired supraspinatus tendons exhibited high SI in 90% of clinically improving patients on MRI performed during the early postsurgical period. The increased SI and thickness of the repaired tendon decreased on the later MRI, suggesting a gradual healing process rather than a retear.

  14. A Content Analysis of the Image Repair Discourses of OSI Group in China’s Food-safety Scandal

    Institute of Scientific and Technical Information of China (English)

    Ya XIE; Xiaojun YAO

    2016-01-01

    Food safety is one of the top issues for Chinese consumers. In the summer of 2014,Shanghai-based Husi Food Co Ltd was mired in a food-safety scandal. OSI Group responded to this situation by releasing statements and holding China press conference. This study focused on OSI Group’s image repair strategies employed in the scandal in Chinese context. A content analysis revealed that OSI Group’s image repair relied primarily on six strategies: defeasibility( appalled by the event),bolstering( factory in Henan is state-of-art),minimization( it was an isolated event),corrective action( thorough internal investigation),and mortification( sincerely apologized),and attacking the accuser( launched OSI Food Safety Education Campaign). Basically,OSI Group’s mortification without compensation doomed its efforts to failure.Implications for implementing image repair strategies with the combination of crisis types are addressed.

  15. Resection and repair of large abdominal wall lesions in gynecologic patients

    Institute of Scientific and Technical Information of China (English)

    LIU Zhu-feng; WANG Jin-hui; CUI Bing-qian; FAN Qing-bo; WANG Xiao-jun; ZHAO Ru; SONG Ke-xin

    2013-01-01

    Background The techniques of resection and repair of large lesions in the abdominal wall are very challenging in the area of gynecology.We explored the techniques of resection and plastic surgical repair of large abdominal wall lesions in gynecologic patients.Methods Twenty-six patients with large lesions in the abdominal wall underwent resection by the gynecologists and repair through abdominal plasty and V-Y plasty with or without fascia patch grafting by the gynecologists or plastic surgeons from March 2003 to October 2010.Results All patients had a history of cesarean section.One patient had an infected sinus tract after cesarean section,one patient had an inflammatory nodule,and the others had lesions of endometriosis,including one cancer.The average largest lesion diameter was (4.79 ± 4.18) cm according to the ultrasonography results.The lesions of all patients were completely resected with pretty abdominal contour.A polypropylene biological mesh was added to the fascia in 20 patients.One patient underwent groin flap repair,and one underwent V-Y advanced skin flap repair on the left of the incision to relieve the suture tension.Conclusions Multi-department cooperation involving the gynecology and plastic surgery departments,and even the general surgery department,is essential for patients with large lesions in the abdominal wall.This cooperative effort enabled surgeons to completely resect large lesions.Abdominal wall plastic surgical repair can ameliorate large wounds of the abdominal wall.

  16. Group therapy for spouses of aphasic patients.

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    Johannsen-Horbach, H; Crone, M; Wallesch, C W

    1999-01-01

    The setting, course, and results of a counseling and a therapeutic group for relatives of chronic aphasic patients are reviewed. Generally, providing and discussing information on the illness, its consequences, and medical and social services are greatly appreciated by group members. Counseling and group psychotherapy, as conducted by us, did not result in measurable improvements of relatives' perceptions of personal, social, and familial burdens. We assume, however, that group therapy does lead to more realistic attitudes toward burdensome and severely straining situations and may help with coping. Further research into psychotherapeutic strategies for relatives of disabled persons, who themselves suffer from psychological and social handicaps, is needed.

  17. Ventral hernia repair in patients with abdominal loss of domain: an observational study of one institution's experience.

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    Azar, F K; Crawford, T C; Poruk, K E; Farrow, N; Cornell, P; Nadra, O; Azoury, S C; Soares, K C; Cooney, C M; Eckhauser, F E

    2017-04-01

    Abdominal wall hernias are a common problem. The success of abdominal wall reconstruction decreases with increasing hernia size. This study summarizes the outcomes of one surgeon's experience using a "sandwich" technique for hernia repair in patients with loss of abdominal domain. We reviewed our ventral hernia repair (VHR) experience from 2008 to 2015 among patients with loss of domain, as defined by a hernia defect greater than 300 cm(2). The percent of herniation through the defect, defined by a hernia sac-to-abdominal cavity volume ratio, was measured on preoperative CT scans by four independent reviewers and averaged. Outcomes were compared among those with giant ventral hernias (hernia sac-to-abdominal cavity volume >30%) and those with smaller defect ratios. Over the study period, 21 patients underwent VHR. In 17 patients (81%), a "sandwich" technique was utilized. Ten patients had hernia sac-to-abdominal cavity defects less than 30%, and 11 had defects greater than 30%. Preoperative characteristics were similar in both groups with the exception of a higher ASA score in those with giant ventral hernias and more Ventral Hernia Working Group Grade 3 hernias in those without giant ventral hernias. Postoperative outcomes were similar in both groups. There were no mortalities. There were two recurrences (18%) in the giant VHR group and none in the smaller defect group (p = 0.16). Surgical site occurrences were noted in 48% of patients and did not differ between giant and non-giant VHR groups (50 vs 45%, p = 0.84). Average postoperative length of stay was significantly longer in the giant VHR group (31 vs. 17 days, p = 0.03). Our results suggest that the "sandwich" technique for VHR is a safe and durable method to restore abdominal wall integrity in those with LOD, even in patients with giant ventral hernias.

  18. Outcomes and Prognostic Factors of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Hostile Neck Anatomy

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hye Doo; Lee, Yun Young; Lee, Seung Jin; Yim, Nam Yeol; Kim, Jae Kyu; Choi, Soo Jin Na; Jung, Sang Young [Chonnam National University Hospital, Gwangju (Korea, Republic of); Chang, Nam Kyu [Dept. of Radiology, St. Carollo Hospital, Suncheon (Korea, Republic of); Lim, Jae Hoon [Dept. of Radiology, Donggunsan Hospital, Gunsan (Korea, Republic of)

    2012-09-15

    To evaluate the outcomes and find the prognostic factors of endovascular abdominal aortic aneurysm repair (EVAR) in patients with hostile neck anatomy of the abdominal aorta. This study was performed on 100 patients with abdominal aneurysm who were treated with EVAR between March 2006 and December 2010. We divided the patients into two groups: good neck anatomy (GNA), and hostile neck anatomy (HNA) and then compared the primary success rate and the incidence rate of complications with EVAR between the two groups. Our aim was to determine the factors related to the complications of EVAR among HNA types. There were no significant differences of primary success rate and incidence rate of complications between the two groups. Among the types of HNA, the short neck angle [odd ratio (OR), 4.23; 95% confidence interval (CI), 1.21-18.70; p = 0.023] and large neck angle (OR, 2.58; 95% CI, 0.15-11.85; p = 0.031) showed a low primary success rate. The short neck angle (OR, 2.32; 95% CI, 1.18-12.29; p = 0.002) and large neck angle (OR, 4.67; 95% CI, 0.14-19.07; p = 0.032) showed a high incidence rate of early type 1 complication. In the case of the large neck angle (OR, 3.78; 95% CI, 0.96-20.80; p = 0.047), the large neck thrombus (OR, 2.23; 95% CI, 0.24-7.12; p = 0.035) and large neck calcification (OR, 2.50; 95% CI, 0.08-18.37; p 0.043) showed a high incidence rate of complications within a year. The results suggest that patients with hostile neck anatomy can be treated with EVAR successfully, although there was a higher incidence of complications in patients with a short neck length, severe neck angulation, circumferential thrombosis, and calcified proximal neck.

  19. Mid-term results of mitral valve repair with autologous pericardium in pediatric patients.

    Science.gov (United States)

    Takahashi, Hiroaki; Kadowaki, Tasuku; Maruo, Ayako; Yutaka, Okita; Oshima, Yoshihiro

    2014-05-01

    Mitral valve repair to treat mitral regurgitation (MR) in pediatric patients remains challenging because of the complex morphology and fragility of the leaflets. The study aim was to review retrospectively the authors' experience with mitral valve repair using autologous pericardium. Between April 2004 and November 2011, nine pediatric patients (six males, three females; mean age 2.4 +/- 4.5 years) underwent mitral valve repair with an autologous fresh (n = 5) or glutaraldehyde-treated pericardium (n = 4) to treat severe MR. The etiology of the MR was acute endocarditis, acute chordal rupture and congenital disease in three, two, and four patients, respectively. Autologous pericardium was used for valvuloplasty, leaflet extension plasty and commissuroplasty in two, five, and two patients, respectively. Artificial chordal replacement was performed in three patients. No operative deaths or postoperative endocarditis occurred. One patient required mitral valve replacement at three days after the initial mitral repair. The most recent echocardiography findings of the remaining patients after a mean of 6.3 years (range: 1.3-9.0 years) showed that the severity of mitral insufficiency, left ventricular diastolic diameter and fractional shortening were 1.8 +/- 0.6 (grades 0-4), 40.4 +/- 8.4 mm (114.2 +/- 15.8% of normal) and 35.0 +/- 5.0%, respectively. Mitral valve repair using autologous fresh pericardium is associated with mid-term durability and resistance to infection when used for mitral valve repair of active endocarditis in pediatric patients. Augmentation with autologous pericardium could become an alternative to current surgical options.

  20. A case report on management of synergistic gangrene following an incisional abdominal hernia repair in an immunocompromised obese patient

    Directory of Open Access Journals (Sweden)

    N. Merali

    2015-01-01

    Conclusion: This case has demonstrated how a planned multidisciplinary action can produce prosperous results in a severely obese immunocompromised patient with an SSI, following an incisional hernia repair.

  1. Persistent hyperkinesis in normotensive patients after coarctation repair

    Energy Technology Data Exchange (ETDEWEB)

    Watson, D.D.; Carpenter, M.A.; Dammann, J.F.; Beller, G.A.

    1984-01-01

    Rest and exercise gated radionuclide ventriculography was used to evaluate 30 patients operated on between 1955 and 1982 for coarctation of the aorta. Twenty-one of these (COARC) patients have remained clinically normal for an average time of 15 years between surgery and the time of this study. A second group of 22 normal subjects (CTL) participating in an exercise physiology protocol were used as controls. Similar values were found comparing CTL vs. COARC for rate pressure products of 9.3 vs. 10.2 x 10/sup 3/ at rest and 26.8 vs 26.1 x 10/sup 3/ with exercise. Relative increase in cardiac output with exercise was 2.6 CTL vs. 2.1 COARC. Relative change in end-diastolic volume with exercises was +13% vs +5%. Early diastolic filling velocities at rest were 2.2 vs. 2.7 EDV/SEC and 5.2 vs. 5.2 EDV/SEC at exercise. Highly significant differences were found in resting ejection fraction of 59% CTL vs. 71% COARC, exercise EF of 70% vs. 82%, systolic ejection velocities at rest of 2.3 vs 2.9 EDV/SEC increasing with exercise to 3.6 vs. 4.8 EDV/SEC. Increased wall thickness was noted on scintiphotos and corroborated by thickness and muscle mass estimates from 2-D echo. The data indicate a persistent hyperdynamic state and LVH in these patients many years after elimination of the ventricular pressure overload. Further study is indicated to determine the cause of persistent hyperdynamic function, if this occurs with other after load stresses and the long term affect on cardiovascular function and longevity.

  2. New single nucleotide polymorphisms (SNPs) in homologous recombination repair genes detected by microarray analysis in Polish breast cancer patients.

    Science.gov (United States)

    Romanowicz, Hanna; Strapagiel, Dominik; Słomka, Marcin; Sobalska-Kwapis, Marta; Kępka, Ewa; Siewierska-Górska, Anna; Zadrożny, Marek; Bieńkiewicz, Jan; Smolarz, Beata

    2016-11-30

    Breast cancer is the most common cause of malignancy and mortality in women worldwide. This study aimed at localising homologous recombination repair (HR) genes and their chromosomal loci and correlating their nucleotide variants with susceptibility to breast cancer. In this study, authors analysed the association between single nucleotide polymorphisms (SNPs) in homologous recombination repair genes and the incidence of breast cancer in the population of Polish women. Blood samples from 94 breast cancer patients were analysed as test group. Individuals were recruited into the study at the Department of Oncological Surgery and Breast Diseases of the Institute of the Polish Mother's Memorial Hospital in Lodz, Poland. Healthy controls (n = 500) were obtained from the Biobank Laboratory, Department of Molecular Biophysics, University of Lodz. Then, DNA of breast cancer patients was compared with one of the disease-free women. The test was supported by microarray analysis. Statistically significant correlations were identified between breast cancer and 3 not described previously SNPs of homologous recombination repair genes BRCA1 and BRCA2: rs59004709, rs4986852 and rs1799950. Further studies on larger groups are warranted to support the hypothesis of correlation between the abovementioned genetic variants and breast cancer risk.

  3. Mitral valve repair in a patient with mesocardia.

    Science.gov (United States)

    Morisaki, Akimasa; Hattori, Koji; Motoki, Manabu; Takahashi, Yosuke; Nishimura, Shinsuke; Shibata, Toshihiko

    2014-01-01

    A 75-year-old man was referred for treatment of mitral valve prolapse secondary to tendon rupture. He had been receiving oral and inhaled corticosteroids for bronchial asthma and bronchial ectasia. Chest X-ray showed cardiomegaly with protrusion of the right atrium shadow. Computed tomography revealed dislocation and counterclockwise rotation of the heart with the apex of the heart located in the mid-thorax, indicating mesocardia. We believed that it would have been difficult to expose the mitral valve through a right-sided left atrial approach. Thus, we planned to perform mitral valve repair via a trans-septal approach. The right thoracotomy approach was not suitable because of respiratory dysfunction. After a median sternotomy, the left anterior descending coronary artery was identified just beneath the midline of the sternum. Even after decompression of the heart under cardiopulmonary bypass, we could not obtain a good view of the right side of the left atrium. By a transseptal approach with a self-retaining retractor and atrial hooks, we obtained adequate exposure of the mitral valve and performed the mitral valve repair uneventfully.

  4. Speech understandability of repaired cleft palate patients pre and post caregiver training

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    Jobe Andrea L

    2007-01-01

    Full Text Available Background: Treating speech and language problems in repaired cleft palate patients in India is still an uphill task due to lack of facilities. This study attempted to use parents as team members for the speech management of cleft palate patients in Andhra Pradesh, India. Objectives: To investigate whether a positive change in speech understandability for individuals with cleft palate will result from a parent-administered intervention program. Materials and Methods: Twenty-eight parents had enrolled for the speech camp held in September 2004. The parent-training program at the speech camp ensured that parents were given adequate awareness. Out of the 28, 18 (64.28% reported for one follow-up, referred to in this article as Group I. Ten (35.72% out of the 28 came for two consecutive follow-ups, referred to in this article as Group II. Results: Pre and post training understandability scores obtained in the known context (reciting a familiar poem in the native language, counting 1 to 10 and unknown context (peer group names, family information, describing their journey from home to hospital for Group I and Group II were evaluated. Results revealed that a higher percentage of cases showed significant improvement in understandability in the unknown context after treatment. Unknown context can be considered a measure to assess speech understandability after training. Further, it shows that parent training without practice at home may not show the desired results. Conclusion: This study reveals that parents can effect a positive change in the speech understandability of their children following training, provided the exercises are carried out regularly at home and the parents report for the follow-up assessments and guidance.

  5. Outcomes of mitral valve repair compared with replacement in patients undergoing concomitant aortic valve surgery: a meta-analysis of observational studies.

    Science.gov (United States)

    Saurav, Alok; Alla, Venkata Mahesh; Kaushik, Manu; Hunter, Claire C; Mooss, Aryan V

    2015-09-01

    Long-term superiority of mitral valve (MV) repair compared with replacement is well established in degenerative MV disease. In rheumatic heart disease, its advantages are unclear and it is often performed in conjunction with aortic valve (AV) replacement. Herein, we performed a systematic review and meta-analysis comparing outcomes of MV repair vs replacement in patients undergoing concomitant AV replacement. PubMed, Cochrane and Web of Science databases were searched up to 25 January 2014 for English language studies comparing outcomes of MV repair vs replacement in patients undergoing simultaneous AV replacement. Data of selected studies were extracted. Study quality, publication bias and heterogeneity were assessed. Analysis was performed using a random effects model (meta-analysis of observational studies in epidemiology recommendation). A total of 1202 abstracts/titles were screened. Of these, 20 were selected for full text review and 8 studies (3924 patients) were included in the final analysis: 1255 underwent MV repair and 2669 underwent replacement. Late outcome data were available in seven studies (cumulative follow-up: 15 654 patient-years). The early (in hospital and up to 30 days post-surgery) mortality [risk ratio (RR): 0.68, 95% confidence interval (CI): 0.53-0.87, P = 0.003] and late (>30 days post-surgery) mortality (RR: 0.76, 95% CI: 0.64-0.90 P = 0.001) were significantly lower in the MV repair group compared with the MV replacement group. The MV reoperation rate (RR: 1.89, 95% CI: 0.87-4.10, P = 0.108), thromboembolism (including valve thrombosis) (RR: 0.65, 95% CI: 0.38-1.13, P = 0.128) and major bleeding rates (RR: 0.88, 95% CI: 0.49-1.57, P = 0.659) were found to be comparable between the two groups. In a separate analysis of studies with exclusively rheumatic patients (n = 1106), the early as well as late mortality benefit of MV repair was lost (RR: 0.92, 95% CI: 0.44-1.90, P = 0.81 and RR: 0.69, 95% CI: 0.39-1.22, P = 0.199, respectively

  6. Patients' attitudes toward internet cancer support groups.

    Science.gov (United States)

    Im, Eun-Ok; Chee, Wonshik; Lim, Hyun-Ju; Liu, Yi; Guevara, Enrique; Kim, Kyung Suk

    2007-05-01

    To explore patients' attitudes toward Internet cancer support groups (ICSGs) through an online forum. Qualitative study using a feminist perspective. Internet and real settings. 16 patients with cancer. An online forum was held for one month with six discussion topics. The data were analyzed using thematic analysis. Attitudes toward ICSGs. Through the data-analysis process, four themes were found related to patients' attitudes toward ICSGs. First, the participants universalized patients' needs for and attitudes toward ICSGs. Second, most of the participants wanted to use ICSGs for emotional support, information, and interactions. Third, many of the participants used ICSGs because they could reach out to other patients with cancer without traveling and without interrupting their busy schedules. Finally, many participants were concerned about the security of interactions on ICSGs, so they wanted ICSGs that could ensure privacy and safeguard the anonymity and confidentiality of what they shared online. Patients view ICSGs positively. Additional studies should examine gender-specific and multilanguage ICSGs by recruiting more ethnic minority patients. Despite concerns about the security of Internet interactions, ICSGs would be an excellent source of social support that is acceptable to patients with cancer.

  7. Repair Effect of Seaweed Polysaccharides with Different Contents of Sulfate Group and Molecular Weights on Damaged HK-2 Cells

    Directory of Open Access Journals (Sweden)

    Poonam Bhadja

    2016-05-01

    Full Text Available The structure–activity relationships and repair mechanism of six low-molecular-weight seaweed polysaccharides (SPSs on oxalate-induced damaged human kidney proximal tubular epithelial cells (HK-2 were investigated. These SPSs included Laminaria japonica polysaccharide, degraded Porphyra yezoensis polysaccharide, degraded Gracilaria lemaneiformis polysaccharide, degraded Sargassum fusiforme polysaccharide, Eucheuma gelatinae polysaccharide, and degraded Undaria pinnatifida polysaccharide. These SPSs have a narrow difference of molecular weight (from 1968 to 4020 Da after degradation by controlling H2O2 concentration. The sulfate group (–SO3H content of the six SPSs was 21.7%, 17.9%, 13.3%, 8.2%, 7.0%, and 5.5%, respectively, and the –COOH contents varied between 1.0% to 1.7%. After degradation, no significant difference was observed in the contents of characteristic –SO3H and –COOH groups of polysaccharides. The repair effect of polysaccharides was determined using cell-viability test by CCK-8 assay and cell-morphology test by hematoxylin-eosin staining. The results revealed that these SPSs within 0.1–100 μg/mL did not express cytotoxicity in HK-2 cells, and each polysaccharide had a repair effect on oxalate-induced damaged HK-2 cells. Simultaneously, the content of polysaccharide –SO3H was positively correlated with repair ability. Furthermore, the low-molecular-weight degraded polysaccharides showed better repair activity on damaged HK-2 cells than their undegraded counterpart. Our results can provide reference for inhibiting the formation of kidney stones and for developing original anti-stone polysaccharide drugs.

  8. Umbilical hernia repair in pregnant patients: review of the American College of Surgeons National Surgical Quality Improvement Program.

    Science.gov (United States)

    Haskins, I N; Rosen, M J; Prabhu, A S; Amdur, R L; Rosenblatt, S; Brody, F; Krpata, D M

    2017-07-22

    Umbilical hernias present commonly during pregnancy secondary to increased intra-abdominal pressure. As a result, umbilical hernia incarceration or strangulation may affect pregnant females. The purpose of this study is to detail the operative management and 30-day outcomes of umbilical hernias in pregnant patients using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). All female patients undergoing umbilical hernia repair during pregnancy were identified within the ACS-NSQIP. Preoperative patient variables, intraoperative variables, and 30-day patient morbidity and mortality outcomes were investigated using a variety of statistical tests. A total of 126 pregnant patients underwent umbilical hernia repair from 2005 to 2014; 73 (58%) had incarceration or strangulation at the time of surgical intervention. The majority of patients (95%) underwent open umbilical hernia repair. Superficial surgical site infection was the most common morbidity in patients undergoing open umbilical hernia repair. Based on review of the ACS-NSQIP database, the incidence of umbilical hernia repair during pregnancy is very low; however, the majority of patients required repair for incarceration of strangulation. When symptoms develop, these hernias can be repaired with minimal 30-day morbidity to the mother. Additional studies are needed to determine the long-term recurrence rate of umbilical hernia repairs performed in pregnant patients and the effects of surgical intervention and approach on the fetus.

  9. Prevalence of Germline Mutations in Genes Engaged in DNA Damage Repair by Homologous Recombination in Patients with Triple-Negative and Hereditary Non-Triple-Negative Breast Cancers.

    Directory of Open Access Journals (Sweden)

    Pawel Domagala

    Full Text Available This study sought to assess the prevalence of common germline mutations in several genes engaged in the repair of DNA double-strand break by homologous recombination in patients with triple-negative breast cancers and hereditary non-triple-negative breast cancers. Tumors deficient in this type of DNA damage repair are known to be especially sensitive to DNA cross-linking agents (e.g., platinum drugs and to poly(ADP-ribose polymerase (PARP inhibitors.Genetic testing was performed for 36 common germline mutations in genes engaged in the repair of DNA by homologous recombination, i.e., BRCA1, BRCA2, CHEK2, NBN, ATM, PALB2, BARD1, and RAD51D, in 202 consecutive patients with triple-negative breast cancers and hereditary non-triple-negative breast cancers.Thirty five (22.2% of 158 patients in the triple-negative group carried mutations in genes involved in DNA repair by homologous recombination, while 10 (22.7% of the 44 patients in the hereditary non-triple-negative group carried such mutations. Mutations in BRCA1 were most frequent in patients with triple-negative breast cancer (18.4%, and mutations in CHEK2 were most frequent in patients with hereditary non-triple-negative breast cancers (15.9%. In addition, in the triple-negative group, mutations in CHEK2, NBN, and ATM (3.8% combined were found, while mutations in BRCA1, NBN, and PALB2 (6.8% combined were identified in the hereditary non-triple-negative group.Identifying mutations in genes engaged in DNA damage repair by homologous recombination other than BRCA1/2 can substantially increase the proportion of patients with triple-negative breast cancer and hereditary non-triple-negative breast cancer who may be eligible for therapy using PARP inhibitors and platinum drugs.

  10. [Characteristics and Outcomes of Treatment in Patients with Stage IV Colorectal Cancer with Mismatch Repair Deficiency].

    Science.gov (United States)

    Ishibashi, Keiichiro; Chika, Noriyasu; Suzuki, Okihide; Ito, Tetsuya; Amano, Kunihiko; Kumamoto, Kensuke; Fukuchi, Minoru; Kumagai, Youichi; Mochiki, Erito; Ishida, Hideyuki

    2016-11-01

    Mismatch repair(MMR)protein deficiency in colorectal cancer is well correlated with high-level microsatellite instability (MSI-H). There are little data on mismatch repair deficiency(dMMR)colorectal cancers in Japan. In addition, we have no available data on the therapeutic efficacy of oxaliplatin(oxa)-based chemotherapy, one of the standard treatment regimens for metastatic colorectal cancer, for patients with dMMR colorectal cancer. The subjects were 254 patients with Stage IV colorectal cancer whose tumors were immunohistochemically stained for MMR proteins, MLH1, MSH2, MSH6, and PMS2. Patients who underwent R0 resection were excluded. Clinicopathologic factors and the efficacy of oxa-based chemotherapy were compared between patients with dMMR colorectal cancer and those with mismatch repair proficient(pMMR)colorectal cancer. There were 7(2.8%)patients with dMMR. Four patients demonstrated both MLH1 and PMS2 loss, while 3 patients demonstrated both MSH2 and MSH6 loss. Though the dMMR had a higher frequency in female patients(p=0.02) and a lower frequency in those with liver metastasis(pcolorectal cancers was lower than those(4-11%)reported in Western countries. Therefore, the clinical significance of universal screeningfor dMMR in all colorectal cancer samples may not be valid. Concerningsurvival benefit, oxa-based chemotherapy seems to be an effective alternative in clinical practice for metastatic colorectal cancer patients with dMMR.

  11. Prediction of 30-day mortality after endovascular repair or open surgery in patients with ruptured abdominal aortic aneurysms.

    NARCIS (Netherlands)

    Visser, J.J.; Williams, M.A.; Kievit, J.; Bosch, J.L.; Hunink, M.G.M.; Teijink, J.A.; Verhoeven, E.L.; Smet, A.A. de; Geelkerken, R.H.; Steyerberg, E.W.; Sambeek, M.R. van

    2009-01-01

    OBJECTIVE: To validate the Glasgow Aneurysm Score (GAS) in patients with ruptured abdominal aortic aneurysms (AAAs) treated with endovascular repair or open surgery and to update the GAS so that it predicts 30-day mortality for patients with ruptured AAA treated with endovascular repair or open surg

  12. Autologous chondrocyte implantation: superior biologic properties of hyaline cartilage repairs.

    Science.gov (United States)

    Henderson, Ian; Lavigne, Patrick; Valenzuela, Herminio; Oakes, Barry

    2007-02-01

    Information regarding the quality of autologous chondrocyte implantation repair is needed to determine whether the current autologous chondrocyte implantation surgical technology and the subsequent biologic repair processes are capable of reliably forming durable hyaline or hyaline-like cartilage in vivo. We report and analyze the properties and qualities of autologous chondrocyte implantation repairs. We evaluated 66 autologous chondrocyte implantation repairs in 57 patients, 55 of whom had histology, indentometry, and International Cartilage Repair Society repair scoring at reoperation for mechanical symptoms or pain. International Knee Documentation Committee scores were used to address clinical outcome. Maximum stiffness, normalized stiffness, and International Cartilage Repair Society repair scoring were higher for hyaline articular cartilage repairs compared with fibrocartilage, with no difference in clinical outcome. Reoperations revealed 32 macroscopically abnormal repairs (Group B) and 23 knees with normal-looking repairs in which symptoms leading to arthroscopy were accounted for by other joint disorders (Group A). In Group A, 65% of repairs were either hyaline or hyaline-like cartilage compared with 28% in Group B. Autologous chondrocyte repairs composed of fibrocartilage showed more morphologic abnormalities and became symptomatic earlier than hyaline or hyaline-like cartilage repairs. The hyaline articular cartilage repairs had biomechanical properties comparable to surrounding cartilage and superior to those associated with fibrocartilage repairs.

  13. Earlier Pulmonary Valve Replacement in Down Syndrome Patients Following Tetralogy of Fallot Repair.

    Science.gov (United States)

    Sullivan, Rachel T; Frommelt, Peter C; Hill, Garick D

    2017-08-01

    The association between Down syndrome and pulmonary hypertension could contribute to more severe pulmonary regurgitation after tetralogy of Fallot repair and possibly earlier pulmonary valve replacement. We compared cardiac magnetic resonance measures of pulmonary regurgitation and right ventricular dilation as well as timing of pulmonary valve replacement between those with and without Down syndrome after tetralogy of Fallot repair. Review of our surgical database from 2000 to 2015 identified patients with tetralogy of Fallot with pulmonary stenosis. Those with Down syndrome were compared to those without. The primary outcome of interest was time from repair to pulmonary valve replacement. Secondary outcomes included pulmonary regurgitation and indexed right ventricular volume on cardiac magnetic resonance imaging. The cohort of 284 patients included 35 (12%) with Down syndrome. Transannular patch repair was performed in 210 (74%). Down syndrome showed greater degree of pulmonary regurgitation (55 ± 14 vs. 37 ± 16%, p = 0.01) without a significantly greater rate of right ventricular dilation (p = 0.09). In multivariable analysis, Down syndrome (HR 2.3, 95% CI 1.2-4.5, p = 0.02) and transannular patch repair (HR 5.5, 95% CI 1.7-17.6, p = 0.004) were significant risk factors for valve replacement. Those with Down syndrome had significantly lower freedom from valve replacement (p = 0.03). Down syndrome is associated with an increased degree of pulmonary regurgitation and earlier pulmonary valve replacement after tetralogy of Fallot repair. These patients require earlier assessment by cardiac magnetic resonance imaging to determine timing of pulmonary valve replacement and evaluation for and treatment of preventable causes of pulmonary hypertension.

  14. The impact of radiological equipment on patient radiation exposure during endovascular aortic aneurysm repair

    Energy Technology Data Exchange (ETDEWEB)

    Fossaceca, Rita; Guzzardi, Giuseppe; Cerini, Paolo; Carriero, Alessandro [University Hospital ' ' Maggiore della Carita' ' , Radiology Department, Novara (Italy); Brambilla, Marco; Valzano, Serena [University Hospital ' ' Maggiore della Carita' ' , Medical Physics Department, Novara (Italy); Renghi, Alessandra; Brustia, Piero [University Hospital ' ' Maggiore della Carita' ' , Vascular Surgery Department, Novara (Italy)

    2012-11-15

    To compare the patient radiation dose during endovascular aortic aneurysm repair (EVAR) using different types of radiological systems: a mobile fluoroscopic C-arm, mobile angiographic and fixed angiographic equipment. Dose-area products (DAP) were obtained from a retrospective study of 147 consecutive patients, subjected to 153 EVAR procedures during a 3.5-year period. On the basis of these data, entrance surface dose (ESD) and effective dose (ED) were calculated. EVARs were performed using a fluoroscopic C-arm, mobile or fixed angiographic equipment in 79, 26 and 48 procedures, respectively. Fluoroscopy times were essentially equivalent for all the systems, ranging from 15 to 19 min. The clinical outcomes were not significantly different among the systems. Statistically significant differences among radiological equipment grouping were found for DAP (mobile C-arm: 32 {+-} 20 Gy cm{sup 2}; mobile angiography: 362 {+-} 164 Gy cm{sup 2}; fixed angiography: 464 {+-} 274 Gy cm{sup 2}; P < 10{sup -6}), for ESD (mobile C-arm: 0.18 {+-} 0.11 Gy; mobile angiography: 2.0 {+-} 0.8 Gy; fixed angiography: 2.5 {+-} 1.5 Gy; P < 10{sup -6}) and ED (mobile C-arm: 6.2 {+-} 4.5 mSv; mobile angiography: 64 {+-} 26 mSv; fixed angiography: 129 {+-} 76 mSv; P < 10{sup -6}). Radiation dose in EVAR is substantially less with a modern portable C-arm than with a fixed or mobile dedicated angiographic system. (orig.)

  15. 4D-MR flow analysis in patients after repair for tetralogy of Fallot

    Energy Technology Data Exchange (ETDEWEB)

    Geiger, J.; Markl, M.; Jung, B.; Langer, M. [University Hospital Freiburg, Department of Radiology, Medical Physics, Freiburg (Germany); Grohmann, J.; Stiller, B.; Arnold, R. [University Hospital Freiburg, Department of Congenital Heart Disease and Pediatric Cardiology, Freiburg (Germany)

    2011-08-15

    Comprehensive analysis of haemodynamics by 3D flow visualisation and retrospective flow quantification in patients after repair of tetralogy of Fallot (TOF). Time-resolved flow-sensitive 4D MRI (spatial resolution {proportional_to} 2.5 mm, temporal resolution = 38.4 ms) was acquired in ten patients after repair of TOF and in four healthy controls. Data analysis included the evaluation of haemodynamics in the aorta, the pulmonary trunk (TP) and left (lPA) and right (rPA) pulmonary arteries by 3D blood flow visualisation using particle traces, and quantitative measurements of flow velocity. 3D visualisation of whole heart haemodynamics provided a comprehensive overview on flow pattern changes in TOF patients, mainly alterations in flow velocity, retrograde flow and pathological vortices. There was consistently higher blood flow in the rPA of the patients (rPA/lPA flow ratio: 2.6 {+-} 2.5 vs. 1.1 {+-} 0.1 in controls). Systolic peak velocity in the TP was higher in patients (1.9 m/s {+-} 0.7 m/s) than controls (0.9 m/s {+-} 0.1 m/s). 4D flow-sensitive MRI permits the comprehensive evaluation of blood flow characteristics in patients after repair of TOF. Altered flow patterns for different surgical techniques in the small patient cohort may indicate its value for patient monitoring and potentially identifying optimal surgical strategies. (orig.)

  16. Management of severe asymmetric pectus excavatum complicating aortic repair in a patient with Marfan's syndrome.

    Science.gov (United States)

    Yeung, Jonathan C; Marcuzzi, Danny; Peterson, Mark D; Ko, Michael A

    2016-05-01

    We describe the case of a 28-year old man with Marfan's syndrome and severe pectus excavatum who required an aortic root replacement for an ascending aortic aneurysm. There was a near-vertical angulation of the sternum that presented challenges with opening and exposure of the heart during aortic surgery. Furthermore, removal of the sternal retractor after aortic repair resulted in sudden loss of cardiac output. A Ravitch procedure was then performed to successfully close the chest without further cardiovascular compromise. We propose that patients with a severe pectus excavatum and mediastinal displacement seen on preoperative CT scanning should be considered for simultaneous, elective repair.

  17. Cockayne syndrome group B protein stimulates repair of formamidopyrimidines by NEIL1 DNA glycosylase

    DEFF Research Database (Denmark)

    Muftuoglu, Meltem; de Souza-Pinto, Nadja C; Dogan, Arin

    2009-01-01

    on the role of CSB in repair of oxidatively induced DNA lesions have focused on 7,8-dihydro-8-oxoguanine. This study examines the role of CSB in the repair of formamidopyrimidines 2,6-diamino-4-hydroxy-5-formamidopyrimidine (FapyGua) and 4,6-diamino-5-formamidopyrimidine (FapyAde), which are substrates...... for endonuclease VIII-like (NEIL1) DNA glycosylase. Results presented here show that csb(-/-) mice have a higher level of endogenous FapyAde and FapyGua in DNA from brain and kidney than wild type mice as well as higher levels of endogenous FapyAde in genomic DNA and mtDNA from liver. In addition, CSB stimulates...... of formamidopyrimidines, possibly by interacting with and stimulating NEIL1, and that accumulation of such modifications may have a causal role in the pathogenesis of CS....

  18. A review of surgical repair methods and patient outcomes for gluteal tendon tears.

    Science.gov (United States)

    Ebert, Jay R; Bucher, Thomas A; Ball, Simon V; Janes, Gregory C

    2015-01-01

    Advanced hip imaging and surgical findings have demonstrated that a common cause of greater trochanteric pain syndrome (GTPS) is gluteal tendon tears. Conservative measures are initially employed to treat GTPS and manage gluteal tears, though patients frequently undergo multiple courses of non-operative treatment with only temporary pain relief. Therefore, a number of surgical treatment options for recalcitrant GTPS associated with gluteal tears have been reported. These have included open trans-osseous or bone anchored suture techniques, endoscopic methods and the use of tendon augmentation for repair reinforcement. This review describes the anatomy, pathophysiology and clinical presentation of gluteal tendon tears. Surgical techniques and patient reported outcomes are presented. This review demonstrates that surgical repair can result in improved patient outcomes, irrespective of tear aetiology, and suggests that the patient with "trochanteric bursitis" should be carefully assessed as newer surgical techniques show promise for a condition that historically has been managed conservatively.

  19. Total endoscopic robotic atrial septal defect repair in a patient with dextrocardia and situs inversus totalis.

    Science.gov (United States)

    Iino, Kenji; Watanabe, Go; Ishikawa, Norihiko; Tomita, Shigeyuki

    2012-04-01

    Situs inversus with mirror-image of the heart is a rare condition. The present report describes a case of a patient with dextrocardia with situs inversus who had atrial septal defect with multiple holes in the fossa ovalis. The patient underwent total endoscopic atrial septal defect repair using the da Vinci surgical system. This procedure was achieved safely with good clinical and excellent cosmetic results.

  20. The effects of preoperative cardiology consultation prior to elective abdominal aortic aneurysm repair on patient morbidity.

    Science.gov (United States)

    Boniakowski, Anna E; Davis, Frank M; Phillips, Amanda R; Robinson, Adina B; Coleman, Dawn M; Henke, Peter K

    2017-08-01

    Objectives The relationship between preoperative medical consultations and postoperative complications has not been extensively studied. Thus, we investigated the impact of preoperative consultation on postoperative morbidity following elective abdominal aortic aneurysm repair. Methods A retrospective review was conducted on 469 patients (mean age 72 years, 20% female) who underwent elective abdominal aortic aneurysm repair from June 2007 to July 2014. Data elements included detailed medical history, preoperative cardiology consultation, and postoperative complications. Primary outcomes included 30-day morbidity, consult-specific morbidity, and mortality. A bivariate probit regression model accounting for the endogeneity of binary preoperative medical consult and patient variability was estimated with a maximum likelihood function. Results Eighty patients had preoperative medical consults (85% cardiology); thus, our analysis focuses on the effect of cardiac-related preoperative consults. Hyperlipidemia, increased aneurysm size, and increased revised cardiac risk index increased likelihood of referral to cardiology preoperatively. Surgery type (endovascular versus open repair) was not significant in development of postoperative complications when controlling for revised cardiac risk index ( p = 0.295). After controlling for patient comorbidities, there was no difference in postoperative cardiac-related complications between patients who did and did not undergo cardiology consultation preoperatively ( p = 0.386). Conclusions When controlling for patient disease severity using revised cardiac risk index risk stratification, preoperative cardiology consultation is not associated with postoperative cardiac morbidity.

  1. Germ line mutations of mismatch repair genes in hereditary nonpolyposis colorectal cancer patients with small bowel cancer: International Society for Gastrointestinal Hereditary Tumours Collaborative Study

    DEFF Research Database (Denmark)

    Park, Jae-Gahb; Kim, Duck-Woo; Hong, Chang Won;

    2006-01-01

    PURPOSE: The aim of study was to determine the clinical characteristics and mutational profiles of the mismatch repair genes in hereditary nonpolyposis colorectal cancer (HNPCC) patients with small bowel cancer (SBC). EXPERIMENTAL DESIGN: A questionnaire was mailed to 55 members of the Internatio.......8%, P teens. The distribution of MSH2 mutations found in patients with HNPCC-associated SBCs significantly differed from that found in the control group (P

  2. EXPERIENCE OF INGUINAL HERNIA REPAIR IN 230 PATIENTS BY LICHTENSTEIN TECHNIQUE

    Directory of Open Access Journals (Sweden)

    Mahesh

    2016-01-01

    Full Text Available BACKGROUND The main aim of the surgeon is to lower the recurrence rate while dealing the defect in inguinal canal. Lichtenstein technique has opened a new era in such repairs. In our study we have evaluated 230 patients who have undergone mesh repair in inguinal hernias by Lichtenstein technique. MATERIAL AND METHODS The study was done prospectively from September 2013 to August 2015. Surgery related complications, operative time, hospital stay and return to routine activities were recorded. All the patients with age more than 15 years were included in this study; however patients with medical diseases like diabetes mellitus and chronic obstructive pulmonary disease were not included. Also patients with complications of hernia having features of obstruction or strangulation were also excluded from this study. RESULTS Out of 230 patients, 223 patients (96.95% were male and 07 patients (3.04% were female. Indirect inguinal hernia was present in 122 patients (53.04%, direct inguinal hernia in 93 (40.43% and pantaloon hernia in 15 patients (6.5%. The incidence of unilateral hernia was 75.21% whereas bilateral hernia was observed only in 24.78% patients. Postoperative seroma and haematoma was observed in 3 and 1 patient respectively which were drained successfully. None of our patients encountered postoperative neuralgia, wound infection or recurrence till date. CONCLUSION Lichtenstein technique of inguinal hernia repair in adults is still considered as the method of choice by many surgeons around the world in lieu of its simplicity in performing the procedure, minimum postoperative complications, early recovery with return to normal activities, less hospital stay and very low recurrence rate.

  3. Staged hernia repair preceded by gastric bypass for the treatment of morbidly obese patients with complex ventral hernias.

    Science.gov (United States)

    Newcomb, W L; Polhill, J L; Chen, A Y; Kuwada, T S; Gersin, K S; Getz, S B; Kercher, K W; Heniford, B T

    2008-10-01

    Obesity may be the most predominant risk factor for recurrence following ventral hernia repair. This is secondary to significantly increased intra-abdominal pressures, higher rates of wound complications, and the technical difficulties encountered due to obesity. Medically managed weight loss prior to surgery is difficult. One potential strategy is to provide a surgical means to correct patient weight prior to hernia repair. After institutional review board approval, we reviewed the medical records of all patients who underwent gastric bypass surgery prior to the definitive repair of a complex ventral hernia at our medical center. Twenty-seven morbidly obese patients with an average of 3.7 (range 1-10) failed ventral hernia repairs underwent gastric bypass prior to definitive ventral hernia repair. Twenty-two of the gastric bypasses were open operations and five were laparoscopic. The patients' average pre-bypass body mass index (BMI) was 51 kg/m2 (range 39-69 kg/m2), which decreased to an average of 33 kg/m2 (range 25-37 kg/m2) at the time of hernia repair at a mean of 1.3 years (range 0.9-3.1 years) after gastric bypass. Seven patients had hernia repair at the same time as their gastric bypass (four sutured, three biologic mesh), all of which recurred. Of the 27 patients, 19 had an open hernia repair and eight had a laparoscopic repair. Panniculectomy was performed concurrently in 15 patients who had an open repair. Prior to formal hernia repair, one patient required an urgent operation to repair a hernia incarceration and a small-bowel obstruction 11 months after gastric bypass. The average hernia and mesh size was 203 cm2 (range 24-1,350 cm2) and 1,040 cm2 (range 400-2,700 cm2), respectively. There have been no recurrences at an average follow-up of 20 months (range 2 months-5 years). Gastric bypass prior to staged ventral hernia repair in morbidly obese patients with complex ventral hernias is a safe and definitive method to effect weight loss and facilitate a

  4. Should Endovascular Repair Be Reimbursed for Low Risk Abdominal Aortic Aneurysm Patients? Evidence from Ontario, Canada

    Directory of Open Access Journals (Sweden)

    Jean-Eric Tarride

    2011-01-01

    Full Text Available Background. This paper presents unpublished clinical and economic data associated with open surgical repair (OSR in low risk (LR patients and how it compares with EVAR and OSR in high risk (HR patients with an AAA > 5.5 cm. Design. Data from a 1-year prospective observational study was used to compare EVAR in HR patients versus OSR in HR and LR patients. Results. Between 2003 and 2005, 140 patients were treated with EVAR and 195 with OSR (HR: 52; LR: 143. The 1-year mortality rate with EVAR was statistically lower than HR OSR patients and comparable to LR OSR patients. One-year health-related quality of life was lower in the EVAR patients compared to OSR patients. EVAR was cost-effective compared to OSR HR but not when compared to OSR LR patients. Conclusions. Despite a similar clinical effectiveness, these results suggest that, at the current price, EVAR is more expensive than open repair for low risk patients.

  5. Preoperative intravenous ibuprofen does not influence postoperative narcotic use in patients undergoing elective hernia repair: a randomized, double-blind, placebo controlled prospective trial

    Directory of Open Access Journals (Sweden)

    Sparber LS

    2017-07-01

    Full Text Available Lauren S Sparber,1 Christine SM Lau,1,2 Tanya S Vialet,1 Ronald S Chamberlain1–4 1Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; 2Saint George’s University School of Medicine, Grenada, West Indies; 3Department of Surgery, Banner MD Anderson Cancer Center, Gilbert, AZ, USA; 4Department of Surgery, New Jersey Medical School, Rutgers University, Newark, NJ, USA Introduction: Inguinal and umbilical hernia repairs are among the most common surgical procedures performed in the US. Optimal perioperative pain control regimens remain challenging and opioid analgesics are commonly used. Preoperative nonsteroidal anti-inflammatory drug (NSAID administration has been shown to reduce postoperative narcotic requirements. This study sought to evaluate the efficacy of perioperative intravenous (IV ibuprofen on postoperative pain level and narcotic use in patients undergoing open or laparoscopic inguinal and/or umbilical hernia repair.Methods: A single center, randomized, double-blind placebo-controlled trial involving patients ≥18 years undergoing inguinal and/or umbilical hernia repair was performed. Patients were randomized to receive 800 mg of IV ibuprofen or placebo preoperatively. Outcomes assessed included postoperative pain medication required and visual analog scale (VAS pain scores.Results: Forty-eight adult male patients underwent inguinal and/or umbilical hernia repair. Patients receiving IV ibuprofen used more oxycodone/acetaminophen (32% vs 13% and IV hydromorphone (12% vs 8.7%, and fewer combinations of pain medications (44% vs 65.2% in the first two postoperative hours compared to placebo (p=0.556. The IV ibuprofen group had more patients pain free (28% vs 8.7%, p=0.087 and lower VAS scores (3.08±2.14 vs 3.95±1.54, p=0.134 at 2 hours postoperatively, compared to the placebo group, however, this was not statistically significant. Similar pain levels at 1, 3, and 7 days, postoperative and similar use of rescue

  6. Thoracic endovascular aortic repair for patent ductus arteriosus in an elderly patient with congestive heart failure.

    Science.gov (United States)

    Kato, Gentaro; Nakai, Mikizo; Tokunaga, Noriyuki; Shimizu, Shuji; Okada, Masahiro

    2016-05-01

    In elderly patients, open surgery for patent ductus arteriosus (PDA) is more difficult than that in children and often requires a cardiopulmonary bypass. We report the case of a 67-year-old patient with a PDA that was successfully treated with thoracic endovascular aortic repair (TEVAR). The patient was diagnosed with congestive heart failure (ejection fraction, 36 %) and PDA (9.7 mm in diameter). TEVAR was successfully performed to exclude the PDA. After TEVAR, the patient's heart failure was well controlled by diuretics. TEVAR may be a good alternative to open surgery.

  7. Endovascular Aneurysm Repair in HIV Patients with Ruptured Abdominal Aneurysm and Low CD4

    Directory of Open Access Journals (Sweden)

    Saranat Orrapin

    2016-01-01

    Full Text Available We report two HIV infected patients with ruptured abdominal aneurysm by using endovascular aneurysm repair (EVAR technique. A 59-year-old Thai man had a ruptured abdominal aortic aneurysm and a 57-year-old man had a ruptured iliac artery aneurysm. Both patients had a CD4 level below 200 μ/L indicating a low immune status at admission. They were treated by EVAR. Neither patient had any complications in 3 months postoperatively. EVAR may have a role in HIV patients with ruptured abdominal aneurysm together with very low immunity.

  8. Repair of oronasal fistula with silicone button in patients with head and neck cancer.

    Science.gov (United States)

    Hsu, Yu-Ting; Hao, Sheng-Po

    2015-06-01

    Until now, there is no optimal technique for repairing oronasal fistula in patients with prior head and neck radiotherapy and trismus. Use of the silicone button is a safe, office-based, and validated method in this situation. The indications of this procedure are also clarified in this study. This is a retrospective study of four patients who underwent a newly designed endoscopic repair of oronasal fistula with silicone button under local anesthesia from July 2012 to August 2012. Data on the size of the defect, length of operation, symptom relief, and post-operative complications were collected. Four patients underwent endoscopic repair of oronasal fistula with silicone button under local anesthesia. The diagnoses were benign palate lesion s/p operation, oral cancer s/p operation and radiotherapy. The defect diameter varied from 1 to 1.5 cm. The operation durations were between 20 and 30 min. In all cases, nasal regurgitation symptoms were relieved. The hypernasality of one case improved, while another had decreased nasal crusting and foul odors. No major complications were noted. There was a minor complication in one case, which exhibited frequent crusting around the silicone button. Silicon button can act as a temporary obturator to improve quality of life of patients. The indications for this procedure include patient undergone head and neck radiotherapy with (1) chronic fistula (>6 months); (2) small defect (1-2 cm); and (3) trismus. 4.

  9. Six years' experience with prostaglandin I2 infusion in elective open repair of abdominal aortic aneurysm: a parallel group observational study in a tertiary referral vascular center.

    LENUS (Irish Health Repository)

    Beirne, Chris

    2008-11-01

    The prostaglandin I(2) (PGI(2)) analogue iloprost, a potent vasodilator and inhibitor of platelet activation, has traditionally been utilized in pulmonary hypertension and off-label use for revascularization of chronic critical lower limb ischemia. This study was designed to assess the effect of 72 hr iloprost infusion on systemic ischemia post-open elective abdominal aortic aneurysm (EAAA) surgery. Between January 2000 and 2007, 104 patients undergoing open EAAA were identified: 36 had juxtarenal, 15 had suprarenal, and 53 had infrarenal aneurysms, with a mean maximal diameter of 6.9 cm. The male-to-female ratio was 2.5:1, with a mean age of 71.9 years. No statistically significant difference was seen between the study groups with regard to age, sex, risk factors, American Society of Anesthesiologists (ASA) grade, or diameter of aneurysm repaired. All emergency, urgent, and endovascular procedures for aneurysms were excluded. Fifty-seven patients received iloprost infusion for 72 hr in the immediate postoperative period compared with 47 patients who did not. Patients were monitored for signs of pulmonary, renal, cardiac, systemic ischemia, and postoperative intensive care unit (ICU) morbidity. Statistically significantly increased ventilation rates (p=0.0048), pulmonary complication rates (p=0.0019), and myocardial ischemia (p=0.0446) were noted in those patients not receiving iloprost. These patients also had significantly higher renal indices including estimate glomerular filtration rate changes (p=0.041) and postoperative urea level rises (p=0.0286). Peripheral limb trashing was noted in five patients (11.6%) in the non-iloprost group compared with no patients who received iloprost. Increased rates of transfusion requirements and bowel complications were noted in those who did not receive iloprost, with their ICU stay greater than twice that of iloprost patients. All-cause morbidity affected 67% of patients not receiving iloprost compared to 40% who did

  10. Efficiency of olaparib in colorectal cancer patients with an alteration of the homologous repair protein.

    Science.gov (United States)

    Ghiringhelli, Francois; Richard, Corentin; Chevrier, Sandy; Végran, Frédérique; Boidot, Romain

    2016-12-28

    Precision medicine is defined by the administration of drugs based on the tumor's particular genetic characteristics. It is developing quickly in the field of cancer therapy. For example, KRAS, NRAS and BRAF genetic testing demonstrates its efficiency for precision medicine in colorectal cancer (CRC). Besides for these well-known mutations, the purpose of performing larger genetic testing in this pathology is unknown. Recent reports have shown that using the poly ADP ribose polymerase (PARP) inhibitor olaparib in patients with homologous repair enzyme deficiency gave positive clinical results in breast, ovarian and prostate cancers. We have reported here the cases of 2 patients with multi-treated metastatic CRC who underwent somatic and constitutional exome analyses. The analyses revealed a loss of function mutation in a homologous repair enzyme resulting in the loss of heterozygosity for both patients (Check2 for the first patient and RAD51C for the second one). Both patients were treated with off-label usage of olaparib. While the first patient showed clinical benefit, reduction of carcinoembryonic antigen tumor marker and radiologic response, the second patient quickly presented a progression of the tumor. Additional genetic analyses revealed a frameshift truncating mutation of the TP53BP1 gene in the patient who progressed. Interestingly, deficiency in TP53BP1 was previously described to confer resistance to olaparib in mice breast cancer models. Our findings suggest that exome analysis may be a helpful tool to highlight targetable mutations in CRC and that olaparib may be efficient in patients with a homologous repair deficiency.

  11. SNPs in DNA repair or oxidative stress genes and late subcutaneous fibrosis in patients following single shot partial breast irradiation

    Directory of Open Access Journals (Sweden)

    Falvo Elisabetta

    2012-01-01

    Full Text Available Abstract Background The aim of this study was to evaluate the potential association between single nucleotide polymorphisms related response to radiotherapy injury, such as genes related to DNA repair or enzymes involved in anti-oxidative activities. The paper aims to identify marker genes able to predict an increased risk of late toxicity studying our group of patients who underwent a Single Shot 3D-CRT PBI (SSPBI after BCS (breast conserving surgery. Methods A total of 57 breast cancer patients who underwent SSPBI were genotyped for SNPs (single nucleotide polymorphisms in XRCC1, XRCC3, GST and RAD51 by Pyrosequencing technology. Univariate analysis (ORs and 95% CI was performed to correlate SNPs with the risk of developing ≥ G2 fibrosis or fat necrosis. Results A higher significant risk of developing ≥ G2 fibrosis or fat necrosis in patients with: polymorphic variant GSTP1 (Ile105Val (OR = 2.9; 95%CI, 0.88-10.14, p = 0.047. Conclusions The presence of some SNPs involved in DNA repair or response to oxidative stress seem to be able to predict late toxicity. Trial Registration ClinicalTrials.gov: NCT01316328

  12. Primary repair of colon injuries: clinical study of nonselective approach

    Directory of Open Access Journals (Sweden)

    Krivokapic Zoran V

    2010-12-01

    Full Text Available Abstract Background This study was designed to determine the role of primary repair and to investigate the possibility of expanding indications for primary repair of colon injuries using nonselective approach. Methods Two groups of patients were analyzed. Retrospective (RS group included 30 patients managed by primary repair or two stage surgical procedure according to criteria published by Stone (S/F and Flint (Fl. In this group 18 patients were managed by primary repair. Prospective (PR group included 33 patients with primary repair as a first choice procedure. In this group, primary repair was performed in 30 cases. Results Groups were comparable regarding age, sex, and indexes of trauma severity. Time between injury and surgery was shorter in PR group, (1.3 vs. 3.1 hours. Stab wounds were more frequent in PR group (9:2, and iatrogenic lesions in RS group (6:2. Associated injuries were similar, as well as segmental distribution of colon injuries. S/F criteria and Flint grading were similar. In RS group 15 primary repairs were successful, while in two cases relaparotomy and colostomy was performed due to anastomotic leakage. One patient died. In PR group, 25 primary repairs were successful, with 2 immediate and 3 postoperative (7-10 days deaths, with no evidence of anastomotic leakage. Conclusions Results of this study justify more liberal use of primary repair in early management of colon injuries. Trial registration Current Controlled Trials ISRCTN94682396

  13. MORPHOLOGICAL OUTCOME OF PRIMARY L IP REPAIR IN PATIENTS WITH UNILAT ERAL CLEFT LIP - PALATE WITH THE USE OF INFERIOR TURBINATE F LAP

    Directory of Open Access Journals (Sweden)

    Vijaya Kumar

    2015-06-01

    Full Text Available BACKGROUND: Cleft lip and palate deformity poses problems at every stage of growth and development of the child. Repair of cleft lip - nose complex is a major challenge for the operating surgeon as well the manner in which the deficient tissues are replenished. The major issue which still remains to be tackled is achieving a acceptable nasal correction. In the quest for tissues to bring about a better repair especially in the region of nostril floor and a lar base , the hypertrophied inferior turbinate on the cleft side appears to be a good option. OBJECTIVE: The objective of the study is to evaluate long term aesthetic and morphological outcome of lip and nose in patients with unilateral cleft lip and palate deformity. MATERIALS AND METHOD : A Group of 41 patients were taken in the study and they were randomize d into two groups , Study group 21 cases who underwent primary lip repair with inferior turbinate flap and Control Group B , 20 cases without inferior turbinate flap. Age , sex , side of cleft and photographic evaluation of was done at 2 years and above post o peratively for nostril height , nostril width , nostril basal width and alar base level. RESULTS : On photographic evaluation group a showed statistically significant symmetry in the nasal architecture , and the long term follow up of these patients is necessa ry to comment on the aesthetic outcome. CONCLUSION : Inferior turbinate flap provides an adequate tissue during nostril floor reconstruction and helped in augmenting the depressed alar base on the cleft side.

  14. Transaortic Fallot repair in a grown-up patient: advantages in a situs inversus setting.

    Science.gov (United States)

    Gil-Jaurena, Juan-Miguel; Cano, Joaquín; Cuenca, Victorio

    2012-10-01

    We present the case studies of two adult patients with tetralogy of Fallot who were scheduled for surgery. After addressing the right ventricular outflow tract obstruction, the aorta was opened and the ventricular septal defect was approached in a straightforward manner as it was located just under the overriding aortic valve. The second patient presented with was a situs inversus, dextroapex Fallot. In this setting, the aortic approach simplified the repair expeditiously. After 2 years, both patients are in New York Heart Association class I, with no residual ventricular septal defect, no aortic regurgitation, and complete relief of right ventricular outflow tract obstruction.

  15. Surgical repair of chronic complete hamstring tendon rupture in the adult patient.

    Science.gov (United States)

    Cross, M J; Vandersluis, R; Wood, D; Banff, M

    1998-01-01

    Complete rupture of the hamstring tendons in the adult is a rare injury. This report discusses complete rupture of the hamstring tendons in nine patients treated by late operative repair. All patients were referred from outside centers for a second opinion after failed nonoperative treatment. The diagnosis was made quite easily on clinical grounds and was confirmed at surgery. Surgical treatment in all cases consisted of reattachment of the hamstring tendons to the origin on the ischium, and in all cases it was necessary to perform neurolysis of the sciatic nerve. Good results were achieved in all cases, at follow-up all patients were satisfied with the surgery.

  16. Surgical management of pilonidal sinus patients by primary and secondary repair methods: a comparative study

    Directory of Open Access Journals (Sweden)

    Haji Barati B

    2010-12-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Gross difference in return to work exists in pilonidal sinus patients operated by primary and secondary repair. This survey was to evaluate the results of surgical management of pilonidal sinus with primary or secondary closure."n"nMethods: In a randomized clinical trial, patients with pilonidal sinus referring to the surgical clinic of Shariati Hospital in Tehran, Iran between March 2007 and March 2009 were underwent either excision with midline closure (primary, n=40, or excision without closure (secondary, n=40. The recorded outcomes were hospital stay, healing time, time off work, postoperative pain, patient's satisfaction and the recurrence rate."n"nResults: Majority of the patients were male (87.50%. There was no significant difference in the hospital stay. Time off work (8.65±1.73 Vs. 11.53±2.33 days, p=0.001 and healing time (3.43±0.92 Vs. 5.3±0.79 days, p=0.001 were shorter in primary group; but, there were no significant differences in hospital stay and number of visits. Intensity of postoperative pain in the 1st (37.75±6.5 Vs. 43.63±5.06, p=0.001, 2nd (26.75±6.66 Vs. 34.63±5.48, p=0.001, 3rd (18.25±6.05 Vs. 27.88±6.88, p=0.001, and 7th (8.45±3.85 Vs. 17.88±6.19, p=0.001 days were

  17. Reduced Activity of Double-Strand Break Repair Genes in Prostate Cancer Patients With Late Normal Tissue Radiation Toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Oorschot, Bregje van, E-mail: b.vanoorschot@amc.uva.nl [Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Molecular Medicine (CEMM), Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Hovingh, Suzanne E. [Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Molecular Medicine (CEMM), Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Moerland, Perry D. [Bioinformatics Laboratory, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Medema, Jan Paul; Stalpers, Lukas J.A. [Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Molecular Medicine (CEMM), Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands); Vrieling, Harry [Department of Toxicogenetics, Leiden University Medical Center, Leiden (Netherlands); Franken, Nicolaas A.P. [Laboratory for Experimental Oncology and Radiobiology (LEXOR), Center for Molecular Medicine (CEMM), Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam (Netherlands)

    2014-03-01

    Purpose: To investigate clinical parameters and DNA damage response as possible risk factors for radiation toxicity in the setting of prostate cancer. Methods and Materials: Clinical parameters of 61 prostate cancer patients, 34 with (overresponding, OR) and 27 without (non-responding, NR) severe late radiation toxicity were assembled. In addition, for a matched subset the DNA damage repair kinetics (γ-H2AX assay) and expression profiles of DNA repair genes were determined in ex vivo irradiated lymphocytes. Results: Examination of clinical data indicated none of the considered clinical parameters to be correlated with the susceptibility of patients to develop late radiation toxicity. Although frequencies of γ-H2AX foci induced immediately after irradiation were similar (P=.32), significantly higher numbers of γ-H2AX foci were found 24 hours after irradiation in OR compared with NR patients (P=.03). Patient-specific γ-H2AX foci decay ratios were significantly higher in NR patients than in OR patients (P<.0001). Consequently, NR patients seem to repair DNA double-strand breaks (DSBs) more efficiently than OR patients. Moreover, gene expression analysis indicated several genes of the homologous recombination pathway to be stronger induced in NR compared with OR patients (P<.05). A similar trend was observed in genes of the nonhomologous end-joining repair pathway (P=.09). This is congruent with more proficient repair of DNA DSBs in patients without late radiation toxicity. Conclusions: Both gene expression profiling and DNA DSB repair kinetics data imply that less-efficient repair of radiation-induced DSBs may contribute to the development of late normal tissue damage. Induction levels of DSB repair genes (eg, RAD51) may potentially be used to assess the risk for late radiation toxicity.

  18. Germline mutations in DNA repair genes predispose asbestos-exposed patients to malignant pleural mesothelioma.

    Science.gov (United States)

    Betti, Marta; Casalone, Elisabetta; Ferrante, Daniela; Aspesi, Anna; Morleo, Giulia; Biasi, Alessandra; Sculco, Marika; Mancuso, Giuseppe; Guarrera, Simonetta; Righi, Luisella; Grosso, Federica; Libener, Roberta; Pavesi, Mansueto; Mariani, Narciso; Casadio, Caterina; Boldorini, Renzo; Mirabelli, Dario; Pasini, Barbara; Magnani, Corrado; Matullo, Giuseppe; Dianzani, Irma

    2017-10-01

    Malignant pleural mesothelioma (MPM) is a rare, aggressive cancer caused by asbestos exposure. An inherited predisposition has been suggested to explain multiple cases in the same family and the observation that not all individuals highly exposed to asbestos develop the tumor. Germline mutations in BAP1 are responsible for a rare cancer predisposition syndrome that includes predisposition to mesothelioma. We hypothesized that other genes involved in hereditary cancer syndromes could be responsible for the inherited mesothelioma predisposition. We investigated the prevalence of germline variants in 94 cancer-predisposing genes in 93 MPM patients with a quantified asbestos exposure. Ten pathogenic truncating variants (PTVs) were identified in PALB2, BRCA1, FANCI, ATM, SLX4, BRCA2, FANCC, FANCF, PMS1 and XPC. All these genes are involved in DNA repair pathways, mostly in homologous recombination repair. Patients carrying PTVs represented 9.7% of the panel and showed lower asbestos exposure than did all the other patients (p = 0.0015). This suggests that they did not efficiently repair the DNA damage induced by asbestos and leading to carcinogenesis. This study shows that germline variants in several genes may increase MPM susceptibility in the presence of asbestos exposure and may be important for specific treatment. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  19. X-ray repair cross-complementing group 1 polymorphisms and hepatocellular carcinoma: A meta-analysis

    Institute of Scientific and Technical Information of China (English)

    Tian Xie; Zhen-Guang Wang; Jing-Lei Zhang; Hui Liu

    2012-01-01

    AIM:To perform a systematic meta-analysis to investigate the association between X-ray repair crosscomplementing group 1 (XRCC1) polymorphisms and hepatocellular carcinoma (HCC) risk.METHODS:Relevant studies extracted from PubMed,Embase,Wanfang,VIP and the Chinese National Knowledge Infrastructure databases up to March 2012 were included in the study.Stata software,version 11.0,was used for the statistical analysis.The odds ratios (ORs) and 95% confidence interval (CI) of the XRCC1 polymorphisms in HCC patients were analyzed and compared with healthy controls.The meta-analysis was performed using fixed-effect or random-effect methods,depending on the absence or presence of significant heterogeneity.RESULTS:Eleven studies with 2075 HCC cases and 2604 controls met our eligibility criteria (four studies,888 cases and 938 controls for Arg194Trp,four studies,858 cases and 880 controls for Arg280His,and nine studies,1845 cases and 2401 controls for Arg399Gln).The meta-analysis revealed no associations between the Arg194Trp and Arg399Gln polymorphisms of the XRCC1 gene and HCC risk under all contrast models (codominant,dominant and recessive models) in the overall analysis and sensitivity analysis (the studies with controls not in the Hardy-Weinberg equilibrium were excluded).For XRCC1 Arg280His polymorphism,the overall analysis revealed the significant association between the His/His genotype and the increased risk of HCC (His/His vs Arg/Arg model,OR:1.96,95% CI:1.03-3.75,P =0.04).However,sensitivity analysis showed an altered pattern of result and non-significant association (OR:2.06,95% CI:0.67-6.25,P =0.20).The heterogeneity hypothesis test did not reveal any heterogeneity,and Begg's and Egger's tests did not find any obvious publication bias.CONCLUSION:The XRCC1 Arg194Trp and Arg399Gln polymorphisms are not associated with HCC risk.More rigorous association studies are needed to verify the involvement of XRCC1 Arg280His polymorphism in HCC susceptibility.

  20. Endonasal endoscopic repair of cerebrospinal fluid rhinorrhea in a series of 69 patients.

    Science.gov (United States)

    Ye, Huiping; Zuo, Jian; Zhao, Huoyu; Liu, Shixi; An, Huiming; Liu, Yafeng

    2010-06-01

    We presented our experiences in treatment of Cerebrospinal Fluid (CSF) rhinorrhea with an endoscopic endonasal surgery approach, and showed the severe postoperative complications and failures we experienced, in order to outline some of the characteristic problems that can occur. We performed a retrospective analysis of all of the patients with CSF rhinorrhea. All of the patients were managed with an endonasal endoscopic procedure. Data collected included the site of leakage, the surgical interventions, and the postoperative complications. Sixty-nine patients (33 females and 36 males) were included in this study. All patients underwent an endoscopic repair approach with a multilayer reconstructive technique. The success rates of the first attempt in our study were 89%. Four patients presented with postoperative meningitis and brain abscess and one of these patients died of the brain abscess. Our results indicate that an endoscopic endonasal surgery approach provides a wide, safe, and direct route for treatment of CSF rhinorrhea. The precise location of leakage prior to surgery and proper patient selection, eliminating those with large leakages, are helpful in ensuring a successful endoscopic CSF repair with minimal mortality.

  1. The effect of exercise types for rotator cuff repair patients on activities of shoulder muscles and upper limb disability

    National Research Council Canada - National Science Library

    Kang, Jeong-Il; Moon, Young-Jun; Choi, Hyun; Jeong, Dae-Keun; Kwon, Hye-Min; Park, Jun-Su

    2016-01-01

    [Purpose] This study investigated the effect on activities, shoulder muscle fatigue, upper limb disability of two exercise types performed by patients in the post- immobilization period of rotator cuff repair...

  2. Usefulness of color kinesis imaging for evaluation of regional right ventricular wall motion in patients with surgically repaired tetralogy of Fallot.

    Science.gov (United States)

    Hayabuchi, Y; Matsuoka, S; Kubo, M; Kuroda, Y

    1998-11-15

    We evaluated regional right ventricular wall motion during systole in patients with surgically repaired tetralogy of Fallot (TOF) using color kinesis imaging. Color kinesis images were obtained in a subcostal sagittal view from 19 patients with repaired TOF (TOF group), aged 3 to 5 years, and 20 age-matched normal subjects (control group). For regional wall motion analysis, the endocardial motion distance and the fractional area change (FAC) were calculated for 6 segments obtained from color kinesis images. The endocardial inward excursion distances and the FACs in the upper, middle, and lower posterior segments of the TOF group were significantly greater than those of the control group (p kinesis measurements was excellent (y = 1.14x - 1.30, r = 0.87 for the endocardial inward excursion, and y = 1.03x +/- 0.56, r = 0.91 for the FAC). In conclusion, color kinesis is a useful method for assessing regional right ventricular wall motion. Segmental analysis of color kinesis images provides accurate, automated, and quantitative diagnosis of regional right ventricular wall motion abnormalities in patients with surgically repaired TOF.

  3. Arthroscopic Bristow-Latarjet Combined With Bankart Repair Restores Shoulder Stability in Patients With Glenoid Bone Loss

    OpenAIRE

    Boileau, Pascal; Thélu, Charles-Édouard; Mercier, Numa; Ohl, Xavier; Houghton-Clemmey, Robert; Carles, Michel; Trojani, Christophe

    2014-01-01

    Background Arthroscopic Bankart repair alone cannot restore shoulder stability in patients with glenoid bone loss involving more than 20% of the glenoid surface. Coracoid transposition to prevent recurrent shoulder dislocation according to Bristow-Latarjet is an efficient but controversial procedure. Questions/purposes We determined whether an arthroscopic Bristow-Latarjet procedure with concomitant Bankart repair (1) restored shoulder stability in this selected subgroup of patients, (2) with...

  4. Energy and Technology Review: Unlocking the mysteries of DNA repair

    Energy Technology Data Exchange (ETDEWEB)

    Quirk, W.A.

    1993-04-01

    DNA, the genetic blueprint, has the remarkable property of encoding its own repair following diverse types of structural damage induced by external agents or normal metabolism. We are studying the interplay of DNA damaging agents, repair genes, and their protein products to decipher the complex biochemical pathways that mediate such repair. Our research focuses on repair processes that correct DNA damage produced by chemical mutagens and radiation, both ionizing and ultraviolet. The most important type of DNA repair in human cells is called excision repair. This multistep process removes damaged or inappropriate pieces of DNA -- often as a string of 29 nucleotides containing the damage -- and replaces them with intact ones. We have isolated, cloned, and mapped several human repair genes associated with the nucleotide excision repair pathway and involved in the repair of DNA damage after exposure to ultraviolet light or mutagens in cooked food. We have shown that a defect in one of these repair genes, ERCC2, is responsible for the repair deficiency in one of the groups of patients with the recessive genetic disorder xeroderma pigmentosum (XP group D). We are exploring ways to purify sufficient quantities (milligrams) of the protein products of these and other repair genes so that we can understand their functions. Our long-term goals are to link defective repair proteins to human DNA repair disorders that predispose to cancer, and to produce DNA-repair-deficient mice that can serve as models for the human disorders.

  5. Uterine preservation for advanced pelvic organ prolapse repair: Anatomical results and patient satisfaction.

    Science.gov (United States)

    Fink, Keshet; Shachar, Inbar Ben; Braun, Naama Marcus

    2016-01-01

    The aims of the current study were to evaluate outcomes and patient satisfaction in cases of uterine prolapse treated with vaginal mesh, while preserving the uterus. This is a retrospective cohort study that included all patients operated for prolapse repair with trocar-less vaginal mesh while preserving the uterus between October 2010 and March 2013. Data included: patients pre-and post-operative symptoms, POP-Q and operative complications. Success was defined as prolapse prolapse stage 3, including uterine prolapse of at least stage 2 (mean point C at+1.4 (range+8-(-1)) were included. Mean follow-up was 22 months. Success rate of the vaginal mesh procedure aimed to repair uterine prolapse was 92% (61/66), with mean point C at -6.7 (range (-1) - (-9)). No major intra-or post-operative complication occurred. A telephone survey questionnaire was conducted post-operatively 28 months on average. Ninety-eight percent of women were satisfied with the decision to preserve their uterus. Eighteen patients (34%) received prior consultation elsewhere for hysterectomy due to their prolapse, and decided to have the operation at our center in order to preserve the uterus. Uterine preservation with vaginal mesh was found to be a safe and effective treatment, even in cases with advanced uterine prolapse. Most patients prefer to keep their uterus. Uterus preservation options should be discussed with every patient before surgery for pelvic organ prolapse. Copyright© by the International Brazilian Journal of Urology.

  6. Effect of intra-abdominal pressure on respiratory function in patients undergoing ventral hernia repair.

    Science.gov (United States)

    Gaidukov, Konstantin M; Raibuzhis, Elena N; Hussain, Ayyaz; Teterin, Alexey Y; Smetkin, Alexey A; Kuzkov, Vsevolod V; Malbrain, Manu Lng; Kirov, Mikhail Y

    2013-05-04

    To determine the influence of intra-abdominal pressure (IAP) on respiratory function after surgical repair of ventral hernia and to compare two different methods of IAP measurement during the perioperative period. Thirty adult patients after elective repair of ventral hernia were enrolled into this prospective study. IAP monitoring was performed via both a balloon-tipped nasogastric probe [intragastric pressure (IGP), CiMON, Pulsion Medical Systems, Munich, Germany] and a urinary catheter [intrabladder pressure (IBP), UnoMeterAbdo-Pressure Kit, UnoMedical, Denmark] on five consecutive stages: (1) after tracheal intubation (AI); (2) after ventral hernia repair; (3) at the end of surgery; (4) during spontaneous breathing trial through the endotracheal tube; and (5) at 1 h after tracheal extubation. The patients were in the complete supine position during all study stages. The IAP (measured via both techniques) increased on average by 12% during surgery compared to AI (P IGP and IBP (r = 0.65-0.81, P IGP was 8.0 (5.5-11.0) mmHg and the median IBP was 8.8 (5.8-13.1) mmHg. The overall r (2) value (n = 30) was 0.76 (P IGP or IBP demonstrated excellent concordance.

  7. Breaking and Repairing Trapdoor-Free Group Signature Schemes from Asiacrypt'2004

    Institute of Scientific and Technical Information of China (English)

    Xin-Yi Huang; Willy Susilo; Yi Mu; Fu-Tai Zhang

    2007-01-01

    Group signature schemes allow a member of a group to sign messages anonymously on behalf of the group.In case of later dispute, a designated group manager can revoke the anonymity and identify the originator of a signature.In Asiacrypt2004, Nguyen and Safavi-Naini proposed a group signature scheme that has a constant-sized public key and signature length, and more importantly, their group signature scheme does not require trapdoor.Their scheme is very efficient and the sizes of signatures are smaller than those of the other existing schemes.In this paper, we point out that Nguyen and Safavi-Naini's scheme is insecure.In particular, it is shown in our cryptanalysis of the scheme that it allows a non-member of the group to sign on behalf of the group.And the resulting signature convinces any third party that a member of the group has indeed generated such a signature, although none of the members has done so.Therefore is in case of dispute, even the group manager cannot identify who has signed the message.In the paper a new scheme that does not suffer from this problem is provided.

  8. Long term recurrence, pain and patient satisfaction afterventral hernia mesh repair

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    AIM To compare long term outcomes of laparoscopicand open ventral hernia mesh repair with respect torecurrence, pain and satisfaction.METHODS: We conducted a single-centre follow-upstudy of 194 consecutive patients after laparoscopicand open ventral hernia mesh repair between March2000 and June 2010. Of these, 27 patients (13.9%)died and 12 (6.2%) failed to attend their follow-upappointment. One hundred and fifty-three (78.9%)patients attended for follow-up and two patients (1.0%)were interviewed by telephone. Of those who attendedthe follow-up appointment, 82 (52.9%) patients hadreceived laparoscopic ventral hernia mesh repair(LVHR) while 73 (47.1%) patients had undergoneopen ventral hernia mesh repair (OVHR), including 11conversions. The follow-up study included analysesof medical records, clinical interviews, examination ofhernia recurrence and assessment of pain using a 100mm visual analogue scale (VAS) ruler anchored by word descriptors. Overall patient satisfaction was alsodetermined. Patients with signs of recurrence wereexamined by magnetic resonanceimaging or computedtomography scan.RESULTS: Median time from hernia mesh repair tofollow-up was 48 and 52 mo after LVHR and OVHRrespectively. Overall recurrence rates were 17.1%after LVHR and 23.3% after OVHR. Recurrence afterLVHR was associated with higher body mass index.Smoking was associated with recurrence after OVHR.Chronic pain (VAS 〉 30 mm) was reported by 23.5%in the laparoscopic cohort and by 27.8% in the opensurgery cohort. Recurrence and late complications werepredictors of chronic pain after LVHR. Smoking wasassociated with chronic pain after OVHR. Sixty pointfive percent were satisfied with the outcome after LVHRand 49.3% after OVHR. Predictors for satisfaction wereabsence of chronic pain and recurrence. Old age andshort time to follow-up also predicted satisfaction afterLVHR.CONCLUSION: LVHR and OVHR give similar long termresults for recurrence, pain

  9. Thoracic Endovascular Aortic Repair in a Patient with Mobile Aortic Thrombosis

    Directory of Open Access Journals (Sweden)

    Graham M. Lohrmann

    2014-01-01

    Full Text Available A 58-year-old female presented with acute arterial insufficiency to her left leg. Following cardiovascular evaluation using multimodality imaging, it was discovered that she had mobile thoracic thrombi overlying a normal descending thoracic aorta which had also caused a splenic infarction. This patient was treated with unfractionated heparin for three days and underwent subsequent thoracic endovascular aortic repair (TEVAR uneventfully with no subsequent complications at one-year followup. This case highlights the diagnostic and therapeutic challenges in treating patients with this uncommon challenging clinical scenario.

  10. A comparison of functional outcomes in patients undergoing revision arthroscopic repair of massive rotator cuff tears with and without arthroscopic suprascapular nerve release

    Directory of Open Access Journals (Sweden)

    Savoie III FH

    2016-10-01

    Full Text Available Felix H Savoie III,1 Mark Zunkiewicz,2 Larry D Field,2 William H Replogle,3 Michael J O’Brien1 1Tulane Institute of Sports Medicine, Tulane University School of Medicine, New Orleans, LA, USA; 2Mississippi Sports Medicine and Orthopaedic Center, Jackson, MS, USA; 3Department of Family Medicine, University of Mississippi Medical Center, Jackson, MS, USA Purpose: This study was designed to compare functional outcomes in patients undergoing revision repair of massive rotator cuff tears (retracted medial to the glenoid with Goutallier Grade 4 atrophy and concomitant release of the suprascapular nerve to a similar group of patients with Grade 3 atrophy undergoing revision rotator cuff repair (RTCR without nerve release. We hypothesized that patients undergoing nerve release would have more favorable functional outcomes as measured by the Modified University of California at Los Angeles shoulder rating scale (UCLA. Patients and methods: Twenty-two patients underwent revision repair of massive rotator cuff tears with release of the suprascapular nerve at the suprascapular notch. We compared total preoperative, postoperative, and change in UCLA score in these patients to a similar group of 22 patients undergoing revision RTCR without suprascapular nerve release. Additionally, UCLA subscores between the two groups were compared preoperatively and at final follow-up. Results: The average preoperative UCLA score in the nerve-release group was 7.91, and final follow-up average was 27.86; average 3.05 grades of strength were recovered. In the comparison group, average preoperative UCLA score was 11.77, and final follow-up average was 29.09; average 1.32 grades of strength were recovered. The average preoperative UCLA score was significantly worse in the nerve-release group (P=0.007. The average postoperative UCLA score was not significantly different (P=0.590 between the groups, indicating a better improvement in the nerve-release group with significantly

  11. Chromosomal localization of three repair genes: The xeroderma pigmentosum group C gene and two human homologs of yeast RAD23

    Energy Technology Data Exchange (ETDEWEB)

    Spek, P.J. van der; Smit, E.M.E.; Beverloo, H.B. [Erasmus Univ., Rotterdam (Netherlands)] [and others

    1994-10-01

    The nucleotide excision repair (NER) disorder xeroderma pigmentosum (XP) is characterized by sun (UV) sensitivity, predisposition to skin cancer, and extensive genetic heterogeneity. Recently, we reported the cloning and analysis of three human NER genes, XPC, HHR23A, and HHR23B. The previously cloned XPC gene is involved in the common XP complementation group C, which is defective in excision repair of nontranscribed sequences in the genome. The XPC protein was found to be complexed with the product of HHR23B, one of the two human homologs of the Saccharomyes cerevisiae NER gene RAD23. Here we present the chromosomal localization by in situ hybridization using haptenized probes of all three genes. The HHR23A gene was assigned to chromosome 19p13.2. Interestingly, the HHR23B and XPC genes, the product of which forms a tight complex, were found to colocalize on band 3p25.1. Pulsed-field gel electrophoresis revealed that the HHR23B and XPC genes possibly share a MluI restriction fragment of about 625 kb. Potential involvement of the HHR23 genes in human genetic disorders is discussed. 53 refs., 4 figs., 2 tabs.

  12. Assessment of Pulmonary Artery Stiffness of Repaired Congenital Heart Disease Patients

    Science.gov (United States)

    Lee, Namheon; Banerjee, Rajit; Taylor, Michael; Hor, Kan

    2012-10-01

    Surgical correction or palliation of congenital heart disease (CHD) often requires augmenting the main pulmonary artery (MPA) with non-native material or placing a cylindrical graft. The degree to which this intervention affects PA compliance is largely unknown. In this study, the MPA stiffness characteristics were assessed by its compliance, distensibility, and pressure-strain modulus. Coregistered velocity encoded phase-contrast MRI and cardiac catheterization data were available for a cohort of repaired CHD patients (n=8) and controls (n=3). All patients were repaired with either an RV-PA conduit or a RV outflow tract patch. We measured the MPA area change by MRI and MPA pressure during the cath. The measurements were taken through or just distal to the conduit. The MPA compliance and distensibility for the patients were significantly lower than the controls: compliance (9.8±10.8 vs 28.3±7.7mm^2/mmHg, p<0.05), distensibility (2.2±1.5 vs 6.6±2.1%Area change/mmHg, p=0.05). The patients had a significantly higher pressure-strain modulus (152.3±116.4mmHg, p<0.05) than the controls (35.8±10.6mmHg). The abnormally elevated PA stiffness due to the rigidity of the conduit or patch material may cause a compliance mismatch resulting in high stress levels contributing to the observed progressive PA dilatation. This may be a factor in the progressive RV dilatation seen in this cohort of repaired CHD patients.

  13. Patterns of prefrontal dysfunction in alcoholics with and without Korsakoff's syndrome, patients with Parkinson's disease, and patients with rupture and repair of the anterior communicating artery.

    Science.gov (United States)

    Dirksen, Courtney L; Howard, Julie A; Cronin-Golomb, Alice; Oscar-Berman, Marlene

    2006-09-01

    This study compared patterns of frontal-lobe dysfunction in alcoholics with Korsakoff's syndrome (KS: n = 9), non-Korsakoff alcoholics (AL: n = 28), patients with Parkinson's disease (PD: n = 18), and patients with rupture and repair of the anterior communicating artery (ACoA: n = 4) relative to healthy non-neurological control (NC) participants (n = 70). The tests administered were sensitive to functions of dorsolateral prefrontal and orbito-frontal subsystems. Measures included perseverative errors on the Wisconsin Card Sorting Test (WCST-pe), errors on object alternation (OA), errors on Trails B, number of words generated on the Controlled Oral Word Association Test (COWAT), and number of categories completed on the WCST (WCST-cc). KS patients were as impaired as AL participants on orbitofrontal measures and, on dorsolateral prefrontal measures, were impaired relative to AL participants, whose performance did not differ from controls. Patients with PD also were impaired on tests of orbitofrontal and dorsolateral prefrontal functioning but to a lesser extent than the KS patients. Moreover, most of the PD deficits were driven by the impaired performance of patients whose initial symptoms were on the right side of the body. The ACoA patients were significantly impaired on tests of orbitofrontal but not dorsolateral prefrontal functioning relative to the control group. Together, the results confirm different patterns of frontal-system impairments in patient groups having compromised frontal lobe functioning consequent to varying etiologies.

  14. Group Education for patients with rheumatoid arthritis

    NARCIS (Netherlands)

    Taal, Erik; Riemsma, Rob P.; Brus, Herman L.M.; Seydel, Erwin R.; Rasker, Johannes J.; Wiegman, Oene

    1993-01-01

    Patients with rheumatoid arthritis must learn to adjust their exercise, rest and medication to the varying activity of the disease. Patient education can help patients in making the right decisions about adjustments in their treatment regimen and in attaining ¿self-management¿ behaviors. We develope

  15. Mating-type suppression of the DNA-repair defect of the yeast rad6 delta mutation requires the activity of genes in the RAD52 epistasis group.

    Science.gov (United States)

    Yan, Y X; Schiestl, R H; Prakash, L

    1995-06-01

    The RAD6 gene of Saccharomyces cerevisiae is required for post-replication repair of UV-damaged DNA, UV mutagenesis, and sporulation. Here, we show that the radiation sensitivity of a MATa rad6 delta strain can be suppressed by the MAT alpha 2 gene carried on a multicopy plasmid. The a1-alpha 2 suppression is specific to the RAD6 pathway, as mutations in genes required for nucleotide excision repair or for recombinational repair do not show such mating-type suppression. The a1-alpha 2 suppression of the rad6 delta mutation requires the activity of the RAD52 group of genes, suggesting that suppression occurs by channelling of post-replication gaps present in the rad6 delta mutant into the RAD52 recombinational repair pathway. The a1-alpha 2 repressor could mediate this suppression via an enhancement in the expression, or the activity, of recombination genes.

  16. [Dynamics of lagophthalmos depending on facial nerve repair and its intraoperative monitoring in neurosurgical patients].

    Science.gov (United States)

    Tabachnikova, T V; Serova, N K; Shimansky, V N

    2014-01-01

    Over 200 patients with acoustic neuromas and over 100 patients with posterior cranial fossa meningiomas are annually operated on at the N.N. Burdenko Neurosurgical Institute. Intraoperative monitoring of the facial nerve function is used in most patients with tumors of the posterior cranial fossa to identify the facial nerve in the surgical wound. If the anatomical integrity of the facial nerve in the cranial cavity cannot be retained, facial nerve repair is performed to restore the facial muscle function. Intraoperative electrical stimulation of the facial nerve has a great prognostic significance to evaluate the dynamics of lagophthalmos in the late postoperative period and to select the proper method for lagophthalmos correction. When the facial nerve was reinnervated by the descending branch or trunk of the hypoglossal nerve, sufficient eyelid closure was observed only in 3 patients out of 17.

  17. A 3' --> 5' XPB helicase defect in repair/transcription factor TFIIH of xeroderma pigmentosum group B affects both DNA repair and transcription.

    NARCIS (Netherlands)

    J.R. Hwang; V. Moncollin; W. Vermeulen (Wim); T. Seroz; H. van Vuuren; J.H.J. Hoeijmakers (Jan); J-M. Egly (Jean-Marc)

    1996-01-01

    textabstractXPB is a subunit of the basal transcription factor TFIIH, which is also involved in nucleotide excision repair (NER) and potentially in cell cycle regulation. A frameshift mutation in the 3'-end of the XPB gene is responsible for a concurrence of two disorders: xeroderma pigmentosum (XP)

  18. Effect of Content of Sulfate Groups in Seaweed Polysaccharides on Antioxidant Activity and Repair Effect of Subcellular Organelles in Injured HK-2 Cells

    Directory of Open Access Journals (Sweden)

    Xiao-Tao Ma

    2017-01-01

    Full Text Available This study aims to investigate the repair effect of subcellular structure injuries of the HK-2 cells of four degraded seaweed polysaccharides (DSPs, namely, the degraded Porphyra yezoensis, Gracilaria lemaneiformis, Sargassum fusiform, and Undaria pinnatifida polysaccharides. The four DSPs have similar molecular weight, but with different content of sulfate groups (i.e., 17.9%, 13.3%, 8.2%, and 5.5%, resp.. The damaged model was established using 2.8 mmol/L oxalate to injure HK-2 cells, and 60 μg/mL of various DSPs was used to repair the damaged cells. With the increase of sulfate group content in DSPs, the scavenging activity of radicals and their reducing power were all improved. Four kinds of DSPs have repair effect on the subcellular organelles of damaged HK-2 cells. After being repaired by DSPs, the release amount of lactate dehydrogenase was decreased, the integrity of cell membrane and lysosome increased, the Δψm increased, the cell of G1 phase arrest was inhibited, the proportion of S phase increased, and cell apoptotic and necrosis rates were significantly reduced. The greater the content of sulfate group is, the stronger is the repair ability of the polysaccharide. These DSPs, particularly the polysaccharide with higher sulfate group content, may be a potential drug for the prevention and cure of kidney stones.

  19. Effect of Early Elbow Crutch Mobility on Patients with Post-Anterior Cruciate Ligament Repair

    Directory of Open Access Journals (Sweden)

    Shaji John Kachanathu

    2011-01-01

    Full Text Available Objective: Rehabilitation after anterior cruciate ligament (ACL reconstruction has focused over the past decade on early mobility and exercises in the recent years, due to advancements in the surgical techniques, presumably less strain on the graft. Thus it was necessary to investigate the effect of early mobilization with the single elbow crutch with conventional methods and its outcome responses. Materials and Methods: Totally, 40 subjects of day 1 post-ACL oblique repair with mean age of 25 ± 5.3 years participated in the study. Subjects were divided into experimental and control groups for rehabilitation with single elbow crutch and walker, respectively, along with conventional exercises for 6 weeks. After 4 >th week elbow crutch and walker were discarded for both groups. Interventional outcomes were assessed by static, dynamic stability, and knee functional score at 4 >th and 6 >th weeks post-operatively for both groups. Results: Both groups showed statistically significant difference in static and dynamic stability at 4 >th and 6 >th weeks. Whereas compared with experimental group, in control group Lysholm functional score was low in at 4 >th and 6 >th weeks. It was found that outcomes were improved within each group from 4 >th to 6 >th week. Conclusion: Study concluded that knee stability and Lysholm functional Knee Score were significantly improved by early mobilization although functional score was more significant in single elbow crutch group than walker and also recommended early weaning off walking aids for faster outcomes during rehabilitation of post-ACL repair.

  20. Aberrant repair of etheno-DNA adducts in leukocytes and colon tissue of colon cancer patients.

    Science.gov (United States)

    Obtułowicz, Tomasz; Winczura, Alicja; Speina, Elzbieta; Swoboda, Maja; Janik, Justyna; Janowska, Beata; Cieśla, Jarosław M; Kowalczyk, Paweł; Jawien, Arkadiusz; Gackowski, Daniel; Banaszkiewicz, Zbigniew; Krasnodebski, Ireneusz; Chaber, Andrzej; Olinski, Ryszard; Nair, Jagadesaan; Bartsch, Helmut; Douki, Thierry; Cadet, Jean; Tudek, Barbara

    2010-09-15

    To assess the role of lipid peroxidation-induced DNA damage and repair in colon carcinogenesis, the excision rates and levels of 1,N(6)-etheno-2'-deoxyadenosine (epsilondA), 3,N(4)-etheno-2'-deoxycytidine (epsilondC), and 1,N(2)-etheno-2'-deoxyguanosine (1,N(2)-epsilondG) were analyzed in polymorphic blood leukocytes (PBL) and resected colon tissues of 54 colorectal carcinoma (CRC) patients and PBL of 56 healthy individuals. In PBL the excision rates of 1,N(6)-ethenoadenine (epsilonAde) and 3,N(4)-ethenocytosine (epsilonCyt), measured by the nicking of oligodeoxynucleotide duplexes with single lesions, and unexpectedly also the levels of epsilondA and 1,N(2)-epsilondG, measured by LC/MS/MS, were lower in CRC patients than in controls. In contrast the mRNA levels of repair enzymes, alkylpurine- and thymine-DNA glycosylases and abasic site endonuclease (APE1), were higher in PBL of CRC patients than in those of controls, as measured by QPCR. In the target colon tissues epsilonAde and epsilonCyt excision rates were higher, whereas the epsilondA and epsilondC levels in DNA, measured by (32)P-postlabeling, were lower in tumor than in adjacent colon tissue, although a higher mRNA level was observed only for APE1. This suggests that during the onset of carcinogenesis, etheno adduct repair in the colon seems to be under a complex transcriptional and posttranscriptional control, whereby deregulation may act as a driving force for malignancy.

  1. Cytokines and growth factors in wound drainage fluid from patients undergoing incisional hernia repair.

    Science.gov (United States)

    Di Vita, Gaetano; Patti, Rosalia; D'Agostino, Pietro; Caruso, Giuseppe; Arcara, Matteo; Buscemi, Salvatore; Bonventre, Sebastiano; Ferlazzo, Viviana; Arcoleo, Francesco; Cillari, Enrico

    2006-01-01

    Knowing the dynamics of growth factor and cytokine secretion within the site of a surgical operation is important, as they play a crucial role in the pathophysiology of wound healing and are a target for modifying the repair response. The aim of this study was to evaluate the production of several cytokines and growth factors in the drainage wound fluid from patients undergoing incisional hernia repair: namely, interleukin (IL)-6, IL-10, IL-1alpha, IL-1 ra, interferon-gamma, vascular endothelial growth factors and basic fibroblast growth factor. Ten female patients with abdominal midline incisional hernia undergoing surgical repair were included in this study. In all cases, a closed-suction drain was inserted in the wound below the fascia and removed on postoperative day 4. Wound fluid was collected on postoperative days 1-4 and the amount was recorded each time. Growth factors and cytokines production was evaluated as the whole amount produced over a 24-hour period. In all patients, the amount of drain fluid from surgical wounds was more copious the first day after surgery, it decreased significantly afterward. The presence of all cytokines was highest on postoperative day 1, decreasing over the following days. More specifically, the production of IL-1 ra, IL-6, IL-1alpha, and IL-10 on postoperative day 1 fell sharply on postoperative days 3 and 4, whereas, after an initial reduction, interferon-gamma showed an increase from day 2 onward. Vascular endothelial-derived growth factor production increased progressively after the operation reaching statistical significance only on day 4. As for basic fibroblast growth factor, it showed an opposite pattern: it was higher on postoperative day 1 decreasing thereafter. This analysis of cytokine and growth factor production in the drain fluid will lead us to a better evaluation of the events that follow a surgical wound and to a better understanding of the healing process.

  2. Deoxyribonucleic acid repair gene X-ray repair cross-complementing group 1 polymorphisms and non-carcinogenic disease risk in different populations: A meta-analysis

    Directory of Open Access Journals (Sweden)

    Bagher Larijani

    2013-01-01

    Full Text Available Purpose: This study aims to assess a meta-analysis of the association of X-ray repair cross-complementing group 1 (XRCC1 polymorphisms with the risk of various non-carcinogenic diseases in different population. Materials and Methods: This meta-analysis was performed by critically reviewing reveals 38 studies involving 10043 cases and 11037 controls. Among all the eligible studies, 14 focused on Arg194Trp polymorphism, 33 described the Arg399Gln and three articles investigated on Arg280His. Populations were divided into three different ethnic subgroups include Caucasians, Asians and other (Turkish and Iranian. Results: Pooled results showed no correlation between Arg194Trp and non-carcinogenic disease. There was only weak relation in the recessive (odds ratio [OR] =1.11, 95% confidence interval [CI]: 0.86-1.44 model in Asian population and dominant (OR = 1.04, 95% CI: 0.66-1.63 model of other populations. In Arg399Gln polymorphism, there was no relation with diseases of interest generally. In the pooled analysis, there were weak relation in the dominant (OR = 1.08, 95% CI: 0.86-1.35 model of Asian population and quite well-correlation with recessive (OR = 1.49, 95% CI: 1.19-1.88, dominant (OR = 1.23, 95% CI: 0.94-1.62, and additive (OR = 1.23, 95% CI: 0.94-1.62 models of other subgroup. For Arg280His, there was a weak relation only in the dominant model (OR = 1.06, 95% CI: 0.74-1.51. Conclusion: The present meta-analysis correspondingly shows that Arg399Gln variant to be associated with increased non-carcinogenic diseases risk through dominant and recessive modes among Iranian and Turkish population. It also suggests a trend of dominant and recessive effect of Arg280His variant in all population and its possible protective effect on non-carcinogenic diseases.

  3. Functional evaluation of arthroscopic repair of rotator cuff injuries in patients with pseudoparalysis,

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki

    2014-04-01

    Full Text Available OBJECTIVE: to evaluate the functional result from arthroscopic repair of rotator cuff injuries in patients with pseudoparalysis, defined as incapacity to actively raise the arm above 90◦ , while complete passive elevation was possible.METHODS: we reevaluated 38 patients with a mean follow-up of 51 months (minimum of 24. We analyzed the pseudoparalysis reversion rate and the functional result obtained.RESULTS: according to the assessment criteria of the University of California in Los Angeles (UCLA, 31 (82% patients had good and excellent results, two (5% had fair results and five (13% had poor results. The mean active elevation went from 39◦ before the operation to 139◦ after the operation (p < 0.05; the mean active lateral rotation went from 30◦ to 48◦ (p < 0.05 and the mean active medial rotation went from level L3 to T12 (p < 0.05.CONCLUSION: arthroscopic repair of rotator cuff injuries produced good and excellent results in 82% of the cases and a statistically significant improvement of active range of motion, with reversion of the pseudoparalysis in 97.4% of the cases. It is therefore a good treatment option.

  4. Cockayne syndrome group B protein promotes mitochondrial DNA stability by supporting the DNA repair association with the mitochondrial membrane

    DEFF Research Database (Denmark)

    Aamann, Maria Diget; Sorensen, Martin M; Hvitby, Christina Poulsen;

    2010-01-01

    Cockayne syndrome (CS) is a human premature aging disorder associated with severe developmental deficiencies and neurodegeneration, and phenotypically it resembles some mitochondrial DNA (mtDNA) diseases. Most patients belong to complementation group B, and the CS group B (CSB) protein plays a role...

  5. Therapists' group attachments and their expectations of patients' attitudes about group therapy.

    Science.gov (United States)

    Marmarosh, Cheri L; Franz, Victoria A; Koloi, Mosetsanagape; Majors, Rebekah C; Rahimi, Amanda M; Ronquillo, Jonne G; Somberg, Rachel J; Swope, Jessica S; Zimmer, Katherine

    2006-07-01

    A large body of literature has supported the application of attachment theory to the understanding of psychotherapy. In addition, a more recent social psychological literature is exploring the application of attachment theory to the area of group dynamics and group process. The current study is designed to integrate these two distinct bodies of literature. In a preliminary fashion, we examined the relationship between group therapists' group attachment styles and their assumptions and expectations of their patients' attitudes about group psychotherapy. Seventy-six therapists completed the Smith, Murphy & Coats (1999) measure of group attachment style. They also completed the Revised Group Therapy Survey (Carter, Mitchell, & Krautheim, 2001) from the viewpoint of a typical patient they treat. As hypothesized, therapists with more group attachment anxiety assumed that patients would hold more negative myths and misconceptions about group treatment than therapists with less group attachment anxiety. The utility of a group attachment construct in future research and practice is discussed.

  6. Pediatric patient with Bombay blood group: A rare case report

    Directory of Open Access Journals (Sweden)

    Sudeshna Bhar (Kundu

    2015-01-01

    Full Text Available Bombay blood group is a rare blood group in which there is the absence of H antigen and presence of anti-H antibodies. At the time of blood grouping, this blood group mimics O blood group due to the absence of H antigen, but it shows incompatibility with O group blood during cross matching. Serum grouping or reverse grouping are essential for confirmation of the diagnosis. Patients carrying this blood group can receive blood only from a person with this blood group. Reported cases of anesthesia in the pediatric patient with Bombay blood group are relatively rare. Here, we present successful anesthetic management along with intraoperative blood transfusion in a pediatric patient with Bombay blood group posted for ovarian cystectomy.

  7. Pediatric patient with Bombay blood group: A rare case report.

    Science.gov (United States)

    Bhar Kundu, Sudeshna; De, Anisha; Saha, Anindita; Bhattacharyya, Chiranjib

    2015-01-01

    Bombay blood group is a rare blood group in which there is the absence of H antigen and presence of anti-H antibodies. At the time of blood grouping, this blood group mimics O blood group due to the absence of H antigen, but it shows incompatibility with O group blood during cross matching. Serum grouping or reverse grouping are essential for confirmation of the diagnosis. Patients carrying this blood group can receive blood only from a person with this blood group. Reported cases of anesthesia in the pediatric patient with Bombay blood group are relatively rare. Here, we present successful anesthetic management along with intraoperative blood transfusion in a pediatric patient with Bombay blood group posted for ovarian cystectomy.

  8. Talking therapy groups on acute psychiatric wards: patients' experience of two structured group formats

    Science.gov (United States)

    Radcliffe, Jonathan; Bird, Laura

    2016-01-01

    Aims and method We report the results of a clinical audit of patients' reactions to two types of talking therapy groups facilitated by assistant psychologists and psychology graduates on three acute wards. Patients' experiences of problem-solving and interpersonal group formats were explored via focus groups and structured interviews with 29 group participants. Results Both group formats generated high satisfaction ratings, with benefits related mostly to generic factors. Clinical implications Adequately trained and supported assistant psychologists and psychology graduates can provide supportive talking groups that patients find helpful. PMID:27512586

  9. [Hepatitis C treatment in special patient groups].

    Science.gov (United States)

    Berenguer, Marina; Jorquera, Francisco; Ángel Serra, Miguel; Sola, Ricard; Castellano, Gregorio

    2014-07-01

    The treatment plan for chronic hepatitis C in special populations varies according to comorbidity and the current evidence on treatment. In patients with hepatitis C virus and HIV coinfection, the results of dual therapy (pegylated interferon plus ribavirin) are poor. In patients with genotype 1 infection, triple therapy (dual therapy plus boceprevir or telaprevir) has doubled the response rate, but protease inhibitors can interact with some antiretroviral drugs and provoke more adverse effects. These disadvantages are avoided by the new, second-generation, direct-acting antiviral agents. In patients who are candidates for liver transplantation or are already liver transplant recipients, the optimal therapeutic option at present is to combine the new antiviral agents, with or without ribavirin and without interferon. The treatment of patients under hemodialysis due to chronic renal disease continues to be dual therapy (often with reduced doses of pegylated interferon and ribavirin), since there is still insufficient information on triple therapy and the new antiviral agents. In mixed cryoglobulinemia, despite the scarcity of experience, triple therapy seems to be superior to dual therapy and may be used as rescue therapy in non-responders to dual therapy. However, a decision must always be made on whether antiviral treatment should be used concomitantly or after immunosuppressive therapy. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  10. [Correlation between mismatch repair proteins status and clinicopathological characteristics in sporadic colorectal cancer patients].

    Science.gov (United States)

    Xiao, Z T; Zhang, R X; Zhao, Y; Peng, J H; Lu, S X; Zhang, H Z; Ding, P R; Wu, X J; Lu, Z H; Li, L R; Wan, D S; Pan, Z Z; Chen, G

    2017-04-25

    Objective: To explore the expression of mismatch repair (MMR) proteins in sporadic colorectal cancer (SCRC) patients, and its association with clinicopathological characteristics of SCRC. Methods: Patients with histologically confirmed colorectal cancer were consecutively recruited between December 2011 and June 2015 at Sun Yat-sen University Cancer Center. The exclusion criteria included multiple primary colorectal tumors, hereditary colorectal cancer (including Lynch syndrome, familial adenomatous polyposis), and the patients without the MMR proteins status tested. A total of 2 684 patients were included. Correlations of MMR proteins status and patients' demographics (including gender, age), tumor characteristics (site and differentiation) and TNM staging (excluding 315 SCRC patients receiving neoadjuvant therapy) were investigated. Results: The percentage of deficient MMR (dMMR) in these SCRC patients was 10.2%, and that of proficient MMR (pMMR) was 89.8%. The dMMR was more likely to be detected in younger (≤59 old years) SCRC patients compared to the elderly (>59 years) [12.7%(179/1 406)vs 7.5%(96/1 278), Pcolon cancer was significantly higher than that in left colon cancer and rectal cancer [22.7%(151/664)vs 7.2%(69/956)vs 5.2%(55/1 064), Pcolon mucinous adenocarcinoma among SCRC.

  11. 颅骨缺损修补对病人精神心理的影响%Effect of repair of cranial deficiency on psychology of patients

    Institute of Scientific and Technical Information of China (English)

    王延平

    2002-01-01

    Objective To investigate the effect of repair of cranial deficiency on psychology of patients in rehabilitation stage. Method Apply organic glass or bony cement to repair the skull. Result 26 patients healed by first intention, and the psychological symptoms relieved obviously. Conclusion Repair of skull could not only reconstruct the cranial barrier, but also ameliorate some symptoms and psychological burden, which is benefit for the rehabilitation of patients.

  12. Mismatch repair system (MMR) status correlates with response and survival in non-small cell lung cancer (NSCLC) patients.

    Science.gov (United States)

    Scartozzi, Mario; Franciosi, Vittorio; Campanini, Nicoletta; Benedetti, Giovanni; Barbieri, Fausto; Rossi, Giulio; Berardi, Rossana; Camisa, Roberta; Silva, Rosa Rita; Santinelli, Alfredo; Ardizzoni, Andrea; Crinò, Lucio; Rindi, Guido; Cascinu, Stefano

    2006-07-01

    Pre-clinical data suggested a relationship between inactivation of hMLH1 and hMSH2 and resistance to drugs like cisplatin and carboplatin, but not oxaliplatin. We then hypothesised that NSCLC showing loss of expression of the mismatch repair system (MMR), could be refractory to cisplatin-based, but not to oxaliplatin-based chemotherapy. Immunohistochemical expression of hMLH1 and hMSH2 was analysed on tumour samples from 93 advanced NSCLC, receiving chemotherapy with either cisplatin or oxaliplatin in combination with gemcitabine. Patients showing loss of hMLH1 or hMSH2 expression in > or = 50% of tumour cells were deemed MMR-negative (Group A), whereas cases with a normal hMLH1 or hMSH2 expression in > 50% of the tumour cells were defined MMR-positive (Group B). No differences in the response and progression rate were found in the whole patients population and in the gemcitabine/cisplatin group for both hMLH1 and hMSH2. In the gemcitabine/oxaliplatin group response rate was 38% and 0% (p=0.04) for patients with or without loss of hMSH2 expression. Median survival according to MMR status in Groups A and B, respectively was: 17 months versus 9 months for hMLH1 (p=0.031) and 10 months versus 9 months for hMSH2 (p=0.8330). Both the difference in response rate and in median survival observed according to MMR status seem to confirm what has been suggested by preclinical studies.

  13. Physiological repair of inguinal hernia: a new technique (study of 860 patients).

    Science.gov (United States)

    Desarda, M P

    2006-04-01

    The author has developed a new operation technique based on the physiological principle that provides dynamic posterior wall for inguinal hernia repair. Results of the first series of 400 patients were published in 2001 (ANZ J Surg 71:241-244, 2001). Now the author has described the results of the second series of 860 patients having 920 hernias with follow-up for more than 7 years. An undetached strip of the external oblique aponeurosis (EOA) is sutured to the inguinal ligament below and the muscle arch above, behind the cord, to form a new posterior wall. External oblique muscle gives additional strength to the weakened muscle arch to keep this strip physiologically dynamic. In this prospective study, 920 inguinal hernia repairs were performed between August 1990 and December 2003 in 860 patients. Follow-up was done for 7 years. The main outcome measure was early and late morbidities and especially recurrence in a long-term follow-up. Mean patient age was 50.5 years (range 18-90). A total of 851 (98.95%) patients were operated under local or regional anesthesia; 838 (97.4%) patients were ambulatory with limited movements in 6 h and free movements in 18-24 h; 792 (92%) patients had a hospital stay of one night and 840 (97.6%) patients returned to normal activities within 1-2 weeks. Hematoma formation requiring drainage was observed in one patient, while seven patients had wound edema during the postoperative period which subsided on its own. Follow-up was completed in 623 patients (72.5 %) by clinical examination or questionnaire. The median follow-up period was 7.8 years (range 1-12 years). There was no recurrence of hernia or postoperative neuralgia. This operation is simple to perform, does not require foreign body like a mesh or complicated dissection of the inguinal floor as in Bassini/Shouldice. It has shown excellent results with virtually zero recurrence rates.

  14. Group Health Education in Inpatient Rehabilitation: Patients' Role Perceptions

    Science.gov (United States)

    Schöpf, Andrea C.; Ullrich, Antje; Nagl, Michaela; Farin, Erik

    2016-01-01

    Objective: Group health education is an important aspect of medical rehabilitation. While interaction and active involvement are important characteristics of group health education, little is known about patients' understanding of their role in this form of education. This study explored patients' understanding of their role in group health…

  15. Endovascular Aortic Aneurysm Repair for Abdominal Aortic Aneurysm: Single Center Experience in 122 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yun Young; Song, Jang Hyeon; Kim, Yong Tae; Yim, Nam Yeol; Kim, Jae Kyu; Lee, Ho Kyun; Choi, Soo Jin Na; Chung, Sang Young [Dept. of Radiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju (Korea, Republic of); Kim, Soo Hyun; Chang, Nam Kyu [Dept. of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Hwasun (Korea, Republic of)

    2013-02-15

    To analyze a single center experience of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. Results of 122 patients who underwent EVAR were analyzed, retrospectively. Sex, age, aneurysmal morphology, hostile neck anatomy, preprocedural and postprocedural sac-diameter, technical and clinical success, postprocedural complication and need of additional procedure were analyzed. A total of 111 male and 11 female patients were included. Morphology of the aneurysms was as follows: fusiform (n = 108), saccular (n = 3) and ruptured type (n = 11). Sixty-four patients had hostile neck anatomy. The preprocedural mean sac-diameter was 52.4 mm. Postprocedural sac-diameter was decreased or stable in 110 patients (90.2%) and increased in 8 patients (6.6%). Technical success rate was 100% and clinical success rate was 86.1%. Fifty-one patients showed endoleak (41.8%) and 15 patients (12.3%) underwent secondary intervention due to type I endoleak (n = 4), type II endoleak (n = 4) and stent-graft thrombosis (n = 7). EVAR is a safe and effective therapy for abdominal aortic aneurysm, and it has high technical success and clinical success rate, and low complication rate.

  16. Combined paraesophageal hernia repair and partial longitudinal gastrectomy in obese patients with symptomatic paraesophageal hernias.

    Science.gov (United States)

    Rodriguez, John H; Kroh, Matthew; El-Hayek, Kevin; Timratana, Poochong; Chand, Bipan

    2012-12-01

    Obesity is a risk factor for gastroesophageal reflux disease and hiatal hernia. Studies have demonstrated poor symptom control in obese patients undergoing fundoplication. The ideal operation remains elusive. However, addressing both obesity and the anatomic abnormality should be the goal. This study retrospectively identified 19 obese (body mass index [BMI], >30 kg/m(2)) and morbidly obese (BMI, >40 kg/m(2)) patients who presented between December 2007 and November 2011 for management of large or recurrent paraesophageal hernia. All the patients underwent a combined primary paraesophageal hernia repair and longitudinal gastrectomy. Charts were retrospectively reviewed to collect preoperative, operative, and short-term postoperative results. Quantitative data were analyzed using Student's t test and qualitative data with χ(2) testing. Laparoscopy was successful for all 19 patients. The mean preoperative BMI was 37.8 ± 4.1 kg/m(2), and the mean operative time was 236 ± 80 min. Preoperative endoscopy showed that 5 patients who had undergone prior fundoplication experienced anatomic failures, whereas the remaining 14 patients had type 3 and one type 4 paraesophageal Hernia. Mesh was used to reinforce the hiatus in 15 of the 19 cases. The postoperative complications included pulmonary embolism (n = 1) and pulmonary decompensation (n = 2) due to underlying chronic obstructive pulmonary disease. The mean hospital stay was 5.3 ± 3 days. Upper gastrointestinal esophagography was performed for all the patients, with no short-term recurrence of paraesophageal hernia. Weight loss was seen for all the patients during the first month, with a mean BMI drop of 2.7 ± 1 kg/m(2). All the patients experienced near to total resolution of their preoperative symptoms within the first month. Combined laparoscopic paraesophageal hernia repair and longitudinal gastrectomy offer a safe and feasible approach for the management of large or recurrent paraesophageal

  17. Cutoff value of Japanese Orthopaedic Association shoulder score in patients with rotator cuff repair: Based on the University of California at Los Angeles shoulder score.

    Science.gov (United States)

    Imai, Takaki; Gotoh, Masafumi; Tokunaga, Tsuyoshi; Kawakami, Jyunichi; Mitsui, Yasuhiro; Fukuda, Keiji; Ogino, Misa; Okawa, Takahiro; Shiba, Naoto

    2017-05-01

    The Japanese Orthopaedic Association shoulder score cutoff values were calculated in patients with rotator cuff repair using the University of California at Los Angeles shoulder score. Overall, 175 patients with rotator cuff repair were subjects in this study. The University of California at Los Angeles and Japanese Orthopaedic Association shoulder scores were evaluated before surgery and at 3, 6, 9, and 12 months after surgery. The cutoff value of the Japanese Orthopaedic Association shoulder score was determined using the 4-stage criteria of the University of California at Los Angeles shoulder score and a University of California at Los Angeles shoulder score of 28 points, which is the boundary between an excellent/good group and a fair/poor group. Both the JOA shoulder and UCLA shoulder scores showed significant improvement at 6, 9, and 12 months from the preoperative scores (p values of the two scores (r = 0.85, p value of the Japanese Orthopaedic Association shoulder score based on the highest accuracy from receiver operating characteristic curve analysis was 83 points. A Japanese Orthopaedic Association shoulder score cutoff value of 83 was equivalent to a University of California at Los Angeles shoulder score cutoff value of 28 for distinguishing between excellent/good and fair/poor outcomes after rotator cuff repair. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  18. Multivariate Analysis of Risk Factors of Cerebral Infarction in 439 Patients Undergoing Thoracic Endovascular Aneurysm Repair.

    Science.gov (United States)

    Kanaoka, Yuji; Ohki, Takao; Maeda, Koji; Baba, Takeshi; Fujita, Tetsuji

    2016-04-01

    The aim of the study is to identify the potential risk factors of cerebral infarction associated with thoracic endovascular aneurysm repair (TEVAR). TEVAR was developed as a less invasive surgical alternative to conventional open repair for thoracic aortic aneurysm treatment. However, outcomes following TEVAR of aortic and distal arch aneurysms remain suboptimal. Cerebral infarction is a major concern during the perioperative period. We included 439 patients who underwent TEVAR of aortic aneurysms at a high-volume teaching hospital between July 2006 and June 2013. Univariate and multivariate logistic regression analyses were performed to identify perioperative cerebral infarction risk factors. Four patients (0.9%) died within 30 days of TEVAR; 17 (3.9%) developed cerebral infarction. In univariate analysis, history of ischemic heart disease and cerebral infarction and concomitant cerebrovascular disease were significantly associated with cerebral infarction. "Shaggy aorta" presence, left subclavian artery coverage, carotid artery debranching, and pull-through wire use were identified as independent risk factors of cerebral infarction. In multivariate analysis, history of ischemic heart disease (odds ratio [OR] 6.49, P = 0.046) and cerebral infarction (OR 43.74, P = 0.031), "shaggy aorta" (OR 30.32, P < 0.001), pull-through wire use during surgery (OR 7.196, P = 0.014), and intraoperative blood loss ≥800 mL (OR 24.31, P = 0.017) were found to be independent risk factors of cerebral infarction. This study identified patient- and procedure-related risk factors of cerebral infarction following TEVAR. These results indicate that patient outcomes could be improved through the identification and management of procedure-related risk factors.

  19. Distal small bowel motility and lipid absorption in patients following abdominal aortic aneurysm repair surgery

    Institute of Scientific and Technical Information of China (English)

    Robert J Fraser; Paul Jury; John Dent; Marc Ritz; Addolorata C Di Matteo; Rosalie Vozzo; Monika Kwiatek; Robert Foreman; Brendan Stanley; Jack Walsh; Jim Burnett

    2006-01-01

    AIM: To investigate distal small bowel motility and lipid absorption in patients following elective abdominal aortic aneurysm (AAA) repair surgery.METHODS: Nine patients (aged 35-78 years; body mass index (BMI) range: 23-36 kg/m2) post-surgery for AAA repair, and seven healthy control subjects (20-50 years;BMI range: 21-29 kg/m2) were studied. Continuous distal small bowel manometry was performed for up to 72 h, during periods of fasting and enteral feeding (Nutrison(R)). Recordings were analyzed for the frequency,origin, length of migration, and direction of small intestinal burst activity. Lipid absorption was assessed on the first day and the third day post surgery in a subset of patients using the 13C-triolein-breath test, and compared with healthy controls. Subjects received a 20-min intraduodenal infusion of 50 mL liquid feed mixed with 200 μL 13C-triolein. End-expiratory breath samples were collected for 6 h and analyzed for 13CO2 concentration.RESULTS: The frequency of burst activity in the proximal and distal small intestine was higher in patients than in healthy subjects, under both fasting and fed conditions (P<0.005). In patients there was a higher proportion of abnormally propagated bursts (71% abnormal), which began to normalize by d 3 (25% abnormal) post-surgery.Lipid absorption data was available for seven patients on d 1 and four patients on d 3 post surgery. In patients,absorption on d 1 post-surgery was half that of healthy control subjects (AUC 13CO2 1323 ± 244 vs 2 646 ±365;P< 0.05, respectively), and was reduced to the one-fifth that of healthy controls by d 3 (AUC 13CO2 470 ± 832 vs 2646 ± 365; P< 0.05, respectively).CONCLUSION: Both proximal and distal small intestinal motor activity are transiently disrupted in critically ill patients immediately after major surgery,with abnormal motility patterns extending as far as the ileum. These motor disturbances may contribute to impaired absorption of enteral nutrition, especially when

  20. Checkpoint Kinase ATR Promotes Nucleotide Excision Repair of UV-induced DNA Damage via Physical Interaction with Xeroderma Pigmentosum Group A*

    Science.gov (United States)

    Shell, Steven M.; Li, Zhengke; Shkriabai, Nikolozi; Kvaratskhelia, Mamuka; Brosey, Chris; Serrano, Moises A.; Chazin, Walter J.; Musich, Phillip R.; Zou, Yue

    2009-01-01

    In response to DNA damage, eukaryotic cells activate a series of DNA damage-dependent pathways that serve to arrest cell cycle progression and remove DNA damage. Coordination of cell cycle arrest and damage repair is critical for maintenance of genomic stability. However, this process is still poorly understood. Nucleotide excision repair (NER) and the ATR-dependent cell cycle checkpoint are the major pathways responsible for repair of UV-induced DNA damage. Here we show that ATR physically interacts with the NER factor Xeroderma pigmentosum group A (XPA). Using a mass spectrometry-based protein footprinting method, we found that ATR interacts with a helix-turn-helix motif in the minimal DNA-binding domain of XPA where an ATR phosphorylation site (serine 196) is located. XPA-deficient cells complemented with XPA containing a point mutation of S196A displayed a reduced repair efficiency of cyclobutane pyrimidine dimers as compared with cells complemented with wild-type XPA, although no effect was observed for repair of (6-4) photoproducts. This suggests that the ATR-dependent phosphorylation of XPA may promote NER repair of persistent DNA damage. In addition, a K188A point mutation of XPA that disrupts the ATR-XPA interaction inhibits the nuclear import of XPA after UV irradiation and, thus, significantly reduced DNA repair efficiency. By contrast, the S196A mutation has no effect on XPA nuclear translocation. Taken together, our results suggest that the ATR-XPA interaction mediated by the helix-turn-helix motif of XPA plays an important role in DNA-damage responses to promote cell survival and genomic stability after UV irradiation. PMID:19586908

  1. MSH2/BRCA1 expression as a DNA-repair signature predicting survival in early–stage lung cancer patients from the IFCT-0002 Phase 3 Trial

    Science.gov (United States)

    Levallet, Guénaëlle; Dubois, Fatéméh; Fouret, Pierre; Antoine, Martine; Brosseau, Solenn; Bergot, Emmanuel; Beau-Faller, Michèle; Gounant, Valérie; Brambilla, Elisabeth; Debieuvre, Didier; Molinier, Olivier; Galateau-Sallé, Françoise; Mazieres, Julien; Quoix, Elisabeth; Pujol, Jean-Louis; Moro-Sibilot, Denis; Langlais, Alexandra; Morin, Franck; Westeel, Virginie; Zalcman, Gérard

    2017-01-01

    Introduction DNA repair is a double-edged sword in lung carcinogenesis. When defective, it promotes genetic instability and accumulated genetic alterations. Conversely these defects could sensitize cancer cells to therapeutic agents inducing DNA breaks. Methods We used immunohistochemistry (IHC) to assess MSH2, XRCC5, and BRCA1 expression in 443 post-chemotherapy specimens from patients randomized in a Phase 3 trial, comparing two neoadjuvant regimens in 528 Stage I-II non-small cell lung cancer (NSCLC) patients (IFCT-0002). O6MGMT promoter gene methylation was analyzed in a subset of 208 patients of the same trial with available snap-frozen specimens. Results Median follow-up was from 90 months onwards. Only high BRCA1 (n = 221, hazard ratio [HR] = 1.58, 95% confidence interval [CI] [1.07-2.34], p = 0.02) and low MSH2 expression (n = 356, HR = 1.52, 95% CI [1.11-2.08], p = 0.008) significantly predicted better overall survival (OS) in univariate and multivariate analysis. A bootstrap re-sampling strategy distinguished three patient groups at high (n = 55, low BRCA1 and high MSH2, median OS >96 months, HR = 2.5, 95% CI [1.45-4.33], p = 0.001), intermediate (n = 82, median OS = 73.4 p = 0.0596), and low (high BRCA1 and low MSH2, n = 67, median OS = ND, HR = 0.51, 95% CI [0.31-0.83], p = 0.006) risk of death. Interpretation DNA repair protein expression assessment identified three different groups of risk of death in early-stage lung cancer patients, according to their tumor MSH2 and BRCA1 expression levels. These results deserve prospective evaluation of MSH2/BRCA1 theranostic value in lung cancer patients treated with combinations of DNA-damaging chemotherapy and drugs targeting DNA repair, such as Poly(ADP-ribose) polymerase (PARP) inhibitors. PMID:28008145

  2. DNA mismatch repair deficiency and hereditary syndromes in Latino patients with colorectal cancer.

    Science.gov (United States)

    Ricker, Charité N; Hanna, Diana L; Peng, Cheng; Nguyen, Nathalie T; Stern, Mariana C; Schmit, Stephanie L; Idos, Greg E; Patel, Ravi; Tsai, Steven; Ramirez, Veronica; Lin, Sonia; Shamasunadara, Vinay; Barzi, Afsaneh; Lenz, Heinz-Josef; Figueiredo, Jane C

    2017-10-01

    The landscape of hereditary syndromes and clinicopathologic characteristics among US Latino/Hispanic individuals with colorectal cancer (CRC) remains poorly understood. A total of 265 patients with CRC who were enrolled in the Hispanic Colorectal Cancer Study were included in the current study. Information regarding CRC risk factors was elicited through interviews, and treatment and survival data were abstracted from clinical charts. Tumor studies and germline genetic testing results were collected from medical records or performed using standard molecular methods. The mean age of the patients at the time of diagnosis was 53.7 years (standard deviation, 10.3 years), and 48.3% were female. Overall, 21.2% of patients reported a first-degree or second-degree relative with CRC; 3.4% met Amsterdam I/II criteria. With respect to Bethesda guidelines, 38.5% of patients met at least 1 criterion. Of the 161 individuals who had immunohistochemistry and/or microsatellite instability testing performed, 21 (13.0%) had mismatch repair (MMR)-deficient (dMMR) tumors. dMMR tumors were associated with female sex (61.9%), earlier age at the time of diagnosis (50.4 ± 12.4 years), proximal location (61.9%), and first-degree (23.8%) or second-degree (9.5%) family history of CRC. Among individuals with dMMR tumors, 13 (61.9%) had a germline MMR mutation (MutL homolog 1 [MLH1] in 6 patients; MutS homolog 2 [MSH2] in 4 patients; MutS homolog 6 [MHS6] in 2 patients; and PMS1 homolog 2, mismatch repair system component [PMS2] in 1 patient). The authors identified 2 additional MLH1 mutation carriers by genetic testing who had not received immunohistochemistry/microsatellite instability testing. In total, 5.7% of the entire cohort were confirmed to have Lynch syndrome. In addition, 6 individuals (2.3%) had a polyposis phenotype. The percentage of dMMR tumors noted among Latino individuals (13%) is similar to estimates in non-Hispanic white individuals. In the current study, the majority of

  3. Prognostic impact of mismatch repair genes germline defects in colorectal cancer patients: are all mutations equal?

    Science.gov (United States)

    Maccaroni, Elena; Bracci, Raffaella; Giampieri, Riccardo; Bianchi, Francesca; Belvederesi, Laura; Brugiati, Cristiana; Pagliaretta, Silvia; Del Prete, Michela; Scartozzi, Mario; Cascinu, Stefano

    2015-01-01

    Background Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome, caused by germline mutations in MisMatch Repair (MMR) genes, particularly in MLH1, MSH2 and MSH6. Patients with LS seem to have a more favourable prognosis than those with sporadic CRC, although the prognostic impact of different mutation types is unknown. Aim of our study is to compare survival outcomes of different types of MMR mutations in patients with LS-related CRC. Methods 302 CRC patients were prospectively selected on the basis of Amsterdam or Revised Bethesda criteria to undergo genetic testing: direct sequencing of DNA and MLPA were used to examine the entire MLH1, MSH2 and MSH6 coding sequence. Patients were classified as mutation-positive or negative according to the genetic testing result. Results A deleterious MMR mutation was found in 38/302 patients. Median overall survival (OS) was significantly higher in mutation-positive vs mutation-negative patients (102.6 vs 77.7 months, HR:0.63, 95%CI:0.46–0.89, p = 0.0083). Different types of mutation were significantly related with OS: missense or splicing-site mutations were associated with better OS compared with rearrangement, frameshift or non-sense mutations (132.5 vs 82.5 months, HR:0.46, 95%CI:0.16–0.82, p = 0.0153). Conclusions Our study confirms improved OS for LS-patients compared with mutation-negative CRC patients. In addition, not all mutations could be considered equal: the better prognosis in CRC patients with MMR pathogenic missense or splicing site mutation could be due to different functional activity of the encoded MMR protein. This matter should be investigated by use of functional assays in the future. PMID:26485756

  4. Group therapy in public mental health services: approaches, patients and group therapists.

    Science.gov (United States)

    Lorentzen, S; Ruud, T

    2014-04-01

    Group therapy is used extensively within public mental health services, but more detailed knowledge is needed. All 25 health authorities in Norway were invited to describe their groups: theory, primary tasks, interventions, structure, patients and therapists. Four hundred twenty-six groups, 296 in community mental health centres and 130 in hospitals, were categorized into nine types, based on theoretical background. Psychodynamic groups were most frequent, followed by cognitive-behavioural, psycho-educative, social skills/coping and art/expressive groups. Weekly sessions of 90 min and treatment duration 12 months was most frequent. Main diagnosis for 2391 patients: depression (517), personality disorder (396), schizophrenia/psychosis (313) and social phobia (249). Patients with depression or personality disorder were mostly in psychodynamic groups, psychosis/bipolar disorder in psycho-educative groups. Cognitive-behavioural groups were used across several diagnoses. Most therapists were nurses, only 50% had a formal training in group therapy. There is a plethora of groups, some based on one theoretical school, while others integrate theory from several 'camps'. Patients with similar diagnosis were offered different group approaches, although some trends existed. More research evidence from regular clinical groups is needed, and clinician-researcher networks should be developed. More group therapists with formal training are needed. © 2013 John Wiley & Sons Ltd.

  5. Noninvasive pressure difference mapping derived from 4D flow MRI in patients with unrepaired and repaired aortic coarctation.

    Science.gov (United States)

    Rengier, Fabian; Delles, Michael; Eichhorn, Joachim; Azad, Yoo-Jin; von Tengg-Kobligk, Hendrik; Ley-Zaporozhan, Julia; Dillmann, Rüdiger; Kauczor, Hans-Ulrich; Unterhinninghofen, Roland; Ley, Sebastian

    2014-04-01

    To develop a method for computing and visualizing pressure differences derived from time-resolved velocity-encoded three-dimensional phase-contrast magnetic resonance imaging (4D flow MRI) and to compare pressure difference maps of patients with unrepaired and repaired aortic coarctation to young healthy volunteers. 4D flow MRI data of four patients with aortic coarctation either before or after repair (mean age 17 years, age range 3-28, one female, three males) and four young healthy volunteers without history of cardiovascular disease (mean age 24 years, age range 20-27, one female, three males) was acquired using a 1.5-T clinical MR scanner. Image analysis was performed with in-house developed image processing software. Relative pressures were computed based on the Navier-Stokes equation. A standardized method for intuitive visualization of pressure difference maps was developed and successfully applied to all included patients and volunteers. Young healthy volunteers exhibited smooth and regular distribution of relative pressures in the thoracic aorta at mid systole with very similar distribution in all analyzed volunteers. Patients demonstrated disturbed pressures compared to volunteers. Changes included a pressure drop at the aortic isthmus in all patients, increased relative pressures in the aortic arch in patients with residual narrowing after repair, and increased relative pressures in the descending aorta in a patient after patch aortoplasty. Pressure difference maps derived from 4D flow MRI can depict alterations of spatial pressure distribution in patients with repaired and unrepaired aortic coarctation. The technique might allow identifying pathophysiological conditions underlying complications after aortic coarctation repair.

  6. Transternal repair of a giant Morgagni hernia causing cardiac tamponade in a patient with coexisting severe aortic valve stenosis

    Directory of Open Access Journals (Sweden)

    Koletsis Efstratios N

    2011-03-01

    Full Text Available Abstract Background Foramen of Morgagni hernias have traditionally been repaired by laparotomy, lapascopy or even thoracoscopy. However, the trans-sternal approach should be used when these rare hernias coexist with other cardiac surgical diseases. Case presentation We present the case of a 74 year-old symptomatic male with severe aortic valve stenosis and global respiratory failure due to a giant Morgagni hernia causing additionally cardiac tamponade. The patient underwent simultaneous repair of the hernia defect and aortic valve replacement under cardiopulmonary bypass. The hernia was repaired through the sternotomy approach, without opening of its content and during cardiopulmonary reperfusion. Conclusions Morgagni hernia can rarely accompany cardiac surgical pathologies. The trans-sternal approach for its management is as effective as other popular reconstructive procedures, unless viscera strangulation and necrosis are suspected. If severe compressive effects to the heart dominate the patient's clinical presentation correction during the cardiopulmonary reperfusion period is mandatory.

  7. Importance of patient centred care for various patient groups.

    NARCIS (Netherlands)

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

    2010-01-01

    Background: Though patient centred care is a somewhat ‘fuzzy’ concept, in general it is considered as something to strive for. However, preliminary evidence suggests that the importance of elements of patient-centred care (PCC), such as communication, information and shared decision making, may vary

  8. Autotransfusion performed on a patient with cis AB blood group.

    Science.gov (United States)

    Kawahito, S; Kitahata, H; Kimura, H; Tanaka, K; Oshita, S

    1999-09-01

    Cis AB blood group is a rare variant of the AB blood group resulting from inheritance of both A and B genes on one chromosome. It may lead to misclassification in ABO grouping and clinical misdiagnosis as a result of its divergence from the laws of Landsteiner and Mendel. We encountered a case of cis AB blood group, and we found that autotransfusion was useful during surgery in this patient with a rare blood group.

  9. DNA Damage/Repair and Polymorphism of the hOGG1 Gene in Lymphocytes of AMD Patients

    Directory of Open Access Journals (Sweden)

    Katarzyna Wozniak

    2009-01-01

    Full Text Available Oxidative stress is thought to play a role in the pathogenesis of age-related macular degeneration (AMD. We determined the extent of oxidative DNA damage and the kinetics of its removal as well as the genotypes of the Ser326Cys polymorphism of the hOGG1 gene in lymphocytes of 30 wet AMD patients and 30 controls. Oxidative DNA damage induced by hydrogen peroxide and its repair were evaluated by the comet assay and DNA repair enzymes. We observed a higher extent of endogenous oxidative DNA damage and a lower efficacy of its repair in AMD patients as compared with the controls. We did not find any correlation between the extent of DNA damage and efficacy of DNA repair with genotypes of the Ser326Cys polymorphism. The results obtained suggest that oxidative DNA damage and inefficient DNA repair can be associated with AMD and the variability of the hOOG1 gene may not contribute to this association.

  10. Clinical Effects of the Method for Warming the Middle-jiao and Strengthening the Spleen on Gastric Mucosa Repair in Chronic Gastritis Patients

    Institute of Scientific and Technical Information of China (English)

    Hu Lingjing; Hu Xiaomei; Yang Min; Xie Huimin; Xiang Yanghong

    2008-01-01

    Objective:To observe clinical effects of the method for warming the middle-jiao and strengthening the spleen on gastric mucosa repair in chronic gastritis patients.Methods:The 42 cases of the treatment group were orally adiministered Yiweikang Capsule(益胃康胶囊);while the other 25 cases in the control group wore orally given Wenweishu Capsule(温胃舒胶囊).Both the groups wore observed for 2 months.Results:The total effective rate in the treatment group was obviously higher than that of the control group(P<0.05),with statistical significance shown by the TCM symptom score,gastroscopic examination and the HP test (p<0.05 or P<0.01).Conclusions:Yiweikang Capsule(益胃康胶囊)iS an effeetive medicine for chronic gastritis.

  11. Physician groups' use of data from patient experience surveys.

    Science.gov (United States)

    Friedberg, Mark W; SteelFisher, Gillian K; Karp, Melinda; Schneider, Eric C

    2011-05-01

    In Massachusetts, physician groups' performance on validated surveys of patient experience has been publicly reported since 2006. Groups also receive detailed reports of their own performance, but little is known about how physician groups have responded to these reports. To examine whether and how physician groups are using patient experience data to improve patient care. During 2008, we conducted semi-structured interviews with the leaders of 72 participating physician groups (out of 117 groups receiving patient experience reports). Based on leaders' responses, we identified three levels of engagement with patient experience reporting: no efforts to improve (level 1), efforts to improve only the performance of low-scoring physicians or practice sites (level 2), and efforts to improve group-wide performance (level 3). Groups' level of engagement and specific efforts to improve patient care. Forty-four group leaders (61%) reported group-wide improvement efforts (level 3), 16 (22%) reported efforts to improve only the performance of low-scoring physicians or practice sites (level 2), and 12 (17%) reported no performance improvement efforts (level 1). Level 3 groups were more likely than others to have an integrated medical group organizational model (84% vs. 31% at level 2 and 33% at level 1; P customer service. The most commonly reported improvement initiatives were changing office workflow, providing additional training for nonclinical staff, and adopting or enhancing an electronic health record. Despite statewide public reporting, physician groups' use of patient experience data varied widely. Integrated organizational models were associated with greater engagement, and efforts to enhance clinicians' interpersonal skills were uncommon, with groups predominantly focusing on office workflow and support staff.

  12. Continuous interscalene analgesia for rotator cuff repair: a retrospective comparison of effectiveness and cost in 205 patients from a multi-provider private practice setting.

    Science.gov (United States)

    Fredrickson, M J; Stewart, A W

    2008-11-01

    Several barriers exist to the routine use of continuous interscalene block (CISB) for postoperative analgesia following rotator cuff repair There is a perception that the technique is feasible only for single operators exposed to a high volume case load. The aim of this retrospective review was to compare the three commonly employed analgesic techniques following rotator cuff repair in a multi-provider setting. The techniques studied were CISB, combined single injection interscalene block with postoperative intermittent intra-articular local anaesthetic infiltration (SSISB/IA) and intermittent intra-articular only local anaesthetic infiltration (IA). The clinical records of 205 consecutive patients having open rotator cuff repair over an 18-month period in two private care facilities were reviewed. The primary outcome endpoint was total opioid/tramadol consumption during the period of an overnight hospital stay. The median total opioid and tramadol consumption (in intravenous mg equivalents of morphine) from admission to the post anaesthesia care unit until discharge from hospital was 5 mg in the CISB group and 10 mg for the SSISB/IA and IA groups (P tramadol and antiemetic consumption, and occurred without a significant increase in the monetary cost.

  13. Participation in online patient support groups endorses patients’ empowerment

    NARCIS (Netherlands)

    Uden-Kraan, van C.F.; Drossaert, C.H.C.; Taal, E.; Seydel, E.R.; Laar, van de M.A.F.J.

    2009-01-01

    Objective: Although much has been expected of the empowering effect of taking part in online patient support groups, there is no direct evidence thus far for the effects of participation on patient empowerment. Hence our exploring to what extent patients feel empowered by their participation in onl

  14. Use of the translabyrinthine approach to repair congenital spontaneous cerebrospinal fluid leakage in five Chinese patients with Mondini dysplasia.

    Science.gov (United States)

    Yi, H J; Guo, H; Ch, W; Yang, S M; Liu, P N

    2013-12-01

    To introduce a more effective surgical technique for the repair of spontaneous incurable cerebrospinal fluid (CSF) leakage (CSF otorrhea). The cases of five Chinese patients with Mondini dysplasia and CSF leakage were reviewed. All patients presented with rhinorrhea or otorrhea from childhood and recurrent meningitis attacks. CSF leakage was repaired surgically using the translabyrinthine approach. Facial paralysis occurred in the first two patients, but was cured 2 months later. The other three patients recovered well and had no facial paralysis or complication. CSF leakage did not recur in any patient after follow-up periods of 0.5-3 years. Mondini dysplasia with CSF leakage is rare. Adequate diagnosis and treatment are required to avoid life-threatening complications, such as meningitis. We recommend the translabyrinthine approach as an alternative surgical technique that reduces recurrence. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  15. Physician groups' use of data from patient experience surveys.

    NARCIS (Netherlands)

    Friedberg, M.W.; SteelFisher, G.K.; Karp, M.; Schneider, E.C.

    2011-01-01

    BACKGROUND: In Massachusetts, physician groups' performance on validated surveys of patient experience has been publicly reported since 2006. Groups also receive detailed reports of their own performance, but little is known about how physician groups have responded to these reports. OBJECTIVE: To e

  16. Physician groups' use of data from patient experience surveys.

    NARCIS (Netherlands)

    Friedberg, M.W.; SteelFisher, G.K.; Karp, M.; Schneider, E.C.

    2011-01-01

    BACKGROUND: In Massachusetts, physician groups' performance on validated surveys of patient experience has been publicly reported since 2006. Groups also receive detailed reports of their own performance, but little is known about how physician groups have responded to these reports. OBJECTIVE: To

  17. Slap Lesions in Middle-aged Patients: Biceps Repair or Tenodesis? What Should We Perform for Long Biceps Tendon?

    Directory of Open Access Journals (Sweden)

    Sergi Sastre

    2015-12-01

    Conclusion: Biceps tenodesis is a feasible therapeutic alternative to anatomical repair for the treatment of SLAP lesions in middle-aged patients; the reinsertion failure rates for this type of lesion are rather discouraging due to the high percentage of revision surgeries that must be carried out after the primary intervention.

  18. Usefulness of right ventricular and right atrial two-dimensional speckle tracking strain to predict late arrhythmic events in adult patients with repaired Tetralogy of Fallot.

    Science.gov (United States)

    Timóteo, Ana T; Branco, Luísa M; Rosa, Sílvia A; Ramos, Ruben; Agapito, Ana F; Sousa, Lídia; Galrinho, Ana; Oliveira, José A; Oliveira, Mário M; Ferreira, Rui C

    2017-01-01

    To determine whether right ventricular and/or atrial speckle tracking strain is associated with previous arrhythmic events in patients with repaired tetralogy of Fallot. We studied right ventricular and atrial strain in 100 consecutive patients with repaired tetralogy of Fallot referred for routine echocardiographic evaluation. Patients were divided into two groups, one with previous documentation of arrhythmias (n=26) and one without arrhythmias, in a median follow-up of 22 years. Patients with arrhythmias were older (pright ventricular strain (-14.7±5.5 vs. -16.9±4.0%, p=0.029) and right atrial strain (19.1±7.7% vs. 25.8±11.4%, p=0.001). Neither right ventricular nor right atrial strain were independent predictors of the presence of a history of documented arrhythmias, which was associated with age at correction and with the presence of residual defects. In a subanalysis after excluding 23 patients who had had more than one corrective surgery, right ventricular strain was an independent predictor of the presence of previous arrhythmic events (OR 1.19, 95% CI 1.02-1.38, p=0.025). Right atrial strain was also an independent predictor after adjustment (OR 0.93, 95% CI 0.87-0.99, p=0.029). The ideal cut-off for right ventricular strain was -15.3% and for right atrial strain 23.0%. Compared with conventional echocardiographic parameters, strain measures of the right heart are associated with the presence of arrhythmic events, and may be useful for risk stratification of patients with repaired tetralogy of Fallot, although a prospective study is required. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Tension-free Hernia Repair in the Treatment of Inguinal Hernia in Elderly Patients%老年腹股沟疝采用无张力疝修补术治疗的临床疗效观察

    Institute of Scientific and Technical Information of China (English)

    王永清

    2014-01-01

    目的:研究老年腹股沟疝采用无张力疝修补术的疗效。方法选择我院收治的47例老年腹股沟疝患者,随机分为两组,对照组20例患者采用传统疝修补术治疗,观察组27例采用无张力疝修补术治疗,统计治疗效果。结果观察组手术时间、住院时间都显著优于观察组,并发症较少,无复发。结论老年腹股沟疝行无张力疝修补术治疗,操作方便,创伤小,效果显著。%Objective Application in elderly inguinal hernia tension-free hernia repair efficacy. Methods Select 47 cases of elderly inguinal hernia patients were randomly divided into two groups. 20 patients in the control group using traditional hernia repair, 27 patients in the observation group using tension-free hernia repair, statistical treatment. Results Observed operative time, length of hospital stay were significantly better than in the observation group, fewer complications, and no recurrence. Conclusion Elderly inguinal hernia tension-free hernia repair line treatment, easy operation, trauma, significant effect.

  20. Dreams and fantasies in psychodynamic group psychotherapy of psychotic patients.

    Science.gov (United States)

    Restek-Petrović, Branka; Orešković-Krezler, Nataša; Grah, Majda; Mayer, Nina; Bogović, Anamarija; Mihanović, Mate

    2013-09-01

    Work with dreams in the group analysis represents an important part of the analytical work, with insight into unconscious experiences of the individual dreamer, and his transferrential relations with the therapist, other members of the group, and with the group as a whole. The way dreams are addressed varies from one therapist to another, and in line with that, members of the group have varying frequency of dreams. In groups of psychotic patients dreams are generally rarely discussed and interpreted by the group, with analysis mainly resting on the manifested content. This paper describes a long-term group of psychotic patients which, after sharing the dreams of several members and daydreams of one female patient, their interpretation and reception in the group achieved better cohesion and improved communication and interaction, i.e. created a group matrix. Furthermore, through the content of dreams in the group, traumatic war experiences of several of the group members were opened and discussed, which brought with it recollections of the traumatic life situations of other group members. In expressing a daydream, a female member of the group revealed the background for her behaviour which was earlier interpreted as a negative symptom of the illness.

  1. Investigating the effect of intra-operative infiltration with local anaesthesia on the development of chronic postoperative pain after inguinal hernia repair. A randomized placebo controlled triple blinded and group sequential study design [NCT00484731

    Directory of Open Access Journals (Sweden)

    Audigé Laurent

    2007-11-01

    Full Text Available Abstract Background Inguinal hernia repair is one of the most frequently performed procedures in Switzerland (15'000/year. The most common complication postoperatively is development of chronic pain in up to 30% of all patients irrespective of the operative technique. Methods/Design 264 patients scheduled for an inguinal hernia repair using one of three procedures (Lichtenstein, Barwell and TEP = total extraperitoneal hernioplasty are being randomly allocated intra-operatively into two groups. Group I patients receive a local injection of 20 ml Carbostesin® 0.25% at the end of the operation according to a standardised procedure. Group II patients get a 20 ml placebo (0.9% Saline injection. We use pre-filled identically looking syringes for blinded injection, i.e. the patient, the surgeon and the examinator who performs the postoperative clinical follow-ups remain unaware of group allocation. The primary outcome of the study is the occurrence of developing chronic pain (defined as persistent pain at 3 months FU measured by VAS and Pain Matcher® device (Cefar Medical AB, Lund, Sweden. The study started on July 2006. In addition to a sample size re-evaluation three interim analyses are planned after 120, 180 and 240 patients had finished their 3-months follow-up to allow for early study termination. Discussion Using a group sequential study design the minimum number of patients are enrolled to reach a valid conclusion before the end of the study. To limit subjectivity, both a VAS and the Pain Matcher® device are used for the evaluation of pain. This allows us also to compare these two methods and further assess the use of Pain Matcher® in clinical routine. The occurrence of chronic pain after inguinal hernia repair has been in focus of several clinical studies but the reduction of it has been rarely investigated. We hope to significantly reduce the occurrence of this complication with our investigated intervention. Trial Registration Our trial

  2. The use of Teno Fix tendon repair device in a patient with multiple flexor tendon ruptures

    OpenAIRE

    2010-01-01

    Flexor tendon laceration repairs remain challenging despite numerous advances in hand surgery. Although progress on this vital subject matter has been achieved, there continues to be discussion over which surgical technique produces the optimal result. Currently there are several recommended surgical repair options for the lacerated flexor tendon. However, these repairs continue to have possible significant complications including adhesions, decreased range of motion, gapping, and post operat...

  3. Circadian Rhythms of Oxidative Stress Markers and Melatonin Metabolite in Patients with Xeroderma Pigmentosum Group A

    Directory of Open Access Journals (Sweden)

    Rie Miyata

    2016-01-01

    Full Text Available Xeroderma pigmentosum group A (XPA is a genetic disorder in DNA nucleotide excision repair (NER with severe neurological disorders, in which oxidative stress and disturbed melatonin metabolism may be involved. Herein we confirmed the diurnal variation of melatonin metabolites, oxidative stress markers, and antioxidant power in urine of patients with XPA and age-matched controls, using enzyme-linked immunosorbent assay (ELISA. The peak of 6-sulfatoxymelatonin, a metabolite of melatonin, was seen at 6:00 in both the XPA patients and controls, though the peak value is lower, specifically in the younger age group of XPA patients. The older XPA patients demonstrated an increase in the urinary levels of 8-hydroxy-2′-deoxyguanosine and hexanoyl-lysine, a marker of oxidative DNA damage and lipid peroxidation, having a robust peak at 6:00 and 18:00, respectively. In addition, the urinary level of total antioxidant power was decreased in the older XPA patients. Recently, it is speculated that oxidative stress and antioxidant properties may have a diurnal variation, and the circadian rhythm is likely to influence the NER itself. We believe that the administration of melatonin has the possibility of ameliorating the augmented oxidative stress in neurodegeneration, especially in the older XPA patients, modulating the melatonin metabolism and the circadian rhythm.

  4. A systematic review and meta-analysis of clinical and patient-reported outcomes following two procedures for recurrent traumatic anterior instability of the shoulder: Latarjet procedure vs. Bankart repair.

    Science.gov (United States)

    An, Vincent Vinh Gia; Sivakumar, Brahman Shankar; Phan, Kevin; Trantalis, John

    2016-05-01

    The Bankart repair and Latarjet procedure are both viable surgical options for recurrent traumatic anterior instability of the shoulder joint. The anatomic repair is the more popular option, with 90% of surgeons internationally choosing the Bankart repair as the initial treatment. There has been no previous review directly comparing the 2 techniques. Hence, we aimed to systematically review studies to compare the outcomes of Bankart repairs vs. the Latarjet procedure for recurrent instability of the shoulder. Six electronic databases were searched for original, English-language studies comparing the Bankart and Latarjet procedures. Studies were critically appraised using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Data were extracted from the text, tables, and figures of the selected studies. Eight comparative studies were identified with 795 shoulders; 416 of them underwent open or arthroscopic Bankart repairs, and 379 were repaired by the open Latarjet procedure. Primary and revision procedures were studied. The Latarjet procedure conferred significantly lower risk of recurrence and redislocation. There was no significant difference in the rates of complication requiring reoperation between the two procedures. Rowe scores were higher and loss of external rotation lower in the Latarjet group compared with the Bankart repair group. Our studies demonstrate that the Latarjet procedure is a viable and possibly superior alternative to the Bankart repair, offering greater stability with no significant increase in complication rate. However, the studies identified were retrospective and of limited quality, and therefore randomized controlled trials with large populations of patients or prospective assessment of national orthopedic registries should be employed to confirm our findings. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  5. Distinctive Hemodynamics in the Immediate Postoperative Period of Patients with a Longer Cardiac Intensive Care Stay Post-Tetralogy of Fallot Repair.

    Science.gov (United States)

    Beg, Kisha A; Haq, Anwarul; Amanullah, Muneer; Laique, Sobia N; Sadqani, Saleem; Aslam, Nadeem; Rehmat, Amina Wali; Hasan, Babar S

    2015-01-01

    After complete surgical repair the majority of tetralogy of Fallot (ToF), patients stay ≤2 days in the Cardiac Intensive Care Unit (CICU) while some may stay longer. We undertook this study to investigate the factors associated with shorter vs. longer length of stay in the CICU to help manage resources effectively. Patients who underwent ToF repair at Aga Khan University, Pakistan, between July 2006 and December 2011 were studied in a case-control design. Clinical parameters were compared between short stay group (SSG) (≤2 days) and long stay group (LSG) (>2 days). Odds ratios were calculated, and regression was performed. Ninety-eight patients (LSG 65, SSG 33) were included. Patients with lower preoperative saturation were 2.67 times more likely to be in the LSG group (P = .02). At 4 hours postoperatively, patients with a higher inotropic score (odds ratio [OR] = 3.03, confidence interval [CI] = 1.19-7.7, P = .02), higher central venous pressure (OR = 3.04, CI = 1.27-7.32, P = .013), and significant tachycardia at 4 hours (OR = 3.5, CI = 1.19-10.3. P = .02) were at risk for having a prolonged CICU stay. On multivariate analysis, significant postoperative tachycardia at 4 hours (z-score ≥3) was highly specific (sensitivity = 38.5%, specificity = 84.9%) for predicting the chances of being in the LSG. Other predictors included preop O(2) saturation ≤82.5% (sensitivity = 61.1%, specificity = 63.0%) and CVP ≥10 mm Hg at 4 hours (sensitivity = 55.4%, specificity = 71.9%). Patients who end up staying longer in the CICU have features that are distinctive in the immediate postoperative period, and this can help clinicians in identifying patients who may need more support. © 2015 Wiley Periodicals, Inc.

  6. [Clinical and functional course of patients after arthroscopic repair of a Bankart lesion].

    Science.gov (United States)

    Barrios-Moyano, Antonio; Negrete-Corona, Jorge; Chávez-Hinojosa, Edgard

    2009-01-01

    Show the experience of the Orthopedics Service at Lic. Adolfo López Mateos Regional ISSSTE Hospital, in the management of anterior unidirectional shoulder instability with an arthroscopic technique consisting of reattaching the labrum in the glenoid with anchored sutures and capsular tightening with radiofrequency. Twenty-six patients with anterior unidirectional shoulder instability who were operated-on between August 2006 and November 2008 were included. Twelve patients underwent capsular retightening with radiofrequency and in 14 patients the latter was combined with sutured anchors. The patients selected had a history of relapsing glenohumeral dislocations and subluxations with anterior instability, with or without associated Bankart lesions, and all of them were young. The results were assessed basically with the functional UCLA scale and considering the occurrence of any instability-related event during the postoperative follow-up; from this perspective, there were no cases of recurrent instability. Two cases reported severe postoperative pain, and one had irritation of the sutures; 6 patients had residual limitation of combined lateral rotation and abduction movements, with a mean of 10 degrees compared with the sound contralateral limb. The most frequent incident was infiltration of solutions into the soft tissues due to the operative time. Capsular retightening with radiofrequency, whether combined or not with other repair techniques, has proven highly satisfactory from the perspective of the glenohumeral stabilization for anterior unidirectional instability. The arthroscopic approach offers the known advantages of being less aggressive to the soft tissues and a shorter time to resume work activities when rehabilitation therapy and exercises are followed.

  7. Healthcare providers' perspectives on the social reintegration of patients after surgical fistula repair in the eastern Democratic Republic of Congo.

    Science.gov (United States)

    Young-Lin, Nichole; Namugunga, Esperance N; Lussy, Justin P; Benfield, Nerys

    2015-08-01

    To understand perspectives of local health providers on the social reintegration of patients who have undergone fistula repair in the eastern Democratic Republic of Congo. In a qualitative study, semi-structured individual interviews were conducted with patient-care professionals working with women with fistula at HEAL Africa Hospital (Goma) and Panzi Hospital (Bukavu) between June and August 2011. The interviews were transcribed and themes elicited through manual coding. Overall, 41 interviews were conducted. Successful surgical repair was reported to be the most important factor contributing to patients' ability to lead a normal life by all providers. Family acceptance-especially from the husband-was deemed crucial for reintegration by 39 (95%) providers, and 29 (71%) believed this acceptance was more important than the ability to work. Forty (98%) providers felt that, on the basis of African values, future childbearing was key for family acceptance. Because of poor access and the high cost of cesarean deliveries, 28 (68%) providers were concerned about fistula recurrence. Providers view postsurgical childbearing as crucial for social reintegration after fistula repair. However, cesarean deliveries are costly and often inaccessible. More work is needed to improve reproductive health access for women after fistula repair. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  8. Stable right ventricular size and function during short-term follow-up in patients with pulmonary regurgitation after tetralogy of Fallot repair.

    Science.gov (United States)

    Śpiewak, M; Małek, Ł A; Petryka, J; Biernacka, E K; Hoffman, P; Demkow, M; Miśko, J; Rużyłło, W

    2013-12-01

    To assess changes in ventricular size and function over time in conservatively treated adult patients with repaired tetralogy of Fallot (TOF) and significant pulmonary regurgitation (PR). Patients with repaired TOF who had undergone more than one cardiac magnetic resonance study were identified. To confine the cause of ventricular size and function deviation to PR, patients with residual ventricular septal defect, more than mild regurgitation at a valve other than the pulmonary valve, and known coronary artery disease were excluded. The final analysis included 27 adults with PR fraction >20%. During a follow-up of mean 2.1 ± 0.8 years, there was no change in right ventricular (RV) end-diastolic volume (EDV; 162.1 ± 27.6 versus 164 ± 29.6 ml/m(2), p = 0.5). Left ventricular (LV) EDV showed a small decrease (85.1 ± 16.2 versus 81.5 ± 14.1 ml/m(2), p = 0.02). The mean PR fraction, PR volume, and peak RV outflow tract gradient did not change. Additionally, both RV ejection fraction (EF) and LVEF remained stable over the follow-up period (48.1 ± 6.5 versus 48.4 ± 6.7%, p = 0.83, and 57.3 ± 5.4 versus 57.2 ± 5.1 %, p = 0.91, respectively). Only two asymptomatic patients (7.4% of the study group) developed symptoms and the remaining did not deteriorate. The RVEDV, RVEF, and LVEF remained stable over a mean follow-up of approximately 2 years in the majority of adult patients after TOF repair with significant PR and a wide range of RVEDV. Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  9. The Clinical Comparative Analysis of the Traditional Inguinal Hernia Repair and Tension-free Hernia Repair in the Treatment of Inguinal Hernia of Elderly Patients%老年患者腹股沟斜疝不同手术方式的临床对比研究

    Institute of Scientific and Technical Information of China (English)

    赵学静; 钱峰

    2014-01-01

    Objective:To investigate the clinical curative effect of tension-free hernia repair in the treatment of inguinal hernia of elderly patients. Method:To retrospective analyse the data of 80 cases of elderly patients proceed inguinal hernia repair surgery from January 2011 to December 2011,they were randomly divided tension-free group 40 cases and traditional group 40 cases.The tension-free group adopted hernia ring filling type tension-free hernia repair surgery treatment,the traditional group adopted the traditional hernia repair surgery treatment.To compare the curative effect,surgical operation time, postoperative down time,length of hospital stay,postoperative pain,incidence of complications and recurrence rate of two groups.Result:The total effect rate of the two groups had no significant difference(P>0.05);the operation time and down time,postoperative hospitalization time of tension-free group were significantly shorter than traditional group,postoperative pain score,complications and recurrence rate of tension-free group were significantly lower than the traditional group(P0.05);无张力组手术耗时、下地时间及住院时间均明显短于传统组(P<0.05),术后疼痛、术后并发症发生率以及复发率均明显低于传统组(P<0.05)。结论:疝环充填式无张力疝修补术治疗老年腹股沟斜疝的临床疗效显著,值得临床推广。

  10. Clinical Observation of Oral Self-maintenance after Implant Denture Repair in Periodontitis Patients%牙周炎患者种植义齿修复后口腔自我维护的临床观察

    Institute of Scientific and Technical Information of China (English)

    张飞

    2016-01-01

    Objective To investigate the effect of dental plaque disclosing agent on oral maintenance in patients with peri-odontitis after implant denture repair. Methods 62 patients underwent implant denture repair with 78 implants in total in the hospital from May 2013 to February 2015 were selected as the subjects and randomly divided into observation group and control group, with 31 patients and 39 implants in each group. For the oral self-maintenance, both groups were given the general maintenance, in addition, the observation group were given dental plaque disclosing agent. And the periodontal parameters and incidence of peri-implant mucositis of the two groups were compared. Results Two weeks after the implant denture repair, the difference in PLI, SBI, PD and dental plaque indexes between the two groups had no statistical signifi-cance(P>0.05). Three months after the repair, these indexes for patients in the observation group were better than those in the control group(P0.05);修复3个月后所有患者观察组PLI、SBI、PD和菌斑指数均优于对照组(P<0.05);种植修复后1年内,观察组种植体周围粘膜炎平均发生率为45.6%,对照组为59.4%,差异有统计学意义(P<0.05)。结论系统的口腔自我维护能够显著降低牙周炎患者种植体周围黏膜炎的发生率,使用菌斑显示剂让患者对菌斑有良好的自我控制效果显著。

  11. Assessment of single nucleotide polymorphisms in screening 52 DNA repair and cell cycle control genes in Fanconi anemia patients

    Directory of Open Access Journals (Sweden)

    Petrović Sandra

    2015-01-01

    Full Text Available Fanconi anemia (FA is a rare genetically heterogeneous disorder associated with bone marrow failure, birth defects and cancer susceptibility. Apart from the disease- causing mutations in FANC genes, the identification of specific DNA variations, such as single nucleotide polymorphisms (SNPs, in other candidate genes may lead to a better clinical description of this condition enabling individualized treatment with improvement of the prognosis. In this study, we have assessed 95 SNPs located in 52 key genes involved in base excision repair (BER, nucleotide excision repair (NER, mismatch repair (MMR, double strand break (DSB repair and cell cycle control using a DNA repair chip (Asper Biotech, Estonia which includes most of the common variants for the candidate genes. The SNP genotyping was performed in five FA-D2 patients and in one FA-A patient. The polymorphisms studied were synonymous (n=10, nonsynonymous (missense (n=52 and in non-coding regions of the genome (introns and 5 ‘and 3’ untranslated regions (UTR (n=33. Polymorphisms found at the homozygous state are selected for further analysis. Our results have shown a significant inter-individual variability among patients in the type and the frequency of SNPs and also elucidate the need for further studies of polymorphisms located in ATM, APEX APE 1, XRCC1, ERCC2, MSH3, PARP4, NBS1, BARD1, CDKN1B, TP53 and TP53BP1 which may be of great importance for better clinical description of FA. In addition, the present report recommends the use of SNPs as predictive and prognostic genetic markers to individualize therapy of FA patients. [Projekat Ministarstva nauke Republike Srbije, br. 173046

  12. Inpatient group therapeutic interventions for patients with intellectual disabilities.

    Science.gov (United States)

    Reddy, Vilash

    2015-03-01

    Group therapy can be an effective mode of therapy, used on an inpatient unit, as it can allow patients to become allies in their journey to understand and overcome their mental health needs. The therapeutic principles discussed by Dr Irvin Yalom illustrate the significance and importance of group therapy, which was strongly incorporated into interactive behavior therapy (IBT) developed by Dr Daniel J Tomasulo. IBT is a type of group therapy, more action oriented, created to allow patients with intellectual disabilities (IDs) to better comprehend discussed topics, by designing and tailoring activities to meet their cognitive and linguistic capabilities. Additional details found in this article will illustrate the methods by which IBT is capable of meeting the needs of patients with ID. Such adjustments include shorter duration of activities to maximize concentration, proactive role-playing involving the synergistic effort of all members of the group, and limiting the authoritative role of the therapist in a group environment.

  13. Translocation of Cockayne syndrome group A protein to the nuclear matrix: possible relevance to transcription-coupled DNA repair.

    NARCIS (Netherlands)

    S. Kamiuchi (Shinya); M. Saijo (Masafumi); E. Citterio (Elisabetta); M. de Jager (Martijn); J.H.J. Hoeijmakers (Jan); K. Tanaka (Kiyoji)

    2002-01-01

    textabstractTranscription-coupled repair (TCR) efficiently removes a variety of lesions from the transcribed strand of active genes. By allowing rapid resumption of RNA synthesis, the process is of major importance for cellular resistance to transcription-blocking genotoxic damage. Mutations in the

  14. Chromosomal localization of three repair genes: the xeroderma pigmentosum group C gene and two human homologs of yeast RAD23.

    NARCIS (Netherlands)

    P.J. van der Spek (Peter); E.M.E. Smit (Elisabeth); H.B. Beverloo (Berna); K. Sugasawa (Kaoru); C. Matsutani; F. Hanaoka (Fumio); J.H.J. Hoeijmakers (Jan); A. Hagemeier

    1994-01-01

    textabstractThe nucleotide excision repair (NER) disorder xeroderma pigmentosum (XP) is characterized by sun (UV) sensitivity, predisposition to skin cancer, and extensive genetic heterogeneity. Recently, we reported the cloning and analysis of three human NER genes, XPC, HHR23A, and HHR23B. The

  15. Base excision repair pathway: PARP1 genotypes as modulators of therapy response in cervical cancer patients.

    Science.gov (United States)

    Nogueira, Augusto; Assis, Joana; Faustino, Ilda; Pereira, Deolinda; Catarino, Raquel; Medeiros, Rui

    2017-02-01

    Genetic polymorphisms in genes of the base excision repair (BER) pathway appear to modulate the therapy response of cancer patients. PARP1 protein recognizes the DNA strand damage and facilitates the subsequent recruitment of BER proteins. Few studies have reported an association between PARP1 Val762Ala polymorphism (rs1136410) and cancer therapy response. The purpose of our study was to determine whether PARP1 Val762Ala polymorphism have prognostic value in patients with cervical cancer. Two hundred and sixty adult patients, with histologically confirmed cervical cancer, at FIGO-stages IB2-IVA, primarily treated with concurrent chemotherapy (cisplatin) and radiotherapy. Overall survival (OS) and disease-free survival (DFS) were the primary end points of the analysis. The PARP1 Val762Ala genetic variants were analyzed by allelic discrimination by real-time PCR. We observed that peri- and postmenopausal women carrying the C-allele present a statistically significant lower OS and DFS (log-rank test, p = 0.008 and p = 0.006, respectively) among those with early stage cervical cancer. Cox regression analysis confirmed these results, after adjustment for other prognostic factors (for OS: HR, 3.70; 95%CI, 1.32-10.38; p = 0.013 and for DFS: HR, 3.97; 95%CI, 1.59-9.93; p = 0.003). This is the first study evaluating the effect of PARP1 Val762Ala polymorphism in treatment response in cervical cancer patients. PARP1 genotypes may contribute as an independent prognostic factor in cervical cancer, being useful in predicting the clinical outcome.

  16. No-mesh inguinal hernia repair with continuous absorbable sutures: A dream or reality? (a study of 229 patients

    Directory of Open Access Journals (Sweden)

    Desarda Mohan

    2008-01-01

    Full Text Available Background/Aim: The author has published results from two series based on his new technique of inguinal hernia repair. Interrupted sutures with a nonabsorbable material were used for repairs in both theses series. The author now describes the results of repairs done with continuous absorbable sutures. Materials and Methods: This is a prospective study of 229 patients having 256 hernias operated from December 2003 to December 2006. An undetached strip of the external oblique aponeurosis was sutured between the inguinal ligament and the muscle arch to form the new posterior wall. Continuous sutures were taken with absorbable suture material (Monofilament Polydioxanone Violet. Data of hospital stay, complications, ambulation, recurrences, and pain were recorded. Follow-up was done until June 2007. Results: A total of 224 (97.8% patients were ambulatory within 6-8 h (mean: 6.42 h and they attained free ambulation within 18-24 h (mean: 19.26 h. A total of 222 (96.4% patients returned to work within 6-14 days (mean: 8.62 days and 209 (91.26% patients had one-night stays in the hospital. A total of 216 (94.3% patients had mild pain for 2 days. There were four minor complications, but no recurrence or incidence of chronic groin pain. Patients were followed up for a mean period of 24.28 months (range: 6-42 months. Conclusions: The results of this study correlate well with the author′s previous publications. Continuous suturing saves operative time and one packet of suture material. The dream of every surgeon to give recurrence-free inguinal hernia repair without leaving any foreign body inside the patient may well become a reality in future.

  17. DESARDA’S NO MESH REPAIR VERSUS LICHTENSTEIN’S OPEN MESH REPAIR OF INGUINAL HERNIA: A COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Zaheer

    2015-09-01

    Full Text Available BACKGROUND : The tissue - based techniques are still acceptable for primary inguinal hernia repair according to the European Hernia Society guidelines. Desarda’s no mesh technique, introduced in 2001, is a hernia repair method using an undetached strip of external oblique Apo neurosis . This study compared outcomes after hernia repair with Desarda (D and mesh - based Lichtenstein (L techniques. METHODS : A total of 100 patients were randomly assigned to the D or L group (50 each. The primary outcomes measured were post - operative pain ( D ay1 and day 7, mean hospital stay (in days, return to basic activity (in days and recurrence. RESULTS : During the follow - up, no recurrences were observed in each group (p = 1.000. Average duration of the Desarda’s repair was 65.64 minutes, while the Lichtenstein repair lasted for 65.76 minutes. Mean VAS on 1 st post - operative day was significantly less in Desarda’s repair (2.86 than Lichenstein’s repair (3.50, (p=0.0004. Mean hospital stay was less in Desarda’s repair (2.58 days versus Lichtenstein’s repair (3.90 days p=0.0001. Return to basic physical activity was earlier in Desarda’s repair (7.04 days than Lichenstein’s repair (11.30 days, (p=<0.0001. However there was no recurrence in either group in 18 months follow up. CONCLUSIONS : The Desarda’s and Lichtenstein’s methods of primary inguinal hernia repair do not differ in the means of procedure complexity, surgery time and complication profile. However the return to basic physical activity was earlier in Desarda’s repair. Desarda’s no mesh repair is equally safe and more cost effective than Lichtenstein’s repair. The technique may potentially increase the number of tissue - based methods a vailable for treating inguinal hernias.

  18. Influence of Double-Strand Break Repair on Radiation Therapy-Induced Acute Skin Reactions in Breast Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Mumbrekar, Kamalesh Dattaram [Division of Radiobiology and Toxicology, School of Life Sciences, Manipal University, Manipal, Karnataka (India); Fernandes, Donald Jerard [Department of Radiotherapy and Oncology, Shirdi Sai Baba Cancer Hospital and Research Centre, Kasturba Hospital, Manipal, Karnataka (India); Goutham, Hassan Venkatesh [Division of Radiobiology and Toxicology, School of Life Sciences, Manipal University, Manipal, Karnataka (India); Sharan, Krishna [Department of Radiotherapy and Oncology, Shirdi Sai Baba Cancer Hospital and Research Centre, Kasturba Hospital, Manipal, Karnataka (India); Vadhiraja, Bejadi Manjunath [Manipal Hospital, Bangalore, Karnataka (India); Satyamoorthy, Kapaettu [Division of Biotechnology, School of Life Sciences, Manipal University, Manipal, Karnataka (India); Bola Sadashiva, Satish Rao, E-mail: satishraomlsc@gmail.com [Division of Radiobiology and Toxicology, School of Life Sciences, Manipal University, Manipal, Karnataka (India)

    2014-03-01

    Purpose: Curative radiation therapy (RT)-induced toxicity poses strong limitations for efficient RT and worsens the quality of life. The parameter that explains when and to what extent normal tissue toxicity in RT evolves would be of clinical relevance because of its predictive value and may provide an opportunity for personalized treatment approach. Methods and Materials: DNA double-strand breaks and repair were analyzed by microscopic γ-H2AX foci analysis in peripheral lymphocytes from 38 healthy donors and 80 breast cancer patients before RT, a 2 Gy challenge dose of x-ray exposed in vitro. Results: The actual damage (AD) at 0.25, 3, and 6 hours and percentage residual damage (PRD) at 3 and 6 hours were used as parameters to measure cellular radiosensitivity and correlated with RT-induced acute skin reactions in patients stratified as non-overresponders (NOR) (Radiation Therapy Oncology Group [RTOG] grade <2) and overresponders (OR) (RTOG grade ≥2). The results indicated that the basal and induced (at 0.25 and 3 hours) γ-H2AX foci numbers were nonsignificant (P>.05) between healthy control donors and the NOR and OR groups, whereas it was significant between ORs and healthy donors at 6 hours (P<.001). There was a significantly higher PRD in OR versus NOR (P<.05), OR versus healthy donors (P<.001) and NOR versus healthy donors (P<.01), supported further by the trend analysis (r=.2392; P=.0326 at 6 hours). Conclusions: Our findings strongly suggest that the measurement of PRD by performing γ-H2AX foci analysis has the potential to be developed into a clinically useful predictive assay.

  19. ["Family groups" for relatives of patients with anorexia nervosa].

    Science.gov (United States)

    Brunswick, Astrid; Guy-Rubin, Aurore; Satori, Nadine

    2016-01-01

    Anorexia nervosa affects mainly young adults. During care, caregivers seek alliance with patients' friends and family to be able to relate to the patients' symptoms and also their environment. Collaborative work with families helps build confidence. The "family group" is an example of well-intended partnership.

  20. Anaesthetic Management of Laparoscopic Morgagni Hernia Repair in a Patient with Coexisting Down Syndrome, Patent Foramen Ovale and Pectus Carinatum.

    Science.gov (United States)

    Kozanhan, Betül; Başaran, Betül; Aygın, Feride; Akkoyun, İbrahim; Özmen, Sadık

    2016-02-01

    Laparoscopic repair has several advantages with a minimally invasive surgical option for children with Morgagni hernias; however, a number of physiological sequelae results from pneumoperitoneum and insufflation. These physiological changes may be more significant in patients with a congenital heart disease. Perioperative detailed evaluation, meticulous monitorization and cooperation with a surgical team are important in cases with patent foramen ovale for the possible risk of the paradoxical gas embolism. We present the anaesthetic management of a patient with patent foramen ovale, Down syndrome and pectus carinatus who successfully underwent laparoscopic Morgagni hernia repair. Under a well-managed anaesthesia that prevented complications because of pneumoperitoneum, laparoscopic surgery would be safe enough for patients with Morgagni hernia having an associated congenital heart disease.

  1. Pseudomonas aeruginosa diversity in distinct paediatric patient groups

    DEFF Research Database (Denmark)

    Tramper-Stranders, G.A.; Ent, C.K. van der; Wolfs, T.F.;

    2008-01-01

    and further typed by pulsed-field gel electrophoresis. Simpson's diversity index was calculated for the five groups. CF-chronic patients carried the highest number of distinct P. aeruginosa phenotypes and genotypes per culture. Isolates from the CF-chronic group were significantly less diverse than those from...

  2. 无张力疝修补术与传统疝修补术治疗老年腹外疝的疗效对比%The efficacy of tension-free hernia repair versus that of traditional hernia repair for external abdominal hernias in elderly patients

    Institute of Scientific and Technical Information of China (English)

    岑坚慈

    2013-01-01

    目的 对比用巴德网塞和补片行无张力疝修补术与传统疝修补术治疗老年腹外疝的临床效果.方法 选择2008年1月至2010年1月我院收治的120例老年腹外疝患者,随机分为对照组和观察组各60例,对照组采用传统疝修补术治疗,观察组采用无张力疝修补术治疗,把两组的临床资料进行分析比较,以手术时间、下床时间、伤口疼痛程度、局部不适、并发症及有无复发等为比较对象.结果 无张力疝修补术治疗的患者手术效果明显优于传统疝修补术的患者,并发症少,随访2年无复发病例.结论 无张力疝修补术具有手术时间短,成本低,术后患者痛苦小、恢复快、并发症少、无复发等优点,值得临床推广应用.%Objective To compare the clinical efficacy of tension-free hernia repair with Bard mesh plug and patch with that of traditional hernia repair for external abdominal hernias in elderly hernia.Methods 120 elderly patients with external abdominal hernia who had been hospitalized from January 2008 to January 2010 were randomly divided into a control group (60 patients) and a study group (60 patients).The control group received traditional hernia repair; while the study group received tension-free hernia repair.Surgical duration,time to ambulation,degree of wound pain,local discomforts,complications,and recurrence were compared.Results The study group was superior to the contro group in the efficacy.The patients who underwent tension-free hernia repair had fewer complications and had no recurrence in a 2-year follow-up.Conclusions The patients undergoing tension-free hernia repair have shorter surgical duration,less medical cost,less postoperative pain,faster recovery,fewer complications,and no recurrence.This procedure is worth popularizing clinically.

  3. Negative impact of asthma on patients in different age groups

    Directory of Open Access Journals (Sweden)

    Marcela Batan Alith

    2015-02-01

    Full Text Available Objective: To evaluate the impact of asthma on patients in Brazil, by age group (12-17 years, 18-40 years, and ≥ 41 years. Methods: From a survey conducted in Latin America in 2011, we obtained data on 400 patients diagnosed with asthma and residing in one of four Brazilian state capitals (São Paulo, Rio de Janeiro, Curitiba, and Salvador. The data had been collected using a standardized questionnaire in face-to-face interviews. For the patients who were minors, the parents/guardians had completed the questionnaire. The questions addressed asthma control, number of hospitalizations, number of emergency room visits, and school/work absenteeism, as well as the impact of asthma on the quality of life, sleep, and leisure. We stratified the data by the selected age groups. Results: The proportions of patients who responded in the affirmative to the following questions were significantly higher in the 12- to 17-year age group than in the other two groups: "Have you had at least one episode of severe asthma that prevented you from playing/exercising in the last 12 months?" (p = 0.012; "Have you been absent from school/work in the last 12 months?" (p < 0.001; "Have you discontinued your asthma relief or control medication in the last 12 months?" (p = 0.008. In addition, 30.2% of the patients in the 12- to 17-year age group reported that normal physical exertion was very limiting (p = 0.010 vs. the other groups, whereas 14% of the patients in the ≥ 41-year age group described social activities as very limiting (p = 0.011 vs. the other groups. Conclusions: In this sample, asthma had a greater impact on the patients between 12 and 17 years of age, which might be attributable to poor treatment compliance.

  4. Negative impact of asthma on patients in different age groups.

    Science.gov (United States)

    Alith, Marcela Batan; Gazzotti, Mariana Rodrigues; Montealegre, Federico; Fish, James; Nascimento, Oliver Augusto; Jardim, José Roberto

    2015-01-01

    To evaluate the impact of asthma on patients in Brazil, by age group (12-17 years, 18-40 years, and ≥ 41 years). From a survey conducted in Latin America in 2011, we obtained data on 400 patients diagnosed with asthma and residing in one of four Brazilian state capitals (São Paulo, Rio de Janeiro, Curitiba, and Salvador). The data had been collected using a standardized questionnaire in face-to-face interviews. For the patients who were minors, the parents/guardians had completed the questionnaire. The questions addressed asthma control, number of hospitalizations, number of emergency room visits, and school/work absenteeism, as well as the impact of asthma on the quality of life, sleep, and leisure. We stratified the data by the selected age groups. The proportions of patients who responded in the affirmative to the following questions were significantly higher in the 12- to 17-year age group than in the other two groups: "Have you had at least one episode of severe asthma that prevented you from playing/exercising in the last 12 months?" (p = 0.012); "Have you been absent from school/work in the last 12 months?" (p your asthma relief or control medication in the last 12 months?" (p = 0.008). In addition, 30.2% of the patients in the 12- to 17-year age group reported that normal physical exertion was very limiting (p = 0.010 vs. the other groups), whereas 14% of the patients in the ≥ 41-year age group described social activities as very limiting (p = 0.011 vs. the other groups). In this sample, asthma had a greater impact on the patients between 12 and 17 years of age, which might be attributable to poor treatment compliance.

  5. 76 FR 60495 - Patient Safety Organizations: Voluntary Relinquishment From the Patient Safety Group

    Science.gov (United States)

    2011-09-29

    ... HUMAN SERVICES Agency for Healthcare Research and Quality Patient Safety Organizations: Voluntary Relinquishment From the Patient Safety Group AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS... relinquishment from The Patient Safety Group of its status as a Patient Safety Organization (PSO). The...

  6. Percutaneous mitral valve repair.

    Science.gov (United States)

    Gillinov, A Marc; Liddicoat, John R

    2006-01-01

    Surgical mitral valve repair is the procedure of choice to treat mitral regurgitation of all etiologies. Whereas annuloplasty is the cornerstone of mitral valve repair, a variety of other surgical techniques are utilized to correct dysfunction of the leaflets and subvalvular apparatus; in most cases, surgical repair entails application of multiple repair techniques in each patient. Preclinical studies and early human experience have demonstrated that some of these surgical repair techniques can be performed using percutaneous approaches. Specifically, there has been great progress in the development of novel technology to facilitate percutaneous annuloplasty and percutaneous edge-to-edge repair. The objectives of this report were to (1) discuss the surgical foundations for these percutaneous approaches; (2) review device design and experimental and clinical results of percutaneous valve repair; and (3) address future directions, including the key challenges of patient selection and clinical trial design.

  7. Multidisciplinary patient education in groups increases knowledge on Osteoporosis

    DEFF Research Database (Denmark)

    Nielsen, Dorthe; Ryg, Jesper; Nissen, Nis;

    2008-01-01

    of osteoporosis may be increased by a group-based multidisciplinary education programme. Methods: Three hundred patients, aged 45-81 years, recently diagnosed with osteoporosis and started on specific treatment, were randomized to either the ‘‘school'' or ‘‘control'' group. Teaching was performed by nurses......, physiotherapists, dieticians, and doctors, and designed to increase the patient's empowerment. The patient's knowledge of osteoporosis was tested at study entry and at 3 months using a validated questionnaire. Results: At study entry, no differences in age or score (22 (18-24) (median (25-75 percentiles)) vs. 22...

  8. Effect of a high-dose target-controlled naloxone infusion on pain and hyperalgesia in patients following groin hernia repair

    DEFF Research Database (Denmark)

    Pereira, Manuel Pedro; Utke Werner, Mads; Berg Dahl, Joergen

    2015-01-01

    -dose target-controlled naloxone infusion can reinstate pain and hyperalgesia following recovery from open groin hernia repair and thus consistently demonstrate opioid-mediated latent sensitization in humans. METHODS/DESIGN: Patients submitted to unilateral, primary, open groin hernia repair will be included...

  9. Patient advocacy groups: Need and opportunity in India

    Directory of Open Access Journals (Sweden)

    Kunal Shah

    2011-01-01

    Full Text Available With an increasing number of corporate hospitals, healthcare related issues, research trials and undue attention by media in India, there is a need to focus more on patient′s rights and protection. In India, multiple agencies like regulatory bodies, scientific review committees, ethics committees, NGOs, etc. work toward patient rights and protection. However, these agencies are inadequate to cater to the general issues related to patient′s rights. There′s a need to have a separate group of people who provide advocacy to the patient, or simply, a patient advocacy group which will work explicitly in these areas to increase transparency and credibility of healthcare system in India. This group will provide special attention to patient care and protection of rights from the planning stage rather than at the troubleshooting stage.

  10. Fracture of the Vomero-Premaxillary Junction in a Repaired Bilateral Cleft Lip and Palate Patient

    Science.gov (United States)

    Zwahlen, Roger Arthur; Jayaratne, Yasas Shri Nalaka; Htun, Su Yin; Bütow, Kurt-Wilhelm

    2014-01-01

    Although dental trauma is common in bilateral cleft lip and palate (BCLP), patients' reports on bony fractures of the vomero-premaxillary junction cannot be found. The aim of this report is to illustrate clinical findings and the technique of fracture fixation in a child suffering from a fractured vomero-premaxillary junction as well as subsequent columella lengthening. A 4-year-old girl with a repaired BCLP presented with an open mucosal laceration and fractured vomero-premaxillary junction. Open reduction and fixation of the dislocated premaxilla was performed under general anesthesia. Fractured bone pieces of the vomero-premaxillary junction were removed and sharp bone edges at the vomer and the premaxilla were grinded. The repositioned premaxilla was fixed to the lateral alveolar arches with two mucoperiosteal sutures on each side. Additional columella lengthening was performed 2 years later. All family members were very happy about the new aesthetics of the girl. Although rare, fractures of the vomero-premaxillary junction present several challenges to clinicians related to anatomical, physiological, and psychological issues. Immediate and minimal invasive treatment strategies are recommended when managing such cases. PMID:25383152

  11. COMPARATIVE STUDY OF LICHTENSTEIN VERSUS DESARDA REPAIR FOR INGUINAL HERNIA

    Directory of Open Access Journals (Sweden)

    Sowmya

    2015-12-01

    Full Text Available BACKGROUND Inguinal hernia repair is the most frequently performed operation in any general surgical unit. The Bassini’s, Shouldice and other tissue-based techniques are still being acceptable for primary inguinal hernia repair. Desarda’s technique is originally a tissue based hernia repair using an undetached strip of external oblique aponeurosis to strengthen the posterior wall of the inguinal canal. The aim of the present study was to compare Lichtenstein hernia repair and Desarda herniorrhaphy. METHODS A total of 40 patients with primary unilateral inguinal hernia were subjected either to Desarda herniorrhaphy or Lichtenstein hernioplasty. The patients were followed in terms of recurrence rate, post-operative complications, convalescence, chronic pain and cost effectiveness. RESULTS During the followup all patients had either mild or moderate pain, but the pain intensity was more in Lichtenstein repair compared to Desarda repair in the immediate postoperative period. In Lichenstein repair patients had chronic groin pain even at the end of one year, but none of the patients in Desarda repair had chronic groin pain. Complications such as seroma and wound infection were less in Desarda repair. Time taken to resume normal activities was significantly less in case of Desarda herniorrhaphy; however, there was no recurrence observed in both the groups during the followup period. Average cost incurred for Desarda repair was significantly less than Lichtenstein repair. CONCLUSION Lichtenstein method of hernia repair is simple and safe. But the mesh prosthesis has its drawbacks. Desarda hernia repair is based on physiological principles and the results are good with less convalescence period and fewer recurrences and no chronic groin pain. It is more cost effective.

  12. Multidisciplinary patient education in groups increases knowledge on Osteoporosis

    DEFF Research Database (Denmark)

    Nielsen, Dorthe; Ryg, Jesper; Nissen, Nis

    2008-01-01

    Abstract Introduction: Specific pharmacological treatment reduces the incidence of fractures significantly in patients with osteoporosis. Unfortunately, compliance with such therapy is low in clinical practice and is inversely related to educational level. We hypothesized that patients' knowledge...... of osteoporosis may be increased by a group-based multidisciplinary education programme. Methods: Three hundred patients, aged 45-81 years, recently diagnosed with osteoporosis and started on specific treatment, were randomized to either the ‘‘school'' or ‘‘control'' group. Teaching was performed by nurses......, physiotherapists, dieticians, and doctors, and designed to increase the patient's empowerment. The patient's knowledge of osteoporosis was tested at study entry and at 3 months using a validated questionnaire. Results: At study entry, no differences in age or score (22 (18-24) (median (25-75 percentiles)) vs. 22...

  13. Identification of mismatch repair gene mutations in young patients with colorectal cancer and in patients with multiple tumours associated with hereditary non-polyposis colorectal cancer

    NARCIS (Netherlands)

    Niessen, R C; Berends, M J W; Wu, Y; Sijmons, R H; Hollema, H; Ligtenberg, M J L; de Walle, H E K; de Vries, E G E; Karrenbeld, A; Buys, C H C M; van der Zee, A G J; Hofstra, R M W; Kleibeuker, J H

    2006-01-01

    Background: Patients with early-onset colorectal cancer (CRC) or those with multiple tumours associated with hereditary non-polyposis colorectal cancer (HNPCC) raise suspicion of the presence of germline DNA mismatch repair (MMR) gene mutations. Aim: To analyse the value of family history,

  14. Identification of mismatch repair gene mutations in young patients with colorectal cancer and in patients with multiple tumours associated with hereditary non-polyposis colorectal cancer.

    NARCIS (Netherlands)

    Niessen, R.C.; Berends, M.J.; Wu, Y.; Sijmons, R.H.; Hollema, H.; Ligtenberg, M.J.L.; Walle, H.E. de; Vries, E.G.F. de; Karrenbeld, A.; Buys, C.H.C.M.; Zee, A.G. van der; Hofstra, R.M.; Kleibeuker, J.H.

    2006-01-01

    BACKGROUND: Patients with early-onset colorectal cancer (CRC) or those with multiple tumours associated with hereditary non-polyposis colorectal cancer (HNPCC) raise suspicion of the presence of germline DNA mismatch repair (MMR) gene mutations. AIM: To analyse the value of family history,

  15. Quantitative assessment of systolic left ventricular function with speckle-tracking echocardiography in adult patients with repaired aortic coarctation.

    Science.gov (United States)

    Menting, Myrthe E; van Grootel, Roderick W J; van den Bosch, Annemien E; Eindhoven, Jannet A; McGhie, Jackie S; Cuypers, Judith A A E; Witsenburg, Maarten; Helbing, Willem A; Roos-Hesselink, Jolien W

    2016-05-01

    Despite successful aortic coarctation (CoA) repair, systemic hypertension often recurs which may influence left ventricular (LV) function. We aimed to detect early LV dysfunction using LV global longitudinal strain (GLS) in adults with repaired CoA, and to identify associations with patient and echocardiographic characteristics. In this cross-sectional study, patients with repaired CoA and healthy controls were recruited prospectively. All subjects underwent echocardiography, ECG and blood sampling within 1 day. With speckle-tracking echocardiography, we assessed LV GLS on the apical four-, three- and two-chamber views. We included 150 subjects: 75 patients (57 % male, age 33.4 ± 12.8 years, age at repair 2.5 [IQR: 0.1-11.1] years) and 75 healthy controls of similar sex and age. LV GLS was lower in patients than in controls (-17.1 ± 2.3 vs. -20.2 ± 1.6 %, P < 0.001). Eighty percent of the patients had a normal LV ejection fraction, but GLS was still lower than in controls (P < 0.001). In patients, GLS correlated with systolic and diastolic blood pressure (r = 0.32, P = 0.009; r = 0.31, P = 0.009), QRS duration (r = 0.34, P = 0.005), left atrial dimension (r = 0.27, P = 0.029), LV mass (r = 0.30, P = 0.014) and LV ejection fraction (r = -0.48, P < 0.001). Patients with either associated cardiac lesions, multiple cardiac interventions or aortic valve replacement had lower GLS than patients without. Although the majority of adults with repaired CoA seem to have a normal systolic LV function, LV GLS was decreased. Higher blood pressure, associated cardiac lesions, and larger left atrial dimension are related with lower GLS. Therefore, LV GLS may be used as objective criterion for early detection of ventricular dysfunction.

  16. Central Venous Catheter Repair is Associated with an Increased Risk of Bacteremia and Central Line Associated Bloodstream Infection in Pediatric Patients

    Science.gov (United States)

    LUNDGREN, INGRID S.; ZHOU, CHUAN; MALONE, FRANCES R.; MCAFEE, NANCY G.; GANTT, SOREN; ZERR, DANIELLE M.

    2011-01-01

    Background Repair of broken central venous catheters (CVCs) is common in pediatric patients. We hypothesized that this practice predisposes to bacteremia and CVC-associated bloodstream infections (CLABSI). Methods We conducted a retrospective case-crossover study of pediatric patients aged 1 month to 21 years with CVC breakages who underwent a first-time repair at our institution, using repair kits provided by CVC manufacturers. We compared rates of bacteremia and CLABSI (defined by Centers for Disease Control and Prevention criteria) in the 30 days pre-repair (control period) and the 30 days post-repair (exposure period), with adjustment for within-patient correlation using conditional Poisson regression. Results The mean pre-repair rate of bacteremia was 9.9 per 1000 catheter days, which increased to 24.5 post-repair, resulting in an adjusted incidence rate ratio (IRR) of 1.87 (95% CI 1.05 – 3.33, p = 0.034). Risk of CLABSI demonstrated a greater than two-fold increase (IRR 2.15, 95% CI 1.02 – 4.53, p = 0.045) when all catheter days were included, and a four-fold increase when days on antibiotics were excluded (IRR 4.07, 95% CI 1.43 – 11.57, p = 0.008). Conclusions We found that repair of a broken CVC was associated with a two to four-fold higher risk of developing CLABSI within 30 days of repair in pediatric patients. Further studies are needed to determine interventions to reduce this risk and to better define the relative merits of CVC repair compared with replacement in selected patient populations. PMID:22146741

  17. DNA Damage and Repair Biomarkers in Cervical Cancer Patients Treated with Neoadjuvant Chemotherapy: An Exploratory Analysis.

    Directory of Open Access Journals (Sweden)

    Patrizia Vici

    Full Text Available Cervical cancer cells commonly harbour a defective G1/S checkpoint owing to the interaction of viral oncoproteins with p53 and retinoblastoma protein. The activation of the G2/M checkpoint may thus become essential for protecting cancer cells from genotoxic insults, such as chemotherapy. In 52 cervical cancer patients treated with neoadjuvant chemotherapy, we investigated whether the levels of phosphorylated Wee1 (pWee1, a key G2/M checkpoint kinase, and γ-H2AX, a marker of DNA double-strand breaks, discriminated between patients with a pathological complete response (pCR and those with residual disease. We also tested the association between pWee1 and phosphorylated Chk1 (pChk1, a kinase acting upstream Wee1 in the G2/M checkpoint pathway. pWee1, γ-H2AX and pChk1 were retrospectively assessed in diagnostic biopsies by immunohistochemistry. The degrees of pWee1 and pChk1 expression were defined using three different classification methods, i.e., staining intensity, Allred score, and a multiplicative score. γ-H2AX was analyzed both as continuous and categorical variable. Irrespective of the classification used, elevated levels of pWee1 and γ-H2AX were significantly associated with a lower rate of pCR. In univariate and multivariate analyses, pWee1 and γ-H2AX were both associated with reduced pCR. Internal validation conducted through a re-sampling without replacement procedure confirmed the robustness of the multivariate model. Finally, we found a significant association between pWee1 and pChk1. The message conveyed by the present analysis is that biomarkers of DNA damage and repair may predict the efficacy of neoadjuvant chemotherapy in cervical cancer. Further studies are warranted to prospectively validate these encouraging findings.

  18. Satisfaction, function and repair integrity after arthroscopic versus mini-open rotator cuff repair.

    Science.gov (United States)

    Barnes, L A Fink; Kim, H M; Caldwell, J-M; Buza, J; Ahmad, C S; Bigliani, L U; Levine, W N

    2017-02-01

    Advances in arthroscopic techniques for rotator cuff repair have made the mini-open approach less popular. However, the mini-open approach remains an important technique for repair for many surgeons. The aims of this study were to compare the integrity of the repair, the function of the shoulder and satisfaction post-operatively using these two techniques in patients aged > 50 years. We identified 22 patients treated with mini-open and 128 patients treated with arthroscopic rotator cuff repair of July 2007 and June 2011. The mean follow-up was two years (1 to 5). Outcome was assessed using the American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test (SST) scores, and satisfaction. The integrity of the repair was assessed using ultrasonography. A power analysis ensured sufficient enrolment. There was no statistically significant difference between the age, function, satisfaction, or pain scores (p > 0.05) of the two groups. The integrity of the repair and the mean SST scores were significantly better in the mini-open group (91% of mini-open repairs were intact versus 60% of arthroscopic repairs, p = 0.023; mean SST score 10.9 (standard deviation (sd) 1.3) in the mini-open group; 8.9 (sd 3.5) in arthroscopic group; p = 0.003). The ASES scores were also higher in the mini-open group (mean ASES score 91.0 (sd 10.5) in mini-open group; mean 82.70 (sd 19.8) in the arthroscopic group; p = 0.048). The integrity of the repair and function of the shoulder were better after a mini-open repair than after arthroscopic repair of a rotator cuff tear in these patients. The functional difference did not translate into a difference in satisfaction. Mini-open rotator cuff repair remains a useful technique despite advances in arthroscopy. Cite this article: Bone Joint J 2017;99-B:245-9. ©2017 The British Editorial Society of Bone & Joint Surgery.

  19. Influence of different palate repair protocols on facial growth in unilateral complete cleft lip and palate.

    Science.gov (United States)

    Xu, Xue; Kwon, Hyuk-Jae; Shi, Bing; Zheng, Qian; Yin, Heng; Li, Chenghao

    2015-01-01

    To address the question of whether one- or two-stage palatal treatment protocol has fewer detrimental effects on craniofacial growth in patients aged 5 years with unilateral complete cleft lip and palate. Forty patients with non-syndromic unilateral complete cleft lip and palate (UCCLPs) who had received primary cleft lip repair at age 6-12 months and cleft palate repair at age 18-30 months were selected in this study. Eighteen UCCLP patients who received two-stage palate repair were selected as group 1, and 22 UCCLP patients who received one-stage palate repair were selected as group 2. The control group consisted of 20 patients with unilateral incomplete cleft lip (UICL patients) whose age and gender matched with UCCLP patients. A one-sample Kolmogorov-Smirnov test was used to analyze the nature of data distribution. Bonferroni test and Kruskal-Wallis H tests were used for multiple comparisons. Both case groups showed reduced maxillary sagittal length (ANS-PMP, A-PM, p palate repair had a reduced posterior maxillary vertical height (R-PMP, p palate repair. Vomer flap repair inhibited maxilla vertical growth. Delayed hard palate repair showed less detrimental effects on maxillary growth compared to early hard palate repair in UCCLP patients aged 5 years. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  20. Abdominal Wall Hernia in Complex Patients incidences, risk factors and timing of repair

    NARCIS (Netherlands)

    J. Verhelst (Joost)

    2016-01-01

    markdownabstractThis thesis consists of two parts: __part 1__ describes a new prosthesis for the treatment of large and complex incisional hernia. Furthermore the natural course and consequences of conservative treatment are described; __part 2__ focusses on three complex groups of patients wit

  1. The Effectiveness of Structured Group Education on Ankylosing Spondylitis Patients.

    Science.gov (United States)

    Kasapoglu Aksoy, Meliha; Birtane, Murat; Taştekin, Nurettin; Ekuklu, Galip

    2017-04-01

    Ankylosing spondylitis (AS) is a common inflammatory rheumatic disease that affects the axial skeleton which can lead to structural and functional impairments. It has a negative impact on the person's daily life activities. Early diagnosis, exercise and patient education are factors playing a major role on prognosis. The purpose of the study was to compare the structured theoretical and exercise educational program with routine clinic educational efforts on the parameters of the disorder over a 3 month follow up. This randomized, educational intervention study was performed on 41 AS patients. A 5 day structured education and exercise program was applied to the first group of patients (Group 1) in subgroups consisting 4-5 patients each. Patients had group exercises throughout the education program. The second group followed routine clinical care. The effectiveness of the treatment was assessed by Bath ankylosing spondylitis functional (BASFI), Bath ankylosing spondylitis disease activity (BASDAI), Bath ankylosing spondylitis global (BAS-G), Bath ankylosing spondylitis metrology indices (BASMI), chest expansion, short form-36 (SF-36), ankylosing spondylitis quality of life scale (ASQoL) and laboratory parameters in all patients. Patients were evaluated on initiation and after 3 months. Significant improvements in BASFI, BASDAI and BAS-G, chest expansion, SF-36 and ASQoL indices were observed in Group 1 No difference could be found in BASMI and chest expansion. A structured educational and exercise intervention had a positive effect on the functional status,disease activity, and general well-being and quality of life. It also, shows that education programs should be within the routine treatment program for AS.

  2. Edge-to-edge chordal transfer repair for anterior leaflet prolapse of mitral valve in 21 patients

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jian-qun; CHI Li-qun; KONG Qing-yu; ZHENG Si-hong; XIAO Wei

    2010-01-01

    Background Repair of anterior mitral leaflet (AML) prolapse is still a technical challenge for cardiac surgeons. It is an important issue to find a way to repair the AML prolapse with a reliable and reproducible technique.Methods Between January 2002 and June 2009, the operation of chordal transfer based on the "edge-to-edge"technique was performed in 21 patients with serious mitral valve regurgitation because of prolapse of the anterior leaflet.After the operation, echocardiography was performed in each patient before discharge and at the time of follow-up.Results All patients survived the operation. One patient required mitral valve replacement because of anterior leaflet perforation 3 days after the operation. The other patients were free from reoperation. At the time of follow-up, all these patients were in New York Heart Association (NYHA) functional class I. In all these patients, pre-discharge and follow-up echocardiography showed neither stenosis nor significant regurgitation of the mitral valve: the cross-sectional area of the mitral valve was 3.3-4.8 cm2 (mean (3.78:±0.52) cm2), the mean regurgitation area was (0.45:±0.22) cm2. At the same time, both dimension of left atrium and left ventricle reduced significantly (left atrium diameter: pre-operation (48.26±11.12) mm, post-operation (37.57±9.56) mm, P <0.05; the end-diastolic diameter of the left ventricle:pre-operation (61.43±8.24) mm, post-operation (42.35±10.79) mm, P<0.01).Conclusion "Edge-to-edge" chordal transfer technique is a simple, reliable, and reproducible technique that can provide good results for repair of anterior leaflet prolapse of mitral valve.

  3. Clinical features and mismatch repair gene mutation screening in Chinese patients with hereditary nonpolyposis colorectal carcinoma

    Institute of Scientific and Technical Information of China (English)

    Shan-Run Liu; Bo Zhao; Zhen-Jun Wang; Yuan-Lian Wan; Yan-Ting Huang

    2004-01-01

    AIM: Hereditary nonpolyposis colorectal cancer (HNPCC) is an autosomal dominantly- inherited cancer-susceptibility syndrome that confers an increased risk for colorectal cancer and a variety of other tumors at a young age. It has been associated with germline mutations in five mismatch repair (MMR) genes (hMSH2, hMLH1, hPMS1, hPMS2, and hMSH6/GTBP). The great majority of germline mutations were found in hMSH2 and hMLH1. The purpose of this study was to analyze the clinical features of Chinese HNPCC patients and to screen hMSH2 and hMLH1 gene mutations. METHODS: Twenty-eight independent Chinese families were collected, of which 15 met Amsterdam criteria I and 13 met the Japanese clinical diagnosis criteria. The data were recorded including sex, site of colorectal cancer (CRC),age of diagnosis, history of synchronous and/or metachronous CRC, instance of extracolonic cancers, and histopathology of tumors. Peripheral blood samples were collected from all pedigrees after formal written consents were signed. PCR and denaturing high-performance liquid chromatography (DHPLC) were used to screen the coding regions of hMSH2 and hMLH1 genes. The samples showing abnormal DHPLC profiles were sequenced by a 377 DNA sequencer.RESULTS: One hundred and seventy malignant neoplasms were found in one hundred and twenty-six patients (multiple cancer in twenty-three), including one hundred and twentyseven CRCs, fifteen gastric, seven endometrial, and five esophageal cancers. Seventy-seven point eight percent of the patients had CRCs, sharing the features of early occurrence (average age of onset, 45.9 years) and of the right-sided predominance reported in the literature. In Chinese HNPCC patients, gastric cancer occurred more frequently, accounting for 11.9% of all cancers patients and ranking second in the spectrum of HNPCC predisposing cancers. Synchronous CRCs occurred less frequently, only accounting for 3.1% of the total CRCs. Twenty percent of the colorectal patients had

  4. Pharmacogenetic Study in Rectal Cancer Patients Treated With Preoperative Chemoradiotherapy: Polymorphisms in Thymidylate Synthase, Epidermal Growth Factor Receptor, GSTP1, and DNA Repair Genes

    Energy Technology Data Exchange (ETDEWEB)

    Paez, David, E-mail: dpaez@santpau.cat [Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona (Spain); Salazar, Juliana; Pare, Laia [Centre for Biomedical Network Research on Rare Diseases, Barcelona (Spain); Department of Genetics, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona (Spain); Pertriz, Lourdes [Department of Radiotherapy, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona (Spain); Targarona, Eduardo [Department of Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona (Spain); Rio, Elisabeth del [Centre for Biomedical Network Research on Rare Diseases, Barcelona (Spain); Department of Genetics, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona (Spain); Barnadas, Agusti; Marcuello, Eugenio [Department of Medical Oncology, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona (Spain); Baiget, Montserrat [Centre for Biomedical Network Research on Rare Diseases, Barcelona (Spain); Department of Genetics, Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona (Spain)

    2011-12-01

    Purpose: Several studies have been performed to evaluate the usefulness of neoadjuvant treatment using oxaliplatin and fluoropyrimidines for locally advanced rectal cancer. However, preoperative biomarkers of outcome are lacking. We studied the polymorphisms in thymidylate synthase, epidermal growth factor receptor, glutathione S-transferase pi 1 (GSTP1), and several DNA repair genes to evaluate their usefulness as pharmacogenetic markers in a cohort of 128 rectal cancer patients treated with preoperative chemoradiotherapy. Methods and Materials: Blood samples were obtained from 128 patients with Stage II-III rectal cancer. DNA was extracted from the peripheral blood nucleated cells, and the genotypes were analyzed by polymerase chain reaction amplification and automated sequencing techniques or using a 48.48 dynamic array on the BioMark system. The germline polymorphisms studied were thymidylate synthase, (VNTR/5 Prime UTR, 2R G>C single nucleotide polymorphism [SNP], 3R G>C SNP), epidermal growth factor receptor (Arg497Lys), GSTP1 (Ile105val), excision repair cross-complementing 1 (Asn118Asn, 8092C>A, 19716G>C), X-ray repair cross-complementing group 1 (XRCC1) (Arg194Trp, Arg280His, Arg399Gln), and xeroderma pigmentosum group D (Lys751Gln). The pathologic response, pathologic regression, progression-free survival, and overall survival were evaluated according to each genotype. Results: The Asterisk-Operator 3/ Asterisk-Operator 3 thymidylate synthase genotype was associated with a greater response rate (pathologic complete remission and microfoci residual tumor, 59% in Asterisk-Operator 3/ Asterisk-Operator 3 vs. 35% in Asterisk-Operator 2/ Asterisk-Operator 2 and Asterisk-Operator 2/ Asterisk-Operator 3; p = .013). For the thymidylate synthase genotype, the median progression-free survival was 103 months for the Asterisk-Operator 3/ Asterisk-Operator 3 patients and 84 months for the Asterisk-Operator 2/ Asterisk-Operator 2 and Asterisk-Operator 2/ Asterisk

  5. Nationwide prevalence of groin hernia repair.

    Directory of Open Access Journals (Sweden)

    Jakob Burcharth

    Full Text Available INTRODUCTION: Groin hernia repair is a commonly performed surgical procedure in the western world but large-scaled epidemiologic data are sparse. Large-scale data on the occurrence of groin hernia repair may provide further understanding to the pathophysiology of groin hernia development. This study was undertaken to investigate the age and gender dependent prevalence of groin hernia repair. METHODS: In a nationwide register-based study, using data from the Civil Registration System covering all Danish citizens, we established a population-based cohort of all people living in Denmark on December 31(st, 2010. Within this population all groin hernia repairs during the past 5 years were identified using data from the ICD 10(th edition in the Danish National Hospital Register. RESULTS: The study population covered n = 5,639,885 persons. During the five years study period 46,717 groin hernia repairs were performed (88.6% males, 11.4% females. Inguinal hernias comprised 97% of groin hernia repairs (90.2% males, 9.8% females and femoral hernias 3% of groin hernia repairs (29.8% males, 70.2% females. Patients between 0-5 years and 75-80 years constituted the two dominant groups for inguinal hernia repair. In contrast, the age-specific prevalence of femoral hernia repair increased steadily throughout life peaking at age 80-90 years in both men and women. CONCLUSION: The age distribution of inguinal hernia repair is bimodal peaking at early childhood and old age, whereas the prevalence of femoral hernia repair increased steadily throughout life. This information can be used to formulate new hypotheses regarding disease etiology with regard to age and gender specifications.

  6. Liposomal bupivacaine infiltration into the transversus abdominis plane for postsurgical analgesia in open abdominal umbilical hernia repair: results from a cohort of 13 patients

    Directory of Open Access Journals (Sweden)

    Feierman DE

    2014-08-01

    Full Text Available Dennis E Feierman, Mark Kronenfeld, Piyush M Gupta, Natalie Younger, Eduard Logvinskiy Department of Anesthesiology, Maimonides Medical Center, Brooklyn, NY, USA Background: Achieving adequate control of postsurgical pain remains a challenge in patients undergoing abdominal surgery. Transversus abdominis plane (TAP infiltration has been shown to provide postsurgical analgesia following lower abdominal surgery. We assessed the safety and efficacy of a prolonged-release liposomal formulation of the local anesthetic bupivacaine administered via infiltration into the TAP in a cohort of patients undergoing open abdominal umbilical hernia repair. Methods: Patients included in the study were 18–75 years of age, had American Society of Anesthesiologists physical classification status 1–3, and underwent open abdominal umbilical hernia repair with ultrasound-guided TAP infiltration immediately after surgery using an equal-volume bilateral infusion of liposomal bupivacaine 266 mg (diluted to 30 mL in normal saline. Outcome measures included patient-reported pain intensity (11-point numeric rating scale, satisfaction with postsurgical analgesia (5-point Likert scale, incidence of opioid-related adverse events, and time to first use of supplemental rescue analgesia. Results: Thirteen patients underwent surgery and received bilateral TAP infiltration with liposomal bupivacaine; TAP infiltration failed in the first patient. Mean numeric rating scale pain scores were 0.6 immediately before TAP infiltration and remained 2.3 through 120 hours after infiltration; mean scores at 120 hours and 10 days were 0.9 and 0.4, respectively. Ten patients (77% required supplemental analgesia; median time to first use was 11 hours. At discharge and day 10, 54% and 62% of patients, respectively, were “extremely satisfied” with postsurgical analgesia (Likert score 5. There were no opioid-related or other adverse events. Conclusion: Although the current study was

  7. Systemic biomarkers of neutrophilic inflammation, tissue injury and repair in COPD patients with differing levels of disease severity.

    Directory of Open Access Journals (Sweden)

    Debra A Cockayne

    Full Text Available The identification and validation of biomarkers to support the assessment of novel therapeutics for COPD continues to be an important area of research. The aim of the current study was to identify systemic protein biomarkers correlated with measures of COPD severity, as well as specific protein signatures associated with comorbidities such as metabolic syndrome. 142 protein analytes were measured in serum of 140 patients with stable COPD, 15 smokers without COPD and 30 non-smoking controls. Seven analytes (sRAGE, EN-RAGE, NGAL, Fibrinogen, MPO, TGF-α and HB-EGF showed significant differences between severe/very severe COPD, mild/moderate COPD, smoking and non-smoking control groups. Within the COPD subjects, univariate and multivariate analyses identified analytes significantly associated with FEV(1, FEV(1/FVC and DLCO. Most notably, a set of 5 analytes (HB-EGF, Fibrinogen, MCP-4, sRAGE and Sortilin predicted 21% of the variability in DLCO values. To determine common functions/pathways, analytes were clustered in a correlation network by similarity of expression profile. While analytes related to neutrophil function (EN-RAGE, NGAL, MPO grouped together to form a cluster associated with FEV(1 related parameters, analytes related to the EGFR pathway (HB-EGF, TGF-α formed another cluster associated with both DLCO and FEV(1 related parameters. Associations of Fibrinogen with DLCO and MPO with FEV(1/FVC were stronger in patients without metabolic syndrome (r  =  -0.52, p  =  0.005 and r  =  -0.61, p =  0.023, respectively compared to patients with coexisting metabolic syndrome (r  =  -0.25, p  =  0.47 and r  =  -0.15, p  =  0.96, respectively, and may be driving overall associations in the general cohort. In summary, our study has identified known and novel serum protein biomarkers and has demonstrated specific associations with COPD disease severity, FEV(1, FEV(1/FVC and DLCO. These data highlight systemic

  8. [Identification and grouping of pain patients according to claims data].

    Science.gov (United States)

    Freytag, A; Schiffhorst, G; Thoma, R; Strick, K; Gries, C; Becker, A; Treede, R-D; Müller-Schwefe, G; Casser, H-R; Luley, C; Höer, A; Ujeyl, M; Gothe, H; Kugler, J; Glaeske, G; Häussler, B

    2010-02-01

    The ICD classification does not provide the opportunity to adequately identify pain patients. Therefore we developed an alternative method for the identification and classification of pain patients which is based on prescription and diagnoses data from the year 2006 of one nationwide sickness fund (DAK) and which is led by two main assumptions: 1. Beneficiaries without prescription of an analgetic drug but with a diagnosis pattern that is characteristic of patients who are treated with opioids are also likely to be pain patients. 2. Each combination of diagnosis groups can be traced back to one primary diagnosis out of a diagnosis group according to the patient classification system CCS (Clinical Classifications Software). The selection of this diagnosis group (CCS) allows for the allocation of the beneficiary to only one pain type. As a result we identified 65 combinations of CCS diagnosis groups--aggregated to nine "CCS pain types"--to which 77.1% of all patients with at least two opioid prescriptions can be allocated: 26.3% to pain due to arthrosis, 18.0% to pain due to intervertebral disc illnesses, 13.1% to other specific back pain, 6.7% to neuropathic pain, 4.5% to unspecific back pain, 4.2% to headache, 2.4% to pain after traumatic fractures, 1.3% to pain of multimorbid, high-maintenance patients, and 0.6% to cancer pain. Based on our method beneficiaries who have a high probability of suffering from moderate to strong pain can be identified and included in further claims data analyses of health care delivery and utilization pattern of pain-related disorders in Germany.

  9. "The group facilitates everything": meanings patients with type 2 diabetes mellitus assigned to health education groups.

    Science.gov (United States)

    de Melo, Lucas Pereira; de Campos, Edemilson Antunes

    2014-01-01

    to interpret the meanings patients with type 2 diabetes mellitus assign to health education groups. ethnographic study conducted with Hyperdia groups of a healthcare unit with 26 informants, with type 2 diabetes mellitus, and having participated in the groups for at least three years. Participant observation, social characterization, discussion groups and semi-structured interviews were used to collect data. Data were analyzed through the thematic coding technique. four thematic categories emerged: ease of access to the service and healthcare workers; guidance on diabetes; participation in groups and the experience of diabetes; and sharing knowledge and experiences. The most relevant aspect of this study is the social use the informants in relation to the Hyperdia groups under study. the studied groups are agents producing senses and meanings concerning the process of becoming ill and the means of social navigation within the official health system. We expect this study to contribute to the actions of healthcare workers coordinating these groups given the observation of the cultural universe of these individuals seeking professional care in the various public health care services.

  10. "The group facilitates everything": meanings patients with type 2 diabetes mellitus assigned to health education groups

    Directory of Open Access Journals (Sweden)

    Lucas Pereira de Melo

    2014-12-01

    Full Text Available OBJECTIVE: to interpret the meanings patients with type 2 diabetes mellitus assign to health education groups.METHOD: ethnographic study conducted with Hyperdia groups of a healthcare unit with 26 informants, with type 2 diabetes mellitus, and having participated in the groups for at least three years. Participant observation, social characterization, discussion groups and semi-structured interviews were used to collect data. Data were analyzed through the thematic coding technique.RESULTS: four thematic categories emerged: ease of access to the service and healthcare workers; guidance on diabetes; participation in groups and the experience of diabetes; and sharing knowledge and experiences. The most relevant aspect of this study is the social use the informants in relation to the Hyperdia groups under study.CONCLUSION: the studied groups are agents producing senses and meanings concerning the process of becoming ill and the means of social navigation within the official health system. We expect this study to contribute to the actions of healthcare workers coordinating these groups given the observation of the cultural universe of these individuals seeking professional care in the various public health care services.

  11. Operator Semi-group of Density Evolution Equation for a Repairable Redundant System with Two Same Components%可修冗余系统密度演化方程的算子半群

    Institute of Scientific and Technical Information of China (English)

    史定华; 徐洪; 熊勇; 王远第

    2002-01-01

    For a repairable redundant system consisting of two same components with exponential lifetime and general repair time distribution, the probability densities of the system in some state at time t were determined by a group of ordinary and partial differential equations, called density evolution equations. It was proved that the time-dependent solution of the density evolution equations uniquely exists and strongly converges to its steady state density solution by a semi-group method. In this proof, it is not necessary to suppose that the repair rate function is bounded. The technique of the proof is valuable for many density evolution equations.

  12. The advantages of "Dance-group" for psychotic patients.

    Science.gov (United States)

    Tavormina, Romina; Tavormina, Maurilio Giuseppe Maria; Nemoianni, Eugenio

    2014-11-01

    Psychosocial rehabilitation and in particular group dances allow the recovery of lost or compromised ability of patients with mental illness, and they facilitate their reintegration into the social context. The dance group has enabled users of the Day Centre of the Unit of Mental Health Torre del Greco ASL NA 3 south to achieve the objectives of rehabilitation such as: taking care of themselves, of their bodies and their interests, improving self-esteem , the management of pathological emotions, socialization and integration, overcoming the psychotic closing and relational isolation. In particular, patients with schizophrenia, psychotic and mood disorders had a concrete benefit from such rehabilitation activities, facilitating interpersonal relationships, therapy compliance and significantly improved mood, quality of life, providing them with the rhythm and the security in their relationship with each other. The dance group and for some individuals, also psychotherapy and drug therapy, have facilitated social inclusion, improved the quality of life and cured their diseases. The work is carrying out in a group with patients, practitioners, family members, volunteers, social community workers, following the operating departmental protocols. Using the chorus group "Sing that you go" as an operational tool for psychosocial rehabilitation and therapeutic element we promote the psychological well-being and the enhancement of mood.

  13. Acute Kidney Injury Classification in Neuro-ICU Patient Group

    Directory of Open Access Journals (Sweden)

    Canan Akıncı

    2012-12-01

    Full Text Available Objective: To investigate the role of acute kidney injury (AKI classification system for kidney injury outcome in neuro-Intensive care unit (ICU patients. Material and Method: Total 432 patients who admitted to ICU between 2005 and 2009 evaluated in this study. All patients’ AKI stage, Acute Physiology and Chronic Health Evaluation (APACHE-II, Sequential Organ Failure Assessment Score (SOFA, Glasgow Coma Score (GCS, Glasgow Outcome Score (GOS, mortality rate, length of ICU stay, need for intubation, and mechanical ventilation were recorded. Results: AKI was found in 24 of all 432 patents’ (5.5%. We found that, patients with AKI had higher APHACE-II score, SOFA score and mortality rates; longer ICU stay, duration of mechanical ventilation and intubation and lower GCS and GOS than without AKI group. Conclusion: Length of ICU stay and mortality rate were higher in AKI positive group.

  14. Arthroscopic Bristow-Latarjet combined with bankart repair restores shoulder stability in patients with glenoid bone loss.

    Science.gov (United States)

    Boileau, Pascal; Thélu, Charles-Édouard; Mercier, Numa; Ohl, Xavier; Houghton-Clemmey, Robert; Carles, Michel; Trojani, Christophe

    2014-08-01

    Arthroscopic Bankart repair alone cannot restore shoulder stability in patients with glenoid bone loss involving more than 20% of the glenoid surface. Coracoid transposition to prevent recurrent shoulder dislocation according to Bristow-Latarjet is an efficient but controversial procedure. We determined whether an arthroscopic Bristow-Latarjet procedure with concomitant Bankart repair (1) restored shoulder stability in this selected subgroup of patients, (2) without decreasing mobility, and (3) allowed patients to return to sports at preinjury level. We also evaluated (4) bone block positioning, healing, and arthritis and (5) risk factors for nonunion and coracoid screw pullout. Between July 2007 and August 2010, 79 patients with recurrent anterior instability and bone loss of more than 20% of the glenoid underwent arthroscopic Bristow-Latarjet-Bankart repair; nine patients (11%) were either lost before 2-year followup or had incomplete data, leaving 70 patients available at a mean of 35 months. Postoperative radiographs and CT scans were evaluated for bone block positioning, healing, and arthritis. Any postoperative dislocation or any subjective complaint of occasional to frequent subluxation was considered a failure. Physical examination included ROM in both shoulders to enable comparison and instability signs (apprehension and relocation tests). Rowe and Walch-Duplay scores were obtained at each review. Patients were asked whether they were able to return to sports at the same level and practice forced overhead sports. Potential risk factors for nonhealing were assessed. At latest followup, 69 of 70 (98%) patients had a stable shoulder, external rotation with arm at the side was 9° less than the nonoperated side, and 58 (83%) returned to sports at preinjury level. On latest radiographs, 64 (91%) had no osteoarthritis, and bone block positioning was accurate, with 63 (90%) being below the equator and 65 (93%) flush to the glenoid surface. The coracoid graft

  15. Outcome and survival of patients aged 75 years and older compared to younger patients after ruptured abdominal aortic aneurysm repair: do the results justify the effort?

    DEFF Research Database (Denmark)

    Shahidi, S; Schroeder, T Veith; Carstensen, M.

    2009-01-01

    on prospectively registered data. The protocol was an "all-comers" policy. Seventy-two patients, who were operated on for RAAA in our department from January 1, 2005, to December 30, 2005, are included in this study. The follow-up time of survivors was 1 year. We defined 75-year-old patients as elderly because...... the only significant (p believe that treatment for RAAA can be justified in elderly patients. In our experience, surgical open repair has been life-saving in 33% of patients aged 75 years and older, at a relatively low price for each...

  16. Does a multidisciplinary diabetes group education visit improve patient outcomes?

    Science.gov (United States)

    O'Dell, Kristi J; O'Dell, Michael L; Taylor, James L

    2009-12-01

    Diabetes is a significant and growing public health concern, and patient education is the primary approach for self-management. The objective of this study is to assess the impact of a single session diabetes group education intervention. The design is a one-group pretest/posttest evaluation. Participants were adult outpatients with diabetes who attended a single session group education visit and volunteered to participate in the study. Survey questions include the Single Item Literacy Screener and diabetes knowledge questions. The survey was mailed and collected before the group visit. Diabetes knowledge was collected immediately after the group visit and again by telephone one to four months later. Hemoglobin A1c (HbA1c), lipids, and blood pressure were collected from the patient electronic medical record before and, where available, three months after the group visit. Data analysis includes descriptive statistics and Students t-testing to determine pre- and posttest differences of diabetes knowledge and physiological markers. Thirty-eight adult outpatients participated in the study. Nearly half responded that they never needed to have someone help with written medical materials. There was a significant increase from pretest to immediate posttest diabetes knowledge scores (N = 3; M = 5.58 to M = 7.53 out of 10), t(38) = -5.217, p = education (M = 9.16 to M = 8.52), t(27) = 2.185, p = .038. A single session diabetes group education visit is effective in increasing patients' diabetes knowledge and decreasing HbA1c levels.

  17. Modified CPB circuit for postoperative rescue of high-risk patients following cardiac repair: are we keeping safe?

    Science.gov (United States)

    Pizarro, Christian; Duncan, Daniel; Derby, Christopher D; Kerins, Paul

    2006-01-01

    Extracorporeal membrane oxygenation (ECMO) is commonly used to treat postcardiotomy cardiopulmonary dysfunction in small children. System readiness, need for additional blood products, and exposure to new surfaces are important considerations, particularly when used for resuscitation. We reviewed our experience with a cardiopulmonary bypass (CPB) system modified to provide extended circulatory support system after surgery in patients considered at high risk. When not used in the operating room, the system was recirculated for 24 hours. Before being discarded, blood samples were obtained for activated clotting time, arterial blood gas, and blood cultures from 10 circuits. Between January 2004, and December 2005, 44 patients underwent cardiac repair using this CPB system. ECMO support was initiated in the operating room in 8 patients, and six circuits were used after patient arrival in the intensive care unit. Blood sampling after 24 hours on standby circuits revealed acceptable values for pH, Pao2, hematocrit, ionized calcium, potassium level, and ACT. All blood cultures were negative at 5 days. Survival for patients who received a circuit on standby was 64%.This modified cardiopulmonary circuit can be transformed into a simple, safe, and effective ECMO support system. Deployment of a CPB circuit previously used for cardiac repair has many advantages and maximizes utilization of resources.

  18. Long-term results of modified sandwich repair of aortic root in 151 patients with acute type A aortic dissection.

    Science.gov (United States)

    Tang, Yangfeng; Liao, Zilin; Han, Lin; Tang, Hao; Song, Zhigang; Xu, Zhiyun

    2017-07-01

    Acute type A aortic dissection frequently induces aortic root disease; however, the optimal surgical strategy for aortic root dissection remains a challenge. The objective of this study was to introduce a novel technique for reconstruction of type A dissection to improve patient prognosis. We performed a retrospective review of 791 consecutive patients with acute type A aortic dissection between January 2003 and July 2015. Among these patients, 151 were selected (72% men, age 51.7 ± 9.8 years) to have the modified sandwich repair of aortic root dissection. The in-hospital mortality rate of the 151 patients was 6.6% (10/151). During a mean follow-up period of 52.7 ± 28.6 months, the survival rate was 100, 89.1 and 69.7% at 1, 5 and 10 years, respectively. Echocardiography and computed tomographic angiography were performed every year to monitor the pathological change in the aortic root. Freedom from severe aortic regurgitation at 5 years was 100%. No patients required reintervention due to dissection or pseudoaneurysm of the proximal aortic root. Aortic valve resuspension and repair of the sinus of Valsalva with the modified sandwich technique using Teflon felt strips for acute type A dissection could be reliable and effective.

  19. Endothelium dependent vasomotion and in vitro markers of endothelial repair in patients with severe sepsis: an observational study.

    Directory of Open Access Journals (Sweden)

    Sabrina H van Ierssel

    Full Text Available BACKGROUND: Outcome in sepsis is mainly defined by the degree of organ failure, for which endothelial dysfunction at the macro- and microvascular level is an important determinant. In this study we evaluated endothelial function in patients with severe sepsis using cellular endothelial markers and in vivo assessment of reactive hyperaemia. MATERIALS AND METHODS: Patients with severe sepsis (n = 30 and 15 age- and gender- matched healthy volunteers were included in this study. Using flow cytometry, CD34+/KDR+ endothelial progenitor cells (EPC, CD31+ T-cells, and CD31+/CD42b- endothelial microparticles (EMP were enumerated. Migratory capacity of cultured circulating angiogenic cells (CAC was assessed in vitro. Endothelial function was determined using peripheral arterial tonometry at the fingertip. RESULTS: In patients with severe sepsis, a lower number of EPC, CD31+ T-cells and a decreased migratory capacity of CAC coincided with a blunted reactive hyperaemia response compared to healthy subjects. The number of EMP, on the other hand, did not differ. The presence of organ failure at admission (SOFA score was inversely related with the number of CD31+ T-cells. Furthermore, the number of EPC at admission was decreased in patients with progressive organ failure within the first week. CONCLUSION: In patients with severe sepsis, in vivo measured endothelial dysfunction coincides with lower numbers and reduced function of circulating cells implicated in endothelial repair. Our results suggest that cellular markers of endothelial repair might be valuable in the assessment and evolution of organ dysfunction.

  20. The echocardiographic paradox index in patients with a repaired tetralogy of Fallot.

    Science.gov (United States)

    Lee, Sang-Yun; Song, Jinyoung; Kim, Sung-Ho; Jang, So-Ick; Kim, Yang-Min

    2014-04-01

    Right ventricular (RV) volume is very important for pulmonary valve replacement after the total correction of tetralogy of Fallot (TOF), and we attempted to identify a convenient echocardiographic index that is well correlated with the volumetric data obtained through magnetic resonance imaging (MRI). All patients who underwent cardiac MRI and echocardiography at Sejong General Hospital for evaluating pulmonary regurgitation after TOF total correction were included. The paradox index is the amount of paradoxical motion of the interventricular septum on the short-axis echocardiographic view. The paradox index was compared to several cardiac MRI indices. Fifty-four patients were included. The paradox index for all patients was 1.22 ± 0.12 (1.06-1.67), and the index of the operation group was significantly higher than that of the non-operation group (1.26 ± 1.12 vs 1.16 ± 1.12, P = 0.009). The paradox index was well correlated with the RV systolic and diastolic volumes, as measured by cardiac MRI (P = 0.002 and 0.003). Using a simple linear regression analysis, a paradox index of 1.24 corresponded to a RV diastolic volume of 160 ml/m(2). The paradox index could help to indicate the time for an MRI analysis of the RV volume in patients after TOF total correction.

  1. Group G streptococcal myositis in a patient with myeloproliferative neoplasm

    Directory of Open Access Journals (Sweden)

    Monica Midha, MD MBS

    2016-01-01

    Full Text Available While many cases of streptococcal infection are due to Lancefield groups A and B, there has been a rise in reported cases of infections due to group G streptococcus. We present a case of an individual with a hematologic malignancy who developed myositis secondary to group G streptococcus, with no clearly identifiable source of infection. The patient was managed with antibiotic therapy rather than surgical intervention due to high surgical risk related to severe thrombocytopenia. Targeted antibiotics initiated early in the course of disease may prevent the need for surgical intervention. Early diagnosis and treatment are critical to avoid the high morbidity and mortality of life-threatening infections caused by group G streptococcus.

  2. Symptomatic and quality of life outcomes after site-specific fascial reattachment for pelvic organ prolapse repair.

    Science.gov (United States)

    Fayyad, Abdalla M; Redhead, Emma; Awan, Noveen; Kyrgiou, Maria; Prashar, Sanjeev; Hill, Simon R

    2008-02-01

    The aim of this study was to assess symptomatic and quality of life outcome scores following site specific fascial reattachment surgery for pelvic organ prolapse using the validated Prolapse Quality of Life (P-QOL) questionnaires. One hundred and ninety two women underwent surgery for pelvic organ prolapse; ninety four underwent anterior repair (thirty four of them had vaginal hysterectomy), and ninety eight had posterior repair. Patients filled P-QOL questionnaires 24 hours prior to surgery and a postal P-QOL questionnaire six months post operatively. Pre and post operative questionnaires were paired. Quality of life and symptoms scores were calculated using Wilcoxon signed rank test. One hundred and one women returned their questionnaires and were suitable to include in the study. Forty nine underwent anterior repair (fifteen had vaginal hysterectomy) and 52 underwent posterior repair. Quality of life scores showed significant improvement in the anterior and posterior repair groups with the exception of general health in the anterior repair group and general health and prolapse impact in the posterior repair group. Anterior repair significantly improved urinary voiding and storage symptoms. Posterior repair group showed significant improvement in defecatory symptoms. Both groups showed improvement in sexual function and general prolapse symptoms. Prolapse repair with site specific fascial reattachment results in significant improvement in quality of life scores six months after surgery. Anterior repair improves urinary voiding and storage symptoms and posterior repair improves defecatory dysfunction and urinary voiding. Sexual function improves following prolapse repair with site specific fascial reattachment.

  3. Mislocalization of XPF-ERCC1 nuclease contributes to reduced DNA repair in XP-F patients.

    Directory of Open Access Journals (Sweden)

    Anwaar Ahmad

    2010-03-01

    Full Text Available Xeroderma pigmentosum (XP is caused by defects in the nucleotide excision repair (NER pathway. NER removes helix-distorting DNA lesions, such as UV-induced photodimers, from the genome. Patients suffering from XP exhibit exquisite sun sensitivity, high incidence of skin cancer, and in some cases neurodegeneration. The severity of XP varies tremendously depending upon which NER gene is mutated and how severely the mutation affects DNA repair capacity. XPF-ERCC1 is a structure-specific endonuclease essential for incising the damaged strand of DNA in NER. Missense mutations in XPF can result not only in XP, but also XPF-ERCC1 (XFE progeroid syndrome, a disease of accelerated aging. In an attempt to determine how mutations in XPF can lead to such diverse symptoms, the effects of a progeria-causing mutation (XPF(R153P were compared to an XP-causing mutation (XPF(R799W in vitro and in vivo. Recombinant XPF harboring either mutation was purified in a complex with ERCC1 and tested for its ability to incise a stem-loop structure in vitro. Both mutant complexes nicked the substrate indicating that neither mutation obviates catalytic activity of the nuclease. Surprisingly, differential immunostaining and fractionation of cells from an XFE progeroid patient revealed that XPF-ERCC1 is abundant in the cytoplasm. This was confirmed by fluorescent detection of XPF(R153P-YFP expressed in Xpf mutant cells. In addition, microinjection of XPF(R153P-ERCC1 into the nucleus of XPF-deficient human cells restored nucleotide excision repair of UV-induced DNA damage. Intriguingly, in all XPF mutant cell lines examined, XPF-ERCC1 was detected in the cytoplasm of a fraction of cells. This demonstrates that at least part of the DNA repair defect and symptoms associated with mutations in XPF are due to mislocalization of XPF-ERCC1 into the cytoplasm of cells, likely due to protein misfolding. Analysis of these patient cells therefore reveals a novel mechanism to potentially

  4. [ABO system blood group ratios in patients with neuroinfections].

    Science.gov (United States)

    Rudometov, Iu P; Umanskiĭ, K G; Ashmarina, E E; Andreeva, L S

    1981-01-01

    The distribution of the ABO blood groups in 2009 patients including 1441 ones suffering from etiologically diverse neuroinfections was studied. Certain correlations between the nosological forms and groups of the diseases on the one hand, and the blood factors on the other are demonstrated. The data obtained point to a certain role of hereditary predisposition in the genesis of the neuroinfections. This predisposition predetermines the risk of the illnesses and the gravity of their course, the fact, which is of a practical importance for the clinician.

  5. Specific patient-related prognostic factors for rotator cuff repair : a systematic review

    NARCIS (Netherlands)

    Heerspink, Frederik O. Lambers; Dorrestijn, Oscar; van Raay, Jos J. A. M.; Diercks, Ron L.

    2014-01-01

    Background: Many studies that describe factors affecting outcome in primary rotator cuff repair (RCR) have been published, but so far there is no review that summarizes them. This systematic review was conducted to identify prognostic factors influencing functional (clinical) outcome and radiologica

  6. Specific patient-related prognostic factors for rotator cuff repair : a systematic review

    NARCIS (Netherlands)

    Heerspink, Frederik O. Lambers; Dorrestijn, Oscar; van Raay, Jos J. A. M.; Diercks, Ron L.

    Background: Many studies that describe factors affecting outcome in primary rotator cuff repair (RCR) have been published, but so far there is no review that summarizes them. This systematic review was conducted to identify prognostic factors influencing functional (clinical) outcome and

  7. Short-term outcome after Onstep versus Lichtenstein technique for inguinal hernia repair

    DEFF Research Database (Denmark)

    Andresen, K; Burcharth, J; Fonnes, S;

    2015-01-01

    Because of the high number of patients with chronic pain following inguinal hernia repair, a new, simple and safe method of repair is needed. Onstep is a new type of inguinal hernia repair that might be able to reduce postoperative acute and chronic pain. The aim of this study was to investigate...... patients, > 18 years, with a primary inguinal hernia. Experimental treatment in this study was the Onstep technique, which was compared with the Lichtenstein repair. Primary outcome was postoperative pain during the first 10 days following surgery. Secondary outcomes included duration of surgery, period...... between the groups regarding early postoperative pain or minor postoperative complications. Four patients had a recurrence within the first 10 days of follow-up, one patient in the Lichtenstein group and three patients in the Onstep group, p = 0.30. The Onstep technique for inguinal hernia repair was safe...

  8. INGUINAL HERNIA SURGERY UNDER LOCAL ANAESTHESIA, AS DAY CARE SURGERY AND COMPARISON AMONG THREE GROUP OF PATIENTS CLASSIFIED ACCORDING TO TYPE OF MESH USED

    Directory of Open Access Journals (Sweden)

    Arvind

    2015-06-01

    Full Text Available BACKGROUND: Inguinal hernia repair is one of the most commonly performed operations worldwide . This study was done to evaluate , local anesthesia as choice of procedure for inguinal hernia as day care surgery including both regular & comorbidity associated patients , to know which mesh is suitable smallpore ( H eavy weight or largepore ( L igh t weight and to know if use of absorbable suture is better than non - absorbable suture for fixation of mesh. METHODS: We prospectively studied 69 patients with a primary unilateral inguinal hernia. The study group was randomized to Lichtenstein repair afte r taking full informed consent. Pain was assessed by visual analogue scale , Quality of life was assessed by responses to a health questionnaire administered to post - operative patients . RESULTS: The highest contraction rate was found in polypropylene small pore mesh (28.76% , followed by polypropylene large pore mesh (23.9% and the least contraction seen in knitted composite mesh (17.2%. Quality of life was assessed at 1 month and 3 month have shown significant difference among three groups. CONCLUSION: Mos t of the inguinal hernia surgery can be carried out smoothly in local anesthesia , as day care procedure. It is choice of procedure also in patients with comorbidity. Use of absorbable suture for Lichtenstein hernia repair did not affect recurrence rate. Qu ality of life is better with knitted composite group , than pp large pore group , than Polypropylene small pore mesh.

  9. 57. Aortic valve replacement with sutureless valve and mitral valve repair in patient with infected aortic homograft

    Directory of Open Access Journals (Sweden)

    A. attia

    2016-07-01

    Full Text Available The approach of implanting aortic sutureless valve inside the calcific homograft is suitable in redo surgery especially if associated with mitral valve surgery. Aortic valve replacement in patients who have undergone previous aortic root replacement with an aortic homograft remains a technical challenge because of homograft degeneration and the need for a redo Bentall operation. We report a case of redo aortic valve replacement (valve in valve with a sutureless valve and mitral valve repair by miniband annuloplasty in a female patient aged 64 years old who underwent aortic valve replacement with homograft 14 years ago and presented by sever aortic valve regurge and sever mitral valve regurge because of infective endocarditis. This technique allows rapid aortic valve replacement in a heavily calcified aortic root. It also avoids aortic valve size affection after mitral valve repair by ordinary methods especially in patients with small aortic annulus. This technique is particularly suitable in redo procedures for homograft degeneration, it avoids performing a redo Bentall operation with its known problems as well as to avoid patient prosthesis mismatch.

  10. Serotonin Signal Transduction in Two Groups of Autistic Patients

    Science.gov (United States)

    2013-12-01

    AD_________________ Award Number: W81XWH-11-1-0820 TITLE: Serotonin Signal Transduction in Two...Report 3. DATES COVERED 15 September 2011-14 September 2013 4. TITLE AND SUBTITLE Serotonin Signal Transduction in Two Groups of Autistic Patients...the arena of serotonin sensitivity, from those cells obtained from autistic subjects with normal serum serotonin . This was not the case, as the

  11. The effect of muscle repair on postoperative facial skeletal growth in children with bilateral cleft lip and palate.

    Science.gov (United States)

    Nagase, T; Januszkiewicz, J S; Keall, H J; de Geus, J J

    1998-12-01

    The effect of orbicularis muscle repair on postoperative facial skeletal growth in bilateral cleft lip and palate patients was studied by analysis of cephalometric radiographs and dental casts. Sixty-two patients operated on between 1961-1989 were selected for the study. They were divided into three groups, group 1a (muscle repair; n = 12), group 1b (failed attempt at muscle repair; n = 5), and group 2 (no attempt at muscle repair; n = 45). Comparison of the morphological measurements among these three groups showed that there was a trend towards crossbite in the muscle repair group, but this difference was not significant. Mechanisms by which muscle repair might influence maxillofacial skeletal growth include the possibility that the area around the nasal septum might be the growth centre. The choice of operative technique in bilateral cleft lip and palate should be important.

  12. Laparoscopic lumbar hernia repair.

    Science.gov (United States)

    Madan, Atul K; Ternovits, Craig A; Speck, Karen E; Pritchard, F Elizabeth; Tichansky, David S

    2006-04-01

    Lumbar hernias are rare clinical entities that often pose a challenge for repair. Because of the surrounding anatomy, adequate surgical herniorraphy is often difficult. Minimally invasive surgery has become an option for these hernias. Herein, we describe two patients with lumbar hernias (one with a recurrent traumatic hernia and one with an incisional hernia). Both of these hernias were successfully repaired laparoscopically.

  13. Perventricular device closure of residual muscular ventricular septal defects after repair of complex congenital heart defects in pediatric patients.

    Science.gov (United States)

    Zhu, Da; Tao, Kaiyu; An, Qi; Luo, Shuhua; Gan, Changping; Lin, Ke

    2013-01-01

    Residual muscular ventricular septal defects are surgical challenges, especially after the repair of complex congenital heart defects. We investigated perventricular device closure as a salvage technique in pediatric patients who had postoperative residual muscular ventricular septal defects. From February 2009 through June 2011, 14 pediatric patients at our hospital had residual muscular ventricular septal defects after undergoing surgical repair of complex congenital heart defects. Ten patients met our criteria for perventricular device closure of the residual defects: significant left-to-right shunting (Qp/Qs >1.5) or substantial hemodynamic instability (a defect ≥2 mm in size). The patients' mean age was 20.4 ± 13.5 months, and their mean body weight was 10 ± 3.1 kg. The median diameter of the residual defects was 4.2 mm (range, 2.5-5.1 mm). We deployed a total of 11 SQFDQ-II Muscular VSD Occluders (Shanghai Shape Memory Alloy Co., Ltd.; Shanghai, China) in the 10 patients, in accord with conventional techniques of perventricular device closure. The mean procedural duration was 31.1 ±9.1 min. We recorded the closure and complication rates perioperatively and during a 12-month follow-up period. Complete closure was achieved in 8 patients; 2 patients had persistent trivial residual shunts. No deaths, conduction block, device embolism, or other complications occurred throughout the study period. We conclude that perventricular device closure is a safe, effective salvage treatment for postoperative residual muscular ventricular septal defects in pediatric patients. Long-term studies with larger cohorts might further confirm this method's feasibility.

  14. Midterm results of diagnostic treatment and repair strategy in older patients presenting with nonrestrictive ventricular septal defect and severe pulmonary artery hypertension

    Institute of Scientific and Technical Information of China (English)

    Liu Aijun; Li Zhiqiang; Li Xiaofeng; Fan Xiangming; Su Junwu; Zhang Jing; He Yan

    2014-01-01

    Background Congenital heart disease with severe pulmonary arterial hypertension (SPAH),previously thought to have irreversible pulmonary vascular disease (PVD),has been recently successfully corrected using diagnostic treatment and repair strategy by our surgery team.This study aimed to evaluate the midterm results of a selected cohort of older patients with nonrestrictive ventricular septal defect (VSD) and SPAH using diagnostic treatment and repair strategy.Methods The records of 56 patients older than six years with nonrestrictive VSD and SPAH undergoing diagnostic treatment and repair strategy from 2006 to 2012 were retrospectively reviewed.All patients received advanced pulmonary arterial hypertension (PAH) therapy and radical repairs were performed when transcutaneous oxygen saturation (SPO2) increased up to 93%.Results There were no operative deaths.SPO2 and baseline six-minute walk test (SMWT) distance of all selected patients increased significantly and mean pulmonary artery pressure (MPAP) regressed significantly after diagnostic treatment and at late follow-up (P <0.01).The incidence of late postoperative PAH was seen in six (10.7%) patients and by Logistic regression analysis,early postoperative PAH was an independent risk factor related to late postoperative PAH.Conclusions Diagnostic treatment and repair strategy was effective and safe for treatment of nonrestrictive VSD and SPAH and the midterm results were excellent.Diagnostic treatment strategy was effective in assessing the reversibility of SPAH in older patients associated with nonrestrictive VSD and the PVD in these selective patients is generally reversible.

  15. Altered cortical responsiveness to pain stimuli after high frequency electrical stimulation of the skin in patients with persistent pain after inguinal hernia repair.

    Directory of Open Access Journals (Sweden)

    Emanuel N van den Broeke

    Full Text Available BACKGROUND: High Frequency electrical Stimulation (HFS of the skin induces enhanced brain responsiveness expressed as enhanced Event-Related Potential (ERP N1 amplitude to stimuli applied to the surrounding unconditioned skin in healthy volunteers. The aim of the present study was to investigate whether this enhanced ERP N1 amplitude could be a potential marker for altered cortical sensory processing in patients with persistent pain after surgery. MATERIALS AND METHODS: Nineteen male patients; 9 with and 10 without persistent pain after inguinal hernia repair received HFS. Before, directly after and thirty minutes after HFS evoked potentials and the subjective pain intensity were measured in response to electric pain stimuli applied to the surrounding unconditioned skin. RESULTS: The results show that, thirty minutes after HFS, the ERP N1 amplitude observed at the conditioned arm was statistically significantly larger than the amplitude at the control arm across all patients. No statistically significant differences were observed regarding ERP N1 amplitude between patients with and without persistent pain. However, thirty minutes after HFS we did observe statistically significant differences of P2 amplitude at the conditioned arm between the two groups. The P2 amplitude decreased in comparison to baseline in the group of patients with pain. CONCLUSION: The ERP N1 effect, induced after HFS, was not different between patients with vs. without persistent pain. The decreasing P2 amplitude was not observed in the patients without pain and also not in the previous healthy volunteer study and thus might be a marker for altered cortical sensory processing in patients with persistent pain after surgery.

  16. Transcription-coupled DNA repair in prokaryotes.

    Science.gov (United States)

    Ganesan, Ann; Spivak, Graciela; Hanawalt, Philip C

    2012-01-01

    Transcription-coupled repair (TCR) is a subpathway of nucleotide excision repair (NER) that acts specifically on lesions in the transcribed strand of expressed genes. First reported in mammalian cells, TCR was then documented in Escherichia coli. In this organism, an RNA polymerase arrested at a lesion is displaced by the transcription repair coupling factor, Mfd. This protein recruits the NER lesion-recognition factor UvrA, and then dissociates from the DNA. UvrA binds UvrB, and the assembled UvrAB* complex initiates repair. In mutants lacking active Mfd, TCR is absent. A gene transcribed by the bacteriophage T7 RNA polymerase in E. coli also requires Mfd for TCR. The CSB protein (missing or defective in cells of patients with Cockayne syndrome, complementation group B) is essential for TCR in humans. CSB and its homologs in higher eukaryotes are likely functional equivalents of Mfd. Copyright © 2012 Elsevier Inc. All rights reserved.

  17. A novel silk suture-assisted laparoscopic technique for the repair of a gastrocolic fistula in a pediatric patient

    Directory of Open Access Journals (Sweden)

    Seher Mughal

    2016-10-01

    Full Text Available Percutaneous placement of gastrostomy was first described in 1980. Since then it has become widely used in pediatric surgery throughout the world. Inherent in the technique is the possibility of inadvertent damage to adjacent anatomical structures, most commonly the transverse colon. Management previously had involved laparotomy and correction of the gastrocolic fistula. Here we describe a novel laparoscopic approach to the repair of a gastrocolic fistula following percutaneous gastrostomy, avoiding the morbidity of laparotomy in an immunocompromised patient with a rotund abdomen secondary to steroid usage.

  18. Transcatheter aortic valve repair for management of aortic insufficiency in patients supported with left ventricular assist devices.

    Science.gov (United States)

    Pal, Jay D; McCabe, James M; Dardas, Todd; Aldea, Gabriel S; Mokadam, Nahush A

    2016-10-01

    The development of new aortic insufficiency after a period of support with a left ventricular assist device can result in progressive heart failure symptoms. Transcatheter aortic valve repair can be an effective treatment in selected patients, but the lack of aortic valve calcification can result in unstable prostheses or paravalvular leak. We describe a technique of deploying a self-expanding CoreValve (Medtronic, Minneapolis, MN, USA) into the aortic annulus, followed by a balloon-expandable SAPIEN-3 (Edwards, Irvine, CA, USA).

  19. Cografts of artificial dermis matrix and autogenetic split-thickness of repaired skin in severe hand wounds in patients with deep burns

    Directory of Open Access Journals (Sweden)

    Liu Hongqi

    2014-01-01

    Full Text Available The aim of this paper was to evaluate the effect of using artificial dermis matrix plus autologous split-thickness skin (ADM and ASTS in the treatment of deep-burns in hands of severely burned patients.We recruited a total of 58 patients with large area burns greater than 80% that were eschar-excised. Twenty-eight of them were treated with ADM and ASTS (test group; 30 were treated with autologous medium-thickness skin (AMTS (control group. The healing time of the hand wound was noted, clinical and photographic evaluations were performed, and a Jebsen-Taylor hand function test was compared and analyzed in the two groups. The wound healing time in the test group (24.22±3.34 days were longer than that of the control group (13.42±3.36 days and statistically significant. The healing time of skin graft donor sites was shorter than that of the control group (7.14±1.63 vs. 14.28±2.37 days and statistically significant (P<0.05. The 3rd and 6th month follow-up with clinical and functional evaluations revealed no differences between the two groups. In addition, there was no obvious scar formation and less pigmentation in either group. The repair of deeply burned hands with artificial dermis matrix was beneficial to both wound healing and the donor site, and was beneficial to the whole body rehabilitation of severely burned patients.

  20. Hospital mortality of patients aged 80 and older after surgical repair for type A acute aortic dissection in Japan

    Science.gov (United States)

    Ohnuma, Tetsu; Shinjo, Daisuke; Fushimi, Kiyohide

    2016-01-01

    Abstract To evaluate whether patients aged 80 and older have higher risk of hospital mortality after repair of type A acute aortic dissection (TAAAD). Emergency surgery for TAAAD in patients aged 80 and older remains a controversial issue because of its high surgical risk. Data from patients who underwent surgical repair of TAAAD between April 2011 and March 2013 were retrospectively extracted from the Japanese Diagnosis Procedure Combination database. The effect of age on hospital mortality was evaluated using multivariate logistic regression analysis. A total of 5175 patients were enrolled. The mean age of patients was 67.1 ± 13.0 years, and the male:female ratio was 51:49. Patients aged 80 and older more frequently received tracheostomy than their younger counterparts (9.5% vs 5.4%, P <0.001). Intensive care unit and hospital stays were significantly longer in the elderly cohort versus the younger cohort (7.6 vs 6.7 days, P <0.001, and 42.2 vs 35.8 days, P <0.001, respectively). Logistic regression analysis showed that age ≥80 years was significantly associated with a higher risk of hospital mortality (adjusted odds ratio, 1.62; 95% confidence interval, 1.28–2.06; P <0.001). In linear regression analysis, age ≥80 years was also significantly associated with longer hospital stay (P = 0.007). In a large, nationwide, Japanese database, patients aged 80 and older were at increased risk of hospital mortality and length of hospital stay. PMID:27495057

  1. Two-Tunnel Transtibial Repair of Radial Meniscus Tears Produces Comparable Results to Inside-Out Repair of Vertical Meniscus Tears.

    Science.gov (United States)

    Cinque, Mark E; Geeslin, Andrew G; Chahla, Jorge; Dornan, Grant J; LaPrade, Robert F

    2017-08-01

    Radial meniscus tears disrupt the circumferential fibers and thereby compromise meniscus integrity. Historically, radial tears were often treated with meniscectomy because of an incomplete understanding of the biomechanical consequences of these tears, limited information regarding the biomechanical performance of repair, and the technical difficulty associated with repair. There is a paucity of studies on the outcomes of the repair of radial meniscus tears. Purpose/Hypothesis: The purpose was to determine the outcomes of 2-tunnel transtibial repair of radial meniscus tears and compare these results to the outcomes of patients who underwent the repair of vertical meniscus tears with a minimum of 2-year follow-up. The hypothesis was that radial and vertical meniscus tear repair outcomes were comparable. Cohort study; Level of evidence, 3. Patients who underwent 2-tunnel transtibial pullout repair for a radial meniscus tear were included in this study and compared with patients who underwent inside-out repair for a vertical meniscus tear. Subjective questionnaires were administered preoperatively and at a minimum of 2-year follow-up, including the Lysholm score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Short Form-12 (SF-12) physical component summary (PCS), the Tegner activity scale, and patient satisfaction. Analysis of covariance was used to compare postoperative outcome scores between the meniscus repair groups while accounting for baseline scores. Adjusted mean effects relative to the radial repair group were reported with 95% CIs. Twenty-seven patients who underwent 2-tunnel transtibial pullout repair for radial meniscus tears and 33 patients who underwent inside-out repair for vertical meniscus tears were available for follow-up at a mean of 3.5 years (range, 2.0-5.4 years). No preoperative outcome score significantly differed between the groups. There were no significant group differences for any of the 2-year

  2. Laparoscopic umbilical hernia repair in a cirrhotic patient with a peritoneovenous shunt.

    Science.gov (United States)

    Umemura, Akira; Suto, Takayuki; Sasaki, Akira; Fujita, Tomohiro; Endo, Fumitaka; Wakabayashi, Go

    2015-05-01

    A 62-year-old Japanese woman who had developed massive cirrhotic ascites was referred to our hospital for a peritoneovenous shunt implant. However, CT examination revealed an umbilical hernia that had not been observed before the peritoneovenous shunt was implanted. We decided to perform laparoscopic umbilical hernia repair to keep carbon dioxide from flowing backward into the central circulatory system. We first clamped the catheter and set the upper limit of the pneumoperitoneum pressure to 6 mmHg. The central venous pressure was also measured simultaneously. Mesh was then applied over the hernia and fixed by the double-crown technique. Finally, 1000-mL physiological saline was infused into the abdominal cavity while the pneumoperitoneum was slowly released. In this case, we safely performed laparoscopic umbilical hernia repair while making some alterations, specifically catheter clamping, reducing pneumoperitoneum pressure, monitoring central venous pressure, and infusing physiological saline.

  3. Scientific basis for learning transfer from movements to urinary bladder functions for bladder repair in human patients with CNS injury.

    Science.gov (United States)

    Schalow, G

    2010-01-01

    Coordination Dynamics Therapy (CDT) has been shown to be able to partly repair CNS injury. The repair is based on a movement-based re-learning theory which requires at least three levels of description: the movement or pattern (and anamnesis) level, the collective variable level, and the neuron level. Upon CDT not only the actually performed movement pattern itself is repaired, but the entire dynamics of CNS organization is improved, which is the theoretical basis for (re-) learning transfer. The transfer of learning for repair from jumping on springboard and exercising on a special CDT and recording device to urinary bladder functions is investigated at the neuron level. At the movement or pattern level, the improvement of central nervous system (CNS) functioning in human patients can be seen (or partly measured) by the improvement of the performance of the pattern. At the collective variable level, coordination tendencies can be measured by the so-called 'coordination dynamics' before, during and after treatment. At the neuron level, re-learning can additionally be assessed by surface electromyography (sEMG) as alterations of single motor unit firings and motor programs. But to express the ongoing interaction between the numerous neural, muscular, and metabolic elements involved in perception and action, it is relevant to inquire how the individual afferent and efferent neurons adjust their phase and frequency coordination to other neurons to satisfy learning task requirements. With the single-nerve fibre action potential recording method it was possible to measure that distributed single neurons communicate by phase and frequency coordination. It is shown that this timed firing of neurons is getting impaired upon injury and has to be improved by learning The stability of phase and frequency coordination among afferent and efferent neuron firings can be related to pattern stability. The stability of phase and frequency coordination at the neuron level can

  4. Patient participation in general practice based undergraduate teaching: a focus group study of patient perspectives.

    Science.gov (United States)

    Park, Sophie E; Allfrey, Caroline; Jones, Melvyn M; Chana, Jasprit; Abbott, Ciara; Faircloth, Sofia; Higgins, Nicola; Abdullah, Laila

    2017-04-01

    Patients make a crucial contribution to undergraduate medical education. Although a national resource is available for patients participating in research, none is as yet available for education. This study aimed to explore what information patients would like about participation in general practice based undergraduate medical education, and how they would like to obtain this information. Two focus groups were conducted in London-based practices involved in both undergraduate and postgraduate teaching. Patients both with and without teaching experience were recruited using leaflets, posters, and patient participation groups. An open-ended topic guide explored three areas: perceived barriers that participants anticipated or had experienced; patient roles in medical education; and what help would support participation. Focus groups were audiorecorded, transcribed, and analysed thematically. Patients suggested ways of professionalising the teaching process. These were: making information available to patients about confidentiality, iterative consent, and normalising teaching in the practice. Patients highlighted the importance of relationships, making information available about their GPs' involvement in teaching, and initiating student-patient interactions. Participants emphasised educational principles to maximise exchange of information, including active participation of students, patient identification of student learner needs, and exchange of feedback. This study will inform development of patient information resources to support their participation in teaching and access to information both before and during general practice based teaching encounters. © British Journal of General Practice 2017.

  5. Lip Repair Surgery for Bilateral Cleft Lip and Palate in a Patient Diagnosed with Trisomy 13 and Holoprosencephaly.

    Science.gov (United States)

    Akamatsu, Tadashi; Hanai, Ushio; Nakajima, Serina; Kobayashi, Megumi; Miyasaka, Muneo; Matsuda, Shinichi; Ikegami, Mariko

    2015-06-20

    We report a case of lip repair surgery performed for bilateral cleft lip and palate in a patient diagnosed with trisomy 13 and holoprosencephaly. At the age of 2 years and 7 months, the surgery was performed using a modified De Hann design under general anesthesia. The operation was completed in 1 h and 21 min without large fluctuations in the child's general condition. The precise measurement of the intraoperative design was omitted, and the operation was completed using minimal skin sutures. It is possible to perform less-invasive and short surgical procedures after careful consideration during the preoperative planning. Considering the recent improvements in the life expectancy of patients with trisomy 13, we conclude that surgical treatments for non-life threatening malformations such as cleft lip and palate should be performed for such patients.

  6. Enhanced recovery after giant ventral hernia repair

    DEFF Research Database (Denmark)

    Jensen, K K; Brøndum, T L; Harling, H.

    2016-01-01

    PURPOSE: Giant ventral hernia repair is associated with a high risk of postoperative morbidity and prolonged length of stay (LOS). Enhanced recovery (ERAS) measures have proved to lead to decreased morbidity and LOS after various surgical procedures, but never after giant hernia repair. The current....... Pain, nausea and fatigue were registered prospectively in all patients treated according to ERAS, as well as continuous measurement of transcutaneous capillary oxygen saturation. Postoperative morbidity and LOS were compared between patients treated according to ERAS and a historic group treated...

  7. Inhibition of the dorsal premotor cortex does not repair surround inhibition in writer's cramp patients.

    Science.gov (United States)

    Veugen, Lidwien C; Hoffland, Britt S; Stegeman, Dick F; van de Warrenburg, Bart P

    2013-03-01

    Writer's cramp is a task-specific form of focal dystonia, characterized by abnormal movements and postures of the hand and arm during writing. Two consistent abnormalities in its pathophysiology are a loss of surround inhibition and overactivity of the dorsal premotor cortex (PMd). This study aimed to assess a possible link between these two phenomena by investigating whether PMd inhibition leads to an improvement of surround inhibition, in parallel with previously demonstrated writing improvement. Fifteen writer's cramp patients and ten controls performed a simple motor hand task during which surround inhibition was measured using transcranial magnetic stimulation. Motor cortical excitability was measured of the active and surround muscles at three phases of the task. Surround inhibition and writing performance were assessed before and after PMd inhibitory continuous theta burst stimulation. In contrast to healthy controls, patients did not show inhibition of the abductor digiti minimi muscle during movement initiation of the first dorsal interosseus muscle, confirming the loss of surround inhibition. PMd inhibition led to an improvement of writing speed in writer's cramp patients. However, in both groups, no changes in surround inhibition were observed. The results confirm a role for the PMd in the pathophysiology of writer's cramp. We show that PMd inhibition does not lead to restoration of the surround inhibition defect in writer's cramp, despite the improvement in writing. This questions the involvement of the PMd in the loss of surround inhibition, and perhaps also the direct link between surround inhibition and dystonia.

  8. Comparison of Treatment Outcomes of Arthroscopic Bankart Lesion Repair with Open Bristow-Latarjet Technique in Patients with Anterior Shoulder Instability

    Directory of Open Access Journals (Sweden)

    Mohsen Mardani-Kivi

    2012-12-01

    Full Text Available Background & Objectives: Over 150 different surgical techniques for treatment of anterior shoulder instability has been suggested that there is no consensus in the orthopedics. This study seeks to compare treatment outcomes of arthroscopic Bankart lesion repair methods with Bristow - Latarjet open surgical technique in patients with anterior shoulder instability.   Methods: In this cross-sectional study all patients with recurrent shoulder dislocation from 2009-2011 was divided into two groups, arthroscopic Bankart treatment (28 cases and open Bristow - Latarjet (26 cases that all were treated by one orthopedic surgeon. Patients were visited in 2,4,6,8 weeks also in the third and sixth month post-op .The visual analog scale (VAS for patient satisfaction and Walsch-duplay and Rowe score for functional outcomes of treatment were used in six months follow up. These three criteria were analyzed again after recalling the patients.   Results: Mean age of 54 patients was 29.46±9.16 years and mean follow-up duration was 23.28 ± 6.2 months. Scores of patients in both groups were not statistically different after analyzing the functional outcomes of treatment by Walsch-duplay and Rowe score after six months and final follow-up. Scores of patients by Walsch-duplay measurement in arthroscopic Bankart and Bristow-Latarjet groups were 98.03±4.37 and 97.88±4.51 respectively and by Rowe index were 97.32±5.52 vs. 97.88±4.51at final follow-up. No recurrence was observed in both groups in final follow up. Patient satisfaction in Bankart and operation groups were 9.4 ±0.68 and 9.47±0.58 (p= 0.69.   Conclusion: In anterior shoulder instability, minimally invasive Arthroscopic Bankart procedures almost equal to open Bristow-Latarjet method with regards to shoulder stability, recurrence rate, and range of motion.

  9. Correlation analysis and prognostic impact of {sup 18}F-FDG PET and excision repair cross-complementation group 1 (ERCC-1) expression in non-small cell lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Yong Hyu; Lee, Choong Kun; Jo, Kwan Hyeong; Hwang, Sang Hyun; Cha, Jong Tae; Lee, Jeong Won; Yun, Mi Jin; Cho, Arthur [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2015-06-15

    The aim of this study was to determine the relationship between [{sup 18}]-2-fluoro-2-deoxy-D-glucose (FDG) uptake and excision repair cross-complementation group 1 (ERCC-1) expression and to evaluate the prognostic effect of these two factors in resectable non-small cell lung cancer (NSCLC) patients. We retrospectively reviewed 212 patients with resectable NSCLC who underwent FDG positron emission tomography/computed tomography (PET/CT) scan for cancer staging and ERCC-1 expression analysis between January 2008 to December 2011. All patients were then followed-up for survival analysis. Semiquantitative evaluation of ERCC-1 was performed with the H-scoring system and was correlated with maximum standardized uptake value (SUV{sub max}) of NSCLC. Univariate and multivariate analyses were performed to evaluate for FDG uptake and ERCC-1 expression predicting overall survival. In 212 patients (139 male, median age 68 ± 9.11), 112 patients had ERCC-positive tumors and 100 patients had ERCC-negative tumors. There was no significant difference in SUV{sub max} between ERCC-1-positive tumors (8.02 ±5.40) and ERCC-1-negative tumors (7.57 ± 6.56, p = 0.584). All patients were followed-up for a median of 40.5 months (95 % confidence interval [CI], 38.5–42.2 months). Univariate analysis and multivariate analysis for all patients showed that both ERCC-1 expression (hazard ratio [HR], 2.78; 95 % CI, 1.20–6.47) and FDG uptake (HR, 4.50; 95 % CI, 2.07–9.77) independently predicted overall survival. We have found no statistical correlation between FDG uptake and ERCC-1 expression in NSCLC. However, both higher FDG uptake and positive ERCC-1 expression are independent predictive markers of prognosis, suggesting that both should be obtained during patient workup.

  10. Excellent healing rates and patient satisfaction after arthroscopic repair of medium to large rotator cuff tears with a single-row technique augmented with bone marrow vents.

    Science.gov (United States)

    Dierckman, Brian D; Ni, Jake J; Karzel, Ronald P; Getelman, Mark H

    2017-06-24

    This study evaluated the repair integrity and patient clinical outcomes following arthroscopic rotator cuff repair of medium to large rotator cuff tears using a single-row technique consisting of medially based, triple-loaded anchors augmented with bone marrow vents in the rotator cuff footprint lateral to the repair. This is a retrospective study of 52 patients (53 shoulders) comprising 36 males and 16 females with a median age of 62 (range 44-82) with more than 24-month follow-up, tears between 2 and 4 cm in the anterior-posterior dimension and utilizing triple-loaded anchors. Mann-Whitney test compared Western Ontario Rotator Cuff (WORC) outcome scores between patients with healed and re-torn cuff repairs. Multivariate logistic regression analysed association of variables with healing status and WORC score. Cuff integrity was assessed on MRI, read by a musculoskeletal fellowship-trained radiologist. Magnetic resonance imaging (MRI) demonstrated an intact repair in 48 of 53 shoulders (91%). The overall median WORC score was 95.7 (range 27.6-100.0). A significant difference in WORC scores were seen between patients with healed repairs 96.7 (range 56.7-100.0) compared with a re-tear 64.6 (27.6-73.8), p rotator cuff tears using a triple-loaded single-row repair augmented with bone marrow vents resulted in a 91% healing rate by MRI and excellent patient reported clinical outcomes comparable to similar reported results in the literature. IV.

  11. Clinical application of biliary duct defect repair of biliary tract in patients with Mirizzi syndrome%胆管大范围缺损Mirizzi综合征患者胆道修复术的临床应用研究

    Institute of Scientific and Technical Information of China (English)

    侯焱森; 张力; 吴云; 刘永国

    2014-01-01

    目的:本研究旨在探讨采用胆道修复术对胆管大范围缺损Mirizzi综合征患者进行治疗的临床疗效及安全性,为临床治疗提供参考意见。方法回顾性分析在本院行胆道修复术的22例胆管大范围缺损Mirizzi综合征患者的治疗手段和临床疗效,其中有12例采用带血管蒂胃瓣修补治疗,10例行带脐静脉瓣胆道修复术,对两组患者的一般资料、临床资料及治疗结果进行对比分析。结果两组患者的临床资料比较差异无显著性(P>0.05);胃瓣修补组和脐静脉瓣修复组发生的术后并发症主要为胆管炎症,分别为4例(33.33%)和3例(30%),各组不良反应分别相加得出胃瓣修补组8例,脐静脉瓣修复组5例,两组采用Fisher精确检验得出P>0.05,两组术后不良反应差异无显著性。结论对胆管大范围缺损Mirizzi综合征患者采取胆道修复术(脐静脉瓣胆道修复术、带血管蒂胃瓣修补术)均是行之有效的治疗措施,术后并发症状轻微,无死亡病例发生,可以作为Mirizzi综合征患者的首选治疗措施。%ObjectiveTo investigate the prosthesis operation of bile duct for clinical efifcacy and safety of treatment for bile duct defects in patients with Mirizzi syndrome, and provide a reference for the clinical treatment of bile duct defects in Mirizzi syndrome.MethodsA retrospective analysis of 22 cases of bile duct defects in Mirizzi under went biliary tract prosthesis syndrome treatment and clinical curative effect of the patients, including 12 cases with vascular pedicled gastriclfap for repair of treatment, 10 cases with umbilical vein graft repair of biliary tract, carries on the contrast analysis to the general data, clinical data of two groups of patients and treatment results.ResultsThe clinical data of two patients were not statistically signiifcant (P>0.05); gastric lfap in the repair group and umbilical venous lfap group

  12. High prevalence of deficient mismatch repair phenotype and the V600E BRAF mutation in elderly patients with colorectal cancer.

    Science.gov (United States)

    Aparicio, Thomas; Schischmanoff, Olivier; Poupardin, Cecile; Mary, Florence; Soufir, Nadem; Barrat, Christophe; Bellaiche, Guy; Boubaya, Marouane; Choudat, Laurence; Cucherousset, Joel; DesGuetz, Gaetan; Wind, Philippe; Benamouzig, Robert

    2014-10-01

    Colorectal cancer (CRC) occurs mostly in the elderly. However, the biology of CRC in elderly has been poorly studied. This study examined the prevalence of deficient mismatch repair phenotype (dMMR) and BRAF mutations according to age. MMR phenotype was prospectively determined by molecular analysis in patients of all ages undergoing surgery for CRC. BRAF V600E mutation status was analysed in a subset of dMMR tumours. A total of 754 patients who underwent surgery between 2005 and 2008 were included in the study. Amongst them, 272 (36%) were ≥75years old. The proportion of women prevalence of dMMR was 19.4% in patients ≥75 and 10.7% in patients prevalence of dMMR was significantly higher in women than in men (27% vs 10.2%, respectively; p=0.003) but was similar in women and men prevalence of the BRAF V600E mutation according to sex (78% in women and 70% in men, p=0.9). The prevalence of dMMR in CRC is high in patients over 75. In elderly patients, dMMR tumours are significantly more frequent in women than in men. The BRAF mutation is frequent in elderly patients with CRC. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Excision repair cross-complementation group 1 (ERCC1) in platinum-based treatment of non-small cell lung cancer with special emphasis on carboplatin: a review of current literature

    DEFF Research Database (Denmark)

    Vilmar, A.; Sorensen, J.B.

    2009-01-01

    BACKGROUND: Patients diagnosed with advanced non-small cell lung cancer have a dismal prognosis and are often relative resistant to chemotherapy. A need for markers has emerged based on tumour biology in order to predict which patients will respond to treatment. Excision repair cross-complementat...

  14. Rotator cuff repair - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100229.htm Rotator cuff repair - series—Normal anatomy To use the sharing ... to slide 4 out of 4 Overview The rotator cuff is a group of muscles and tendons that ...

  15. Tendon repair

    Science.gov (United States)

    Repair of tendon ... Tendon repair can be performed using: Local anesthesia (the immediate area of the surgery is pain-free) ... a cut on the skin over the injured tendon. The damaged or torn ends of the tendon ...

  16. Anesthetic management of vaginal tear repair during early puerperium in a patient with acute intermittent porphyria

    Directory of Open Access Journals (Sweden)

    Mahmood Ghazanwy

    2014-04-01

    Full Text Available A 26 year old female with history of acute intermittent porphyria (AIP was scheduled for vaginal tear repair after delivering her first baby. Raised blood pressure during her antenatal period was safely treated with α-methyl dopa. Her preoperative examination revealed no symptoms suggestive of acute exacerbation of AIP. Anesthesia was induced with fentanyl and propofol, and a proseal laryngeal mask airway (LMA was inserted and maintained with intermittent propofol and inhalation of isoflurane in nitrous oxide and oxygen. Her intraoperative and postoperative period remained uneventful.

  17. Predictive and Prognostic Value of Ribonucleotide Reductase Regulatory Subunit M1 and Excision Repair Cross-Complementation Group 1 in Advanced Urothelial Carcinoma (UC Treated with First-Line Gemcitabine Plus Platinum Combination Chemotherapy.

    Directory of Open Access Journals (Sweden)

    Miso Kim

    Full Text Available Preclinical and clinical studies have suggested that expression of ribonucleotide reductase regulatory subunit M1 (RRM1 and excision repair cross-complementation group 1 (ERCC1 is associated with resistance to gemcitabine and cisplatin, respectively. We evaluated the significance of RRM1 and ERCC1 expression to predict tumor response to gemcitabine plus platinum chemotherapy (GP and survival in advanced UC. We retrospectively collected tumor samples and reviewed clinical data of 53 patients with unresectable or metastatic UC, who were treated with first-line GP. RRM1 and ERCC1 expression were measured by immunohistochemistry. Among 53 patients, 12 (22.6% and 26 (49.1% patients had tumors that demonstrated a high expression for RRM1 and ERCC1, respectively. Twenty-nine (70.7% of 41 patients with low RRM1 expression achieved a clinical response (complete + partial responses, but only 3 (25.0% of 12 patients with high RRM1 expression achieved a clinical response after GP (P=0.007. Nineteen (70.4% of 27 patients with low ERCC1 expression achieved a clinical response, while 13 (50.0% of 26 patients with high ERCC1 expression achieved a clinical response (P=0.130. High RRM1 expression was associated with shorter progression free survival and overall survival (PFS P=0.006, OS P=0.006. Multivariate analysis confirmed that patients with high RRM1 expression had a significantly greater risk of progression and death than those with low RRM1 expression. ERCC1 status was not a significant predictor for PFS and OS. RRM1 expression was predictive and prognostic of clinical outcome in advanced UC treated with gemcitabine plus platinum combination chemotherapy.

  18. Characterization of a group unrelated patients with arthrogryposis multiplex congenita

    Directory of Open Access Journals (Sweden)

    Margarita Valdés-Flores

    2016-02-01

    Full Text Available ABSTRACT OBJECTIVE: Arthrogryposis multiplex congenita is a relatively rare neuromuscular syndrome, with a prevalence of 1:3000-5000 newborns. In this study, the authors describe the clinical features of a group of 50 unrelated Mexican patients with arthrogryposis multiplex congenita. METHODS: Patients were diagnosed by physical and radiographic examination and the family history was evaluated. RESULTS: Of the 50 cases, nine presented other features (pectum excavatum, cleft palate, mental retardation, ulnar agenesis, etc.. Environmental factors, as well as prenatal and family history, were analyzed. The chromosomal anomalies and clinical entities associated with arthrogryposis multiplex congenita were reported. No chromosomal aberrations were present in the cases with mental retardation. Three unrelated familial cases with arthrogryposis multiplex congenita were observed in which autosomal recessive, autosomal dominant and X-linked inheritance patterns are possible. A literature review regarding arthrogryposis multiplex congenita was also conducted. CONCLUSIONS: It is important to establish patient-specific physical therapy and rehabilitation programs. A multidisciplinary approach is necessary, with medical, surgical, rehabilitation, social and psychological care, including genetic counseling.

  19. Anesthetic management for combined mitral valve replacement and aortic valve repair in a patient with osteogenesis imperfecta

    Directory of Open Access Journals (Sweden)

    Huang Jiapeng

    2011-01-01

    Full Text Available Osteogenesis imperfecta is a rare disorder of connective tissues and presents multiple challenges, including difficult airway, hyperthermia, coagulopathy and respiratory dysfunction, for anesthesiologists, especially during cardiac surgery. We present anesthetic management of a patient with osteogenesis impertecta during double valve surgery. Dexmedetomidine infusion minimized the risks of malignant hyperthermia. Glidescope and in-line stabilization facilitated endotracheal intubation and protected his oral structures and cervical spine. Transesophageal echocardiography (TEE diagnosed a flail A3 segment and redundant left coronary cusp causing mitral and aortic regurgitation. The mitral valve was replaced and the aortic valve repaired. Coagulopathy was corrected according to comprehensive coagulation analysis. Glidescope, dexmedetomidine, coagulation analysis and TEE could facilitate anesthetic management in these patients.

  20. Outcomes of robot-assisted versus laparoscopic repair of small-sized ventral hernias.

    Science.gov (United States)

    Chen, Y Julia; Huynh, Desmond; Nguyen, Scott; Chin, Edward; Divino, Celia; Zhang, Linda

    2017-03-01

    The aim of the study is to investigate the outcomes of the da Vinci robot-assisted laparoscopic hernia repair of small-sized ventral hernias with circumferential suturing of the mesh compared to the traditional laparoscopic repair with trans-fascial suturing. A retrospective review was conducted of all robot-assisted umbilical, epigastric and incisional hernia repairs performed at our institution between 2013 and 2015 compared to laparoscopic umbilical or epigastric hernia repairs. Patient characteristics, operative details and postoperative complications were collected and analyzed using univariate analysis. Three primary minimally invasive fellowship trained surgeons performed all of the procedures included in the analysis. 72 patients were identified during the study period. 39 patients underwent robot- assisted repair (21 umbilical, 14 epigastric, 4 incisional), and 33 patients laparoscopic repair (27 umbilical, 6 epigastric). Seven had recurrent hernias (robot: 4, laparoscopic: 3). There were no significant differences in preoperative characteristics between the two groups. Average operative time was 156 min for robot-assisted repair and 65 min for laparoscopic repair (p robot group [3.07 cm (1-9 cm)] than that for the laparoscopic group [2.02 cm (0.5-5 cm)] (p robot-assisted technique versus the standard laparoscopic repair.

  1. Patellar ligament rupture in the dog: repair methods and patient outcomes in 43 cases.

    Science.gov (United States)

    Das, S; Thorne, R; Lorenz, N D; Clarke, S P; Madden, M; Langley-Hobbs, S J; Perry, K L; Burton, N J; Moores, A L; Mosley, J R

    2014-10-18

    The medical records of dogs receiving surgery for unilateral patellar ligament rupture between 1999 and 2012 at 12 multidisciplinary referral centres were reviewed. Forty-three cases were identified; 26 were traumatic in origin; almost one-third were iatrogenic, of which over three-quarters occurred as a complication following surgical stabilisation of patellar luxation. Treatment involved primary reapposition of the ligament (36 cases). The repair was protected by circumpatellar and/or transpatellar loop(s) of orthopaedic wire, nylon, polypropylene or polydioxanone suture (34 cases). Wire loops were more likely to require surgical removal compared with loops of other materials (P=0.0014). The stifle joint was immobilised postoperatively by the applications of a transarticular external skeletal fixator (taESF) in 17 cases and by external coaptation (EC) in 8 cases; in 18 cases, no postoperative joint immobilisation was provided. Complications specific to the method of immobilisation occurred in seven of the cases with taESF and six of the cases with EC. Revision surgery to address failure of repair was required in five cases. Outcome was classified as acceptable or good in over three-quarters of the cases (31/40) and poor in less than a quarter (9/40). These data highlight patellar ligament rupture as a complication of surgical stabilisation of patellar luxation. British Veterinary Association.

  2. Repair of abnormal perfusion foci in idiopathic epilepsy patients under long-term antiepileptic treatment

    Institute of Scientific and Technical Information of China (English)

    Weimin Wang; Siyu Zhao; Yaqing Liu

    2011-01-01

    Epileptic seizure control and the disappearance of epileptiform discharge are not indicative of the absence of abnormal perfusion foci.Perfusion abnormalities are a major cause of epileptic discharge, and the existence of abnormal perfusion foci implies possible relapse.Very little is known about perfusion abnormality repair in epilepsy.The present study selected 43 cases of idiopathic epilepsy under antiepileptic drug control for an average of 24 months.Comparisons between interictal single-photon emission CT (SPECT)images and long-term electroencephalogram (EEG) pre- and post-treatment showed that cases of normal SPECT increased by 48% (12/25) following treatment, with a total number of 15 reduced foci (36%, 15/41).Perfusion foci, i.e., region of interest, were altered following treatment.These changes included:normal to abnormal in 3 cases (7%, 3/43; 2 hyperperfusion and 1 hypoperfusion); abnormal to normal in 14 cases (32%, 14/43; 10 pre-treatment hypoperfusion and 4 hyperperfusion); abnormal to abnormal in 7 cases (16%, 7/43; hyperperfusion to hypoperfusion in 5 cases, hypoperfusion to hyperperfusion in 2 cases).Long-term EEG revealed in an increase in the number of normal cases by 20 (40%, 20/39), and there were 25 fewer cases with epileptiform discharges (66%, 25/38).These findings demonstrate that long-term control of anti-epileptic drugs partially repaired cerebral perfusion abnormalities and reduced epileptiform discharges in idiopathic epilepsy.

  3. How Satisfied Are Patients with Arthroscopic Bankart Repair? A 2-Year Follow-up on Quality-of-Life Outcome.

    Science.gov (United States)

    Saier, Tim; Plath, Johannes E; Waibel, Sabrina; Minzlaff, Philipp; Feucht, Matthias J; Herschbach, Peter; Imhoff, Andreas B; Braun, Sepp

    2017-06-29

    To report general life and health satisfaction after arthroscopic Bankart repair in patients with post-traumatic recurrent anterior glenohumeral instability and to investigate postoperative time lost to return to work at 2-year follow-up. Between 2011 and 2013 patients treated with arthroscopic Bankart repair in the beach chair position for acute shoulder instability were included in this study. Questions on Life Satisfaction Modules (FLZ(M)) and the Short Form 12 (SF-12) were used as quality-of-life outcome scales. Oxford Instability Score (OIS), Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), and self-reported American Shoulder and Elbow Surgeons (ASES) shoulder index were used as functional outcome scales. Return to work (months) was monitored and analyzed depending on physical workload. Data were assessed the day before surgery and prospectively monitored until 24 months postoperatively. Quality-of-life outcome was correlated with functional shoulder outcome and compared with normative age-adjusted data. Paired t-test, Wilcoxon test, Mann-Whitney U-Test, and Spearman's correlation coefficient were used for statistical analysis. Fifty-three patients were prospectively included. The mean age at surgery was 29.4 years. Satisfaction with general life and satisfaction with health (FLZ(M)) as well as physical component scale (SF-12) improved significantly to values above normative data within 6 to 12 months after surgery (each P return to work was 2 months (range, 0-10; standard deviation, 1.9), with significantly longer time intervals observed in patients with heavy physical workload (3.1 months; range, 0 to 10; standard deviation, 2.4; P = .002). Following arthroscopic Bankart repair, quality of life was impaired during early course after surgery and increased significantly above preoperative levels within 6 to 12 months after the procedure. A steady state of excellent quality-of-life and functional outcomes was noted after 12

  4. Use of a dynamic self-regulating prosthesis (P.A.D.) in inguinal hernia repair: our first experience in 214 patients.

    Science.gov (United States)

    Ferranti, Fabrizio; Marzano, Marco; Quintiliani, Alberto

    2009-01-01

    Numerous techniques exist for inguinal hernia treatment. Currently, open mesh tension-free repair is regarded as the repair method of choice. In particular Lichtenstein repair is the most common procedure performed, although several articles have reported long-lasting postoperative pain and a higher recurrence rate than originally reported. This study describes the P.A.D. (Protesi Autoregolantesi Dinamica) prosthesis implantation technique and reports postoperative complications and long-term results. From June 2002 to May 2005 a total of 214 patients underwent P.A.D. prosthesis inguinal repair. All patients were male, with a mean age of 51 years. All hernias were treated via an open inguinal approach using the original technique described by Valenti, with slight modifications. A total of 171'patients (80%) were available to follow-up 3 years after surgery. Early postoperative complications occurred in 14 patients (8.4%). Four patients (12.1%), who had undergone regional anaesthesia, developed urinary retention. Wound infection occurred in 3 patients (1.4%). There were two direct recurrences (0.93%) whereas chronic postoperative inguinal pain was reported in 4.2% of patients. Within the limitations of a short follow-up, our results show that the P.A.D. prosthesis procedure is a reliable technique with a low recurrence rate and low postoperative morbidity.

  5. 36. Anesthesia for high risk patients undergoing percutaneous mitral valve repair with the mitraclip system in the catheterization laboratory

    Directory of Open Access Journals (Sweden)

    R. Soliman

    2016-07-01

    Full Text Available MitraClip system implantation is used inhigh-risk patients with severe mitral regurgitation.anesthetic management for mitral clip implantation. The study included 34patients scheduled for MitraClip implantations in the catheterization laboratory. An arterial line and central venous line were inserted under local anesthesia before induction. Epinephrine was started before induction and milrinone infusion was started after induction. The anesthetic technique for induction and maintenance was the same for all patients. All patients were hemodynamically stable intra- and postoperatively. The intervention was successful in 33 cases and aborted in one case because of severe posteromedial leaflet tethering. The epinephrine and milrinone were weaned and all patients were extubated, except, one case mortality happened within the first 8 hours postoperatively. Percutaneous mitral valve repair with MitraClip implantation is a successful alternative in high-risk patients with symptomatic severe mitral regurgitation. Starting epinephrine before anesthetic induction and milrinone infusion induction resulted in decreased pulmonary artery pressure, increased ejection fraction and maintained arterial blood pressure during procedure inspite of worse preoperative conditions.

  6. Can early computed tomography angiography after endovascular aortic aneurysm repair predict the need for reintervention in patients with type II endoleak?

    Science.gov (United States)

    Dudeck, O; Schnapauff, D; Herzog, L; Löwenthal, D; Bulla, K; Bulla, B; Halloul, Z; Meyer, F; Pech, M; Gebauer, B; Ricke, J

    2015-02-01

    This study was designed to identify parameters on CT angiography (CTA) of type II endoleaks following endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA), which can be used to predict the subsequent need for reinterventions. We retrospectively identified 62 patients with type II endoleak who underwent early CTA in mean 3.7 ± 1.9 days after EVAR. On the basis of follow-up examinations (mean follow-up period 911 days; range, 373-1,987 days), patients were stratified into two groups: those who did (n = 18) and those who did not (n = 44) require reintervention. CTA characteristics, such as AAA, endoleak, as well as nidus dimensions, patency of the inferior mesenteric artery, number of aortic branch vessels, and the pattern of endoleak appearance, were recorded and correlated with the clinical outcome. Univariate and receiver operating characteristic curve regression analyses revealed significant differences between the two groups for the endoleak volume (surveillance group: 1391.6 ± 1427.9 mm(3); reintervention group: 3227.7 ± 2693.8 mm(3); cutoff value of 2,386 mm(3); p = 0.002), the endoleak diameter (13.6 ± 4.3 mm compared with 25.9 ± 9.6 mm; cutoff value of 19 mm; p < 0.0001), the number of aortic branch vessels (2.9 ± 1.2 compared with 4.2 ± 1.4 vessels; p = 0.001), as well as a "complex type" endoleak pattern (13.6 %, n = 6 compared with 44.4 %, n = 8; p = 0.02). Early CTA can predict the future need for reintervention in patients with type II endoleak. Therefore, treatment decision should be based not only on aneurysm enlargement alone but also on other imaging characteristics.

  7. INTERNAL REPAIR OF PIPELINES

    Energy Technology Data Exchange (ETDEWEB)

    Bill Bruce; Nancy Porter; George Ritter; Matt Boring; Mark Lozev; Ian Harris; Bill Mohr; Dennis Harwig; Robin Gordon; Chris Neary; Mike Sullivan

    2005-07-20

    The two broad categories of fiber-reinforced composite liner repair and deposited weld metal repair technologies were reviewed and evaluated for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Principal conclusions from a survey of natural gas transmission industry pipeline operators can be summarized in terms of the following performance requirements for internal repair: (1) Use of internal repair is most attractive for river crossings, under other bodies of water, in difficult soil conditions, under highways, under congested intersections, and under railway crossings. (2) Internal pipe repair offers a strong potential advantage to the high cost of horizontal direct drilling when a new bore must be created to solve a leak or other problem. (3) Typical travel distances can be divided into three distinct groups: up to 305 m (1,000 ft.); between 305 m and 610 m (1,000 ft. and 2,000 ft.); and beyond 914 m (3,000 ft.). All three groups require pig-based systems. A despooled umbilical system would suffice for the first two groups which represents 81% of survey respondents. The third group would require an onboard self-contained power unit for propulsion and welding/liner repair energy needs. (4) The most common size range for 80% to 90% of operators surveyed is 508 mm (20 in.) to 762 mm (30 in.), with 95% using 558.8 mm (22 in.) pipe. Evaluation trials were conducted on pipe sections with simulated corrosion damage repaired with glass fiber-reinforced composite liners, carbon fiber-reinforced composite liners, and weld deposition. Additional un-repaired pipe sections were evaluated in the virgin condition and with simulated damage. Hydrostatic failure pressures for pipe sections repaired with glass fiber-reinforced composite liner were only marginally greater than that of pipe sections without

  8. Hard palate-repair technique and facial growth in patients with cleft lip and palate: a systematic review.

    Science.gov (United States)

    Lee, Ying-Hsin; Liao, Yu-Fang

    2013-12-01

    The vomer flap technique for repair of the hard palate is assumed to improve maxillary growth because it causes less scarring in growth-sensitive areas of the palate. The aim of this systematic review was to investigate the effect of techniques using the vomer flap compared with the palatal flap on facial growth in patients with cleft lip and palate. All papers published before 21 July 2012 were sought in the databases PubMed and MEDLINE. Search terms included "facial growth", "cleft lip and palate", "palatal repair technique", and "vomer flap". Additional studies were identified by hand searching the reference lists of the papers retrieved from the electronic search. Two independent reviewers assessed the eligibility of studies for inclusion, extracted the data, and assessed the quality of the methods. Six studies met the selection criteria. Outcomes assessed in 4 studies were dentofacial morphology after vomer or palatal flap, maxillary dental arch in 1 study, and dental arch relations in 2 studies. The quality of the methods used in 3 studies was poor. Contradictory results and a lack of high-quality and long-term outcomes of reviewed studies provided no conclusive scientific evidence about whether the vomer flap technique has more or less of an adverse effect on maxillary growth than the palatal flap. Further well-designed, well-controlled, and long-term studies particularly of the vomer flap (2-stage) and palatal flap (von Langenbeck or two-flap, 1-stage) are needed.

  9. DNA-repair measurements by use of the modified comet assay: an inter-laboratory comparison within the European Comet Assay Validation Group (ECVAG).

    Science.gov (United States)

    Godschalk, Roger W L; Ersson, Clara; Riso, Patrizia; Porrini, Marisa; Langie, Sabine A S; van Schooten, Frederik-Jan; Azqueta, Amaya; Collins, Andrew R; Jones, George D D; Kwok, Rachel W L; Phillips, David H; Sozeri, Osman; Allione, Alessandra; Matullo, Giuseppe; Möller, Lennart; Forchhammer, Lykke; Loft, Steffen; Møller, Peter

    2013-09-18

    The measurement of DNA-repair activity by extracts from cells or tissues by means of the single-cell gel electrophoresis (comet) assay has a high potential to become widely used in biomonitoring studies. We assessed the inter-laboratory variation in reported values of DNA-repair activity on substrate cells that had been incubated with Ro19-8022 plus light to generate oxidatively damaged DNA. Eight laboratories assessed the DNA-repair activity of three cell lines (i.e. one epithelial and two fibroblast cell lines), starting with cell pellets or with cell extracts provided by the coordinating laboratory. There was a large inter-laboratory variation, as evidenced by the range in the mean level of repair incisions between the laboratory with the lowest (0.002incisions/10(6)bp) and highest (0.988incisions/10(6)bp) incision activity. Nevertheless, six out of eight laboratories reported the same cell line as having the highest level of DNA-repair activity. The two laboratories that reported discordant results (with another cell line having the highest level of DNA-repair activity) were those that reported to have little experience with the modified comet assay to assess DNA repair. The laboratories were also less consistent in ordering the repair activity of the other two cell lines, probably because the DNA-repair activity by extracts from these cell lines were very similar (on average approximately 60-65% of the cell line with the highest repair capacity). A significant correlation was observed between the repair activity found in the provided and the self-made cell extracts (r=0.71, Pcomet assay for base-excision repair.

  10. -SH groups and glutathione in cancer patient's blood.

    Science.gov (United States)

    della Rovere, F; Granata, A; Saija, A; Broccio, M; Tomaino, A; Zirilli, A; De Caridi, G; Broccio, G

    2000-01-01

    As reported in previous investigations, erythrocytes are the elements of peripheral blood most affected by free radical activity in the pathogenesis of cancer. In these studies, the level of sulphydrilic groups and reduced glutathione were assayed in the erythrocytes and plasma, while their successful scavenger activity against cell membrane oxidation and peroxidation has already been established. In subjects with cancer, the levels of -SH groups (p < 0.002) and reduced glutathione in both plasma and erythrocytes (p < 0.0001) were shown be a statistically significantly decreased compared to healthy controls. These differences were related to the defence of the hematic tissue against free radical activity. A similar pattern has also been reported when studying vitamin A and E content in the peripheral blood of cancer patients. The role of oxido-reduction phenomena in this disease is discussed, as well as the importance of reducing the oxido-peroxidation involvement of tissues and cell elements. The study of the GSH/GSSG ratio in order to determine the stage of the disease would be useful and might represent a systemic marker for cancerous lesions.

  11. Optimizing paced ventricular function in patients with and without repaired congenital heart disease by contractility-guided lead implant.

    Science.gov (United States)

    Karpawich, Peter P; Singh, Harinder; Zelin, Kathleen

    2015-01-01

    This study evaluates the concept of optimizing ventricular pacing in regard to functional cardiac response. Lead implant based on physiologic variables of contractility at various sites was performed in patients with and without congenital heart disease (CHD). Since right ventricular apical pacing may adversely alter contractility and myocellular function, septal and outflow tract pacing have been advocated. However, there are few studies in the young and essentially none in those with CHD. A total of 113 consecutive patients with and without repaired CHD, aged two to 51 (median 16), some with preexisting epicardial pacemakers, underwent transvenous pacemaker implant using standard sensing/pacing indices plus measurements of pressures, QRS, and contractility responses at each of five predefined potential ventricular implant sites: apex, inflow-, low-, mid-, and infundibular/outflow-septal with each patient serving as his/her own control. Implant was at the site of best contractility with active-fixation, low-threshold steroid-eluting leads. Measured contractility indices varied up to 31% (mean 12%) between sites per patient. Septal regions (mid-, inflow-, and low-) were associated with the most optimal and right ventricular epicardial showed the worst contractility (P implant sites are patient and CHD variable. Current lead designs ensure chronic stability/performance regardless of site. Proactive contractility-guided pacing implant can optimize chronic paced ventricular function. ©2014 Wiley Periodicals, Inc.

  12. Resultados tardios da plastia mitral em pacientes reumáticos Late outcomes of mitral repair in rheumatic patients

    Directory of Open Access Journals (Sweden)

    Elaine Soraya Barbosa de Oliveira Severino

    2011-12-01

    Full Text Available INTRODUÇÃO: Os resultados tardios da plastia mitral em pacientes reumáticos são controversos na literatura. OBJETIVO: Estudo observacional e prospectivo que avalia os resultados tardios e identifica os fatores associados à reoperação e à mortalidade em pacientes reumáticos submetidos à plastia da valva mitral. MÉTODOS: Incluídos somente os pacientes com valvopatia mitral reumática submetidos a plastia, com insuficiência tricúspide associada ou não. Excluídos os pacientes com outros procedimentos associados. Um total de 104 pacientes foi estudado. Sobrevida e reoperação foram avaliadas pela analise de Kaplan-Meier e regressão logística de Cox. RESULTADOS: O tempo de seguimento foi de 63 ± 39 meses (IC 95% 36 a 74 meses. A classe funcional III e IV estava presente em 65,4% dos pacientes no pré-operatório. Foram realizadas 33 plastias do anel posterior, 21 comissurotomias, 50 comissurotomias e plastias do anel posterior. Não houve mortalidade operatória e a tardia foi de três (2,8% pacientes. A reoperação tardia esteve associada à insuficiência mitral residual no pós-operatório (PINTRODUCTION AND AIMS: The long-term results after surgical repair of rheumatic mitral valve remain controversial in literature. Our aim was to determine the predictive factors which impact the long-term results after isolated rheumatic mitral valve repair and to evaluate the effect of those factors on reoperation and late mortality. METHODS: One hundred and four patients with rheumatic valve disease who had undergone mitral valve repair with or without tricuspid valve annuloplasty were included. All patients with associated procedures were excluded. The predictive variables for reoperation were assessed with Cox regression and Kaplan Meier survival curves. RESULTS: The mean follow-up time was 63 ± 39 months (CI 95% 36 to 74 months. The functional class III and IV was observed in 65.4% of all patients. The posterior ring annuloplasty was

  13. Phenotypic Heterogeneity by Germline Mismatch Repair Gene Defect in Lynch Syndrome Patients.

    Science.gov (United States)

    Hernâni-Eusébio, Jorge; Barbosa, Elisabete

    2016-10-01

    Introdução: A síndrome de Lynch é a forma hereditária mais comum de cancro colo-rectal, sendo também responsável por cancro do endométrio e de outros tipos. Associa-se a mutações germinativas nos genes de mismatch repair do ADN e a instabilidade de microssatélites. As mutações MLH1 e MSH2 têm um fenótipo de síndrome de Lynch ‘clássico’, sendo o MSH2 mais associado a cancro extra-cólico. Mutações do MSH6 e PMS2 têm um fenótipo atípico. A expressão clínica é heterogénea, existindo uma correlação entre o gene mismatch repair mutado e o padrão fenotípico. Material e Métodos: Análise retrospetiva dos dados clínicos de doentes que cumpriam os critérios de Amesterdão ou que tinha mutações nos genes mismatch repair, entre setembro de 2012 e outubro de 2015. Resultados: Identificámos 28 doentes. Dezassete tinham cancro colo-rectal sendo a localização no cólon direito predominante. Cinco tiveram cancro do endométrio (mediana da idade de diagnóstico – 53), sem qualquer mutação no MSH6. Cinco desenvolveram outros cancros. Todos os casos com mutações mismatch repair estudados tinham instabilidade de microssatélites. Discussão: Na maioria dos casos foi encontrada mutação no MSH2 apesar de o MLH1 ser descrito na literatura como o gene mais frequentemente mutado. Interessa dizer que os doentes com cancro colo-rectal não evidenciam uma tendência para ter muito infiltrado inflamatório. Na maioria dos casos foi realizada colectomia parcial apesar da incidência elevada de lesões síncronas e metácronas associadas. Histerectomia e anexectomia profilática foi realizada em doentes em menopausa/perimenopausa. Conclusão: O registo standardizado dos dados dos doentes poderá levar a um melhor acompanhamento e conhecimento desta síndrome. O uso das Guidelines de Bethesda poderá identificar novos casos que escapam aos critérios de Amesterdão. A pesquisa de instabilidade de microssatélites deve ser feita em muito maior n

  14. Regulatory Challenges for Cartilage Repair Technologies.

    Science.gov (United States)

    McGowan, Kevin B; Stiegman, Glenn

    2013-01-01

    In the United States, few Food and Drug Administration (FDA)-approved options exist for the treatment of focal cartilage and osteochondral lesions. Developers of products for cartilage repair face many challenges to obtain marketing approval from the FDA. The objective of this review is to discuss the necessary steps for FDA application and approval for a new cartilage repair product. FDA Guidance Documents, FDA Panel Meetings, scientific organization recommendations, and clinicaltrials.gov were reviewed to demonstrate the current thinking of FDA and the scientific community on the regulatory process for cartilage repair therapies. Cartilage repair therapies can receive market approval from FDA as medical devices, drugs, or biologics, and the specific classification of product can affect the nonclinical, clinical, and regulatory strategy to bring the product to market. Recent FDA guidance gives an outline of the required elements to bring a cartilage repair product to market, although these standards are often very general. As a result, companies have to carefully craft their study patient population, comparator group, and clinical endpoint to best showcase their product's attributes. In addition, regulatory strategy and manufacturing process validation need to be considered early in the clinical study process to allow for timely product approval following the completion of clinical study. Although the path to regulatory approval for a cartilage repair therapy is challenging and time-consuming, proper clinical trial planning and attention to the details can eventually save companies time and money by bringing a product to the market in the most expeditious process possible.

  15. INTERNAL REPAIR OF PIPELINES

    Energy Technology Data Exchange (ETDEWEB)

    Robin Gordon; Bill Bruce; Ian Harris; Dennis Harwig; George Ritter; Bill Mohr; Matt Boring; Nancy Porter; Mike Sullivan; Chris Neary

    2004-12-31

    The two broad categories of fiber-reinforced composite liner repair and deposited weld metal repair technologies were reviewed and evaluated for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Principal conclusions from a survey of natural gas transmission industry pipeline operators can be summarized in terms of the following performance requirements for internal repair: (1) Use of internal repair is most attractive for river crossings, under other bodies of water, in difficult soil conditions, under highways, under congested intersections, and under railway crossings. (2) Internal pipe repair offers a strong potential advantage to the high cost of horizontal direct drilling when a new bore must be created to solve a leak or other problem. (3) Typical travel distances can be divided into three distinct groups: up to 305 m (1,000 ft.); between 305 m and 610 m (1,000 ft. and 2,000 ft.); and beyond 914 m (3,000 ft.). All three groups require pig-based systems. A despooled umbilical system would suffice for the first two groups which represents 81% of survey respondents. The third group would require an onboard self-contained power unit for propulsion and welding/liner repair energy needs. (4) The most common size range for 80% to 90% of operators surveyed is 508 mm (20 in.) to 762 mm (30 in.), with 95% using 558.8 mm (22 in.) pipe. Evaluation trials were conducted on pipe sections with simulated corrosion damage repaired with glass fiber-reinforced composite liners, carbon fiber-reinforced composite liners, and weld deposition. Additional un-repaired pipe sections were evaluated in the virgin condition and with simulated damage. Hydrostatic failure pressures for pipe sections repaired with glass fiber-reinforced composite liner were only marginally greater than that of pipe sections without

  16. Postoperative pulmonary and aortic 3D haemodynamics in patients after repair of transposition of the great arteries

    Energy Technology Data Exchange (ETDEWEB)

    Geiger, Julia; Buerk, Jonas; Jung, Bernd; Langer, Mathias [University Medical Center Freiburg, Department of Radiology, Medical Physics, Freiburg (Germany); Hirtler, Daniel; Stiller, Brigitte [University Medical Center Freiburg-Bad Krozingen, Department of Congenital Heart Disease and Paediatric Cardiology, Freiburg (Germany); Arnold, Raoul [University Medical Center Heidelberg, Department of Congenital Heart Disease and Paediatric Cardiology, Heidelberg (Germany); Markl, Michael [Northwestern University, Department of Radiology, Feinberg School of Medicine, Chicago (United States); Northwestern University, Department Biomedical Engineering, McCormick School of Engineering, Chicago (United States)

    2014-01-15

    To characterise aortic and pulmonary haemodynamics and investigate the correlation with post-surgical anatomy in patients with dextro-transposition of the great arteries (d-TGA). Four-dimensional (4D) MRI was performed in 17 patients after switch repair of TGA and 12 healthy controls (age, 11.9 ± 5.4 vs 23.3 ± 1.6 years). Patients were divided according to the pulmonary trunk (TP) position in relation to the ascending aorta (AAo): anterior (n = 10) and right/left anterior position (n = 7). Analysis included visual grading (ranking 0-2) of pulmonary and aortic vortical and helical flow, flow velocity quantification, blood-flow distribution to the right and left pulmonary arteries (flow ratio rPA:lPA), and vessel lumen areas. Anterior TP position was associated with increased vortices in six out of ten patients compared with right anterior TP position (one out of seven) and controls (none). Reduced systolic lPA and TP lumina in patients resulted in significantly increased peak systolic velocities (P < 0.001). Flow ratio rPA:lPA was more heterogeneous in patients (rPA:lPA = 1.56 ± 0.78 vs volunteers 1.09 ± 0.15; P < 0.05) with predominant flow to the rPA. Eleven patients presented increased helices in the AAo (grade 1.6). Evaluation of post-surgical haemodynamics in TGA patients revealed increased vortical flow for anterior TP position, asymmetric flow and increased systolic flow velocity in the pulmonary arteries owing to reduced vascular lumina. (orig.)

  17. Endovascular repair of an abdominal aortic aneurysm in a patient with horseshoe kidney: report of a case.

    Science.gov (United States)

    Volpe, Piero; Nano, Giovanni; Dalainas, Ilias; Palazzo, Vincenzo; Casana, Renato; Paroni, Giovanni

    2006-01-01

    A horseshoe kidney poses special problems during treatment of an abdominal aortic aneurysm (AAA), and there is much controversy about the most suitable method of repair. We report the case of a 65-year-old man with a horseshoe kidney, in whom an AAA was treated with a unibody bifurcated endograft. During the procedure, the two anomalous renal arteries were sacrificed. Although there was transient elevation of the creatinine levels, the patient was discharged with normal renal function and no endoleak from the accessory renal arteries. Thus, when two normal and two accessory renal arteries arise from the non-aneurysmatic proximal aortic neck, providing that preoperative kidney function is normal, it seems that the treatment can be safely carried out using an endovascular technique and excluding the accessory renal arteries. This case supports the feasibility of endovascular surgery for the treatment of AAA in the presence of a horseshoe kidney.

  18. Thoracic aorta aneurysm repair in a patient with a solitary kidney: Hybrid Surgery as a bailout procedure

    Directory of Open Access Journals (Sweden)

    Chris Bakoyiannis

    2016-11-01

    Full Text Available Thoracic endovascular aortic repair (TEVAR is an emerging treatment option for thoracic aorta aneurysms (TAA. Endovascular access is a challenge. We present a novel TEVAR-technique in a patient with single kidney and a 6.4cm TAA. Attempting to place a sheath through iliac arteries was unsuccessful. The decision to proceed to hybrid-TEVAR was made. The protection of the solitary kidney was achieved through axillo-femoral bypass, followed by an end-to-side anastomosis between the aorta and a bifurcated graft. Through the graft, a stent was introduced in the thoracic aorta. With the use of contrast material, the right position of the graft was confirmed.

  19. Bladder exstrophy repair

    Science.gov (United States)

    Bladder birth defect repair; Everted bladder repair; Exposed bladder repair; Repair of bladder exstrophy ... Bladder exstrophy repair involves two surgeries. The first surgery is to repair the bladder and the second one is to attach ...

  20. Resultados da cirurgia do aneurisma da aorta abdominal em pacientes jovens Outcomes after surgical repair of abdominal aortic aneurysms in young patients

    Directory of Open Access Journals (Sweden)

    Telmo P. Bonamigo

    2009-06-01

    Full Text Available CONTEXTO: A presença de aneurisma da aorta abdominal (AAA é rara em pacientes jovens. OBJETIVO: Avaliar os resultados da cirurgia do AAA em pacientes com idade BACKGROUND: Abdominal aortic aneurysms (AAA are rare in young patients. OBJECTIVE: To evaluate outcomes after AAA repair in patients aged < 50 years. METHODS: Between June 1979 and January 2008, 946 patients underwent elective repair for an infrarenal AAA performed by the first author. Of these, 13 patients (1.4% were < 50 years old at surgery. Demographic characteristics and surgical data were analyzed, as well as early and late outcomes after surgical intervention. RESULTS: Mean age was 46±3.4 years (ranging from 43 to 50 years. Most patients were men (76.9%, hypertensive (76.9% and smokers (61.5%. Perioperative morbidity and mortality rates were low (15.4% and 0%, respectively; one patient had respiratory infection and another patient had unstable angina. Median follow-up was 85.5 months, and two patients died due to ischemic cardiopathy and cerebrovascular accident during the follow-up period. CONCLUSION: AAA repair in young patients is a safe procedure, with good long-term results. In our study, there were no perioperative deaths, and a good long-term survival was observed.

  1. Early postoperative fluoroquinolone use is associated with an increased revision rate after arthroscopic rotator cuff repair.

    Science.gov (United States)

    Cancienne, Jourdan M; Brockmeier, Stephen F; Rodeo, Scott A; Young, Chris; Werner, Brian C

    2017-07-01

    To evaluate the association of postoperative fluoroquinolone use following arthroscopic primary rotator cuff repair with failure requiring revision rotator cuff repair. An insurance database was queried for patients undergoing rotator cuff repair from 2007 to 2015. These patients were divided into three groups: (1) patients prescribed fluoroquinolones within 6 months postoperatively (divided into 0-2, 2-4, and 4-6 months), (2) a matched negative control cohort of patients not prescribed fluoroquinolones, and (3) a matched positive control cohort of patients prescribed fluoroquinolones between 6 and 18 months following rotator cuff repair. Rates of failure requiring revision rotator cuff repair were compared within 2 years. A total of 1292 patients were prescribed fluoroquinolones within 6 months after rotator cuff repair, including 442 within 2 months, 433 within 2 to 4 months, and 417 within 4 to 6 months, and were compared to 5225 matched negative controls and 1597 matched positive controls. The rate of revision rotator cuff repair was significantly higher in patients prescribed fluoroquinolones within 2 months (6.1 %) compared to matched negative (2.2 %, P = 0.0009) and positive controls (2.4 %, P = 0.0026). There were no significant differences in the rate of revision rotator cuff repair when fluoroquinolones were prescribed >2 months after rotator cuff repair. Early use of fluoroquinolones following rotator cuff repair was independently associated with significantly increased rates of failure requiring revision rotator cuff repair. This is the first clinical study examining the association of postoperative fluoroquinolone use with failure following arthroscopic rotator cuff repair. III.

  2. MRI in the evaluation of spina bifida patients in the remote period after meningomyelocele repair

    Energy Technology Data Exchange (ETDEWEB)

    Williamson, M.R.; Glasier, C.M.; Chadduck, W.M.; Angtuaco, E.J.C.; Binet, E.F.

    1989-07-01

    MRI was performed on 22 patients ranging in age from 3 months to 16 years who had closure of their meningomyelocele shortly after birth. These patients had developed new clinical findings suggestive of spinal cord dysfunction. MRI showed low placement of the spinal cord in all 22. Six patients had lipomas, five had diastematomyelia and six had hydromyelia. Four patients had an obviously dysplastic terminal cord. (orig.).

  3. INTERNAL REPAIR OF PIPELINES

    Energy Technology Data Exchange (ETDEWEB)

    Robin Gordon; Bill Bruce; Ian Harris; Dennis Harwig; George Ritter; Bill Mohr; Matt Boring; Nancy Porter; Mike Sullivan; Chris Neary

    2004-08-17

    The two broad categories of fiber-reinforced composite liner repair and deposited weld metal repair technologies were reviewed and evaluated for potential application for internal repair of gas transmission pipelines. Both are used to some extent for other applications and could be further developed for internal, local, structural repair of gas transmission pipelines. Principal conclusions from a survey of natural gas transmission industry pipeline operators can be summarized in terms of the following performance requirements for internal repair: (1) Use of internal repair is most attractive for river crossings, under other bodies of water, in difficult soil conditions, under highways, under congested intersections, and under railway. (2) Internal pipe repair offers a strong potential advantage to the high cost of horizontal direct drilling when a new bore must be created to solve a leak or other problem. (3) Typical travel distances can be divided into three distinct groups: up to 305 m (1,000 ft.); between 305 m and 610 m (1,000 ft. and 2,000 ft.); and beyond 914 m (3,000 ft.). All three groups require pig-based systems. A despooled umbilical system would suffice for the first two groups which represents 81% of survey respondents. The third group would require an onboard self-contained power unit for propulsion and welding/liner repair energy needs. (4) The most common size range for 80% to 90% of operators surveyed is 508 mm (20 in.) to 762 mm (30 in.), with 95% using 558.8 mm (22 in.) pipe. Evaluation trials were conducted on pipe sections with simulated corrosion damage repaired with glass fiber-reinforced composite liners, carbon fiber-reinforced composite liners, and weld deposition. Additional un-repaired pipe sections were evaluated in the virgin condition and with simulated damage. Hydrostatic failure pressures for pipe sections repaired with glass fiber-reinforced composite liner were only marginally greater than that of pipe sections without liners

  4. Relationship between acute kidney injury before thoracic endovascular aneurysm repair and in-hospital outcomes in patients with type B acute aortic dissection

    Institute of Scientific and Technical Information of China (English)

    Hong-Mei REN; Xiao WANG; Chun-Yan HU; Bin QUE; Hui AI; Chun-Mei WANG; Li-Zhong SUN; Shao-Ping NIE

    2015-01-01

    Objective Acute kidney injury (AKI) frequently occurs after catheter-based interventional procedures and increases mortality. How-ever, the implications of AKI before thoracic endovascular aneurysm repair (TEVAR) of type B acute aortic dissection (AAD) remain un-clear. This study evaluated the incidence, predictors, and in-hospital outcomes of AKI before TEVAR in patients with type B AAD. Meth-ods Between 2009 and 2013, 76 patients were retrospectively evaluated who received TEVAR for type B AAD within 36 h from symptom onset. The patients were classified into no-AKI vs. AKI groups, and the severity of AKI was further staged according to kidney disease:im-proving global outcomes criteria before TEVAR. Results The incidence of preoperative AKI was 36.8%. In-hospital complications was significantly higher in patients with preoperative AKI compared with no-AKI (50.0%vs. 4.2%, respectively;P<0.001), including acute renal failure (21.4%vs. 0, respectively;P<0.001), and they increased with severity of AKI (P<0.001). The maximum levels of body tem-perature and white blood cell count were significantly related to maximum serum creatinine level before TEVAR. Multivariate analysis showed that systolic blood pressure on admission (OR:1.023;95%CI:1.003–1.044;P=0.0238) and bilateral renal artery involvement (OR:19.076;95%CI:1.914–190.164;P=0.0120) were strong predictors of preoperative AKI. Conclusions Preoperative AKI frequently oc-curred in patients with type B AAD, and correlated with higher in-hospital complications and enhanced inflammatory reaction. Systolic blood pressure on admission and bilateral renal artery involvement were major risk factors for AKI before TEVAR.

  5. Abdominal wall hernia repair with a composite ePTFE/polypropylene mesh: clinical outcome and quality of life in 152 patients

    DEFF Research Database (Denmark)

    Iversen, E; Lykke, Anna; Hensler, M

    2010-01-01

    No consensus has yet been reached regarding the optimal mesh for the repair of small ventral hernias. A composite polytetrafluoroethylene/polypropylene mesh (Ventralex(®)) is designed for this purpose, and this paper reports its use in a larger series of patients....

  6. A comparison of hemodynamic effects of levosimendan and dobutamine in patients undergoing mitral valve repair / replacement for severe mitral stenosis

    Directory of Open Access Journals (Sweden)

    Ravikumar Gandham

    2013-01-01

    Full Text Available Aims and Objectives: We aimed to compare the hemodynamic effects of levosimendan and dobutamine in patients undergoing mitral valve surgery on cardiopulmonary bypass (CPB. Materials and Methods: Sixty patients were divided into 2 groups of 30 each. Group-L patients received levosimendan 0.1 μg/kg/min and Group-D patients received dobutamine 5 μg/kg/min while weaning off CPB. Additional inotrope and/or vasoconstrictor were started based on hemodynamic parameters. Hemodynamic data were collected at the end and at 30 minutes after CPB, thereafter at 6, 12, 24, and 36 hours post-CPB. Mean arterial pressure (MAP, central venous pressure (CVP, heart rate (HR, cardiac index (CI, systemic vascular resistance index (SVRI, and lactate levels were measured. Results: Group-L showed increased requirement of inotropes and vasoconstrictors. The SVRI, CVP, and MAP were reduced more in Group-L. The CI was low in Group-L in the initial period when compared to Group-D. Later Group-L patients showed a statistically significant increase in CI even after 12 hrs of discontinuation of levosimendan infusion. The HR was increased more in Group-D. Lactate levels, intensive care unit stay, and duration of ventilation were similar in both groups. Conclusions: Levosimendan 0.1 μg/kg/min compared to dobutamine 5 μg/kg/min showed more vasodilation and lesser inotropic activity in patients undergoing mitral valve surgery for mitral stenosis. Levosimendan compared to dobutamine showed a statistically significant increase in CI even after 12 hrs of discontinuation. The requirement of another inotrope or vasopressor was frequent in levosimendan group.

  7. Absorbable Polydioxanone (PDS) suture provides fewer wound complications than polyester (ethibond) suture in acute Tendo-Achilles rupture repair

    LENUS (Irish Health Repository)

    Baig, M N

    2017-05-01

    We prospectively studied acute Achilles tendon rupture in patients over a two 2-year period and reviewed the causes, outcome and complications. There were 53 patients included with acute Achilles rupture with minimum follow up period of 6 months. We compared the outcomes including infection rate and Boyden score between the two groups repaired by Polydioxanone and Polyester respectively. All infected cases had a suture repair using the polyester suture. The difference in the infection rate was highly significant between the 2 groups (p=0.001). All 34 patients (100%) in the PDS group had good \\/ excellent results based on the Boyden clinical assessment. Conversely, only 16 patients 9(68.4%) had good or excellent results IN Polyester repair group. Patients treated with a non- absorbable suture (ethibond) material for repair had a higher incidence infection and worse Boyden scores than the absorbable PDS group.

  8. Prolongation of PR interval is associated with endothelial dysfunction and activation of vascular repair in high-risk cardiovascular patients.

    Science.gov (United States)

    Chan, Yap-Hang; Siu, Chung-Wah; Yiu, Kai-Hang; Yiu, Yuen-Fung; Lau, Kui-Kai; Lam, Tai-Hing; Lau, Chu-Pak; Tse, Hung-Fat

    2013-06-01

    Epidemiological studies showed that PR prolongation is associated with increased risk of adverse cardiovascular outcomes. We investigated the relations of PR interval with indices of vascular function and endothelial repair as the underlying mechanisms. The study comprised 348 high-risk patients with prior coronary artery disease, ischemic stroke, and/or diabetes mellitus recruited from medical outpatient clinics and 150 healthy subjects without such a history. PR interval was considered prolonged if >200 ms, as determined from resting 12-lead electrocardiogram. Vascular function was assessed by brachial flow-meditated dilatation (FMD) using high-resolution ultrasound. Circulating CD133(+)/KDR(+) endothelial progenitor cell (EPC) levels were measured by flow cytometry. Among healthy subjects, PR interval was inversely associated with FMD (R = -0.20, P = 0.015), but not with the level of circulating CD133(+)/KDR(+) EPC (R = 0.05, P = 0.58). Among high-risk cardiovascular patients, PR prolongation >200 ms was more common compared with healthy subjects (45/348 (13 %) versus 4/150 (3 %), P PR interval was associated inversely with FMD (R = -0.14, P = 0.01) and positively with circulating CD133(+)/KDR(+) EPC level (R = +0.14, P = 0.009). Circulating CD133(+)/KDR(+) EPC level was significantly increased in patients with PR prolongation >200 ms (0.87 ± 0.37 versus 0.68 ± 0.42 (log, ×10(-3)/ml), P = 0.005). Adjusted for potential confounders, increased PR interval remained independently associated with increased CD133(+)/KDR(+) EPC by +0.002 (95 % confidence interval (CI) 0.000 to 0.004 (log, ×10(-3)/ml), P = 0.011) and depressed FMD (B = -0.014 %, 95 % CI -0.027 to -0.002, P = 0.026). PR prolongation is associated with endothelial dysfunction and evidence of endothelial repair activation in patients with high cardiovascular risk.

  9. Survey on mental state of hymen repair patients and its psychological intervention%处女膜修补术患者心理状况调查与心理干预

    Institute of Scientific and Technical Information of China (English)

    杨君; 刘远新; 胡永超; 吴清香

    2009-01-01

    Objective To investigate the mental state of hymen repair patients and the intervention effect, so as to provide theorieal basis for developing the psycholngical intervention in clinic. Methods 40 hymen repair patients were randomly divided into the intervention group and the control group, each with 20 patients. The control group received the routine psychological care. The intervention group was treated with measures established by the psychological intervention mode. Every patient was given a score with self-rating scale (SCL-90) before and after operation. The mental states of the two groups were compared. Results After the psychological intervention, the scores of anxiety, depression, phobic anxiety, compulsivity, hostility and interpersonal relationship showed significant reduction in the intervention group compared with the control group (P <0. 05). Condusions To practice psychological intervention can reduce the negative emotion of hymen repair patients and help them maintain suitable psychosematie states.%目的 探讨处女膜修补患者的心理状况及干预效果,为临床开展心理干预提供理论依据.方法 选取处女膜修补术患者40例,随机分为干预组和对照组,每组各20例.对照组采取常规心理护理,干预组在此基础上给予针对性心理干预,分别于手术前后采用SCL-90自评量表评估并比较两组患者的心理状态.结果 干预后,干预组患者焦虑、抑郁、恐怖、强迫、敌对和人际关系分值明显低于对照组,差异有统计学意义(P<0.05).结论 实施心理干预可缓解处女膜修补患者的负性情绪,帮助其保持良好的身心状态.

  10. Intraluminal pressure, transmucosal potential difference, and pH studies in the oesophagus of patients before and after Collis repair of a hiatal hernia

    Science.gov (United States)

    Habibulla, K. S.; Collis, J. Leigh

    1973-01-01

    Intraluminal pressure, transmucosal potential difference, and endo-oesophageal pH measurements were studied in patients with hiatal hernia—before and after a hiatal repair. The operation employed is the Collis (1968) repair for uncomplicated hiatal hernia and does not refer to gastroplasty as recommended for peptic stricture (Collis, 1961). Postoperative studies show that the repair approximates the inferior oesophageal sphincter to the hiatus with the production of a single band of raised pressure at the lower end of the oesophagus. This band is similar to that seen in normal subjects and its appearance was associated with cure of the symptoms, abolition of the gastro-oesophageal reflux, and improvement in the function of the inferior oesophageal sphincter and the musculature of the body of the oesophagus. Certain physiological implications of this study are discussed. Images PMID:4724501

  11. Functional cine MRI of the abdomen for the assessment of implanted synthetic mesh in patients after incisional hernia repair: initial results

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, Tanja [Ludwig-Maximilians-University Munich, Department of Clinical Radiology, Munich (Germany); Ludwig-Maximilians-University Munich, Department of Clinical Radiology, Klinikum Innenstadt, Munich (Germany); Ladurner, Roland; Mussack, Thomas [Ludwig-Maximilians-University Munich, Department of Surgery and Traumatology, Klinikum Innenstadt, Munich (Germany); Gangkofer, Alexander; Reiser, Maximilian; Lienemann, Andreas [Ludwig-Maximilians-University Munich, Department of Clinical Radiology, Munich (Germany)

    2007-12-15

    The aim of our study was to develop a method that allows the vizualiation and evaluation of implanted mesh in patients after incisional hernia repair with MRI. Furthermore, we assessed problems typically related with mesh implantation like adhesions and muscular atrophy. We enrolled 28 patients after incisional hernia repair. In 10 patients mesh implantation was done by laparoscopy (expanded polytetrafluoroethylene=ePTFE mesh) and in 18 by laparotomy (polypropylene mesh). Functional MRI was performed on a 1.5-T system in supine position. Sagittal and axial TrueFISP images of the entire abdomen were acquired with the patient repeatedly straining. Evaluation included: correct position and intact fixation of the mesh, furthermore visceral adhesions, recurrent hernia and atrophy of the rectus muscle. The ePTFE mesh was visible in all cases; the polypropylene mesh was not detectable. In seven of the ten ePTFE meshes the fixation was not intact; two recurrent hernias were detected. Twenty of 28 patients had intraabdominal adhesions. In 5 cases mobility of the abdominal wall was reduced, and 16 patients showed an atropy of the rectus muscle. Functional cine MRI is a suitable method for follow-up studies in patients after hernia repair. ePTFE meshes can be visualized directly, and typical complications like intestinal adhesions and abdominal wall dysmotility can be assessed reliably. (orig.)

  12. Emergency Abdominal Aortic Aneurysm Repair in a Patient with Failing Heart: Axillofemoral Bypass Using a Centrifugal Pump Combined with Levosimendan for Inotropic Support

    Directory of Open Access Journals (Sweden)

    Pavel Michalek

    2011-01-01

    Full Text Available We describe the case of an 83-year-old patient requiring repair of a large symptomatic abdominal aortic aneurysm (AAA. The patient was known to have coronary artery disease (CAD with symptoms and signs of significant myocardial dysfunction, left-heart failure, and severe aortic insufficiency. The procedure was performed with the help of both mechanical and pharmacological circulatory support. Distal perfusion was provided by an axillofemoral bypass with a centrifugal pump, with dobutamine and levosimendan administered as pharmacological inotropic support. The patient's hemodynamic status was monitored with continuous cardiac output monitoring and transesophageal echocardiography. No serious circulatory complications were recorded during the perioperative and postoperative periods. This paper suggests a potential novel approach to combined circulatory support in patients with heart failure, scheduled for open abdominal aortic aneurysm repair.

  13. Pre-treatment interleukin-6 levels strongly affect bone erosion progression and repair detected by magnetic resonance imaging in rheumatoid arthritis patients.

    Science.gov (United States)

    Kondo, Yasushi; Kaneko, Yuko; Sugiura, Hiroaki; Matsumoto, Shunsuke; Nishina, Naoshi; Kuwana, Masataka; Jinzaki, Masahiro; Takeuchi, Tsutomu

    2017-07-01

    To examine the relationship between MRI structural damage and repair and plasma inflammatory cytokines in patients with RA. A total of 88 newly diagnosed, untreated RA patients were enrolled. Contrast MRI of the dominant hand and X-rays of the hands and feet were performed at baseline and 1 year later. MR images were evaluated using RA MRI scoring, and X-ray. Progression of bone erosion and repair were observed more frequently in MRI than in X-rays (erosion, 52% vs 26%, P erosion progression, with IL-6 having stronger effect than seropositivity. A receiver operating characteristic curve identified the baseline IL-6 level of 7.6 pg/ml for predicting erosion progression during 1 year, with an area under the curve of 0.82; higher IL-6 levels resulted in more erosion progression. Baseline low IL-6 was also an independent predictor for MRI erosion repair. In newly diagnosed, untreated RA patients, baseline plasma IL-6 levels are responsible for 1-year MRI bone erosion progression and repair.

  14. Laparoscopic Repair of Morgagni Hernia

    Directory of Open Access Journals (Sweden)

    ilker murat arer

    2015-03-01

    Full Text Available Morgagni hernia is a congenital herniation of abdominal contents into the thoracic cavity through a retrosternal diaphragmatic defect and make up about 1 % - 5 % of all types of congenital diaphragmatic hernias. Surgical repair of Morgagni hernias is usually indicated when patients are symptomatic and have a high risk of strangulation or incarceration of the contained viscera. 71-year-old male patient admitted to emergency department with a 2-day history of abdominal pain, vomiting and obstipation. Laparoscopic repair for Morgagni hernia was performed. Laparoscopic repair for Morgagni hernia with mesh repair is secure, satisfactory and easily performed. [Cukurova Med J 2015; 40(Suppl 1: 71-74

  15. Effects of percutaneous mitral valve repair with Mitraclip on clinical status, ventricular remodeling and neurohormonal profile in patients with advanced heart failure and significant functional mitral regurgitation

    OpenAIRE

    Berardini, Alessandra

    2016-01-01

    The role of percutaneous mitral valve repair (PMVR) in patients with advanced heart failure (HF) and functional mitral regurgitation (FMR) is unclear. The aim of this study was to assess the effects (PMVR) therapy on clinical outcomes , left ventricular (LV) remodeling and neurohormonal changes in inoperable critical patients with chronically symptomatic FMR despite optical medical /electrical therapy and severe LV dysfunction. We analyzed the clinical and echocardiographic data of twenty-fiv...

  16. Anesthetic Considerations in a Patient with Myotonic Dystrophy for Hip Labral Repair

    Science.gov (United States)

    Wang, David; Ludwin, Danielle

    2017-01-01

    Myotonic Dystrophy (DM) affects multiple organ systems. Disorders such as hyperthyroidism, progressive musculoskeletal weakness, cardiac dysrhythmias, hypoventilation, and cognitive-behavioral disorders may be present in these patients. Thorough preoperative assessment and anesthetic planning are required to minimize the risk of anesthetic complications. Patients with DM can exhibit exquisite sensitivity to sedatives, neuromuscular blocking agents, and volatile anesthetics, resulting in potential postoperative complications. There is limited literature available on successful anesthetic techniques for the DM patient. We present this case report to add to our current fund of knowledge. PMID:28316843

  17. INTERNAL REPAIR OF PIPELINES

    Energy Technology Data Exchange (ETDEWEB)

    Robin Gordon; Bill Bruce; Ian Harris; Dennis Harwig; Nancy Porter; Mike Sullivan; Chris Neary

    2004-04-12

    to solve a leak or other problem. (3) Typical travel distances can be divided into three distinct groups: up to 305 m (1,000 ft.); between 305 m and 610 m (1,000 ft. and 2,000 ft.); and beyond 914 m (3,000 ft.). All three groups require pig-based systems. A despooled umbilical system would suffice for the first two groups which represents 81% of survey respondents. The third group would require an onboard self-contained power unit for propulsion and welding/liner repair energy needs. (4) Pipe diameter sizes range from 50.8 mm (2 in.) through 1,219.2 mm (48 in.). The most common size range for 80% to 90% of operators surveyed is 508 mm to 762 mm (20 in. to 30 in.), with 95% using 558.8 mm (22 in.) pipe. An evaluation of potential repair methods clearly indicates that the project should continue to focus on the development of a repair process involving the use of GMAW welding and on the development of a repair process involving the use of fiber-reinforced composite liners.

  18. Members of the RAD52 Epistasis Group Contribute to Mitochondrial Homologous Recombination and Double-Strand Break Repair in Saccharomyces cerevisiae.

    Science.gov (United States)

    Stein, Alexis; Kalifa, Lidza; Sia, Elaine A

    2015-11-01

    Mitochondria contain an independently maintained genome that encodes several proteins required for cellular respiration. Deletions in the mitochondrial genome have been identified that cause several maternally inherited diseases and are associated with certain cancers and neurological disorders. The majority of these deletions in human cells are flanked by short, repetitive sequences, suggesting that these deletions may result from recombination events. Our current understanding of the maintenance and repair of mtDNA is quite limited compared to our understanding of similar events in the nucleus. Many nuclear DNA repair proteins are now known to also localize to mitochondria, but their function and the mechanism of their action remain largely unknown. This study investigated the contribution of the nuclear double-strand break repair (DSBR) proteins Rad51p, Rad52p and Rad59p in mtDNA repair. We have determined that both Rad51p and Rad59p are localized to the matrix of the mitochondria and that Rad51p binds directly to mitochondrial DNA. In addition, a mitochondrially-targeted restriction endonuclease (mtLS-KpnI) was used to produce a unique double-strand break (DSB) in the mitochondrial genome, which allowed direct analysis of DSB repair in vivo in Saccharomyces cerevisiae. We find that loss of these three proteins significantly decreases the rate of spontaneous deletion events and the loss of Rad51p and Rad59p impairs the repair of induced mtDNA DSBs.

  19. Patients with schizophrenia do not preserve automatic grouping when mentally re-grouping figures: shedding light on an ignored difficulty

    Directory of Open Access Journals (Sweden)

    Anne eGiersch

    2012-08-01

    Full Text Available Looking at a pair of objects is easy when automatic grouping mechanisms bind these objects together, but visual exploration can also be more flexible. It is possible to mentally ‘re-group’ two objects that are not only separate but belong to different pairs of objects. ‘Re-grouping’ is in conflict with automatic grouping, since it entails a separation of each item from the set it belongs to. This ability appears to be impaired in patients with schizophrenia. Here we check if this impairment is selective, which would suggest a dissociation between grouping and ‘re-grouping’, or if it impacts on usual, automatic grouping, which would call for a better understanding of the interactions between automatic grouping and ‘re-grouping’. Sixteen outpatients with schizophrenia and healthy controls had to identify two identical and contiguous target figures within a display of circles and squares alternating around a fixation point. Eye-tracking was used to check central fixation. The target pair could be located in the same or separate hemifields. Identical figures were grouped by a connector (grouped automatically or not (to be re-grouped. Attention modulation of automatic grouping was tested by manipulating the proportion of connected and unconnected targets, thus prompting subjects to focalize on either connected or unconnected pairs. Both groups were sensitive to automatic grouping in most conditions, but patients were unusually slowed down for connected targets while focalizing on unconnected pairs. In addition, this unusual effect occurred only when target were presented within the same hemifield. Patients and controls differed on this asymmetry between within- and across-hemifield presentation, suggesting that patients with schizophrenia do not re-group figures in the same way as controls do. We discuss possible implications on how ‘re-grouping’ ties in with ongoing, automatic perception in healthy volunteers.

  20. 28 Comparative Study of Open Mesh Repair and Desarda's No ...

    African Journals Online (AJOL)

    user

    2006-12-02

    Dec 2, 2006 ... East And Central African Journal of Surgery Volume 11 Number 2. ... new technique and the open mesh repair done in a district level general hospital set ... laparoscopic repairs or the patients given ..... Hernia repair (Open Vs.

  1. Prevalence of autoantibodies in a group of hereditary angioedema patients.

    Science.gov (United States)

    Dortas Junior, Sergio Duarte; Valle, Solange Oliveira Rodrigues; Levy, Soloni Afra Pires; Tortora, Rosangela P; Abe, Augusto Tiaqui; Pires, Gisele Viana; Papi, José Angelo de Souza; França, Alfeu Tavares

    2012-01-01

    Hereditary Angioedema is a dominantly inherited disease. Routine screening of autoantibodies (AAB) is not recommended for individuals with Hereditary Angioedema; however, prevalence of these antibodies in Hereditary Angioedema patients is not well documented. We aim to determine the prevalence of AAB so that individuals at risk of developing autoimmune diseases can be identified. Fifteen patients with Hereditary Angioedema attended at Clementino Fraga Filho University Hospital accepted to participate in this study. Prevalence of AAB was 40%. Our data indicate high prevalence of AAB in patients with Hereditary Angioedema. Large-scale studies should be considered to determine the significance of these AAB in the follow-up care of patients with Hereditary Angioedema.

  2. Quantitative assessment of systolic left ventricular function with speckle-tracking echocardiography in adult patients with repaired aortic coarctation

    NARCIS (Netherlands)

    M.E. Menting (Myrthe); R.W.J. van Grootel (Roderick W. J.); A.E. van den Bosch (Annemien); J.A. Eindhoven (Jannet); J.S. McGhie (Jackie); J.A.A.E. Cuypers (Judith); M. Witsenburg (Maarten); W.A. Helbing (Willem); J.W. Roos-Hesselink (Jolien)

    2016-01-01

    textabstractDespite successful aortic coarctation (CoA) repair, systemic hypertension often recurs which may influence left ventricular (LV) function. We aimed to detect early LV dysfunction using LV global longitudinal strain (GLS) in adults with repaired CoA, and to identify associations with pati

  3. 腹腔镜手术治疗食管裂孔疝八例体会%Experience of eight patients treated by laparoscopic esophageal hiatal hernia repair

    Institute of Scientific and Technical Information of China (English)

    赵鹏; 张国志; 陈建立; 李曙光; 崔明新

    2012-01-01

    Objective To explore the safety and therapeutic effect of 8 patients with esophageal Hiatal Hernia treated by laparoscopic hernia repair.Methods A retrospective analysis was performed on the clinical data of 8 patients with esophageal Hiatal Hernia form Jun.2009 to Jun. 2010.Among the participants,3 conducted 360-degree fundoplication,5 conducted partial(270-degree) fundoplication.Silk sutures were used for the repair of esophageal perforation in 4 patients,and patch repair was used for the other 4 cases.Results Eight patients were treated by laparoscopic hernia repair,and all of them were cured without postoperative complications.The mean duration of surgery was ( 120 ± 30) min,with average blood loss ( 50 ± 12 ) ml.Patients had a mean postoperative hospital stay of(4.5 ± 2.5 )days.All the patients were followed up for 1 to 2 years,and no case was found to be relapsed.Conclusion Total laparoscopic hernia repair is minimally invasive,with short recovery course,less pain after surgery,little complication and short hospitalized time.Laparoscopic Hernia repair should be the preferred effective operation method for patients with esophageal Hiatal Hernia.%目的 探讨使用腹腔镜行食管裂孔疝修补术的疗效和安全性.方法 对8例食管裂孔疝患者行腹腔镜食管裂孔疝修补术,其中3例行360°胃底折叠术,5例行270°胃底部分折叠术.4例采用丝线缝合修补食管裂孔,4例应用补片修补食管裂孔.结果 8例腹腔镜食管裂孔疝修补术全部成功.手术时间平均( 120±30) min,术中出血量平均(50±12)ml,无术后并发症,术后平均住院(4.5±2.5)d.术后症状完全消失7例,好转1例.随访1~2年,无复发.结论 腹腔镜食管裂孔疝修补术具有疗效确定、安全和创伤小的优点,值得进一步推广应用.

  4. Communication needs of patients with altered hearing ability: Informing pharmacists' patient care services through focus groups.

    Science.gov (United States)

    Ferguson, McKenzie; Liu, Min

    2015-01-01

    The purpose of this research is to identify communication barriers and needs for Deaf and hard-of-hearing (HOH) patients when they seek pharmaceutical care, and to better understand the impact of poor communication upon medication adherence and medication errors among this underserved population. Focus group discussion. Midwestern United States in September 2013 through April 2014. Deaf/HOH patients aged 18 years or older who used American Sign Language as their primary method of communication and were taking at least two long-term prescription medications. Qualitative themes. Many of the Deaf/HOH still perceived community pharmacists in a dispensing role and lacked an understanding of other services being offered in this setting. In addition, pharmacists who demonstrated a lack of sensitivity and patience towards the Deaf/HOH risk weakening the relationship between patient and provider. As a result, safe use of medications is compromised. Deaf and HOH patients have unique needs that pharmacists must understand and address. Effective communication and literacy assessment is essential to ensure safe medication use and optimal health outcomes. Pharmacist education and staff training are needed to increase awareness of this patient population's needs and to strengthen the patient-pharmacist relationship.

  5. A new primary cleft lip repair technique tailored for Asian patients that combines three surgical concepts: Comparison with rotation--advancement and straight-line methods.

    Science.gov (United States)

    Funayama, Emi; Yamamoto, Yuhei; Furukawa, Hiroshi; Murao, Naoki; Shichinohe, Ryuji; Hayashi, Toshihiko; Oyama, Akihiko

    2016-01-01

    Various techniques have been described for unilateral cleft lip repair. These may be broadly classified into three types of procedure/concept: the straight-line method (SL; Rose-Thompson effect); rotation-advancement (RA; upper-lip Z-plasty); and the triangular flap method (TA; lower-lip Z-plasty). Based on these procedures, cleft lip repair has evolved in recent decades. The cleft lip repair method in our institution has also undergone several changes. However, we have found that further modifications are needed for Asian patients who have wider philtral dimples and columns than Caucasians, while following the principles of the original techniques mentioned above. Here, we have incorporated the advantages of each procedure and propose a refined hybrid operating technique, seeking a more appropriate procedure for Asian patients. To evaluate our new technique, a comparison study was performed to evaluate RA, SL, and our technique. We have used our new technique to treat 137 consecutive cleft lip cases of all types and degrees of severity, with or without a cleft palate, since 2009. In the time since we adopted the hybrid technique, we have observed improved esthetics of the repaired lip. Our technique demonstrated higher glance impression average scores than RA/SL.

  6. [The importance of social psychological and clinical factors for prescribing group psychotherapy for neurosis patients].

    Science.gov (United States)

    Grineva, I M; Khokholeva, A A; Obora, V V; Karagodina, E G; Lazarenko, A N

    1989-11-01

    Socio-psychological and clinical factors and their significance for group psychotherapy were investigated in 62 patients with neuroses. The obtained statistically valid differences of some characteristic aspects between groups of patients with positive and negative directives. This indicates the necessity of differential approach to group psychotherapy and active individual and group work on the creation of positive motivation to this type of treatment.

  7. Endovascular repair of multiple infrageniculate aneurysms in a patient with vascular type Ehlers-Danlos syndrome.

    Science.gov (United States)

    Domenick, Natalie; Cho, Jae S; Abu Hamad, Ghassan; Makaroun, Michel S; Chaer, Rabih A

    2011-09-01

    Patients with vascular type Ehler-Danlos syndrome can develop aneurysms in unusual locations. We describe the case of a 33-year-old woman with vascular type Ehlers-Danlos syndrome who developed metachronous tibial artery aneurysms that were sequentially treated with endovascular means.

  8. Patient-Related Risk Factors for Recurrence After Inguinal Hernia Repair

    DEFF Research Database (Denmark)

    Burcharth, Jakob; Pommergaard, Hans-Christian; Bisgaard, Thue

    2015-01-01

    Background. Several factors influence the risk of recurrence after inguinal hernia surgery; however, a systematic review and meta-analysis of patient-related risk factors for recurrence after inguinal hernia surgery has not been performed earlier. Methods. MEDLINE, Embase, and Cochrane databases ...

  9. Impact on cartilage repair of the knee: Patient profiling and single-stage regeneration

    NARCIS (Netherlands)

    Windt, T.S. de

    2015-01-01

    Cartilage defects are considered troublesome injuries, which can cause symptoms as pain, swelling and locking, limit function and impede quality of life, similar to patients with osteoarthritis. Treatment of these defects is a clinical challenge as currently, an ideal strategy is lacking, especially

  10. Spinal versus general anesthesia for transabdominal preperitoneal (TAPP) repair of inguinal hernia: Interim analysis of a controlled randomized trial.

    Science.gov (United States)

    Sarakatsianou, Chamaidi; Georgopoulou, Stavroula; Baloyiannis, Ioannis; Chatzimichail, Maria; Vretzakis, George; Zacharoulis, Dimitris; Tzovaras, George

    2017-08-01

    General anesthesia has been used as standard for laparoscopic hernia repair by the transabdominal preperitoneal (TAPP) approach. Regional anesthesia has been occasionally applied in high risk patients where general anesthesia is contraindicated. This randomized clinical trial compares spinal anesthesia with general anesthesia for TAPP inguinal hernia repair in non-high risk patients. Seventy adult American Society of Anesthesiologists I, II and III patients undergoing elective TAPP inguinal hernia repair were randomized to either general or spinal anesthesia. Postoperative morphine consumption was significantly less immediately postoperatively (p spinal anesthesia group. Postoperative pain was also significantly decreased within the first 8 h postoperatively (p spinal anesthesia group. Spinal anesthesia offers some advantages in patient analgesia during the early postoperative period after TAPP inguinal hernia repair and can be proposed as an effective alternative method of anesthesia for TAPP repair. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. A two-year follow-up for Chinese patients with abdominal aortic aneurysm undergoing open/endovascular repair

    Institute of Scientific and Technical Information of China (English)

    Sun Tao; Zhang Hongju; Cheng Yutong; Wang Su; Tao Ying; Zhang Donghua; Huang Ji

    2014-01-01

    Background A number of studies have demonstrated the rates of overall and aneurysm-related mortality and morbidity in Western populations.The cardiovascular risk factors influencing postoperative outcome have been also reported.Until recently,little has been known about the prognosis in this patient cohort in the Chinese population.We evaluated the independent predictors of mortality and morbidity in abdominal aortic aneurysm (AAA) patients undergoing elective surgical treatment and emphasized whether the coronary artery revascularization could have any effect on the overall mortality and morbidity in patients following the current guideline recommendation.Methods A total of 386 patients (174 women) undergoing surgery in Beijing Anzhen Hospital from January 2008 to June 2010 were enrolled (mean age (70.6±10.5) years).Kaplan-Meier curves were constructed to compare the mortality and morbidity of AAA patients with coronary artery revascularization and those without.A Cox proportional hazards model was constructed to identify clinical factors associated with two-year outcomes.The primary outcomes were death from any cause,the pre-specified morbidity was re-hospitalization for pulmonary conditions,congestive heart failure,angina,ischemic/hemorrhagic stroke.Results During the two-year follow-up,34 patients died and 65 experienced re-hospitalization with pulmonary conditions,congestive heart failure,angina,or ischemic/hemorrhagic stroke.Kaplan-Meier survival analysis showed that the AAA patients with cardiac revascularization had no higher incidence of overall mortality and major morbidity than those without (log-rank test P=0.35 and P=0.40,respectively).Cox proportional hazards regression analysis showed that level of low-density lipoprotein (HR,4.06; 95% CI:1.19-18.7,P=0.027) and AAA size (HR,2.18; 95% CI:1.28-11.65,P=0.036) were independently associated with the incidence of overall mortality.Long-term use of angiotensin converting enzyme inhibitors

  12. Laparoscopic reconstruction of iatrogenic-induced lower ureteric strictures: Does timing of repair influence the outcome?

    Directory of Open Access Journals (Sweden)

    George P Abraham

    2011-01-01

    Full Text Available Context: Influence of timing of repair on outcome following laparoscopic reconstruction of lower ureteric strictures Aims: To assess the influence of timing of repair on outcome following laparoscopic reconstruction of lower ureteric strictures in our adult patient population. Settings and Design: Single surgeon operative experience in two institutes. Retrospective analysis. Materials and Methods: All patients were worked up in detail. All patients underwent cystoscopy and retrograde pyelography prior to laparoscopic approach. Patients were categorised into two groups: early repair (within seven days of inciting event and delayed repair (after two weeks. Operative parameters and postoperative events were recorded. Postprocedure all patients were evaluated three monthly. Follow-up imaging was ordered at six months postoperatively. Improvement in renal function, resolution of hydronephrosis and unhindered drainage of contrast through the reconstructed unit on follow-up imaging was interpreted as a satisfactory outcome. Statistical Analysis Used: Mean, standard deviation, equal variance t test, Mann Whitney Z test, Aspin-Welch unequal variance t test. Results: Thirty-six patients (37 units, 36 unilateral and 1 simultaneous bilateral underwent laparoscopic ureteral reconstruction of lower ureteric stricture following iatrogenic injury - 21 early repair (Group I and 15 delayed repair (Group II. All patients were hemodynamically stable at presentation. Early repair was more technically demanding with increased operation duration. There was no difference in blood loss, operative complications, postoperative parameters, or longterm outcome. Conclusions: In hemodynamically stable patients, laparoscopic repair of iatrogenically induced lower ureteric strictures can be conveniently undertaken without undue delay from the inciting event. Compared to delayed repairs, the procedure is technically more demanding but morbidity incurred and outcome is at par.

  13. Can Early Computed Tomography Angiography after Endovascular Aortic Aneurysm Repair Predict the Need for Reintervention in Patients with Type II Endoleak?

    Energy Technology Data Exchange (ETDEWEB)

    Dudeck, O., E-mail: oliver.dudeck@med.ovgu.de [University of Magdeburg, Department of Radiology and Nuclear Medicine (Germany); Schnapauff, D. [Charité Universitätsmedizin Berlin, Department of Radiology (Germany); Herzog, L.; Löwenthal, D.; Bulla, K.; Bulla, B. [University of Magdeburg, Department of Radiology and Nuclear Medicine (Germany); Halloul, Z.; Meyer, F. [University of Magdeburg, Department of General, Visceral and Vascular Surgery (Germany); Pech, M. [University of Magdeburg, Department of Radiology and Nuclear Medicine (Germany); Gebauer, B. [Charité Universitätsmedizin Berlin, Department of Radiology (Germany); Ricke, J. [University of Magdeburg, Department of Radiology and Nuclear Medicine (Germany)

    2015-02-15

    PurposeThis study was designed to identify parameters on CT angiography (CTA) of type II endoleaks following endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA), which can be used to predict the subsequent need for reinterventions.MethodsWe retrospectively identified 62 patients with type II endoleak who underwent early CTA in mean 3.7 ± 1.9 days after EVAR. On the basis of follow-up examinations (mean follow-up period 911 days; range, 373–1,987 days), patients were stratified into two groups: those who did (n = 18) and those who did not (n = 44) require reintervention. CTA characteristics, such as AAA, endoleak, as well as nidus dimensions, patency of the inferior mesenteric artery, number of aortic branch vessels, and the pattern of endoleak appearance, were recorded and correlated with the clinical outcome.ResultsUnivariate and receiver operating characteristic curve regression analyses revealed significant differences between the two groups for the endoleak volume (surveillance group: 1391.6 ± 1427.9 mm{sup 3}; reintervention group: 3227.7 ± 2693.8 mm{sup 3}; cutoff value of 2,386 mm{sup 3}; p = 0.002), the endoleak diameter (13.6 ± 4.3 mm compared with 25.9 ± 9.6 mm; cutoff value of 19 mm; p < 0.0001), the number of aortic branch vessels (2.9 ± 1.2 compared with 4.2 ± 1.4 vessels; p = 0.001), as well as a “complex type” endoleak pattern (13.6 %, n = 6 compared with 44.4 %, n = 8; p = 0.02).ConclusionsEarly CTA can predict the future need for reintervention in patients with type II endoleak. Therefore, treatment decision should be based not only on aneurysm enlargement alone but also on other imaging characteristics.

  14. Autologous hematopoietic stem cell transplantation in lymphoma patients is associated with a decrease in the double strand break repair capacity of peripheral blood lymphocytes.

    Science.gov (United States)

    Lacoste, Sandrine; Bhatia, Smita; Chen, Yanjun; Bhatia, Ravi; O'Connor, Timothy R

    2017-01-01

    Patients who undergo autologous hematopoietic stem cell transplantation (aHCT) for treatment of a relapsed or refractory lymphoma are at risk of developing therapy related- myelodysplasia/acute myeloid leukemia (t-MDS/AML). Part of the risk likely resides in inherent interindividual differences in their DNA repair capacity (DRC), which is thought to influence the effect chemotherapeutic treatments have on the patient's stem cells prior to aHCT. Measuring DRC involves identifying small differences in repair proficiency among individuals. Initially, we investigated the cell model in healthy individuals (primary lymphocytes and/or lymphoblastoid cell lines) that would be appropriate to measure genetically determined DRC using host-cell reactivation assays. We present evidence that interindividual differences in DRC double-strand break repair (by non-homologous end-joining [NHEJ] or single-strand annealing [SSA]) are better preserved in non-induced primary lymphocytes. In contrast, lymphocytes induced to proliferate are required to assay base excision (BER) or nucleotide excision repair (NER). We established that both NHEJ and SSA DRCs in lymphocytes of healthy individuals were inversely correlated with the age of the donor, indicating that DSB repair in lymphocytes is likely not a constant feature but rather something that decreases with age (~0.37% NHEJ DRC/year). To investigate the predictive value of pre-aHCT DRC on outcome in patients, we then applied the optimized assays to the analysis of primary lymphocytes from lymphoma patients and found that individuals who later developed t-MDS/AML (cases) were indistinguishable in their DRC from controls who never developed t-MDS/AML. However, when DRC was investigated shortly after aHCT in the same individuals (21.6 months later on average), aHCT patients (both cases and controls) showed a significant decrease in DSB repair measurements. The average decrease of 6.9% in NHEJ DRC observed among aHCT patients was much higher

  15. Patient advisory groups in practice improvement: sample case presentation with a discussion of best practices.

    Science.gov (United States)

    Angstman, Kurt B; Bender, Robert O; Bruce, Steven M

    2009-01-01

    Using patient advisory groups can affect practice changes and create a patient-centric focus for a primary care practice. A successful patient advisory group has been developed for our primary care clinics. Utilizing this group, we have implemented practice improvement changes that have had a significant impact in patient care. This will be demonstrated in a case presentation involving the implementation of depression care managers at our practice sites. We will review key "best practices," as defined by the group, regarding size, composition, and meeting frequency that can be used for the development of a clinical patient advisory group.

  16. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years

    NARCIS (Netherlands)

    J. Powell (Janet); Sweeting, M.J.; Ulug, P.; Blankensteijn, J.D.; F.A. Lederle (Frank); Becquemin, J.-P.; Greenhalgh, R.M.; Greenhalgh, R.M.; J. Beard (James); M. Buxton (M.); Brown, L.C.; Harris, P.L.; Powell, J.T.; Rose, J.D.G.; Russell, I.T.; Sculpher, M.J.; S.G. Thompson (Simon); Lilford, R.J.; Bell, P.R.F.; Greenhalgh, R.M.; Whitaker, S.C.; Poole-Wilson, P.A.; Ruckley, C.V.; Campbell, W.B.; Dean, M.R.E.; Ruttley, M.S.T.; Coles, E.C.; Powell, J.T.; A. Halliday (A.); Gibbs, S.J.; Brown, L.C.; Epstein, D.; M. Sculpher (Mark); Thompson, S.G.; Hannon, R.J.; Johnston, L.; L.A. Bradbury (Linda); Henderson, M.J.; Parvin, S.D.; Shepherd, D.F.C.; Greenhalgh, R.M.; Mitchell, A.W.; Edwards, P.R.; Abbott, G.T.; Higman, D.J.; Vohra, A.; Ashley, S.; Robottom, C.; M. Wyatt (M.); Rose, J.D.G.; Byrne, D.; Edwards, R.; Leiberman, D.P.; McCarter, D.H.; Taylor, P.R.; Reidy, J.F.; Wilkinson, A.R.; D. Ettles (D.); Clason, A.E.; Leen, G.L.S.; Wilson, N.V.; Downes, M.; S. Walker (S.); Lavelle, J.M.; Gough, M.J.; McPherson, S.; D.J.A. Scott (D Julian); Kessell, D.O.; C.D. Naylor; I. Sayers (Ian); Fishwick, N.G.; Harris, P.L.; Gould, D.A.; Walker, M.G.; Chalmers, N.C.; Garnham, A.; Collins, M.A.; Beard, J.D.; P.A. Gaines (Peter); Ashour, M.Y.; Uberoi, R.; Braithwaite, B.; Whitaker, S.C.; Davies, J.N.; Travis, S.; Hamilton, G.; A. Platts (A.); Shandall, A.; Sullivan, B.A.; Sobeh, M.; Matson, M.; Fox, A.D.; Orme, R.; Yusef, W.; Doyle, T.; Horrocks, M.; Hardman, J.; Blair, P.H.B.; Ellis, P.K.; Morris, G.; Odurny, A.; Vohra, R.; Duddy, M.; M.J. Thompson (Matthew); Loosemore, T.M.L.; Belli, A.M.; Morgan, R.; Adiseshiah, M.; J. Brookes (J.); McCollum, C.N.; R. Ashleigh (R.); Aukett, M.; Baker, S.; Barbe, E.; Batson, N.; J.L. Bell (Jocelyn); Blundell, J.; Boardley, D.; Boyes, S.; Brown, O.; Bryce, J.; Carmichael, M.; Chance, T.; Coleman, J.; Cosgrove, C.; Curran, G.; Dennison, T.; Devine, C.; Dewhirst, N.; Errington, B.; Farrell, H.; Fisher, C.; Fulford, P.; Gough, M.; Graham, C.; Hooper, R.; Horne, G.; Horrocks, L.; Hughes, B.; Hutchings, T.; Ireland, M.; Judge, C.; Kelly, L.; Kemp, J.; Kite, A.; Kivela, M.; Lapworth, M.; Lee, C.; Linekar, L.; Mahmood, A.; March, L.; Martin, J.; Matharu, N.; McGuigen, K.; Morris-Vincent, P.; Murray, S.; Murtagh, A.; Owen, G.; Ramoutar, V.; Rippin, C.; Rowley, J.; Sinclair, J.; Spencer, S.; Taylor, V.; Tomlinson, C.; Ward, S.; Wealleans, V.; West, J.; White, K.; Williams, J.; Wilson, L.; D.E. Grobbee (Diederick); Blankensteijn, J.D.; Bak, A.A.A.; Buth, J.; P.M.T. Pattynama (Peter M.T.); Verhoeven, E.L.G.; van Voorthuisen, A.E.; Blankensteijn, J.D.; Balm, R.; Buth, J.; P.M.W. Cuypers (Philippe); D.E. Grobbee (Diederick); Prinssen, M.; M.H.R.M. van Sambeek (Marc H. R.); Verhoeven, E.L.G.; A.F. Baas (Annette); Hunink, M.G.; J.M. Engelshoven (Jos); M. Jacobs (Michael); B.A.J.M. de Mol; J.H. van Bockel; Balm, R.; J.A. Reekers (Jim); X. Tielbeek; E.L.G. Verhoeven (Eric); W. Wisselink; N. Boekema; Heuveling, L.M.; I. Sikking; M. Prinssen (Monique); R. Balm (Ron); J.D. Blankensteijn (Jan); J. Buth (Jaap); P.M.W. Cuypers (Philippe); van Sambeek, M.R.H.M.; Verhoeven, E.L.G.; J.L. de Bruin (Jorg); A.F. Baas (Annette); Blankensteijn, J.D.; Prinssen, M.; J. Buth (Jacob); A.V. Tielbeek (Alexander); J.D. Blankensteijn (Jan); R. Balm (Ron); Reekers, J.A.; M.R.H.M. van Sambeek (M. R H M); P.M.T. Pattynama (Peter); E.L.G. Verhoeven (Eric); T. Prins (T.); A.C. van der Ham (Arie); van der Velden, J.J.I.M.; S.M.M. van Sterkenburg (S. M M); G.B. ten Haken (G.); C.M.A. Bruijninckx; H. van Overhagen (H.); R.P. Tutein Nolthenius; C. Hendriksz (Chris); J.A.W. Teijink (J. A W); H.F. Odink (H.); A.A. de Smet (André); D. Vroegindeweij (Dammis); R.M.M. van Loenhout (R. M M); M.J. Rutten (M.); J.F. Hamming (Jaap); L.E.H. Lampmann (L. E H); M.H.M. Bender (M. H M); S.G.M.A. Pasmans (Suzanne); A. Vahl (Anco); C. de Vries (Cees); A.J. Mackaay (Albert); L. van Dortmont (Laura); van der Vliet, A.J.; L.J. Schultze Kool (L.); J.B.B. Boomsma (J. B B); H.R. van Dop (H.); J.C.A. de Mol van Otterloo (J. C A); T.P.W. de Rooij (T. P W); T.M. Smits (T.); P. Yilmaz (Pinar); Wisselink, W.; F.G. van den Berg (Fred); M.J.T. Visser (M. J T); E. van der Linden (Edwin); G.W. Schurink; M.G. Haan (Michiel); H.J. Smeets (Harm); Stabel, P.; F. van Elst (F.); J. Poniewierski (J.); F. Vermassen (Frank); Lederle, F.A.; Freischlag, J.A.; Kohler, T.R.; Latts, E.; Matsumura, J.; Padberg, F.T.; Kyriakides, T.C.; Swanson, K.M.; Guarino, P.; Peduzzi, P.; Antonelli, M.; Cushing, C.; Davis, E.; Durant, L.; Joyner, S.; Kossack, A.; Kyriakides, T.C.; LeGwin, M. (Mary); McBride, V.; O'Connor, T.; Poulton, J.; Stratton, S.; Zellner, S.; Snodgrass, A.J.; Thornton, J.; Swanson, K.M.; Haakenson, C.M.; Stroupe, K.T.; Jonk, Y.; Hallett, J.W.; Hertzer, N.; Towne, J.; Katz, D.A.; Karrison, T.; Matts, J.P.; Marottoli, R.; Kasl, S.; Mehta, R.; Feldman, R.; Farrell, W.; Allore, H.; Perry, E.; Niederman, J.; Randall, F.; Zeman, M.; Beckwith, D.; O'Leary, T.J.; Huang, G.D.; Latts, E.; Bader, M.; Ketteler, E.R.; Kingsley, D.D.; Marek, J.M.; Massen, R.J.; Matteson, B.D.; Pitcher, J.D.; Langsfeld, M.; Corson, J.D.; Goff, J.M.; Kasirajan, K.; Paap, C.; Robertson, D.C.; Salam, A.; Veeraswamy, R.; Milner, R.; Kasirajan, K.; Guidot, J.; Lal, B.K.; Busuttil, S.J.; Lilly, M.P.; Braganza, M.; Ellis, K.; Patterson, M.A.; Jordan, W.D.; Whitley, D.; Taylor, S.; Passman, M.; Kerns, D.; Inman, C.; Poirier, J.; Ebaugh, J.; Raffetto, J.; Chew, D.; Lathi, S.; Owens, C.; Hickson, K.; Dosluoglu, H.H.; Eschberger, K.; Kibbe, M.R.; Baraniewski, H.M.; Matsumura, J.; Endo, M.; Busman, A.; Meadows, W.; Evans, M.; Giglia, J.S.; El Sayed, H.; Reed, A.B.; Ruf, M.; Ross, S.; Jean-Claude, J.M.; Pinault, G.; Kang, P.; White, N.; Eiseman, M.; Jones, R.; Timaran, C.H.; Modrall, J.G.; Welborn, M.B.; Lopez, J.; Nguyen, T.; Chacko, J.K.Y.; Granke, K.; Vouyouka, A.G.; Olgren, E.; Chand, P.; Allende, B.; Ranella, M.; Yales, C.; Whitehill, T.A.; Krupski, W.C.; Nehler, M.R.; Johnson, S.P.; Jones, D.N.; Strecker, P.; Bhola, M.A.; Shortell, C.K.; Gray, J.L.; Lawson, J.H.; McCann, R.; Sebastian, M.W.; Kistler Tetterton, J.; Blackwell, C.; Prinzo, P.A.; Lee, N.; Padberg, F.T.; Cerveira, J.J.; Lal, B.K.; Zickler, R.W.; Hauck, K.A.; Berceli, S.A.; Lee, W.A.; Ozaki, C.K.; Nelson, P.R.; Irwin, A.S.; Baum, R.; Aulivola, B.; Rodriguez, H.; Littooy, F.N.; Greisler, H.; O'Sullivan, M.T.; Kougias, P.; Lin, P.H.; Bush, R.L.; Guinn, G.; Bechara, C.; Cagiannos, C.; Pisimisis, G.; Barshes, N.; Pillack, S.; Guillory, B.; Cikrit, D.; Lalka, S.G.; Lemmon, G.; Nachreiner, R.; Rusomaroff, M.; O'Brien, E.; Cullen, J.J.; Hoballah, J.; Sharp, W.J.; McCandless, J.L.; Beach, V.; Minion, D.; Schwarcz, T.H.; Kimbrough, J.; Ashe, L.; Rockich, A.; Warner-Carpenter, J.; Moursi, M.; Eidt, J.F.; Brock, S.; Bianchi, C.; Bishop, V.; Gordon, I.L.; Fujitani, R.; Kubaska, S.M.; Behdad, M.; Azadegan, R.; Ma Agas, C.; Zalecki, K.; Hoch, J.R.; Carr, S.C.; Acher, C.; Schwarze, M.; Tefera, G.; Mell, M.; Dunlap, B.; Rieder, J.; Stuart, J.M.; Weiman, D.S.; Abul-Khoudoud, O.; Garrett, H.E.; Walsh, S.M.; Wilson, K.L.; Seabrook, G.R.; Cambria, R.A.; Brown, K.R.; Lewis, B.D.; Framberg, S.; Kallio, C.; Barke, R.A.; Santilli, S.M.; d'Audiffret, A.C.; Oberle, N.; Proebstle, C.; Johnson, L.L.; Jacobowitz, G.R.; Cayne, N.; Rockman, C.; Adelman, M.; P.J. Gagne (Paul); Nalbandian, M.; Caropolo, L.J.; Pipinos, I.I.; Johanning, J.; Lynch, T.; DeSpiegelaere, H.; Purviance, G.; Zhou, W.; Dalman, R.; Lee, J.T.; Safadi, B.; Coogan, S.M.; Wren, S.M.; Bahmani, D.D.; Maples, D.; Thunen, S.; Golden, M.A.; Mitchell, M.E.; Fairman, R.; Reinhardt, S.; Wilson, M.A.; Tzeng, E.; Muluk, S.; Peterson, N.M.; Foster, M.; Edwards, J.; G. Moneta (Greg); Landry, G.; Taylor, L.; Yeager, R.; Cannady, E.; Treiman, G.; Hatton-Ward, S.; Salabsky, B.; Kansal, N.; Owens, E.; Estes, M.; Forbes, B.A.; Sobotta, C.; Rapp, J.H.; Reilly, L.M.; Perez, S.L.; Yan, K.; Sarkar, R.; Dwyer, S.S.; Perez, S.; Chong, K.; Kohler, T.R.; Hatsukami, T.S.; Glickerman, D.G.; Sobel, M.; Burdick, T.S.; Pedersen, K.; Cleary, P.; Back, M.; Bandyk, D.; Johnson, B.; Shames, M.; Reinhard, R.L.; Thomas, S.C.; Hunter, G.C.; Leon, L.R.; Westerband, A.; Guerra, R.J.; Riveros, M.; Mills, J.L.; Hughes, J.D.; Escalante, A.M.; Psalms, S.B.; Day, N.N.; Macsata, R.; Sidawy, A.; Weiswasser, J.; Arora, S.; Jasper, B.J.; A. Dardik; Gahtan, V.; B.E. Muhs (Bart); B.E. Sumpio (Bauer); R.J. Gusberg (Richard Jefferson); Spector, M.; Pollak, J.; Aruny, J.; Kelly, E.L.; Wong, J.; Vasilas, P.; Joncas, C.; Gelabert, H.A.; DeVirgillio, C.; Rigberg, D.A.; Cole, L.; Becquemin, J.-P.; Marzelle, J.; Becquemin, J.-P.; Sapoval, M.; Becquemin, J.-P.; Favre, J.-P.; Watelet, J.; Lermusiaux, P.; Sapoval, M.; Lepage, E.; Hemery, F.; Dolbeau, G.; Hawajry, N.; Cunin, P.; Harris, P.; L. Stockx (Luc); Chatellier, G.; Mialhe, C.; Fiessinger, J.-N.; Pagny, L.; Kobeiter, H.; Boissier, C.; Lacroix, P.; Ledru, F.; Pinot, J.-J.; Deux, J.-F.; Tzvetkov, B.; Duvaldestin, P.; Watelet, J.; Jourdain, C.; David, V.; Enouf, D.; Ady, N.; Krimi, A.; Boudjema, N.; Jousset, Y.; Enon, B.; Blin, V.; Picquet, J.; L'Hoste, P.; Thouveny, F.; Borie, H.; Kowarski, S.; Pernes, J.-M.; Auguste, M.; Becquemin, J.-P.; Desgranges, P.; Allaire, E.; Marzelle, J.; H. Kobeiter (Hicham); Meaulle, P.-Y.; Chaix, D.; Juliae, P.; Fabiani, J.N.; Chevalier, P.; Combes, M.; Seguin, A.; Belhomme, D.; M. Sapoval; Baque, J.; Pellerin, O.; Favre, J.P.; Barral, X.; Veyret, C.; Watelet, J.; Peillon, C.; Plissonier, D.; Thomas, P.; Clavier, E.; Lermusiaux, P.; Martinez, R.; Bleuet, F.; Dupreix, C.; Verhoye, J.P.; Langanay, T.; Heautot, J.F.; Koussa, M.; Haulon, S.; Halna, P.; Destrieux, L.; Lions, C.; Wiloteaux, S.; J.P. Beregi (Jean Paul); Bergeron, P.; Pinot, J.-J.; Patra, P.; Costargent, A.; Chaillou, P.; D'Alicourt, A.; Goueffic, Y.; Cheysson, E.; Parrot, A.; Garance, P.; Demon, A.; Tyazi, A.; Pillet, J.-C.; Lescalie, F.; Tilly, G.; Steinmetz, E.; Favier, C.; Brenot, R.; Krause, D.; Cercueil, J.P.; O. Vahdat (Olivier); Sauer, M.; Soula, P.; Querian, A.; Garcia, O.; Levade, M.; Colombier, D.; Cardon, J.-M.; Joyeux, A.; Borrelly, P.; Dogas, G.; Magnan, P.-É.; Branchereau, A.; Bartoli, J.-M.; Hassen-Khodja, R.; Batt, M.; Planchard, P.-F.; Bouillanne, P.-J.; Haudebourg, P.; Bayne, J.; Gouny, P.; Badra, A.; Braesco, J.; Nonent, M.; Lucas, A.; Cardon, A.; Kerdiles, Y.; Rolland, Y.; Kassab, M.; Brillu, C.; Goubault, F.; Tailboux, L.; Darrieux, H.; Briand, O.; Maillard, J.-C.; Varty, K.; Cousins, C.

    2017-01-01

    textabstractBackground: The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. Methods: An individual-patient data meta-analysis of four multicentre randomized tri

  17. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years

    NARCIS (Netherlands)

    J. Powell (Janet); Sweeting, M.J.; Ulug, P.; Blankensteijn, J.D.; F.A. Lederle (Frank); Becquemin, J.-P.; Greenhalgh, R.M.; Greenhalgh, R.M.; J. Beard (James); M. Buxton (M.); Brown, L.C.; Harris, P.L.; Powell, J.T.; Rose, J.D.G.; Russell, I.T.; Sculpher, M.J.; S.G. Thompson (Simon); Lilford, R.J.; Bell, P.R.F.; Greenhalgh, R.M.; Whitaker, S.C.; Poole-Wilson, P.A.; Ruckley, C.V.; Campbell, W.B.; Dean, M.R.E.; Ruttley, M.S.T.; Coles, E.C.; Powell, J.T.; A. Halliday (A.); Gibbs, S.J.; Brown, L.C.; Epstein, D.; M. Sculpher (Mark); Thompson, S.G.; Hannon, R.J.; Johnston, L.; L.A. Bradbury (Linda); Henderson, M.J.; Parvin, S.D.; Shepherd, D.F.C.; Greenhalgh, R.M.; Mitchell, A.W.; Edwards, P.R.; Abbott, G.T.; Higman, D.J.; Vohra, A.; Ashley, S.; Robottom, C.; M. Wyatt (M.); Rose, J.D.G.; Byrne, D.; Edwards, R.; Leiberman, D.P.; McCarter, D.H.; Taylor, P.R.; Reidy, J.F.; Wilkinson, A.R.; D. Ettles (D.); Clason, A.E.; Leen, G.L.S.; Wilson, N.V.; Downes, M.; S. Walker (S.); Lavelle, J.M.; Gough, M.J.; McPherson, S.; D.J.A. Scott (D Julian); Kessell, D.O.; C.D. Naylor; I. Sayers (Ian); Fishwick, N.G.; Harris, P.L.; Gould, D.A.; Walker, M.G.; Chalmers, N.C.; Garnham, A.; Collins, M.A.; Beard, J.D.; P.A. Gaines (Peter); Ashour, M.Y.; Uberoi, R.; Braithwaite, B.; Whitaker, S.C.; Davies, J.N.; Travis, S.; Hamilton, G.; A. Platts (A.); Shandall, A.; Sullivan, B.A.; Sobeh, M.; Matson, M.; Fox, A.D.; Orme, R.; Yusef, W.; Doyle, T.; Horrocks, M.; Hardman, J.; Blair, P.H.B.; Ellis, P.K.; Morris, G.; Odurny, A.; Vohra, R.; Duddy, M.; M.J. Thompson (Matthew); Loosemore, T.M.L.; Belli, A.M.; Morgan, R.; Adiseshiah, M.; J. Brookes (J.); McCollum, C.N.; R. Ashleigh (R.); Aukett, M.; Baker, S.; Barbe, E.; Batson, N.; J.L. Bell (Jocelyn); Blundell, J.; Boardley, D.; Boyes, S.; Brown, O.; Bryce, J.; Carmichael, M.; Chance, T.; Coleman, J.; Cosgrove, C.; Curran, G.; Dennison, T.; Devine, C.; Dewhirst, N.; Errington, B.; Farrell, H.; Fisher, C.; Fulford, P.; Gough, M.; Graham, C.; Hooper, R.; Horne, G.; Horrocks, L.; Hughes, B.; Hutchings, T.; Ireland, M.; Judge, C.; Kelly, L.; Kemp, J.; Kite, A.; Kivela, M.; Lapworth, M.; Lee, C.; Linekar, L.; Mahmood, A.; March, L.; Martin, J.; Matharu, N.; McGuigen, K.; Morris-Vincent, P.; Murray, S.; Murtagh, A.; Owen, G.; Ramoutar, V.; Rippin, C.; Rowley, J.; Sinclair, J.; Spencer, S.; Taylor, V.; Tomlinson, C.; Ward, S.; Wealleans, V.; West, J.; White, K.; Williams, J.; Wilson, L.; D.E. Grobbee (Diederick); Blankensteijn, J.D.; Bak, A.A.A.; Buth, J.; P.M.T. Pattynama (Peter M.T.); Verhoeven, E.L.G.; van Voorthuisen, A.E.; Blankensteijn, J.D.; Balm, R.; Buth, J.; P.M.W. Cuypers (Philippe); D.E. Grobbee (Diederick); Prinssen, M.; M.H.R.M. van Sambeek (Marc H. R.); Verhoeven, E.L.G.; A.F. Baas (Annette); Hunink, M.G.; J.M. Engelshoven (Jos); M. Jacobs (Michael); B.A.J.M. de Mol; J.H. van Bockel; Balm, R.; J.A. Reekers (Jim); X. Tielbeek; E.L.G. Verhoeven (Eric); W. Wisselink; N. Boekema; Heuveling, L.M.; I. Sikking; M. Prinssen (Monique); R. Balm (Ron); J.D. Blankensteijn (Jan); J. Buth (Jaap); P.M.W. Cuypers (Philippe); van Sambeek, M.R.H.M.; Verhoeven, E.L.G.; J.L. de Bruin (Jorg); A.F. Baas (Annette); Blankensteijn, J.D.; Prinssen, M.; J. Buth (Jacob); A.V. Tielbeek (Alexander); J.D. Blankensteijn (Jan); R. Balm (Ron); Reekers, J.A.; M.R.H.M. van Sambeek (M. R H M); P.M.T. Pattynama (Peter); E.L.G. Verhoeven (Eric); T. Prins (T.); A.C. van der Ham; van der Velden, J.J.I.M.; S.M.M. van Sterkenburg (S. M M); G.B. ten Haken (G.); C.M.A. Bruijninckx; H. van Overhagen (H.); R.P. Tutein Nolthenius; C. Hendriksz (Chris); J.A.W. Teijink (J. A W); H.F. Odink (H.); A.A. de Smet (André); D. Vroegindeweij (Dammis); R.M.M. van Loenhout (R. M M); M.J. Rutten (M.); J.F. Hamming (Jaap); L.E.H. Lampmann (L. E H); M.H.M. Bender (M. H M); S.G.M.A. Pasmans (Suzanne); A. Vahl (Anco); C. de Vries (Cees); A.J. Mackaay (Albert); L. van Dortmont (Laura); van der Vliet, A.J.; L.J. Schultze Kool (L.); J.B.B. Boomsma (J. B B); H.R. van Dop (H.); J.C.A. de Mol van Otterloo (J. C A); T.P.W. de Rooij (T. P W); T.M. Smits (T.); P. Yilmaz (Pinar); Wisselink, W.; F.G. van den Berg (Fred); M.J.T. Visser (M. J T); E. van der Linden (Edwin); G.W. Schurink; M.G. Haan (Michiel); H.J. Smeets (Harm); Stabel, P.; F. van Elst (F.); J. Poniewierski (J.); F. Vermassen (Frank); Lederle, F.A.; Freischlag, J.A.; Kohler, T.R.; Latts, E.; Matsumura, J.; Padberg, F.T.; Kyriakides, T.C.; Swanson, K.M.; Guarino, P.; Peduzzi, P.; Antonelli, M.; Cushing, C.; Davis, E.; Durant, L.; Joyner, S.; Kossack, A.; Kyriakides, T.C.; LeGwin, M. (Mary); McBride, V.; O'Connor, T.; Poulton, J.; Stratton, S.; Zellner, S.; Snodgrass, A.J.; Thornton, J.; Swanson, K.M.; Haakenson, C.M.; Stroupe, K.T.; Jonk, Y.; Hallett, J.W.; Hertzer, N.; Towne, J.; Katz, D.A.; Karrison, T.; Matts, J.P.; Marottoli, R.; Kasl, S.; Mehta, R.; Feldman, R.; Farrell, W.; Allore, H.; Perry, E.; Niederman, J.; Randall, F.; Zeman, M.; Beckwith, D.; O'Leary, T.J.; Huang, G.D.; Latts, E.; Bader, M.; Ketteler, E.R.; Kingsley, D.D.; Marek, J.M.; Massen, R.J.; Matteson, B.D.; Pitcher, J.D.; Langsfeld, M.; Corson, J.D.; Goff, J.M.; Kasirajan, K.; Paap, C.; Robertson, D.C.; Salam, A.; Veeraswamy, R.; Milner, R.; Kasirajan, K.; Guidot, J.; Lal, B.K.; Busuttil, S.J.; Lilly, M.P.; Braganza, M.; Ellis, K.; Patterson, M.A.; Jordan, W.D.; Whitley, D.; Taylor, S.; Passman, M.; Kerns, D.; Inman, C.; Poirier, J.; Ebaugh, J.; Raffetto, J.; Chew, D.; Lathi, S.; Owens, C.; Hickson, K.; Dosluoglu, H.H.; Eschberger, K.; Kibbe, M.R.; Baraniewski, H.M.; Matsumura, J.; Endo, M.; Busman, A.; Meadows, W.; Evans, M.; Giglia, J.S.; El Sayed, H.; Reed, A.B.; Ruf, M.; Ross, S.; Jean-Claude, J.M.; Pinault, G.; Kang, P.; White, N.; Eiseman, M.; Jones, R.; Timaran, C.H.; Modrall, J.G.; Welborn, M.B.; Lopez, J.; Nguyen, T.; Chacko, J.K.Y.; Granke, K.; Vouyouka, A.G.; Olgren, E.; Chand, P.; Allende, B.; Ranella, M.; Yales, C.; Whitehill, T.A.; Krupski, W.C.; Nehler, M.R.; Johnson, S.P.; Jones, D.N.; Strecker, P.; Bhola, M.A.; Shortell, C.K.; Gray, J.L.; Lawson, J.H.; McCann, R.; Sebastian, M.W.; Kistler Tetterton, J.; Blackwell, C.; Prinzo, P.A.; Lee, N.; Padberg, F.T.; Cerveira, J.J.; Lal, B.K.; Zickler, R.W.; Hauck, K.A.; Berceli, S.A.; Lee, W.A.; Ozaki, C.K.; Nelson, P.R.; Irwin, A.S.; Baum, R.; Aulivola, B.; Rodriguez, H.; Littooy, F.N.; Greisler, H.; O'Sullivan, M.T.; Kougias, P.; Lin, P.H.; Bush, R.L.; Guinn, G.; Bechara, C.; Cagiannos, C.; Pisimisis, G.; Barshes, N.; Pillack, S.; Guillory, B.; Cikrit, D.; Lalka, S.G.; Lemmon, G.; Nachreiner, R.; Rusomaroff, M.; O'Brien, E.; Cullen, J.J.; Hoballah, J.; Sharp, W.J.; McCandless, J.L.; Beach, V.; Minion, D.; Schwarcz, T.H.; Kimbrough, J.; Ashe, L.; Rockich, A.; Warner-Carpenter, J.; Moursi, M.; Eidt, J.F.; Brock, S.; Bianchi, C.; Bishop, V.; Gordon, I.L.; Fujitani, R.; Kubaska, S.M.; Behdad, M.; Azadegan, R.; Ma Agas, C.; Zalecki, K.; Hoch, J.R.; Carr, S.C.; Acher, C.; Schwarze, M.; Tefera, G.; Mell, M.; Dunlap, B.; Rieder, J.; Stuart, J.M.; Weiman, D.S.; Abul-Khoudoud, O.; Garrett, H.E.; Walsh, S.M.; Wilson, K.L.; Seabrook, G.R.; Cambria, R.A.; Brown, K.R.; Lewis, B.D.; Framberg, S.; Kallio, C.; Barke, R.A.; Santilli, S.M.; d'Audiffret, A.C.; Oberle, N.; Proebstle, C.; Johnson, L.L.; Jacobowitz, G.R.; Cayne, N.; Rockman, C.; Adelman, M.; P.J. Gagne (Paul); Nalbandian, M.; Caropolo, L.J.; Pipinos, I.I.; Johanning, J.; Lynch, T.; DeSpiegelaere, H.; Purviance, G.; Zhou, W.; Dalman, R.; Lee, J.T.; Safadi, B.; Coogan, S.M.; Wren, S.M.; Bahmani, D.D.; Maples, D.; Thunen, S.; Golden, M.A.; Mitchell, M.E.; Fairman, R.; Reinhardt, S.; Wilson, M.A.; Tzeng, E.; Muluk, S.; Peterson, N.M.; Foster, M.; Edwards, J.; G. Moneta (Greg); Landry, G.; Taylor, L.; Yeager, R.; Cannady, E.; Treiman, G.; Hatton-Ward, S.; Salabsky, B.; Kansal, N.; Owens, E.; Estes, M.; Forbes, B.A.; Sobotta, C.; Rapp, J.H.; Reilly, L.M.; Perez, S.L.; Yan, K.; Sarkar, R.; Dwyer, S.S.; Perez, S.; Chong, K.; Kohler, T.R.; Hatsukami, T.S.; Glickerman, D.G.; Sobel, M.; Burdick, T.S.; Pedersen, K.; Cleary, P.; Back, M.; Bandyk, D.; Johnson, B.; Shames, M.; Reinhard, R.L.; Thomas, S.C.; Hunter, G.C.; Leon, L.R.; Westerband, A.; Guerra, R.J.; Riveros, M.; Mills, J.L.; Hughes, J.D.; Escalante, A.M.; Psalms, S.B.; Day, N.N.; Macsata, R.; Sidawy, A.; Weiswasser, J.; Arora, S.; Jasper, B.J.; A. Dardik; Gahtan, V.; B.E. Muhs (Bart); B.E. Sumpio (Bauer); R.J. Gusberg (Richard Jefferson); Spector, M.; Pollak, J.; Aruny, J.; Kelly, E.L.; Wong, J.; Vasilas, P.; Joncas, C.; Gelabert, H.A.; DeVirgillio, C.; Rigberg, D.A.; Cole, L.; Becquemin, J.-P.; Marzelle, J.; Becquemin, J.-P.; Sapoval, M.; Becquemin, J.-P.; Favre, J.-P.; Watelet, J.; Lermusiaux, P.; Sapoval, M.; Lepage, E.; Hemery, F.; Dolbeau, G.; Hawajry, N.; Cunin, P.; Harris, P.; L. Stockx (Luc); Chatellier, G.; Mialhe, C.; Fiessinger, J.-N.; Pagny, L.; Kobeiter, H.; Boissier, C.; Lacroix, P.; Ledru, F.; Pinot, J.-J.; Deux, J.-F.; Tzvetkov, B.; Duvaldestin, P.; Watelet, J.; Jourdain, C.; David, V.; Enouf, D.; Ady, N.; Krimi, A.; Boudjema, N.; Jousset, Y.; Enon, B.; Blin, V.; Picquet, J.; L'Hoste, P.; Thouveny, F.; Borie, H.; Kowarski, S.; Pernes, J.-M.; Auguste, M.; Becquemin, J.-P.; Desgranges, P.; Allaire, E.; Marzelle, J.; H. Kobeiter (Hicham); Meaulle, P.-Y.; Chaix, D.; Juliae, P.; Fabiani, J.N.; Chevalier, P.; Combes, M.; Seguin, A.; Belhomme, D.; M. Sapoval; Baque, J.; Pellerin, O.; Favre, J.P.; Barral, X.; Veyret, C.; Watelet, J.; Peillon, C.; Plissonier, D.; Thomas, P.; Clavier, E.; Lermusiaux, P.; Martinez, R.; Bleuet, F.; Dupreix, C.; Verhoye, J.P.; Langanay, T.; Heautot, J.F.; Koussa, M.; Haulon, S.; Halna, P.; Destrieux, L.; Lions, C.; Wiloteaux, S.; J.P. Beregi (Jean Paul); Bergeron, P.; Pinot, J.-J.; Patra, P.; Costargent, A.; Chaillou, P.; D'Alicourt, A.; Goueffic, Y.; Cheysson, E.; Parrot, A.; Garance, P.; Demon, A.; Tyazi, A.; Pillet, J.-C.; Lescalie, F.; Tilly, G.; Steinmetz, E.; Favier, C.; Brenot, R.; Krause, D.; Cercueil, J.P.; O. Vahdat (Olivier); Sauer, M.; Soula, P.; Querian, A.; Garcia, O.; Levade, M.; Colombier, D.; Cardon, J.-M.; Joyeux, A.; Borrelly, P.; Dogas, G.; Magnan, P.-É.; Branchereau, A.; Bartoli, J.-M.; Hassen-Khodja, R.; Batt, M.; Planchard, P.-F.; Bouillanne, P.-J.; Haudebourg, P.; Bayne, J.; Gouny, P.; Badra, A.; Braesco, J.; Nonent, M.; Lucas, A.; Cardon, A.; Kerdiles, Y.; Rolland, Y.; Kassab, M.; Brillu, C.; Goubault, F.; Tailboux, L.; Darrieux, H.; Briand, O.; Maillard, J.-C.; Varty, K.; Cousins, C.

    2017-01-01

    textabstractBackground: The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. Methods: An individual-patient data meta-analysis of four multicentre randomized tri

  18. Abdominal aortic aneurysm repair in patient with a renal allograft: a case report.

    Science.gov (United States)

    Kim, Hyung-Kee; Ryuk, Jong-Pil; Choi, Hyang Hee; Kwon, Sang-Hwy; Huh, Seung

    2009-02-01

    Renal transplant recipients requiring aortic reconstruction due to abdominal aortic aneurysm (AAA) pose a unique clinical problem. The concern during surgery is causing ischemic injury to the renal allograft. A variety of strategies for protection of the renal allograft during AAA intervention have been described including a temporary shunt, cold renal perfusion, extracorporeal bypass, general hypothermia, and endovascular stent-grafting. In addition, some investigators have reported no remarkable complications of the renal allograft without any specific measures. We treated a case of AAA in a patient with a renal allograft using a temporary aortofemoral shunt with good result. Since this technique is safe and effective, it should be considered in similar patients with AAA and previously placed renal allografts.

  19. Repair and reconstruction of severe leg injuries: retrospective review of eighty-five patients

    Institute of Scientific and Technical Information of China (English)

    XU Yong-qing; SHI Ji-hong; LI Chun-xiao; MA Tao; LIN Yue-qiu; LI Jun; DING Jing; ZHU Yue-liang; RUAN Mo; GUO Yuan-fa; WANG Xin-ming; X(U) Xiao-shan

    2006-01-01

    Objective: To explore a good way of the reconstruction of severe tibial shaft fractures by using different flaps and external fixators.Methods: Eighty-five patients of Type ⅢC tibial shaft fractures with average age of 42.5 years were treated in our hospital from 1990 to 2005. Injuries were caused by motorcycle accidents in 66 patients, by machine accidents in 16 patients, and by stone bruise in 3 patients. The management procedures consisted of administration of antibiotics, serial debridment, bone grafting if needed,application of different flaps, such as free thoracoumbilical flaps, fasciocutaneous flaps, saphenous neurocutaneous vascular flaps, sural neurocutaneous vascular flaps and gastrocnemius muscular flaps, and different external fixations, for instance, half-ring fixators, unilateral axial dynamic fixators, AO fixators, Weifang fixators, and Hybrid fixators. The average follow up was 6.3 years.Results: All flaps survived. Eighty-three cases had bone healed. The average bone healing time of different external fixations was 5.5 months in 47 cases with half-ring fixators, 9.2 months in 4 cases treated with unilateral axial dynamic fixators, 8.5 months in 6 cases with AO fixators,10.7 months in 16 cases with Weifang fixators, and 7.8months in 10 cases with assembly fixators. Except half-ring fixation, other fixations all needed necessary bone graft.Two cases treated with unilateral axial dynamic fixators had nonunion of bone and developed osteomyelitis. The wounds healed after the removal of the fixators and immobilization by plaster. The last follow up examination showed ankle and knee motion was normal and no pain was noted.Conclusions: The combination of half- ring external fixators with various flaps provides good results for Type ⅢC tibial shaft fractures.

  20. Laparoscopic and open incisional hernia repair: A prospective randomized study

    Directory of Open Access Journals (Sweden)

    Mehmet Zafer Sabuncuoğlu

    2015-07-01

    Full Text Available As the number of major surgical procedures has increased in recent years, so there has been an increase in incisional hernias. With gained experience and new materials, laparoscopic repair of incisional hernia is now applied. This study was aimed to compare the results of incisional hernia repair with the open surgery or laparoscopic approach at the only centre in the region for laparoscopic incisional hernia repair. A total of 55 cases of incisional hernia at the General Surgery Clinic of SDU between November 2012 and 2014 were underwent laparoscopic ventral hernia repair (L-VHR and conventional incisional hernia repair (C-VHR. From the L-VHR group 6 cases and from the C-VHR 9 cases were excluded from the study, as they did not meet the inclusion criteria or did not wish to participate in the study. The two techniques were compared in respect of operative time, length of hospital stay, postoperative pain scores, complications and recurrence. A total of 40 cases of incisional hernia repair were evaluated. The mean follow-up period was found as 12.75±4.19 months. No difference was determined between the characteristics of the patients due to age, body mass index, American Society of Anesthesiologists (ASA score, comorbidities, hernia size, and follow-up. In the laparoscopic repair group, the postoperative pain scores, complication rates and duration of hospital stay were found significantly superior to those of the open technique group. While there was no mortality seen and wound complications as a morbidity were 0 % in the L-VHR (n = 0 and 20 % in C-VHR group (n = 4. In the comparison of mean operative time, the duration of surgery was significantly shorter in the laparoscopic repair group (67.25±19.23 min compared to the open technique group (91.50±24.87 min (p=0.001. Laparoscopic repair was associated with less postoperative pain (4.35±1.03 vs 5.60±1.31, p=0.002, lesser postoperative complications (5% vs. 35%, p=0.044, and shorter

  1. Augmented Versus Nonaugmented Repair of Acute Achilles Tendon Rupture: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Zhang, Yi-Jun; Zhang, Chi; Wang, Quan; Lin, Xiang-Jin

    2017-04-01

    Although simple end-to-end repair of the Achilles tendon is common, many augmented repair protocols have been implemented for acute Achilles tendon rupture. However, whether augmented repair is better than nonaugmented repair of an acute Achilles tendon rupture is still unknown. To conduct a meta-analysis to determine whether augmented surgical repair of an acute Achilles tendon rupture improved subjective patient satisfaction without an increase in rerupture rates. Secondary outcomes assessed included infections, ankle range of motion, calf muscle strength, and minor complications. Meta-analysis. A systematic literature search of peer-reviewed articles was conducted to identify all randomized controlled trials (RCTs) comparing augmented repair and nonaugmented repair for acute Achilles tendon rupture from January 1980 to August 2016 in the electronic databases of PubMed, Web of Science (SCI-E/SSCI/A&HCI), and EMBASE. The keywords (Achilles tendon rupture) AND (surg* OR operat* OR repair* OR augment* OR non-augment* OR end-to-end OR sutur*) were combined, and results were limited to human RCTs and controlled clinical trials published in the English language. Four RCTs involving 169 participants were eligible for inclusion; 83 participants were treated with augmented repair and 86 were treated with nonaugmented repair. Augmented repair led to similar responses when compared with nonaugmented repair for acute Achilles tendon rupture (93% vs 90%, respectively; P = .53). The rerupture rates showed no significant difference for augmented versus nonaugmented repair (7.2% vs 9.3%, respectively; P = .69). No differences in superficial and deep infections occurred in augmented (7 infections) and nonaugmented (8 infections) repair groups during postoperative follow-up ( P = .89). The average incisional infection rate was 8.4% with augmented repair and 9.3% with nonaugmented repair. No significant differences in other complications were found between augmented (7.2%) and

  2. Outcomes of Open Versus Endoscopic Repair of Abductor Muscle Tears of the Hip: A Systematic Review.

    Science.gov (United States)

    Chandrasekaran, Sivashankar; Lodhia, Parth; Gui, Chengcheng; Vemula, S Pavan; Martin, Timothy J; Domb, Benjamin G

    2015-10-01

    To compare the outcome of open versus endoscopic gluteal tendon repair. An extensive review of PubMed was conducted by 2 independent reviewers for articles containing at least 1 of the following search terms: gluteus medius, gluteus medius tear, gluteus medius tendinopathy, gluteus medius repair, hip abductors, hip abductor tears, hip abductor repair, hip rotator cuff, hip rotator cuff repair, trochanteric bursa, trochanteric bursitis, trochanteric bursectomy, peritrochanteric procedures, peritrochanteric repair, and peritrochanteric arthroscopy. This yielded 313 articles. Of these articles, 7 satisfied the following inclusion criteria: description of an open or endoscopic gluteal repair with outcomes consisting of patient-reported outcome scores, patient satisfaction, strength scores, pain scores, and complications. Three studies on open gluteal repairs and 4 on endoscopic gluteal repairs met the inclusion criteria. In total, there were 127 patients who underwent open procedures and 40 patients who underwent endoscopic procedures. Of the 40 patients who underwent endoscopic procedures, 15 had concomitant intra-articular procedures documented, as compared with 0 in the open group. The modified Harris Hip Score was common to 1 study on open repairs and 3 studies on endoscopic repairs. The scores were similar for follow-up periods of 1 and 2 years. Visual analog pain scale scores were reported in 1 study on open gluteal repairs and 1 study on endoscopic repairs and were similar between the 2 studies. Improvement in abductor strength was also similarly reported in selected studies between the 2 groups. The only difference between the 2 groups was the reported incidence of complications, which was higher in the open group. Open and endoscopic gluteal repairs have similar patient-reported outcome scores, pain scores, and improvement in abduction strength. Open techniques have a higher reported complication rate. Randomized studies of sufficient numbers of patients are

  3. Effect of Preoperative Fatty Degeneration of the Rotator Cuff Muscles on the Clinical Outcome of Patients With Intact Tendons After Arthroscopic Rotator Cuff Repair of Large/Massive Cuff Tears.

    Science.gov (United States)

    Ohzono, Hiroki; Gotoh, Masafumi; Nakamura, Hidehiro; Honda, Hirokazu; Mitsui, Yasuhiro; Kakuma, Tatsuyuki; Okawa, Takahiro; Shiba, Naoto

    2017-09-01

    Fatty degeneration of the rotator cuff muscles is associated not only with postoperative retear but also with postoperative muscle weakness; therefore, fatty changes in the muscles may affect the clinical outcome even in patients with these tears who have intact tendons after arthroscopic rotator cuff repair (ARCR). To evaluate the effect of fatty infiltration on the clinical outcome in patients with intact tendons after arthroscopic repair of large/massive cuff tears. Case-control study; Level of evidence, 3. One hundred fifty-five consecutive patients with large/massive rotator cuff tears underwent ARCR. Of these, 55 patients (mean ± SD age, 64.4 ± 9.1 years) in whom intact tendons after surgery were confirmed with magnetic resonance imaging at final follow-up (mean ± SD, 2.5 ± 1.4 years) were included in this study. Depending on their University of California Los Angeles (UCLA) score at the final follow-up, they were assigned to either the unsatisfactory group (score ≤27; n = 12) or the satisfactory group (score >27; n = 43). Various clinical parameters affecting the clinical outcome were examined through univariate and multivariate analyses. The UCLA score of all patients significantly improved from 18.1 ± 4.4 points preoperatively to 29.8 ± 4.5 points postoperatively ( P muscles, with area under the curve values of 0.79 (sensitivity 91% and specificity 51%) and 0.84 (sensitivity 100% and specificity 54%) in the infraspinatus and subscapularis, respectively. Preoperative fatty degeneration of the infraspinatus and/or subscapularis with Goutallier stage 2 or higher was significantly associated with worse outcome in patients with large/massive tears who had intact tendons after ARCR.

  4. Autologous hematopoietic stem cell transplantation in lymphoma patients is associated with a decrease in the double strand break repair capacity of peripheral blood lymphocytes

    Science.gov (United States)

    Lacoste, Sandrine; Bhatia, Smita; Chen, Yanjun; Bhatia, Ravi; O’Connor, Timothy R.

    2017-01-01

    Patients who undergo autologous hematopoietic stem cell transplantation (aHCT) for treatment of a relapsed or refractory lymphoma are at risk of developing therapy related- myelodysplasia/acute myeloid leukemia (t-MDS/AML). Part of the risk likely resides in inherent interindividual differences in their DNA repair capacity (DRC), which is thought to influence the effect chemotherapeutic treatments have on the patient’s stem cells prior to aHCT. Measuring DRC involves identifying small differences in repair proficiency among individuals. Initially, we investigated the cell model in healthy individuals (primary lymphocytes and/or lymphoblastoid cell lines) that would be appropriate to measure genetically determined DRC using host-cell reactivation assays. We present evidence that interindividual differences in DRC double-strand break repair (by non-homologous end-joining [NHEJ] or single-strand annealing [SSA]) are better preserved in non-induced primary lymphocytes. In contrast, lymphocytes induced to proliferate are required to assay base excision (BER) or nucleotide excision repair (NER). We established that both NHEJ and SSA DRCs in lymphocytes of healthy individuals were inversely correlated with the age of the donor, indicating that DSB repair in lymphocytes is likely not a constant feature but rather something that decreases with age (~0.37% NHEJ DRC/year). To investigate the predictive value of pre-aHCT DRC on outcome in patients, we then applied the optimized assays to the analysis of primary lymphocytes from lymphoma patients and found that individuals who later developed t-MDS/AML (cases) were indistinguishable in their DRC from controls who never developed t-MDS/AML. However, when DRC was investigated shortly after aHCT in the same individuals (21.6 months later on average), aHCT patients (both cases and controls) showed a significant decrease in DSB repair measurements. The average decrease of 6.9% in NHEJ DRC observed among aHCT patients was much

  5. Hypospadias repair

    Science.gov (United States)

    ... the problem. If the repair is not done, problems may occur later on such as: Difficulty controlling and directing urine stream A curve in the penis during erection Decreased fertility Embarrassment about appearance of penis Surgery ...

  6. Long-term results of total repair of tetralogy of Fallot in adulthood: 35 years follow-up in 104 patients corrected at the age of 18 or older.

    Science.gov (United States)

    Nollert, G; Fischlein, T; Bouterwek, S; Böhmer, C; Dewald, O; Kreuzer, E; Welz, A; Netz, H; Klinner, W; Reichart, B

    1997-08-01

    Long-term survival after surgical repair of tetralogy of Fallot (TOF) is reported to be excellent if the patients are corrected in childhood. However, age at operation has been demonstrated as an important risk-factor. The aim of our study was to investigate whether adult patients also benefit from surgery. From December 1958 to May 1977, 739 patients underwent a correction of their TOF with pulmonary stenosis at our institution. Foreigners (n = 52) and those who moved to a foreign country (n = 13) were excluded from further analysis. Sixteen patients were lost during follow-up (98% complete). Of the remaining patient population (n = 658; mean age: 12.2 +/- 8.6 years; range 2-67 years), 104 patients were 18 years or older at the time of correction. Operative (n = 25) and one-year (n = 8) deaths were excluded for long-term calculations, resulting in a study group of 71 patients. Actuarial 10, 20, 30, and 35-year survival rates were 94%, 93%, 83%, and 72% respectively, and not different from normal life expectancy. The most common cause of death was congestive heart failure (n = 3), followed by myocardial infarction (n = 2) and sudden death (n = 2). Parameters influencing longterm survival could not be detected. At follow-up (mean 27.7 years), more than 80% (n = 48) of the 58 survivors reported themselves to be in NYHA functional class I or II and 95% (n = 55) were in a better condition than before the operation. Repair of tetralogy of Fallot in adulthood shows excellent results with normal life expectancy for the patients.

  7. Anatomy of the female pelvic viscera before and after transobturator tape procedures and anterior vaginal wall repair in patients with stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Laketić Darko

    2016-01-01

    Full Text Available Anatomy of the female pelvic viscera was investigated before and after the Tension free Vaginal tape (TVT-O. Forty patients were included in the study. Surgery was performed between 2009 and 2012 in Clinic of Urology (Clinical Center Nis and Department of Urology (Municipal Hospital Prokuplje. Stress Urinary Incontinence (SUI and anterior vaginal wall prolapse was confirmed in all patients. In all patients with anterior vaginal wall prolapse (grade≥2 both tension free vaginal tape (TVT-O and anterior vaginal wall repair were performed. Pelvic Organ Prolapse Quantification (POPQ system was used for the evaluation of prolapse before and after the surgery. Mean age of patients was 61 years. Spinal anesthesia was performed in thirty patients and general anesthesia in 10 patients. Intraoperative blood loss was under 50 ml. There were no bladder, nerve and blood vessels injuries . Thirty eight out of forty patients (95% were satisfied with the outcome of the surgery. There was a significant correction of prolapse after the surgery. Recurrence of prolapse was found in patients with the high grade prolapse before the surgery, as well as, in patients with the history of previous anterior vaginal repair. Pelvic organ prolapse, congenital or acquired, is supported by the congenital weakness of the pelvic floor.

  8. Anaesthesia management in a patient with a severe biotinidase deficiency for congenital scoliosis repair

    Directory of Open Access Journals (Sweden)

    Ebrahim Almasri

    2016-01-01

    Full Text Available A 17 year old female patient with a biotinidase enzyme deficiency, cerebral palsy, aphamis, generalized hyperreflexia and spasticity, epilepsy and mental retardation came for the severe kyphoscoliotic deformity correction. Biotinidase enzyme deficiency is an autosomal recessive disorder with incidence of 1:60,000 neonatal birth. Treatment with biotin results in a rapid biochemical and clinical improvement. This enzyme deficiency involves neurological, neuromuscular, respiratory, dermatological and immunological problems. If untreated it can lead to convulsions, coma and death. Cobb’s angle that measures the curvature of scoliosis, determined by measurements made on X rays in this case was 120° with clinical presentation of recurrent respiratory tract infection, inability to maintain sagittal posture, inability to eat or feed and difficulty in nursing care. Anaesthetic management in these patients should focus primarily on associated comorbidities and congenital anomalies affecting the course of the perioperative management and thereafter comprehensive preoperative strategies must be executed to enhance the safety profile during the surgery.

  9. Hiatal hernia repair with biologic mesh reinforcement reduces recurrence rate in small hiatal hernias.

    Science.gov (United States)

    Schmidt, E; Shaligram, A; Reynoso, J F; Kothari, V; Oleynikov, D

    2014-01-01

    The utility of mesh reinforcement for small hiatal hernia found especially during antireflux surgery is unknown. Initial reports for the use of biological mesh for crural reinforcement during repair for defects greater than 5 cm have been shown to decrease recurrence rates. This study compares patients with small hiatal hernias who underwent onlay biologic mesh buttress repair versus those with suture cruroplasty alone. This is a single-institution retrospective review of all patients undergoing repair of hiatal hernia measuring 1-5 cm between 2002 and 2009. The patients were evaluated based on surgical repair: one group undergoing crural reinforcement with onlay biologic mesh and other group with suture cruroplasty only. Seventy patients with hiatal hernia measuring 1-5 cm were identified. Thirty-eight patients had hernia repair with biologic mesh, and 32 patients had repair with suture cruroplasty only. Recurrence rate at 1 year was 16% (5/32) in patients who had suture cruroplasty only and 0% (0/38) in the group with crural reinforcement with absorbable mesh (statistically significant, P = 0.017). Suture cruroplasty alone appears to be inadequate for hiatal hernias measuring 1-5 cm with significant recurrence rate and failure of antireflux surgery. Crural reinforcement with absorbable mesh may reduce hiatal hernia recurrence rate in small hiatal hernias. © 2013 Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

  10. Histomorphologic liver abnormalities in a group of alcoholic patients

    Directory of Open Access Journals (Sweden)

    Libán Álvarez Cáceres

    2010-11-01

    Full Text Available Background: the ingestion of alcohol has been directly involved in the development of liver diseases. Nowadays, the liver damage by ethanol is a serious health problem all over the world. To achieve satisfactory results In order to face it, it is necessary to provide multidisciplinary attention. Objective: to determine the histomorphologic liver impairments in alcoholic patients. Methods: an observational, descriptive, co-relational and prospective study conducted in 23 patients with an alcoholism diagnosis at the Provincial University Hospital "Arnaldo Milián Castro" in Villa Clara. Inclusion and exclusion criteria were taken into account. The variables studied were: laparoscopic evolution, period of time consuming alcohol (in years, histologic evolution and alanine aminotransferase. Results: both trough laparoscopic and liver biopsy, the most frequent diagnosis was steatosis, followed by chronic hepatitis. In one patient cirrhosis was diagnosed through laparoscopy: a biopsy was not performed in this case. Conclusion: there were a high proportion of patients with impaired liver aminotransferases and severe histological diagnoses, especially those of chronic hepatitis and liver cirrhosis.

  11. 传统疝修补术与无张力疝修补术86例随访%A follow-up study on traditional repair and tension free hernia repair for the treatment of 86 patients with inguinal hernia

    Institute of Scientific and Technical Information of China (English)

    徐士礼

    2014-01-01

    Objective:To compare the traditional hernioplasty and plug mesh hernia repair in the clinical treatment effect of inguinal hernia through a short and long-term follow-up of 86 patients with inguinal hernia. Methods:86 cases of inguinal hernia patients with complete clinic and follow-up data were divided into traditional hernia repair in 47 cases (control group) and tension free hernia repair in 39 cases (treatment group), and compared the two group clinical effects. Results:The treatment group was superior clinical efficacy compared with the control group, the difference was statistically significant ( P<0.05). Conclusion:Tension free herniorrhaphy for treatment of inguinal hernia operation was better, the operation was simple, effective, and suitable for promotion in the primary hospital.%目的:通过对86例不同方式腹股沟疝修补术患者的近、远期随访,比较传统疝修补术与无张力疝修补术对腹股沟疝治疗的临床疗效。方法:收集临床及随访资料完整并行疝修补术者86例,其中行传统疝修补术者47例(对照组),无张力疝修补术39例(治疗组),对两组患者的临床治疗效果进行比较分析。结果:治疗组较对照组近、远期临床疗效更优,两组比较差异有统计学意义(P<0.05)。结论:无张力修补术是治疗腹股沟疝较好的手术方式,该术式操作简单,且近、远期疗效较好适于在基层推广。

  12. Assessment of pain among a group of Nigerian dental patients.

    Science.gov (United States)

    Odai, Emeka Danielson; Ehizele, Adebola Oluyemisi; Enabulele, Joan Emien

    2015-06-19

    Pain is considered a key symptom associated with possible impairment of oral-health-related quality of life and its assessment is important for the planning and evaluation of preventive and treatment effort. The tools for assessing pain must therefore be valid and consistent. The objective of this study was to assess dental patients' level of pain based on the clinical diagnosis of their dental condition and the correlation between two pain assessment scales, Visual analogue scale (VAS) and the Full Cup Test (FCT), for the assessment of pain among dental patients. A total of 185 patients presenting at the University of Benin Teaching Hospital dental outpatient clinics with various forms of orofacial pain were included in this study. The mean VAS scores and mean FCT scores for the different dental conditions were compared. Agreement between VAS and FCT was evaluated using the Intra-class correlation (ICC) coefficients and Cronbach alpha coefficient was also calculated to assess consistency of the two pain scales. Majority i.e. 95.1, 96.2 and 100% who presented with acute pulpitis, acute apical periodontitis and pericoronitis respectively, presented with moderate to severe pain levels (p < 0.05). Only 25.9 and 4% who presented with chronic marginal gingivitis and chronic pulpitis respectively presented with no pain (p < 0.05). A large proportion (75%) of patients with no pain had single diagnosis while more than half (52.1%) of those who presented with severe pain had multiple diagnoses (p = 0.025). The mean VAS and FCT scores for acute pain were 6.1 ± 2.1 and 5.9 ± 2.4 respectively and for chronic pain 3.9 ± 2.7 and 3.7 ± 2.7 respectively (P = 0.001). The interclass correlation coefficient revealed that the mean VAS and FCT scores were statistically correlated and reliable with a Cronbach alpha coefficient of 0.85. It can be concluded that patients who presented with either acute or chronic dental conditions may experience moderate to severe level of pain, with

  13. assessment of nutritional status of a group of hypertensive patients ...

    African Journals Online (AJOL)

    2014-03-01

    Mar 1, 2014 ... Objective: To assess the prevalence of overweight and obesity among adult hypertensive ... smoking tobacco while 53.8% of the respondents engaged in regular physical exercise. The BMI showed ..... Rural School Going Children in Ludhiana. Indian ... Pressure Education Program Working Group. Arch.

  14. Patient Engagement Practices in Clinical Research among Patient Groups, Industry, and Academia in the United States: A Survey.

    Directory of Open Access Journals (Sweden)

    Sophia K Smith

    Full Text Available Patient-centered clinical trial design and execution is becoming increasingly important. No best practice guidelines exist despite a key stakeholder declaration to create more effective engagement models. This study aims to gain a better understanding of attitudes and practices for engaging patient groups so that actionable recommendations may be developed.Individuals from industry, academic institutions, and patient groups were identified through Clinical Trials Transformation Initiative and Drug Information Association rosters and mailing lists. Objectives, practices, and perceived barriers related to engaging patient groups in the planning, conduct, and interpretation of clinical trials were reported in an online survey. Descriptive and inferential statistical analysis of survey data followed a literature review to inform survey questions.Survey respondents (n = 179 valued the importance of involving patient groups in research; however, patient group respondents valued their contributions to research protocol development, funding acquisition, and interpretation of study results more highly than those contributions were valued by industry and academic respondents (all p < .001. Patient group respondents placed higher value in open communications, clear expectations, and detailed contract execution than did non-patient group respondents (all p < .05. Industry and academic respondents more often cited internal bureaucratic processes and reluctance to share information as engagement barriers than did patient group respondents (all p < .01. Patient groups reported that a lack of transparency and understanding of the benefits of collaboration on the part of industry and academia were greater barriers than did non-patient group respondents (all p< .01.Despite reported similarities among approaches to engagement by the three stakeholder groups, key differences exist in perceived barriers and benefits to partnering with patient groups among the

  15. Will Preoperative Atrophy and Fatty Degeneration of the Shoulder Muscles Improve after Rotator Cuff Repair in Patients with Massive Rotator Cuff Tears?

    Directory of Open Access Journals (Sweden)

    Hiroshi Yamaguchi

    2012-01-01

    Full Text Available Recently, retear rate after repair for massive cuff tear have been improved through devised suture techniques. However, reported retear rate is relevant to preoperative atrophy and fatty degeneration. The purpose of this study was to investigate whether preoperative atrophy and fatty degeneration of rotator cuff muscles improve by successful repair. Twenty-four patients with massive rotator cuff tear were evaluated on the recovery of atrophy and fatty degeneration of supraspinatus and infraspinatus muscle after surgery. Atrophy was classified by the occupation ratio and fatty degeneration by modified Goutallier's classification. Both were assessed on magnetic resonance imaging (MRI before and after the operation. When the cuff was well repaired, improvement of the atrophy and fatty degeneration were observed in a half and a one-fourth of the cases, respectively. In retear cases, however, atrophy and fatty degeneration became worse. Improvement of atrophy and fatty degeneration of the rotator cuff muscles may be expected in the cases with successful achievement of rotator cuff repair for large and massive tear.

  16. Patient-centered care in affective, non-affective, and schizoaffective groups: patients' opinions and attitudes.

    Science.gov (United States)

    Tempier, Raymond; Hepp, Shelanne L; Duncan, C Randy; Rohr, Betty; Hachey, Krystal; Mosier, Karen

    2010-10-01

    An outcome evaluation was conducted to obtain psychiatric inpatients' perspectives on acute care mental health treatment and services. The applicability of diagnostic categories based on affective, non-affective, and schizoaffective disorder were considered in the predictability of responses to treatment regimens and the related services provided in an inpatient psychiatric unit. A multidimensional approach was used to survey patients, which included the DAI-30, the BMQ, the SERVQUAL, and the CSQ-8. Overall, findings indicate that inpatient satisfaction could be improved with tailoring treatment to suit their respective symptoms. Furthermore, this exploratory study demonstrates some preliminary support for the inclusion of patients with a diagnosis of schizoaffective disorder as a separate group toward improving acute mental health care while hospitalized.

  17. Evaluation of Anesthesia Profile in Pediatric Patients after Inguinal Hernia Repair with Caudal Block or Local Wound Infiltration

    Directory of Open Access Journals (Sweden)

    Aleksandra Gavrilovska-Brzanov

    2016-02-01

    CONCLUSIONS: Between children undergoing inguinal hernia repair, local wound infiltration insures safety and satisfactory analgesia for surgery. Compared to caudal block it is not overwhelming. Caudal block provides longer analgesia, however complications are rather common.

  18. Seasonal variation of DNA damage and repair in patients with non-melanoma skin cancer and referents with and without psoriasis

    DEFF Research Database (Denmark)

    Møller, P; Knudsen, Lisbeth E.; Frentz, G;

    1998-01-01

    Quadruples of skin cancer patients with and without psoriasis and referents with and without psoriasis (4 x 20 study persons) were identified and examined for DNA damage by single cell gel electrophoresis (comet-assay) and DNA-repair by UV-induced unscheduled DNA synthesis (UDS) in mononuclear...... to solar radiation. When the comet tail moment data were stratified by sampling period, an interaction between psoriasis and skin cancer was detected, with patients with psoriasis and skin cancer exhibiting more DNA damage. Patients with psoriasis and skin cancer also had lower UDS compared to healthy...

  19. The Influence of Arthroscopic Remplissage for Engaging Hill-Sachs Lesions Combined with Bankart Repair on Redislocation and Shoulder Function Compared with Bankart Repair Alone.

    Science.gov (United States)

    Ko, Sang-Hun; Cha, Jae-Ryong; Lee, Chae-Chil; Hwang, Il-Yeong; Choe, Chang-Gyu; Kim, Min-Seok

    2016-12-01

    Recurrence of glenohumeral dislocation after arthroscopic Bankart repair can be associated with a large osseous defect in the posterosuperior part of the humeral head. Our hypothesis is that remplissage is more effective to prevent recurrence of glenohumeral instability without a severe motion deficit. Engaging Hill-Sachs lesions were observed in 48 of 737 patients (6.5%). Twenty-four patients underwent arthroscopic Bankart repair combined with remplissage (group I) and the other 24 patients underwent arthroscopic Bankart repair alone (group II). Clinical outcomes were prospectively evaluated by assessing the range of motion. Complications, recurrence rates, and functional results were assessed utilizing the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, and the Korean Shoulder Score for Instability (KSSI) score. Capsulotenodesis healing after remplissage was evaluated with magnetic resonance imaging. The average ASES, Rowe, and KSSI scores were statistically significantly higher in group I than group II. The frequency of recurrence was statistically significantly higher in group II. The average loss in external rotation measured with the arm positioned at the side of the trunk was greater in group II and that in abduction was also higher in group II. Compared to single arthroscopic Bankart repair, the remplissage procedure combined with arthroscopic Bankart repair was more effective to prevent the recurrence of anterior shoulder instability without significant impact on shoulder mobility in patients who had huge Hill-Sachs lesions.

  20. Observation on the clinical efficacy of tension free hernia repair in elderly patients with inguinal hernia%老年腹股沟疝行平片无张力疝修补术治疗的临床效果观察

    Institute of Scientific and Technical Information of China (English)

    秦周礼

    2015-01-01

    Objective:To investigate the clinical effect of tension free hernia repair in the treatment of elderly patients with inguinal hernia.Methods:114 elderly patients with inguinal hernia were randomly divided into the control group and the observation group.Patients in the observation group were treated with tension free hernia repair of plain film,while in the control group were treated with traditional hernia repair.Results:The postoperative complications,postoperative recurrence rate, postoperative pain time and average hospitalization time in the observation group were significantly better than those in the control group(P<0.05).Conclusion:Plain film tension free hernia repair has higher clinical efficacy in the treatment of elderly patients with inguinal hernia,also the incidence of complications and recurrence rate are lower.%目的:探讨平片无张力疝修补术治疗老年腹股沟疝的临床效果.方法:收治腹股沟疝老年患者114例,随机分为对照组和观察组,观察组给予平片无张力疝修补术治疗,对照组给予传统疝修补术治疗.结果:观察组在术后并发症、术后复发率、术后疼痛时间以及平均住院时间均明上显优于对照组(P<0.05).结论:平片无张力疝修补术治疗老年腹股沟疝的临床效果高,并且并发症的发生率和复发率都比较低.

  1. Rapid bone repair in a patient with lung cancer metastases to the spine using a novel herbal medicine: A case report

    OpenAIRE

    2016-01-01

    The prognosis of lung carcinoma with metastasis to the bone, particularly to the spine, is poor. Chemotherapy and radiotherapy are established treatments for metastatic bone disease, but their effectiveness is unsatisfactory and bone repair following their use is slow and difficult. Medicine prepared from herbal extracts may be an alternative treatment option. The present study discusses the case of a 59-year-old patient diagnosed with squamous cell lung cancer (T2N3M1) in which first-line ch...

  2. Severe tracheobronchial compression in a patient with Turner′s syndrome undergoing repair of a complex aorto-subclavian aneurysm: Anesthesia perspectives

    Directory of Open Access Journals (Sweden)

    Christopher C .C. Hudson

    2014-01-01

    Full Text Available We present a case of severe tracheobronchial compression from a complex aorto-subclavian aneurysm in a patient with Turner′s syndrome undergoing open surgical repair. Significant airway compression is a challenging situation and requires careful preoperative preparation, maintenance of spontaneous breathing when possible, and consideration of having an alternative source of oxygenation and circulation established prior to induction of general anesthesia. Cardiopulmonary monitoring is essential for safe general anesthesia and diagnosis of unexpected intraoperative events.

  3. Evaluation of acute kidney injury as defined by the risk, injury,failure, loss, and end-stage criteria in critically ill patients undergoing abdominal aortic aneurysm repair

    Institute of Scientific and Technical Information of China (English)

    YUE Jia-ning; LUO Zhe; GUO Da-qiao; XU Xin; CHEN Bin; JIANG Jun-hao; YANG Jue

    2013-01-01

    Background Acute kidney injury (AKI) is considered as a common and significant complication following abdominal aortic aneurysm (AAA) repair.This study aimed to assess the associated risk factors of AKI in the critically ill patients undergoing AAA repair and to evaluate the appropriate AKI management in the specific population.Methods We retrospectively examined data from all critically ill patients undergoing AAA repairs at our institution from April 2007 to March 2012.Multivariable analysis was used to identify factors associated with postoperative AKI,which was defined by risk,injury,failure,loss and end-stage (RIFLE) kidney disease criteria.The goal-directed hemodynamic optimization (maintenance of optimal hemodynamics and neutral or negative fluid balance) and renal outcomes were also reviewed.Results Of the 71 patients enrolled,32 (45.1%) developed AKI,with 30 (93.8%) cases diagnosed on admission to surgical intensive care unit (SICU).Risk factors for AKI were ruptured AAA (odds ratio (OR)=5.846,95% confidence interval (Cl):1.346-25.390),intraoperative hypotension (OR=6.008,95% CI:1.176 to 30.683),and perioperative blood transfusion (OR=4.611,95% CI:1.307-16.276).Goal-directed hemodynamic optimization resulted in 75.0% complete and 18.8% partial renal recovery.Overall in-hospital mortality was 2.8% AKI was associated with significantly increased length of stay ((136.9±24.5) hours vs.(70.4±11.3) hours)in Surgical Intensive Care Unit.Conclusions Critically ill patients undergoing AAA repair have a high incidence of AKI,which can be early recognized by RIFLE criteria.Rupture,hypotension,and blood transfusion are the significant associated risk factors.Application of goal-directed hemodynamic optimization in this cohort appeared to be effective in improving renal outcome.

  4. Identification of genetic polymorphisms in DNA repair xenoderma pigmentosum group D gene and its association with head and neck cancer susceptibility in rural Indian population: a hospital based case-control study from south-western Maharashtra, India

    Directory of Open Access Journals (Sweden)

    Kailas D. Datkhile

    2016-06-01

    Conclusions: This study indicates that polymorphisms in cd199 of XPD gene could play a role in modifying genetic susceptibility of individual to head and neck cancer in Maharashtra patients. Thus, the case-control study suggest that selected DNA repair genes represent genetic determinants in oral carcinogenesis along with other risk factors in the rural Indian population. [Int J Res Med Sci 2016; 4(6.000: 1997-2005

  5. Paravertebral blocks provide superior same-day recovery over general anesthesia for patients undergoing inguinal hernia repair.

    Science.gov (United States)

    Hadzic, Admir; Kerimoglu, Beklen; Loreio, Dan; Karaca, Pelin Emine; Claudio, Richard E; Yufa, Marina; Wedderburn, Ray; Santos, Alan C; Thys, Daniel M

    2006-04-01

    Inguinal herniorrhaphy is commonly performed on an outpatient basis under nerve blocks or local or general anesthesia (GA). Our hypothesis is that use of paravertebral blocks (PVB) as the sole anesthetic technique will result in shorter time to achieve home readiness and improved same-day recovery over a 'fast-track' GA. Fifty patients were randomly assigned to receive either PVB or GA under standardized protocols (PVB = 0.75% ropivacaine, followed by propofol sedation; GA = dolasetron 12.5 mg, propofol induction, rocuronium, endotracheal intubation; desflurane; bupivacaine 0.25% for field block). Eligibility for postanesthetic care unit (PACU) bypass and data on time-to-postoperative pain, ambulation, home readiness, and incidence of adverse events were collected. More patients in the PVB group (71%) met the criteria to bypass the postanesthetic care unit compared with patients in the GA group (8%; P local anesthetic (P = 0.005). Patients in the PVB group were able to ambulate earlier (102 +/- 55 minutes) than those in the GA group (213 +/- 108 minutes; P inguinal herniorrhaphy, PVB resulted in faster time to home readiness and was associated with fewer adverse events and better analgesia before discharge than GA.

  6. Excision repair cross-complementation group 1 codon 118 polymorphism, micro ribonucleic acid and protein expression, clinical outcome of the advanced gastric cancer response to first-line FOLFOX-4 in Qinghai-Tibetan plateau population

    Directory of Open Access Journals (Sweden)

    Yu-Juan Qi

    2013-01-01

    Full Text Available Context: The excision repair cross-complementation group 1 (ERCC1 codon 118 C/T polymorphism has been associated with clinical outcome in cancer patients treated with platinum chemotherapy. Ethnic differences in the frequency of this polymorphism have been observed in Caucasian and African populations. Aim: The aim of this study was to evaluate the frequency and survival benefit of the ERCC1 codon 118 C/T polymorphism in a high-altitude population with advanced gastric cancer. Materials and Methods: Polymerase chain reaction-restriction fragment length polymorphism was used to determine the frequency of ERCC1 118 codon C/T polymorphism in 206 advanced gastric cancer patients residing in the high-altitude Qinghai-Tibetan plateau. The influence of the ERCC1 codon 118 C/T polymorphism on its micro ribonucleic acid (mRNA and protein expression, clinicopathological features; response to the platinum-based combination chemotherapy, and the outcome was evaluated. Statistical Analysis: The Kaplan-Meier method was used for survival analysis. The correlation of ERCC1 codon 118 polymorphism with ERCC1 mRNA and protein expression, clinicopathological characteristics, and first-line oxaliplatin, 5-fluorouracil, and leucovorin (FOLFOX-4 response was determined by χ2 -test. Results and Conclusions: ERCC1 codon 118 C/T polymorphism was not associated with ERCC1 mRNA and protein expression, FOLFOX-4 response, and progression-free survival (PFS or overall survival (OS. High ERCC1 mRNA and protein expression levels were associated with significantly lower FOLFOX-4 responses, PFS, and OS. ERCC1 codon 118 C/T polymorphism is not an important prognostic marker for advanced gastric cancer. Determination of ERCC1 mRNA and protein levels may be beneficial in predicting the response and outcome of FOLFOX-4 therapy in gastric cancer.

  7. ABO blood group is a predictor of survival in patients with laryngeal cancer.

    Science.gov (United States)

    Jin, Ting; Li, Pei-Jing; Chen, Xiao-Zhong; Hu, Wei-Han

    2016-10-13

    Whether the ABO blood group is associated with the survival of patients with laryngeal cancer remains unknown. The purpose of this study was to investigate the association between the ABO blood group and clinicopathologic characteristics of patients with laryngeal cancer and assess whether the ABO blood group was associated with prognosis. We analyzed the records of 1260 patients with laryngeal cancer who underwent curative treatment at Sun Yat-sen University Cancer Center between January 1993 and December 2009. The Chi-square test was used to assess the relationship between the ABO blood group and clinicopathologic characteristics. The Kaplan-Meier method was used to estimate 3-, 5-, and 10-year overall survival (OS) rates. The Cox proportional hazards model was used in univariate and multivariate analyses of OS. No significant association was found between the ABO blood group and clinicopathologic characteristics except for primary tumor site. The median OS for patients with blood groups A, B, AB, and O were 87.0, 80.0, 90.0, and 72.5 months, respectively. The 3-, 5-, and 10-year OS rates were 82.4%, 76.0%, and 67.5% for patients with blood group A; 77.4%, 69.8%, and 58.4% for patients with blood group B; 82.2%, 73.1%, and 65.6% for patients with blood group AB; and 71.7%, 66.4%, and 55.5% for patients with blood group O, respectively. Univariate and multivariate analyses showed that the ABO blood group had significant effects on prognosis in patients with laryngeal cancer. The ABO blood group is associated with survival in patients with laryngeal cancer. Patients with blood group O had significantly shorter OS than patients with other ABO blood groups.

  8. Patient involvement in diabetes care: experiences in nine diabetes care groups

    Directory of Open Access Journals (Sweden)

    Lidwien Lemmens

    2015-12-01

    Full Text Available Introduction: Despite the expected beneficial effects on quality of care, patient involvement in diabetes care groups, which deliver a bundled paid integrated care programme for diabetes type 2, seems to be limited. The aim of this study was to gain insight into levels and methods of patient involvement, into facilitators and barriers, and into the future preferences of care groups and patient representatives.Theory and methods: Semi-structured interviews were held with 10 representatives of care groups and 11 representatives of patient advocacy groups. An adapted version of Arnstein's ladder of citizen participation was used to define five levels of patient involvement.Results: Patient involvement in care groups was mostly limited to informing and consulting patients. Higher levels, i.e., advising, co-producing and decision-making, were less frequently observed. Care groups and patient representatives perceived largely the same barriers and facilitators and had similar preferences regarding future themes and design of patient involvement.Conclusion: Constructive collaboration between diabetes care groups and patient representatives to enhance patient involvement in the future seems viable. Several issues such as the lack of evidence for effectiveness of patient involvement, differences in viewpoints on the role and responsibilities of care groups and perceived barriers need to be addressed.

  9. Self-Reported Differences in Empowerment Between Lurkers and Posters in Online Patient Support Groups

    NARCIS (Netherlands)

    Uden-Kraan, van Cornelia F.; Drossaert, Constance H.C.; Taal, Erik; Seydel, Erwin R.; Laar, van de Mart A.F.J.

    2008-01-01

    Background: Patients who visit online support groups benefit in various ways. Results of our earlier study indicated that participation in online support groups had a profound effect on the participants’ feelings of “being empowered.” However, most studies of online patient support groups have focus

  10. The efficacy of the semi-blind approach of transversus abdominis plane block on postoperative analgesia in patients undergoing inguinal hernia repair: a prospective randomized double-blind study

    Directory of Open Access Journals (Sweden)

    Salman AE

    2013-01-01

    Full Text Available A Ebru Salman,1 Fahri Yetisir,2 Banu Yürekli,3 Mustafa Aksoy,1 Murat Yildirim,2 Mehmet Kiliç21Anesthesiology and Reanimation Department, 2General Surgery Department, Atatürk Research and Training Hospital, Ankara, Turkey; 3Endocrinology Department, Bozyaka Research and Training Hospital, Izmir, TurkeyPurpose: In this prospective, randomized, double-blind study, our aim was to compare the analgesic efficacy of the semi-blind approach of transversus abdominis plane (TAP block with a placebo block in patients undergoing unilateral inguinal hernia repair.Methods: After receiving hospital ethical committee approval and informed patient consents, American Society of Anesthesiologists (ASA I–III patients aged 18–80 were enrolled in the study. Standard anesthesia monitoring was applied to all patients. After premedication, spinal anesthesia was administered to all patients with 3.5 mL heavy bupivacaine at the L3-L4 subarachnoid space. Patients were randomly allocated into 2 groups. Group I (n = 32 received a placebo block with 20 mL saline, Group II (n = 32 received semi-blind TAP block with 0.25% bupivacaine in 20 mL with a blunt regional anesthesia needle into the neurofascial plane via the lumbar triangle of Petit near the midaxillary line before fascial closure. At the end of the operation, intravenous (IV dexketoprofen was given to all patients. The verbal analog scale (VAS was recorded at 2, 4, 6, 12, and 24 hours postoperatively. Paracetamol IV was given to patients if their VAS score > 3. A rescue analgesic of 0.05 mg/kg morphine IV was applied if VAS > 3. Total analgesic consumption and morphine requirement in 24 hours were recorded.Results: TAP block reduced VAS scores at all postoperative time points (P < 0.001. Postoperative analgesic and morphine requirement in 24 hours was significantly lower in group II (P < 0.01.Conclusion: Semi-blind TAP block provided effective analgesia, reducing total 24-hour postoperative analgesic

  11. 颅骨修补手术患者术前共情沟通的效果观察%Effect of Preoperative Empathy Communication on Patients with Skull Repair Surgery

    Institute of Scientific and Technical Information of China (English)

    马桂珍; 马丽娜; 陶永红; 廉爱玲; 吴怀兰

    2014-01-01

    Objective To explore the effect of preoperative empathy communication on patients with skull repair surgery. Methods One hundred patients with skull repair surgery were divided into control group and observation group. Conventional preoperative communication was conducted in control group while empathy communication in addition to conventional preoperative communication in observation group. Patients’ anxiety and their satisfaction with nursing were compared. Results There was lower score of anxiety and patients were more satisfied with the nursing in the 2nd day of operation in observation group(P<0.05). Conclusion Empathy communication contributes to the alleviation of patients’ anxiety in skull repair surgery and the improvement of patients’ satisfaction with nursing service.%目的:探讨共情沟通方式在颅骨修补手术患者中的应用效果。方法选取2012年2月-2014年3月在黑龙江某三级甲等医院行颅骨修补手术患者100例,2012年2月-2013年2月行颅骨修补手术的50例患者为对照组,2013年3月-2014年3月行颅骨修补手术的50例患者为观察组,对照组采取手术常规沟通,观察组在此基础上实施共情沟通。比较两组患者焦虑评分及对护理工作满意度。结果术后第2天观察组焦虑评分低于对照组,差异有统计学意义(P<0.05);术后第2天观察组对护理工作满意度高于对照组,差异有统计学意义(P<0.05)。结论实施共情沟通能减轻颅骨修补手术患者的焦虑情绪,并提高患者对护理工作的满意度。

  12. X-ray repair cross-complementing group 1 (XRCC1) genetic polymorphisms and cervical cancer risk: a huge systematic review and meta-analysis.

    Science.gov (United States)

    Li, Ya; Liu, Fei; Tan, Shi-Qiao; Wang, Yan; Li, Shang-Wei

    2012-01-01

    Previous studies investigating the association between X-ray repair cross-complementation group 1(XRCC1) polymorphisms and cervical cancer (CC) risk has provided inconsistent results. The aim of our study was to assess the association between the XRCC1 gene Arg399Gln, Arg194Trp, Arg280His polymorphisms and risk of CC. Two investigators independently searched the Medline, Embase, CNKI, and Chinese Biomedicine Databases for studies published before March 2011.Summary odds ratios (ORs) and 95% confidence intervals (CIs) for XRCC1 polymorphisms and CC were calculated in a fixed-effects model or a random-effects model when appropriate. Ultimately, 9, 5 and 2 studies were found to be eligible for meta-analyses of Arg399Gln, Arg194Trp and Arg280His, respectively. Our analysis suggested that the variant genotypes of Arg194Trp were associated with a significantly increased CC risk (Trp/Trp vs Arg/Arg, OR = 2.21, 95% CI = 1.60-3.06; Arg/Trp vs Arg/Arg, OR = 1.23, 95% CI = 1.02-1.49; dominant model, OR = 1.36, 95% CI = 1.14-1.63; recessive model, OR = 2.06, 95% CI = 1.51-2.82). For Arg280His polymorphism, no obvious associations were found for all genetic models. For Arg399Gln polymorphism, also no obvious associations were found for all genetic models. In the subgroup analyses by ethnicity/country, a significantly increased risk was observed among Asian, especially among Chinese. To get more precise evidences, adjusted ORs (95%CI) by potential confounders (such as age, ethnicity or smoking, etc) were also calculated for XRCC1 Arg399Gln and Arg194Trp, however, the estimated pooled adjusted OR still did not change at all. This meta-analysis suggests that Arg194Trp polymorphism may be associated with CC risk, Arg399Gln polymorphism might be a low-penetrent risk factor for CC only in Asians, and there may be no association between Arg280His polymorphism and CC risk.

  13. X-ray repair cross-complementing group 1 (XRCC1 genetic polymorphisms and cervical cancer risk: a huge systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Ya Li

    Full Text Available BACKGROUND: Previous studies investigating the association between X-ray repair cross-complementation group 1(XRCC1 polymorphisms and cervical cancer (CC risk has provided inconsistent results. The aim of our study was to assess the association between the XRCC1 gene Arg399Gln, Arg194Trp, Arg280His polymorphisms and risk of CC. METHODS: Two investigators independently searched the Medline, Embase, CNKI, and Chinese Biomedicine Databases for studies published before March 2011.Summary odds ratios (ORs and 95% confidence intervals (CIs for XRCC1 polymorphisms and CC were calculated in a fixed-effects model or a random-effects model when appropriate. RESULTS: Ultimately, 9, 5 and 2 studies were found to be eligible for meta-analyses of Arg399Gln, Arg194Trp and Arg280His, respectively. Our analysis suggested that the variant genotypes of Arg194Trp were associated with a significantly increased CC risk (Trp/Trp vs Arg/Arg, OR = 2.21, 95% CI = 1.60-3.06; Arg/Trp vs Arg/Arg, OR = 1.23, 95% CI = 1.02-1.49; dominant model, OR = 1.36, 95% CI = 1.14-1.63; recessive model, OR = 2.06, 95% CI = 1.51-2.82. For Arg280His polymorphism, no obvious associations were found for all genetic models. For Arg399Gln polymorphism, also no obvious associations were found for all genetic models. In the subgroup analyses by ethnicity/country, a significantly increased risk was observed among Asian, especially among Chinese. To get more precise evidences, adjusted ORs (95%CI by potential confounders (such as age, ethnicity or smoking, etc were also calculated for XRCC1 Arg399Gln and Arg194Trp, however, the estimated pooled adjusted OR still did not change at all. CONCLUSION: This meta-analysis suggests that Arg194Trp polymorphism may be associated with CC risk, Arg399Gln polymorphism might be a low-penetrent risk factor for CC only in Asians, and there may be no association between Arg280His polymorphism and CC risk.

  14. Clinical inquiry of elderly patients with oral cavity repair%对老年患者口腔修复的临床探究

    Institute of Scientific and Technical Information of China (English)

    季立山

    2015-01-01

    目的:探讨老年患者口腔修复的效果。方法:采用牙体取模并制作腊牙合垫、处理牙合垫、试戴牙合垫、佩戴牙合垫式的义齿步骤进行口腔修复。结果:共修复活动义齿缺失牙齿1014颗,包括全口义齿的患者38例(33.33%)、上半口义齿的患者33例(28.95%)、下半口义齿的患者32例(28.07%)、赝复体11例(11.40%)。固定义齿修复18例患者,共修复牙单位43个。结论:根据老年患者口腔修复的特点制定合适的方案,从而提高老年患者口腔修复的水平。%Objective:To explore the effect of oral cavity repair in the elderly patients.Methods:The oral cavity was repaired through the steps including taking tooth modulus and making wax occlusal pad,processing of occlusal pad,trying occlusal pad and wearing occlusal pad type of denture.Results:1 014 denture teeth of dentition defect were repair,including 38 cases with complete denture(33.33%),33 cases with upper complete denture(28.95%),32 cases with the lower complete denture(28.07%),11 cases with prosthesis(11.40%).18 cases had fixed denture and 43 dental units had been repaired.Conclusion:The appropriate solutions are made according to the characteristics of elderly patients with oral cavity repair in order to improve the oral cavity repair level of the elderly patients.

  15. Open versus laparoscopic unilateral inguinal hernia repairs: defining the ideal BMI to reduce complications.

    Science.gov (United States)

    Willoughby, Ashley D; Lim, Robert B; Lustik, Michael B

    2017-01-01

    Open inguinal hernia repair is felt to be a less expensive operation than a laparoscopic one. Performing open repair on patients with an obese body mass index (BMI) results in longer operative times, longer hospital stay, and complications that will potentially impose higher cost to the facility and patient. This study aims to define the ideal BMI at which a laparoscopic inguinal hernia repair will be advantageous over open inguinal hernia repair. The NSQIP database was analyzed for (n = 64,501) complications, mortality, and operating time for open and laparoscopic inguinal hernia repairs during the time period from 2005 to 2012. Bilateral and recurrent hernias were excluded. Chi-square tests and Fisher's exact tests were used to assess associations between type of surgery and categorical variables including demographics, risk factors, and 30-day outcomes. Multivariable regression analyses were performed to determine whether odds ratios differed by level of BMI. The HCUP database was used for determining difference in cost and length of stay between open and laparoscopic procedures. There were 17,919 laparoscopic repairs and 46,582 open repairs in the study period. The overall morbidity (across all BMI categories) is statistically greater in the open repair group when compared to the laparoscopic group (p = 0.03). Postoperative complications (including wound disruption, failure to wean from the ventilator, and UTI) were greater in the open repair group across all BMI categories. Deep incisional surgical site infections (SSI) were more common in the overweight open repair group (p = 0.026). The return to the operating room across all BMI categories was statistically significant for the open repair group (n = 269) compared to the laparoscopic repair group (n = 70) with p = 0.003. There was no difference in the return to operating room between the BMI categories. The odds ratio (OR) was found to be statistically significant when comparing the obese

  16. Femoral hernia repair

    Science.gov (United States)

    Femorocele repair; Herniorrhaphy; Hernioplasty - femoral ... During surgery to repair the hernia, the bulging tissue is pushed back in. The weakened area is sewn closed or strengthened. This repair ...

  17. ABO blood group is a predictor of survival in patients with laryngeal cancer

    OpenAIRE

    Jin, Ting; Li, Pei-Jing; Chen, Xiao-zhong; Hu, Wei-Han

    2016-01-01

    Background Whether the ABO blood group is associated with the survival of patients with laryngeal cancer remains unknown. The purpose of this study was to investigate the association between the ABO blood group and clinicopathologic characteristics of patients with laryngeal cancer and assess whether the ABO blood group was associated with prognosis. Methods We analyzed the records of 1260 patients with laryngeal cancer who underwent curative treatment at Sun Yat-sen University Cancer Center ...

  18. Metacognitive group training for schizophrenia spectrum patients with delusions : a randomized controlled trial

    NARCIS (Netherlands)

    van Oosterhout, B.; Krabbendam, L.; de Boer, K.; Ferwerda, J.; van der Helm, M.; Stant, A. D.; van der Gaag, M.

    2014-01-01

    Background. Metacognitive training (MCT) for patients with psychosis is a psychological group intervention that aims to educate patients about common cognitive biases underlying delusion formation and maintenance, and to highlight their negative consequences in daily functioning. Method. In this ran

  19. Trichothiodystrophy, a human DNA repair disorder with heterogeneity in the cellular response to ultraviolet light

    Energy Technology Data Exchange (ETDEWEB)

    Lehmann, A.R.; Arlett, C.F.; Broughton, B.C.; Harcourt, S.A.; Steingrimsdottir, H.; Stefanini, M.; Malcolm, A.; Taylor, R.; Natarajan, A.T.; Green, S.

    1988-11-01

    Trichothiodystrophy (TTD) is an autosomal recessive disorder characterized by brittle hair with reduced sulfur content, ichthyosis, peculiar face, and mental and physical retardation. Some patients are photosensitive. A previous study by Stefanini et al. showed that cells from four photosensitive patients with TTD had a molecular defect in DNA repair, which was not complemented by cells from xeroderma pigmentosum, complementation group D. In a detailed molecular and cellular study of the effects of UV light on cells cultured from three further TTD patients who did not exhibit photosensitivity we have found an array of different responses. In cells from the first patient, survival, excision repair, and DNA and RNA synthesis following UV irradiation were all normal, whereas in cells from the second patient all these responses were similar to those of excision-defective xeroderma pigmentosum (group D) cells. With the third patient, cell survival measured by colony-forming ability was normal following UV irradiation, even though repair synthesis was only 50% of normal and RNA synthesis was severely reduced. The excision-repair defect in these cells was not complemented by other TTD cell strains. These cellular characteristics of patient 3 have not been described previously for any other cell line. The normal survival may be attributed to the finding that the deficiency in excision-repair is confined to early times after irradiation. Our results pose a number of questions about the relationship between the molecular defect in DNA repair and the clinical symptoms of xeroderma pigmentosum and TTD.

  20. Immunochemical determination of an initial step in thymine dimer excision repair in xeroderma pigmentosum variant fibroblasts and biopsy material from the normal population and patients with basal cell carcinoma and melanoma

    Energy Technology Data Exchange (ETDEWEB)

    Roth, M.; Mueller, H.B.; Boyle, J.M.

    1987-09-01

    A monoclonal antibody specific for u.v.-induced thymine-thymine dimers in single-stranded DNA has been used in an enzyme immunoassay to investigate the loss of antigenicity associated with repair of this lesion in the first 2 h following 10 J/m/sup 2/ 254 nm radiation. Variances of +/- 10% for the method and +/- 6.5% for individuals were established using primary cultures of biopsies from healthy individuals. No differences in the rate of loss of antigenicity was observed between 20 normal lymphocyte samples and 10 normal skin biopsies. Of three xeroderma pigmentosum (XP) variant cell lines tested, GM3617 could not be distinguished from normal cells but GM1227 and GM3053 showed lower rates of loss than any of the healthy samples. When the group mean values were compared there was no significant difference between normals and biopsies from sun-shielded skin areas from 16 basal cell carcinomas but similar material from 10 melanoma patients showed a significantly reduced (P = 0.001) rate of loss of antigenicity. Since the rate of loss of antigenicity in normal and XP variant cells reflected their relative abilities to perform unscheduled DNA synthesis, our results suggest that some melanoma patients may also have a minor deficiency in an early stage of excision repair.

  1. Nationwide quality improvement of groin hernia repair from the Danish Hernia Database of 87,840 patients from 1998 to 2005

    DEFF Research Database (Denmark)

    Kehlet, H.; Bay-Nielsen, M.

    2008-01-01

    BACKGROUND: Increased focus and research on surgical technique and anaesthesia in groin hernia repair have improved outcomes from centres of interest in hernia surgery, but little information is available from nationwide data to document the incorporation of scientific evidence into general...... clinical practice. AIM: To review outcomes after groin hernia repair in Denmark from the Danish Hernia Database 1998-2005 in 87,840 patients. RESULTS: The nationwide Danish hernia collaboration with two annual meetings discussing own results and those of others has led to >50% reduction in reoperation...... rates, increased use of the Lichtenstein hernia technique, higher rate of outpatient surgery, near elimination of regional anaesthesia, and documentation and focus on incidence and mechanisms of chronic pain. CONCLUSION: Establishment of nationwide groin hernia databases leads to general improvement...

  2. Bond strength of repaired amalgam restorations.

    Science.gov (United States)

    Rey, Rosalia; Mondragon, Eduardo; Shen, Chiayi

    2015-01-01

    This in vitro study investigated the interfacial flexural strength (FS) of amalgam repairs and the optimal combination of repair materials and mechanical retention required for a consistent and durable repair bond. Amalgam bricks were created, each with 1 end roughened to expose a fresh surface before repair. Four groups followed separate repair protocols: group 1, bonding agent with amalgam; group 2, bonding agent with composite resin; group 3, mechanical retention (slot) with amalgam; and group 4, slot with bonding agent and amalgam. Repaired specimens were stored in artificial saliva for 1, 10, 30, 120, or 360 days before being loaded to failure in a 3-point bending test. Statistical analysis showed significant changes in median FS over time in groups 2 and 4. The effect of the repair method on the FS values after each storage period was significant for most groups except the 30-day storage groups. Amalgam-amalgam repair with adequate condensation yielded the most consistent and durable bond. An amalgam bonding agent could be beneficial when firm condensation on the repair surface cannot be achieved or when tooth structure is involved. Composite resin can be a viable option for amalgam repair in an esthetically demanding region, but proper mechanical modification of the amalgam surface and selection of the proper bonding system are essential.

  3. The Effects of Cognitive Behavorial Therapy Group and Social Support Group on the Self Esteem among Breast Cancer Patients

    Directory of Open Access Journals (Sweden)

    Namora Lumongga Lubis

    2011-12-01

    Full Text Available This study is aimed to determine the main effects of CBT group, social support group (DS and control group (KK on the self esteem among breast cancer patients. Rosemberg self esteem scale (RSE was used to measure self-esteem. The treatment group consisted of CBT and DS groups. Each treatment group received 12 counselling sessions within six weeks. Quantitative analysis general linear model (GLM repeated measures was used to identify the groups’ (CBT, DS, and KK main effect, the repeated test RSE scale (pre test, post test 1, post test 2, and post test 3 main effect and the interaction effect (CBT, DS, and KK, and repeated tests RSE scale (pre test, post test 1,post test 2, post test 3. There was no significant difference in the groups (CBT, DS, and KK main effect on the Rosenberg Self Esteem (RSE scores. There was a significant difference (F (3.10 = 66.823,p = 0.0001 (Wilk's Lambda on the repeated test RSE scale (pre test, post test 1, post test 2, and post test 3 main effects on self esteemscore. Overall findings showed an increase in RSE scores between the pre test, post test 1, post test 2 and post test 3.

  4. Compassionate use of the PASCAL transcatheter mitral valve repair system for patients with severe mitral regurgitation: a multicentre, prospective, observational, first-in-man study.

    Science.gov (United States)

    Praz, Fabien; Spargias, Konstantinos; Chrissoheris, Michael; Büllesfeld, Lutz; Nickenig, Georg; Deuschl, Florian; Schueler, Robert; Fam, Neil P; Moss, Robert; Makar, Moody; Boone, Robert; Edwards, Jeremy; Moschovitis, Aris; Kar, Saibal; Webb, John; Schäfer, Ulrich; Feldman, Ted; Windecker, Stephan

    2017-08-19

    Severe mitral regurgitation is associated with impaired prognosis if left untreated. Using the devices currently available, transcatheter mitral valve repair (TMVr) remains challenging in complex anatomical situations. We report the procedural and 30-day results of the first-in-man study of the Edwards PASCAL TMVr system. In this multicentre, prospective, observational, first-in-man study, we collected data from seven tertiary care hospitals in five countries that had a compassionate use programme in which patients underwent transcatheter mitral valve repair using the Edwards PASCAL TMVr system. Eligible patients were those with symptomatic, severe functional, degenerative, or mixed mitral regurgitation deemed at high risk or inoperable. Safety and efficacy of the procedure were prospectively assessed at device implantation, discharge, and 30 days after device implantation. The key study endpoints were technical success assessed at the end of the procedure and device success 30 days after implantation using the Mitral Valve Academic Research Consortium definitions. Between Sept 1, 2016, and March 31, 2017, 23 patients (median age 75 years [IQR 61-82]) had treatment for moderate-to-severe (grade 3+) or severe (grade 4+) mitral regurgitation using the Edwards PASCAL TMVr system. At baseline, the median EuroScore II score was 7·1% (IQR 3·6-12·8) and the median Society of Thoracic Surgeons predicted risk of mortality for mitral valve repair was 4·8% (2·1-9·0) and 6·8% (2·9-10·1) for mitral valve replacement. 22 (96%) of 23 patients were New York Heart Association (NYHA) class III or IV at baseline. The implantation of at least one device was successful in all patients, resulting in procedural residual mitral regurgitation of grade 2+ or less in 22 (96%) patients. Six (26%) of 23 patients had two implants. Periprocedural complications occurred in two (9%) of 23 patients (one minor bleeding event and one transient ischaemic attack). Despite the anatomical

  5. Biomechanical Study of Two Peripheral Suture Methods on Repaired Tendons

    Science.gov (United States)

    Qiu, Zhenling

    2015-01-01

    Flexor digitorum tendon injuries are challenging conditions to manage to ensure optimal patient outcomes. While several surgical approaches with high success rates have been developed, there remains no gold standard for suture technique for the repair of flexor tendon injuries. In this study, we compared two distinct peripheral suture methods on the strength of repaired tendons. Pig flexor digitorum profundus tendons were used in biomechanical studies and the biomechanical influence on tendon repair of continuous running peripheral suture (CRPS) and continuous locking peripheral suture (CLPS), were compared, using stitch length ranging from 1mm to 5mm. In CRPS, the 1mm stitch length group displayed the highest maximum load and breaking power, which was 1.57 fold higher than the 2mm stitch length group. Pairwise comparison revealed that the 1 and 2mm groups were statistically different from the 3, 4, and 5mm stitch length groups while comparison among the latter groups was not statistically significant. For CLPS, the 1mm group exhibited consistently the highest maximum load strength and breaking power, which was twice the strength displayed by the 2mm group. Pairwise comparisons between groups showed statistical significance. For future repairs of flexor tendon injuries, 1mm stitch length is highly recommended for simple peripheral suture.

  6. Xenograft scaffold full-wrap reinforcement of Krackow achilles tendon repair.

    Science.gov (United States)

    Wisbeck, Jacob M; Parks, Brent G; Schon, Lew C

    2012-03-07

    Standard 4-strand repair of Achilles tendon tears is effective, but additional strength may be desirable in patients who are compromised or those with reruptures. Use of a xenograft scaffold has not been investigated biomechanically in Achilles tendon repair. This study compared stiffness, gap formation, and ultimate load to failure with Krackow repair vs Krackow repair augmented with xenograft scaffold in 6 matched pairs of fresh-frozen human lower extremities. The Achilles tendon was transected 4 cm above the calcaneal insertion. Specimens were randomized to receive standard Krackow repair or Krackow repair augmented with a porcine xenograft scaffold. The graft was wrapped around the repaired tendon, sutured to itself with 2-0 FiberWire (Arthrex, Naples, Florida), and attached to the tendon distally and proximally and then medially and laterally. Specimens were loaded for 200 cycles between 5 and 30 N. Load to 5-mm gapping and load to ultimate failure were measured. Xenograft scaffold augmentation of standard Krakow Achilles tendon repair was significantly stronger and stiffer than standard Krackow repair in a biomechanical model immediately after repair (39.0±8.8 vs 24.4±4.6 N/mm; P=.01). The augmented repair group had significantly higher load to ultimate failure than did the Krackow group (862.7±174.0 vs 479.5±65.5 N; P<.01). Biological factors remain to be investigated, but this augmentation method could provide additional strength in patients who are compromised or those with reruptures.

  7. Impaired 8-Hydroxyguanine Repair Activity of MUTYH Variant p.Arg109Trp Found in a Japanese Patient with Early-Onset Colorectal Cancer

    Directory of Open Access Journals (Sweden)

    Kazuya Shinmura

    2014-01-01

    Full Text Available Purpose. The biallelic inactivation of the 8-hydroxyguanine repair gene MUTYH leads to MUTYH-associated polyposis (MAP, which is characterized by colorectal multiple polyps and carcinoma(s. However, only limited information regarding MAP in the Japanese population is presently available. Since early-onset colorectal cancer (CRC is a characteristic of MAP and might be caused by the inactivation of another 8-hydroxyguanine repair gene, OGG1, we investigated whether germline MUTYH and OGG1 mutations are involved in early-onset CRC in Japanese patients. Methods. Thirty-four Japanese patients with early-onset CRC were examined for germline MUTYH and OGG1 mutations using sequencing. Results. Biallelic pathogenic mutations were not found in any of the patients; however, a heterozygous p.Arg19*  MUTYH variant and a heterozygous p.Arg109Trp MUTYH variant were detected in one patient each. The p.Arg19* and p.Arg109Trp corresponded to p.Arg5* and p.Arg81Trp, respectively, in the type 2 nuclear-form protein. The defective DNA repair activity of p.Arg5* is apparent, while that of p.Arg81Trp has been demonstrated using DNA cleavage and supF forward mutation assays. Conclusion. These results suggest that biallelic MUTYH or OGG1 pathogenic mutations are rare in Japanese patients with early-onset CRC; however, the p.Arg19* and p.Arg109Trp MUTYH variants are associated with functional impairments.

  8. 老年食管裂孔疝的腹腔镜治疗%Laparoscopic repair of the esophageal hiatal hernia in elderly patients

    Institute of Scientific and Technical Information of China (English)

    郑亚杰; 田文; 马冰; 丁国飞

    2012-01-01

    Objective To investigate the methods,safety and efficacy of laparoscopic repair of the esophageal hiatal hernia in elderly patients. Methods There were twenty one elderly patients with esophageal hiatal hernia received the laparoscopic repair in our hospital from March 2007 to November 2010. The clinical data were analyzed and patients were followed up after surgery. Results All of the twenty one patients were completed laparoscopic repair of the esophageal hiatal hernia successfully. The operation time was 78 min in average (61-128 min)and the blood loss was between 10-110 ml,25ml in average. Six patients developed transient dysphagia after surgery,the symptoms subsided after conservative treatment. The mean postoperative hospital stay was 5 days (3-21 days). The patients were followed up for 12-31 months (mean 20 months),no recurrence or complication with mesh were found. Conclusions Laparoscopic repair of the esophageal hiatal hernia in elderly patients is a safe and can achieve good clinical results.%目的 探讨腹腔镜下应用补片行老年食管裂孔疝修补术的方法、安全性及临床效果.方法 2007年3月~2010年11月在腹腔镜下应用补片修补食管裂孔疝的21例老年患者,回顾分析临床资料并进行术后随访.结果 21例腹腔镜下应用补片行食管裂孔疝修补术的患者均顺利完成手术.手术时间61~128 min,平均78 min;手术出血10~1 10ml,平均25 ml;术后住院3~21 d,平均5d.术后6例出现短期的吞咽困难,均经保守治疗后好转,无手术死亡发生.随访12~31个月,平均20个月,未见食管裂孔疝复发病例及有关补片并发症的发生.结论 腹腔镜技术对老年人实施食管裂孔疝修补术是一项安全有效的手术方式,能够取得良好的临床效果.

  9. Intestinal obstruction repair

    Science.gov (United States)

    Repair of volvulus; Intestinal volvulus - repair; Bowel obstruction - repair ... Intestinal obstruction repair is done while you are under general anesthesia . This means you are asleep and DO NOT feel pain. ...

  10. Aortic aneurysm repair - endovascular

    Science.gov (United States)

    EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... Endovascular aortic repair is done because your aneurysm is very large, growing quickly, or is leaking or bleeding. You may have ...

  11. Patterns of prefrontal dysfunction in alcoholics with and without Korsakoff’s syndrome, patients with Parkinson’s disease, and patients with rupture and repair of the anterior communicating artery

    OpenAIRE

    Dirksen, Courtney L; Howard, Julie A.; Cronin-Golomb, Alice; Oscar-Berman, Marlene

    2006-01-01

    This study compared patterns of frontal-lobe dysfunction in alcoholics with Korsakoff’s syndrome (KS: n = 9), non-Korsakoff alcoholics (AL: n = 28), patients with Parkinson’s disease (PD: n = 18), and patients with rupture and repair of the anterior communicating artery (ACoA: n = 4) relative to healthy non-neurological control (NC) participants (n = 70). The tests administered were sensitive to functions of dorsolateral prefrontal and orbito-frontal subsystems. Measures included perseverativ...

  12. Laparoscopic-assisted Ventral Hernia Repair: Primary Fascial Repair with Polyester Mesh versus Polyester Mesh Alone.

    Science.gov (United States)

    Karipineni, Farah; Joshi, Priya; Parsikia, Afshin; Dhir, Teena; Joshi, Amit R T

    2016-03-01

    Laparoscopic-assisted ventral hernia repair (LAVHR) with mesh is well established as the preferred technique for hernia repair. We sought to determine whether primary fascial closure and/or overlap of the mesh reduced recurrence and/or complications. We conducted a retrospective review on 57 LAVHR patients using polyester composite mesh between August 2010 and July 2013. They were divided into mesh-only (nonclosure) and primary fascial closure with mesh (closure) groups. Patient demographics, prior surgical history, mesh overlap, complications, and recurrence rates were compared. Thirty-nine (68%) of 57 patients were in the closure group and 18 (32%) in the nonclosure group. Mean defect sizes were 15.5 and 22.5 cm(2), respectively. Participants were followed for a mean of 1.3 years [standard deviation (SD) = 0.7]. Recurrence rates were 2/39 (5.1%) in the closure group and 1/18 (5.6%) in the nonclosure group (P = 0.947). There were no major postoperative complications in the nonclosure group. The closure group experienced four (10.3%) complications. This was not a statistically significant difference (P = 0.159). The median mesh-to-hernia ratio for all repairs was 15.2 (surface area) and 3.9 (diameter). Median length of stay was 14.5 hours (1.7-99.3) for patients with nonclosure and 11.9 hours (6.9-90.3 hours) for patients with closure (P = 0.625). In conclusion, this is one of the largest series of LAVHR exclusively using polyester dual-sided mesh. Our recurrence rate was about 5 per cent. Significant mesh overlap is needed to achieve such low recurrence rates. Primary closure of hernias seems less important than adequate mesh overlap in preventing recurrence after LAVHR.

  13. Motorcycle Repair.

    Science.gov (United States)

    Hein, Jim; Bundy, Mike

    This motorcycle repair curriculum guide contains the following ten areas of study: brake systems, clutches, constant mesh transmissions, final drives, suspension, mechanical starting mechanisms, electrical systems, fuel systems, lubrication systems, and overhead camshafts. Each area consists of one or more units of instruction. Each instructional…

  14. Occupational Therapy in the practice of therapeutic groups and workshops with mental health patients

    Directory of Open Access Journals (Sweden)

    Janaina Bussola Montrezor

    2013-12-01

    Full Text Available In this study, we aimed to demonstrate the effectiveness of occupational therapy to patients with mental disorders through therapy groups in an intensive inpatient unit. The following treatment groups were performed: focus groups, operative groups, drawing workshops, and arts workshops. The study included 280 patients (46.07% with ICD F20-29, 23.57% with ICD F30-39, and 14.28% with ICD F19. Of all the patients studied (n = 280, 54.00% participated in the operative groups, 52.85% in the focus groups, 46.80% in the drawing workshops, and 45.70% in the art workshops. In all groups, the participation of the ICD F20-29 group was higher (focus group with 49.25%, 54.00% in the operative group, 51.00% in the workshops of drawing, and 66.00% in art workshops, followed by the ICD F30-39 group with 24.25% in the focus group, 27.00% in the operative group, and 22.00% in the drawing workshops; the ICD F19 group stood out in the arts workshops. Patients with schizophrenia, psychoses, bipolar disorders, among others (ICD F20-20 and ICD F30-39 were the most active in the therapeutic groups, which discussed contents such as joy, anger, fear, thoughts of death, etc. The ICD F19 group presented the greatest participation in the art workshops, a fact that can be explained by the profile of these patients, because many have been in prison and/or admitted to long-stays in hospitals where they learned to perform manual tasks for subsequent survival in society. We concluded that therapeutic groups are effective in treating mental health patients because they contribute to hospital discharge and improve patients’ conditions.

  15. Improvement of motor function and decreased need for postnatal shunting in children who had undergone intrauterine myelomeningocele repair

    Directory of Open Access Journals (Sweden)

    Tereza Cristina Carbonari de Faria

    2013-09-01

    Full Text Available Objective To compare neuromotor development between patients who did and those who did not undergo intrauterine myelomeningocele repair. Methods Children with myelomeningocele aged between 3.5 and 6 years who did undergo intrauterine repair (Group A, n=6 or not (Group B; n=7 were assessed for neuromotor development at both anatomical and functional levels, need for orthoses, and cognitive function. Results Intrauterine myelomeningocele repair significantly improved motor function. The functional level was higher than the anatomical level by 2 or more spinal segments in all children in Group A and 2 children in Group B, with a significant statistical difference between groups (p<0.05. Five children in Group A and one in Group B were community ambulators. Conclusion Despite the small sample, it was observed that an improvement of motor function and decreased need for postnatal shunting in the 6 children who had undergone intrauterine myelomeningocele repair.

  16. Repairing Learned Knowledge Using Experience

    Science.gov (United States)

    1990-05-01

    It necessar and Identify by’ 6109h nii be) learning precedent-based learning knowledge repair explanation-based learning near - miss groups 20. ABSTRACT...can a program use explanations to repair a recollection, preventing further misapplication? Near - Miss Groups Isolate Suspicious Relations If a metal...pail differs from a porcelain cup only in the position of handle attachment, then we would say that the pail is a near miss . Unfortunately, there are

  17. Effective background infusion rate of ropivacaine 0.2% for patient-controlled interscalene brachial plexus analgesia after rotator cuff repair surgery

    Institute of Scientific and Technical Information of China (English)

    Wei Yue; Li Min; Rong Yulan; Guo Xiangyang

    2014-01-01

    Background Continuous interscalene nerve block (CISB) is considered to be the most effective method for postoperative analgesia after shoulder surgery with prolonged severe pain.This study was performed to evaluate the minimum effective background infusion rate and the effective background infusion rate of ropivacaine 0.2% for CISB after arthroscopic rotator cuff repair surgery in 95% of patients.Methods Patients scheduled for arthroscopic rotator cuff repair surgery under general anesthesia at Peking University Third Hospital were prospectively enrolled from December 2011 to May 2012.Preoperatively,an interscalene catheter (ISC) was placed under the guidance of ultrasound and nerve stimulation in each patient.Consecutively,30 patients with successful nerve block were included.A continuous infusion of ropivacaine 0.2% with a 5 ml patient-controlled bolus available hourly was started at postoperative anesthesia care unit (PACU) after completion of surgery.The initial background infusion rate was 6 ml/h,which was subsequently varied for each consecutive patient according to the analgesic effects of the previous one.The minimum effective background rate was determined using the Dixon and Massey up-and-down method.The effective background rate in 95% of patients was calculated using isotonic analysis.Results The minimum effective background rate based on the Dixon and Massey up-and-down method was 2.8 ml/h (95% CI,2.3-3.3 ml/h).The effective background rate in 95% of patients calculated with the isotonic regression analysis was 4.4 ml/h (95% CI,3.8-6.5 ml/h).Conclusion The effective background rate for patient-controlled interscalene brachial plexus analgesia after shoulder surgery in 50% and 95% of the patients was 2.8 and 4.4 ml/h,respectively.

  18. Patient perspectives on the impact of acromegaly: results from individual and group interviews.

    Science.gov (United States)

    Gurel, Michelle H; Bruening, Paul R; Rhodes, Christine; Lomax, Kathleen G

    2014-01-09

    Acromegaly is a chronic condition resulting from a growth hormone-secreting pituitary tumor that can substantially impact patients' physical and emotional well-being. We sought to understand the impact of acromegaly on disease-related concerns and treatment choices from the patient perspective. The path to diagnosis, current disease management, interactions with the treating health care providers (HCPs), and support networks were also assessed. Acromegaly patients were recruited primarily from a patient support group (Acromegaly Community). In Phase I, ten patients participated over the course of 5 days in a moderated online discussion board and they answered questions about their disease. In Phase II, a separate nine-patient cohort participated in face-to-face interviews conducted during an acromegaly patient conference. Data were summarized qualitatively by grouping similar answers and quotations. Nineteen acromegaly patients were recruited across the two cohorts, and both groups shared similar concerns. They demonstrated a notable interest in understanding their disease and its treatment. Patients were focused on the impact of the disease on their life, and they expressed a desire to get beyond reminders of their disease. The patients described long journeys to a correct diagnosis and relief at having a name for their condition. Many shared a sense of shock at needing pituitary surgery and felt unsatisfied by the treatment decision process, motivating them to discuss it with other patients. Patients not connected to a patient support group reported feeling helpless and lonely. Most patients shared a desire to improve their general knowledge about acromegaly to spare others their protracted diagnostic period. Patients also reported hesitancy in asking questions or sharing details about the disease's impact on their lives with their HCPs. Acromegaly can be a life-changing diagnosis with profound, ongoing effects on patients' lives. Patients struggle with many

  19. Evaluation of Using Interdomal Suture and Crescentic Skin Excision with Standard Cleft Lip Repair for Correction of Cleft Lip-Nose Simultaneously with Primary Lip Repair

    Directory of Open Access Journals (Sweden)

    Mert Çalış

    2017-06-01

    Full Text Available Objective: The aim of this study is to compare the postoperative correction rates in the follow-up after simultaneous cleft lip nose (CLN repair with cleft lip repair using either interdomal suture or crescentic skin excision. Material and Methods: Eighty-three unilateral cleft lip patients were operated using modified Millard rotation advancement technique for cleft lip repair and simultaneous cleft lip repair using either interdomal suture or crescentic skin excision. The evaluation of the patients was made using routine standardized preoperative and early and later postoperative caudal nasal photographs. The distance between the nasal base and the most projectile point of the nostril was measured, and the ratio of the cleft side to the non-cleft side was calculated. Results: The highest rate was calculated in the early postoperative period in the crescentic skin excision group (1.07±0.29. The ratio was found to be 0.87±0.22 in patients with interdomal suture placement. The lowest rate was observed in patients who did not have any nasal reshaping procedure other than a standard cleft lip repair (0.71±0.16. The highest rate of recurrence was observed among the patients who had crescentic skin excision (0.39 ± 0.16. When recurrence rates were compared, a significant difference was observed in the crescentic skin excision group compared to the interdomal suture placed patients (p=0.005. Conclusion: The simultaneous primary rhinoplasty approach with cleft lip repair appears to be necessary for CLN repair in the long term. Although crescentic skin excision and placement of interdomal suture for this purpose achieve symmetry with the noncleft side and successful results in the early postoperative period, the probability of recurrence should always be taken in consideration. If either of these two techniques is to be preferred for CLN repair, then overcorrection should always be taken in consideration.

  20. Turbine repair process, repaired coating, and repaired turbine component

    Energy Technology Data Exchange (ETDEWEB)

    Das, Rupak; Delvaux, John McConnell; Garcia-Crespo, Andres Jose

    2015-11-03

    A turbine repair process, a repaired coating, and a repaired turbine component are disclosed. The turbine repair process includes providing a turbine component having a higher-pressure region and a lower-pressure region, introducing particles into the higher-pressure region, and at least partially repairing an opening between the higher-pressure region and the lower-pressure region with at least one of the particles to form a repaired turbine component. The repaired coating includes a silicon material, a ceramic matrix composite material, and a repaired region having the silicon material deposited on and surrounded by the ceramic matrix composite material. The repaired turbine component a ceramic matrix composite layer and a repaired region having silicon material deposited on and surrounded by the ceramic matrix composite material.

  1. Group Therapy with Patients in the Waiting Room of an Oncology Clinic.

    Science.gov (United States)

    Arnowitz, Edward; And Others

    1983-01-01

    Describes a therapy group for cancer patients, conducted by cotherapists in an oncology waiting room. Group members provided mutual support and shared concerns and coping methods. Medical staff members became more involved and were more able to address the affective needs of the patients and their families. (JAC)

  2. Individual neuropsychological support and group sessions for relatives to TBI patients

    DEFF Research Database (Denmark)

    Siert, Lars

    TITLE: Individual neuropsychological support and group sessions for relatives to TBI patients. OBJECTIVE: To describe how the neuropsychologist work with early and ongoing individual support and group sessions for relatives to adult TBI patients in the acute and sub acute phase and after discharge...

  3. [Impulsivity-focused Group Intervention to reduce Binge Eating Episodes in Patients with Binge Eating Disorder - A Group Training Program].

    Science.gov (United States)

    Schag, Kathrin; Leehr, Elisabeth J; Skoda, Eva-Maria; Becker, Sandra; Zipfel, Stephan; Giel, Katrin E

    2016-11-01

    Binge Eating Disorder (BED) is an eating disorder where cognitive behavioural therapy (CBT) could already show reliable efficacy. Relying on basic research, CBT interventions which especially focus on impulsivity could be effective, because binge eating episodes represent highly impulsive eating behaviour. For this reason, we developed a treatment concept about an impulsivity-focused behavioural group intervention for patients with BED, called IMPULS. The efficacy of IMPULS is currently investigated in a randomised controlled trial 1. IMPULS is drafted as a weekly group training programme with 5-6 participants per group. The essential interventions are food-related cue exposure with response prevention and the development of self-control strategies. These interventions are adapted onto the impulsivity concept from conventional treatment of addictive disorders and BED. © Georg Thieme Verlag KG Stuttgart · New York.

  4. 聚丙烯补片修复老年女性前盆腔器官功能障碍%Polypropylene patch repairs anterior pelvic organ dysfunction in older women patients

    Institute of Scientific and Technical Information of China (English)

    张小月

    2015-01-01

    BACKGROUND:The patch materials, originaly applied in the reconstruction and repair of abdominal hernia, have been successfuly applied in the vagina surgery; thus, it has been gradualy generalized in gynecological pelvic floor reconstruction. OBJECTIVE:To analyze the clinical effect of polypropylene patch in older female patients with anterior pelvic organ reconstruction. METHODS:Totaly 24 older female patients with stage III,IV anterior pelvic floor dysfunction were enroled. The individual treatment was formulated according to the wishes of patients, of which 12 patients underwent anterior pelvic organ reconstruction using polypropylene patch (test group), and 12 patients underwent the simply modified vaginal repair treatment (control group). Patients were folowed up for 12 months after repair. The clinical symptom remission, wound healing, pelvic organ prolapse staging and subjective disability index scores were observed. RESULTS AND CONCLUSIONS: After repair, the clinical symptoms in these two groups were significantly aleviated, and there was no infection, poor wound healing and other adverse reactions. At 12 months of folow-up, the subjective disability index scores in these two groups were al significantly lower than those before repair (P < 0.05); moreover, these scores were significantly lower in the test group than the control group (P < 0.05). There were eight cases of pelvic organ prolapse staging I, four cases of pelvic organ prolapse staging II in the test group;seven cases of pelvic organ prolapse staging I, two cases of pelvic organ prolapse staging II, two cases of pelvic organ prolapse staging III and one case of pelvic organ prolapse staging IV in the control group. The degree of organ prolapse in the test group was lower than that in the control group (P < 0.05). These results demonstrate that polypropylene patch repair used in older female anterior pelvic organ reconstruction is safe and effective, and leads to a low recurrence rate.%背景:

  5. Evaluation of gastrectomy in patients with delayed gastric emptying after antireflux surgery or large hiatal hernia repair

    NARCIS (Netherlands)

    Gerritsen, A.; Furnee, E.J.B.; Gooszen, H.G.; Wondergem, M.; Hazebroek, E.J.

    2013-01-01

    BACKGROUND: Revision antireflux surgery and large hiatal hernia repair require extensive dissection at the gastroesophageal junction. This may lead to troublesome symptoms due to delayed gastric emptying, eventually requiring gastrectomy. The aim of this study was to evaluate the outcome of gastrect

  6. Is Early Nasal Shaping With a Limited Alar Base Incision Possible in the Repair of Cleft Lips?

    Science.gov (United States)

    Kapi, Emin; Bozkurt, Mehmet; Ozer, Torun; Celik, Mehmet Yusuf

    2016-05-01

    The repair of cleft lips has an important place in plastic and reconstructive surgery. In the treatment of these deformities, the aim was to restore the normal lip morphology in the cleft area as well as repairing any coexisting nasal deformities. Various methods are in use for this purpose. One of the most commonly employed surgical methods is Millard repair. However, this method may lead to additional scarring in the alar base on the cleft side subsequent to the incision. In this study, the results obtained from a group who have been applied alar base incisions during the modified Millard repair are compared to a group who have undergone intranasal wide dissections.The patients enrolled in the study were randomized into 2 groups. The first group were applied the modified Millard repair. In the second group, the rotation, advancement, and C-flaps were prepared according to Millard surgical repair technique; however, instead of an alar base and nasofacial groove incision on the cleft side, a nasal and maxillary supraperiosteal wide dissection was made through the incision in the mucosa of the nostril.The intranasal dissection performed during the study was observed to provide the targeted outcome and a more satisfactory cosmetic result through the modified Millard repair. In conclusion, the authors are of the opinion that the limited alar base incision and the wide supraperiosteal dissection performed in patients with cleft lips is an alternative method that can be employed in a wide range of patients.

  7. [No influence of physiotherapy on outcome after open repair of achilles tendon ruptures?].

    Science.gov (United States)

    Ateschrang, A; Gratzer, C; Rolauffs, B; Glatzle, J; Weise, K; Braun, A

    2008-12-01

    Many studies have been performed to analyse the influence of surgical techniques and the postoperative aftercare after Achilles tendon ruptures on the outcome. However, there is no study investigating the influence of physiotherapy on outcome after surgical repair and standardised early functional rehabilitation of Achilles tendon rupture, so that this was the objective of the present study. In this retrospective study, 104 patients with Achilles tendon ruptures, all treated by open repair followed by a standardised early rehabilitation, were evaluated by the Thermann score. The average age was 42 years. We could identify 3 patient groups. Group I (n=23) did not receive any physiotherapy. Group II (n=41) received physiotherapy for 3-6 weeks, and group III (n=40) received more than 6 weeks of physiotherapy. Physiotherapy consisted of 3 units per week. Each unit lasted for 30 min. All groups were compared statistically via variance analysis. Group I scored on average 88.8 points, group II 88.6 and group III 87.0 points. There were no statistically significant differences between the three groups (p=0.50). The age of patients had also no relevant influence on the outcome (p=0.48). Physiotherapy and age of the patients involved were not found to influence the outcome after open augmented repair of Achilles tendon ruptures followed by a standardised early rehabilitation. These results should be confirmed by a prospective randomised trial. Also elderly patients participating in demanding sport activities should receive a surgical repair.

  8. Benefits of groups in managing systemic arterial hypertension: perceptions of patients and physicians

    OpenAIRE

    Rodrigo Pereira do Amaral; Charles Dalcanale Tesser; Pedro Müller

    2013-01-01

    Objective: To investigate the nature of the benefits of using groups within primary care services to manage hypertension, from the point of view of both patients and physicians. Methods: A qualitative descriptive study using semi-structured interviews with patients and doctors attending distinct consolidated groups, which have been purposely selected and carried out in physician-patient pairs until reaching data saturation. The interviews were subjected to thematic analysis. Results and discu...

  9. Intercostal nerve cryoablation versus thoracic epidural catheters for postoperative analgesia following pectus excavatum repair: Preliminary outcomes in twenty-six cryoablation patients.

    Science.gov (United States)

    Keller, Benjamin A; Kabagambe, Sandra K; Becker, James C; Chen, Y Julia; Goodman, Laura F; Clark-Wronski, Julianna M; Furukawa, Kenneth; Stark, Rebecca A; Rahm, Amy L; Hirose, Shinjiro; Raff, Gary W

    2016-12-01

    Multimodal pain management strategies are used for analgesia following pectus excavatum repair. However, the optimal regimen has not been identified. We describe our early experience with intercostal cryoablation for pain management in children undergoing the Nuss procedure and compare early cryoablation outcomes to our prior outcomes using thoracic epidural analgesia. A multi-institutional, retrospective review of fifty-two patients undergoing Nuss bar placement with either intercostal cryoablation (n=26) or thoracic epidural analgesia (n=26) from March 2013 to January 2016 was conducted. The primary outcome was hospital length of stay. Secondary outcomes included telemetry unit monitoring time, total intravenous narcotic use, duration of intravenous narcotic use, and postoperative complications. Patients who underwent intercostal cryoablation had a significant reduction in the mean hospital length of stay, time in a monitored telemetry bed, total use of intravenous narcotics, and the duration of intravenous narcotic administration when compared to thoracic epidural patients. Cryoablation patients had a slightly higher rate of postoperative complications. Intercostal cryoablation is a promising technique for postoperative pain management in children undergoing repair of pectus excavatum. This therapy results in reduced time to hospital discharge, decreased intravenous narcotic utilization, and has eliminated epidurals from our practice. Retrospective study - level III. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. The Skills of Facilitator Nurses in Psycho-Social Group Intervention for Cancer Patients

    OpenAIRE

    Chujo, Masami; Okamura, Hitoshi

    2015-01-01

    Background The objective of this study was to provide cancer patients with a psychosocial group intervention consisting of 3 parts, i.e., education on how to cope with stress and solve problems, group discussions, and progressive muscle relaxation, and to investigate the intervention techniques of Japanese facilitators. Methods Group interventions for breast cancer patients performed by 3 facilitators were analyzed qualitatively and inductively using a phenomenological approach. Results The s...

  11. Neuromechanical Modulation of the Achilles Tendon During Bilateral Hopping in Patients with Unilateral Achilles Tendon Rupture, Over 1 Year After Surgical Repair.

    Science.gov (United States)

    Oda, Hiroyuki; Sano, Kanae; Kunimasa, Yoko; Komi, Paavo V; Ishikawa, Masaki

    2017-06-01

    Patients who have had an Achilles tendon (AT) rupture repaired are potentially at higher risk for re-rupture than those without previous rupture. Little attention has been given to the neuromechanical modulation of muscle-tendon interaction and muscle activation profiles during human dynamic movements after AT rupture repair. The purpose of this study was to examine muscle-tendon behavior and muscle activation during bilateral hopping. We enrolled nine subjects who had undergone surgical repair of unilateral AT rupture within the past 1-2 years. Subjects performed bilateral hopping while we took ultrasound, kinematic, and electromyogram recordings and measurements. AT behaviors were also recorded. We then compared responses between values obtained from the ruptured AT leg (LEGATR) and non-ruptured AT leg (LEGNOR). During hopping, the AT stretching amplitudes were greater in the LEGATR than in the LEGNOR, although the peak AT force and stiffness were smaller in the LEGATR than in the LEGNOR. The AT negative mechanical work did not show any significant differences between both legs. However, positive works were significantly lower in the LEGATR than in the LEGNOR. Electromyogram patterns in both soleus and tibialis anterior muscles clearly differed after ground contact for the LEGATR and the LEGNOR. These results suggest that the repaired ruptured AT can be compliant and have insufficient Young's modulus, which can influence mechanical responses in muscle activities. The modulation of agonist-antagonist muscle activities corresponding to the different levels of stiffness between the LEGATR and the LEGNOR may not be fully functioning during the pre-activation phase.

  12. 77 FR 42737 - Patient Safety Organizations: Delisting for Cause for The Steward Group PSO

    Science.gov (United States)

    2012-07-20

    ... Cause for The Steward Group PSO AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS. ACTION: Notice of delisting. SUMMARY: AHRQ has delisted The Steward Group PSO as a Patient Safety Organization... Steward Group PSO failed to respond to a Notice of Preliminary Finding of Deficiency sent by AHRQ...

  13. Difference in vascular patterns between transosseous-equivalent and transosseous rotator cuff repair.

    Science.gov (United States)

    Urita, Atsushi; Funakoshi, Tadanao; Horie, Tatsunori; Nishida, Mutsumi; Iwasaki, Norimasa

    2017-01-01

    Vascularity is the important factor of biologic healing of the repaired tissue. The purpose of this study was to clarify sequential vascular patterns of repaired rotator cuff by suture techniques. We randomized 21 shoulders in 20 patients undergoing arthroscopic rotator cuff repair into 2 groups: transosseous-equivalent repair (TOE group, n = 10) and transosseous repair (TO group, n = 11). Blood flow in 4 regions inside the cuff (lateral articular, lateral bursal, medial articular, and medial bursal), in the knotless suture anchor in the TOE group, and in the bone tunnel in the TO group was measured using contrast-enhanced ultrasound at 1 month, 2 months, 3 months, and 6 months postoperatively. The sequential vascular pattern inside the repaired rotator cuff was different between groups. The blood flow in the lateral articular area at 1 month, 2 months, and 3 months (P = .002, .005, and .025) and that in the lateral bursal area at 2 months (P = .031) in the TO group were significantly greater than those in the TOE group postoperatively. Blood flow was significantly greater for the bone tunnels in the TO group than for the knotless suture anchor in the TOE group at 1 month and 2 months postoperatively (P = .041 and .009). This study clarified that the sequential vascular pattern inside the repaired rotator cuff depends on the suture technique used. Bone tunnels through the footprint may contribute to biologic healing by increasing blood flow in the repaired rotator cuff. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  14. Experience of 38 patients under laparoscopic directly hiatal hernia repair%腹腔镜食管裂孔疝修补术38例体会

    Institute of Scientific and Technical Information of China (English)

    黄伟; 张明敏; 贾俊奇; 郭永忠

    2015-01-01

    目的:探讨腹腔镜食管裂孔疝修补术的可行性及安全性。方法回顾性分析2012年12月至2015年3月,伊犁州友谊医院开展腹腔镜食管裂孔疝修补术38例患者的临床资料。结果38例腹腔镜直接食管裂孔疝修补全部获得成功。其中5例行胃底270°部分折叠术(Toupet 术),33例行胃底360°折叠术(Nissen 术),手术时间50~150 min,平均手术时间100 min,失血15~60 ml,术后24 h拔出胃管并全流质饮食,无术后并发症。平均住院7 d。术后随访3个月至3年,35例患者反酸、烧灼、胸痛症状较术前明显改善,3例改善欠佳,给予服用口服药物。结论食管裂孔疝腹腔镜修补技术是一种安全、可靠、有效的治疗方法。%Objective To explore the feasibility and safety of laparoscopic directly hiatal hernia repair.Methods Retrospective analysis the clinical data of 38 patients under laparoscopic hiatal hernia repair from December 2012 to March 2015.Results 38 cases of laparoscopic hiatal hernia repair all success directly.5 routine stomach bottom part 270°fold surgery ( Toupet) 33 stomach bottom part 360°fold after operation( Nissen) operation time on average 50 to 150 minutes, the average operation time, 100 in laparoscopic hiatal hernia repair,15 to 60 ml blood loss,postoperative 24 hours to pull out the tube and liquid diet,no postoperative complications.Average hospital 7 days.Conclusion After the three months follow-up, 38 cases of patients with no recurrence of 35 cases with acid reflux,chest pain obviously improved compared with preoperative, for hiatal hernia, laparoscopic hiatal hernia repair surgery is a safe, reliable, effective treatment.

  15. Metoprolol in acute myocardial infarction. Patient population. The MIAMI Trial Research Group.

    Science.gov (United States)

    1985-11-22

    During the recruitment phase of the MIAMI trial (December 1982 to March 1984), data on 26,439 patients eligible for inclusion were entered. Of these, 5,778 patients were included. Current treatment with either beta blockers or calcium-channel blockers (51%) was the most predominant reason for exclusion. The randomized and excluded patients differed. The randomized patients were younger and more often men. The mean age of the patients was 59 years in both the placebo and the metoprolol groups. The 2 groups were evenly balanced with regard to basic demographic variables. The median delay between onset of symptoms and randomization was 7 hours, and 25% of the patients were included within 4 hours. Previous clinical history and pharmacologic treatment given before admission were well balanced in the groups. Mean heart rate for the 2 groups before randomization was 83 beats/min and systolic blood pressure was 141 mm Hg. Approximately 15% of randomized patients presented with pulmonary rales. Before randomization 20% of the patients had normal electrocardiograms; 70% could be classified as having electrocardiographic signs of acute myocardial infarction; and 10% presented with other electrocardiographic abnormalities. Electrocardiographic signs at entry suggested a predominance of anterior wall infarctions. The randomized patients were not representative of eligible patients and the treatment groups were well balanced at entry.

  16. PROSPECTIVE STUDY ON DARNING AND LICHTENSTEIN MESH HERNIOPLASTY (LMH IN INGUINAL HERNIA REPAIR

    Directory of Open Access Journals (Sweden)

    Affin

    2016-01-01

    Full Text Available INTRODUCTION Prospective study on Darning and Lichtenstein Mesh Hernioplasty in Inguinal Hernia Repair is a study of 61 cases of inguinal hernias which were treated by either open Inguinal hernia mesh repair (Lichtenstein or darning repair. The study was conducted with an objective to compare the effectiveness of these procedures and complications if any. 61 cases of inguinal hernia admitted in Yenepoya Medical College Hospital, Mangalore were selected on the basis of the non-probability (prospective sampling method. All patients with uncomplicated direct and indirect hernias treated by darning or mesh repair were included. After preoperative preparation they were randomly chosen for darning or mesh repair. The age/sex incidence, mode of presentation, precipitating factors, surgical treatment and postoperative complications were all evaluated and compared with standard published literature. The total number of postoperative complications was reported in 13.9% patients, complications was high after Mesh repair when compared to Darning. Seroma was the most common complication followed by funiculitis and wound infection. There was one recurrence each noted till date in the two groups under study. Darn repair is equally effective and much less costly treatment for inguinal hernia than mesh repair which had more risk of infection.

  17. One-stage dorsal lingual mucosal graft urethroplasty for the treatment of failed hypospadias repair

    Directory of Open Access Journals (Sweden)

    Hong-Bin Li

    2016-01-01

    Full Text Available The aim of this study was to retrospectively investigate the outcomes of patients who underwent one-stage onlay or inlay urethroplasty using a lingual mucosal graft (LMG after failed hypospadias repairs. Inclusion criteria included a history of failed hypospadias repair, insufficiency of the local skin that made a reoperation with skin flaps difficult, and necessity of an oral mucosal graft urethroplasty. Patients were excluded if they had undergone a failed hypospadias repair using the foreskin or a multistage repair urethroplasty. Between January 2008 and December 2012, 110 patients with failed hypospadias repairs were treated in our center. Of these patients, 56 underwent a one-stage onlay or inlay urethroplasty using LMG. The median age was 21.8 years (range: 4-45 years. Of the 56 patients, one-stage onlay LMG urethroplasty was performed in 42 patients (group 1, and a modified Snodgrass technique using one-stage inlay LMG urethroplasty was performed in 14 (group 2. The median LMG urethroplasty length was 5.6 ± 1.6 cm (range: 4-13 cm. The mean follow-up was 34.7 months (range: 10-58 months, and complications developed in 12 of 56 patients (21.4%, including urethrocutaneous fistulas in 7 (6 in group 1, 1 in group 2 and neourethral strictures in 5 (4 in group 1, 1 in group 2. The total success rate was 78.6%. Our survey suggests that one-stage onlay or inlay urethroplasty with LMG may be an effective option to treat the patients with less available skin after failed hypospadias repairs; LMG harvesting is easy and safe, irrespective of the patient′s age.

  18. Human Cardiosphere-Derived Cells From Advanced Heart Failure Patients Exhibit Augmented Functional Potency in Myocardial Repair

    Science.gov (United States)

    Shen, Deliang; Sun, Baiming; Blusztajn, Agnieszka; Xie, Yucai; Ibrahim, Ahmed; Aminzadeh, Mohammad Amin; Liu, Weixin; Li, Tao-Sheng; De Robertis, Michele A.; Marbán, Linda; Czer, Lawrence S. C.; Trento, Alfredo; Marbán, Eduardo

    2014-01-01

    Objectives This study sought to compare the regenerative potency of cells derived from healthy and diseased human hearts. Background Results from pre-clinical studies and the CADUCEUS (CArdiosphere-Derived aUtologous stem CElls to reverse ventricUlar dySfunction) trial support the notion that cardiosphere-derived cells (CDCs) from normal and recently infarcted hearts are capable of regenerating healthy heart tissue after myocardial infarction (MI). It is unknown whether CDCs derived from advanced heart failure (HF) patients retain the same regenerative potency. Methods In a mouse model of acute MI, we compared the regenerative potential and functional benefits of CDCs derived from 3 groups: 1) non-failing (NF) donor: healthy donor hearts post-transplantation; 2) MI: patients who had an MI 9 to 35 days before biopsy; and 3) HF: advanced cardiomyopathy tissue explanted at cardiac transplantation. Results Cell growth and phenotype were identical in all 3 groups. Injection of HF CDCs led to the greatest therapeutic benefit in mice, with the highest left ventricular ejection fraction, thickest infarct wall, most viable tissue, and least scar 3 weeks after treatment. In vitro assays revealed that HF CDCs secreted higher levels of stromal cell-derived factor 1 (SDF-1), which may contribute to the cells’ augmented resistance to oxidative stress, enhanced angiogenesis, and improved myocyte survival. Histological analysis indicated that HF CDCs engrafted better, recruited more endogenous stem cells, and induced greater angiogenesis and cardiomyocyte cell-cycle re-entry. CDC-secreted SDF-1 levels correlated with decreases in scar mass over time in CADUCEUS patients treated with autologous CDCs. Conclusions CDCs from advanced HF patients exhibit augmented potency in ameliorating ventricular dysfunction post-MI, possibly through SDF-1–mediated mechanisms. PMID:24511463

  19. [Azoospermia and a history of inguinal hernia repair in adult].

    Science.gov (United States)

    Khodari, M; Ouzzane, A; Marcelli, F; Yakoubi, R; Mitchell, V; Zerbib, P; Rigot, J-M

    2015-10-01

    Inguinal hernia repair is one of the most performed surgeries in the world. It is recognized that any surgery of the pelvic floor may represent a risk factor of male infertility. Retrospective study of patients with azoospermia and a history of adult inguinal hernia repair surgery and referred to our center between January 1990 and January 2011 for infertility. Among 69 azoospermia patients with history of adult inguinal hernia repair surgery, 60 patients underwent surgical extraction of sperm that was successful in 75% (45/60). Positive extraction rate decreases in the subgroup of patients with risk factors for infertility (61.4%) as well as in the group with bilateral inguinal hernia (67.9%). There was no statistically significant difference in the positive rate of sperm retrieval according to surgical technique or according to the use of polypropylene mesh (P>0.05). The obstruction of the vas deferens due to an inguinal hernia repair was a potential iatrogenic cause of male infertility that was rare and underestimated. The influence of using a polypropylene mesh was not clearly demonstrated. The management of these patients is based on prevention in order to identify patients with risk factors of infertility in order to propose a presurgery cryopreservation of sperm. 5. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  20. Anesthetic management for surgical repair of Ebstein′s anomaly along with coexistent Wolff-Parkinson-White syndrome in a patient with severe mitral stenosis

    Directory of Open Access Journals (Sweden)

    Sinha Prabhat

    2010-01-01

    Full Text Available Ebstein′s anomaly (EA is the most common cause of congenital tricuspid regurgitation. The associated anomalies commonly seen are atrial septal defect or patent foramen ovale and accessory conduction pathways. Its association with coexisting mitral stenosis (MS has uncommonly been described. The hemodynamic consequences and anesthetic implications, of a combination of EA and rheumatic MS, have not so far been discussed in the literature. We report successful anesthetic management of a repair of EA and mitral valve replacement in a patient with coexisting Wolff-Parkinson-White (WPW syndrome.

  1. Patients' experiences and expectations of general practice: a questionnaire study of differences by ethnic group

    Science.gov (United States)

    Ogden, Jane; Jain, Asha

    2005-01-01

    Background Research has highlighted variations in morbidity, mortality and health needs by ethnic group, and suggests that some ethnic groups may receive a poorer service. Aim To explore the impact of ethnic group on patients' experiences and expectations of their general practice consultation. Design of study Cross-sectional survey. Setting One general practice in a multicultural area of London. Method A total of 604 consecutive patients attending their general practice (response rate = 60.4%) who described their ethnic group as white British, black African, black African Caribbean or Vietnamese completed a measure relating to their experiences and their expectations of the general practice consultation in terms of treatment, communication, patients' agenda, patients' choice and doctor consistency. Results No differences were found for the black African or black African Caribbean patients. The Vietnamese patients reported better experiences of communication, more focus on their agenda and more attention to their choices than the white British patients. However, they also reported expecting lower levels of communication, less focus on their own agenda and reported wanting less GP consistency than the other ethnic groups. Conclusion Vietnamese patients state that they are receiving better standards of care in general practice than other ethnic groups. However, they also state that they expect less. This may illustrate a problem with assessing experiences of primary care. Higher scores of experience may not illustrate better consultations as such, but only better when compared with a lower level of initial expectation. A lower expectation is easier to fulfil. PMID:15904553

  2. ARTHROSCOPIC MENISCUS REPAIR WITH BIOABSORBABLE ARROWS IN LOCAL ANESTHESIA

    Directory of Open Access Journals (Sweden)

    Vladimir Senekovič

    2004-11-01

    Full Text Available Background. The menisci have important function in the knee joint. Because of this it is universally accepted that we have to preserve them as much as possible. After open and partially arthroscopic suture techniques new methods of all-inside meniscus repair with bioabsorbable arrows have been developed in the last decade. The meniscus repair using these arrows represents an easy task for a skilled surgeon. In addition, it can be performed in local anesthesia. We have evaluated the results of the first group of patients who were treated by this method.Methods. From February 2001 to August 2002 15 patients with torn meniscuses have been treated at the Clinical Department for Traumatology, University Medical centre, Ljubljana. We repaired their torn menisci arthroscopically with bioabsorbable arrows in local anesthesia. We divided patients in three groups: a group with isolated meniscus injury, a group with meniscus injury and anterior cruciate ligament injury and a group with associated pathology. Four patients had incarcerated meniscuses. Preoperative Lysholm score in the first group was 38, in the second 42 and in the third group 48. We repaired 12 medial and 3 lateral meniscuses. On average we need 45 minutes for therapeutic arthroscopy. Torn meniscus was fixated with minimum of 1 and maximum of 5 bioabsorbable arrows. All patients except one had the affected knee immobilized with cylinder plaster for 15 days on average.Results. At least three months after the arthroscopic fixation of the torn meniscus in local anesthesia another clinical evaluation was made. In all groups significant improvement was observed regarding the range of motions and absence of pain. Postoperative Lysholm score in the first group was 89, in the second 75 and in the third 71. Average deficit of flexion was 3 degrees while extension was full. One patient complained about the same pain in the joint, he underwent another arthroscopy which showed that the meniscus was

  3. CLASSIFICATION OF ORTHOGNATHIC SURGERY PATIENTS INTO LOW AND HIGH BLEEDING RISK GROUPS USING THROMBELASTOGRAPHY

    DEFF Research Database (Denmark)

    Elenius Madsen, Daniel

    2012-01-01

    Title: CLASSIFICATION OF ORTHOGNATHIC SURGERY PATIENTS INTO LOW AND HIGH BLEEDING RISK GROUPS USING THROMBELASTOGRAPHY Objectives: Orthognathic surgery involves surgical manipulation of jaw and face skeletal structure. A subgroup of patients undergoing orthognathic surgery suffers from excessive ...... to their bleeding risk. This valuable knowledge will be useful with regard to optimization of patient safety, staff composition and transfusion preparations. This pilot study included only 41 patients, and further studies are needed to consolidate the observations done....

  4. CLASSIFICATION OF ORTHOGNATHIC SURGERY PATIENTS INTO LOW AND HIGH BLEEDING RISK GROUPS USING THROMBELASTOGRAPHY

    DEFF Research Database (Denmark)

    Elenius Madsen, Daniel

    2012-01-01

    Title: CLASSIFICATION OF ORTHOGNATHIC SURGERY PATIENTS INTO LOW AND HIGH BLEEDING RISK GROUPS USING THROMBELASTOGRAPHY Objectives: Orthognathic surgery involves surgical manipulation of jaw and face skeletal structure. A subgroup of patients undergoing orthognathic surgery suffers from excessive...... intraoperative blood loss. Classification of patients according to their bleeding risk will improve the surgical procedure with regard to staff composition, blood transfusion and patient safety. Thrombelastography is a global coagulation assay measuring the viscoelastic properties of whole blood samples, taking...

  5. Excision Repair Cross-complementation Group 1 is a Prognostic Biomarker in Patients with Colorectal Cancer Receiving Chemotherapy

    Directory of Open Access Journals (Sweden)

    Mu-Xing Li

    2016-01-01

    Conclusions: ERCC1 expression may be taken as an effective prognostic factor predicting the response to chemotherapy, OS, and PFS. Further studies with better study design and longer follow-up are warranted in order to gain a deeper understanding of ERCC1's prognostic value.

  6. Ultrasound evaluation of the distal migration of the long head of biceps tendon following tenotomy in patients undergoing arthroscopic repair of tears of the rotator cuff.

    Science.gov (United States)

    Karataglis, D; Papadopoulos, P; Boutsiadis, A; Fotiadou, A; Ditsios, K; Hatzokos, I; Christodoulou, A

    2012-11-01

    This study evaluates the position of the long head of biceps tendon using ultrasound following simple tenotomy, in patients with arthroscopically repaired rotator cuff tears. In total, 52 patients with a mean age of 60.7 years (45 to 75) underwent arthroscopic repair of the rotator cuff and simple tenotomy of the long head of biceps tendon. At two years post-operatively, ultrasound revealed that the tendon was inside the bicipital groove in 43 patients (82.7%) and outside in nine (17.3%); in six of these it was lying just outside the groove and in the remaining three (5.8%) it was in a remote position with a positive Popeye Sign. A dynamic ultrasound scan revealed that the tenotomised tendons had adhered to the surrounding tissues (autotenodesis).The initial condition of the tendon influenced its final position (p Popeye sign was statistically influenced by the pre-operative co-existence of supraspinatus and subscapularis tears (p Popeye sign.

  7. Noninvasive 4D pressure difference mapping derived from 4D flow MRI in patients with repaired aortic coarctation: comparison with young healthy volunteers.

    Science.gov (United States)

    Rengier, Fabian; Delles, Michael; Eichhorn, Joachim; Azad, Yoo-Jin; von Tengg-Kobligk, Hendrik; Ley-Zaporozhan, Julia; Dillmann, Rüdiger; Kauczor, Hans-Ulrich; Unterhinninghofen, Roland; Ley, Sebastian

    2015-04-01

    To assess spatial and temporal pressure characteristics in patients with repaired aortic coarctation compared to young healthy volunteers using time-resolved velocity-encoded three-dimensional phase-contrast magnetic resonance imaging (4D flow MRI) and derived 4D pressure difference maps. After in vitro validation against invasive catheterization as gold standard, 4D flow MRI of the thoracic aorta was performed at 1.5T in 13 consecutive patients after aortic coarctation repair without recoarctation and 13 healthy volunteers. Using in-house developed processing software, 4D pressure difference maps were computed based on the Navier-Stokes equation. Pressure difference amplitudes, maximum slope of pressure amplitudes and spatial pressure range at mid systole were retrospectively measured by three readers, and twice by one reader to assess inter- and intraobserver agreement. In vitro, pressure differences derived from 4D flow MRI showed excellent agreement to invasive catheter measurements. In vivo, pressure difference amplitudes, maximum slope of pressure difference amplitudes and spatial pressure range at mid systole were significantly increased in patients compared to volunteers in the aortic arch, the proximal descending and the distal descending thoracic aorta (p coarctation.

  8. Challenges in the doctor-patient relationship: 12 tips for more effective peer group discussion.

    Science.gov (United States)

    Wilson, Hamish

    2015-09-01

    In New Zealand, almost all general practitioners are members of peer groups, which provide opportunities for both clinical discussion and collegial support. This article proposes that peer groups can also be a useful medium for exploring specific challenges within the doctor-patient relationship. However, the peer group culture needs to be receptive to this particular goal. Structured discussion can help peer group members explore interpersonal issues more thoroughly.

  9. Comparison of familial and psychological factors in groups of encopresis patients with constipation and without constipation.

    Science.gov (United States)

    Çengel-Kültür, S Ebru; Akdemir, Devrim; Saltık-Temizel, İnci N

    2014-01-01

    The study aimed to evaluate the differences between groups of encopresis patients with constipation and without constipation. The Symptom Checklist- 90-Revised, the COPE Questionnaire, the Relationship Scales Questionnaire, the McMaster Family Assessment Device and the Parenting Style Scale were used to evaluate, respectively, maternal psychiatric symptoms, coping abilities, attachment style, family functioning and children's perceptions of parenting behaviors. Psychiatric diagnoses were evaluated using the K-SADS. A higher level of maternal psychiatric symptoms, impaired role and affective involvement functioning of the family and less psychological autonomy were observed in the group of encopresis patients with constipation than in the group of encopresis patients without constipation. No significant differences were found between the groups in psychiatric comorbidities, maternal coping abilities and attachment style. The two groups had a similar pattern of comorbid psychiatric disorders and maternal psychological factors, although some familial factors-related mainly to parental authority-were differentiated in the encopresis with constipation group.

  10. Mitral valve repair is not always needed in patients with functional mitral regurgitation undergoing coronary artery bypass grafting and/or aortic valve replacement

    Science.gov (United States)

    Lindeboom, J.E.; Jaarsma, W.; Kelder, J.C.; Morshuis, W.J.; Visser, C.A.

    2005-01-01

    Background and aim Functional mitral regurgitation (FMR) is defined as mitral regurgitation in the absence of intrinsic valvular abnormalities. We prospectively evaluated the effect of coronary artery bypass grafting (CABG) and/or aortic valve replacement (AVR), without additional mitral valve repair, on the degree of moderate or severe FMR. Study design and methods From a cohort of 2829 patients undergoing CABG and/or AVR in the St. Antonius Hospital, 67 patients were identified with moderate or severe FMR by transthoracic and transoesophageal Doppler echocardiography. Results Two out of the 67 patients (3%) died perioperatively. During follow-up (3-18 months) mitral regurgitation decreased by one grade in 29 patients, by two grades in 28, by three grades in five patients and remained unchanged in one patient (p=0.0001). Of all patients, 85% had grade I mitral regurgitation or less. Grade II mitral regurgitation remained in nine patients with a previous large myocardial infarction and/or annular calcifications. NYHA class improved from 3.1+0.5 to 1.4+0.4 (p=0.0001). Ejection fraction increased from 46 to 55% (p=0.0001). Overall, left atrial and left ventricular end-diastolic dimensions decreased significantly. In contrast, no decrease in dimensions was seen in patients with postoperative grade II mitral regurgitation. Conclusion FMR may improve significantly following CABG and/or AVR, although a previous large myocardial infarction and/or annular calcifications may affect outcome. PMID:25696484

  11. [A Case of General Anesthesia for a Cardiac Transplanted Patient Undergoing Inguinal Hernia Repair under Laparoscopic Surgery].

    Science.gov (United States)

    Inoue, Mitsuko; Hayashi, Yasue; Fujita, Yuki; Shimizu, Motoko; Hotta, Arisa; Nakamoto, Ai; Yoshikawa, Noriko; Ohira, Naoko; Tatekawa, Shigeki

    2016-04-01

    A 52-year-old man was scheduled for the repair of inguinal hernia recurrence. When he was 48 years of age, he received a heart transplantation due to severe heart failure resulting from ischemic heart disease. When he was 50 years old, he suffered from inguinal hernia, and it was repaired under spinal anesthesia. During this surgery, he experienced pain because of the inadequate effect of anesthesia, but his blood pressure and heart rate were stable. We suspected that this was because of denervation of the heart. On hernia repair for inguinal hernia recurrence, general anesthesia was chosen, induced with midazolam, rocuronium, and fentanyl and maintained with sevoflurane, rocuronium, fentanyl, and remifentanil. The blood pressure was mostly stable during anesthesia, but we noted an increase in the heart rate when the trachea was intubated and extubated and when surgical incision started. This phenomenon may indicate reinnervation of the transplanted heart. We could safely manage anesthesia without invasive monitoring because the transplanted heart functioned favorably and surgery was minimally invasive.

  12. Results of arthroscopic capsulolabral repair: Bankart lesion versus anterior labroligamentous periosteal sleeve avulsion lesion.

    Science.gov (United States)

    Ozbaydar, Mehmet; Elhassan, Bassem; Diller, David; Massimini, Daniel; Higgins, Laurence D; Warner, Jon J P

    2008-11-01

    The purpose of this study was to evaluate the results of arthroscopic capsulolabral repair for traumatic anterior shoulder instability and to compare the outcome in patients who have Bankart lesions versus those with anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions. This study included 99 patients (93 shoulders), 72 male and 17 female, with a mean age of 32 years, who underwent arthroscopic Bankart repair for traumatic, recurrent anterior shoulder instability, by use of suture anchors. In 67 shoulders (72%) a discrete Bankart lesion was repaired, and in 26 shoulders (28%) an ALPSA lesion was repaired. The 2 groups were analyzed with regard to the number of preoperative dislocations and number of postoperative recurrences. At a mean follow-up of 47 months (range, 24 to 98 months), recurrence of instability was documented in 10 shoulders (10.7%). Of the shoulders, 5 had Bankart lesions (7.4%) and 5 had ALPSA lesions (19.2%) (P = .0501). The mean number of dislocations or subluxations before the index surgery was significantly higher in the ALPSA group (mean, 12.3 [range, 2 to 57]) than in the Bankart group (mean, 4.9 [range, 2 to 24]) (P Bankart lesions between the groups (P > .05 for all). Patients with ALPSA lesions present with a higher number of recurrent dislocations than those with discrete Bankart lesions. In addition, the failure rate after arthroscopic capsulolabral repair is higher in the ALPSA group than in the Bankart group. Level IV, therapeutic case series.

  13. Risk of motion loss with combined Bankart and SLAP repairs.

    Science.gov (United States)

    Takase, Katsumi

    2009-08-01

    We have performed arthroscopic Bankart procedures using absorbable or metallic suture anchors for traumatic anterior shoulder instability for over a decade. This article describes the frequency, pathology, and therapeutic results of patients treated for superior labrum anterior and posterior (SLAP) lesions concomitant with Bankart lesions. Twenty patients (Group A) had a mean age of 33.8 years at the time of surgery. On arthroscopic findings, SLAP lesions were classified type 2 in 15 patients and type 4 in 5, based on Snyder's criteria. In addition, intra-articular free bodies were present in 2 SLAP lesions, and a capsular tear was present in 1. We performed debridement (Group A1) or reattachment (Group A2) to the superior glenoid edge of these lesions, considering whether they communicated to Bankart lesions. The therapeutic results were evaluated according to the Japanese Orthopaedic Association (JOA) score and Japan Shoulder Society (JSS) shoulder instability score. Mean JOA and JSS shoulder instability scores were 95.1 and 90.8 points, respectively. All Group A patients remained pain free, and no instability recurred in any patient. Meanwhile, mean JSS shoulder instability function and range of motion scores were 18.9 and 15.1 points, respectively, in Group A1, and 17.5 and 10.1 points, respectively, in Group A2. A significant correlation in range of motion was observed in Groups A1 and A2 (P=.04). Regarding postoperative limitation in external rotation with the arm at the side, the difference in range from that on the healthy side was 9.8 degrees in Group A (7.0 degrees in Group A1 and 12.6 degrees in Group A2). When SLAP lesions communicated to Bankart lesions, we had satisfactory results without SLAP repair; therefore, unnecessary repairs for the concomitant pathology should be avoided, and different postoperative care should be performed for patients with Bankart repair with reattachment of a SLAP lesion.

  14. Group-based trajectory modeling to assess adherence to biologics among patients with psoriasis

    Directory of Open Access Journals (Sweden)

    Li Y

    2014-04-01

    Full Text Available Yunfeng Li,1 Huanxue Zhou,2 Beilei Cai,1 Kristijan H Kahler,1 Haijun Tian,1 Susan Gabriel,1 Steve Arcona11Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 2KMK Consulting Inc., Florham Park, NJ, USABackground: Proportion of days covered (PDC, a commonly used adherence metric, does not provide information about the longitudinal course of adherence to treatment over time. Group-based trajectory model (GBTM is an alternative method that overcomes this limitation.Methods: The statistical principles of GBTM and PDC were applied to assess adherence during a 12-month follow-up in psoriasis patients starting treatment with a biologic. The optimal GBTM model was determined on the basis of the balance between each model's Bayesian information criterion and the percentage of patients in the smallest group in each model. Variables potentially predictive of adherence were evaluated.Results: In all, 3,249 patients were included in the analysis. Four GBTM adherence groups were suggested by the optimal model, and patients were categorized as demonstrating continuously high adherence, high-then-low adherence, moderate-then-low adherence, or consistently moderate adherence during follow-up. For comparison, four PDC groups were constructed: PDC Group 4 (PDC ≥75%, PDC Group 3 (25%≤ PDC <50%, PDC Group 2 (PDC <25%, and PDC Group 1 (50%≤ PDC <75%. Our findings suggest that the majority of patients (97.9% from PDC Group 2 demonstrated moderate-then-low adherence, whereas 96.4% of patients from PDC Group 4 showed continuously high adherence. The remaining PDC-based categorizations did not capture patients with uniform adherence behavior based on GBTM. In PDC Group 3, 25.3%, 17.2%, and 57.5% of patients exhibited GBTM-defined consistently moderate adherence, moderate-then-low adherence, or high-then-low adherence, respectively. In PDC Group 1, 70.8%, 23.6%, and 5.7% of patients had consistently moderate adherence, high-then-low adherence, and

  15. Patients' experience of home and hospital based cardiac rehabilitation: a focus group study.

    Science.gov (United States)

    Jones, Miren I; Greenfield, Sheila; Jolly, Kate

    2009-03-01

    New cardiac rehabilitation (CR) programmes, such as home programmes using the Heart Manual, are being introduced but little is known about patients' experiences of these. To compare the views of patients who had completed a home or hospital-based CR programme and explore the benefits and problems of each programme. 16 patients from 4 hospital programmes attended one of 3 focus groups; 10 home programme patients attended one of 2 focus groups. Some themes were common to all focus groups: loss of confidence; continuing to exercise and lifestyle changes; understanding of heart disease. Hospital programme patients particularly enjoyed exercising in a group and mixing with other people, and gained motivation and support from others. Home programme patients spoke very highly of the Heart Manual and valued the one-to-one support of the nurse facilitators. They described the home programme as a lifestyle change compared to the hospital programme which they suggested was more like a treatment. Patients in the hospital programme enjoyed the camaraderie of group exercise and patients in the home programme valued the wealth of information and advice in the Heart Manual and this gave them a feeling of being in control of their health.

  16. Frequency of ABO/Rhesus Blood Groups in Patients with Diabetes Mellitus.

    Science.gov (United States)

    Oner, Can; Dogan, Burcu; Telatar, Berrin; Celik Yagan, Canan Fidan; Oguz, Aytekin

    2016-01-01

    The correlation between ABO/Rh blood groups and diabetes mellitus is still controversial. The aim of this study was to determine the relationship between ABO/Rhesus blood groups and diabetes in Turkish population. This cross-sectional study was conducted in Istanbul Medeniyet University Göztepe Education and Training Hospital's Diabetes Units. The study group was composed of 421 patients with type-1 diabetes, 484 patients with type-2 diabetes and 432 controls. Blood samples were collected and tested for ABO/Rhesus blood groups. Data was analyzed by SPSS version 17.0. A significant association was found between blood groups and diabetes mellitus. The frequency of AB blood group was significantly higher in type-1 diabetics; and A blood group was significantly higher in type-2 diabetics. Furthermore, Rh negativity were significantly more frequent in type-2 diabetics.

  17. Emergency incisional hernia repair: a difficult problem waiting for a solution

    Directory of Open Access Journals (Sweden)

    Zafar Hasnain

    2012-01-01

    Full Text Available Abstract Background Emergency repair of incarcerated incisional hernia with associated bowel obstruction in potentially or contaminated field is technically challenging due to edematous, inflamed and friable tissues with occasional need for concurrent bowel resection and carries high rates of post-operative infectious complications. The aim of this study was to retrospectively assess the wound related morbidity of use of permanent prosthetic mesh in emergency repair of incarcerated incisional hernia with associated bowel obstruction. We also describe a new technique of leaving the mesh exposed to heal by secondary intention with granulation tissue. Methods Between 2000 and 2010 a total of 60 patients underwent emergency surgery for incarcerated incisional hernia with associated bowel obstruction with placement of permanent prosthetic mesh. The wound was closed after hernia repair in 55 patients while it was left open to granulate in 5 patients. Results In the group of patients with primary wound closure, 11 patients developed superficial surgical site infection, 5 developed deep wound infection and one patient had cellulitis. These patients were treated with wound debridement and antibiotics. Mesh removal was required in one patient. There were no infections in the group of patients who had their surgical wounds left open. One patient in this group died on the fifth postoperative day from septicemia. Conclusion Use of permanent prosthetic mesh in emergency repair of incarcerated incisional hernia with associated bowel obstruction. in contaminated field is associated with high risk of wound infection.

  18. PREVALENCE OF VITAMIN D DEFICIENCY IN DIFFERENT GROUPS OF CHRONIC RENAL FAILURE PATIENTS.

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    Bistra T. Galunska

    2015-09-01

    Full Text Available Purpose: To determine and compare the vitamin D status of different groups CKD patients on hemodialysis, peritoneal dialysis, or no renal replacement therapy and to evaluate the effect of vitamin D therapy. Patients and Methods: This pilot study enrolled 40 consecutive CKD patients (21 men, 19 women divided into three groups: 15 CKD patients in 1,2,3,4 stage of the disease without renal replacement therapy (RRT; 10CKD patients on hemodialysis (HD and 15 CKD patients on peritoneal dialysis (PD, ten of which were on vitamin D therapy. Vitamin D status was determined by serum 25-xydroxyvitamin D (25OHD. Results: Ninety percent of patients were in vitamin D deficiency/insufficiency; and only 4 patients (10.0% reached 25OHD levels above 75nmol/L. The median 25OHD level was 31.15nmol/L (interquartile range: 16.67-48.33nmol/L.Tendency of worse vitamin D status in women than in men was observed. Higher 25OHD levels were found in pre-dialysis patients (median 44.81nmol/L, 25%-75% percentile 16.24-52.21nmol/L and lower in HD (median 31.15nmol/L, 25%-75% percentile 13.04-64.45nmol/L and PD patients (median 33.38nmol/L, 25%-75% percentile 23.15-48.49nmol/L, but the difference did not reach statistical significance. Better vitamin D status was found in the PD group of patients receiving vitamin D preparations (p<0.05. Conclusions: 25OHD deficiency/insufficiency is prevalent in renal failure patients with or without renal replacement therapy. It seems that vitamin D therapy improves the vitamin D status of PD patients. Further larger studies are needed to clarify the effect of specific type vitamin D therapy on serum 25OHD levels and clinical outcome in different groups of CKD patients.

  19. Patient perspectives on the impact of acromegaly: results from individual and group interviews

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    Gurel MH

    2014-01-01

    Full Text Available Michelle H Gurel,1 Paul R Bruening,2 Christine Rhodes,2 Kathleen G Lomax31Neuroendocrine Clinical Center, Massachusetts General Hospital, Boston, MA, USA; 2Nicholas Research Associates International, New York, NY, USA; 3Medical Affairs, Ipsen Biopharmaceuticals, Inc., Basking Ridge, NJ, USAPurpose: Acromegaly is a chronic condition resulting from a growth hormone-secreting pituitary tumor that can substantially impact patients' physical and emotional well-being. We sought to understand the impact of acromegaly on disease-related concerns and treatment choices from the patient perspective. The path to diagnosis, current disease management, interactions with the treating health care providers (HCPs, and support networks were also assessed.Methods: Acromegaly patients were recruited primarily from a patient support group (Acromegaly Community. In Phase I, ten patients participated over the course of 5 days in a moderated online discussion board and they answered questions about their disease. In Phase II, a separate nine-patient cohort participated in face-to-face interviews conducted during an acromegaly patient conference. Data were summarized qualitatively by grouping similar answers and quotations.Results: Nineteen acromegaly patients were recruited across the two cohorts, and both groups shared similar concerns. They demonstrated a notable interest in understanding their disease and its treatment. Patients were focused on the impact of the disease on their life, and they expressed a desire to get beyond reminders of their disease. The patients described long journeys to a correct diagnosis and relief at having a name for their condition. Many shared a sense of shock at needing pituitary surgery and felt unsatisfied by the treatment decision process, motivating them to discuss it with other patients. Patients not connected to a patient support group reported feeling helpless and lonely. Most patients shared a desire to improve their general

  20. Hand function after nerve repair.

    OpenAIRE

    Lundborg, Göran; Rosén, Birgitta

    2007-01-01

    Treatment of injuries to major nerve trunks in the hand and upper extremity remains a major and challenging reconstructive problem. Such injuries may cause long-lasting disabilities in terms of lost fine sensory and motor functions. Nowadays there is no surgical repair technique that can ensure recovery of tactile discrimination in the hand of an adult patient following nerve repair while very young individuals usually regain a complete recovery of functional sensibility. Post-traumatic nerve...

  1. Cobbler's technique for Iridodialysis repair

    Directory of Open Access Journals (Sweden)

    Surinder Singh Pandav

    2016-01-01

    Full Text Available We describe a novel “Cobbler's technique” for iridodialysis repair in the right eye of a patient aged 18 years, with a traumatic iridodialysis secondary to open globe injury with an iron rod. Our technique is simple with easy surgical maneuvers, that is, effective for repairing iridodialysis. The “Cobbler's technique” allows a maximally functional and cosmetic result for iridodialysis.

  2. 金属烤瓷联冠对牙周病患者的修复治疗效果分析%Analysis on the Repair of Therapeutic Effect of Patients with Periodontal Disease Combined Porcelain Fused to Metal Crown

    Institute of Scientific and Technical Information of China (English)

    丁玲

    2015-01-01