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Sample records for suggests insufficient preoperative

  1. Frequent change of procedure during coronary artery bypass surgery suggests insufficient preoperative diagnostic strategy

    DEFF Research Database (Denmark)

    Eckardt, Rozy; Kjeldsen, Bo Juel; Thayssen, Per

    2007-01-01

    We sought to evaluate how often and in what way surgeons change peroperatively their preoperative coronary artery bypass grafting strategy and to what degree these changes affect postoperative graft patency. A series of 109 patients with stable angina pectoris and at least one occluded coronary...... a discrepancy in 22% of the patients, resulting in a lower or higher number of grafts than pre-operatively estimated. The difference in shift rates between the three sites, left anterior descending, left circumflex, and right coronary artery, was significant (P=0.014). Patency rates were highest when only...... preoperatively planned grafts were inserted. When shifts occurred, no matter in which direction, it resulted in a decreased patency rate of the inserted grafts. This finding was significant for LAD (P=0.037). Our findings might indicate the necessity of future studies with the use of scintigraphy or fractional...

  2. Primary chronic venous insufficiency of the lower extremities: preoperative color duplex Doppler ultrasound study

    International Nuclear Information System (INIS)

    Selfa, S.; Diago, T.; Ricart, M.; Chulia, R.; Martin, F.

    2000-01-01

    To asses the role of color duplex Doppler ultrasound (CDU) in the preoperative study of patients with varicose veins in lower extremities. We employed CDU to examine varicose veins in 342 lower limbs, assessing reflux in saphenous veins (SV), deep venous system (DVS) and perforating veins (PV). We analyzed the relationship between the anatomical extent of the reflux and the clinical findings. Insufficiency of the superficial venous system alone was uncommon, occurring in only 10.8% of the limbs examined. Reflux was observed in SV and PV in 48.2% of the legs. It was detected in all three systems in 29.2% of cases. The presence of reflux in more than one system and more than one value was associated with increased clinical severity. The site of venous reflux in lower extremities with varicose veins varies. Greater clinical severity is observed in the presence of more marked reflux in the DVS and PV. CDU provides anatomic and functional data on the three venous systems of the lower limbs, allowing an individualized therapeutic surgery. Preoperative localization of incompetent PV by means of CDU facilities their ligation. CDU is the technique of choice for the preoperative examination of the venous systems of patients with varicose veins. (Author)

  3. Zebrafish models of BAG3 myofibrillar myopathy suggest a toxic gain of function leading to BAG3 insufficiency.

    Science.gov (United States)

    Ruparelia, Avnika A; Oorschot, Viola; Vaz, Raquel; Ramm, Georg; Bryson-Richardson, Robert J

    2014-12-01

    Mutations in the co-chaperone Bcl2-associated athanogene 3 (BAG3) can cause myofibrillar myopathy (MFM), a childhood-onset progressive muscle disease, characterized by the formation of protein aggregates and myofibrillar disintegration. In contrast to other MFM-causing proteins, BAG3 has no direct structural role, but regulates autophagy and the degradation of misfolded proteins. To investigate the mechanism of disease in BAG3-related MFM, we expressed wild-type BAG3 or the dominant MFM-causing BAG3 (BAG3(P209L)) in zebrafish. Expression of the mutant protein results in the formation of aggregates that contain wild-type BAG3. Through the stimulation and inhibition of autophagy, we tested the prevailing hypothesis that impaired autophagic function is responsible for the formation of protein aggregates. Contrary to the existing theory, our studies reveal that inhibition of autophagy is not sufficient to induce protein aggregation. Expression of the mutant protein, however, did not induce myofibrillar disintegration and we therefore examined the effect of knocking down Bag3 function. Loss of Bag3 resulted in myofibrillar disintegration, but not in the formation of protein aggregates. Remarkably, BAG3(P209L) is able to rescue the myofibrillar disintegration phenotype, further demonstrating that its function is not impaired. Together, our knockdown and overexpression experiments identify a mechanism whereby BAG3(P209L) aggregates form, gradually reducing the pool of available BAG3, which eventually results in BAG3 insufficiency and myofibrillar disintegration. This mechanism is consistent with the childhood onset and progressive nature of MFM and suggests that reducing aggregation through enhanced degradation or inhibition of nucleation would be an effective therapy for this disease.

  4. Can preoperative CEA and CA19-9 serum concentrations suggest metastatic disease in colorectal cancer patients?

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    Stojkovic Lalosevic, Milica; Stankovic, Sanja; Stojkovic, Mirjana; Markovic, Velimir; Dimitrijevic, Ivan; Lalosevic, Jovan; Petrovic, Jelena; Brankovic, Marija; Pavlovic Markovic, Aleksandra; Krivokapic, Zoran

    2017-01-01

    This study was designed to investigate the efficiency of preoperative serum carcinoembryonic antigen (CEA) and carbohydrate cancer antigen (CA19-9) levels for diagnosing synchronous liver metastases and lymph node in colorectal carcinoma (CRC) patients. A total of 300 patients with histologically diagnosed CRC were included in this study between May 2014 and March 2015. The data were obtained prospectively from patient's medical records: medical history, demographics, tumor location, differentiation (grade), depth of the tumor (T), lymph node metastases (N), distant metastases (M), lymphatics, venous and perineural invasion, and disease stage. Tumor markers were measured with an electrochemiluminescent assay and the reference value was 5ng/ml for CEA and for Ca19-9, 37u/ml. There was A high statistically significant difference in the levels of serum CEA and CA19-9 between different disease stages of CRC (PCEA (stage I 3.76±8.73; II 5.68±17.27, III 7.56±14.81, and IV 70.90±253.23) and CA 19-9 levels (stage I 9.65±11.03, II 9.83±11.09; III 19.58±36.91, and IV 228.9±985.38, respectively). The mean CEA and CA19-9 serum levels were significantly higher in patients with regional lymph nodes involvement (CEA 37.21±177.85 vs 4.79±9.90, CA19-9 119.51±687.71 VS 12.24±17.69, respectively, PCEA 86.56±277.65 vs. 5.98±12.98, and CA19-9 273.27±1073.46 vs. 4.98±3142, respectively, with PCEA and CA 19-9, 3.5 ng/mL and 7.5 U/mL, respectively. While, a cut-off value for the presence of synchronous liver metastases of these two markers was 3.5ng/mL AND 5.5 U/mL. Our study showed that tumor makers, CEA and CA19-9, can be used as diagnostic factors regarding the severity of CRC specifically to suggest metastatic disease in CRC.

  5. [Preoperative fasting. An update].

    Science.gov (United States)

    Spies, C D; Breuer, J P; Gust, R; Wichmann, M; Adolph, M; Senkal, M; Kampa, U; Weissauer, W; Schleppers, A; Soreide, E; Martin, E; Kaisers, U; Falke, K J; Haas, N; Kox, W J

    2003-11-01

    In Germany the predominant standard of preoperative care for elective surgery is fasting after midnight, with the aim of reducing the risk of pulmonary aspiration. However, for the past several years the scientific evidence supporting such a practice has been challenged. Experimental and clinical studies prove a reliable gastric emptying within 2 h suggesting that, particularly for limited intake of clear fluids up to 2 h preoperatively, there would be no increased risk for the patient. In addition, the general incidence of pulmonary aspiration during general anaesthesia (before induction, during surgery and during recovery) is extremely low, has a good prognosis and is more a consequence of insufficient airway protection and/or inadequate anaesthetic depth rather than due to the patient's fasting state. Therefore, primarily to decrease perioperative discomfort for patients, several national anaesthesia societies have changed their guidelines for preoperative fasting. They recommend a more liberal policy regarding per os intake of both liquid and solid food, with consideration of certain conditions and contraindications. The following article reviews the literature and gives an overview of the scientific background on which the national guidelines are based. The intention of this review is to propose recommendations for preoperative fasting regarding clear fluids for Germany as well.

  6. Aortic insufficiency

    Science.gov (United States)

    ... page, please enable JavaScript. Aortic insufficiency is a heart valve disease in which the aortic valve does not close ... aortic insufficiency Images Aortic insufficiency References Carabello BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman-Cecil ...

  7. The effect of preoperative suggestions on perioperative dreams and dream recalls after administration of different general anesthetic combinations: a randomized trial in maxillofacial surgery.

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    Gyulaházi, Judit; Varga, Katalin; Iglói, Endre; Redl, Pál; Kormos, János; Fülesdi, Béla

    2015-01-01

    Images evoked immediately before the induction of anesthesia with the help of suggestions may influence dreaming during anesthesia.The aim of the study was to assess the incidence of evoked dreams and dream recalls by employing suggestions before induction of anesthesia while administering different general anesthetic combinations. This is a single center, prospective randomized including 270 adult patients scheduled for maxillofacial surgical interventions. Patients were assigned to control, suggestion and dreamfilm groups according to the psychological method used. According to the anesthetic protocol there were also three subgroups: etomidate & sevoflurane, propofol & sevoflurane, propofol & propofol groups. Primary outcome measure was the incidence of postoperative dreams in the non-intervention group and in the three groups receiving different psychological interventions. Secondary endpoint was to test the effect of perioperative suggestions and dreamfilm-formation training on the occurrance of dreams and recallable dreams in different general anesthesiological techniques. Dream incidence rates measured in the control group did not differ significantly (etomidate & sevoflurane: 40%, propofol & sevoflurane: 26%, propofol & propofol: 39%). A significant increase could be observed in the incidence rate of dreams between the control and suggestion groups in the propofol & sevoflurane (26%-52%) group (p = 0.023). There was a significant difference in the incidence of dreams between the control and dreamfilm subgroup in the propofol & sevoflurane (26% vs. 57%), and in the propofol & propofol group (39% vs.70%) (p = 0.010, and p = 0.009, respectively). Similar to this, there was a significant difference in dream incidence between the dreamfilm and the suggestion subgroups (44% vs. 70%) in the propofol & propofol group (p = 0.019). Propofol as an induction agent contributed most to dream formation and recalls (χ2-test p value: 0.005). The content of images and dreams

  8. Preoperative evaluation

    International Nuclear Information System (INIS)

    Murphy, C.H.; Murphy, M.R.

    1987-01-01

    The value of a preoperative chest radiograph is twofold. The examination may reveal unsuspected pathology that would alter the approach to surgery of anesthesia. Secondly, it provides a baseline or reference from which to evaluate subsequent post-operative films. The percentage of detection of unsuspected pathology on preoperative chest radiographs has been shown to be exceedingly small in certain patient populations. The authors do not recommend routine use of preoperative chest radiographs in children or in adults under the age of 40 who do not smoke, unless (1) the surgical disease has chest manifestations; (2) there is historic or clinical evidence of a coexisting disease with chest involvement; or (3) there is a likelihood that post-operative management will require follow-up films

  9. Preoperative alcoholism and postoperative morbidity

    DEFF Research Database (Denmark)

    Tonnesen, H; Kehlet, H

    1999-01-01

    BACKGROUND: Preoperative risk assessment has become part of daily clinical practice, but preoperative alcohol abuse has not received much attention. METHODS: A Medline search was carried out to identify original papers published from 1967 to 1998. Relevant articles on postoperative morbidity...... in alcohol abusers were used to evaluate the evidence. RESULTS: Prospective and retrospective studies demonstrate a twofold to threefold increase in postoperative morbidity in alcohol abusers, the most frequent complications being infections, bleeding and cardiopulmonary insufficiency. Wound complications...... to postoperative morbidity. CONCLUSION: Alcohol consumption should be included in the preoperative assessment of likely postoperative outcome. Reduction of postoperative morbidity in alcohol abusers may include preoperative alcohol abstinence to improve organ function, or perioperative alcohol administration...

  10. Recurrent Tricuspid Insufficiency

    Science.gov (United States)

    Kara, Ibrahim; Koksal, Cengiz; Cakalagaoglu, Canturk; Sahin, Muslum; Yanartas, Mehmet; Ay, Yasin; Demir, Serdar

    2013-01-01

    This study compares the medium-term results of De Vega, modified De Vega, and ring annuloplasty techniques for the correction of tricuspid insufficiency and investigates the risk factors for recurrent grades 3 and 4 tricuspid insufficiency after repair. In our clinic, 93 patients with functional tricuspid insufficiency underwent surgical tricuspid repair from May 2007 through October 2010. The study was retrospective, and all the data pertaining to the patients were retrieved from hospital records. Functional capacity, recurrent tricuspid insufficiency, and risk factors aggravating the insufficiency were analyzed for each patient. In the medium term (25.4 ± 10.3 mo), the rates of grades 3 and 4 tricuspid insufficiency in the De Vega, modified De Vega, and ring annuloplasty groups were 31%, 23.1%, and 6.1%, respectively. Logistic regression analysis revealed that chronic obstructive pulmonary disease, left ventricular dysfunction (ejection fraction, tricuspid insufficiency. Medium-term survival was 90.6% for the De Vega group, 96.3% for the modified De Vega group, and 97.1% for the ring annuloplasty group. Ring annuloplasty provided the best relief from recurrent tricuspid insufficiency when compared with DeVega annuloplasty. Modified De Vega annuloplasty might be a suitable alternative to ring annuloplasty when rings are not available. PMID:23466680

  11. Imaging of insufficiency fractures

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    Krestan, Christian [Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna (Austria)], E-mail: christian.krestan@meduniwien.ac.at; Hojreh, Azadeh [Department of Radiology, Medical University of Vienna, Vienna General Hospital, Waehringerstr. 18-20, 1090 Vienna (Austria)

    2009-09-15

    This review focuses on the occurrence, imaging and differential diagnosis of insufficiency fractures. Prevalence, the most common sites of insufficiency fractures and their clinical implications are discussed. Insufficiency fractures occur with normal stress exerted on weakened bone. Postmenopausal osteoporosis is the most common cause of insufficiency fractures. Other conditions which affect bone turnover include osteomalacia, hyperparathyroidism, chronic renal failure and high-dose glucocorticoid therapy. It is a challenge for the radiologist to detect and diagnose insufficiency fractures, and to differentiate them from other bone lesions. Radiographs are still the most widely used imaging method for identification of insufficiency fractures, but sensitivity is limited, depending on the location of the fractures. Magnetic resonance imaging (MRI) is a very sensitive tool to visualize bone marrow abnormalities associated with insufficiency fractures. Thin section, multi-detector computed tomography (MDCT) depicts subtle fracture lines allowing direct visualization of cortical and trabecular bone. Bone scintigraphy still plays a role in detecting fractures, with good sensitivity but limited specificity. The most important differential diagnosis is underlying malignant disease leading to pathologic fractures. Bone densitometry and clinical history may also be helpful in confirming the diagnosis of insufficiency fractures.

  12. Obstructed pancreaticojejunostomy partly explains exocrine insufficiency after pancreatic head resection.

    Science.gov (United States)

    Nordback, Isto; Parviainen, Mickael; Piironen, Anneli; Räty, Sari; Sand, Juhani

    2007-02-01

    The majority of patients with long-term survival after pancreatic head resection suffer from pancreatic exocrine insufficiency. The objective of this study was to investigate whether this is due to glandular malfunction or obstructed pancreaticojejunal anastomosis. Twenty-six patients (10 M, 16 F, mean age 61 years, range 34-81 years) were re-examined a median of 52 months (range 3-76 months) after pancreatic head resection and end-to-end invaginated pancreaticojejunostomy. Pancreatic exocrine function was measured by fecal elastase-1 assay. The size of the pancreatic remnant, glandular secretion and the flow through the anastomosis were analyzed with secretin-stimulated dynamic magnetic resonance pancreatography (D-MRP). All patients had pancreatic exocrine insufficiency, 24 (92%) of them having severe insufficiency. Eighteen patients (69%) reported moderate to severe diarrhea. Lowest fecal elastase-1 concentrations were associated with the initial diagnosis of chronic pancreatitis or ductal adenocarcinoma, suggesting preoperative primary or secondary chronic pancreatitis as important determinants. The size of the remnant gland did not correlate with the fecal elastase-1 concentrations. D-MRP failed in three patients. Severe glandular malfunctions were found in 7 (30%) of the 23 successful D-MRP examinations. The anastomosis was totally obstructed in 5 patients (22%) or partially obstructed in 6 (26%) but remained perfectly open in 5 patients (22%). The five patients with perfect anastomoses had the highest measured median fecal elastase-1 activity. Although late diarrhea and pancreatic exocrine insufficiency may be partly induced already by the disease treated with resection, at least half may be explained by obstructed anastomosis. To obtain better late functional results, improvements may be required in the surgical techniques.

  13. [Traumatic tricuspid insufficiency].

    Science.gov (United States)

    Vayre, F; Richard, P; Ollivier, J P

    1996-04-01

    Traumatic tricuspid insufficiency is a rare condition. The diagnosis is difficult because of the slow progression of this pathology and the presence of more clinically acute lesions. Non-penetrating chest trauma is responsible for 90% of cases. Echocardiography is the investigation of choice for assessing the mechanism of the tricuspid regurgitation and for diagnosing associated lesions. It should be performed systematically in patients with multiple trauma. The surgical indications are difficult to determine and depend on the patients' symptoms and the type of anatomical lesions. It should be undertaken before right ventricular myocardial dysfunction. Several techniques may be used from valvuloplasty to valve replacement mainly with bioprostheses in symptomatic patients.

  14. Adopting preoperative fasting guidelines.

    Science.gov (United States)

    Anderson, Megan; Comrie, Rhonda

    2009-07-01

    In 1999, the American Society of Anesthesiologists adopted preoperative fasting guidelines to enhance the quality and efficiency of patient care. Guidelines suggest that healthy, non-pregnant patients should fast six hours from solids and two hours from liquids. Although these guidelines are in place, studies suggest that providers are still using the blanket statement "NPO after midnight" without regard to patient characteristics, the procedure, or the time of the procedure. Using theory to help change provider's beliefs may help make change more successful. Rogers' Theory of Diffusion of Innovations can assist in changing long-time practice by laying the groundwork for an analysis of the benefits and disadvantages of proposed changes, such as changes to fasting orders, while helping initiate local protocols instead of additional national guidelines.

  15. Preoperative fasting: a clinical audit.

    Science.gov (United States)

    Roberts, Stuart

    2013-01-01

    This clinical audit examines the adherence to guidelines suggested by the Royal College of Nursing (2005); the results uphold previous studies of a preoperative starving period for patients undergoing elective surgical procedures. Patients excessively starved of food or fluids report problems relating to their health. These include hunger, distress and complaints of nausea.

  16. Fatigue and insufficiency fractures

    International Nuclear Information System (INIS)

    Lodwick, G.S.; Rosenthal, D.I.; Kattapuram, S.V.; Hudson, T.M.

    1987-01-01

    The incidence of stress fracture is increasing. In our younger society this is due largely to a preocupation with physical conditioning, but in our elderly population it is due to improved recognition and better methods of detection and diagnosis. Stress fracture of the elderly is an insufficiency fracture which occurs in the spine, the pelvis, the sacrum and other bones afflicted with disorders which cause osteopenia. Stress fracture is frequently misdiagnosed as a malignant lesion of bone resulting in biopsy. Scintiscanning provides the greatest frequency of detection, while computed tomography often provides the definitive diagnosis. With increased interest and experience a better insight into the disease has been achieved, and what was once thought of as a simple manifestation of mechanical stress is now known to be an orderly, complex pattern of physiological changes in bone which conform to a model by Frost. The diffuse nature of these changes can be recognized by scintigraphy, radiography and magnetic resonance imaging. 27 refs.; 8 figs

  17. Predictive factors for exocrine pancreatic insufficiency after pancreatoduodenectomy with pancreaticogastrostomy.

    Science.gov (United States)

    Nakamura, Hiroyuki; Murakami, Yoshiaki; Uemura, Kenichiro; Hayashidani, Yasuo; Sudo, Takeshi; Ohge, Hiroki; Sueda, Taijiro

    2009-07-01

    The aim of this study was to determine risk factors for exocrine pancreatic insufficiency after pancreatoduodenectomy (PD) with pancreaticogastrostomy (PG). A (13)C-labeled mixed triglyceride breath test was performed in 61 patients after PD to assess exocrine pancreatic function. Percent (13)CO(2) cumulative dose at 7 h pancreatic insufficiency. Abdominal computed tomography scans were utilized to assess the dilatation of the main pancreatic duct (MPD dilatation) in the remnant. Thirty-eight of 61 patients (62.3%) were diagnosed with exocrine pancreatic insufficiency. Univariate analysis identified significant associations between two preoperative factors (preoperative impaired endocrine function and a hard pancreatic texture induced by preexisting obstructive pancreatitis), plus one postoperative factor (MPD dilatation caused by PG stricture) and exocrine pancreatic insufficiency (P pancreatic insufficiency after PD may be partly explainable by preexisting obstructive pancreatitis prior to surgery, surgeons desiring to obtain better postoperative exocrine pancreatic function after PD would be well-advised to devote considerable attention to preventing PG stricture.

  18. Clinical significance of gamma camera renography in chronic renal insufficiency

    International Nuclear Information System (INIS)

    Dudczak, R.; Frischauf, H.; Kletter, K.

    1980-01-01

    Gamma camera renography allows, together with renal imaging, an evaluation of individual renal function. For these examinations, I 123 orthoiodohippurate is preferred and most widely used. The results on patients with chronic renal insufficiency, including urologic and posttransplantation patients, are reported. Whereas the method is of clinical significance in evaluating posttransplantation complications and in assessing individual kidney function preoperatively in urology, as well as in monitoring therapeutic effects in the early period of renal disease, it is of limited diagnostic value in chronic renal insufficiency. In this latter regard, clinical and laboratory examinations are of primary importance. (author)

  19. [Addison's disease : Primary adrenal insufficiency].

    Science.gov (United States)

    Pulzer, A; Burger-Stritt, S; Hahner, S

    2016-05-01

    Adrenal insufficiency, a rare disorder which is characterized by the inadequate production or absence of adrenal hormones, may be classified as primary adrenal insufficiency in case of direct affection of the adrenal glands or secondary adrenal insufficiency, which is mostly due to pituitary or hypothalamic disease. Primary adrenal insufficiency affects 11 of 100,000 individuals. Clinical symptoms are mainly nonspecific and include fatigue, weight loss, and hypotension. The diagnostic test of choice is dynamic testing with synthetic ACTH. Patients suffering from chronic adrenal insufficiency require lifelong hormone supplementation. Education in dose adaption during physical and mental stress or emergency situations is essential to prevent life-threatening adrenal crises. Patients with adrenal insufficiency should carry an emergency card and emergency kit with them.

  20. Assessment of preoperative exams request in a teaching hospital

    Directory of Open Access Journals (Sweden)

    Eduardo Toshiyuki Moro

    2014-04-01

    Background: preoperative exams aim to identify disorders that may compromise the patient´s perioperative care. However, unnecessary tests rarely change the outcome, and are expensive to institution. The aim of this study was to evaluate the preoperative tests ordered in Santa Lucinda hospital, Sorocaba - SP. Methods: after approval by the Ethics Committee of PUC-SP University, we assessed pre-anesthetic evaluation of patients undergoing elective surgery from march to August, 2011. We recorded: age, sex, ASA physical status, the presence of coexisting diseases, medication use, type of surgery and preoperative tests. They were classified as sufficient, sufficient with unnecessary tests, insufficient, or insufficient with unnecessary tests. Results: two hundred and nineteen records were evaluated, of which 52% were considered sufficient, but with unnecessary tests. For 24% of patients, the tests were insufficient, with some ordered unnecessarily. To 8% of patients, the tests were insufficient, and only 16% didn´t have insufficient and unnecessary tests. The most frequently ordered tests were hematocrit and hemoglobin. The exams most unnecessarily ordered were coagulation tests and dosage of serum urea. Among the necessary examinations, but unsolicited, there were ECG (27%, electrolytes (13% and creatinine (11%. Seventy-nine tests showed some kind of problem, but they didn´t change in behavior. Conclusions: preoperative tests unnecessarily ordered are frequent, which do not guarantee that some patients present to surgery without fundamental exams according to their risk group.

  1. Pancreatic fibrosis correlates with exocrine pancreatic insufficiency after pancreatoduodenectomy.

    Science.gov (United States)

    Tran, T C K; van 't Hof, G; Kazemier, G; Hop, W C; Pek, C; van Toorenenbergen, A W; van Dekken, H; van Eijck, C H J

    2008-01-01

    Obstruction of the pancreatic duct can lead to pancreatic fibrosis. We investigated the correlation between the extent of pancreatic fibrosis and the postoperative exocrine and endocrine pancreatic function. Fifty-five patients who were treated for pancreatic and periampullary carcinoma and 19 patients with chronic pancreatitis were evaluated. Exocrine pancreatic function was evaluated by fecal elastase-1 test, while endocrine pancreatic function was assessed by plasma glucose level. The extent of fibrosis, duct dilation and endocrine tissue loss was examined histopathologically. A strong correlation was found between pancreatic fibrosis and elastase-1 level less than 100 microg/g (p pancreatic insufficiency. A strong correlation was found between pancreatic fibrosis and endocrine tissue loss (p pancreatic fibrosis nor endocrine tissue loss were correlated with the development of postoperative diabetes mellitus. Duct dilation alone was neither correlated with exocrine nor with endocrine function loss. The majority of patients develop severe exocrine pancreatic insufficiency after pancreatoduodenectomy. The extent of exocrine pancreatic insufficiency is strongly correlated with preoperative fibrosis. The loss of endocrine tissue does not correlate with postoperative diabetes mellitus. Preoperative dilation of the pancreatic duct per se does not predict exocrine or endocrine pancreatic insufficiency postoperatively. Copyright 2008 S. Karger AG, Basel.

  2. Insufficiency fracture after radiation therapy

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    Oh, Dong Ryul; Huh, Seung Jae [Dept.of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2014-12-15

    Insufficiency fracture occurs when normal or physiological stress applied to weakened bone with demineralization and decreased elastic resistance. Recently, many studies reported the development of IF after radiation therapy (RT) in gynecological cancer, prostate cancer, anal cancer and rectal cancer. The RT-induced insufficiency fracture is a common complication during the follow-up using modern imaging studies. The clinical suspicion and knowledge the characteristic imaging patterns of insufficiency fracture is essential to differentiate it from metastatic bone lesions, because it sometimes cause severe pain, and it may be confused with bone metastasis.

  3. Adrenal Insufficiency and Addison's Disease

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    ... These conditions can lead to an adrenal crisis. Pregnancy Women with adrenal insufficiency who become pregnant are ... can benefit from following a diet rich in sodium. A health care provider or a dietitian can ...

  4. [Preoperative structured patient education].

    Science.gov (United States)

    Lamarche, D

    1993-04-01

    This article describes the factors that motivated the nursing staff of the cardiac surgery unit at the Royal Victoria Hospital in Montreal, to revise their preoperative teaching program. The motivating factors described are the length of the preoperative waiting period; the level of preoperative anxiety; the decreased length of hospital stay; the dissatisfaction of the nursing staff with current patient teaching practices; and the lack of available resources. The reorganization of the teaching program was based upon the previously described factors combined with a review of the literature that demonstrated the impact of preoperative anxiety, emotional support and psycho-educational interventions upon the client's recovery. The goals of the new teaching program are to provide the client and the family with cognitive and sensory information about the client's impending hospitalization, chronic illness and necessary lifestyle modifications. The program consists of a system of telephone calls during the preoperative waiting period; a videotape viewing; a tour of the cardiac surgery unit; informal discussion groups; and the availability of nursing consultation to decrease preoperative anxiety. The end result of these interventions is more time for client support and integration of necessary information by the client and family. This kind of program has the potential to provide satisfaction at many levels by identifying client's at risk; increasing client knowledge; increasing support; decreasing anxiety during the preoperative waiting period; and decreasing the length of hospital stay. The nursing staff gained a heightened sense of accomplishment because the program was developed according to the nursing department's philosophy, which includes primary nursing.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Immediate preoperative enteral nutrition (preoperative enteral nutrition

    Directory of Open Access Journals (Sweden)

    Lađević Nebojša

    2017-01-01

    Full Text Available Nutritional support of surgical patients is a necessary part of the treatment. It alone cannot cure the disease but it significantly affects the recovery of patients and supports surgical interventions. Patients in malnutrition have shown to have significantly more postoperative infectious and non-infectious complications. This significantly prolongs treatment time and increases costs. However, there is one fact that cannot be expressed in money, which is the patient's impression of the surgical intervention. Adequate preoperative patient support, based on the intake of liquid nutritive solutions, reduces preoperative stress and deflects the metabolic response. Now, it is recommended for adults and children older than one year to drink clear liquid up to 2 hours before induction in anesthesia. Appropriate enteral nutrition has a significant place in the postoperative recovery of patients. Enteral nutrition is reducing complications, mainly infectious complications because the function of the digestive system as one large immune system is preserved. Perioperative enteral nutrition is a necessary part of the modern treatment of surgical patients. In addition to the significant effect on the occurrence of postoperative complications, it is also important that this type of diet improves the psychological status of patients.

  6. Thirty-day outcomes underestimate endocrine and exocrine insufficiency after pancreatic resection.

    Science.gov (United States)

    Lim, Pei-Wen; Dinh, Kate H; Sullivan, Mary; Wassef, Wahid Y; Zivny, Jaroslav; Whalen, Giles F; LaFemina, Jennifer

    2016-04-01

    Long-term incidence of endocrine and exocrine insufficiency after pancreatectomy is poorly described. We analyze the long-term risks of pancreatic insufficiency after pancreatectomy. Subjects who underwent pancreatectomy from 2002 to 2012 were identified from a prospective database (n = 227). Subjects who underwent total pancreatectomy or pancreatitis surgery were excluded. New post-operative endocrine and exocrine insufficiency was defined as the need for new pharmacologic intervention within 1000 days from resection. 28 (16%) of 178 subjects without pre-existing endocrine insufficiency developed post-operative endocrine insufficiency: 7 (25%) did so within 30 days, 8 (29%) between 30 and 90 days, and 13 (46%) after 90 days. 94 (43%) of 214 subjects without pre-operative exocrine insufficiency developed exocrine insufficiency: 20 (21%) did so within 30 days, 29 (31%) between 30 and 90 days, and 45 (48%) after 90 days. Adjuvant radiation was associated with new endocrine insufficiency. On multivariate regression, pancreaticoduodenectomy and chemotherapy were associated with a greater risk of exocrine insufficiency. Reporting 30-day functional outcomes for pancreatic resection is insufficient, as nearly 45% of subjects who develop disease do so after 90 days. Reporting of at least 90-day outcomes may more reliably assess risk for post-operative endocrine and exocrine insufficiency. Copyright © 2016 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

  7. Surgical management of traumatic tricuspid insufficiency.

    Science.gov (United States)

    Zhang, Zhiqi; Yin, Kanhua; Dong, Lili; Sun, Yongxin; Guo, Changfa; Lin, Yi; Wang, Chunsheng

    2017-06-01

    This study reviews our experience with traumatic tricuspid insufficiency (TTI) following blunt chest trauma. From January 2010 to June 2016, 10 patients (nine males, mean age 49.0 ± 12.4 years) underwent surgical treatment of TTI following blunt chest trauma. The mean intervals between trauma and diagnosis and between trauma and surgery were 74.1 and 81.8 months, respectively. Preoperatively, all patients exhibited severe tricuspid regurgitation. Five patients underwent tricuspid valve repair, and the remaining patients underwent valve replacement. The mean follow-up duration (with echocardiography) was 29.7 months. There was no early or late death. Seven patients had anterior chordal rupture, two patients had anterior papillary muscle rupture, and one patient had both anterior chordal and anterior leaflet rupture. The median postoperative intensive care unit and hospital stays were 1 and 6 days, respectively. There were no severe postoperative complications. During follow-up, four patients exhibited trivial to mild tricuspid regurgitation, and the remaining six patients exhibited no regurgitation. Surgical treatment of TTI via either valve repair or replacement can be performed with low perioperative morbidity and mortality. Early surgery is recommended for achieving a successful valve repair and preserving right ventricular function. © 2017 Wiley Periodicals, Inc.

  8. Ping-pong champion with adrenal insufficiency

    Science.gov (United States)

    Arima, Hiroshi; Imamine, Rui; Oiso, Yutaka

    2009-01-01

    A 62-year-old Japanese man, a bronze medal winner in the World Championship of table tennis when in his 20s, was diagnosed with secondary adrenocortical insufficiency due to isolated adrenocorticotropic hormone (ACTH) deficiency, and steroid administration was started. About 1 year after the diagnosis, he took part in a table tennis championship which was open to those 40 years or older. He took 10 mg hydrocortisone after breakfast as usual, played 10 matches, each of which took 20–30 min, and won the championship in about 8 h. Since the man could not always win the gruelling competition even when in his 50s, it is suggested that extra steroid hormone is not necessary for patients with adrenocortical insufficiency due to ACTH deficiency in order to successfully engage in sports requiring such intensity and endurance. PMID:21686433

  9. Interventions for preoperative smoking cessation

    DEFF Research Database (Denmark)

    Møller, A; Villebro, N

    2005-01-01

    Smokers have a substantially increased risk of intra- and postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence. The preoperative period may be a well chosen time to offer smoking cessation interventions due to increased patient motivation....

  10. The preoperative evaluation prevent the postoperative complications of thyroidectomy

    Directory of Open Access Journals (Sweden)

    Chien-Feng Huang

    2015-03-01

    Conclusions: The success of thyroid surgery depends on careful preoperative planning, including a preoperative neck ultrasound to determine the proximity of the nodule to the recurrent laryngeal nerve course, and the consideration of the type of anesthesia, adjuvant devices for intra-op monitoring of the RLN, and surgical modalities. Our results suggest that preoperative evaluation implementations are positively associated with strategy of surgery and postoperative hypocalcemia prevention.

  11. Preoperative fasting time in children.

    LENUS (Irish Health Repository)

    Adeel, S

    2012-02-01

    The aim of preoperative fasting is to prevent regurgitation and pulmonary aspiration while limiting potential problems of thirst, dehydration and hypoglycaemia. The American Society of Anaesthesiologists (ASA) has suggested guidelines for preoperative fasting for children undergoing elective surgery. We did a postal survey to determine the current practice regarding these guidelines amongst all specialist registrars in anaesthesia in Ireland. A questionnaire was sent to all specialist registrars in anaesthesia (90 in total), 60 (67%) were returned and analysed. The question asked was how long children should be kept fasting before elective surgery. The results of our survey suggest that most of the respondents are following the ASA guidelines for clear fluids and solids however there were differing opinion regarding the duration of fasting for formula milk and breast milk. In conclusion, we would recommend greater awareness and collaboration between anaesthetists, nurses and surgeons to ensure that fasting instructions are consistent with the ASA guidelines and that patient and their parents understand these directives as well.

  12. Preoperative bone scans

    International Nuclear Information System (INIS)

    Charkes, N.D.; Malmud, L.S.; Caswell, T.; Goldman, L.; Hall, J.; Lauby, V.; Lightfoot, W.; Maier, W.; Rosemond, G.

    1975-01-01

    Strontium nitrate Sr-87m bone scans were made preoperatively in a group of women with suspected breast cancer, 35 of whom subsequently underwent radical mastectomy. In 3 of the 35 (9 percent), the scans were abnormal despite the absence of clinical or roentgenographic evidence of metastatic disease. All three patients had extensive axillary lymph node involvement by tumor, and went on to have additional bone metastases, from which one died. Roentgenograms failed to detect the metastases in all three. Occult bone metastases account in part for the failure of radical mastectomy to cure some patients with breast cancer. It is recommended that all candidates for radical mastectomy have a preoperative bone scan. (U.S.)

  13. [Adrenal insufficiency of the adult].

    Science.gov (United States)

    Jublanc, C; Bruckert, E

    2016-12-01

    Adrenal insufficiency is a rare but life-threatening disorder. Clinical manifestations include fatigue, weight loss, gastrointestinal manifestations and skin hyperpigmentation, the latter being specific of primary adrenal failure. Because of non-specific clinical features of this rare disorder, diagnosis can be delayed and adrenal failure be revealed by an acute crisis. Adrenal insufficiency can be primary (Addison disease), most frequently autoimmune, or secondary, resulting from long term administration of exogenous glucocorticoids or more rarely from pituitary disorders. Monitoring of substitutive treatment is now well codified. Patient education is very important in this chronic disease that remains associated with a persistent high risk of adrenal crisis. Copyright © 2016 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  14. Primary ovarian insufficiency: an update

    Directory of Open Access Journals (Sweden)

    Cox L

    2014-02-01

    Full Text Available Leticia Cox, James H LiuUH Case Medical Center, MacDonald Women's Hospital, Department of Obstetrics and Gynecology, Case Western Reserve University School of Medicine, Department of Reproductive Biology, Cleveland, OH, USAAbstract: Primary ovarian insufficiency is a condition that represents impaired ovarian function on a continuum with intermittent ovulation. This condition commonly leads to premature menopause, defined as cessation of ovulation prior to the age of 40 years. Because there are potential immediate and long-term consequences of hypoestrogenism, a timely diagnosis is invaluable. This comprehensive review will discuss identifiable causes for primary ovarian insufficiency, including genetic disorders and metabolic abnormalities, as well as review current strategies for diagnosis, evaluation, and management of women with this condition.Keywords: premature ovarian failure, premature menopause, ovarian dysfunction

  15. Pubic insufficiency fracture: MRI findings

    International Nuclear Information System (INIS)

    Min, Tae Kyu; Lee, Yeon Soo; Park, Jeong Mi; Kim, Jee Young; Chung, Hong Jun; Lee, Eun Hee; Lee, Eun Ja; Kang, So Won; Han Tae Il

    2000-01-01

    To evaluate the characteristic MRI findings of pubic insufficiency fracture. In nine cases of pubic insufficiency fracture, the findings of plain radiography (n=9), MRI (n=9), and bone scintigraphy (n=8) were reviewed. We retrospectively analyzed, with regard to fracture site, the destructive pattern revealed by plain radiography, and uptake by other pelvic bones, as demonstrated by RI bone scanning. The MR findings evaluated were the fracture gap and its signal intensity, the site and signal intensity of the soft tissue mass, and other pelvic bone fractures. Plain radiography revealed osteolysis and sclerosis of pubic bone in eight of nine cases (89%), and parasymphyseal fractures in seven (78%). RI indicated uptake by the sacrum in six cases (66%), and by the ilium in three (33%). MR findings of fracture gap (seven cases, 78%) were hypo to isointensity on T1WI, hyper intensity on T2WI and the absence of contrast enhancement. Soft tissue masses were found in seven cases (78%); in four of these the location was parasymphyseal, and in three, surrounding muscle was involved. Hypo to isointensity was revealed by T1WI, hyperintensity by T2WI, and there was peripheral enhancement. Other associated pelvic bone fractures involved the sacrum in seven cases and the ilium in four. The characteristic MR findings of pubic insufficiency fracture were parasymphyseal location, fracture gap, peripherally enhanced soft tissue mass formation, and fractures of other pelvic bones, namely the sacrum and ilium

  16. Endovenous Laser Ablation as a Treatment for Postsurgical Recurrent Saphenous Insufficiency

    International Nuclear Information System (INIS)

    Anchala, Praveen R.; Wickman, Christopher; Chen, Richard; Faundeen, Tonya; Pearce, William; Narducy, Lisa; Resnick, Scott A.

    2010-01-01

    The purpose of this study was to investigate the safety and efficacy of endovenous laser ablation as a treatment for recurrent symptomatic saphenous insufficiency occurring after saphenous vein ligation and stripping. A single-center retrospective review of patients who received endovenous laser ablation as a treatment for recurrent symptomatic saphenous insufficiency after ligation and stripping between November 2003 and October 2006 was performed. Fifty-six insufficient saphenous systems were identified in 38 patients. Follow-up consisted of a clinical examination in all patients as well as selective lower-extremity duplex ultrasound as clinically indicated. All 38 patients demonstrated complete closure of the insufficient saphenous vein by clinical examination and/or duplex ultrasound evaluation. Preoperative symptoms resolved after treatment in all 38 patients. No major complications were identified. Endovenous laser ablation of recurrent symptomatic saphenous venous insufficiency is a safe and effective treatment in patients who develop recurrent symptoms after saphenous vein ligation and stripping.

  17. Effectiveness of vision therapy in school children with symptomatic convergence insufficiency

    Directory of Open Access Journals (Sweden)

    Jung Un Jang

    2017-01-01

    Conclusion: Among convergence insufficiency symptoms, the following improved in particular: near point of convergence, exophoria, and near positive fusional vergence. These findings suggest that vision therapy is very effective to recover from symptomatic convergence insufficiency.

  18. The impact of acute preoperative beta-blockade on perioperative ...

    African Journals Online (AJOL)

    To determine the impact of acute preoperative β-blockade on the incidence of perioperative cardiovascular morbidity and all- ... Our findings suggest that acute preoperative β-blockade is associated with an increased risk of perioperative cardiac ..... Shammash JB, Trost JC, Gold JM, Berlin JA, Golden MA, Kimmel SE.

  19. Preoperative weight gain might increase risk of gastric bypass surgery.

    Science.gov (United States)

    Istfan, Nawfal W; Anderson, Wendy A; Apovian, Caroline M; Hess, Donald T; Forse, R Armour

    2011-01-01

    Weight loss improves the cardiovascular and metabolic risk associated with obesity. However, insufficient data are available about the health effects of weight gain, separate from the obesity itself. We sought to determine whether the changes in body weight before open gastric bypass surgery (OGB) would have a significant effect on the immediate perioperative hospital course. A retrospective chart review of 100 consecutive patients was performed to examine the effects of co-morbidities and body weight changes in the immediate preoperative period on the hospital length of stay and the rate of admission to the surgical intensive care unit (SICU). Of our class III obese patients undergoing OGB, 95% had ≥1 co-morbid condition and an overall SICU admission rate of 18%. Compared with the patients with no perioperative SICU admission, the patients admitted to the SICU had a greater degree of insulin resistance (homeostatic model analysis-insulin resistance 10.8 ± 1.3 versus 5.9 ± 0.5, P = .001), greater serum triglyceride levels (225 ± 47 versus 143 ± 8 mg/dL, P = .003), and had gained more weight preoperatively (.52 ± .13 versus .06 ± .06 lb/wk, P = .003). The multivariate analyses showed that preoperative weight gain was a risk factor for a longer length of stay and more SICU admissions lasting ≥3 days, as were a diagnosis of sleep apnea and an elevated serum triglyceride concentration. The results of the present retrospective study suggest that weight gain increases the risk of perioperative SICU admission associated with OGB, independent of the body mass index. Sleep apnea and elevated serum triglyceride levels were also important determinants of perioperative morbidity. In view of the increasing epidemic of obesity and the popularity of bariatric surgical procedures, we propose that additional clinical and metabolic research focusing on the understanding of the complex relationship among obesity, positive energy balance, weight gain, and perioperative

  20. An audit of documented preoperative evaluation of surgery patients ...

    African Journals Online (AJOL)

    Southern African Journal of Anaesthesia and Analgesia 2015; 21(4):23-28 ... Background:The anaesthetic preoperative evaluation of a patient is the clinical foundation of perioperative patient .... suggested a need for further investigation.

  1. MRI of congenital pituitary insufficiency

    International Nuclear Information System (INIS)

    Almeida Magalhaes, Alvaro C. de; Uehara, Karla C.; Iezzi, Denise

    1995-01-01

    We compare 1,5 T magnetic resonance (MR) image findings in 193 patients with congenital pituitary congenital insufficiency. One hundred and thirty nine of the MR studies were obtained in patients who had isolated growth hormone deficiency. Other fifth - four patients had multiple pituitary hormone deficiency. On MR images, normal anterior and posterior lobes of the pituitary glands can be clearly differentiated because the posterior lobe has a characteristic high intensity on TI-weighted images. In fifty-four patients, the high- intensity of the posterior lobe was not seen, but a similar high signal intensity was observed at the proximal stump in fifty-one patients. this high- intensity area is the newly formed ectopic posterior lobe, which also secrets anti-diuretic hormone just as the posterior lobe would. MR imaging can demonstrate the transection of the pituitary stalk and the formation of the ectopic lobe, revealing to be a useful diagnostic tool in the definition of the type of alteration in growth defects of endocrine origin. (author)

  2. Convergence Insufficiency, Accommodative Insufficiency, Visual Symptoms, and Astigmatism in Tohono O'odham Students.

    Science.gov (United States)

    Davis, Amy L; Harvey, Erin M; Twelker, J Daniel; Miller, Joseph M; Leonard-Green, Tina; Campus, Irene

    2016-01-01

    Purpose. To determine rate of convergence insufficiency (CI) and accommodative insufficiency (AI) and assess the relation between CI, AI, visual symptoms, and astigmatism in school-age children. Methods. 3rd-8th-grade students completed the Convergence Insufficiency Symptom Survey (CISS) and binocular vision testing with correction if prescribed. Students were categorized by astigmatism magnitude (no/low: <1.00 D, moderate: 1.00 D to <3.00 D, and high: ≥3.00 D), presence/absence of clinical signs of CI and AI, and presence of symptoms. Analyses determine rate of clinical CI and AI and symptomatic CI and AI and assessed the relation between CI, AI, visual symptoms, and astigmatism. Results. In the sample of 484 students (11.67 ± 1.81 years of age), rate of symptomatic CI was 6.2% and symptomatic AI 18.2%. AI was more common in students with CI than without CI. Students with AI only (p = 0.02) and with CI and AI (p = 0.001) had higher symptom scores than students with neither CI nor AI. Moderate and high astigmats were not at increased risk for CI or AI. Conclusions. With-the-rule astigmats are not at increased risk for CI or AI. High comorbidity rates of CI and AI and higher symptoms scores with AI suggest that research is needed to determine symptomatology specific to CI.

  3. The role of anxiolytic premedication in reducing preoperative anxiety.

    LENUS (Irish Health Repository)

    Carroll, Jennifer K

    2012-01-01

    Prevention of preoperative anxiety with anxiolytic premedication is associated with improved preoperative outcomes in surgical patients. The objective of the authors\\' study was to evaluate the percentage of surgical patients that are prescribed premedication for preoperative anxiety before their anticipated surgical procedure. A prospective study was carried out by theatre nursing staff in the theatre reception bay of a university teaching hospital. A questionnaire was designed to record the number of patients that described symptoms consistent with preoperative anxiety. The number of patients that had been offered anxiolytic premedication for preoperative anxiety was also recorded. Consent was obtained from 115 consecutive surgical patients (male, n=52; female, n=63). Of these, 66% (n=76) reported anxiety before their surgical procedure (male: n=27, female: n=49). Premedication with a low-dose benzodiazepine was prescribed by an anaesthetist in 4% of cases (n=5). Patients that received premedication preoperatively reported effective relief of their anxiety symptoms This study demonstrates that preoperative patient anxiety is highly prevalent. The authors\\' findings suggest that premedication with anxiolytic pharmacological therapy may be an underused therapeutic resource for managing preoperative patient anxiety.

  4. VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

    Directory of Open Access Journals (Sweden)

    Bonno van BELLEN

    2013-09-01

    Full Text Available Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings, type of surgery (open or laparoscopic, abdominal circumference, body mass index (BMI and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%, the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%, but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although

  5. Preoperative blood transfusions for sickle cell disease

    Science.gov (United States)

    Estcourt, Lise J; Fortin, Patricia M; Trivella, Marialena; Hopewell, Sally

    2016-01-01

    trial, 65 participants, low quality evidence). There was an increase in the number of people developing circulatory overload in those receiving preoperative transfusions compared to those not receiving preoperative transfusions in one of the two trials, and no events were seen in the other trial (no meta-analysis performed). Authors’ conclusions There is insufficient evidence from randomised trials to determine whether conservative preoperative blood transfusion is as effective as aggressive preoperative blood transfusion in preventing sickle-related or surgery-related complications in people with HbSS disease. There is very low quality evidence that preoperative blood transfusion may prevent development of acute chest syndrome. Due to lack of evidence this review cannot comment on management for people with HbSC or HbSβ+ disease or for those with high baseline haemoglobin concentrations. PMID:27049331

  6. Preoperative automated fibre quantification predicts postoperative seizure outcome in temporal lobe epilepsy.

    Science.gov (United States)

    Keller, Simon S; Glenn, G Russell; Weber, Bernd; Kreilkamp, Barbara A K; Jensen, Jens H; Helpern, Joseph A; Wagner, Jan; Barker, Gareth J; Richardson, Mark P; Bonilha, Leonardo

    2017-01-01

    . Using receiver operating characteristic curves, diffusion characteristics of these regions could classify individual patients according to outcome with 84% sensitivity and 89% specificity. Pathological changes in the dorsal fornix were beyond the margins of resection, and contralateral parahippocampal changes may suggest a bitemporal disorder in some patients. Furthermore, diffusion characteristics of the ipsilateral uncinate could classify patients from controls with a sensitivity of 98%; importantly, by co-registering the preoperative fibre maps to postoperative surgical lacuna maps, we observed that the extent of uncinate resection was significantly greater in patients who were rendered seizure-free, suggesting that a smaller resection of the uncinate may represent insufficient disconnection of an anterior temporal epileptogenic network. These results may have the potential to be developed into imaging prognostic markers of postoperative outcome and provide new insights for why some patients with temporal lobe epilepsy continue to experience postoperative seizures. © The Author (2016). Published by Oxford University Press on behalf of the Guarantors of Brain.

  7. Glottal insufficiency with aspiration risk in dysphagia.

    Science.gov (United States)

    Giraldez-Rodriguez, Laureano A; Johns, Michael

    2013-12-01

    Glottal closure is an important part of the mechanism that protects the airway during the normal swallow. Glottal insufficiency disrupts glottal closure and therefore puts patients at risk of aspiration. Treatment of glottal insufficiency can be classified as surgical or nonsurgical. The objective of treating glottal insufficiency is to avoid aspiration or penetration of secretions or food into the airway. Nonsurgical treatment consists of swallowing maneuvers and other measures. Surgical treatment of glottal insufficiency includes injection laryngoplasty, medialization thyroplasty with or without arytenoid adduction or with arytenopexy and cricothyroid subluxation, hypopharyngoplasty, cricopharynx muscle dilation, and cricopharynx myotomy. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. Hypothalamic functions in patients with pituitary insufficiency

    NARCIS (Netherlands)

    Borgers, A.J.F.

    2013-01-01

    The main objective of this thesis is to increase our understanding of hypothalamic (dys)function in patients with pituitary insufficiency. This goal is driven by the clinical experience of persisting symptoms in patients adequately treated for pituitary insufficiency. We focus primarily on patients

  9. Optimal glucocorticoid replacement in adrenal insufficiency.

    Science.gov (United States)

    Øksnes, Marianne; Ross, Richard; Løvås, Kristian

    2015-01-01

    Adrenal insufficiency (glucocorticoid deficiency) comprises a group of rare diseases, including primary adrenal insufficiency, secondary adrenal insufficiency and congenital adrenal hyperplasia. Lifesaving glucocorticoid therapy was introduced over 60 years ago, but since then a number of advances in treatment have taken place. Specifically, little is known about short- and long-term treatment effects, and morbidity and mortality. Over the past decade, systematic cohort and registry studies have described reduced health-related quality of life, an unfavourable metabolic profile and increased mortality in patients with adrenal insufficiency, which may relate to unphysiological glucocorticoid replacement. This has led to the development of new modes of replacement that aim to mimic normal glucocorticoid physiology. Here, evidence for the inadequacy of conventional glucocorticoid therapy and recent developments in treatment are reviewed, with an emphasis on primary adrenal insufficiency. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Traumatic tricuspid valve insufficiency. Experience in thirteen patients.

    Science.gov (United States)

    van Son, J A; Danielson, G K; Schaff, H V; Miller, F A

    1994-11-01

    From 1964 through June 1993, thirteen patients with traumatic tricuspid insufficiency were treated surgically; all were male, and the ages ranged from 17 to 64 years (median 39 years). The condition was associated with blunt chest trauma in all patients: motor vehicle accidents in twelve and an explosion of a tank of compressed air in one. The median duration between trauma and operation was 17 years (range 1 month to 37 years). Preoperatively, six patients were in sinus rhythm and seven were in atrial fibrillation. At operation, the right ventricular function appeared moderately to severely depressed in twelve patients. In twelve patients, the anterior leaflet was flail because of chordal rupture (n = 9), rupture of anterior papillary muscle (n = 3), or tear in the anterior leaflet (n = 1). In one patient, the septal leaflet was missing and in another it was retracted and adherent to the ventricular septum. In five patients the tricuspid valve was repaired and in eight it was replaced. In seven patients in the latter group, the chordae, papillary muscles, and/or tricuspid valve leaflet(s) were found to be in a contracted and atrophic state, precluding repair. No early or late deaths occurred. At follow-up extending to 26 years (median 12 years), 12 patients are in New York Heart Association class I and one patient is in class II. Nine patients were in sinus rhythm and four were in atrial fibrillation. Although our experience indicates that good functional results can still be achieved many years after the onset of traumatic tricuspid valve insufficiency, earlier diagnosis and surgical treatment should increase the feasibility of tricuspid valve insufficiency, earlier diagnosis and surgical treatment should increase the feasibility of tricuspid valve repair, prevent progressive deterioration of right ventricular function, and increase the possibility of maintaining late sinus rhythm in a greater number of patients.

  11. Why Sleep Matters—The Economic Costs of Insufficient Sleep

    Science.gov (United States)

    Hafner, Marco; Stepanek, Martin; Taylor, Jirka; Troxel, Wendy M.; van Stolk, Christian

    2017-01-01

    Abstract The Centers for Disease Control and Prevention (CDC) in the United States has declared insufficient sleep a “public health problem.” Indeed, according to a recent CDC study, more than a third of American adults are not getting enough sleep on a regular basis. However, insufficient sleep is not exclusively a US problem, and equally concerns other industrialised countries such as the United Kingdom, Japan, Germany, or Canada. According to some evidence, the proportion of people sleeping less than the recommended hours of sleep is rising and associated with lifestyle factors related to a modern 24/7 society, such as psychosocial stress, alcohol consumption, smoking, lack of physical activity and excessive electronic media use, among others. This is alarming as insufficient sleep has been found to be associated with a range of negative health and social outcomes, including success at school and in the labour market. Over the last few decades, for example, there has been growing evidence suggesting a strong association between short sleep duration and elevated mortality risks. Given the potential adverse effects of insufficient sleep on health, well-being and productivity, the consequences of sleep-deprivation have far-reaching economic consequences. Hence, in order to raise awareness of the scale of insufficient sleep as a public-health issue, comparative quantitative figures need to be provided for policy- and decision-makers, as well as recommendations and potential solutions that can help tackling the problem. PMID:28983434

  12. Do Routine Preoperative and Intraoperative Urine Cultures Benefit Pediatric Vesicoureteral Reflux Surgery?

    Directory of Open Access Journals (Sweden)

    Daniel R. Hettel

    2017-01-01

    Full Text Available Objective. To determine if routine preoperative and intraoperative urine cultures (UCx are necessary in pediatric vesicoureteral (VUR reflux surgery by identifying their association with each other, preoperative symptoms, and surgical outcomes. Materials and Methods. A retrospective review of patients undergoing ureteral reimplant(s for primary VUR at a tertiary academic medical center between years 2000 and 2014 was done. Preoperative UCx were defined as those within 30 days before surgery. A positive culture was defined as >50,000 colony forming units of a single organism. Results. A total of 185 patients were identified and 87/185 (47.0% met inclusion criteria. Of those, 39/87 (45% completed a preoperative UCx. Only 3/39 (8% preoperative cultures returned positive, and all of those patients were preoperatively symptomatic. No preoperatively asymptomatic patients had positive preoperative cultures. Intraoperative cultures were obtained in 21/87 (24.1% patients; all were negative. No associations were found between preoperative culture results and intraoperative cultures or between culture result and postoperative complications. Conclusions. In asymptomatic patients, no associations were found between the completion of a preoperative or intraoperative UCx and surgical outcomes, suggesting that not all patients may require preoperative screening. Children presenting with symptoms of urinary tract infection (UTI prior to ureteral reimplantation may benefit from preoperative UCx.

  13. Interventions for preoperative smoking cessation

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Villebro, Nete; Møller, Ann Merete

    2014-01-01

    BACKGROUND: Smokers have a substantially increased risk of postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence, and surgery may constitute a unique opportunity for smoking cessation interventions. OBJECTIVES: The objectives of this review...... are to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively, and on the incidence of postoperative complications. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group Specialized Register in January 2014. SELECTION CRITERIA......: Randomized controlled trials that recruited people who smoked prior to surgery, offered a smoking cessation intervention, and measured preoperative and long-term abstinence from smoking or the incidence of postoperative complications or both outcomes. DATA COLLECTION AND ANALYSIS: The review authors...

  14. Preoperative staging of rectal cancer.

    Science.gov (United States)

    Smith, Neil; Brown, Gina

    2008-01-01

    Detailed preoperative staging using high resolution magnetic resonance imaging (MRI) enables the selection of patients that require preoperative therapy for tumour regression. This information can be used to instigate neoadjuvant therapy in those patients with poor prognostic features prior to disturbing the tumour bed and potentially disseminating disease. The design of trials incorporating MR assessment of prognostic factors prior to therapy has been found to be of value in assessing treatment modalities and outcomes that are targeted to these preoperative prognostic subgroups and in providing a quantifiable assessment of the efficacy of particular chemoradiation treatment protocols by comparing pre-treatment MR staging with post therapy histology assessment. At present, we are focused on achieving clear surgical margins of excision (CRM) to avoid local recurrence. We recommend that all patients with rectal cancer should undergo pre-operative MRI staging. Of these, about half will have good prognosis features (T1-T3b, N0, EMVI negative, CRM clear) and may safely undergo primary total mesorectal excision. Of the remainder, those with threatened or involved margins will certainly benefit from pre-operative chemoradiotherapy with the aim of downstaging to permit safe surgical excision. In the future, our ability to recognise features predicting distant failure, such as extramural vascular invasion (EMVI) may be used to stratify patients for neo-adjuvant systemic chemotherapy in an effort to prevent distant relapse. The optimal pre-operative treatment regimes for these patients (radiotherapy alone, systemic chemotherapy alone or combination chemo-radiotherapy) is the subject of current and future trials.

  15. Pancreatic insufficiency secondary to abdominal radiotherapy

    International Nuclear Information System (INIS)

    Dookeran, K.A.; Thompson, M.M.; Allum, W.H.

    1993-01-01

    Delayed post-irradiation steatorrhoea secondary to acute pancreatic insufficiency is rare. The authors describe a case occurring in a patient 23 years following radical abdominal radiotherapy for testicular seminoma. (Author)

  16. Pancreatic insufficiency secondary to abdominal radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Dookeran, K.A.; Thompson, M.M.; Allum, W.H. (Leicester Royal Infirmary (United Kingdom). Dept. of Surgery)

    1993-02-01

    Delayed post-irradiation steatorrhoea secondary to acute pancreatic insufficiency is rare. The authors describe a case occurring in a patient 23 years following radical abdominal radiotherapy for testicular seminoma. (Author).

  17. Hypnosis, suggestion, and suggestibility: an integrative model.

    Science.gov (United States)

    Lynn, Steven Jay; Laurence, Jean-Roch; Kirsch, Irving

    2015-01-01

    This article elucidates an integrative model of hypnosis that integrates social, cultural, cognitive, and neurophysiological variables at play both in and out of hypnosis and considers their dynamic interaction as determinants of the multifaceted experience of hypnosis. The roles of these variables are examined in the induction and suggestion stages of hypnosis, including how they are related to the experience of involuntariness, one of the hallmarks of hypnosis. It is suggested that studies of the modification of hypnotic suggestibility; cognitive flexibility; response sets and expectancies; the default-mode network; and the search for the neurophysiological correlates of hypnosis, more broadly, in conjunction with research on social psychological variables, hold much promise to further understanding of hypnosis.

  18. Traumatic Tricuspid Insufficiency Requiring Valve Repair in an Acute Setting.

    Science.gov (United States)

    Enomoto, Yoshinori; Sudo, Yoshio; Sueta, Tomonori

    2015-01-01

    Tricuspid insufficiency due to penetrating cardiac trauma is rare. Patients with tricuspid insufficiency due to trauma can tolerate this abnormality for months or even years. We report a case of a 66-year-old female with penetrating cardiac trauma on the right side of her heart that required tricuspid valve repair in an acute setting. She sustained cut and stab wounds on her bilateral forearms and in the neck and epigastric region. She had cardiac tamponade and developed pulseless electrical activity, which required emergency surgery. The right ventricle and superior vena cava were dissected approximately 5 cm and 2 cm, respectively. After these wounds had been repaired, the patient's inability to wean from cardiopulmonary bypass suggested rightsided heart failure; transesophageal echocardiography revealed tricuspid insufficiency. Right atriotomy was performed, and a detailed examination revealed that the tricuspid valve septal leaflet was split in two. There was also an atrial septal injury that created a connection with the left atrium; these injuries were not detected from the right ventricular wound. After repair, weaning from cardiopulmonary bypass with mild tricuspid insufficiency was achieved, and she recovered uneventfully. This case emphasized the importance of thoroughly investigating intracardiac injury and transesophageal echocardiography.

  19. Association between Pre-Operative Cefazolin Dose and Surgical Site Infection in Obese Patients.

    Science.gov (United States)

    Peppard, William J; Eberle, David G; Kugler, Nathan W; Mabrey, Danielle M; Weigelt, John A

    A fixed dose of cefazolin results in serum concentrations that decrease as body mass increases. Current national guidelines suggest a pre-operative cefazolin dose of two grams may be insufficient for patients ≥120 kg; thus a three gram dose is recommended. These recommendations, however, are based on pharmacokinetic rather than outcome data. We evaluate the efficacy of pre-operative cefazolin two gram and three gram doses as measured by the rate of surgical site infection (SSI). We conducted a retrospective review of adult patients ≥100 kg who were prescribed cefazolin as surgical prophylaxis between September 1, 2012 and May 31, 2013 at an academic medical center. Patients were excluded if cefazolin was prescribed but not administered, had a known infection at the site of surgery, or inappropriately received cefazolin prophylaxis based on surgical indication. The SSIs were identified by documentation of SSI in the medical record or findings consistent with the standard Centers for Disease Control and Prevention definition. Inpatient and outpatient records up to 90 days post-operative were reviewed for delayed SSI. Four hundred eighty-three surgical cases were identified in which pre-operative cefazolin was prescribed. Forty-seven patients were excluded leaving a total of 436 patients for final analysis: 152 in the cefazolin two gram group and 284 in the three gram group. Baseline demographics were similar between groups with a mean follow-up duration of 77 days for both groups. Unadjusted SSI rates were 7.2% and 7.4% (odds ratio [OR] 0.98, p = 0.95), for the two gram and three gram groups, respectively. When differences in follow-up between groups were considered and logistic regression was adjusted with propensity score, there remained no difference in SSI rates (OR 0.87, 95% confidence interval 0.36-2.06, p = 0.77). In otherwise similar obese surgical patients weighing ≥100 kg, the administration of a pre-operative cefazolin two gram dose is

  20. Tricuspid insufficiency after laser lead extraction.

    Science.gov (United States)

    Rodriguez, Yasser; Mesa, Julian; Arguelles, Eric; Carrillo, Roger G

    2013-08-01

    The use of laser lead extraction (LLE) to remove pacemaker and implantable cardiac defibrillator leads has become more prevalent in the past decade. Though the procedure is associated with a low rate of complications, LLE still poses some risks to patients. Some reports have suggested an increase in tricuspid insufficiency (TI) associated with LLE. We present a series of patients who underwent both LLE and complete evaluation for TI with echocardiographic techniques. From August 2008 to January 2010, 173 prospective, consecutive patients underwent LLE in a single center. All patients had transesophageal echocardiograms (TEE) during the extraction. Fifty-three patients had tricuspid valve function evaluated a day before the procedure with a transthoracic echocardiogram (TTE), during the procedure with a TEE and 2 days postoperatively with a TTE. All 173 patients experienced no change in tricuspid valve function during the procedure with TEE. Of the 53 patients who underwent a complete TI evaluation, 38 were males (72%) and 15 females (38%), with a mean age of 69.45 ± 14.08. Mean ejection fraction was 35.82 ± 14.72. Three (6%) patients experienced TI after the procedure (two mild and one severe, all with tricuspid valve endocarditis); 16 (30%) patients were found to have TI before LLE that returned to normal valve function during or after the procedure. Thirty-four (64%) patients did not experience any significant change of the tricuspid valve performance after LLE. LLE was not associated with increased TI. ©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.

  1. Pre-operative evaluation for thorax surgery

    International Nuclear Information System (INIS)

    Silva Luis, Saenz; Morales, Oscar Alberto

    2002-01-01

    A pre-operative analysis of the function of the breathing system is made in the patient that will be taken to thorax surgery. The paper includes risk factors, pre-operative clinical evaluation and of breathing and cardiovascular system

  2. Preoperative nuclear scans in patients with melanoma

    International Nuclear Information System (INIS)

    Au, F.C.; Maier, W.P.; Malmud, L.S.; Goldman, L.I.; Clark, W.H. Jr.

    1984-01-01

    One hundred forty-one liver scans, 137 brain scans, and 112 bone scans were performed in 192 patients with clinical Stage 1 melanoma. One liver scan was interpreted as abnormal; liver biopsy of that patient showed no metastasis. There were 11 suggestive liver scans; three of the patients with suggestive liver scans had negative liver biopsies. The remaining eight patients were followed from 4 to 6 years and none of those patients developed clinical evidence of hepatic metastases. All of the brain scans were normal. Five patients had suggestive bone scans and none of those patients had manifested symptoms of osseous metastases with a follow-up of 2 to 4.5 years. This study demonstrates that the use of preoperative liver, brain and bone scan in the evaluation of patients with clinical Stage 1 melanoma is virtually unproductive

  3. Pancreatic Exocrine Insufficiency in Pancreatic Cancer.

    Science.gov (United States)

    Vujasinovic, Miroslav; Valente, Roberto; Del Chiaro, Marco; Permert, Johan; Löhr, J-Matthias

    2017-02-23

    Abstract : Cancer patients experience weight loss for a variety of reasons, commencing with the tumor's metabolism (Warburg effect) and proceeding via cachexia to loss of appetite. In pancreatic cancer, several other factors are involved, including a loss of appetite with a particular aversion to meat and the incapacity of the pancreatic gland to function normally when a tumor is present in the pancreatic head. Pancreatic exocrine insufficiency is characterized by a deficiency of the enzymes secreted from the pancreas due to the obstructive tumor, resulting in maldigestion. This, in turn, contributes to malnutrition, specifically a lack of fat-soluble vitamins, antioxidants, and other micronutrients. Patients with pancreatic cancer and pancreatic exocrine insufficiency have, overall, an extremely poor prognosis with regard to surgical outcome and overall survival. Therefore, it is crucial to be aware of the mechanisms involved in the disease, to be able to diagnose pancreatic exocrine insufficiency early on, and to treat malnutrition appropriately, for example, with pancreatic enzymes.

  4. Adalimumab treatment in patients with rheumatoid arthritis with renal insufficiency.

    Science.gov (United States)

    Sumida, Keiichi; Ubara, Yoshifumi; Suwabe, Tatsuya; Hayami, Noriko; Hiramatsu, Rikako; Hasegawa, Eiko; Yamanouchi, Masayuki; Hoshino, Junichi; Sawa, Naoki; Takaichi, Kenmei

    2013-03-01

    To elucidate the safety of adalimumab for rheumatoid arthritis (RA) patients with renal insufficiency, including those with end-stage renal disease undergoing hemodialysis. Sixty-five RA patients, including 2 patients undergoing hemodialysis, treated with adalimumab in our hospital from December 1, 2008 to June 30, 2011 were retrospectively analyzed. Renal function was evaluated by the estimated glomerular filtration rate (eGFR) calculated from the Cockcroft-Gault formula at the start and end of followup after adalimumab treatment. The proportion of the patients who discontinued or switched adalimumab treatment and the change of the eGFR were compared between patients with (n = 39) and without (n = 26) renal insufficiency, defined as an eGFR patients who discontinued or switched adalimumab treatment (51.3% versus 50.0%; P = 0.53). The mean ± SD changes of eGFR were from 41.6 ± 13.3 to 43.4 ± 17.9 ml/minute/1.73 m(2) in patients with renal insufficiency and from 83.6 ± 17.5 to 83.0 ± 16.8 ml/minute/1.73 m(2) in patients without renal insufficiency, and the differences in each group were not statistically significant (P = 0.92 and P = 0.78, respectively). No severe infections or other severe adverse events were observed in either group during adalimumab treatment. Our data indicate that adalimumab does not worsen renal function and has no serious adverse events even for RA patients with renal insufficiency, including those undergoing hemodialysis, and suggest that it could be a potential therapeutic option for them. Copyright © 2013 by the American College of Rheumatology.

  5. Initial clinical experience with a novel biodegradable ring in patients with functional tricuspid insufficiency: Kalangos Biodegradable Tricuspid Ring.

    Science.gov (United States)

    Burma, O; Ustunsoy, H; Davutoglu, V; Celkan, M A; Kazaz, H; Pektok, E

    2007-08-01

    Tricuspid annuloplasty procedures have been widely performed in clinics for many years. The Kalangos Biodegradable Tricuspid Ring (Kalangos Biodegradable Tricuspid Ring, Bioring SA, Lonay, Switzerland) is a novel prosthesis for the treatment of tricuspid insufficiency. The aim of this study was to evaluate the clinical and echocardiographic results of this novel prosthesis for functional tricuspid insufficiency. Between October 2005 and May 2006, 15 patients with the diagnosis of moderate or severe functional tricuspid insufficiency were treated by implantation of a Kalangos Biodegradable Tricuspid Ring. All patients were evaluated clinically and by echocardiography preoperatively, and control tests were performed at the end of the 1st and 6th month following surgery. Moderate and severe insufficiency was documented in 11 and 4 patients, respectively, in the preoperative tests. 1 and 6 months after surgery, 4 patients had trace and 1 patient had mild tricuspid insufficiency, while 10 patients had none. At the 1st and 6th month follow-up, systolic pulmonary arterial pressure, right atrial dimension and right ventricular diastolic diameter were found to be significantly lower than the preoperative values ( P tricuspid valve area had decreased significantly at the end of the 1st month; however, no significant difference was found between the 1st and 6th month tests ( P > 0.05). Three-quarters of the annuloplasty ring had degraded at 6 months. No complications related to the prosthesis or the procedure occurred within this period. Kalangos Biodegradable Ring is a promising prosthesis in patients with functional tricuspid insufficiency, with encouraging initial results.

  6. Antineoplastic treatment of patients with renal insufficiency

    International Nuclear Information System (INIS)

    Rajec, J.; Mego, M.; Rajec, J.

    2011-01-01

    Kidneys are the main route of elimination for many antineoplastic drugs and their metabolites. The kidney dysfunction may lead to the drug cumulation in organism with the resulting increased systemic toxicity. A lot of used cytostatics requires a dose modification at different levels of renal insufficiency. Due to the lack of data from clinical trials, the limiting of systemic toxicity is difficult especially in patients with severe renal impairment or patients undergoing chronic hemodialysis. The following article is focused on the preventive strategies dealing with recommended dosing modification of various antineoplastic agents in patients with renal insufficiency. (author)

  7. [Association between Williams syndrome and adrenal insufficiency].

    Science.gov (United States)

    Rchachi, Meryem; Larwanou, Maazou Mahamane; El Ouahabi, Hanan; Ajdi, Farida

    2017-01-01

    Williams syndrome is a developmental disorder including dysmorphia, cardiovascular malformations and a specific neuropsychological profile together with other associated disorders. We report the case of a 17-year old girl, born of a non-inbred marriage, with Williams syndrome discovered during an assessment of degree of failure to thrive. Its association with primary adrenal insufficiency makes it unique. Diagnosis is confirmed by cytogenetic and molecular analysis. Its management consists of the implementation of treatment for adrenal insufficiency associated with a clinico-biological monitoring.

  8. Preoperative staging of rectal cancer

    International Nuclear Information System (INIS)

    Schaefer, A.O.; Baumann, T.; Pache, G.; Langer, M.; Wiech, T.

    2007-01-01

    Accurate preoperative staging of rectal cancer is crucial for therapeutic decision making, as local tumor extent, nodal status, and patterns of metastatic spread are directly associated with different treatment strategies. Recently, treatment approaches have been widely standardized according to large studies and consensus guidelines. Introduced by Heald, total mesorectal excision (TME) is widely accepted as the surgical procedure of choice to remove the rectum together with its enveloping tissues and the mesorectal fascia. Neoadjuvant radiochemotherapy also plays a key role in the treatment of locally advanced stages, while the use of new drugs will lead to a further improvement in oncological outcome. Visualization of the circumferential resection margin is the hallmark of any preoperative imaging and a prerequisite for high-quality TME surgery. The aim of this article is to present an overview on current cross-sectional imaging with emphasis on magnetic resonance imaging. Future perspectives in rectal cancer imaging are addressed. (orig.)

  9. Interventions for preoperative smoking cessation

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Villebro, N.; Møller, Ann Merete

    2010-01-01

    Background Smokers have a substantially increased risk of postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence, and surgery may constitute a unique opportunity for smoking cessation interventions. Objectives The objective of this review...... was to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively and on the incidence of postoperative complications. Search strategy The specialized register of the Cochrane Tobacco Addiction Group was searched using the free text...... and keywords (surgery) or (operation) or (anaesthesia) or (anesthesia). MEDLINE, EMBASE and CINAHL were also searched, combining tobacco- and surgery-related terms. Most recent search April 2010. Selection criteria Randomized controlled trials that recruited people who smoked prior to surgery, offered...

  10. FFTF preoperational survey. Program report

    International Nuclear Information System (INIS)

    Twitty, B.L.; Bicehouse, H.J.

    1980-12-01

    The FFTF will become operational with criticality early in 1980. This facility is composed of the test reactor, fuel examination cells, expended fuel storage systems and fuel handling systems. The reactor and storage systems are sodium-cooled with the heat load dumped to the ambient air through heat exchangers. In order to assure that the operation of the FFTF has minimal impact on the environment, a monitoring program has been established. Prior to operation of a new facility, a preoperational environmental survey is required. It is the purpose of this report to briefly describe the environmental survey program and to provide the background data obtained during the preoperational phase of the survey program. Nine stations in the program of particular importance to FFTF are discussed in detail with results of monitoring given. No unexplained trends were noted

  11. The value of preoperative planning.

    Science.gov (United States)

    Graves, Matt L

    2013-10-01

    "Better to throw your disasters into the waste paper basket than to consign your patients to the scrap heap" has been a proverb of Jeff Mast, one of the greatest fracture and deformity surgeons in the history of our specialty. Stated slightly more scientifically, one of the major values of simulation is that it allows one to make mistakes in a consequence-free environment. Preoperative planning is the focus of this article. The primary goal is not to provide you with a recipe of how to steps. Rather, the primary goal of this article is to explain why preoperative planning should be standard, to clarify what should be included, and to provide examples of what can happen when planning is ignored. At the end of this, we should all feel the need to approach fracture care more intellectually with forethought, both in our own practices and in our educational system.

  12. [Preoperative fasting guidelines: an update].

    Science.gov (United States)

    López Muñoz, A C; Busto Aguirreurreta, N; Tomás Braulio, J

    2015-03-01

    Anesthesiology societies have issued various guidelines on preoperative fasting since 1990, not only to decrease the incidence of lung aspiration and anesthetic morbidity, but also to increase patient comfort prior to anesthesia. Some of these societies have been updating their guidelines, as such that, since 2010, we now have 2 evidence-based preoperative fasting guidelines available. In this article, an attempt is made to review these updated guidelines, as well as the current instructions for more controversial patients such as infants, the obese, and a particular type of ophthalmic surgery. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Preoperative nutrition therapy - novel developments

    OpenAIRE

    Ljungqvist, Olle; Nygren, Jonas; Hausel, Jonatan; Thorell, Anders

    2000-01-01

    Elective surgery has until recently been performed in the overnight fasted state in order to reduce the risk of aspiration of gastric content during the induction of anaesthesia. However, in order to increase the preoperative well-being of surgical patients, most western countries have changed their routines during the last 10-15 years, allowing intake of clear fluids up to 2 hours before anaesthesia in most patients. Animal studies have demonstrated that undergoing different situations of st...

  14. Open to Suggestion.

    Science.gov (United States)

    Journal of Reading, 1987

    1987-01-01

    Offers (1) suggestions for improving college students' study skills; (2) a system for keeping track of parent, teacher, and community contacts; (3) suggestions for motivating students using tic tac toe; (4) suggestions for using etymology to improve word retention; (5) a word search grid; and (6) suggestions for using postcards in remedial reading…

  15. AMH as Predictor of Premature Ovarian Insufficiency

    DEFF Research Database (Denmark)

    Lunding, Stine Aa; Aksglæde, Lise; Anderson, Richard A

    2015-01-01

    CONTEXT: The majority of Turner syndrome (TS) patients suffer from accelerated loss of primordial follicles. Low circulating levels of anti-Müllerian hormone (AMH) may predict the lack of spontaneous puberty in prepubertal girls and imminent premature ovarian insufficiency (POI) in TS women...

  16. Subchondral insufficiency fractures of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Davies, M.; Cassar-Pullicino, V.N. [Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, SY10 7AG, Shropshire (United Kingdom); Darby, A.J. [Department of Pathology, Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, SY10 7AG, Shropshire (United Kingdom)

    2004-02-01

    The aim of this study was to increase awareness of, and to show the variable clinical and radiological features of, subchondral insufficiency fractures of the femoral head. The clinical and radiological findings in 7 patients with subchondral insufficiency fractures of the femoral head were reviewed retrospectively. The diagnosis was confirmed histologically in 4 patients. Radiographs were performed in all patients, MRI in 5 and scintigraphy in 4 patients. Radiographs showed varying degrees of femoral head collapse in 4 patients. In the remaining 3 patients radiographs showed a normal femoral head, regional osteoporosis and focal sclerosis, respectively. Magnetic resonance imaging showed a low-signal band on T1- and T2-weighted images in the subchondral bone adjacent or parallel to the articular surface associated with bone marrow oedema. Scintigraphy showed increased uptake in the femoral head. Insufficiency fractures of the femoral head are easily overlooked or confused with avascular necrosis and, when there is significant joint destruction, osteoarthritis. Unsuspected insufficiency fracture of the femoral head can lead to significant and rapid loss of bone stock in osteoporotic patients waiting for arthroplasty for osteoarthritis. Increased awareness of this condition will hopefully lead to earlier diagnosis and a successful outcome of conservative treatment. (orig.)

  17. Relative adrenal insufficiency in post-transplant lymphoproliferative disorder.

    Directory of Open Access Journals (Sweden)

    Cinclair R

    2003-01-01

    Full Text Available Post-transplant lymphoproliferative disorder is treated with rapid decrement of immunosuppressive therapy. This cannot be achieved with ease in patients on long-term glucocorticoid therapy, as chronically suppressed adrenal glands may not be capable of mounting adequate response to stress. A 52-year-old Caucasian male presented with fever, orthostatic hypotension, lymphadenopathy and hyponatraemia. Serum cortisol levels were within normal levels with a sub optimal response to stimulation by ACTH. Hyponatraemia and orthostasis responded poorly to fluid restriction, saline and salt repletion but corrected after increasing the steroid dose. The normal baseline cortisol levels represented a stimulated adrenal gland, however, the ACTH stimulation had inadequate response. This sub optimal stimulation and a good response to increased steroids suggest the presence of relative or occult adrenal insufficiency. Relative adrenal insufficiency must be considered in patients who have received prolonged glucocorticoid therapy and have symptoms such as hypotension and/or hyponatraemia.

  18. Effect of practical use of preoperative immunonutrition with Impact on prevention of postoperative pneumonia after esophagectomy

    International Nuclear Information System (INIS)

    Kano, Masayuki; Nabeya, Yoshihiro; Akutsu, Yasunori; Shuto, Kiyohiko; Uesato, Masaya; Miyazawa, Yukimasa; Matsubara, Hisahiro

    2009-01-01

    To clarify the clinical benefits of administering immune-enhancing diet, Impact, we examined retrospectively the effect of preoperative immunonutrition with Impact on prevention of postoperative pneumonia after esophagectomy. In 47 patients without preoperative radiotherapy, no patient who preoperatively administered Impact ≥2,250 mL failed to develop pneumonia. The patients whose postoperative hospital stay was more than 30 days were administered Impact ≤2,000 mL except for one case. These results suggest that even preoperative administration of less amount of Impact than an estimated maximum dose, depending on patients' condition, may be beneficial to prevent postoperative pneumonia and a long hospital stay after surgery. (author)

  19. Adrenal insufficiency in pakistani hiv infected patients

    International Nuclear Information System (INIS)

    Afreen, B.; Khan, K.A.; Riaz, A.

    2017-01-01

    Background: Adrenal insufficiency (AI) is the most common endocrine complication among patients with AIDS/HIV infection and there are number of causes of AI in HIV patients. Human immunodeficiency virus directly as well as indirectly destroys adrenal glands. The estimates of its prevalence and severity vary. AI is the most life threatening but readily correctable endocrine complication that occurs in persons with HIV infection. This study was carried out to determine the frequency of Adrenal Insufficiency in HIV patients and their clinical features as proper diagnosis and timely treatment have been shown to improve quality of life and long-term mortality in AIDS patients. Methods: It was a cross sectional survey conducted at HIV clinic and Jinnah Allama Iqbal Institute of Diabetes and Endocrinology, Jinnah Hospital Lahore. Sixty-four HIV positive patients, both male and female, aged above 15 years were included in the study. HIV patients who had recently taken steroids, ketoconazole or rifampicin, determined on history, were excluded from the study. The data was collected on a structured proforma and analysis was performed in SPSS-21.0. Frequency and percentages for adrenal insufficiency and its characteristics were calculated. Chi-square test was used with p<0.05 as statistically significant. Results: In this study, 9 (14.06%) HIV patients were diagnosed with adrenal insufficiency, male to female ratio was 3.5:1 and AI was found statistically significantly associated with fatigue (p<0.008) and weight loss (p<0.001). Conclusion: Adrenal insufficiency was high among the patients with HIV, it was not gender specific but it was found to be associated with fatigue and weight loss. (author)

  20. Suicidality and interrogative suggestibility.

    Science.gov (United States)

    Pritchard-Boone, Lea; Range, Lillian M

    2005-01-01

    All people are subject to memory suggestibility, but suicidal individuals may be especially so. The link between suicidality and suggestibility is unclear given mixed findings and methodological weaknesses of past research. To test the link between suicidality and interrogative suggestibility, 149 undergraduates answered questions about suicidal thoughts and reasons for living, and participated in a direct suggestibility procedure. As expected, suggestibility correlated with suicidality but accounted for little overall variance (4%). Mental health professionals might be able to take advantage of client suggestibility by directly telling suicidal persons to refrain from suicidal thoughts or actions.

  1. Religiousness and preoperative anxiety: a correlational study

    Directory of Open Access Journals (Sweden)

    Karimollahi Mansoureh

    2007-06-01

    Full Text Available Abstract Background Major life changes are among factors that cause anxiety, and one of these changes is surgery. Emotional reactions to surgery have specific effects on the intensity and velocity as well as the process of physical disease. In addition, they can cause delay in patients recovery. This study is aimed at determining the relationship between religious beliefs and preoperative anxiety. Methods This survey is a correlational study to assess the relationship between religious beliefs and preoperative anxiety of patients undergoing abdominal, orthopaedic, and gynaecologic surgery in educational hospitals. We used the convenience sampling method. The data collection instruments included a questionnaire containing the Spielberger State-Trait Anxiety Inventory (STAI, and another questionnaire formulated by the researcher with queries on religious beliefs and demographic characteristics as well as disease-related information. Analysis of the data was carried out with SPSS software using descriptive and inferential statistics. Results were arranged in three tables. Results The findings showed that almost all the subjects had high level of religiosity and moderate level of anxiety. In addition, there was an inverse relationship between religiosity and intensity of anxiety, though this was not statistically significant. Conclusion The results of this study can be used as evidence for presenting religious counselling and spiritual interventions for individuals undergoing stress. Finally, based on the results of this study, the researcher suggested some recommendations for applying results and conducting further research.

  2. Religiousness and preoperative anxiety: a correlational study.

    Science.gov (United States)

    Kalkhoran, Masoomeh Aghamohammadi; Karimollahi, Mansoureh

    2007-06-29

    Major life changes are among factors that cause anxiety, and one of these changes is surgery. Emotional reactions to surgery have specific effects on the intensity and velocity as well as the process of physical disease. In addition, they can cause delay in patients recovery. This study is aimed at determining the relationship between religious beliefs and preoperative anxiety. This survey is a correlational study to assess the relationship between religious beliefs and preoperative anxiety of patients undergoing abdominal, orthopaedic, and gynaecologic surgery in educational hospitals. We used the convenience sampling method. The data collection instruments included a questionnaire containing the Spielberger State-Trait Anxiety Inventory (STAI), and another questionnaire formulated by the researcher with queries on religious beliefs and demographic characteristics as well as disease-related information. Analysis of the data was carried out with SPSS software using descriptive and inferential statistics. Results were arranged in three tables. The findings showed that almost all the subjects had high level of religiosity and moderate level of anxiety. In addition, there was an inverse relationship between religiosity and intensity of anxiety, though this was not statistically significant. The results of this study can be used as evidence for presenting religious counselling and spiritual interventions for individuals undergoing stress. Finally, based on the results of this study, the researcher suggested some recommendations for applying results and conducting further research.

  3. Evaluation of Artisan aphakic intraocular lens in cases of pediatric aphakia with insufficient capsular support.

    Science.gov (United States)

    Gawdat, Ghada I; Taher, Sameh G; Salama, Marwa M; Ali, Adel A

    2015-06-01

    To evaluate the visual outcomes and complications after Artisan iris-claw lens implantation in aphakic children with insufficient capsular support. In this prospective, interventional noncontrolled study, aphakic eyes of consecutive patients >2 years of age with insufficient capsular support who underwent Artisan intraocular lens (IOL) implantation between June 2011 and December 2012 were followed for 1 year. Patients with anterior chamber depth IOL were included, 18 eyes with subluxated lens and 7 following trauma. The mean preoperative logMAR best-corrected visual acuity for traumatic aphakic patients was 0.95 ± 0.36; for patients with subluxation, 0.7 ± 0.26. Values improved at 1 year to 0.38 ± 0.15 (P IOL implantation for pediatric aphakia achieved a good visual outcome. Copyright © 2015 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.

  4. Study of acute renal insufficiency and chronic renal insufficiency using radioisotopes

    International Nuclear Information System (INIS)

    Raynaud, C.

    1976-01-01

    Radioisotopic renal function tests are of assistance to diagnose and follow-up the course of renal insufficiency. The radioisotopic renogram is useful in assessing the response to therapy of child obstructive uropathies and evaluating renal transplant function. The renal scan is helpful, in an emergency service, to differenciate chronic renal insufficiency from acute renal insufficiency. Hg renal uptake test provides informations on physiopathological problems. Among them, the following problems are emphasized: evolution of a nonfunctioning kidney, control of the success of a reparative surgery and of bilateral obstructive uropathies with unilateral symptoms [fr

  5. Predictive factors of endocrine and exocrine insufficiency after resection of a benign tumour of the pancreas.

    Science.gov (United States)

    Neophytou, Hélène; Wangermez, Marc; Gand, Elise; Carretier, Michel; Danion, Jérôme; Richer, Jean-Pierre

    2018-04-01

    The aim of the present study is to evaluate the risk factors of endocrine and exocrine insufficiency occurring few years after pancreatic resections in a consecutive series of patients who underwent pancreatoduodenectomy (PD), left pancreatectomy (LP) or enucleation for benign neoplasms at a referral centre. Pancreatic exocrine insufficiency (PEI) was defined by the onset of steatorrhea associated with weight loss, and endocrine insufficiency was determinate by fasting plasma glucose. Association between pancreatic insufficiency and clinical, pathological, and perioperative features was studied using univariate and multivariate Cox regression analysis. A prospective cohort of 92 patients underwent PD (48%), LP (44%) or enucleation (8%) for benign tumours, from 2005 to 2016 in the University Hospital in Poitiers (France). The median follow-up was 68.6±42.4months. During the following, 54 patients developed exocrine insufficiency whereas 32 patients presented endocrine insufficiency. In the Cox model, a BMI>28kg/m 2 , being a man and presenting a metabolic syndrome were significantly associated with a higher risk to develop postoperative diabetes. The risks factors for the occurrence of PEI were preoperative chronic pancreatitis, a BMIpancreatic head, biological markers of chronic obstruction and fibrotic pancreas. Undergoing LP or enucleation were protective factors of PEI. Histological categories such as neuroendocrine tumours and cystadenomas were also associated with a decreased incidence of PEI. Men with metabolic syndrome and obesity should be closely followed-up for diabetes, and patients with obstructive tumours, pancreatic fibrosis or chronic pancreatitis require a vigilant follow up on their pancreatic exocrine function. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  6. Clinicoroentgenological diagnosis of chronic venous ovarian insufficiency

    International Nuclear Information System (INIS)

    Grakova, L.S.; Galkin, E.V.; Naumova, E.B.

    1989-01-01

    The paper is devoted to clinicoroentgenological correlations of venous renogonadal hemodynamics in 168 women of reproductive age (151 women with infertility, habitual abortion, disordered menstrual function and 17 patients without disorders of the reproductive tract). Clinicolaboratory investigation was followed by visceral and parietal flebography for the detection of a pathological venous reflux into the ovarian pampiniform plexus. Clinicoroentgenological semiotics of chronic venous ovarian insufficiency was analyzed. Infertility was shown to be the main clinical manifestation of ovarian varicocele

  7. Homeostatic responses to amino acid insufficiency

    Directory of Open Access Journals (Sweden)

    Tracy G. Anthony

    2015-09-01

    Full Text Available This article provides a brief overview describing how two key signaling pathways, namely the integrated stress response and the mammalian target of rapamycin complex 1, work together to facilitate cellular adaptation to dietary amino acid insufficiency. A deeper understanding of these mechanisms is leading to identification of novel targets which aid in disease treatments, improve stress recovery and increase health span through slowed aging and enhanced metabolic fitness.

  8. Diagnosis and management of pancreatic exocrine insufficiency.

    Science.gov (United States)

    Nikfarjam, Mehrdad; Wilson, Jeremy S; Smith, Ross C

    2017-08-21

    In 2015, the Australasian Pancreatic Club (APC) published the Australasian guidelines for the management of pancreatic exocrine insufficiency (http://pancreas.org.au/2016/01/pancreatic-exocrine-insufficiency-guidelines). Pancreatic exocrine insufficiency (PEI) occurs when normal digestion cannot be sustained due to insufficient pancreatic digestive enzyme activity. This may be related to a breakdown, at any point, in the pancreatic digestive chain: pancreatic stimulation; synthesis, release or transportation of pancreatic enzymes; or synchronisation of secretions to mix with ingested food. Main recommendations: The guidelines provide advice on diagnosis and management of PEI, noting the following: A high prevalence of PEI is seen in certain diseases and conditions, such as cystic fibrosis, acute and chronic pancreatitis, pancreatic cancer and pancreatic surgery. The main symptoms of PEI are steatorrhoea or diarrhoea, abdominal pain, bloating and weight loss. These symptoms are non-specific and often go undetected and untreated. PEI diagnosis is predominantly based on clinical findings and the presence of underlying disease. The likelihood of PEI in suspected patients has been categorised into three groups: definite, possible and unlikely. If left untreated, PEI may lead to complications related to fat malabsorption and malnutrition, and have an impact on quality of life. Pancreatic enzyme replacement therapy (PERT) remains the mainstay of PEI treatment with the recommended adult initial enzyme dose being 25 000-40 000 units of lipase per meal, titrating up to a maximum of 75 000-80 000 units of lipase per meal. Adjunct acid-suppressing therapy may be useful when patients still experience symptoms of PEI on high dose PERT. Nutritional management by an experienced dietitian is essential. Changes in management as a result of these guidelines: These are the first guidelines to classify PEI as being definite, possible or unlikely, and provide a diagnostic algorithm to

  9. Chronic Heroin Dependence Leading to Adrenal Insufficiency

    Directory of Open Access Journals (Sweden)

    Gautam Das

    2014-01-01

    Full Text Available Opioids have been the mainstay for pain relief and palliation over a long period of time. They are commonly abused by drug addicts and such dependence usually imparts severe physiologic effects on multiple organ systems. The negative impact of opioids on the endocrine system is poorly understood and often underestimated. We describe a patient who developed severe suppression of the hypothalamic-pituitary adrenal (HPA axis leading to secondary adrenal insufficiency due to long standing abuse of opioids.

  10. Pancreatic Exocrine Insufficiency in Pancreatic Cancer

    Directory of Open Access Journals (Sweden)

    Miroslav Vujasinovic

    2017-02-01

    Full Text Available Abstract: Cancer patients experience weight loss for a variety of reasons, commencing with the tumor’s metabolism (Warburg effect and proceeding via cachexia to loss of appetite. In pancreatic cancer, several other factors are involved, including a loss of appetite with a particular aversion to meat and the incapacity of the pancreatic gland to function normally when a tumor is present in the pancreatic head. Pancreatic exocrine insufficiency is characterized by a deficiency of the enzymes secreted from the pancreas due to the obstructive tumor, resulting in maldigestion. This, in turn, contributes to malnutrition, specifically a lack of fat-soluble vitamins, antioxidants, and other micronutrients. Patients with pancreatic cancer and pancreatic exocrine insufficiency have, overall, an extremely poor prognosis with regard to surgical outcome and overall survival. Therefore, it is crucial to be aware of the mechanisms involved in the disease, to be able to diagnose pancreatic exocrine insufficiency early on, and to treat malnutrition appropriately, for example, with pancreatic enzymes.

  11. Household food insufficiency is associated with dietary intake in Korean adults.

    Science.gov (United States)

    Lee, Sang Eun; Song, Yoon Ju; Kim, Young; Choe, Jeongsook; Paik, Hee-Young

    2016-04-01

    To examine the association of food insufficiency with dietary intake and eating and health behaviours. A cross-sectional study. Data were obtained from a secondary source, the Fifth Korea National Health and Nutrition Examination Survey (2010-2012). The sample size consisted of 15 603 adults over 19 years of age (8898 households). Significant differences in socio-economic factors were observed according to food insufficiency level (Pfood-insufficient group, but we found no association with fat intake. Regarding micronutrients, Ca, Fe, vitamin A, thiamin, riboflavin niacin and vitamin C intakes were negatively associated with food insufficiency level (P trendfood groups, such as meat, fish, eggs and beans, vegetables and fruits, was significantly lower as food insufficiency level decreased after controlling for all possible variables; food group consumption also differed by sex. Overall eating and health behaviours were poorer in the mildly and severely food-insufficient groups, who received more food assistance but less nutritional education. Our results showed that dietary intake as well as eating and health behaviours are adversely associated with food insufficiency. These findings suggest that specific strategies to help food-insufficient individuals should be developed in order to improve their dietary quality and health status.

  12. Preoperative irradiation of hypernephroid carcinoma

    International Nuclear Information System (INIS)

    Akbar, D.

    1982-01-01

    Since 1969, preoperative irradiation of hypernephiroid carcinoma has been a routine measure at the Steglitz medical clinic: It consists in the application of a focal dose of 30 Gy, fractionated into doses of 2.5 Gy, as Betatron pendulum irradiation (42 MeV photons) covering the para-aortic lymph nodes. After a treatment-free interval of 3 weeks, radical nephrectomy is carried through. Of 178 patients, 47 were in tumor stage I, 15 in stage II, 83 in stage III and 33 in stage IV. In 99 patients the treatment dated back longer than 5 years; the survival rate was 52%. 67% of the patients had survived longer than 3 years. Operation lethality was 3%. The preoperative irradiation pursues the following aims: 1. Devitalization of potentially proliferating cells in the tumor periphery, and thus prevention of displaced tumor cells growing on and postoperative local recidivations; 2. Shrinking of the tumor, facilitating the surgical intervention. In a third of the cases a measurable alteration of the tumor was confirmed by X-ray. The low operation lethality of 3% is attributed to this. (orig./MG) [de

  13. Preoperative embolization of gigantic meningioma

    International Nuclear Information System (INIS)

    Wang Hongsheng; Chen Huaqun; Dong Congsong; Li Wenhui; Dai Zhenyu; Chen Guozhi

    2006-01-01

    Objective: To evaluate the clinical efficacy of preoperative embolization in treatment of patients with gigantic meningioma. Methods: Fourteen cases of gigantic meningioma diameter from 6 to 11 cm were measured by CT and MRI scan. DSA manifested that they are vascularizd meningioma and showed the mainly feeding arteries. We used getation sponge to superselectively embilized the feeding arteries. All tumors were performed surgical excision 3-7 days after the embolization. Results: DSA showed the blood supplies in the tumors in 9 cases were completely blocked, and that in 5 cases were dramatically eliminated. All patients were operated 3-7 days after the embolization. During the operations the bleeding were dramatically decreased and the operation time was shortened compared with those in unembolized cases. It helps us remove the tumors easy and quickly from the attachments. No complication occurred during and after the operations. Conclusion: Preoperative embolization of gigantic meningioma is a useful and relatively safe method in helping surgicaly and completely excised of tumor with significant reduction of blood loss and operation time. (authors)

  14. Preoperative embolization of facial angiomas

    International Nuclear Information System (INIS)

    Causmano, F.; Bruschi, G.; De Donatis, M.; Piazza, P.; Bassi, P.

    1988-01-01

    Preoperative embolization was performed on 27 patients with facial angiomas supplied by the external carotid branches. Sixteen were males and 11 females; 13 of these angiomas were high-flow arterio-venous (A-V), 14 were low-flow capillary malformations. Fourteen patients underwent surgical removal after preoperative embolization; in this group embolization was carried out with Spongel in 3 cases and with Lyodura in 11 cases. In 12 of these patients the last angiographic examination was performed 3-6 years later: angiography evidenced no recurrence in 8 cases (67%), while in 3 cases (25%) there was capillary residual angioma of negligible size. Treatment was unsuccessful in one patient only, due to the large recurrent A-V angioma. Thirteen patients underwent embolization only, which was carried out with Lyodura in 10 cases, and with Ivalon in 3 cases. On 12 of these patients the last angiographic study was performed 2-14 months later: there was recurrent A-V angioma in 5 patients (42%), who underwent a subsequent embolization; angiography evidenced no recurrence in the other 7 patients (58%). In both series, the best results were obtained in the patients with low-flow capillary angiomas. Embolization and subsequent surgical removal are the treatment of choice for facial angiomas; embolization alone is useful in the management of surgically inacessible vascular malformations, and it can be the only treatment in patients with small low-flow angiomas when distal occlusion of the feeding vessel with Lyodura or Ivalon particles is performed

  15. Pre-operative optimisation of lung function

    Directory of Open Access Journals (Sweden)

    Naheed Azhar

    2015-01-01

    Full Text Available The anaesthetic management of patients with pre-existing pulmonary disease is a challenging task. It is associated with increased morbidity in the form of post-operative pulmonary complications. Pre-operative optimisation of lung function helps in reducing these complications. Patients are advised to stop smoking for a period of 4–6 weeks. This reduces airway reactivity, improves mucociliary function and decreases carboxy-haemoglobin. The widely used incentive spirometry may be useful only when combined with other respiratory muscle exercises. Volume-based inspiratory devices have the best results. Pharmacotherapy of asthma and chronic obstructive pulmonary disease must be optimised before considering the patient for elective surgery. Beta 2 agonists, inhaled corticosteroids and systemic corticosteroids, are the main drugs used for this and several drugs play an adjunctive role in medical therapy. A graded approach has been suggested to manage these patients for elective surgery with an aim to achieve optimal pulmonary function.

  16. Preoperative patient education: evaluating postoperative patient outcomes.

    Science.gov (United States)

    Meeker, B J

    1994-04-01

    Preoperative teaching is an important part of patient care and can prevent complications, as well as promote patient fulfillment during hospitalization. A study was conducted at Alton Ochsner Medical Foundation in New Orleans, LA, in 1989, to determine the impact of a preoperative teaching program on the incidence of postoperative atelectasis and patient satisfaction. Results showed no significant difference of postoperative complications and patient gratification after participating in a structured preoperative teaching program. As part of this study, it was identified that a patient evaluation tool for a preoperative teaching class needed to be developed. The phases of this process are explained in the following article.

  17. Endovascular therapy for chronic cerebrospinal venous insufficiency in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Marc A. Lazzaro

    2011-07-01

    Full Text Available Recent reports have emerged suggesting that multiple sclerosis (MS may be due to abnormal venous outflow from the central nervous system, termed Chronic Cerebrospinal Venous Insufficiency (CCSVI. These reports have generated strong interest and controversy over the prospect of a treatable cause of this chronic debilitating disease. This review aims to describe the proposed association between CCSVI and MS, summarize the current data, and discuss the role of endovascular therapy and the need for rigorous randomized clinical trials to evaluate this association and treatment.

  18. Interventions for preoperative smoking cessation

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Villebro, Nete; Møller, Ann Merete

    2010-01-01

    a smoking cessation intervention, and measured preoperative and long-term abstinence from smoking and/or the incidence of postoperative complications. Data collection and analysis The authors independently assessed studies to determine eligibility. Results were discussed between the authors. Main results...... Eight trials enrolling a total of 1156 people met the inclusion criteria. One of these did not report cessation as an outcome. Two trials initiated multisession face to face counselling at least 6 weeks before surgery whilst six used a brief intervention. Nicotine replacement therapy (NRT) was offered......; pooled RR 10.76 (95% confidence interval (CI) 4.55 to 25.46, two trials) and RR 1.41 (95% CI 1.22 to 1.63, five trials) respectively. Four trials evaluating the effect on long-term smoking cessation found a significant effect; pooled RR 1.61 (95% CI 1.12 to 2.33). However, when pooling intensive...

  19. Nasopharyngeal pushback in treatment of velopharyngeal insufficiency.

    Science.gov (United States)

    Smith, H W; Lee, K J

    1976-02-01

    We describe a new technique for extensive retropositioning of the soft palate for the treatment of velopharyngeal insufficiency. This technique is identified as a nasopharyngeal pushback, and has been used repeatedly in conjunction with both a Cronin nasal flap and a superiorly based pharyngeal flap when maximum retropositioning was needed. This procedure has been used for over ten years, each time obtaining an additional pushback distance equal to or greater than the distance achieved by freeling the soft palate from the posterior border of the hard palate.

  20. Various musculoskeletal manifestations of chronic renal insufficiency

    International Nuclear Information System (INIS)

    Lim, C.Y.; Ong, K.O.

    2013-01-01

    Musculoskeletal manifestations in chronic renal insufficiency are caused by complex bone metabolism alterations, now described under the umbrella term of chronic kidney disease mineral- and bone-related disorder (CKD-MBD), as well as iatrogenic processes related to renal replacement treatment. Radiological imaging remains the mainstay of disease assessment. This review aims to illustrate the radiological features of CKD-MBD, such as secondary hyperparathyroidism, osteomalacia, adynamic bone disease, soft-tissue calcifications; as well as features associated with renal replacement therapy, such as aluminium toxicity, secondary amyloidosis, destructive spondyloarthropathy, haemodialysis-related erosive arthropathy, tendon rupture, osteonecrosis, and infection

  1. Preoperative preparation of patients with pituitary gland disorders.

    Science.gov (United States)

    Malenković, Vesna; Gvozdenović, Ljiljana; Milaković, Branko; Sabljak, Vera; Ladjević, Nebojsa; Zivaljević, Vladan

    2011-01-01

    This paper presents the most common disorders of pituitary function: acromegaly, hypopituitarism, diabetes insipidus and syndrome similar to diabetes insipidus, in terms of their importance in preoperative preparation of patients. Pituitary function manages almost the entire endocrine system using the negative feedback mechanism that is impaired by these diseases. The cause of acromegaly is a pituitary adenoma, which produces growth hormone in adults. Primary therapy of acromegaly is surgical, with or without associated radiotherapy. If a patient with acromegaly as comorbidity prepares for non-elective neurosurgical operation, then it requires consultation with brain surgeons for possible delays of that operation and primary surgical treatment of pituitary gland. If operative treatment of pituitary gland is carried out, the preoperative preparation (for other surgical interventions) should consider the need for perioperative glucocorticoid supplementation. Panhypopituitarism consequences are different in children and adults and the first step in diagnosis is to assess the function of target organs. Change of electrolytes and water occurs in the case of pituitary lesions in the form of central or nephrogenic diabetes insipidus as a syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Preoperative preparation of patients with pituitary dysfunction should be multidisciplinary, whether it is a neurosurgical or some other surgical intervention. The aim is to evaluate the result of insufficient production of pituitary hormones (hypopituitarism), excessive production of adenohypophysis hormones (acromegaly, Cushing's disease and hyperprolactinemia) and the influence of pituitary tumours in surrounding structures (compression syndrome) and to determine the level of perioperative risk. Pharmacological suppressive therapy of the hyperfunctional pituitary disorders can have significant interactions with drugs used in the perioperative period.

  2. Inflammatory manifestations of experimental lymphatic insufficiency.

    Directory of Open Access Journals (Sweden)

    Raymond Tabibiazar

    2006-07-01

    Full Text Available BACKGROUND: Sustained lymph stagnation engenders a pathological response that is complex and not well characterized. Tissue inflammation in lymphedema may reflect either an active or passive consequence of impaired immune traffic. METHODS AND FINDINGS: We studied an experimental model of acute post-surgical lymphedema in the tails of female hairless, immunocompetent SKH-1 mice. We performed in vivo imaging of impaired immune traffic in experimental, murine acquired lymphatic insufficiency. We demonstrated impaired mobilization of immunocompetent cells from the lymphedematous region. These findings correlated with histopathological alterations and large-scale transcriptional profiling results. We found intense inflammatory changes in the dermis and the subdermis. The molecular pattern in the RNA extracted from the whole tissue was dominated by the upregulation of genes related to acute inflammation, immune response, complement activation, wound healing, fibrosis, and oxidative stress response. CONCLUSIONS: We have characterized a mouse model of acute, acquired lymphedema using in vivo functional imaging and histopathological correlation. The model closely simulates the volume response, histopathology, and lymphoscintigraphic characteristics of human acquired lymphedema, and the response is accompanied by an increase in the number and size of microlymphatic structures in the lymphedematous cutaneous tissues. Molecular characterization through clustering of genes with known functions provides insights into processes and signaling pathways that compose the acute tissue response to lymph stagnation. Further study of genes identified through this effort will continue to elucidate the molecular mechanisms and lead to potential therapeutic strategies for lymphatic vascular insufficiency.

  3. Suggestive Objects at Work

    DEFF Research Database (Denmark)

    Ratner, Helene Gad

    2009-01-01

    In Western secular societies, spiritual life is no longer limited to classical religious institutions but can also be found at workplace organizations. While spirituality is conventionally understood as a subjective and internal process, this paper proposes the concept of ‘suggestive objects......’, constructed by combining insights from Gabriel Tarde's sociology with Bruno Latour's actor-network theory, to theorize the material dimension of organizational spirituality. The sacred in organizations arises not from the internalization of collective values but through the establishment of material...... scaffolding. This has deep implications for our understanding of the sacred, including a better appreciation of the way that suggestive objects make the sacred durable, the way they organize it....

  4. Intraoperative Adrenal Insufficiency in a Patient with Prader-Willi Syndrome

    OpenAIRE

    Barbara, David W.; Hannon, James D.; Hartman, William R.

    2012-01-01

    Prader-Willi syndrome (PW) is a rare genetic disorder with multi-organ system involvement. These patients present many perioperative challenges including sleep-related breathing disorders, morbid obesity, thick salivary secretions, mental retardation, and difficult intravenous access. PW has been suggested to be associated with central adrenal insufficiency. We report a novel case of persistent severe hypotension from previously undiagnosed and asymptomatic adrenal insufficiency in a pediatri...

  5. Impaired anastomotic healing after preoperative radiotherapy ...

    African Journals Online (AJOL)

    Background. Patients with rectal carcinoma undergoing total mesorectal excision (TME) have a lower recurrence rate with preoperative radiotherapy (RT). The aim of this study was to assess the side-effects in patients who had preoperative RT compared with those who did not receive it (because of palliative resections, ...

  6. Preoperative Smoking Status and Postoperative Complications

    DEFF Research Database (Denmark)

    Pedersen, Marie Grønkjær; Eliasen, Marie; Skov-Ettrup, Lise Skrubbeltrang

    2014-01-01

    To systematically review and summarize the evidence of an association between preoperative smoking status and postoperative complications elaborated on complication type.......To systematically review and summarize the evidence of an association between preoperative smoking status and postoperative complications elaborated on complication type....

  7. Preoperative breast radiation therapy: Indications and perspectives

    DEFF Research Database (Denmark)

    Lightowlers, S V; Boersma, L J; Fourquet, A

    2017-01-01

    Preoperative breast radiation therapy (RT) is not a new concept, but older studies failed to change practice. More recently, there has been interest in revisiting preoperative RT using modern techniques. This current perspective discusses the indications, summarises the published literature and t...

  8. Patterns of Response After Preoperative Treatment in Gastric Cancer

    International Nuclear Information System (INIS)

    Diaz-Gonzalez, Juan A.; Rodriguez, Javier; Hernandez-Lizoain, Jose L.; Ciervide, Raquel; Gaztanaga, Miren; San Miguel, Inigo; Arbea, Leire; Aristu, J. Javier; Chopitea, Ana; Martinez-Regueira, Fernando; Valenti, Victor; Garcia-Foncillas, Jesus; Martinez-Monge, Rafael; Sola, Jesus J.

    2011-01-01

    Purpose: To analyze the rate of pathologic response in patients with locally advanced gastric cancer treated with preoperative chemotherapy with and without chemoradiation at our institution. Methods and Materials: From 2000 to 2007 patients were retrospectively identified who received preoperative treatment for gastric cancer (cT3-4/ N+) with induction chemotherapy (Ch) or with Ch followed by concurrent chemoradiotherapy (45 Gy in 5 weeks) (ChRT). Surgery was planned 4-6 weeks after the completion of neoadjuvant treatment. Pathologic assessment was used to investigate the patterns of pathologic response after neoadjuvant treatment. Results: Sixty-one patients were analyzed. Of 61 patients, 58 (95%) underwent surgery. The R0 resection rate was 87%. Pathologic complete response was achieved in 12% of the patients. A major pathologic response (<10% of residual tumor) was observed in 53% of patients, and T downstaging was observed in 75%. Median follow-up was 38.7 months. Median disease-free survival (DFS) was 36.5 months. The only patient-, tumor-, and treatment-related factor associated with pathologic response was the use of preoperative ChRT. Patients achieving major pathologic response had a 3-year actuarial DFS rate of 63%. Conclusions: The patterns of pathologic response after preoperative ChRT suggest encouraging intervals of DFS. Such a strategy may be of interest to be explored in gastric cancer.

  9. Genetics Home Reference: fragile X-associated primary ovarian insufficiency

    Science.gov (United States)

    ... Share: Email Facebook Twitter Home Health Conditions FXPOI Fragile X-associated primary ovarian insufficiency Printable PDF Open All ... Javascript to view the expand/collapse boxes. Description Fragile X-associated primary ovarian insufficiency ( FXPOI ) is a condition ...

  10. Cervical spondylosis: a rare and curable cause of vertebrobasilar insufficiency.

    Science.gov (United States)

    Denis, Daniel J; Shedid, Daniel; Shehadeh, Mohammad; Weil, Alexander G; Lanthier, Sylvain

    2014-05-01

    Spondylotic vertebral artery (VA) compression is a rare cause of vertebrobasilar insufficiency and stroke. A 53-year-old man experienced multiple brief vertebrobasilar transient ischemic attacks (TIAs) and strokes, not apparently triggered by neck movements. Brain magnetic resonance imaging (MRI) documented consecutive infarcts, first in the left then right medial posterior inferior cerebellar artery (PICA) territories. Angiography showed two extracranial right vertebral artery (VA) stenoses, left VA hypoplasia, absence of left PICA and a dominant right PICA. Computed tomography angiography revealed right VA compression by osteophytes at C5-C6 and C6-C7 levels. No further vertebrobasilar insufficiency symptoms occurred in the 65 months following VA surgical decompression. Our literature review found 49 published surgical cases with vertebrobasilar symptoms caused by cervical spondylosis. Forty cases had one or more brief TIAs frequently triggered by neck movements. Three cases presented with stroke without prior TIA, with symptoms suggesting a top of the basilar artery embolic infarcts (one combined with a PICA infarct). Six cases had both TIAs and minor stroke. VA compression by uncovertebral osteophytes at the C5-C6 level was common. Dynamic angiography done in 38 cases systematically revealed worsening of VA stenosis or complete occlusion with either neck extension or rotation (ipsilateral when specified). Contralateral VA incompetence was found in 14 patients. Spondylotic VA stenosis can cause hemodynamic TIAs and watershed strokes, especially when contralateral VA insufficiency is combined to specific neck movements. Low-amplitude neck movement may suffice in severe cases. Embolic vertebrobasilar events are less frequent. VA decompression from spondylosis may prevent recurrent ischemic episodes.

  11. Insufficient incentives for investment in electricity generations

    Energy Technology Data Exchange (ETDEWEB)

    Neuhoff, K. [Cambridge University (United Kingdom). Dept. of Applied Economics; De Vries, L. [Delft University of Technology (Netherlands). Faculty of Technology, Policy and Management

    2004-12-01

    In theory, competitive electricity markets provide incentives for efficient investment in generation capacity. We show that if consumers and investors are risk averse, investment is efficient only if investors in generation capacity can sign long-term contracts with consumers. Otherwise the uncovered price risk increases financing costs, reduces equilibrium investment levels, distorts technology choice towards less capital-intensive generation and reduces consumer utility. We observe insufficient levels of long-term contracts in existing markets, possibly because retail companies are not credible counter-parties if their final customers can switch easily between them. With a consumer franchise, retailers can sign long-term contracts, but this solution comes at the expense of retail competition. Alternative capacity mechanisms to stimulate investment are discussed. (author)

  12. Ultrasound assessment of great saphenous vein insufficiency

    Directory of Open Access Journals (Sweden)

    Chander RK

    2015-06-01

    Full Text Available Rajiv K Chander,1 Thomas S Monahan1,2 1Section of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, 2Department of Surgery, Baltimore Veterans Affairs Medical Center, Baltimore, MD, USA Abstract: Duplex ultrasonography is the ideal modality to assess great saphenous vein insufficiency. Duplex ultrasonography incorporates both gray scale images to delineate anatomy and color-Doppler imaging that visualizes the flow of blood in a structure. Assessment of great saphenous vein requires definition of the anatomy, augmentation of flow, evaluation for both superficial and deep vein thrombosis, and determining the presence of reflux. Currently, evolution in the treatment of reflux also relies on ultrasound for the treatment of the disease. Understanding the utilization of the ultrasound for the diagnosis and treatment of greater saphenous vein reflux is important for practitioners treating reflux disease. Keywords: duplex ultrasonography, small saphenous vein 

  13. Fractures due to insufficient pelvic girdle

    International Nuclear Information System (INIS)

    Garcia Aguayo, F.J.; Martinez Almagro, A.

    1995-01-01

    Eleven cases are presented of postmenopausal women with a total of 37 fractures due to insufficient pelvic girdle: 15 located in sacrum, ten in the pubic rami, four in ilium proximal to the sacroiliac joint, three in iliac fossa, two in iliac tuberosity and three in the public body. Eight of the patients were diagnosed over a period of six years when seeking medical attention for bone pain. The other three were diagnosed retrospectively among a group of 33 cancer patients (the majority having having breast cancer) who presented positive pelvic radionuclide bone scan. CT was superior to conventional radiology in detecting fractures of this type, especially those of sacrum and ilium. Radionuclide bone scan was highly sensitive but its specificity was low, requiring back-up radiology and above all CT to establish the differential diagnosis with respect to other types of lesions, especially metastases. (Author) 14 refs

  14. Preoperative and postoperative serial assessments of postural balance and fall risk in patients with arthroscopic anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Gokalp, Oguzhan; Akkaya, Semih; Akkaya, Nuray; Buker, Nihal; Gungor, Harun R; Ok, Nusret; Yorukoglu, Cagdas

    2016-04-27

    Impaired postural balance due to somatosensory data loss with mechanical instability has been shown in patients with ACL deficiency. To assess postural balance in patients with ACL insufficiency prior to surgery and following reconstruction with serial evaluations. Thirty patients (mean age of 27.7 ± 6.7 years) who underwent arthroscopic reconstruction of ACL with bone-patellar tendon-bone autograft were examined for clinical and functional variables at preoperative day and postoperative 12th week. Posturographic analysis were performed by using Tetrax Interactive Balance System (Sunlight Medical Ltd, Israel) at preoperative day, at 4th, 8th, and 12th weeks following reconstruction. Data computed by posturographic software by the considerations of the oscillation velocities of body sways is fall risk as a numeric value (0-100, lower values indicate better condition). All of the patients (mean age of 27.7 ± 6.7 years) had significant improvements for clinical, functional evaluations and fall risk (pfall risk was within high-risk category (59.9 ± 22.8) preoperatively. The highest fall risk was detected at postoperative 4th week. Patients had high fall risk at 8th week similar to preoperative value. Mean fall risk decreased to low level risk at 12th week. Preoperative symptom duration had relationships with preoperative fall risk and postoperative improvement of fall risk (p= 0.001, r= -0.632, p= 0.001, r= -0.870, respectively). The improvement of fall risk was higher in patients with symptoms shorter than 6 months (p= 0.001). According to these results, mean fall risk of patients with ACL insufficiency was within high risk category preoperatively, and fall risk improves after surgical reconstruction, but as the duration of complaints lengthens especially longer than 6 months, the improvement of fall risk decreases following reconstruction.

  15. Insufficient sleep in adolescents: causes and consequences.

    Science.gov (United States)

    Owens, Judith A; Weiss, Miriam R

    2017-08-01

    Insufficient sleep poses an important and complicated set of health risks in the adolescent population. Not only is deficient sleep (defined as both sleep duration inadequate to meet sleep needs and sleep timing misaligned with the body's circadian rhythms) at epidemic levels in this population, but the contributing factors are both complex and numerous and there are a myriad of negative physical and mental health, safety and performance consequences. Causes of inadequate sleep identified in this population include internal biological processes such as the normal shift (delay) in circadian rhythm that occurs in association with puberty and a developmentally-based slowing of the "sleep drive", and external factors including extracurricular activities, excessive homework load, evening use of electronic media, caffeine intake and early school start times. Consequences range from inattentiveness, reduction in executive functioning and poor academic performance to increased risk of obesity and cardio-metabolic dysfunction, mood disturbances which include increased suicidal ideation, a higher risk of engaging in health risk behaviors such as alcohol and substance use, and increased rates of car crashes, occupational injuries and sports-related injuries. In response to these concerns, a number of promising measures have been proposed to reduce the burden of adolescent sleep loss, including healthy sleep education for students and families, and later school start times to allow adolescents to obtain sufficient and appropriately-timed sleep.

  16. Premature ovarian insufficiency: Pathogenesis and management

    Directory of Open Access Journals (Sweden)

    Anna J Fenton

    2015-01-01

    Full Text Available The term premature ovarian insufficiency (POI describes a continuum of declining ovarian function in a young woman, resulting in an earlier than average menopause. It is a term that reflects the variable nature of the condition and is substantially less emotive than the formerly used "premature ovarian failure" which signaled a single event in time. Contrary to the decline in the age of menarche seen over the last 3-4 decades there has been no similar change in the age of menopause. In developed nations, the average age for cessation of menstrual cycles is 50-52 years. The age is younger among women from developing nations. Much has been written about POI despite a lack of good data on the incidence of this condition. It is believed that 1% of women under the age of 40 years and 0.1% under the age of 30 years will develop POI. Research is increasingly providing information about the pathogenesis and treatments are being developed to better preserve ovarian function during cancer treatment and to improve fertility options. This narrative review summarizes the current literature to provide an approach to best practice management of POI.

  17. Can tricuspid annuloplasty of the donor heart reduce valve insufficiency following cardiac transplantation with bicaval anastomosis?

    Science.gov (United States)

    Fiorelli, Alfredo I; Oliveira, José L; Santos, Ronaldo H B; Coelho, Guilherme B; Oliveira, Adriana S; Lourenço-Filho, Domingos D; Lapenna, Gisele; Dias, Ricardo R; Bacal, Fernando; Bocchi, Edimar A; Stolf, Noedir A G

    2010-06-01

    The aim of this study was to evaluate the degree of tricuspid valve insufficiency after orthotopic cardiac transplantation with bicaval anastomosis and prophylactic donor heart annuloplasty. At present, our cardiac transplantation experience includes 478 cases. After January 2002, we included 30 consecutive patients in this study who had undergone orthotopic cardiac transplantation and survived >6 months. The patients were divided into 2 groups: group I, 15 patients who underwent transplantation with prophylactic tricuspid annuloplasty on the donor heart with the De Vega technique; and group II, 15 patients who underwent transplantation without this procedure. Their preoperative clinical characteristics were the same. During the late postoperative follow-up, the degree of tricuspid insufficiency was evaluated by transthoracic Doppler echocardiography and assessed according to the Simpson scale: 0, absent; 1, mild; 2, moderate; and 3, severe. Hemodynamic parameters were evaluated invasively by means of a Swan-Ganz catheter during routine endomyocardial biopsies. The mean follow-up time was 26.9 +/- 5.4 months (range, 12-36 months). In group I, 1 patient (6.6%) died from infection in the 18th month after the operation; the death was not related to the annuloplasty. In group II, 1 death (6.6%) occurred after 10 months because of rejection (P > .05). After the 24-month follow-up, the mean degree of tricuspid insufficiency was 0.4 +/- 0.5 in group I and 1.7 +/- 0.9 in group II (P tricuspid annuloplasty on the donor heart was able to reduce significantly the degree of valvular insufficiency, even in cardiac transplantation with bicaval anastomosis; however, it did not modify significantly the hemodynamic performance of the allograft during the investigation period. It is very important to extend the observation period and casuistics to verify other benefits that this technique may offer.

  18. 16. PRE-OPERATIVE BLADDER IRRIGATION

    African Journals Online (AJOL)

    Esem

    effectiveness of using preoperative bladder irrigation with 1% povidone iodine in reducing ... consenting patient who presented to the department of surgery for open ..... infections in a tertiary care center in south-western. Nigeria. International ...

  19. Preoperative bowel preparation in children: Polyethylene glycol ...

    African Journals Online (AJOL)

    Preoperative bowel preparation in children: Polyethylene glycol versus normal saline. ... In children, (is this standard of care?: this method is mostly followed) this is usually ... Patients and Methods: Thirty patients, admitted in the Department of ...

  20. Preoperative Alcohol Consumption and Postoperative Complications

    DEFF Research Database (Denmark)

    Eliasen, Marie; Grønkjær, Marie; Skov-Ettrup, Lise Skrubbeltrang

    2013-01-01

    OBJECTIVE:: To systematically review and summarize the evidence of the association between preoperative alcohol consumption and postoperative complications elaborated on complication type. BACKGROUND:: Conclusions in studies on preoperative alcohol consumption and postoperative complications have...... been inconsistent. METHODS:: A systematic review and meta-analysis based on a search in MEDLINE, EMBASE, CINAHL, and PsycINFO citations. Included were original studies of the association between preoperative alcohol consumption and postoperative complications occurring within 30 days of the operation.......30-2.49), prolonged stay at the hospital (RR = 1.24; 95% CI: 1.18-1.31), and admission to intensive care unit (RR = 1.29; 95% CI: 1.03-1.61). Clearly defined high alcohol consumption was associated with increased risk of postoperative mortality (RR = 2.68; 95% CI: 1.50-4.78). Low to moderate preoperative alcohol...

  1. Integrated preoperative irradiation and radical cystectomy

    International Nuclear Information System (INIS)

    Sagerman, R.H.; Yu, W.S.; Ryoo, M.C.; King, G.A.; Chung, C.T.; Emmanuel, I.G.

    1980-01-01

    Thirty patients with stage B 2 -C-D 1 and/or grade III-IV transitional cell carcinoma of the bladder were entered into a pilot study of integrated surgery and radiotherapy. Staging laparotomy with formation of an ileal loop preceded the delivery of 4000 to 5000 rad in 4 to 5 weeks to the pelvis; cystectomy was accomplished in 26 patients 4 to 8 weeks after completion of irradiation. The program was accomplished without undue difficulty and resulted in a lowering of the clinical stage in 22 of 26 patients; no residual invasive cancer was seen histologically in 8 patients. Although it was formidable, the morbidity rate was not significantly different than it was after cystectomy without preoperative irradiation. The short term survival rate, in conjunction with an analysis of sites of failure, suggests that a prospective study be accomplished to document the validity of this therapeutic approach to bladder cancer; patient selection, surgical technique, and time-dose-volume radiation factors should also be considered

  2. Perioperative management of endocrine insufficiency after total pancreatectomy for neoplasia.

    Science.gov (United States)

    Maker, Ajay V; Sheikh, Raashid; Bhagia, Vinita

    2017-09-01

    Indications for total pancreatectomy (TP) have increased, including for diffuse main duct intrapapillary mucinous neoplasms of the pancreas and malignancy; therefore, the need persists for surgeons to develop appropriate endocrine post-operative management strategies. The brittle diabetes after TP differs from type 1/2 diabetes in that patients have absolute deficiency of insulin and functional glucagon. This makes glucose management challenging, complicates recovery, and predisposes to hospital readmissions. This article aims to define the disease, describe the cause for its occurrence, review the anatomy of the endocrine pancreas, and explain how this condition differs from diabetes mellitus in the setting of post-operative management. The morbidity and mortality of post-TP endocrine insufficiency and practical treatment strategies are systematically reviewed from the literature. Finally, an evidence-based treatment algorithm is created for the practicing pancreatic surgeon and their care team of endocrinologists to aid in managing these complex patients. A PubMed, Science Citation Index/Social sciences Citation Index, and Cochrane Evidence-Based Medicine database search was undertaken along with extensive backward search of the references of published articles to identify studies evaluating endocrine morbidity and treatment after TP and to establish an evidence-based treatment strategy. Indications for TP and the etiology of pancreatogenic diabetes are reviewed. After TP, ~80% patients develop hypoglycemic episodes and 40% experience severe hypoglycemia, resulting in 0-8% mortality and 25-45% morbidity. Referral to a nutritionist and endocrinologist for patient education before surgery followed by surgical reevaluation to determine if the patient has the appropriate understanding, support, and resources preoperatively has significantly reduced morbidity and mortality. The use of modern recombinant long-acting insulin analogues, continuous subcutaneous insulin

  3. Preoperative Diagnosis of Adult Intussusception Caused by Small Bowel Lipoma

    Directory of Open Access Journals (Sweden)

    Hiroaki Shiba

    2009-11-01

    Full Text Available Adult intussusception is rare, accounting for only 5% of all intussusceptions, for which preoperative diagnosis is difficult. We herein report a preoperatively diagnosed case of adult intussusception caused by a small bowel lipoma. A 33-year-old man was admitted to our hospital with three weeks history of colicky epigastric pain. Computed tomography revealed thickening of the ileal wall suggestive of intussusception. Colonoscopy revealed an ileocolic intussusception. Barium enema for reduction of ileocolic intussusception demonstrated a small bowel tumor in the ileum 15 cm proximal to the ileocecal valve. The intussusception was reduced, and the patient underwent partial resection of the ileum encompassing the small bowel tumor. Histological findings confirmed the diagnosis of lipoma of the small bowel. The patient made a satisfactory recovery and remains well.

  4. Preoperative diagnosis of carcinoma within fibroadenoma on screening mammograms

    International Nuclear Information System (INIS)

    Borecky, N.; Rickard, M.

    2008-01-01

    Three cases of fibroadenoma associated with carcinoma are reported. These cases were diagnosed within a screening programme as a result of suspicious mammographic findings, and the diagnosis of malignancy was confirmed preoperatively by core biopsy in all cases. The mammographic findings suggestive of carcinoma within fibroadenoma were irregularity of margins in one case and associated new suspicious pleomorphic and linear calcifications in the two other cases. The preoperative diagnosis of carcinoma within fibroadenoma was provided by ultrasound-guided core biopsy in two cases and core biopsy under stereotactic guidance in one case. Whereas asymptomatic fibroadenoma with benign imaging appearances usually does not require further investigation, fibroadenoma with atypical imaging features requires a triple test investigation.

  5. [APPLICATION OF PHOTOSHOP CS16.0 SOFTWARE IN PREOPERATIVE OSTEOTOMY DESIGN OF ANKYLOSING SPONDYLITIS KYPHOSIS].

    Science.gov (United States)

    Wang, Fei; Tao, Huiren; Liu, Zhibin; Zhang, Jianhua; Han, Fangmin

    2015-02-01

    of internal fixation was found, and bony fusion was obtained. The preoperative osteotomy design by using PS software can precisely recover the spinal sagittal balance and horizontal angle of view, so it can effectively avoid excessive correction and insufficient correction of the deformity and obtain good effectiveness in treating ASK.

  6. The controversy on chronic cerebrospinal venous insufficiency

    Directory of Open Access Journals (Sweden)

    Paolo Zamboni

    2013-08-01

    Full Text Available The objective of this review is to analyze the actual scientific controversy on chronic cerebrospinal venous insufficiency (CCSVI and its association with both neurodegenerative disorders and multiple sclerosis (MS. We revised all published studies on prevalence of CCSVI in MS patients, including ultrasound and catheter venography series. Furthermore, we take into consideration other publications dealing with the pathophysiologic consequences of CCSVI in the brain, as well as ecent data characterizing the pathology of the venous wall in course of CCSVI. Finally, safety and pilot data on effectiveness of endovascular CCSVI treatment were further updated. Studies of prevalence show a big variability in prevalence of CCSVI in MS patients assessed by established ultrasonographic criteria. This could be related to high operator dependency of ultrasound. However, 12 studies, by the means of more objective catheter venography, show a prevalence >90% of CCSVI in MS. Global hypo-hypoperfusion of the brain, and reduced cerebral spinal fluid dynamics in MS was shown to be related to CCSVI. Postmortem studies and histology corroborate the 2009 International Union of Phlebology (UIP Consensus decision to insert CCSVI among venous malformations. Finally, safety of balloon angioplasty of the extracranial veins was certainly demonstrated, while prospective data on the potential effectiveness of endovascular treatment of CCSVI support to increase the level of evidence by proceeding with a randomized control trial (RCT. Taking into account the current epidemiological data, including studies on catheter venography, the autoptic findings, and the relationship between CCSVI and both hypo-perfusion and cerebro-spinal fluid flow, we conclude that CCSVI can be definitively inserted among the medical entities. Research is still inconclusive in elucidating the CCSVI role in the pathogenesis of neurological disorders. The controversy between the vascular and the

  7. Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis

    Science.gov (United States)

    Wylde, Vikki; Sayers, Adrian; Lenguerrand, Erik; Gooberman-Hill, Rachael; Pyke, Mark; Beswick, Andrew D.; Dieppe, Paul; Blom, Ashley W.

    2015-01-01

    Abstract Chronic pain after joint replacement is common, affecting approximately 10% of patients after total hip replacement (THR) and 20% of patients after total knee replacement (TKR). Heightened generalized sensitivity to nociceptive input could be a risk factor for the development of this pain. The primary aim of this study was to investigate whether preoperative widespread pain sensitivity was associated with chronic pain after joint replacement. Data were analyzed from 254 patients receiving THR and 239 patients receiving TKR. Pain was assessed preoperatively and at 12 months after surgery using the Western Ontario and McMaster Universities Osteoarthritis Pain Scale. Preoperative widespread pain sensitivity was assessed through measurement of pressure pain thresholds (PPTs) at the forearm using an algometer. Statistical analysis was conducted using linear regression and linear mixed models, and adjustments were made for confounding variables. In both the THR and TKR cohort, lower PPTs (heightened widespread pain sensitivity) were significantly associated with higher preoperative pain severity. Lower PPTs were also significantly associated with higher pain severity at 12 months after surgery in the THR cohort. However, PPTs were not associated with the change in pain severity from preoperative to 12 months postoperative in either the TKR or THR cohort. These findings suggest that although preoperative widespread pressure pain sensitivity is associated with pain severity before and after joint replacement, it is not a predictor of the amount of pain relief that patients gain from joint replacement surgery, independent of preoperative pain severity. PMID:25599300

  8. Pre-operative imaging of rectal cancer and its impact on surgical performance and treatment outcome.

    Science.gov (United States)

    Beets-Tan, R G H; Lettinga, T; Beets, G L

    2005-08-01

    To discuss the ability of pre-operative MRI to have a beneficial effect on surgical performance and treatment outcome in patients with rectal cancer. A description on how MRI can be used as a tool so select patients for differentiated neoadjuvant treatment, how it can be used as an anatomical road map for the resection of locally advanced cases, and how it can serve as a tool for quality assurance of both the surgical procedure and overall patient management. As an illustration the proportion of microscopically complete resections of the period 1993-1997, when there was no routine pre-operative imaging, is compared to that of the period 1998-2002, when pre-operative MR imaging was standardized. The proportion of R0 resections increased from 92.5 to 97% (p=0.08) and the proportion of resections with a lateral tumour free margin of >1mm increased from 84.4 to 92.1% (p=0.03). The incomplete resections in the first period were mainly due to inadequate surgical management of unsuspected advanced or bulky tumours, whereas in the second period insufficient consideration was given to extensive neoadjuvant treatment when the tumour was close to or invading the mesorectal fascia on MR. There are good indications that in our setting pre-operative MR imaging, along with other improvements in rectal cancer management, had a beneficial effect on patient outcome. Audit and discussion of the incomplete resections can lead to an improved operative and perioperative management.

  9. Cervical cerclage placement decreases local levels of proinflammatory cytokines in patients with cervical insufficiency.

    Science.gov (United States)

    Monsanto, Stephany P; Daher, Silvia; Ono, Erika; Pendeloski, Karen Priscilla Tezotto; Trainá, Évelyn; Mattar, Rosiane; Tayade, Chandrakant

    2017-10-01

    . Compared with normal women, patients with cervical insufficiency have elevated levels of proinflammatory cytokines in cervicovaginal fluid but not in serum, suggesting a dysregulation of the local immune environment. Cerclage intervention led to a significant decline in these proinflammatory cytokines, suggesting that cerclage may help reduce local inflammation in cervical insufficiency. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Renal tubular acidosis complicated with hyponatremia due to cortisol insufficiency

    OpenAIRE

    Izumi, Yuichiro; Nakayama, Yushi; Onoue, Tomoaki; Inoue, Hideki; Mukoyama, Masashi

    2015-01-01

    Adrenocortical insufficiency such as occurs in Addison's disease causes hyponatremia and renal tubular acidosis (RTA). Hyponatremia results from both aldosterone and cortisol insufficiency. RTA is due to aldosterone insufficiency. The involvement of cortisol in RTA is unclear. Here, we report a woman in her 70s who was admitted to our hospital with severe hyponatremia (106 mEq/l) and RTA. The patient exhibited low plasma cortisol levels with little response to rapid adrenocorticotropic hormon...

  11. [The role of magnetic resonance imaging to select patients for preoperative treatment in rectal cancer].

    Science.gov (United States)

    Rödel, Claus; Sauer, Rolf; Fietkau, Rainer

    2009-08-01

    Traditionally, the decision to apply preoperative treatment for rectal cancer patients has been based on the T- and N-category. Recently, the radial distance of the tumor to the circumferential resection margin (CRM) has been identified as an important risk factor for local failure. By magnetic resonance imaging (MRI) this distance can be measured preoperatively with high reliability. Thus, selected groups have started to limit the indication for preoperative therapy to tumors extending to - or growing within 1 mm from - the mesorectal fascia (CRM+). Pros and cons of this selected approach for preoperative treatment and first clinical results are presented. Prerequisites are the availability of modern high-resolution thin-section MRI technology as well as strict quality control of MRI and surgical quality of total mesorectal excision (TME). By selecting patients with CRM-positive tumors on MRI for preoperative therapy, only approximately 35% patients will require preoperative radiotherapy (RT) or radiochemotherapy (RCT). However, with histopathologic work-up of the resected specimen after primary surgery, the indication for postoperative RCT is given for a rather large percentage of patients, i.e., for pCRM+ (5-10%), intramesorectal or intramural excision (30-40%), pN+ (30-40%). Postoperative RCT, however, is significantly less effective and more toxic than preoperative RCT. A further point of concern is the assertion that patients, in whom a CRM-negative status is achieved by surgery alone, do not benefit from additional RT. Data of the Dutch TME trial and the British MRC (Medical Research Council) CR07 trial, however, suggest the reverse. To omit preoperative RT/RCT for CRM-negative tumors on MRI needs to be further investigated in prospective clinical trials. The German guidelines for the treatment of colorectal cancer 2008 continue to indicate preoperative RT/RCT based on the T- and N-category.

  12. The role of magnetic resonance imaging to select patients for preoperative treatment in rectal cancer

    International Nuclear Information System (INIS)

    Roedel, Claus; Sauer, Rolf; Fietkau, Rainer

    2009-01-01

    Background: Traditionally, the decision to apply preoperative treatment for rectal cancer patients has been based on the T- and N-category. Recently, the radial distance of the tumor to the circumferential resection margin (CRM) has been identified as an important risk factor for local failure. By magnetic resonance imaging (MRI) this distance can be measured preoperatively with high reliability. Thus, selected groups have started to limit the indication for preoperative therapy to tumors extending to - or growing within 1 mm from - the mesorectal fascia (CRM+). Methods: Pros and cons of this selected approach for preoperative treatment and first clinical results are presented. Prerequisites are the availability of modern high-resolution thin-section MRI technology as well as strict quality control of MRI and surgical quality of total mesorectal excision (TME). Results: By selecting patients with CRM-positive tumors on MRI for preoperative therapy, only approximately 35% patients will require preoperative radiotherapy (RT) or radiochemotherapy (RCT). However, with histopathologic work-up of the resected specimen after primary surgery, the indication for postoperative RCT is given for a rather large percentage of patients, i.e., for pCRM+ (5-10%), intramesorectal or intramural excision (30-40%), pN+ (30-40%). Postoperative RCT, however, is significantly less effective and more toxic than preoperative RCT. A further point of concern is the assertion that patients, in whom a CRM-negative status is achieved by surgery alone, do not benefit from additional RT. Data of the Dutch TME trial and the British MRC (Medical Research Council) CR07 trial, however, suggest the reverse. Conclusion: To omit preoperative RT/RCT for CRM-negative tumors on MRI needs to be further investigated in prospective clinical trials. The German guidelines for the treatment of colorectal cancer 2008 continue to indicate preoperative RT/RCT based on the T- and N-category. (orig.)

  13. Outcomes of tubeless percutaneous nephrolithotomy in patients with chronic renal insufficiency.

    Science.gov (United States)

    Etemadian, Masoud; Maghsoudi, Robab; Shadpour, Pejman; Ghasemi, Hadi; Shati, Mohsen

    2012-05-01

    We evaluated the outcomes of percutaneous nephrolithotomy in patients with chronic renal insufficiency. A total of 60 patients with a creatinine level greater than 1.5 mg/dL who underwent PCNL were included. Serum creatinine level, as a kidney function index, was assessed before and after the operation. The mean calculus size was 31.13 ± 9.38 mm. The mean pre-operative and 2-week postoperative serum creatinine levels were 2.43 ± 0.75 mg/dL and 2.08 ± 0.78 mg/dL, respectively. There was a significant difference between the pre-operative and postoperative creatinine levels in all postoperative days (days 1, 2, and 14). Fifty of the 60 patients (83.3%) were stone free. Ten patients (16.6%) developed postoperative fever. We can conclude that percutaneous nephrolithotomy seems to be a safe and effective therapeutic option for kidney calculi in patients with chronic kidney disease.

  14. Association of Velopharyngeal Insufficiency With Quality of Life and Patient-Reported Outcomes After Speech Surgery.

    Science.gov (United States)

    Bhuskute, Aditi; Skirko, Jonathan R; Roth, Christina; Bayoumi, Ahmed; Durbin-Johnson, Blythe; Tollefson, Travis T

    2017-09-01

    Patients with cleft palate and other causes of velopharyngeal insufficiency (VPI) suffer adverse effects on social interactions and communication. Measurement of these patient-reported outcomes is needed to help guide surgical and nonsurgical care. To further validate the VPI Effects on Life Outcomes (VELO) instrument, measure the change in quality of life (QOL) after speech surgery, and test the association of change in speech with change in QOL. Prospective descriptive cohort including children and young adults undergoing speech surgery for VPI in a tertiary academic center. Participants completed the validated VELO instrument before and after surgical treatment. The main outcome measures were preoperative and postoperative VELO scores and the perceptual speech assessment of speech intelligibility. The VELO scores are divided into subscale domains. Changes in VELO after surgery were analyzed using linear regression models. VELO scores were analyzed as a function of speech intelligibility adjusting for age and cleft type. The correlation between speech intelligibility rating and VELO scores was estimated using the polyserial correlation. Twenty-nine patients (13 males and 16 females) were included. Mean (SD) age was 7.9 (4.1) years (range, 4-20 years). Pharyngeal flap was used in 14 (48%) cases, Furlow palatoplasty in 12 (41%), and sphincter pharyngoplasty in 1 (3%). The mean (SD) preoperative speech intelligibility rating was 1.71 (1.08), which decreased postoperatively to 0.79 (0.93) in 24 patients who completed protocol (P Speech Intelligibility was correlated with preoperative and postoperative total VELO score (P speech intelligibility. Speech surgery improves VPI-specific quality of life. We confirmed validation in a population of untreated patients with VPI and included pharyngeal flap surgery, which had not previously been included in validation studies. The VELO instrument provides patient-specific outcomes, which allows a broader understanding of the

  15. Preoperative thyroid function and weight loss after bariatric surgery.

    Science.gov (United States)

    Neves, João Sérgio; Souteiro, Pedro; Oliveira, Sofia Castro; Pedro, Jorge; Magalhães, Daniela; Guerreiro, Vanessa; Costa, Maria Manuel; Bettencourt-Silva, Rita; Santos, Ana Cristina; Queirós, Joana; Varela, Ana; Freitas, Paula; Carvalho, Davide

    2018-05-16

    Thyroid function has an important role on body weight regulation. However, the impact of thyroid function on weight loss after bariatric surgery is still largely unknown. We evaluated the association between preoperative thyroid function and the excess weight loss 1 year after surgery, in 641 patients with morbid obesity who underwent bariatric surgery. Patients with a history of thyroid disease, treatment with thyroid hormone or antithyroid drugs and those with preoperative evaluation consistent with overt hypothyroidism or hyperthyroidism were excluded. The preoperative levels of TSH and FT4 were not associated with weight loss after bariatric surgery. The variation of FT3 within the reference range was also not associated with weight loss. In contrast, the subgroup with FT3 above the reference range (12.3% of patients) had a significantly higher excess weight loss than patients with normal FT3. This difference remained significant after adjustment for age, sex, BMI, type of surgery, TSH and FT4. In conclusion, we observed an association between high FT3 and a greater weight loss after bariatric surgery, highlighting a group of patients with an increased benefit from this intervention. Our results also suggest a novel hypothesis: the pharmacological modulation of thyroid function may be a potential therapeutic target in patients undergoing bariatric surgery.

  16. Oral rehydration therapy for preoperative fluid and electrolyte management.

    Science.gov (United States)

    Taniguchi, Hideki; Sasaki, Toshio; Fujita, Hisae

    2011-01-01

    Preoperative fluid and electrolyte management is usually performed by intravenous therapy. We investigated the safety and effectiveness of oral rehydration therapy (ORT) for preoperative fluid and electrolyte management of surgical patients. The study consisted of two studies, designed as a prospective observational study. In a pilot study, 20 surgical patients consumed 1000 mL of an oral rehydration solution (ORS) until 2 h before induction of general anesthesia. Parameters such as serum electrolyte concentrations, fractional excretion of sodium (FENa) as an index of renal blood flow, volume of esophageal-pharyngeal fluid and gastric fluid (EPGF), and patient satisfaction with ORT were assessed. In a follow-up study to assess the safety of ORT, 1078 surgical patients, who consumed ORS until 2 h before induction of general anesthesia, were assessed. In the pilot study, water, electrolytes, and carbohydrate were effectively and safely supplied by ORT. The FENa value was increased at 2 h following ORT. The volume of EPGF collected following the induction of anesthesia was 5.3±5.6 mL. In the follow-up study, a small amount of vomiting occurred in one patient, and no aspiration occurred in the patients. These results suggest that ORT is a safe and effective therapy for the preoperative fluid and electrolyte management of selected surgical patients.

  17. Preoperative Site Marking: Are We Adhering to Good Surgical Practice?

    Science.gov (United States)

    Bathla, Sonia; Chadwick, Michael; Nevins, Edward J; Seward, Joanna

    2017-06-29

    Wrong-site surgery is a never event and a serious, preventable patient safety incident. Within the United Kingdom, national guidance has been issued to minimize the risk of such events. The mandate includes preoperative marking of all surgical patients. This study aimed to quantify regional variation in practice within general surgery and opinions of the surgeons, to help guide the formulation and implementation of a regional general surgery preoperative marking protocol. A SurveyMonkey questionnaire was designed and distributed to 120 surgeons within the Mersey region, United Kingdom. This included all surgical trainees in Mersey (47 registrars, 56 core trainees), 15 consultants, and 2 surgical care practitioners. This sought to ascertain their routine practice and how they would choose to mark for 12 index procedures in general surgery, if mandated to do so. A total of 72 responses (60%) were obtained to the SurveyMonkey questionnaire. Only 26 (36.1%) said that they routinely marked all of their patients preoperatively. The operating surgeon marked the patient in 69% of responses, with the remainder delegating this task. Markings were visible after draping in only 55.6% of marked cases. Based on our findings, surgeons may not be adhering to "Good Surgical Practice"; practice is widely variable and surgeons are largely opposed and resistant to marking patients unless laterality is involved. We suggest that all surgeons need to be actively engaged in the design of local marking protocols to gain support, change practice, and reduce errors.

  18. Prevalence of Convergence Insufficiency-Type Symptomatology in Parkinson's Disease.

    Science.gov (United States)

    Law, Caroline; Chriqui, Estefania; Kergoat, Marie-Jeanne; Leclerc, Bernard-Simon; Panisset, Michel; Irving, Elizabeth L; Postuma, Ronald B; Chouinard, Sylvain; Kergoat, Hélène

    2017-09-01

    Individuals with Parkinson's disease (PD) often present with visual symptoms (e.g., difficulty in reading, double vision) that can also be found in convergence insufficiency (CI). Our objective was to estimate the prevalence of CI-type visual symptomatology in individuals with PD, in comparison with controls. Participants ≥50 years with (n=300) and without (n=300) PD were recruited. They were administered the Convergence Insufficiency Symptom Survey (CISS-15) over the phone. A score of ≥21 on the CISS-15, considered positive for CI-type symptomatology, served as the cutoff. Data from individuals (n=87 with, n=94 without PD) who were approached but who reported having a known oculovisual condition were analysed separately. Student's t test and chi-square at the 0.05 level were employed for statistical significance. A total of 29.3% of participants with versus 7.3% without PD presented with a score of ≥21 on the CISS-15 (p=0.001). Of the participants having a known oculovisual condition, 39.1% with versus 19.1% without PD presented with a score of ≥21 on the CISS-15 (p=0.01). The prevalence of CI-type visual symptoms is higher in individuals with versus without PD whether or not they have a coexisting oculovisual condition. These results suggest that PD per se places individuals with the disease at greater risk of visual symptomatology. These results further underline the importance of providing regular eye exams for individuals with PD.

  19. Preoperative chemoradiation using oral capecitabine in locally advanced rectal cancer

    International Nuclear Information System (INIS)

    Kim, Jun-Sang; Kim, Jae-Sung; Cho, Moon-June; Song, Kyu-Sang; Yoon, Wan-Hee

    2002-01-01

    Purpose: Capecitabine (Xeloda) is a new orally administered fluoropyrimidine carbamate that was rationally designed to exert its effect by tumor-selective activation. We attempted to evaluate the efficacy and toxicity of preoperative chemoradiation using capecitabine in locally advanced rectal cancer. Methods and Materials: Between July 1999 and March 2001, 45 patients with locally advanced rectal cancer (cT3/T4 or N+) were treated with preoperative chemoradiation. Radiation of 45 Gy/25 fractions was delivered to the pelvis, followed by a 5.4 Gy/3 fractions boost to the primary tumor. Chemotherapy was administered concurrent with radiotherapy and consisted of 2 cycles of 14-day oral capecitabine (1650 mg/m 2 /day) and leucovorin (20 mg/m 2 /day), each of which was followed by a 7-day rest period. Surgery was performed 6 weeks after the completion of chemoradiation. Results: Thirty-eight patients received definitive surgery. Primary tumor and node downstaging occurred in 63% and 90% of patients, respectively. The overall downstaging rate, including both primary tumor and nodes, was 84%. A pathologic complete response was achieved in 31% of patients. Twenty-one patients had tumors located initially 5 cm or less from the anal verge; among the 18 treated with surgery, 72% received sphincter-preserving surgery. No Grade 3 or 4 hematologic toxicities developed. Other Grade 3 toxicities were as follows: hand-foot syndrome (7%), fatigue (4%), diarrhea (4%), and radiation dermatitis (2%). Conclusion: These preliminary results suggest that preoperative chemoradiation with capecitabine is a safe, well-tolerated, and effective neoadjuvant treatment modality for locally advanced rectal cancer. In addition, this preoperative treatment has a considerable downstaging effect on the tumor and can increase the possibility of sphincter preservation in distal rectal cancer

  20. Association between vitamin D insufficiency and elevated serum uric acid among middle-aged and elderly Chinese Han women.

    Directory of Open Access Journals (Sweden)

    Hao Peng

    Full Text Available BACKGROUND: Association between vitamin D insufficiency and hyperuricemia has not been reported so far. We aimed to study the association of vitamin D insufficiency with elevated serum uric acid among middle-aged and elderly Chinese Han women. METHODS: We collected data from participants residing in Jinchang district of Suzhou from January to May, 2010. Serum uric acid, 25-hydroxy vitamin D and other traditional biomarkers including fasting plasma glucose and blood lipids were determined in 1726 women aged above 30 years. Association between vitamin D insufficiency and elevated uric acid was analyzed in premenopausal and postmenopausal women, respectively. RESULTS: Among postmenopausal women, 25-hydroxy vitamin D level of participants with elevated uric acid was lower than that of those with normal uric acid (median [interquartile range]: 35[28-57] vs 40[32-58], µg/L; P = 0.006. Elevated uric acid was more prevalent in participants with vitamin D insufficiency compared to those without vitamin D insufficiency (16.50% vs 8.08%; P<0.001. Association between vitamin D insufficiency and elevated uric acid was not significant among premenopausal women. However, participants with vitamin D insufficiency were more likely to have elevated uric acid compared with those without vitamin D insufficiency among postmenopausal women (OR, 95% CI: 2.38, 1.47-3.87. Moreover, after excluding individuals with diabetes and/or hypertension, the association of vitamin D insufficiency with elevated uric acid was still significant (OR, 95% CI: 2.48, 1.17-5.44. CONCLUSIONS: Vitamin D insufficiency was significantly associated with elevated uric acid among postmenopausal Chinese Han women. This study suggested that a clinical trial should be conducted to confirm the association of vitamin D insufficiency with hyperuricemia.

  1. Autologous fat injection combined with palatoplasty and pharyngoplasty for velopharyngeal insufficiency and cleft palate: preliminary experience.

    Science.gov (United States)

    Cao, Yimei; Ma, Tingting; Wu, Di; Yin, Ningbei; Zhao, Zhenmin

    2013-08-01

    The aim was to evaluate clinical application of autologous fat transplantation in the posterior pharynx to treat velopharyngeal incompetence and cleft palate. Case series with chart review. Cleft Lip and Palate Center of Plastic Surgery Hospital, an academic medical center. We studied 11 patients (age, 5-26 years) with a cleft palate and velopharyngeal insufficiency who underwent autologous fat injection. Patients were followed for 9 to 40 months. Pronunciation evaluation, visual appearance of the palatopharyngeal area, nasopharyngeal fibroscopy (NPF), palatopharyngeal lateral radiography, and magnetic resonance imaging (MRI) were undertaken before and after the operation. Speech intelligibility was markedly increased in all patients. Pronunciation was good to excellent compared with the preoperative level (P = .001). Mean velopharyngeal insufficiency rate was significantly reduced from 26.05% to 6.96% (P = .028) by NPF and from 26.42% to 7.11% (P = .017) by MRI (axial plane). Magnetic resonance imaging indicated significantly reduced mean minimum velopharyngeal distance, from 10.39 to 3.65 mm (P = .012) in the sagittal plane, and markedly increased thickness of transplanted fat in the posterior pharyngeal wall (sagittal, 5.43 mm; axial, 4.74 mm). There were few complications (sleep apnea, nasopharyngeal regurgitation). Autologous fat transplantation in the posterior pharyngeal wall was a good method for treating velopharyngeal incompetence. The safety profile was good in our sample, and we got a consistent result in the follow-up period. In addition, it also could be combined with routine surgery.

  2. Do preoperative antibiotics prevent dental implant complications?

    Science.gov (United States)

    Balevi, Ben

    2008-01-01

    The Cochrane Oral Health Group's Trials Registry, the Cochrane Central Register of Controlled Trials, Medline and Embase were consulted to find relevant work. Searches were made by hand of numerous journals pertinent to oral implantology. There were no language restrictions. Randomised controlled clinical trials (RCT) with a followup of at least 3 months were chosen. Outcome measures were prosthesis failures, implant failures, postoperative infections and adverse events (gastrointestinal, hypersensitivity, etc.). Two reviewers independently assessed the quality and extracted relevant data from included studies. The estimated effect of the intervention was expressed as a risk ratio together with its 95% confidence interval (CI). Numbers-needed-to-treat (NNT) were calculated from numbers of patients affected by implant failures. Meta-analysis was done only if there were studies with similar comparisons that reported the same outcome measure. Significance of any discrepancies between studies was assessed by means of the Cochran's test for heterogeneity and the I2 statistic. Only two RCT met the inclusion criteria. Meta-analysis of these two trials showed a statistically significantly higher number of patients experiencing implant failures in the group not receiving antibiotics (relative risk, 0.22; 95% CI, 0.06-0.86). The NNT to prevent one patient having an implant failure is 25 (95%CI, 13-100), based on a patient implant failure rate of 6% in people not receiving antibiotics. The following outcomes were not statistically significantly linked with implant failure: prosthesis failure, postoperative infection and adverse events (eg, gastrointestinal effects, hypersensitivity). There is some evidence suggesting that 2 g of amoxicillin given orally 1 h preoperatively significantly reduces failures of dental implants placed in ordinary conditions. It remains unclear whether postoperative antibiotics are beneficial, and which is the most effective antibiotic. One dose of

  3. Catawba nuclear station preoperational ALARA review

    International Nuclear Information System (INIS)

    Deal, W.P.

    1985-01-01

    This paper describes the particular emphasis placed on preoperational as los as reasonably achievable (ALARA) considerations at Duke Power's Catawba Nuclear Station. A strong station commitment to the ALARA philosophy, and review of existing capabilities, led to development of an aggressive two-part ALARA program. Capabilities consisted of sufficient numbers of available personnel, lengthy lead time during construction, a very detailed plastic model, and a sister plant of similar design. The program, as developed, consisted of a preoperational program, which looked at design and construction aspects of ALARA, and the operational program, dealing with the ALARA committee and operational problems. MAnagement's philosophy of holding everyone responsible for ALARA provided the motivation to organize the preoperational program to use that resource. The Health Physics group accepted responsibility for development, coordination, and reviewer training. The problem provided a base to build on as station personnel gained experience in their own crafts and radiation protection in general

  4. Pre-operative fasting guidelines: an update

    DEFF Research Database (Denmark)

    Søreide, E; Eriksson, L I; Hirlekar, G

    2005-01-01

    Liberal pre-operative fasting routines have been implemented in most countries. In general, clear fluids are allowed up to 2 h before anaesthesia, and light meals up to 6 h. The same recommendations apply for children and pregnant women not in labour. In children......Liberal pre-operative fasting routines have been implemented in most countries. In general, clear fluids are allowed up to 2 h before anaesthesia, and light meals up to 6 h. The same recommendations apply for children and pregnant women not in labour. In children...

  5. Why Sleep Matters-The Economic Costs of Insufficient Sleep: A Cross-Country Comparative Analysis.

    Science.gov (United States)

    Hafner, Marco; Stepanek, Martin; Taylor, Jirka; Troxel, Wendy M; van Stolk, Christian

    2017-01-01

    The Centers for Disease Control and Prevention (CDC) in the United States has declared insufficient sleep a "public health problem." Indeed, according to a recent CDC study, more than a third of American adults are not getting enough sleep on a regular basis. However, insufficient sleep is not exclusively a US problem, and equally concerns other industrialised countries such as the United Kingdom, Japan, Germany, or Canada. According to some evidence, the proportion of people sleeping less than the recommended hours of sleep is rising and associated with lifestyle factors related to a modern 24/7 society, such as psychosocial stress, alcohol consumption, smoking, lack of physical activity and excessive electronic media use, among others. This is alarming as insufficient sleep has been found to be associated with a range of negative health and social outcomes, including success at school and in the labour market. Over the last few decades, for example, there has been growing evidence suggesting a strong association between short sleep duration and elevated mortality risks. Given the potential adverse effects of insufficient sleep on health, well-being and productivity, the consequences of sleep-deprivation have far-reaching economic consequences. Hence, in order to raise awareness of the scale of insufficient sleep as a public-health issue, comparative quantitative figures need to be provided for policy- and decision-makers, as well as recommendations and potential solutions that can help tackling the problem.

  6. Zinc status in chronic pancreatitis and its relationship with exocrine and endocrine insufficiency.

    Science.gov (United States)

    Girish, Banavara Narasimhamurthy; Rajesh, Gopalakrishna; Vaidyanathan, Kannan; Balakrishnan, Vallath

    2009-11-05

    A major role of the pancreas in zinc homeostasis has been suggested. To assess erythrocyte zinc status in chronic pancreatitis and to correlate it with pancreatic exocrine and endocrine insufficiency. One hundred and one patients with chronic pancreatitis (34 alcoholic chronic pancreatitis, 67 tropical chronic pancreatitis) were prospectively studied. Disease characteristics and imaging features were recorded. Erythrocyte zinc was estimated by flame atomic absorption spectrophotometry. Exocrine insufficiency was assessed using polyclonal antibody ELISA for pancreatic stool elastase1. Endocrine insufficiency was assessed by serum glucose levels and insulin requirement. Erythrocyte zinc was significantly lower in chronic pancreatitis patients than in the controls (26.5+/-9.5 microg/g Hb vs. 38.0+/-6.6 microg/g Hb; Ppancreatitis than in alcoholic chronic pancreatitis (25.0+/-10.4 microg/g Hb vs. 29.6+/-6.5 microg/g Hb, P=0.001). In chronic pancreatitis patients who had exocrine insufficiency, erythrocyte zinc positively correlated with stool elastase1 (r=0.587, Ppancreatitis patients, and that zinc deficiency correlates with exocrine and endocrine insufficiency. Further studies may clarify the possible benefits of zinc supplementation in chronic pancreatitis.

  7. Subchondral insufficiency fracture of the femoral head in a patient with alkaptonuria

    Energy Technology Data Exchange (ETDEWEB)

    Hamada, Takahiro; Shida, Jun-ichi; Inokuchi, Akihiko; Arizono, Takeshi [Kyushu Central Hospital, Department of Orthopaedic Surgery, Fukuoka-city (Japan); Yamamoto, Takuaki [Kyushu University, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Fukuoka-city (Japan)

    2014-06-15

    We report a patient with alkaptonuria accompanied by bilateral rapidly destructive arthrosis of the hip. The destruction of the left hip joint with its severe functional impairment necessitated total hip arthroplasty (THA). The outcome was satisfactory. Both magnetic resonance imaging (MRI) and pathologic findings were compatible with a subchondral insufficiency fracture. A year and half later, during a follow-up visit, the patient complained of right coxalgia. Radiography showed that the right femoral head had already disappeared, requiring THA of the right hip. Although there have been a few reports of rapid destructive hip osteoarthritis associated with ochronotic arthropathy, the pathogenesis of the destructive change is not clear. Subchondral insufficiency fracture was diagnosed on MR imaging and pathologically confirmed in our patient with alkaptonuria, suggesting that subchondral insufficiency fracture is one of the causes of ochronotic hip destruction. (orig.)

  8. Subchondral insufficiency fracture of the femoral head in a patient with alkaptonuria

    International Nuclear Information System (INIS)

    Hamada, Takahiro; Shida, Jun-ichi; Inokuchi, Akihiko; Arizono, Takeshi; Yamamoto, Takuaki

    2014-01-01

    We report a patient with alkaptonuria accompanied by bilateral rapidly destructive arthrosis of the hip. The destruction of the left hip joint with its severe functional impairment necessitated total hip arthroplasty (THA). The outcome was satisfactory. Both magnetic resonance imaging (MRI) and pathologic findings were compatible with a subchondral insufficiency fracture. A year and half later, during a follow-up visit, the patient complained of right coxalgia. Radiography showed that the right femoral head had already disappeared, requiring THA of the right hip. Although there have been a few reports of rapid destructive hip osteoarthritis associated with ochronotic arthropathy, the pathogenesis of the destructive change is not clear. Subchondral insufficiency fracture was diagnosed on MR imaging and pathologically confirmed in our patient with alkaptonuria, suggesting that subchondral insufficiency fracture is one of the causes of ochronotic hip destruction. (orig.)

  9. Subchondral insufficiency fracture of the femoral head in a patient with alkaptonuria.

    Science.gov (United States)

    Hamada, Takahiro; Yamamoto, Takuaki; Shida, Jun-ichi; Inokuchi, Akihiko; Arizono, Takeshi

    2014-06-01

    We report a patient with alkaptonuria accompanied by bilateral rapidly destructive arthrosis of the hip. The destruction of the left hip joint with its severe functional impairment necessitated total hip arthroplasty (THA). The outcome was satisfactory. Both magnetic resonance imaging (MRI) and pathologic findings were compatible with a subchondral insufficiency fracture. A year and half later, during a follow-up visit, the patient complained of right coxalgia. Radiography showed that the right femoral head had already disappeared, requiring THA of the right hip. Although there have been a few reports of rapid destructive hip osteoarthritis associated with ochronotic arthropathy, the pathogenesis of the destructive change is not clear. Subchondral insufficiency fracture was diagnosed on MR imaging and pathologically confirmed in our patient with alkaptonuria, suggesting that subchondral insufficiency fracture is one of the causes of ochronotic hip destruction.

  10. ECONOMIC IMPLICATIONS OF INSUFFICIENT HEALTH LITERACY

    OpenAIRE

    Dukić, Nikolina; Arbula Blecich, Andrea; Cerović, Ljerka

    2013-01-01

    The main goal of this paper is to elaborate the importance of health literacy in cost-effective utilization of health care services which influence the efficiency of the entire health care sector. In order to complement the theoretical framework of the economic implications and the circular influence of health literacy on the economy, an empirical analysis was carried out using S–TOFHLA. The results suggest that the patients’ personal characteristics and the accessibil...

  11. Preoperational test report, primary ventilation system

    International Nuclear Information System (INIS)

    Clifton, F.T.

    1997-01-01

    This represents a preoperational test report for Primary Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space filtered venting of tanks AY101, AY102, AZ101, AZ102. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System

  12. Preoperative biliary drainage for pancreatic cancer

    NARCIS (Netherlands)

    van Heek, N. T.; Busch, O. R.; van Gulik, T. M.; Gouma, D. J.

    2014-01-01

    This review is to summarize the current knowledge about preoperative biliary drainage (PBD) in patients with biliary obstruction caused by pancreatic cancer. Most patients with pancreatic carcinoma (85%) will present with obstructive jaundice. The presence of toxic substances as bilirubin and bile

  13. PREOPERATIVE ENDOSCOPIC MARKING OF UNPALPABLE COLONIC TUMORS

    Directory of Open Access Journals (Sweden)

    A. L. Goncharov

    2013-01-01

    Full Text Available The identification of small colon lesions is one of the major problems in laparoscopic colonic resection.Research objective: to develop a technique of visualization of small tumors of a colon by preoperative endoscopic marking of a tumor.Materials and methods. In one day prior to operation to the patient after bowel preparation the colonoscopy is carried out. In the planned point near tumor on antimesentery edge the submucous infiltration of marking solution (Micky Sharpz blue tattoo pigment, UK is made. The volume of entered solution of 1–3 ml. In only 5 months of use of a technique preoperative marking to 14 patients with small (the size of 1–3 cm malignant tumors of the left colon is performed.Results. The tattoo mark was well visualized by during operation at 13 of 14 patients. In all cases we recorded no complications. Time of operation with preoperative marking averaged 108 min, that is significantly less in comparison with average time of operation with an intra-operative colonoscopy – 155 min (р < 0.001.Conclusions. The first experience of preoperative endoscopic marking of non palpable small tumors of a colon is encouraging. Performance of a technique wasn't accompanied by complications and allowed to reduce significantly time of operation and to simplify conditions of performance of operation.

  14. Preoperative exercise training to improve postoperative outcomes

    NARCIS (Netherlands)

    Valkenet, K.

    2017-01-01

    It is common knowledge that better preoperative physical fitness is associated with better postoperative outcomes. However, as a result of aging of the population and improved surgical and anaesthesia techniques, the proportion of frail patients with decreased physical fitness levels undergoing

  15. Interdisciplinary preoperative patient education in cardiac surgery.

    NARCIS (Netherlands)

    Weert, J. van; Dulmen, S. van; Bar, P.; Venus, E.

    2003-01-01

    Patient education in cardiac surgery is complicated by the fact that cardiac surgery patients meet a lot of different health care providers. Little is known about education processes in terms of interdisciplinary tuning. In this study, complete series of consecutive preoperative consultations of 51

  16. Preoperative diagnosis of malignant hyperthermia | Brand ...

    African Journals Online (AJOL)

    Southern African Journal of Anaesthesia and Analgesia. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 9, No 1 (2003) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Preoperative diagnosis of malignant ...

  17. Preoperational test report, primary ventilation system

    Energy Technology Data Exchange (ETDEWEB)

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Primary Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space filtered venting of tanks AY101, AY102, AZ101, AZ102. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  18. Ampullopancreatic carcinoma: preoperative TNM classification with endosonography

    NARCIS (Netherlands)

    Tio, T. L.; Tytgat, G. N.; Cikot, R. J.; Houthoff, H. J.; Sars, P. R.

    1990-01-01

    Endosonography (ES) was used for the preoperative TNM (1987) staging of tumors in 43 patients with pancreatic cancer and 24 patients with ampullary carcinomas. These results were correlated with the histologic findings of resected specimens. Early-stage tumors could be distinguished from advanced

  19. Preoperative screening: value of previous tests.

    Science.gov (United States)

    Macpherson, D S; Snow, R; Lofgren, R P

    1990-12-15

    To determine the frequency of tests done in the year before elective surgery that might substitute for preoperative screening tests and to determine the frequency of test results that change from a normal value to a value likely to alter perioperative management. Retrospective cohort analysis of computerized laboratory data (complete blood count, sodium, potassium, and creatinine levels, prothrombin time, and partial thromboplastin time). Urban tertiary care Veterans Affairs Hospital. Consecutive sample of 1109 patients who had elective surgery in 1988. At admission, 7549 preoperative tests were done, 47% of which duplicated tests performed in the previous year. Of 3096 previous results that were normal as defined by hospital reference range and done closest to the time of but before admission (median interval, 2 months), 13 (0.4%; 95% CI, 0.2% to 0.7%), repeat values were outside a range considered acceptable for surgery. Most of the abnormalities were predictable from the patient's history, and most were not noted in the medical record. Of 461 previous tests that were abnormal, 78 (17%; CI, 13% to 20%) repeat values at admission were outside a range considered acceptable for surgery (P less than 0.001, frequency of clinically important abnormalities of patients with normal previous results with those with abnormal previous results). Physicians evaluating patients preoperatively could safely substitute the previous test results analyzed in this study for preoperative screening tests if the previous tests are normal and no obvious indication for retesting is present.

  20. Preoperational test report, vent building ventilation system

    International Nuclear Information System (INIS)

    Clifton, F.T.

    1997-01-01

    This represents a preoperational test report for Vent Building Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides Heating, Ventilation, and Air Conditioning (HVAC) for the W-030 Ventilation Building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System

  1. Preoperative evaluation : risk management and implementation aspects

    NARCIS (Netherlands)

    Klei, W.A. van

    2002-01-01

    In preoperative risk management the anesthesiologist uses diagnostic information to estimate the probability of outcomes and to decide on the anesthetic strategy in a particular patient. The aim of this thesis was explore to what extent simple patient characteristics, particularly obtained from

  2. Magnetic resonance imaging in osteomalacic insufficiency fractures of the pelvis

    Energy Technology Data Exchange (ETDEWEB)

    Kanberoglu, K. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey)]. E-mail: zkanber@istanbul.edu.tr; Kantarci, F. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey); Cebi, D. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey); Yilmaz, M.H. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey); Kurugoglu, S. [Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey); Bilici, A. [Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey); Koyuncu, H. [Department of Physical Medicine and Rehabilitation, Cerrahpasa Medical Faculty, Istanbul University, Istanbul (Turkey)

    2005-01-01

    AIMS: To report the magnetic resonance imaging (MRI) findings of osteomalacic insufficiency fractures of the pelvis. MATERIALS AND METHODS: In all, 12 persons presenting with chronic pelvic pain and with a definitive diagnosis of osteomalacia (OM) were enrolled in this study. Radiological work-up included direct radiographs (n=12), computed tomography (n=5), scintigraphy n=12) and MRI (n=12). The location of the insufficiency fractures and corresponding MRI appearances were evaluated. Depending on the presence or absence of signal intensity around the fractures, the lesions were grouped into active and chronic forms. RESULTS: A total of 34 insufficiency fractures were depicted on imaging studies. MRI demonstrated 33 of the lesions. All the insufficiency fractures were seen as a hypointense lines or fissures on T1- and T2-weighted and STIR MR images. There was a high frequency of insufficiency fractures at the sacrum and iliac bone (16/34, 47%). Overall, 11 chronic-type (no abnormal signal intensity around the fissure) and 22 active-type (abnormal signal intensity around the fissure) insufficiency fractures were detected by MRI. Follow-up MR examinations of 2 subjects showed that abnormal signal intensity had disappeared after appropriate treatment. CONCLUSION: The results of this study showed that the iliac and sacral bones are frequently involved in patients with OM. MRI can determine the clinical activity of the disease, and can monitor the response to treatment of the active type of insufficiency fractures.

  3. Magnetic resonance imaging in osteomalacic insufficiency fractures of the pelvis

    International Nuclear Information System (INIS)

    Kanberoglu, K.; Kantarci, F.; Cebi, D.; Yilmaz, M.H.; Kurugoglu, S.; Bilici, A.; Koyuncu, H.

    2005-01-01

    AIMS: To report the magnetic resonance imaging (MRI) findings of osteomalacic insufficiency fractures of the pelvis. MATERIALS AND METHODS: In all, 12 persons presenting with chronic pelvic pain and with a definitive diagnosis of osteomalacia (OM) were enrolled in this study. Radiological work-up included direct radiographs (n=12), computed tomography (n=5), scintigraphy n=12) and MRI (n=12). The location of the insufficiency fractures and corresponding MRI appearances were evaluated. Depending on the presence or absence of signal intensity around the fractures, the lesions were grouped into active and chronic forms. RESULTS: A total of 34 insufficiency fractures were depicted on imaging studies. MRI demonstrated 33 of the lesions. All the insufficiency fractures were seen as a hypointense lines or fissures on T1- and T2-weighted and STIR MR images. There was a high frequency of insufficiency fractures at the sacrum and iliac bone (16/34, 47%). Overall, 11 chronic-type (no abnormal signal intensity around the fissure) and 22 active-type (abnormal signal intensity around the fissure) insufficiency fractures were detected by MRI. Follow-up MR examinations of 2 subjects showed that abnormal signal intensity had disappeared after appropriate treatment. CONCLUSION: The results of this study showed that the iliac and sacral bones are frequently involved in patients with OM. MRI can determine the clinical activity of the disease, and can monitor the response to treatment of the active type of insufficiency fractures

  4. [Traumatic tricuspid insufficiency. Apropos of 2 cases].

    Science.gov (United States)

    Ventre, F; Bertinchant, J P; Noblet, D; Frapier, J M; Carabasse, D; Nigond, J; Ledermann, B; Cohen, S; Joubert, P; Grolleau-Raoux, R

    1995-06-01

    The authors report two cases of tricuspid regurgitation by a ruptured anterior papillary muscle secondary to non-penetrating thoracic trauma. In the presence of suggestive clinical and electrocardiographic abnormalities (systolic murmur, right heart failure, right bundle branch block), echocardiography confirmed the tricuspid regurgitation, showed its mechanism and excluded any other intracardiac lesions. Tricuspid annuloplasty was performed in both cases because of the persistence of failure or degradation of the patient's clinical condition. Peroperative echocardiography was used to judge the quality of the surgical repair in both cases. Traumatic tricuspid regurgitation is a rare condition and the diagnosis is often delayed. Echocardiography is the investigation of choice and guides treatment which is essentially valvular repair in symptomatic patients.

  5. Types of suggestibility: Relationships among compliance, indirect, and direct suggestibility.

    Science.gov (United States)

    Polczyk, Romuald; Pasek, Tomasz

    2006-10-01

    It is commonly believed that direct suggestibility, referring to overt influence, and indirect suggestibility, in which the intention to influence is hidden, correlate poorly. This study demonstrates that they are substantially related, provided that they tap similar areas of influence. Test results from 103 students, 55 women and 48 men, were entered into regression analyses. Indirect suggestibility, as measured by the Sensory Suggestibility Scale for Groups, and compliance, measured by the Gudjonsson Compliance Scale, were predictors of direct suggestibility, assessed with the Barber Suggestibility Scale. Spectral analyses showed that indirect suggestibility is more related to difficult tasks on the BSS, but compliance is more related to easy tasks on this scale.

  6. Radiotherapy in addition to radical surgery in rectal cancer: evidence for a dose-response effect favoring preoperative treatment

    International Nuclear Information System (INIS)

    Glimelius, Bengt; Isacsson, Ulf; Jung, Bo; Paahlman, Lars

    1997-01-01

    Purpose: This study explored the relationship between radiation dose and reduction in local recurrence rate after preoperative and postoperative radiotherapy in rectal cancer. Methods and Materials: All randomized trials initiated prior to 1988 comparing preoperative and postoperative radiotherapy with surgery alone or with each other were included. Local failure rates were available in 5626 randomized patients. The linear quadratic formula was used to compensate for different radiotherapy schedules. Results: For preoperative radiotherapy, a clear dose-response relationship could be established. For postoperative radiotherapy, the range of doses was narrow, and a dose-response relationship could not be demonstrated. At similar doses, preoperative radiotherapy appeared to be more efficient in reducing local failure rate than postoperative. The only trial comparing preoperative with postoperative radiotherapy confirms this notion. A 15-20 Gy higher dose may be required postoperatively than preoperatively to reach similar efficacy. Neither approach alone significantly influences survival, although it is likely that a small survival benefit may be seen after preoperative radiotherapy. Conclusions: The information from the entire randomized experience suggests that preoperative radiotherapy may be more dose efficient than postoperative radiotherapy

  7. Preoperative Chemotherapy Versus Preoperative Chemoradiotherapy for Stage III (N2) Non-Small-Cell Lung Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Higgins, Kristin [Department of Radiation Oncology, Duke University of Medical Center, Durham, NC (United States); Chino, Junzo P [Department of Radiation Oncology, Duke University of Medical Center, Durham, NC (United States); Marks, Lawrence B [Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC (United States); Ready, Neal [Department of Medicine, Division of Medical Oncology, Duke University of Medical Center, Durham, NC (United States); D' Amico, Thomas A [Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University of Medical Center, Durham, NC (United States); Clough, Robert W; Kelsey, Chris R [Department of Radiation Oncology, Duke University of Medical Center, Durham, NC (United States)

    2009-12-01

    Purpose: To compare preoperative chemotherapy (ChT) and preoperative chemoradiotherapy (ChT-RT) in operable Stage III non-small-cell lung cancer. Methods and Materials: This retrospective study analyzed all patients with pathologically confirmed Stage III (N2) non-small-cell lung cancer who initiated preoperative ChT or ChT-RT at Duke University between 1995 and 2006. Mediastinal pathologic complete response (pCR) rates were compared using a chi-square test. The actuarial overall survival, disease-free survival, and local control were estimated using the Kaplan-Meier method and compared using the log-rank test. Multivariate Cox regression analysis was also performed. Results: A total of 101 patients who initiated preoperative therapy with planned resection were identified. The median follow-up was 20 months for all patients and 38 months for survivors. The mediastinal lymph nodes were reassessed after preoperative therapy in 88 patients (87%). Within this group, a mediastinal pCR was achieved in 35% after preoperative ChT vs. 65% after preoperative ChT-RT (p = 0.01). Resection was performed in 69% after ChT and 84% after ChT-RT (p = 0.1). For all patients, the overall survival, disease-free survival, and local control rate at 3 years was 40%, 27%, and 66%, respectively. No statistically significant differences were found in the clinical endpoints between the ChT and ChT-RT subgroups. On multivariate analysis, a mediastinal pCR was associated with improved disease-free survival (p = 0.03) and local control (p = 0.03), but not overall survival (p = 0.86). Conclusion: Preoperative ChT-RT was associated with higher mediastinal pCR rates but not improved survival.

  8. Preoperative Chemotherapy Versus Preoperative Chemoradiotherapy for Stage III (N2) Non-Small-Cell Lung Cancer

    International Nuclear Information System (INIS)

    Higgins, Kristin; Chino, Junzo P.; Marks, Lawrence B.; Ready, Neal; D'Amico, Thomas A.; Clough, Robert W.; Kelsey, Chris R.

    2009-01-01

    Purpose: To compare preoperative chemotherapy (ChT) and preoperative chemoradiotherapy (ChT-RT) in operable Stage III non-small-cell lung cancer. Methods and Materials: This retrospective study analyzed all patients with pathologically confirmed Stage III (N2) non-small-cell lung cancer who initiated preoperative ChT or ChT-RT at Duke University between 1995 and 2006. Mediastinal pathologic complete response (pCR) rates were compared using a chi-square test. The actuarial overall survival, disease-free survival, and local control were estimated using the Kaplan-Meier method and compared using the log-rank test. Multivariate Cox regression analysis was also performed. Results: A total of 101 patients who initiated preoperative therapy with planned resection were identified. The median follow-up was 20 months for all patients and 38 months for survivors. The mediastinal lymph nodes were reassessed after preoperative therapy in 88 patients (87%). Within this group, a mediastinal pCR was achieved in 35% after preoperative ChT vs. 65% after preoperative ChT-RT (p = 0.01). Resection was performed in 69% after ChT and 84% after ChT-RT (p = 0.1). For all patients, the overall survival, disease-free survival, and local control rate at 3 years was 40%, 27%, and 66%, respectively. No statistically significant differences were found in the clinical endpoints between the ChT and ChT-RT subgroups. On multivariate analysis, a mediastinal pCR was associated with improved disease-free survival (p = 0.03) and local control (p = 0.03), but not overall survival (p = 0.86). Conclusion: Preoperative ChT-RT was associated with higher mediastinal pCR rates but not improved survival.

  9. Posterior tibial tendon insufficiency results at different stages.

    Science.gov (United States)

    Deland, Jonathan T; Page, Alexandra; Sung, Il-Hoon; O'Malley, Martin J; Inda, David; Choung, Steven

    2006-09-01

    The results of surgical treatment of posterior tibial tendon insufficiency (PTTI) may be different at different stages of the disease. No single study has compared the results at different stages. This comparison can be helpful to the patient and physician if the patient asks "What if I wait and the disease progresses, how will my results be different?" A preliminary study comparing results for stage IIa, stage IIb (advanced stage II), and stage III was performed followed by a larger study comparing IIa and IIb with 26 and 22 patients, respectively. American Orthopaedic Foot and Ankle Society (AOFAS) outcome scores as well as radiographs and functional questions were used. Nearly all patients, regardless of stage, felt they were helped by surgical treatment. However, the lowest AOFAS score was in stage III, the most advanced stage investigated in this study. In comparing stage IIa and IIb patients, stage IIb patients had a statistically higher incidence of lateral discomfort. Although statistically significant differences were not found in all comparisons, this study suggests that the results of surgical treatment for PTTI declines with increasing stage or severity of disease.

  10. Prevalence and prognostic significance of malnutrition in chronic renal insufficiency.

    Science.gov (United States)

    Lawson, J A; Lazarus, R; Kelly, J J

    2001-01-01

    Malnutrition is present in a significant proportion of patients commencing dialysis. However, the prevalence and prognostic significance of malnutrition within the chronic renal insufficiency (CRI) population before the initiation of dialysis is poorly characterized. The aim of this study was to determine the prevalence and prognostic significance of malnutrition in an unselected group of patients with CRI. Cohort analytic study. Ambulatory care practice of a university teaching hospital. Fifty patients with CRI (serum creatinine concentration > or = 1.7 mg/dL) were enrolled. Patients with a recent acute illness, nephrotic syndrome, intercurrent steroid therapy, gastrointestinal disease, or other severe organ failure that may have independently influenced nutritional status were excluded. At baseline, patients had a nutritional assessment consisting of subjective global assessment (SGA), measurement of body mass index (BMI), midarm circumference (MAC), serum albumin concentration, total lymphocyte count, and single frequency bioelectrical impedance analysis. Patients received standard medical care and were followed prospectively at quarterly intervals for 12 months. At baseline assessment, 28% of patients had evidence of malnutrition by SGA criteria. The malnourished group of patients had a significantly lower creatinine clearance (18.9 +/- 9.8 v 36.5 +/- 14.0 mL/min/1.73 m(2), mean +/- SD, P renal failure. These data suggest that SGA provides a useful means of assessing nutritional status and is helpful in identifying patients with increased risk of morbidity and mortality in the setting of CRI.

  11. Iodine insufficiency: a global health problem?

    Science.gov (United States)

    Swanson, Christine A; Pearce, Elizabeth N

    2013-09-01

    As a result of collaborative efforts with international organizations and the salt industry, many developing and developed countries practice universal salt iodization (USI) or have mandatory salt fortification programs. As a consequence, the prevalence of iodine deficiency decreased dramatically. The United States and Canada are among the few developed countries that do not practice USI. Such an undertaking would require evidence of deficiency among vulnerable population groups, including pregnant women, newborns, and developing infants. Government agencies in the United States rely heavily on data from NHANES to assess the iodine status of the general population and pregnant women in particular. NHANES data suggest that pregnant women in the United States remain mildly deficient. This is important, because the developing fetus is dependent on maternal iodine intake for normal brain development throughout pregnancy. Professional societies have recommended that pregnant and lactating women, or those considering pregnancy, consume a supplement providing 150 μg iodine daily. The United States and Canada collaborate on the daily recommended intake and are also confronted with the challenge of identifying the studies needed to determine if USI is likely to be beneficial to vulnerable population groups without exposing them to harm.

  12. The role of the anterolateral ligament in ACL insufficient and reconstructed knees on rotary stability

    DEFF Research Database (Denmark)

    Tavlo, Mette; Eljaja, S; Tranum-Jensen, Jørgen

    2016-01-01

    Studies suggest that the anterolateral ligament (ALL) is important for knee stability. The purpose was to clarify ALL's effect on rotatory and anterior-posterior stability in the anterior cruciate ligament (ACL)-insufficient and reconstructed knees and the effect of reconstruction of an insuffici......Studies suggest that the anterolateral ligament (ALL) is important for knee stability. The purpose was to clarify ALL's effect on rotatory and anterior-posterior stability in the anterior cruciate ligament (ACL)-insufficient and reconstructed knees and the effect of reconstruction...... of an insufficient ALL. Eighteen cadaveric knees were included. Stability was tested for intact (+ALL), detached (-ALL) and reconstructed (+ reALL) ALL, with ACL removed (-ACL) and reconstructed (+ACL) in six combinations. All were tested in 0, 30, 60, and 90 °C flexion. Anterior-posterior stability was measured...... with a rolimeter. Rotation with a torque of 8.85 Nm was measured photographically. The ALL was well defined in 78% of knees. ACL reconstruction had a significant effect on anterior-posterior stability. Detaching the ALL had a significant effect on internal rotatory stability and on anterior-posterior stability...

  13. Suggestibility and suggestive modulation of the Stroop effect.

    Science.gov (United States)

    Kirsch, Irving

    2011-06-01

    Although the induction of a hypnotic state does not seem necessary for suggestive modulation of the Stroop effect, this important phenomenon has seemed to be dependent on the subject's level of hypnotic suggestibility. Raz and Campbell's (2011) study indicates that suggestion can modulate the Stroop effect substantially in very low suggestible subjects, as well as in those who are highly suggestible. This finding casts doubt on the presumed mechanism by which suggestive modulation is brought about. Research aimed at uncovering the means by which low suggestible individuals are able to modulate the Stroop effect would be welcome, as would assessment of this effect in moderately suggestible people. Copyright © 2010 Elsevier Inc. All rights reserved.

  14. Pre-operative haematological investigations in paediatric orofacial ...

    African Journals Online (AJOL)

    Pre-operative haematological investigations in paediatric orofacial cleft repair: Any relevance to management outcome? ... Aim and Objectives: To determine the value of routine pre-operative haematologic investigations in children undergoing orofacial cleft repair. Background: Although routine pre-operative laboratory ...

  15. Dipyridamole-thallium scanning in patients undergoing vascular surgery. Optimizing preoperative evaluation of cardiac risk

    International Nuclear Information System (INIS)

    Eagle, K.A.; Singer, D.E.; Brewster, D.C.; Darling, R.C.; Mulley, A.G.; Boucher, C.A.

    1987-01-01

    Dipyridamole-thallium imaging has been suggested as a method of preoperatively assessing cardiac risk in patients undergoing major surgery. To define more clearly its proper role in preoperative assessment, we prospectively evaluated 111 patients undergoing vascular surgery. In the first set of 61 patients, our data confirmed the value of preoperative dipyridamole-thallium scanning in identifying the patients who suffered postoperative ischemic events. Events occurred in eight of 18 patients with reversible defects on preoperative imaging, compared with no events in 43 patients with no thallium redistribution (confidence interval for the risk difference: 0.624, 0.256). The results also suggested that clinical factors might allow identification of a low-risk subset of patients. To test the hypothesis that patients with no evidence of congestive heart failure, angina, prior myocardial infarction, or diabetes do not require further preoperative testing, we evaluated an additional 50 patients having vascular procedures. None of the 23 without the clinical markers had untoward outcomes, while ten of 27 patients with one or more of these clinical markers suffered postoperative ischemic events (confidence interval for the risk difference: 0.592, 0.148). In the clinical high-risk subset, further risk stratification is achieved with dipyridamole-thallium scanning

  16. Preoperative modifiable risk factors in colorectal surgery

    DEFF Research Database (Denmark)

    van Rooijen, Stefanus; Carli, Francesco; Dalton, Susanne O

    2017-01-01

    in higher mortality rates and greater hospital costs. The number and severity of complications is closely related to patients' preoperative performance status. The aim of this study was to identify the most important preoperative modifiable risk factors that could be part of a multimodal prehabilitation...... program. METHODS: Prospectively collected data of a consecutive series of Dutch CRC patients undergoing colorectal surgery were analyzed. Modifiable risk factors were correlated to the Comprehensive Complication Index (CCI) and compared within two groups: none or mild complications (CCI ... complications (CCI ≥20). Multivariate logistic regression analysis was done to explore the combined effect of individual risk factors. RESULTS: In this 139 patient cohort, smoking, malnutrition, alcohol consumption, neoadjuvant therapy, higher age, and male sex, were seen more frequently in the severe...

  17. Evaluation of preoperative embolization of meningioma

    International Nuclear Information System (INIS)

    Park, Sung Tae; Suh, Dae Chul; Lee, Ho Kyu; Choi, Choong Gon; Lee, Myung Jun; Ji, Eun Kyung; Shin, Byung Suck; Kim, Chang Jin; Kim, Jong Uk; Whang, C. Jin

    1998-01-01

    To evaluate the efficacy and safety of preoperative embolization of intrancranial meningioma.Materials and Methods : We retrospectively reviewed intrancranial meningioma patients (n=37) who underwent preoperative embolization. They were categorized into two groups, skull base lesions (n=22) and non-skull base lesions (n=15), according to tumor location. In addition, embolization results were classified by comparison between pre- and post-embolization angiography as complete (residual tumor staining 10 or 30%). In each group, estimated blood loss (EBL) was estimated by amount of intraoperative transfusion with pre- and post-operative hemoglobin level. Tumor resectability was evaluated by follow-up computed tomography. New symptoms occurring within 24 hours of embolization were considered to be those associated with embolization ; symptoms improved by conservative treatment were regarded as mild, while those resulting in new deficits were considered severe. Results : In the group with skull base lesions (n=22), complete embolization with the criteria of residual tumor staining of less than 30% was performed in 14 patients(EBL=1770ml;complete surgical removal in nine patients and incomplete removal four). Incomplete embolization was performed in eight patients (EBL=3210ml; complete and incomplete removal each in four patients). In the group with non-skull base lesions, complete embolization with the criteria of residual tumor staining of less than 10% was performed in five patients (EBL=970ml) and incomplete embolization in ten (EBL=2260ml). Complete tumor removal was possible in this group regardless of the completeness of preoperative tumor embolization. In a case of intraventricular meningioma (3%), intratumoral hemorrhage occurred on the day following embolization. Other mild post-embolization complications occurred in three cases (8%). Conclusion : Preoperative embolization can be an effective and safe procedure for meningioma and may reduce intraoperative blood

  18. Religiousness and preoperative anxiety: a correlational study

    OpenAIRE

    Aghamohammadi Kalkhoran, Masoomeh; Karimollahi, Mansoureh

    2007-01-01

    Abstract Background Major life changes are among factors that cause anxiety, and one of these changes is surgery. Emotional reactions to surgery have specific effects on the intensity and velocity as well as the process of physical disease. In addition, they can cause delay in patients recovery. This study is aimed at determining the relationship between religious beliefs and preoperative anxiety. Methods This survey is a correlational study to assess the relationship between religious belief...

  19. Implications of preoperative hypoalbuminemia in colorectal surgery.

    OpenAIRE

    Truong, A; Hanna, MH; Moghadamyeghaneh, Z; Stamos, MJ

    2016-01-01

    Serum albumin has traditionally been used as a quantitative measure of a patient’s nutritional status because of its availability and low cost. While malnutrition has a clear definition within both the American and European Societies for Parenteral and Enteral Nutrition clinical guidelines, individual surgeons often determine nutritional status anecdotally. Preoperative albumin level has been shown to be the best predictor of mortality after colorectal cancer surgery. Specifically in colorect...

  20. Clinical and prognostic value of preoperative hydronephrosis in upper tract urothelial carcinoma: a systematic review and meta-analysis

    Science.gov (United States)

    Wang, Zhiping

    2016-01-01

    Background. Epidemiological studies have reported various results relating preoperative hydronephrosis to upper tract urothelial carcinoma (UTUC). However, the clinical significance and prognostic value of preoperative hydronephrosis in UTUC remains controversial. The aim of this study was to provide a comprehensive meta-analysis of the extent of the possible association between preoperative hydronephrosis and the risk of UTUC. Methods. We searched PubMed, ISI Web of Knowledge, and Embase to identify eligible studies written in English. Summary odds ratios (ORs) or hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using fixed-effects or random-effects models. Results. Nineteen relevant studies, which had a total of 5,782 UTUC patients enrolled, were selected for statistical analysis. The clinicopathological and prognostic relevance of preoperative hydronephrosis was evaluated in the UTUC patients. The results showed that all tumor stages, lymph node status and tumor location, as well as the risk of cancer-specific survival (CSS), overall survival (OS), recurrence-free survival (RFS) and metastasis-free survival (MFS) were significantly different between UTUC patients with elevated preoperative hydronephrosis and those with low preoperative hydronephrosis. High preoperative hydronephrosis indicated a poor prognosis. Additionally, significant correlations between preoperative hydronephrosis and tumor grade (high grade vs. low grade) were observed in UTUC patients; however, no significant difference was observed for tumor grading (G1 vs. G2 + G3 and G1 + G2 vs. G3). In contrast, no such correlations were evident for recurrence status or gender in UTUC patients. Conclusions. The results of this meta-analysis suggest that preoperative hydronephrosis is associated with increased risk and poor survival in UTUC patients. The presence of preoperative hydronephrosis plays an important role in the carcinogenesis and prognosis of UTUC. PMID:27366646

  1. Insufficient evidence to assess the effectiveness of antibiotics for irreversible pulpitis.

    Science.gov (United States)

    George, Roy

    2014-03-01

    The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase and the US National Institutes of Health Trials Register. Randomised controlled trials (RCTs) which compared pain relief with systemic antibiotics and analgesics, against placebo and analgesics in the acute preoperative phase of irreversible pulpitis. Study selection, risk of bias assessment and data extraction were carried out independently by two reviewers. Pooling of data was not possible and a descriptive summary is presented. One trial assessed at low risk of bias, involving 40 participants, was included in this update of the review. The quality of the body of evidence was rated low for the different outcomes. There was a close parallel distribution of the pain ratings in both the intervention and placebo groups over the seven-day study period.There was insufficient evidence to claim or refute a benefit for penicillin for pain intensity. There was no significant difference in the mean total number of ibuprofen tablets taken over the study period: 9.2 (standard deviation (SD) 6.02) in the penicillin group versus 9.6 (SD 6.34) in the placebo group; mean difference -0.40 (95% confidence interval (CI) -4.23 to 3.43; P value = 0.84). This applied equally for the mean total number of Tylenol tablets: 6.9 (SD 6.87) used in the penicillin group versus 4.45 (SD 4.82) in the placebo group; mean difference 2.45 (95% CI -1.23 to 6.13; P value = 0.19). Our secondary outcome on reporting of adverse events was not addressed in this study. This systematic, review which was based on one low-powered small sample trial assessed as a low risk of bias, illustrates that there is insufficient evidence to determine whether antibiotics reduce pain or not compared to not having antibiotics. The results of this review confirm the necessity for further larger sample and methodologically sound trials that can provide additional evidence as to whether antibiotics

  2. A Case of Rathke’s Cleft Cyst Associated with Transient Central Adrenal Insufficiency and Masked Diabetes Insipidus

    Directory of Open Access Journals (Sweden)

    Masahiro Asakawa

    2014-01-01

    Full Text Available A 73-year-old woman admitted to our hospital because of headache, poor appetite, malaise, weight loss, and vomiting was found to have central adrenal insufficiency and thyrotoxicosis due to silent thyroiditis. Polyuria developed after replacement with glucocorticoid (masked diabetes insipidus, which was controlled with nasal administration of desmopressin. Magnetic resonance imaging of the brain showed a large cystic pituitary mass (18 × 18 × 12 mm extending suprasellarly to the optic chiasm. Transsphenoidal surgery revealed that the pituitary tumor was Rathke’s cleft cyst. Following surgery, replacement with neither glucocorticoid nor desmopressin was needed any more. Therefore, it is suggested that Rathke’s cleft cyst is responsible for the masked diabetes insipidus and the central insufficiency. Furthermore, it is speculated that thyrotoxicosis with painless thyroiditis might induce changes from subclinical adrenal insufficiency to transiently overt insufficiency.

  3. Determining health personnel's application trends of new guidelines for preoperative fasting: findings from a survey.

    Science.gov (United States)

    Karadağ, Mevlüde; Pekin İşeri, Ozge

    2014-06-01

    For over a century, the discontinuation of oral food intake preoperatively after midnight has been routinely applied. Although routine fasting during the night before elective surgery has been abandoned by many modern centers, preoperative fasting after midnight continues as a routine practice. The purpose of this study was to determine trends in health personnel's application of new guidelines for preoperative fasting. The research sample of this descriptive study consisted of 73 nurses and physicians who were working in the surgical clinics during the time when the study was conducted and who agreed to participate in the study. The data of the study were collected using a questionnaire designed by the researchers. Of the health personnel included in the study group, 43.8% routinely kept adult patients fasting after midnight, 34.2% discontinued solid food intake 8 hours preoperatively, 5.5% discontinued solid food intake 6 hours preoperatively, and 34.2% discontinued the intake of clear and particulate liquids 4 to 8 hours preoperatively. Compliance of the American Society of Anesthesiologists' "2-4-6-8 rule" by health staff was very low. This study was carried out in a hospital and based on the statements of health staff. Therefore, the findings of the study are suggestive in nature and cannot be generalized. We recommend that the study should be conducted with larger sample groups and that actual preoperative fasting periods of the patients should be determined. Copyright © 2014 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  4. MR images of oral cancer treated with preoperative radiotherapy

    International Nuclear Information System (INIS)

    Onizawa, Kojiro; Niitsu Mamoru; Yusa, Hiroshi; Yanagawa, Toru; Yoshida, Hiroshi

    2003-01-01

    This study was carried out to evaluate the relationship between the effect of preoperative radiotherapy for oral cancer and the changes of signal intensity with MR images. T2-weighted images were compared before and after radiotherapy in 18 patients with primary oral cancer, and the effect on the lesions was histologically evaluated in surgically resected specimens obtained four weeks after the therapy. The MR images showed significantly decreased signal intensity of the lesions. The decrease of signal intensity was remarkable starting at two weeks after completion of the radiotherapy, compared with the decrease at less than two weeks after the therapy. The change of signal intensity was more obvious in tongue cancer than in other oral cancers. There was no significant difference in the change of the signal intensity between cancers with histologically poor response to the therapy and those with good response. These results suggested that signal intensity of oral cancer on T2-weighted images showed a significant decrease after preoperative radiotherapy, and that the intensity could be affected by duration after radiotherapy and primary sites. (author)

  5. Preoperative diagnosis of pelvic actinomycosis by clinical cytology

    Directory of Open Access Journals (Sweden)

    Matsuda K

    2012-09-01

    Full Text Available Katsuya Matsuda,1 Hisayoshi Nakajima,2 Khaleque N Khan,1 Terumi Tanigawa,1 Daisuke Hamaguchi,1 Michio Kitajima,1 Koichi Hiraki,1 Shingo Moriyama,3 Hideaki Masuzaki11Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Sciences, 2Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences, 3Shimabara Maternity Clinic, Nagasaki, JapanBackground: The purpose of this work was to investigate whether clinical cytology could be useful in the preoperative diagnosis of pelvic actinomycosis.Methods: This study involved the prospective collection of samples derived from the endometrium and the uterine cervix, and retrospective data analysis. Nine patients with clinically diagnosed pelvic actinomycosis were enrolled. The clinical and hematological characteristics of patients were recorded, and detection of actinomyces was performed by cytology, pathology, and bacteriological culture of samples and by imprint intrauterine contraceptive device (IUD cytology.Results: The detection rate of actinomyces was 77.7% by combined cervical and endometrial cytology, 50.0% by pathology, and 11.1% by bacterial culture.Conclusion: The higher detection rate of actinomyces by cytology than by pathology or bacteriology suggests that careful cytological examination may be clinically useful in the preoperative diagnosis of pelvic actinomycosis.Keywords: actinomycosis, cytology, pathology, intrauterine contraceptive device, pelvic inflammatory disease

  6. Acute gallbladder torsion - a continued pre-operative diagnostic dilemma

    Directory of Open Access Journals (Sweden)

    Desrochers Randal

    2011-04-01

    Full Text Available Abstract Acute gallbladder volvulus continues to remain a relatively uncommon process, manifesting itself usually during exploration for an acute surgical abdomen with a presumptive diagnosis of acute cholecystitis. The pathophysiology is that of mechanical organo-axial torsion along the gallbladder's longitudinal axis involving the cystic duct and cystic artery, and with a pre-requisite of local mesenteric redundancy. The demographic tendency is septua- and octo-genarians of the female sex, and its overall incidence is increasing, this being attributed to increasing life expectancy. We discuss two cases of elderly, fragile women presenting to the emergency department complaining of sudden onset right upper quadrant abdominal pain. Their subsequent evaluation suggested acute cholecystitis. Ultimately both were taken to the operating room where the correct diagnosis of gallbladder torsion was made. Pre-operative diagnosis continues to be a major challenge with only 4 cases reported in the literature diagnosed with pre-operative imaging; the remainder were found intra-operatively. Consequently, a delay in diagnosis can have devastating patient outcomes. Herein we propose a necessary high index of suspicion for gallbladder volvulus in the outlined patient demographic with symptoms and signs mimicking acute cholecystitis.

  7. MRI of occult sacral insufficiency fractures following radiotherapy

    International Nuclear Information System (INIS)

    Mammone, J.F.; Schweitzer, M.E.

    1995-01-01

    Following radiation therapy, marrow abnormalities noted on magnetic resonance imaging (MRI) are frequent and may mimic metastases. Specific radiotherapy changes are usually easily identifiable; however, traumatic lesions cause more interpretive difficulties. We assessed the incidence and MRI characteristics of insufficiency fractures in this population. During a 5-year span (1987-1991), 546 patients received pelvic radiotherapy for primary malignancies. MRI was performed in 25 of these patients at least 3 months after treatment. The mean dose in this group was 53 Gy. These MRI scans were retrospectively reviewed for the appearance of the sacrum with particular attention to the presence of insufficiency fractures. This was correlated with clinical course and scintigraphic findings. Presumed insufficiency fractures on MRI paralleled the sacral side of the sacroiliac joint, enhanced with Gd-DTPA, were most prominent or initially seen anteriorly, and had ill-defined margins on all imaging sequences. The incidence of occult sacral insufficiency fractures was at least 20%. Insufficiency fractures of the sacrum in the post-radiotherapy patient are a relatively frequent occurrence which can mimic metastases. Consideration of this phenomenon and knowledge of differential features may avoid overdiagnosis of osseous metastases. (orig.)

  8. Preoperative psychosocial risk factors for poor outcomes at 1 and 5 years after total knee replacement.

    Science.gov (United States)

    Wylde, Vikki; Trela-Larsen, Lea; Whitehouse, Michael R; Blom, Ashley W

    2017-10-01

    Background and purpose - Psychosocial factors are important risk factors for poor outcomes in the first year after total knee replacement (TKR), however their impact on long-term outcomes is unclear. We aimed to identify preoperative psychosocial risk factors for poor outcomes at 1 year and 5 years after TKR. Patients and methods - 266 patients were recruited prior to TKR surgery. Knee pain and function were assessed preoperatively and at 1 and 5 years postoperative using the WOMAC Pain score, WOMAC Function score and American Knee Society Score (AKSS) Knee score. Preoperative depression, anxiety, catastrophizing, pain self-efficacy and social support were assessed. Statistical analyses involved multiple linear regression and mixed effect linear regression. Results - Higher anxiety was a risk factor for worse pain at 1 year postoperative. No psychosocial factors were associated with any outcomes at 5 years postoperative. Analysis of change over time found that patients with higher pain self-efficacy had lower preoperative pain and experienced less improvement in pain up to 1 year postoperative. Higher pain self-efficacy was associated with less improvement in the AKSS up to 1 year postoperative but more improvement between 1 and 5 years postoperative. Interpretation - Preoperative anxiety was found to influence pain at 1 year after TKR. However, none of the psychosocial variables were risk factors for a poor outcome at 5 years post-operative, suggesting that the negative effects of anxiety on outcome do not persist in the longer-term.

  9. Impact of preoperative chronic renal failure on liver transplantation: a population-based cohort study

    Science.gov (United States)

    Chung, Peter Chi-Ho; Chen, Hsiu-Pin; Lin, Jr-Rung; Liu, Fu-Chao; Yu, Huang-Ping

    2016-01-01

    Purpose The purpose of this study was to assess whether preoperative chronic renal failure (CRF) affects the rates of postoperative complications and survival after liver transplantation. Methods This population-based retrospective cohort study included 2,931 recipients of liver transplantation performed between 1998 and 2012, enrolled from the Taiwan National Health Insurance Research Database. Patients were divided into two groups, based on the presence or absence of preoperative CRF. Results The overall estimated survival rate of liver transplantation recipients (LTRs) with preoperative CRF was significantly lower than that of patients without preoperative CRF (P=0.0085). There was no significant difference between the groups in terms of duration of intensive care unit stay, total hospital stay, bacteremia, postoperative bleeding, and pneumonia during hospitalization. Long-term adverse effects, including cerebrovascular disease and coronary heart disease, were not different between patients with versus without CRF. Conclusion These findings suggest that LTRs with preoperative CRF have a higher rate of mortality. PMID:28008264

  10. Deepening Sleep by Hypnotic Suggestion

    Science.gov (United States)

    Cordi, Maren J.; Schlarb, Angelika A.; Rasch, Björn

    2014-01-01

    Study Objectives: Slow wave sleep (SWS) plays a critical role in body restoration and promotes brain plasticity; however, it markedly declines across the lifespan. Despite its importance, effective tools to increase SWS are rare. Here we tested whether a hypnotic suggestion to “sleep deeper” extends the amount of SWS. Design: Within-subject, placebo-controlled crossover design. Setting: Sleep laboratory at the University of Zurich, Switzerland. Participants: Seventy healthy females 23.27 ± 3.17 y. Intervention: Participants listened to an auditory text with hypnotic suggestions or a control tape before napping for 90 min while high-density electroencephalography was recorded. Measurements and Results: After participants listened to the hypnotic suggestion to “sleep deeper” subsequent SWS was increased by 81% and time spent awake was reduced by 67% (with the amount of SWS or wake in the control condition set to 100%). Other sleep stages remained unaffected. Additionally, slow wave activity was significantly enhanced after hypnotic suggestions. During the hypnotic tape, parietal theta power increases predicted the hypnosis-induced extension of SWS. Additional experiments confirmed that the beneficial effect of hypnotic suggestions on SWS was specific to the hypnotic suggestion and did not occur in low suggestible participants. Conclusions: Our results demonstrate the effectiveness of hypnotic suggestions to specifically increase the amount and duration of slow wave sleep (SWS) in a midday nap using objective measures of sleep in young, healthy, suggestible females. Hypnotic suggestions might be a successful tool with a lower risk of adverse side effects than pharmacological treatments to extend SWS also in clinical and elderly populations. Citation: Cordi MJ, Schlarb AA, Rasch B. Deepening sleep by hypnotic suggestion. SLEEP 2014;37(6):1143-1152. PMID:24882909

  11. Visualization of traumatic tricuspid insufficiency by three-dimensional echocardiography.

    Science.gov (United States)

    Nishimura, Kazuhisa; Okayama, Hideki; Inoue, Katsuji; Saito, Makoto; Nagai, Takayuki; Suzuki, Jun; Ogimoto, Akiyoshi; Ohtsuka, Tomoaki; Higaki, Jitsuo

    2010-01-01

    A 19-year-old male was admitted to the emergency room of our hospital after a motor vehicle accident. During his first physical examination, a holosystolic murmur was heard at the fourth left parasternal border. Transthoracic echocardiography showed severe tricuspid insufficiency, but the cause of tricuspid insufficiency was unclear. Therefore, three-dimensional echocardiography was performed and demonstrated flail anterior, posterior and septal leaflets of the tricuspid valve. The diagnosis was tricuspid insufficiency due to papillary muscle rupture secondary to chest blunt trauma. Surgical repair of the tricuspid valve was performed in this patient. After surgery, the signs and symptoms of right ventricular heart failure were relieved. In this case, three-dimensional echocardiography was very useful for the evaluation of spatial destruction of the tricuspid valve and papillary muscle. 2009 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  12. MR appearance of parasymphyseal insufficiency fractures of the os pubis

    Energy Technology Data Exchange (ETDEWEB)

    Hosono, Mariko; Fujimoto, Ryota; Konishi, Junji [Department of Nuclear Medicine, Faculty of Medicine, Kyoto University, 54 Shogoin-kawahara-cho, Sakyo-ku, Kyoto (Japan); Kobayashi, Hisataka [Nulcear Medicine Department, National Institutes of Health, Building 10, Room 1C-401, Bethesda, MD 20892 (United States); Tsutsui, Kazushige [Department of Radiology, Japanese Red Cross Society Wakayama Medical Center, Wakayama (Japan); Kotoura, Yoshihiko [Department of Orthopaedic Surgery, Nagahama City Hospital, Nagahama, Shiga (Japan); Tsuboyama, Tadao; Nakamura, Takashi [Department of Orthopaedic Surgery, Faculty of Medicine, Kyoto University, Kyoto (Japan); Hayashi, Hikaru [Department of Orthopaedic Surgery, Japanese Red Cross Society Wakayama Medical Center, Wakayama (Japan)

    1997-09-01

    Objective. To clarify the MRI features of parasymphyseal insufficiency fractures of the os pubis. Design and patients. MRI was performed in four postmenopausal women with parasymphyseal insufficiency fractures. The diagnosis was confirmed with plain films in every patient. T1-weighted and T2-weighted images were obtained in four patients using a 1.5-T unit. Postcontrast T1-weighted imaging was also done in three patients. Results and conclusions. MRI of pubic parasymphyseal insufficiency fracture characteristically demonstrates a hyperintense mass lesion with a hypointense rim on T2-weighted imaging, showing peripheral and septal enhancement after contrast administration. It is important to have this entity in mind in patients with osteoporosis, especially in patients with a history of pelvic irradiation for malignant disease, so as not to misinterpret it as a chondroid tumor or bone metastasis. (orig.). With 2 figs., 2 tabs.

  13. Chronic workplace stress and insufficient physical activity: a cohort study.

    Science.gov (United States)

    Kouvonen, Anne; Vahtera, Jussi; Oksanen, Tuula; Pentti, Jaana; Väänänen, Ari K P; Heponiemi, Tarja; Salo, Paula; Virtanen, Marianna; Kivimäki, Mika

    2013-01-01

    To examine whether exposure to workplace stressors predicts changes in physical activity and the risk of insufficient physical activity. Prospective data from the Finnish Public Sector Study. Repeated exposure to low job control, high job demands, low effort, low rewards and compositions of these (job strain and effort-reward imbalance) were assessed at Time 1 (2000-2002) and Time 2 (2004). Insufficient physical activity (workplace stressors on change in physical activity was examined using fixed-effects (within-subject) logistic regression models (N=6665). In addition, logistic regression analysis was applied to examine the associations between repeated exposure to workplace stressors and insufficient physical activity (N=13 976). In these analyses, coworker assessed workplace stressor scores were used in addition to individual level scores. The proportion of participants with insufficient physical activity was 24% at baseline and 26% at follow-up. 19% of the participants who were sufficiently active at baseline became insufficiently active at follow-up. In the fixed-effect analysis, an increase in workplace stress was weakly related to an increase in physical inactivity within an individual. In between-subjects analysis, employees with repeated exposure to low job control and low rewards were more likely to be insufficiently active at follow-up than those with no reports of these stressors; fully adjusted ORs ranged from 1.11 (95% CI 1.00 to 1.24) to 1.21 (95% CI 1.05 to 1.39). Workplace stress is associated with a slightly increased risk of physical inactivity.

  14. Vitamin D Insufficiency among Free-Living Healthy Young Adults

    OpenAIRE

    Tangpricha, Vin; Pearce, Elizabeth N.; Chen, Tai C.; Holick, Michael F.

    2002-01-01

    Long-term vitamin D insufficiency can cause secondary hyperparathyroidism and osteomalacia (1). In addition, there is increasing evidence that vitamin D may protect against common cancers, such as cancer of the colon (2–4), prostate (5), and breast (6). Young adults aged 17 to 35 years drink inadequate amounts of milk (7) and are concerned about exposure to the sun because of the fear of developing skin cancer (8,9), which increases the risk of vitamin D insufficiency (10). We sought to exami...

  15. Early intervention and management of adrenal insufficiency in children.

    LENUS (Irish Health Repository)

    Moloney, Sinéad

    2012-09-01

    The endocrine disorder adrenal insufficiency includes inadequate production of the steroid hormone cortisol. This results in poor physiological responses to illness, trauma or other stressors and risk of adrenal crisis. Management is based on administration of hydrocortisone. It is important to avoid under- or over-treatment and increase the dosage during times of physiological stress. To reduce morbidity, hospital admissions and mortality, the education and empowerment of parents and carers, and prompt intervention when necessary are essential. A steroid therapy card for adrenal insufficiency containing personal information on a patient\\'s condition was developed for use by families and their specialist centres.

  16. Preoperational test report, recirculation ventilation systems

    International Nuclear Information System (INIS)

    Clifton, F.T.

    1997-01-01

    This represents a preoperational test report for Recirculation Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102 and supports the ability to exhaust air from each tank. Each system consists of a valved piping loop, a fan, condenser, and moisture separator; equipment is located inside each respective tank farm in its own hardened building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System

  17. Preoperational test report, raw water system

    Energy Technology Data Exchange (ETDEWEB)

    Clifton, F.T.

    1997-10-29

    This represents the preoperational test report for the Raw Water System, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system supplies makeup water to the W-030 recirculation evaporative cooling towers for tanks AY1O1, AY102, AZ1O1, AZ102. The Raw Water pipe riser and associated strainer and valving is located in the W-030 diesel generator building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  18. Preoperational test report, recirculation ventilation systems

    Energy Technology Data Exchange (ETDEWEB)

    Clifton, F.T.

    1997-11-11

    This represents a preoperational test report for Recirculation Ventilation Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102 and supports the ability to exhaust air from each tank. Each system consists of a valved piping loop, a fan, condenser, and moisture separator; equipment is located inside each respective tank farm in its own hardened building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  19. Preoperational test report, primary ventilation condensate system

    Energy Technology Data Exchange (ETDEWEB)

    Clifton, F.T.

    1997-01-29

    Preoperational test report for Primary Ventilation Condensate System, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system provides a collection point for condensate generated by the W-030 primary vent offgas cooling system serving tanks AYIOI, AY102, AZIOI, AZI02. The system is located inside a shielded ventilation equipment cell and consists of a condensate seal pot, sampling features, a drain line to existing Catch Tank 241-AZ-151, and a cell sump jet pump. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  20. Preoperational test report, raw water system

    International Nuclear Information System (INIS)

    Clifton, F.T.

    1997-01-01

    This represents the preoperational test report for the Raw Water System, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The system supplies makeup water to the W-030 recirculation evaporative cooling towers for tanks AY1O1, AY102, AZ1O1, AZ102. The Raw Water pipe riser and associated strainer and valving is located in the W-030 diesel generator building. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System

  1. Preoperative steroid in abdominal wall reconstruction

    DEFF Research Database (Denmark)

    Jensen, Kristian Kiim; Brøndum, Tina Lee; Belhage, Bo

    2016-01-01

    INTRODUCTION: Preoperative administration of high-dose glucocorticoid leads to improved recovery and decreased length of stay after abdominal surgery. Even so, studies on administration of glucocorticoids for patients undergoing abdominal wall reconstruction (AWR) for giant ventral hernia repair...... defect exceeding 10 cm will be randomised for intravenous administration of either 125 mg methylprednisolone or saline at the induction of anaesthesia. The primary endpoint is pain at rest on the first post-operative day. Patients will be followed until 30 days post-operatively, and secondary outcomes...

  2. Facility-level association of preoperative stress testing and postoperative adverse cardiac events.

    Science.gov (United States)

    Valle, Javier A; Graham, Laura; Thiruvoipati, Thejasvi; Grunwald, Gary; Armstrong, Ehrin J; Maddox, Thomas M; Hawn, Mary T; Bradley, Steven M

    2018-06-22

    Despite limited indications, preoperative stress testing is often used prior to non-cardiac surgery. Patient-level analyses of stress testing and outcomes are limited by case mix and selection bias. Therefore, we sought to describe facility-level rates of preoperative stress testing for non-cardiac surgery, and to determine the association between facility-level preoperative stress testing and postoperative major adverse cardiac events (MACE). We identified patients undergoing non-cardiac surgery within 2 years of percutaneous coronary intervention in the Veterans Affairs (VA) Health Care System, from 2004 to 2011, facility-level rates of preoperative stress testing and postoperative MACE (death, myocardial infarction (MI) or revascularisation within 30 days). We determined risk-standardised facility-level rates of stress testing and postoperative MACE, and the relationship between facility-level preoperative stress testing and postoperative MACE. Among 29 937 patients undergoing non-cardiac surgery at 131 VA facilities, the median facility rate of preoperative stress testing was 13.2% (IQR 9.7%-15.9%; range 6.0%-21.5%), and 30-day postoperative MACE was 4.0% (IQR 2.4%-5.4%). After risk standardisation, the median facility-level rate of stress testing was 12.7% (IQR 8.4%-17.4%) and postoperative MACE was 3.8% (IQR 2.3%-5.6%). There was no correlation between risk-standardised stress testing and composite MACE at the facility level (r=0.022, p=0.81), or with individual outcomes of death, MI or revascularisation. In a national cohort of veterans undergoing non-cardiac surgery, we observed substantial variation in facility-level rates of preoperative stress testing. Facilities with higher rates of preoperative stress testing were not associated with better postoperative outcomes. These findings suggest an opportunity to reduce variation in preoperative stress testing without sacrificing patient outcomes. © Article author(s) (or their employer(s) unless otherwise

  3. Telomere Elongation and Naive Pluripotent Stem Cells Achieved from Telomerase Haplo-Insufficient Cells by Somatic Cell Nuclear Transfer

    Directory of Open Access Journals (Sweden)

    Li-Ying Sung

    2014-12-01

    Full Text Available Summary: Haplo-insufficiency of telomerase genes in humans leads to telomere syndromes such as dyskeratosis congenital and idiopathic pulmonary fibrosis. Generation of pluripotent stem cells from telomerase haplo-insufficient donor cells would provide unique opportunities toward the realization of patient-specific stem cell therapies. Recently, pluripotent human embryonic stem cells (ntESCs have been efficiently achieved by somatic cell nuclear transfer (SCNT. We tested the hypothesis that SCNT could effectively elongate shortening telomeres of telomerase haplo-insufficient cells in the ntESCs with relevant mouse models. Indeed, telomeres of telomerase haplo-insufficient (Terc+/− mouse cells are elongated in ntESCs. Moreover, ntESCs derived from Terc+/− cells exhibit naive pluripotency as evidenced by generation of Terc+/− ntESC clone pups by tetraploid embryo complementation, the most stringent test of naive pluripotency. These data suggest that SCNT could offer a powerful tool to reprogram telomeres and to discover the factors for robust restoration of telomeres and pluripotency of telomerase haplo-insufficient somatic cells. : Sung et al. demonstrate in a mouse model that telomeres of telomerase haplo-insufficient cells can be elongated by somatic cell nuclear transfer. Moreover, ntESCs derived from Terc+/− cells exhibit pluripotency evidenced by generation of Terc+/−ntESC clone pups by tetraploid embryo complementation, the most stringent test of naive pluripotency.

  4. Representational constraints on children's suggestibility.

    Science.gov (United States)

    Ceci, Stephen J; Papierno, Paul B; Kulkofsky, Sarah

    2007-06-01

    In a multistage experiment, twelve 4- and 9-year-old children participated in a triad rating task. Their ratings were mapped with multidimensional scaling, from which euclidean distances were computed to operationalize semantic distance between items in target pairs. These children and age-mates then participated in an experiment that employed these target pairs in a story, which was followed by a misinformation manipulation. Analyses linked individual and developmental differences in suggestibility to children's representations of the target items. Semantic proximity was a strong predictor of differences in suggestibility: The closer a suggested distractor was to the original item's representation, the greater was the distractor's suggestive influence. The triad participants' semantic proximity subsequently served as the basis for correctly predicting memory performance in the larger group. Semantic proximity enabled a priori counterintuitive predictions of reverse age-related trends to be confirmed whenever the distance between representations of items in a target pair was greater for younger than for older children.

  5. Foraminal syringomyelia: suggestion for a grading system.

    Science.gov (United States)

    Versari, P P; D'Aliberti, G; Talamonti, G; Collice, M

    1993-01-01

    The standard treatment of foraminal syringomyelia includes foramen magnum decompression and duraplasty. Improvement or stabilization of the disease are achieved in most of cases. However, at least one third of patients are reported to receive little or no benefit. In this paper we retrospectively reviewed a series of 40 consecutive foramen magnum decompressions in order to identify the possible pre-operative outcome predictors. Based on clinical evolution, neurological impairment and radiological features, a scale of severity was fixed and retrospectively tested. A pre-operative score was obtained for each patient and was correlated with the surgical results. Then a four level grading system was derived. All grade I and grade II patients achieved good results (improvement or stabilization), whereas grade III patients showed intermediate behaviour and grade IV invariably worsened. On this basis, surgical results of foramen magnum decompression might be further improved provided that a careful pre-operative selection is made.

  6. Preoperative chemoradiation therapy for advanced rectal cancer

    International Nuclear Information System (INIS)

    Tsujinaka, Toshimasa; Murotani, Masahiro; Iihara, Keisuke

    1997-01-01

    Preoperative concurrent chemoradiation therapy with 5-fluorouracil and cisplatin was applied for advanced rectal cancer. Eligible criteria were as follows: no previous treatment, more than hemicircular occupation, T 3 or more, invasion to adjacent organs or lymph node metastasis on CT scan, tumor fixation by digital examination. Eleven patients were enrolled with this regimen consisting of 5-FU; 500 mg/day x 5/w x 4, CDDP; 10 mg/day x 5/w x 4 and radiation; 2 Gy x 5/w x 4. As a toxicity, grade 2 leukopenia in 2 cases, grade 2 GI symptoms in one case and radiation dermatitis was observed in 8 cases. As a local response, there were PR in 10 cases and NC in 1 case. Surgical resection was performed on 8 patients. Histological responses in the resected specimens were grade 2, 5 cases; grade 1b, 1 case; and grade 1a, 2 cases. Operative radicalities were grade A, 3 cases; grade B, 3 cases; and grade C, 2 cases. Preoperative chemoradiation is one of the effective options in multimodal treatment for advanced rectal cancer. (author)

  7. Preoperative chemoradiotherapy for locally advanced gastric cancer

    International Nuclear Information System (INIS)

    Pepek, Joseph M; Chino, Junzo P; Willett, Christopher G; Palta, Manisha; Blazer III, Dan G; Tyler, Douglas S; Uronis, Hope E; Czito, Brian G

    2013-01-01

    To examine toxicity and outcomes for patients treated with preoperative chemoradiotherapy (CRT) for gastric cancer. Patients with gastroesophageal (GE) junction (Siewert type II and III) or gastric adenocarcinoma who underwent neoadjuvant CRT followed by planned surgical resection at Duke University between 1987 and 2009 were reviewed. Overall survival (OS), local control (LC) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. Toxicity was graded according to the Common Toxicity Criteria for Adverse Events version 4.0. Forty-eight patients were included. Most (73%) had proximal (GE junction, cardia and fundus) tumors. Median radiation therapy dose was 45 Gy. All patients received concurrent chemotherapy. Thirty-six patients (75%) underwent surgery. Pathologic complete response and R0 resection rates were 19% and 86%, respectively. Thirty-day surgical mortality was 6%. At 42 months median follow-up, 3-year actuarial OS was 40%. For patients undergoing surgery, 3-year OS, LC and DFS were 50%, 73% and 41%, respectively. Preoperative CRT for gastric cancer is well tolerated with acceptable rates of perioperative morbidity and mortality. In this patient cohort with primarily advanced disease, OS, LC and DFS rates in resected patients are comparable to similarly staged, adjuvantly treated patients in randomized trials. Further study comparing neoadjuvant CRT to standard treatment approaches for gastric cancer is indicated

  8. Preoperative chemoradiotherapy for locally advanced gastric cancer

    Directory of Open Access Journals (Sweden)

    Pepek Joseph M

    2013-01-01

    Full Text Available Abstract Background To examine toxicity and outcomes for patients treated with preoperative chemoradiotherapy (CRT for gastric cancer. Methods Patients with gastroesophageal (GE junction (Siewert type II and III or gastric adenocarcinoma who underwent neoadjuvant CRT followed by planned surgical resection at Duke University between 1987 and 2009 were reviewed. Overall survival (OS, local control (LC and disease-free survival (DFS were estimated using the Kaplan-Meier method. Toxicity was graded according to the Common Toxicity Criteria for Adverse Events version 4.0. Results Forty-eight patients were included. Most (73% had proximal (GE junction, cardia and fundus tumors. Median radiation therapy dose was 45 Gy. All patients received concurrent chemotherapy. Thirty-six patients (75% underwent surgery. Pathologic complete response and R0 resection rates were 19% and 86%, respectively. Thirty-day surgical mortality was 6%. At 42 months median follow-up, 3-year actuarial OS was 40%. For patients undergoing surgery, 3-year OS, LC and DFS were 50%, 73% and 41%, respectively. Conclusions Preoperative CRT for gastric cancer is well tolerated with acceptable rates of perioperative morbidity and mortality. In this patient cohort with primarily advanced disease, OS, LC and DFS rates in resected patients are comparable to similarly staged, adjuvantly treated patients in randomized trials. Further study comparing neoadjuvant CRT to standard treatment approaches for gastric cancer is indicated.

  9. The preoperative imaging evaluation for cochlear implantation

    International Nuclear Information System (INIS)

    Liu Zhonglin; Wang Zhenchang; Fu Lin; Li Yong; Xian Junfang; Yang Bentao; Lan Baosen; Li Yongxin; Zheng Jun; Song Yan; Liu Bo; Chen Xueqing; He Haili

    2006-01-01

    Objective: To analyze CT and MRI findings of temporal bone and to evaluate preoperative diagnostic value for cochlear implantation. Methods: One hundred and sixty candidates for cochlear implantation were examined with axial CT scan, 64 of them also with coronal CT scan, and 119 patients with MRI. Results: All of 320 ears were well-aerated, and 206 ears had mastoid cavities extended posteriorly to the sigmoid sinus. The length from posterior-lateral tympanic wall to the outer cortex was (2.34±0.42) mm (left side) and (2.25±0.40) mm (right side) (U=1.887, P 1 and T 2 signal on MRI. The congenital malformations of inner ear occurred in 67 ears, including complete dysplasia in 1 ear, cochlear hypodysplasia in 6 ears, Mondini deformation in 5 ears, enlarged vestibular aqueduct in 40 ears, dysplastic semicircular canal and the vestibulae in 10 ears, and narrowing of internal auditory canal in 5 ears. Conclusion: Preoperative imaging examinations can provide critical information to ensure successful cochlear' implantation. (authors)

  10. A critical inventory of preoperative skull replicas.

    Science.gov (United States)

    Fasel, J H D; Beinemann, J; Schaller, K; Gailloud, P

    2013-09-01

    Physical replicas of organs are used increasingly for preoperative planning. The quality of these models is generally accepted by surgeons. In view of the strong trend towards minimally invasive and personalised surgery, however, the aim of this investigation was to assess qualitatively the accuracy of such replicas, using skull models as an example. Skull imaging was acquired for three cadavers by computed tomography using clinical routine parameters. After digital three-dimensional (3D) reconstruction, physical replicas were produced by 3D printing. The facsimilia were analysed systematically and compared with the best gold standard possible: the macerated skull itself. The skull models were far from anatomically accurate. Non-conforming rendering was observed in particular for foramina, sutures, notches, fissures, grooves, channels, tuberosities, thin-walled structures, sharp peaks and crests, and teeth. Surgeons should be aware that preoperative models may not yet render the exact anatomy of the patient under consideration and are advised to continue relying, in specific conditions, on their own analysis of the native computed tomography or magnetic resonance imaging.

  11. Physiologic AV valvular insufficiency in cine MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Yoon Hyung; Kang, Eun Joo; Baik, Seung Kug; Ahn, Woo Hyun; Choi, Han Yong; Kim, Bong Gi [Wallace Memorial Baptist Hospital, Pusan (Korea, Republic of)

    1994-05-15

    To give a help in the interpretation of cardiac cine-MR examination, the extent, shape, and timing of appearance of signal void regions near atrioventricular(A-V) valve prospectively evaluate in the healthy population. Using an axial gradient-echo technique with small flip angle, repetition time(TR) of 36 msec and echo time(TE) of 22 msec, 20 volunteers without known valvular abnormalities undertook cardiac cine-MR imaging including atrioventricular valve areas. Transient signal void was observed within the near the tricuspid(13/20 = 65%) and mitral valves(9/20 = 45%), respectively, which is so called {sup p}hysioloic atrioventricular valvular insufficiency{sup .} Eight subjects revealed the signal void areas near both tricuspid and mitral valves but, 5 subjects did not show any evidence of physiologic insufficiency. This physiologic condition does not extend more than 1 cm proximal to A-V valve plane and is generally observed only during early systole. Its morphology is semilunar or triangular configuration with the base to the valve plane in most cases of normal tricuspid insufficiency and small globular appearance in most cases of normal mitral insufficiency. Awareness of normal signal void areas near the A-V valve and their characteristics is critical in the interpretation of cardiac cine MR examinations and maybe helpful in the study of the normal cardiac physiology.

  12. Physiologic AV valvular insufficiency in cine MR imaging

    International Nuclear Information System (INIS)

    Jang, Yoon Hyung; Kang, Eun Joo; Baik, Seung Kug; Ahn, Woo Hyun; Choi, Han Yong; Kim, Bong Gi

    1994-01-01

    To give a help in the interpretation of cardiac cine-MR examination, the extent, shape, and timing of appearance of signal void regions near atrioventricular(A-V) valve prospectively evaluate in the healthy population. Using an axial gradient-echo technique with small flip angle, repetition time(TR) of 36 msec and echo time(TE) of 22 msec, 20 volunteers without known valvular abnormalities undertook cardiac cine-MR imaging including atrioventricular valve areas. Transient signal void was observed within the near the tricuspid(13/20 = 65%) and mitral valves(9/20 = 45%), respectively, which is so called p hysioloic atrioventricular valvular insufficiency . Eight subjects revealed the signal void areas near both tricuspid and mitral valves but, 5 subjects did not show any evidence of physiologic insufficiency. This physiologic condition does not extend more than 1 cm proximal to A-V valve plane and is generally observed only during early systole. Its morphology is semilunar or triangular configuration with the base to the valve plane in most cases of normal tricuspid insufficiency and small globular appearance in most cases of normal mitral insufficiency. Awareness of normal signal void areas near the A-V valve and their characteristics is critical in the interpretation of cardiac cine MR examinations and maybe helpful in the study of the normal cardiac physiology

  13. Adrenal insufficiency in critically ill septic patients at Dr George ...

    African Journals Online (AJOL)

    Adele

    eosinophillia and hypoglycemia. Hyponatremia and hyperkalemia are uncommon. There has been much controversy regarding the criteria for the diagnosis of adrenal insufficiency.10,11,12 The diagnosis would be best made using an end-organ marker of adrenal steroid action. No such marker is available at present. Free.

  14. Treatment of insufficient lactation is often not evidence-based

    DEFF Research Database (Denmark)

    Axelsson, Paul Bryde; Bjerrum, Flemming; Løkkegaard, Ellen Christine Leth

    2014-01-01

    INTRODUCTION: Breast milk has many advantages over formula for infants in developed and developing countries alike. Despite intentions of breastfeeding, some women develop insufficient lactation. Treatment options traditionally include breastfeeding education and pharmacotherapy. MATERIAL AND MET...... be initiated by counselling and education. Only when these treatment options are exhausted should pharmacotherapy with a suitable medication be considered. FUNDING: not relevant. TRIAL REGISTRATION: not relevant....

  15. Hydrocortisone dose in adrenal insufficiency : Balancing harms and benefits

    NARCIS (Netherlands)

    Werumeus Buning, Jorien

    2017-01-01

    Patients with secondary adrenal insufficiency do not produce cortisol and are therefore treated with hydrocortisone tablets. The optimal substitution dose for hydrocortisone is unknown. We therefore performed this study, in which two different doses of hydrocortisone and its effect on cognition

  16. Nocturnal foot blood flow in patients with arterial insufficiency

    DEFF Research Database (Denmark)

    Jelnes, Rolf; Tønnesen, K H

    1984-01-01

    Twenty-four hour continuous recording of xenon (133Xe) wash-out from the forefoot was performed on patients with normal circulations (n = 10) and on patients with different degrees of arterial insufficiency (n = 36). During day hours the calculated subcutaneous blood flow in the forefoot was on a...

  17. 29 CFR 541.2 - Job titles insufficient.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Job titles insufficient. 541.2 Section 541.2 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS DEFINING AND DELIMITING THE EXEMPTIONS FOR EXECUTIVE, ADMINISTRATIVE, PROFESSIONAL, COMPUTER AND OUTSIDE SALES EMPLOYEES...

  18. Prevalence and effects of functional vitamin K insufficiency

    NARCIS (Netherlands)

    Riphagen, Ineke J.; Keyzer, Charlotte A.; Drummen, Nadja E.A.; Borst, de Martin H.; Beulens, Joline W.J.; Gansevoort, Ron T.; Geleijnse, Johanna M.; Muskiet, Frits A.J.; Navis, Gerjan; Visser, Sipke T.; Vermeer, Cees; Kema, Ido P.; Bakker, Stephan J.L.

    2017-01-01

    Matrix Gla Protein (MGP) is a strong vitamin K-dependent inhibitor of soft tissue calcification. We assessed the prevalence of functional vitamin K insufficiency, as derived from plasma desphospho-uncarboxylated MGP (dp-ucMGP), and investigated whether plasma dp-ucMGP is associated with all-cause

  19. Health consequences of shift work and insufficient sleep

    NARCIS (Netherlands)

    Kecklund, L.G.; Axelsson, J.

    2016-01-01

    This review summarises the literature on shift work and its relation to insufficient sleep, chronic diseases, and accidents. It is based on 38 meta-analyses and 24 systematic reviews, with additional narrative reviews and articles used for outlining possible mechanisms by which shift work may cause

  20. Health consequences of shift work and insufficient sleep.

    Science.gov (United States)

    Kecklund, Göran; Axelsson, John

    2016-11-01

    This review summarises the literature on shift work and its relation to insufficient sleep, chronic diseases, and accidents. It is based on 38 meta-analyses and 24 systematic reviews, with additional narrative reviews and articles used for outlining possible mechanisms by which shift work may cause accidents and adverse health. Evidence shows that the effect of shift work on sleep mainly concerns acute sleep loss in connection with night shifts and early morning shifts. A link also exists between shift work and accidents, type 2 diabetes (relative risk range 1.09-1.40), weight gain, coronary heart disease (relative risk 1.23), stroke (relative risk 1.05), and cancer (relative risk range 1.01-1.32), although the original studies showed mixed results. The relations of shift work to cardiometabolic diseases and accidents mimic those with insufficient sleep. Laboratory studies indicate that cardiometabolic stress and cognitive impairments are increased by shift work, as well as by sleep loss. Given that the health and safety consequences of shift work and insufficient sleep are very similar, they are likely to share common mechanisms. However, additional research is needed to determine whether insufficient sleep is a causal pathway for the adverse health effects associated with shift work. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Pancreatic insufficiency after different resections for benign tumours.

    Science.gov (United States)

    Falconi, M; Mantovani, W; Crippa, S; Mascetta, G; Salvia, R; Pederzoli, P

    2008-01-01

    Pancreatic resections for benign diseases may lead to long-term endocrine/exocrine impairment. The aim of this study was to compare postoperative and long-term results after different pancreatic resections for benign disease. Between 1990 and 1999, 62 patients underwent pancreaticoduodenectomy (PD), 36 atypical resection (AR) and 64 left pancreatectomy (LP) for benign tumours. Exocrine and endocrine pancreatic function was evaluated by 72-h faecal chymotrypsin and oral glucose tolerance test. The incidence of pancreatic fistula was significantly higher after AR than after LP (11 of 36 versus seven of 64; P = 0.028). The long-term incidence of endocrine pancreatic insufficiency was significantly lower after AR than after PD (P insufficiency was more common after PD (P endocrine and exocrine insufficiency was higher for PD and LP than for AR (32, 27 and 3 per cent respectively at 1 year; 58, 29 and 3 per cent at 5 years; P pancreatic resections are associated with different risks of developing long-term pancreatic insufficiency. AR represents the best option in terms of long-term endocrine and exocrine function, although it is associated with more postoperative complications. Copyright (c) 2007 British Journal of Surgery Society Ltd.

  2. A new peroxisomal disorder with fetal and neonatal adrenal insufficiency

    NARCIS (Netherlands)

    Vanhole, C.; de Zegher, F.; Casaer, P.; Devlieger, H.; Wanders, R. J.; Vanhove, G.; Jaeken, J.

    1994-01-01

    A boy with a new type of adrenoleukodystrophy is described. This was characterised by fetal and neonatal adrenal insufficiency, a neurological picture as seen in neonatal adrenoleukodystrophy, but with a normal number of peroxisomes in the liver and a peroxisomal dysfunction limited to the very long

  3. Response of geomorphic and geological processes to insufficient ...

    Indian Academy of Sciences (India)

    Depositional models have been constructed for each segment: a constant shelf break model with insufficient sediment supply in the east, and a migration shelf break model with plenty sediment supply in the west. This case study contributes to the understanding of the upper slope sedimentary process and stratigraphic style ...

  4. Results of aortic root reimplantation in patients with ascending aortic aneurysm and concomitant aortic insufficiency

    Directory of Open Access Journals (Sweden)

    А. М. Чернявский

    2016-01-01

    Full Text Available Objective. The research was designed to evaluate the results of valve-sparing operations: aortic root reimplantation versus aortic valve reimplantation when repairing an ascending aortic aneurysm with concomitant aortic insufficiency.Methods. Within a blind prospective randomized study conducted over a period from 2011 to 2015, 64 patients underwent aortic valve-sparing surgery. The inclusion criteria were the presence of an aortic aneurysm of the ascending aorta exceeding 4.5 cm and concomitant aortic insufficiency. All patients were divided into two groups: FS-group, aortic root reimplantation (modified Florida Sleeve technique (n = 32 and D-group, aortic valve reimplantation (David procedure (n = 32. The average age of patients was 57±13 (23–73 years in the FS-group and 55±11 (15–72 years in the D-group (p = 0.54. Both groups had 78% of males (p>0.99. A Marfan syndrome was identified in 6% and 9% in the FS-group and D-group respectively (p>0.99. Mean diameter of the sinuses of Valsalva was 51±7 mm and 56±10 mm (p = 0.09, aortic insufficiency 2.6±0.7 and 2.8±0.8 (p = 0.15 in the FS-group and D-group respectively. In the FS-group and D-group LVEDD amounted to 5.5±0.7 mm and 5.9±1.0 mm (p = 0.09 respectively. All patients took echocardiography in the preoperative, postoperative and follow-up periods.Results. In the long-term period, the degree of aortic regurgitation was 1.2±0.1 in the FS-group and 1.3±0.6 in the D-group (p = 0.72. LVEDD was 123±23 mm in the FS-group and 139.6±80 mm in the D-group at follow-up (p = 0.77. There were no statistically significant differences in the analysis of complications. Overall 30-day in-hospital mortality was 7.8%. There were 2 (6.3% deaths in the FS-group and 3 (9.4% in the D-group (p = 0.5.Late mortality was 6.3% in the FS-group and 3.1% in the D-group (p>0.99. Cumulative survival at 4 years was 84.3% and 84.8% in the FS-group and the D-group respectively (p = 0.94. Cumulative freedom from

  5. Classification of hadith into positive suggestion, negative suggestion, and information

    Science.gov (United States)

    Faraby, Said Al; Riviera Rachmawati Jasin, Eliza; Kusumaningrum, Andina; Adiwijaya

    2018-03-01

    As one of the Muslim life guidelines, based on the meaning of its sentence(s), a hadith can be viewed as a suggestion for doing something, or a suggestion for not doing something, or just information without any suggestion. In this paper, we tried to classify the Bahasa translation of hadith into the three categories using machine learning approach. We tried stemming and stopword removal in preprocessing, and TF-IDF of unigram, bigram, and trigram as the extracted features. As the classifier, we compared between SVM and Neural Network. Since the categories are new, so in order to compare the results of the previous pipelines, we created a baseline classifier using simple rule-based string matching technique. The rule-based algorithm conditions on the occurrence of words such as “janganlah, sholatlah, and so on” to determine the category. The baseline method achieved F1-Score of 0.69, while the best F1-Score from the machine learning approach was 0.88, and it was produced by SVM model with the linear kernel.

  6. Diagnostic Accuracy of Perioperative Measurement of Basal Anterior Pituitary and Target Gland Hormones in Predicting Adrenal Insufficiency After Pituitary Surgery.

    Science.gov (United States)

    Cerina, Vatroslav; Kruljac, Ivan; Radosevic, Jelena Marinkovic; Kirigin, Lora Stanka; Stipic, Darko; Pecina, Hrvoje Ivan; Vrkljan, Milan

    2016-03-01

    The insulin tolerance test (ITT) is the gold standard for diagnosing adrenal insufficiency (AI) after pituitary surgery. The ITT is unpleasant for patients, requires close medical supervision and is contraindicated in several comorbidities. The aim of this study was to analyze whether tumor size, remission rate, preoperative, and early postoperative baseline hormone concentrations could serve as predictors of AI in order to increase the diagnostic accuracy of morning serum cortisol. This prospective study enrolled 70 consecutive patients with newly diagnosed pituitary adenomas. Thirty-seven patients had nonfunctioning pituitary adenomas (NPA), 28 had prolactinomas and 5 had somatotropinomas. Thyroxin (T4), thyrotropin (TSH), prolactin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and insulin-like growth factor 1 (IGF-I) were measured preoperatively and on the sixth postoperative day. Serum morning cortisol was measured on the third postoperative day (CORT3) as well as the sixth postoperative day (CORT6). Tumor mass was measured preoperatively and remission was assessed 3 months after surgery. An ITT was performed 3 to 6 months postoperatively. Remission was achieved in 48% of patients and AI occurred in 51%. Remission rates and tumor type were not associated with AI. CORT3 had the best predictive value for AI (area under the curve (AUC) 0.868, sensitivity 82.4%, specificity 83.3%). Tumor size, preoperative T4, postoperative T4, and TSH were also associated with AI in a multivariate regression model. A combination of all preoperative and postoperative variables (excluding serum cortisol) had a sensitivity of 75.0% and specificity of 77.8%. The predictive power of CORT3 substantially improved by adding those variables into the model (AUC 0.921, sensitivity 94.1%, specificity 78.3%, PPV 81.9%, NPV of 92.7%). In a subgroup analysis that included only female patients with NPA, LH had exactly the same predictive value as CORT3. The addition

  7. [Foreign body in the tricuspid valve with valvular insufficiency and right-left shunt].

    Science.gov (United States)

    Delebarre, P; Augustin-Normand, C; Capronier, C; Cramer, J; Godeau, P; Letac, B; Forman, J; Maurice, P; Ourbak, P

    1987-05-01

    We present the case of a 50-year old man who progressively developed tricuspid valve insufficiency with opening of a patent foramen ovale responsible for right-to-left shunt with polycythaemia. The tricuspid valve insufficiency was due to a foreign body, probably of surgical origin as suggested by its radiological image and by the patient's previous history. It would have been introduced, far away from the tricuspid valve (compound fracture of the wrist), several years previously. At surgery, we found the foreign body embedded in the valve system. As a possible mechanism for the mutilation, an undiagnosed endocarditis was suspected but could not be confirmed. Three cases tricuspid endocarditis (with foreign bodies in the right ventricle) and 3 cases of asymptomatic tricuspid valve foreign bodies have been published. Fifty-five cases of foreign bodies introduced peripherally and migrated into the heart, the pericardium and the pulmonary artery are reviewed.

  8. Bilateral insufficiency fracture of the femoral head and neck in a case of oncogenic osteomalacia.

    Science.gov (United States)

    Chouhan, V; Agrawal, K; Vinothkumar, T K; Mathesul, A

    2010-07-01

    We describe a case of oncogenic osteomalacia in an adult male who presented with low back pain and bilateral hip pain. Extensive investigations had failed to find a cause. A plain pelvic radiograph showed Looser's zones in both femoral necks. MRI confirmed the presence of insufficiency fractures bilaterally in the femoral head and neck. Biochemical investigations confirmed osteomalacia which was unresponsive to treatment with vitamin D and calcium. A persistently low serum phosphate level suggested a diagnosis of hypophosphataemic osteomalacia. The level of fibroblast growth factor-23 was highly raised, indicating the cause as oncogenic osteomalacia. This was confirmed on positron-emission tomography, MRI and excision of a benign fibrous histiocytoma following a rapid recovery. The diagnosis of oncogenic osteomalacia may be delayed due to the non-specific presenting symptoms. Subchondral insufficiency fractures of the femoral head may be missed unless specifically looked for.

  9. Interrogative suggestibility in opiate users.

    Science.gov (United States)

    Murakami, A; Edelmann, R J; Davis, P E

    1996-09-01

    The present study investigated interrogative suggestibility in opiate users. A group of patients undergoing a methadone detoxification programme in an in-patient drug treatment unit (Detox group, n = 21), and a group of residents who had come off drugs and were no longer suffering from withdrawal syndrome (Rehab group, n = 19) were compared on interrogative suggestibility and various other psychological factors. Significant differences were found between the two groups, with the Detox group having more physical and psychological problems, and a higher total suggestibility score in comparison with the Rehab group. These findings are discussed in relation to the context of police interrogations and the reliability of confessions made by suspects and witnesses dependent on opiates.

  10. Preoperative DTI and probabilistic tractography in an amputee with deep brain stimulation for lower limb stump pain.

    Science.gov (United States)

    Owen, S L F; Heath, J; Kringelbach, M L; Stein, J F; Aziz, T Z

    2007-10-01

    This study aimed to find out whether preoperative diffusion tensor imaging (DTI) and probabilistic tractography could help with surgical planning for deep brain stimulation in the periaqueductal/periventricular grey area (PAG/PVG) in a patient with lower leg stump pain. A preoperative DTI was obtained from the patient, who then received DBS surgery in the PAG/PVG area with good pain relief. The postoperative MRI scan showing electrode placement was used to calculate four seed areas to represent the contacts on the Medtronic 3387 electrode. Probabilistic tractography was then performed from the pre-operative DTI image. Tracts were seen to connect to many areas within the pain network from the four different contacts. These initial findings suggest that preoperative DTI scanning and probabilistic tractography may be able to assist surgical planning in the future.

  11. [Perinatal complications in patients with chronic renal insufficiency on hemodialysis].

    Science.gov (United States)

    Vázquez-Rodríguez, Juan Gustavo; del Angel-García, Guadalupe

    2010-09-01

    Pregnant patients with chronic renal insufficiency treated with hemodialysis experience adverse perinatal results. To compare perinatal complications of patients with chronic renal insufficiency undergoing hemodialysis who become pregnant vs. the complications of women with chronic renal insufficiency not undergoing dialysis but who then require dialysis during gestation. Transversal and retrospective study that included three patients with chronic renal insufficiency on chronic hemodialysis who became pregnant (group A) and three patients with chronic renal insufficiency without hemodialysis at the time of conception but who required dialysis during gestation (group B). Perinatal results were compared. Statistical analysis was performed with measures of central tendency and dispersion and Student t-test. Group A had 25 sessions vs. group B with 29 hemodialysis sessions (p = 0.88). Maternal complications were anemia 100% (six cases), Cesarean delivery 83.3% (group A 2 cases vs. group B 2 cases), preeclampsia 50% (group A 2 cases vs. group B 1 case), uncontrolled hypertension 50% (group A 2 cases vs. group B 1 case), preterm delivery 50% (group A 2 cases vs. group B 1 case), transfusion 33.3% (group A 2 cases), polyhydramnios 33.3% (group A 1 case vs. group B 1 case) and abortion 16.6% (group A 1 case). Fetal complications included fetal loss 16.6% (group A 1 case), neonatal mortality 33.3% (group A 1 cases vs. group B 1 case), prematurity 50% (group A2 cases vs. group B 1 case), fetal distress 50% (group A 1 case vs. group B 2 cases), respiratory failure 33.3% (group A 2 cases) and fetal growth restriction 16.6% (group A 1 case). Frequency of perinatal complications is elevated in both groups.

  12. Preoperative Quality of Life in Patients with Gastric Cancer

    OpenAIRE

    Suk, Hyoam; Kwon, Oh Kyung; Yu, Wansik

    2015-01-01

    Purpose We evaluated the socio-personal and clinical factors that can affect preoperative quality of life to determine how to improve preoperative quality of life in patients with gastric cancer. Materials and Methods The preoperative quality of life data of 200 patients (68 females and 132 males; mean age 58.9?12.6 years) with gastric cancer were analyzed according to socio-personal and clinical factors. The Korean versions of the European Organization for Research and Treatment of Cancer (E...

  13. Chromosomal instability in women with primary ovarian insufficiency.

    Science.gov (United States)

    Katari, Sunita; Aarabi, Mahmoud; Kintigh, Angela; Mann, Susan; Yatsenko, Svetlana A; Sanfilippo, Joseph S; Zeleznik, Anthony J; Rajkovic, Aleksandar

    2018-02-07

    What is the prevalence of somatic chromosomal instability among women with idiopathic primary ovarian insufficiency (POI)? A subset of women with idiopathic POI may have functional impairment in DNA repair leading to chromosomal instability in their soma. The formation and repair of DNA double-strand breaks during meiotic recombination are fundamental processes of gametogenesis. Oocytes with compromised DNA integrity are susceptible to apoptosis which could trigger premature ovarian aging and accelerated wastage of the human follicle reserve. Genomewide association studies, as well as whole exome sequencing, have implicated multiple genes involved in DNA damage repair. However, the prevalence of defective DNA damage repair in the soma of women with POI is unknown. In total, 46 women with POI and 15 family members were evaluated for excessive mitomycin-C (MMC)-induced chromosome breakage. Healthy fertile females (n = 20) and two lymphoblastoid cell lines served as negative and as positive controls, respectively. We performed a pilot functional study utilizing MMC to assess chromosomal instability in the peripheral blood of participants. A high-resolution array comparative genomic hybridization (aCGH) was performed on 16 POI patients to identify copy number variations (CNVs) for a set of 341 targeted genes implicated in DNA repair. Array CGH revealed three POI patients (3/16, 18.8%) with pathogenic CNVs. Excessive chromosomal breakage suggestive of a constitutional deficiency in DNA repair was detected in one POI patient with the 16p12.3 duplication. In two patients with negative chromosome breakage analysis, aCGH detected a Xq28 deletion comprising the Centrin EF-hand Protein 2 (CETN2) and HAUS Augmin Like Complex Subunit 7 (HAUS7) genes essential for meiotic DNA repair, and a duplication in the 3p22.2 region comprising a part of the ATPase domain of the MutL Homolog 1 (MLH1) gene. Peripheral lymphocytes, used as a surrogate tissue to quantify induced chromosome

  14. Cement stress predictions after anatomic total shoulder arthroplasty are correlated with preoperative glenoid bone quality.

    Science.gov (United States)

    Terrier, Alexandre; Obrist, Raphaël; Becce, Fabio; Farron, Alain

    2017-09-01

    We hypothesized that biomechanical parameters typically associated with glenoid implant failure after anatomic total shoulder arthroplasty (aTSA) would be correlated with preoperative glenoid bone quality. We developed an objective automated method to quantify preoperative glenoid bone quality in different volumes of interest (VOIs): cortical bone, subchondral cortical plate, subchondral bone after reaming, subchondral trabecular bone, and successive layers of trabecular bone. Average computed tomography (CT) numbers (in Hounsfield units [HU]) were measured in each VOI from preoperative CT scans. In parallel, we built patient-specific finite element models of simulated aTSAs to predict cement stress, bone-cement interfacial stress, and bone strain around the glenoid implant. CT measurements and finite element predictions were obtained for 20 patients undergoing aTSA for primary glenohumeral osteoarthritis. We tested all linear correlations between preoperative patient characteristics (age, sex, height, weight, glenoid bone quality) and biomechanical predictions (cement stress, bone-cement interfacial stress, bone strain). Average CT numbers gradually decreased from cortical (717 HU) to subchondral and trabecular (362 HU) bone. Peak cement stress (4-10 MPa) was located within the keel hole, above the keel, or behind the glenoid implant backside. Cement stress, bone-cement interfacial stress, and bone strain were strongly negatively correlated with preoperative glenoid bone quality, particularly in VOIs behind the implant backside (subchondral trabecular bone) but also in deeper trabecular VOIs. Our numerical study suggests that preoperative glenoid bone quality is an important parameter to consider in aTSA, which may be associated with aseptic loosening of the glenoid implant. These initial results should now be confronted with clinical and radiologic outcomes. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc

  15. Preoperative stoma site marking in the general surgery population.

    Science.gov (United States)

    Zimnicki, Katherine M

    2013-01-01

    Preoperative teaching and stoma site marking are supported by research and professional organizations as interventions that can reduce the incidence of problematic stomas and improve patient outcomes. This study investigated the translation of this research into practice in the acute care surgery population. A retrospective chart review using convenience sampling was conducted at a large urban hospital in the Midwestern United States. Thirty patients underwent a surgical procedure that resulted in the creation of a fecal ostomy over a 5-month period. Descriptive statistical analysis examined the reason for surgery, preoperative length of stay (LOS), the percentage of patients who received preoperative teaching and stoma marking and the relationship between preoperative LOS and the use of preoperative teaching and stoma marking. Twenty-one of 30 patients were admitted to hospital 24 hours or more before surgery. No participants were admitted urgently. Three (14%) of those admitted for more than 24 hours received preoperative marking or teaching. There was no significant relationship between preoperative LOS and preoperative teaching and stoma marking. The opportunity exists to promote successful adaptation in this surgical population through the implementation of the evidence-based interventions of preoperative teaching and stoma marking. Additional study is needed to determine barriers to their use as well as to develop effective implementation strategies.

  16. Pre-operative pain and sensory function in groin hernia

    DEFF Research Database (Denmark)

    Aasvang, Eske K; Hansen, Jeanette B; Kehlet, Henrik

    2009-01-01

    BACKGROUND: Although persistent postherniotomy occurs in 5-10% of patients, pathogenic mechanisms remain debatable. Since pre-operative pain has been demonstrated to be a risk factor for persistent postherniotomy pain, pre-operative alterations in nociceptive function may be a potential pathogenic...... mechanism. AIMS: To investigate the correlation between pre-operative pain intensity and sensory functions in the groin hernia area. METHODS: Patients with unilateral groin hernia were examined preoperatively by quantitative sensory testing (thermal, mechanical, and pressure [detection and pain thresholds...... (7%), all whom experienced no pain or pain less than weekly. Only cool detection thresholds were significantly lower between the hernia vs. contralateral side (poperative groin hernia...

  17. Intraoperative Frontal Alpha-Band Power Correlates with Preoperative Neurocognitive Function in Older Adults

    Directory of Open Access Journals (Sweden)

    Charles M. Giattino

    2017-05-01

    Full Text Available Each year over 16 million older Americans undergo general anesthesia for surgery, and up to 40% develop postoperative delirium and/or cognitive dysfunction (POCD. Delirium and POCD are each associated with decreased quality of life, early retirement, increased 1-year mortality, and long-term cognitive decline. Multiple investigators have thus suggested that anesthesia and surgery place severe stress on the aging brain, and that patients with less ability to withstand this stress will be at increased risk for developing postoperative delirium and POCD. Delirium and POCD risk are increased in patients with lower preoperative cognitive function, yet preoperative cognitive function is not routinely assessed, and no intraoperative physiological predictors have been found that correlate with lower preoperative cognitive function. Since general anesthesia causes alpha-band (8–12 Hz electroencephalogram (EEG power to decrease occipitally and increase frontally (known as “anteriorization”, and anesthetic-induced frontal alpha power is reduced in older adults, we hypothesized that lower intraoperative frontal alpha power might correlate with lower preoperative cognitive function. Here, we provide evidence that such a correlation exists, suggesting that lower intraoperative frontal alpha power could be used as a physiological marker to identify older adults with lower preoperative cognitive function. Lower intraoperative frontal alpha power could thus be used to target these at-risk patients for possible therapeutic interventions to help prevent postoperative delirium and POCD, or for increased postoperative monitoring and follow-up. More generally, these results suggest that understanding interindividual differences in how the brain responds to anesthetic drugs can be used as a probe of neurocognitive function (and dysfunction, and might be a useful measure of neurocognitive function in older adults.

  18. Preoperational test report, recirculation condenser cooling systems

    International Nuclear Information System (INIS)

    Clifton, F.T.

    1997-01-01

    This represents a preoperational test report for Recirculation Condenser Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The four system provide condenser cooling water for vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102. Each system consists of a valved piping loop, a pair of redundant recirculation pumps, a closed-loop evaporative cooling tower, and supporting instrumentation; equipment is located outside the farm on concrete slabs. Piping is routed to the each ventilation condenser inside the farm via below-grade concrete trenches. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System

  19. Preoperational test report, recirculation condenser cooling systems

    Energy Technology Data Exchange (ETDEWEB)

    Clifton, F.T.

    1997-11-04

    This represents a preoperational test report for Recirculation Condenser Systems, Project W-030. Project W-030 provides a ventilation upgrade for the four Aging Waste Facility tanks. The four system provide condenser cooling water for vapor space cooling of tanks AY1O1, AY102, AZ1O1, AZ102. Each system consists of a valved piping loop, a pair of redundant recirculation pumps, a closed-loop evaporative cooling tower, and supporting instrumentation; equipment is located outside the farm on concrete slabs. Piping is routed to the each ventilation condenser inside the farm via below-grade concrete trenches. The tests verify correct system operation and correct indications displayed by the central Monitor and Control System.

  20. Preoperative and intraoperative irradiation for osteosarcoma

    International Nuclear Information System (INIS)

    Furuya, Kotaro; Amino, Katsuhisa; Kawaguchi, Noriyoshi.

    1980-01-01

    1) 8 cases of osteosarcoma were treated with preoperative massive irradiation, the over 5 years survival rate was 3/8 (37.5%). 7 out of 8 cases (87.5%) metastasized to the lung. From these result, it is considered that tumorspecific immunological effect can not be expected from irradiation. Irradiation therapy is essentially a local treatment, and therefore systemic chemotherapy is necessary to prevent metastasis. 2) Osteosarcoma was considered to be radioresistant tumor previously, however local control can be obtained by direct view irradiation without the damage of surrounding tissue. This irradiation method is indicated only for young adult in whom the primary tumor is localized. 3) In the experimental study on heterotransplanted human osteosarcoma in nude mice, combined treatment with radiation and chemotherapy (HD-MTX, ADM and EDX) was proven to be more effective as compared with radiation alone. (author)

  1. Preoperative ripening of the cervix before operative hysteroscopy.

    Science.gov (United States)

    Al-Fozan, Haya; Firwana, Belal; Al Kadri, Hanan; Hassan, Samar; Tulandi, Togas

    2015-04-23

    , abandonment of the procedure, side effects of dilating agents and duration of surgery. We calculated odds ratios (ORs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, with 95% confidence intervals ( CIs). Data were statistically pooled where appropriate. Heterogeneity was assessed using the I(2) statistic. The overall quality of the evidence was assessed using GRADE methods. Nineteen RCTs with a total of 1870 participants were included. They compared misoprostol with no treatment or placebo, dinoprostone or osmotic dilators.Misoprostol was more effective for cervical dilatation than placebo or no intervention, with fewer women requiring mechanical dilatation (OR 0.08, 95% CI 0.04 to 0.16, five RCTs, 441 participants, I(2)=0%, moderate quality evidence). This suggests that in a population in which 80% of women undergoing hysteroscopy require mechanical dilatation without use of preoperative ripening agents, use of misoprostol will reduce the need for mechanical dilatation to between 14% and 39%. Misoprostol was associated with fewer intraoperative complications (OR 0.37, 95% CI 0.18 to 0.77, 12 RCTs, 901 participants, I(2)=0%, moderate quality evidence). This suggests that in a population in which 3% of women undergoing hysteroscopy experience intraoperative complications without use of preoperative ripening agents, use of misoprostol will reduce the risk of complications to 2% or less.When specific complications were considered, the misoprostol group had a lower rate of cervical laceration or tearing (OR 0.25, 95% CI 0.11 to 0.57, nine RCTS, 669 women, I(2)=0%, moderate quality evidence) or false track formation (OR 0.34, 95% CI 0.12 to 0.97, seven RCTs, 560 participants, I(2)=0%, moderate quality evidence). There was no evidence of a difference between the groups in rates of uterine perforation (0.42, 95% CI 0.13 to 1.38, seven RCTs, 455 participants, I(2)=0%, low quality evidence) or uterine bleeding (OR 0.51, 95% CI 0.10 to 2.49, four RCTs, 340

  2. Background parenchymal enhancement in preoperative breast MRI.

    Science.gov (United States)

    Kohara, Satoko; Ishigaki, Satoko; Satake, Hiroko; Kawamura, Akiko; Kawai, Hisashi; Kikumori, Toyone; Naganawa, Shinji

    2015-08-01

    We aimed to assess the influence of background parenchymal enhancement (BPE) on surgical planning performed using preoperative MRI for breast cancer evaluation. Between January 2009 and December 2010, 91 newly diagnosed breast cancer patients (mean age, 55.5 years; range, 30-88 years) who underwent preoperative bilateral breast MRI followed by planned breast conservation therapy were retrospectively enrolled. MRI was performed to assess the tumor extent in addition to mammography and breast ultrasonography. BPE in the contralateral normal breast MRI at the early dynamic phase was visually classified as follows: minimal (n=49), mild (n=27), moderate (n=7), and marked (n=8). The correlations between the BPE grade and age, menopausal status, index tumor size, changes in surgical management based on MRI results, positive predictive value (PPV) of MRI, and surgical margins were assessed. Patients in the strong BPE groups were significantly younger (p=0.002) and generally premenopausal (p<0.001). Surgical treatment was not changed in 67 cases (73.6%), while extended excision and mastectomy were performed in 12 cases (13.2%), each based on additional lesions on MRI. Six of 79 (7.6%) patients who underwent breast conservation therapy had tumor-positive resection margins. In cases where surgical management was changed, the PPV for MRI-detected foci was high in the minimal (91.7%) and mild groups (66.7%), and 0% in the moderate and marked groups (p=0.002). Strong BPE causes false-positive MRI findings and may lead to overly extensive surgery, whereas MRI may be beneficial in select patients with weak BPE.

  3. Preoperative information needs of children undergoing tonsillectomy.

    LENUS (Irish Health Repository)

    Buckley, Aoife

    2012-02-01

    AIMS AND OBJECTIVES: To identify the information needs of children undergoing tonsillectomy with reference to content of information, method of delivery, information providers and timing of information provision. BACKGROUND: Tonsillectomy can be anxiety provoking for children and preoperative preparation programmes are long recognised to reduce anxiety. However, few have been designed from the perspectives of children and to date little is known about how best to prepare children in terms of what to tell them, how to convey information to them, who can best provide information and what is the best timing for information provision. DESIGN: A qualitative descriptive study. METHOD: Data were collected from nine children (aged 6-9) using interviews supported by a write and draw technique. Data were coded and categorised into themes reflecting content, method, providers and timing of information. RESULTS: Children openly communicated their information needs especially on what to tell them to expect when facing a tonsillectomy. Their principal concerns were about operation procedures, experiencing \\'soreness\\' and discomfort postoperatively and parental presence. Mothers were viewed as best situated to provide them with information. Children were uncertain about what method of information and timing would be most helpful to them. CONCLUSION: Preoperative educational interventions need to take account of children\\'s information needs so that they are prepared for surgery in ways that are meaningful and relevant to them. Future research is needed in this area. RELEVANCE TO CLINICAL PRACTICE: Practical steps towards informing children about having a tonsillectomy include asking them what they need to know and addressing their queries accordingly. Child-centred information leaflets using a question and answer format could also be helpful to children.

  4. News about the genetics of congenital primary adrenal insufficiency.

    Science.gov (United States)

    Roucher-Boulez, Florence; Mallet-Motak, Delphine; Tardy-Guidollet, Véronique; Menassa, Rita; Goursaud, Claire; Plotton, Ingrid; Morel, Yves

    2018-04-13

    Primary adrenal insufficiency (PAI) is characterized by impaired production of steroid hormones due to an adrenal cortex defect. This condition incurs a risk of acute insufficiency which may be life-threatening. Today, 80% of pediatric forms of PAI have a genetic origin but 5% have no clear genetic support. Recently discovered mutations in genes relating to oxidative stress have opened the way to research on genes unrelated to the adrenal gland. Identification of causal mutations in a gene responsible for PAI allows genetic counseling, guidance of follow-up and prevention of complications. This is particularly true for stress oxidative anomalies, as extra-adrenal manifestations may occur due to the sensitivity to oxidative stress of other organs such as the heart, thyroid, liver, kidney and pancreas. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  5. Rectal hydrocortisone during vomiting in children with adrenal insufficiency.

    Science.gov (United States)

    Ní Chróinín, M; Fallon, M; Kenny, D; Moriarty, S; Hoey, H; Costigan, C

    2003-01-01

    To evaluate rectal hydrocortisone as an emergency glucocorticoid replacement therapy in adrenal insufficient children. A parental questionnaire evaluated preferred treatment, problems or benefits of i.m. and rectal hydrocortisone, frequency and indications for administration and who administered treatment. Admissions of children with adrenal insufficiency were monitored. There were 39/52 families who responded to the questionnaire. 93% (26/28) preferred rectal hydrocortisone. Parents or children who previously received emergency treatment from a doctor now self-administered rectal hydrocortisone. The cost of suppositories and i.m. hydrocortisone is similar; however, storage of suppositories was inconvenient. One girl presented with pneumonia and collapse despite rectal hydrocortisone and a hydrocortisone level at admission of >2000 nmol/l with normal electrolytes. Rectal hydrocortisone is an acceptable and safe emergency therapy. We still advise i.m. hydrocortisone if rectal administration is not possible or with suppository extrusion.

  6. Diabetes mellitus and exocrine pancreatic insufficiency (review of literature

    Directory of Open Access Journals (Sweden)

    L.T. Daminova

    2018-02-01

    Full Text Available Currently, an increasing importance is given to the study of the problem of exocrine pancreatic insufficiency, which is observed in a significant number of patients with diabetes mellitus (DM type 1 and 2 and can potentially affect the compensation of DM. The mechanism of reducing the external secretion of the pancreas in DM is associated with an imbalance of inhibitory and stimulating pancreatic secretion of hormones, with fibrosis of the gland as a result of diabetic angiopathy. In type 2 DM, the mechanisms that result from the metabolic syndrome are involved in the pathogenesis of exocrine pancreatic insufficiency. Enzyme replacement the­rapy should be considered as one of the promising methods of treating DM patients.

  7. [An update on the treatment of venous insufficiency in pregnancy].

    Science.gov (United States)

    Rodríguez-Nora, B; Álvarez-Silvares, E

    Chronic venous insufficiency is a long-term pathological condition resulting from anatomical or functional alterations of the venous system. This leads to the appearance of symptoms and physical signs that affect a large part of the population and particularly pregnant women, due to the physiology of pregnancy. The few published studies on the use of pharmacological treatments of venous insufficiency in this group of the population, often makes the management of this condition difficult in routine clinical practice. A review is presented in this article, with all the latest updates in the treatment of this condition during pregnancy. There are numerous general, and some pharmacological, recommendations, that we can safely offer the pregnant patient. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Adrenal insufficiency in a child with MELAS syndrome.

    Science.gov (United States)

    Afroze, Bushra; Amjad, Nida; Ibrahim, Shahnaz H; Humayun, Khadija Nuzhat; Yakob, Yusnita

    2014-11-01

    Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) are established subgroups of mitochondrial encephalomyopathy. m.3243A>G a common point mutation is detected in tRNA in majority of patients with MELAS phenotype whereas m.8344A>G point mutation in tRNA is observed, in MERRF phenotype. Adrenal insufficiency has not been reported in mitochondrial disease, except in Kearns-Sayre Syndrome (KSS), which is a mitochondrial deletion syndrome. We report an unusual presentation in a five year old boy who presented with clinical phenotype of MELAS and was found to have m.8344A>G mutation in tRNA. Addison disease was identified due to hyperpigmentation of lips and gums present from early childhood. This is the first report describing adrenal insufficiency in a child with MELAS phenotype. Copyright © 2014 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  9. Preoperative learning goals set by surgical residents and faculty.

    Science.gov (United States)

    Pernar, Luise I M; Breen, Elizabeth; Ashley, Stanley W; Peyre, Sarah E

    2011-09-01

    The operating room (OR) remains the main teaching venue for surgical trainees. The OR is considered a pure-discovery learning environment; the downsides of this can be putatively overcome when faculty and trainee arrive at a shared understanding of learning. This study aimed to better understand preoperative learning goals to identify areas of commonalities and potential barrier to intraoperative teaching. Brief, structured preoperative interviews were conducted outside the OR with the resident and faculty member who were scheduled to operate together. Answers were analyzed and grouped using grounded theory. Twenty-seven resident-faculty pairs were interviewed. Nine residents (33.3%) were junior (PGY 1 and 2) and 18 (66.7%) were senior (PGY 3 through 5). Learning goal categories that emerged from the response analysis were anatomy, basic and advanced surgical skills, general and specific procedural tasks, technical autonomy, and pre-, intra-, and postoperative considerations. Residents articulated fewer learning goals than faculty (1.5 versus 2.4; P = 0.024). The most frequently identified learning goal by both groups was one classifiable under general procedural tasks; the greatest divergence was seen regarding perioperative considerations, which were identified frequently by faculty members but rarely by residents. Faculty articulate significantly more learning goals for the residents they will operate with than residents articulate for themselves. Our data suggest that residents and faculty align on some learning goals for the OR but residents tend to be more limited, focusing predominantly on technical aspects of the operation. Faculty members tend to hold a broader view of the learning potential of the OR. These discrepancies may present barriers to effective intraoperative teaching. Copyright © 2011 Elsevier Inc. All rights reserved.

  10. Analysis of Chinese women with primary ovarian insufficiency by high resolution array-comparative genomic hybridization.

    Science.gov (United States)

    Liao, Can; Fu, Fang; Yang, Xin; Sun, Yi-Min; Li, Dong-Zhi

    2011-06-01

    Primary ovarian insufficiency (POI) is defined as a primary ovarian defect characterized by absent menarche (primary amenorrhea) or premature depletion of ovarian follicles before the age of 40 years. The etiology of primary ovarian insufficiency in human female patients is still unclear. The purpose of this study is to investigate the potential genetic causes in primary amenorrhea patients by high resolution array based comparative genomic hybridization (array-CGH) analysis. Following the standard karyotyping analysis, genomic DNA from whole blood of 15 primary amenorrhea patients and 15 normal control women was hybridized with Affymetrix cytogenetic 2.7M arrays following the standard protocol. Copy number variations identified by array-CGH were confirmed by real time polymerase chain reaction. All the 30 samples were negative by conventional karyotyping analysis. Microdeletions on chromosome 17q21.31-q21.32 with approximately 1.3 Mb were identified in four patients by high resolution array-CGH analysis. This included the female reproductive secretory pathway related factor N-ethylmaleimide-sensitive factor (NSF) gene. The results of the present study suggest that there may be critical regions regulating primary ovarian insufficiency in women with a 17q21.31-q21.32 microdeletion. This effect might be due to the loss of function of the NSF gene/genes within the deleted region or to effects on contiguous genes.

  11. Adrenal Insufficiency under Standard Dosage of Glucocorticoid Replacement after Unilateral Adrenalectomy for Cushing’s Syndrome

    Directory of Open Access Journals (Sweden)

    Kentaro Fujii

    2016-01-01

    Full Text Available Glucocorticoid replacement is needed for patients after adrenal surgery for Cushing’s syndrome; however, the adequate dosage is not easily determined. The patient was a 62-year-old woman who has had hypertension for 5 years and presented with heart failure due to hypertrophic cardiomyopathy. She consulted with us because of general fatigue, facial edema, and muscle weakness and was diagnosed with Cushing’s syndrome. A laparoscopic left adrenalectomy was performed, standard dosage of postoperative replacement was administered, and she was discharged with 30 mg/day of hydrocortisone (cortisol. However, she suffered from loss of appetite and was transferred to an emergency unit with the symptoms of adrenal insufficiency on postoperative day 15. After initial hydrocortisone replacement with 200 mg/day, the dosage was gradually decreased during hospitalization; however, reduction of hydrocortisone dosage lower than 60 mg/day was difficult because of nausea and fatigue. Her circadian cortisol profile after hydrocortisone administration showed delayed and lowered peaks, which suggested that hydrocortisone absorption in the intestine was impaired. Therefore, complicated heart failure may have led to the adrenal insufficiency in the patient. In such cases, we should consider postoperative administration of more than the standard dosage of hydrocortisone to avoid adrenal insufficiency after surgery for Cushing’s syndrome.

  12. Stated Uptake of Physical Activity Rewards Programmes Among Active and Insufficiently Active Full-Time Employees.

    Science.gov (United States)

    Ozdemir, Semra; Bilger, Marcel; Finkelstein, Eric A

    2017-10-01

    Employers are increasingly relying on rewards programmes in an effort to promote greater levels of activity among employees; however, if enrolment in these programmes is dominated by active employees, then they are unlikely to be a good use of resources. This study uses a stated-preference survey to better understand who participates in rewards-based physical activity programmes, and to quantify stated uptake by active and insufficiently active employees. The survey was fielded to a national sample of 950 full-time employees in Singapore between 2012 and 2013. Participants were asked to choose between hypothetical rewards programmes that varied along key dimensions and whether or not they would join their preferred programme if given the opportunity. A mixed logit model was used to analyse the data and estimate predicted uptake for specific programmes. We then simulated employer payments based on predictions for the percentage of each type of employee likely to meet the activity goal. Stated uptake ranged from 31 to 67% of employees, depending on programme features. For each programme, approximately two-thirds of those likely to enrol were insufficiently active. Results showed that insufficiently active employees, who represent the majority, are attracted to rewards-based physical activity programmes, and at approximately the same rate as active employees, even when enrolment fees are required. This suggests that a programme with generous rewards and a modest enrolment fee may have strong employee support and be within the range of what employers may be willing to spend.

  13. Risk of vertebral insufficiency fractures in relation to compressive strength predicted by quantitative computed tomography

    International Nuclear Information System (INIS)

    Biggemann, M.; Hilweg, D.; Seidel, S.; Horst, M.; Brinckmann, P.

    1991-01-01

    Vertebral insufficiency fractures may result from excessive loading of normal and routine loading of osteoporotic spines. Fractures occur when the mechanical load exceeds the vertebral compressive strength, i.e., the maximum load a vertebra can tolerate. Vertebral compressive strength is determined by trabecular bone density and the size of end-plate area. Both parameters can be measured non-invasively by quanti-tative computed tomography (QCT). In 75 patients compressive strength (i.e., trabecular bone density and endplate area) of the vertebra L3 was determined using QCT. In addition, conventional radiographs of the spines were analysed for the prevalence of insufficiency fractures in each case. By relating fracture prevalence to strength, 3 fracture risk groups were found: a high-risk group with strength values of L3 5 kN and a fracture risk near 0 percent. Biomechanical measurements and model calculations indicate that spinal loads of 3 to 4 kN at L3/4 will be common in everyday activities. These data and the results described above suggest that spines with strength values of L3<3 kN are at an extremely high risk of insufficiency fractures in daily life. Advantages of fracture risk assessment by strength determination over risk estimation based on clinically used trabecular bone density measurements are discussed. (author). 18 refs.; 4 figs

  14. Cytogenetic Analysis of 65 Women with Premature Ovarian Insufficiency

    OpenAIRE

    Seda Ates

    2016-01-01

    Aim: Premature ovarian insufficiency (POI) is characterized as amenorrhea for more than 6 months, occurring before the age of 40, with an increased follicle-stimulating hormone and low estrogen concentrations. The aim of our study is to determine the types and distribution of cytogenetic abnormalities among women with POI. Material and Method: The study is based on the retrospective karyotype analysis of 65 women with idiopathic POI referred to the Medical Genetics Department at the Bezmialem...

  15. The Soft Palate Friendly Speech Bulb for Velopharyngeal Insufficiency

    OpenAIRE

    Kahlon, Sukhdeep Singh; Kahlon, Monaliza; Gupta, Shilpa; Dhingra, Parvinder Singh

    2016-01-01

    Velopharyngeal insufficiency is an anatomic defect of the soft palate making palatopharyngeal sphincter incomplete. It is an important concern to address in patients with bilateral cleft lip and palate. Speech aid prosthesis or speech bulbs are best choice in cases where surgically repaired soft palate is too short to contact pharyngeal walls during function but these prosthesis have been associated with inadequate marginal closure, ulcerations and patient discomfort. Here is a case report of...

  16. Repair of traumatic tricuspid insufficiency via minimally invasive port access.

    Science.gov (United States)

    Kasahara, Hirofumi; Kudo, Mikihiko; Kawajiri, Hiroyuki; Yozu, Ryohei

    2010-04-01

    We report on a successful tricuspid valve plasty using port-access minimally invasive cardiac surgery (MICS) for severe traumatic tricuspid insufficiency caused by blunt chest trauma suffered 15 years previously. A combination repair procedure, consisting of cleft closures, plication of the anteroseptal commissure, and ring annuloplasty, was necessary to achieve valve competence and proved possible via port access without difficulty. Port-access MICS is an alternative approach for tricuspid valve surgery.

  17. Relationship between clinical signs and symptoms of convergence insufficiency.

    Science.gov (United States)

    Bade, Annette; Boas, Mark; Gallaway, Michael; Mitchell, G Lynn; Scheiman, Mitchell; Kulp, Marjean T; Cotter, Susan A; Rouse, Michael

    2013-09-01

    The percentage of children who are symptomatic has been shown to increase with the number of signs of convergence insufficiency (CI). Our goal was to investigate whether there is a relationship between the severity of the clinical signs of CI and symptom level reported in children with a three-sign symptomatic CI. The Convergence Insufficiency Treatment Trial enrolled 221 children with symptomatic CI from ages 9 to 17 years. Inclusion criteria included the following three signs of CI: (1) exophoria at near at least 4Δ greater than at distance, (2) insufficient positive fusional vergence (PFV) at near, and (3) a receded near point of convergence (NPC) of 6 cm break or greater. The relationships between the severity of each sign of CI (mild, moderate, and severe) and the level of symptoms as measured by the Convergence Insufficiency Symptom Survey (CISS) at baseline were evaluated. Mean CISS scores were not significantly different between mild, moderate, and severe exophoria (p = 0.60), PFV blur (p = 0.99), Sheard's criterion (p = 0.89), or NPC break (p = 0.84). There was also no difference between the frequency of subjects scoring at mild, moderate, or severe levels on the CISS and the severity of each sign of CI. Correlations between individual clinical signs and the CISS score were very low and not statistically significant. Among symptomatic children with a CISS score of 16 or higher and three clinical signs of CI, there is no further association between the severity of the clinical signs and their level of symptoms.

  18. Vitamin D deficiency and insufficiency among patients with prostate cancer.

    Science.gov (United States)

    Trump, Donald L; Chadha, Manpreet K; Sunga, Annette Y; Fakih, Marwan G; Ashraf, Umeer; Silliman, Carrie G; Hollis, Bruce W; Nesline, Mary K; Tian, Lili; Tan, Wei; Johnson, Candace S

    2009-10-01

    To assess the frequency of vitamin D deficiency among men with prostate cancer, as considerable epidemiological, in vitro, in vivo and clinical data support an association between vitamin D deficiency and prostate cancer outcome. The study included 120 ambulatory men with recurrent prostate cancer and 50 with clinically localized prostate cancer who were evaluated and serum samples assayed for 25-OH vitamin D levels. Then 100 controls (both sexes), matched for age and season of serum sample, were chosen from a prospective serum banking protocol. The relationship between age, body mass index, disease stage, Eastern Cooperative Oncology Group performance status, season and previous therapy on vitamin D status were evaluated using univariate and multivariate analyses. The mean 25-OH vitamin D level was 25.9 ng/mL in those with recurrent disease, 27.5 ng/mL in men with clinically localized prostate cancer and 24.5 ng/mL in controls. The frequency of vitamin D deficiency (<20 ng/mL) and insufficiency (20-31 ng/mL) was 40% and 32% in men with recurrent prostate; 28% had vitamin D levels that were normal (32-100 ng/mL). Among men with localized prostate cancer, 18% were deficient, 50% were insufficient and 32% were normal. Among controls, 31% were deficient, 40% were insufficient and 29% were normal. Metastatic disease (P = 0.005) and season of blood sampling (winter/spring; P = 0.01) were associated with vitamin D deficiency in patients with prostate cancer, while age, race, performance status and body mass index were not. Vitamin D deficiency and insufficiency were common among men with prostate cancer and apparently normal controls in the western New York region.

  19. Effective antihypertensive treatment postpones renal insufficiency in diabetic nephropathy

    DEFF Research Database (Denmark)

    Parving, H H; Smidt, U M; Hommel, E

    1993-01-01

    The effect of long-term, aggressive, antihypertensive treatment on kidney function in diabetic nephropathy was studied prospectively in 11 insulin-dependent diabetic patients (mean age, 30 years). Renal function was assessed every 4 months by measurement of glomerular filtration rate (GFR) (single...... infarction (GFR, 46 mL/min/1.73 m2). Effective antihypertensive treatment postpones renal insufficiency in diabetic nephropathy....

  20. CT pre-operative planning of a new semi-implantable bone conduction hearing device

    Energy Technology Data Exchange (ETDEWEB)

    Law, Eric K.C.; Bhatia, Kunwar S.S. [Prince of Wales Hospital, The Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Hong Kong, SAR (China); Tsang, Willis S.S.; Tong, Michael C.F. [Prince of Wales Hospital, The Chinese University of Hong Kong, Department of Otorhinolaryngology, Head and Neck Surgery, Hong Kong, SAR (China); Shi, Lin [The Chinese University of Hong Kong, Department of Medicine and Therapeutics, Hong Kong, SAR (China); The Chinese University of Hong Kong, Chow Yuk Ho Technology Center for Innovative Medicine, Hong Kong, SAR (China)

    2016-06-15

    Accommodating a novel semi-implantable bone conduction hearing device within the temporal bone presents challenges for surgical planning. This study describes the utility of CT in pre-operative assessment of such an implant. Retrospective review of pre-operative CT, clinical and surgical records of 16 adults considered for device implantation. Radiological suitability was assessed on CT using 3D simulation software. Antero-posterior (AP) dimensions of the mastoid bone and minimum skull thickness were measured. CT planning results were correlated with operative records. Eight and five candidates were suitable for device placement in the transmastoid and retrosigmoid positions, respectively, and three were radiologically unsuitable. The mean AP diameter of the mastoid cavity was 14.6 mm for the transmastoid group and 4.6 mm for the retrosigmoid group (p < 0.05). Contracted mastoid and/or prior surgery were predisposing factors for unsuitability. Four transmastoid and five retrosigmoid positions required sigmoid sinus/dural depression and/or use of lifts due to insufficient bone capacity. A high proportion of patients being considered have contracted or operated mastoids, which reduces the feasibility of the transmastoid approach. This finding combined with the complex temporal bone geometry illustrates the importance of careful CT evaluation using 3D software for precise device simulation. (orig.)

  1. The relationships between preoperative urodynamic parameters and clinical outcomes in urinary stress incontinence

    Directory of Open Access Journals (Sweden)

    Yaşar Bozkurt

    2008-12-01

    Full Text Available The aim of present study was to evaluate the influence of urodynamic parameters on preoperative and postoperative clinical pictures in stress incontinence.Charts of patients, who were operated for stress incontinence using autologous rectus fascia sling between March 1999 and January 2005 in Tepecik Training and Research Hospital Urology Clinic, were evaluated retrospectively.A total of 41 patients were divided into two subgroups as, pure (10 patients and mixed stress incontinence (31 patients groups. Mean age of patients was 50.4 (33-70 years. Fifteen patients had intrinsic sphincter insufficiency (ISI. Mixed incontinence group had lower volume for first sensation and more detrusor overactivity than pure group. ISI did not alter the success of operation. Urodynamically no relationship was found between detrusor pressure and postoperative postvoiding residual urine (P>0.05.In conclusion, urodynamic evaluation before surgery was not related to preoperative and postoperative clinical picture of patients, but first sensation of bladder is only predictive for the success in fascial sling surgery.

  2. Transverse maxillary distraction in patients with periodontal pathology or insufficient tooth anchorage using custom-made devices.

    Science.gov (United States)

    Fernández-Sanromán, Jacinto; Donascimento, Montserrat González; López, Alberto Costas; Ferro, Martín Fernández; Berrondo, Ibon Almandoz

    2010-07-01

    We present our experience using modified Hyrax devices for treating transverse deficiencies of the maxilla in adult patients with periodontal pathology or insufficient tooth anchorage. The surgical technique, clinical indications, and results are discussed. Eight adult patients (6 females, 2 males) requiring maxillary expansion were studied prospectively between July 2002 and July 2007. All the patients had periodontal pathology or insufficient tooth anchorage preventing the use of conventional Hyrax devices. Patients underwent surgically assisted rapid maxillary expansion with the use of custom-made modified Hyrax devices (bone-borne or tooth-bone-borne devices). Patients received preoperatively (T1), at the end of distraction (T2), at removal of the expansion device (T3), and 12 months after surgery (T4) lateral and posterior anterior cephalograms and study models to measure the width of the anterior and posterior dental arches with a digital sliding calliper. Mean age was 28.5 years (range, 18-45 years). A significant widening of the anterior (6.3 +/- 1.6 mm) and posterior (7.1 +/- 1.2 mm) dental arches was demonstrated. No significant differences were found when comparing T3 with T4 measures. No significant complications were found. The results indicated that maxillary expansion with custom-made devices in adults was an easy, affordable, predictable and stable technique without significant complications in patients who suffer periodontal pathology or patients without enough dental support. Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Central Adrenal Insufficiency and Diabetes Insipidus Misdiagnosed as Severe Depression

    Directory of Open Access Journals (Sweden)

    Naoki Hiroi

    2010-01-01

    Full Text Available A 68 year-old Japanese man, who had been suffering from immobilization and disuse syndrome, was admitted to our hospital for evaluation of polyuria with polyposia, hyponatremia and low blood pressure. His plasma osmolality was greater than that of his urine. His endocrinological examination revealed low levels of plasma adrenocorticotropic hormone (ACTH and cortisol, and a normal response of ACTH to the corticotrophin-releasing hormone (CRH challenge. Plasma ACTH did not increase with insulin loading. A low plasma vasopressin (AVP level and no response of AVP to a 5% saline administration were observed. We diagnosed central adrenal insufficiency with central diabetes insipidus. Six months after starting administration of hydrocortisone and 1-deamino-8D-arginine vasopressin, his psychological symptoms had improved, and 1.5 years after starting treatment, he was able to walk. In conclusion, it is not particularly rare for adrenal insufficiency to be misdiagnosed as depression. However, a correct early diagnosis is necessary, because, if adrenal insufficiency is not definitively diagnosed, the patient's quality of life diminishes markedly.

  4. Hereditary myopathies with early respiratory insufficiency in adults.

    Science.gov (United States)

    Naddaf, Elie; Milone, Margherita

    2017-11-01

    Hereditary myopathies with early respiratory insufficiency as a predominant feature of the clinical phenotype are uncommon and underestimated in adults. We reviewed the clinical and laboratory data of patients with hereditary myopathies who demonstrated early respiratory insufficiency before the need for ambulatory assistance. Only patients with disease-causing mutations or a specific histopathological diagnosis were included. Patients with cardiomyopathy were excluded. We identified 22 patients; half had isolated respiratory symptoms at onset. The diagnosis of the myopathy was often delayed, resulting in delayed ventilatory support. The most common myopathies were adult-onset Pompe disease, myofibrillar myopathy, multi-minicore disease, and myotonic dystrophy type 1. Single cases of laminopathy, MELAS (mitochondrial encephalomyopathy with lactic acidosis and strokelike events), centronuclear myopathy, and cytoplasmic body myopathy were identified. We highlighted the most common hereditary myopathies associated with early respiratory insufficiency as the predominant clinical feature, and underscored the importance of a timely diagnosis for patient care. Muscle Nerve 56: 881-886, 2017. © 2017 Wiley Periodicals, Inc.

  5. Impact of placental insufficiency on fetal skeletal muscle growth

    Science.gov (United States)

    Hay, William W.

    2016-01-01

    Intrauterine growth restriction (IUGR) caused by placental insufficiency is one of the most common and complex problems in perinatology, with no known cure. In pregnancies affected by placental insufficiency, a poorly functioning placenta restricts nutrient supply to the fetus and prevents normal fetal growth. Among other significant deficits in organ development, the IUGR fetus characteristically has less lean body and skeletal muscle mass than their appropriately-grown counterparts. Reduced skeletal muscle growth is not fully compensated after birth, as individuals who were born small for gestational age (SGA) from IUGR have persistent reductions in muscle mass and strength into adulthood. The consequences of restricted muscle growth and accelerated postnatal “catch-up” growth in the form of adiposity may contribute to the increased later life risk for visceral adiposity, peripheral insulin resistance, diabetes, and cardiovascular disease in individuals who were formerly IUGR. This review will discuss how an insufficient placenta results in impaired fetal skeletal muscle growth and how lifelong reductions in muscle mass might contribute to increased metabolic disease risk in this vulnerable population. PMID:26994511

  6. Respiratory insufficiency with preserved diaphragmatic function in amyotrophic lateral sclerosis.

    Science.gov (United States)

    Yamauchi, Rika; Imai, Tomihiro; Tsuda, Emiko; Hozuki, Takayoshi; Yamamoto, Daisuke; Shimohama, Shun

    2014-01-01

    We performed a longitudinal study to elucidate the correlation between respiratory insufficiency and respiratory biomarkers, including diaphragmatic compound muscle action potential (DCMAP), at the initiation of noninvasive ventilation (NIV) in patients with amyotrophic lateral sclerosis (ALS). The patients were assessed at least every six months. Additional assessments were performed at the start of respiratory therapy when the patients met the criteria for the initiation of NIV. Each assessment consisted of a full neurological examination, a phrenic nerve conduction study, respiratory function tests, and nocturnal pulsed oximetry. We enrolled 43 patients with either definite or probable ALS as defined by the revised El Escorial criteria. The patients were divided into two groups according to the timing of the initiation of respiratory therapy. Seventeen patients (group A) met the criteria for NIV initiation when their DCMAP remained normal. Twenty-six patients (group B) met the criteria when their DCMAP decreased below normal limits. Although respiratory function parameters were significantly worse in group B compared with group A at NIV initiation, more than 80% of the patients in both groups developed nocturnal desaturation during sleep. DCMAP is not always a reliable indicator for determining the optimal timing for NIV initiation during the progression of respiratory insufficiency in ALS. Physicians should be aware of the risk of respiratory insufficiency during sleep in patients with ALS.

  7. Leptomeningeal dissemination of an astrocytoma causing hypophyseal insufficiency

    International Nuclear Information System (INIS)

    Suzan, S.; Cigdem, O.; Furkan, U.; Baki, A.

    2012-01-01

    Full text: Introduction: Hypophyseal insufficiency is an unusual clinical presentation of metastatic disease. Objectives: In this report, a case of leptomeningeal metastasis of an astrocytoma to the infundibular recess, causing hypophyseal insufficiency is presented with its magnetic resonance imaging (MRI) findings. Materials and methods: A 27-year-old woman presented with nausea, vomiting and generalized weakness. Her laboratory results were consistent with hypopituitarism. She had an operation history for astrocytoma. She was referred to radiology department for brain MRI study. Contrast-enhanced MRI scan showed extensive wall enhancement of ventricles consistent with leptomeningeal metastases. A nodular mass with pronounced contrast enhancement was also detected at the infundibular stalk. Results: Because suprasellar cistern was normal and extensive leptomeningeal metastases was detected, the nodular mass at the infundibular stalk thought to be secondary to leptomeningeal involvement of the infundibular recess. Conclusion: When a patient with a known malignancy presented with hypophyseal insufficiency, it should be thought that leptomeningeal metastases to the infundibular recess may also be a cause. The neuroimaging, especially contrast-enhanced studies, is necessary for the confirmation

  8. Rationale for and approach to preoperative opioid weaning: a preoperative optimization protocol

    Directory of Open Access Journals (Sweden)

    Heath McAnally

    2017-11-01

    Full Text Available Abstract The practice of chronic opioid prescription for chronic non-cancer pain has come under considerable scrutiny within the past several years as mounting evidence reveals a generally unfavorable risk to benefit ratio and the nation reels from the grim mortality statistics associated with the opioid epidemic. Patients struggling with chronic pain tend to use opioids and also seek out operative intervention for their complaints, which combination may be leading to increased postoperative “acute-on-chronic” pain and fueling worsened chronic pain and opioid dependence. Besides worsened postoperative pain, a growing body of literature, reviewed herein, indicates that preoperative opioid use is associated with significantly worsened surgical outcomes, and severely increased financial drain on an already severely overburdened healthcare budget. Conversely, there is evidence that preoperative opioid reduction may result in substantial improvements in outcome. In the era of accountable care, efforts such as the Enhanced Recovery After Surgery (ERAS protocol have been introduced in an attempt to standardize and facilitate evidence-based perioperative interventions to optimize surgical outcomes. We propose that addressing preoperative opioid reduction as part of a targeted optimization approach for chronic pain patients seeking surgery is not only logical but mandatory given the stakes involved. Simple opioid reduction/abstinence however is not likely to occur in the absence of provision of viable and palatable alternatives to managing pain, which will require a strong focus upon reducing pain catastrophization and bolstering self-efficacy and resilience. In response to a call from our surgical community toward that end, we have developed a simple and easy-to-implement outpatient preoperative optimization program focusing on gentle opioid weaning/elimination as well as a few other high-yield areas of intervention, requiring a minimum of resources.

  9. Does preoperative physiotherapy improve postoperative, patient-based outcomes in older adults who have undergone total knee arthroplasty? A systematic review.

    Science.gov (United States)

    Chesham, Ross Alexander; Shanmugam, Sivaramkumar

    2017-01-01

    Knee osteoarthritis (OA) is a leading cause of disability in older adults (≥60) in the UK. If nonsurgical management fails and if OA severity becomes too great, knee arthroplasty is a preferred treatment choice. Preoperative physiotherapy is often offered as part of rehabilitation to improve postoperative patient-based outcomes. Systematically review whether preoperative physiotherapy improves postoperative, patient-based outcomes in older adults who have undergone total knee arthroplasty (TKA) and compare study interventions to best-practice guidelines. A literature search of Randomized Controlled Trials (RCTs), published April 2004-April 2014, was performed across six databases. Individual studies were evaluated for quality using the PEDro Scale. Ten RCTs met the full inclusion/exclusion criteria. RCTs compared control groups versus: preoperative exercise (n = 5); combined exercise and education (n = 2); combined exercise and acupuncture (n = 1); neuromuscular electrical stimulation (NMES; n = 1); and acupuncture versus exercise (n = 1). RCTs recorded many patient-based outcomes including knee strength, ambulation, and pain. Minimal evidence is presented that preoperative physiotherapy is more effective than no physiotherapy or usual care. PEDro Scale and critical appraisal highlighted substantial methodological quality issues within the RCTs. There is insufficient quality evidence to support the efficacy of preoperative physiotherapy in older adults who undergo total knee arthroplasty.

  10. Quality assurance during preoperational testing and during startup operation

    International Nuclear Information System (INIS)

    Eisele, H.; Meyer, F.A.

    1980-01-01

    Rules and guidelines for the quality assurance. Quality assurance in the course of preoperational testing and the startup period: preoperational testing; hot functional test I; hot functional test II; initial making critical and zero power physics testing; power range testing. Startup documents: startup program; startup instructions; startup data sheet; startup sequence outlines; final startup reports. Advisory safety committee for nuclear startup. (orig./RW)

  11. Long-term effects of a preoperative smoking cessation programme

    DEFF Research Database (Denmark)

    Villebro, Nete Munk; Pedersen, Tom; Møller, Ann M

    2008-01-01

    Preoperative smoking intervention programmes reduce post-operative complications in smokers. Little is known about the long-term effect upon smoking cessation.......Preoperative smoking intervention programmes reduce post-operative complications in smokers. Little is known about the long-term effect upon smoking cessation....

  12. The Effect of Mild Preoperative Renal Impairment on Early ...

    African Journals Online (AJOL)

    Introduction: Severe preoperative renal impairment (RI) is often included in score systems used to predict outcome after open cardiac surgery. The purpose of this study was to investigate the impact of mild preoperative RI on the early postoperative mortality after open heart surgery. Methods: We retrospectively collected ...

  13. A new digital preoperative planning method for total hip arthroplasties

    NARCIS (Netherlands)

    Crooijmans, H.J.A.; Laumen, A.M.R.P.; van Pul, C.; van Mourik, J.B.A.

    Preoperative templating is an important part of a THA. The ability to accurately determine magnification of the hip on the radiograph and apply identical magnification to the radiograph and template will improve accuracy of preoperative templating of THA. We designed a templating method using a new

  14. The preoperative cardiology consultation: Indications and risk modification

    NARCIS (Netherlands)

    M.W. de Groot (Mark); A. Spronk (Angela); S.E. Hoeks (Sanne); R.J. Stolker (Robert); F. van Lier (Felix)

    2017-01-01

    textabstractBackground The cardiologist is regularly consulted preop-eratively by anaesthesiologists. However, insights into the efficiency and usefulness of these consultations are unclear. Methods This is a retrospective study of 24,174 preoperatively screened patients ≥18 years scheduled for

  15. Implementation of Pre-Operative Checklist: An Effort to Reduce ...

    African Journals Online (AJOL)

    Implementation of Pre-Operative Checklist: An Effort to Reduce Delays in. Surgery and ... insight to develop a pre-operative checklist to ensure that patients were prepared for surgery and to minimize disruptions ... documentation audit was conducted in May 2014, showing 59% compliance in completing the checklist. Since.

  16. The appropriateness of preoperative blood testing: A retrospective ...

    African Journals Online (AJOL)

    Background. Inappropriate preoperative blood testing can negatively contribute to healthcare costs. Objective. To determine the extent and cost implications of inappropriate preoperative blood testing in adult patients booked for orthopaedic, general or trauma surgical procedures at a regional hospital in KwaZulu-Natal ...

  17. Obstetric spinal hypotension: Preoperative risk factors and the ...

    African Journals Online (AJOL)

    Obstetric spinal hypotension: Preoperative risk factors and the development of a preliminary risk score – the PRAM score. ... We used empirical cut-point estimations in a logistic regression model to develop a scoring system for prediction of hypotension. Results. From 504 eligible patients, preoperative heart rate (odds ratio ...

  18. Superselective transcatheter renal arterial embolization for acute renal bleeding in patients with renal insufficiency: its clinical efficacy and safety

    International Nuclear Information System (INIS)

    Hu Tingyang; Zhou Bing; Yu Wenqiang; Luo Zuyan; Mao Yingmin; Chen Fanghong; Li Bo; Yuan Jianhua

    2010-01-01

    Objective: To discuss the clinical efficacy and complications of super selective renal arterial embolization in treating acute renal arterial bleeding in patients with renal insufficiency, and to evaluate the influence of the treatment on the renal function. Methods: During the period of January 2000 December 2009, super selective renal arterial embolization was performed in our institution for acute renal bleeding in 13 patients with renal insufficiency. The complete clinical and imaging materials of all patients were properly collected. The clinical effectiveness, the renal function, the extent of embolization and the complications were observed and the relationship between each other was analyzed. Results: The embolization procedure was successfully completed in all patients with a technical success rate of 100%. The mean embolized territory was 22% of a single kidney. Three days after the procedure, the hemoglobin level, hematocrit, blood pressure and heart rate were considerably improved in all patients. Compared to the corresponding preoperative data, all the differences were statistically significant (P 0.05), while the blood urea nitrogen was markedly decreased (P=0.011). Post embolization syndrome occurred in 5 patients and progressive aggravation of the renal function was observed in one patient, who had to receive hemodialysis finally. The embolized territory in patients occurring complications was larger than that in patients without occurring complications (U=1.500, P=0.006). Conclusion: Super selective renal arterial embolization is an effective and safe treatment for acute renal arterial bleeding in patients with renal insufficiency, the therapy will not significantly worsen the renal function. Appropriate and reasonable extent of embolization, as small as possible, is the key point for reducing the complications. (authors)

  19. No Postoperative Adrenal Insufficiency in a Patient with Unilateral Cortisol-Secreting Adenomas Treated with Mifepristone before Surgery

    Directory of Open Access Journals (Sweden)

    Rachel M. Saroka

    2016-01-01

    Full Text Available Background Glucocorticoid replacement is commonly required to treat secondary adrenal insufficiency after surgical resection of unilateral cortisol-secreting adrenocortical adenomas. Here, we describe a patient with unilateral cortisol-secreting adenomas in which the preoperative use of mifepristone therapy was associated with recovery of the hypothalamic–pituitary–adrenal (HPA axis, eliminating the need for postoperative glucocorticoid replacement. Case Presentation A 66-year-old Caucasian man with type 2 diabetes mellitus, hyperlipidemia, hypertension, and obesity was hospitalized for Fournier's gangrene and methicillin-resistant Staphylococcus aureus sepsis. Abdominal computed tomography scan revealed three left adrenal adenomas measuring 1.4, 2.1, and 1.2 cm and an atrophic right adrenal gland. Twenty-four-hour urinary free cortisol level was elevated (237 µg/24 hours, reference range 0–50 µg/24 hours. Hormonal evaluation after resolution of the infection showed an abnormal 8 mg overnight dexamethasone suppression test (cortisol postdexamethasone 14.5 µg/dL, suppressed adrenocorticotropic hormone (ACTH; <5 pg/mL, reference range 7.2–63.3 pg/mL, and low-normal dehydroepiandrosterone sulfate (50.5 µg/dL, male reference range 30.9–295.6 µg/dL. Because of his poor medical condition and uncontrolled diabetes, his Cushing's syndrome was treated with medical therapy before surgery. Mifepristone therapy was started and, within five months, his diabetes was controlled and insulin discontinued. The previously suppressed ACTH increased to above normal range accompanied by an increase in dehydroepiandrosterone sulfate levels, indicating recovery of the HPA axis and atrophic contralateral adrenal gland. The patient received one precautionary intraoperative dose of hydrocortisone and none thereafter. Two days postoperatively, ACTH (843 pg/mL and cortisol levels (44.8 µg/dL were significantly elevated, reflecting an appropriate HPA axis

  20. No Postoperative Adrenal Insufficiency in a Patient with Unilateral Cortisol-Secreting Adenomas Treated with Mifepristone Before Surgery

    Science.gov (United States)

    Saroka, Rachel M.; Kane, Michael P.; Robinson, Lawrence; Busch, Robert S.

    2016-01-01

    BACKGROUND Glucocorticoid replacement is commonly required to treat secondary adrenal insufficiency after surgical resection of unilateral cortisol-secreting adrenocortical adenomas. Here, we describe a patient with unilateral cortisol-secreting adenomas in which the preoperative use of mifepristone therapy was associated with recovery of the hypothalamic–pituitary–adrenal (HPA) axis, eliminating the need for postoperative glucocorticoid replacement. CASE PRESENTATION A 66-year-old Caucasian man with type 2 diabetes mellitus, hyperlipidemia, hypertension, and obesity was hospitalized for Fournier’s gangrene and methicillin-resistant Staphylococcus aureus sepsis. Abdominal computed tomography scan revealed three left adrenal adenomas measuring 1.4, 2.1, and 1.2 cm and an atrophic right adrenal gland. Twenty-four-hour urinary free cortisol level was elevated (237 µg/24 hours, reference range 0–50 µg/24 hours). Hormonal evaluation after resolution of the infection showed an abnormal 8 mg overnight dexamethasone suppression test (cortisol postdexamethasone 14.5 µg/dL), suppressed adrenocorticotropic hormone (ACTH; <5 pg/mL, reference range 7.2–63.3 pg/mL), and low-normal dehydroepiandrosterone sulfate (50.5 µg/dL, male reference range 30.9–295.6 µg/dL). Because of his poor medical condition and uncontrolled diabetes, his Cushing’s syndrome was treated with medical therapy before surgery. Mifepristone therapy was started and, within five months, his diabetes was controlled and insulin discontinued. The previously suppressed ACTH increased to above normal range accompanied by an increase in dehydroepiandrosterone sulfate levels, indicating recovery of the HPA axis and atrophic contralateral adrenal gland. The patient received one precautionary intraoperative dose of hydrocortisone and none thereafter. Two days postoperatively, ACTH (843 pg/mL) and cortisol levels (44.8 µg/dL) were significantly elevated, reflecting an appropriate HPA axis response to

  1. The application of preoperative computed tomography angiogram for hemispherectomy

    Directory of Open Access Journals (Sweden)

    Jiqing Qiu

    2017-10-01

    Full Text Available Hemispherectomy is an established neurosurgical procedure for unilateral refractory epilepsy . Even though the surgical approach has evolved greatly, prevention of catastrophic intraoperative bleeding is a challenge. It is important that surgeons know the abnormal blood vessel before surgery. Herein, we report our experience with two patients in whom computed tomographic angiography (CTA was used in the preoperative evaluation for hemispherectomy. CTA allowed for precise anatomical delineation of the hemispheric vascular abnormalities. Preoperative CTA showed that the specific cerebral arteries and their branches ipsilateral to the lesion were slender. Elaborate preoperative planning for the surgical approach helped prevent catastrophic intraoperative bleeding. Favorable outcomes were achieved in both children. CTA appears to confer a considerable advantage in the preoperative vascular and anatomical delineation in patients scheduled for hemispherectomy. To our knowledge, this is the first report about the application of CTA for hemispherectomy preoperative planning.

  2. Photosensitivity and Acute Liver Insufficiency in Late-Onset Erythropoietic Protoporphyria with a Chromosome 18q Abnormality

    Directory of Open Access Journals (Sweden)

    Yuka Oshikawa

    2012-07-01

    Full Text Available Late-onset erythropoietic protoporphyria (EPP is rare, and it is usually associated with an acquired somatic mutation of the ferrochelatase gene secondary to hematological malignancy such as myelodysplastic syndrome or myeloproliferative disorder. In 0.5–1% of patients with EPP, deposition of protoporphyrin in the liver leads to progressive liver insufficiency. Herein, we report the case of a 67-year-old female who developed EPP with typical photosensitivity and hemolytic anemia. Six months later, she was admitted with acute liver damage with a rapidly progressing course, and developed liver insufficiency. She recovered from the liver insufficiency after undergoing plasmapheresis and red blood cell exchange transfusion. A bone marrow examination revealed normal features; however, a cytogenetic analysis identified an abnormal clone of cells with a translocation between chromosomes 13q12 and 18q21.1. This is the first report of a patient who recovered from liver insufficiency. The results of this report suggest that plasmapheresis and red blood cell exchange transfusion are effective for treating liver insufficiency in patients with late-onset EPP.

  3. Preoperative Surgical Discussion and Information Retention by Patients.

    Science.gov (United States)

    Feiner, David E; Rayan, Ghazi M

    2016-10-01

    To assess how much information communicated to patients is understood and retained after preoperative discussion of upper extremity procedures. A prospective study was designed by recruiting patients prior to undergoing upper extremity surgical procedures after a detailed discussion of their operative technique, postoperative care and treatment outcomes. Patients were given the same 20-item questionnaire to fill out twice, at two pre operative visits. An independent evaluator filled out a third questionnaire as a control. Various discussion points of the survey were compared among the 3 questionnaires and retained information and perceived comprehension were evaluated. The average patients' age was 50.3 (27-75) years The average time between the two surveys preoperative 1 and preoperative 2 was 40.7 (7-75) days,. The average patient had approximately 2 years of college or an associate's degree. Patients initially retained 73% (52-90%) of discussion points presented during preoperative 1 and 61% (36-85%) of the information at preoperative 2 p = .002. 50% of patients felt they understood 100% of the discussion, this dropped to only 10% at their preoperative 2 visit. 15% of our patients did not know what type of anesthesia they were having at preoperative 2. A communication barrier between patients and physicians exists when patients are informed about their preoperative surgical discussion. The retention of information presented is worsened with elapsing time from the initial preoperative discussion to the second preoperative visit immediately prior to surgery. Methods to enhance patients' retention of information prior to surgery must be sought and implemented which will improve patients' treatment outcome.

  4. Preoperative radiotherapy of maxillary sinus cancer

    International Nuclear Information System (INIS)

    Kim, Jae Chul; Park, In Kyu

    1998-01-01

    This study was to evaluate the effectiveness of preoperative radiotherapy in maxillary sinus cancer. A retrospective analysis was done for 42 patients with maxillary sinus cancer who were treated with radiation with or without surgery from April 1986 to September 1996. There were 27 male and 15 female patients. Patients' age ranged from 24 to 75 years (median 56 years). Stage distribution showed 2 in T2, 19 in T3, and 21 in T4 lesions. The histologic type was squamous cell carcinoma in 38, undifferentiated carcinoma in 1, transitional cell carcinoma in 1, and adenoid cystic carcinoma in 2 patients, All patients were treated with radiation initially with a dosage range of 50.4-70.2 Gy (median 70.2 Gy) before further evaluation of remnant disease. Eleven patients were given induction chemotherapy (2 cycles of 5-fluorouracil and cisplatin) concurrently with radiotherapy. Six to eight weeks after radiotherapy with or without chemotherapy, computerized tomography (CT) of paranasal sinus was taken to evaluate remnant disease. If the CT finding showed remnant disease, a Caldwell-Luc procedure was done to get the specimen of suspicious lesions. A radical maxillectomy was done if the specimen was proven to contain malignancy. In contrast periodic follow-up examination was done without any radical surgery if the tissue showed only granulation tissue. Follow-up period ranged from 3 to 92 months with a median 16 months. Nine (21.4%) patients showed complete response (CR) and 33 patients (78.6%) showed persistent disease (PER) to initial radiotherapy. Among the 9 CR patients, 7 patients had no evidence of disease (NED), 1 patient had local failure, and 1 patient had regional failure. Among 33 PER patients, salvage total maxillectomy was done in 10 patients, and the surgery was not feasible or refused in 23 patients. Following the salvage radical surgery, 2 patients were NED and 8 patients were PER status. Overall and disease- free survival rate at 5 years was 23.1% and 16

  5. Preoperative radiotherapy of maxillary sinus cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jae Chul; Park, In Kyu [College of Medicine, Kyungpook National Univ., Taegu (Korea, Republic of)

    1998-09-01

    This study was to evaluate the effectiveness of preoperative radiotherapy in maxillary sinus cancer. A retrospective analysis was done for 42 patients with maxillary sinus cancer who were treated with radiation with or without surgery from April 1986 to September 1996. There were 27 male and 15 female patients. Patients' age ranged from 24 to 75 years (median 56 years). Stage distribution showed 2 in T2, 19 in T3, and 21 in T4 lesions. The histologic type was squamous cell carcinoma in 38, undifferentiated carcinoma in 1, transitional cell carcinoma in 1, and adenoid cystic carcinoma in 2 patients, All patients were treated with radiation initially with a dosage range of 50.4-70.2 Gy (median 70.2 Gy) before further evaluation of remnant disease. Eleven patients were given induction chemotherapy (2 cycles of 5-fluorouracil and cisplatin) concurrently with radiotherapy. Six to eight weeks after radiotherapy with or without chemotherapy, computerized tomography (CT) of paranasal sinus was taken to evaluate remnant disease. If the CT finding showed remnant disease, a Caldwell-Luc procedure was done to get the specimen of suspicious lesions. A radical maxillectomy was done if the specimen was proven to contain malignancy. In contrast periodic follow-up examination was done without any radical surgery if the tissue showed only granulation tissue. Follow-up period ranged from 3 to 92 months with a median 16 months. Nine (21.4%) patients showed complete response (CR) and 33 patients (78.6%) showed persistent disease (PER) to initial radiotherapy. Among the 9 CR patients, 7 patients had no evidence of disease (NED), 1 patient had local failure, and 1 patient had regional failure. Among 33 PER patients, salvage total maxillectomy was done in 10 patients, and the surgery was not feasible or refused in 23 patients. Following the salvage radical surgery, 2 patients were NED and 8 patients were PER status. Overall and disease- free survival rate at 5 years was 23.1% and 16

  6. Piperazine side-effects in a patient with pre-existing renal insufficiency

    Directory of Open Access Journals (Sweden)

    Majid Malaki

    2014-01-01

    Full Text Available Piperazine as an antihelminth has many adverse effects, especially on patients with renal insufficiency. We report the use of piperazine in a girl with a moderately severe kidney disease due to Biedl Bardet syndrome. She developed coma and acute kidney injury due to acute interstitial nephritis (AIN, anemia and thrombocytopenia. The presence of fever, proteinuria, acidosis, anemia, sterile pyuria and non-oliguric renal failure strongly suggested AIN. Her problems abated mostly by discontinuing of piperazine and supportive therapy, except anemia and thrombocytopenia.

  7. Preoperative evaluation of locally spreaded pelvic tumors

    International Nuclear Information System (INIS)

    Baramia, M.; Todua, F.; Gotsadze, D.; Khutulashvili, N.; Lashkhi, K.; Nadareishvili, A.

    1998-01-01

    Am of the study: preoperative evaluation of patients with locally advanced pelvic tumors subjected to pelvic exenteration. Determine operability to avoid explorative laparatomies, which cause serious complications in these patients. Evaluate condition of urinary system in case of this pathology. Materials and methods: 34 patients with locally advanced pelvic tumors where pelvic exenteration was attempted were studied. Along with other methods of diagnostic CT and MRI were performed. Results: In all patients secondary involvement of the urinary bladder was noted. In 30 patients CT and MR findings were confirmed (88,2%) intraoperatively and different types of pelvic organs exenteration were performed. In 1 case spread of tomoruos infiltrate to the pelvic wall and common iliac vessels was detected intraoperatively (patient had history of radiation therapy). In 2 cases carcinomatosis of the peritoneum was found. In 1 case involvement of urinary bladder was simulated by close attachment of enlarged uterus. Conclusion: Obtained results show, that CT and MR are highly informative methods of disease spread evaluation and thus determining operability. Radiotherapy performed prior to operation sets difficulties in differentiation for tumourous infiltrate and post-radiotherapy changes in pelvis. (Full text)

  8. PROJECT HEAVEN: Preoperative Training in Virtual Reality.

    Science.gov (United States)

    Iamsakul, Kiratipath; Pavlovcik, Alexander V; Calderon, Jesus I; Sanderson, Lance M

    2017-01-01

    A cephalosomatic anastomosis (CSA; also called HEAVEN: head anastomosis venture) has been proposed as an option for patients with neurological impairments, such as spinal cord injury (SCI), and terminal medical illnesses, for which medicine is currently powerless. Protocols to prepare a patient for life after CSA do not currently exist. However, methods used in conventional neurorehabilitation can be used as a reference for developing preparatory training. Studies on virtual reality (VR) technologies have documented VR's ability to enhance rehabilitation and improve the quality of recovery in patients with neurological disabilities. VR-augmented rehabilitation resulted in increased motivation towards performing functional training and improved the biopsychosocial state of patients. In addition, VR experiences coupled with haptic feedback promote neuroplasticity, resulting in the recovery of motor functions in neurologically-impaired individuals. To prepare the recipient psychologically for life after CSA, the development of VR experiences paired with haptic feedback is proposed. This proposal aims to innovate techniques in conventional neurorehabilitation to implement preoperative psychological training for the recipient of HEAVEN. Recipient's familiarity to body movements will prevent unexpected psychological reactions from occurring after the HEAVEN procedure.

  9. Preoperative biliary drainage for pancreatic cancer.

    Science.gov (United States)

    Van Heek, N T; Busch, O R; Van Gulik, T M; Gouma, D J

    2014-04-01

    This review is to summarize the current knowledge about preoperative biliary drainage (PBD) in patients with biliary obstruction caused by pancreatic cancer. Most patients with pancreatic carcinoma (85%) will present with obstructive jaundice. The presence of toxic substances as bilirubin and bile salts, impaired liver function and altered nutritional status due to obstructive jaundice have been characterized as factors for development of complications after surgery. Whereas PBD was to yield beneficial effects in the experimental setting, conflicting results have been observed in clinical studies. The meta-analysis from relative older studies as well as more importantly a recent clinical trial showed that PBD should not be performed routinely. PBD for patients with a distal biliary obstruction is leading to more serious complications compared with early surgery. Arguments for PBD have shifted from a potential therapeutic benefit towards a logistic problem such as patients suffering from cholangitis and severe jaundice at admission or patients who need extra diagnostic tests, or delay in surgery due to a referral pattern or waiting list for surgery as well as candidates for neoadjuvant chemo(radio)therapy. If drainage is indicated in these patients it should be performed with a metal stent to reduce complications after the drainage procedure such as stent occlusion and cholangitis. Considering a change towards more neoadjuvant therapy regimes improvement of the quality of the biliary drainage concept is still important.

  10. JOYO construction and preoperational test experience

    International Nuclear Information System (INIS)

    1976-03-01

    The construction and installation of Joyo, the first experimental fast reactor in Japan, have been completed. The application for the license for Joyo was made with the output of 50 MWt, and the power raising to 100 MWt target is left for future. Joyo is a sodium-cooled fast breeder reactor with mixed oxide fuel. The research and development for and the construction of Joyo are described. The initial stage of the preoperational test has been finished, and the further test stage is in progress. Sodium-cooled fast reactors are operated at higher temperature and lower pressure as compared with light water reactors, therefore the thermal stress is high, while the mechanical stress is low. The materials used for the sodium components are apt to creep, while the mechanical properties are impaired by the mass transfer in the hot sodium circuits. The guide lines for the structural design of Joyo were established on the basis of ASME Boiler and Pressure Vessel Code. The basic philosophy and the method of the aseismatic design for Joyo are almost same as those for large commercial reactor plants. The thermal shock due to air blast coolers cannot be avoided in LMFBRs, but care should be taken in the design to mitigate the shock. It is desirable to establish more detailed standards on inspection and examination to cope with complex LMFBRs. (Kako, I.)

  11. The preoperative venogram in planning extended craniectomies

    International Nuclear Information System (INIS)

    Lanzieri, C.F.; Duchesneau, P.M.; Rosenbloom, S.A.; Weinstein, M.A.; Sacher, M.

    1987-01-01

    A technique of extended craniectomy sometimes allows removal of large central or transtentorial mass lesions at a single operative sitting because it affords better exposure and control of normal structures. While seeking to avoid multiple craniotomies, this method requires permanent ligation of the transverse venous sinus. Unless there is adequate collateral venous drainage from the ipsilateral hemisphere, the patient is at risk for venous infarction in the post-craniectomy period. The purpose of this study is to propose a method of establishing the presence of collateral venous drainage preoperatively. Each carotid artery is injected with the head in a neutral position and with the head turned to the side ipsilateral to the carotid artery injection in an attempt to divert the venous flow. Fifty patients were examined using this method; seven were being evaluated for possible craniectomies. The technique identified nine patients with potential venous collaterals (20%). They would otherwise have been considered nonoperable: two of the six patients eventually operated upon (33%) fell into this category. In general, the operative procedure may be safe more often on the left than the right (45%) vs (20%). Particular attention must be given to the pattern of venous drainage from the posterior temporal lobe to avoid isolation of the venous drainage from this area. (orig.)

  12. Readability of online patient education materials for velopharyngeal insufficiency.

    Science.gov (United States)

    Xie, Deborah X; Wang, Ray Y; Chinnadurai, Sivakumar

    2018-01-01

    Evaluate the readability of online and mobile application health information about velopharyngeal insufficiency (VPI). Top website and mobile application results for search terms "velopharyngeal insufficiency", "velopharyngeal dysfunction", "VPI", and "VPD" were analyzed. Readability was determined using 10 algorithms with Readability Studio Professional Edition (Oleander Software Ltd; Vandalia, OH). Subgroup analysis was performed based on search term and article source - academic hospital, general online resource, peer-reviewed journal, or professional organization. 18 unique articles were identified. Overall mean reading grade level was a 12.89 ± 2.9. The highest reading level among these articles was 15.47-approximately the level of a college senior. Articles from "velopharyngeal dysfunction" had the highest mean reading level (13.73 ± 2.11), above "velopharyngeal insufficiency" (12.30 ± 1.56) and "VPI" (11.66 ± 1.70). Articles from peer-reviewed journals had the highest mean reading level (15.35 ± 2.79), while articles from academic hospitals had the lowest (12.81 ± 1.66). There were statistically significant differences in reading levels between the different search terms (P reading level guidelines, online patient education materials for VPI are disseminated with language too complex for most readers. There is also a lack of VPI-related mobile application data available for patients. Patients will benefit if future updates to websites and disseminated patient information are undertaken with health literacy in mind. Future studies will investigate patient comprehension of these materials. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Gastroenterological surgery for patients with chronic respiratory insufficiency.

    Science.gov (United States)

    Shimada, M; Kano, T; Matsuzaki, Y; Miyazaki, N; Ninomiya, K

    1998-01-01

    The aim of this study was to clarify the surgical indications for patients with chronic respiratory insufficiency. Fourteen patients with chronic respiratory insufficiency who underwent abdominal surgical procedures, were retrospectively studied. The surgical indications were carefully determined based primarily on the performance status (PS) of each patient and cardiopulmonary function tests. A PS of equal to or less than 3, which meant the patient's status required bed rest > 50% of the time, and the need for assistance in performing normal activities were all factors considered for surgical indications. During the period studied, two patients were excluded from the surgical indications due to the fact that one was at a terminal stage of pulmonary disease and was completely bedridden (PS = 4), while the other demonstrated active pneumonia with a considerable amount of purulent sputa. Regarding the pulmonary function tests for patients who underwent surgery, the lowest limits of those examinations were as follows: 810 ml of vital capacity (VC), 23.8% of predicted VC, 610 ml of forced expiratory volume in one second (FEV1.0), 38.6% of predicted FEV1.0, 50.5 mmHg of PaO2 while inhaling 4 liters of oxygen and 73.8 mmHg of PaCO2. No surgery related mortality or hospital death within 30 days after operation was observed. Only two patients had cardiopulmonary complications (consisting of pulmonary edema with atrial fibrillation in one patient, and acute myocardial infarction in another patient). However, neither pneumonia, prolonged ventilatory support for more than 2 days, nor the need for a tracheostomy after surgery was observed. Gastroenterological surgery is thus considered to be indicated even for patients with chronic respiratory insufficiency, as long as the PS can be maintained (PS of equal to or less than 3) and no active pneumonia with a considerable amount of purulent sputa is present.

  14. The efficacy of supplemental intraosseous anesthesia after insufficient mandibular block

    Directory of Open Access Journals (Sweden)

    Samir Prohić

    2005-02-01

    Full Text Available It is a well-known scientific fact that only a small percentage of infiltration of inferior alveolar nerve is clinically proven to be efficient. The objective of this study was to determine the anesthetic efficacy of supplemental intraosseous injection, used after the insufficient classical mandibular block that didn't provide deep pulp anesthesia of mandibular molar planed for extraction. The experimental teeth consisted of 98 mandibular molars with clinical indication for extraction. Based on the history of disease, we indicated the extraction of the tooth. After that each tooth was tested with a electric pulp tester P1. We tested the pulp vitality and precisely determined the level of vitality. After that, each patient received classical mandibular block, and the pulp vitality was tested again. If the pulp tester indicated negative vitality for the certain mandibular molar, and the patient didn't complain about pain or discomfort during the extraction, the molar was extracted and the result was added to anesthetic success rate for the classical mandibular block. If, five minutes after receiving the mandibular block, the pulp tester indicated positive vitality (parameters of vitality or the patient complained about pain or discomfort (parameters of pain and discomfort, we used the Stabident intraosseous anesthesia system. Three minutes after the application of supplemental intraosseous injection the molar was tested with the pulp tester again. The anesthetic solution used in both anesthetic techniques is lidocaine with 1:100.000 epinephrine. The results of this study indicate that the anesthetic efficacy of the mandibular block is 74.5%, and that supplemental intraosseous anesthesia, applied after the insufficient mandibular block, provides pulpal anesthesia in 94.9% of mandibular molars. The difference between anesthetic efficacy of the classical mandibular block and anesthetic efficacy of the supplemental intraosseous anesthesia, applied

  15. The efficacy of supplemental intraosseous anesthesia after insufficient mandibular block.

    Science.gov (United States)

    Prohić, Samir; Sulejmanagić, Halid; Secić, Sadeta

    2005-02-01

    It is a well-known scientific fact that only a small percentage of infiltration of inferior alveolar nerve is clinically proven to be efficient. The objective of this study was to determine the anesthetic efficacy of supplemental intraosseous injection, used after the insufficient classical mandibular block that didn't provide deep pulp anesthesia of mandibular molar planed for extraction. The experimental teeth consisted of 98 mandibular molars with clinical indication for extraction. Based on the history of disease, we indicated the extraction of the tooth. After that each tooth was tested with a electric pulp tester P1. We tested the pulp vitality and precisely determined the level of vitality. After that, each patient received classical mandibular block, and the pulp vitality was tested again. If the pulp tester indicated negative vitality for the certain mandibular molar, and the patient didn't complain about pain or discomfort during the extraction, the molar was extracted and the result was added to anesthetic success rate for the classical mandibular block. If, five minutes after receiving the mandibular block, the pulp tester indicated positive vitality (parameters of vitality) or the patient complained about pain or discomfort (parameters of pain and discomfort), we used the Stabident intraosseous anesthesia system. Three minutes after the application of supplemental intraosseous injection the molar was tested with the pulp tester again. The anesthetic solution used in both anesthetic techniques is lidocaine with 1:100.000 epinephrine. The results of this study indicate that the anesthetic efficacy of the mandibular block is 74.5%, and that supplemental intraosseous anesthesia, applied after the insufficient mandibular block, provides pulpal anesthesia in 94.9% of mandibular molars. The difference between anesthetic efficacy of the classical mandibular block and anesthetic efficacy of the supplemental intraosseous anesthesia, applied after the

  16. Health-related quality of life in children with thoracic insufficiency syndrome.

    Science.gov (United States)

    Vitale, Michael G; Matsumoto, Hiroko; Roye, David P; Gomez, Jaime A; Betz, Randal R; Emans, John B; Skaggs, David L; Smith, John T; Song, Kit M; Campbell, Robert M

    2008-03-01

    The traditional techniques to treat thoracic insufficiency syndrome (TIS) are not able to stabilize or improve chest wall size or pulmonary function while allowing spine growth. To this end, vertical expandable prosthetic titanium rib (VEPTR) was specifically designed to treat TIS by allowing growth of the thoracic cavity and control/correction of spine deformity. The purpose of this study was to determine quality of life (QOL) of children with TIS and its impact on their parents before and after implantation of the VEPTR and also compare these results to those of healthy children. As part of the original multicenter evaluation of the VEPTR, a Child Health Questionnaire (CHQ) was collected preoperatively on 45 patients who were subsequently treated with expansion thoracoplasty using the VEPTR. The average age was 8.2 +/- 2.6 years, and the parent form of the CHQ was filled out by the primary caretaker. Patients were divided into 3 diagnostic categories: rib fusion (n = 15), hypoplastic thorax syndromes (n = 17), and progressive spinal deformity (n = 13). There were significant differences between the study patients and healthy children in physical domains. Compared with parents of healthy children, parents of children with TIS experienced more limitations on their time and emotional lives due to their children's health problems. There were no significant differences in CHQ before and after the surgery except for a significant decrease in the self-esteem among a subgroup of patients with hypoplastic thorax syndromes. There were no significant differences in postoperative QOL between patients who had VEPTR-related complications and patients who did not have the complications. The children with TIS had lower physical scores and higher caregiver burden scores than healthy children. However, the scores in psychosocial domains were similar to those in healthy children. Our study demonstrated that QOL of children and burden of care in their parents remained the same after

  17. Tricuspid insufficiency detected by equilibrium gated radionuclide study

    International Nuclear Information System (INIS)

    Handler, B.; Pavel, D.G.; Lam, W.; Byrom, E.; Swiryn, S.; Pietras, R.; Rosen, K.M.

    1981-01-01

    The results of a gated radionuclide cardiac study are reported in a patient with biventricular failure and tricuspid insufficiency demonstrated by clinical evaluation, M-mode and 2-D sector echocardiography, and cardia catheterization. The processed gated radionuclide cardiac study showed a left ventricular/right ventricular stroke volume ratio of 0.5; expansion of the hepatic blood pool demonstrated by hepatic time activity curve and calculation of an '''expansion fraction''; and synchronous changes of count rate of the atrial and hepatic regions detected by phase analysis

  18. Evidence of perception of AIDS insufficient for verdict.

    Science.gov (United States)

    1997-11-28

    The 8th U.S. Circuit Court of Appeals overturned the jury verdict in favor of [name removed], a welder who claimed he was fired because his employer, [name removed] National Vendor, thought he had AIDS. According to [name removed], when his health and physical appearance began deteriorating due to Graves disease, a thyroid condition, he was terminated. [Name removed] filed a grievance through his labor union and filed a lawsuit under the Americans with Disabilities Act (ADA). The Circuit Court panel determined there was insufficient evidence to conclude that the company's officials and key decision makers regarded [name removed] as having AIDS.

  19. French Military Intervention in Mali: Inevitable, Consensual yet Insufficient

    Directory of Open Access Journals (Sweden)

    Isaline Bergamaschi

    2013-06-01

    Full Text Available This practice note offers an account of France’s military intervention in Mali launched on 11 January 2013. Firstly, it provides an analysis of the events that led up to the dual crisis in the country’s northern and southern regions and to a new wave of armed conflict between government and rebel forces. Then, it is argued that although the French military intervention was framed as inevitable and based on a broad consensus, it will nevertheless be insufficient to address the root sociopolitical causes of Mali´s multidimensional crisis.

  20. THE METHOD OF MANAGEMENT WOMEN WITH ISTHMIC-CERVICAL INSUFFICIENCY

    Directory of Open Access Journals (Sweden)

    Мария Сергеевна Воронцова

    2018-01-01

    Full Text Available Isthmic-cervical insufficiency (ICI is one of the most common causes of spontaneous premature births. In II trimester of pregnancy in the structure of miscarriages, the share of ICI accounts for about 40 % of cases. The purpose – evaluate the effectiveness of the complex method of correction of isthmic-cervical insufficiency. Materials and methods. A simple, open, prospective, randomized study was performed on the basis of the City Clinical Perinatal Center in Omsk. Under observation, there were 60 patients aged 18-40 years in gestation period of 13-33 weeks 6 days with a proven diagnosis of «isthmic-cervical insufficiency». The main group included 30 patients who received treatment with a new combined method: the obstetric pessary «CVK», which differs from the analogues by a more anatomical ellipsoidal form and an increased number of perforations to improve the outflow of vaginal secretions in combination with intravaginal injection of micronized progesterone in a dosage of 100 mg 2 times a day and a drug normalizing the biocenosis of the vagina, as a lyophilized culture of lactobacilli L. casei rhamnosus Doderleini in a dosage of 340 mg, 1 capsule intravaginally at night 2 times a week. The comparison group consisted of 30 patients who received treatment: obstetric silicone pessary + micronized progesterone at a dosage of 200 mg per day intravaginally. The outcomes of pregnancy and childbirth were evaluated. Results. The total number of premature births in the main group was 4 (13.3 % compared to 12 (40 % in the comparison group (p = 0,023. Based on the results of the study, a statistically significant reduction in patients with recurrent vaginal flora (p = 0,0001 was obtained and, due to a decrease in this indicator, a general decrease in the number of women with complications of pregnancy was registered (p = 0,019. The conclusion. The proposed method of correction of isthmic-cervical insufficiency is more effective

  1. Distal vertebral artery reconstruction when managing vertebrobasilar insufficiency

    Directory of Open Access Journals (Sweden)

    D. M. Galaktionov

    2017-11-01

    Full Text Available This article presents a literature review devoted to the reconstruction of the distal vertebral artery and a clinical case of successful surgical treatment of a patient suffering from vertebrobasilar insufficiency caused by occlusion of the vertebral artery in a proximal segment. The external carotid artery-distal vertebral artery bypass was performed by using the radial artery.Received 27 February 2017. Revised 25 July 2017. Accepted 3 August 2017.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest. 

  2. Preoperative combination therapy of 5-fluorouracil suppository and radiation for carcinoma of the rectum

    International Nuclear Information System (INIS)

    Mizusawa, Hirokazu

    1986-01-01

    The effect of adjuvant preoperative treatments with radiation and 5-fluorouracil (5-FU) on rectal carcinomas was investigated. The radiation therapy was administered in the area including the rectum and regional lymph nodes up to the level of the promontorium with 10 doses of 300 rad in three-week periods (a total dose of 3,000 rad). The suppository containing 100 mg of 5-FU was given intrarectally twice daily in the same period (a total dose of 4,000 mg of 5-FU). The surgical procedure with either abdominoperineal excision or anterior resection was performed within 14 days after the last preoperative treatment. The resected specimens were examined microscopically. The mean thickness of excised tumor-free tissue around the rectal wall having the most extended tumor growth was 6.2 mm in 16 patients receiving the treatment with radiation and 5-FU, 3.9 mm in 31 patients with 5-FU alone and 3.7 mm in 19 patients without preoperative treatments. Lymph node metastases were detected in 3 of 17 patients (19 %) with radiation and 5-FU, in 18 of 33 patients (55 %) with 5-FU alone, and in 11 of 24 patients (46 %) without preoperative treatments. The extensive degenerative pictures of cancer cells such as nuclear picnosis, and the growth of collagen fibers in carcinoma foci were observed in resected specimens with radiation and 5-FU treatments. Those findings suggest that preoperative adjuvant therapy with moderate dose of radiation and 5-FU affected significantly rectal carcinomas. There were no adverse effects. It seems likely, thus, that this combined therapy could prevent postoperative local or intrapelvic recurrence, which was the most frequent form of recurrence after curative surgery in rectal cancer. (author)

  3. Psychological contributors to noncompletion of an adolescent preoperative bariatric surgery program.

    Science.gov (United States)

    Cohen, Megan J; Curran, Jennifer L; Phan, Thao-Ly T; Reichard, Kirk; Datto, George A

    2017-01-01

    Noncompletion of preoperative bariatric programs is a significant problem among adolescents. Adult studies suggest that psychological factors contribute to noncompletion of preoperative bariatric programs. The aim of this study was to determine the association between adolescent psychological functioning and completion of the preoperative phase of a bariatric program. The study was conducted at a tertiary care children's hospital affiliated with a university medical center. Seventy-four adolescents and their parents completed an assessment measure of psychological functioning with the Behavior Assessment System for Children, Second Edition. We compared these scores between adolescents who completed the preoperative phase of the bariatric program and proceeded to surgery (completers) to those who did not (noncompleters) using multivariate analysis of covariance and logistic regression analyses, adjusting for demographic characteristics and baseline body mass index. The mean age was 16.0 (1.1) years, most were female (79.8%), and the group was diverse (48.6%, Caucasian; 33.8%, black; 17.6%, other, including Hispanic, Asian, and biracial). Average body mass index was 50.5 (7.6) kg/m 2 . Forty-two percent of participants were noncompleters. Noncompleters were reported by parents to have more clinically significant externalizing and internalizing behaviors and fewer adaptive behaviors. Noncompleters self-reported more clinically significant internalizing symptoms, emotional problems, and poor personal adjustment. Adolescents who did not complete the preoperative phase of a bariatric surgery program had more clinically significant psychological symptoms across multiple domains compared with those who successfully proceeded to bariatric surgery. Early identification and treatment of psychological symptoms may be important in helping adolescents successfully proceed to surgery. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights

  4. Preoperative depression symptom severity and its impact on adherence to preoperative beta-blocker therapy.

    Science.gov (United States)

    Schonberger, Robert B; Feinleib, Jessica; Holt, Natalie; Dai, Feng; Brandt, Cynthia; Burg, Matthew M

    2014-12-01

    To test the association among depression symptoms, distressed personality type, and preoperative beta-blocker nonadherence and to estimate the prevalence of untreated major depression in this population. Prospective observational study. A veterans hospital. One hundred twenty patients on outpatient beta-blocker therapy presenting for surgery. The Patient Health Questionnaire (PHQ)-9, the D-Scale-14 (DS14), and Modified Morisky Scale (MMS) questionnaires. Of 99 participants who presented for surgery, the incidence of preoperative nonadherence was 14.1% (95% confidence interval 7%-21%), consistent with prior research. Nonadherence was 9.5% among those with no depression, 27.8% among those with mild depression, and 28.6% among those with moderate-to-severe depression (Cochran-Armitage test for trend p = 0.03). Distressed personality type was found in 35% of the cohort (95% confidence interval 26-45%) and was not associated with beta-blocker nonadherence (Fisher's exact test, p = 0.24). Among participants with symptoms of major depressive disorder (n = 25, 25.3%), more than half (n = 14, 56%) had no indication of depression listed at their most recent primary care visit. Patients with symptoms of depression on chronic beta-blocker therapy are susceptible to medication nonadherence on the day of surgery. Most surgical patients with symptoms of major depression lack a diagnosis of depression. Preoperative depression screening may thus (1) identify a population at increased risk of beta-blocker withdrawal, and (2) identify patients who may benefit from anesthesiologist-initiated referral for this treatable condition. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Multimodal Emotion Recognition Is Resilient to Insufficient Sleep: Results From Cross-Sectional and Experimental Studies.

    Science.gov (United States)

    Holding, Benjamin C; Laukka, Petri; Fischer, Håkan; Bänziger, Tanja; Axelsson, John; Sundelin, Tina

    2017-11-01

    Insufficient sleep has been associated with impaired recognition of facial emotions. However, previous studies have found inconsistent results, potentially stemming from the type of static picture task used. We therefore examined whether insufficient sleep was associated with decreased emotion recognition ability in two separate studies using a dynamic multimodal task. Study 1 used a cross-sectional design consisting of 291 participants with questionnaire measures assessing sleep duration and self-reported sleep quality for the previous night. Study 2 used an experimental design involving 181 participants where individuals were quasi-randomized into either a sleep-deprivation (N = 90) or a sleep-control (N = 91) condition. All participants from both studies were tested on the same forced-choice multimodal test of emotion recognition to assess the accuracy of emotion categorization. Sleep duration, self-reported sleep quality (study 1), and sleep deprivation (study 2) did not predict overall emotion recognition accuracy or speed. Similarly, the responses to each of the twelve emotions tested showed no evidence of impaired recognition ability, apart from one positive association suggesting that greater self-reported sleep quality could predict more accurate recognition of disgust (study 1). The studies presented here involve considerably larger samples than previous studies and the results support the null hypotheses. Therefore, we suggest that the ability to accurately categorize the emotions of others is not associated with short-term sleep duration or sleep quality and is resilient to acute periods of insufficient sleep. © Sleep Research Society 2017. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.

  6. Preoperative radiotherapy for bone and soft tissue sarcoma

    International Nuclear Information System (INIS)

    Matsumoto, Seiichi; Kawaguchi, Noriyoshi; Amino, Katsuhisa; Manabe, Jun; Yamashita, Takashi; Kaneta, Kouichi; Furuya, Kohtaro; Isobe, Yasushi.

    1989-01-01

    The role of preoperative radiotherapy was evaluated in 16 cases with soft tissue sarcoma and 13 cases with osteosarcoma. Nine osteosarcoma cases underwent radiotherapy of whole lesion, and 4 cases had radiotherapy only of the surgically uncurable portion. There were no local recurrences in M0 cases, but skin necrosis occurred in the whole radiation group. As for the soft tissue sarcomas, local recurrence was not seen in virgin cases, but two cases which had received previous treatment showed local recurrence. There were no cases with severe side effects. Partial radiotherapy was effective as preoperative treatment for osteosarcoma. Preoperative radiotherapy is better than postoperative radiotherapy from many standpoints. (author)

  7. Anterior mediastinal paraganglioma: A case for preoperative embolization

    Directory of Open Access Journals (Sweden)

    Shakir Murtaza

    2012-07-01

    Full Text Available Abstract Background Paraganglioma is a rare but highly vascular tumor of the anterior mediastinum. Surgical resection is a challenge owing to the close proximity to vital structures including the heart, trachea and great vessels. Preoperative embolization has been reported once to facilitate surgical treatment. Case presentation We report a case of anterior mediastinal paraganglioma that was embolized preoperatively, and was resected without the need for cardiopulmonary bypass and without major bleeding complications. Conclusion We make a case to further the role of preoperative embolization in the treatment of mediastinal paragangliomas.

  8. Preoperative fasting: will the evidence ever be put into practice?

    Science.gov (United States)

    Crenshaw, Jeannette T

    2011-10-01

    Decades of research support the safety and health benefits of consuming clear liquids, including those that are carbohydrate rich, until a few hours before elective surgery or other procedures requiring sedation or anesthesia. Still, U.S. clinicians routinely instruct patients to fast for excessively long preoperative periods. Evidence-based guidelines, published over the past 25 years in the United States, Canada, and throughout Europe, recommend liberalizing preoperative fasting policies. To improve patient safety and health care quality, it's essential that health care professionals abandon outdated preoperative fasting policies and allow available evidence to guide preanesthetic practices.

  9. The Soft Palate Friendly Speech Bulb for Velopharyngeal Insufficiency.

    Science.gov (United States)

    Kahlon, Sukhdeep Singh; Kahlon, Monaliza; Gupta, Shilpa; Dhingra, Parvinder Singh

    2016-09-01

    Velopharyngeal insufficiency is an anatomic defect of the soft palate making palatopharyngeal sphincter incomplete. It is an important concern to address in patients with bilateral cleft lip and palate. Speech aid prosthesis or speech bulbs are best choice in cases where surgically repaired soft palate is too short to contact pharyngeal walls during function but these prosthesis have been associated with inadequate marginal closure, ulcerations and patient discomfort. Here is a case report of untreated bilateral cleft lip and palate associated with palatal insufficiency treated by means of palate friendly innovative speech bulb. This modified speech bulb is a combination of hard acrylic and soft lining material. The hard self-curing acrylic resin covers only the hard palate area and a permanent soft silicone lining material covering the soft palate area. A claw-shaped wire component was extended backwards from acrylic and was embedded in soft silicone to aid in retention and approximation of two materials. The advantage of adding the soft lining material in posterior area helped in covering the adequate superior extension and margins for maximal pharyngeal activity. This also improved the hypernasality, speech, comfort and overall patient acceptance.

  10. Cognitive function in patients with primary adrenal insufficiency (Addison's disease).

    Science.gov (United States)

    Schultebraucks, Katharina; Wingenfeld, Katja; Heimes, Jana; Quinkler, Marcus; Otte, Christian

    2015-05-01

    Patients with primary adrenal insufficiency (AI) need to replace glucocorticoids and mineralocorticoids that act on glucocorticoid (GR) and mineralocorticoid receptors (MR). Both receptors are highly expressed in the hippocampus and are closely associated with cognitive function, which might be impaired by insufficient or increased GR and MR stimulation. However, little is known about cognitive function in patients with AI. It was examined whether patients with AI exhibit worse cognitive function compared to sex-, age-, and education-matched controls. Cognitive function (executive function, concentration, verbal memory, visual memory, working memory, and autobiographical memory) was assessed in 30 patients with AI (mean age 52.4 yrs. ±14.4, n=21 women, mean duration of illness 18.2 yrs. ±11.1) and 30 matched controls. We also measured depressive symptoms, body mass index (BMI), and blood pressure. Patients with AI showed more depressive symptoms, had a greater BMI and lower systolic blood pressure compared to controls. Adjusted analyses controlling for these variables revealed that patients with AI performed significantly worse in verbal learning (F=7.8, p=.007). Executive function, concentration, working memory, verbal memory, visuospatial memory, and autobiographical memory did not differ between groups. No clinically relevant cognitive impairment was found in patients with AI compared to matched controls. Even long-term glucocorticoid and mineralocorticoid substitution over almost two decades appears to have only subtle effects on cognition in patients with AI. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. The physical mechanism of successful treatment for cervical insufficiency

    Science.gov (United States)

    Baumer, Alexa; Amechi, Alexis; Codrington, Paige; Leftwich, Megan C.

    2017-11-01

    Cervical insufficiency is a medical condition during pregnancy in which the uterine cervix softens and begins to dilate before reaching full term, usually between 18 and 22 weeks gestation. It is the most common cause of second trimester pregnancy loss. One clinical technique used to treat cervical insufficiency is the cervical cerclage, a procedure to close the cervix with a purse-string stitch. There are conflicting findings on the efficacy of a cerclage, with most studies relying on statistical evidence. The purpose of this investigation is to examine the mechanical limitations of a cervical cerclage by pressurizing a stitched, synthetic cervix until rupture. A synthetic model of the cervix is generated using ultrasound images collected by clinical collaborators and fabricated with silicon to imitate physiological properties. Medical residents from The George Washington University Hospital stitch the synthetic cervixes using clinical techniques. Pressure transducers record the maximum force on the stitch before rupture. The results of this study will provide insight into the most effective clinical interventions and the mechanism of their success.

  12. Adolescent Premature Ovarian Insufficiency Following Human Papillomavirus Vaccination

    Directory of Open Access Journals (Sweden)

    Deirdre Therese Little MBBS, DRANZCOG, FACRRM

    2014-10-01

    Full Text Available Three young women who developed premature ovarian insufficiency following quadrivalent human papillomavirus (HPV vaccination presented to a general practitioner in rural New South Wales, Australia. The unrelated girls were aged 16, 16, and 18 years at diagnosis. Each had received HPV vaccinations prior to the onset of ovarian decline. Vaccinations had been administered in different regions of the state of New South Wales and the 3 girls lived in different towns in that state. Each had been prescribed the oral contraceptive pill to treat menstrual cycle abnormalities prior to investigation and diagnosis. Vaccine research does not present an ovary histology report of tested rats but does present a testicular histology report. Enduring ovarian capacity and duration of function following vaccination is unresearched in preclinical studies, clinical and postlicensure studies. Postmarketing surveillance does not accurately represent diagnoses in adverse event notifications and can neither represent unnotified cases nor compare incident statistics with vaccine course administration rates. The potential significance of a case series of adolescents with idiopathic premature ovarian insufficiency following HPV vaccination presenting to a general practice warrants further research. Preservation of reproductive health is a primary concern in the recipient target group. Since this group includes all prepubertal and pubertal young women, demonstration of ongoing, uncompromised safety for the ovary is urgently required. This matter needs to be resolved for the purposes of population health and public vaccine confidence.

  13. Urinary hemosiderin: role in evaluation of chronic venous insufficiency

    Directory of Open Access Journals (Sweden)

    Ashish Lal Shrestha

    2012-08-01

    Full Text Available Chronic venous insufficiency (CVI leads to skin changes with dermal hemosiderin deposition. We studied the presence of hemosiderin in the urine to assess if this could be used as a biochemical marker for CVI. Hereby we present a case control study conducted in a tertiary care centre in South India. There were 100 cases with evidence of advanced CVI (the Clinical-Etiology-Anatomy-Pathophysiology classification: C5, C6 confirmed by duplex scanning. Controls were 50 patients with leg ulcers due to other etiologies. All patients were subjected to urinary hemosiderin testing. In all 100 patients with CVI (C5 and C6 disease axial venous reflux was confirmed by duplex ultrasound. Superficial venous reflux was noted in 71% of patients and deep venous reflux in 54.%. Primary venous insufficiency was the etiology in 81% of patients. Only 4/100 patients had detectable amounts of hemosiderin in the urine. Urine hemosiderin testing to determine presence or absence of CVI yielded the following values: positive predictive value-80%; negative predictive value-33%; sensitivity-4% and specificity-98%. The test could not be recommended as a marker of CVI. In Indian patients urinary hemosiderin is not a useful screening test in CVI.

  14. Autoimmune hyperthyroidism due to secondary adrenal insufficiency: resolution with glucocorticoids.

    Science.gov (United States)

    Skamagas, Maria; Geer, Eliza B

    2011-01-01

    To describe the course of autoimmune hyperthyroid disease in a patient with corticotropin (ACTH) deficiency treated with glucocorticoids. We report the clinical presentation, laboratory data, imaging studies, and management of a patient with weight loss, fatigue, apathy, hallucinations, and arthritis. Autoimmune hyperthyroidism (positive thyroperoxidase and thyroglobulin antibodies and borderline positive thyrotropin receptor antibody) was diagnosed in a 71-year-old woman. New psychotic symptoms prompted brain magnetic resonance imaging, which revealed a partially empty sella. Undetectable morning cortisol, undetectable ACTH, and failure to stimulate cortisol with synthetic ACTH (cosyntropin 250 mcg) secured the diagnosis of long-standing secondary adrenal insufficiency. Hydrocortisone replacement improved the patient's symptoms, resolved the thyroid disease, and decreased thyroid antibody titers. In retrospect, the patient recalled severe postpartum hemorrhage requiring blood transfusion at age 38 years. A Sheehan event probably occurred 33 years before the patient presented with corticotropin deficiency. Hyperthyroidism accelerated cortisol metabolism and provoked symptoms of adrenal insufficiency. The hypocortisolemic state may precipitate hyperimmunity and autoimmune thyroid disease. Rapid resolution of hyperthyroidism and decreased thyroid antibody titers with glucocorticoid treatment support this hypothesis.

  15. Insufficiency Fractures After Pelvic Radiotherapy in Patients With Prostate Cancer

    International Nuclear Information System (INIS)

    Igdem, Sefik; Alco, Guel; Ercan, Tuelay; Barlan, Metin; Ganiyusufoglu, Kuersat; Unalan, Buelent; Turkan, Sedat; Okkan, Sait

    2010-01-01

    Purpose: To assess the incidence, predisposing factors, and clinical characteristics of insufficiency fractures (IF) in patients with prostate cancer, who received pelvic radiotherapy as part of their definitive treatment. Methods and Materials: The charts of 134 prostate cancer patients, who were treated with pelvic radiotherapy between 1998 and 2007 were retrospectively reviewed. IF was diagnosed by bone scan and/or CT and/or MRI. The cumulative incidence of symptomatic IF was estimated by actuarial methods. Results: Eight patients were identified with symptomatic IF after a median follow-up period of 68 months (range, 12-116 months). The 5-year cumulative incidence of symptomatic IF was 6.8%. All patients presented with lower back pain. Insufficiency fracture developed at a median time of 20 months after the end of radiotherapy and was managed conservatively without any need for hospitalization. Three patients were thought to have metastatic disease because of increased uptake in their bone scans. However, subsequent CT and MR imaging revealed characteristic changes of IF, avoiding any further intervention. No predisposing factors for development of IF could be identified. Conclusions: Pelvic IF is a rare complication of pelvic radiotherapy in prostate cancer. Knowledge of pelvic IF is essential to rule out metastatic disease and prevent unnecessary treatment, especially in a patient cohort with high-risk features for distant spread.

  16. Impact of Aortic Insufficiency on Ascending Aortic Dilatation and Adverse Aortic Events After Isolated Aortic Valve Replacement in Patients With a Bicuspid Aortic Valve.

    Science.gov (United States)

    Wang, Yongshi; Wu, Boting; Li, Jun; Dong, Lili; Wang, Chunsheng; Shu, Xianhong

    2016-05-01

    Aberrant flow pattern and congenital fragility bestows bicuspid aortic valve (BAV) with a propensity toward ascending aorta dilatation, aneurysm, and dissection. Whether isolated aortic valve replacement (AVR) can prevent further dilatation in BAV ascending aorta and what indicates concurrent aortic intervention in the case of valve operation remain controversial. From June 2006 to January 2009, patients with a BAV who underwent isolated AVR were consecutively included and categorized into aortic insufficiency (BAV-AI, n = 84) and aortic stenosis (n = 112) groups, and another population of patients with a tricuspid aortic valve with aortic insufficiency (n = 149) was also recruited during the same period for comparison of annual aortic dilatation rate and adverse aortic events after isolated AVR. With a median follow-up period of 72 months (interquartile range, 66 to 78 months), ascending aorta dilatation rates were faster in the BAV-AI group than the BAV plus aortic stenosis and tricuspid aortic valve with aortic insufficiency groups (both p regression analysis identified aortic insufficiency (hazard ratio, 3.7; 95% confidence interval, 1.2 to 11.1; p = 0.019) as an independent risk factor for adverse aortic events among patients with BAV in general, whereas preoperative ascending aortic diameter larger than 45 mm (hazard ratio, 13.8; 95% confidence interval, 3.0 to 63.3; p = 0.001) served as a prognostic indicator in the BAV-AI group. An aggressive policy of preventive aortic interventions seemed appropriate in patients with BAV-AI during AVR, and BAV phenotype presenting as either insufficiency or stenosis should be taken into consideration when contemplating optimal surgical strategies for BAV aortopathy. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  17. [Spectrum and susceptibility of preoperative conjunctival bacteria].

    Science.gov (United States)

    Fernández-Rubio, M E; Cuesta-Rodríguez, T; Urcelay-Segura, J L; Cortés-Valdés, C

    2013-12-01

    To describe the conjunctival bacterial spectrum of our patients undergoing intraocular surgery and their antibiotic sensitivity during the study period. A retrospective study of preoperative conjunctival culture of patients consecutively scheduled for intraocular surgery from 21 February 2011 to 1 April 2013. Specimens were directly seeded onto blood-agar and MacConkey-agar (aerobiosis incubation, 2 days), and on chocolate-agar (6% CO2 incubation, 7 days). The identified bacteria were divided into 3 groups according to their origin; the bacteria susceptibility tests were performed on those more pathogenic and on some of the less pathogenic when more than 5 colonies were isolated. The sensitivity of the exigent growing bacteria was obtained with disk diffusion technique, and for of the non-exigent bacteria by determining their minimum inhibitory concentration. The Epidat 3.1 program was used for statistical calculations. A total of 13,203 bacteria were identified in 6,051 cultures, with 88.7% being typical colonizers of conjunctiva (group 1), 8.8% typical of airways (group 2), and the remaining 2.5% of undetermined origin (group 3). 530 cultures (8.8%) were sterile. The sensitivity of group 1 was: 99% vancomycin, 95% rifampicin, 87% chloramphenicol, 76% tetracycline. Levels of co-trimoxazole, aminoglycosides, quinolones, β-lactams and macrolides decreased since 2007. The group 2 was very sensitive to chloramphenicol, cefuroxime, rifampicin, ciprofloxacin and amoxicillin/clavulanate. In group 3, to levofloxacin 93%, ciprofloxacin 89%, tobramycin 76%, but ceftazidime 53% and cefuroxime 29% decreased. None of the tested antibiotics could eradicate all possible conjunctival bacteria. Bacteria living permanently on the conjunctiva (group 1) have achieved higher resistance than the eventual colonizers. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  18. Preoperative management in patients with Graves' disease.

    Science.gov (United States)

    Piantanida, Eliana

    2017-10-01

    Graves' disease is the most frequent cause of hyperthyroidism in iodine-sufficient geographical areas and is characterized by the presence in patients' serum of autoantibodies directed against the thyrotropin receptor (TRAb) that cause overproduction and release of thyroid hormones. Clinical presentation results from both hyperthyroidism and underlying autoimmunity. The diagnosis is based on characteristic clinical features and biochemical abnormalities. If serum thyrotropin (TSH) is low, serum free thyroxine (FT4) and free triiodothyronine (FT3) concentrations should be measured to distinguish between subclinical (with normal circulating thyroid hormones) and overt hyperthyroidism (with increased circulating thyroid hormones). Graves' disease is treated with any of three effective and relatively safe initial treatment options: antithyroid drugs (ATDs), radioactive iodine ablation (RAIU), and surgery. Total thyroidectomy is favored in several clinical situations, such as intolerance, ineffectiveness or recurrence after ATD treatment, radioiodine therapy contraindicated, documented or suspected thyroid malignancy, one or more large thyroid nodules, coexisting moderate-to-severe active Graves' orbitopathy, women planning a pregnancy within 6 months. Whenever surgery is selected as treatment, selection of an expert high-volume thyroid surgeons is fundamental and careful preoperative management is essential to optimize surgical outcomes. Pretreatment with ATDs in order to promptly achieve the euthyroid state is recommended to avoid the risk of precipitating thyroid storm during surgery. For the majority of patients, euthyroidism is achieved after few weeks of ATD treatment. Beta-blockers, such as propranolol, are often added effectively to control hyperthyroid symptoms. Saturated solution of potassium iodide (SSKI) or potassium iodine (Lugol's solution), given for a short period prior to surgery, in order to reduce both thyroid hormone release and thyroid gland

  19. Preoperative factors influencing success in pterygium surgery.

    Science.gov (United States)

    Torres-Gimeno, Ana; Martínez-Costa, Lucía; Ayala, Guillermo

    2012-08-08

    To identify preoperative, perioperative and postoperative risk factors that influence the success of pterygium surgery. This is a prospective study of thirty-six patients with primary or recurrent pterygia. A detailed anamnesis and an ophthalmological examination were performed looking for the following factors: age, race, latitude and altitude of the main place of residence, hours of exposure to the sun, use of protective measures against UV-radiation, classification of pterygium, width of the pterygium at limbus, surgical technique (conjunctival autograft plus suturing versus tissue glue), graft alterations (misapposition, granuloma, haemorrhage, oedema, retraction or necrosis), and postoperative symptoms (foreign-body sensation, pain). The examinations were performed 2 and 7 days and 2, 6 and 12 months after surgery. In addition, recurrence was defined as any growth of conjunctiva into the cornea. A logistic regression and a survival analysis have been used to perform data analysis. A total number of 36 patients completed a one year follow-up. A total of 13 patients were born and lived in Spain, and 26 came from other countries, mostly Latin America. A total number of 8 males (no women) presented a recurrence, mainly between 2 and 6 months. The hours of sun exposure through their life was independently related to surgical success. Pterygia of less than 5 mm of base width showed a weak positive correlation with recurrence. None of the other factors considered were significantly related to recurrence. Male gender and high sun exposure are strongly and independently related to surgical success after the removal of pterygia.

  20. Preoperative factors influencing success in pterygium surgery

    Directory of Open Access Journals (Sweden)

    Torres-Gimeno Ana

    2012-08-01

    Full Text Available Abstract Background To identify preoperative, perioperative and postoperative risk factors that influence the success of pterygium surgery. Methods This is a prospective study of thirty-six patients with primary or recurrent pterygia. A detailed anamnesis and an ophthalmological examination were performed looking for the following factors: age, race, latitude and altitude of the main place of residence, hours of exposure to the sun, use of protective measures against UV-radiation, classification of pterygium, width of the pterygium at limbus, surgical technique (conjunctival autograft plus suturing versus tissue glue, graft alterations (misapposition, granuloma, haemorrhage, oedema, retraction or necrosis, and postoperative symptoms (foreign-body sensation, pain. The examinations were performed 2 and 7 days and 2, 6 and 12 months after surgery. In addition, recurrence was defined as any growth of conjunctiva into the cornea. Results A logistic regression and a survival analysis have been used to perform data analysis. A total number of 36 patients completed a one year follow-up. A total of 13 patients were born and lived in Spain, and 26 came from other countries, mostly Latin America. A total number of 8 males (no women presented a recurrence, mainly between 2 and 6 months. The hours of sun exposure through their life was independently related to surgical success. Pterygia of less than 5 mm of base width showed a weak positive correlation with recurrence. None of the other factors considered were significantly related to recurrence. Conclusions Male gender and high sun exposure are strongly and independently related to surgical success after the removal of pterygia.

  1. Renovascular hypertension due to insufficient collateral flow in segmental artery occulusion

    International Nuclear Information System (INIS)

    Park, Y. H.; Lee, S. Y.; Kim, S. H.; Sohn, H. S.; Chung, S. K.

    2001-01-01

    We report a case in which a 33-year-old woman with renovascular hypertension due to insufficient collateral flow in segmental renal artery occlusion demonstrated abnormality on captopril renal scintigram. Baseline renal scintigram with DTPA showed normal perfusion and excretion in left kidney and captopril renal scintigram with DTPA showed a focal area of decreased perfusion and delayed clearance in lower half of left kidney, suggesting segmental renal artery stenosis. Selective left renal arteriography showed complete obstruction in proximal portion of anterior segmental artery with multiple small collateral vessels from posterior segmental artery and capsular artery and delayed opacification in lower half of left kidney. These findings are suggestive of segmental hypoperfusion due to insufficient collateral blood flow resulting to positive captopril response. Patient's blood pressure have been controlled well with ACE (angiotensin converting enzyme) inhibitor and calcium channel blocker for 2 year. Follow-up baseline renal scintigram with MAG3 showed normal perfusion and excretion in left kidney and captopril renal scintigram with MAG3 showed a focal area of decreased perfusion and delayed clearance in lower lateral portion of left kidney, which was smaller size than that of previous renal scintigram. And captopril renal scintigram with DMSA demonstrated a small area of decreased DMSA uptake on this lesion compared to baseline DMSA scintigram

  2. Establishment of a novel dwarf rat strain: cartilage calcification insufficient (CCI) rats.

    Science.gov (United States)

    Tanaka, Masami; Watanabe, Minoru; Yokomi, Izuru; Matsumoto, Naoki; Sudo, Katsuko; Satoh, Hitoshi; Igarashi, Tsuneo; Seki, Azusa; Amano, Hitoshi; Ohura, Kiyoshi; Ryu, Kakei; Shibata, Shunichi; Nagayama, Motohiko; Tanuma, Jun-ichi

    2015-01-01

    Rats with dwarfism accompanied by skeletal abnormalities, such as shortness of the limbs, tail, and body (dwarf rats), emerged in a Jcl-derived Sprague-Dawley rat colony maintained at the Institute for Animal Experimentation, St. Marianna University Graduate School of Medicine. Since the dwarfism was assumed to be due to a genetic mutation based on its frequency, we bred the dwarf rats and investigated their characteristics in order to identify the causative factors of their phenotypes and whether they could be used as a human disease model. One male and female that produced dwarf progeny were selected, and reproduction was initiated by mating the pair. The incidence of dwarfism was 25.8% among the resultant litter, and dwarfism occurred in both genders, suggesting that it was inherited in an autosomal recessive manner. At 12 weeks of age, the body weights of the male and female dwarf rats were 40% and 57% of those of the normal rats, respectively. In soft X-ray radiographic and histological examinations, shortening and hypoplasia of the long bones, such as the tibia and femur, were observed, which were suggestive of endochondral ossification abnormalities. An immunohistochemical examination detected an aggrecan synthesis disorder, which might have led to delayed calcification and increased growth plate thickening in the dwarf rats. We hypothesized that the principal characteristics of the dwarf rats were systemically induced by insufficient cartilage calcification in their long bones; thus, we named them cartilage calcification insufficient (CCI) rats.

  3. Establishment of a novel dwarf rat strain: cartilage calcification insufficient (CCI) rats

    Science.gov (United States)

    TANAKA, Masami; WATANABE, Minoru; YOKOMI, Izuru; MATSUMOTO, Naoki; SUDO, Katsuko; SATOH, Hitoshi; IGARASHI, Tsuneo; SEKI, Azusa; AMANO, Hitoshi; OHURA, Kiyoshi; RYU, Kakei; SHIBATA, Shunichi; NAGAYAMA, Motohiko; TANUMA, Jun-ichi

    2014-01-01

    Rats with dwarfism accompanied by skeletal abnormalities, such as shortness of the limbs, tail, and body (dwarf rats), emerged in a Jcl-derived Sprague-Dawley rat colony maintained at the Institute for Animal Experimentation, St. Marianna University Graduate School of Medicine. Since the dwarfism was assumed to be due to a genetic mutation based on its frequency, we bred the dwarf rats and investigated their characteristics in order to identify the causative factors of their phenotypes and whether they could be used as a human disease model. One male and female that produced dwarf progeny were selected, and reproduction was initiated by mating the pair. The incidence of dwarfism was 25.8% among the resultant litter, and dwarfism occurred in both genders, suggesting that it was inherited in an autosomal recessive manner. At 12 weeks of age, the body weights of the male and female dwarf rats were 40% and 57% of those of the normal rats, respectively. In soft X-ray radiographic and histological examinations, shortening and hypoplasia of the long bones, such as the tibia and femur, were observed, which were suggestive of endochondral ossification abnormalities. An immunohistochemical examination detected an aggrecan synthesis disorder, which might have led to delayed calcification and increased growth plate thickening in the dwarf rats. We hypothesized that the principal characteristics of the dwarf rats were systemically induced by insufficient cartilage calcification in their long bones; thus, we named them cartilage calcification insufficient (CCI) rats. PMID:25736479

  4. Agreement between pre-operative and intra-operative bacteriological samples in 85 chronic peri-prosthetic infections.

    Science.gov (United States)

    Matter-Parrat, V; Ronde-Oustau, C; Boéri, C; Gaudias, J; Jenny, J-Y

    2017-04-01

    Whether pre-operative microbiological sampling contributes to the management of chronic peri-prosthetic infection remains controversial. We assessed agreement between the results of pre-operative and intra-operative samples in patients undergoing single-stage prosthesis exchange to treat chronic peri-prosthetic infection. Agreement between pre-operative and intra-operative samples exceeds 75% in patients undergoing single-stage exchange of a hip or knee prosthesis to treat chronic peri-prosthetic infection. This single-centre retrospective study included 85 single-stage prosthesis exchange procedures in 82 patients with chronic peri-prosthetic infection at the hip or knee. Agreement between pre-operative and intra-operative sample results was evaluated. Changes to the initial antibiotic regimen made based on the intra-operative sample results were recorded. Of 149 pre-operative samples, 109 yielded positive cultures, in 75/85 cases. Of 452 intra-operative samples, 354 yielded positive cultures, in 85/85 cases. Agreement was complete in 54 (63%) cases and partial in 9 (11%) cases; there was no agreement in the remaining 22 (26%) cases. The complete agreement rate was significantly lower than 75% (P=0.01). The initial antibiotic regimen was inadequate in a single case. Pre-operative sampling may contribute to the diagnosis of peri-prosthetic infection but is neither necessary nor sufficient to confirm the diagnosis and identify the causative agent. The spectrum of the initial antibiotic regimen cannot be safely narrowed based on the pre-operative sample results. We suggest the routine prescription of a probabilistic broad-spectrum antibiotic regimen immediately after the prosthesis exchange, even when a pathogen was identified before surgery. IV, retrospective study. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  5. Evaluating the effect of preoperative oral gabapentin on ...

    African Journals Online (AJOL)

    Evaluating the effect of preoperative oral gabapentin on postoperative pain in patients receiving spinal ... Southern African Journal of Anaesthesia and Analgesia ... Group III (n = 30) patients received an oral placebo one hour prior to surgery.

  6. Preoperative fasting times: Prescribed and actual fasting times at ...

    African Journals Online (AJOL)

    The current international guidelines for preoperative fasting for elective surgery are 6 ... to determine whether this policy was being followed and patients were being starved ..... recommended fasting time, so that autonomous patients take care.

  7. Preoperation of Hamaoka Nuclear Power Station Unit No. 4

    International Nuclear Information System (INIS)

    Fukuyo, Tadashi; Kurata, Satoshi

    1994-01-01

    Chubu Electric Power Co. finished preoperation of Hamaoka Nuclear Power Station Unit No. 4 in September, 1993. Although unit 4 has the same reactor design as unit 3, its rated electrical output (1,137MW) is 37MW more than that of unit 3. This increase was achieved mainly by adopting a Moisture Separater Heater in the turbine system. We started preoperation of unit 4 in November 1992 and performed various tests at electrical outputs of 20%, 50%, 75%, and 100%. We finished preoperation without any scram or other major problems and obtained satisfactory results for the functions and performance of the plant. This paper describes the major results of unit 4 preoperation. (author)

  8. Preoperative B-type natriuretic peptides in patients undergoing ...

    African Journals Online (AJOL)

    Background: A plethora of studies have shown elevated preoperative natriuretic peptide measurements to predict ... In October 2014, we searched the following online databases, ... excluded because they had been retracted due to fraud.

  9. Outpatient Preoperative Education Needs Identified by Nurses and Patients

    National Research Council Canada - National Science Library

    Reilly, Cheryl

    1998-01-01

    ... patients and nurses believe is important. Yount and Schoessler (1991) conducted a study to examine patient and nurse perceptions of preoperative teaching in an inpatient setting. Brumfield, Kee, & Johnson (1996...

  10. Preoperative B-type natriuretic peptides in patients undergoing ...

    African Journals Online (AJOL)

    Southern African Journal of Anaesthesia and Analgesia ... Preoperative B-type natriuretic peptides in patients undergoing noncardiac surgery: a cumulative ... Future investigation should focus on the clinical implications of these data and the ...

  11. Comparison between preoperative biopsy and post-excision ...

    African Journals Online (AJOL)

    Comparison between preoperative biopsy and post-excision histology results in sarcoma: Experience at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. KG Panda, MJ Hale, D Kruger, TE Luvhengo ...

  12. Low dose preoperative radiotherapy for carcinoma of the oesophagus

    International Nuclear Information System (INIS)

    Arnott, S.J.; Duncan, W.; Kerr, G.R.; Jack, W.J.L.; Mackillop, W.J.; Walbaum, P.R.; Cameron, E.

    1992-01-01

    Patients (176) with potentially operable squamous cell carcinoma or adenocarcinoma of middle or lower thirds of oesophagus were randomly assigned to preoperative radiotherapy or surgery alone. Patients assigned to the radiotherapy arm received 20 Gy in 10 treatments over 2 weeks, using parallel opposed 4 MV beams. The preoperative radiotherapy was not associated with any significant acute morbidity or any increase in operative complications. The median survival of the overall group of 176 patients was 8 moths, and the 5-year survival was 13%. There was no significant difference in the survival of the 90 patients who received preoperative radiotherapy and the 86 who were managed by surgery alone. Proportional hazards analysis identified lymph node involvement, high tumor grade and male sex as significant adverse prognostic features, but the treatment option assigned had no prognostic significance. It was concluded that low dose preoperative radiotherapy offered no advantage over surgery alone. (author). 9 refs.; 3 figs.; 6 tabs

  13. Reducing preoperative fasting time: A trend based on evidence.

    Science.gov (United States)

    de Aguilar-Nascimento, José Eduardo; Dock-Nascimento, Diana Borges

    2010-03-27

    Preoperative fasting is mandatory before anesthesia to reduce the risk of aspiration. However, the prescribed 6-8 h of fasting is usually prolonged to 12-16 h for various reasons. Prolonged fasting triggers a metabolic response that precipitates gluconeogenesis and increases the organic response to trauma. Various randomized trials and meta-analyses have consistently shown that is safe to reduce the preoperative fasting time with a carbohydrate-rich drink up to 2 h before surgery. Benefits related to this shorter preoperative fasting include the reduction of postoperative gastrointestinal discomfort and insulin resistance. New formulas containing amino acids such as glutamine and other peptides are being studied and are promising candidates to be used to reduce preoperative fasting time.

  14. Nature exposure sufficiency and insufficiency: The benefits of environmental preservation.

    Science.gov (United States)

    Reddon, John R; Durante, Salvatore B

    2018-01-01

    Increasing industrialization, urbanization, and a failure of many world leaders to appreciate the consequences of climate change are deleteriously impacting quality of life as well as diminishing the prospects for long term survival. Economic competitiveness and corporate profitability often pre-empt environmental concerns. The calving of an iceberg in Antarctica and the hurricane activity in the Caribbean during 2017 are unfortunate illustrations of the continuing escalation of environmental issues. We provide historical and current evidence for the importance of Nature Exposure (NE) and introduce the continuum Nature Exposure Sufficiency (NES) and Insufficiency (NEI). Insufficiency includes impoverished environments (e.g., slums and prisons) where nature exposure is very limited. Nature Exposure Sufficiency (NES) is an optimal amount of exposure to nature where many benefits such as reinvigoration can be obtained by everyone. NES also has several benefits for individuals with various health conditions such as arthritis, dementia, or depression. The benefits of NE are not just derivable from parks, forests, and other natural settings. Interiors of buildings and homes can be enhanced with plants and even pictures or objects from nature. Additionally, there is abundant evidence indicating that virtual and artificial environments depicting nature can provide substantial NE and therefore contribute to general wellbeing. Besides the difficulty in achieving cooperation amongst nations, corporations, and other collectives in developing and implementing long range plans to deal with climate change, there is also sometimes an aversion at the individual level whereby people are unwilling to experience nature due to insects and other discomforts. Such individuals are often averse to supplanting the comforts of home, even temporarily, with inadequate facilities that are seemingly less pleasant than their typical dwellings. We propose using the term Nature Exposure Aversion

  15. Efficacy and safety of benazepril for advanced chronic renal insufficiency.

    Science.gov (United States)

    Hou, Fan Fan; Zhang, Xun; Zhang, Guo Hua; Xie, Di; Chen, Ping Yan; Zhang, Wei Ru; Jiang, Jian Ping; Liang, Min; Wang, Guo Bao; Liu, Zheng Rong; Geng, Ren Wen

    2006-01-12

    Angiotensin-converting-enzyme inhibitors provide renal protection in patients with mild-to-moderate renal insufficiency (serum creatinine level, 3.0 mg per deciliter or less). We assessed the efficacy and safety of benazepril in patients without diabetes who had advanced renal insufficiency. We enrolled 422 patients in a randomized, double-blind study. After an eight-week run-in period, 104 patients with serum creatinine levels of 1.5 to 3.0 mg per deciliter (group 1) received 20 mg of benazepril per day, whereas 224 patients with serum creatinine levels of 3.1 to 5.0 mg per deciliter (group 2) were randomly assigned to receive 20 mg of benazepril per day (112 patients) or placebo (112 patients) and then followed for a mean of 3.4 years. All patients received conventional antihypertensive therapy. The primary outcome was the composite of a doubling of the serum creatinine level, end-stage renal disease, or death. Secondary end points included changes in the level of proteinuria and the rate of progression of renal disease. Of 102 patients in group 1, 22 (22 percent) reached the primary end point, as compared with 44 of 108 patients given benazepril in group 2 (41 percent) and 65 of 107 patients given placebo in group 2 (60 percent). As compared with placebo, benazepril was associated with a 43 percent reduction in the risk of the primary end point in group 2 (P=0.005). This benefit did not appear to be attributable to blood-pressure control. Benazepril therapy was associated with a 52 percent reduction in the level of proteinuria and a reduction of 23 percent in the rate of decline in renal function. The overall incidence of major adverse events in the benazepril and placebo subgroups of group 2 was similar. Benazepril conferred substantial renal benefits in patients without diabetes who had advanced renal insufficiency. (ClinicalTrials.gov number, NCT00270426.) Copyright 2006 Massachusetts Medical Society.

  16. Evaluating the use of preoperative antibiotics in pediatric orthopaedic surgery.

    Science.gov (United States)

    Formaini, Nathan; Jacob, Paul; Willis, Leisel; Kean, John R

    2012-01-01

    To evaluate the rate of infection after minimally invasive procedures on a consecutive series of pediatric orthopaedic patients. We hypothesized that the use of preoperative antibiotics for minimally invasive pediatric orthopaedic procedures does not significantly reduce the incidence of surgical site infection requiring surgical debridement within 30 days of the primary procedure. We retrospectively reviewed 2330 patients having undergone minimally invasive orthopaedic procedures at our institution between March 2008 and November 2010. Knee arthroscopy, closed reduction with percutaneous fixation, soft tissue releases, excision of bony or soft-tissue masses, and removal of hardware constituted the vast majority of included procedures. Two groups, based on whether prophylactic antibiotics were administered before surgery, were created and the incidence of a repeat procedure required for deep infection was recorded. Statistical analysis was performed to determine significance, if any, between the 2 groups. Chart review of the 2330 patients identified 1087 as having received preoperative antibiotics, whereas the remaining 1243 patients did not receive antibiotics before surgery. Only 1 patient out of the 1243 cases in which antibiotics were not given required additional surgery within 30 days of the primary procedure due to a complicated surgical site infection (an incidence of 0.0008%). No patients in the antibiotic group developed a postoperative infection within 30 days requiring a return to the operating room for management. Our data revealed no significant increase in the incidence of complicated infection requiring additional procedures when antibiotics were not administered before surgery. Though prophylactic antibiotics have been shown to confer numerous benefits for patients undergoing relatively major operations, their use in cases of minimally invasive and/or percutaneous orthopaedic surgery is not well defined. Our data suggest that the use of

  17. Predictors of Preoperative Tinnitus in Unilateral Sporadic Vestibular Schwannoma

    Directory of Open Access Journals (Sweden)

    Georgios Naros

    2017-08-01

    Full Text Available ObjectiveNearly two-thirds of patients with vestibular schwannoma (VS are reporting a significantly impaired quality of life due to tinnitus. VS-associated tinnitus is attributed to an anatomical and physiological damage of the hearing nerve by displacing growth of the tumor. In contrast, the current pathophysiological concept of non-VS tinnitus hypothesizes a maladaptive neuroplasticity of the central nervous system to a (hidden hearing impairment resulting in a subjective misperception. However, it is unclear whether this concept fits to VS-associated tinnitus. This study aims to determine the clinical predictors of VS-associated tinnitus to ascertain the compatibility of both pathophysiological concepts.MethodsThis retrospective study includes a group of 478 neurosurgical patients with unilateral sporadic VS evaluated preoperatively regarding the occurrence of ipsilateral tinnitus depending on different clinical factors, i.e., age, gender, tumor side, tumor size (T1–T4 according to the Hannover classification, and hearing impairment (Gardner–Robertson classification, GR1–5, using a binary logistic regression.Results61.8% of patients complain about a preoperative tinnitus. The binary logistic regression analysis identified male gender [OR 1.90 (1.25–2.75; p = 0.002] and hearing impairment GR3 [OR 1.90 (1.08–3.35; p = 0.026] and GR4 [OR 8.21 (2.29–29.50; p = 0.001] as positive predictors. In contrast, patients with large T4 tumors [OR 0.33 (0.13–0.86; p = 0.024] and complete hearing loss GR5 [OR 0.36 (0.15–0.84; p = 0.017] were less likely to develop a tinnitus. Yet, 60% of the patients with good clinical hearing (GR1 and 25% of patients with complete hearing loss (GR5 suffered from tinnitus.ConclusionThese data are good accordance with literature about non-VS tinnitus indicating hearing impairment as main risk factor. In contrast, complete hearing loss appears a negative predictor for tinnitus. For the first

  18. Prophylactic digitalization preoperatively of patients with arteriosclerotic heart disease.

    Science.gov (United States)

    Bille-Brahe, N E; Engell, H C; Sørensen, M B

    1981-02-01

    This study was undertaken to investigate the hemodynamic effect of prophylactic digitalization before major surgical procedures. Sixteen patients, all admitted for an elective vascular operation for arteriosclerotic disease and all with impaired left ventricular function, were investigated. In half of the patients, digitalis was given before the operation, the other half of the patients served as the control study. The measured parameters were pulmonary artery mean pressure, pulmonary capillary wedge pressure, central venous pressure, mean arterial blood pressure, heart rate, cardiac output, blood volume and arterial, as well as venous, oxygen content. Preoperatively, before digitalization, no significant differences were noted between the two groups at rest and during exercise. Before anesthesia and postoperatively, those given digitalis had improved cardiac function. Those in both groups, however, had a normal hemodynamic response to the surgical trauma. In this study, a definite answer is not provided concerning the usefulness of prophylactic digitalization but an increase in the ability of the digitalized heart to withstand the imposition of a pressure load postoperatively is suggested.

  19. Varicography in the preoperative evaluation of primary varicose veins

    International Nuclear Information System (INIS)

    Pinzani, A.; Paoli, G.; Gongolo, A.; Spreafico, G.

    1989-01-01

    Primary varicose veins in the lower limb are usually well evaluated by the surgeon, who avails himself of tornequet tests and Doppler US. However, the operation is often followed by failure or recurrence, or else it requires ugly skin dissection to eradicate an unforeseeably complicated varicose vein. The authors suggest that, whenever the surgeon considers the information obtained with tests and Doppler US inadequate for planning surgery, varicography be performed to get further morphological (and functional) data about the origin of varicose veins, which is of fundamental importance for an accurate surgical planning (crossectomy, stripping, ligation, sclerosis). Out of 100 varicographies consecutively carried out on patients in whom clinical examination was not conclusive, 62% allowed an already planned surgical approach to be changed. The figure rose to 100% in the case of unusual varicose veins. Such a results allowed the needs of both the surgeon (selectivity, effectiveness, radicality) and the patients (narrow scars, absence of relapse) to be respected. Furthermore, it has been pointed out that some vein segments are often only pathological, and they are to be adequately treated, while others can be undamaged, and they are to be preserved for both their function and an eventual by-pass surgery. Varicography is rapidly performed, without complication, and is well accepted by the patients. It is a fundamental help in the preoperative study of primary varicose veins, especially in case of unusual ones, whenever the surgeon is in the slightest diagnostic - and therefore surgical - doubt

  20. Preoperative localization of parathyroid tumor by computerized tomography

    International Nuclear Information System (INIS)

    Kan, Seiji; Hiraishi, Koji; Nakamura, Shoichiro; Yamamoto, Schuzo; Odachi, Motoaki; Yamashita, Toshiyuki.

    1984-01-01

    Five patients of primary hyperparathyroidism with urolithiasis underwent CT-scanning for the preoperative localization of parathyroid tumor. The tumor was identified in all patients but one, who had a multiple adenomatous goiter. In this case, postoperative observation of the CT-scan revealed the parathyroid tumor. It appears that if the size of the parathyroid tumor is about 1cm in diameter, there is a high possibility of preoperative localization by computerized tomography. (author)

  1. A randomized trial of preoperative oral carbohydrates in abdominal surgery

    OpenAIRE

    Sada, Fatos; Krasniqi, Avdyl; Hamza, Astrit; Gecaj-Gashi, Agreta; Bicaj, Besnik; Kavaja, Floren

    2014-01-01

    Background Carbohydrate-rich liquid drinks (CRLDs) have been recommended to attenuate insulin resistance by shortening the preoperative fasting interval. The aim of our study the effect of preoperative oral administration of CRLDs on the well-being and clinical status of patients. Methods A randomized, double blind, prospective study of patients undergoing open colorectal operations (CR) and open cholecyctectomy (CH) was conducted. Patients were divided into three groups: study, placebo, and ...

  2. Preoperative PET/CT in early-stage breast cancer

    DEFF Research Database (Denmark)

    Bernsdorf, M; Berthelsen, A K; Timmermans-Wielenga, Vera

    2012-01-01

    The aim of this study was to assess the diagnostic and therapeutic impact of preoperative positron emission tomography and computed tomography (PET/CT) in the initial staging of patients with early-stage breast cancer.......The aim of this study was to assess the diagnostic and therapeutic impact of preoperative positron emission tomography and computed tomography (PET/CT) in the initial staging of patients with early-stage breast cancer....

  3. Reducing preoperative fasting time: A trend based on evidence

    OpenAIRE

    de Aguilar-Nascimento, José Eduardo; Dock-Nascimento, Diana Borges

    2010-01-01

    Preoperative fasting is mandatory before anesthesia to reduce the risk of aspiration. However, the prescribed 6-8 h of fasting is usually prolonged to 12-16 h for various reasons. Prolonged fasting triggers a metabolic response that precipitates gluconeogenesis and increases the organic response to trauma. Various randomized trials and meta-analyses have consistently shown that is safe to reduce the preoperative fasting time with a carbohydrate-rich drink up to 2 h before surgery. Benefits re...

  4. Recurrent Tricuspid Insufficiency: Is the Surgical Repair Technique a Risk Factor?

    OpenAIRE

    Kara, Ibrahim; Koksal, Cengiz; Cakalagaoglu, Canturk; Sahin, Muslum; Yanartas, Mehmet; Ay, Yasin; Demir, Serdar

    2013-01-01

    This study compares the medium-term results of De Vega, modified De Vega, and ring annuloplasty techniques for the correction of tricuspid insufficiency and investigates the risk factors for recurrent grades 3 and 4 tricuspid insufficiency after repair.

  5. Moderate perinatal thyroid hormone insufficiency alters visual system function in adult rats.

    Science.gov (United States)

    Boyes, William K; Degn, Laura; George, Barbara Jane; Gilbert, Mary E

    2018-04-21

    Thyroid hormone (TH) is critical for many aspects of neurodevelopment and can be disrupted by a variety of environmental contaminants. Sensory systems, including audition and vision are vulnerable to TH insufficiencies, but little data are available on visual system development at less than severe levels of TH deprivation. The goal of the current experiments was to explore dose-response relations between graded levels of TH insufficiency during development and the visual function of adult offspring. Pregnant Long Evans rats received 0 or 3 ppm (Experiment 1), or 0, 1, 2, or 3 ppm (Experiment 2) of propylthiouracil (PTU), an inhibitor of thyroid hormone synthesis, in drinking water from gestation day (GD) 6 to postnatal day (PN) 21. Treatment with PTU caused dose-related reductions of serum T4, with recovery on termination of exposure, and euthyroidism by the time of visual function testing. Tests of retinal (electroretinograms; ERGs) and visual cortex (visual evoked potentials; VEPs) function were assessed in adult offspring. Dark-adapted ERG a-waves, reflecting rod photoreceptors, were increased in amplitude by PTU. Light-adapted green flicker ERGs, reflecting M-cone photoreceptors, were reduced by PTU exposure. UV-flicker ERGs, reflecting S-cones, were not altered. Pattern-elicited VEPs were significantly reduced by 2 and 3 ppm PTU across a range of stimulus contrast values. The slope of VEP amplitude-log contrast functions was reduced by PTU, suggesting impaired visual contrast gain. Visual contrast gain primarily reflects function of visual cortex, and is responsible for adjusting sensitivity of perceptual mechanisms in response to changing visual scenes. The results indicate that moderate levels of pre-and post-natal TH insufficiency led to alterations in visual function of adult rats, including both retinal and visual cortex sites of dysfunction. Copyright © 2018. Published by Elsevier B.V.

  6. The role of insufficient copper in lipid synthesis and fatty-liver disease.

    Science.gov (United States)

    Morrell, Austin; Tallino, Savannah; Yu, Lei; Burkhead, Jason L

    2017-04-01

    The essential transition metal copper is important in lipid metabolism, redox balance, iron mobilization, and many other critical processes in eukaryotic organisms. Genetic diseases where copper homeostasis is disrupted, including Menkes disease and Wilson disease, indicate the importance of copper balance to human health. The severe consequences of insufficient copper supply are illustrated by Menkes disease, caused by mutation in the X-linked ATP7A gene encoding a protein that transports copper from intestinal epithelia into the bloodstream and across the blood-brain barrier. Inadequate copper supply to the body due to poor diet quality or malabsorption can disrupt several molecular level pathways and processes. Though much of the copper distribution machinery has been described and consequences of disrupted copper handling have been characterized in human disease as well as animal models, physiological consequences of sub-optimal copper due to poor nutrition or malabsorption have not been extensively studied. Recent work indicates that insufficient copper may be important in a number of common diseases including obesity, ischemic heart disease, and metabolic syndrome. Specifically, marginal copper deficiency (CuD) has been reported as a potential etiologic factor in diseases characterized by disrupted lipid metabolism such as non-alcoholic fatty-liver disease (NAFLD). In this review, we discuss the available data suggesting that a significant portion of the North American population may consume insufficient copper, the potential mechanisms by which CuD may promote lipid biosynthesis, and the interaction between CuD and dietary fructose in the etiology of NAFLD. © 2016 IUBMB Life, 69(4):263-270, 2017. © 2017 International Union of Biochemistry and Molecular Biology.

  7. Impact of insufficient energy content in the design time history on the structure response

    International Nuclear Information System (INIS)

    Ma, D.C.; Gvildys, J.; Chang, Y.W.; Seidensticker, R.W.

    1989-01-01

    In the design of nuclear power plants, it is often desirable to use the time history method in the soil-structure interaction analysis to determine the plant floor response to seismic loads. Because many design criteria are specified in terms of design response spectra, the artificial time history needs to be generated under the requirement that the response spectra of the artificial history should envelop the given design response spectra. However, recent studies indicate that the artificial time history used in the plant design may have insufficient energy in the frequency range of interest, even though the response spectra of the design time history closely envelop the design response spectra. Therefore, the proposed changes in the NRC Standard Review Plan requires that when a single time history is used in the seismic design, it must satisfy requirements for both response spectra enveloping and matching a power spectra density (PSD) function in the frequency range of interest. The use of multiple artificial time histories (at least five time histories) in the plant design is also suggested in the new Standard Review Plan. This paper presents an investigation of the effects of the insufficient energy content in the design time history on the response of the soil-structure system. Numerical studies were carried out. Both the real earthquake records and the artificial time histories were used as the input motions in a simple lumped-mass soil-structure interaction model. The results obtained from this study provide a better understanding of the effects of the insufficient energy content in the design time history on the structural response. 5 refs., 10 figs., 1 tab

  8. Preoperative skin antiseptic preparations for preventing surgical site infections: a systematic review.

    Science.gov (United States)

    Kamel, Chris; McGahan, Lynda; Polisena, Julie; Mierzwinski-Urban, Monika; Embil, John M

    2012-06-01

    To evaluate the clinical effectiveness of preoperative skin antiseptic preparations and application techniques for the prevention of surgical site infections (SSIs). Systematic review of the literature using Medline, EMBASE, and other databases, for the period January 2001 to June 2011. Comparative studies (including randomized and nonrandomized trials) of preoperative skin antisepsis preparations and application techniques were included. Two researchers reviewed each study and extracted data using standardized tables developed before the study. Studies were reviewed for their methodological quality and clinical findings. Twenty studies (n = 9,520 patients) were included in the review. The results indicated that presurgical antiseptic showering is effective for reducing skin flora and may reduce SSI rates. Given the heterogeneity of the studies and the results, conclusions about which antiseptic is more effective at reducing SSIs cannot be drawn. The evidence suggests that preoperative antiseptic showers reduce bacterial colonization and may be effective at preventing SSIs. The antiseptic application method is inconsequential, and data are lacking to suggest which antiseptic solution is the most effective. Disinfectant products are often mixed with alcohol or water, which makes it difficult to form overall conclusions regarding an active ingredient. Large, well-conducted randomized controlled trials with consistent protocols comparing agents in the same bases are needed to provide unequivocal evidence on the effectiveness of one antiseptic preparation over another for the prevention of SSIs.

  9. Post-traumatic tricuspid insufficiency: a case report.

    Science.gov (United States)

    Tütün, Ufuk; Aksöyek, Ayşen; Parlar, Ali Ihsan; Cobanoğlu, Adnan

    2011-11-01

    Post-traumatic tricuspid insufficiency is a rare complication of chest trauma. An 18-year-old male patient was injured in a bicycle accident from his abdominal and anterior chest wall. The tear on the inferior diaphragmatic surface of the heart was repaired with primary sutures by the attending surgeon. Eighteen years later, he was admitted to the hospital with severe tricuspid regurgitation (3+/4+). During the operation, the valve was determined unsuitable for repair and was replaced with a bioprosthesis. The hemodynamic aberrations relevant to an isolated tricuspid valve injury are very often well-tolerated. Reconstructive surgery may be possible in the early period. In the late cases, repair is sometimes not feasible due to degeneration of the valvular apparatus. Replacement with a biological prosthesis may give the best long-term results in longstanding cases.

  10. Uncertainties in endocrine substitution therapy for central endocrine insufficiencies: hypothyroidism.

    Science.gov (United States)

    Persani, Luca; Bonomi, Marco

    2014-01-01

    In patients with primary hypothyroidism (PH), L-T4 replacement therapy can safely be adjusted to the individual needs by testing serum thyrotropin (TSH) concentration exclusively. Central hypothyrodism (CeH) is a particular hypothyroid condition due to an insufficient stimulation by TSH of an otherwise normal thyroid gland. CeH is about 1000-fold rarer than PH and raises several challenges for clinicians, mainly because they cannot rely on the systematic use of the reflex TSH strategy for diagnosis or therapy monitoring. Therefore, L-T4 replacement in CeH should rely on the combined evaluation of several biochemical and clinical parameters in order to overcome the lack of accuracy of the single index. The management of CeH replacement is further complicated by the frequent combination with other pituitary deficiencies and their treatment. © 2014 Elsevier B.V. All rights reserved.

  11. Speech Outcomes after Tonsillectomy in Patients with Known Velopharyngeal Insufficiency

    Directory of Open Access Journals (Sweden)

    L. M. Paulson

    2012-01-01

    Full Text Available Introduction. Controversy exists over whether tonsillectomy will affect speech in patients with known velopharyngeal insufficiency (VPI, particularly in those with cleft palate. Methods. All patients seen at the OHSU Doernbecher Children's Hospital VPI clinic between 1997 and 2010 with VPI who underwent tonsillectomy were reviewed. Speech parameters were assessed before and after tonsillectomy. Wilcoxon rank-sum testing was used to evaluate for significance. Results. A total of 46 patients with VPI underwent tonsillectomy during this period. Twenty-three had pre- and postoperative speech evaluation sufficient for analysis. The majority (87% had a history of cleft palate. Indications for tonsillectomy included obstructive sleep apnea in 11 (48% and staged tonsillectomy prior to pharyngoplasty in 10 (43%. There was no significant difference between pre- and postoperative speech intelligibility or velopharyngeal competency in this population. Conclusion. In this study, tonsillectomy in patients with VPI did not significantly alter speech intelligibility or velopharyngeal competence.

  12. Refractory Hyperlactatemia with Organ Insufficiency in Lipid Storage Myopathy.

    Science.gov (United States)

    Xu, Yuanda; Zhou, Li; Liang, Weibo; He, Weiqun; Liu, Xiaoqing; Liang, Xiuling; Zhong, Nanshan; Li, Yimin

    2015-08-01

    Lipid storage myopathy is a metabolic disorder characterized by abnormal lipid accumulation in muscle fibers and progressive muscle weakness. Here, we report the case of a 17-year-old woman with progressive muscle weakness, refractory hyperlactatemia, and multiple organ insufficiency. Severe pneumonia was the initial diagnosis. After anti-infective treatment, fluid resuscitation, and mechanical ventilation, the patient's symptoms improved but hyperlactatemia and muscle weakness persisted. She was empirically treated with carnitine. Biochemical tests, electromyography, and muscle biopsy confirmed lipid storage myopathy. After 7 weeks of treatment, the patient resumed normal daily life. An empirical treatment with carnitine may be beneficial for patients before an accurate diagnosis of lipid storage myopathy is made.

  13. Nuclear power as a necessary option, albeit in insufficient one

    International Nuclear Information System (INIS)

    Altin, V.

    2007-01-01

    In this presentation a comparative assessment of known energy resources are made with respect to their energy densities. Fossil fuels have formed the foundation of a worldwide economic development realized throughout the 20th century. Their comparatively high energy densities have made faster energy flows and thereby higher power levels and speedy development possible. However, renewable sources that are already feasible have much lower levels of energy densities. Their large scale utilization in lieu of fossil fuels would necessitate either reduction of economic growth rates to 'sustainable' levels or speedy development of feasible large scale storage technologies. Nuclear energy appears to impose itself as a necessity to alleviate this transition period, albeit within the constraint of known uranium reserves an insufficient one

  14. The musculoskeletal radiologic findings associated with chronic renal insufficiency

    International Nuclear Information System (INIS)

    Ruiz, P.J.; Gomez, I.; Hernandez, L.; Relanzon, S.; Hurtado, M.

    1997-01-01

    The numerous musculoskeletal changes associated with chronic renal insufficiency (CRI) are detected with increasing frequency since hemodialysis and kidney transplantation have prolonged the survival of these patients. These signs have been divided into two large groups. The first includes secondary hyperparathyroidism (bone resorption, periostitis and brown tumors), osteoporosis, osteosclerosis, osteomalacia and vascular and soft tissue calcification, all of which are grouped under the term renal osteodystrophy. the second group is composed of miscellaneous disorders including aluminum poisoning, amyloid and crystal deposition, destructive spondyloarthropathy, tendon rupture, infection and avascular necrosis. These changes are less common and occur especially in patients under prolonged hemodialysis or kidney transplant recipients. The detection of musculoskeletal involvement in CRI patients has a considerable impact on their clinical management. The present article reviews the radiological signs of these changes, including representative images that will aid in their recognition. (Author) 33 refs

  15. Neurosarcoidosis-associated central diabetes insipidus masked by adrenal insufficiency.

    Science.gov (United States)

    Non, Lemuel; Brito, Daniel; Anastasopoulou, Catherine

    2015-01-22

    Central diabetes insipidus (CDI) is an infrequent complication of neurosarcoidosis (NS). Its presentation may be masked by adrenal insufficiency (AI) and uncovered by subsequent steroid replacement. A 45-year-old woman with a history of NS presented 2 weeks after abrupt cessation of prednisone with nausea, vomiting, decreased oral intake and confusion. She was diagnosed with secondary AI and intravenous hydrocortisone was promptly begun. Over the next few days, however, the patient developed severe thirst and polyuria exceeding 6 L of urine per day, accompanied by hypernatraemia and hypo-osmolar urine. She was presumed to have CDI due to NS, and intranasal desmopressin was administered. This eventually normalised her urine output and serum sodium. The patient was discharged improved on intranasal desmopressin and oral prednisone. AI may mask the manifestation of CDI because low serum cortisol impairs renal-free water clearance. Steroid replacement reverses this process and unmasks an underlying CDI. 2015 BMJ Publishing Group Ltd.

  16. Primary Ovarian Insufficiency: X chromosome defects and autoimmunity.

    Science.gov (United States)

    Persani, Luca; Rossetti, Raffaella; Cacciatore, Chiara; Bonomi, Marco

    2009-08-01

    Premature ovarian failure (POF) is a primary ovarian defect characterized by absent menarche or premature depletion of ovarian follicles before the age of 40 years. However, in several instances the distinction between definitive or intermittent POF may be difficult on clinical bases, therefore the more appropriate term Primary Ovarian Insufficiency (POI) has been recently proposed and will be used in this review. POI is a heterogeneous disorder affecting approximately 1% of women disappearance of menstrual cycles (secondary amenorrhea) associated with a defective folliculogenesis. POI is generally characterized by low levels of gonadal hormones (estrogens and inhibins) and high levels of gonadotropins (LH and FSH) (hypergonadotropic amenorrhea). Heterogeneity of POI is reflected by the variety of possible causes, including autoimmunity, toxics, drugs, as well as genetic defects. Several data indicate that POI has a strong genetic component. In this manuscript we discuss the X chromosome abnormalities that are associated with POI.

  17. Management of pancreatic exocrine insufficiency: Australasian Pancreatic Club recommendations.

    Science.gov (United States)

    Toouli, James; Biankin, Andrew V; Oliver, Mark R; Pearce, Callum B; Wilson, Jeremy S; Wray, Nicholas H

    2010-10-18

    Pancreatic exocrine insufficiency (PEI) occurs when the amounts of enzymes secreted into the duodenum in response to a meal are insufficient to maintain normal digestive processes. The main clinical consequence of PEI is fat maldigestion and malabsorption, resulting in steatorrhoea. Pancreatic exocrine function is commonly assessed by conducting a 3-day faecal fat test and by measuring levels of faecal elastase-1 and serum trypsinogen. Pancreatic enzyme replacement therapy is the mainstay of treatment for PEI. In adults, the initial recommended dose of pancreatic enzymes is 25,000 units of lipase per meal, titrating up to a maximum of 80,000 units of lipase per meal. In infants and children, the initial recommended dose of pancreatic enzymes is 500 units of lipase per gram of dietary fat; the maximum daily dose should not exceed 10,000 units of lipase per kilogram of bodyweight. Oral pancreatic enzymes should be taken with meals to ensure adequate mixing with the chyme. Adjunct therapy with acid-suppressing agents may be useful in patients who continue to experience symptoms of PEI despite high-dose enzyme therapy. A dietitian experienced in treating PEI should be involved in patient management. Dietary fat restriction is not recommended for patients with PEI. Patients with PEI should be encouraged to consume small, frequent meals and to abstain from alcohol. Medium-chain triglycerides do not provide any clear nutritional advantage over long-chain triglycerides, but can be trialled in patients who fail to gain or to maintain adequate bodyweight in order to increase energy intake.

  18. Imaging features of anterior cruciate ligament reconstruction graft insufficiency

    International Nuclear Information System (INIS)

    Shang Yao; Zhang Yue; Tian Chunyan; Zheng Zhuozhao

    2011-01-01

    Objective: To investigate the imaging features of anterior cruciate ligament (ACL) graft insufficiency. Methods: X-Ray and MR imaging examinations in 24 consecutive patients who had ACL reconstructive graft insufficiency were retrospectively evaluated for tunnel position, osteoarthrosis and its related complications. Follow-up arthroscopy showed 16 graft tears and 8 graft laxities. Fisher exact test was used to compare tunnel malpositions, the proportion of graft tear on MRI and osteoarthrosis between graft tear group and graft laxity group. Results: Two malpositions of tibial tunnel and 3 malpositions of femoral tunnel were seen in graft tear group. Three-malpositions of tibial tunnel and 4 malpositions of femoral tunnel were seen in graft laxity group. The proportion of tibial or femoral malposition showed no significant difference between the two groups (P=0.289, P=0.167). In graft tear group, 15 complete graft tears were diagnosed correctly, 1 partial tear was misdiagnosed as normal on MRI. In graft laxity group, 4 grafts were diagnosed as normal and 4 were considered as graft tear on MRI. A significant difference was seen between the two groups (P=0.028) in the proportion of graft tear diagnosed on MRI. Fourteen osteoarthrosis were seen in graft tear group and 5 in graft laxity group. No significant difference was seen between the two groups (P= 0.289) in the proportion of osteoarthrosis. Conclusion: The proportions of tunnel malposition and osteoarthrosis showed no significant difference between the graft tear group and graft Laxity group. Most graft tears can be diagnosed accurately on MRI, but some cases of graft laxity may be misdiagnosed for graft tear. (authors)

  19. PLACENTAL INSUFFICIENCY IN PREGNANCY AFTER 40th WEEK OF GESTATION

    Directory of Open Access Journals (Sweden)

    Vladimir Antic

    2007-12-01

    Full Text Available Pregnancy after the 40th week of gestation is often a great dilemma for obstetrician in diagnostic, therapeutic and in psychological terms as well. The aim of this study was to confirm the phenomenon of placental insufficiency in pregnancy after the 40th gestation week, the modality of delivery and perinatal outcome.The study comprised 3405 deliveries in a period of one year, 391 of which were terminated after the end of the 40th gestation week, including healthy pregnant women with singleton pregnancies. Control group included healthy pregnant women delivered between the 37th and 40th gestation week.The incidence of deliveries after the 40th week of gestation is 11.48%. Non-stress test was reactive in 99.65% of women in the study group. At the same time, CST (constriction– stress test was assessed as negative in 78.67% of cases. The pathological CST was found in only 1.33% of cases. Doppler ultrasound measurements showed the increased resistance in umbilical artery flow in 3% of cases. Vacuum extraction was used for 16.62%of deliveries in the study group, and 8.73% of deliveries in the control group (χ2=23.24;p<0.001. In the study group, Caesarean section was performed in 14.58% of cases, and in control group in 9.07% (χ2=11.09; p<0.001.Placental insufficiency induced by duration of pregnancy is a rear phenomenon in uncompromised pregnancy. There was no significant difference in the morbidity and mortality rates between the study and control group.

  20. Preoperative values of inflammatory markers predict clinical outcomes in patients after CABG, regardless of the use of cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Dariusz Plicner

    2016-12-01

    Conclusion: Links between preoperative 8-iso-PGF2α, ADMA and β-TG and unfavorable early post-CABG outcomes suggest that these markers could be useful in identifying patients with increased risk of LCOS, PMI and in-hospital cardiovascular death following elective CABG.

  1. Population-based estimates of the prevalence of FMR1 expansion mutations in women with early menopause and primary ovarian insufficiency.

    Science.gov (United States)

    Murray, Anna; Schoemaker, Minouk J; Bennett, Claire E; Ennis, Sarah; Macpherson, James N; Jones, Michael; Morris, Danielle H; Orr, Nick; Ashworth, Alan; Jacobs, Patricia A; Swerdlow, Anthony J

    2014-01-01

    Primary ovarian insufficiency before the age of 40 years affects 1% of the female population and is characterized by permanent cessation of menstruation. Genetic causes include FMR1 expansion mutations. Previous studies have estimated mutation prevalence in clinical referrals for primary ovarian insufficiency, but these are likely to be biased as compared with cases in the general population. The prevalence of FMR1 expansion mutations in early menopause (between the ages of 40 and 45 years) has not been published. We studied FMR1 CGG repeat number in more than 2,000 women from the Breakthrough Generations Study who underwent menopause before the age of 46 years. We determined the prevalence of premutation (55-200 CGG repeats) and intermediate (45-54 CGG repeats) alleles in women with primary ovarian insufficiency (n = 254) and early menopause (n = 1,881). The prevalence of the premutation was 2.0% in primary ovarian insufficiency, 0.7% in early menopause, and 0.4% in controls, corresponding to odds ratios of 5.4 (95% confidence interval = 1.7-17.4; P = 0.004) for primary ovarian insufficiency and 2.0 (95% confidence interval = 0.8-5.1; P = 0.12) for early menopause. Combining primary ovarian insufficiency and early menopause gave an odds ratio of 2.4 (95% confidence interval = 1.02-5.8; P = 0.04). Intermediate alleles were not significant risk factors for either early menopause or primary ovarian insufficiency. FMR1 premutations are not as prevalent in women with ovarian insufficiency as previous estimates have suggested, but they still represent a substantial cause of primary ovarian insufficiency and early menopause.

  2. Combining task-evoked and spontaneous activity to improve pre-operative brain mapping with fMRI

    Science.gov (United States)

    Fox, Michael D.; Qian, Tianyi; Madsen, Joseph R.; Wang, Danhong; Li, Meiling; Ge, Manling; Zuo, Huan-cong; Groppe, David M.; Mehta, Ashesh D.; Hong, Bo; Liu, Hesheng

    2016-01-01

    Noninvasive localization of brain function is used to understand and treat neurological disease, exemplified by pre-operative fMRI mapping prior to neurosurgical intervention. The principal approach for generating these maps relies on brain responses evoked by a task and, despite known limitations, has dominated clinical practice for over 20 years. Recently, pre-operative fMRI mapping based on correlations in spontaneous brain activity has been demonstrated, however this approach has its own limitations and has not seen widespread clinical use. Here we show that spontaneous and task-based mapping can be performed together using the same pre-operative fMRI data, provide complimentary information relevant for functional localization, and can be combined to improve identification of eloquent motor cortex. Accuracy, sensitivity, and specificity of our approach are quantified through comparison with electrical cortical stimulation mapping in eight patients with intractable epilepsy. Broad applicability and reproducibility of our approach is demonstrated through prospective replication in an independent dataset of six patients from a different center. In both cohorts and every individual patient, we see a significant improvement in signal to noise and mapping accuracy independent of threshold, quantified using receiver operating characteristic curves. Collectively, our results suggest that modifying the processing of fMRI data to incorporate both task-based and spontaneous activity significantly improves functional localization in pre-operative patients. Because this method requires no additional scan time or modification to conventional pre-operative data acquisition protocols it could have widespread utility. PMID:26408860

  3. Prevalence of insufficient, borderline, and optimal hours of sleep among high school students - United States, 2007.

    Science.gov (United States)

    Eaton, Danice K; McKnight-Eily, Lela R; Lowry, Richard; Perry, Geraldine S; Presley-Cantrell, Letitia; Croft, Janet B

    2010-04-01

    We describe the prevalence of insufficient, borderline, and optimal sleep hours among U.S. high school students on an average school night. Most students (68.9%) reported insufficient sleep, whereas few (7.6%) reported optimal sleep. The prevalence of insufficient sleep was highest among female and black students, and students in grades 11 and 12. Published by Elsevier Inc.

  4. A histopathological effectiveness of pre-operative irradiation for biliary tract cancer

    International Nuclear Information System (INIS)

    Mizusaki, Kaoru

    1993-01-01

    There is almost no report on pre-operative irradiation therapy in biliary tract cancer. For the purpose of attaining improved operative results, pre-operative irradiation has so for been performed in our department. We experienced 106 cases of biliary tract cancer during the period from January 1982 to December 1990, including 30 cases treated by pre-operative irradiation. Among 30 cases, 20 cases, including 9 cases of gallbladder cancer and 11 cases of bile duct cancer, were resectable. Final histopathological findings were obtained in 8 cases of gallbladder cancer and 9 cases of bile duct cancer. The effectiveness of irradiation was evaluated according to the histopathological criteria proposed by Ohboshi and Shimosato in 1971. Four cases were Grade I, 2 cases were Grade IIA, and 2 cases were Grade IIB, and 1 case was Grade III of bile duct cancer. In both groups, no correlation was observed between the exposure doses and their effects. Although no correlation was noted between the degree of differentiation of tubular adenocarcinoma of microscopic pathological findings and the irradiation effects, 1 case of poorly differentiated tubular adenocarcinoma of the bile duct was evaluated as Grade III. Mucinous adenocarcinoma and papillary adenocarcinoma of the gallbladder were revealed to be Grade I. According to the main affected site of bile duct cancer, a good irradiation effect was obtained in patients with upper to middle bile duct cancer. The irradiation effect on the gallbladder and the bile duct wall was predominant on the mucous side but less effective on the serous side. From the histopathological findings, the effectiveness of pre-operative irradiation was suggested. These results suggested that the further clinical evaluation, such as rates of resection or prognostic outcome would be relevant. (author)

  5. An anaesthetic pre-operative assessment clinic reduces pre-operative inpatient stay in patients requiring major vascular surgery.

    LENUS (Irish Health Repository)

    O'Connor, D B

    2012-02-01

    BACKGROUND: Patients undergoing major vascular surgery (MVS) require extensive anaesthetic assessment. This can require extended pre-operative stays. AIMS: We investigated whether a newly established anaesthetic pre-operative assessment clinic (PAC) would reduce the pre-operative inpatient stay, avoid unnecessary investigations and facilitate day before surgery (DBS) admissions for patients undergoing MVS. PATIENT AND METHODS: One year following and preceding the establishment of the PAC the records of patients undergoing open or endovascular aortic aneurysm repair, carotid endarterectomy and infra-inguinal bypass were reviewed to measure pre-operative length of stay (LoS). RESULTS: Pre-operative LoS was significantly reduced in the study period (1.85 vs. 4.2 days, respectively, P < 0.0001). Only 12 out of 61 patients in 2007 were admitted on the DBS and this increased to 33 out of 63 patients (P = 0.0002). No procedure was cancelled for medical reasons. CONCLUSION: The PAC has facilitated accurate outpatient anaesthetic assessment for patients requiring MVS. The pre-operative in-patient stay has been significantly reduced.

  6. Pre-operative biliary drainage for obstructive jaundice

    Science.gov (United States)

    Fang, Yuan; Gurusamy, Kurinchi Selvan; Wang, Qin; Davidson, Brian R; Lin, He; Xie, Xiaodong; Wang, Chaohua

    2014-01-01

    Background Patients with obstructive jaundice have various pathophysiological changes that affect the liver, kidney, heart, and the immune system. There is considerable controversy as to whether temporary relief of biliary obstruction prior to major definitive surgery (pre-operative biliary drainage) is of any benefit to the patient. Objectives To assess the benefits and harms of pre-operative biliary drainage versus no pre-operative biliary drainage (direct surgery) in patients with obstructive jaundice (irrespective of a benign or malignant cause). Search methods We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Clinical Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until February 2012. Selection criteria We included all randomised clinical trials comparing biliary drainage followed by surgery versus direct surgery, performed for obstructive jaundice, irrespective of the sample size, language, and publication status. Data collection and analysis Two authors independently assessed trials for inclusion and extracted data. We calculated the risk ratio (RR), rate ratio (RaR), or mean difference (MD) with 95% confidence intervals (CI) based on the available patient analyses. We assessed the risk of bias (systematic overestimation of benefit or systematic underestimation of harm) with components of the Cochrane risk of bias tool. We assessed the risk of play of chance (random errors) with trial sequential analysis. Main results We included six trials with 520 patients comparing pre-operative biliary drainage (265 patients) versus no pre-operative biliary drainage (255 patients). Four trials used percutaneous transhepatic biliary drainage and two trials used endoscopic sphincterotomy and stenting as the method of pre-operative biliary drainage. The risk of bias was high in all trials. The proportion of patients with malignant obstruction varied between 60

  7. Failure to unmask pseudonormal diastolic function by a valsalva maneuver: tricuspid insufficiency is a major factor.

    Science.gov (United States)

    Hu, Kai; Liu, Dan; Niemann, Markus; Hatle, Liv; Herrmann, Sebastian; Voelker, Wolfram; Ertl, Georg; Bijnens, Bart; Weidemann, Frank

    2011-11-01

    For the clinical assessment of patients with dyspnea, the inversion of the early (E) and late (A) transmitral flow during Valsalva maneuver (VM) frequently helps to distinguish pseudonormal from normal filling pattern. However, in an important number of patients, VM fails to reveal the change from dominant early mitral flow velocity toward larger late velocity. From December 2009 to October 2010, we selected consecutive patients with abnormal filling with (n=25) and without E/A inversion (n=25) during VM. Transmitral, tricuspid, and pulmonary Doppler traces were recorded and the degree of insufficiency was estimated. After evaluating all standard echocardiographic morphological, functional, and flow-related parameters, it became evident that the failure to unmask the pseudonormal filling pattern by VM was related to the degree of the tricuspid insufficiency (TI). TI was graded as mild in 24 of 25 patients in the group with E/A inversion during VM, whereas TI was graded as moderate to severe in 24 of the 25 patients with pseudonormal diastolic function without E/A inversion during VM. Our data suggest that TI is a major factor to prevent E/A inversion during a VM in patients with pseudonormal diastolic function. This probably is due to a decrease in TI resulting in an increase in forward flow rather than the expected decrease during the VM. Thus, whenever a pseudonormal diastolic filling pattern is suspected, the use of a VM is not an informative discriminator in the presence of moderate or severe TI.

  8. Acute adrenal insufficiency: an aide-memoire of the critical importance of its recognition and prevention.

    Science.gov (United States)

    Gargya, A; Chua, E; Hetherington, J; Sommer, K; Cooper, M

    2016-03-01

    Adrenal crisis is a life-threatening emergency that causes significant excess mortality in patients with adrenal insufficiency. Delayed recognition by medical staff of an impending adrenal crisis and failure to give timely hydrocortisone therapy within the emergency department continue to be commonly encountered, even in metropolitan teaching hospitals. Within the authors' institutions, several cases of poorly handled adrenal crises have occurred over the last 2 years. Anecdotal accounts from members of the Addison's support group suggest that these issues are common in Australia. This manuscript is a timely reminder for clinical staff on the critical importance of the recognition, treatment and prevention of adrenal crisis. The manuscript: (i) outlines a case and the clinical outcome of sub-optimally managed adrenal crisis, (ii) summarises the clinical features and acute management of adrenal crisis, (iii) provides recommendations on the prevention of adrenal crisis and (iv) provides guidance on the management of 'sick days' in patients with adrenal insufficiency. © 2016 Royal Australasian College of Physicians.

  9. Distributed pubertal growth in girls after acute leukemia: a relative growth hormone insufficiency with late presentation

    Energy Technology Data Exchange (ETDEWEB)

    Moell, C.

    1988-01-01

    Long-term follow-up of growth and development after acute lymphoblastic leukaemia (ALL) in childhood has previously been limited to the prepubertal period. This study describes pubertal growth, final height and the spontaneous secretion of GH in girls treated for ALL, including CNS irradiation with 24 GY. Ten girls, treated earlier for ALL, experienced the menarche at a mean age of 12.2 years. This is significantly earlier than the mean for Swedish girls. Prepubertal growth was near normal after the end of therapy for leukaemia. Mean final height was -1.7 SD, which is 1.5 SD less than at onset and 1.0 SD less than 1 year after the end of treatment. Thirteen other girls had a blunted spontaneous secretion of GH, several years after treatment for ALL; there was no increase in GH secretion during puberty. These results suggest that girls who have been treated for ALL, including CNS irradiation, have a relative GH insufficiency. This insufficiency becomes obvious only when girls cannot respond to the increased need for GH during the pubertal spurt.

  10. Haplo-insufficiency of both BubR1 and SGO1 accelerates cellular senescence

    Directory of Open Access Journals (Sweden)

    Sung-Hyun Park

    2016-02-01

    Full Text Available Abstract Background Spindle assembly checkpoint components BubR1 and Sgo1 play a key role in the maintenance of chromosomal instability during cell division. These proteins function to block the anaphase entry until all condensed chromosomes have been attached by the microtubules emanating from both spindle poles. Haplo-insufficiency of either BubR1 or SGO1 results in enhanced chromosomal instability and tumor development in the intestine. Recent studies show that spindle checkpoint proteins also have a role in slowing down the ageing process. Therefore, we want to study whether haplo-insufficiency of both BubR1 and SGO1 accelerates cellular senescence in mice. Methods We took advantage of the availability of BubR1 and SGO1 knockout mice and generated primary murine embryonic fibroblasts (MEFs with mutations in either BubR1, SGO1, or both and analyzed cellular senescence of the MEFs of various genetic backgrounds. Results We observed that BubR1 +/− SGO +/− MEFs had an accelerated cellular senescence characterized by morphological changes and expressed senescence-associated β-galactosidase. In addition, compared with wild-type MEFs or MEFs with a single gene deficiency, BubR1 +/− SGO1 +/− MEFs expressed enhanced levels of p21 but not p16. Conclusions Taken together, our observations suggest that combined deficiency of BubR1 and Sgo1 accelerates cellular senescence.

  11. Distributed pubertal growth in girls after acute leukemia: a relative growth hormone insufficiency with late presentation

    International Nuclear Information System (INIS)

    Moell, C.

    1988-01-01

    Long-term follow-up of growth and development after acute lymphoblastic leukaemia (ALL) in childhood has previously been limited to the prepubertal period. This study describes pubertal growth, final height and the spontaneous secretion of GH in girls treated for ALL, including CNS irradiation with 24 GY. Ten girls, treated earlier for ALL, experienced the menarche at a mean age of 12.2 years. This is significantly earlier than the mean for Swedish girls. Prepubertal growth was near normal after the end of therapy for leukaemia. Mean final height was -1.7 SD, which is 1.5 SD less than at onset and 1.0 SD less than 1 year after the end of treatment. Thirteen other girls had a blunted spontaneous secretion of GH, several years after treatment for ALL; there was no increase in GH secretion during puberty. These results suggest that girls who have been treated for ALL, including CNS irradiation, have a relative GH insufficiency. This insufficiency becomes obvious only when girls cannot respond to the increased need for GH during the pubertal spurt. (author)

  12. The cholesteryl octanoate breath test: a new procedure for detection of pancreatic insufficiency in the rat.

    Science.gov (United States)

    Mundlos, S; Rhodes, J B; Hofmann, A F

    1987-09-01

    A breath test for the detection of pancreatic insufficiency was developed and tested in rats. The test features the hydrophobic molecule cholesteryl-1-14C-octanoate, which liberates 14C-octanoic acid when hydrolyzed by carboxyl ester lipase (cholesterol esterase). The 14C-octanoate is absorbed passively and rapidly metabolized to 14CO2, which is excreted in expired air. The compound was administered as an emulsion of cholesteryl octanoate, triglyceride, and lecithin to rats with mild pancreatic insufficiency induced by injecting the pancreatic duct with zein. The animals had exocrine pancreatic hypofunction based on the enzyme content of pancreas at autopsy. Amylase was reduced by 97.1 +/- 1.4%, whereas chymotrypsin was reduced by 73 +/- 14%. The p-aminobenzoic acid test was abnormal at 1 wk (21.68 +/- 8.4%), but become normal at 3 months (72.08 +/- 5.8%) after zein injection. Despite this, the animals gained weight and absorbed fat normally. The 14CO2 excretion rate in the 110-min interval after feeding was significantly reduced to 60% of sham-operated animals. Peak 14CO2 collections 20 min after feeding were reduced by 75 +/- 11%. 14CO2 output was completely normalized by administration of pancreatin prior to the test meal. The results suggest that a sensitive, noninvasive method for detecting deficiency of pancreatic carboxyl ester lipase (cholesterol esterase) secretion in the rat has been developed.

  13. Predicting erectile dysfunction following surgical correction of Peyronie's disease without inflatable penile prosthesis placement: vascular assessment and preoperative risk factors.

    Science.gov (United States)

    Taylor, Frederick L; Abern, Michael R; Levine, Laurence A

    2012-01-01

    Surgical therapy remains the gold standard treatment for Peyronie's Disease (PD). Surgical options include plication, grafting, and placement of inflatable penile prosthesis (IPP). Postoperative erectile dysfunction (ED) is a potential complication for PD surgery without IPP. We present our large series follow-up to evaluate preoperative risk factors for postoperative ED. The aim of this study is to evaluate preoperative risk factors for the development of ED following surgical correction of PD taking into account the degree of curvature, graft size, surgical approach, hypertension, hyperlipidemia, diabetes, smoking history, preoperative use of phosphodiesterase 5 inhibitors (PDE5), and preoperative duplex ultrasound findings including peak systolic and end diastolic velocities and resistive index. We identified 218 men undergoing either tunica albuginea plication (TAP) or partial plaque excision with pericardial grafting for PD following a previously published algorithm between November 1992 and April 2007. Preoperative and postoperative erectile function, curvature characteristics, presence of vascular risk factors, and duplex ultrasound findings were available on 109 patients. Our primary outcome measure is the development of ED after surgery for PD. Ten percent of TAP and 21% of plaque excision with grafting patients developed postoperative ED. Neither curve direction (P = 0.76), graft area (P = 0.78), surgical approach (P = 0.12), chronic hypertension (P = 0.51), hyperlipidemia (P = 0.87), diabetes (P = 0.69), nor smoking history (P = 0.99) were significant predictors of postoperative ED. No combination of risk factors was found to be predictive of postoperative ED. Preoperative use of PDE5 was not a significant predictor of postoperative ED (P = 0.33). Neither peak systolic, end diastolic, nor resistive index were significant predictors of ED (P = 0.28, 0.28, and 0.25, respectively). This long-term follow-up of a large published series suggests that neither

  14. Osteoporotic compression fracture of the thoracolumbar spine and sacral insufficiency fracture: incidence and analysis of the relationship according to the clinical factors

    International Nuclear Information System (INIS)

    Kong, Jeong Hwa; Park, Ji Sun; Ryu, Kyung Nam

    2006-01-01

    insufficiency fracture, which was not uncommon. These findings suggest the need to consider the possibility of pelvic sacral insufficiency fracture in cases of T/L spinal MRI for patients with osteoporotic compression fracture

  15. Pre-operative Duplex Ultrasonography in Arteriovenous Fistula Creation: Intra- and Inter-observer Agreement.

    Science.gov (United States)

    Zonnebeld, Niek; Maas, Tommy M G; Huberts, Wouter; van Loon, Magda M; Delhaas, Tammo; Tordoir, Jan H M

    2017-11-01

    Although clinical guidelines on arteriovenous fistula (AVF) creation advocate minimum luminal arterial and venous diameters, assessed by duplex ultrasonography (DUS), the clinical value of routine DUS examination is under debate. DUS might be an insufficiently repeatable and/or reproducible imaging modality because of its operator dependency. The present study aimed to assess intra- and inter-observer agreement of DUS examination in support of AVF surgery planning. Ten end stage renal disease patients were included, to assess intra- and inter-observer agreement of pre-operative DUS measurements. All measurements were performed by two trained and experienced vascular technicians, blinded to measurement readings. From the routine DUS protocol, representative measurements (venous diameters, and arterial diameters and volume flow in the upper arm and forearm) were selected. For intra-observer agreement the measurements were performed in triplicate, with the probe released from the skin between each. Intraclass correlation coefficients were calculated for intra- and inter-observer agreement, and Bland-Altman plots used to graphically display mean measurement differences and limits of agreement. Ten patients (6 male, 59.4±19.7 years) consented to participate, and all predefined measurements were obtained. Intraclass correlation coefficients for intra-observer agreement of diameter measurements were at least 0.90 (95% CI 0.74-0.97; radial artery). Inter-observer agreement was at least 0.83 (0.46-0.96; lateral diameter upper arm cephalic vein). The Bland-Altman plots showed acceptable mean measurement differences and limits of agreement. In experienced hands, excellent intra- and inter-observer agreement can be reached for the discrete pre-operative DUS measurements advocated in clinical guidelines. DUS is therefore a reliable imaging modality to support AVF surgery planning. The content of DUS protocols, however, needs further standardisation. Copyright © 2017 European

  16. Imaging Features of Helical Computed Tomography Suggesting Advanced Urothelial Carcinoma Arising from the Pelvocalyceal System

    International Nuclear Information System (INIS)

    Kwak, Kyung Won; Park, Byung Kwan; Kim, Chan Kyo; Lee, Hyun Moo; Choi, Han Y ong

    2008-01-01

    Background: Urothelial carcinoma is the most common malignant tumor arising from the pelvocalyceal system. Helical computed tomography (CT) is probably the best preoperative-stage modality for the determination of treatment plan and prognosis. Purpose: To obtain helical CT imaging features suggesting advanced pelvocalyceal urothelial carcinoma. Material and Methods: Preoperative CT images in 44 patients with pelvocalyceal urothelial carcinoma were retrospectively reviewed and correlated with the pathological examination to determine imaging features suggesting stage III or IV of the disease. Results: Pathological stages revealed stage I in 16, stage II in three, stage III in 17, and stage IV in eight patients. Seven patients had metastatic lymph nodes. CT imaging showed that renal parenchymal invasion, sinus fat invasion, and lymph node metastasis were highly suggestive of advanced urothelial cell carcinoma (P<0.05). Helical CT sensitivity, specificity, and accuracy for advanced pelvocalyceal urothelial carcinoma were 76% (19/25), 84% (16/19), and 80% (35/44), respectively. Conclusion: Preoperative helical CT may suggest imaging features of advanced urothelial carcinoma, influencing treatment plan and patient prognosis, even though its accuracy is not so high

  17. Prognostic significance of preoperative serum CA125, CA19-9 and CEA in gastric carcinoma

    Science.gov (United States)

    Wang, Wei; Chen, Xiao-Long; Zhao, Shen-Yu; Xu, Yu-Hui; Zhang, Wei-Han; Liu, Kai; Chen, Xin-Zu; Yang, Kun; Zhang, Bo; Chen, Zhi-Xin; Chen, Jia-Ping; Zhou, Zong-Guang; Hu, Jian-Kun

    2016-01-01

    The prognostic significance of preoperative serum CA125, CA19-9 and CEA in gastric carcinoma (GC) has been widely reported and is still under debate. Here, we evaluated the prognostic significance of preoperative serum CA125, CA19-9 and CEA in patients with GC. 1692 patients with GC who underwent gastrectomy were divided into the training (from January 2005 to December 2011, n = 1024) and the validation (from January 2012 to December 2013, n = 668) cohorts. Positive groups of CA125 (> 13.72 U/ml), CA19-9 (> 23.36 U/ml) and CEA (> 4.28 ng/ml) were significantly associated with more advanced clinicopathological traits and worse outcomes than that of negative groups (all P tumor size (P tumor markers (NPTM) were more accurate in prognostic prediction than TNM stage alone. Our findings suggested that elevated preoperative serum CA125, CA19-9 and CEA were associated with more advanced clinicopathological traits and less favorable outcomes. In addition, CA125 as an independent prognostic factor should be further investigated. Nomogram based on NPTM could accurately predict the prognosis of GC patients. PMID:27097114

  18. Preoperative and Postoperative Nomograms Incorporating Surgeon Experience for Clinically Localized Prostate Cancer

    Science.gov (United States)

    Kattan, Michael W.; Vickers, Andrew J.; Yu, Changhong; Bianco, Fernando J.; Cronin, Angel M.; Eastham, James A.; Klein, Eric A.; Reuther, Alwyn M.; Pontes, Jose Edson; Scardino, Peter T.

    2012-01-01

    BACKGROUND Accurate preoperative and postoperative risk assessment has been critical for counseling patients regarding radical prostatectomy for clinically localized prostate cancer. In addition to other treatment modalities, neoadjuvant or adjuvant therapies have been considered. The growing literature suggested that the experience of the surgeon may affect the risk of prostate cancer recurrence. The purpose of this study was to develop and internally validate nomograms to predict the probability of recurrence, both preoperatively and postoperatively, with adjustment for standard parameters plus surgeon experience. METHODS The study cohort included 7724 eligible prostate cancer patients treated with radical prostatectomy by 1 of 72 surgeons. For each patient, surgeon experience was coded as the total number of cases conducted by the surgeon before the patient’s operation. Multivariable Cox proportional hazards regression models were developed to predict recurrence. Discrimination and calibration of the models was assessed following bootstrapping methods, and the models were presented as nomograms. RESULTS In this combined series, the 10-year probability of recurrence was 23.9%. The nomograms were quite discriminating (preoperative concordance index, 0.767; postoperative concordance index, 0.812). Calibration appeared to be very good for each. Surgeon experience seemed to have a quite modest effect, especially postoperatively. CONCLUSIONS Nomograms have been developed that consider the surgeon’s experience as a predictor. The tools appeared to predict reasonably well but were somewhat little improved with the addition of surgeon experience as a predictor variable. PMID:19156928

  19. Experience with the biofragmentable anastomotic ring (BAR) in bowel preoperatively irradiated with 6000 rad

    Energy Technology Data Exchange (ETDEWEB)

    Croston, J.K.; Jacobs, D.M.; Kelly, P.H.; Feeney, D.A.; Johnston, G.R.; Strom, R.L.; Bubrick, M.P. (Hennepin County Medical Center, Minneapolis, MN (USA))

    1990-03-01

    Previous studies from the authors' laboratory using the biodegradable anastomotic ring (BAR) have demonstrated the safety of this device in animals irradiated preoperatively with the equivalent of 5000 rad; sutured, stapled, and BAR anastomoses all had leak rates of 10 percent or less in this setting. This study was undertaken to assess the safety of the BAR after irradiation with the equivalent of 6000 rad. Thirteen mongrel dogs underwent preoperative irradiation to the rectum and rectosigmoid, receiving 6000 rad according to the nominal standard dose equation. After a three-week rest period, each dog underwent anterior resection of the rectosigmoid and anastomosis with the BAR. The anastomoses were evaluated for early and late healing and anastomotic leaks. The results were compared with previous data from the authors' laboratory using an identical model. Radiographic leaks were found in 7 of 10 sutured anastomoses, 8 of 10 stapled anastomoses, and 3 of 13 BAR anastomoses (P less than 0.01). Comparative clinical leaks were 5 of 10 for sutured, 5 of 10 for stapled, and 3 of 13 for BAR anastomoses. These data suggest that the BAR may offer added safety to an anastomosis after preoperative irradiation. Whether this effect is due to the atraumatic technique of placing the device, improved blood flow to the anastomotic margins, or other factors, is still underdetermined.

  20. Experience with the biofragmentable anastomotic ring (BAR) in bowel preoperatively irradiated with 6000 rad

    International Nuclear Information System (INIS)

    Croston, J.K.; Jacobs, D.M.; Kelly, P.H.; Feeney, D.A.; Johnston, G.R.; Strom, R.L.; Bubrick, M.P.

    1990-01-01

    Previous studies from the authors' laboratory using the biodegradable anastomotic ring (BAR) have demonstrated the safety of this device in animals irradiated preoperatively with the equivalent of 5000 rad; sutured, stapled, and BAR anastomoses all had leak rates of 10 percent or less in this setting. This study was undertaken to assess the safety of the BAR after irradiation with the equivalent of 6000 rad. Thirteen mongrel dogs underwent preoperative irradiation to the rectum and rectosigmoid, receiving 6000 rad according to the nominal standard dose equation. After a three-week rest period, each dog underwent anterior resection of the rectosigmoid and anastomosis with the BAR. The anastomoses were evaluated for early and late healing and anastomotic leaks. The results were compared with previous data from the authors' laboratory using an identical model. Radiographic leaks were found in 7 of 10 sutured anastomoses, 8 of 10 stapled anastomoses, and 3 of 13 BAR anastomoses (P less than 0.01). Comparative clinical leaks were 5 of 10 for sutured, 5 of 10 for stapled, and 3 of 13 for BAR anastomoses. These data suggest that the BAR may offer added safety to an anastomosis after preoperative irradiation. Whether this effect is due to the atraumatic technique of placing the device, improved blood flow to the anastomotic margins, or other factors, is still underdetermined

  1. Systematic Review: Audiovisual Interventions for Reducing Preoperative Anxiety in Children Undergoing Elective Surgery

    Science.gov (United States)

    Van Lieshout, Ryan J.; Schmidt, Louis A.; Dobson, Kathleen G.; Buckley, Norman

    2016-01-01

    Objective To examine the effectiveness of Audiovisual (AV) interventions at reducing preoperative anxiety and its associated outcomes in children undergoing elective surgery. Methods A systematic review of randomized controlled trials (RCTs) and nonrandomized studies where the primary outcome was children’s preoperative anxiety was conducted. Secondary outcomes included postoperative pain, behavioral changes, recovery, induction compliance, satisfaction, and cost-effectiveness. The risk of bias of each study was assessed. Results In all, 18 studies were identified. A meta-analytic approach and narrative synthesis of findings were used to summarize the results of the studies. Conclusions This systematic review suggests that AV interventions can be effective in reducing children’s preoperative anxiety. Videos, multi-faceted programs, and interactive games appear to be most effective, whereas music therapy and Internet programs are less effective. While AV interventions appear potentially useful, adequately powered RCTs are required to conclusively pinpoint the components and mechanisms of the most effective AV interventions and guide practice. PMID:26476281

  2. Pre-operative Asymptomatic Bacteriuria: A Risk Factor For Prosthetic Joint Infection?

    Science.gov (United States)

    Weale, R; El-Bakri, F; Saeed, Kordo

    2018-04-13

    Infection is a rare complication following implantation of prosthetic material into a joint. The impact of asymptomatic bacteriuria (ASB) before elective operations and the subsequent risk of prosthetic joint infection (PJI) are not well understood. • Assess the prevalence of ASB amongst patients undergoing total arthroplasty of the hip and knee. • Determine the rates of PJI diagnosed within two years of the arthroplasty and if ASB is an independent risk factor for developing PJI. Patients who had total/unicondylar knee or total hip arthroplasty were retrospectively reviewed over a five-year period. Pre-operative urine samples within one year of surgery were analysed and those with ASB identified. Primary outcome was prosthetic joint infection (PJI) within the first postoperative year. 5542 patients were included. 4368 had a pre-operative urine culture recorded. The prevalence of ASB was 140 of 4368 (3.2%). The overall PJI rate was 56 of 5542 (1.01%). Of those with a PJI, 33 had a pre-operative urine sample recorded. The infection rate in the ASB group was 5% (7 of 140), in the no-ASB group it was 0.61% (26 of 4228) and in the group without a urine sample it was 1.96% (23 of 1174) (p value prosthetic joint, suggestive the relationship is unlikely causal. Copyright © 2018. Published by Elsevier Ltd.

  3. Preoperative determination of appropriate cutting line for proximal gastrectomy to avoid postoperative jejunal ulcer.

    Science.gov (United States)

    Takahashi, Naoto; Kashimura, Hirotaka; Nimura, Hiroshi; Watanabe, Atsushi; Yano, Kentaro; Aoki, Hiroaki; Koyama, Tomoki; Sasaki, Toshiyuki; Shida, Atsuo; Mitsumori, Norio; Aoki, Teruaki; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

    2012-01-01

    Although proximal gastrectomy has become a procedure of choice for patients' early cancer in the upper third of stomach, no clinical guide for optimal gastric resection in order to avoid postoperative jejunal ulcer is available. The aim of this study was to investigate whether determining the distribution of parietal and chief cells of the stomach using Congo red test is clinically relevant. The F-line was defined as a boundary line between fundic and intermediate area of the stomach according to the pathological findings in 29 patients who underwent total gastrectomy for early gastric cancer, whereas the f-line was regarded as a boundary line between intermediate and pyloric area. In the additional 6 patients undergoing vagus-preserving proximal gastrectomy with jejunal pouch interposition, endoscopic Congo red test was preoperatively performed to determine the F-f-line. The distances from the pyloric ring to f-line on the lesser and greater curvatures were variable. Long-term outcomes of proximal gastrectomy guided by preoperative endoscopic Congo red test were favorable. It is suggested that preoperative endoscopic Congo red test is useful to determine the appropriate cutting line in order to avoid postoperative jejunal ulcer after proximal gastrectomy.

  4. The Usefulness of 99mTc-Sestamibi Scan in Preoperative Localization in Primary Hyperparathyroidism

    International Nuclear Information System (INIS)

    Baik, S. H.; Kim, S. M.; Choi, K. M.; Choi, Y. S.; Kim, S. J.; Yu, J. M.; Choi, D. S.; Choe, J. C.

    1995-01-01

    An accurate preoperative localization in patients with primary hyperparathyroidism is important for successful surgical intervention. There are many methods for the localization of the primary hyperparathyroidism such as ultrasonography, computerized tomography(CT), magnetic resonance imaging(MRI), angiography and 201 T1/ 99m Tc-subtraction scan. Among them 201T1/99mTc subtraction scan in known as the most accurate tool for preoperative localization. Recently 201 T1/ 99m Tc-Sestamibi has been used for parathyroid gland imaging. We experienced 19 primary hyperparathyroidisms accurately localized with 201 T1/ 99m Tcsubtraction imaging and 99m Tc-Sestamibi. The sensitivities of the 99m Tc-Sestamibi, 201T1/99mTc subtraction imaging, CT and US were 100%(5/5), 89.5%(17/19) and 61.7(12/19) respectively. With the combination of 99m Tc-Sestamibi and 201 T1/ 99T c-subtraction imaging we could localize with 100% accuracy. Although the case number is small, this study suggests that the 99m Tc-Sestamibi parathyroid scan is very useful and easy to use for preoperative localization in primary hyperparathyroidism.

  5. Effect of Preoperative Pain on Inferior Alveolar Nerve Block

    Science.gov (United States)

    Aggarwal, Vivek; Singla, Mamta; Subbiya, Arunajatesan; Vivekanandhan, Paramasivam; Sharma, Vikram; Sharma, Ritu; Prakash, Venkatachalam; Geethapriya, Nagarajan

    2015-01-01

    The present study tested the hypothesis that the amount and severity of preoperative pain will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. One-hundred seventy-seven adult volunteer subjects, actively experiencing pain in a mandibular molar, participated in this prospective double-blind study carried out at 2 different centers. The patients were classified into 3 groups on the basis of severity of preoperative pain: mild, 1–54 mm on the Heft-Parker visual analog scale (HP VAS); moderate, 55–114 mm; and severe, greater than 114 mm. After IANB with 1.8 mL of 2% lidocaine, endodontic access preparation was initiated. Pain during treatment was recorded using the HP VAS. The primary outcome measure was the ability to undertake pulp access and canal instrumentation with no or mild pain. The success rates were statistically analyzed by multiple logistic regression test. There was a significant difference between the mild and severe preoperative pain group (P = .03). There was a positive correlation between the values of preoperative and intraoperative pain (r = .2 and .4 at 2 centers). The amount of preoperative pain can affect the anesthetic success rates of IANB in patients with symptomatic irreversible pulpitis. PMID:26650491

  6. Effect of Preoperative Pain on Inferior Alveolar Nerve Block.

    Science.gov (United States)

    Aggarwal, Vivek; Singla, Mamta; Subbiya, Arunajatesan; Vivekanandhan, Paramasivam; Sharma, Vikram; Sharma, Ritu; Prakash, Venkatachalam; Geethapriya, Nagarajan

    2015-01-01

    The present study tested the hypothesis that the amount and severity of preoperative pain will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. One-hundred seventy-seven adult volunteer subjects, actively experiencing pain in a mandibular molar, participated in this prospective double-blind study carried out at 2 different centers. The patients were classified into 3 groups on the basis of severity of preoperative pain: mild, 1-54 mm on the Heft-Parker visual analog scale (HP VAS); moderate, 55-114 mm; and severe, greater than 114 mm. After IANB with 1.8 mL of 2% lidocaine, endodontic access preparation was initiated. Pain during treatment was recorded using the HP VAS. The primary outcome measure was the ability to undertake pulp access and canal instrumentation with no or mild pain. The success rates were statistically analyzed by multiple logistic regression test. There was a significant difference between the mild and severe preoperative pain group (P = .03). There was a positive correlation between the values of preoperative and intraoperative pain (r = .2 and .4 at 2 centers). The amount of preoperative pain can affect the anesthetic success rates of IANB in patients with symptomatic irreversible pulpitis.

  7. Feasibility of dynamic MRI for evaluating velopharyngeal insufficiency in children

    Energy Technology Data Exchange (ETDEWEB)

    Drissi, C. [St Vincent de Paul Hospital, Pediatric Radiology, 82 av Denfert Rochereau, 75674, Paris Cedex 14 (France); Institut National de Neurologie, Radiology Department, Tunis (Tunisia); Mitrofanoff, M.; Talandier, C. [St Vincent de Paul Hospital, Plastic Surgery, Paris Cedex 14 (France); Falip, C. [St Vincent de Paul Hospital, Pediatric Radiology, 82 av Denfert Rochereau, 75674, Paris Cedex 14 (France); Paris Descartes University, Paris Cedex (France); Couls, V. le [Siemens, St Denis (France); Adamsbaum, C. [St Vincent de Paul Hospital, Pediatric Radiology, 82 av Denfert Rochereau, 75674, Paris Cedex 14 (France); Paris Descartes University, Paris Cedex (France); St Vincent de Paul Hospital, AP-HP - Pediatric Imaging, Paris (France)

    2011-07-15

    To demonstrate the feasibility of dynamic MRI with near-real-time temporal resolution for analysing velopharyngeal closure. Eleven children and young adults (seven girls, four boys, mean age: 8.4 years) with suspected velopharyngeal insufficiency (VPI), and one healthy volunteer underwent MRI (1.5 Tesla) using T2 fast imaging sequences. Imaging was done without any sedation at rest and during various phonations in the axial and sagittal planes. Images were analysed by two radiologists, a plastic surgeon and a speech therapist. The MRI examinations were well tolerated by even the youngest patient. A qualitative analysis found that the sagittal dynamic sequences during phonation were in relation to the clinical data in all patients. A quantitative analysis enabled calculation of the elevation angle of the soft palate in relation to the hard palate, the velar eminence angle and the percentage of reduction of the antero-posterior diameter of the pharyngeal lumen. Dynamic MRI is a non-invasive, rapid and repeatable method. It can be considered a complementary tool to endoscopy and fluoroscopy, particularly in children, for assessing VPI without any sedation or radiation exposure. (orig.)

  8. We can predict postpalatoplasty velopharyngeal insufficiency in cleft palate patients.

    Science.gov (United States)

    Leclerc, Jacques E; Godbout, Audrey; Arteau-Gauthier, Isabelle; Lacour, Sophie; Abel, Kati; McConnell, Elisa-Maude

    2014-02-01

    To find an anatomical measurement of the cleft palate (or a calculated parameter) that predicts the occurrence of velopharyngeal insufficiency (VPI) after palatal cleft repair. Retrospective cohort study. Charts were reviewed from cleft palate patients who underwent palatoplasty by the Von Langenbeck technique for isolated cleft palate or Bardach two-flap palatoplasty for cleft lip-palate. Seven anatomical cleft parameters were prospectively measured during the palatoplasty procedure. Three blinded speech-language pathologists retrospectively scored the clinically assessed VPI at 4 years of age. The recommendation of pharyngoplasty was also used as an indicator of VPI. From 1993 to 2008, 67 patients were enrolled in the study. The best predicting parameter was the ratio a/(30 - b1), in which a is defined as the posterior gap between the soft palate and the posterior pharyngeal wall and b1 is the width of the cleft at the hard palate level. An a/(30 - b1) ratio >0.7 to 0.8 is associated with a higher risk of developing VPI (relative risk = 2.2-5.1, sensitivity = 72%-81%, P cleft at the hard palate level and the posterior gap between the soft palate and the posterior pharyngeal wall were found to be the most significant parameters in predicting VPI. The best correlation was obtained with the ratio a/(30 - b1). 4. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  9. Ocular pressure waveform reflects ventricular bigeminy and aortic insufficiency

    Directory of Open Access Journals (Sweden)

    Jean B Kassem

    2015-01-01

    Full Text Available Ocular pulse amplitude (OPA is defined as the difference between maximum and minimum intraocular pressure (IOP during a cardiac cycle. Average values of OPA range from 1 to 4 mmHg. The purpose of this investigation is to determine the source of an irregular IOP waveform with elevated OPA in a 48-year-old male. Ocular pressure waveforms had an unusual shape consistent with early ventricular contraction. With a normal IOP, OPA was 9 mmHg, which is extraordinarily high. The subject was examined by a cardiologist and was determined to be in ventricular bigeminy. In addition, he had bounding carotid pulses and echocardiogram confirmed aortic insufficiency. After replacement of the aortic valve, the bigeminy resolved and the ocular pulse waveform became regular in appearance with an OPA of 1.6-2.0 mmHg. The ocular pressure waveform is a direct reflection of hemodynamics. Evaluating this waveform may provide an additional opportunity for screening subjects for cardiovascular anomalies and arrhythmias.

  10. Insufficiency fractures following radiation therapy for gynecologic malignancies

    Energy Technology Data Exchange (ETDEWEB)

    Ikushima, Hitoshi; Takegawa, Yoshihiro; Matsuki, Hirokazu; Yasuda, Hiroaki; Kawanaka, Takashi; Shiba, Atsushi; Kishida, Yoshiomi; Iwamoto, Seiji; Nishitani, Hiromu [Tokushima Univ. (Japan). School of Medicine

    2002-12-01

    The purpose of this study was to investigate the incidence, clinical and radiological findings of insufficiency fractures (IF) of the female pelvis following radiation therapy. We retrospectively reviewed the radiation oncology records of 108 patients with gynecologic malignancies who underwent external beam radiation therapy of the whole pelvis. All patients underwent conventional radiography and computed tomography (CT) scan every 6 months in follow-up after radiation therapy and magnetic resonance imaging (MRI) and radionuclide bone scan were added when the patients complained of pelvic pain. Thirteen of 108 patients (12%) developed IF in the irradiated field with a median interval of 6 months (range 3-51) from the completion of external beam radiation therapy. All patients who developed IF were postmenopausal women. Age of the patients who developed IF was significantly higher than that of the other patients. The parts of IF were sacroiliac joints, pubis, sacral body and 5th lumbar vertebra and six of 14 patients had multiple lesions. Treatment with rest and nonsteroidal anti-inflammatory drugs lead to symptomatic relief in all patients, although symptoms lasted from 3 to 20 months. Radiation-induced pelvic IF following radiation therapy for gynecologic malignancies were frequently observed in the post-menopausal patients within 1 year after external beam radiation therapy. Symmetrical fractures of the bilateral sacroiliac joint and pubis were the characteristic pattern of pelvic IF. All patients healed with conservative treatment, and nobody became non-ambulant. (author)

  11. Impaired acid neutralization in the duodenum in pancreatic insufficiency.

    Science.gov (United States)

    Dutta, S K; Russell, R M; Iber, F L

    1979-10-01

    The influence of severe exocrine pancreatic disease on the acid-neutralizing capacity of the duodenum was studied in five patients with pancreatic insufficiency (PI) and six control subjects using duodenal perfusion-marker technique. Hydrochloric acid (0.1 N containing 1% PEG) was infused at constant rates (1.2, 4.5 and 7.0 ml/min) into the duodenum just distal to the duodenal bulb. Samples were aspirated from the tip of the duodenal perfusion tube located at the ligament of Treitz. All samples were analyzed for volume, pH, titrable acidity, PEG and [14C]PEG (gastric marker) determination. Patients with PI demonstrated significantly diminished ability to neutralize various acid loads as compared to controls who virtually completely neutralized acid loads in the range of maximal gastric acid secretion. Exogenous secretin did not significantly improve percent acid neutralized in PI. These data clearly indicate that patients with PI have significantly impaired ability to neutralize even small loads of acid in the duodenum.

  12. Vertebrobasilar insufficiency and possible relationships with arterial changes

    International Nuclear Information System (INIS)

    Tonagel, J.

    1982-01-01

    The study described was carried out in order to clarify the question as to whether overt neurological disorders in the vertebrobasilar region are connected with arterial changes that may be ascertained by means of X-ray examinations. For this purpose, the clinical and angiographic data of 54 patients showing vertebrobasilar insufficiency were subjected to detailed analysis. In all cases, an angiographic examination of the branchial artery had been so performed as to permit visualisation of the vertebrobasilar territory. The macroscopic changes revealed by angiography were evaluated on the basis of the severity of the clinical symptoms and the age of the patient. It was found that the frequency of visualised changes in the arterial system that could be matched with neurological symptoms only just attained statistical significance in women of advanced age, while the findings revealed in men were not consistent with the clinical signs. The manifestation of those changes largely depends on the individual degree of collateral blood supply. This, a direct relationship between the angiographic findings and the clinical symptoms is only likely to be observed in cases where the development of collaterals was prevented due to the site of vascular obstruction or where the incident happened just prior to the examination. A typical example here is recent thrombosis of the basilar artery. (TRV) [de

  13. Sodium nitrite: the "cure" for nitric oxide insufficiency.

    Science.gov (United States)

    Parthasarathy, Deepa K; Bryan, Nathan S

    2012-11-01

    This process of "curing" food is a long practice that dates back thousands of years long before refrigeration or food safety regulations. Today food safety and mass manufacturing are dependent upon safe and effective means to cure and preserve foods including meats. Nitrite remains the most effective curing agent to prevent food spoilage and bacterial contamination. Despite decades of rigorous research on its safety and efficacy as a curing agent, it is still regarded by many as a toxic undesirable food additive. However, research within the biomedical science community has revealed enormous therapeutic benefits of nitrite that is currently being developed as novel therapies for conditions associated with nitric oxide (NO) insufficiency. Much of the same biochemistry that has been understood for decades in the meat industry has been rediscovered in human physiology. This review will highlight the fundamental biochemistry of nitrite in human physiology and highlight the risk benefit evaluation surrounding nitrite in food and meat products. Foods or diets enriched with nitrite can have profound positive health benefits. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. Insufficient self-shielding correction in VITAMIN-B6

    International Nuclear Information System (INIS)

    Konno, Chikara; Ochiai, Kentaro; Ohnishi, Seiki

    2011-01-01

    We carried out a simple benchmark calculation test with a multigroup cross-section library VITAMIN-B6 generated from ENDF/B-VI. The model of this test consisted of an iron sphere of 1 m in radius with an isotropic 20 MeV neutron source in the center. Neutron spectra in the sphere were calculated with an Sn code ANISN and VITAMIN-B6 or FENDL/MG-1.1. A calculation with MCNP and ENDF/B-VI was carried out as a reference. The neutron spectra with ANISN and FENDL/MG-1.1 agreed with those with MCNP, while those with ANISN and VITAMIN-B6 were at most 50% different from those with MCNP. We uncovered that the discrepancy came from insufficient self-shielding correction due to the followings; 1) The smallest background cross section of 56 Fe in VITAMIN-B6 is 1. 2) The weighting flux used in generating VITAMIN-B6 is not adequate. VITAMIN-B6 should be revised for adequate self-shielding correction. (author)

  15. ATM induction insufficiency in a radiosensitive breast-cancer patient

    International Nuclear Information System (INIS)

    Clarke, R.A.; Fang, Z.H.; Marr, P.J.; Kearsley, J.H.; Papadatos, G.; Lee, C.S.; University of Sydney, Camperdown, NSW

    2002-01-01

    ATM induction insufficiency in a radiosensitive breast-cancer patient The ataxia telangiectasia (A-T) gene (ATM) is a dominant breast cancer gene with tumour suppressor activity. ATM also regulates cellular sensitivity to ionising radiation (IR) presumably through its role as a facilitator of DNA repair. In normal cells and tissues the ATM protein is rapidly induced by IR to threshold/maximum levels. The kinase function of the ATM protein is also rapidly activated in response to IR. The fact that women carriers of ATM mutations can have an increased risk of developing breast cancer and that many sporadic breast tumours have reduced levels of the ATM protein broadens the scope of ATM's tumour suppressor within the breast. This report describes the downregulation of ATM protein levels in a radiosensitive breast cancer patient. Postinduction ATM levels were up to tenfold lower in the patient's fresh tissues compared to normal controls. These results might indicate a much broader role for ATM anomalies in breast cancer aetiology. Copyright (2002) Blackwell Science Pty Ltd

  16. Mild cognitive deficits in patients with primary adrenal insufficiency.

    Science.gov (United States)

    Tiemensma, Jitske; Andela, Cornelie D; Biermasz, Nienke R; Romijn, Johannes A; Pereira, Alberto M

    2016-01-01

    The brain is a major target organ for cortisol considering its high density of glucocorticoid receptors. Several states of hypothalamus-pituitary-adrenal dysregulation point towards impairments in cognitive functioning. However, there is a very limited body of research on the effects of hypocortisolism on cognitive functioning. To evaluate cognitive functioning in patients with hypocortisolism (i.e., primary adrenal insufficiency (PAI)) and to examine the possible effect of postponing early-morning hydrocortisone intake on cognitive functioning. Thirty-one patients with PAI on regular morning hydrocortisone intake and 31 healthy matched controls underwent nine neuropsychological tests, evaluating memory and executive functioning. In addition, the effect of normal timing and postponement of morning hydrocortisone intake on neuropsychological tests were assessed in an additional 29 patients with PAI. Compared to controls, patients with PAI performed worse on auditory and visual memory tasks (all P ≤ 0.024) and executive functioning tasks (all P ≤ 0.012). In contrast, patients performed better on a concentration and an attention task (both Paffect the outcomes of neuropsychological tests. Patients on long-term hydrocortisone replacement for PAI show mild cognitive deficits compared to controls. There was no effect of postponement of regular hydrocortisone intake on cognition. Copyright © 2015 Elsevier Ltd. All rights reserved.

  17. Exocrine pancreatic insufficiency in diabetic patients: prevalence, mechanisms, and treatment.

    Science.gov (United States)

    Piciucchi, Matteo; Capurso, Gabriele; Archibugi, Livia; Delle Fave, Martina Maria; Capasso, Marina; Delle Fave, Gianfranco

    2015-01-01

    Pancreas is a doubled-entity organ, with both an exocrine and an endocrine component, reciprocally interacting in a composed system whose function is relevant for digestion, absorption, and homeostasis of nutrients. Thus, it is not surprising that disorders of the exocrine pancreas also affect the endocrine system and vice versa. It is well-known that patients with chronic pancreatitis develop a peculiar form of diabetes (type III), caused by destruction and fibrotic injury of islet cells. However, less is known on the influence of diabetes on pancreatic exocrine function. Pancreatic exocrine insufficiency (PEI) has been reported to be common in diabetics, with a prevalence widely ranging, in different studies, in both type I (25-74%) and type II (28-54%) diabetes. A long disease duration, high insulin requirement, and poor glycemic control seem to be risk factors for PEI occurrence. The impact of pancreatic exocrine replacement therapy on glycemic, insulin, and incretins profiles has not been fully elucidated. The present paper is aimed at reviewing published studies investigating the prevalence of PEI in diabetic patients and factors associated with its occurrence.

  18. Feasibility of dynamic MRI for evaluating velopharyngeal insufficiency in children

    International Nuclear Information System (INIS)

    Drissi, C.; Mitrofanoff, M.; Talandier, C.; Falip, C.; Couls, V. le; Adamsbaum, C.

    2011-01-01

    To demonstrate the feasibility of dynamic MRI with near-real-time temporal resolution for analysing velopharyngeal closure. Eleven children and young adults (seven girls, four boys, mean age: 8.4 years) with suspected velopharyngeal insufficiency (VPI), and one healthy volunteer underwent MRI (1.5 Tesla) using T2 fast imaging sequences. Imaging was done without any sedation at rest and during various phonations in the axial and sagittal planes. Images were analysed by two radiologists, a plastic surgeon and a speech therapist. The MRI examinations were well tolerated by even the youngest patient. A qualitative analysis found that the sagittal dynamic sequences during phonation were in relation to the clinical data in all patients. A quantitative analysis enabled calculation of the elevation angle of the soft palate in relation to the hard palate, the velar eminence angle and the percentage of reduction of the antero-posterior diameter of the pharyngeal lumen. Dynamic MRI is a non-invasive, rapid and repeatable method. It can be considered a complementary tool to endoscopy and fluoroscopy, particularly in children, for assessing VPI without any sedation or radiation exposure. (orig.)

  19. Academic performance among adolescents with behaviorally induced insufficient sleep syndrome.

    Science.gov (United States)

    Lee, Yu Jin; Park, Juhyun; Kim, Soohyun; Cho, Seong-Jin; Kim, Seog Ju

    2015-01-15

    The present study investigated academic performance among adolescents with behaviorally induced insufficient sleep syndrome (BISS) and attempted to identify independent predictors of academic performance among BISS-related factors. A total of 51 students with BISS and 50 without BISS were recruited from high schools in South Korea based on self-reported weekday sleep durations, weekend oversleep, and the Epworth Sleepiness Scale (ESS). Participants reported their academic performance in the form of class quartile ranking. The Korean version of the Composite Scale (KtCS) for morningness/eveningness, the Beck Depression Inventory (BDI) for depression, and the Barratt Impulsiveness Scale-II (BIS-II) for impulsivity were administered. Adolescents with BISS reported poorer academic performance than adolescents without BISS (p = 0.02). Adolescents with BISS also exhibited greater levels of eveningness (p academic performance among adolescents with BISS even after controlling for ESS, KtCS, BDI, and BIS-II (β = 0.42, p academic performance and that sleep debt, as represented by weekend oversleep, predicts poorer academic performance independent of depression, impulsiveness, weekday sleep duration, daytime sleepiness, and morningness/eveningness among adolescents with BISS. © 2015 American Academy of Sleep Medicine.

  20. Surgical treatment of traumatic tricuspid insufficiency: experience in 13 cases.

    Science.gov (United States)

    Ma, Wei-Guo; Luo, Guo-Hua; Sun, Han-Song; Xu, Jian-Ping; Hu, Sheng-Shou; Zhu, Xiao-Dong

    2010-12-01

    Traumatic tricuspid insufficiency (TTI) is uncommon and surgical experience is limited. We report our surgical experience with TTI in 13 patients. From January 2000 through March 2008, we operated on 13 patients with TTI (10 men 3 women; mean age, 39.8 ± 10.5 years). The intervals from trauma to diagnosis and from trauma to surgery averaged 37.4 and 54.4 months, respectively. At operation, the mechanism of TTI was due to anterior chordal rupture in 8, anterior papillary muscle rupture in 3, rupture of anterior papillary muscle and chordae in 1, and anterior leaflet defect in 1. In 7 patients the annulus was dilated. Valve repair was successful in 13 patients. No early or late deaths occurred. Severe hemolysis occurred in 1 patient after tricuspid and mitral valve repairs. At follow-up extending to 9.5 years, 9 patients were in New York Heart Association functional class I, and 4 were in class II. Transthoracic echocardiography demonstrated no or trivial residual regurgitation in 7 patients, mild regurgitation in 4, and mild-to-moderate regurgitation in 2. A significant decrease of the right ventricular end-diastolic dimension (37.7 ± 9.7 vs 20.7 ± 4.6 mm; p tricuspid valve repair. Early surgical intervention should be emphasized to achieve good functional results and preserve the right ventricular function. Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Cytogenetic Analysis of 65 Women with Premature Ovarian Insufficiency

    Directory of Open Access Journals (Sweden)

    Seda Ates

    2016-09-01

    Full Text Available Aim: Premature ovarian insufficiency (POI is characterized as amenorrhea for more than 6 months, occurring before the age of 40, with an increased follicle-stimulating hormone and low estrogen concentrations. The aim of our study is to determine the types and distribution of cytogenetic abnormalities among women with POI. Material and Method: The study is based on the retrospective karyotype analysis of 65 women with idiopathic POI referred to the Medical Genetics Department at the Bezmialem Vakif University Hospital. Results: Chromosomal abnormalities were present in 12 of 65 cases (18.4%. All of them had numerical abnormalities of the X chromosome. The most frequently detected abnormalities were X chromosome mosaicisms. Two cases had fragile X premutation carriers. Eight (12.3% women were considered as familial POI. Discussion: Our results underline the essential role of the X chromosome in the etiology of POI. Therefore, regardless of clinical features and woman%u2019s age, cytogenetic investigations should be routinely performed in cases with POI.

  2. Frontal Bone Insufficiency in Gsk3β Mutant Mice.

    Directory of Open Access Journals (Sweden)

    Heather Szabo-Rogers

    Full Text Available The development of the mammalian skull is a complex process that requires multiple tissue interactions and a balance of growth and differentiation. Disrupting this balance can lead to changes in the shape and size of skull bones, which can have serious clinical implications. For example, insufficient ossification of the bony elements leads to enlarged anterior fontanelles and reduced mechanical protection of the brain. In this report, we find that loss of Gsk3β leads to a fully penetrant reduction of frontal bone size and subsequent enlarged frontal fontanelle. In the absence of Gsk3β the frontal bone primordium undergoes increased cell death and reduced proliferation with a concomitant increase in Fgfr2-IIIc and Twist1 expression. This leads to a smaller condensation and premature differentiation. This phenotype appears to be Wnt-independent and is not rescued by decreasing the genetic dose of β-catenin/Ctnnb1. Taken together, our work defines a novel role for Gsk3β in skull development.

  3. Exocrine Pancreatic Insufficiency in Diabetic Patients: Prevalence, Mechanisms, and Treatment

    Directory of Open Access Journals (Sweden)

    Matteo Piciucchi

    2015-01-01

    Full Text Available Pancreas is a doubled-entity organ, with both an exocrine and an endocrine component, reciprocally interacting in a composed system whose function is relevant for digestion, absorption, and homeostasis of nutrients. Thus, it is not surprising that disorders of the exocrine pancreas also affect the endocrine system and vice versa. It is well-known that patients with chronic pancreatitis develop a peculiar form of diabetes (type III, caused by destruction and fibrotic injury of islet cells. However, less is known on the influence of diabetes on pancreatic exocrine function. Pancreatic exocrine insufficiency (PEI has been reported to be common in diabetics, with a prevalence widely ranging, in different studies, in both type I (25–74% and type II (28–54% diabetes. A long disease duration, high insulin requirement, and poor glycemic control seem to be risk factors for PEI occurrence. The impact of pancreatic exocrine replacement therapy on glycemic, insulin, and incretins profiles has not been fully elucidated. The present paper is aimed at reviewing published studies investigating the prevalence of PEI in diabetic patients and factors associated with its occurrence.

  4. Clinical feasibility of pre-operative neurodevelopmental assessment of infants undergoing open heart surgery.

    Science.gov (United States)

    Campbell, Miranda; Rabbidge, Bridgette; Ziviani, Jenny; Sakzewski, Leanne

    2017-08-01

    Assessing the neurodevelopmental status of infants with congenital heart disease before surgery provides a means of identifying those at heightened risk of developmental delay. This study aimed to investigate factors impacting clinical feasibility of pre-operative neurodevelopmental assessment of infants undergoing early open heart surgery. Infants who underwent open heart surgery prior to 4 months of age participated in this cross-sectional study. The Test of Infant Motor Performance and Prechtl's Assessment of General Movements were undertaken on infants pre-operatively. When assessments could not be undertaken, reasons were ascribed to either infant or environmental circumstances. Demographic data and Aristotle scores were compared between groups of infants who did or did not undergo assessment. Binary logistic regression was used to explore associations. A total of 60 infants participated in the study. Median gestational age was 38.78 weeks (interquartile range: 36.93-39.72). Of these infants, 37 (62%) were unable to undergo pre-operative assessment. Twenty-four (40%) could not complete assessment due to infant-related factors and 13 (22%) due to environmental-related factors. For every point increase in the Aristotle Patient-Adjusted Complexity score, the infants likelihood of being unable to undergo assessment increased by 35% (odds ratio: 0.35; 95% confidence interval: 1.03-1.77, P = 0.03). Over half of the infants undergoing open heart surgery were unable to complete pre-operative neurodevelopmental assessment. The primary reason for this was infant-related medical instability. Findings suggest further research is warranted to investigate whether the Aristotle Patient-Adjusted Complexity score might serve as an indicator to inform developmental surveillance with this medically fragile cohort. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  5. Preoperative Detection of Sarcopenic Obesity Helps to Predict the Occurrence of Gastric Leak After Sleeve Gastrectomy.

    Science.gov (United States)

    Gaillard, Martin; Tranchart, Hadrien; Maitre, Sophie; Perlemuter, Gabriel; Lainas, Panagiotis; Dagher, Ibrahim

    2018-03-02

    Sleeve gastrectomy (SG) has become the primary procedure for many bariatric teams and staple-line leak represents its most feared complication. Sarcopenic obesity combines the risks of obesity and depleted lean mass leading possibly to an inferior surgical outcome after abdominal surgery. The aim of this study was to evaluate the existence of a potential link between radiologically determined sarcopenic obesity and staple-line leak risk after SG. A retrospective analysis of a prospective database was performed in consecutive patients undergoing SG as primary procedure. Total psoas muscles (TPA) and total visible muscles (TMA) areas were measured on a preoperative computed tomography (CT). Sarcopenia was defined as lowest tertile of skeletal muscular mass indexes (muscular areas over square of height) in each gender (using TPA or TMA). Multivariate analysis was performed to determine preoperative risk factors for staple-line leak. During the study period, 205 patients were included in the analysis. Median BMI was 40.8 kg/m 2 (34.2-49.6), and 9 patients (4.4%) presented a gastric leak. The sex-specific cut-offs for skeletal muscular mass index according to TPA were 8.2 cm 2 /m 2 for men and 6.08 cm 2 /m 2 for women. After multivariate analysis, preoperative weight (OR = 1043) and sarcopenia (TPA) (OR = 5204) were independent predictive factors for gastric leak. The present series suggests that CT scan-determined sarcopenic obesity is associated with increased risk of gastric leak after SG. This preoperatively radiological examination would be a useful clinical tool to tailor patient management according to gastric leak risk.

  6. EFFECT OF PREOPERATIVE PAIN AND DEPRESSIVE SYMPTOMS ON THE DEVELOPMENT OF POSTOPERATIVE DELIRIUM.

    Science.gov (United States)

    Kosar, Cyrus M; Tabloski, Patricia A; Travison, Thomas G; Jones, Richard N; Schmitt, Eva M; Puelle, Margaret R; Inloes, Jennifer B; Saczynski, Jane S; Marcantonio, Edward R; Meagher, David; Reid, M Carrington; Inouye, Sharon K

    2014-11-01

    Preoperative pain and depression predispose patients to delirium. Our goal was to determine whether pain and depressive symptoms interact to increase delirium risk. We enrolled 459 persons without dementia aged ≥70 years scheduled for elective orthopedic surgery. At baseline, participants reported their worst and average pain within seven days and current pain on a 0-10 scale. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale and chart. Delirium was assessed with the Confusion Assessment Method and chart. We examined the relationship between preoperative pain, depressive symptoms and delirium using multivariable analysis of pain and delirium stratified by presence of depressive symptoms. Delirium, occurring in 23% of the sample, was significantly higher in those with depressive symptoms at baseline than those without (relative risk, RR, 1·6, 95% confidence interval, CI, 1·2-2·3). Preoperative pain was associated with an increased adjusted risk for delirium across all pain measures (RR from 1·07-1·08 per point of pain). In stratified analyses, patients with depressive symptoms had a 21% increased risk for delirium for each one-point increase in worst pain score, demonstrating a significant interaction ( P =0·049). Similarly, a significant 13% increased risk for delirium was demonstrated for a one-point increase in average pain score, but the interaction did not achieve statistical significance. Preoperative pain and depressive symptoms demonstrated increased risk for delirium independently and with substantial interaction, suggesting a cumulative impact. Thus, pain and depression are vulnerability factors for delirium that should be assessed before surgery. U.S. National Institute on Aging.

  7. Quality assurance of pre-operative assessment--a review of quality assurance activities related to pre-operative assessment in nine hospitals in The Netherlands

    NARCIS (Netherlands)

    Klazinga, N. S.; Helsloot, R.

    1989-01-01

    Pre-operative assessment of patients for surgery is one of the most prevalent topics for quality assurance by peer-review in Dutch hospitals. This article describes the experiences with pre-operative assessment in nine hospitals. It is discussed why preoperative assessment is performed, what tests

  8. The variability in Oxford hip and knee scores in the preoperative period: is there an ideal time to score?

    Science.gov (United States)

    Quah, C; Holmes, D; Khan, T; Cockshott, S; Lewis, J; Stephen, A

    2018-01-01

    Background All NHS-funded providers are required to collect and report patient-reported outcome measures for hip and knee arthroplasty. Although there are established guidelines for timing such measures following arthroplasty, there are no specific time-points for collection in the preoperative period. The primary aim of this study was to identify whether there was a significant amount of variability in the Oxford hip and knee scores prior to surgical intervention when completed in the outpatient clinic at the time of listing for arthroplasty or when completed at the preoperative assessment clinic. Methods A prospective cohort study of patients listed for primary hip or knee arthroplasty was conducted. Patients were asked to fill in a preoperative Oxford score in the outpatient clinic at the time of listing. They were then invited to fill in the official outcome measures questionnaire at the preoperative assessment clinic. The postoperative Oxford score was then completed when the patient was seen again at their postoperative follow up in clinic. Results Of the total of 109 patients included in this study period, there were 18 (17%) who had a worse score of 4 or more points difference and 43 (39.4%) who had an improvement of 4 or more points difference when the scores were compared between time of listing at the outpatient and at the preoperative assessment clinic. There was a statistically significant difference (P = 0.0054) in the mean Oxford scores. Conclusions The results of our study suggest that there should be standardisation of timing for completing the preoperative patient-reported outcome measures.

  9. Primary Ovarian Insufficiency Induced by Fanconi Anemia E Mutation in a Mouse Model.

    Science.gov (United States)

    Fu, Chun; Begum, Khurshida; Overbeek, Paul A

    2016-01-01

    In most cases of primary ovarian insufficiency (POI), the cause of the depletion of ovarian follicles is unknown. Fanconi anemia (FA) proteins are known to play important roles in follicular development. Using random insertional mutagenesis with a lentiviral transgene, we identified a family with reduced fertility in the homozygous transgenic mice. We identified the integration site and found that the lentivirus had integrated into intron 8 of the Fanconi E gene (Fance). By RT-PCR and in situ hybridization, we found that Fance transcript levels were significantly reduced. The Fance homozygous mutant mice were assayed for changes in ovarian development, follicle numbers and estrous cycle. Ovarian dysplasias and a severe lack of follicles were seen in the mutant mice. In addition, the estrous cycle was disrupted in adult females. Our results suggest that POI has been induced by the Fance mutation in this new mouse model.

  10. Reduction of regurgitation in aortic insufficiency by inhibition of the renin/angiotensin conversion enzyme

    Energy Technology Data Exchange (ETDEWEB)

    Reske, S.N.; Heck, I.; Mattern, H.

    1984-10-01

    The effect of captopril-mediated afterload reduction on regurgitation was investigated in 10 patients with aortic insufficiency. Regurgitation was quantitated by the regurgitation fraction and the relation of regurgitant volume to end-diastolic volume, which were derived from gated radionuclide ventriculography. 19 patients with coronary artery disease and no evidence of valvular heart disease served as controls. In patients with coronary artery disease no significant reguration was found. In patients with aortic regurgitation the blood concentration of angiotensin I increased whereas that of angiotensin II decreased significantly after captopril-medication; thus, the conversion of angiotensin I to II was reduced to about 50% of the control value. Whereas blood pressure and heart rate did not change significantly, the regurgitation fraction and the normalized regurgitant volume were significantly reduced. The ejection fraction remained essentially unchanged. These findings suggest a favorable influence of captopril-induced afterload reduction on hemodynamics in aortic regurgitation.

  11. Vitamin D status is insufficient in the majority of children at diagnosis of nephrotic syndrome

    DEFF Research Database (Denmark)

    Nielsen, Cecilie Ane; Jensen, Jens-Erik Bech; Cortes, Dina

    2015-01-01

    (p = 0.048). CONCLUSION: The vitamin D status was insufficient in 93% of the patients. We suggest that vitamin D status in children with NS be measured routinely at the time of diagnosis so that an individual treatment strategy for vitamin D defi-ciency can be given. Further studies are needed......INTRODUCTION: Children with nephrotic syndrome (NS) are treated for at least 12 weeks with high doses of prednisolone, which may be harmful to the bones. Vitamin D deficiency is also harmful to the bones. METHODS: This was a prospective study of consecutive children with first episode of NS...... at the time of their diagnosis before treatment with glucocorticoids. The following plasma levels were measured: 25-hydroxy-vitamin-D (25(OH)D), albumin, ionised calcium, phosphate, parathyroid hormone (PTH), alkaline phosphatase and creatinine. The glomerular filtration rate (GFR) was estimated from...

  12. Vitamin D status is insufficient in the majority of children at diagnosis of nephrotic syndrome

    DEFF Research Database (Denmark)

    Nielsen, Cecilie Ane; Jensen, Jens-Erik Bech; Cortes, Dina

    2015-01-01

    (p = 0.048). CONCLUSION: The vitamin D status was insufficient in 93% of the patients. We suggest that vitamin D status in children with NS be measured routinely at the time of diagnosis so that an individual treatment strategy for vitamin D deficiency can be given. Further studies are needed......INTRODUCTION: Children with nephrotic syndrome (NS) are treated for at least 12 weeks with high doses of prednisolone, which may be harmful to the bones. Vitamin D deficiency is also harmful to the bones. METHODS: This was a prospective study of consecutive children with first episode of NS...... at the time of their diagnosis before treatment with glucocorticoids. The following plasma levels were measured: 25-hydroxy-vitamin-D (25(OH)D), albumin, ionised calcium, phosphate, parathyroid hormone (PTH), alkaline phosphatase and creatinine. The glomerular filtration rate (GFR) was estimated from...

  13. Preoperative embolization in surgical treatment of spinal metastases

    DEFF Research Database (Denmark)

    Clausen, Caroline; Dahl, Benny; Frevert, Susanne Christiansen

    2015-01-01

    PURPOSE: To assess whether preoperative transcatheter arterial embolization of spinal metastases reduces blood loss, the need for transfusion with allogeneic red blood cells (RBCs), and surgery time in the surgical treatment of patients with symptomatic metastatic spinal cord compression. MATERIALS......L) versus 902 mL (SD, 416 mL). CONCLUSIONS: Preoperative embolization in patients with symptomatic spinal metastasis independent of primary tumor diagnosis did not reduce intraoperative blood loss and allogeneic RBC transfusion significantly but did reduce the surgery time. A small reduction...... instrumentation and randomly assigned to either preoperative embolization (n = 23) or a control group (n = 22). The primary outcome was intraoperative blood loss. Secondary outcomes were perioperative blood loss, allogeneic RBC transfusion, and surgery time. Analyses were performed by intention-to-treat. RESULTS...

  14. Effects of preoperative irradiation on primary tracheal anastomosis

    International Nuclear Information System (INIS)

    Tsubota, N.; Simpson, W.J.; Van Nostrand, A.W.P.; Pearson, F.G.

    1975-01-01

    Preoperative radiotherapy was used in the management of selected patients with cancer of the lung or trachea who might subsequently require segmental resection of bronchus or trachea and reconstruction by primary anastomosis. This study was designed to determine the effects of varying dosages of preoperative irradiation on anastomotic healing. Two rings were resected from the cervical trachea of 20 dogs following irradiation with varying doses of cesium. There were no important adverse effects on healing of the trachea or adjacent organs in dogs receiving up to 3,500 rads. All dogs receiving a higher dose than this developed some anastomotic stenosis, which was severe in 6 of 8 animals. Similar adverse effects were observed in 2 patients managed by preoperative radiotherapy (4,000 rads in three weeks) and tracheal resection with primary anastomosis

  15. Preoperative gemcitabine-based chemoradiation therapy for resectable pancreatic cancer

    International Nuclear Information System (INIS)

    Takahashi, Hidenori; Ohigashi, Hiroaki; Goto, Kunihito; Marubashi, Shigeru; Yano, Masahiko; Ishikawa, Osamu

    2013-01-01

    During the period from 2002 to 2011, a total of 240 consecutive patients with resectable pancreatic cancer received preoperative chemoradiation therapy (CRT). Among 240 patients, 201 patients underwent the subsequent pancreatectomy (resection rate: 84%). The 5-year overall survival of resected cases was 56% and the median survival of 39 unresected cases was 11 months. The 5-year locoregional recurrence rate of resected cases was 15%. The 5-year overall survival of the entire cohort (n=240) was 47%. The preoperative CRT and subsequent pancreatectomy provided a favorable surgical result, which was contributed by several characteristics of preoperative CRT: the prominent locoregional treatment effect with lower incidence of locoregional recurrence, and the discrimination between patients who are likely to benefit from subsequent surgery and those who are not. (author)

  16. Indications of laparoscopic cholecystectomy based on preoperative imaging findings

    International Nuclear Information System (INIS)

    Wakizaka, Yoshitaka; Sano, Syuichi; Nakanishi, Yoshimi; Koike, Yoshinobu; Ozaki, Susumu; Iwanaga, Rikizo; Uchino, Junichi.

    1994-01-01

    We studied the indications for laparoscopic cholecystectomy (LC) and values of preoperative imaging findings in 82 patients who underwent preoperative imaging diagnostic tests (abdominal echogram, abdominal CAT scan, ERCP). We analyzed mainly patients who were considered to be indicated for LC but whose gallbladders could be removed by open laparotomy, or whose gallbladders were removed by open laparotomy but were considered indicated for LC from retrospective study. We found the following results. LC could be easily performed in patients with a history of severe acute cholecystitis if they had no findings of a thickened wall or negative gallbladder signs. Abdominal echogram and CAT scan were the best preoperative imaging tests for determining the gallbladder's state, especially for obstruction of the cystic duct. These results are important today when the operative indications of LC are extremely indefinite because of the accumulation of operative experience and technological improvements. (author)

  17. Effects of preoperative irradiation on primary tracheal anastomosis

    Energy Technology Data Exchange (ETDEWEB)

    Tsubota, N.; Simpson, W.J.; Van Nostrand, A.W.P.; Pearson, F.G.

    1975-08-01

    Preoperative radiotherapy was used in the management of selected patients with cancer of the lung or trachea who might subsequently require segmental resection of bronchus or trachea and reconstruction by primary anastomosis. This study was designed to determine the effects of varying dosages of preoperative irradiation on anastomotic healing. Two rings were resected from the cervical trachea of 20 dogs following irradiation with varying doses of cesium. There were no important adverse effects on healing of the trachea or adjacent organs in dogs receiving up to 3,500 rads. All dogs receiving a higher dose than this developed some anastomotic stenosis, which was severe in 6 of 8 animals. Similar adverse effects were observed in 2 patients managed by preoperative radiotherapy (4,000 rads in three weeks) and tracheal resection with primary anastomosis.

  18. Pre-operative pain and sensory function in groin hernia

    DEFF Research Database (Denmark)

    Aasvang, Eske K; Hansen, Jeanette B; Kehlet, Henrik

    2009-01-01

    (rho=-0.413, p=0.049), indicating a paradoxical association between level of mechanical pain threshold and magnitude of spontaneous pain. No other sensory modality was significantly correlated to pain intensity. New/increased pain during repetitive pinprick stimulation (wind-up) was seen in 3 patients...... mechanism. AIMS: To investigate the correlation between pre-operative pain intensity and sensory functions in the groin hernia area. METHODS: Patients with unilateral groin hernia were examined preoperatively by quantitative sensory testing (thermal, mechanical, and pressure [detection and pain thresholds...... pain is not related to findings of hyperalgesia or other changes in sensory function that may support pain-induced pre-operative neuroplasticity as a pathogenic mechanism for the development of persistent postherniotomy pain....

  19. Safe pediatric surgery: development and validation of preoperative interventions checklist

    Directory of Open Access Journals (Sweden)

    Maria Paula de Oliveira Pires

    2013-09-01

    Full Text Available OBJECTIVES: this study was aimed at developing and validating a checklist of preoperative pediatric interventions related to the safety of surgical patients. METHOD: methodological study concerning the construction and validation of an instrument with safe preoperative care indicators. The checklist was subject to validation through the Delphi technique, establishing a consensus level of 80%. RESULTS: five professional specialists in the area conducted the validation and a consensus on the content and the construct was reached after two applications of the Delphi technique. CONCLUSION: the "Safe Pediatric Surgery Checklist", simulating the preoperative trajectory of children, is an instrument capable of contributing to the preparation and promotion of safe surgery, as it identifies the presence or absence of measures required to promote patient safety.

  20. Preoperative Education for Hip and Knee Replacement: Never Stop Learning.

    Science.gov (United States)

    Edwards, Paul K; Mears, Simon C; Lowry Barnes, C

    2017-09-01

    Participation in alternative payment models has focused efforts to improve outcomes and patient satisfaction while also lowering cost for elective hip and knee replacement. The purpose of this review is to determine if preoperative education classes for elective hip and knee replacement achieve these goals. Recent literature demonstrates that patients who attend education classes prior to surgery have decreased anxiety, better post-operative pain control, more realistic expectations of surgery, and a better understanding of their surgery. As a result, comprehensive clinical pathways incorporating a preoperative education program for elective hip and knee replacement lead to lower hospital length of stay, higher home discharge, lower readmission, and improved cost. In summary, we report convincing evidence that preoperative education classes are an essential element to successful participation in alternative payment models such as the Bundle Payment Care Initiative.

  1. Food insufficiency and food insecurity as risk factors for physical disability among Palestinian refugees in Lebanon: Evidence from an observational study.

    Science.gov (United States)

    Salti, Nisreen; Ghattas, Hala

    2016-10-01

    Potential interactions between malnutrition and disability are increasingly recognized, and both are important global health issues. Causal effects working from nutrition to disability and from disability back to nutrition present an empirical challenge to measuring either of these effects. However, disability affects nutrition whatever the cause of disability, whereas nutrition is likelier to affect disease-related disability than war- or work-related disability. This paper investigates the association of food insufficiency with the risk of physical disability. Data on disability by cause allow us to address the difficulty of reverse causality. Multinomial logit regressions of disability by cause on food insufficiency are run using survey data from 2010 on 2575 Palestinian refugee households in Lebanon. Controls include household sociodemographic, health and economic characteristics. Regressions of food insufficiency on disability by cause are also run. Disability has a significant coefficient in regressions of food insufficiency, whatever the cause of disability; but in regressions of disability on food insufficiency, food insufficiency is significant only for disease-related disability (log odds of disease-related disability .78 higher, p = .008). The difference in the results by cause of disability is evidence of a significant association between food insufficiency and disease-related disability, net of any reverse effect from disability to food access. The association between disease-related disability and food insufficiency is statistically significant suggesting that even taking into account feedback from disability to nutrition, nutrition is an effective level of intervention to avert the poverty-disability trap resulting from the impoverishing effect of disability. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Pretreatment clinical findings predict outcome for patients receiving preoperative radiation for rectal cancer

    International Nuclear Information System (INIS)

    Myerson, Robert J.; Singh, Anurag; Birnbaum, Elisa H.; Fry, Robert D.; Fleshman, James W.; Kodner, Ira J.; Lockett, Mary Ann; Picus, Joel; Walz, Bruce J.; Read, Thomas E.

    2001-01-01

    adverse clinical factors were present: 0 for none, 1 for one or two, 2 for three or four. This sorted outcome highly significantly (p≤0.002, Tarone Ware), with 5-year LC/FFR of 98%/85% (score 0), 90%/72% (score 1), and 74%/58% (score 2). The scoring system sorts the data for both subgroups of surgeons; however, there are substantial differences in LC on the basis of the surgeon's experience. For colorectal specialists (251 cases), the 5-year LC is 100%, 94%, and 78% for scores of 0, 1, and 2, respectively (p=0.004). For the more mixed group of nonspecialist surgeons (133 cases), LC is 98%, 80%, and 65% for scores of 0, 1, and 2 (p=0.008). In multivariate analysis, the clinical score and surgeon's background retained independent predictive value, even when pathologic stage was included. Conclusions: For many patients with rectal cancer, adjuvant treatment can be administered in a well-tolerated sequential fashion--moderate doses of preoperative radiation followed by surgery followed by postoperative chemotherapy to address the risk of occult metastatic disease. A clinical scoring system has been presented here that would suggest that the local control is excellent for lesions with a score of 0 or (if the surgeon is experienced) 1, and therefore sequential treatment could be considered. Cases with a clinical score of 2 should be strongly considered for protocols evaluating more aggressive preoperative treatment, such as combined modality preoperative treatment

  3. Assessment of patient satisfaction with the preoperative anesthetic evaluation

    Directory of Open Access Journals (Sweden)

    Gebremedhn EG

    2014-09-01

    Full Text Available Endale Gebreegziabher Gebremedhn, Vidhya Nagaratnam Department of Anesthesia, School of Medicine, Gondar College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Background: The evaluation of patient satisfaction is a core aspect of the continuous quality improvement in anesthesia service that can be affected by the preoperative anesthetist visit. This visit enables the anesthetist to know about the patient's general health status and the nature of surgery, to choose the type of anesthesia, and to discuss perioperative complications and their management with the patient. Patients have sometimes complained about the information given during the preoperative anesthetic evaluation in the University of Gondar teaching and referral hospital. The aim of this study was to determine the level of patient satisfaction with the preoperative anesthetist visit. Methods: A cross-sectional study was conducted from February 15 to April 15, 2013. All consecutive elective patients who were operated upon under anesthesia during the study period were interviewed 24 hours after operation. A pretested questionnaire and checklists, which were developed based on the hospital's anesthetic evaluation sheet, were used for data collection. Results: A total of 116 elective patients were operated upon under anesthesia during the study period. Of these, 102 patients were included in our study, with a response rate of 87.9%. Anesthetists introduced themselves to ~24% patients; provided information about anesthesia to ~32%, postoperative complications to ~21%, postoperative analgesia to ~18, and postoperative nausea and vomiting to ~21%; and spent adequate time with ~74%. Patients' questions were answered by the anesthetist in ~65% of cases, and ~65% of patients had reduced anxiety after the anesthetist visit. The patients' overall satisfaction with the preoperative anesthetist visit was ~65%. Conclusion and recommendation: Patient satisfaction with the

  4. Do Mixed-Flora Preoperative Urine Cultures Matter?

    Science.gov (United States)

    Polin, Michael R; Kawasaki, Amie; Amundsen, Cindy L; Weidner, Alison C; Siddiqui, Nazema Y

    2017-06-01

    To determine whether mixed-flora preoperative urine cultures, as compared with no-growth preoperative urine cultures, are associated with a higher prevalence of postoperative urinary tract infections (UTIs). This was a retrospective cohort study. Women who underwent urogynecologic surgery were included if their preoperative clean-catch urine culture result was mixed flora or no growth. Women were excluded if they received postoperative antibiotics for reasons other than treatment of a UTI. Women were divided into two cohorts based on preoperative urine culture results-mixed flora or no growth; the prevalence of postoperative UTI was compared between cohorts. Baseline characteristics were compared using χ 2 or Student t tests. A logistic regression analysis then was performed. We included 282 women who were predominantly postmenopausal, white, and overweight. There were many concomitant procedures; 46% underwent a midurethral sling procedure and 68% underwent pelvic organ prolapse surgery. Preoperative urine cultures resulted as mixed flora in 192 (68%) and no growth in 90 (32%) patients. Overall, 14% were treated for a UTI postoperatively. There was no difference in the proportion of patients treated for a postoperative UTI between the two cohorts (25 mixed flora vs 13 no growth, P = 0.77). These results remained when controlling for potentially confounding variables in a logistic regression model (adjusted odds ratio 0.92, 95% confidence interval 0.43-1.96). In women with mixed-flora compared with no-growth preoperative urine cultures, there were no differences in the prevalence of postoperative UTI. The clinical practice of interpreting mixed-flora cultures as negative is appropriate.

  5. Low Prevalence of Vitamin D Insufficiency among Nepalese Infants Despite High Prevalence of Vitamin D Insufficiency among Their Mothers

    Directory of Open Access Journals (Sweden)

    Johanne Haugen

    2016-12-01

    Full Text Available Background: Describing vitamin D status and its predictors in various populations is important in order to target public health measures. Objectives: To describe the status and predictors of vitamin D status in healthy Nepalese mothers and infants. Methods: 500 randomly selected Nepalese mother and infant pairs were included in a cross-sectional study. Plasma 25(OHD concentrations were measured by LC-MS/MS and multiple linear regression analyses were used to identify predictors of vitamin D status. Results: Among the infants, the prevalence of vitamin D insufficiency (25(OHD <50 nmol/L and deficiency (<30 nmol/L were 3.6% and 0.6%, respectively, in contrast to 59.8% and 14.0% among their mothers. Infant 25(OHD concentrations were negatively associated with infant age and positively associated with maternal vitamin D status and body mass index (BMI, explaining 22% of the variability in 25(OHD concentration. Global solar radiation, maternal age and BMI predicted maternal 25(OHD concentration, explaining 9.7% of its variability. Conclusion: Age and maternal vitamin D status are the main predictors of vitamin D status in infants in Bhaktapur, Nepal, who have adequate vitamin D status despite poor vitamin D status in their mothers.

  6. Communicating about nuclear events: Some suggestions to improve INES

    International Nuclear Information System (INIS)

    Kermisch, Céline; Labeau, Pierre-Etienne

    2013-01-01

    This paper provides a critical analysis of the International Nuclear and Radiological Event Scale (INES) and its use, both from an epistemic and an ethical perspective. As very few papers have been dedicated to this subject, our critical analysis is mainly based on the INES 2009 User's Manual and on technical information issued by different nuclear agencies. Our critical analysis leads to suggest several elements, which could contribute to the improvement of the INES scale and thereby to a better communication about nuclear events. First, we show that multiple criteria are used to assign an INES rating, which could lead to an insufficient differentiation between events. In order to avoid this issue, we suggest to clarify the criteria that are used to assess the level of the event. Then, we show that level 7 of the INES scale is ill-defined as it does not allow to properly take differences in severity between disasters into account. In this regard, we recommend to use an open scale instead. Moreover, we highlight the fact that INES is able to take into account neither events with long-term evolution nor events involving multiple initiators. In this respect, we suggest providing additional guidelines and reflecting about the data on which to rely, in order to assess an INES level. Furthermore, we reflect on who should be rating a nuclear event and we recommend that, for severe events, an independent and plural agency should be in charge. Finally, we show why INES appears to be insufficient for a global communication, and we suggest to complement the INES rating with additional information in parallel. -- Highlights: •We provide a critical analysis of the INES scale and suggestions to improve it. •The rating criteria should be clarified to allow differentiation between events. •An open scale should be used to differentiate between level-7 accidents. •Additional guidelines should be provided for complex and evolving events. •We provide suggestions to satisfy

  7. Preoperative CT evaluation on nasal cavity for transsphenoidal approach

    International Nuclear Information System (INIS)

    Saeki, Naokatsu; Yamaura, Akira; Hoshi, Seiichiro; Sunada, Souichi; Sunami, Kenro

    1997-01-01

    Preoperative bone CT scans sliced parallel to the surgical plane were evaluated in 32 cases of transsphenoidal surgery. This method predicted patients with narrow nasal cavity, and helped to determine the rhinological maneuvers for providing a wider operative field. In addition, it helps to plan the need and extent of sella floor removal in re-operated cases. There was relatively little difference in the width and length of the nasal cavity between acromegalic and non-acromegalic patients. Hence, bone CT scans are useful in the preoperative evaluation of patients undergoing transsphenoidal surgery. (author)

  8. Preoperative intraluminal irradiation of the extrahepatic bile duct tumor

    International Nuclear Information System (INIS)

    Kamada, Tadashi; Tsujii, Hirohiko; Arimoto, Takuro; Irie, Goro.

    1991-01-01

    From 1984 through 1986, six patients with extrahepatic bile duct tumor were treated preoperatively with intraluminal irradiation of the bile duct. There were no unresectable cases and pathological examination of the surgical specimens showed moderate to remarkable tumor regression in all cases. Postoperative biliary tract hemorrhage occurred in 2 of 3 patients who received 60 Gy at a point 7.5 mm from the center of the source. With accurate preoperative diagnosis of the tumor extent and careful setting of the target area of intraluminal irradiation, improved local tumor control of extrahepatic bile duct tumor can be expected with this method. (author)

  9. Effect of preoperative irradiation on healing of low colorectal anastomoses

    International Nuclear Information System (INIS)

    Morgenstern, L.; Sanders, G.; Wahlstrom, E.; Yadegar, J.; Amodeo, P.

    1984-01-01

    The effect of preoperative irradiation on the healing of low colorectal anastomoses was studied experimentally. In 12 dogs in whom preoperative irradiation of 4,000 rads was given before low colorectal stapled anastomosis was performed, anastomotic leakage occurred in 66 percent. More than half of the anastomotic leaks were associated with either severe sepsis or death. In a matched group of control animals that underwent stapled anastomoses without irradiation, no anastomotic complications occurred. The clinical implications of this study are that stapled anastomoses in irradiated colon are at serious risk of anastomotic dehiscence and, therefore, should be protected with a proximal colostomy

  10. Preoperative visual field deficits in temporal lobe epilepsy

    Directory of Open Access Journals (Sweden)

    Sanjeet S. Grewal

    2017-01-01

    Full Text Available Surgical resection and laser thermoablation have been used to treat drug resistant epilepsy with good results. However, they are not without risk. One of the most commonly reported complications of temporal lobe surgery is contralateral superior homonymous quadrantanopsia. We describe a patient with asymptomatic preoperative quadrantanopsia fortuitously discovered as part of our recently modified protocol to evaluate patients prior to temporal lobe epilepsy surgery. This visual field deficit was subtle and not detected on routine clinical neurological examination. While we understand that this is a single case, we advocate further study for more detailed preoperative visual field examinations to characterize the true incidence of postoperative visual field lesions.

  11. Preoperative diagnosis of Amyand's hernia by ultrasound and computed tomography

    Directory of Open Access Journals (Sweden)

    Husam Vehbi

    2016-06-01

    Full Text Available Inguinal hernia is the most common seen groin hernias which mostly contain bowel. The incidence of vermiform appendix in an inguinal hernia is seen in 1% of all inguinal hernia. This is known as Amyand's hernia. Appendix within a hernia can be normal or complicated by appendicitis. Most of these cases are not diagnosed preoperatively and managed during surgery. Preoperative diagnosis of these cases is so rare. Very few cases have been reported so far.In our case, we diagnosed an inflamed appendix in a 49 years old female within right inguinal hernia by using ultrasound and confirmed it by CT scan. Keywords: Amyand's hernia, Appendicitis

  12. Insufficiency of Medical Care for Patients with Acute Respiratory Failure

    Directory of Open Access Journals (Sweden)

    A. V. Dats

    2017-01-01

    Full Text Available The purpose of the research: to analyze insufficiency of medical care for patients with acute respiratory failure in the ICU.Materials and methods. It was a retrospective study of 160 patients' medical records (age from 15 to 84 years with acute respiratory failure (ARF hospitalized in the ICUs of 24 regional and municipal hospitals of the Irkutsk Oblast. Medical records were provided by the Territorial Fund of Compulsory Medical Insurance of citizens of Irkutsk region.The results. The basic defects in conducting mechanical ventilation were associated with improper lung function evaluation, microbiological tests of sputum and radiology. ARF was not diagnosed in 32 of 160 ICU patients (20%. In 23% of cases the causes of ARF were not diagnosed. The greatest part of the defects in the treatment of patients with acute respiratory failure was found during the treatment of hypoxemia: no recovery of the respiratory tract patency, no prescription of oxygen for hypoxemia, no mechanical ventilation for persistent hypoxemia on the background of maximum oxygen supply and late switching to mechanical ventilation at the stage of hypoxic cardiac arrest.Conclusions. The use of pulse oximetry alone in the absence of arterial blood gas analysis in 98% of patients with acute respiratory failure and failure to perform the lung X-ray and/or MSCT imaging in 21% of patients were accompanied by a high level of undiagnosed acute respiratory distress syndrome (78%, lung contusion (60%, pulmonary embolism (40%, cardiogenic pulmonary edema (33%, and nosocomial pneumonia (28%. Defects of treatment of patients with ARF in 46% of cases were caused by inadequate management of hypoxemia associated with the recovery of the respiratory tract patency, prescription of oxygen, and mechanical ventilation. 

  13. [Physiotherapy in outpatients with osteoporosis. Insufficient evidence for therapy success].

    Science.gov (United States)

    Lange, U; Müller-Ladner, U; Teichmann, J

    2012-06-01

    This prospective study analyzed the quality and number of physiotherapeutic reports, the cooperation between physiotherapists and rheumatologists/osteologists as well as the correctness of the physiotherapy in relation to the respective prescription within the German medical healthcare system. Furthermore, it was evaluated whether reported information is sufficient to evaluate outpatient physiotherapy. In 475 physiotherapeutic prescriptions for conservative treatment of patients with osteoporosis, the report quality was evaluated prospectively. The types of prescription and actually performed physiotherapy were compared. The ability of the patients to demonstrate the exercises, as had to be learned during therapy, was analyzed and also the number of mandatory documented questioned follow-up forms. Furthermore, the efficiency of different types of physiotherapy was evaluated. Only 46 reports from 475 prescriptions were received, i.e., the obligation to report was performed only in 9.7% of the cases. Depending on the type of physiotherapy, there was a different range in reporting (classical massage 6.8%, thermotherapy 12.8%, active muscle training with weights and resistant exercises or in water 9.1-20.4% and electrical field treatment 20%). In 141 prescriptions the patients should have learned to do the exercises by themselves as a home program. However, only 38 patients (27%) were able to demonstrate this at the reassessment appointment. In addition in 38 cases of the 46 reports, i.e. in 82.6%, the physiotherapist asked for another prescription. The data illustrate that for outpatient treatment of osteoporosis patients there is insufficient cooperation between physiotherapists and rheumatologists and/or osteologists. Owing to this shortcoming, the efficiency of physiotherapy could not be evaluated due to lack of prescription reports. Therefore, new control mechanisms as well as sufficient education in prescription of physiotherapy should be implemented.

  14. Mean Platelet Volume in Patients with Chronic Venous Insufficiency

    Directory of Open Access Journals (Sweden)

    Mehmet Akif Sarıca

    2016-03-01

    Full Text Available Objective: the mean platelet volume (MPV is a good indicator of platelet activity; it is reported to increase in diseases associated with inflammatory processes and in vascular diseases. This study investigated the importance of mean platelet volume in patients with chronic venous insufficiency (CVI and whether the MPV was likely to be a predictor of the CVI. Methods: 117 patients who were diagnosed as CVI by colored Doppler Ultrasound (CDU method and 49 healthy volunteers (forming the control group were en­rolled to this study, which was planned retrospectively. The patients’ blood count values taken within one month before and after the CDU evaluation were recorded by the hospital information system. The complete blood count, routine biochemical tests and thyroid function tests of the patients diagnosed with CVI were compared to the control group. Results: Significant differences were not detected be­tween the patients and the control group in terms of the levels of creatinine, aspartate aminotransferase, total cholesterol, LDL cholesterol, HDL cholesterol, triglycer­ides, erythrocyte, sedimentation speed, leukocyte, hae­moglobin and thrombocyte (p>0.05. The thyroid stimulat­ing hormone and the MPV levels were significantly lower in the control group (p<0.05. Conclusion: MPV levels as an easy, cheap and practi­cal data extracted from complete blood count, were found higher in patients diagnosed with CVI compared to the control group. This may be originated from endothelium changes as an answer to venous hypertension and dila­tation in CVI. MPV can be used as a follow-up marker in CVI patients. J Clin Exp Invest 2016; 7 (1: 73-77

  15. Role of preoperative air-bone gap in tinnitus outcome after tympanoplasty for chronic otitis media with tinnitus.

    Science.gov (United States)

    Kim, Hong Chan; Jang, Chul Ho; Kim, Young Yoon; Seong, Jong Yuap; Kang, Sung Hoon; Cho, Yong Beom

    Previous reports indicated that middle ear surgery might partially improve tinnitus after surgery. However, until now, no influencing factor has been determined for tinnitus outcome after middle ear surgery. The purpose of this study was to investigate the association between preoperative air-bone gap and tinnitus outcome after tympanoplasty type I. Seventy-five patients with tinnitus who had more than 6 months of symptoms of chronic otitis media on the ipsilateral side that were refractory to medical treatment were included in this study. All patients were evaluated through otoendoscopy, pure tone/speech audiometer, questionnaire survey using the visual analog scale and the tinnitus handicap inventory for tinnitus symptoms before and 6 months after tympanoplasty. The influence of preoperative bone conduction, preoperative air-bone-gap, and postoperative air-bone-gap on tinnitus outcome after the operation was investigated. The patients were divided into two groups based on preoperative bone conduction of less than 25dB (n=50) or more than 25dB (n=25). The postoperative improvement of tinnitus in both groups showed statistical significance. Patients whose preoperative air-bone-gap was less than 15dB showed no improvement in postoperative tinnitus using the visual analog scale (p=0.889) and the tinnitus handicap inventory (p=0.802). However, patients whose preoperative air-bone-gap was more than 15dB showed statistically significant improvement in postoperative tinnitus using the visual analog scale (ptinnitus handicap inventory (p=0.016). Postoperative change in tinnitus showed significance compared with preoperative tinnitus using visual analog scale (p=0.006). However, the correlation between reduction in the visual analog scale score and air-bone-gap (p=0.202) or between reduction in tinnitus handicap inventory score and air-bone-gap (p=0.290) was not significant. We suggest that the preoperative air-bone-gap can be a predictor of tinnitus outcome after

  16. Subchondral insufficiency fracture of the knee: a non-traumatic injury with prolonged recovery time

    OpenAIRE

    Gourlay, Margaret L; Renner, Jordan B; Spang, Jeffrey T; Rubin, Janet E

    2015-01-01

    Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. Patients with subchondral insufficiency fracture characteristically have unremarkable plain radiographs, while MRI examination may reveal extensive bone marrow oedema and subchondral bone collapse. This article presents a 51...

  17. Preoperative biliary drainage using a fully covered self-expandable metallic stent for pancreatic head cancer: A prospective feasibility study.

    Science.gov (United States)

    Togawa, Osamu; Isayama, Hiroyuki; Kawakami, Hiroshi; Nakai, Yousuke; Mohri, Dai; Hamada, Tsuyoshi; Kogure, Hirofumi; Kawakubo, Kazumichi; Sakamoto, Naoya; Koike, Kazuhiko; Kita, Hiroto

    2018-01-01

    The role of endoscopic preoperative biliary drainage (PBD) for pancreatic head cancer is controversial because of the high incidence of stent occlusion before surgery. This study was performed to evaluate the feasibility and safety of PBD using a fully covered self-expandable metallic stent (FCSEMS). This multicenter prospective study involved 26 patients treated for pancreatic head cancer with distal bile duct obstruction from April 2011 to March 2013. An FCSEMS was endoscopically placed in 24 patients. Among these, 7 patients were diagnosed with unresectable cancer, and 17 underwent surgery at a median of 18 days after FCSEMS placement. The main outcome measure was preoperative and postoperative adverse events. Two adverse events (cholecystitis and insufficient resolution of jaundice) occurred between FCSEMS placement and surgery (12%). Postoperative adverse events occurred in eight patients (47%). The cumulative incidence of stent-related adverse events 4 and 8 weeks after FCSEMS placement among the 24 patients who underwent this procedure were 19%. PBD using an FCSEMS is feasible in patients with resectable pancreatic head cancer. Placement of an FCSEMS can be an alternative PBD technique when surgery without delay is impossible. A larger randomized controlled trial is warranted.

  18. Chondropathia patellae - preoperative and postoperative demonstration of the patellar structure in plain roentgenography

    International Nuclear Information System (INIS)

    Schumacher, K.A.; Mutschler, W.; Bargon, G.

    1982-01-01

    The study is based on 86 patients surgically treated for chondromalacia patellae, who in a 2 year follow-up were controlled by defile-radiographs and clinical examination. While there was an improvement of all clinical symptoms examined, no significant change in the radiologic appearance of the patellar structure was observed as compared with the pre-operative status. This includes that neither significant changes indicating development of arthrosis nor aggravation of pre-existing arthrotic lesions could be found. However, it is commonly suggested from roentgenographic findings with type 3 lesions, that severe chondromalacia patellae may be a precursor of osteoarthrosis. (orig.) [de

  19. Chondropathia patellae - preoperative and postoperative demonstration of the patellar structure in plain roentgenography

    Energy Technology Data Exchange (ETDEWEB)

    Schumacher, K.A.; Mutschler, W.; Bargon, G.

    1982-07-01

    The study is based on 86 patients surgically treated for chondromalacia patellae, who in a 2 year follow-up were controlled by defile-radiographs and clinical examination. While there was an improvement of all clinical symptoms examined, no significant change in the radiologic appearance of the patellar structure was observed as compared with the pre-operative status. This includes that neither significant changes indicating development of arthrosis nor aggravation of pre-existing arthrotic lesions could be found. However, it is commonly suggested from roentgenographic findings with type 3 lesions, that severe chondromalacia patellae may be a precursor of osteoarthrosis.

  20. Accommodative insufficiency in a student population in Iran.

    Science.gov (United States)

    Hashemi, Hassan; Khabazkhoob, Mehdi; Nabovati, Payam; Shahraki, Fatemeh Azad; Ostadimoghaddam, Hadi; Faghihi, Mohammad; Aghamirsalim, Mohamadreza; Doostdar, Asgar; Yekta, Abbasali

    2018-05-22

    To determine the prevalence of accommodative insufficiency (AI) and its relation with age, gender, and refractive errors in a college-age student population in Iran. The present study was conducted cross-sectionally in 2017. All students had optometric tests including measurement of visual acuity, objective and subjective refraction, as well as binocular vision and accommodative examinations. Amplitude of accommodation was measured with the Donders' push-up method using the Royal Air Force (RAF) rule. Monocular accommodative facility was measured with ±2.00diopter flipper lenses. The accommodative response was tested using dynamic retinoscopy with the monocular estimation method (MEM). The prevalence of AI in the studied population was 4.07% (95% CI: 2.61-5.52). The rate was 6.04% (95% CI: 3.58-8.50) in females and 2.01% (95% CI: 0.53-3.48) in males, and logistic regression showed a significantly higher odds of AI in females (OR=3.14, 95% CI: 1.33-7.45, p-value=0.009). The prevalence of AI was 2.59% (95% CI: 0.55-7.56) in the 18-19-year-old age group and 4.08% (95% CI: 0.09-8.07) in the 24-25-year-old group (p-value=0.848). The prevalence of AI among emmetropic, myopic, and hyperopic individuals was 3.74% (95% CI: 1.88-5.61), 4.44% (95% CI: 2.07-6.81), and 5.26% (95% CI: 4.79-16.32), respectively (p-value=0.869). In the multiple regression model, only gender showed significant relationship with AI (Odds ratio=3.14, 95% CI: 1.33-7.45; p-values=0.009). The prevalence of AI in the present study is lower than the most prevalence rates reported in previous studies. In the present study, gender and AI showed a strong association, such that AI prevalence was significantly higher in females than males. Copyright © 2018 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.

  1. Diphtheria in Lao PDR: Insufficient Coverage or Ineffective Vaccine?

    Science.gov (United States)

    Nanthavong, Naphavanh; Black, Antony P; Nouanthong, Phonethipsavanh; Souvannaso, Chanthasone; Vilivong, Keooudomphone; Muller, Claude P; Goossens, Sylvie; Quet, Fabrice; Buisson, Yves

    2015-01-01

    During late 2012 and early 2013 several outbreaks of diphtheria were notified in the North of the Lao People's Democratic Republic. The aim of this study was to determine whether the re-emergence of this vaccine-preventable disease was due to insufficient vaccination coverage or reduction of vaccine effectiveness within the affected regions. A serosurvey was conducted in the Huaphan Province on a cluster sampling of 132 children aged 12-59 months. Serum samples, socio-demographic data, nutritional status and vaccination history were collected when available. Anti-diphtheria and anti-tetanus IgG antibody levels were measured by ELISA. Overall, 63.6% of participants had detectable diphtheria antibodies and 71.2% tetanus antibodies. Factors independently associated with non-vaccination against diphtheria were the distance from the health centre (OR: 6.35 [95% CI: 1.4-28.8], p = 0.01), the Lao Theung ethnicity (OR: 12.2 [95% CI:1,74-85, 4], p = 0.01) and the lack of advice on vaccination given at birth (OR: 9.8 [95% CI: 1.5-63.8], (p = 0.01) while the level of maternal edu-cation was a protective factor (OR: 0.08 [95% CI: 0.008-0.81], p = 0.03). Most respondents claimed financial difficulties as the main reason for non-vaccination. Out of 55 children whose vaccination certificates stated that they were given all 3 doses of diphtheria-containing vaccine, 83.6% had diphtheria antibodies and 92.7% had tetanus antibodies. Furthermore, despite a high prevalence of stunted and underweight children (53% and 25.8%, respectively), the low levels of anti-diphtheria antibodies were not correlated to the nutritional status. Our data highlight a significant deficit in both the vaccination coverage and diphtheria vaccine effectiveness within the Huaphan Province. Technical deficiencies in the methods of storage and distribution of vaccines as well as unreliability of vaccination cards are discussed. Several hypotheses are advanced to explain such a decline in immunity against

  2. Insufficiency fracture of the pelvis after the radiotherapy for carcinoma of the uterine cervix

    International Nuclear Information System (INIS)

    Nishimura, Tetsuo; Shimizu, Teppei; Sugiyama, Akira; Ichinohe, Kenji; Teshima, Takeshi; Takahashi, Motoichiro; Takai, Michikatsu; Kaneko, Masao

    1990-01-01

    Bone injury after radiotherapy for carcinoma of the uterine cervix has been reported since early days of this century. Recently, the concept of insufficiency fracture has been confirmed. Insufficiency fracture is one of the stress fractures and occurs when the elastic resistance of bone is inadequate to withstand normal or physiological stress. In the American and European studies, radiotherapy is known as a cause of insufficiency fracture. There are no reports on insufficiency fracture in the Japanese literatures. Four cases of carcinomas of the uterine cervix presented pelvic insufficiency fractures following radiotherapy. In the pubic bone, a vertical parasymphyseal fracture with mixed lytic and sclerotic changes of surrounding tissue is characteristic. Sacral insufficiency fracture shows a vertical or horizontal line with lytic and sclerotic appearance. Bone scintigraphy is a sensitive modality for the early detection. H-shaped configuration is diagnostic for sacral insufficiency fracture. CT is an accurate technique demonstrating a vertical fracture and excluding the malignant bony lesion. Although radiological findings of insufficiency fracture are similar to bone malignancy, differential diagnosis from malignant lesions is possible. Bony symptoms of all patients disappeared without specific treatments. In the follow-up study of patients with carcinomas of the uterine cervix after radiotherapy, it is important to have the consideration on insufficiency fracture. (author)

  3. Bedtime procrastination: A self-regulation perspective on sleep insufficiency in the general population.

    Science.gov (United States)

    Kroese, Floor M; Evers, Catharine; Adriaanse, Marieke A; de Ridder, Denise T D

    2016-05-01

    Getting insufficient sleep has serious consequences in terms of mental and physical health. The current study is the first to approach insufficient sleep from a self-regulation perspective by investigating the phenomenon of bedtime procrastination: going to bed later than intended, without having external reasons for doing so. Data from a representative sample of Dutch adults (N = 2431) revealed that a large proportion of the general population experiences getting insufficient sleep and regularly goes to bed later than they would like to. Most importantly, a relationship between self-regulation and experienced insufficient sleep was found, which was mediated by bedtime procrastination. © The Author(s) 2014.

  4. Preoperative imaging and surgical margins in maxillectomy patients

    NARCIS (Netherlands)

    Kreeft, Anne Marijn; Smeele, Ludwig E.; Rasch, Coen R. N.; Hauptmann, Michael; Rietveld, Derk H. F.; Leemans, C. René; Balm, Alfons J. M.

    2012-01-01

    Background High rates of positive surgical margins are reported after a maxillectomy. A large part of tumors that are preoperatively considered operable can thus not be resected with tumor-free margins. Methods This was a retrospective study on medical files of 69 patients that underwent

  5. Comparison between preoperative biopsy and post-excision ...

    African Journals Online (AJOL)

    peripheral nerve sheath tumour (6%).[6] Soft-tissue sarcomas most frequently affect the extremities and include MFH (40%), lipo- sarcoma (25%), synovial sarcoma and fibrosarcoma.[7]. Appropriate management is reliant on an accurate preoperative histology result. Excision biopsy is recommended for tumours. <3 cm in ...

  6. Preoperative B-type natriuretic peptide risk stratification: do ...

    African Journals Online (AJOL)

    2012-09-11

    Sep 11, 2012 ... and noncardiac surgery.6,7 An individual patient data meta- analysis of 850 patients undergoing vascular surgery found that preoperative BNP ..... range. BNP: B-type natriuretic peptide, CVA: cerebrovascular accident, RCRI: revised cardiac risk index ... and avoiding the use of blood stored for >14 days.

  7. Anxiety in the preoperative phase of awake brain tumor surgery

    NARCIS (Netherlands)

    Ruis, Carla; Huenges Wajer, I.M.C.; Robe, Pierre; van Zandvoort, Martine

    OBJECTIVE: Awake surgery emerges as a standard of care for brain tumors located in or near eloquent areas. Levels of preoperative anxiety in patients are important, because anxiety can influence cognitive performance and participation, hence altering the outcome of the procedure. In this study we

  8. Anxiety in the preoperative phase of awake brain tumor surgery

    NARCIS (Netherlands)

    Ruis, C.; Huenges Wajer, I.M.C.; Robe, Pierre; van Zandvoort, M.J.E.

    Objective Awake surgery emerges as a standard of care for brain tumors located in or near eloquent areas. Levels of preoperative anxiety in patients are important, because anxiety can influence cognitive performance and participation, hence altering the outcome of the procedure. In this study we

  9. Surgical misadventure: A case for thoughtful patient preoperative ...

    African Journals Online (AJOL)

    An assessment of the psychological impact of losing a breast in this patient was not possible as patient was lost to follow up. Optimal clinical examination by the surgeon and preoperative cytological diagnosis would ensure that the patient is spared unnecessary mutilating surgery. Nigerian Journal of Surgical Research Vol.

  10. Clinical application of preoperative endovascular management for jugular paraganglioma

    International Nuclear Information System (INIS)

    Yu Juming; Fan Guoping; Zhong Weixing; Zhang Yongping; Peng Haiteng; Cheng Yongde

    2009-01-01

    Objective: To investigate the clinical value of preoperative angiography and embolization managements for jugular paraganglioma. Methods: Fourteen patients with jugular paraganglioma were carefully evaluated with CT, MRI and clinical ENT exams. Bilateral carotid and affected-side vertebral angiography together with embolization of the feeding arteries and tumor nidi were performed in all 14 patients before surgery. Internal carotid artery balloon occlusive test was employed to check the function of Willis' circle in 7 patients. The tumors were excised within 48 hours after embolization. Results: Preoperative angiographic and embolization procedures of jugular paraganglioma were successfully accomplished in all patients. The mean blood loss during the surgery was obviously less than usual. Of seven cases who passed the internal carotid artery balloon occlusive test,carotid artery ligation was adopted in 3. No new symptoms and signs of nervous system developed after the surgery and during the follow-up period. Conclusion: The angiography and embolization of feeding-arteries and tumor nidi, and the preoperative balloon occlusive test of carotid artery performed before the surgery of jugular paraganglioma are safe and reliable, which can be regarded as a routine preoperative preparation. (authors)

  11. Lower rectal cancer. Preoperative staging with CT air enema technique

    International Nuclear Information System (INIS)

    Kanazawa, Amane; Fujii, Shouichi; Iwata, Seiichirou

    2009-01-01

    Preoperative assessment of rectal cancer wall invasion is an important indication of the need for lateral side wall dissection. The purpose of this study was to determine the accuracy rates and clinical usefulness of air-enema CT in preoperative staging of lower rectal cancer. A total of 88 patients diagnosed with lower rectal cancer were examined with an air-enema CT preoperatively and had surgical resection performed. One group was T1-T2 while the other was T3-T4. Forty-two patients were T1-T2, and 46 patients were T3-T4. In univariate and multivariate analysis, irregularities of the rectal wall and spiculated appearance of the rectal wall were significant predictive factors in T3-T4. In patients with air-enema CT findings of rectal wall irregularities and speculated appearance, the accuracy rate for detecting T3-T4 was 85.2-86.45 percent. These results show that air-enema CT is useful for determining the preoperative staging of lower rectal cancer and indication of the need for lateral side wall dissection. (author)

  12. Evaluating the effect of preoperative oral gabapentin on

    African Journals Online (AJOL)

    2010-05-02

    May 2, 2010 ... Conclusion: Preoperative gabapentin, when administered one hour prior to surgery in a dose of 1 200 mg, decreases postoperative pain scores at ... and impending tissue damage. Acute pain accompanies almost all surgical procedures. .... consumption after mastectomy. Anesthesiology 2002;97:560–4. 8.

  13. The potential benefit of pre-operative assessment of amputation ...

    African Journals Online (AJOL)

    The potential benefit of pre-operative assessment of amputation wound healing potential in peripheral vascular disease. M. Mars, R. P. Mills, J. V. Robbs. Abstract. Choosing the most distal amputation level that will heal is difficult in patients with peripheral vascular disease. From 1984 to 1988,965 patients underwent 1 563 ...

  14. Preoperative B-type natriuretic peptide risk stratification: Do ...

    African Journals Online (AJOL)

    Objectives: It is unclear if there is value in measuring postoperative B-type natriuretic peptide (BNP) in patients risk-stratified using preoperative BNP. Design: Prospective observational study. Setting and subjects: Patients undergoing vascular surgery at Inkosi Albert Luthuli Hospital, Durban. Data on intraoperative risk ...

  15. Predicting postoperative pain by preoperative pressure pain assessment.

    Science.gov (United States)

    Hsu, Yung-Wei; Somma, Jacques; Hung, Yu-Chun; Tsai, Pei-Shan; Yang, Chen-Hsien; Chen, Chien-Chuan

    2005-09-01

    The goal of this study was to evaluate whether preoperative pressure pain sensitivity testing is predictive of postoperative surgical pain. Female subjects undergoing lower abdominal gynecologic surgery were studied. A pressure algometer was used preoperatively to determine the pressure pain threshold and tolerance. A visual analog scale (VAS) was used to assess postoperative pain. A State-Trait Anxiety Inventory was used to assess patients' anxiety. Subjects received intravenous patient-controlled analgesia for postoperative pain control. The preoperative pain threshold and tolerance were compared with the postoperative VAS pain score and morphine consumption. Forty women were enrolled. Their preoperative pressure pain threshold and tolerance were 141 +/- 65 kPa and 223 +/- 62 kPa, respectively. The VAS pain score in the postanesthesia care unit and at 24 h postoperatively were 81 +/- 24 and 31 +/- 10, respectively. Highly anxious patients had higher VAS pain scores in the postanesthesia care unit (P pain tolerance was significantly correlated with the VAS at 24 h postoperatively (P pain tolerance after fentanyl administration (mean, 272 +/- 68 kPa) correlated significantly with morphine consumption in the first 24 h postoperatively (P pain tolerance is significantly correlated with the level of postoperative pain. Pain tolerance assessment after fentanyl was administered and fentanyl sensitivity predicted the dose of analgesics used in the first 24 h after surgery. The algometer is thus a simple, useful tool for predicting postoperative pain and analgesic consumption.

  16. Answer to preoperative chemie radiation in locally advanced rectum cancer

    International Nuclear Information System (INIS)

    Villegas Mendez, Silvia

    2006-01-01

    Study the pre-operative combined therapy effect in the treatment of the rectum cancer cases of the Servicio de Cirugia General 2 of the Hospital Mexico. The study covers since January of 2003 until December of 2005. It has like specific objectives to analyze the effect in the tumour stages, the sphincters preservation and the recurrence. In the conclusions, it notes that the pre-operative chemie-radiation in the rectum cancer is indicated in II and III stages, in which it has showed most advantages for the patient. It describes that the time between the end of pre-operative combined treatment and the surgery must has at least six weeks to guarantee the effect in the tumour and to reduce the treatment toxicity. It concludes besides, that the complication rate after the pre-operative combined therapy and the total meso rectum excision is approximately of 33%; however, the pelvic septic complications can reduce with an ostomy of protection. It focus that the technique of sphincters preservation has showed to be effective and secure if it does a previous selection to the patients in appropriate form. To get an suitable stages must count with trans rectum endoscopic ultrasound and a tomography of suitable quality. It concludes, also, in intervened tumours after of neo-adjuvancy they don't need free distal margins of illness higher to 2 cm. The total meso rectum excision is the updated surgical recommendation in the rectum cancer [es

  17. Pre-operative bladder irrigation with 1% Povidone iodine in ...

    African Journals Online (AJOL)

    Purpose: The aim of the study is to assess the effectiveness of using preoperative bladder irrigation with 1% povidone iodine in reducing post transvesical prostatectomy surgical site infections. Study design: This was a prospective randomized cohort study with blinding of patients and outcome adjudicator regarding group ...

  18. Primary muscular hydatid: preoperative diagnosis Throught computerized tomography and ultrasonography

    International Nuclear Information System (INIS)

    Macho Fernandez, J.M.; Marin Cardenas, M.A.; Mazas Artasona, L.; Lample Lacasa, C.; Otero Sierra, C.; Hernandez Navarrete, M.J.; Gomez-Pereda, R.

    1995-01-01

    Primary muscular hydatid disease, is extremely rare,- but not exceptional-, comparatively with other atypical localization. In this article the authors revised 474 patients with hydatid disease over a ten years period. Three cases of primary muscular localization were found. The ultrasonography and computed tomography facilitates the preoperative diagnosis. (Author) 40 refs

  19. Hypothesis Sampling Systems among Preoperational and Concrete Operational Kindergarten Children

    Science.gov (United States)

    Gholson, Barry; And Others

    1976-01-01

    Preoperational and concrete operational kindergarten children received stimulus differentiation training, either with or without feedback, and then a series of discrimination learning problems in which a blank trial probe was used to detect a child's hypothesis after each feedback trial. Piagetian stage theory requires elaboration to account…

  20. Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones

    DEFF Research Database (Denmark)

    Borly, L; Anderson, I B; Bardram, L

    1999-01-01

    patients completed all questionnaires. Twenty-one patients continued to have abdominal pain after the operation. Patients with pain 1 year after cholecystectomy were characterized by the preoperative presence of a high dyspepsia score, 'irritating' abdominal pain, and an introverted personality...

  1. What are the benefits and the pitfalls of preoperative fasting?

    Science.gov (United States)

    Webb, Katherine

    Preoperative fasting has been a traditional practice for many years to reduce the risk of aspiration while the patient is under general anaesthetic and to eliminate the risk of postoperative nausea and vomiting. Although it is generally accepted that fasting is beneficial, the fasting regimens that patients undergo are not dependent on the individual patient or the timing of their operation.

  2. Association of the Preoperative Neutrophil-to-ymphocyte Count Ratio and Platelet-to-Lymphocyte Count Ratio with Clinicopathological Characteristics in Patients with Papillary Thyroid Cancer

    Directory of Open Access Journals (Sweden)

    Sang Mi Kim

    2015-12-01

    Full Text Available BackgroundSeveral inflammatory biomarkers, especially a high preoperative neutrophil-to-lymphocyte count ratio (NLR and platelet-to-lymphocyte count ratio (PLR, are known to be indicator of poor prognosis in several cancers. However, very few studies have evaluated the significance of the NLR and PLR in papillary thyroid cancer (PTC. We evaluated the association of the preoperative NLR and PLR with clinicopathological characteristics in patients with PTC.MethodsThis study included 1,066 female patients who underwent total thyroidectomy for PTC. Patients were stratified into 4 quartiles by preoperative NLR and PLR. And the combination of preoperative NLR and PLR was calculated on the basis of data obtained value of tertile as follows: patients with both an elevated PLR and an elevated NLR were allocated a score of 2, and patients showing one or neither were allocated a score of 1 or 0, respectively.ResultsThe preoperative NLR and PLR were significantly lower in patients aged ≥45 years and in patients with Hashimoto's thyroiditis. The PLR was significantly higher in patients with tumor size >1 cm (P=0.021.When the patients were categorized into the aforementioned four groups, the group with the higher preoperative PLR was found to have a significantly increased incidence of lateral lymph node metastasis (LNM (P=0.018. However, there are no significant association between the combination of preoperative NLR and PLR and prognostic factors in PTC patients.ConclusionThese results suggest that a preoperative high PLR were significant associated with lateral LNM in female patients with PTC.

  3. Preoperative antiseptic skin preparations and reducing SSI.

    Science.gov (United States)

    Al Maqbali, Mohammed Abdullah

    Surgical site infection (SSI) can affect the quality of care and increase the morbidity and mortality rate in after-surgical procedure. The use of an antiseptic skin preparation agent before the procedure can reduce the pathogens in the skin surface around the incision. Indicating the type of skin antiseptic preparation could prevent the infection and contamination of the wound. The most commonly used types of skin preparations are chlorhexidine and povidone iodine. However, the antiseptic solutions of both agents are strengthened with alcohol to prevent postoperative wound infection. The aim of this paper is to identify the best antiseptic agent in terms of skin preparation by evaluating the evidence in the literature. The factors associated with choosing the antiseptic skin agent, such as patients' allergies, skin condition and environmental risk, are also taken into account. This review suggests that cholorhexdine with alcohol may be the most effective in terms of reducing SSI.

  4. Book Review: Chemistry in Theatre. Insufficiency, Phallacy or Both

    Science.gov (United States)

    Sterken, Christiaan; Djerassi, Carl

    2012-11-01

    This book deals with the question of what role a play, or the theatre, can fulfill as an educational or pedagogic tool in the broad scope of science learning and education. The book contains the texts of two of the author's recent plays, viz. Insufficiency and Phallacy. Carl Djerassi is a writer and an emeritus professor of chemistry at Stanford University. He has published short stories, poetry, some novels and several "science-in-theatre" plays. Almost one fifth of this slim booklet is occupied by Djerassi's preface that is, in its own right, a most useful essay worth reading by any student of the exact sciences. Djerassi's point is that most of the modern science plays have a didactic component, and aim to illustrate - through the medium of theatre - what science or scientists are all about. To make such plays available to a broad audience, he advocates the production of readable books written in play format. The strong point of such plays is the dialogue format - as was already very well known by forerunners like Galileo Galilei with his Dialogue Concerning the Two Chief World Systems, published in 1632. Djerassi does not tell what his characters do, but he emphasises how and why they do some specific thing. Insufficiency is about the chemistry of champagne bubbles (coined bubbleology, i.e., the science of champagne or beer bubbles), in a scientific academic context dealing with tenure and fashion. The story clearly shows how the life of a young tenure-seeking scientist develops under the strong interlock of forced - but also of voluntary - overwork that leads to tenure (in turn accompanied by an increase in material security). But it also mentions the self-imposed and seemingly unescapable treadmill of success and scientific achievement that comes with tenure. The play also deals with fashion in science via the simplistically coined term bubbleology, and the author shows that the actual implications of this "science" actually even reach to cosmology. The

  5. Laparoscopic-endoscopic rendezvous versus preoperative endoscopic sphincterotomy in people undergoing laparoscopic cholecystectomy for stones in the gallbladder and bile duct.

    Science.gov (United States)

    Vettoretto, Nereo; Arezzo, Alberto; Famiglietti, Federico; Cirocchi, Roberto; Moja, Lorenzo; Morino, Mario

    2018-04-11

    years. The run-in and follow-up periods of the trials ranged from 32 months to 84 months. Overall, the five trials were judged at high risk of bias. Athough all trials measured mortality, there was just one death reported in one trial, in the laparoscopic-endoscopic rendezvous group (low-quality evidence). The overall morbidity (surgical morbidity plus general morbidity) may be lower with laparoscopic rendezvous (RR 0.59, 95% CI 0.29 to 1.20; participants = 434, trials = 4; I² = 28%; low-quality evidence); the effect was a little more certain when a fixed-effect model was used (RR 0.56, 95% CI 0.32 to 0.99). There was insufficient evidence to determine the effects of the two approaches on the failure of primary clearance of the bile duct (RR 0.55, 95% CI 0.22 to 1.38; participants = 517; trials = 5; I² = 58%; very low-quality evidence). The effects of either approach on clinical post-operative pancreatitis were unclear (RR 0.29, 95% CI 0.07 to 1.12; participants = 517, trials = 5; I² = 24%; low-quality evidence). Hospital stay appeared to be lower in the laparoscopic-endoscopic rendezvous group by about three days (95% CI 3.51 to 2.50 days shorter; 515 participants in five trials; low-quality evidence). There was very low-quality evidence that suggested longer operative time with laparoscopic-endoscopic rendezvous (MD 34.07 minutes, 95% CI 11.41 to 56.74; participants = 313; trials = 3; I² = 93%). The Trial Sequential Analyses of operating time and the length of hospital stay indicated that all the trials crossed the conventional boundaries, suggesting that the sample sizes were adequate, with a low risk of random error. There was insufficient evidence to determine the effects of the laparoscopic-endoscopic rendezvous versus preoperative endoscopic sphincterotomy techniques in people undergoing laparoscopic cholecystectomy on mortality and morbidity. The laparoscopic-endoscopic rendezvous procedure may lead to longer operating times, but it may reduce the length of

  6. Pre-operative radiochemotherapy of locally advanced rectal cancer

    Institute of Scientific and Technical Information of China (English)

    Xiao-Nan Sun; Qi-Chu Yang; Jian-Bin Hu

    2003-01-01

    AIM: To evaluate results of pre-operative radiochemotherapy followed by surgery for 15 patients with locally advanced un-resectable rectal cancer.METHODS: 15 patients with advanced non-resectable rectal cancer were treated with pre-operative irriadiation of 40-46 Gy plus concomitant chemotherapy (5-FU+LV and 5′-DFuR) (RCS group). For comparison, 27 similar patients,treated by preoperative radiotherapy (40-50 Gy) plus surgery were served as control (RS group).RESULTS: No radiochemotherapy or radiotherapy was interrupted and then was delayed because of toxicities in both groups. The radical resectability rate was 73.3% in the RCS group and 37.0% (P=0.024) in RS group. Sphincter preservation rates were 26.6% and 3.7% respectively (P=0.028). Sphincter preservation rates of lower rectal cancer were 27.3 % and 0.0 % respectively (P=0.014). Response rates of RCS and RS groups were 46.7 % and 18.5 %(P=0.053). The tumor downstage rates were 8 (53.3%)and 9 (33.3%) in these groups (P=0.206). The 3-year overall survival rates were 66.7 % and 55.6% (P=0.485), and the disease free survival rates were 40.1% and 33.2%(P=0.663). The 3-year local recurrent rates were 26.7%and 48.1% (P=0.174). No obvious late effects were found in either groups.CONCLUSION: High resectability is possible following preoperative radiochemotherapy and can have more sphincters preserved. It is important to improve the quality of the patients′ life even without increasing the survival or local control rates. Preoperative radiotherapy with concomitant full course chemotherapy (5-Fu+LV and 5′-DFuR) is effective and safe.

  7. Preoperative cryotherapy use in anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Koyonos, Loukas; Owsley, Kevin; Vollmer, Emily; Limpisvasti, Orr; Gambardella, Ralph

    2014-12-01

    Unrelieved postoperative pain may impair rehabilitation, compromise functional outcomes, and lead to patient dissatisfaction. Preemptive multimodal analgesic techniques may improve outcomes after surgery. We hypothesized that patients using preoperative cryotherapy plus a standardized postoperative treatment plan will have lower pain scores and require less pain medication compared with patients receiving a standardized postoperative treatment plan alone after arthroscopically assisted anterior cruciate ligament reconstruction (ACLR). A total of 53 consecutive patients undergoing arthroscopically assisted ACLR performed by one of seven surgeons were randomly assigned to one of two groups. Group 1 received no preoperative cryotherapy and group 2 received 30 to 90 minutes of preoperative cryotherapy to the operative leg using a commercial noncompressive cryotherapy unit. Visual analog scale pain scores and narcotic use were recorded for the first 4 days postoperatively. Total hours of cold therapy and continuous passive motion (CPM) use and highest degree of flexion achieved were recorded as well. Group 1 consisted of 26 patients (15 allograft Achilles tendon and 11 autograft bone patellar tendon bone [BPTB]), and group 2 consisted of 27 patients (16 allograft Achilles tendon and 11 autograft BPTB). Group 2 patients reported less pain (average 1.3 units, p cryotherapy, hours of CPM use, or maximum knee flexion achieved. Complications did not occur in either group. This is the first report we are aware of showing the postoperative effects of preoperative cryotherapy. Our results support the safety and efficacy of preoperative cryotherapy in a multimodal pain regimen for patients undergoing ACL reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  8. Preoperative Prolapse Stage as Predictor of Failure of Sacrocolpopexy.

    Science.gov (United States)

    Aslam, Muhammad F; Osmundsen, Blake; Edwards, Sharon R; Matthews, Catherine; Gregory, William T

    2016-01-01

    Our aim was to determine if there was a correlation between the preoperative prolapse stage and postoperative recurrence of prolapse 1 year after sacrocolpopexy. Our null hypothesis is that the preoperative stage of prolapse does not increase the risk of recurrence. This is a multicenter cohort study from 3 centers. We included subjects who underwent robotic-assisted sacrocolpopexy and completed a standardized 1-year follow-up from 2009-2014. All subjects underwent a complete preoperative evaluation and completed 12 months of follow-up with the pelvic organ prolapse quantification examination. We compared those subjects who met the definition of recurrence with those who did not, analyzing the following covariates: stage of prolapse using International Continence Society (ICS) definitions, individual pelvic organ prolapse quantification points, age, body mass index, race, exogenous estrogen use, menopause, smoking, vaginal parity, cesarean section, and performance of concomitant procedures. We defined recurrence as any prolapse beyond the hymen. We had 125 women from 3 centers who met our criteria, with 23.2% of them having recurrence at 1 year. We found that recurrence increased as the preoperative ICS stage of prolapse increased (P = <0.001 in the univariate model). In the multivariate model, using logistic regression, we found that the risk of recurrence of pelvic organ prolapse increased as the presurgery clinical stage increased with an odds ratio of 3.8 (95% confidence interval, 1.5-9) when controlling for age, menopausal status, and genital hiatus (P = 0.004). Much like a higher stage of disease in oncology, we found that increasing stage of prolapse preoperatively increased the risk of recurrence at 1 year after sacrocolpopexy.

  9. Association of preoperative radiation effect with tumor angiogenesis and vascular endothelial growth factor in oral squamous cell carcinoma

    International Nuclear Information System (INIS)

    Shintani, Satoru; Kiyota, Akihisa; Mihara, Mariko; Nakahara, Yuuji; Terakado, Nagaaki; Ueyama, Yoshiya; Matsumura, Tomohiro

    2000-01-01

    This study examined the relationship between tumor angiogenesis and the radiation-induced response, evaluated based on pathological changes, in oral squamous cell carcinoma patients treated with preoperative radiation therapy. Forty-one cases of squamous cell carcinoma treated with preoperative radiation therapy were investigated. Tumor angiogenesis was assessed by scoring the intratumor microvessel density (IMVD). Expression of vascular endothelial growth factor (VEGF) was also evaluated before and after preoperative radiotherapy. There was no correlation between IMVD in the specimens before therapy and the pathological response to radiation therapy. However, radiation therapy decreased IMVD in the specimens after therapy. A significant association was observed between VEGF expression and resistance to radiation therapy: only 4 of the 21 patients whose tumors exhibited a high level (2+ or 3+) of VEGF staining experienced a major (3+ or 4+) pathological response to radiation therapy. Furthermore, an increasing level of VEGF expression after radiation therapy was observed in non-effective (0 to 2+) response cases. These results suggest that VEGF expression and the induction of this protein are related to radiosensitivity and could be used to predict the effects of preoperative radiation therapy on oral squamous cell carcinoma. (author)

  10. Nodal tumor response according to the count of peripheral blood lymphocyte subpopulations during preoperative chemoradiotherapy in locally advanced rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Heo, Jae Sung; Oh, Young Tae; Noh, O Kyu; Chun, Mi Son; Park, Jun Eun; Cho, Sung Ran [Ajou University School of Medicine, Suwon (Korea, Republic of)

    2016-12-15

    The objective of this prospective study was to evaluate the relationship between the circulating lymphocyte subpopulation counts during preoperative chemoradiotherapy (CRT) and tumor response in locally advanced rectal cancer. From August 2015 to June 2016, 10 patients treated with preoperative CRT followed by surgery were enrolled. Patients received conventional fractionated radiotherapy (50.4 Gy) with fluorouracil-based chemotherapy. Surgical resection was performed at 4 to 8 weeks after the completion of preoperative CRT. The absolute blood lymphocyte subpopulation was obtained prior to and after 4 weeks of CRT. We analyzed the association between a tumor response and change in the lymphocyte subpopulation during CRT. Among 10 patients, 2 (20%) had evidence of pathologic complete response. In 8 patients with clinically node positive, 4 (50%) had nodal tumor response. All lymphocyte subpopulation counts at 4 weeks after CRT were significantly lower than those observed during pretreatment (p < 0.01). A high decrease in natural killer (NK) cell, count during CRT (baseline cell count - cell count at 4 weeks) was associated with node down staging (p = 0.034). Our results suggest that the change of lymphocyte subset to preoperative CRT may be a predictive factor for tumor response in rectal cancer.

  11. Genetics of primary ovarian insufficiency: new developments and opportunities.

    Science.gov (United States)

    Qin, Yingying; Jiao, Xue; Simpson, Joe Leigh; Chen, Zi-Jiang

    2015-01-01

    Primary ovarian insufficiency (POI) is characterized by marked heterogeneity, but with a significant genetic contribution. Identifying exact causative genes has been challenging, with many discoveries not replicated. It is timely to take stock of the field, outlining the progress made, framing the controversies and anticipating future directions in elucidating the genetics of POI. A search for original articles published up to May 2015 was performed using PubMed and Google Scholar, identifying studies on the genetic etiology of POI. Studies were included if chromosomal analysis, candidate gene screening and a genome-wide study were conducted. Articles identified were restricted to English language full-text papers. Chromosomal abnormalities have long been recognized as a frequent cause of POI, with a currently estimated prevalence of 10-13%. Using the traditional karyotype methodology, monosomy X, mosaicism, X chromosome deletions and rearrangements, X-autosome translocations, and isochromosomes have been detected. Based on candidate gene studies, single gene perturbations unequivocally having a deleterious effect in at least one population include Bone morphogenetic protein 15 (BMP15), Progesterone receptor membrane component 1 (PGRMC1), and Fragile X mental retardation 1 (FMR1) premutation on the X chromosome; Growth differentiation factor 9 (GDF9), Folliculogenesis specific bHLH transcription factor (FIGLA), Newborn ovary homeobox gene (NOBOX), Nuclear receptor subfamily 5, group A, member 1 (NR5A1) and Nanos homolog 3 (NANOS3) seem likely as well, but mostly being found in no more than 1-2% of a single population studied. Whole genome approaches have utilized genome-wide association studies (GWAS) to reveal loci not predicted on the basis of a candidate gene, but it remains difficult to locate causative genes and susceptible loci were not always replicated. Cytogenomic methods (array CGH) have identified other regions of interest but studies have not shown

  12. Suggestibility and negative priming: two replication studies.

    Science.gov (United States)

    David, Daniel; Brown, Richard J

    2002-07-01

    Research suggests that inhibiting the effect of irrelevant stimuli on subsequent thought and action (cognitive inhibition) may be an important component of suggestibility. Two small correlation studies were conducted to address the relationship between different aspects of suggestibility and individual differences in cognitive inhibition, operationalized as the degree of negative priming generated by to-be-ignored stimuli in a semantic categorization task. The first study found significant positive correlations between negative priming, hypnotic suggestibility, and creative imagination; a significant negative correlation was obtained between negative priming and interrogative suggestibility, demonstrating the discriminant validity of the study results. The second study replicated the correlation between negative priming and hypnotic suggestibility, using a different suggestibility measurement procedure that assessed subjective experience and hypnotic involuntariness as well as objective responses to suggestions. These studies support the notion that the ability to engage in cognitive inhibition may be an important component of hypnotic responsivity and maybe of other forms of suggestibility.

  13. Recurrent tricuspid insufficiency: is the surgical repair technique a risk factor?

    Science.gov (United States)

    Kara, Ibrahim; Koksal, Cengiz; Cakalagaoglu, Canturk; Sahin, Muslum; Yanartas, Mehmet; Ay, Yasin; Demir, Serdar

    2013-01-01

    This study compares the medium-term results of De Vega, modified De Vega, and ring annuloplasty techniques for the correction of tricuspid insufficiency and investigates the risk factors for recurrent grades 3 and 4 tricuspid insufficiency after repair. In our clinic, 93 patients with functional tricuspid insufficiency underwent surgical tricuspid repair from May 2007 through October 2010. The study was retrospective, and all the data pertaining to the patients were retrieved from hospital records. Functional capacity, recurrent tricuspid insufficiency, and risk factors aggravating the insufficiency were analyzed for each patient. In the medium term (25.4 ± 10.3 mo), the rates of grades 3 and 4 tricuspid insufficiency in the De Vega, modified De Vega, and ring annuloplasty groups were 31%, 23.1%, and 6.1%, respectively. Logistic regression analysis revealed that chronic obstructive pulmonary disease, left ventricular dysfunction (ejection fraction, tricuspid insufficiency. Medium-term survival was 90.6% for the De Vega group, 96.3% for the modified De Vega group, and 97.1% for the ring annuloplasty group. Ring annuloplasty provided the best relief from recurrent tricuspid insufficiency when compared with DeVega annuloplasty. Modified De Vega annuloplasty might be a suitable alternative to ring annuloplasty when rings are not available.

  14. Bedtime procrastination: a self-regulation perspective on sleep insufficiency in the general population

    NARCIS (Netherlands)

    Kroese, Floor|info:eu-repo/dai/nl/313869871; Evers, Catharine|info:eu-repo/dai/nl/280594232; Adriaanse, Marieke|info:eu-repo/dai/nl/304823023; de Ridder, Denise|info:eu-repo/dai/nl/070706174

    2016-01-01

    Getting insufficient sleep has serious consequences in terms of mental and physical health. The current study is the first to approach insufficient sleep from a self-regulation perspective by investigating the phenomenon of bedtime procrastination: going to bed later than intended, without having

  15. Assessing adrenal insufficiency of corticosteroid secretion using free versus total cortisol levels in critical illness

    NARCIS (Netherlands)

    Molenaar, N.; Groeneveld, A.B.J.; Dijstelbloem, H.M.; de Jong, M.F.C.; Girbes, A.R.J.; Heijboer, A.C.; Beishuizen, A.

    2011-01-01

    Purpose: To study the value of free versus total cortisol levels in assessing relative adrenal insufficiency during critical illness-related corticosteroid insufficiency. Methods: A prospective study in a mixed intensive care unit from 2004 to 2007. We consecutively included 49 septic and 63

  16. Assessing adrenal insufficiency of corticosteroid secretion using free versus total cortisol levels in critical illness

    NARCIS (Netherlands)

    Molenaar, Nienke; Johan Groeneveld, A. B.; Dijstelbloem, Hilde M.; de Jong, Margriet F. C.; Girbes, Armand R. J.; Heijboer, Annemieke C.; Beishuizen, Albertus

    2011-01-01

    To study the value of free versus total cortisol levels in assessing relative adrenal insufficiency during critical illness-related corticosteroid insufficiency. A prospective study in a mixed intensive care unit from 2004 to 2007. We consecutively included 49 septic and 63 non-septic patients with

  17. Predictors of persistence of preoperative urgency incontinence in women following pelvic organ prolapse repair

    Directory of Open Access Journals (Sweden)

    Ching-Chung Liang

    2015-12-01

    Conclusion: For women with identified preoperative risk factors, including MCC 60 months, preoperative counseling should consist of a discussion about persistent UUI symptoms following TVM repair and the development of de novo stress urinary incontinence.

  18. Patient Experiences with the Preoperative Assessment Clinic (PEPAC): validation of an instrument to measure patient experiences

    NARCIS (Netherlands)

    Edward, G. M.; Lemaire, L. C.; Preckel, B.; Oort, F. J.; Bucx, M. J. L.; Hollmann, M. W.; de Haes, J. C. J. M.

    2007-01-01

    Background. Presently, no comprehensive and validated questionnaire to measure patient experiences of the preoperative assessment clinic (PAC) is available. We developed and validated the Patient Experiences with the Preoperative Assessment Clinic (PEPAC) questionnaire, which can be used for

  19. The effect of preoperative Lugol's iodine on intraoperative bleeding in patients with hyperthyroidism

    Directory of Open Access Journals (Sweden)

    Yeliz Yilmaz

    2016-08-01

    Conclusion: Preoperative Lugol solution treatment was found to be a significant independent determinant of intraoperative blood loss. Moreover, preoperative Lugol solution treatment decreased the rate of blood flow, and intraoperative blood loss during thyroidectomy.

  20. Acute proximal junctional failure in patients with preoperative sagittal imbalance.

    Science.gov (United States)

    Smith, Micah W; Annis, Prokopis; Lawrence, Brandon D; Daubs, Michael D; Brodke, Darrel S

    2015-10-01

    Proximal junctional failure (PJF) is a recognized complication of spinal deformity surgery. Acute PJF (APJF) has recently been demonstrated to be 5.6% in the adult spinal deformity (ASD) population. The incidence and rate of return to the operating room for APJF have not been specifically investigated in individuals with sagittal imbalance. The purpose of this study was to report the incidence of APJF in patients with preoperative sagittal imbalance and the rate of return to the operating room for APJF. This study is based on a retrospective review of prospectively collected database of ASD patients. One hundred seventy-three consecutive patients were included with preoperative sagittal imbalance according to one of the following common parameters: sagittal vertical axis (SVA) greater than 50 mm, global sagittal alignment greater than 45°, or pelvic incidence minus lumbar lordosis greater than 10°. Outcome measure was presence and/or absence of APJF defined as fracture at the upper instrumented vertebra (UIV) or UIV+1, failure of UIV fixation, 15° or more proximal junctional kyphosis, or need for extension of instrumentation within 6 months of surgery. We performed radiographic measurements on X-rays at preoperative, immediate postoperative, and 6-month follow-up visits. The APJF rate was reported for the entire patient population with preoperative sagittal imbalance. Acute PJF incidence was calculated postoperatively for each of the accepted sagittal balance parameters and/or formulas. Patients with persistent postoperative sagittal imbalance were compared with the sagittally balanced group. We also assessed for threshold values. Acute PJF was observed in 60 of 173 patients (35%) and was least common in fusions with the UIV in the upper thoracic (UT) spine (p=.035). Of those who developed APJF, 21.7% required surgery. Proximal junctional kyphosis 15° or more was the most common form of APJF in fusions to the UT spine but least likely to need revision (p=.014

  1. Suggestibility and Expectancy in a Counseling Analogue

    Science.gov (United States)

    Kaul, Theodore J.; Parker, Clyde A.

    1971-01-01

    The data indicated that (a) subjectively experienced suggestibility was more closely related to attitude change than was objective suggestibility, and (b) the generalized expectancy treatments were ineffective in influencing different criterion scores. (Author)

  2. Homozygous Inactivating Mutation in NANOS3 in Two Sisters with Primary Ovarian Insufficiency

    Directory of Open Access Journals (Sweden)

    Mariza G. Santos

    2014-01-01

    Full Text Available Despite the increasing understanding of female reproduction, the molecular diagnosis of primary ovarian insufficiency (POI is seldom obtained. The RNA-binding protein NANOS3 poses as an interesting candidate gene for POI since members of the Nanos family have an evolutionarily conserved function in germ cell development and maintenance by repressing apoptosis. We performed mutational analysis of NANOS3 in a cohort of 85 Brazilian women with familial or isolated POI, presenting with primary or secondary amenorrhea, and in ethnically-matched control women. A homozygous p.Glu120Lys mutation in NANOS3 was identified in two sisters with primary amenorrhea. The substituted amino acid is located within the second C2HC motif in the conserved zinc finger domain of NANOS3 and in silico molecular modelling suggests destabilization of protein-RNA interaction. In vitro analyses of apoptosis through flow cytometry and confocal microscopy show that NANOS3 capacity to prevent apoptosis was impaired by this mutation. The identification of an inactivating missense mutation in NANOS3 suggests a mechanism for POI involving increased primordial germ cells (PGCs apoptosis during embryonic cell migration and highlights the importance of NANOS proteins in human ovarian biology.

  3. Preoperative anaemia and newly diagnosed cancer 1 year after elective total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jørgensen, C. C.; Jans, Ø.; Kehlet, H.

    2015-01-01

    BACKGROUND: Preoperative anaemia is a well-established risk factor for use of blood transfusions and postoperative morbidity. Consequently, focus on preoperative evaluation of haemoglobin levels is increasing. In this context, iron deficiency anaemia may be a symptom of undiscovered gastrointesti......BACKGROUND: Preoperative anaemia is a well-established risk factor for use of blood transfusions and postoperative morbidity. Consequently, focus on preoperative evaluation of haemoglobin levels is increasing. In this context, iron deficiency anaemia may be a symptom of undiscovered...

  4. Evidentiality and Suggestibility: A New Research Venue

    Science.gov (United States)

    Aydin, Cagla; Ceci, Stephen J.

    2009-01-01

    Recent research suggests that acquisition of mental-state language may influence conceptual development. We examine this possibility by investigating the conceptual links between evidentiality in language and suggestibility. Young children are disproportionately suggestible and tend to change their reports or memories when questioned. The authors…

  5. The Effects of Suggestibility on Relaxation.

    Science.gov (United States)

    Rickard, Henry C.; And Others

    1985-01-01

    Selected undergraduates (N=32) on the basis of Creative Imagination Scale scores and randomly assigned high and low suggestibility subjects to progressive relaxation (PR) and suggestions of relaxation (SR) training modes. Results revealed a significant pre-post relaxation effect, and main efffects for both suggestibility and training mode. (NRB)

  6. Reinventing suggestion systems for continuous improvement

    NARCIS (Netherlands)

    Schuring, R.W.; Luijten, Harald

    2001-01-01

    This article reports an experiment to increase the effectiveness of a suggestion system by deliberately applying principles of the kaizen and performance management. Design rules for suggestion systems are derived from these theories. The suggestion system that resulted differs from traditional

  7. Combining task-evoked and spontaneous activity to improve pre-operative brain mapping with fMRI.

    Science.gov (United States)

    Fox, Michael D; Qian, Tianyi; Madsen, Joseph R; Wang, Danhong; Li, Meiling; Ge, Manling; Zuo, Huan-Cong; Groppe, David M; Mehta, Ashesh D; Hong, Bo; Liu, Hesheng

    2016-01-01

    Noninvasive localization of brain function is used to understand and treat neurological disease, exemplified by pre-operative fMRI mapping prior to neurosurgical intervention. The principal approach for generating these maps relies on brain responses evoked by a task and, despite known limitations, has dominated clinical practice for over 20years. Recently, pre-operative fMRI mapping based on correlations in spontaneous brain activity has been demonstrated, however this approach has its own limitations and has not seen widespread clinical use. Here we show that spontaneous and task-based mapping can be performed together using the same pre-operative fMRI data, provide complimentary information relevant for functional localization, and can be combined to improve identification of eloquent motor cortex. Accuracy, sensitivity, and specificity of our approach are quantified through comparison with electrical cortical stimulation mapping in eight patients with intractable epilepsy. Broad applicability and reproducibility of our approach are demonstrated through prospective replication in an independent dataset of six patients from a different center. In both cohorts and every individual patient, we see a significant improvement in signal to noise and mapping accuracy independent of threshold, quantified using receiver operating characteristic curves. Collectively, our results suggest that modifying the processing of fMRI data to incorporate both task-based and spontaneous activity significantly improves functional localization in pre-operative patients. Because this method requires no additional scan time or modification to conventional pre-operative data acquisition protocols it could have widespread utility. Copyright © 2015. Published by Elsevier Inc.

  8. Sphincter preservation in rectal cancer with preoperative radiation therapy and coloanal anastomosis: long term follow-up

    International Nuclear Information System (INIS)

    Wagman, Raquel; Minsky, Bruce D.; Cohen, Alfred M.; Guillem, Jose G.; Paty, Philip P.

    1998-01-01

    Background: To determine if preoperative radiation therapy allows sphincter preservation in the treatment of rectal cancer. Methods: Thirty six patients with the diagnosis of invasive, resectable, primary adenocarcinoma of the rectum limited to the pelvis were enrolled on a Phase I/II trial of preoperative radiation therapy plus low anterior resection/coloanal anastomosis. By preoperative assessment, all patients had invasive tumors (5,T 2; 31,T 3 ) involving the distal half of the rectum and clinically required an abdominoperineal resection. The median tumor size was 3.8 cm [range: 1.5-7 cm] and the median distance from the anal verge was 4 cm [range: 3-7 cm]. The whole pelvis received 46.80 Gy followed by a 3.60 Gy boost to the primary tumor bed. The median follow-up was 56 months [range: 4-121 months]. Results: Of the 35 patients who underwent resection, 5 (14%) had a complete pathologic response and 27 (77%) were able to successfully undergo a low anterior resection/coloanal anastomosis. The incidence of local failure was crude: 17% and 5-year actuarial: 21%. The 5-year actuarial survival was 64%. Analysis of sphincter function using a previously published scale was performed at the time of last follow-up in the 27 patients who underwent a low anterior resection/coloanal anastomosis. Function was good or excellent in 85%. The median number of bowel movements/day was 2 (range: 0-8). Conclusions: Our data suggest that preoperative radiation therapy allows sphincter preservation in 77% of selected patients who would otherwise require an abdominoperineal resection, and 85% have good to excellent sphincter function. Given the moderate local failure rate, we now routinely use preoperative combined modality therapy plus postoperative chemotherapy for patients with clinical T 3 disease

  9. Home telemonitoring of severe chronic respiratory insufficient and asthmatic patients

    Directory of Open Access Journals (Sweden)

    Manuela Zamith

    2009-05-01

    Full Text Available For 9 months we evaluated a portable device to transfer patient-clinician data by Internet: oximetry, ECG, clinical questionnaires and messages from the doctor. Fifty-one patients with severe chronic respiratory insufficiency (CRI were followed at the hospital Pulido Valente and Espirito Santo and 21 asthmatics (A were followed at the latter hospital. The use and acceptance of this device was evaluated through questionnaires soliciting patients’ and health professionals’ opinions. Patients with CRI followed in Lisbon were also asked about hospital admissions and quality of life compared with a nine month period before the monitoring programme.CRI patients found learning to use the system more difficult; the majority (80% reported problems with the equipment, qualified as rare/occasional in 62% of the cases. For 31 CRI patients followed in Lisbon, the use of the system was classified as correct in 12 patients, incorrect in 7 and reasonable in 12 patients. The first group had a reducded number and duration of hospital admissions and also improved quality of life. With this remote monitoring system 80% of CRI patients reported they were more/much more supported and 33 patients (75% would use this system in the future. 81% of asthmatic patients would also like to maintain this type of monitoring. The service was considered useful by the researchers. We concluded that home telemonitoring was a positive contribution to the management of chronic patients and raised awareness of it should be considered in the future. Resumo: Durante nove meses avaliámos umdispositivo portátil para transferência de dados pelaInternet entre doentes e profissionais de saúde: oximetria,ECG, respostas a questionários e mensagens. Foramincluídos 51 insuficientes respiratórioscrónicos (IRC graves acompanhados no Hospital de PulidoValente (Lisboa e no Hospital do Espírito Santo(Évora e 21 asmáticos deste último hospital. Autiliza

  10. The influence of suggestibility on memory.

    Science.gov (United States)

    Nicolas, Serge; Collins, Thérèse; Gounden, Yannick; Roediger, Henry L

    2011-06-01

    We provide a translation of Binet and Henri's pioneering 1894 paper on the influence of suggestibility on memory. Alfred Binet (1857-1911) is famous as the author who created the IQ test that bears his name, but he is almost unknown as the psychological investigator who generated numerous original experiments and fascinating results in the study of memory. His experiments published in 1894 manipulated suggestibility in several ways to determine effects on remembering. Three particular modes of suggestion were employed to induce false recognitions: (1) indirect suggestion by a preconceived idea; (2) direct suggestion; and (3) collective suggestion. In the commentary we suggest that Binet and Henri's (1894) paper written over 115 years ago is still highly relevant even today. In particular, Binet's legacy lives on in modern research on misinformation effects in memory, in studies of conformity, and in experiments on the social contagion of memory. Copyright © 2010 Elsevier Inc. All rights reserved.

  11. The relationships between suggestibility, influenceability, and relaxability.

    Science.gov (United States)

    Polczyk, Romuald; Frey, Olga; Szpitalak, Malwina

    2013-01-01

    This research explores the relationships between relaxability and various aspects of suggestibility and influenceability. The Jacobson Progressive Muscle Relaxation procedure was used to induce relaxation. Tests of direct suggestibility, relating to the susceptibility of overt suggestions, and indirect suggestibility, referring to indirect hidden influence, as well as self-description questionnaires on suggestibility and the tendency to comply were used. Thayer's Activation-Deactivation Adjective Check List, measuring various kinds of activation and used as a pre- and posttest, determined the efficacy of the relaxation procedure. Indirect, direct, and self-measured suggestibility proved to be positively related to the ability to relax, measured by Thayer's subscales relating to emotions. Compliance was not related to relaxability. The results are discussed in terms of the aspects of relaxation training connected with suggestibility.

  12. MR angiography and the preoperative evaluation of renal arteries

    International Nuclear Information System (INIS)

    Nakahara, Kimitoshi; Yokoyama, Hiroshi; Tsuji, Yuji

    2001-01-01

    To determine the accuracy of gadolinium-enhanced, three-dimensional, magnetic resonance angiography (3D-MRA) in the visualization of the arterial anatomy of the kidney, we compared preoperative 3D-MRA results with surgical findings in 37 patients who underwent renal surgery. 3D-MRA findings were confirmed surgically in 30 of these patients (81%). However, 4 of 7 accessory renal arteries were missed by this imaging technique. Furthermore, 3D-MRA failed to visualize renal arteries in all of the three atrophic kidneys. 3D-MRA is a safe and reliable procedure for the preoperative evaluation of renal arteries. However, the depiction of smaller renal arteries, such as accessory and atrophic arteries, is less accurate. (author)

  13. New concepts in preoperative imaging of anorectal malformation

    International Nuclear Information System (INIS)

    Taccone, A.; Delliacqua, A.; Marzoli, A.; Martucciello, G.; Jasonni, V.; Dodero, P.; Salomone, G.

    1992-01-01

    In this study of 14 patients with anorectal anomalies CT and MRI were employed for preoperative assessment. The use of a pressure enhanced water soluble enema via the colostomy proved to be an extremely efficient method for showing a fistula. MRI studies were enhanced by the use of vaseline oil and in one case this technique was used prior to surgery to provide important information by injecting through a perineal fistula. CT and axial MRI proved to be more valuable than sagittal MRI which is only useful for the length of the atretic segment. The authors consider that a combined approach using pressure enhanced water soluble enema and MRI will provide the most valuable preoperative information to plan a successful operative approach and enable an accurate prognostic evaluation of continence in these difficult and complex patients. (orig.)

  14. Preoperative staging and treatment options in T1 rectal adenocarcinoma

    DEFF Research Database (Denmark)

    Baatrup, Gunnar; Endreseth, Birger H; Isaksen, Vidar

    2009-01-01

    . Results. Local treatment of T1 cancers combined with close follow-up, early salvage surgery or later radical resection of local recurrences or with chemo-radiation may lead to fewer severe complications and comparable, or even better, long-term survival. Accurate preoperative staging and careful selection...... of patients for local or non-operative treatment are mandatory. As preoperative staging, at present, is not sufficiently accurate, strategies for completion, salvage or rescue surgery is important, and must be accepted by the patient before local treatment for cure is initiated. Recommendations......Background. Major rectal resection for T1 rectal cancer offers more than 95% cancer specific five-year survival to patients surviving the first 30 days after surgery. A significant further improvement by development of the surgical technique may not be possible. Improvements in the total survival...

  15. Ranitidine improves postoperative suppression of antibody response to preoperative vaccination

    DEFF Research Database (Denmark)

    Nielsen, Hans Jørgen; Hammer, J H; Moesgaard, F

    1992-01-01

    The effect of the histamine-2 receptor antagonist ranitidine (100 mg intravenously every 12 hours for 72 hours) on postoperative serum antibody responses to preoperative immunization with six limit of flocculation tetanus toxoid and six limit of flocculation diphtheria toxoid was assessed...... in a double-blind, placebo-controlled randomized study in 26 patients undergoing major abdominal surgery. The preoperative antitetanus antibody level was less than 0.1 IU/ml in all patients, and they were inoculated with both antigens 48 hours before surgery. Serum samples for analysis of antitetanus toxoid...... and antidiphtheria toxoid were drawn before skin incision and on postoperative days 1, 3, 5, 7, 10, 14, 21, and 28. Ranitidine significantly increased the postoperative antibody response to tetanus toxoid, (p less than 0.01) and insignificantly increased that to diphtheria toxoid vaccination (p less than 0...

  16. Aneurysms of proximal pulmonary arteries: CT diagnosis and preoperative assessment

    International Nuclear Information System (INIS)

    Iula, G.; Ziviello, R.; Del Vecchio, W.

    1996-01-01

    We reviewed our experience with proximal pulmonary artery aneurysm (PPAA) to determine whether accurate preoperative evaluation (crucial to differential diagnosis and surgical planning) had been obtained on the basis of CT study alone. Three patients with PPAA were studied with contrast-enhanced CT. We evaluated the size and shape of PPAAs, their proximal and distal extent, eventual presence of intraluminal thrombi, dissection, perianeurysmal fibrosis, and rupture. The results were compared with surgical findings. In two patients the aneurysm involved the pulmonary trunk and both the right and left arteries origin. In one patient the aneurysm extended from the left artery origin to the hilum of the left lung. Contrast-enhanced CT alone allows detection of aneurysm in the pulmonary trunk, in right or left pulmonary arteries with precise preoperative evaluation of the extent, size, shape, and complications. The CT imaging was unable to establish the etiologic origin and presence of small intimal tears in PPAA. (orig.)

  17. Limited utility of preoperative studies in preparation for colostomy closure.

    Science.gov (United States)

    Pokorny, R M; Heniford, T; Allen, J W; Tuckson, W B; Galandiuk, S

    1999-04-01

    Numerous diagnostic and therapeutic practices are used in an attempt to reduce the morbidity of colostomy closures. Our principal aim was to evaluate the role of preoperative studies, specifically barium enemas and endoscopic examinations, performed before colostomy closures. Additionally, we wished to identify other practices involved in the perioperative management of patients undergoing colostomy closure that influenced morbidity. The records of 100 consecutive patients who underwent elective colostomy closure at University of Louisville Hospital between January 1989 and July 1995 were reviewed. Wound infection was the most common complication (12%). Various bowel preparations were equivalent in efficacy and did not influence the complication rate. Intermittent wound irrigation with antibiotics for 3 days postoperatively, via subcutaneous drains, was associated with a low incidence of incision infection. Preoperative barium enema or sigmoidoscopy were often performed but rarely useful. Performing these examinations merely increased hospital cost without a corresponding decline in morbidity.

  18. Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones

    DEFF Research Database (Denmark)

    Borly, L; Anderson, I B; Bardram, L

    1999-01-01

    and sonography evaluated gallbladder motility, gallstones, and gallbladder volume. Preoperative variables in patients with or without postcholecystectomy pain were compared statistically, and significant variables were combined in a logistic regression model to predict the postoperative outcome. RESULTS: Eighty...... and by the absence of 'agonizing' pain and of symptoms coinciding with pain (P model 15 of 18 predicted patients had postoperative pain (PVpos = 0.83). Of 62 patients predicted as having no pain postoperatively, 56 were pain-free (PVneg = 0.90). Overall accuracy...... was 89%. CONCLUSION: From this prospective study a model based on preoperative symptoms was developed to predict postcholecystectomy pain. Since intrastudy reclassification may give too optimistic results, the model should be validated in future studies....

  19. Preoperative staging of rectal cancer; Praeoperatives Staging des Rektumkarzinoms

    Energy Technology Data Exchange (ETDEWEB)

    Schaefer, A.O.; Baumann, T.; Pache, G.; Langer, M. [Abt. Roentgendiagnostik, Radiologische Universitaetsklinik Freiburg, Freiburg im Breisgau (Germany); Wiech, T. [Inst. fuer Pathologie, Universitaetsklinik Freiburg, Freiburg (Germany)

    2007-07-15

    Accurate preoperative staging of rectal cancer is crucial for therapeutic decision making, as local tumor extent, nodal status, and patterns of metastatic spread are directly associated with different treatment strategies. Recently, treatment approaches have been widely standardized according to large studies and consensus guidelines. Introduced by Heald, total mesorectal excision (TME) is widely accepted as the surgical procedure of choice to remove the rectum together with its enveloping tissues and the mesorectal fascia. Neoadjuvant radiochemotherapy also plays a key role in the treatment of locally advanced stages, while the use of new drugs will lead to a further improvement in oncological outcome. Visualization of the circumferential resection margin is the hallmark of any preoperative imaging and a prerequisite for high-quality TME surgery. The aim of this article is to present an overview on current cross-sectional imaging with emphasis on magnetic resonance imaging. Future perspectives in rectal cancer imaging are addressed. (orig.)

  20. Changes in preoperative characteristics in patients undergoing radical prostatectomy

    DEFF Research Database (Denmark)

    Røder, Martin Andreas; Brasso, Klaus; Christensen, Ib Jarle

    2014-01-01

    of a shift in attitude with increasing opportunistic PSA testing. This had led to an increasing number of RPs being performed in Denmark. The objective of this study was to analyze changes in preoperative characteristics over time for the complete cohort of 6489 men who underwent RP between 1995 and 2011....... Our hypothesis was that an increasing amount of men undergo RP for lower risk PCa. MATERIAL AND METHODS: All patients operated from 1995 to 2011 were identified via patient files and registries. Changes over time in age at surgery, preoperative PSA, clinical T-category, biopsy Gleason score (GS......, especially after 2005. Biopsy GS = 7 was found in 20.2% of the patients in 2005 compared to 57.1% in 2011. The proportion of T1 disease increased from 32% to 56%. Significant changes in percentage of patients according to the D'Amico classification were found. After 2005 the proportion of intermediate...