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Sample records for surgery study cass

  1. Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 1: planning sequence.

    Science.gov (United States)

    Xia, J J; Gateno, J; Teichgraeber, J F; Yuan, P; Chen, K-C; Li, J; Zhang, X; Tang, Z; Alfi, D M

    2015-12-01

    The success of craniomaxillofacial (CMF) surgery depends not only on the surgical techniques, but also on an accurate surgical plan. The adoption of computer-aided surgical simulation (CASS) has created a paradigm shift in surgical planning. However, planning an orthognathic operation using CASS differs fundamentally from planning using traditional methods. With this in mind, the Surgical Planning Laboratory of Houston Methodist Research Institute has developed a CASS protocol designed specifically for orthognathic surgery. The purpose of this article is to present an algorithm using virtual tools for planning a double-jaw orthognathic operation. This paper will serve as an operation manual for surgeons wanting to incorporate CASS into their clinical practice.

  2. Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 1: planning sequence

    Science.gov (United States)

    Xia, J. J.; Gateno, J.; Teichgraeber, J. F.; Yuan, P.; Chen, K.-C.; Li, J.; Zhang, X.; Tang, Z.; Alfi, D. M.

    2015-01-01

    The success of craniomaxillofacial (CMF) surgery depends not only on the surgical techniques, but also on an accurate surgical plan. The adoption of computer-aided surgical simulation (CASS) has created a paradigm shift in surgical planning. However, planning an orthognathic operation using CASS differs fundamentally from planning using traditional methods. With this in mind, the Surgical Planning Laboratory of Houston Methodist Research Institute has developed a CASS protocol designed specifically for orthognathic surgery. The purpose of this article is to present an algorithm using virtual tools for planning a double-jaw orthognathic operation. This paper will serve as an operation manual for surgeons wanting to incorporate CASS into their clinical practice. PMID:26573562

  3. CASS Ferrite and Grain Structure Relationship

    Energy Technology Data Exchange (ETDEWEB)

    Ruud, Clayton O. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Ramuhalli, Pradeep [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Meyer, Ryan M. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Diaz, Aaron A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Anderson, Michael T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2016-07-13

    This document summarizes the results of research conducted at Pacific Northwest National Laboratory (PNNL) to determine whether, based on experimental measurements, a correlation existed between grain structure in cast austenitic stainless steel (CASS) piping and ferrite content of the casting alloy. The motivation for this research lies in the fact that ultrasonic testing (UT) is strongly influenced by CASS grain structure; knowledge of this grain structure may help improve the ability to interpret UT responses, thereby improving the overall reliability of UT inspections of CASS components.

  4. FY95 software project management plan: TMACS, CASS computer systems

    Energy Technology Data Exchange (ETDEWEB)

    Spurling, D.G.

    1994-11-11

    The FY95 Work Plan for TMACS and CASS Software Projects describes the activities planned for the current fiscal year. This plan replaces WHC-SD-WM-SDP-008. The TMACS project schedule is included in the TWRS Integrated Schedule.

  5. Consolidated Automated Support System (CASS) Efficiency and Allocation Cost Improvement

    Science.gov (United States)

    2013-12-01

    CASS (RTCASS)–Provides as man- portable CASS configuration using COTS hardware and software to meet USMC V-22 and H-1 support requirements as well as to...the capabilities of the software readily available. Also, the model had to remain simple enough for the managers to manipulate for the model to be a...Maintenance Center (No. CRM - 96-53). Alexandria, VA: Center for Naval Analyses. Mild, P., & Salo, A. (2009). Combining a multiattribute value function

  6. Helena Carreiras, Gender and the Military. Women in the Armed Forces of Western Democracies, London: Routledge (Cass Military Studies, 2006, 262 pages.

    Directory of Open Access Journals (Sweden)

    Vincent Porteret

    2007-12-01

    Full Text Available Helena Carreiras’ book is a recent contribution to the study of what the author calls Women Military Participation (WMP. Far away from some militant works, it “contends that gender does not have an epistemological or ontological primacy in explaining social reality (no more than other category of social analysis” (p. 203.As a starting point, in a review of the main works about WMP the author makes some specifications regarding her object (concept and measurement, explanatory factors, analy...

  7. Sesquiterpene lactones. XXXIII. Guaianolides in the subgenus Psephellus (Cass.) Schmalh., genus Centaurea L.

    OpenAIRE

    Gerard Nowak; Bohdan Drożdż; Miroslav Holub; Agnieszka Łagodzińska

    2014-01-01

    Sesquiterpene lactones were found to occur in all of the studied species of the subgenus Psephellus (Cass.) Schmalh. Differing compositions were found in the representatives of three sections. In Centaurea declinata MB. from the section Leucophylle (Sosn.) Sosn.. 15-deoxyrepin, linichlorin B and cynaropicrin were found. Linichlorin B dominated in Centaurea hypoleucu DC. from section Hypoleucae (Sosn.) Sosn., while in the species classified in section Psephellus Sosn., repin, acroptilin, jener...

  8. Sesquiterpene lactones. XXXIII. Guaianolides in the subgenus Psephellus (Cass. Schmalh., genus Centaurea L.

    Directory of Open Access Journals (Sweden)

    Gerard Nowak

    2014-01-01

    Full Text Available Sesquiterpene lactones were found to occur in all of the studied species of the subgenus Psephellus (Cass. Schmalh. Differing compositions were found in the representatives of three sections. In Centaurea declinata MB. from the section Leucophylle (Sosn. Sosn.. 15-deoxyrepin, linichlorin B and cynaropicrin were found. Linichlorin B dominated in Centaurea hypoleucu DC. from section Hypoleucae (Sosn. Sosn., while in the species classified in section Psephellus Sosn., repin, acroptilin, jenerin, centaurepensin and, in some, also cynaropicrin. dominated.

  9. 铁炭内电解-CASS工艺处理模拟印染废水实验研究%Experimental Study on Iron-Carbon Internal Electrolysis-CASS Process for Simulated Printing and Dyeing Wastewater

    Institute of Scientific and Technical Information of China (English)

    吴烈善; 杨希; 罗锴

    2011-01-01

    With characteristics of great variation of water quality and quantity, high COD and chrome and poor biodegradability, dyeing wastewater is one of the refractory industrial wastewaters. Simulated dyeing wastewater was treated by technology of iron-carbon internal electrolysis and CASS process. Experiment results showed that removal rate of COD was 88%~92%, BOD5 was 90%~94% and decoration was 92%~95% in condition that the rate between iron and carbon was 3,retention time was 80 min, pH 6, aeration capacity 0.3 m3/h, CASS reactor aeration volume range from 0.375 to 0.5 m3/h,drainage ratio was 0.3 and run cycle was 6 h including water aeration 5.0 h, precipitation 20 min, drainage 30 min and idle 10 min. Pre-treatnent process which can destruct the refractory material and improve the performance of activated sludge is used in the subsequent CASS process and improve the treatment effect of COD in wastewater.%印染废水具有水质水量变化大,COD、色度高,可生化性差等特点,属于难处理工业废水之一.采用铁炭内电解预处理以及CASS工艺处理模拟印染废水,试验结果表明:当铁炭床的铁炭质量比为3:1,停留时间为80min,pH为6,曝气量为0.3m3/h及CASS反应器曝气量为0375-0.5 m3/h,排水比为0.3,运行周期6 h,其中,进水曝气5.0 h,沉淀20 min,排水30 min,闲置10 min时,废水处理效果最佳,其COD去除率可达88%-92%,BODs去除率可达91%-94%,脱色率可达92%-95%.预处理段可以破坏废水中的难降解物质,提高废水的可生化性,且增加的铁离子含量可以改善后续CASS工艺活性污泥的沉降性能,提高废水COD的处理效果.

  10. The Consolidated Automated Support System (CASS): A Comparative Evaluation

    Science.gov (United States)

    1990-06-01

    Example Data for Computing Average Availabilty (A.,g) .............. 90 X. 1987 Cost-Benefit Analysis of Procurement of CASS versus AFOT ...... 94 XI...function, station usage , operator identification, and the results of UUT testing. [Ref. 191 The Operational Management System (OMS) aids I level...69)1 = .72. (.002 * 3) + (.005 * 2) + (.003 * 3) 89 Table IX. Example Data for Computing Average Availabilty (A.,,) UUT Sta A Sta B Sta C Sta D 1

  11. Functional properties, nutritional value, and industrial applications of Niger Oilseeds (Guizotia abyssinica Cass.).

    Science.gov (United States)

    Ramadan, Mohamed Fawzy

    2012-01-01

    Non-conventional seeds are being considered as novel food because their constituents have unique chemical properties and may augment the supply of nutritional and functional products. Niger (Guizotia abyssinica Cass.) seed and its crude oil have been widely used in traditional nutritional and medicinal applications. Consequently, niger seed has been extensively studied for its nutritional value, biological activities, and antioxidative properties. In consideration of their potential utilization, detailed knowledge on the composition of niger oilseeds is of major importance. The diversity of applications to which niger seed can be put gives this oilseed great industrial importance. This review summarizes the nutritional value, functional properties, and industrical applications of niger seeds.

  12. Ambulatory spine surgery: a survey study.

    Science.gov (United States)

    Baird, Evan O; Brietzke, Sasha C; Weinberg, Alan D; McAnany, Steven J; Qureshi, Sheeraz A; Cho, Samuel K; Hecht, Andrew C

    2014-08-01

    Study Design Cross-sectional study. Objective To assess the current practices of spine surgeons performing ambulatory surgery in the United States. Methods An electronic survey was distributed to members of the International Society for the Advancement of Spine Surgery. Data were initially examined in a univariate manner; variables with a p value ambulatory spine surgery, and 49.1% were investors in an ambulatory surgery center. Surgeon investors in ambulatory surgery centers were more likely to perform procedures of increased complexity than noninvestors, though limited data precluded a statistical correlation. Surgeons in private practice were more likely to perform ambulatory surgery (94.3%; p = 0.0176), and nonacademic surgeons were both more likely to invest in ambulatory surgery centers (p = 0.0024) and perform surgery at least part of the time in a surgery center (p = 0.0039). Conclusions Though the numbers were too few to calculate statistical significance, there was a trend toward the performance of high-risk procedures on an ambulatory basis being undertaken by those with investment status in an ambulatory center. It is possible that this plays a role in the decision to perform these procedures in this setting versus that of a hospital, where a patient may have better access to care should a complication arise requiring emergent assessment and treatment by a physician. This decision should divest itself of financial incentives and focus entirely on patient safety.

  13. A STUDY OF CONVERSIONS OF LAPAROSOCOPIC SURGERIES INTO OPEN SURGERIES: A ANALYTICAL STUDY

    Directory of Open Access Journals (Sweden)

    Venkata Reddy

    2015-12-01

    Full Text Available INTRODUCTION: The aim of present study is to know the Conversions in Laparoscopic surgery to Open surgery in The patients of all the surgical units in the Department of General Surgery, Government General Hospital, Rangaraya Medical College, Kakinada over a period of 2 years from July 2013 to July 2015. The Objectives of present study is to compare the Conversion Rates of Laparoscopic Surgery to Open Surgery and the factors causing Conversion to Open Surgery in our institution. PATIENTS AND METHODS The protocol is approved by institution ethics committee and written informed consent was taken from each patient. Present clinical Study is an Analytical study conducted over period of 2 years from July 2013 to July 2015 in the Department of General Surgery, Government General Hospital, Rangaraya Medical College, Kakinada, Andhra Pradesh. RESULTS Total number of 536 laparoscopic surgeries were attempted in elective operation theatres with 21 cases out of 536 cases were converted from laparoscopy to open surgery. Total conversion rate in present study is 4%. Most of conversions occurred in laparoscopic chelecystectomy 5.73% cases in comparison to laparoscopic appendectomy 2.26% and laparoscopic hernia repair with 0%. CONCLUSIONS Over all conversion rates of laparoscopic procedure into open surgery is low when compared to other international studies. Most common causes of conversion in present study is altered anatomy, adhesions and intra operative bleed. Conversion of laparoscopic surgery into open surgery resulted in decreased morbidity, complications and increase in duration of hospital stay

  14. Case study on the combined process ,UASB+CASS for the treatment of beer wastewater%UASB+CASS组合工艺处理啤酒废水工程实例

    Institute of Scientific and Technical Information of China (English)

    李晓婷

    2016-01-01

    Based on the comprehensive analysis of the characteristics of the wastewater from beer production ,combi-ning with the original technology in water treatment stations and a number of practical experiences of similar waste-water plants,it is proposed that the combined process,UASB+CASS,is to be used for the treatment of beer waste-water. The running results show that all the effluent COD,BOD5,SS,and NH3-N can meet the requirements specified in Level l of the Discharge Standard of Pollutants for Beer Industry (GB 19821—2005). The effluent,animal and plant oils,and anionic surfactant can meet the requirements specified in Level l of Integrated Wastewater Discharge Stan-dard(GB 8978—1996). Using the combined process for the treatment of wastewater from beer production is techni-cally and economically feasible.%通过对啤酒生产制作废水特点的综合分析,结合原有污水处理站工艺及多家同类污水站的实践经验,提出采用UASB+CASS组合工艺处理啤酒废水.运行结果表明:出水COD、BOD5、SS、NH3-N均满足《啤酒工业污染物排放标准》(GB 19821—2005)一级标准,出水动植物油、阴离子表面活性剂满足《污水综合排放标准》(GB 8978—1996)一级标准,采用该组合工艺处理啤酒生产废水,在技术和经济上可行.

  15. Redelineation Submission for Cass County, TX

    Data.gov (United States)

    Federal Emergency Management Agency, Department of Homeland Security — The Floodplain Mapping/Redelineation study deliverables depict and quantify the flood risks for the study area. The primary risk classifications used are the...

  16. A new 2-alkylhydroquinone glucoside from Phagnalon saxatile (L.) Cass.

    Science.gov (United States)

    Cherchar, Hanene; Lehbili, Meriem; Berrehal, Djemaa; Morjani, Hamid; Alabdul Magid, Abdulmagid; Voutquenne-Nazabadioko, Laurence; Kabouche, Ahmed; Kabouche, Zahia

    2017-09-25

    A new 2-alkylhydroquinone glucoside, 1-O-β-d-glucopyranosyl-1,4-dihydroxy-2-((E) 2-oxo-3-butenyl)benzene (1), in addition to nine known compounds were isolated from the aerial parts of Phagnalon saxatile (L.) Cass. (Asteraceae). Their structures were identified based on spectroscopic methods including 1D and 2D NMR, mass spectrometry (HR-ESI-MS), UV spectral analyses and by comparison with literature data. The cytotoxic activity of three isolated compounds (1-3) was evaluated against fibrosarcoma (HT1080), human lung cancer (A549) and breast cancer (MCF7) cell lines.

  17. A randomized study of combining maze surgery for atrial fibrillation with mitral valve surgery

    NARCIS (Netherlands)

    Jessurun, ER; Van Hemel, NM; Defauw, JJ; De La Riviere, AB; Stofmeel, MAM; Kingma, JH; Ernst, JMPG

    Aim Mitral valve surgery seldom suppresses atrial fibrillation (AF), present prior to surgery. Maze III surgery eliminates AF in >80% of cases, the reason why combining this procedure with mitral valve surgery in patients with AF seems worthwhile. We prospectively studied the outcome of combining

  18. A randomized study of combining maze surgery for atrial fibrillation with mitral valve surgery

    NARCIS (Netherlands)

    Jessurun, ER; Van Hemel, NM; Defauw, JJ; De La Riviere, AB; Stofmeel, MAM; Kingma, JH; Ernst, JMPG

    2003-01-01

    Aim Mitral valve surgery seldom suppresses atrial fibrillation (AF), present prior to surgery. Maze III surgery eliminates AF in >80% of cases, the reason why combining this procedure with mitral valve surgery in patients with AF seems worthwhile. We prospectively studied the outcome of combining th

  19. Mandarin Pronunciation Modeling Based on CASS Corpus

    Institute of Scientific and Technical Information of China (English)

    郑方; 宋战江; Pascale Fung; William Byrne

    2002-01-01

    The pronunciation variability is an important issue that must be faced with when developing practical automatic spontaneous speech recognition systems. In this paper, the factors that may affect the recognition performance are analyzed, including those specific to the Chinese language. By studying the INITIAL/FINAL (IF) characteristics of Chinese language and developing the Bayesian equation, the concepts of generalized INITIAL/FINAL (GIF) and generalized syllable (GS), the GIF modeling and the IF-GIF modeling, as well as the contextdependent pronunciation weighting, are proposed based on a well phonetically transcribed seed database. By using these methods, the Chinese syllable error rate (SER) is reduced by 6.3%and 4.2% compared with the GIF modeling and IF modeling respectively when the language model, such as syllable or word N-gram, is not used. The effectiveness of these methods is also proved when more data without the phonetic transcription are used to refine the acoustic model using the proposed iterative forced-alignment based transcribing (IFABT) method, achieving a 5.7% SER reduction.

  20. Does computer-aided surgical simulation improve efficiency in bimaxillary orthognathic surgery?

    Science.gov (United States)

    Schwartz, H C

    2014-05-01

    The purpose of this study was to compare the efficiency of bimaxillary orthognathic surgery using computer-aided surgical simulation (CASS), with cases planned using traditional methods. Total doctor time was used to measure efficiency. While costs vary widely in different localities and in different health schemes, time is a valuable and limited resource everywhere. For this reason, total doctor time is a more useful measure of efficiency than is cost. Even though we use CASS primarily for planning more complex cases at the present time, this study showed an average saving of 60min for each case. In the context of a department that performs 200 bimaxillary cases each year, this would represent a saving of 25 days of doctor time, if applied to every case. It is concluded that CASS offers great potential for improving efficiency when used in the planning of bimaxillary orthognathic surgery. It saves significant doctor time that can be applied to additional surgical work. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  1. Continuous antigenic stimulation system (CASS) as a new immunization strategy.

    Science.gov (United States)

    Gomez-Vargas, Andrew; Rosenthal, Kenneth L; McDermott, Mark R; Hortelano, Gonzalo

    2004-09-28

    Protection against diseases is mediated by a sustained immune response. Here, we describe a new immunization strategy. Mice implanted with encapsulated C2C12 myoblasts secreting human factor IX (hFIX) elicited a strong humoral response against the transgene, as compared to mice immunized with complete Freund's adjuvant (FA). Mice also had increasing IgG2a antibody titer, indicating a switch to a Th1 profile immune response. Mice developed strong hFIX-specific cytotoxic T lymphocytes (CTL) that was detectable 213 days after implantation, demonstrating the sustained immunity elicited by encapsulated cells. Here, we propose continuous antigenic stimulation system (CASS) as a novel immunization strategy with potential application in the design of novel vaccines.

  2. Minimalismo judicial ¿Cass Sunstein en la Corte Constitucional?

    Directory of Open Access Journals (Sweden)

    Mario Cajas Sarria

    2007-12-01

    Full Text Available Cass Sustein Unstein es hoy en día uno de los principales expositores de la tesis del minimalismo judicial, metodología de adjudicación que puede ser utilizada por el máximo órgano de control constitucional cuando interpreta la Constitución. En este artículo se exponen las principales características y ventajas de esta metodología, así como una comparación con las otras formas de adjudicación presentes actualmente en el derecho estadounidense. Posteriormente, se analiza el uso dado al minimalismo judicial por la Corte Constitucional de Colombia en el control que ésta realiza a la legislación, prestando especial atención a los argumentos presentados por la Corte para declarar inconstitucional el estatuto antiterrorista del año 2003.

  3. Distribution of iron- and sulfate-reducing bacteria across a coastal acid sulfate soil (CASS environment: implications for passive bioremediation by tidal inundation

    Directory of Open Access Journals (Sweden)

    Yu-Chen eLing

    2015-07-01

    Full Text Available Coastal acid sulfate soils (CASS constitute a serious and global environmental problem. Oxidation of iron sulfide minerals exposed to air generates sulfuric acid with consequently negative impacts on coastal and estuarine ecosystems. Tidal inundation represents one current treatment strategy for CASS, with the aim of neutralizing acidity by triggering microbial iron- and sulfate-reduction and inducing the precipitation of iron-sulfides. Although well-known functional guilds of bacteria drive these processes, their distributions within CASS environments, as well as their relationships to tidal cycling and the availability of nutrients and electron acceptors, are poorly understood. These factors will determine the long-term efficacy of passive CASS remediation strategies. Here we studied microbial community structure and functional guild distribution in sediment cores obtained from ten depths ranging from 0-20 cm in three sites located in the supra-, inter- and sub-tidal segments, respectively, of a CASS-affected salt marsh (East Trinity, Cairns, Australia. Whole community 16S rRNA gene diversity within each site was assessed by 454 pyrotag sequencing and bioinformatic analyses in the context of local hydrological, geochemical and lithological factors. The results illustrate spatial overlap, or close association, of iron- and sulfate-reducing bacteria in an environment rich in organic matter and controlled by parameters such as acidity, redox potential, degree of water saturation, and mineralization. The observed spatial distribution implies the need for empirical understanding of the timing, relative to tidal cycling, of various terminal electron-accepting processes that control acid generation and biogeochemical iron and sulfur cycling.

  4. Adolescent girls' views on cosmetic surgery: A focus group study.

    Science.gov (United States)

    Ashikali, Eleni-Marina; Dittmar, Helga; Ayers, Susan

    2016-01-01

    This study examined adolescent girls' views of cosmetic surgery. Seven focus groups were run with girls aged 15-18 years (N = 27). Participants read case studies of women having cosmetic surgery, followed by discussion and exploration of their views. Thematic analysis identified four themes: (1) dissatisfaction with appearance, (2) acceptability of cosmetic surgery, (3) feelings about undergoing cosmetic surgery and (4) cosmetic surgery in the media. Results suggest the acceptability of cosmetic surgery varies according to the reasons for having it and that the media play an important role by normalising surgery and under-representing the risks associated with it.

  5. Sesquiterpene lactones. XXXII. Guaianolides in species from the genus Chartolepis Cass.

    OpenAIRE

    Gerard Nowak; Bohdan Drożdż; Miroslav Holub

    2014-01-01

    Differences in the composition of the "lactone fraction" of 4 species from the genus Chartolepis Cass. were observed. Cynaropierin was isolated from the above-ground parts of Chartolepis intermedia Boiss. and the occurrence there of grossheimin was confirmed. The following compounds were isolated from the above-ground parts of Chartolepis glastifolia (L.) Cass.: centaurepensin, repin, cebellin C, acroptillin, cebellin D, cynaropicrin, cebellin F and janerin. Centaurepensin, repin, cebellin C,...

  6. Recording the PHILAE Touchdown using CASSE: Laboratory Experiments

    Science.gov (United States)

    Knapmeyer, Martin; Faber, Claudia; Tune, Jean-Baptiste; Arnold, Walter; Witte, Lars; Schröder, Silvio; Roll, Reinhard; Chares, Bernd; Fischer, Hans-Herbert; Möhlmann, Diedrich; Seidensticker, Klaus

    2014-05-01

    The landing of Philae on comet 67P/Churyumov-Gerasimenko is scheduled for November 11, 2014. Its landing feet house the triaxial acceleration sensors of CASSE (Comet Acoustic Surface Sounding Experiment) which will thus be the first sensors to be in mechanical contact with the cometary surface. It is planned that CASSE will be in listening mode to record the deceleration of the lander by the collision with the comet. The analysis of this data will not only support an engineering analysis of the landing process itself but also yield information about the mechanical properties of the comet's surface. Here, we describe a series of controlled landings of a lander model. The tests were conducted in the Landing & Mobility Test Facility (LAMA) of the DLR Institute of Space Systems in Bremen, Germany, where an industrial robot can be programmed to move landers or rovers along predefined paths and under simulated low gravity. The qualification model of the Philae landing gear was used in the tests. It consists of three legs manufactured of carbon fiber and metal joints. Attached to each leg is a foot with two soles and a mechanically driven ice screw to secure the lander on the comet. The right one of these soles, if viewed from the outside towards the lander body, houses a Brüel & Kjaer DeltaTron 4506 triaxial piezoelectric accelerometer as used on the spacecraft. Orientation of the three axes was such that the X-axis of the accelerometer points downwards while the Y and Z axes are horizontal. This somewhat uncommon orientation was necessary due to the position of the electric connector on the 4506. Data was recorded at a sampling rate of 8.2 kHz for a duration of 2 s. Touchdown measurements were conducted on three types of ground with different landing velocities. Landings with low velocities were carried out on the concrete floor of the LAMA to determine the stiffness of the landing gear based on the deceleration data measured with the accelerometer. Landings on fine

  7. Synergistic effect of BAP and GA3 on in vitro flowering of Guizotia abyssinica Cass.-A multipurpose oil crop.

    Science.gov (United States)

    Baghel, S; Bansal, Y K

    2014-04-01

    Apical and axillary buds of Guizotia abyssinica Cass., isolated from seedlings raised in vitro, were cultured. High frequency of shoot regeneration was achieved on MS medium with BAP (1 mgl(-1)). Effect of BAP, Kn and GA3 applied successively in culture on shoot regeneration and flower bud formation has been studied. The shoots differentiated in cultures elongated on this medium. These rooted subsequently on half strength MS medium. The shoots flowered in vitro on MS medium with a combination of BAP (0.1mgl(-1)) + GA3 (0.1 mgl(-1)). The plantlets thus formed were successfully hardened with 90 % survival.

  8. Phased Array Ultrasonic Examination of Reactor Coolant System (Carbon Steel-to-CASS) Dissimilar Metal Weld Mockup Specimen

    Energy Technology Data Exchange (ETDEWEB)

    Crawford, S. L. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Cinson, A. D. [US Nuclear Regulatory Commission (NRC), Washington, DC (United States); Diaz, A. A. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Anderson, M. T. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2015-11-23

    In the summer of 2009, Pacific Northwest National Laboratory (PNNL) staff traveled to the Electric Power Research Institute (EPRI) NDE Center in Charlotte, North Carolina, to conduct phased-array ultrasonic testing on a large bore, reactor coolant pump nozzle-to-safe-end mockup. This mockup was fabricated by FlawTech, Inc. and the configuration originated from the Port St. Lucie nuclear power plant. These plants are Combustion Engineering-designed reactors. This mockup consists of a carbon steel elbow with stainless steel cladding joined to a cast austenitic stainless steel (CASS) safe-end with a dissimilar metal weld and is owned by Florida Power & Light. The objective of this study, and the data acquisition exercise held at the EPRI NDE Center, were focused on evaluating the capabilities of advanced, low-frequency phased-array ultrasonic testing (PA-UT) examination techniques for detection and characterization of implanted circumferential flaws and machined reflectors in a thick-section CASS dissimilar metal weld component. This work was limited to PA-UT assessments using 500 kHz and 800 kHz probes on circumferential flaws only, and evaluated detection and characterization of these flaws and machined reflectors from the CASS safe-end side only. All data were obtained using spatially encoded, manual scanning techniques. The effects of such factors as line-scan versus raster-scan examination approaches were evaluated, and PA-UT detection and characterization performance as a function of inspection frequency/wavelength, were also assessed. A comparative assessment of the data is provided, using length-sizing root-mean-square-error and position/localization results (flaw start/stop information) as the key criteria for flaw characterization performance. In addition, flaw signal-to-noise ratio was identified as the key criterion for detection performance.

  9. Telemedicine and Plastic Surgery: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Denis Souto Valente

    2015-01-01

    Full Text Available Background. Telemedicine can be defined as the use of electronic media for transmission of information and medical data from one site to another. The objective of this study is to demonstrate an experience of telemedicine in plastic surgery. Methods. 32 plastic surgeons received a link with password for real-time streaming of a surgery. At the end of the procedure, the surgeons attending the procedure by the Internet answered five questions. The results were analyzed with descriptive statistics. Results. 27 plastic surgeons attended the online procedure in real-time. 96.3% considered the access to the website as good or excellent and 3.7% considered it bad. 14.8% reported that the transmission was bad and 85.2% considered the quality of transmission as good or excellent. 96.3% classified the live broadcasting as a good or excellent learning experience and 3.7% considered it a bad experience. 92.6% reported feeling able to perform this surgery after watching the demo and 7.4% did not feel able. 100% of participants said they would like to participate in other surgical demonstrations over the Internet. Conclusion. We conclude that the use of telemedicine can provide more access to education and medical research, for plastic surgeons looking for medical education from distant regions.

  10. Video-Assisted Thoracic Surgery Study Group.

    Science.gov (United States)

    LoCicero, J

    1993-09-01

    Both patients and the medical profession are quick to embrace new technology, particularly when it may replace an existing surgical procedure. Unfortunately, the rapidity of acceptance is rarely associated with careful evaluation. Laparoscopy is a recent example of such widely embraced technology. Studies of laparoscopy that yielded good comparative data to more traditional methods were slow to accrue. This led to the exposure of its shortcomings through governmental reports and the lay press. To prevent this from happening in thoracoscopy, two types of studies are required so that valid conclusions about the new technology can be drawn. The first is an accounting of the new technology as procedures evolve around it. The data collected in such a study should contain basic information, including the indications for the procedure, how it was performed, procedure length, associated complications, and patient outcome. Such information provides a broad profile of the technology, emphasizing from the outset its potential strengths and weaknesses. The second type of study involves a more detailed concurrent comparison of the specific procedures utilizing this technology to the established traditional methods. Such randomized studies help to firmly establish through scientific process the place of the new technology. The Video-Assisted Thoracic Surgery Study Group was organized in early 1992 to address these concerns. From an initial four surgeons the group has grown to include more than 41 institutions. Currently the group is collecting data in a registry and has established three clinical trials to evaluate video-assisted thoracic surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

  11. Current peripheral bypass surgery: various clinical studies

    NARCIS (Netherlands)

    Slaa, Alexander te

    2011-01-01

    Substantial post-operative edema occurs in the majority of patients who undergo peripheral bypass surgery due to severe peripheral arterial disease (PAD). The pathophysiological mechanisms that underlay edema formation following peripheral bypass surgery include hyperemia, an increased capillary per

  12. Current peripheral bypass surgery: various clinical studies

    NARCIS (Netherlands)

    Slaa, Alexander te

    2011-01-01

    Substantial post-operative edema occurs in the majority of patients who undergo peripheral bypass surgery due to severe peripheral arterial disease (PAD). The pathophysiological mechanisms that underlay edema formation following peripheral bypass surgery include hyperemia, an increased capillary per

  13. Obesity Slows Recovery for Heart Surgery Patients: Study

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_167721.html Obesity Slows Recovery for Heart Surgery Patients: Study They' ... Aug. 10 in The Annals of Thoracic Surgery . "Obesity is a growing problem for society that has ...

  14. [Feasibility study for ambulatory surgery in emergency].

    Science.gov (United States)

    Franck, L; Maesani, M; Birenbaum, A; Delerme, S; Riou, B; Langeron, O; Le Saché, F

    2013-06-01

    Development of outpatient care is one of the major goals of public health policy in our country. For the purpose of this study, we set up an emergency outpatient surgery unit 24hours a day in our hospital. We assessed the feasibility of such a unit with a length of stay less than 12hours and no patient readmission. A prospective observational and monocentric study was conducted in our hospital by systematically including patients eligible for emergency surgery outpatient care. We built a database compiling patient characteristics, lengths of stay, surgical and anesthesic procedures, complications and readmission rate. Satisfaction was then assessed by the « EVAN-G » questionnaire. From May 2011 to October 2012, 147 patients were included in our research. They were 31years old [25-43]. Hundred and twenty-six of them (86%) remained in the outpatient procedure without any readmission. Twenty-one (14%) were excluded, essentially for surgical contraindications or due to the absence of an accompanying person. Length of stay was of 10.5hours [8.5-13]. The satisfaction survey showed an average score of 83/100. The setting up of an ambulatory emergency surgery unit is possible after proper training of emergency care specialists, anesthesiologists, and surgeons. This activity is compatible with safe care and a high level of patient satisfaction. It must be considered as part of the emergency procedures available and should not be systematically ruled out. Copyright © 2013 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  15. LAPAROSCOPIC GYNAEC SURGERIES – A RETROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Hiremath

    2013-10-01

    Full Text Available ABSTRACT : BACKGROUND: There has been a rapid worldwide adoption of laparoscopic procedures across many surgical specialt ies, most notably in Gynaecology. Unfortunately, the increased adoption of laparoscopic surgery has also been accompanied by a corresponding rise in the rates and types of complications reported. AIMS : To audit the different types of laparoscopic surgerie s and their complications and comparison with other routes of surgery. METHODS & MATERIALS : We have retrospectively analysed 285 laparoscopic surgeries and 306 other routes of surgery which were done at our institute from July 2011 to April 2013.We admit t he patients 1 - 2 days prior to surgery and a complete medical work - up of the patient is done for elective laparoscopic surgery .We defer laparoscopy for malignant conditions, uterine size more than 20 weeks, cervix flushed to the vagina or with history of m ore than 2 pelvic surgeries. Sub - fertile women, after an initial workup, are subjected to diagnostic laparoscopy with chromopertubation. For laparoscopic cystectomies, patients with ultrasono graphy findings suggestive of benign tumours are selected. RESULT S : We have performed 285 laparoscopic procedures over this time period till date. Majority of these cases are Laparoscopic Assisted Vaginal Hysterectomies (LAVH [111 – 38.9%], followed by laparoscopic surgeries for various benign ovarian conditions ( BOC [62 – 21%] and Diagnostic Laparoscopies ( DL with or without laparoscopic ovarian drilling ( LOD [59 cases – 20.7%]. Out of 111 LAVH, 3 patients had bladder injury [2.7%] ; Out of 285 cases that underwent laparoscopic procedures, 5 [1.75%] required conversi on to laparotomy. Overall operative complications including major and minor, are significantly higher in the abdominal surgery group as compared to the laparoscopic group ( p value= 0.001 CONCLUSION : Laparoscopy is a safe route for conventional surgery, with lesser intraoperative, immediate post

  16. Sesquiterpene lactones. XXXII. Guaianolides in species from the genus Chartolepis Cass.

    Directory of Open Access Journals (Sweden)

    Gerard Nowak

    2014-01-01

    Full Text Available Differences in the composition of the "lactone fraction" of 4 species from the genus Chartolepis Cass. were observed. Cynaropierin was isolated from the above-ground parts of Chartolepis intermedia Boiss. and the occurrence there of grossheimin was confirmed. The following compounds were isolated from the above-ground parts of Chartolepis glastifolia (L. Cass.: centaurepensin, repin, cebellin C, acroptillin, cebellin D, cynaropicrin, cebellin F and janerin. Centaurepensin, repin, cebellin C, acroptillin, cynaropicrin, janerin and a new guaianolide, pterocaulin were isolated from the herb Chartolepis biebersteinii Jaub. et Spach. In addition to the lactones found in Chartolepis biebersteinii, Chartolepis pterocaula (Trautv. Czer. also accumulated grossheimin.

  17. Improvement of the South CASS Function with GIS Technology%结合 ArcGIS 技术改进南方 CASS 功能

    Institute of Scientific and Technical Information of China (English)

    段建刚

    2015-01-01

    At present, the topographic mapping software use by most of the surveying and mapping institutes is using South CASS.But it has some shortcomings.Some function of ArcGIS software can make up for its shortcomings and the insufficiency.Based on ArcGIS COM technology to develop AutoCAD plug-ins to integrate the functions of ArcGIS to the CASS software.%目前,大部分测绘单位的地形图制图软件都采用南方CASS软件,但其功能上存在一些不足,而ArcGIS软件的某些功能恰好可以弥补。同时,借助于ArcGIS COM组件技术开发AutoCAD功能插件,以完成ArcGIS与CASS软件的功能整合。

  18. A prospective clinical study of polycarboxylate cement in periapical surgery

    National Research Council Canada - National Science Library

    Peñarrocha-Diago, M-A; Ortega-Sánchez, B; García-Mira, B; Maestre-Ferrín, L; Peñarrocha-Oltra, D; Gay-Escoda, C

    .... A prospective clinical study was made of 25 patients subjected to periapical surgery with ultrasound and magnifying loupes, in which polycarboxylate cement was used as retrograde filling material...

  19. South Bronx High School, Project CASS. O.E.E. Evaluation Report, 1982-1983.

    Science.gov (United States)

    Velazquez, Clara; Schulman, Robert

    Project CASS (Career Awareness/Survival Skills) in its first year of a two-year funding cycle provided English as a second language (ESL) and native language instruction, as well as bilingual instruction in mathematics, science, history and economics, to 250 low income, Spanish speaking students at South Bronx High School. The program's primary…

  20. Fate and transport of petroleum hydrocarbons in the subsurface near Cass Lake, Minnesota

    Science.gov (United States)

    Drennan, Dina M.; Bekins, Barbara A.; Warren, Ean; Cozzarelli, Isabelle M.; Baedecker, Mary Jo; Herkelrath, William N.; Delin, Geoffrey N.; Rosenbauer, Robert J.; Campbell, Pamela L.

    2010-01-01

    The U.S. Geological Survey (USGS) investigated the natural attenuation of subsurface petroleum hydrocarbons leaked over an unknown number of years from an oil pipeline under the Enbridge Energy Limited Partnership South Cass Lake Pumping Station, in Cass Lake, Minnesota. Three weeks of field work conducted between May 2007 and July 2008 delineated a dissolved plume of aromatic hydrocarbons and characterized the biodegradation processes of the petroleum. Field activities included installing monitoring wells, collecting sediment cores, sampling water from wells, and measuring water-table elevations. Geochemical measurements included concentrations of constituents in both spilled and pipeline oil, dissolved alkylbenzenes and redox constituents, sediment bioavailable iron, and aquifer microbial populations. Groundwater in this area flows east-southeast at approximately 26 meters per year. Results from the oil analyses indicate a high degree of biodegradation, characterized by nearly complete absence of n-alkanes. Cass Lake oil samples were more degraded than two oil samples collected in 2008 from the similarly contaminated USGS Bemidji, Minnesota, research site 40 kilometers away. Based on 19 ratios developed for comparing oil sources, the conclusion is that the oils at the two sites appear to be from the same hydrocarbon source. In the Cass Lake groundwater plume, benzene concentrations decrease by three orders of magnitude within 150 meters (m) downgradient from the oil body floating on the water table (between well MW-10 and USGS-4 well nest). The depths of the highest benzene concentrations increase with distance downgradient from the oil, a condition typical of plumes in shallow, unconfined aquifers. Background groundwater, which is nearly saturated with oxygen, becomes almost entirely anaerobic in the plume. As at the Bemidji site, the most important biodegradation processes are anaerobic and dominated by iron reduction. The similarity between the Cass Lake and

  1. Preparing for successful surgery: an implementation study.

    Science.gov (United States)

    Diaz, Manuel; Larsen, Brad

    2005-01-01

    To evaluate the implementation of a mind-body program for surgical patients in a community hospital, assessing patient participation, patient perception, and program impact on anxiety, pain, and quality of sleep during the perioperative period. Two hundred thirty patients having total hip replacement, total knee replacement, hysterectomy, or colectomy participated in this investigation. One hundred fifteen patients were assigned to the control group before the start of the mind-body program and received routine care. The subsequent 115 patients were assigned to the intervention group and were given an audio CD (containing guided imagery, affirmations, and relaxation music) and a brochure three to seven days before surgery. The brochure recommended that patients listen to the CD twice a day before and after surgery. Anxiety, pain at rest, pain with movement, quality of sleep, and program participation were assessed for the first two postoperative days, and patient perception of the program was assessed at the end of the two days. Anxiety scores were lower in the intervention group on the evening of surgery. Despite a trend toward lower pain scores in the intervention group, no difference between the intervention and control groups reached statistical significance, including quality of sleep. Of patients in the intervention group, 74% listened to the CD at least once after surgery, and 37% listened to the program three or more times. Most patients who used the CD at least once rated it as helpful, and 87% said they would use it for future operations. Patient response to a perioperative mind-body program was favorable. Most patients listened to the program CD at least once, and a third used the CD repeatedly, as recommended. The majority of patients who used the CD felt it had been helpful and would use it again. Program participants experienced less anxiety on the night of surgery.

  2. Simultaneous bilateral cataract surgery: economic analysis; Helsinki Simultaneous Bilateral Cataract Surgery Study Report 2.

    Science.gov (United States)

    Leivo, Tiina; Sarikkola, Anna-Ulrika; Uusitalo, Risto J; Hellstedt, Timo; Ess, Sirje-Linda; Kivelä, Tero

    2011-06-01

    To present an economic-analysis comparison of simultaneous and sequential bilateral cataract surgery. Helsinki University Eye Hospital, Helsinki, Finland. Economic analysis. Effects were estimated from data in a study in which patients were randomized to have bilateral cataract surgery on the same day (study group) or sequentially (control group). The main clinical outcomes were corrected distance visual acuity, refraction, complications, Visual Function Index-7 (VF-7) scores, and patient-rated satisfaction with vision. Health-care costs of surgeries and preoperative and postoperative visits were estimated, including the cost of staff, equipment, material, floor space, overhead, and complications. The data were obtained from staff measurements, questionnaires, internal hospital records, and accountancy. Non-health-care costs of travel, home care, and time were estimated based on questionnaires from a random subset of patients. The main economic outcome measures were cost per VF-7 score unit change and cost per patient in simultaneous versus sequential surgery. The study comprised 520 patients (241 patients included non-health-care and time cost analyses). Surgical outcomes and patient satisfaction were similar in both groups. Simultaneous cataract surgery saved 449 Euros (€) per patient in health-care costs and €739 when travel and paid home-care costs were included. The savings added up to €849 per patient when the cost of lost working time was included. Compared with sequential bilateral cataract surgery, simultaneous bilateral cataract surgery provided comparable clinical outcomes with substantial savings in health-care and non-health-care-related costs. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  3. Socioeconomic outcome of epilepsy surgery: A controlled national study

    DEFF Research Database (Denmark)

    Jennum, Poul; Sabers, Anne; Christensen, Jakob

    2016-01-01

    PURPOSE: Epilepsy surgery has been a standard treatment for refractory epilepsies that cannot be controlled by standard medical treatment. We aimed to evaluate the health and social consequences of resective surgery relative to controls from a study of national data. METHODS: Using the Danish...... National Patient Registry we identified all subjects with an epilepsy diagnosis between 1996 and 2009 and compared them with a group of patients with an epilepsy diagnosis who had had neither epilepsy surgery nor a vagus stimulation diagnosis by the index date, and who were matched by gender, index year...... for epilepsy diagnosis, and index year for epilepsy surgery. We considered all the health and social information available in the Danish health, medication and social registers. The duration of follow-up was three years. RESULTS: 254 epilepsy patients and 989 controls were analyzed. Surgery patients were more...

  4. Fracture risk following bariatric surgery: a population-based study.

    Science.gov (United States)

    Nakamura, K M; Haglind, E G C; Clowes, J A; Achenbach, S J; Atkinson, E J; Melton, L J; Kennel, K A

    2014-01-01

    The effects of bariatric surgery on skeletal health are poorly understood. We found that bariatric surgery patients are more prone to fracture when compared to the general population. While further studies of fracture risk in this population are needed, bone health should be discussed in bariatric surgery clinics. Bariatric surgery is an increasingly common treatment for medically complicated obesity. Adverse skeletal changes after bariatric surgery have been reported, but their clinical importance remains unknown. We hypothesized that bariatric surgery patients are at increased risk of fracture. We conducted a historical cohort study of fracture incidence among 258 Olmsted County, Minnesota, residents who underwent a first bariatric surgery in 1985-2004. Relative fracture risk was expressed as standardized incidence ratios (SIRs), while potential risk factors were evaluated by hazard ratios (HR) obtained from a time-to-fracture regression model. The mean (±SD) body mass index at bariatric surgery was 49.0 ± 8.4 kg/m(2), with an average age of 44 ± 10 years and 82% (212) females. Gastric bypass surgery was performed in 94% of cases. Median follow-up was 7.7 years (range, 6 days to 25 years), during which 79 subjects experienced 132 fractures. Relative risk for any fracture was increased 2.3-fold (95% confidence interval (CI), 1.8-2.8) and was elevated for a first fracture at the hip, spine, wrist, or humerus (SIR, 1.9; 95% CI, 1.1-2.9), as well as for a first fracture at any other site (SIR, 2.5; 95% CI, 2.0-3.2). Better preoperative activity status was associated with a lower age-adjusted risk (HR, 0.4; 95% CI, 0.2-0.8) while prior fracture history was not associated with postoperative fracture risk. Bariatric surgery, which is accompanied by substantial biochemical, hormonal, and mechanical changes, is associated with an increased risk of fracture.

  5. Is Cass's Model of Homosexual Identity Formation Relevant to Today's Society?

    Science.gov (United States)

    Kenneady, Donna Ann; Oswalt, Sara B.

    2014-01-01

    Cass's Homosexual Identity Formation Model (1979) is one of the most well-known and well-referenced models of identity development for gay males and lesbians. This article provides a review of Cass's six steps of the model, as well as research support for and critiques of the model. As the model was developed more than 30 years ago, the…

  6. Opioid pain medication use after dermatologic surgery: a prospective observational study of 212 dermatologic surgery patients.

    Science.gov (United States)

    Harris, KaLynne; Curtis, Julia; Larsen, Brooke; Calder, Scott; Duffy, Keith; Bowen, Glen; Hadley, Michael; Tristani-Firouzi, Payam

    2013-03-01

    To better understand postoperative opioid use after dermatologic surgery. Prospective observational study. Academic dermatology department. The study included 212 adults (1) who were undergoing a single skin excision (including Mohs micrographic surgery), (2) who consented to participate,and (3) who were able to be reached by telephone on postoperative day 3 or 4. Patients who did not meet these criteria and those referred to another physician for further surgical treatment or repair were excluded. The study examined(1) the incidence of opioid prescription after dermatologic surgery, (2) the percentage of prescribed opioid pain medications used in the postoperative period, and (3) patient and surgical characteristics associated with opioid pain medication prescription and use. Opioids were prescribed to 72 of the 212 patients(34%). Twenty-five of the 72 patients (35%) who were prescribed opioids did not use them. Forty-nine of 57 patients (86%) who filled an opioid prescription had leftover pills, and 26 of the 49 patients (53%) planned to keep them. Only maximum pain score was significantly associated with opioid use. Opioids were over prescribed after dermatologic surgery. Patients who had left over opioids did not dispose of them properly, which could lead to potential misuse and abuse.

  7. SURGICAL SITE INFECTION IN ABDOMINAL SURGERIES: A CLINICAL STUDY

    Directory of Open Access Journals (Sweden)

    Amit

    2014-09-01

    Full Text Available Purpose: A prospective study of incisional surgical site infection in abdominal surgeries was conducted to find out incidence, common predisposing factors and microbiological profile. METHODS: 375 patients who underwent abdominal surgeries were studied in a span of 1 year. They were divided into two groups – group 1 – 316 cases who did not develop Surgical Site Infection (SSI, the 2nd group – 59 cases that developed SSI. These patients were studied by interviewing and examination according to a set proforma. The results were statistically analyzed by comparing averages using Chi square chart for finding significance of difference where applicable. RESULT: The overall SSI incidence was 15.7 % (59/375. In elective surgeries, the SSI rate was 5.7% and in emergency surgeries, it was 28.6%. It was found that SSI increased with increasing age linearly. Other significant factors involved were increasing class of wound (dirty > clean wound class, increased preoperative stay, presence of remote site infection, increased duration of surgery and use of drains. E. coli was found to be the most common organism causing SSI in abdominal operations. CONCLUSION: SSI can be reduced by decreasing the preoperative hospital stay, appropriate antibiotic administration policies, preoperative control of remote site infections, adequate preoperative patient preparation, reducing the duration of surgery to minimum, judicious use of drains and intraoperative maintenance of asepsis and following operation theatre discipline properly.

  8. A nationwide study on anastomotic leakage after colonic cancer surgery

    DEFF Research Database (Denmark)

    Krarup, Peter-Martin; Jorgensen, L N; Andreasen, A H

    2012-01-01

    Aim: Anastomotic leakage (AL) is a major challenge in colorectal cancer surgery due to increased morbidity and mortality. Possible risk factors should be investigated differentially, distinguishing between rectal and colonic surgery in large-scale studies to avoid selection bias and confounding....... Method: The incidence and risk factors associated with AL were analysed in an unselected nation-wide prospective cohort of patient subjected to curative colonic cancer surgery with primary anastomosis and entered into The Danish Colorectal Cancer Group database between May 2001 and December 2008. Results......: AL occurred in 593 (6.4%) of 9333 patients. Laparoscopic surgery (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.05-1.70; P = 0.03); left hemicolectomy (OR, 2.02; 95% CI, 1.50-2.72) or sigmoid colectomy (OR, 1.69; 95% CI, 1.32-2.17; P = 0.01); intraoperative blood loss (OR, 1.04; 95% CI, 1...

  9. Outpatient- and inpatient-based buckling surgery: a comparative study

    Directory of Open Access Journals (Sweden)

    Lee JC

    2014-04-01

    Full Text Available Jin Cheol Lee,* Yu Cheol Kim*Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea *Both authors contributed equally to this workPurpose: To evaluate the clinical outcomes of ambulatory buckling surgery, comparing outpatient- with inpatient-based surgery.Methods: The authors performed a retrospective study of 80 consecutive cases of rhegmato genous retinal detachment from January 2009 to December 2011 treated by scleral buckling surgery. Two groups of patients were defined according to inpatient (group 1 or outpatient (group 2 surgery, and a comparison of several parameters between these two groups was performed.Results: Of the 80 subjects in this study, the average age of group 1 (50 patients was 49.7 years, and that of group 2 (30 patients was 47.5 years. There were no statistically significant differences in the average logarithm of the minimum angle of resolution-visual acuity, the condition of the lens, or the presence of retinal lattice degeneration prior to the surgery between the groups. There were no statistically significant differences in the patterns of tear or retinal detachment or in surgical procedure between the groups. Comparing the best-corrected visual acuity after 6 months with that prior to the surgery, the changes in group 1 and group 2 were 0.26 and 0.31, respectively. The functional success rates of group 1 and group 2 after 6 months were 90% and 93%, respectively, and the anatomical success rates of group 1 and group 2 after 6 months were 94% and 96%, respectively, but these were also statistically insignificant.Conclusion: Hospitalization is not essential for buckling surgery in uncomplicated rhegmatogenous retinal detachment surgery.Keywords: ambulatory, scleral buckling, rhegmatogenous retinal detachment

  10. Treatment of FIGO stage IV ovarian carcinoma: results of primary surgery or interval surgery after neoadjuvant chemotherapy: a retrospective study.

    Science.gov (United States)

    Rafii, A; Deval, B; Geay, J-F; Chopin, N; Paoletti, X; Paraiso, D; Pujade-Lauraine, E

    2007-01-01

    The objective of the study is to determine whether surgery influences the outcome of stage IV ovarian cancer. The study design is as follows: From May 1995 to December 2000, 129 patients with FIGO stage IV ovarian cancer, recruited in 42 centers, were prospectively included in GINECO first-line randomized studies of platinum-based regimens with paclitaxel administered simultaneously or sequentially. In all, 109 were eligible for this study. Standard peritoneal cytoreductive surgery was defined as a procedure including at least total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and peritoneal debulking. Surgery was considered optimal if residual lesions were smaller than 1 cm. The Kaplan-Meier method was used to compare survival. Initial abdominopelvic cytoreductive surgery was considered standard in 55 (54%) patients. Abdominopelvic surgery was optimal in 29 patients and nonoptimal in 26. Twenty-two (22%) patients had a simple biopsy, and 25 (24%) patients underwent substandard surgery. Twenty-two of these 47 patients without initial standard surgery underwent a second surgical procedure, and 17 of the 22 patients completed standard surgery. The median overall survival time in the entire population was 24.3 months (95% confidence interval [CI], 19.5-29.1 months). Patients treated without a cytoreductive surgical procedure had significantly worse median survival (15.1 months; 95% CI, 5.4-24.9 months) than patients who had optimal primary surgery (22.9 months; 95% CI, 15.6-30.1 months), nonoptimal primary surgery (27.1 months; 95% CI, 21.2-32.9 months), or neoadjuvant chemotherapy followed by surgery (45.5 months; 95% CI, 23.5-67.5 months) (P= .001). In conclusion, this study shows a significant benefit of debulking surgery in stage IV ovarian cancer patients who responded to neoadjuvant chemotherapy. Neoadjuvant chemotherapy can help to select patients for surgery.

  11. Mexican Arnica (Heterotheca inuloides Cass. Asteraceae: Astereae): Ethnomedical uses, chemical constituents and biological properties.

    Science.gov (United States)

    Rodríguez-Chávez, José Luis; Egas, Verónica; Linares, Edelmira; Bye, Robert; Hernández, Tzasna; Espinosa-García, Francisco J; Delgado, Guillermo

    2017-01-04

    Heterotheca inuloides Cass. (Asteraceae) has been traditionally used to treat a wide range of diseases in Mexico in the treatment of rheumatism, topical skin inflammation, muscular pain colic, and other painful conditions associated with inflammatory processes, additionally has been used to treat dental diseases, and gastrointestinal disorders. This species has also been used for the treatment of cancer and diabetes. This review provides up-to-date information on the botanical characterization, traditional uses, chemical constituents, as well as the biolological activities of H. inuloides. A literature search was conducted by analyzing the published scientific material. Information related to H. inuloides was collected from various primary information sources, including books, published articles in peer-reviewed journals, monographs, theses and government survey reports. The electronic search of bibliographic information was gathered from accepted scientific databases such as Scienfinder, ISI Web of Science, Scielo, LILACS, Redalyc, Pubmed, SCOPUS and Google Scholar. To date, more than 140 compounds have been identified from H. inuloides, including cadinane sesquiterpenes, flavonoids, phytosterols, triterpenes, benzoic acid derivatives, and other types of compounds. Many biological properties associated with H. inuloides. Many studies have shown that the extracts and some compounds isolated from this plant exhibit a broad spectrum of biological activities such as antioxidant, antitumor, anti-inflammatory, cytotoxic, and chelating activities, as well as insecticidal and phytotoxic activity. To date, reports on the toxicity of H. inuloides are limited. A comprehensive analysis of the literature obtained through the above-mentioned sources confirmed that ethnomedical uses of H. inuloides have been recorded in Mexico to treat rheumatism, pain, and conditions associated with inflammatory processes. Pharmacological studies have demonstrated the activity of certain

  12. A prospective clinical study of polycarboxylate cement in periapical surgery

    Science.gov (United States)

    Ortega-Sánchez, Bárbara; García-Mira, Berta; Maestre-Ferrín, Laura; Peñarrocha-Oltra, David; Gay-Escoda, Cosme

    2012-01-01

    Objective: To evaluate the clinical efficacy of polycarboxylate cement as retrograde filling material. Design: A prospective clinical study was made of 25 patients subjected to periapical surgery with ultrasound and magnifying loupes, in which polycarboxylate cement was used as retrograde filling material. Measurements were made of the area and diameter of the lesions pre- and postoperatively, and 6 and 12 months after the operation. The apical resection and retrograde filling areas were also measured, and the prognosis following surgery was recorded. Results: A total of 23 patients with 31 apicoectomized teeth were studied (2 patients being lost to follow-up). The mean area of the periapical lesions before surgery was 52.25 mm2, with a mean major diameter of 6.1 mm and a mean lesser diameter of 4.8 mm. The success rate after 12 months was 54.7%, according to the criteria of Von Arx and Kurt. The prognosis was poorer in females, in larger lesions, and in cases with larger retrograde filling areas. Conclusions: Polycarboxylate cement offers good results, with important bone regeneration after periapical surgery. Key words: Periapical surgery, endodontic treatment, polycarboxylate cement. PMID:22143701

  13. A STUDY ON INCISIONAL HERNIA FOLLOWING OBSTETRICS AND GYNAECOLOGICAL SURGERIES

    Directory of Open Access Journals (Sweden)

    Sumathi Ravikumar

    2016-12-01

    Full Text Available BACKGROUND The term ventral hernia encompasses incisional, epigastric, paraumbilical, spigelian and traumatic hernias. This is a hernia that protrudes through defect in an abdominal wound. With evolution of modern surgery and rapid increase in the number of abdominal operations performed, incisional hernias have risen in frequency and this hernia seems to be more common in females following obstetric and gynaecological surgeries. This study undertaken to stress the problem of incisional hernias in females occurring after obstetric and gynaecological surgeries. The aim of the study is to- 1. Study the incidence and prevalence of incisional hernias following obstetrics and gynaecological surgeries in KAPV Government Medical College, Tiruchirappalli. 2. Study aetiological factors for incisional hernia following obstetric and gynaecological surgeries. 3. Analyse preventive measures. 4. Analyse the problems in females, which led to incisional hernia. MATERIALS AND METHODS 178 cases of incisional hernia admitted in KAPV Government Medical College, Tiruchirappalli, during the period of 2 years from June 2014 to May 2016. The cases analysed according to age, previous history, type of incision, suture material used and associated comorbidities. RESULTS Maximum age affected is between 50 to 59 years and with 10 years of surgery. Incidence more following LSCS with midline incision. Incidence more with the usage of absorbable suture material. Postoperative wound infection and anaemia were leading associated factors for incisional hernia. CONCLUSION The incidence of incisional hernia is more common in females especially in obese and multiparous woman. The incidence is more after LSCS and puerperal sterilisation. Onlay reinforced mesh repair using Prolene mesh have given good results. Prolene mesh appears to be best tolerated by body tissues. The use of closed suction drain have significantly reduced the postoperative wound infection.

  14. Robotic consolle for ocular surgery: a preliminary study

    Science.gov (United States)

    Rossi, Francesca; Pini, Roberto; Menabuoni, Luca; Lenzetti, Ivo; Russo, Sheila; Menciassi, Arianna; Fortuna, Damiano

    2014-02-01

    Minimally invasive surgery has recently been improved by the use of robot-assisted procedures in several medical fields. Among the ocular surgeries there are a few examples of sophisticated vitreoretinal procedures, while robotic-assisted surgery of the anterior eye segment is still under study. In this paper we propose a new approach to the robotic assisted ocular surgery: a CO2 laser system is equipped with a micromanipulator and scanner, and it is proposed to induce photothermal effects for the removal of neoformations. A sensorized tool is connected to the patient eye and to the robotic arm. This tool is equipped with force and position sensors: by the use of the spatial information from the robotic console and from the patient it is possible to control the position of the target itself and to block it in the correct position for performing surgery. The system is provided by a feedback alarm that remove the block of the patient head in any moment. The optimized robotic consolle can be used in performing scleral cuts and in the treatment of pterigium or neoformations.

  15. NeoCASS: An integrated tool for structural sizing, aeroelastic analysis and MDO at conceptual design level

    Science.gov (United States)

    Cavagna, Luca; Ricci, Sergio; Travaglini, Lorenzo

    2011-11-01

    This paper presents a design framework called NeoCASS (Next generation Conceptual Aero-Structural Sizing Suite), developed at the Department of Aerospace Engineering of Politecnico di Milano in the frame of SimSAC (Simulating Aircraft Stability And Control Characteristics for Use in Conceptual Design) project, funded by EU in the context of 6th Framework Program. It enables the creation of efficient low-order, medium fidelity models particularly suitable for structural sizing, aeroelastic analysis and optimization at the conceptual design level. The whole methodology is based on the integration of geometry construction, aerodynamic and structural analysis codes that combine depictive, computational, analytical, and semi-empirical methods, validated in an aircraft design environment. The work here presented aims at including the airframe and its effect from the very beginning of the conceptual design. This aspect is usually not considered in this early phase. In most cases, very simplified formulas and datasheets are adopted, which implies a low level of detail and a poor accuracy. Through NeoCASS, a preliminar distribution of stiffness and inertias can be determined, given the initial layout. The adoption of empirical formulas is reduced to the minimum in favor of simple numerical methods. This allows to consider the aeroelastic behavior and performances, as well, improving the accuracy of the design tools during the iterative steps and lowering the development costs and reducing the time to market. The result achieved is a design tool based on computational methods for the aero-structural analysis and Multi-Disciplinary Optimization (MDO) of aircraft layouts at the conceptual design stage. A complete case study regarding the TransoniCRuiser aircraft, including validation of the results obtained using industrial standard tools like MSC/NASTRAN and a CFD (Computational Fluid Dynamics) code, is reported. As it will be shown, it is possible to improve the degree of

  16. Endodontic surgery: an online study guide.

    Science.gov (United States)

    2008-05-01

    The Editorial Board of the Journal of Endodontics has developed a literature-based study guide of topical areas related to endodontics. This study guide is intended to give the reader a focused review of the essential endodontic literature and does not cite all possible articles related to each topic. Although citing all articles would be comprehensive, it would defeat the idea of a study guide. This section will cover indications and contraindications, surgical anatomy related to endodontics, flap design, root-end resection, the beveled root surface, root-end preparation techniques, root-end filling materials, endodontic surgical aids, endodontic surgical wound healing, incision and drainage, surgical trephination, intentional replantation, endodontic endosseous implants, submergence of roots, transplantation of teeth, and cystic decompression.

  17. Mortality after surgery in Europe: a 7 day cohort study

    NARCIS (Netherlands)

    Pearse, R.M.; Moreno, R.P.; Bauer, P.; Pelosi, P.; Metnitz, P.; Spies, C.; Vallet, B.; Vincent, J.L.; Hoeft, A.; Rhodes, A.; Pickkers, P.; Bouw, M.P.

    2012-01-01

    BACKGROUND: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an intern

  18. Ultrasonic Phased Array Sound Field Mapping Through Large-Bore Coarse Grained Cast Austenitic Stainless Steel (CASS) Piping Materials

    Energy Technology Data Exchange (ETDEWEB)

    Cinson, Anthony D.; Crawford, Susan L.; Prowant, Matthew S.; Diaz, Aaron A.; Hathaway, John E.; Anderson, Michael T.

    2012-04-16

    A sound field beam mapping exercise was conducted to further understand the effects of coarse grained microstructures found in CASS materials on phased array ultrasonic wave propagation. Laboratory measurements were made on three CASS specimens with different microstructures; the specimens were polished and etched to reveal measurable grain sizes, shapes and orientations. Three longitudinal, phased array probes were fixed on a specimen's outside diameter with the sound field directed toward one end (face) of the pipe segment over a fixed range of angles. A point receiver was raster scanned over the surface of the specimen face generating a sound field image. A slice of CASS material was then removed from the specimen end and the beam mapping exercise repeated. The sound fields acquired were analyzed for spot size, coherency, and beam redirection. Analyses were conducted between the resulting sound fields and the microstructural characteristics of each specimen.

  19. Bariatric Surgery in Moderately Obese Patients: A Prospective Study

    Science.gov (United States)

    Cerci, M.; Bellini, M. I.; Russo, F.; Benavoli, D.; Capperucci, M.; Gaspari, A. L.; Gentileschi, P.

    2013-01-01

    Introduction. Moderate obesity (BMI 30–35 kg/m2) affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery. Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative mean BMI 33.2 kg/m2, 10 males, mean age 42 years. In presence of type 2 diabetes mellitus (T2DM) (56%), gastric bypass was performed; in cases with hypertension (64%) and obstructive sleep apnea (OSA) (12%), sleeve gastrectomy was performed. All operations were performed laparoscopically. Results. Mean follow-up was 12.4 months. A postoperative complication occurred: bleeding from the trocar site was resolved with surgery in local anesthesia. Reduction in average BMI was 6 points, with a value of 27.2 kg/m2. Of the 14 patients with T2DM, 12 (86%) discontinued medical therapy because of a normalization of glycemia. Of the 16 patients with arterial hypertension, 14 (87%) showed remission and 2 (13%) improvement. Complete remission was observed in patients with OSAS. Conclusions. The results of our study support the validity of bariatric surgery in patients with BMI 30–35 kg/m2. Our opinion is that, in the future, bariatric surgery could be successful in selected cases of moderately obese patients. PMID:24454338

  20. Bariatric Surgery in Moderately Obese Patients: A Prospective Study

    Directory of Open Access Journals (Sweden)

    M. Cerci

    2013-01-01

    Full Text Available Introduction. Moderate obesity (BMI 30–35 kg/m2 affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery. Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative mean BMI 33.2 kg/m2, 10 males, mean age 42 years. In presence of type 2 diabetes mellitus (T2DM (56%, gastric bypass was performed; in cases with hypertension (64% and obstructive sleep apnea (OSA (12%, sleeve gastrectomy was performed. All operations were performed laparoscopically. Results. Mean follow-up was 12.4 months. A postoperative complication occurred: bleeding from the trocar site was resolved with surgery in local anesthesia. Reduction in average BMI was 6 points, with a value of 27.2 kg/m2. Of the 14 patients with T2DM, 12 (86% discontinued medical therapy because of a normalization of glycemia. Of the 16 patients with arterial hypertension, 14 (87% showed remission and 2 (13% improvement. Complete remission was observed in patients with OSAS. Conclusions. The results of our study support the validity of bariatric surgery in patients with BMI 30–35 kg/m2. Our opinion is that, in the future, bariatric surgery could be successful in selected cases of moderately obese patients.

  1. NSAID Use after Bariatric Surgery: a Randomized Controlled Intervention Study.

    Science.gov (United States)

    Yska, Jan Peter; Gertsen, Sanneke; Flapper, Gerbrich; Emous, Marloes; Wilffert, Bob; van Roon, Eric N

    2016-12-01

    Use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in bariatric surgery patients. If use of an NSAID is inevitable, a proton pump inhibitor (PPI) should also be used. To determine the effect of an, compared to care-as-usual, additional intervention to reduce NSAID use in patients who underwent bariatric surgery, and to determine the use of PPIs in patients who use NSAIDs after bariatric surgery. A randomized controlled intervention study in patients after bariatric surgery. Patients were randomized to an intervention or a control group. The intervention consisted of sending a letter to patients and their general practitioners on the risks of use of NSAIDs after bariatric surgery and the importance of avoiding NSAID use. The control group received care-as-usual. Dispensing data of NSAIDs and PPIs were collected from patients' pharmacies: from a period of 6 months before and from 3 until 9 months after the intervention. Two hundred forty-eight patients were included (intervention group: 124; control group: 124). The number of users of NSAIDs decreased from 22 to 18 % in the intervention group and increased from 20 to 21 % in the control group (NS). The use of a PPI with an NSAID rose from 52 to 55 % in the intervention group, and from 52 to 69 % in the control group (NS). Informing patients and their general practitioners by letter, in addition to care-as-usual, is not an effective intervention to reduce the use of NSAIDs after bariatric surgery (trial number NTR3665).

  2. Short- and long-term outcomes of laparoscopic surgery vs open surgery for transverse colon cancer: a retrospective multicenter study

    Directory of Open Access Journals (Sweden)

    Kim JW

    2016-04-01

    Full Text Available Jong Wan Kim,1 Jeong Yeon Kim,1 Byung Mo Kang,2 Bong Hwa Lee,3 Byung Chun Kim,4 Jun Ho Park5 1Department of Surgery, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong Si, 2Department of Surgery, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon Si, 3Department of Surgery, Hallym Sacred Heart Hospital, College of Medicine, Hallym University, Anyang Si, 4Department of Surgery, Kangnam Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, 5Department of Surgery, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Republic of Korea Purpose: The purpose of the present study was to compare the perioperative and oncologic outcomes between laparoscopic surgery and open surgery for transverse colon cancer.Patients and methods: We conducted a retrospective review of patients who underwent surgery for transverse colon cancer at six Hallym University-affiliated hospitals between January 2005 and June 2015. The perioperative outcomes and oncologic outcomes were compared between laparoscopic and open surgery.Results: Of 226 patients with transverse colon cancer, 103 underwent laparoscopic surgery and 123 underwent open surgery. There were no differences in the patient characteristics between the two groups. Regarding perioperative outcomes, the operation time was significantly longer in the laparoscopic group than in the open group (267.3 vs 172.7 minutes, P<0.001, but the time to soft food intake (6.0 vs 6.6 days, P=0.036 and the postoperative hospital stay (13.7 vs 15.7 days, P=0.018 were shorter in the laparoscopic group. The number of harvested lymph nodes was lower in the laparoscopic group than in the open group (20.3 vs 24.3, P<0.001. The 5-year overall survival (90.8% vs 88.6%, P=0.540 and disease-free survival (86.1% vs 78.9%, P=0.201 rates were similar in both groups.Conclusion: The present study showed that laparoscopic surgery is associated

  3. Case-mix study of single incision laparoscopic surgery (SILS) vs. Conventional laparoscopic surgery in colonic cancer resections

    DEFF Research Database (Denmark)

    Mynster, Tommie; Wille-Jørgensen, Peer

    2013-01-01

    Single incision laparoscopic surgery (SILS) may be even less invasive to a patient than conventional laparoscopic surgery (CLS). Aim of the study of the applicability of the procedure, the first 1½ year of experiences and comparison with CLS for colonic cancer resections Material and methods. Since...

  4. Application of CASS in Earthwork Calculation%南方CASS在土方计算中的应用

    Institute of Scientific and Technical Information of China (English)

    范玉平

    2011-01-01

    Combined with the CASS2008 topographical and cadastral mapping software,this paper discussed on the working flowchart,operating method,calculation plan selection of earthwork computation,and the issues that to be solved in the procedure of computation.%结合南方CASS 2008地形地籍成图软件对土方计算的操作流程、使用方法、计算方案选择及其计算过程中可能遇到的问题进行了阐述。

  5. COMPARATIVE RETROSPECTIVE STUDY ON ANAESTHESIA APPROACHES FOR LUMBAR SPINE SURGERY

    Directory of Open Access Journals (Sweden)

    Rangalakshmi S

    2016-07-01

    Full Text Available OBJECTIVE Lumbar spinal surgeries have been performed with either spinal or general anaesthesia. In this study, we aimed to evaluate the superiority of either spinal or general anaesthesia on lumbar spine surgery. METHODS After approval of institutional ethical committee, we retrospectively analysed 270 patients (ASA I and II undergoing surgery of lumbar spine from 2009 to 2015 by one surgeon. Of these 150 patients underwent general anaesthesia with controlled ventilation, 120 patients were offered spinal anaesthesia with conscious sedation. Patient records were reviewed to obtain demographic features, type of anaesthesia, baseline heart rate, mean arterial pressure, intraoperative maximum heart rate, mean arterial pressure, duration of surgery, amount of intravenous fluids, intraoperative blood loss, incidence of perioperative complications such as bleeding, nausea, vomiting, hypotension, bradycardia, and postoperative analgesic consumption. RESULTS Patient characteristics including baseline/intraoperative mean arterial pressure and heart rate values did not differ between groups. However, the spinal anaesthesia group experienced significantly shorter durations in the operating room and had a lower incidence of nausea, vomiting. Analgesic consumptions in general anaesthesia group was significantly higher than in spinal anaesthesia group. CONCLUSION The present study revealed that spinal anaesthesia is a safe and effective alternative to general anaesthesia for patients undergoing single level or two level lumbar laminectomy, discectomy, or even instrumentation below L2 level and has the advantage of decreased nausea, antiemetic, analgesic requirements, and fewer complications. It also ensures better postoperative recovery when compared to general anaesthesia

  6. Exploring media bias with semantic analysis tools: validation of the Contrast Analysis of Semantic Similarity (CASS).

    Science.gov (United States)

    Holtzman, Nicholas S; Schott, John Paul; Jones, Michael N; Balota, David A; Yarkoni, Tal

    2011-03-01

    Text-analytic methods have become increasingly popular in cognitive science for understanding differences in semantic structure between documents. However, such methods have not been widely used in other disciplines. With the aim of disseminating these approaches, we introduce a text-analytic technique (Contrast Analysis of Semantic Similarity, CASS, www.casstools.org), based on the BEAGLE semantic space model (Jones & Mewhort, Psychological Review, 114, 1-37, 2007) and add new features to test between-corpora differences in semantic associations (e.g., the association between democrat and good, compared to democrat and bad). By analyzing television transcripts from cable news from a 12-month period, we reveal significant differences in political bias between television channels (liberal to conservative: MSNBC, CNN, FoxNews) and find expected differences between newscasters (Colmes, Hannity). Compared to existing measures of media bias, our measure has higher reliability. CASS can be used to investigate semantic structure when exploring any topic (e.g., self-esteem or stereotyping) that affords a large text-based database.

  7. The surgery-first approach in orthognathic surgery: a retrospective study of 50 cases.

    Science.gov (United States)

    Yu, H B; Mao, L X; Wang, X D; Fang, B; Shen, S G

    2015-12-01

    The surgery-first approach (SFA), without presurgical orthodontic treatment, has become favoured in the treatment of dentomaxillofacial deformities. This approach has been applied in our institution since 2012. The purpose of this study was to report our experience with the SFA for skeletal malocclusion. Fifty patients with skeletal malocclusions were enrolled in this study (11 bimaxillary protrusion, 27 skeletal class III malocclusion, and 12 facial asymmetry). After orthognathic-orthodontic consultation, suitability for SFA was determined and a treatment plan drawn up. Patients then underwent orthognathic surgery, which included Le Fort I maxillary osteotomy, bilateral sagittal split ramus osteotomy, subapical osteotomy, and genioplasty. Postoperative orthodontic treatment was started after a healing period of 2 weeks. The mean postoperative orthodontic treatment duration was 14.9 months, which is shorter than that of traditional joint orthognathic-orthodontic treatment. In the bimaxillary protrusion group, this was about 19 months, which was longer than for the other groups. After joint orthognathic-orthodontic treatment, a good facial profile and ideal occlusion were achieved. With the advantages of earlier improvements in patient facial aesthetics and dental function, the reduction in difficulty and treatment duration of orthodontic management, and increasing patient acceptance, SFA is regarded as an ideal and valuable alternative for this potentially complicated procedure.

  8. Priority setting and cardiac surgery: a qualitative case study.

    Science.gov (United States)

    Walton, Nancy A; Martin, Douglas K; Peter, Elizabeth H; Pringle, Dorothy M; Singer, Peter A

    2007-03-01

    The purpose of this study is to describe priority setting in cardiac surgery and evaluate it using an ethical framework, "accountability for reasonableness". Cardiac surgery is an expensive part of hospital budgets. Priority setting decisions are made daily regarding ever increasing volumes of patients. While much attention has been paid to the management of cardiac surgery waiting lists, little empirical research exists into the way actual decision makers deliberate upon and resolve priority setting decisions on a daily basis. A key goal of priority setting, in cardiac surgical areas as well as others, is fairness. "Accountability for reasonableness" is a leading ethical framework for fair priority setting, and can be used to identify opportunities for improvement (i.e. make it fairer) and highlight good practices. A case study was conducted to examine the process of priority setting processes at three University of Toronto affiliated cardiac surgery centres. Relevant documents were examined, weekly triage rounds were observed for 27 months, and interviews were carried out with 23 key participants including cardiac surgeons, cardiologists, and triage nurses. In data analysis, the conditions of "accountability for reasonableness" (relevance, publicity, appeals and enforcement) were used as an analytic lens. While decisions may appear to be based strictly upon clinical criteria (e.g. coronary anatomy); non-clinical criteria also have an impact upon decision-making (e.g. patients' lifestyle choices, type of surgical practice and departmental constraints on resource use). Participants stated that these factors influence their decision-making and can result in unfair and inconsistent decisions. PUBLICITY: Non-clinical reasons are not publicly accessible, nor are they clearly acknowledged in discussions between cardiac clinicians. APPEALS: There are mechanisms for challenging decisions however without access to the non-clinical reasons, this can be problematic

  9. A prospective clinical study of polycarboxylate cement in periapical surgery

    OpenAIRE

    Peñarrocha Diago, María; Ortega Sánchez, Bárbara; García Mira, Berta; Maestre Ferrín, Laura; Peñarrocha Oltra, David; Gay Escoda,Cosme

    2012-01-01

    Objective: To evaluate the clinical efficacy of polycarboxylate cement as retrograde filling material. Design: A prospective clinical study was made of 25 patients subjected to periapical surgery with ultrasound and magnifying loupes, in which polycarboxylate cement was used as retrograde filling material. Measurements were made of the area and diameter of the lesions pre- and postoperatively, and 6 and 12 months after the operation. The apical resection and retrograde filling areas were also...

  10. SESAME/CASSE listening to the insertion of the MUPUS PEN at Abydos site, 67P/Churyumov-Gerasimenko

    Science.gov (United States)

    Knapmeyer, M.; Fischer, H.-H.; Knollenberg, J.; Seidensticker, K. J.; Thiel, K.; Arnold, W.; Faber, C.; Möhlmann, D.

    2015-10-01

    SESAME is a suite of three instruments (the Comet Acoustic Surface Sounding Experiment CASSE, the Dust Impact Monitor DIM, and the electrical Permittivity Probe PP) that have sensors and transmitters distributed all over the Philae lander, but share common electronics for commanding and processing. SESAME is conducted by a consortium of DLR, the Max Planck Institute for Solar System Research (Göttingen), and the Finnish Meteorological Institute (Helsinki, [1]). The Multi-Purpose Sensor MUPUS, run also by DLR, combines a thermal conductivity and heat flow experiment with a mechanical properties experiment associated with the anchoring harpoons of the lander ([2]). It was recognized early in the preparation of both the SESAME and MUPUS experiments that the hammering mechanism of the latter, which drives the thermal probe into the ground, might as well serve as source of elastic waves for the CASSE experiment. To support the CASSE experiment, the MUPUS flight software provides information on its hammering process in a shared memory of the lander data management system. CASSE listening to the MUPUS PEN hammer mechanism proved to be the first active seismic experiment conducted on a celestial body other than Earth since the Lunar Seismic Profiling Experiment, which was carried out on the Moon by the Apollo 17 astronauts in 1972 (e.g. [3]).

  11. Immediate postoperative complications in transsphenoidal pituitary surgery: A prospective study

    Directory of Open Access Journals (Sweden)

    Tumul Chowdhury

    2014-01-01

    Full Text Available Background: Considering the important role of pituitary gland in regulating various endocrine axes and its unique anatomical location, various postoperative complications can be anticipated resulting from surgery on pituitary tumors. We examined and categorized the immediate postoperative complications according to various tumor pathologies. Materials and Methods: We carried out a prospective study in 152 consecutive patients and noted various postoperative complications during neurosurgical intensive care unit stay (within 48 hrs of hospital stay in patients undergoing transsphenoidal removal of pituitary tumors. Results: In our series, various groups showed different postoperative complications out of which, cerebrospinal fluid leak was the commonest followed by diabetes insipidus, postoperative nausea and vomiting, and hematoma at operation site. Conclusion: Various immediate postoperative complications can be anticipated in transsphenoidal pituitary surgery even though, it is considered to be relatively safe.

  12. Clinical study of a new approach to thoracolumbar surgery

    Institute of Scientific and Technical Information of China (English)

    LIU Gang; ZHAO Jian-ning; Akira Dezawa

    2008-01-01

    Objective: The conventional approaches for treatment of thoracolumbar diseases require extensive surgical exposure, often leading to postoperative pain and morbidity. Thoracoscopic-assisted surgery in these regions usually requires an extended recovery period due to the placement of drainage. We developed an innovative retro-peritoneal-extrapleural approach to thoracolumbar involvement by an extra-diaphragmatic technique using dedicated instruments. Neither incision nor reconstruction of the diaphragm was necessary. Exposure to the lateral part of the thoracolumbar vertebrae could be achieved without crus resection. This study is aimed to evaluate the clinical outcomes of this new surgical procedure. Methods: A total of 9 cases (5 cases of thoracolumbar fracture-dislocation, 1 each of spinal infection, tumor, thoracolumbar scoliosis and ossification of posterior longitudinal ligament) were subjected to the study. The average of the patients was 52.3 years. The results were com pared with the control group consisting of thoracoscopic surgery subgroup (5 patients, mean age 52.1 years) and conventional surgery subgroup (12 patients, mean age 61.3 years). Results: Compared with the control group, the average period of bed confinement and mean intra- and post-operative blood loss decreased significantly. Pulmonary complications were avoided in all cases. The surgical time was shortened, postoperative pain was reduced, and early postoperative ambulation became possible. Conclusion: The diaphragm-preserving retroperito-neal-extrapleural approach that we developed is a valid minimally invasive alternative for the treatment of thora-columbar diseases.

  13. "Hardware breakage in spine surgery (A retrospective clinical study "

    Directory of Open Access Journals (Sweden)

    "Sadat MM

    2001-11-01

    Full Text Available This was a retrospective review of a consecutive series of patients with spinal disease in year 2000, who underwent posterior fusion and instrumentation with Harrington distraction and Cotrel-Dobousset system to evaluate causes of hardware failure. Many cases of clinical failure has been observed in spinal instrumentation used in spinal disorder like spondylolisthesis, fractures, deformities, … . Thirty six cases that were operated because of spinal disorders like spondylolisthesis, fractures, deformities, …, were included in this study. Seventeen of this cases had breakage of device. Factors like age at surgery, type of instrumentation, angles before and after surgery and …, were compared in two groups of patients. The most common instrument breakage was pedicle screw breakage. Pseudoarthrosis was the main factor that was presented in failure group (P value<0.001. Other important causes were, age of patient at surgery (P value=0.04, pedicle screw placement off center in the sagittal or coronal plane of the pedicle (P value=0.04. Instrumentation loads increased significantly as a direct result of variations in surgical technique that produce pseudoarthrosis, pedicle screw placement off center in the sagittal plane of the pedicle, or using less than 6 mm diameter screw. This factor can be prevented with meticulous surgical technique and using proper devices.

  14. Improved Surgery Planning Using 3-D Printing: a Case Study.

    Science.gov (United States)

    Singhal, A J; Shetty, V; Bhagavan, K R; Ragothaman, Ananthan; Shetty, V; Koneru, Ganesh; Agarwala, M

    2016-04-01

    The role of 3-D printing is presented for improved patient-specific surgery planning. Key benefits are time saved and surgery outcome. Two hard-tissue surgery models were 3-D printed, for orthopedic, pelvic surgery, and craniofacial surgery. We discuss software data conversion in computed tomography (CT)/magnetic resonance (MR) medical image for 3-D printing. 3-D printed models save time in surgery planning and help visualize complex pre-operative anatomy. Time saved in surgery planning can be as much as two thirds. In addition to improved surgery accuracy, 3-D printing presents opportunity in materials research. Other hard-tissue and soft-tissue cases in maxillofacial, abdominal, thoracic, cardiac, orthodontics, and neurosurgery are considered. We recommend using 3-D printing as standard protocol for surgery planning and for teaching surgery practices. A quick turnaround time of a 3-D printed surgery model, in improved accuracy in surgery planning, is helpful for the surgery team. It is recommended that these costs be within 20 % of the total surgery budget.

  15. Integrating surgery and radiology in one suite: a multicenter study.

    Science.gov (United States)

    ten Cate, Gerben; Fosse, Erik; Hol, Per Kristian; Samset, Eigil; Bock, Richard W; McKinsey, James F; Pearce, Benjamin J; Lothert, Mark

    2004-09-01

    The study was performed to evaluate the performance of digital fixed-mounted angiographic C-arm systems in the operating room as used by surgeons, cardiologists, and interventional radiologists. An observational study in the operating room was performed, along with a structured questionnaire and semi-structured interviews. Twenty interventions were observed at 5 sites. Workflow was analyzed. Integration of high-end angiographic imaging equipment in the operating room enables image-guided surgery with high-quality images, on-table quality assessment of surgical procedures, and "one-stop shopping" procedures. Integrated suites were run by surgery as well as radiology departments, and are used for a variety of procedures, including vascular, cardiothoracic, open surgical, percutaneous, and combined procedures. Operation of the angiographic system and its user interface design were not considered ideal for operating room use. Limited patient accessibility was observed, sometimes leading to uncomfortable positions for the operating physicians. Certain procedures, such as tibial artery surgery, were difficult to perform, owing to lack of accessories. Patient transfer was considered inadequate. Cleaning of the system was rated as poor. Operating room use puts an even higher demand on reliability of the system. Integration of digital angiographic systems into operating rooms has produced opportunities for new treatments and offers a superior solution for interdisciplinary work among surgeons, cardiologists, and radiologists. However, the context of use differs radically from that in the traditional radiologic examination room; the environment, users, and procedures are all different. Integration of imaging methods into the operating room can be more successful if special operating room conditions are taken into account by medical systems manufacturers.

  16. In vitro activity of 'Mexican Arnica' Heterotheca inuloides Cass natural products and some derivatives against Giardia intestinalis.

    Science.gov (United States)

    Rodríguez-Chávez, José Luis; Rufino-González, Yadira; Ponce-Macotela, Martha; Delgado, Guillermo

    2015-04-01

    Giardiasis is a gastrointestinal disease that affects humans and other animals caused by parasitic protists of the genus Giardia. Giardia intestinalis (Syn. Giardia lamblia; Giardia duodenalis) infections can cause acute or chronic diarrhoea, dehydration, abdominal discomfort and weight loss. Metronidazole is the most widely used drug for treating giardiasis. Although effective, metronidazol has undesirable secondary effects. Plants used in traditional medicine as antidiarrhoeals or antiparasitics may represent alternative sources for new compounds to treat giardiasis. Heterotheca inuloides Cass. (Asteraceae/Compositae) plant is widely used in Mexican traditional medicine. The following secondary metabolites were isolated from H. inuloides flowers: 7-hydroxy-3,4-dihydrocadalene (1), 7-hydroxycadalene (2), 3,7-dihydroxy-3(4H)-isocadalen-4-one (3), 1R,4R-hydroxy-1,2,3,4-tetrahydrocadalen-15-oic acid (4), quercetin (5), quercetin-3,7,3'-trimethyl ether (6), quercetin-3,7,3',4'-tetramethyl ether (7) and eriodictyol-7,4'-dimethyl ether (8). The activity of these compounds against Giardia intestinalis trophozoites was assessed in vitro as was the activity of the semisynthetic compounds 7-acetoxy-3,4-dihydrocadalene (9), 7-benzoxy-3,4-dihydrocadalene (10), 7-acetoxycadalene (11), 7-benzoxycadalene (12), quercetin pentaacetate (13) and 7-hydroxycalamenene (14). Among these, 7-hydroxy-3,4-dihydrocadalene (1) and 7-hydroxycalamenene (14) were the most active, whereas the remaining compounds showed moderate or no activity. The G. intestinalis trophozoites exposed to compound 1 showed marked changes in cellular architecture along with ultrastructural disorganization. The aim of this study was to evaluate the giardicidal activity of selected H. inuloides metabolites and some semisynthetic derivatives using an in vitro experimental model of giardiasis.

  17. Study of scattered radiation during fluoroscopy in hip surgery*

    Science.gov (United States)

    Lesyuk, Oksana; Sousa, Patrick Emmanuel; Rodrigues, Sónia Isabel do Espirito Santo; Abrantes, António Fernando; de Almeida, Rui Pedro Pereira; Pinheiro, João Pedro; Azevedo, Kevin Barros; Ribeiro, Luís Pedro Vieira

    2016-01-01

    Objective To measure the scattered radiation dose at different positions simulating hip surgery. Materials and Methods We simulated fluoroscopy-assisted hip surgery in order to study the distribution of scattered radiation in the operating room. To simulate the patient, we used a anthropomorphic whole-body phantom, and we used an X-ray-specific detector to quantify the radiation. Radiographs were obtained with a mobile C-arm X-ray system in continuous scan mode, with the tube at 0º (configuration 1) or 90º (configuration 2). The operating parameters employed (voltage, current, and exposure time) were determined by a statistical analysis based on the observation of orthopedic surgical procedures involving the hip. Results For all measurements, higher exposures were observed in configuration 2. In the measurements obtained as a function of height, the maximum dose rates observed were 1.167 (± 0.023) µSv/s and 2.278 (± 0.023) µSv/s in configurations 1 and 2, respectively, corresponding to the chest level of health care professionals within the operating room. Proximal to the patient, the maximum values were recorded in the position occupied by the surgeon. Conclusion We can conclude that, in the scenario under study, health care professionals workers are exposed to low levels of radiation, and that those levels can be reduced through the use of personal protective equipment. PMID:27777477

  18. Risk factors for incidental durotomy during lumbar surgery: a retrospective study by multivariate analysis.

    Science.gov (United States)

    Chen, Zhixiang; Shao, Peng; Sun, Qizhao; Zhao, Dong

    2015-03-01

    The purpose of the present study was to use a prospectively collected data to evaluate the rate of incidental durotomy (ID) during lumbar surgery and determine the associated risk factors by using univariate and multivariate analysis. We retrospectively reviewed 2184 patients who underwent lumbar surgery from January 1, 2009 to December 31, 2011 at a single hospital. Patients with ID (n=97) were compared with the patients without ID (n=2019). The influences of several potential risk factors that might affect the occurrence of ID were assessed using univariate and multivariate analyses. The overall incidence of ID was 4.62%. Univariate analysis demonstrated that older age, diabetes, lumbar central stenosis, posterior approach, revision surgery, prior lumber surgery and minimal invasive surgery are risk factors for ID during lumbar surgery. However, multivariate analysis identified older age, prior lumber surgery, revision surgery, and minimally invasive surgery as independent risk factors. Older age, prior lumber surgery, revision surgery, and minimal invasive surgery were independent risk factors for ID during lumbar surgery. These findings may guide clinicians making future surgical decisions regarding ID and aid in the patient counseling process to alleviate risks and complications. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Accuracy study of new computer-assisted orthopedic surgery software

    Energy Technology Data Exchange (ETDEWEB)

    Sidon, Eli [Department of Orthopaedic Surgery, Beilinson-Rabin Medical Center, Petach Tikva (Israel); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (Israel); Steinberg, Ely L., E-mail: steinberge@tasmc.health.gov.il [Department of Orthopaedic Surgery, Tel-Aviv Medical Center, Tel Aviv (Israel); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (Israel)

    2012-12-15

    Purpose: The new computerized system is based on image analysis and designed to aid in orthopedic surgeries by virtual trajectory of the guide wire, intra-operative planning and various measurements. Validation of the accuracy and safety of any computer-aided surgery system is essential before implementing it clinically. We examined the accuracy of guide-wire length and angle measurements and fusion of multiple adjacent images (panoramic view image, PVI{sup ®}) of the new software. Methods: This is a 2-part study. Part I: twenty guide wires were drilled to various depths in a synthetic femur model and the results obtained by the software measurements were compared with manual measurements by a caliper and a depth gauge. Part II: a sawbone femur shaft was osteotomized and various inclinations of >10° to the varus or valgus angles were tested. The manually obtained measurements of angles and lengths were compared to the new computerized system software PVI. Results: There was a significant positive linear correlation between all groups of the computerized length and the control measurements (r > 0.983, p < 0.01). There was no significant difference among different distances, angles or positions from the image intensifier. There was a significant positive linear correlation between the angle and length measurement on the PVI and the control measurement (r > 0.993, p < 0.01). Conclusions: The new computerized software has high reliability in performing measurements of length using an aiming, positioning and referring device intra-operatively.

  20. Core Outcomes for Colorectal Cancer Surgery: A Consensus Study.

    Directory of Open Access Journals (Sweden)

    Angus G K McNair

    2016-08-01

    Full Text Available Colorectal cancer (CRC is a major cause of worldwide morbidity and mortality. Surgical treatment is common, and there is a great need to improve the delivery of such care. The gold standard for evaluating surgery is within well-designed randomized controlled trials (RCTs; however, the impact of RCTs is diminished by a lack of coordinated outcome measurement and reporting. A solution to these issues is to develop an agreed standard "core" set of outcomes to be measured in all trials to facilitate cross-study comparisons, meta-analysis, and minimize outcome reporting bias. This study defines a core outcome set for CRC surgery.The scope of this COS includes clinical effectiveness trials of surgical interventions for colorectal cancer. Excluded were nonsurgical oncological interventions. Potential outcomes of importance to patients and professionals were identified through systematic literature reviews and patient interviews. All outcomes were transcribed verbatim and categorized into domains by two independent researchers. This informed a questionnaire survey that asked stakeholders (patients and professionals from United Kingdom CRC centers to rate the importance of each domain. Respondents were resurveyed following group feedback (Delphi methods. Outcomes rated as less important were discarded after each survey round according to predefined criteria, and remaining outcomes were considered at three consensus meetings; two involving international professionals and a separate one with patients. A modified nominal group technique was used to gain the final consensus. Data sources identified 1,216 outcomes of CRC surgery that informed a 91 domain questionnaire. First round questionnaires were returned from 63 out of 81 (78% centers, including 90 professionals, and 97 out of 267 (35% patients. Second round response rates were high for all stakeholders (>80%. Analysis of responses lead to 45 and 23 outcome domains being retained after the first and

  1. NGC 147, NGC 185 and CassII: a genetic approach to orbital properties, star formation and tidal debris

    CERN Document Server

    Arias, Veronica; Fernando, Nuwanthika; Lewis, Geraint F; Bland-Hawthorn, Joss; Bate, Nicholas F; Conn, Anthony; Irwin, Mike J; Ferguson, Annette M N; Ibata, Rodrigo A; McConnachie, Alan W; Martin, Nicolas

    2015-01-01

    NGC147, NGC185 and CassiopeiaII (CassII) have similar positions in the sky, distances and measured line of sight velocities. This proximity in phase space suggests that these three satellites of M31 form a subgroup within the Local Group. Nevertheless, the differences in their star formation history and interstellar medium, and the recent discovery of a stellar stream in NGC~147, combined with the lack of tidal features in the other two satellites, are all indications of complex and diverse interactions between M31 and these three satellites. We use a genetic algorithm to explore the different orbits that these satellites can have and select six sets of orbits that could best explain the observational features of the NGC147, NGC185 and CassII satellites. The parameters of these orbits are then used as a starting point for N-body simulations. We present models for which NGC147, NGC185 and CassII are a bound group for a total time of at least one Gyr but still undergo different interactions with M31 and as a re...

  2. Phase stability in thermally-aged CASS CF8 under heavy ion irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Li, Meimei, E-mail: mli@anl.gov [Argonne National Laboratory, 9700 S. Cass Avenue, Argonne, IL 60439 (United States); Miller, Michael K. [Oak Ridge National Laboratory, P.O. Box 2008, Oak Ridge, TN 37831 (United States); Chen, Wei-Ying [Argonne National Laboratory, 9700 S. Cass Avenue, Argonne, IL 60439 (United States)

    2015-07-15

    Highlights: • Thermally-aged CF8 was irradiated with 1 MeV Kr ions at 400 °C. • Atom probe tomography revealed a strong dose dependence of G-phase precipitates. • Phase separation of α and α′ in ferrite was reduced after irradiation. - Abstract: The stability of the microstructure of a cast austenitic stainless steel (CASS), before and after heavy ion irradiation, was investigated by atom probe tomography (APT). A CF8 ferrite–austenite duplex alloy was thermally aged at 400 °C for 10,000 h. After this treatment, APT revealed nanometer-sized G-phase precipitates and Fe-rich α and Cr-enriched α′ phase separated regions in the ferrite. The thermally-aged CF8 specimen was irradiated with 1 MeV Kr ions to a fluence of 1.88 × 10{sup 19} ions/m{sup 2} at 400 °C. After irradiation, APT analysis revealed a strong spatial/dose dependence of the G-phase precipitates and the α–α′ spinodal decomposition in the ferrite. For the G-phase precipitates, the number density increased and the mean size decreased with increasing dose, and the particle size distribution changed considerably under irradiation. The inverse coarsening process can be described by recoil resolution. The amplitude of the α–α′ spinodal decomposition in the ferrite was apparently reduced after heavy ion irradiation.

  3. Phase stability in thermally-aged CASS CF8 under heavy ion irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Li, Meimei; Miller, M; Chen, Wei-Ying

    2015-07-01

    The stability of the microstructure of a cast austenitic stainless steel (CASS), before and after heavy ion irradiation, was investigated by atom probe tomography (APT). A CF8 ferrite-austenite duplex alloy was thermally aged at 400 degrees C for 10,000 h. After this treatment, APT revealed nanometer-sized G-phase precipitates and Fe-rich alpha and Cr-enriched alpha' phase separated regions in the ferrite. The thermally-aged CF8 specimen was irradiated with 1 MeV Kr ions to a fluence of 1.88 x 10(19) ions/m(2) at 400 degrees C. After irradiation, APT analysis revealed a strong spatial/dose dependence of the G-phase precipitates and the alpha-alpha' spinodal decomposition in the ferrite. For the G-phase precipitates, the number density increased and the mean size decreased with increasing dose, and the particle size distribution changed considerably under irradiation. The inverse coarsening process can be described by recoil resolution. The amplitude of the alpha-alpha' spinodal decomposition in the ferrite was apparently reduced after heavy ion irradiation. (C) 2015 Elsevier B.V. All rights reserved

  4. Transoral robotic surgery for sellar tumors: first clinical study.

    Science.gov (United States)

    Chauvet, Dorian; Hans, Stéphane; Missistrano, Antoine; Rebours, Celeste; Bakkouri, Wissame El; Lot, Guillaume

    2016-12-23

    OBJECTIVE The aim of this study was to confirm the feasibility of an innovative transoral robotic surgery (TORS), using the da Vinci Surgical System, for patients with sellar tumors. This technique was designed to offer a new minimally invasive approach, without soft-palate splitting, that avoids the rhinological side effects of classic endonasal approaches. METHODS The authors performed a prospective study of TORS in patients with symptomatic sellar tumors. Specific anatomical features were required for inclusion in the study and were determined on the basis of preoperative open-mouth CT scans of the brain. The main outcome measure was sellar accessibility using the robot. Resection quality, mean operative time, postoperative changes in patients' vision, side effects, and complications were additionally reported. RESULTS Between February and May 2016, 4 patients (all female, mean age 49.5 years) underwent TORS for resection of sellar tumors as participants in this study. All patients presented with symptomatic visual deficits confirmed as bitemporal hemianopsia. All tumors had a suprasellar portion and a cystic part. In all 4 cases, the operation was performed via TORS, without the need for a second surgery. Sella turcica accessibility was satisfactory in all cases. In 3 cases, tumor resection was complete. The mean operative time was 2 hours 43 minutes. Three patients had a significant visual improvement at Day 1. No rhinological side effects or complications in patients occurred. No pathological examination was performed regarding the fluid component of the tumors. There was 1 postoperative delayed CSF leak and 1 case of transient diabetes insipidus. Side effects specific to TORS included minor sore throat, transient hypernasal speech, and 1 case of delayed otitis media. The mean length of hospital stay and mean follow up were 8.25 days and 82 days, respectively. CONCLUSIONS To our knowledge, this is the first report of the surgical treatment of sellar tumors by

  5. Joint Processes of Heterogeneous Catalytic Oxidation and Cyclic Activated Sludge System (CASS) for Wastewater Treatment of Tea Polyphenol Extraction Production%多相催化氧化与周期循环活性污泥法(CASS)组合工艺处理茶多酚精制生产废水

    Institute of Scientific and Technical Information of China (English)

    张波; 肖乾芬; 夏四清

    2011-01-01

    A joint system consisting of heterogeneous catalytic oxidization technology and cyclic activated sludge system (CASS) to treat wastewater from tea polyphenol extraction was studied. Pilot scale test proves that the treatment process is efficient and it's feasible to apply for industry. The results show when CODCr of influent is 2 900~4 100 mg/L and color of influent is 400~500, CODCr of effluent is less than 100 mg/L, the average removal rate of which is 98.0 %, color of effluent is less than 30, the average removal rate of which is 92.7 %. The effluent quality meets the integrated wastewater discharge standard of shanghai (DB 31/199-2009).%通过中试研究,探讨了多相催化氧化一周期循环活性污泥法(CASS)组合工艺处理茶多酚精制生产废水的可行性.试验结果表明:当进水CODCr为2 900-4 100 mg/L、色度为400~550倍,经组合工艺处理后,出水CODCr小于100 mg/L,平均去除率达98.0%;出水色度小于30倍,平均处理效率为92.7%.出水水质达到上海市污水综合排放标准(DB 31/199-2009)二级标准.

  6. Pseudoepitheliomatous hyperplasia after diode laser oral surgery. An experimental study

    Science.gov (United States)

    Seoane, Juan; González-Mosquera, Antonio; García-Martín, José-Manuel; García-Caballero, Lucía; Varela-Centelles, Pablo

    2015-01-01

    Background To examine the process of epithelial reparation in a surgical wound caused by diode laser. Material and Methods An experimental study with 27 Sprage-Dawley rats was undertaken. The animals were randomly allocated to two experimental groups, whose individuals underwent glossectomy by means of a diode laser at different wattages, and a control group treated using a number 15 scalpel blade. The animals were slaughtered at the 2nd, 7th, and 14th day after glossectomy. The specimens were independently studied by two pathologists (blinded for the specimens’ group). Results At the 7th day, re-epithelisation was slightly faster for the control group (conventional scalpel) (p=0.011). At the 14th day, complete re-epithelization was observed for all groups. The experimental groups displayed a pseudoepitheliomatous hyperplasia. Conclusions It is concluded that, considering the limitations of this kind of experimental studies, early re-epithelisation occurs slightly faster when a conventional scalpel is used for incision, although re-epithelisation is completed in two weeks no matter the instrument used. In addition, pseudoepitheliomatous hyperplasia is a potential event after oral mucosa surgery with diode laser. Knowledge about this phenomenon (not previously described) may prevent diagnostic mistakes and inadequate treatment approaches, particularly when dealing with potentially malignant oral lesions. Key words:Diode laser, animal model, oral biopsy, oral cancer, oral precancer, pseudoepitheliomatous hyperplasia. PMID:26116841

  7. Psychological and social factors in undergoing reconstructive surgery among individuals with craniofacial conditions: an exploratory study.

    Science.gov (United States)

    Bemmels, Heather; Biesecker, Barbara; Schmidt, Johanna L; Krokosky, Alyson; Guidotti, Rick; Sutton, Erica J

    2013-03-01

    Objective : Reconstructive surgery to improve psychological well-being is commonly offered to children with craniofacial conditions. Few studies have explored the challenges of reconstructive surgery beyond the physical risks: poor treatment outcomes, infection, brain damage, and death. This qualitative study aims to understand the psychological and social implications such interventions can have for individuals with craniofacial conditions. Design : A total of 38 individuals between the ages of 12 and 61 with such craniofacial conditions as Sturge-Weber syndrome, Treacher Collins syndrome, Möbius syndrome, cleft lip and palate, Noonan syndrome, Crouzon syndrome, and amniotic band syndrome participated in semistructured video-recorded interviews. Participants were recruited at conferences, through study flyers, and by word of mouth. Descriptive, thematic analysis was used to identify themes related to reconstructive surgery. Results : Dominant themes included undergoing surgery to reduce stigmatization, the psychological and social implications of the interventions, outcome satisfaction, parental involvement in decision making about surgery, and recommendations for parents considering surgery for their children with craniofacial conditions. Experiences with reconstructive surgery varied, with some participants expressing surgical benefits and others, disillusionment. Conclusions : The range of participant attitudes and experiences reflect the complexity of reconstructive surgery. Pediatric health care teams involved in the care of children with craniofacial conditions play an important role in advising patients (and their parents) about existing treatment options. The psychological and social implications of reconstructive surgery should be relayed to help families weigh the risks and benefits of surgery in an informed and meaningful way.

  8. Epilepsy Surgery Series: A Study of 502 Consecutive Patients from a Developing Country

    Directory of Open Access Journals (Sweden)

    Abdulaziz Alsemari

    2014-01-01

    Full Text Available Purpose. To review the postoperative seizure outcomes of patients that underwent surgery for epilepsy at King Faisal Specialist Hospital & Research Centre (KFSHRC. Methods. A descriptive retrospective study for 502 patients operated on for medically intractable epilepsy between 1998 and 2012. The surgical outcome was measured using the ILAE criteria. Results. The epilepsy surgery outcome for temporal lobe epilepsy surgery (ILAE classes 1, 2, and 3 at 12, 36, and 60 months is 79.6%, 74.2%, and 67%, respectively. The favorable 12- and 36-month outcomes for frontal lobe epilepsy surgery are 62% and 52%, respectively. For both parietal and occipital epilepsy lobe surgeries the 12- and 36-month outcomes are 67%. For multilobar epilepsy surgery, the 12- and 36-month outcomes are 65% and 50%, respectively. The 12- and 36-month outcomes for functional hemispherectomy epilepsy surgery are 64.2% and 63%, respectively. According to histopathology diagnosis, mesiotemporal sclerosis (MTS and benign CNS tumors had the best favorable outcome after surgery at 1 year (77.27% and 84.3%, resp., and 3 years (76% and 75%, resp.,. The least favorable seizure-free outcome after 3 years occurred in cases with dual pathology (66.6%. Thirty-four epilepsy patients with normal magnetic resonance imaging (MRI brain scans were surgically treated. The first- and third-year epilepsy surgery outcome of 17 temporal lobe surgeries were (53% and (47% seizure-free, respectively. The first- and third-year epilepsy surgery outcomes of 15 extratemporal epilepsy surgeries were (47% and (33% seizure-free. Conclusion. The best outcomes are achieved with temporal epilepsy surgery, mesial temporal sclerosis, and benign CNS tumor. The worst outcomes are from multilobar surgery, dual pathology, and normal MRI.

  9. Multicenter follow-up study of ankle fracture surgery

    Institute of Scientific and Technical Information of China (English)

    XU Hai-lin; WANG Gang; WANG Guang-lin; WU Xin-bao; LIU Li-min; LI Xuan; ZHANG Dian-ying; FU Zhong-guo; WANG Tian-bing; ZHANG Pei-xun; JIANG Bao-guo; SHEN Hui-liang

    2012-01-01

    Background Few data on ankle fractures in China from large multicenter epidemiological and clinical studies are available.The aim of this research was to evaluate the epidemiological features and surgical outcomes of ankle fractures by reviewing 235 patients who underwent ankle fracture surgery at five hospitals in China.Methods This study included patients who underwent ankle fracture surgery at five Chinese hospitals from January 2000 to July 2009.Age,gender,mechanism of injury,Arbeitsgemeinschaft für Osteosynthesefragen (AO) fracture type,fracture pattern,length of hospital stay and treatment outcome were recorded.Statistical analyses were conducted using SPSS software.The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale,visual analogue scale (VAS),and arthritis scale were used to evaluate outcome.Results Of 235 patients with ankle fractures,105 were male with an average age of 37.8 years and 130 were female with an average age of 47.3 years.The average follow-up period was 55.7 months.There were significant differences in the ratios of patients in different age groups between males and females,and in mechanisms of injury among different age groups.There were also significant differences in the length of hospital stay among different fracture types and mechanisms of injury.In healed fractures,the average AOFAS ankle-hindfoot score was 95.5,with an excellence rate of 99.6%,the average VAS score was 0.17,and the average arthritis score was 0.18.Movement of the injured ankle was significantly different to that of the uninjured ankle.There were no significant differences between AO fracture types,fracture patterns or follow-up periods and AOFAS score,but there were some significant differences between these parameters and ankle joint movements,pain VAS score and arthritis score.Conclusions Ankle fractures occur most commonly in middle-aged and young males aged 20-39 years and in elderly females aged 50-69 years.The most common mechanisms of

  10. The Utility of Outcome Studies in Plastic Surgery

    Directory of Open Access Journals (Sweden)

    Hani Sinno, MD, MEng

    2014-07-01

    Full Text Available Summary: Outcome studies help provide the evidence-based science rationalizing treatment end results that factor the experience of patients and the impact on society. They improve the recognition of the shortcoming in clinical practice and provide the foundation for the development of gold standard care. With such evidence, health care practitioners can develop evidence-based justification for treatments and offer patients with superior informed consent for their treatment options. Furthermore, health care and insurance agencies can recognize improved cost-benefit options in the purpose of disease prevention and alleviation of its impact on the patient and society. Health care outcomes are ultimately measured by the treatment of disease, the reduction of symptoms, the normalization of laboratory results and physical measures, saving a life, and patient satisfaction. In this review, we outline the tools available to measure outcomes in plastic surgery and subsequently allow the objective measurements of plastic surgical conditions. Six major outcome categories are discussed: (1 functional measures; (2 preference-based measures and utility outcome scores; (3 patient satisfaction; (4 health outcomes and time; (5 other tools: patient-reported outcome measurement information system, BREAST-Q, and Tracking Operations and Outcomes for Plastic Surgeons; and (6 cost-effectiveness analysis. We use breast hypertrophy requiring breast reduction as an example throughout this review as a representative plastic surgical condition with multiple treatments available.

  11. Periapical endodontic surgery: a 3-year follow-up study.

    Science.gov (United States)

    Maddalone, M; Gagliani, M

    2003-03-01

    To monitor the outcome of periradicular surgery in a group of teeth treated with microsurgical technology and ultrasonic root-end preparation. One hundred and twenty-eight teeth with failed conventional root canal treatment were included. The surgical procedure was completed using ultrasonic retrotips and a zinc oxide-EBA (Super Seal, Ogna Pharmaceuticals. Milan, Italy)-reinforced material was used to seal the root end cavities. Lesions were examined radiologically at 1. 3. 6. 12, 24 and 36-month intervals. Radiographs were independently analysed according to a previously published classification. Eight teeth were extracted due to fracture or perforations undetected radiologically: these cases were excluded from the study. Of the 120 teeth examined. the overall success rate was 92.5%; 94 healed with complete bone filling of the surgical cavity, 17 were considered to have healed by apical scar formation, four demonstrated uncertain healing and five were considered failures. Eighty of 120 teeth examined had successfully healed from a radiological point of view within 12 months. No differences in outcome occurred between anterior, premolar and molar teeth. Although all failures occurred in teeth with posts, no statistically significant difference was noted (Mann-Whitney U-test, P = 0.37). Modern surgical endodontic procedures associated and ERA (Super Seal, Ogna Pharmaceuticals, Milan, Italy) root end fillings were successful over 3 years in 92.5% of cases.

  12. Esophageal adenocarcinoma after obesity surgery in a population-based cohort study.

    Science.gov (United States)

    Maret-Ouda, John; Tao, Wenjing; Mattsson, Fredrik; Brusselaers, Nele; El-Serag, Hashem B; Lagergren, Jesper

    2017-01-01

    Obesity is strongly associated with esophageal adenocarcinoma (EAC), yet it is unclear whether weight loss reduces the risk of EAC. To test the hypothesis that the risk of EAC decreases after weight reduction achieved by obesity surgery. Nationwide register-based cohort study. This study included a majority of individuals who underwent obesity surgery in Sweden in 1980 to 2012. The incidence of EAC after obesity surgery was compared with the incidence in the corresponding background population of Sweden by means of calculation of standardized incidence ratios (SIRs) with 95% confidence intervals (CIs). The risk of EAC after obesity surgery also was compared with the risk in obese individuals who did not undergo obesity surgery by means of multivariable Cox regression, providing hazard ratios with 95% CIs, adjusted for potential confounders. Among 34,437 study participants undergoing obesity surgery and 239,775 person-years of follow-up, 8 cases of EAC occurred (SIR 1.6; 95% CI .7-3.2). No clear trend of decreased SIRs was observed in relation to increased follow-up time after surgery. The SIR of EACs (n = 53) among 123,695 obese individuals who did not undergo obesity surgery (673,238 person-years) was increased to a similar extent as in the obesity surgery cohort (SIR = 1.9, 95% CI 1.4-2.5). Cox regression demonstrated no difference in risk of EAC between participants who underwent obesity surgery and those who did not (adjusted hazard ratio = .9, 95% CI .4-1.9). The risk of EAC might not decrease after obesity surgery, but larger studies with longer follow-up are needed to establish this association. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  13. Partners' experiences of the postdischarge period after day surgery - a qualitative study

    DEFF Research Database (Denmark)

    Majholm, Birgitte; Esbensen, Bente A; Thomsen, Thordis;

    2012-01-01

    Aims and objectives.  Day surgery shifts the responsibility of care from the hospital to patients and their families. This study explored how partners of day surgery patients experienced their role after patient discharge. Background.  Many surgical procedures formerly requiring inpatient care...... are now carried out on a day surgery basis, shifting responsibility of care to patients and their partners/relatives. Little is known about how partners of day surgery patients manage this responsibility. Design.  Qualitative descriptive. Methods.  Individual semi-structured interviews with 11 partners...... of day surgery patients who had undergone shoulder surgery. Systematic text condensation was used to analyse data. Results.  The following aspects were identified: the first is 'It's all about being there for the patient by taking care of the patient's needs and by mobilising one's network,' referring...

  14. Is gynaecological laparoscopic surgery safe for elderly women? A comparison study.

    Science.gov (United States)

    Cengiz, H; Dagdeviren, H; Kanawati, A; Kaya, C; Ekin, M

    2014-10-01

    The aim of this study was to evaluate the efficacy and safety of gynaecological laparoscopic surgery in an elderly group, by comparing the operative outcomes of the elderly group with those of the younger group. We analysed retrospective data of 121 women who underwent laparoscopic surgery for benign gynaecological disease. Women aged > 60 years were compared with women aged between 30 and 50 years who had the same operation. We evaluated body mass index, comorbidities, number of previous abdominal surgeries, operating time, haemoglobin change, postoperative complications, hospital stay and return of bowel activity. There were no significant differences between the elderly and a matched younger group in number of previous abdominal surgeries, operating time, ASA score distribution, changes in haemoglobin level, hospital stay and postoperative complications (p > 0.05). Laparoscopic surgery can be safely performed in elderly patients with benign gynaecological disease, and surgeons should not hesitate to perform laparoscopic surgery in elderly patients.

  15. Use and Evaluation of a Cooling Aid in Laser-Assisted Dental Surgery: An Innovative Study.

    Science.gov (United States)

    Bernardi, Sara; Mummolo, Stefano; Zeka, Keti; Pajewski, Leonardo; Continenza, Maria Adelaide; Marzo, Giuseppe

    2016-06-01

    The aim of this study was to evaluate the beneficial effect of NeoHeal during laser-assisted oral surgery. Laser-assisted surgery is a less invasive technique than conventional surgery using a blade; however, the heat produced by the laser can damage tissue proximal to the treated area. We hypothesized the hydrogel NeoHeal could be applied during oral surgery and have similar benefits as those already described for dermatological surgery. In our randomized controlled trial, we first selected 30 patients who were to undergo laser surgical intervention using a diode laser. Both at the end of intervention and at follow-up, each patient filled out a questionnaire comprising two questions. The answers to the questions were statistically analyzed with regard to frequency of each response, and validated by the Wilcoxon test with a p value cooling aid in laser-assisted dental surgery.

  16. Pyoderma gangrenosum mimicking mediastinitis after cardiac surgery: a case study.

    Science.gov (United States)

    Hysi, I; Vincentelli, A

    2016-06-01

    Pyoderma gangrenosum is a dermatosis which associates both, necrosis and polynuclear infiltration of the skin. While the aetiology is not well understood, the disease is thought to be due to immune system dysfunction and it can occur after minor trauma or surgery. Although it has seldom been reported after cardiac surgery in the literature, it is not exceptional. Here we report a case of pyoderma gangrenosum after coronary artery bypass grafting in a 76-year-old patient with chronic idiopathic myelofibrosis. Diagnosis was clinically made and the patient was treated with systemic steroids. The lesions showed a remarkable improvement with this therapy. In the field of cardiac surgery, physicians of the surgical team and nurses should think about this diagnosis in all rapidly expanding postoperative lesions without improvement after debridement or antibiotics. The authors have no conflicts of interest to declare.

  17. Sacrococcygeal pilonidal disease: sinotomy versus excisional surgery, a retrospective study.

    Science.gov (United States)

    Rabie, M Ezzedien; Al Refeidi, Abdullah A; Al Haizaee, Abdullah; Hilal, Saleh; Al Ajmi, Hassan; Al Amri, Abdul Aziz

    2007-03-01

    Pilonidal disease is a disease of relatively young people, the exact aetiology of which is unknown. Treatment options vary from simple incision to complex flap procedures. Each method has its advocates and they all have a variable recurrence rate. The multiplicity of procedures testifies to the lack of an optimal treatment method. The objective of this study is to compare sinotomy, that is, simply laying the sinus open with the more popular radical surgery, where the sinus-bearing tissues are excised. Patients who were admitted to Aseer Central Hospital, Saudi Arabia with a pilonidal sinus or abscess, in the period from April 1999 to January 2005, were identified. The medical records were reviewed and data related to the patient characteristics, disease process and the procedures carried out were noted. Identified patients were contacted by phone to check recurrence of the disease and their abidance to instructions regarding regular hair removal from the area. Eighty-one patients were included in the study. The median age was 24.2 years (range 16-60 years). There were 9 women and 72 men. All procedures were carried out under general anaesthesia except sinotomy, which was carried out under general or local anaesthesia. The surgical procedure was incision and drainage of abscess in 16 cases (19.8%), excision with primary closure in 29 cases (35.8%), excision by the open method in 15 cases (18.5%), sinotomy in 14 cases (17.3%) and rhomboid flap construction in 8 cases (9.9%). The overall recurrence rate was 26.9%, and the mean hospital stay was 4.1 days. Sinotomy had a low recurrence rate (12.5%) and a short hospital stay (2.8 days). Sinotomy has the advantages of simplicity, the possibility of operating under local anaesthesia, with an acceptable recurrence rate. We recommend sinotomy for pilonidal sinus and abscess alike, both in primary and recurrent cases.

  18. Population-based study of the need for cholecystectomy after obesity surgery.

    Science.gov (United States)

    Plecka Östlund, M; Wenger, U; Mattsson, F; Ebrahim, F; Botha, A; Lagergren, J

    2012-06-01

    Weight loss following obesity surgery is associated with gallstone formation, but there is limited evidence on whether prophylactic cholecystectomy is indicated during obesity surgery. The aim of this study was to clarify the need for cholecystectomy following obesity surgery. A Swedish nationwide, population-based cohort study was conducted during the 22-year interval 1987-2008. Need for later cholecystectomy for gallstone disease was assessed in patients who had undergone obesity surgery in comparison with the general population of corresponding age, sex and calendar year. This need was also compared with the need for cholecystectomy in cohorts of patients who had undergone antireflux surgery and appendicectomy. Standardized incidence ratios (SIRs) with 95 per cent confidence intervals (c.i.) were calculated to estimate the relative risk. In the obesity surgery cohort of 13 443 patients, the observed number of cholecystectomies (1149, 8·5 per cent) exceeded the expected number by over fivefold (SIR 5·5, 95 per cent c.i. 5·1 to 5·8). The observed need for imperative cholecystectomy (for cholecystitis, cholangitis, pancreatitis, or jaundice; 427, 3·2 per cent) was also greater than expected (SIR 5·2, 4·7 to 5·7). The SIR peaked 7-24 months after obesity surgery and decreased with longer follow-up. The SIRs for cholecystectomy after antireflux surgery and appendicectomy were 2·4 (2·2 to 2·6) and 1·7 (1·6 to 1·7) respectively. An increased need for cholecystectomy after obesity surgery was confirmed, but was probably partly due to an increased detection of gallbladder disease only because of the surgery; the individual's risk of imperative cholecystectomy was low. Therefore, prophylactic cholecystectomy might not be recommended during obesity surgery. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  19. Psychological change after aesthetic plastic surgery: a prospective controlled outcome study.

    Science.gov (United States)

    Moss, Timothy P; Harris, David L

    2009-10-01

    Aesthetic plastic surgery has been long practiced for primarily psychological rather than physical benefit to patients. However, evaluation of the psychological impact of aesthetic plastic surgery has often been of limited methodological rigor in both study design and appropriate measurement. This study is intended to evaluate the psychological impact of aesthetic surgery on patients seeking such intervention in regard to concerns about breasts, nose or upper limbs using standardised psychometric instruments. Participants were recruited through the Plastic Surgery Unit (Patients) and general surgery, ENT surgery and Maxillo-facial surgery (Comparisons) at a UK General Hospital. Outcome measures included the Crown-Crisp Experiential Inventory anxiety scale, Beck Depression Inventory and Derriford Appearance Scale-24, a valid and reliable measure of distress and dysfunction in relation to self-consciousness of appearance. Data were collected pre-operatively (T1) and 3 months post-operatively (T2) for both groups. Longitudinal appearance adjustment for the plastic surgery group was also assessed at 12 months (T3). Both groups were less depressed and anxious post-operatively. The improvement in anxiety was significantly greater in the plastic surgery group. Body site specific appearance distress was significantly improved for the plastics group only, and the level of improvement was related to the body site affected.

  20. Collateral Weight Loss in Children Living with Adult Bariatric Surgery Patients: A Case Control Study

    Science.gov (United States)

    Hirsch, Annemarie G.; Wood, G. Craig; Bailey-Davis, Lisa; Lent, Michelle R.; Gerhard, Glenn S.; Still, Christopher D.

    2014-01-01

    Objective To evaluate the impact of adult bariatric surgery on the Body Mass Index (BMI) of children living in the same household. Design and Methods A retrospective case-control study. Case dyads (n=128) were composed of one adult who had bariatric surgery and one child at the same address. Control dyads (n=384) were composed of an adult with obesity but no bariatric surgery and a child at the same address. We used a two-sample t-test to determine whether the differences between actual and expected BMI at follow-up (post-surgery) differed between children in the case and control dyads. Results Among boys who were overweight, boys who lived with a surgery patient had a lower than expected BMI post-surgery, while boys who did not live with a surgery patient had a higher than expected BMI at follow-up (p=0.045). Differences between actual and expected BMIs of children were not significantly different between cases and controls in girls or in children in other weight classes. Conclusions Overweight boys who lived with an adult bariatric surgery patient had a lower than expected BMI after surgery as compared to controls. Future studies may be warranted to determine the mechanisms by which these children experience collateral weight loss. PMID:24989939

  1. Risk factors associated with postoperative pain after ophthalmic surgery: a prospective study

    Directory of Open Access Journals (Sweden)

    Lesin M

    2016-01-01

    Full Text Available Mladen Lesin,1,* Mirna Dzaja Lozo,1,* Zeljka Duplancic-Sundov,1 Ivana Dzaja,1 Nikolina Davidovic,2 Adriana Banozic,3 Livia Puljak3 1Department of Ophthalmology, 2Department of Psychiatry, University Hospital Split, 3Laboratory for Pain Research, University of Split School of Medicine, Split, Croatia *These authors contributed equally to this work Background: Risk factors associated with postoperative pain intensity and duration, as well as consumption of analgesics after ophthalmic surgery are poorly understood. Methods: A prospective study was conducted among adults (N=226 who underwent eye surgery at the University Hospital Split, Croatia. A day before the surgery, the patients filled out questionnaires assessing personality, anxiety, pain catastrophizing, sociodemographics were given and details about the procedure, anesthesia, and analgesia for each postoperative day. All scales were previously used for the Croatian population. The intensity of pain was measured using a numerical rating scale from 0 to 10, where 0 was no pain and 10 was the worst imaginable pain. The intensity of pain was measured before the surgery and then 1 hour, 3 hours, 6 hours, and 24 hours after surgery, and then once a day until discharge from the hospital. Univariate and multivariate analyses were performed. Results: A multivariate analysis indicated that independent predictors of average pain intensity after the surgery were: absence of premedication before surgery, surgery in general anesthesia, higher pain intensity before surgery and pain catastrophizing level. Independent predictors of postoperative pain duration were intensity of pain before surgery, type of anesthesia, and self-assessment of health. Independent predictors of pain intensity ≥5 during the first 6 hours after the procedure were the type of procedure, self-assessment of health, premedication, and the level of pain catastrophizing. Conclusion: Awareness about independent predictors associated

  2. NSAID Use after Bariatric Surgery : a Randomized Controlled Intervention Study

    NARCIS (Netherlands)

    Yska, Jan Peter; Gertsen, Sanneke; Flapper, Gerbrich; Emous, Marloes; Wilffert, Bob; van Roon, Eric N.

    2016-01-01

    Background Use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in bariatric surgery patients. If use of an NSAID is inevitable, a proton pump inhibitor (PPI) should also be used. Aim To determine the effect of an, compared to care-as-usual, additional intervention to reduce NSAID

  3. NSAID Use after Bariatric Surgery : a Randomized Controlled Intervention Study

    NARCIS (Netherlands)

    Yska, Jan Peter; Gertsen, Sanneke; Flapper, Gerbrich; Emous, Marloes; Wilffert, Bob; van Roon, Eric N.

    2016-01-01

    Background Use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in bariatric surgery patients. If use of an NSAID is inevitable, a proton pump inhibitor (PPI) should also be used. Aim To determine the effect of an, compared to care-as-usual, additional intervention to reduce NSAID

  4. Long-term outcomes of epilepsy surgery in Sweden: a national prospective and longitudinal study.

    Science.gov (United States)

    Edelvik, Anna; Rydenhag, Bertil; Olsson, Ingrid; Flink, Roland; Kumlien, Eva; Källén, Kristina; Malmgren, Kristina

    2013-10-01

    To investigate prospective, population-based long-term outcomes concerning seizures and antiepileptic drug (AED) treatment after resective epilepsy surgery in Sweden. Ten- and 5-year follow-ups were performed in 2005 to 2007 for 278/327 patients after resective epilepsy surgery from 1995 to 1997 and 2000 to 2002, respectively. All patients had been prospectively followed in the Swedish National Epilepsy Surgery Register. Ninety-three patients, who were presurgically evaluated but not operated, served as controls. In the long term (mean 7.6 years), 62% of operated adults and 50% of operated children were seizure-free, compared to 14% of nonoperated adults (p seizure freedom since surgery, compared to none of the controls (p seizures/month at baseline and long epilepsy duration as negative predictors and positive MRI to be a positive predictor of long-term seizure-free outcome. Ten years after surgery, 86% of seizure-free children and 43% of seizure-free adults had stopped AEDs in the surgery groups compared to none of the controls (p seizure outcomes after resective epilepsy surgery. The majority of the patients who are seizure-free after 5 and 10 years have sustained seizure freedom since surgery. Many patients who gain seizure freedom can successfully discontinue AEDs, more often children than adults. This study provides Class III evidence that more patients are seizure-free and have stopped AED treatment in the long term after resective epilepsy surgery than nonoperated epilepsy patients.

  5. Minimally invasive strabismus surgery versus paralimbal approach: A randomized, parallel design study is minimally invasive strabismus surgery worth the effort?

    Directory of Open Access Journals (Sweden)

    Richa Sharma

    2014-01-01

    Full Text Available Introduction : Minimal access surgery is common in all fields of medicine. We compared a new minimally invasive strabismus surgery (MISS approach with a standard paralimbal strabismus surgery (SPSS approach in terms of post-operative course. Materials and Methods: This parallel design study was done on 28 eyes of 14 patients, in which one eye was randomized to MISS and the other to SPSS. MISS was performed by giving two conjunctival incisions parallel to the horizontal rectus muscles; performing recession or resection below the conjunctival strip so obtained. We compared post-operative redness, congestion, chemosis, foreign body sensation (FBS, and drop intolerance (DI on a graded scale of 0 to 3 on post-operative day 1, at 2-3 weeks, and 6 weeks. In addition, all scores were added to obtain a total inflammatory score (TIS. Statistical Analysis: Inflammatory scores were analyzed using Wilcoxon′s signed rank test. Results: On the first post-operative day, only FBS (P = 0.01 and TIS (P = 0.04 showed significant difference favoring MISS. At 2-3 weeks, redness (P = 0.04, congestion (P = 0.04, FBS (P = 0.02, and TIS (P = 0.04 were significantly less in MISS eye. At 6 weeks, only redness (P = 0.04 and TIS (P = 0.05 were significantly less. Conclusion: MISS is more comfortable in the immediate post-operative period and provides better cosmesis in the intermediate period.

  6. Collaborating to increase access to clinical and educational resources for surgery: a case study.

    Science.gov (United States)

    Tomasko, Jonathan M; Adams, Nancy E; Garritano, Frank G; Santos, Mary C; Dillon, Peter W

    2014-01-01

    A case study is described in which collaborations between a Department of Surgery, a Department of Information Technology, and an academic health sciences library resulted in the development of an electronic surgical library available at the bedside, the deployment of tablet devices for surgery residents, and implementation of a tablet-friendly user interface for the institution's electronic medical record.

  7. Children Coping with Surgery through Drawings: A Case Study from a Parenting Class

    Science.gov (United States)

    Broecher, Joachim

    2012-01-01

    This case study illustrates how parents can help their children cope with the fear and pain of surgery by engaging them in expressive drawing. As part of a parenting class that utilized art therapy techniques, a father shared his 6-year-old son's spontaneous drawings that had been created directly before and after surgery. Through guidance by the…

  8. Children Coping with Surgery through Drawings: A Case Study from a Parenting Class

    Science.gov (United States)

    Broecher, Joachim

    2012-01-01

    This case study illustrates how parents can help their children cope with the fear and pain of surgery by engaging them in expressive drawing. As part of a parenting class that utilized art therapy techniques, a father shared his 6-year-old son's spontaneous drawings that had been created directly before and after surgery. Through guidance by the…

  9. Anesthesia for Ambulatory Pediatric Surgery in Sub-Saharan Africa: A Pilot Study in Burkina Faso.

    Science.gov (United States)

    Kabré, Yvette B; Traoré, Idriss S S; Kaboré, Flavien A R; Ki, Bertille; Traoré, Alain I; Ouédraogo, Isso; Bandré, Emile; Wandaogo, Albert; Ouédraogo, Nazinigouba

    2017-02-01

    Long surgical wait times and limited hospital capacity are common obstacles to surgical care in many countries in Sub-Saharan Africa (SSA). Introducing ambulatory surgery might contribute to a solution to these problems. The purpose of this study was to evaluate the safety and feasibility of introducing ambulatory surgery into a pediatric hospital in SSA. This is a cross-sectional descriptive study that took place over 6 months. It includes all patients assigned to undergo ambulatory surgery in the Pediatric University Hospital in Ouagadougou, Burkina Faso. Eligibility criteria for the ambulatory surgery program included >1 year of age, American Society of Anesthesiologists (ASA) 1 status, surgery with a low risk of bleeding, lasting surgery, of whom 515 were elective cases; 115 of these met the criteria for ambulatory surgery; 103 patients, with an average age of 59.74 ± 41.57 months, actually underwent surgery. The principal indications for surgery were inguinal (62) and umbilical (47) hernias. All patients had general anesthesia with halothane. Sixty-five percent also received regional or local anesthesia consisting of caudal block in 79.23% or nerve block in 20.77%. The average duration of surgery was 33 ± 17.47 minutes. No intraoperative complications were noted. All the patients received acetaminophen and a nonsteroidal anti-inflammatory drug in the recovery room. Twelve (11.7%) patients had complications in recovery, principally nausea and vomiting. Eight (7.8%) patients were admitted to the hospital. No serious complications were associated with ambulatory surgery. Its introduction could possibly be a solution to improving pediatric surgical access in low-income countries.

  10. Potent anti-inflammatory activity of sesquiterpene lactones from Neurolaena lobata (L.) R. Br. ex Cass., a Q'eqchi' Maya traditional medicine.

    Science.gov (United States)

    Walshe-Roussel, Brendan; Choueiri, Christine; Saleem, Ammar; Asim, Muhammd; Caal, Federico; Cal, Victor; Rojas, Marco Otarola; Pesek, Todd; Durst, Tony; Arnason, John Thor

    2013-08-01

    The widespread use of Neurolaena lobata (L.) R. Br. ex Cass. by Q'eqchi' Maya and indigenous healers throughout the Caribbean for inflammatory conditions prompted the study of the anti-inflammatory activity of this traditional medicine. The objectives of this study were to conduct a detailed ethnobotanical investigation of the uses of N. lobata by the Q'eqchi' Maya of Belize for a variety of inflammatory symptoms and to evaluate the in vitro anti-inflammatory activity of leaf extract and isolated sesquiterpene lactones. The crude 80% EtOH extract of N. lobata leaves administered at 100 μg/mL reduced LPS-stimulated TNF-α production in THP-1 monocytes by 72% relative to the stimulated vehicle control. Isolated sesquiterpene lactones, neurolenins B, C+D, lobatin B and 9α-hydroxy-8β-isovalerianyloxy-calyculatolide were more active (IC50=0.17-2.32 μM) than the positive control parthenolide (IC50=4.79 μM). The results provide a pharmacological and phytochemical basis for the traditional use of this leaf for inflammatory conditions.

  11. A Retrospective Study of Combined Cardiac and Carotid Surgery

    Directory of Open Access Journals (Sweden)

    Fabrizio Sansone

    2012-08-01

    Full Text Available Introduction: A combined carotid endarterectomy (CEA and cardiac procedure has higher early risk of stroke than isolated CEA because of the widespread atherosclerosis in patients selected for simultaneous procedures. In this retrospective study, we review the results of combined coronary artery bypass grafting (CABG and carotid endarterectomy (CEA procedures. Materials and methods: Between January 2000 and December 2007, 91 patients with a mean age of 69.2+6.6 (24/67 female/male underwent combined operations (CEA-CABG on cardiopulmonary bypass (CPB as elective surgery. The study population was divided, as follows: Group A: 83 patients (91.2% had both venous and arterial revascularization; Group B: 8 patients (8.8% had total arterial revascularization. CEA was performed in case of stenosis more than 80% and always before cardiac operation. These techniques were used: standard procedure (54.8%, eversion (39.2%, patch enlargement (6%. Immediately after the vascular procedure, CABGs were performed through median sternotomy. The mean EUROscore was 6.9+2.5%. Results: All neurological complications were in the group who underwent both venous and arterial revascularization (Group A, where a proximal anastomosis was made. All complications and deaths were in group A. Six patients had stroke (6.6% and 2 had acute myocardial infarction (AMI (2.2%. There were 8 in-hospital deaths (8.8% and 1 late death (for stroke after five months. Conclusions: In our center, the incidence of stroke in simultaneous cardiovascular procedures was 5.5 times greater than in isolated cardiac or vascular procedures, which was probably related to the widespread vessels disease. An aortic cross clamp and surgical procedure on the ascending aorta are relevant risk factors for developing neurological events; much attention should be paid to aortic manipulation. In the sub-group who underwent total arterial revascularization with associated CEA procedures, we had no neurological

  12. Post-destructive eye surgery, associated depression at Sekuru Kaguvi Hospital Eye Unit, Zimbabwe: Pilot Study

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    M. M. Kawome

    2013-12-01

    Full Text Available Destructive eye surgery is associated with more complications than just loss of visual functions of the eye and aesthetics. Currently there is very little published literature on post-destructive eye surgery associated depression. Zimbabwe has been experiencing a surge in the rate of destructive eye surgery done at the National Tertiary Eye Unit. This situation could be churning out lots of unrecognized depressed clients into the community who require assistance in one form or another.Objectives: To determine the prevalence of post-destructive eye surgery associated depression among patients attending Sekuru Kaguvi Hospital Eye Unit and assess if the current management protocol of patients undergoing destructive eye surgery at the Eye Unit addresses the problem adequately.Methods: A cross-sectional study of 28 randomly selected patients who had destructive eye surgeries at Sekuru Kaguvi Hospital was conducted over five months from 1st March 2012 to end of July 2012. A structured questionnaire containing 15 questions on the following items: gender, age, diagnosis, surgical procedure done, expectations before and after surgery, adequacy of counseling given and involvement of family was used to collect data. Nine questions to assess depression were adapted from the Patient Health Questionnaire (PHQ-9.Setting:  The study was conducted at SekuruKaguvi Hospital Eye Unit, Parirenyatwa Group of Hospitals in Harare.Results:  Twenty-eight patients who underwent destructive eye surgery during the study period were selected using systematic random sampling. The gender ratio was 1:1 and the mean age was 38.7 years with a range from 24 to 65 years. Fifty percent of the patients in the study had orbital exenteration while the rest had enucleation (14% and evisceration (36%. Twenty-eight percent of the study population had depression.Conclusion: Destructive eye surgery is frequently associated with depression and our current management protocol of patients

  13. Utility of melatonin to treat surgical stress after major vascular surgery - a safety study

    DEFF Research Database (Denmark)

    Kücükakin, Bülent; Lykkesfeldt, Jens; Nielsen, Hans Jørgen

    2008-01-01

    Surgery for abdominal aortic aneurysm is associated with elevated oxidative stress. As an antioxidant in animal and human studies, melatonin has the potential of ameliorating some of this oxidative stress, but melatonin has never been administered to adults during surgery for the purpose of reduc......Surgery for abdominal aortic aneurysm is associated with elevated oxidative stress. As an antioxidant in animal and human studies, melatonin has the potential of ameliorating some of this oxidative stress, but melatonin has never been administered to adults during surgery for the purpose...... in the intraoperative phase was safe and without complications. Melatonin may decrease oxidative damage resulting from surgery, but randomized clinical trials are required before definitive conclusions can be drawn regarding the clinical benefit of melatonin in surgical situations....

  14. Children's vomiting following posterior fossa surgery: A retrospective study

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    Dundon Belinda

    2009-07-01

    Full Text Available Abstract Background Nausea and vomiting is a problem for children after neurosurgery and those requiring posterior fossa procedures appear to have a high incidence. This clinical observation has not been quantified nor have risk factors unique to this group of children been elucidated. Methods A six year retrospective chart audit at two Canadian children's hospitals was conducted. The incidence of nausea and vomiting was extracted. Hierarchical multivariable logistic regression was used to quantify risk and protective factors at 120 hours after surgery and early vs. late vomiting. Results The incidence of vomiting over a ten day postoperative period was 76.7%. Documented vomiting ranged from single events to greater than 20 over the same period. In the final multivariable model: adolescents (age 12 to Conclusion The incidence of vomiting in children after posterior fossa surgery is sufficient to consider all children requiring these procedures to be at high risk for POV. Nausea requires better assessment and documentation.

  15. Coagulation and fibrinolysis during lung surgery:an experimental study

    DEFF Research Database (Denmark)

    Trabjerg, Theis B; Sander, Klaus D; Nybo, Mads

    2014-01-01

    OBJECTIVES: Postoperative thromboembolism is a serious complication, but the incidence following surgery for lung cancer appears to be much lower compared with other surgical specialties. The reason is unknown and one may speculate that the lungs are reservoirs of anticoagulants or fibrinolytic...... substances, which are released by manipulation of the lung parenchyma during surgery. METHODS: Standardized lung manipulation, single-lung ventilation and pneumonectomy were performed in 10 anaesthetized pigs. Baseline and serial postmanipulation intravenous and intra-arterial blood samples were analysed...... for a wide range of fibrinolytic substances as well as pro- and anticoagulant factors. RESULTS: We found a transient but significant decrease in activated partial thromboplastin time (aPTT) and plasminogen activator inhibitor following manipulation of the lungs. Pneumonectomy resulted in minor...

  16. Colorectal Cancer Prognosis Following Obesity Surgery in a Population-Based Cohort Study.

    Science.gov (United States)

    Tao, Wenjing; Konings, Peter; Hull, Mark A; Adami, Hans-Olov; Mattsson, Fredrik; Lagergren, Jesper

    2017-05-01

    Obesity surgery involves mechanical and physiological changes of the gastrointestinal tract that might promote colorectal cancer progression. Thus, we hypothesised that obesity surgery is associated with poorer prognosis in patients with colorectal cancer. This nationwide population-based cohort study included all patients with an obesity diagnosis who subsequently developed colorectal cancer in Sweden from 1980 to 2012. The exposure was obesity surgery, and the main and secondary outcomes were disease-specific mortality and all-cause mortality, respectively. Cox proportional hazard survival models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for sex, age, calendar year and education level. The exposed and unexposed cohort included 131 obesity surgery and 1332 non-obesity surgery patients with colorectal cancer. There was a statistically significant increased rate of colorectal cancer deaths following obesity surgery (disease-specific HR 1.50, 95% CI 1.00-2.19). When analysed separately, the mortality rate was more than threefold increased in rectal cancer patients with prior obesity surgery (disease-specific HR 3.70, 95% CI 2.00-6.90), while no increased mortality rate was found in colon cancer patients (disease-specific HR 1.10, 85% CI 0.67-1.70). This population-based study among obese individuals found a poorer prognosis in colorectal cancer following obesity surgery, which was primarily driven by the higher mortality rate in rectal cancer.

  17. Psychological and health comorbidities before and after bariatric surgery: a longitudinal study

    Directory of Open Access Journals (Sweden)

    Susana Sofia Pereira da Silva

    2013-12-01

    Full Text Available INTRODUCTION: Morbid obesity has multiple implications for psychological and physical health. Bariatric surgery has been selected as the treatment of choice for this chronic disease, despite the controversial impact of the surgery on psychosocial health. The objective of this study was to describe candidates for bariatric surgery and analyze changes in weight, psychopathology, personality, and health problems and complaints at 6- and 12- month follow-up assessments. METHODS: Thirty obese patients (20 women and 10 men with a mean age of 39.17±8.81 years were evaluated in different dimensions before surgery and 6 and 12 months after the procedure. RESULTS: Six and 12 months after bariatric surgery, patients reported significant weight loss and a significant reduction in the number of health problems and complaints. The rates of self-reported psychopathology were low before surgery, and there were no statistically significant changes over time. The conscientiousness, extraversion, and agreeableness dimensions increased, but neuroticism and openness remained unchanged. All changes had a medium effect size. CONCLUSIONS: Our results suggest that patients experience significant health improvements and some positive personality changes after bariatric surgery. Even though these findings underscore the role of bariatric surgery as a relevant treatment for morbid obesity, more in-depth longitudinal studies are needed to elucidate the evolution of patients after the procedure.

  18. Cataract surgery rates in latin america: a four-year longitudinal study of 19 countries.

    Science.gov (United States)

    Lansingh, Van C; Resnikoff, Serge; Tingley-Kelley, Kimberly; Nano, María E; Martens, Marion; Silva, Juan C; Duerksen, Rainald; Carter, Marissa J

    2010-03-01

    To collect cataract surgery rates data in 19 Latin American countries over a 4-year period as data published to date have been limited. Cataract surgery rates were obtained from National Society of Ophthalmology, National VISION 2020/Prevention of Blindness Committee and Ministry of Health representatives for each country for 2005 to 2008. Economic (gross national income per capita) and other data were collected from publicly available databases. Linear and power correlations between gross national incomes and cataract surgery rates were calculated. Over the study period, most countries increased their cataract surgery rates, with the largest increases observed for Venezuela (186%), Nicaragua (183%), Costa Rica (100%), Uruguay (97%), and Peru (88%). Mean cataract surgery rates for 2005, 2006, 2007, and 2008 for the ensemble of countries were 1545, 1684, 1660, and 1822 per million population, respectively, with a growth over the study period of 17.9%, concurrent with an increase of 57 million (11.5%) in the population. A good correlation between cataract surgery rate and gross national income per capita was found (P < .001). Although progress is being made in the region, the cataract surgery rates represent only one parameter. When they are examined in the context of cataract surgical coverage it is clear that substantial proportions of bilaterally blind persons are still not receiving surgery.

  19. Evaluation of quality of life in Chilean patients with orthognathic surgery. A cohort study.

    Directory of Open Access Journals (Sweden)

    Macarena Cea-Herrera

    2016-12-01

    Full Text Available To compare the presurgical and immediate postsurgical quality of life in Chilean patients with orthognathic surgery. Material and Methods: Cohort study. The study included 30 patients (mean age 20.73, 53.33% male who underwent orthognathic surgery primarily for severe skeletal abnormalities, (17 surgeries, 56.7% and moderate skeletal abnormalities (12 surgeries, 40%, from three Chilean hospitals between February and June 2016. Patients were asked to answer the World Health Organization quality of life Bref version questionnaire (WHOQOL-BREF validated in Spanish to measure quality of life (QoL two weeks before and three months after the surgery. Scores for general QoL and for every domain of QoL were described. Variations in the scores of general QoL were analyzed according to sex and severity of orofacial malformation (mild, moderate or severe (t-test p<0.05; STATA 10.0. Results: The average score for QoL according to the WHOQOL-BREF scale was 76.43±13.83 before surgery and 90.5±7.18 three months after surgery (p<0.001. Statistically significant differences according to sex and type of orofacial malformation were found (p<0.01. An increase in the score in all the domains of the WHOQOOL-BREF scale was observed. Conclusion: Orthognathic surgery significantly improved QoL scores in Chilean patients according to the WHOQOL-BREF scale.

  20. Cataract Surgery and Visual Acuity in Elderly Japanese: Results of Fujiwara-kyo Eye Study

    Science.gov (United States)

    Miyata, Kimie; Yoshikawa, Tadanobu; Mine, Masashi; Nishi, Tomo; Okamoto, Nozomi; Ueda, Tetsuo; Kawasaki, Ryo; Kurumatani, Norio; Ogata, Nahoko

    2017-01-01

    Abstract The aim of this study was to determine the presence of prior cataract surgery and best-corrected visual acuity (BCVA) in an elderly Japanese cohort. The Fujiwara-kyo Eye Study was a prospective, population-based, cross-sectional epidemiological study. The subjects were ≥68 years who lived in the Nara Prefecture and responded to recruitment notices. All of the subjects underwent comprehensive ophthalmological examinations, and the sociodemographic information and medical history, including prior cataract surgery, were obtained by answers to a questionnaire. The associations between the BCVA, age, sex, and history of cataract surgery were determined. A total of 2,873 subjects whose mean age was 76.3 ± 4.9 (mean ± standard deviation) years were studied. The mean BCVA was −0.020 ± 0.14 logarithm of the minimum angle of resolution units, and it was significantly better in the group with education ≥13 years (p < 0.01). Overall, 24.2% of the subjects had undergone cataract surgery, and 41.7% of the subjects ≥80 years had undergone cataract surgery. The incidence of prior cataract surgery increased with increasing age (p < 0.001 for trend). The mean BCVA of eyes with cataract surgery was significantly better than that of eyes without cataract surgery in subjects ≥80 years (p < 0.01). Visual acuity was generally good in this cohort of elderly Japanese subjects. In this cohort, 24.2% of the subjects had undergone cataract surgery, and the subjects ≥80 years had better BCVA than those without cataract surgery. PMID:28451472

  1. 百能葳属--江西省菊科一新记录属%Blainvillea Cass.(Asteraceae), a newly recorded genus in Jiangxi Province, China

    Institute of Scientific and Technical Information of China (English)

    曾宪锋; 邱贺媛

    2014-01-01

    [目的]探讨赣南地区的植物区系特点.[方法]在赣南地区采集、鉴定了大批植物标本.[结果和结论]报道了江西省菊科一新记录属---百能葳属Blainvillea Cass.及一新记录种---百能葳Blainvillea acmella (Linn.) Phillip-son.标本存放于华南农业大学林学院树木标本室( CANT).%[Objective]To study the nature of flora in South jiangxi .[Method]Plant specimens were col-lected and identified.[Result and conclusion]The genus Blainvillea Cass.(Asteraceae) and the species Blainvillea acmella (Linn.) Phillipson were reported as new records in Jiangxi Province , China.Vouch-er specimens are deposited in Dendrological Herbarium of the Forestry College , South China Agricultural University ( CANT) .

  2. Hydrogeology and water quality of glacial-drift aquifers in the Bemidji-Bagley area, Beltrami, Clearwater, Cass, and Hubbard counties, Minnesota

    Science.gov (United States)

    Stark, J.R.; Busch, J.P.; Deters, M.H.

    1991-01-01

    Unconfined and the upper confined aquifers in glacial drift are the primary sources of water in a 1,600 square-mile area including parts of Beltrami, Cass, Clearwater, and Hubbard Counties, Minnesota. The unconfineddrift aquifer consists of coarse sand and gravel in the center of the study area. The total area underlain by the unconfined-drift aquifer is approximately 550 square miles. The unconfined aquifer ranges in thickness from 0 to 130 feet, and is greater than 20 feet thick over an area of 280 square miles. On the basis of scant data, the transmissivity of the unconfined aquifer ranges from less than 70 feet squared per day in the south and west to greater than 8,900 feet squared per day in an area west of Bemidji. Well yields from 10 to 300 gallons per minute are possible in some areas. The unconfined and upper confined-drift aquifers are separated by a fine-grained confining unit of till or lake deposits.

  3. Study on Clinical Application of Nerve Monitor in Parotid Tumor Surgery

    Institute of Scientific and Technical Information of China (English)

    XU Liang-peng; JIA Bao-jun; AO Jian-hua; QU Dan-yang; SHENG Yan-jiao

    2014-01-01

    Objective The purpose of the study is to explore the application value of the nerve monitor adopted to pinpoint facial nerves before anatomization during a parotid tumor surgery. Methods Facial nerves of 36 patients were pinpointed by N800 nerve monitor produced by Shandong Weigao Group Medical Polymer Co. Ltd before being anatomized and exposed in parotid surgeries in order to protect the corresponding facial nerve branch and complete the related surgery. Results All the facial nerves of the 36 patients were located precisely and 108 related facial nerves were suc-cessfully anatomized and protected without any damage. Conclusion Pinpointing the facial nerve branch with a nerve monitor before anatomization pro-motes not only the efficiency of the surgery but also the safety of it and is proved to be more significant in a secondary surgery.

  4. Clinical and neuropsychiatric correlates of lumbar spinal surgery in older adults: results of a pilot study.

    Science.gov (United States)

    Karp, Jordan F; McGovern, Jonathan; Marron, Megan M; Gerszten, Peter; Weiner, Debra K; Okonkwo, David; Kanter, Adam S

    2016-11-01

    To improve selection of older lumbar surgical candidates, we surveyed correlates of functioning and satisfaction with surgery. Prospective sample at lumbar spine surgery clinic. Patients (n = 48) were evaluated before surgery and after 3 months. Dependent variables were functioning and surgical satisfaction. Baseline variables associated with disability at 3 months included cognitive status and widespread pain. There was clinically significant improvement with moderate effects sizes for anxiety and depression at follow-up. Patients with at least a 30% improvement in disability had better physical health-related quality of life and were less likely to report widespread pain before surgery. Although preliminary, two novel potential predictors of lumbar surgery outcome include diminished cognitive functioning and widespread pain. Further study of these variables on post-surgical functioning and satisfaction may improve patient selection.

  5. Risk factors for acute surgical site infections after lumbar surgery: a retrospective study.

    Science.gov (United States)

    Lai, Qi; Song, Quanwei; Guo, Runsheng; Bi, Haidi; Liu, Xuqiang; Yu, Xiaolong; Zhu, Jianghao; Dai, Min; Zhang, Bin

    2017-07-19

    Currently, many scholars are concerned about the treatment of postoperative infection; however, few have completed multivariate analyses to determine factors that contribute to the risk of infection. Therefore, we conducted a multivariate analysis of a retrospectively collected database to analyze the risk factors for acute surgical site infection following lumbar surgery, including fracture fixation, lumbar fusion, and minimally invasive lumbar surgery. We retrospectively reviewed data from patients who underwent lumbar surgery between 2014 and 2016, including lumbar fusion, internal fracture fixation, and minimally invasive surgery in our hospital's spinal surgery unit. Patient demographics, procedures, and wound infection rates were analyzed using descriptive statistics, and risk factors were analyzed using logistic regression analyses. Twenty-six patients (2.81%) experienced acute surgical site infection following lumbar surgery in our study. The patients' mean body mass index, smoking history, operative time, blood loss, draining time, and drainage volume in the acute surgical site infection group were significantly different from those in the non-acute surgical site infection group (p surgical site infection group were significantly different than those in the non-acute surgical site infection group (p surgical site infection following lumbar surgery. In order to reduce the risk of infection following lumbar surgery, patients should be evaluated for the risk factors noted above.

  6. A comparative study of short- and medium-term outcomes comparing emergent surgery and stenting as a bridge to surgery in patients with acute malignant colonic obstruction.

    LENUS (Irish Health Repository)

    Kavanagh, Dara O

    2013-04-01

    The use of self-expanding metal stents as a bridge to surgery in the setting of malignant colorectal obstruction has been advocated as an acceptable alternative to emergency surgery. However, concerns about the safety of stenting have been raised following recent randomized studies.

  7. Food addiction and the outcome of bariatric surgery at 1-year: Prospective observational study.

    Science.gov (United States)

    Sevinçer, Güzin Mukaddes; Konuk, Numan; Bozkurt, Süleyman; Coşkun, Halil

    2016-10-30

    The objectives of the current study were to determine the prevalence of food addiction in bariatric surgery candidates and whether food addiction is associated with weight loss after bariatric surgery. This prospective observational study was performed on morbidly obese patients who had been found suitable for bariatric surgery. Follow-up was conducted at the 6 and 12 month post-surgery. The Yale Food Addiction Scale (YFAS) was used to determine food addiction. One hundred seventy-eight patients were included. Pre-operative food addiction was found in 57.8% of patients. Food addiction prevalence decreased at the 6 and 12 month follow ups, to 7.2% and 13.7% respectively. There were no statistically differences between those with food addiction and those without addiction with regard to weight loss measured as percent of excess BMI at the 12 month follow-up. Food addiction as measured by the YFAS decreases significantly after bariatric surgery. The presence of food addiction before surgery was not associated with weight loss as measured EBL%. However, in view of the increase in BMI, 2 years after surgery longer follow up studies are warranted. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. Effects of tolvaptan in the early postoperative stage after heart valve surgery: results of the STAR (Study of Tolvaptan for fluid retention AfteR valve surgery) trial.

    Science.gov (United States)

    Nishi, Hiroyuki; Toda, Koichi; Miyagawa, Shigeru; Yoshikawa, Yasushi; Fukushima, Satsuki; Kawamura, Masashi; Yoshioka, Daisuke; Saito, Tetsuya; Ueno, Takayoshi; Kuratani, Toru; Sawa, Yoshiki

    2015-12-01

    The purpose of this study was to assess the efficacy of tolvaptan, a vasopressin V2 receptor antagonist, for the management of postoperative surgical fluid retention after heart valve surgery. This was a prospective observational study of 64 patients with heart valve disease who underwent valve surgery between 2013 and 2014. Those in the tolvaptan group received tolvaptan in addition to conventional diuretic therapy. The results were compared to the results of 55 patients who underwent heart valve surgery between 2007 and 2010 and received conventional postoperative diuretics alone. The time to return to the preoperative BW was significantly shorter in the patients who received tolvaptan (6.1 ± 3.8 vs. 8.7 ± 6.7 days, p fluid retention during the early postoperative stage in cardiac surgery patients, without increased renal failure or abnormal electrolyte levels. This new type of diuretic therapy may be a suitable option for postoperative fluid management in patients undergoing cardiac surgery.

  9. Adolescent Bariatric Surgery Program Characteristics: The Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study Experience

    Science.gov (United States)

    Michalsky, M.P.; Inge, T.H.; Teich, S.; Eneli, I.; Miller, R.; Brandt, M.L.; Helmrath, M.; Harmon, C.M.; Zeller, M.H.; Jenkins, T.M.; Courcoulas, A.; Buncher, C.R.

    2013-01-01

    Background The number of adolescents undergoing weight loss surgery (WLS) has increased in response to the increasing prevalence of severe childhood obesity. Adolescents undergoing WLS require unique support, which may differ from adult programs. The aim of this study was to describe institutional and programmatic characteristics of centers participating in Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS), a prospective study investigating safety and efficacy of adolescent WLS. Methods Data were obtained from the Teen-LABS database and site survey completed by Teen-LABS investigators. The survey queried (1) institutional characteristics, (2) multidisciplinary team composition, (3) clinical program characteristics, and (4) clinical research infrastructure. Results All centers had extensive multidisciplinary involvement in the assessment, preoperative education and post-operative management of adolescents undergoing WLS. Eligibility criteria, pre-operative clinical and diagnostic evaluations were similar between programs. All programs have well developed clinical research infrastructure, use adolescent-specific educational resources, and maintain specialty equipment, including high weight capacity diagnostic imaging equipment. Conclusions The composition of clinical team and institutional resources are consistent with current clinical practice guidelines. These characteristics, coupled with dedicated research staff, have facilitated enrollment of 242 participants into Teen-LABS. PMID:24491361

  10. Adolescent bariatric surgery program characteristics: the Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study experience.

    Science.gov (United States)

    Michalsky, Marc P; Inge, Thomas H; Teich, Steven; Eneli, Ihuoma; Miller, Rosemary; Brandt, Mary L; Helmrath, Michael; Harmon, Carroll M; Zeller, Meg H; Jenkins, Todd M; Courcoulas, Anita; Buncher, Ralph C

    2014-02-01

    The number of adolescents undergoing weight loss surgery (WLS) has increased in response to the increasing prevalence of severe childhood obesity. Adolescents undergoing WLS require unique support, which may differ from adult programs. The aim of this study was to describe institutional and programmatic characteristics of centers participating in Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS), a prospective study investigating safety and efficacy of adolescent WLS. Data were obtained from the Teen-LABS database, and site survey completed by Teen-LABS investigators. The survey queried (1) institutional characteristics, (2) multidisciplinary team composition, (3) clinical program characteristics, and (4) clinical research infrastructure. All centers had extensive multidisciplinary involvement in the assessment, pre-operative education, and post-operative management of adolescents undergoing WLS. Eligibility criteria and pre-operative clinical and diagnostic evaluations were similar between programs. All programs have well-developed clinical research infrastructure, use adolescent-specific educational resources, and maintain specialty equipment, including high weight capacity diagnostic imaging equipment. The composition of clinical team and institutional resources is consistent with current clinical practice guidelines. These characteristics, coupled with dedicated research staff, have facilitated enrollment of 242 participants into Teen-LABS. © 2013 Published by Elsevier Inc.

  11. The comparative study of epidural levobupivacaine and bupivacaine in major abdominal surgeries

    Directory of Open Access Journals (Sweden)

    Ali Uzuner

    2011-01-01

    Conclusions: The results of our study suggest that same concentration of epidural levobupivacaine and bupivacaine with fentanyl provide stable postoperative analgesia and both were found safe for the patients undergoing major abdominal surgery.

  12. Use of Chinese Medicine and Subsequent Surgery in Women with Uterine Fibroid: A Retrospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Shan-Yu Su

    2012-01-01

    Full Text Available Background. Chinese medicine (CM has been used to relieve symptoms relevant to uterine fibroids. Objective. This study investigated the association between the use of CM and the incidence of uterine surgery in women with uterine fibroids. Subjects and Methods. This retrospective cohort study extracted records for 16,690 subjects diagnosed with a uterine fibroid between 2000 and 2003 from the National Health Insurance reimbursement database. The risk factors for surgery were examined via Cox proportional hazard analysis, and the difference in incidence of surgery between CM users and nonusers was compared using incidence rate ratios (IRRs derived from Poisson's models. Results. After an average follow-up period of 4.5 years, the cumulative incidence of uterine surgery was significantly lower in CM users than CM nonusers (P<0.0001. Compared to CM nonusers, CM users were more unlikely to undergo uterine surgery (adjusted hazard ratio = 0.18, 95% confidence interval (CI = 0.17, 0.19. The incidence of surgery in CM users was dramatically different from that for CM nonusers (IRR = 0.17, 95% CI = 0.16, 0.18. Conclusion. The risk of uterine surgery among fibroid patients who used CM was significantly decreased, implying an effective treatment of fibroid-related symptoms provided by CM.

  13. A Prospective Clinical Study on Blood Mercury Levels Following Endodontic Root-end Surgery with Amalgam.

    Science.gov (United States)

    Saatchi, Masoud; Shadmehr, Elham; Talebi, Seyed Morteza; Nazeri, Mohsen

    2013-01-01

    The purpose of this clinical study was to compare the blood mercury levels before and after endodontic surgery using amalgam as a root-end filling material. Fourteen patients requiring periradicular surgery participated in this prospective clinical study. A zinc-free amalgam was employed as root-end filling material. Blood samples were collected at three intervals: immediately before, immediately after and one week postoperatively. Mercury content of the blood was determined using gold amalgamation cold-vapor atomic absorption spectrometry. Obtained data were analyzed using analysis of variance for repeated measures and paired t-test. The mean (SD) of blood mercury levels was 2.20 (0.24) ng/mL immediately before surgery, 2.24 (0.28) ng/mL immediately after surgery and 2.44 (0.17) ng/mL one week after the periradicular surgery. The blood mercury level one week post-operative was significantly higher than both blood mercury levels immediately before (P<0.001) and immediately after (P=0.005) the surgery. Placement of an amalgam retroseal during endodontic surgery can increase blood mercury levels after one week. The mercury levels however, are still lower than the toxic mercury levels. We suggest using more suitable and biocompatible root-end filling materials.

  14. The temerloh hospital cataract complications study: factors associated with, types and outcomes of cataract surgery complications

    Directory of Open Access Journals (Sweden)

    Thevi Thanigasalam

    2014-08-01

    Full Text Available AIM: To study the prevalence of complications of cataract surgery and any association between the occurrence of complications and experience of surgeon, type of surgery, type of anaesthesia and visual outcome.METHODS: This was a retrospective study of patients who underwent cataract surgery over a period of two years in a district hospital in Malaysia. The demographic details of patients, type of surgery done, as well as type of anaesthesia used and experience of the surgeon were noted. The types of intraoperative and postoperative complications were recorded. The final best corrected visual outcome was recorded.RESULTS: Complications occurred in 11.1% of the total 1007 patients operated. Posterior capsule rupture(3.6%was the most common complication. The experience of the surgeon and the type of anaesthesia used did not affect complications during surgery. Intracapsular cataract extraction(ICCEand phacoemulsification converted to extracapsular cataract extraction(ECCEwere significantly associated with more complications(PPCONCLUSION: The occurrence of complications during cataract surgery significantly affected the visual outcome. The type of surgery done was associated by the occurrence of complications. However, the experience of the surgeon and the type of anaesthesia used did not affect the occurrence of complications. We recommend that particular attention be given to ICCE and phacoemulsification converted to ECCE to minimise the complications and thereby reducing the chances of poor vision postoperatively.

  15. 农户对农村居民点整合的意愿及其驱动机制——以重庆市沙坪坝区曾家镇白林村为例%Farmers' rural settlement integration aspiration and driving mechanism:A cass study of Bailin village in Chongqing

    Institute of Scientific and Technical Information of China (English)

    李晓庆; 王成; 王利平; 蒋伟; 熊川铭

    2013-01-01

    Rural settlement integration as the important content of the integration of rural governance.At the time, it should be contact with the rural residential building at last long time,in the space it should must the needs of different farmer's production and life demand, and we must consider the space levels of the village. So the coupling of respect the farmers' rural settlement integration aspiration and give play to the effect of rural residential integration related to the improvement of farmers' production and living conditions, and it has became the focus of rural settlement integration and effectively solve the people's livelihood problem. This study took Bailin Village in Chongqing as an example, adopting the methods of ' PRA+3S', constructed a database integrated the spatial characteristics of 'farmers-land' and development trend of future livelihood dynamic to quantize farmers' livelihood assets, analyzed different types of farmers' rural settlement integration aspiration and dynamic mechanism. The results of this study showed that: Different types of farmers' rural settlement integration aspiration have significant differences, generally the order of 5 types of farmers' rural settlement integration as piration strength is: non-agricultural specialization development type (72.82%)>non-agricultural diversification farmer type(49.66%)>part-time development type(44.44%)>agricultural specialization type(36.84%)>agricultur-al diversification development type (37.33%); Farmers' rural settlement integration aspiration is the driving as ymptotic outcome of the push-pull power from farmers' economy, living environment, social interaction and policy factors, it embodies the result of game between farmers' endogenous power and external environment; The farmers' future livelihood source and income changes, living conditions, neighborhood relations, perception of social status are the important driving mechanism of forming farmers' rural settlement integration aspiration

  16. Application of CASS Process in Sewage Treatment Plant%CASS工艺在生活污水处理厂中的应用

    Institute of Scientific and Technical Information of China (English)

    段果

    2012-01-01

    In some sewage treatment plants,CASS Process is adopted,the main characteristics of which is high-efficiency,stability and Simple process.The CASS Process has the removal function of organic pollutants in the sewage,at the same time with nitrogen and phosphorus.Sewage treatment plant using CASS Process has so high automation level that can greatly reduce the cost of wastewater treatment plant of operation.The paper states the key design point of the main processing structures in the sewage treatment plant using CASS Process on a concrete usage.%在某些生活污水处理厂中采用CASS工艺,其主要特点是高效、稳定、工艺流程简单,并且在去除污水中有机污染物的同时,具有脱氮除磷的功能。CASS工艺的污水处理厂具有较高的自动化水平,可大大降低污水厂的运行成本。文章结合具体事例,介绍CASS工艺污水处理厂主要处理构筑物的设计要点。

  17. The role of patient's profile and allogeneic blood transfusion in development of post-cardiac surgery infections: a retrospective study

    NARCIS (Netherlands)

    Vranken, N.P.; Weerwind, P.W.; Barenbrug, P.J.; Teerenstra, S.; Ganushchak, Y.M.; Maessen, J.G.

    2014-01-01

    OBJECTIVES: We aimed to investigate the association of patient characteristics and allogeneic blood transfusion products in development of post-cardiac surgery nosocomial infections. METHODS: This retrospective study was conducted in 7888 patients undergoing cardiac surgery with median sternotomy an

  18. [Comparative study of two protocols of antibiotic prophylaxis in endoscopic urologic surgery].

    Science.gov (United States)

    Lepage, J Y; Malinowsky, J M; Cozian, A; Viers, M F; Rolland, M T; Péron, M; Souron, R; Baron, D

    1990-06-01

    We report an open, prospective, randomized and double-blind study which compared two groups of patients without preoperative bacteriuria, undergoing transurethral urologic surgery. A first group received cefazoline 3 g perioperatively and a second group a single preoperative dose of cefotiam 1 g. A hundred patients were included in each group which were well matched on all essential characteristics, risk factors, surgery, anesthesia and postoperative temperature. The incidence of postoperative infection (bacteriemia and bacteriuria) was the same in both groups (16%). It is concluded that in transurethral urologic surgery performed in patients without preoperative bacteriuria, 1 preoperative dose cefotiam is as efficacious as 3 perioperative doses cefazoline.

  19. Relationships between study habits, burnout, and general surgery resident performance on the American Board of Surgery In-Training Examination.

    Science.gov (United States)

    Smeds, Matthew R; Thrush, Carol R; McDaniel, Faith K; Gill, Roop; Kimbrough, Mary K; Shames, Brian D; Sussman, Jeffrey J; Galante, Joseph M; Wittgen, Catherine M; Ansari, Parswa; Allen, Steven R; Nussbaum, Michael S; Hess, Donald T; Knight, David C; Bentley, Frederick R

    2017-09-01

    The American Board of Surgery In-Training Examination (ABSITE) is used by programs to evaluate the knowledge and readiness of trainees to sit for the general surgery qualifying examination. It is often used as a tool for resident promotion and may be used by fellowship programs to evaluate candidates. Burnout has been associated with job performance and satisfaction; however, its presence and effects on surgical trainees' performance are not well studied. We sought to understand factors including burnout and study habits that may contribute to performance on the ABSITE examination. Anonymous electronic surveys were distributed to all residents at 10 surgical residency programs (n = 326). Questions included demographics as well as study habits, career interests, residency characteristics, and burnout scores using the Oldenburg Burnout Inventory, which assesses burnout because of both exhaustion and disengagement. These surveys were then linked to the individual's 2016 ABSITE and United States Medical Licensing Examination (USMLE) step 1 and 2 scores provided by the programs to determine factors associated with successful ABSITE performance. In total, 48% (n = 157) of the residents completed the survey. Of those completing the survey, 48 (31%) scored in the highest ABSITE quartile (≥75th percentile) and 109 (69%) scored less than the 75th percentile. In univariate analyses, those in the highest ABSITE quartile had significantly higher USMLE step 1 and step 2 scores (P burnout scores (disengagement, P Burnout Inventory exhaustion (P = 0.02), and USMLE step 1 and 2 scores (P = 0.007 and 0.0001, respectively). Residents who perform higher on the ABSITE have a regular study schedule throughout the year, report less burnout because of exhaustion, study away from home, and have shown success in prior standardized tests. Further study is needed to determine the effects of burnout on clinical duties, career advancement, and satisfaction. Copyright © 2017

  20. Oncologic Safety of Robot Thyroid Surgery for Papillary Thyroid Carcinoma: A Comparative Study of Robot versus Open Thyroid Surgery Using Inverse Probability of Treatment Weighting.

    Science.gov (United States)

    Sung, Tae-Yon; Yoon, Jong Ho; Han, Minkyu; Lee, Yi Ho; Lee, Yu-Mi; Song, Dong Eun; Chung, Ki-Wook; Kim, Won Bae; Shong, Young Kee; Hong, Suck Joon

    2016-01-01

    The aim of this study was to evaluate the oncologic safety of robot thyroid surgery compared to open thyroid surgery for papillary thyroid carcinoma (PTC). We enrolled 722 patients with PTC who underwent a total thyroidectomy with central compartment node dissection (CCND) from January 2009 to December 2010. These patients were classified into open thyroid surgery (n = 610) or robot thyroid surgery (n = 112) groups. We verified the impact of robot thyroid surgery on clinical recurrence and ablation/control-stimulated thyroglobulin (sTg) levels predictive of non-recurrence using weighted logistic regression models with inverse probability of treatment weighting (IPTW). Age, sex, thyroid weight, extent of CCND, and TNM were significantly different between the two groups (p robot groups (1.5% vs. 2.7%; p = 0.608). The proportion of patients with ablation sTg 0.05). Logistic regression with IPTW using the propensity scores estimated by adjusting all of the parameters demonstrated that robot thyroid surgery did not influence the clinical recurrence (OR; 0.784, 95% CI; 0.150-3.403, p = 0.750), ablation sTg (OR; 0.950, 95% CI; 0.361-2.399, p = 0.914), and control sTg levels (OR; 0.498, 95% CI; 0.190-1.189, p = 0.130). Robot thyroid surgery is comparable to open thyroid surgery with regard to oncologic safety in PTC patients.

  1. The Zelnorm epidemiologic study (ZEST: a cohort study evaluating incidence of abdominal and pelvic surgery related to tegaserod treatment

    Directory of Open Access Journals (Sweden)

    Seeger John D

    2012-11-01

    Full Text Available Abstract Background Pre-marketing clinical studies of tegaserod suggested an increased risk of abdominal surgery, particularly cholecystectomy. We sought to quantify the association between tegaserod use and the occurrence of abdominal or pelvic surgery, including cholecystectomy. Methods This cohort study was conducted within an insured population. Tegaserod initiators and similar persons who did not initiate tegaserod were followed for up to six months for the occurrence of abdominal or pelvic surgery. Surgical procedures were identified from health insurance claims validated by review of medical records. The incidence of confirmed outcomes was compared using both as-matched and as-treated analyses. Results Among 2,762 tegaserod initiators, there were 94 abdominal or pelvic surgeries (36 gallbladder: among 2,762 comparators there were 134 abdominal or pelvic surgeries (37 gallbladder (hazard ratio HR] = 0.70, 95% confidence interval [C.I.] = 0.54-0.91 overall, HR = 0.98, 95% C.I. = 0.62-1.55 for gallbladder. Current tegaserod exposure compared to nonexposure was associated with a rate ratio [RR] of 0.68 (95% C.I. = 0.48-0.95 overall, while the RR was 0.99 (95% C.I. = 0.56-1.77 for gallbladder surgery. Conclusions In this study, tegaserod use was not found to increase the risk of abdominal or pelvic surgery nor the specific subset of gallbladder surgery.

  2. Software project profitability analysis using temporal probabilistic reasoning; an empirical study with the CASSE framework

    CSIR Research Space (South Africa)

    Balikuddembe, JK

    2009-04-01

    Full Text Available Undertaking adequate risk management by understanding project requirements and ensuring that viable estimates are made on software projects require extensive application and sophisticated techniques of analysis and interpretation. Informative...

  3. The impact of pelvic floor surgery on female sexual function: a mixed quantitative and qualitative study.

    Science.gov (United States)

    Roos, A M; Thakar, R; Sultan, A H; de Leeuw, J W; Paulus, A T G

    2014-01-01

    To assess whether the current condition-specific sexual function questionnaire provides full insight into sexual function following pelvic floor surgery. Prospective, mixed quantitative and qualitative study. Urogynaecology clinic in a large university hospital. Thirty-seven women undergoing surgery for pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI). Women were seen before surgery and 3 months postoperatively. At both visits the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ) was completed and a qualitative face-to-face semi-structured interview was conducted. PISQ total and domain scores, as well as the change in the preoperative and postoperative score, were calculated and analysed using Wilcoxon signed rank test and one-sample t-test. The qualitative data were systematically analysed using data-matrices. The impact of pelvic floor surgery on female sexual function. Significant improvement was seen for PISQ total score (P = 0.003) as well as Physical (P qualitative data showed that improvement in sexual function was a result of cure of POP and SUI symptoms. Deterioration of sexual function was due to dyspareunia, fear of causing damage to the surgical result, new symptoms and a disappointing result of surgery. Our qualitative data show that PISQ is limited in the assessment of sexual function after pelvic floor surgery as it does not assess most surgery-specific negative effects on sexual function. © 2013 Royal College of Obstetricians and Gynaecologists.

  4. Comparison of combined and sequential surgery for proliferative diabetic retinopathy: a single surgeon study.

    Directory of Open Access Journals (Sweden)

    Ye Yang

    Full Text Available PURPOSE: To compare the results of combined and consecutive surgeries to treat proliferative diabetic retinopathy and cataract. METHODS: Retrospective comparative study. Forty-one patients with proliferative diabetic retinopathy (PDR were enrolled. Twenty-nine eyes for the combined surgery group and twelve eyes for the sequential group were included. All surgeries were performed by one surgeon. Phacoemulsification was performed using a clear cornea incision. The vitrectomy was performed using a 20-gauge vitreous cutter. RESULTS: The best corrected visual acuity (BCVA and intra- and post-operative complications were the main outcome measures. In the combined surgery group, the BCVA increased in 18 (62.1% eyes, while eight (27.6% eyes remained stable and three (10.3% eyes decreased. Postoperative complications included fibrinous exudation in nine eyes, macular edema in three eyes and vitreous hemorrhage in three eyes. In the sequential surgery group, the BCVA increased in seven (58.3% eyes, remained the same in four (33.3% eyes and was reduced in one (8.3% eye. Postoperative complications included macular edema in two eyes, neovascular glaucoma in two eyes and vitreous hemorrhage in one eye. CONCLUSIONS: Both combined and sequential surgeries are safe and effective for treating PDR and cataracts. The combined surgery had a higher incidence of fibrinous exudation.

  5. Perioperative Outcome of Adolescents Undergoing Bariatric Surgery: The Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study

    Science.gov (United States)

    Inge, T.H.; Zeller, M.H.; Jenkins, T.M.; Helmrath, M.; Brandt, M.L.; Michalsky, M.P.; Harmon, C.M.; Courcoulas, A.; Horlick, M.; Xanthakos, S.A.; Dolan, L.; Mitsnefes, M.; Barnett, S.J.; Buncher, C.R.

    2014-01-01

    Importance Severe obesity in childhood is a major health problem with few effective treatments. Weight loss surgery (WLS) is being used to treat severely obese adolescents, although with very limited data regarding surgical safety for currently used, minimally-invasive procedures. Objective To assess preoperative clinical characteristics perioperative safety outcomes of severely obese adolescents undergoing WLS. Design This prospective, multi-site observational study enrolled from 2007 through 2012. Setting This study was conducted at 5 academic referral centers in the U.S Participants Consecutive subjects ≤ age 19 years who were approved to undergo (n=277) were offered enrollment into the study; 13 declined participation and 22 did not undergo surgery after enrollment thus the final analysis cohort consisted of 242 individuals. There were no withdrawals. Main Outcomes & Measures This analysis examined preoperative anthropometrics, comorbid conditions, and major and minor complications occurring within 30 days of operation. All data were collected in a standardized fashion. Re-operations and hospital re-admissions were adjudicated by independent reviewers to assess relatedness to the WLS procedure. Results Mean age of participants was 17.1±1.6 years and the median BMI was 50.5 kg/m2. Fifty-one percent demonstrated four or more major co-morbid conditions. Laparoscopic Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and adjustable gastric banding were performed in 66%, 28%, and 6% of subjects, respectively. There were no deaths during the initial hospitalization or within 30 days of operation; major complications (eg., reoperation) were seen in 19 subjects (8%). Minor complications (eg., readmission for dehydration) were noted in 36 subjects (15%). All re-operations and 85% of re-admissions were related to WLS. Conclusions & Relevance In this series, adolescents with severe obesity presented with abundant comorbid conditions. We observed a favorable short

  6. Hyperbilirubinemia after extracorporeal circulation surgery: A recent and prospective study

    Institute of Scientific and Technical Information of China (English)

    Yong An; Ying-Bin Xiao; Qian-Jin Zhong

    2006-01-01

    AIM: To clarify the incidence and nature of postoperative hyperbilirubinemia in patients after modern extracorporeal circulation, to analyze possible perioperative risk factors, and to elucidate the clinical significance of postoperative hyperbilirubinemia associated morality and morbidity.METHODS: Between March 2005 and May 2006, three hundred and eighty six consecutive patients undergoing extracorporeal circulation surgery due to a variety of cardiac lesions were investigated prospectively. The incidence of postoperative hyperbilirubinemia was defined as a serum total bilirubin concentration of more than 51 μmol/L. Several perioperative parameters were compared by logistic regression between hyperbilirubinemia and non-hyperbilirubinemia patients to determine possible risk factors contributing to postoperative hyperbilirubinemia and mortality.RESULTS: Overall incidence of postoperative hyperbilirubinemia was 25.3% (98/386). In patients with postoperative hyperbilirubinemia, 56.2%reached peak total bilirubin concentration on the first postoperative day, 33.5% on the second day, and 10.3%on the seventh day. Eighty percent of the increase of total bilirubin resulted from an increase of both conjugated and unconjugated bilirubin. Development of postoperative hyperbilirubinemia was associated with a higher mortality (P < 0.01), longer duration of mechanical ventilation (P < 0.05) and longer ICU stay time (P < 0.05). Preoperative total bilirubin concentration, preoperative right atrium pressure,numbers of valves replaced and of blood transfusion requirement were identified as important predictors for postoperative hyperbilirubinemia.CONCLUSION: Early postoperative hyperbilirubinemia after modern extracorporeal circulation is mainly caused by an increase in both conjugated and unconjugated bilirubin, and is associated with a high mortality.Important contributing factors are the preoperative total bilirubin concentration, preoperative severity of right atrial

  7. [Risk of laparoscopic surgery. 100 records of complications. A qualitative study].

    Science.gov (United States)

    Hureau, J; Vayre, P; Chapuis, Y; Germain, M A; Jost, J L; Murat, J; Spay, G

    1996-01-01

    A total of 100 accidents occurring during laparoscopic surgery between 1969 and 1993 were studied. Fifty-five of the cases concerned gynaecology surgery over a 24 year period. The other 45 concerned digestive surgery over a 5 year period (1989-1993). The surgical risk was not statistically greater compared with open surgery. Overall morbidity was 1%. Overall mortality was 0.5/1000. A more precise statistical analysis was recently reported. The examination of the 100 cases was qualitative rather than quantitative. The study demonstrated an imbalance between age (mean age 38 years) in patients with major pathology initially and the gravity of the induced accidents: 26 deaths for 100 observations. These deaths were related to technology trocar, capnoperitoneum, electrocoagulation. Technical skill, cautiousness, vigilance and humility are qualities the surgeon must have to perform successful operations. The irreversible acceleration of the new surgical technique should not cloud the basic precepts of sound surgical technique.

  8. A Comparative Study of Single-Port Laparoscopic Surgery Versus Robotic-Assisted Laparoscopic Surgery for Rectal Cancer

    DEFF Research Database (Denmark)

    Levic, Katarina; Donatsky, Anders Meller; Bulut, Orhan

    2015-01-01

    INTRODUCTION: Conventional laparoscopic surgery is the treatment of choice for many abdominal procedures. To further reduce surgical trauma, new minimal invasive procedures such as single-port laparoscopic surgery (SPLS) and robotic assisted laparoscopic surgery (RALS) have emerged. The aim...... in either of the groups. There was no difference in median follow-up time between groups (P = .58). CONCLUSION: Both SPLS and RALS may have a role in rectal surgery. The short-term oncological outcomes were similar, although RALS harvested more lymph nodes than the SPLS procedure. However, SPLS seems...

  9. Urogenital function in robotic vs laparoscopic rectal cancer surgery: a comparative study

    OpenAIRE

    Panteleimonitis, Sofoklis; Ahmed, Jamil; Ramachandra, Meghana; Farooq, Muhammad; Harper, Mick; Parvaiz, Amjad

    2016-01-01

    Purpose - Urological and sexual dysfunction are recognised risks of rectal cancer surgery; however, there is limited evidence regarding urogenital function comparing robotic to laparoscopic techniques. The aim of this study was to assess the urogenital functional outcomes of patients undergoing laparoscopic and robotic rectal cancer surgery. Methods - Urological and sexual functions were assessed using gender-specific validated standardised questionnaires. Questionnaires were sent a minimum o...

  10. CASS工艺在生活污水处理厂的应用%CASS Process in Sewage Treatment Plant

    Institute of Scientific and Technical Information of China (English)

    陈智根

    2016-01-01

    Currently,the environmental pollution problems more attention by the general public,not only the impact of pollutants on people’s health,to a certain extent also hinder the current economic development.The current water resources in China is very tight, the production of various types of industrial waste is released upon contact with water,it is bound to affect people’s health and daily water poses a great threat.The CASS process in sewage treatment plants can play a significant role,and can meet the needs of China’s relevant environmental management.Therefore,the CASS process was simple complaint,and discuss its application in sewage treatment plants.%目前,环境污染问题越发受到大众的关注,污染物不仅对人们的健康带来影响,一定程度上还会阻碍当前的经济发展。当前我国水资源十分紧张,各类工业生产释放的废弃物一旦接触水源,势必会对人们的健康以及日常用水造成巨大威胁。而CASS工艺在生活污水处理厂中能起到显著的作用,并能满足我国相关环境管理的需求。因此,对CASS工艺进行简诉,并对其在生活污水处理厂中的应用进行探讨。

  11. The SESAME/CASSE instrument listening to the MUPUS PEN insertion phase on comet 67P/Churyumov-Gerasimenko

    Science.gov (United States)

    Knapmeyer, M.; Fischer, H.-H.; Knollenberg, J.; Seidensticker, K. J.; Thiel, K.; Arnold, W.; Schmidt, W.; Faber, C.; Finke, F.; Möhlmann, D.

    2016-08-01

    After the final landing of Philae at the Abydos site on comet 67/P Churyumov-Gerasimenko, the MUPUS (Multipurpose Sensors for Surface and Sub-Surface Science) device started hammering itself into the cometary ground on 14th November 2014, and continued hammering for more than 3 h. During this period, the CASSE (Comet Acoustic Surface Sounding Experiment) instrument, part of SESAME (Surface Electric Sounding and Acoustic Monitoring Experiment), was listening to the hammer strokes of MUPUS, which was the strongest available source for a seismic-acoustic experiment to determine mechanical properties of the ground. All sensors survived the multiple touchdowns of Philae undamaged and provided recordings of 14 hammer strokes at audible frequencies. The data suggests that Philae was slightly rocking or swinging during the initial phase of the experiment, finally finding an attitude that not only stopped this motion but also improved the coupling of sensors to the ground and thus the recordings. The experiment provides several lessons that might be useful for the development of similar experiments on future spacecraft. The most serious issues concerning the CASSE recordings are clock accuracy and synchronicity and the timing of the source. Future designs may want to consider additional sensors in close proximity to the source, and direct communication between experiments to overcome this. The present design allows the evaluation of arrival time differences only, rather than absolute travel times. In this contribution, we focus on the technical and operational aspects of this experiment. A scientific evaluation of the data received will follow in a second paper.

  12. Weight regain among women after metabolic and bariatric surgery: a qualitative study in Brazil

    Directory of Open Access Journals (Sweden)

    Ataliba de Carvalho Jr.

    2014-09-01

    Full Text Available INTRODUCTION: Due to the increased number of bariatric surgeries over the years, aspects contributing or hindering the achievement of outcomes, among them weight regain, have acquired increased significance. Psychological factors directly influence on this unwanted situation, but there are few studies and controversies about the degree of participation of these factors. We propose a qualitative investigation to analyze the meanings of weight regain after surgery among women and how these factors influence this outcome.METHOD: This study uses the clinical-qualitative method, by means of a semi-structured interview with open questions in an intentional sample, closed by saturation, with eight women who underwent surgery at the Bariatric Surgery Outpatient Clinic of Hospital das Clínicas, Universidade Estadual de Campinas (UNICAMP, in the state of São Paulo, Brazil.RESULTS: A feeling of defeat and failure emerges with weight regain, which contributes to social isolation; there is no regret, but gratitude for the surgery; among patients, there is a sense of feeling rejected greater than a rejection that actually exists.CONCLUSION: We found out the need for further qualitative studies that help the health team to better understand the dynamic psychological factors involved in the meaning of weight regain after bariatric surgery among women, in order to adopt appropriate conducts to deal with this problem.

  13. Perioperative Nurses' Work Experience With Robotic Surgery: A Focus Group Study.

    Science.gov (United States)

    Kang, Min Jung; De Gagne, Jennie C; Kang, Hee Sun

    2016-04-01

    The aim of this study was to explore the work experience of perioperative nurses involved in robotic surgery. A qualitative descriptive study was conducted. Participants were 15 nurses who had been on a robotic surgery team at one of five major university hospitals in Seoul, South Korea. Participants were one male and 14 female nurses (mean age, 31.33 [SD, 4.19] years; range, 25-41 years). Their experience as robotic surgery nurses ranged from 8 months to 6 years. Nurses' experiences with robotic surgery were categorized within four main themes: (1) constant checking on patients' safety and the robot's functions; (2) unexpected robotic machine errors or malfunctions; (3) feelings of burden in a robotic surgical team; and (4) need and desire for more information and education. This study showed that there are common concerns about patient safety and the possibility of emergencies related to robot system failure among nurses. Offering more support for nurses involved in robotic surgery should be a priority to empower them to play an extended role in robotic surgery.

  14. Organizational Factors and Long-Term Mortality after Hip Fracture Surgery. A Cohort Study of 6143 Consecutive Patients Undergoing Hip Fracture Surgery

    DEFF Research Database (Denmark)

    Lund, Caterina A; Møller, Ann M; Wetterslev, Jørn

    2014-01-01

    OBJECTIVE: In hospital and health care organizational factors may be changed to reduce postoperative mortality. The aim of this study is to evaluate a possible association between mortality and 'length of hospital stay', 'priority of surgery', 'time of surgery', or 'surgical delay' in hip fracture......, anaesthetic and surgical procedures were retrieved. PARTICIPANTS: 6143 patients aged more than 65 years undergoing hip fracture surgery. MAIN OUTCOME MEASURES: All-cause mortality. RESULTS: The one year mortality was 30% (28-31%, 95% Confidence interval (CI)). In a multivariate model 'length of hospital stay...

  15. Occurrence of trigeminocardiac reflex during dental implant surgery: An observational prospective study.

    Science.gov (United States)

    Huang, James I-Sheng; Yu, Hui-Chieh; Chang, Yu-Chao

    2017-10-01

    Trigeminocardiac reflex (TCR) is a clinical phenomenon that manifests as s sudden onset of hemodynamic perturbations. TCR has been reported in cranio-maxillofacial surgery resulting in severe medical risks. Monitoring the hemodynamic changes during cranio-maxillofacial surgery can provide important information to ensure the continuous evaluation of patient's physical conditions. This prospective observational study was conducted to determine the hemodynamic alterations related to the possibly of occurrence of TCR in patients during dental implant surgery. One hundred and thirty-five patients (69 males and 66 females) received dental implant placement were enrolled in this study. The hemodynamic changes were evaluated by monitoring heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse oximetry (SpO2). The above data were collected before, during, and after dental implant surgery. The data demonstrated that the minimal values of HR, SBP, and DBP as well as MABP decreased significantly during operation comparing with the corresponding values before operation (p implant placement in the mandible, patients received dental implant placement in the maxilla had more risks to confront with MABP reduction (OR = 3.98; 95% confidence interval: 1.12-13.2). A significant HR and BP reduction possibly due to TCR can occur during dental implant surgery. Therefore, the dentists should monitor the hemodynamic changes during dental implant surgery to prevent the possible occurrence of medical risks related to TCR. Copyright © 2017. Published by Elsevier B.V.

  16. Urogenital function in robotic vs laparoscopic rectal cancer surgery: a comparative study.

    Science.gov (United States)

    Panteleimonitis, Sofoklis; Ahmed, Jamil; Ramachandra, Meghana; Farooq, Muhammad; Harper, Mick; Parvaiz, Amjad

    2017-02-01

    Urological and sexual dysfunction are recognised risks of rectal cancer surgery; however, there is limited evidence regarding urogenital function comparing robotic to laparoscopic techniques. The aim of this study was to assess the urogenital functional outcomes of patients undergoing laparoscopic and robotic rectal cancer surgery. Urological and sexual functions were assessed using gender-specific validated standardised questionnaires. Questionnaires were sent a minimum of 6 months after surgery, and patients were asked to report their urogenital function pre- and post-operatively, allowing changes in urogenital function to be identified. Questionnaires were sent to 158 patients (89 laparoscopy, 69 robotic) of whom 126 (80 %) responded. Seventy-eight (49 male, 29 female) of the responders underwent laparoscopic and 48 (35 male, 13 female) robotic surgery. Male patients in the robotic group deteriorated less across all components of sexual function and in five components of urological function. Composite male urological and sexual function score changes from baseline were better in the robotic cohort (p function. However, composite female urological function score change from baseline was better in the robotic group (p = 0.003). Robotic rectal cancer surgery might offer better post-operative urological and sexual outcomes compared to laparoscopic surgery in male patients and better urological outcomes in females. Larger scale, prospective randomised control studies including urodynamic assessment of urogenital function are required to validate these results.

  17. Pregnancy and foetal outcome after bariatric surgery: a review of recent studies.

    Science.gov (United States)

    Dalfrà, Maria Grazia; Busetto, Luca; Chilelli, Nino Cristiano; Lapolla, Annunziata

    2012-09-01

    It is well known that maternal obesity has adverse effects on the health of offspring, causing immediate and long-term morbidities. The various types of procedure coming under the heading of bariatric surgery have proved effective in preventing some maternal and foetal complications in morbidly obese pregnant women. This review aims to assess the role, the risks and the benefits of bariatric surgery for mothers and offspring. According to recent findings, pregnancy and neonatal outcomes in morbidly obese women who have undergone bariatric surgery depend to some extent on the type of surgery used. Maternal complications, nutritional defects and intestinal obstruction are more frequently reported after Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) than after laparoscopic adjustable gastric banding (LAGB) procedures, whereas caesarean section, preterm delivery and neonatal death are more commonly reported after RYGB than after LAGB. The authors of the only long-term follow-up study conducted on this subject reported that the rate of obesity in the children dropped by 52% after bariatric surgery for the mother, and the cases of severe obesity decreased by 45%. Data on pregnancy and bariatric surgery confirm that the procedure is more effective than dietary measures alone in morbidly obese women, and that pregnancy outcome is generally favorable after surgery. Some studies have indicated, nonetheless, that pregnancies after bariatric surgery are at higher risk: the women affected require special medical attention, particularly as concerns gastrointestinal symptoms and vitamin deficiencies, warranting nutritional/dietary counselling by a multidisciplinary team before, during and after pregnancy.

  18. Implementation of the Spanish National Enhanced Recovery Program (ERAS) in Bariatric Surgery: A Pilot Study.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Royo, Pablo; Muñoz, José L; Duran, Manuel; Redondo, Elisabeth; Ramirez, Jose M

    2016-12-01

    The essence of Enhanced Recovery After Surgery (ERAS) programs is the multimodal approach, and many authors have demonstrated safety and feasibility in fast track bariatric surgery. According to this concept, a multidisciplinary ERAS program for bariatric surgery has been developed by the Spanish fast track group (ERAS Spain). The aim of this study was to analyze the initial implementation of this Spanish National ERAS protocol in bariatric surgery. A multicentric prospective pilot study was performed, including 125 consecutive patients undergoing bariatric surgery at 3 Spanish hospitals between January and June 2015, after the Spanish National ERAS protocol in bariatric surgery. Compliance with the protocol, morbidity, mortality, hospital stay, and readmission were evaluated. Bariatric techniques performed included 68 Roux-en-Y gastric bypass (54.4%) and 57 laparoscopic sleeve gastrectomy (45.6%) cases. All surgeries were laparoscopically performed with conversion in only 1 case (0.8%). Median postoperative pain evaluated by visual analogic scale 24 hours after surgery was 2 (range, 0 to 5). Postoperative nausea or vomiting appeared in 7 patients (5.6%). Complications appeared in 6 patients (4.8%). The reoperation rate was 4%. The mortality rate was 0.8%. The median hospital stay was 2 days (range, 2 to 10 d) and readmission rate was 2.4%. The compliance of all the items of the protocol was achieved in 78.4% of the patients. The Spanish National ERAS protocol is a safe issue with a high implementation rate. It can be recommended to establish this protocol to other institutions.

  19. Comparison of clinical outcome of periapical surgery in endodontic and oral surgery units of a teaching dental hospital: a retrospective study.

    Science.gov (United States)

    Rahbaran, S; Gilthorpe, M S; Harrison, S D; Gulabivala, K

    2001-06-01

    The aims of this retrospective study were (1) to compare the outcome of periapical surgery performed in endodontic and in oral surgery units of a teaching dental hospital and (2) to evaluate the influence of factors affecting outcome. A total of 176 teeth (endodontic unit, 83; oral surgery unit, 93) surgically treated more than 4 years previously were examined clinically and radiographically by means of strict criteria. Multiple logistic regression analysis was used. The rate of complete healing for patients treated in the endodontic unit (37.4%) was significantly (P = .009) higher than that for patients treated in the oral surgery unit (19.4%). The technical quality of surgery (P < .001), placement of root-end filling (P = .039), absence of a preoperative periapical lesion (P = .042), absence of a post (P = .047), and presence of an adequate coronal restoration (P = .056, odds ratio = 3.71) had significant effects on treatment outcome. The technical quality of periapical surgery, the presence of a periapical lesion, and adequate apical and coronal seal are important prognostic determinants of successful periapical surgery.

  20. Complications of epilepsy surgery in Sweden 1996-2010: a prospective, population-based study.

    Science.gov (United States)

    Bjellvi, Johan; Flink, Roland; Rydenhag, Bertil; Malmgren, Kristina

    2015-03-01

    Detailed risk information is essential for presurgical patient counseling and surgical quality assessments in epilepsy surgery. This study was conducted to investigate major and minor complications related to epilepsy surgery in a large, prospective series. The Swedish National Epilepsy Surgery Register provides extensive population-based data on all patients who were surgically treated in Sweden since 1990. The authors have analyzed complication data for therapeutic epilepsy surgery procedures performed between 1996 and 2010. Complications are classified as major (affecting daily life and lasting longer than 3 months) or minor (resolving within 3 months). A total of 865 therapeutic epilepsy surgery procedures were performed between 1996 and 2010, of which 158 were reoperations. There were no postoperative deaths. Major complications occurred in 26 procedures (3%), and minor complications in 65 (7.5%). In temporal lobe resections (n = 523), there were 15 major (2.9%) and 41 minor complications (7.8%); in extratemporal resections (n = 275) there were 9 major (3.3%) and 22 minor complications (8%); and in nonresective procedures (n = 67) there were 2 major (3%) and 2 minor complications (3%). The risk for any complication increased significantly with age (OR 1.26 per 10-year interval, 95% CI 1.09-1.45). Compared with previously published results from the same register, there is a trend toward lower complication rates, especially in patients older than 50 years. This is the largest reported prospective series of complication data in epilepsy surgery. The complication rates comply well with published results from larger single centers, confirming that epilepsy surgery performed in the 6 Swedish centers is safe. Patient age should be taken into account when counseling patients before surgery.

  1. Incidence of myofascial pain syndrome in breast cancer surgery: a prospective study.

    Science.gov (United States)

    Torres Lacomba, María; Mayoral del Moral, Orlando; Coperias Zazo, José Luís; Gerwin, Robert D; Goñí, Alvaro Zapico

    2010-05-01

    Pain after breast cancer therapy is a recognized complication found to have an adverse impact on patient's quality of life, increasing psychosocial distress. In recent years, case reports about myofascial pain syndrome are emerging in thoracic surgery as a cause of postsurgery pain. Myofascial pain syndrome is a regional pain syndrome characterized by myofascial trigger points in palpable taut bands of skeletal muscle that refers pain a distance, and that can cause distant motor and autonomic effects. The objective of this study was to assess the incidence of myofascial pain syndrome prospectively 12 months after breast cancer surgery. Each participant was assessed preoperatively, postoperatively between day 3 and day 5, and at 1, 3, 6, and 12 months after surgery. A physical therapist, expert in the diagnosis of myofascial pain syndrome, performed follow-up assessments. Pain descriptions by the patients and pain pattern drawings in body forms guided the physical examination. The patients were not given any information concerning myofascial pain or other muscle pain syndromes. One year follow-up was completed by 116 women. Of these, 52 women developed myofascial pain syndrome (44.8%, 95% confidence interval: 35.6, 54.3). Myofascial pain syndrome is a common source of pain in women undergoing breast cancer surgery that includes axillary lymph node dissection at least during the first year after surgery. Myofascial pain syndrome is one potential cause of chronic pain in breast cancer survivors who have undergone this kind of surgery.

  2. Topical diclofenac patch for postoperative wound pain in laparoscopic gynecologic surgery: a randomized study.

    Science.gov (United States)

    Alessandri, Franco; Lijoi, Davide; Mistrangelo, Emanuela; Nicoletti, Annamaria; Crosa, Marco; Ragni, Nicola

    2006-01-01

    To compare pain management of standard analgesic and standard analgesic plus diclofenac transdermal patch in patients who undergo laparoscopic gynecologic surgery. Randomized prospective study (Canadian Task Force classification I). University hospital. One hundred twenty patients requiring laparoscopic surgery for gynecologic benign diseases. Patients were divided into two groups, one medicated with a diclofenac patch (diclofenac group) and the other medicated with standard skin medication (placebo; control group) at all incisional areas at the end of the operation. The principal measures of outcome were pain intensity at 6, 12, and 24 hours after surgery and consumption of analgesics. The two treatment groups were comparable with respect to demographic and intraoperative characteristics. No significant difference was observed between the two groups in mean pain intensity at 6 hours after surgery. Mean pain intensity at 12 and 24 hours, respectively, after surgery was significantly lower in the diclofenac group (3.7 +/- 1.3 and 2.0 +/- 0.6) than that observed in the control group (5.7 +/- 1.9 and 4.6 +/- 0.5) (p value, respectively, .002 and diclofenac group required analgesics in the first 36 hours after the operation versus 43 patients (71.7%) in the control group (p diclofenac group (28 +/- 5 hours vs 39 +/- 3 hours; p = .031). Diclofenac transdermal administration seems a valid help to standard analgesic treatment in postoperative pain control and could also help reduce the period of hospitalization of patients who undergo laparoscopic benign gynecologic surgery. Copyright 2006 AAGL

  3. The influence of general anesthesia and surgery on cognition in old age: A twin study

    DEFF Research Database (Denmark)

    Dokkedal, Unni; Hansen, Tom G.; Rasmussen, Lars S;

    Introduction: There is a pronounced variation in level of cognitive function and rate of cognitive decline in late life. Results from smaller human and animal studies suggest that exposure to anesthesia may be a risk factor for cognitive impairment. Using a twin design, the objective of the present...... study was to examine whether exposure to anesthesia and surgery is associated with level of cognitive function in middle and old age. Materials and Methods: The study is based on two population-based surveys comprising 8,503 Danish twins aged 45–102 years at study intake during 1995–2001. Through...... linkage to the Danish National Patient Register, we obtained information on surgeries performed in hospitals in Denmark from 1977 and until study intake. Four exposure groups were defined based on type of surgery (major, minor, knee and hip replacement, other). A cognitive test battery consisting of five...

  4. Music intervention study in abdominal surgery patients: challenges of an intervention study in clinical practice.

    Science.gov (United States)

    Vaajoki, Anne; Pietilä, Anna-Maija; Kankkunen, Päivi; Vehviläinen-Julkunen, Katri

    2013-04-01

    Evidence-based nursing requires carefully designed interventions. This paper discusses methodological issues and explores practical solutions in the use of music intervention in pain management among adults after major abdominal surgery. There is a need to study nursing interventions that develop and test the effects of interventions to advanced clinical nursing knowledge and practice. There are challenges in carrying out intervention studies in clinical settings because of several interacting components and the length and complexity of the causal chains linking intervention with outcome. Intervention study is time-consuming and requires both researchers and participants' commitment to the study. Interdisciplinary and multiprofessional collaboration is also paramount. In this study, patients were allocated into the music group, in which patients listened to music 30 minutes at a time, or the control group, in which patients did not listen to any music during the same period.

  5. Quality of life among patients undergoing bariatric surgery: associations with mental health- A 1 year follow-up study of bariatric surgery patients

    Directory of Open Access Journals (Sweden)

    Stubhaug Bjarte

    2011-09-01

    Full Text Available Abstract Background Preoperative mental health seems to have useful predictive value for Health Related Quality of Life (HRQOL after bariatric surgery. The aim of the present study was to assess pre- and postoperative psychiatric disorders and their associations with pre- and postoperative HRQOL. Method Data were assessed before (n = 127 and one year after surgery (n = 87. Psychiatric disorders were assessed by Mini International Neuropsychiatric Interview (M.I.N.I. and Structured Clinical Interview (SCID-II. HRQOL was assessed by the Short Form 36 (SF-36 questionnaire. Results Significant improvements were found in HRQOL from preoperative assessment to follow-up one year after surgery. For the total study population, the degree of improvement was statistically significant (p values Conclusion This study reports the novel finding that patients without postoperative psychiatric disorders achieved a HRQOL comparable to the general population one year after bariatric surgery; while patients with postoperative psychiatric disorders did not reach the HRQOL level of the general population. Our results support monitoring patients with psychiatric disorders persisting after surgery for suboptimal improvements in quality of life after bariatric surgery. Trial Registration The trial is registered at http://www.clinicaltrials.gov prior to patient inclusion (ProtocolID16280.

  6. A RETROSPECTIVE CLINICAL STUDY OF LAPAROSCOPIC AND OPEN SURGERY FOR CHOLECYSTECTOMY PROCEDURE

    Directory of Open Access Journals (Sweden)

    Konduru Siva Prasada Raju

    2017-03-01

    Full Text Available BACKGROUND The gall stone is one of the commonest ailments for which the hospital doors are knocked in India. Recent statistics suggest that about 15 to 30 percent of women in the fourth and fifth decade of life commonly suffer from this. The gall bladder should not be removed just considering the fact that the stones are there but the stones are formed in it and one major problem is its recurrence. Recent non – operative procedures like shock wave therapy and drugs are non - promising. Minimal access surgery is now the trend in any kind of surgery and cholecystectomy is no exception. Initially there was a huge benefit seen but now more and more complications are reported. In this study an effort has been put to understand the complications involved in both the Laparoscopic and Open type of surgery. This study is intended to help the practicing surgeon to anticipate the commonly involved complications in both the type of surgeries and also to help them understand the pros and cons of each type especially in resource challenged settings. MATERIALS AND METHODS This study was done in the Department of General Surgery in RIMS Medical College at Ongole. This study was done from January 2014 to December 2016. A sample size of 131 patients was selected and the retrospective analysis was done. RESULTS The mean age of the population in the sample size was 44.18 years and the range of the patients included from 10 years to 81 years. There were thirty seven males and ninety four females in the total study population. Female preponderance was seen which was statistically significant. Open surgery is the method of choice in an emergencyod of choice in case of emergency.All twenty three patients who underwent open surgery had significant post operative pain complained of post - operative pain requiring analgesic intervention. Only two patients complained of post – operative pain in case of laparoscopic procedure and none of them needed analgesics. Other

  7. The Impact of Surgery on the Developmental Status of Late Preterm Infants – A Cohort Study

    Science.gov (United States)

    Trivedi, Amit; Walker, Karen; Loughran-Fowlds, Alison; Halliday, Robert; J. A. Holland, Andrew; Badawi, Nadia

    2015-01-01

    Aims: Despite increasing evidence in the literature regarding the impact of late prematurity on subsequent developmental impairment, the developmental outcome of late preterm infants who undergo major surgery remains unclear. The aim of this study therefore was to determine the developmental outcome for a cohort of late preterm surgical population. Methods: Late preterm infants with a gestational age from 34-36 weeks inclusive who were enrolled in the state-wide prospective Development After Infant Surgery (DAISy) study and who had undergone non-cardiac major surgery within the first ninety days of life were eligible for inclusion. Infants were assessed at one and three years of ages. Results: Forty-six infants were enrolled in the study, of which 38 infants had a complete developmental assessment at one year of age. Of these infants, late preterm infants scored significantly lower than the standardized norms of the assessment on the expressive language and gross motor subscales. At three years of age 26 infants were reassessed: late preterm infants who underwent major surgery only scored significantly lower than the standardized norms on the cognitive subscale (p less than 0.001). Conclusions: These data provide the evidence that late preterm infants who undergo major non-cardiac surgery are at risk of developmental impairment and consideration should be given to enrolling this cohort in multi-disciplinary developmental follow-up clinics. PMID:26023526

  8. The Impact of Surgery on the Developmental Status of Late Preterm Infants – A Cohort Study

    Directory of Open Access Journals (Sweden)

    Amit Trivedi

    2015-01-01

    Full Text Available Aims: Despite increasing evidence in the literature regarding the impact of late prematurity on subsequent developmental impairment, the developmental outcome of late preterm infants who undergo major surgery remains unclear. The aim of this study therefore was to determine the developmental outcome for a cohort of late preterm surgical population.Methods: Late preterm infants with a gestational age from 34-36 weeks inclusive who were enrolled in the state-wide prospective Development After Infant Surgery (DAISy study and who had undergone non-cardiac major surgery within the first ninety days of life were eligible for inclusion. Infants were assessed at one and three years of ages.Results: Forty-six infants were enrolled in the study, of which 38 infants had a complete developmental assessment at one year of age. Of these infants, late preterm infants scored significantly lower than the standardized norms of the assessment on the expressive language and gross motor subscales. At three years of age 26 infants were reassessed: late preterm infants who underwent major surgery only scored significantly lower than the standardized norms on the cognitive subscale (p<0.001.Conclusions: These data provide the evidence that late preterm infants who undergo major non-cardiac surgery are at risk of developmental impairment and consideration should be given to enrolling this cohort in multi-disciplinary developmental follow-up clinics.

  9. Broken faces: reconstructive surgery during and after the Great War.

    Science.gov (United States)

    Pichel, Beatriz

    2010-03-01

    Amongst the most terrifying injuries experienced by the soldiers during the First World War (1914-1918) were facial wounds. The French Medical Corps took photographic portraits of these wounded men, the so-called gueules cassées, with a view to conducting reconstructive surgery. However, other groups were quick to use the images they produced for their own political, social or artistic purposes. These photographs then, with their many meanings, capture the diversity of attitudes towards the Great War in its aftermath.

  10. Conserved Metabolic Changes in Nondiabetic and Type 2 Diabetic Bariatric Surgery Patients: Global Metabolomic Pilot Study.

    Science.gov (United States)

    Sarosiek, Konrad; Pappan, Kirk L; Gandhi, Ankit V; Saxena, Shivam; Kang, Christopher Y; McMahon, Heather; Chipitsyna, Galina I; Tichansky, David S; Arafat, Hwyda A

    2016-01-01

    The goal of this study was to provide insight into the mechanism by which bariatric surgical procedures led to weight loss and improvement or resolution of diabetes. Global biochemical profiling was used to evaluate changes occurring in nondiabetic and type 2 diabetic (T2D) patients experiencing either less extreme sleeve gastrectomy or a full gastric bypass. We were able to identify changes in metabolism that were affected by standard preoperation liquid weight loss diet as well as by bariatric surgery itself. Preoperation weight-loss diet was associated with a strong lipid metabolism signature largely related to the consumption of adipose reserves for energy production. Glucose usage shift away from glycolytic pyruvate production toward pentose phosphate pathway, via glucose-6-phosphate, appeared to be shared across all patients regardless of T2D status or bariatric surgery procedure. Our results suggested that bariatric surgery might promote antioxidant defense and insulin sensitivity through both increased heme synthesis and HO activity or expression. Changes in histidine and its metabolites following surgery might be an indication of altered gut microbiome ecology or liver function. This initial study provided broad understanding of how metabolism changed globally in morbidly obese nondiabetic and T2D patients following weight-loss surgery.

  11. Conserved Metabolic Changes in Nondiabetic and Type 2 Diabetic Bariatric Surgery Patients: Global Metabolomic Pilot Study

    Directory of Open Access Journals (Sweden)

    Konrad Sarosiek

    2016-01-01

    Full Text Available The goal of this study was to provide insight into the mechanism by which bariatric surgical procedures led to weight loss and improvement or resolution of diabetes. Global biochemical profiling was used to evaluate changes occurring in nondiabetic and type 2 diabetic (T2D patients experiencing either less extreme sleeve gastrectomy or a full gastric bypass. We were able to identify changes in metabolism that were affected by standard preoperation liquid weight loss diet as well as by bariatric surgery itself. Preoperation weight-loss diet was associated with a strong lipid metabolism signature largely related to the consumption of adipose reserves for energy production. Glucose usage shift away from glycolytic pyruvate production toward pentose phosphate pathway, via glucose-6-phosphate, appeared to be shared across all patients regardless of T2D status or bariatric surgery procedure. Our results suggested that bariatric surgery might promote antioxidant defense and insulin sensitivity through both increased heme synthesis and HO activity or expression. Changes in histidine and its metabolites following surgery might be an indication of altered gut microbiome ecology or liver function. This initial study provided broad understanding of how metabolism changed globally in morbidly obese nondiabetic and T2D patients following weight-loss surgery.

  12. Factors affecting wound complications in head and neck surgery: A prospective study

    Directory of Open Access Journals (Sweden)

    Devendra A Chaukar

    2013-01-01

    Full Text Available Context: Head and neck surgeries are complex. Wound complications are associated with considerable morbidity and can result in delay in the adjuvant treatment. Identification of factors will help in formulating preventive guidelines. Aims: The aim of this study is to identify perioperative factors responsible for wound complications. Settings and Design: Prospective study of 186 head and neck patients. Subjects and Methods: Pre-operative, intraoperative and post-operative factors were recorded. Each patient was evaluated for minor and major wound complications twice daily during the hospital stay. Statistical Analysis: Chi-square test was used for univariate and log regression test was used for multivariate analysis. Results: The overall wound complication rate was 29% with 7% major and 22% minor complications. On univariate analysis, laryngeal and hypopharyngeal location, advanced T stage, poor oral hygiene, clean-contaminated surgery, low Karnofsky performance status (KPS, flap reconstruction, blood loss more than 1000 ml, perioperative blood transfusion, duration of surgery greater than 4.3 h and post-operative hemoglobin lesser than 11 g%, post-operative tracheostomy and resection of mandible were statistical significant factors. On multivariate analysis, post-operative tracheostomy, low KPS, post-operative serum albumin less than 3.7 g/dl and duration of surgery greater than 4.3 h were significant factors. Conclusion : Apart from unavoidable factors, it is essential to take care of certain factors viz nutrition, haemoglobin, oral hygiene, asepsis and repeating antibiotics in prolonged surgery.

  13. Bacterial contamination of suction catheter tips during aortic valve replacement surgery: a prospective observational cohort study.

    Science.gov (United States)

    Larsson, Johanna; Sutherland, Sofia; Söderström, Åsa; Roman-Emanuel, Christine; Jeppsson, Anders; Olofsson, Elisabeth Hansson; Svensson, Per-Arne

    2015-01-01

    Bacterial mediastinitis is a severe complication after open heart surgery. The infection causes prolonged hospitalization and an increased mortality risk. Observations from orthopaedic surgery showed that the suction catheter used during surgery is commonly contaminated with bacteria. The aim of this study was to describe the prevalence of suction catheter contamination in cardiac surgery and to study if suction time influences the contamination risk. Fifty suction catheter tips were collected during 25 aortic valve replacement operations. The suction tip was exchanged once during the operation (after aortotomy closure). The tips were subjected to bacterial contamination analysis. In 20 of the 25 investigated cases (80%), bacterial contamination was detected on one or both tips. The tip used during the beginning of the operation showed bacterial contamination in 13/25 cases (52%) and the second tip in 12/25 (48%). In 5/25 cases (20%) both tips were contaminated. There was no association between bacterial contamination and suction time. Coagulase-negative staphylococcus was the most commonly detected microorganism. The suction device should be considered as a potential source of bacterial contamination in cardiac surgery. The results suggest that the suction catheter should be replaced before key moments like valve implantation and sternal closure.

  14. Electroacupuncture Reduces Postoperative Pain and Analgesic Consumption in Patients Undergoing Thoracic Surgery: A Randomized Study

    Science.gov (United States)

    Chen, Tongyu; Xu, Jianjun; Ma, Wen; Zhou, Jia

    2016-01-01

    The aim of this study was to evaluate the effect of electroacupuncture (EA) on postoperative pain management in patients undergoing thoracic surgery. A randomized study was conducted. Ninety-two thoracic surgical patients were randomly divided into an EA group and a sham group. Postoperative intravenous analgesia was applied with a half dose of the conventional drug concentration in both groups. In the EA group, EA treatment was administered for three consecutive days after the surgery with 6 sessions of 30 min each. Compared with the sham group, patients in the EA group had a lower visual analogue scale (VAS) score at 2, 24, 48, and 72 hours and consumed less analgesic after surgery. The incidence of opioid-related adverse effects of nausea was lower in the EA group. The time to first flatus and defecation was also shorter in the EA group. Furthermore, the plasma β-endorphin (β-EP) level was higher by radioimmunoassay and the plasma 5-hydroxytryptamine (5-HT) level was lower in the EA group by enzyme-linked immunosorbent assay during the first 72 hr after thoracic surgery. Therefore, EA is suitable as an adjunct treatment for postoperative pain management after thoracic surgery. PMID:27073400

  15. A comparative study of Sterofundin and Ringer lactate based infusion protocol in scoliosis correction surgery

    Science.gov (United States)

    Sharma, Ashima; Yadav, Monu; Kumar, B. Rajesh; Lakshman, P. Sai; Iyenger, Raju; Ramchandran, Gopinath

    2016-01-01

    Background: A major change in anesthesia practice as regards to intraoperative infusion therapy is the present requirement. Switching over to balanced fluids can substantially decrease the incidence of lactic acidosis and hyperchloremic acidosis. The deleterious effects of unbalanced fluids are more recognizable during major surgeries. We prospectively studied the influence of Sterofundin (SF) and Ringer lactate (RL) on acid–base changes, hemodynamics, and readiness for extubation during scoliosis surgery. Subjects and Methods: Thirty consecutive children posted for scoliosis surgery were randomized to receive either RL (n = 15) or SF (n = 15) as intraoperative fluid at 10 mg/kg/h. Fluid boluses were added according to the study fluid algorithm. Arterial blood was sampled and analyzed at hourly intervals during surgery. Red blood cell transfusion was guided by hematocrit below 27. Patients were followed for 24 h postoperatively in the Intensive Care Unit. Results: There was no statistically significant difference in the volume of infused fluid (2400 ± 512 ml in Group RL and 2200 ± 640 ml in Group SF. There were no significant changes in pH of patients infused with SF. Statistically, significant higher lactate levels were seen in RL-infused group. The strong ion difference was decreased in both groups, but it normalized earlier with SF. Conclusions: SF-infused patients had nonremarkable changes in acid–base physiology in scoliosis surgery. PMID:27746547

  16. Electroacupuncture Reduces Postoperative Pain and Analgesic Consumption in Patients Undergoing Thoracic Surgery: A Randomized Study

    Directory of Open Access Journals (Sweden)

    Tongyu Chen

    2016-01-01

    Full Text Available The aim of this study was to evaluate the effect of electroacupuncture (EA on postoperative pain management in patients undergoing thoracic surgery. A randomized study was conducted. Ninety-two thoracic surgical patients were randomly divided into an EA group and a sham group. Postoperative intravenous analgesia was applied with a half dose of the conventional drug concentration in both groups. In the EA group, EA treatment was administered for three consecutive days after the surgery with 6 sessions of 30 min each. Compared with the sham group, patients in the EA group had a lower visual analogue scale (VAS score at 2, 24, 48, and 72 hours and consumed less analgesic after surgery. The incidence of opioid-related adverse effects of nausea was lower in the EA group. The time to first flatus and defecation was also shorter in the EA group. Furthermore, the plasma β-endorphin (β-EP level was higher by radioimmunoassay and the plasma 5-hydroxytryptamine (5-HT level was lower in the EA group by enzyme-linked immunosorbent assay during the first 72 hr after thoracic surgery. Therefore, EA is suitable as an adjunct treatment for postoperative pain management after thoracic surgery.

  17. Labial frenectomy with Nd:YAG laser and conventional surgery: a comparative study.

    Science.gov (United States)

    Medeiros Júnior, Rui; Gueiros, Luiz Alcino; Silva, Igor Henrique; de Albuquerque Carvalho, Alessandra; Leão, Jair Carneiro

    2015-02-01

    Labial frenulums are sagittal fibrous folds of oral mucosa with a periosteal insertion that extend from the lips to the alveolar or gingival mucosa. Occasionally, they assume inadequate size or location and may lead to functional and esthetic limitations. The aim of the present study was to compare pre-, trans-, and postsurgical clinical parameters of labial frenectomies performed with conventional surgery and neodymium-doped yttrium aluminum garnet (Nd:YAG) laser. Forty individuals were assessed as a convenience sample and were divided into two groups according to the treatment: group 1 (G1), conventional surgery (n = 22), and G2, Nd:YAG laser surgery (n = 18). Clinical parameters such as frenulum insertion, location, bleeding, surgical time, suturing, preoperative fear, and postoperative discomfort/functional limitations were evaluated. All surgeries were performed by the same operator, and the level of fear, pain, and discomfort related to oral functions were assessed with a visual numeric scale. Most of the frenulums (90%) were classified as papillary or transpapillary insertion. Preoperative fear was similar between groups (p = 0.593). All G2 patients did not require suture (p frenectomies reduces transoperative bleeding, avoiding the need of suturing, and promotes a significant reduction of surgical time in comparison with conventional surgery. Therefore, further studies are necessary to provide a complete understanding and standardization of the technique as well as the expected clinical results.

  18. Fetal growth in pregnancies conceived after gastric bypass surgery in relation to surgery-to-conception interval: a Danish national cohort study.

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    Lone Nikoline Nørgaard

    Full Text Available OBJECTIVE: To describe early and late fetal growth in pregnancies conceived after gastric bypass surgery in relation to time from surgery to conception of pregnancy. METHODS: National cohort study on 387 Danish women, who had laparoscopic or open gastric bypass surgery prior to a singleton pregnancy in which first trimester screening was performed between January 2008 and June 2011. Data were derived from national registers (Danish National Registry of Patients and Danish National Birth Registry, Pregnancy Complications and Abortion-clinical quality database (PreCAb and the Danish Fetal Medicine Database. Main outcome measures were early and late fetal growth in relation to time from bariatric surgery to conception of the pregnancy. Early fetal growth was expressed as "Fetal Growth Index": the ratio between the estimated number of days from first trimester ultrasound to second trimester ultrasound biometries and the actual calender time elapsed in days. Late fetal growth was expressed as the observed versus expected birthweight according to gestational age (GA. RESULTS: The surgery-to-conception interval ranged from 3 to 1851 days with a mean value of 502 (SD, 351 days. The mean "fetal growth index" was 0.99 (SD, 0.02 days/day and thus significantly lower than in the background population (mean, 1.04 (SD, 0.09 days/day, p<0.0001. The proportion of infants being small for gestational age was 18.8% and the proportion of large for gestational age infants was 6.7%. The correlation coefficients between surgery-to-conception time and "fetal growth index" and birthweight according to GA were 0.01 (p = 0.8 and 0.04 (p = 0.4, respectively. CONCLUSION: Fetal growth index was lower than reported in the background population. No correlation was found between the surgery-to-conception interval and early or late fetal growth in pregnancies conceived after gastric bypass surgery.

  19. Open surgery versus retroperitoneal laparoscopic nephrectomy for renal tuberculosis: a retrospective study of 120 patients

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    Su Zhang

    2016-11-01

    Full Text Available Background Laparoscopic renal surgery has been widely used in the treatment of renal diseases. However, there is still little research about its application in addressing renal tuberculosis. The purpose of this study is to retrospectively investigate the surgical results of laparoscopic and open surgery for nonfunctional tuberculous kidneys. Methods Between May 2011 and June 2016, 120 nephrectomies were performed in patients with a nonfunctional tuberculous kidney. Of these, 69 patients underwent retroperitoneal laparoscopic nephrectomy, and 51 patients underwent open nephrectomy. Data about the patients’ characteristics and surgical outcomes were collected from their electronic medical records. Outcomes were compared between these two groups. Results Our results showed that a number of renal tuberculosis patients presented no significant symptoms during their disease. Lower urinary tract symptoms (LUTS were the most common at a rate of 73/120, followed by flank pain or accidently discovery (66/120, urine abnormality (30/120 and fever (27/120. Patients who underwent open surgery were similar to laparoscopic patients with regard to sex, BMI, location, previous tuberculous history, grade, anemia, adhesion, hypertension, diabetes and preoperative serum creatinine level, but were generally older than laparoscopic patients. There were no significant differences between open and laparoscopic surgery in estimated blood loss, transfusion, postoperative hospital days and perioperative complication rate. However, the median operation time of laparoscopic operation was much longer than open surgery (180 [150–225] vs 135 [120–165] minutes, P < 0.01. Seven of the 69 laparoscopic operations were converted to open surgery because of severe adhesions. Conclusion Laparoscopic nephrectomy is as an effective treatment as open surgery for a nonfunctional tuberculous kidney, although it requires more time during the surgical procedure. No significant

  20. COMPARATIVE STUDY OF SPINAL ANESTHESIA AND GENERAL ANESTHESIA IN CHILDREN UNDERGOING SURGERIES BELOW UMBILICUS

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    Ashish

    2014-09-01

    Full Text Available AIM: Aim of our study to compare the spinal anaesthesia and general anaesthesia in children undergoing surgeries below umbilicus. OBJECTIVE: to assess the patient comfort in pt. with GA and pt. with spinal anaesthesia, the adequate surgical condition, assess the hemodynamic change, assess the post op analgesia and to assess the post op complication. MATERIAL AND METHOD: 60 ASA grade I & II children of either sex, aged 5-12 yrs undergoing elective surgeries for the lower abdominal, perineal and lower limb surgeries were taken. After taking a detailed history, thorough general physical examination, all pertinent investigation were carried out to exclude any systemic disease. Patients were classified randomly into 2 groups (30 patients in each group. Group A: General anesthesia was given. Group P: subarachnoid block was given. Intraoperative monitoring consisted of SPO2, PR, NIBP, RR and assessment of duration of post-operative analgesia. P-value <0.05 consider significant. RESULT: Analysis revealed that there were no significant differences between the patients with respect to age, sex, duration and type of surgery In SAB since less general anaesthetic drug including parental opioid are used the risk and postoperative respiratory depression is minimal. The stress response to surgery is also limited and recovery is fast. Postoperatively complications like sore throat, laryngeal irritation, cough etc. was also less associated with it. CONCLUSION pediatric spinal anesthesia is not only a safe alternative to general anesthesia but often the anesthesia technique of choice in many lower abdominal and lower limb surgeries in children. The misconception regarding its safety and flexibility is broken and is now found to be even more cost effective. It is much preferred technique special for common day case surgeries generally performed in the pediatric age group.

  1. Suspensory Materials for Surgery of Blepharoptosis: A Systematic Review of Observational Studies

    Science.gov (United States)

    Pacella, Elena; Mipatrini, Daniele; Pacella, Fernanda; Amorelli, Giulia; Bottone, Andrea; Smaldone, Gianpaolo; Turchetti, Paolo; La Torre, Giuseppe

    2016-01-01

    Background Frontalis suspension surgery is considered the procedure of choice in cases of blepharoptosis. Among all the materials used in this type of surgery, ophthalmic and plastic surgeons prefer to use autologous Fascia Lata. However, during years, other autogenous and exogenous materials have been introduced. Objectives The aim of this study was therefore that of systematically reviewing the functional results and the rate of complications of different synthetic materials, as compared to autogenous Fascia Lata. The primary objective was to determine the rates of Successful Surgeries (SSs) of these materials. The secondary objective was to assess the onset of complications. The following materials were investigated: Fascia Lata, Mersilene, polytetrafluoroethylene (PTFE) and Silicon. Data Source and Methods Following the Prisma procedure, on January 30th, 2016 we used the following electronic databases to select the studies: MEDLINE and Scopus. Results The search strategy retrieved 48 publications that met the eligibility criteria of the systematic review. All studies were non-comparative. PTFE (n = 5) showed the best rate of SSs among the materials compared (statistically significant). Surgeries performed with autogenous Fascia Lata (n = 19) had a 87% rate of success those performed with Mersilene (n = 12)had 92% and those performed with Silicon (n = 17)88%. PTFE had the best outcome, with 99% success rate. As for complications, surgeries performed with PTFE had a higher rate of suture infections (1.9%) as compared to Fascia Lata, but lower incidence for all other complications. Conclusions Although most studies were good quality cohort studies, the overall quality of this evidence should be regarded as low due to their non-comparative design. Our data suggest that PTFE seems to be the most valid alternative material for frontalis suspension surgery, with low recurrence rates and good cosmetic and functional results. PMID:27631781

  2. BARRIERS RESPONSIBLE FOR DELAYED UTILIZATION OF CATARACT SURGERY: AN EYE CAMP STUDY FROM CENTRAL INDIA

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    Umesh

    2014-03-01

    Full Text Available INTRODUCTION: Blindness is one of the significant social problems in India with 7 million of the total 45 million blind people in the world residing in our country. Apart from health and status of vision, there are many other socio-economic factors and perceptions, which influence the decision making of the people for getting operated for cataract. But very few studies have been done on the social factors influencing the utilization of cataract surgery. MATERIAL AND METHODS: It was a hospital-based, descriptive study. The study subjects were recruited from the Ophthalmology department from cataract camp held in Chirayu medical College, Hospital during October 2013 to January 2014. RESULTS: In present study, insufficient family income and no one to accompany (60% and 10% was responded by majority of the subjects. In present study, the barriers for delayed utilization of cataract surgery like could manage to do daily work was responded by 513 (85.5% out of total 600 subjects, could see with the other eye clearly 470 (78.3%, busy with work 118 (19.6%, being female70 (11.6%, fear of surgery 115 (19.1%, old age 200 (33.3%, fear that surgery could lead to loss of eyesight 55 (9.1%, it was Gods will 35 (5.8%, fear about the cost of surgery 375 (62.5% and fear that surgery could lead to death was responded by 15 (2.5% out of total 600 subjects. CONCLUSION: Expansion of outreach programmes to different communities rather than concentrate in urban areas, and offering cataract surgical services at affordable rates will also be of help. Health Education has a great role to play as well, especially in creating awareness. Adequate dissemination of information through various media is usually will be very helpful

  3. A study to evaluate cephalometric hard tissue profile of Tamil population for orthognathic surgery.

    Science.gov (United States)

    Nachiappan, S; Tharanikumar, S; Chandran, Ajay; Anusudha, P; Nandini, G D; Balasubramaniam, Murali

    2015-08-01

    The primary aim of this study is to compare, the cephalometric hard tissue profile values and analysis between Tamil and Caucasian population. The study also aims to create a better understanding in the facial proportions of Tamil Nadu population and to have better diagnosis and treatment planning for orthognathic surgery for Tamil population in Tamil Nadu.

  4. Ultrasonic root-end preparation in apical surgery : a prospective randomized study

    NARCIS (Netherlands)

    de Lange, Jan; Putters, Thomas; Baas, Erik M.; van Ingen, Johan M.

    2007-01-01

    Objective. The purpose of this study was to evaluate the potential benefit of an ultrasonic device in apical surgery on the outcome of treatment. Study design. A randomized prospective design was used in a standardized treatment protocol. Patients were allocated to treatment with an ultrasonic devic

  5. Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study.

    Science.gov (United States)

    Bauer, Brent A; Cutshall, Susanne M; Wentworth, Laura J; Engen, Deborah; Messner, Penny K; Wood, Christina M; Brekke, Karen M; Kelly, Ryan F; Sundt, Thoralf M

    2010-05-01

    Integrative therapies such as massage have gained support as interventions that improve the overall patient experience during hospitalization. Cardiac surgery patients undergo long procedures and commonly have postoperative back and shoulder pain, anxiety, and tension. Given the promising effects of massage therapy for alleviation of pain, tension, and anxiety, we studied the efficacy and feasibility of massage therapy delivered in the postoperative cardiovascular surgery setting. Patients were randomized to receive a massage or to have quiet relaxation time (control). In total, 113 patients completed the study (massage, n=62; control, n=51). Patients receiving massage therapy had significantly decreased pain, anxiety, and tension. Patients were highly satisfied with the intervention, and no major barriers to implementing massage therapy were identified. Massage therapy may be an important component of the healing experience for patients after cardiovascular surgery.

  6. The clinical effect of LLLT in endodontic surgery: a prospective study on 72 cases.

    Science.gov (United States)

    Payer, Michael; Jakse, Norbert; Pertl, Christoph; Truschnegg, Astrid; Lechner, Evelyn; Eskici, Antranik

    2005-09-01

    The purpose of this prospective study was to evaluate a possible clinical benefit of LLLT in endodontic surgery. Seventy-two endosurgery cases on incisors and premolars were included to the study and were split randomly into an LLLT test group, a placebo group, and a control group. In the LLLT group, irradiation was performed intraoperatively and postoperatively 1, 3, and 7 days after surgery. In the placebo group, irradiation was performed without laser activation. In the control group, neither LLLT nor placebo therapy was used. Swelling, wound healing, and pain were evaluated by a blinded investigator 1, 3, and 7 days postoperatively. No statistically relevant differences between the LLLT and the placebo groups were found. Patients in the control group reported on statistically relevant stronger pain. In routine endodontic surgery cases, LLLT does not achieve a significant clinical benefit. Further, the results indicate a prominent placebo effect of the soft laser therapy.

  7. Early Oral Feeding After Surgery for Upper Gastrointestinal Malignancies: A Prospective Cohort Study

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    Saeed Shoar

    2016-05-01

    Full Text Available Objectives: Poor nutritional status following abdominal surgeries for esophageal and gastric cancers remains a major challenge in postoperative care. Our study aimed to investigate the efficacy of starting early oral feeding (EOF in patients undergoing surgical resection of upper gastrointestinal malignancies. Methods: A total of 180 consecutive patients with a diagnosis of esophageal or gastric malignancies undergoing elective surgical resection between January 2008 and February 2011 were enrolled in this prospective cohort study. Seventy-two patients were assigned to the EOF group, and 108 patients received late oral feeding (LOF. Postoperative endpoints were compared between the two groups. Results: Nasogastric tubes were removed from patients on average 3.3±1.6 days after the surgery in the EOF group and 5.2±2.5 days in the LOF group (p 0.050. Conclusions: EOF is safe following esophageal and gastric cancer surgery and results in faster recovery and hospital discharge.

  8. 浅谈CASS7.0绘图软件在地图数字化和编辑中的应用

    Institute of Scientific and Technical Information of China (English)

    杜秀新

    2013-01-01

    在中国的测绘事业发展过程中,在DIS和AotoCAD基础上,为了更好的实现数字地图的编辑,不断开发出越来越多的绘图软件,诸如在AotoCAD基础上研发的绘图软件,在测绘工作中广泛使用的CASS7.0绘图软件。本文简单论述了CASS7.0绘图软件在地图编辑及数字化中的应用。

  9. Postoperative bacteremia in periodontal flap surgery, with and without prophylactic antibiotic administration: A comparative study

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    Asi Kanwarjit

    2010-01-01

    Full Text Available Objectives: Many a times in clinical periodontology, the decision whether to prescribe prophylactic antibiotics or not , is perplexing.The present study was conducted to compare the bacteremias induced after periodontal flap surgeries with and without prophylactic antibiotics. Materials and Methods: The occurrence of postoperative bacteremia following periodontal flap surgery was studied in 30 patients. On these patients, 30 quadrant wise flap surgeries were carried out without any preoperative prophylactic antibiotics and 30 surgeries carried out after prophylactic administration of amoxycillin preoperatively. A blood sample was taken from each patient at the time of maximum surgical trauma and was cultured for micro-organisms and antibiotic sensitivity. Results: 18 out of 60 blood samples were positive for micro-organisms. There was a significant reduction in post operative bacteremia after amoxycillin prophylaxis (x - 7.96 with P< 0.01 as post operative bacteremia was found in 14 of the non medicated patients as compared to only 4 of the pre medicated patients. The micro-organisms encountered in the study are as follows:- 1 Staphylococcus albus coagulase negative, 2 Klebsiella, 3 Psedomonas aerugenosa, 4 Streptococcus viridans, 5 Alpha hemolytic streptococcus, 6 Neisseria catarrhalis Conclusion: On the basis of the study, it is concluded that the incidence of postoperative bacteremia following periodontal flap surgery is not as high as previously reported. The clinical results show that Amoxicillin is highly effective in reducing postoperative bacteremia in periodontal flap surgery and thus in preventing the possible sequelae (Infective Endocarditis and other systemic maladies in susceptible patients. However, cefotaxime and cephalexin may prove to be more effective in preventing the same.

  10. Factors predicting surgical site infection after posterior lumbar surgery: A multicenter retrospective study.

    Science.gov (United States)

    Wang, Tao; Wang, Hui; Yang, Da-Long; Jiang, Li-Qiang; Zhang, Li-Jun; Ding, Wen-Yuan

    2017-02-01

    This is a retrospective study.The purpose of this study is to explore incidence and risk factors for surgical site infection (SSI) after posterior lumbar surgery.SSI is a common complication after posterior lumbar surgery, bringing mental and physical pain and prolonging hospital stay. However, predisposing factors, as reported less, remain controversial.Patients who underwent posterior lumbar surgery at 3 centers between 2006 and 2016 were included. The possible factors include 3 aspects: demographic variables-age, sex, body mass index (BMI), waist-to-hip radio (WHR), hypertension, diabetes, heart disease, smoking, drinking, steroidal injection, surgical time between June and September, preoperative shower; blood test variables-white blood cell (WBC), neutrophil, red blood cell (RBC), hemoglobin (Hb), total protein (TP), albumin, albumin/globulin (A/G), C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR) and surgical related variables-operation time, blood loss, operative level, instrumentation, incision length. Factors related with SSI were also performed by multivariate analysis.The prevalence of SSI was 3.00% (267 cases of 8879) had a postoperative wound infection. There were significant difference in WHR (0.92 vs 0.83), WBC (4.31 vs 6.69), TP (58.7 vs 65.2), albumin (36.9 vs 43.2), CRP (2.01 vs 0.57), PCT (0.097 vs 0.067), operation time (217.9 vs 195.7), blood loss (997.1 vs 915.3) and operative level (3.05 vs 2.45) and incision length (24.1 vs 20.0) between SSI group and non-SSI group. >60 years old, female, BMI 30.0, diabetes, male smoking, preoperative steroidal injection, surgical time between June and September, no preoperative shower, instrumentation surgery were risk factors for SSI after posterior lumbar surgery.Many factors, >60 years old, female, BMI, WHR, diabetes, male smoking, preoperative steroidal injection, surgical time between June and September, preoperative shower, WBC, TP, albumin, CRP, PCT, operation time

  11. Aldis, Anne C. and Roger N. McDermott, eds., Russian Military Reform, 1992-2002. Portland, OR: Frank Cass, 2003.

    Directory of Open Access Journals (Sweden)

    Christian Erickson

    2004-07-01

    Full Text Available In this edited volume, the fourth book in the Cass Series on Soviet (Russian Military Institutions, the authors analyze the security threats the first two post-Soviet administrations and military apparatus have had to contend with. The period covered by this volume is one of the most tumultuous which has confronted the Russian military. The array of new threats, resource limitations, the ambiguity of civil-military relations, and the interaction between the military, law enforcement, and int...

  12. Early career choices and successful career progression in surgery in the UK: prospective cohort studies

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    Richards Jennifer MJ

    2010-11-01

    Full Text Available Abstract Background Changes to the structure of medical training worldwide require doctors to decide on their career specialty at an increasingly early stage after graduation. We studied trends in career choices for surgery, and the eventual career destinations, of UK graduates who declared an early preference for surgery. Methods Postal questionnaires were sent, at regular time intervals after qualification, to all medical qualifiers from all UK medical schools in selected qualification years between 1974 and 2005. They were sent in the first year after qualification, at year three and five years after qualification, and at longer time intervals thereafter. Results Responses were received from 27 749 of 38 280 doctors (73% at year one, 23 468 of 33151 (71% at year three, and 17 689 of 24 870 (71% at year five. Early career preferences showed that surgery has become more popular over the past two decades. Looking forward from early career choice, 60% of respondents (64% of men, 48% of women with a first preference for a surgical specialty at year one eventually worked in surgery (p Conclusions Surgery is a popular specialty choice in the UK. The great majority of doctors who progressed in a surgical career made an early and definitive decision to do so.

  13. Factors predisposing to wound infection in cardiac surgery. A prospective study of 517 patients.

    Science.gov (United States)

    Wilson, A P; Livesey, S A; Treasure, T; Grüneberg, R N; Sturridge, M F

    1987-01-01

    Postoperative wound infection can greatly prolong hospital stay after cardiac surgery, so the identification of predisposing factors may help in prevention or early institution of treatment. Transfer of organisms from the leg to the sternum during coronary artery surgery has been proposed as a major additional cause of sepsis. The definition of wound infection is not standardised and therefore makes comparison between centres difficult. In a prospective study of 517 patients, a wound scoring method (ASEPSIS) has been used to register all abnormal wounds to maximise the chances of identifying factors predisposing to infection. Abnormal healing was noted in 99 (19%) sternal wounds and 29 (8%) leg wounds. Obesity was the principal risk factor (P less than 0.005). Diabetes, reoperation, length of preoperative hospital stay, age, sex, or previous cardiac surgery had little effect on wound healing. The range of bacteria isolated from chest wounds after coronary artery surgery was similar to that after valvular surgery, but the rate of isolation was significantly greater. With careful attention to technique, leg wound infection rarely presented a clinical problem and did not appear to be a source of bacteria infecting the chest wound.

  14. Patients' expectations for the functional and psychosocial outcomes of orbital decompression surgery for thyroid eye disease: a qualitative study.

    Science.gov (United States)

    Wickwar, Sadie; McBain, Hayley; Edmunds, Matthew R; Ezra, Daniel G; Rose, Geoffrey E; Newman, Stanton P

    2017-07-25

    Patients with appearance-altering conditions may be dissatisfied with the outcomes of reconstructive surgery due to unmet expectations. This study explored patients' expectations of orbital decompression surgery for thyroid eye disease (TED) and whether these were met. Semi-structured interviews were conducted at two times: (1) in the weeks after patients were listed for decompression surgery and before surgery; (2) up to 12 months after surgery. Thematic analysis was performed for each time point, to identify themes within the data. Fourteen adults with TED were interviewed prior to surgery and five were followed up after surgery. Thematic analyses found: (1) Prior to surgery, patients had formed expectations through online information about the procedure, consultations with physicians, the impact TED had on their lives, and speaking to relevant others. Patients had specific expectations about the procedure, the recovery, post-operative appearance and post-operative vision. (2) After surgery, patients generally felt their appearance and well-being had improved. However, dissatisfaction was linked to unanticipated specific aspects of surgical care, recovery, or appearance. Dissatisfaction can arise from unmet expectations for the outcomes of reconstructive surgery. Physicians should be aware of the processes by which patients form expectations, for example different types and quality of online information. Ensuring that preoperative expectations are realistic could enhance satisfaction after surgery.

  15. Study examines outcomes from surgery to prevent ovarian cancer

    Science.gov (United States)

    A new study looked at women at high risk of ovarian cancer who had no clinical signs of the disease and who underwent risk-reducing salpingo-oophorectomy (RRSO). The study results showed cancer in the removed tissues of 2.6 percent (25 of 966) of the par

  16. Laparoscopic surgery for colorectal cancer is safe and has survival outcomes similar to those of open surgery in elderly patients with a poor performance status: subanalysis of a large multicenter case-control study in Japan.

    Science.gov (United States)

    Niitsu, Hiroaki; Hinoi, Takao; Kawaguchi, Yasuo; Ohdan, Hideki; Hasegawa, Hirotoshi; Suzuka, Ichio; Fukunaga, Yosuke; Yamaguchi, Takashi; Endo, Shungo; Tagami, Soichi; Idani, Hitoshi; Ichihara, Takao; Watanabe, Kazuteru; Watanabe, Masahiko

    2016-01-01

    It remains controversial whether open or laparoscopic surgery should be indicated for elderly patients with colorectal cancer and a poor performance status. In those patients aged 80 years or older with Eastern Cooperative Oncology Group performance status score of 2 or greater who received elective surgery for stage 0 to stage III colorectal adenocarcinoma and had no concomitant malignancies and who were enrolled in a multicenter case-control study entitled "Retrospective study of laparoscopic colorectal surgery for elderly patients" that was conducted in Japan between 2003 and 2007, background characteristics and short-term and long-term outcomes for open surgery and laparoscopic surgery were compared. Of the 398 patients included, 295 underwent open surgery and 103 underwent laparoscopic surgery. There were no significant differences in the baseline characteristics between open surgery and laparoscopic surgery patients, except for previous abdominal surgery and TNM stage. The median operation duration was shorter with open surgery (open surgery, 153 min; laparoscopic surgery, 202 min; P cancer patients with a poor performance status is safe and not inferior to open surgery in terms of overall survival.

  17. The Design and Implementation of Outputting Files to CASS 9.0 on EPS 2008 Platform%EPS2008输出CASS9.0规则dwg文件设计与实现

    Institute of Scientific and Technical Information of China (English)

    张君华; 王健; 王友昆; 王华峰

    2011-01-01

    很多测绘单位使用的测图软件都是EPS 2008,但是甲方一般都要求提交的地形图数据格式为AutoCAD版的DWG格式。所以需要对EPS 2008的EDB文件进行转换输出至DWG文件。本文详细介绍了通过定制模板及编写脚本,满足EPS 2008平台输出CASS 9.0规则的DWG文件需要。%Many agents use EPS 2008 for mapping.However,the part A usually requires for a topographic map file outputted by AutoCAD whose format is DWG.So,we should transform EPS's EDB file to DWG file.This text introduces how to output a DWG file on the EPS 2008 platform in detail,by means of customizing formwork and writing script.

  18. Academic plastic surgery: a study of current issues and future challenges.

    Science.gov (United States)

    Zetrenne, Eleonore; Kosins, Aaron M; Wirth, Garrett A; Bui, Albert; Evans, Gregory R D; Wells, James H

    2008-06-01

    The objectives of this study were (1) to evaluate the role of a full-time academic plastic surgeon, (2) to define the indicators predictive of a successful career in academic plastic surgery, and (3) to understand the current issues that will affect future trends in the practice of academic plastic surgery. A questionnaire was developed to evaluate the role of current full-time academic plastic surgeons and to understand the current issues and future challenges facing academic plastic surgery. Each plastic surgery program director in the United States was sent the survey for distribution among all full-time academic plastic surgeons. Over a 6-week period, responses from 143 full-time academic plastic surgeons (approximately 31%) were returned. Fifty-three percent of respondents had been academic plastic surgeons for longer than 10 years. Seventy-three percent of respondents defined academic plastic surgeons as clinicians who are teachers and researchers. However, 53% of respondents believed that academic plastic surgeons were not required to teach or practice within university hospitals/academic centers. The 3 factors reported most frequently as indicative of a successful career in academic plastic surgery were peer recognition, personal satisfaction, and program reputation. Dedication and motivation were the personal characteristics rated most likely to contribute to academic success. Forty-four percent of respondents were unable to identify future academic plastic surgeons from plastic surgery residency applicants, and 27% were not sure. Most (93%) of the respondents believed that academic surgery as practiced today will change. The overall job description of a full-time academic plastic surgeon remains unchanged (teacher and researcher). Whereas peer recognition, personal satisfaction, and program reputation were most frequently cited as indicative of a successful plastic surgery career, financial success was rated the least indicative. Similarly, whereas the

  19. Minimization of nitrous oxide emission from CASS process treating low carbon source domestic wastewater: Effect of feeding strategy and aeration rate.

    Science.gov (United States)

    Liang, Weihao; Yu, Chao; Ren, Hongqiang; Geng, Jinju; Ding, Lili; Xu, Ke

    2015-12-01

    Nitrous oxide (N2O) emission during wastewater treatment can be mitigated by improving operational conditions, e.g., organic carbon supply and dissolved oxygen. To evaluate the control parameters for N2O emission in the low carbon source domestic wastewater treatment process, N2O emissions from Cyclic Activated Sludge System (CASS) under different feeding strategies and aeration rates were investigated. Results showed that continuous feeding enhanced nitrogen removal and reduced N2O emission compared to batch feeding, while a higher aeration rate led to less N2O emission. N2O was mainly produced during non-aeration phases in batch feeding CASS and the amount of N2O generated from denitrification decreased under continuous feeding, indicating that carbon source in the continuous influent relieved the electron competition between denitrification reductases during non-aeration phase. Moreover, taxonomic analysis based on high-throughput 16S rRNA gene sequencing revealed higher abundance of denitrifying bacteria, especially N2O-reducing bacteria in continuous feeding CASS.

  20. A PRELIMINARY STUDY FOR SIX SIGMA IMPLEMENTATION IN LASER IN SITU KERATOMILEUSIS (LASIK SURGERIES

    Directory of Open Access Journals (Sweden)

    Mehmet Tolga Taner

    2014-01-01

    Full Text Available The purpose of this study is to show how a private eye care center in Turkey developed a Six Sigma infrastructure to investigate the root causes of complications occuring during LASIK surgeries. To analyze the collected data, main tools of Six Sigma’s Define-Measure-Analyze-Improve-Control(DMAIC improvement cycle such as SIPOC table, Fishbone Diagram and, Failure, Mode and Effect Analysis were implemented. Experience of the refractive surgeons, type of microkeratome and hygiene of microkeratome were identified to be Critical-to-Quality (CTQ factors for a successful LASIK surgery. The most frequent complications of LASIK surgeries were found to be dry eye syndrome, subconjunctival haemorrhage and flap edge melt. The process sigma level was found to be 3.7135.

  1. Surgery and parental separation as potential risk factors for abnormal eating attitudes-longitudinal study.

    Science.gov (United States)

    Bachar, Eytan; Stein, Daniel; Canetti, Laura; Gur, Eitan

    2008-11-01

    Due to the susceptibility of eating disorders (ED) to stressful life events, we wanted to examine longitudinally whether two childhood adversities: (1) surgery and (2) parental separation, will affect abnormal eating attitudes in adolescents. Consecutively for 4 years, the eating attitude test (EAT-26) and the eating disorder inventory-2 (EDI-2) questionnaires were administered to students from grades 7th through 10th and 8th through 11th. Multilevel analysis revealed that parental separation and oral or cosmetic dermatologic surgeries were significantly correlated with EAT-26 and EDI-2 scores throughout the 4 years of the study. Post-hoc interpretation suggests a connection between (A) chirurgic intervention in the oral cavity and problematic eating attitudes, and (B) cosmetic dermatologic surgery and greater awareness to body appearance-a feature which might characterize adolescents who are prone to develop ED.

  2. Beyond repair - family and community reintegration after obstetric fistula surgery: study protocol.

    Science.gov (United States)

    Byamugisha, Josaphat; El Ayadi, Alison; Obore, Susan; Mwanje, Haruna; Kakaire, Othman; Barageine, Justus; Lester, Felicia; Butrick, Elizabeth; Korn, Abner; Nalubwama, Hadija; Knight, Sharon; Miller, Suellen

    2015-12-18

    Obstetric fistula is a debilitating birth injury that affects an estimated 2-3 million women globally, most in sub-Saharan Africa and Asia. The urinary and/or fecal incontinence associated with fistula affects women physically, psychologically and socioeconomically. Surgical management of fistula is available with clinical success rates ranging from 65-95 %. Previous research on fistula repair outcomes has focused primarily on clinical outcomes without considering the broader goal of successful reintegration into family and community. The objectives for this study are to understand the process of family and community reintegration post fistula surgery and develop a measurement tool to assess long-term success of post-surgical family and community reintegration. This study is an exploratory sequential mixed-methods design including a preliminary qualitative component comprising in-depth interviews and focus group discussions to explore reintegration to family and community after fistula surgery. These results will be used to develop a reintegration tool, and the tool will be validated within a small longitudinal cohort (n = 60) that will follow women for 12 months after obstetric fistula surgery. Medical record abstraction will be conducted for patients managed within the fistula unit. Ethical approval for the study has been granted. This study will provide information regarding the success of family and community reintegration among women returning home after obstetric fistula surgery. The clinical and research community can utilize the standardized measurement tool in future studies of this patient population.

  3. Comparative health technology assessment of robotic-assisted, direct manual laparoscopic and open surgery: a prospective study

    OpenAIRE

    Turchetti, Giuseppe; Pierotti, Francesca; Palla, Ilaria; Manetti, Stefania; Freschi, Cinzia; Ferrari, Vincenzo; Cuschieri, Alfred

    2016-01-01

    Background Despite many publications reporting on the increased hospital cost of robotic-assisted surgery (RAS) compared to direct manual laparoscopic surgery (DMLS) and open surgery (OS), the reported health economic studies lack details on clinical outcome, precluding valid health technology assessment (HTA). Methods The present prospective study reports total cost analysis on 699 patients undergoing general surgical, gynecological and thoracic operations between 2011 and 2014 in the Italia...

  4. Cataract surgery and the risk of aging macula disorder: The Rotterdam study

    NARCIS (Netherlands)

    L. Ho (Lintje); S. Boekhoorn (Sharmila); A. Liana (Alin); P. Tikka-Kleemola (Päivi); A.G. Uitterlinden (André); A. Hofman (Albert); P.T.V.M. de Jong (Paulus); Th. Stijnen (Theo); J.R. Vingerling (Hans)

    2008-01-01

    textabstractPURPOSE. To investigate still-controversial associations between prior cataract surgery and aging macula disorder (AMD) in a general population. METHODS. Baseline lens status and risk of incident AMD (iAMD) were examined in participants of the prospective population-based Rotterdam Study

  5. Post-operative rounds by anaesthesiologists after hip fracture surgery: a pilot study

    DEFF Research Database (Denmark)

    Foss, Nicolai Bang; Christensen, Dorte Stig; Krasheninnikoff, Michael

    2006-01-01

    conditions. CONCLUSION: This pilot study, with insufficient power to show significant differences in outcome, supports further evaluation of the concept of intensified orthopaedic-anaesthesiological co-operation after hip fracture surgery. Such a randomized trial should evaluate economic and clinical outcome...

  6. Phased Array Ultrasonic Sound Field Mapping through Large-Bore Coarse Grained Cast Austenitic Stainless Steel (CASS) Components

    Energy Technology Data Exchange (ETDEWEB)

    Crawford, Susan L.; Cinson, Anthony D.; Prowant, Matthew S.; Coble, Jamie B.; Diaz, Aaron A.; Anderson, Michael T.

    2012-09-01

    A sound field beam mapping exercise was conducted to assist in understanding the effects of coarse-grained microstructures found in cast austenitic stainless steel (CASS) materials on acoustic longitudinal wave propagation. Ultrasonic laboratory measurements were made on three specimens representing four different grain structures. Phased array (PA) probes were fixed on each specimen surface and excited in the longitudinal mode at specific angles while a point receiver was scanned in a raster pattern over the end of the specimen, generating a transmitted sound field image. Three probes operating at nominal frequencies of 0.5, 0.8, and 1.0 MHz were used. A 6.4 mm (0.25-in.) thick slice was removed from the specimen end and beam mapping was repeated three times, yielding four full sets of beam images. Data were collected both with a constant part path for each configuration (probe, specimen and slice, angle, etc.) and with a variable part path (fixed position on the surface). The base specimens and slices were then polished and etched to reveal measureable grain microstructures that were compared to the sound field interactions and scattering effects seen in the collected data.

  7. Fracture Risk After Bariatric Surgery: A 12-Year Nationwide Cohort Study.

    Science.gov (United States)

    Lu, Chia-Wen; Chang, Yu-Kang; Chang, Hao-Hsiang; Kuo, Chia-Sheng; Huang, Chi-Ting; Hsu, Chih-Cheng; Huang, Kuo-Chin

    2015-12-01

    Bariatric surgery has been shown to impair bone health. This study aimed to investigate the fracture risk in patients after bariatric surgery versus propensity score-matched controls. The authors used the National Health Insurance Research Database of Taiwan and identified 2064 patients who underwent bariatric surgery during 2001 to 2009. These patients were matched to 5027 obese patients who did not receive bariatric surgery, using propensity score matching accounting for age, sex, Charlson Comorbidity Index, diabetes, hypertension, hyperlipidemia and the year morbid obesity was diagnosed. The authors followed the surgical and control cohorts to death, any diagnosis of fracture, or December 31, 2012, whichever occurred first. Cox proportional hazard regression models were used to calculate relative rates of fractures in the surgical group and control group. At the end of the 12-year study period, there were 183 fractures in the surgical group (mean follow-up 4.8 years) and 374 fractures in the matched control group (mean follow-up 4.9 years). Overall, there was a 1.21-fold [95% confidence interval (CI): 1.02-1.43] significantly increased risk of fracture in the surgical group compared with the control group. Stratified by surgical procedures, malabsorptive procedures showed a significantly higher fracture risk (1.47, 95% CI: 1.01-2.15). The Kaplan-Meier estimated fracture rates were 1.60% at 1 year, 2.37% at 2 years, 1.69% at 5 years, and 2.06% after 5 years for the surgical patients, compared with 1.51%, 1.65%, 1.53%, and 1.42%, respectively, for the matched controls. Adjusted analysis showed a trend towards an increased fracture risk, 1 to 2 years after bariatric surgery. (1.42, 95% CI: 0.99-2.05). Bariatric surgery was significantly associated with an increased risk of fractures, mainly with malabsorptive procedures, with a trend of an increased fracture risk 1 to 2 years after surgery. These results provide further evidence for the adverse effects of bariatric

  8. Image-guided endoscopic spine surgery: Part I. A feasibility study.

    Science.gov (United States)

    Assaker, R; Cinquin, P; Cotten, A; Lejeune, J P

    2001-08-01

    A feasibility study was performed to determine the efficacy of computer assistance in endoscopic spine surgery. To assess a new method for computer assistance based on image guidance during thoracoscopic or any endoscopic spine procedure. To evaluate the reproducibility, the sensitivity and the reliability of the technique first in vitro and second in clinical use. The computer-based, image-guided surgery is now a routine tool used in open spine surgery. Exposure of the anatomy of the vertebra is needed for registration. This methodology is inapplicable in endoscopic approach. Fluoroscopic-based navigation combines the technology of image-guided surgery and C-arm fluoroscopy. The navigation is based on the fluoroscopic images acquired before surgery. This technology is applicable to endoscopic surgery but the navigation is based on fluoroscopic image. The computed tomography images are not exploited. There are no published data on a technique that allows image-guided surgery based on computed tomography and magnetic resonance imaging. A laboratory study was performed on a thoracic human spine. One vertebra was marked on the right lateral side of the body with five titanium marks. A percutaneous reference frame was specifically designed to be placed in the pedicle of the same marked vertebrae. The reference frame acted as a 3D localizer and a registration tool. The spine model was scanned including the reference frame. A standard Stealth station treatment guidance platform (Medtronic, Sofamor Danek, Memphis, TN) was used for simulation. The registration was obtained using the reference frame. Twenty navigation procedure trials were done and the error was recorded based on the distance between the anatomical point and the corresponding virtual one. Registration was always possible using the stealth station and a standard spine navigational software (spine 3, Medtronic Sofamor Danek, Memphis, TN). The mean error after registration given by the computer was 0.96 mm

  9. Thermocamera studies of nitrous oxide dispersion in the dental surgery

    Energy Technology Data Exchange (ETDEWEB)

    Carlsson, P.; Hallen, B.; Hallonsten, A.L.; Ljungqvist, B.

    1983-06-01

    Nitrous oxide is used in dentistry for sedation and analgesia. Chronic occupational exposure of dental personnel to trace concentrations of nitrous oxide has been reported as a potential health hazard. A new application of the thermocamera technique was used to study the dispersion of nitrous oxide during dental analgesia. Four breathing systems with different evacuation systems were tested and found to vary in scavenging efficiency. A local exhaust system ensured minimal exposure when nitrous oxide leaks contaminating the air in the dentist's breathing zone occur.

  10. Open surgery versus retroperitoneal laparoscopic nephrectomy for renal tuberculosis: a retrospective study of 120 patients.

    Science.gov (United States)

    Zhang, Su; Luo, You; Wang, Cheng; Xiong, Hu; Fu, Sheng-Jun; Yang, Li

    2016-01-01

    Laparoscopic renal surgery has been widely used in the treatment of renal diseases. However, there is still little research about its application in addressing renal tuberculosis. The purpose of this study is to retrospectively investigate the surgical results of laparoscopic and open surgery for nonfunctional tuberculous kidneys. Between May 2011 and June 2016, 120 nephrectomies were performed in patients with a nonfunctional tuberculous kidney. Of these, 69 patients underwent retroperitoneal laparoscopic nephrectomy, and 51 patients underwent open nephrectomy. Data about the patients' characteristics and surgical outcomes were collected from their electronic medical records. Outcomes were compared between these two groups. Our results showed that a number of renal tuberculosis patients presented no significant symptoms during their disease. Lower urinary tract symptoms (LUTS) were the most common at a rate of 73/120, followed by flank pain or accidently discovery (66/120), urine abnormality (30/120) and fever (27/120). Patients who underwent open surgery were similar to laparoscopic patients with regard to sex, BMI, location, previous tuberculous history, grade, anemia, adhesion, hypertension, diabetes and preoperative serum creatinine level, but were generally older than laparoscopic patients. There were no significant differences between open and laparoscopic surgery in estimated blood loss, transfusion, postoperative hospital days and perioperative complication rate. However, the median operation time of laparoscopic operation was much longer than open surgery (180 [150-225] vs 135 [120-165] minutes, P treatment as open surgery for a nonfunctional tuberculous kidney, although it requires more time during the surgical procedure. No significant differences in other surgical outcomes were observed.

  11. Two mechanical methods for thromboembolism prophylaxis after gynaecological pelvic surgery: a prospective, randomised study

    Institute of Scientific and Technical Information of China (English)

    GAO Jie; JIANG Ying; ZHAO Na; ZHANG Zhen-yu; LI Zhan; LIU Chong-dong; ZHAN Yu-xin; QIAO Bao-li; SANG Cui-qin; GUO Shu-li; WANG Shu-zhen

    2012-01-01

    Background Venous thromboembolism is known to be an important social and health care problem because of its high incidence among patients who undergo surgery.Studies on the mechanical prophylaxis of thromboembolism after gynaecological pelvic surgery are few.The aim of our study was to evaluate the effect of mechanical thromboembolism prophylaxis after gynaecological pelvic surgery using a combination of graduated compression stockings (GCS) and intermittent pneumatic compression (IPC) or GCS alone.Methods The study was performed on 108 patients who were randomly assigned to two groups.The first group received GCS before the operation and IPC during the operation (IPC+GCS group).The second group received GCS before the operation (GCS group).To analyze the effect of the preventive measures and the laboratory examination on the incidence of thrombosis and to compare the safety of these measures,the incidence of adverse reactions was assessed.Results The morbidity associated with DVT was 4.8% (5/104) in the IPC+GCS group and 12.5% (14/112) in the GCS group.There were significant statistical differences between the two groups.There were no adverse effects in either group.Conclusions The therapeutic combination of GCS and IPC was more effective than GCS alone for thrombosis prevention in high-risk patients undergoing gynaecological pelvic surgery,and there were no adverse effects in either group.(No.ChiCTR-PRC-10000935).

  12. Surgical glove perforation among nurses in ophthalmic surgery: a case-control study.

    Science.gov (United States)

    Shek, Karen Mei-Yan; Chau, Janita Pak-Chun

    2014-04-01

    Many of the ophthalmic surgical instruments are extremely fine and sharp. Due to the dim light environment required for ophthalmic surgical procedures, the passing of sharp instruments among surgeons and scrub nurses also poses a risk for glove perforations. A case-control study was performed to determine the number and site of perforations in the surgical gloves used by a group of scrub nurses during ophthalmic surgery. All six nurses working in an eye and refractive surgery centre in Hong Kong participated in the study. A total of 100 (50 pairs) used surgical gloves were collected following 50 ophthalmic surgeries. Fifty pairs of new surgical gloves were also collected. Every collected surgical glove underwent the water leak test. The surgical procedure perforation rate was 8%, and none of the perforations were detected by the scrub nurses. No perforations were found in any unused gloves. The findings indicate that glove perforations for scrub nurses during ophthalmic surgery do occur and mostly go unnoticed. Future studies should continue to explore factors contributing to surgical glove perforation.

  13. Transobturator surgery in presence of corona mortis: a study in 13 women.

    Science.gov (United States)

    Castellani, Daniele; Saldutto, Pietro; Galica, Vikiela; Masciovecchio, Stefano; Galatioto, Giuseppe Paradiso; Vicentini, Carlo

    2016-11-18

    Severe and life-threatening bleeding has been reported in the literature after retropubic mid-urethral slings procedure, due to corona mortis damage. The aim of this study is to evaluate safety of transobturator passage of the tape in stress-urinary incontinence (SUI) correction and anchoring the mesh in pelvic-organ prolapse (POP) repair in the presence of corona mortis. Thirteen women with a pre-operatory contrast-enhanced abdominal multidetector computed tomography were prospectively enrolled in the study between January 2009 and December 2014. Eight women underwent a Monarc® and one a Spark® Sling System procedures for SUI correction, and three an Elevate® Anterior and Apical prolapse system and one a Perigee procedure to repair anterior/apical POP. All procedures were performed by a single experienced pelvic surgeon. Surgery was uneventful in all cases. No major bleeding was seen during surgery. No pelvic hematoma was identified 24 hours after the procedure. All women were discharged 1 day after surgery. Transobturator surgery seems to be a safe way in the presence of the corona mortis. However, further studies are needed to confirm these preliminary findings.

  14. Outcomes of cataract surgery in urban southern China: the Liwan Eye Study.

    Science.gov (United States)

    Huang, Wenyong; Huang, Guofu; Wang, Dandan; Yin, Qiuxia; Foster, Paul J; He, Mingguang

    2011-01-01

    The outcomes of cataract surgery have been well reported in rural China; however, the situation in the urban population remains unclear. This study assessed the outcomes of cataract surgery in urban southern China. Data were gathered from the Liwan Eye Study, a population-based, cross-sectional study conducted in people aged 50 years or more in the Liwan District of Guangzhou. Presenting and best corrected visual acuity and a detailed eye examination were performed. For all aphakic and pseudophakic participants identified, information on the date, setting, type, and complications of cataract surgery were recorded. Of the 1405 participants, 62 people (90 eyes) had undergone cataract surgery. Of those, 54.4% underwent the phacoemulsification (Phaco) technique, 33.3% extracapsular cataract extraction (ECCE) with intraocular lens (IOL) implantation, and 11.1% ECCE without IOL; 1 patient had intracapsular cataract extraction (ICCE). Presenting visual acuity (PVA) was >6/18 in 56 (62.2%) eyes, 6/60 in 20 (22.2%) eyes, 3/60 in 3 (3.3%) eyes, and ECCE or Phaco with IOL are the major surgical techniques used in urban southern China. More than half of the eyes with poor outcomes due to uncorrected aphakia, refractive error, or PCO are potentially treatable. This result suggests a pressing need for improved surgical training and postoperative care.

  15. Antithrombin III in cardiac surgery: an outcome study.

    Science.gov (United States)

    Conley, J C; Plunkett, P F

    1998-12-01

    A retrospective study examined the impact, in heparin resistant patients (HRP), of lyophilized antithrombin III (ATIII) upon five patient outcomes: intensive care unit stay (ICU-S), 24 hour chest tube drainage (CTD in ml), blood and blood product usage (BPU), development of postoperative coagulopathy (PO-Coag), and reoperation for bleeding (Re-Op). Data was collected from the medical records of 311 patients admitted to the hospital between 12/15/95 and 10/24/96. Subjects were divided into three groups based upon heparin resistance and hemostasis medication. Group 1 (n = 109) were HRP treated with increased heparin, Group 2 (n = 100) were HRP receiving ATIII, and Group 3 (n = 102) were non-HRP and served as controls. Group 2 was also subdivided by use of aminocaproic acid and time of ATIII administration. No significant differences were found between the groups for PO-Coag. and Re-Op. However, significant reduction in CTD (p = 0.05) was seen in the aminocaproic acid patients who were treated with ATIII pre-CPB or within the first 20 minutes of CPB. The CTD in this group was (419.37, +/- 72.96) as compared to Group 1 (782.88, +/- 360.94) and Group 3 (766.67, +/- 407.56). Other Group 2 subgroups showed significant differences in BPU, ICU-S and CTD. The results of this study support the notion that early identification and treatment of HRP with ATIII and aminocaproic acid may decrease postoperative blood loss.

  16. Going home after infant cardiac surgery: a UK qualitative study.

    Science.gov (United States)

    Tregay, Jenifer; Wray, Jo; Crowe, Sonya; Knowles, Rachel; Daubeney, Piers; Franklin, Rodney; Barron, David; Hull, Sally; Barnes, Nick; Bull, Catherine; Brown, Katherine L

    2016-04-01

    To qualitatively assess the discharge processes and postdischarge care in the community for infants discharged after congenital heart interventions in the first year of life. Qualitative study using semistructured interviews and Framework Analysis. UK specialist cardiac centres and the services their patients are discharged to. Twenty-five cardiologists and nurses from tertiary centres, 11 primary and secondary health professionals and 20 parents of children who had either died after discharge or had needed emergency readmission. Participants indicated that going home with an infant after cardiac intervention represents a major challenge for parents and professionals. Although there were reported examples of good care, difficulties are exacerbated by inconsistent pathways and potential loss of information between the multiple teams involved. Written documentation from tertiary centres frequently lacks crucial contact information and contains too many specialist terms. Non-tertiary professionals and parents may not hold the information required to respond appropriately when an infant deteriorates, this contributing to the stressful experience of managing these infants at home. Where they exist, the content of formal 'home monitoring pathways' varies nationally, and families can find this onerous. Service improvements are needed for infants going home after cardiac intervention in the UK, focusing especially on enhancing mechanisms for effective transfer of information outside the tertiary centre and processes to assist with monitoring and triage of vulnerable infants in the community by primary and secondary care professionals. At present there is no routine audit for this stage of the patient journey. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  17. A STUDY OF EFFECTS OF ORAL CLONIDINE ON PREMEDICATION AND HAEMODYNAMIC CHANGES DURING LAPAROSCOPIC SURGERY

    Directory of Open Access Journals (Sweden)

    Sanjeev Rao

    2016-02-01

    Full Text Available BACKGROUND Use of Clonidine as a premedicant started incidentally. Clonidine is a potent antihypertensive drug that suppresses RAAS. Clonidine may be beneficial during laparoscopy in patients with hypertension, cardiovascular and/or renal diseases. AIM OF STUDY To determine the effects of Oral Clonidine on premedication and haemodynamic changes during Laparoscopic surgery. MATERIAL AND METHODS Study was conducted on 60 adult patients belonging to ASA physical status I & II. They were randomly assigned to 2 groups of 30 each. Group C received oral clonidine 150 mcg 90 minutes before surgery and group P received oral ranitidine 150 mg 90 minutes before surgery. Sedation score was noted on arrival to operation theatre. All vital parameters were recorded at regular intervals intra-operatively. RESULTS Clonidine premedication was able to achieve haemodynamic stability during pneumoperitoneum. CONCLUSION Premedication with 150mcg oral Clonidine has been found to be relatively safe as well as effective method that provides stable haemodynamics and protection against stress response triggered by pneumoperitoneum in patients undergoing laparoscopic surgeries.

  18. Acute cholecystitis – early laparoskopic surgery versus antibiotic therapy and delayed elective cholecystectomy: ACDC-study

    Directory of Open Access Journals (Sweden)

    Büchler Markus W

    2007-10-01

    Full Text Available Abstract Background Acute cholecystitis occurs frequently in the elderly and in patients with gall stones. Most cases of severe or recurrent cholecystitis eventually require surgery, usually laparoscopic cholecystectomy in the Western World. It is unclear whether an initial, conservative approach with antibiotic and symptomatic therapy followed by delayed elective surgery would result in better morbidity and outcome than immediate surgery. At present, treatment is generally determined by whether the patient first sees a surgeon or a gastroenterologist. We wish to investigate whether both approaches are equivalent. The primary endpoint is the morbidity until day 75 after inclusion into the study. Design A multicenter, prospective, randomized non-blinded study to compare treatment outcome, complications and 75-day morbidity in patients with acute cholecystitis randomized to laparoscopic cholecystectomy within 24 hours of symptom onset or antibiotic treatment with moxifloxacin and subsequent elective cholecystectomy. For consistency in both arms moxifloxacin, a fluorquinolone with broad spectrum of activity and high bile concentration is used as antibiotic. Duration: October 2006 – November 2008 Organisation/Responsibility The trial was planned and is being conducted and analysed by the Departments of Gastroenterology and General Surgery at the University Hospital of Heidelberg according to the ethical, regulatory and scientific principles governing clinical research as set out in the Declaration of Helsinki (1989 and the Good Clinical Practice guideline (GCP. Trial Registration ClinicalTrials.gov NCT00447304

  19. Nutritional status in Parkinson's disease patients undergoing deep brain stimulation surgery: a pilot study.

    Science.gov (United States)

    Sheard, J M; Ash, S; Silburn, P A; Kerr, G K

    2013-02-01

    People with Parkinson's disease (PD) are at higher risk of malnutrition due to PD symptoms and pharmacotherapy side effects. When pharmacotherapy is no longer effective for symptom control, deep-brain stimulation (DBS) surgery may be considered. The aim of this study was to assess the nutritional status of people with PD who may be at higher risk of malnutrition related to unsatisfactory symptom management with optimised medical therapy. This was an observational study using a convenience sample. Participants were seen during their hospital admission for their deep brain stimulation surgery. People with PD scheduled for DBS surgery were recruited from a Brisbane neurological clinic (n=15). The Patient-Generated Subjective Global Assessment (PG-SGA), weight, height and body composition were assessed to determine nutritional status. Six participants (40%) were classified as moderately malnourished (SGA-B). Eight participants (53%) reported previous unintentional weight loss (average loss of 13%). On average, participants classified as well-nourished (SGA-A) were younger, had shorter disease durations, lower PG-SGA scores, higher body mass (BMI) and fat free mass indices (FFMI) when compared to malnourished participants (SGA-B). Five participants had previously received dietetic advice but only one in relation to unintentional weight loss. Malnutrition remains unrecognised and untreated in this group despite unintentional weight loss and presence of nutrition impact symptoms. Improving nutritional status prior to surgery may improve surgical outcomes.

  20. Nurses' educational needs for pain management of post-cardiac surgery patients: a qualitative study.

    Science.gov (United States)

    Leegaard, Marit; Watt-Watson, Judy; McGillion, Michael; Costello, Judy; Elgie-Watson, Jeanne; Partridge, Kim

    2011-01-01

    Inadequate knowledge among health care providers is a key barrier to good pain management, and nurses have a major role to provide education to patients. The purpose of this study was to identify nurses' learning needs to prepare patients for managing pain before and after discharge home from cardiac surgery. The overall aim is to develop a pain education intervention for nurses working with cardiac surgical patients. This was a focus groups study. Participants (N=22) were asked about their perceptions of patients' education needs for pain management after cardiac surgery and approaches to help nurses meet these needs. The Pain Beliefs Scale was used to capture nurses' own misbeliefs about pain that would need clarification in a successful pain education intervention. Nurses identified pain management challenges in the hospital, particularly related to patients' age, patient concerns about the use of opioids, the need to use multiple management strategies, and preparing patients to manage pain at home. Pain Beliefs Scale scores were low related to opioid dosing and adverse effects. Participants identified their most helpful educational approaches being brief in-services, hands-on learning, lunch-and-learn sessions, and designated education days. Participants identified the most common pain knowledge gaps for patients before and after discharge after cardiac surgery. These data will be used to develop an education intervention for nurses to help their cardiac surgery patients with more effective pain management strategies before and after discharge home. Copyright © 2011 Lippincott Williams & Wilkins.

  1. Bariatric Surgery

    Science.gov (United States)

    ... Metabolic and Bariatric Surgery MedlinePlus What is bariatric surgery? Bariatric surgery helps people who are very obese to ... What are the endocrine-related benefits of bariatric surgery? Bariatric surgery and the weight loss that results can: ...

  2. Factors of importance for the functional outcome in orthognathic surgery patients: a prospective study of 118 patients

    DEFF Research Database (Denmark)

    Øland, Jesper; Jensen, John; Melsen, Birte

    2010-01-01

    The aim of this study was to assess the influence of orthognathic surgery on patients' stomatognathic function and, further, to evaluate how post-treatment function relates to satisfaction.......The aim of this study was to assess the influence of orthognathic surgery on patients' stomatognathic function and, further, to evaluate how post-treatment function relates to satisfaction....

  3. Bleeding during laparoscopic gastric bypass surgery as a risk factor for less favorable outcome. A cohort study from the Scandinavian Obesity Surgery Registry.

    Science.gov (United States)

    Stenberg, Erik; Szabo, Eva; Näslund, Ingmar; Ottosson, Johan

    2017-06-02

    Intraoperative adverse events are known to be associated with postoperative complications; however, little is known about whether or not blood loss during laparoscopic gastric bypass surgery affects the outcome. To see if intraoperative bleeding was associated with a less favorable outcome, and to identify patient-specific risk factors for intraoperative bleeding. Nationwide, Sweden. Patients who underwent laparoscopic gastric bypass surgery between January 8, 2007, and September 15, 2015, were included in the study. The volume of intraoperative blood loss was compared with data from follow-up at day 30 and 1 and 2 years after surgery. Patient-specific factors were analyzed as potential risk factors for intraoperative bleeding. The study included 43,157 patients. Intraoperative bleeding was associated with an increased risk for postoperative complication (100-499 mL, odds ratio [OR] 2.97, 95% confidence interval [95%CI] 2.53-3.50;>500 mL OR 3.34, 95%CI 2.05-5.44), lower weight loss (500 mL 76.9±23.89 %EBMIL, P = .063) and lower reported quality-of-life 2 years after surgery (500 mL, OP 25.2±24.46, P = .272). Diabetes (OR 1.30, 95%CI 1.08-1.58), age (OR 1.02, 95%CI 1.02-1.03), and body mass index (OR 1.03, 95%CI 1.02-1.05) were patient-specific risk factors for intraoperative bleeding≥100 mL, whereas intentional preoperative weight loss was associated with a lower risk (OR .50, 95%CI .43-.57). Intraoperative bleeding was associated with less favorable outcome after laparoscopic gastric bypass surgery. Age, body mass index, and diabetes were risk factors for intraoperative bleeding, while preoperative weight reduction seems to be protective. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  4. Development and characterization of local anti-inflammatory implantation for the controlled release of the hexane extract of the flower-heads of Euryops pectinatus L. (Cass.).

    Science.gov (United States)

    Nesseem, D I; Michel, C G

    2011-04-01

    A hexane extract of the flower-heads of Euryops pectinatus L. (Cass.) was formulated into local anti-inflammatory implantation patches with controlled release. Cross-linked sodium hyaluronate patches (F1-F3) and chitosan patches (F4-F6) were prepared by a casting/solvent evaporation technique. Morphological and mechanical characterizations including the components ratio, surfactant and the loaded amount of the hexane extract (50, 100, and 200 mg/kg b.wt.) were investigated. Release studies were performed during 24 h using a diffusion cell. Films with optimum in vitro release rate have been investigated for testing the anti-inflammatory activity and the sustaining effect of the formulations. The sustained anti-inflammatory effect of the hexane extract of E. pectinatus flower-heads from the selected films was studied by inducing paw edema in rats with 1% (w/v) carrageenan solution. The results indicated the compatibility of hexane extract with both sodium hyaluronate and chitosan patches forming yellowish transparent films. Based on variations in drug release profiles throughout the 24-h among the formulations (F1-F6) studies, F3 and F6 were selected for further investigation. When the films were applied 1 h before the subplantar injection of carrageenan in the hind paw of male Albino rats, formulation (F3) provided its maximum inhibition of paw edema in rats (91.3%) 4 h after edema induction whereas, formulation (F6) showed less inhibition after 4 h (70.6%). The previous two formulations (F3 and F6) produced potent results (95.3 and 89.5%, respectively) after 24 h when compared with a local market preparation containing 25% β-sitosterol used as positive control. Histophathological investigation was conducted for 1, 4, and 12 weeks to study the tissue response for the two formulations (F3 and F6) at the implantation site. Chemical investigation of the hexane extract was achieved for both unsaponifiable matter (USM) and fatty acid methyl esters (FAME) using gas

  5. Creating an advance-care-planning decision aid for high-risk surgery: a qualitative study.

    Science.gov (United States)

    Schuster, Anne Lr; Aslakson, Rebecca A; Bridges, John Fp

    2014-01-01

    High-risk surgery patients may lose decision-making capacity as a result of surgical complications. Advance care planning prior to surgery may be beneficial, but remains controversial and is hindered by a lack of appropriate decision aids. This study sought to examine stakeholders' views on the appropriateness of using decision aids, in general, to support advance care planning among high-risk surgery populations and the design of such a decision aid. Key informants were recruited through purposive and snowball sampling. Semi-structured interviews were conducted by phone until data collected reached theoretical saturation. Key informants were asked to discuss their thoughts about advance care planning and interventions to support advance care planning, particularly for this population. Researchers took de-identified notes that were analyzed for emerging concordant, discordant, and recurrent themes using interpretative phenomenological analysis. Key informants described the importance of initiating advance care planning preoperatively, despite potential challenges present in surgical settings. In general, decision aids were viewed as an appropriate approach to support advance care planning for this population. A recipe emerged from the data that outlines tools, ingredients, and tips for success that are needed to design an advance care planning decision aid for high-risk surgical settings. Stakeholders supported incorporating advance care planning in high-risk surgical settings and endorsed the appropriateness of using decision aids to do so. Findings will inform the next stages of developing the first advance care planning decision aid for high-risk surgery patients.

  6. Predictors of red blood cell transfusion after cardiac surgery: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Camila Takao Lopes

    2015-12-01

    Full Text Available Abstract OBJECTIVE To identify predictors of red blood cell transfusion (RBCT after cardiac surgery. METHOD A prospective cohort study performed with 323 adults after cardiac surgery, from April to December of 2013. A data collection instrument was constructed by the researchers containing factors associated with excessive bleeding after cardiac surgery, as found in the literature, for investigation in the immediate postoperative period. The relationship between risk factors and the outcome was assessed by univariate analysis and logistic regression. RESULTS The factors associated with RBCT in the immediate postoperative period included lower height and weight, decreased platelet count, lower hemoglobin level, higher prevalence of platelet count <150x10 3/mm3, lower volume of protamine, longer duration of anesthesia, higher prevalence of intraoperative RBCT, lower body temperature, higher heart rate and higher positive end-expiratory pressure. The independent predictor was weight <66.5Kg. CONCLUSION Factors associated with RBCT in the immediate postoperative period of cardiac surgery were found. The independent predictor was weight.

  7. Study of the Dynamics of Transcephalic Cerebral Impedance Data during Cardio-Vascular Surgery

    Science.gov (United States)

    Atefi, S. R.; Seoane, F.; Lindecrantz, K.

    2013-04-01

    Postoperative neurological deficits are one of the risks associated with cardio vascular surgery, necessitating development of new techniques for cerebral monitoring. In this study an experimental observation regarding the dynamics of transcephalic Electrical Bioimpedance (EBI) in patients undergoing cardiac surgery with and without extracorporeal circulation (ECC) was conducted to investigate the potential use of electrical Bioimpedance for cerebral monitoring in cardio vascular surgery. Tetrapolar transcephalic EBI measurements at single frequency of 50 kHz were recorded prior to and during cardio vascular surgery. The obtained results show that the transcephalic impedance decreases in both groups of patients as operation starts, however slight differences in these two groups were also observed with the cerebral impedance reduction in patients having no ECC being less common and not as pronounced as in the ECC group. Changes in the cerebral impedance were in agreement with changes of haematocrit and temperature. The origin of EBI changes is still unexplained however these results encourage us to continue investigating the application of electrical bioimpedance cerebral monitoring clinically.

  8. Iatrogenic facial nerve injuries during chronic otitis media surgery: a multicentre retrospective study.

    Science.gov (United States)

    Linder, T; Mulazimoglu, S; El Hadi, T; Darrouzet, V; Ayache, D; Somers, T; Schmerber, S; Vincent, C; Mondain, M; Lescanne, E; Bonnard, D

    2017-06-01

    To give an insight into why, when and where iatrogenic facial nerve (FN) injuries may occur and to explain how to deal with them in an emergency setting. Multicentre retrospective study in eight tertiary referral hospitals over 17 years. Twenty patients with partial or total FN injury during surgery for chronic otitis media (COM) were revised. Indication and type of surgery, experience of the surgeon, intra- and postoperative findings, value of CT scanning, patient management and final FN outcome were recorded. In 12 cases, the nerve was completely transected, but the surgeon was unaware in 11 cases. A minority of cases occurred in academic teaching hospitals. Tympanic segment, second genu and proximal mastoid segments were the sites involved during injury. The FN was not deliberately identified in 18 patients at the time of injury, and nerve monitoring was only applied in one patient. Before revision surgery, CT scanning correctly identified the lesion site in 11 of 12 cases and depicted additional lesions such as damage to the lateral semicircular canal. A greater auricular nerve graft was interposed in 10 cases of total transection and in one partially lesioned nerve: seven of them resulted in an HB III functional outcome. In two of the transected nerves, rerouting and direct end-to-end anastomosis was applied. A simple FN decompression was used in four cases of superficially traumatised nerves. We suggest checklists for preoperative, intraoperative and postoperative management to prevent and treat iatrogenic FN injury during COM surgery. © 2016 John Wiley & Sons Ltd.

  9. [Surgery as specialization for female physicians: Results from course evaluations and alumni studies at MHH].

    Science.gov (United States)

    Paulmann, V; Fischer, V; Dudzinska, A; Pabst, R

    2015-06-01

    There is a lack of young surgeons in Germany. In order to provide a successful learning environment in medical education and to attract more physicians, training concepts need to be regularly controlled. Evaluation results compiled over several years from the Hanover Medical School (MHH) were analyzed for gender-related differences. In addition to overall satisfaction with practical training items were included that consider aspects of interaction between students and instructors. Furthermore, alumni studies provided data on the postgraduate specialty choice made by MHH students. Surgical training is integrated into medical education as block training periods of various durations. Against the background of an increased percentage of women in medicine this article analyzed whether surgery is evaluated differently between female and male medical students with respect to their experiences in clinical teaching. Evaluations of clinical training in surgery demonstrated that female and male medical students do not differ substantially with respect to the teaching quality; however, young female physicians choose surgery as a professional option less frequently than men. A systematic review of clinical training evaluations is crucial to identify weaknesses of current curricula. More empirical data from other faculties can induce discussions about the attractiveness of surgery as a profession.

  10. A stepped strategy that aims at the nationwide implementation of the Enhanced Recovery After Surgery programme in major gynaecological surgery: study protocol of a cluster randomised controlled trial

    NARCIS (Netherlands)

    Groot, J.J.A.M. de; Maessen, J.M.; Slangen, B.F.; Winkens, B.; Dirksen, C.D.; Weijden, T.T. van der

    2015-01-01

    BACKGROUND: Enhanced Recovery After Surgery (ERAS) programmes aim at an early recovery after surgical trauma and consequently at a reduced length of hospitalisation. This paper presents the protocol for a study that focuses on large-scale implementation of the ERAS programme in major gynaecological

  11. A stepped strategy that aims at the nationwide implementation of the Enhanced Recovery After Surgery programme in major gynaecological surgery: study protocol of a cluster randomised controlled trial

    NARCIS (Netherlands)

    Groot, J.J.A.M. de; Maessen, J.M.; Slangen, B.F.; Winkens, B.; Dirksen, C.D.; Weijden, T.T. van der

    2015-01-01

    BACKGROUND: Enhanced Recovery After Surgery (ERAS) programmes aim at an early recovery after surgical trauma and consequently at a reduced length of hospitalisation. This paper presents the protocol for a study that focuses on large-scale implementation of the ERAS programme in major gynaecological

  12. A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study.

    Science.gov (United States)

    Li, Liang; Yang, Jian; Chu, Yakui; Wu, Wenbo; Xue, Jin; Liang, Ping; Chen, Lei

    2016-01-01

    To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery. In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems. The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D) virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons. The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon's skills and knowledge, not as a substitute.

  13. A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study

    Science.gov (United States)

    Li, Liang; Yang, Jian; Chu, Yakui; Wu, Wenbo; Xue, Jin; Liang, Ping; Chen, Lei

    2016-01-01

    Objective To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery. Materials and Methods In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems. Results The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D) virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons. Conclusion The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon’s skills and knowledge, not as a substitute. PMID:26757365

  14. A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study.

    Directory of Open Access Journals (Sweden)

    Liang Li

    Full Text Available To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery.In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems.The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons.The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon's skills and knowledge, not as a substitute.

  15. Adherence to ERAS elements in major visceral surgery-an observational pilot study.

    Science.gov (United States)

    Wolk, Steffen; Distler, Marius; Müssle, Benjamin; Söthje, Susanne; Weitz, Jürgen; Welsch, Thilo

    2016-05-01

    Enhanced recovery after surgery (ERAS) programs have been introduced increasingly into major visceral surgery. Key elements target on early drain removal and mobilization of the patients; however, reporting of adherence to ERAS protocols has often been insufficiently assessed. The present study aims to prospectively evaluate ERAS compliance after major visceral surgery. A prospective pilot study was designed, and 34 patients scheduled for major hepatopancreatic or gastric surgery were followed postoperatively until postoperative day (POD) 10. Analgesia and drain management, diet, mobilization, willingness to exercise, and the use of discharge criteria were accurately assessed within an established ERAS protocol scenario. Thirty-one cases were analyzed that consisted of 54.8 % major pancreatic, 29.0 % hepatic, and 16.1 % gastric resections. The median hospital stay was 12.5 days, and 83.9 % of the patients met the objective criteria before discharge. By POD 4, wound, epidural, and urinary catheters were still in place in 70, 60, and 40 % of the patients, respectively. Fifty percent of the patients ambulated out of bed until POD 2. The cumulative duration of postoperative mobilization per day ranged from 15 to 155 min, and only 40 % of the patients felt comfortable with additional mobilization or physical exercise. Adherence to ERAS protocols is poorly reported. The results indicate a discrepancy between ERAS targets and actual practice in comorbid patients undergoing major visceral surgery, need for a prompt redefinition of ERAS mobilization targets, need for the improvement of counseling, and need for the implementation of ERAS principles.

  16. A STUDY OF EFFECTS OF ORAL CLONIDINE ON PREMEDICATION AND HAEMODYNAMIC CHANGES DURING LAPAROSCOPIC SURGERY

    OpenAIRE

    Sanjeev Rao; Mahesh,

    2016-01-01

    BACKGROUND Use of Clonidine as a premedicant started incidentally. Clonidine is a potent antihypertensive drug that suppresses RAAS. Clonidine may be beneficial during laparoscopy in patients with hypertension, cardiovascular and/or renal diseases. AIM OF STUDY To determine the effects of Oral Clonidine on premedication and haemodynamic changes during Laparoscopic surgery. MATERIAL AND METHODS Study was conducted on 60 adult patients belonging to ASA physical...

  17. The benefits of hypopharyngeal packing in nasal surgery: a pilot study.

    LENUS (Irish Health Repository)

    Fennessy, B G

    2012-02-01

    BACKGROUND: Hypopharyngeal packs are used in nasal surgery to reduce the risk of aspiration and postoperative nausea and vomiting. Side effects associated with their use range from throat pain to retained packs postoperatively. AIM: To evaluate, as a pilot study, postoperative nausea\\/vomiting and throat pain scores for patients undergoing nasal surgery in whom a wet or dry hypopharyngeal pack was placed compared with patients who received no packing. METHODS: A randomized, double-blind prospective trial in a general ENT unit. RESULTS: The study failed to show a statistically significant difference between the three groups in terms of their postoperative nausea\\/vomiting and throat pain scores at 2 and 6 h postoperatively. This is the first study in which dry packs have been compared with wet and absent packs. CONCLUSION: Based on our findings, the authors recommend against placing hypopharyngeal packs for the purpose of preventing postoperative nausea and vomiting.

  18. A Pilot Study of an Acceptance-Based Behavioral Intervention for Weight Regain After Bariatric Surgery.

    Science.gov (United States)

    Bradley, Lauren E; Forman, Evan M; Kerrigan, Stephanie G; Butryn, Meghan L; Herbert, James D; Sarwer, David B

    2016-10-01

    Tens of thousands of bariatric surgery patients each year experience sub-optimal weight loss, significant regain, or both. Weight regain can contribute to a worsening of weight-related co-morbidities, and for some, leads to secondary surgical procedures. Poor weight outcomes have been associated with decreased compliance to the recommended postoperative diet. Decreased compliance may be partially due to a lack of psychological skills necessary to engage in healthy eating behaviors over the long term, especially as the effects of surgery (on appetite, hunger, and desire for food) decrease. Many behavioral interventions do not sufficiently address these challenges and often have limited effectiveness. The study aimed to evaluate the feasibility, acceptability, and preliminary effectiveness of a novel 10-week acceptance-based behavioral intervention to stop postoperative weight regain. A sample of bariatric surgery patients (n = 11) who regained at least 10 % of their maximum lost postoperative weight was recruited. All participants received the intervention, which emphasized psychological skills thought to be integral to successful weight control post-surgery. The intervention was shown to be feasible and acceptable, with 72 % retention and high mean rating (4.25 out of 5.00) of program satisfaction among completers. Weight regain was stopped, and even reversed, with a mean total body weight loss of 3.58 ± 3.02 % throughout the 10-week intervention. There were also significant improvements in eating-related and acceptance-related variables. These findings provide initial support for the use of a psychological acceptance-based intervention for weight regain in bariatric surgery patients.

  19. Effect of cataract surgery volume constraints on recently graduated ophthalmologists: a population-based cohort study

    Science.gov (United States)

    Campbell, Robert J.; El-Defrawy, Sherif R.; Bell, Chaim M.; Gill, Sudeep S.; Hooper, Philip L.; Whitehead, Marlo; Campbell, Erica de L.P.; Nesdole, Robert; Warder, Daniel; ten Hove, Martin

    2017-01-01

    BACKGROUND: Across Canada, graduates from several medical and surgical specialties have recently had difficulty securing practice opportunities, especially in specialties dependent on limited resources such as ophthalmology. We aimed to investigate whether resource constraints in the health care system have a greater impact on the volume of cataract surgery performed by recent graduates than on established physicians. METHODS: We used population-based administrative data from Ontario for the period Jan. 1, 1994, to June 30, 2013, to compare health services provided by recent graduates and established ophthalmologists. The primary outcome was volume of cataract surgery, a resource-intensive service for which volume is controlled by the province. RESULTS: When cataract surgery volume in Ontario entered a period of government-mandated zero growth in 2007, the mean number of cataract operations performed by recent graduates dropped significantly (−46.37 operations/quarter, 95% confidence interval [CI] −62.73 to −30.00 operations/quarter), whereas the mean rate for established ophthalmologists remained stable (+5.89 operations/quarter, 95% CI 95% CI −1.47 to +13.24 operations/quarter). Decreases in service provision among recent graduates did not occur for services without volume control. The proportion of recent graduates providing exclusively cataract surgery increased over the study period, and recent graduates in this group were 5.24 times (95% CI 2.15 to 12.76 times) more likely to fall within the lowest quartile for cataract surgical volume during the period of zero growth in provincial cataract volume (2007–2013) than in the preceding period (1996–2006). INTERPRETATION: Recent ophthalmology graduates performed many fewer cataract surgery procedures after volume controls were implemented in Ontario. Integrated initiatives involving multiple stakeholders are needed to address the issues facing recently graduated physicians in Canada. PMID:27920012

  20. Muscular workload of veterinary students during simulated open and laparoscopic surgery: A pilot study.

    Science.gov (United States)

    Kilkenny, Jessica; Larson, Dennis J; MacCormick, Mathew; Brown, Stephen H M; Singh, Ameet

    2017-08-01

    To compare upper extremity muscle activity and workload between simulated open surgery, multiple port laparoscopic surgery (MLS), and single incision laparoscopic surgery (SLS) techniques in veterinary students. Pilot study. Veterinary students (n = 10) from years 1 to 4. Bipolar skin surface electrodes were fixed bilaterally to the forearm flexor, forearm extensor, biceps brachii, triceps brachii, and upper trapezius muscles. Electromyography data were recorded during one repetition of 2 simulated surgical exercises via open surgery, MLS, and SLS. Participants completed a validated workload survey after each simulated surgical technique. Muscle activity and perceived workload were compared between surgical techniques with 1-way ANOVAs and Fisher's LSD post hoc tests. Muscle activity during peg transfer was higher with MLS and SLS compared to simulated open surgery in the right and left forearm extensors (both P < .0001), right (P < .0001) and left biceps (P = .0005), right triceps (P = .0004), and right upper trapezius muscles (P = .0211). Similar results were found for the right and left forearm extensors (both P < .0001), right (P = .0381) and left (P = .0147) forearm flexors, right biceps (P < .0001), and right triceps (P = .0004) during a simulated suture task. Participants found laparoscopic techniques more mentally demanding, physically demanding, complex, and stressful compared to a simulated open surgical technique. In veterinary students, average muscle activity and perceived workload were highest using MLS and SLS compared to an open surgical technique when performing simulated surgical exercises in a laparoscopic box trainer. © 2017 The American College of Veterinary Surgeons.

  1. ANALYSIS OF SURGICAL SITE INFECTIONS IN PEDIATRIC PATIENTS AFTER ORTHOPEDIC SURGERY: A CASE-CONTROL STUDY

    Science.gov (United States)

    Chagas, Mariana de Queiroz Leite; Costa, Ana Maria Magalhães; Mendes, Pedro Henrique Barros; Gomes, Saint Clair

    2017-01-01

    ABSTRACT Objectives: To describe the rate of surgical site infections in children undergoing orthopedic surgery in centers of excellence and analyze the patients’ profiles. Methods: Medical records of pediatric patients undergoing orthopedic surgery in the Jamil Haddad National Institute of Traumatology and Orthopedics from January 2012 to December 2013 were analyzed and monitored for one year. Patients diagnosed with surgical site infection were matched with patients without infection by age, date of admission, field of orthopedic surgery and type of surgical procedure. Patient, surgical and follow-up variables were examined. Descriptive, bivariate and correspondence analyses were performed to evaluate the patients’ profiles. Results: 347 surgeries and 10 surgical site infections (2.88%) were identified. There was association of infections with age - odds ratio (OR) 11.5 (confidence interval - 95%CI 1.41-94.9) -, implant - OR 7.3 (95%CI 1.46-36.3) -, preoperative period - OR 9.8 (95%CI 1.83-53.0), and length of hospitalization - OR 20.6 (95%CI 3.7-114.2). The correspondence analysis correlated the infection and preoperative period, weight, weight Z-score, age, implant, type of surgical procedure, and length of hospitalization. Average time to diagnosis of infection occurred 26.5±111.46 days after surgery. Conclusions: The rate of surgical site infection was 2.88%, while higher in children over 24 months of age who underwent surgical implant procedures and had longer preoperative periods and lengths of hospitalization. This study identified variables for the epidemiological surveillance of these events in children. Available databases and appropriate analysis methods are essential to monitor and improve the quality of care offered to the pediatric population.

  2. Comparative study on effect of different surgeries for vision and ocular tissues in leprosy patients with lagophthalmos

    Directory of Open Access Journals (Sweden)

    Jian-Sheng Hu

    2017-09-01

    Full Text Available AIM:To study the effect of different surgeries for vision and postoperative complications in leprosy patients with lagophthalmos.METHODS: A retrospective analysis. Totally 68 leprosy patients(97 eyeswith lagophthalmos were selected who treated with different surgeries during May 2007 to September 2015 in our sanatorium. The surgeries included nylon thread correction surgery, tarsorrhaphy, temporalis transposition surgery. We observed and compared the best corrected visual acuity(BCVAand the rate of postoperative complications, such as epiphora, lacrimal duct injury, hard to open eyes, infection at the inner and lateral canthus and scar formation of lacrimal apparatus.RESULTS: The effect on BCVA of patients treated with nylon thread correction surgery and tarsorrhaphy: the preoperative and postoperative BCVA was significantly different of the two groups(Z=-4.193, -4.213; PZ=-1.532, P >0.05. The postoperative complications:(1epiphora: there was 91% in patients underwent nylon thread correction surgery, 89% in patients underwent tarsorrhaphy, 59% in patients underwent temporalis transposition surgery, the difference was statistically significant(χ2=12.198, Pχ2=22.415, Pχ2=8.795, Pχ2=60.858, PCONCLUSION: There are certain clinical efficacy for lagophthalmos caused by leprosy after surgery, especially patients after temporalis transposition surgery can close eyes by oneself. And their vision does not change significantly, which suggests that this surgery may prevent exposure injury for cornea. But the iatrogenic injury, the vision decrease in patients underwent other surgeries and the ocular tissue damage, such as epiphora, lacrimal duct injury, hard to open eyes, infection at the inner and lateral canthus and scar formation of lacrimal apparatus should be pay more attention to.

  3. Inverting Comet Acoustic Surface Sounding Experiment (CASSE) touchdown signals to measure the elastic modulus of comet material

    Science.gov (United States)

    Arnold, W.; Faber, C.; Knapmeyer, M.; Witte, L.; Schröder, S.; Tune, J.; Möhlmann, D.; Roll, R.; Chares, B.; Fischer, H.; Seidensticker, K.

    2014-07-01

    The landing of Philae on comet 67P/Churyumov-Gerasimenko is scheduled for November 11, 2014. Each of the three landing feet of Philae house a triaxial acceleration sensor of CASSE, which will thus be the first sensors to be in mechanical contact with the cometary surface. CASSE will be in listening mode to record the deceleration of the lander, when it impacts with the comet at a velocity of approx. 0.5 m/s. The analysis of this data yields information on the reduced elastic modulus and the yield stress of the comet's surface material. We describe a series of controlled landings of a lander model. The tests were conducted in the Landing & Mobility Test Facility (LAMA) of the DLR Institute of Space Systems in Bremen, Germany, where an industrial robot can be programmed to move landers or rovers along predefined paths, allowing to adapt landing procedures with predefined velocities. The qualification model of the Philae landing gear was used in the tests. It consists of three legs manufactured of carbon fiber and metal joints. A dead mass of the size and mass of the lander housing is attached via a damper above the landing gear to represent the lander structure as a whole. Attached to each leg is a foot with two soles and a mechanically driven fixation screw (''ice screw'') to secure the lander on the comet. The right soles, if viewed from the outside towards the lander body, house a Brüel & Kjaer DeltaTron 4506 triaxial piezoelectric accelerometer as used on the spacecraft. Orientation of the three axes was such that one of the axes, here the X-axis of the accelerometer, points downwards, while the Y- and Z-axes are horizontal. Data were recorded at a sampling rate of 8.2 kHz within a time gate of 2 s. In parallel, a video sequence was taken, in order to monitor the touchdown on the sand and the movement of the ice screws. Touchdown measurements were conducted on three types of ground with landing velocities between 0.1 to 1.1 m/s. Landings with low velocities were

  4. Plastic surgery residents' attitudes and understanding of biostatistics: a pilot study.

    Science.gov (United States)

    Susarla, Srinivas M; Redett, Richard J

    2014-01-01

    To assess plastic surgery residents' knowledge, attitudes, and comfort with biostatistics. Cross-sectional study. Department of Plastic and Reconstructive Surgery at Johns Hopkins Hospital. A total of 22 plastic surgery residents (91% response rate) completed the study. The study sample consisted of 18 residents in the integrated training path and 4 in the independent training track and was equally divided between junior and senior residents. Most respondents (>54%) had taken at least 1 course in biostatistics or epidemiology. More than 90% of residents reported reading at least 1 plastic surgical journal on a regular basis (mean 2.1 ± 1.5 journals/month). Most residents expressed a desire to learn more about biostatistics (68.2%), reported using statistical information in forming clinical opinions (86.3%), and placed a high value on knowledge of biostatistics in appraising the surgical literature (90.9%). However, only 45% of respondents reported being able to understand all the statistical terms encountered in journal articles. Only 50% of respondents felt comfortable with assessing whether the appropriate statistical tests were used to answer a research question. In case studies, the mean percentage of correct responses was 53.0 ± 24.5% (range: 0-83.3). Higher performance scores were associated with a prior course in biostatistics (p = 0.04) and the number of journals read monthly (p = 0.003). Respondents had difficulty with study design (45.5% correct), analysis of variance (45.5% correct), time to event analysis (9.1% correct), and interpreting a 95% confidence interval (45.5% correct). The number of correct responses strongly correlated with respondent confidence in biostatistics (r = 0.70, p biostatistics but have only a fair understanding of core statistical concepts. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  5. Self-determination and motivation for bariatric surgery: a qualitative study.

    Science.gov (United States)

    Park, Juyeon

    2016-10-01

    This study examined how obese individuals acquire their motivation to undergo weight loss surgery and characterized the motivations within the framework of the self-determination theory (SDT). Participants expecting to have bariatric surgery were recruited and participated in semi-structured interviews. Interview accounts characterized different types of motivation for individuals seeking surgical weight loss treatments on the SDT continuum of relative autonomy. This study demonstrated that the more one's motivation was internally regulated, related to one's personal life and supported for competency, the more personal and hopeful were the anecdotes participants mentioned in accounts, thus the more positive the surgical outcomes were anticipated. Study limitations and future research were discussed as was the need for a systematic scheme to categorize types of motivation within the SDT, a longitudinal approach to measure actual weight loss outcomes based on the patient's pre-surgical motivation, and a further investigation with a larger sample size and balanced gender ratio. Practical implications of the study findings were also discussed as a novel strategy to internalize bariatric patients' motivation, further helping to improve their long-term quality of life post-surgery.

  6. Predictors of wound infection in elective colorectal surgery. Multicenter observational case-control study.

    Science.gov (United States)

    Fraccalvieri, Doménico; Kreisler Moreno, Esther; Flor Lorente, Blas; Torres García, Antonio; Muñoz Calero, Alberto; Mateo Vallejo, Francisco; Biondo, Sebastiano

    2014-01-01

    The aim of this study is to evaluate the usefulness of Vicryl Plus(®) suture in reducing the rate of postoperative wound infection in elective colorectal surgery. A prospective case-control multicenter study with 480 patients undergoing elective colorectal surgery was performed between 2006 and 2007. Patients were divided in 2 groups of equal sample size: group 1, closure of the abdominal wall using Vicryl Plus(®) and group 2 where PDS II(®) was used. The study involved 5 hospitals in the Spanish State. Wound infection was classified into superficial and deep. All patients diagnosed of wound infection during the hospital stay and up to 30 days after discharge were studied. For the statistical analysis Chi-square test and Fisher exact were used for bivariate analysis and logistic regression model for multivariate analysis. Wound infection rates were significantly lower in group 1: 14.6 vs. 29.2. Multivariate analysis showed that risk of wound infection was higher in patients with cancer, lung disease, anemia, operative time greater than 2 h, lack of second dose intra-operative prophylactic antibiotic and laparotomy closure with PDS suture II(®). The use of suture coated with triclosan can be an effective prophylactic tool in reducing wound infection rate in patients undergoing elective colorectal surgery. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  7. A CLINICAL STUDY OF EFFECT OF FIELD BLOCK ON INGUINAL HERNIORRHAPHY IN AN OUTPATIENT SURGERY

    Directory of Open Access Journals (Sweden)

    Velagalaburre Yalappa

    2016-01-01

    Full Text Available Aim of the study is to evaluate effectiveness of lignocaine with adrenaline for field block as well as for day care surgery and its complications. MATERIAL AND METHODS One hundred patients aged between 18 to 60 years of ASA class I and II posted for elective inguinal herniorrhaphy, agreeing and co-operative for inguinal field block. RESULTS An 80% patients had excellent, 15% had good, 2% had fair, 3% had poor quality of analgesia. Using modified Aldrete score. 1 fit for discharge studied; 12 patients became fit for discharge in 60 mins; 64 patients fit for discharge in 90 mins; 86 patients fit for discharge in 120 mins and 97 patients became fit for discharge in 150 mins. CONCLUSION Field block is found safe and fulfils the requirement of surgical relaxation and also best method as far as recovery profile is concerned in ambulatory surgery

  8. A tomographic study of positional and bony changes in the temporomandibular joint following orthognathic surgery

    Energy Technology Data Exchange (ETDEWEB)

    Song, Nam Kyu; Kim Min Suk; Koh, Kwang Joon [Dept. of Oral Radiology, College of Dentistry, Chonpook National University, Chonju (Korea, Republic of)

    1992-08-15

    The purpose of this study was to aid in the evaluation of prognosis of temporomandibular joint following orthognathic surgery. For this study, 20 patients (40 TMJ) who undergone orthognathic surgery were examined. Preoperative and postoperative tomograms of TMJ were taken. And the subjects were divided into 3 groups according to postoperative periods. The obtained results were as follows : 1. There were no significant differences between preoperative and postoperative changes in joint spaces in each group and between groups (P<0.05). 2. There were no significant differences between preoperative and postoperative ratio of joint spaces (P<0.05).3. There were no significant differences between preoperative and postoperative changes in the range of motion of condylar head (P<0.05). 4. The bony changes of condylar head were observed in 14 (35%) condyles (6 erosion, 2 flattening, 5 double contour, 1 osteophyte).

  9. Rehabilitative challenges in the bilateral aural stenosis post chronic suppurative otitis media surgery: A case study

    Directory of Open Access Journals (Sweden)

    Himanshu Verma

    2015-01-01

    Full Text Available Introduction: Chronic suppurative otitis media (CSOM is an infection characterized by recurrent ear discharge through a persistent tympanic membrane perforation. In cases such as these, an ASLP is concerned with early prevention, assessment and provision of suitable client based rehabilitation options. Case Report: A 3.5yrs old male with bilateral aural stenosis post CSOM surgery reported to clinic with a complaint of reduced hearing sensitivity to soft sounds with delayed in speech and language. A test battery approach for Audiological and Speech and Language evaluation was conducted. Recommendations and referrals were suggested at the end. Discussion: Regardless of all the restrictions, this study highlights the challenges encountered by an ASLP in dealing with post operative aural stenotic case. This case study highlights the occurrence of stenosis post surgery of bilateral CSOM, which is rarely found.

  10. Adoption of intracameral antibiotic prophylaxis of endophthalmitis following cataract surgery: update on the ESCRS Endophthalmitis Study.

    LENUS (Irish Health Repository)

    Barry, Peter

    2014-01-01

    To determine the use of intracameral cefuroxime at the end of cataract surgery since the beneficial results were first reported by the European Society of Cataract and Refractive Surgeons Endophthalmitis Study Group in 2006, 250 ophthalmic surgeons affiliated with both public and private hospitals and clinics across Europe were surveyed. The questions regarded their awareness of the results of the ESCRS endophthalmitis study and their current use or non-use of intracameral antibiotics in their cataract procedures. Seventy-four percent of respondents said they always or usually use intracameral antibiotics in their cataract surgery procedures. The most frequently cited reasons for not using cefuroxime or other intracameral antibiotics was the lack of an approved commercial preparation and related anxieties regarding the risk of dilution errors and contamination. More than 90% of respondents said they would use cefuroxime if an approved single-unit dose product were commercially available.

  11. Effect of massage therapy on pain, anxiety, relaxation, and tension after colorectal surgery: A randomized study.

    Science.gov (United States)

    Dreyer, Nikol E; Cutshall, Susanne M; Huebner, Marianne; Foss, Diane M; Lovely, Jenna K; Bauer, Brent A; Cima, Robert R

    2015-08-01

    The purpose of this randomized controlled trial was to evaluate the effect of postoperative massage in patients undergoing abdominal colorectal surgery. One hundred twenty-seven patients were randomized to receive a 20-min massage (n = 61) or social visit and relaxation session (no massage; n = 66) on postoperative days 2 and 3. Vital signs and psychological well-being (pain, tension, anxiety, satisfaction with care, relaxation) were assessed before and after each intervention. The study results indicated that postoperative massage significantly improved the patients' perception of pain, tension, and anxiety, but overall satisfaction was unchanged. In conclusion, massage may be beneficial during postoperative recovery for patients undergoing abdominal colorectal surgery. Further studies are warranted to optimize timing and duration and to determine other benefits in this clinical setting.

  12. Clinical attitudes towards pain treatment post-orthopedic surgery: a multicenter study in Beijing

    Institute of Scientific and Technical Information of China (English)

    WANG Zhi-qiang; ZHAN Si-yan; Marlene Fransen; LIN Jian-hao

    2012-01-01

    Background Pain is a common post-operative complication.Incidence of pain directly affects patients' quality of life in terms of patient physiology,psychology,and social characteristics.This study was to understand clinical attitudes with regards to Beijing surgeons,and patients' attitude towards pain treatment after orthopedic surgery.Methods A hospital-based cross-sectional and cluster sample survey of 40 hospitals in Beijing was conducted,including 20 level Ⅲ (tier three) and 20 level Ⅱ (tier two) general hospitals.Enrolled subjects completed a specifically designed interview-questionnaire.Results The prevalence of pain 2 weeks post-orthopedic surgery was high in Beijing (96.1%).Meanwhile,collected data indicated most subjects in Beijing suffered moderate to severe pain,45.1% and 41.4%,respectively,post-surgery.And for the concern of patients before surgery,most subjects chose full recovery from surgery (78.6%),as well as,the pain after operation was 39.2% ranked the third.According to the data from the study,Tramadol use was more common in Level Ⅲ hospitals,where Somiton was preferred in Level Ⅱ hospitals.When it came to the education of pain before and after operation,more patients get educated before operation than after it,In our study,case physicians or attending physicians enacted education before and after surgery.Related to the sense of patients,among the surgeons preferring post-operative analgesia,67.6% considered administration when receiving complaints of moderate level pain,50.0%indicated they will terminate analgesic treatment once pain degree scale wise decreases to benign pain.Conclusions The majority of orthopedic patients experience post-operative pain.Identification of post-operative pain will facilitate future awareness on pain treatment and nursing care in Beijing hospitals,with pain relief through regulated improvements in strategic pain management.

  13. The role of rehabilitative camouflage after cervicofacial reconstructive surgery: a preliminary study

    Directory of Open Access Journals (Sweden)

    Nicoletti G

    2014-01-01

    Full Text Available Giovanni Nicoletti,1–3 Andrea Sasso,1 Alberto Malovini,4,5 Luisa Ponchio,6 Silvia Scevola,2 Angela Faga,1–3 Aldo Pontone1 1Plastic and Reconstructive Surgery, Department of Clinical Surgical Diagnostic and Pediatric Sciences, 2Advanced Technologies for Regenerative Medicine and Inductive Surgery Research Centre, University of Pavia, Pavia, Italy; 3Plastic and Reconstructive Surgery Unit, Salvatore Maugeri Research and Care Institute, Pavia, Italy; 4Department of Computer Engineering and Systems Science, University of Pavia, Pavia, Italy; 5Laboratory of Informatics and Systems Engineering for Clinical Research, 6Oncology Unit, Salvatore Maugeri Research and Care Institute, Pavia, Italy Abstract: A randomized, prospective, controlled study was carried out at the Plastic and Reconstructive Surgery Unit of the University of Pavia, Salvatore Maugeri Research and Care Institute, Pavia, Italy, to evaluate the psychological benefits from corrective medical camouflage (CMC following surgical treatment for skin cancer of the face. Twenty-four female patients, following recovery from facial skin cancer surgery, were enrolled in the study over a period of 1 year. The study was performed using two health-related quality of life tests, the Satisfaction Profile (SAT-P test and the Body Uneasiness Test (BUT. The patients were randomized into two groups: group A, patients undergoing CMC; and group B, controls. Both the SAT-P and BUT demonstrated statistically significant better results in the treated patients versus the controls in the following functional parameters: Psychological Functionality (PsF, Physical Functionality (PhF, and Work Performance (WP for the SAT-P test and Compulsive Self-Monitoring (CSM for the BUT. The PsF demonstrated a better result 6 months post-treatment. Such a difference was particularly significant when comparing the performance at 6 months versus that at 3 months. The PhF demonstrated a better outcome at 6 months post

  14. Colonic stenting as bridge to surgery versus emergency surgery for management of acute left-sided malignant colonic obstruction: a multicenter randomized trial (Stent-in 2 study

    Directory of Open Access Journals (Sweden)

    Scholten Pieter

    2007-07-01

    Full Text Available Abstract Background Acute left-sided colonic obstruction is most often caused by malignancy and the surgical treatment is associated with a high mortality and morbidity rate. Moreover, these operated patients end up with a temporary or permanent stoma. Initial insertion of an enteral stent to decompress the obstructed colon, allowing for surgery to be performed electively, is gaining popularity. In uncontrolled studies stent placement before elective surgery has been suggested to decrease mortality, morbidity and number of colostomies. However stent perforation can lead to peritoneal tumor spill, changing a potentially curable disease in an incurable one. Therefore it is of paramount importance to compare the outcomes of colonic stenting followed by elective surgery with emergency surgery for the management of acute left-sided malignant colonic obstruction in a randomized multicenter fashion. Methods/design Patients with acute left-sided malignant colonic obstruction eligible for this study will be randomized to either emergency surgery (current standard treatment or colonic stenting as bridge to elective surgery. Outcome measurements are effectiveness and costs of both strategies. Effectiveness will be evaluated in terms of quality of life, morbidity and mortality. Quality of life will be measured with standardized questionnaires (EORTC QLQ-C30, EORTC QLQ-CR38, EQ-5D and EQ-VAS. Morbidity is defined as every event leading to hospital admission or prolonging hospital stay. Mortality will be analyzed as total mortality as well as procedure-related mortality. The total costs of treatment will be evaluated by counting volumes and calculating unit prices. Including 120 patients on a 1:1 basis will have 80% power to detect an effect size of 0.5 on the EORTC QLQ-C30 global health scale, using a two group t-test with a 0.05 two-sided significance level. Differences in quality of life and morbidity will be analyzed using mixed-models repeated measures

  15. Suction drain tip culture in orthopaedic surgery: a prospective study of 214 clean operations

    OpenAIRE

    Sankar, B.; P Ray; Rai, J.

    2004-01-01

    We conducted a prospective cohort study in order to determine whether suction drain specimen cultures from orthopaedic surgery predicted an early wound infection. We included 218 consecutive clean orthopaedic operations requiring drains in one unit over a period of 1 year. The suction drain tip, drain fluid and wound discharge specimens were cultured, and the surgical wound was followed up for 3 months. There were six deep and two superficial wound infections. Wound infection was significantl...

  16. "The study on surgical services for the United States": a valid prescription for American surgery?

    Science.gov (United States)

    Hughes, E F; Lewit, E M; Pauly, M V

    1977-01-01

    The overall approach of SOSSUS to the study of surgical services, the interpretation of findings, and policy recommendations are rightly called into question. But singular concern with the consequences of monopolistic control by the profession is no substitute for analysis of the dynamics among demand, production, and supply of surgery. Any delivery system--and many models are feasible--involving consumers, providers, and payers is a market in which multidimensional behavior must be anticipated.

  17. Routine calcium measurement is not necessary after most thyroid surgeries: a prospective clinical study.

    LENUS (Irish Health Repository)

    Quinn, E M

    2010-12-01

    Calcium levels are often measured to diagnose postoperative hypocalcaemia following thyroidectomy. The aims of this study were to (i) prospectively determine the incidence of symptomatic and biochemical hypocalcaemia following thyroidectomy, (ii) to identify if any associations exist between hypocalcaemia, type of surgery, histological diagnosis, specimen size\\/weight and the presence of histological parathyroid tissue and (iii) to evaluate the necessity of routine measurement of calcium levels following all thyroidectomies.

  18. A nationwide epidemiologic study of breast cancer incidence following breast reduction surgery in a large cohort of Swedish women.

    Science.gov (United States)

    Fryzek, Jon P; Ye, Weimin; Nyrén, Olof; Tarone, Robert E; Lipworth, Loren; McLaughlin, Joseph K

    2006-05-01

    While it has been demonstrated that prophylactic mastectomy reduces breast cancer incidence among women at high risk, many women often consider this disfiguring surgery unacceptable. One alternative approach may be breast reduction surgery. In order to evaluate the long-term incidence of breast cancer following surgical removal of breast tissue, we have extended by 9 years the follow-up period of our earlier retrospective cohort study of Swedish women electing cosmetic breast reduction surgery (n=30,444) between 1965 and 1993, yielding an average of nearly 16 years of follow-up. Cancer incidence through 2002 was ascertained via the Swedish Cancer Registry. Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated comparing women who underwent breast reduction surgery with women in the general Swedish population. Breast cancer was observed in 443 women versus 624 expected for a statistically significant reduced SIR of 0.71 (95% CI=0.65-0.78). Analyses by age at surgery, time since surgery or calendar year of surgery revealed similar reductions in risk. Our study of over 30,000 women with long-term follow-up offers further evidence that women undergoing breast reduction surgery have reduced breast cancer risk. As the evidence from large-scale cohort studies accumulates, direct testing of this reduction in risk through clinical trials should be considered.

  19. Antiphospholipid antibodies in vascular surgery patients. A cross-sectional study.

    Science.gov (United States)

    Taylor, L M; Chitwood, R W; Dalman, R L; Sexton, G; Goodnight, S H; Porter, J M

    1994-01-01

    BACKGROUND: Autoantibodies to phospholipid (aPL) have been associated with vascular thromboses in cerebral, coronary, and peripheral venous and arterial sites. To date, no large cross-sectional study has examined the incidence of occurrence of aPL in patients with peripheral arterial disease. METHODS: A cross-sectional study was performed with patients admitted for vascular surgery procedures to treat peripheral arterial disease for 23 months between January 1, 1990 and November 1, 1991. Consecutive patients were evaluated for the presence of aPL. Medical records for each patient were reviewed in detail, and historic, operative, and postoperative parameters were tabulated for relationship to the presence of aPL. RESULTS: Two hundred thirty-four patients underwent complete testing for aPL. All patients were receiving chronic aspirin therapy. This represented 86% of admissions. Antiphospholipid antibodies were detected in 60 patients (26%). No differences in age, sex, operation performed, or postoperative outcome were found between patients with and without aPL. However, patients with aPL were 1.8 times more likely to have undergone previous lower extremity (LE) vascular surgery than patients without aPL (95% confidence interval = 1.0 - 3.6, p = 0.047). Patients with aPL and previous LE vascular surgery were 5.6 times more likely to have had occlusion of that procedure than patients without aPL (95% confidence interval = 1.9 - 16.8, p = 0.03). The occluded previous LE procedures had a shorter duration of patency before occlusion in patients with aPL than in those without (mean duration of patency 17 months vs. 50 months, p < 0.003). Patients with occluded previous LE procedures and aPL were 4 times more likely to be female (95% C.I. = 1.4 - 11.3, p = 0.018). CONCLUSIONS: The incidence of aPL in vascular surgery patients is substantial. Vascular surgery patients with aPL are more likely to have failure of previous LE bypass procedures and to be female and the bypass

  20. Postoperative pain management with transdermal fentanyl after forefoot surgery: a randomized, placebo-controlled study

    Directory of Open Access Journals (Sweden)

    Merivirta R

    2015-01-01

    Full Text Available Riika Merivirta,1 Mikko Pitkänen,2 Jouko Alanen,3 Elina Haapoja,1 Mari Koivisto,4 Kristiina Kuusniemi11Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine of Turku University Hospital and University of Turku, Turku, 2Department of Anaesthesia, Hospital Orton, Invalid Foundation, Helsinki, 3Terveystalo Clinic Hospital, Helsinki, 4Department of Biostatistics, University of Turku, Turku, FinlandBackground: Quality of life is decreased in patients with hallux valgus deformity, mainly because of pain. Significant improvement is usually achieved by surgery. However, postoperative pain can be moderate to severe for 2–3 days. The aim of the present study was to evaluate the use of transdermal fentanyl for postoperative pain management after forefoot surgery.Methods: Sixty patients undergoing hallux valgus or hallux rigidus surgery were allocated to receive a patch delivering either fentanyl 12 µg/hour or placebo for postoperative pain. The consumption of rescue opioid oxycodone, the primary outcome measure, was evaluated daily until the fourth postoperative day. Total consumption of oxycodone during the study period was also assessed. Pain scores and possible adverse effects were evaluated every 6 hours during the first 24 hours and on the fourth postoperative day.Results: The use of rescue opioid was low in both groups, the median (range consumption of oxycodone being 10 (0–50 mg on the day of surgery (no difference between the groups, P=0.31 and 0 (0–35 mg thereafter. The total combined consumption was 10 (0–105 mg in the fentanyl group and 20 (0–70 mg in the placebo group (P=0.23. There were no statistically significant differences in pain scores or adverse effects between the groups.Conclusion: As a part of multimodal analgesia with ibuprofen and acetaminophen, a patch delivering fentanyl 12 µg/hour did not significantly decrease the consumption of rescue opioid or pain scores after forefoot surgery

  1. The study of risk factors of pressure sore for elective orthopedic surgery patients

    Directory of Open Access Journals (Sweden)

    Yuping ZHOU

    2013-12-01

    Full Text Available Objectives:The purposes of the study were to investigate the incidence of pressure ulcer of orthopedics patients undergoing selective operation, and to identify the risk factors of pressure ulcer.Methods: A prospective cohort study was employed in this study. Data were collected concerning the general characteristics as well as preoperative, intraoperative and postoperative indicators probable to induce pressure ulcer and then analyzed in view of the risk factors of pressure ulcer. Results: (1 Pressure ulcers developed in thirty five patients (10.1% on day 0 and the first 3 days following surgery; (2 age, hemoglobin, lymphocyte and getting up late for the first time after surgery were significantly associated with the occurrence of pressure ulcers (odds ratio 1.068,  0.948, 0.293, 1.019, respectively.Conclusions: (1 Patients have higher risk of developing pressure ulcer after operation, the critical period beginning from the operation day to the 3rd day after operation. (2 The age older, the later getting up for the first time after surgery, the liable it is for the patients to develop pressure ulcer postoperatively.

  2. [Anesthesia in the pleuropulmonary complications surgery of tuberculosis: a 79 cases study].

    Science.gov (United States)

    Kane, O; Diouf, E; Beye, M D; Diarra, O; Ndoye Diop, M; Diouf, M; Ndiaye, M; Ka Sall, B

    2003-01-01

    Reported is a retrospective study carried out from Aristide Le Dantec Hospital in patients who underwent pleuropulmonary surgery after tuberculosis complication, from June 1995 to June 1999. The aim of this study was to evaluate the anaesthesiology procedures and outcomes of tuberculosis pleuropulmonary complications surgery. Seventy nine patients were studied. Their mean age was 34.63 years, and the sex ratio was 3.14. They all underwent general anaesthesia procedures with barbituric, morphinics et myorelaxants drugs. The peroperative complications noted were distributed as follow: 50 cases of haemorrhage needing transfusion, 18 cases of hypotension associated to the anaesthesia. In the intensive care period, we have noticed 30 atelectasia cases associated to a spastic bronchopathy, 3 cases of pulmonary oedema and 1 case of pulmonary infarctus. In the postoperative period, 8 cases of hemodynamic instability occurred, including 5 cases of cardiovascular collapsus treated by filling, and 2 septic shocks cases. An infectious bronchopneumopathy was noticed on 11 patients with two cases of septicaemia. The mortality rate was 6.3% (5 cases of death). The pleuropulmonary surgery in tuberculosis complication is very haemorrhagic, and therefore require an adequate preoperative preparation.

  3. Sedation in oral and maxillofacial day care surgery: A comparative study between intravenous dexmedetomidine and midazolam.

    Science.gov (United States)

    Mishra, Niranjan; Birmiwal, Krishna Gopal; Pani, Nibedita; Raut, Subhrajit; Sharma, Gaurav; Rath, Krushna Chandra

    2016-01-01

    Sedation is an important component of day care oral and maxillofacial surgical procedures under local anesthesia. Although various sedative drugs in different regimens have been used for sedation, an ideal agent and regimen are yet to be established. The aim of this study is to compare the efficacy of intravenous (IV) dexmedetomidine and midazolam as a sedative agent for day care oral and maxillofacial surgical procedures. The study was conducted in the Department of Oral and Maxillofacial Surgery, SCB Dental College and Hospital, Cuttack, Odisha, India. A total of sixty adult patients of age group 18-65 years, of either sex were randomly selected equally in two groups for the study. One group named Group D received dexmedetomidine and the other named Group M received midazolam. Patients were evaluated for oxygen saturation (SPO2), respiration rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), Ramsay sedation score, bispectral index (BIS) score, amnesia, Aldrete score, relaxation during the surgery, and drug preference. Midazolam was associated with greater amnesia. Dexmedetomidine was associated with lower heart rate, SBP, and DBP. There was no significant difference in SPO2, RR, Aldrete score, Ramsay sedation score, and BIS score between the two drugs. Patient preference and relaxation were more in dexmedetomidine group. IV dexmedetomidine is a comparable alternative to midazolam for sedation in day care oral and maxillofacial surgery under local anesthesia. It is the preferred drug when a lower heart rate and blood pressure or less amnesia is needed without any serious side effects.

  4. Efficacy and safety of a diode laser in second-stage implant surgery: a comparative study.

    Science.gov (United States)

    El-Kholey, K E

    2014-05-01

    For more than a decade, peri-implant tissues have been treated with soft tissue lasers to create a bloodless flap for implant placement and to uncover implants with minimal bleeding, trauma, and anaesthesia. This study was designed to assess if dental implant uncovering is possible with a diode laser without anaesthesia, and to compare its performance with traditional cold scalpel surgery. Thirty patients with a total of 45 completely osseointegrated implants participated in this study. Patients were divided into two groups. For the study group, second-stage implant surgery was done with a 970nm diode laser. For the control group, the implants were exposed with a surgical blade. Certain parameters were used for evaluation of the two techniques. The use of the diode laser obviated the need for local anaesthesia; there was a significant difference between the two groups regarding the need for anaesthesia (Pdiode laser can be used effectively for second-stage implant surgery, providing both the dentist and the patient with additional advantages over the conventional methods used for implant exposure.

  5. Efficacy of fentanyl transdermal patch in pain control after lower third molar surgery: A preliminary study

    Science.gov (United States)

    Vasovic, Miroslav; Andric, Miroslav; Todorovic, Ljubomir; Kokovic, Vladimir

    2016-01-01

    Background Surgical removal of impacted lower third molars is a common oral surgical procedure, generally followed by moderate to severe postoperative pain. Transdermal drug delivery as a concept offers interesting possibilities for postoperative pain control. The aim of this study was to evaluate the efficacy of transdermal system with fentanyl in relieving pain following impacted lower third molar surgery. Material and Methods Seventeen patients with bilateral impacted lower third molars were included in this preliminary study. For postoperative pain control, patients randomly received a fentanyl patch plus placebo tablet after the first operation and regular (placebo) patch and an analgesic, after the second operation. Analgesia was evaluated during first 24 hours postoperatively according to patients’ reports about time of first pain appearance and additional analgesic consumption. Pain severity was rated using a 10 cm long visual analogue scale (VAS). Results Intensity of postoperative pain and postoperative analgesic consumption were significantly lower after the Fentanyl Transdermal System (FTS) was applied (p<0.05). Duration of postoperative analgesia was significantly higher with FTS when compared to control treatment (p<0.05). Conclusions Based on the results of this preliminary study, transdermal system with fentanyl significantly reduced postoperative pain after third molar surgery. Key words:Analgesia, fentanyl, transdermal administration, third molar surgery, acute pain, postoperative care. PMID:27475691

  6. Dexmedetomidine as an adjunct in postoperative analgesia following cardiac surgery: A randomized, double-blind study

    Directory of Open Access Journals (Sweden)

    Shio Priye

    2015-01-01

    Full Text Available Objectives: The purpose of this study was to determine analgesic efficacy of dexmedetomidine used as a continuous infusion without loading dose in postcardiac surgery patients. Settings and Design: A prospective, randomized, double-blind clinical study in a single tertiary care hospital on patients posted for elective cardiac surgery under cardiopulmonary bypass. Interventions: Sixty-four patients who underwent elective cardiac surgery under general anesthesia were shifted to intensive care unit (ICU and randomly divided into two groups. Group A (n = 32 received a 12 h infusion of normal saline and group B (n = 32 received a 12 h infusion of dexmedetomidine 0.4 μg/kg/h. Postoperative pain was managed with bolus intravenous fentanyl. Total fentanyl consumption, hemodynamic monitoring, Visual Analogue Scale (VAS pain ratings, Ramsay Sedation Scale were charted every 6 th hourly for 24 h postoperatively and followed-up till recovery from ICU. Student′s t-test, Chi-square/Fisher′s exact test has been used to find the significance of study parameters between the groups. Results: Dexmedetomidine treated patients had significantly less VAS score at each level (P < 0.001. Total fentanyl consumption in dexmedetomidine group was 128.13 ± 35.78 μg versus 201.56 ± 36.99 μg in saline group (P < 0.001. A statistically significant but clinically unimportant sedation was noted at 6 and 12 h (P < 0.001, and P = 0.046 respectively. Incidence of delirium was less in dexmedetomidine group (P = 0.086+. Hemodynamic parameters were statistically insignificant. Conclusions: Dexmedetomidine infusion even without loading dose provides safe, effective adjunct analgesia, reduces narcotic consumption, and showed a reduced trend of delirium incidence without undesirable hemodynamic effects in the cardiac surgery patients.

  7. The study of I-123-IMP-SPECT before and after surgery for craniosynostosis

    Energy Technology Data Exchange (ETDEWEB)

    Satoh, Motohiro (University Hospital of Tsukuba, Ibaraki (Japan)); Ishikawa, Nobuyoshi; Enomoto, Takao; Takeda, Tohru; Yoshizawa, Takashi; Nose, Tadao

    1990-12-01

    Single photon emission computed tomography with N-isopropyl-p-(I-123)iodoamphetamine was performed in 13 cases of craniosynostosis before and after surgery. Of 13 cases, 8 cases (62%) showed focal low perfusion area on preoperative study. Four of seven cases (57%) with brachycephaly showed low perfusion areas in either of frontal lobes, occipital lobes, and cerebellum. Besides, two patients with scaphocephaly and one with plagiocephaly showed low perfusion area in the unilateral cerebral hemisphere. Two Crouzon disease cases showed no focal low perfusion area, but an Apert disease showed low perfusion areas in both frontal lobes, cerebellum, as well as left occipital lobe. Corresponding CT and MRI showed no focal abnormality in any of these cases. These low perfusion areas were diminished or disappeared after surgical treatment in 6 cases (75%). We conclude that the I-123-IMP-SPECT is considered to be a useful index for the evaluation of functional recovery after surgery in cases of craniosynostosis. (author).

  8. Gingival recession following apical surgery in the esthetic zone: a clinical study with 70 cases

    DEFF Research Database (Denmark)

    von Arx, Thomas; Salvi, Giovanni E; Janner, Simone

    2009-01-01

    The present study evaluated gingival recession 1 year following apical surgery of 70 maxillary anterior teeth (central and lateral incisors, canines, and first premolars). A visual assessment of the mid-facial aspect of the gingival level and of papillary heights of treated teeth was carried out...... using photographs taken at pre-treatment and 1-year follow-up appointments. In addition, changes in the gingival margin (GM) and clinical attachment levels (CAL) were calculated with the use of clinical measurements, that is, pre-treatment and 1-year follow-up pocket probing depth and level of gingival...... margin. Changes in GM and CAL were then correlated with patient-, tooth-, and surgery-related parameters. The following parameters were found to significantly influence changes in GM and CAL over time: gingival biotype (P gingival recession than thick biotype...

  9. The effect of the Ontario Bariatric Network on health services utilization after bariatric surgery: a retrospective cohort study

    Science.gov (United States)

    Elnahas, Ahmad; Jackson, Timothy D.; Okrainec, Allan; Austin, Peter C.; Bell, Chaim M.; Urbach, David R.

    2016-01-01

    Background: In 2009, the Ontario Bariatric Network was established to address the exploding demand by Ontario residents for bariatric surgery services outside Canada. We compared the use of postoperative hospital services between out-of-country surgery recipients and patients within the Ontario Bariatric Network. Methods: We conducted a population-based, comparative study using administrative data held at the Institute for Clinical Evaluative Sciences. We included Ontario residents who underwent bariatric surgery between 2007 and 2012 either outside the country or at one of the Ontario Bariatric Network's designated centres of excellence. The primary outcome was use of hospital services in Ontario within 1 year after surgery. Results: A total of 4852 patients received bariatric surgery out of country, and 5179 patients underwent surgery through the Ontario Bariatric Network. After adjustment, surgery at a network centre was associated with a significantly lower utilization rate of postoperative hospital services than surgery out of country (rate ratio 0.90, 95% confidence interval [CI] 0.84 to 0.97). No statistically significant differences were found with respect to time in critical care or mortality. However, the physician assessment and reoperation rates were significantly higher among patients who received surgery at a network centre than among those who had bariatric surgery out of country (rate ratio 4.10, 95% CI 3.69 to 4.56, and rate ratio 1.84, 95% CI 1.34 to 2.53, respectively). Interpretation: The implementation of a comprehensive, multidisciplinary provincial program to replace outsourcing of bariatric surgical services was associated with less use of postoperative hospital services by Ontario residents undergoing bariatric surgery. Future research should include an economic evaluation to determine the costs and benefits of the Ontario Bariatric Network. PMID:27730113

  10. Current challenges in providing bariatric surgery in France: A nationwide study.

    Science.gov (United States)

    Czernichow, Sébastien; Paita, Michel; Nocca, David; Msika, Simon; Basdevant, Arnaud; Millat, Bertrand; Fagot-Campagna, Anne

    2016-12-01

    Bariatric surgery is a well-accepted procedure for severe and massive obesity management. We aimed to determine trends, geographical variations, and factors influencing bariatric surgery and the choice of procedure in France in a large observational study.The Health Insurance Fund for Salaried Workers (Caisse National Assurance Maladie Travailleurs Salariés) covers about 86% of the French population. The Système National d'Information Inter-régimes de l'Assurance Maladie database contains individualized and anonymized patient data on all reimbursements for healthcare expenditure. All types of primary bariatric procedures (Roux-en-Y gastric bypass [RYGB] or omega loop, adjustable gastric banding [AGB], or longitudinal sleeve gastrectomy [LSG]) performed during 2011 to 2013 were systematically recorded. Surgical techniques performed by region of residence and age-range relative risks with 95% confidence intervals of undergoing LSG or RYGB versus AGB were computed.In 2013, LSG was performed more frequently than RYGB and AGB (57% vs 31% and 13%, respectively). A total of 41,648 patients underwent a bariatric procedure; they were predominantly female (82%) with a mean (±standard deviation) age of 40 (±12) years and a body mass index ≥40 kg/m for 68% of them. A total of 114 procedures were performed in patients younger than 18 years and 2381 procedures were performed in patients aged 60 years and older. Beneficiaries of the French universal health insurance coverage for low-income patients were more likely to undergo surgery than the general population. Large nationwide variations were observed in the type choice of bariatric surgical procedures. Significant positive predictors for undergoing RYGB compared to those for undergoing AGB were as follows: referral to a center performing a large number of surgeries or to a public hospital, older age, female gender, body mass index ≥50 kg/m, and treatment for obstructive sleep apnea syndrome, diabetes, or

  11. Understanding the life experiences of Brazilian women after bariatric surgery: a qualitative study.

    Science.gov (United States)

    Magdaleno, Ronis; Chaim, Elinton Adami; Turato, Egberto Ribeiro

    2010-08-01

    The increase in bariatric surgeries has called into question the aspects that contribute to or impair the results. Psychosocial factors directly influence the results of the surgery, but a lot of controversy exists in relation to the degree of influence of these factors. We propose a qualitative investigation to understand the significance of the surgery for women and how these factors influence the outcomes. This study is a clinical-qualitative method, through the semi-directed interview with open-ended questions in an intentional sample, closed by saturation, with seven women operated in a period of 1.5-3 years, following the definition of emergent categories and qualitative content analysis. The experience of acceptance and social reinsertion is a motivating factor to keep up the challenge of weight loss; social discrimination is a risk factor leading to losing the stimulus to continue the process; the recuperation of self-esteem and personal identity is a factor that improves the quality of life and psychopathological symptoms; disillusionment is an important risk factor, linked principally to the experiences of failure. We observe the necessity of qualitative studies that serve the health team in the handling of these patients, aiming for a greater understanding of their psychological dynamics and of the meanings that weight loss has for them.

  12. [Validation and reliability study of the parent concerns about surgery questionnaire: What worries parents?

    Science.gov (United States)

    Gironés Muriel, Alberto; Campos Segovia, Ana; Ríos Gómez, Patricia

    2017-03-01

    The study of mediating variables and psychological responses to child surgery involves the evaluation of both the patient and the parents as regards different stressors. To have a reliable and reproducible valid evaluation tool that assesses the level of paternal involvement in relation to different stressors in the setting of surgery. A self-report questionnaire study was completed by 123 subjects of both sexes, subdivided into 2populations, due to their relationship with the hospital setting. The items were determined by a group of experts and analysed using the Lawshe validity index to determine a first validity of content. Subsequently, the reliability of the tool was determined by an item-re-item analysis of the 2sub-populations. A factorial analysis was performed to analyse the construct validity with the maximum likelihood and rotation of varimax type factors. A questionnaire of paternal concern was offered, consisting of 21 items with a Cronbach coefficient of 0.97, giving good precision and stability. The posterior factor analysis gives an adequate validity to the questionnaire, with the determination of 10 common stressors that cover 74.08% of the common and non-common variance of the questionnaire. The proposed questionnaire is reliable, valid and easy-to-apply and is developed to assess the level of paternal concern about the surgery of a child and to be able to apply measures and programs through the prior assessment of these elements. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  13. Barriers to nurse-patient communication in cardiac surgery wards: a qualitative study.

    Science.gov (United States)

    Shafipour, Vida; Mohammad, Eesa; Ahmadi, Fazlollah

    2014-08-15

    An appropriate and effective nurse-patient communication is of the most important aspect of caring. The formation and continuation of such a relationship depends on various factors such as the conditions and context of communication and a mutual understanding between the two. A review of the literature shows that little research is carried out on identification of such barriers in hospital wards between the patients and the healthcare staff. The present study was therefore conducted to explore the experiences of nurses and patients on communication barriers in hospital cardiac surgery wards. This qualitative research was carried out using a content analysis method (Graneheim & Lundman, 2004). The participants were selected by a purposeful sampling and consist of 10 nurses and 11 patients from the cardiac surgery wards of three teaching hospitals in Tehran, Iran. Data was gathered by unstructured interviews. All interviews were audio-taped and transcribed verbatim. Findings were emerged in three main themes including job dissatisfaction (with the sub-themes of workload tension and decreased motivation), routine-centered care (with the sub-themes of habitual interventions, routinized and technical interventions, and objective supervision), and distrust in competency of nurses (with the sub-themes of cultural contrast, less responsible nurses, and their apathy towards the patients). Compared to other studies, our findings identified different types of communication barriers depending on the nursing settings. These findings can be used by the ward clinical nursing managers at cardiac surgery wards to improve the quality of nursing care.

  14. Meralgia paraesthetica following lumbar spine surgery: A study in 110 consecutive surgically treated cases

    Directory of Open Access Journals (Sweden)

    Gupta A

    2004-01-01

    Full Text Available Background: Lateral cutaneous femoral nerve (LCFN injury or Meralgia paraesthetica (MP results in restriction of activity. Compression of the nerve by disc hernia, retroperitoneal tumors, and external pressure around the anterior superior iliac spine is common. However, it is not commonly observed after lumbar spinal surgery in prone position. Study design: In this prospective study of 110 patients who underwent elective lumbar spinal surgery, managed from January 2002 to June 2002, the incidence, possible risk factors, etiopathogenesis and management of MP were analyzed. Results: There were 66 males and 44 females. The age of the patients ranged from 15 to 81 years (mean 46.9 yrs.. Thirteen patients (12% suffered from MP. It is more common in thinner individuals due to pressure injury to the nerve at its exit point. Ninety-two per cent of the patients were asymptomatic at follow-up after 6 months. In 7 out of 13 patients, patchy sensory loss on clinical examination was seen at 6 months. Conclusion: MP after posterior lumbar spinal surgery is uncommon. Smaller bolsters may avoid some of the vulnerable pressure points, as the surface area available is relatively smaller. The posts of the Hall-Relton frame over the anterior superior iliac crest should be adequately padded. The condition is usually self-limiting. Surgical division or decompression of the LCFN is reserved for persistent or severe MP.

  15. Surgery or general medicine: a study of the reasons underlying the choice of medical specialty

    Directory of Open Access Journals (Sweden)

    Patrícia Lacerda Bellodi

    Full Text Available CONTEXT: The reality of medical services in Brazil points towards expansion and diversification of medical knowledge. However, there are few Brazilian studies on choosing a medical specialty. OBJECTIVE: To investigate and characterize the process of choosing the medical specialty among Brazilian resident doctors, with a comparison of the choice between general medicine and surgery. TYPE OF STUDY: Stratified survey. SETTING: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP. METHODS: A randomized sample of resident doctors in general medicine (30 and surgery (30 was interviewed. Data on sociodemographic characteristics and the moment, stability and reasons for the choice of specialty were obtained. RESULTS: The moment of choice between the two specialties differed. Surgeons (30% choose the specialty earlier, while general doctors decided progressively, mainly during the internship (43%. Most residents in both fields (73% general medicine, 70% surgery said they had considered another specialty before the current choice. The main reasons for general doctors' choice were contact with patients (50%, intellectual activities (30% and knowledge of the field (27%. For surgeons the main reasons were practical intervention (43%, manual activities (43% and the results obtained (40%. Personality was important in the choice for 20% of general doctors and for 27% of surgeons. DISCUSSION: The reasons found for the choice between general medicine and surgery were consistent with the literature. The concepts of wanting to be a general doctor or a surgeon are similar throughout the world. Personality characteristics were an important influencing factor for all residents, without statistical difference between the specialties, as was lifestyle. Remuneration did not appear as a determinant. CONCLUSION: The results from this group of Brazilian resident doctors corroborated data on choosing a medical specialty from other countries

  16. An excellent navigation system and experience in craniomaxillofacial navigation surgery: a double-center study.

    Science.gov (United States)

    Dai, Jiewen; Wu, Jinyang; Wang, Xudong; Yang, Xudong; Wu, Yunong; Xu, Bing; Shi, Jun; Yu, Hongbo; Cai, Min; Zhang, Wenbin; Zhang, Lei; Sun, Hao; Shen, Guofang; Zhang, Shilei

    2016-06-16

    Numerous problems regarding craniomaxillofacial navigation surgery are not well understood. In this study, we performed a double-center clinical study to quantitatively evaluate the characteristics of our navigation system and experience in craniomaxillofacial navigation surgery. Fifty-six patients with craniomaxillofacial disease were included and randomly divided into experimental (using our AccuNavi-A system) and control (using Strker system) groups to compare the surgical effects. The results revealed that the average pre-operative planning time was 32.32 mins vs 29.74 mins between the experimental and control group, respectively (p > 0.05). The average operative time was 295.61 mins vs 233.56 mins (p > 0.05). The point registration orientation accuracy was 0.83 mm vs 0.92 mm. The maximal average preoperative navigation orientation accuracy was 1.03 mm vs 1.17 mm. The maximal average persistent navigation orientation accuracy was 1.15 mm vs 0.09 mm. The maximal average navigation orientation accuracy after registration recovery was 1.15 mm vs 1.39 mm between the experimental and control group. All patients healed, and their function and profile improved. These findings demonstrate that although surgeons should consider the patients' time and monetary costs, our qualified navigation surgery system and experience could offer an accurate guide during a variety of craniomaxillofacial surgeries.

  17. Are non-cardiac surgeries safe for dialysis patients? - A population-based retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Yih-Giun Cherng

    Full Text Available BACKGROUND: End-stage renal disease represents a risk complex that complicates surgical results. The surgical outcomes of dialysis patients have been studied in specific fields, but the global features of postoperative adverse outcomes in dialysis patients receiving non-cardiac surgeries have not been examined. METHODS: Taiwan's National Health Insurance Research Database was used to study 8,937 patients under regular dialysis with 8,937 propensity-score matched-pair controls receiving non-cardiac surgery between 2004 and 2007. We investigated the influence of hemodialysis and peritoneal dialysis, effects of hypertension and diabetes, and impact of additional comorbidities on postoperative adverse outcomes. RESULTS: Postoperative mortality in dialysis patients was higher than in controls (odds ratio [OR] 3.33, 95% confidence interval [CI] 2.56 to 4.33 when receiving non-cardiac surgeries. Complications such as acute myocardial infarction, pneumonia, bleeding, and septicemia were significantly increased. Postoperative mortality was significantly increased among peritoneal dialysis patients (OR 2.71, 95% CI 1.70 to 4.31 and hemodialysis patients (OR 3.42, 95% CI 2.62 to 4.47 than in controls. Dialysis patients with both hypertension and diabetes had the highest risk of postoperative complications; these risks increased with number of preoperative medical conditions. Patients under dialysis also showed significantly increased length of hospitalization, more ICU stays and higher medical expenditures. CONCLUSION: Surgical patients under dialysis encountered significantly higher postoperative complications and mortality than controls when receiving non-cardiac surgeries. Different dialysis techniques, pre-existing hypertension/diabetes, and various comorbidities had complication-specific impacts on surgical adverse outcomes. These findings can help surgical teams provide better risk assessment and postoperative care for dialysis patients.

  18. Collagen implant with gentamicin sulphate reduces surgical site infection in vascular surgery: a prospective cohort study.

    Science.gov (United States)

    Costa Almeida, Carlos Eduardo Perdigão; Reis, Luis; Carvalho, Luis; Costa Almeida, Carlos Manuel

    2014-10-01

    Surgical site infection (SSI) is a common complication after vascular surgery. It may cause exposure of the underlying prosthesis causing graft infection, which may require the removal of the vascular graft, increasing amputation and mortality risks. Graft contamination usually occurs during operative procedure or by direct spread from an infected wound. It is therefore advisable to a strong effort in reducing SSI. Topic antibiotics have not been fully studied in vascular surgery, but collagen implant with gentamicin sulphate has shown to reduce SSI in cardiac surgery, orthopaedics, and general surgery procedures. Sixty (60) non-diabetic and non-obese patients with lower limb ischaemia with indication for femoropopliteal PTFE prosthetic bypass were allocated into 2 groups of 30 patients. A collagen implant impregnated with gentamicin sulphate (Collatamp(®)) was applied in the groin incision adjacent to the prosthesis in one group, and the other was a control group. The same surgical team operated all patients. Szilagyi classification was used. There was no SSI (0% - 0/30) in the collagen implant with gentamicin sulphate group, contrasting with 6 cases (20% - 6/30) of SSI (grade I and II) in the control group (p = 0.024). In-hospital day's data shows a significant difference between the two groups (p = 0.004) with a mean of 5.66 days for implant group and 8.10 days for control group. There was no SSI grade III. Collagen implant with gentamicin sulphate (Collatamp(®)) reduces SSI in the groin incision in ischaemic patients submitted to femoropopliteal PTFE prosthetic bypass. Days of hospitalization are also reduced. Decreasing SSI rate and in-hospital days, this implant may also reduce health care costs. Because this is a small pilot study, a multicentre RCT is necessary for validation. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  19. The quality of control groups in nonrandomized studies published in the Journal of Hand Surgery.

    Science.gov (United States)

    Johnson, Shepard P; Malay, Sunitha; Chung, Kevin C

    2015-01-01

    To evaluate control group selection in nonrandomized studies published in the Journal of Hand Surgery American (JHS). We reviewed all papers published in JHS in 2013 to identify studies that used nonrandomized control groups. Data collected included type of study design and control group characteristics. We then appraised studies to determine whether authors discussed confounding and selection bias and how they controlled for confounding. Thirty-seven nonrandomized studies were published in JHS in 2013. The source of control was either the same institution as the study group, a different institution, a database, or not provided in the manuscript. Twenty-nine (78%) studies statistically compared key characteristics between control and study group. Confounding was controlled with matching, exclusion criteria, or regression analysis. Twenty-two (59%) papers explicitly discussed the threat of confounding and 18 (49%) identified sources of selection bias. In our review of nonrandomized studies published in JHS, papers had well-defined controls that were similar to the study group, allowing for reasonable comparisons. However, we identified substantial confounding and bias that were not addressed as explicit limitations, which might lead the reader to overestimate the scientific validity of the data. Incorporating a brief discussion of control group selection in scientific manuscripts should help readers interpret the study more appropriately. Authors, reviewers, and editors should strive to address this component of clinical importance. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  20. Orthognathic Surgery

    DEFF Research Database (Denmark)

    Kjærgaard Larsen, Marie; Thygesen, Torben Henrik

    2016-01-01

    The literature shows that the indications for orthognathic surgery (OS) are often functional problems and unsatisfactory facial esthetics. This study investigated the esthetic outcomes and overall satisfaction following OS. Somatosensory change is a relatively common complication and its influence...... on the level of satisfaction was studied. The social-networking web site Facebook was used to identify the study population. An online questionnaire was performed using the website SurveyMonkey. In all, 105 (9%) respondents from the Danish Facebook group about OS, called Kaebeoperation (jaw surgery), were...... in beauty than women (P = 0.030). Sixty-four percent replied that their attractiveness had been increased after OS. Eighty-six percent were happy with the results and 89% would recommend the surgery to others in need. No significant differences in esthetic results and satisfaction were seen with regard...

  1. Thyroid Surgery

    Science.gov (United States)

    ... Fax/Phone Home » Thyroid Surgery Leer en Español Thyroid Surgery GENERAL INFORMATION Your doctor may recommend that ... made in conjunction with your endocrinologist and surgeon. Thyroid Surgery FAQs QUESTIONS AND CONSIDERATIONS When thyroid surgery ...

  2. Plastic Surgery

    Science.gov (United States)

    ... Surgery? A Week of Healthy Breakfasts Shyness Plastic Surgery KidsHealth > For Teens > Plastic Surgery Print A A ... forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word "plastic" ...

  3. A Qual Abyssi ity cha inica C aracter Cass.) p rization produc Et n of ...

    African Journals Online (AJOL)

    SAM

    High cholesterol, smoking and high blood pressure are the principal ... as providing essential components of membrane and serving as a ... cold temperature storage of the fruit. This high ... oil chain length that is used in this study. According to.

  4. [Study on effect of spine surgery on gastric function and its efficacy of relevant treatments].

    Science.gov (United States)

    Lin, X; Wu, J; Du, J

    2000-11-01

    To study the effect of spine surgery (SpS) on gastric function and the efficacy of relevant treatments. Sixty patients in the spine surgery group, 20 patients in the extremity surgery (ES) group and 20 healthy subjects in the control group were observed. Electrogastrography (EGG) was used to observe gastroelectric activity before and after operation. Twenty patients among the SpS group were examined with barium meal under actinoscopy to observe the gastric peristaltic waves before and after operation. The SpS group was randomly subdivided into 3 groups, and treated by Xiangsha Yangwei pill (XSYW), moxibustion and motilium respectively. At the same time, the EGG of various groups was observed and the change of preoperative and postoperative EGG were compared. The gastroelectric rhythm of SpS group was remarkably abnormal, both frequency and amplitude of EGG were significantly different from the other two groups (P 0.05). SpS could change the gastroelectric rhythm to cause the gastric functional disorder and induce gastroparesis, EGG can get satisfactory results in the diagnosis of these illnesses. XSYW, moxibustion and motilium all have significant effects on the gastric function after SpS.

  5. Is the Use of a Drain for Thyroid Surgery Realistic? A Prospective Randomized Interventional Study

    Directory of Open Access Journals (Sweden)

    Ugur Deveci

    2013-01-01

    Full Text Available Background. The use of a suction drain in thyroid surgery is common practice in order to avoid hematomas or seromas. The aim of this study was to determine the efficacy of routine drainage after thyroid surgery. Methods. In this prospective randomized trial, 400 patients who underwent either a total thyroidectomy or lobectomy for thyroid disorders were randomly allocated to either the nondrainage (group 1 or the drainage (group 2 group. The volume of fluid collection in the operative bed, postoperative pain, complications, and length of hospital stay were then recorded. Results. Both groups were homogeneous according to age, gender, thyroid volume, type of procedure performed, and histopathological diagnosis. After assessment by USG, no significant difference was found between the groups in the fluid collection of the thyroid bed (, but the length of hospital stay was significantly reduced in group 1 (. Conclusions. In our experience, the use of drain for thyroid surgery is not a routine procedure. However, it should be used in the presence of extensive dead space, particularly when there is retrosternal or intrathoracic extension, or when the patient is on anticoagulant treatment. This trial was registered with clinical Trials.gov NCT01771523.

  6. Pilot prospective study of post-surgery sleep and EEG predictors of post-operative delirium.

    Science.gov (United States)

    Evans, Joanna L; Nadler, Jacob W; Preud'homme, Xavier A; Fang, Eric; Daughtry, Rommie L; Chapman, Joseph B; Attarian, David; Wellman, Samuel; Krystal, Andrew D

    2017-08-01

    Delirium is a common post-operative complication associated with significant costs, morbidity, and mortality. We sought sleep/EEG predictors of delirium present prior to delirium symptoms to facilitate developing and targeting therapies. Continuous EEG data were obtained in 12 patients post-orthopedic surgery from the day of surgery until delirium assessment on post-operative day 2 (POD2). Diminished total sleep time (r=-0.68; pdelirium severity. Patients experiencing delirium slept 2.4h less and took 2h longer to fall asleep. Greater waking EEG delta power (r=0.84; pdelirium severity. Loss of sleep on night1 post-surgery is an early predictor of subsequent delirium. EEG Delta Power alterations in waking and sleep appear to be later indicators of impending delirium. Further work is needed to evaluate reproducibility/generalizability and assess whether sleep loss contributes to causing delirium. This first study to prospectively collect continuous EEG data for an extended period prior to delirium onset identified EEG-derived indices that predict subsequent delirium that could aid in developing and targeting therapies. Copyright © 2017. Published by Elsevier B.V.

  7. Nonshaved cranial surgery in black Africans: technical report and a medium-term prospective outcome study.

    Science.gov (United States)

    Adeleye, Amos O

    2016-07-01

    Nonshaved neurosurgery, cranial or spinal, is well reported among Caucasians but hardly among native Africans. The ungroomed scalp hairs of black Africans have unique anthropological characteristics needing special attention for shaveless cranial surgery. A technical report of the execution of this surgical procedure among an indigenous patient population in a sub-Sahara African country is presented, as well as an outcome analysis in a prospective cohort over a 7-year period. A total of 303 patients (211 males, 70 %) fulfilled the criteria for this study. The surgical procedure was primary in 278 (92 %) and redo in 8 %. It was emergency surgery in 153 (51 %). They were trauma craniotomies or decompressive craniectomies in 95 cases (31 %), craniotomies for tumour resections in 86 (28 %), and the surgical dissections for other conditions in 122 (41 %). The duration of surgery ranged from 30 min to 8.5 h, mean 2.5 (SD, 1.6), median 2. In-hospital clinical outcome was good (normal status or moderate deficit on dichotomized Glasgow outcome scale (GOS)) in 273 (90.1 %) cases while surgical site infections occurred in only 10 cases (3.3 %). The type of surgery, redo or primary, did not have any significant association with the in-hospital outcome (p = 0.5), nor with the presence of surgical site infection (SSI) (p = 0.7). The length of follow-up ranged from 2 to 63 months (mean, 7) with no untoward complications reported so far. Medium-term outcome of nonshaved neurosurgery in this indigenous black Africans remains favourable with no attendant significant adverse after-effects.

  8. Are general surgery residents adequately prepared for hepatopancreatobiliary fellowships? A questionnaire-based study

    Science.gov (United States)

    Osman, Houssam; Parikh, Janak; Patel, Shirali; Jeyarajah, D Rohan

    2015-01-01

    Background The present study was conducted to assess the preparedness of hepatopancreatobiliary (HPB) fellows upon entering fellowship, identify challenges encountered by HPB fellows during the initial part of their HPB training, and identify potential solutions to these challenges that can be applied during residency training. Methods A questionnaire was distributed to all HPB fellows in accredited HPB fellowship programmes in two consecutive academic years (n = 42). Reponses were then analysed. Results A total of 19 (45%) fellows responded. Prior to their fellowship, 10 (53%) were in surgical residency and the rest were in other surgical fellowships or surgical practice. Thirteen (68%) were graduates of university-based residency programmes. All fellows felt comfortable in performing basic laparoscopic procedures independently at the completion of residency and less comfortable in performing advanced laparoscopy. Eight (42%) fellows cited a combination of inadequate case volume and lack of autonomy during residency as the reasons for this lack of comfort. Thirteen (68%) identified inadequate preoperative workup and management as their biggest fear upon entering practice after general surgery training. A total of 17 (89%) fellows felt they were adequately prepared to enter HPB fellowship. Extra rotations in transplant, vascular or minimally invasive surgery were believed to be most helpful in preparing general surgery residents pursing HPB fellowships. Conclusions Overall, HPB fellows felt themselves to be adequately prepared for fellowship. Advanced laparoscopic procedures and the perioperative management of complex patients are two of the challenges facing HPB fellows. General surgery residents who plan to pursue an HPB fellowship may benefit from spending extra rotations on certain subspecialties. Focus on perioperative workup and management should be an integral part of residency and fellowship training. PMID:25387852

  9. Surgical treatment of tricuspid regurgitation after mitral valve surgery: a retrospective study in China

    Directory of Open Access Journals (Sweden)

    Li Zong-Xiao

    2012-04-01

    Full Text Available Abstract Background Functional tricuspid regurgitation (TR occurs in patients with rheumatic mitral valve disease even after mitral valve surgery. The aim of this study was to analyze surgical results of TR after previous successful mitral valve surgery. Methods From September 1996 to September 2008, 45 patients with TR after previous mitral valve replacement underwent second operation for TR. In those, 43 patients (95.6% had right heart failure symptoms (edema of lower extremities, ascites, hepatic congestion, etc. and 40 patients (88.9% had atrial fibrillation. Twenty-six patients (57.8% were in New York Heart Association (NYHA functional class III, and 19 (42.2% in class IV. Previous operations included: 41 for mechanical mitral valve replacement (91.1%, 4 for bioprosthetic mitral valve replacement (8.9%, and 7 for tricuspid annuloplasty (15.6%. Results The tricuspid valves were repaired with Kay's (7 cases, 15.6% or De Vega technique (4 cases, 8.9%. Tricuspid valve replacement was performed in 34 cases (75.6%. One patient (2.2% died. Postoperative low cardiac output (LCO occurred in 5 patients and treated successfully. Postoperative echocardiography showed obvious reduction of right atrium and ventricle. The anterioposterior diameter of the right ventricle decreased to 25.5 ± 7.1 mm from 33.7 ± 6.2 mm preoperatively (P Conclusion TR after mitral valve replacement in rheumatic heart disease is a serious clinical problem. If it occurs or progresses late after mitral valve surgery, tricuspid valve annuloplasty or replacement may be performed with satisfactory results. Due to the serious consequence of untreated TR, aggressive treatment of existing TR during mitral valve surgery is recommended.

  10. [Effects of carbon dioxide insufflation on regional cerebral oxygenation during laparoscopic surgery in children: a prospective study].

    Science.gov (United States)

    Tuna, Ayca Tas; Akkoyun, Ibrahim; Darcin, Sevtap; Palabiyik, Onur

    2016-01-01

    Laparoscopic surgery has become a popular surgical tool when compared to traditional open surgery. There are limited data on pediatric patients regarding whether pneumoperitoneum affects cerebral oxygenation although end-tidal CO2 concentration remains normal. Therefore, this study was designed to evaluate the changes of cerebral oxygen saturation using near-infrared spectroscope during laparoscopic surgery in children. The study comprised forty children who were scheduled for laparoscopic (Group L, n=20) or open (Group O, n=20) appendectomy. Hemodynamic variables, right and left regional cerebral oxygen saturation (RrSO2 and LrSO2), fraction of inspired oxygen, end-tidal carbon dioxide pressure (PETCO2), peak inspiratory pressure (Ppeak), respiratory minute volume, inspiratory and end-tidal concentrations of sevoflurane and body temperature were recorded. All parameters were recorded after anesthesia induction and before start of surgery (T0, baseline), 15min after start of surgery (T1), 30min after start of surgery (T2), 45min after start of surgery (T3), 60min after start of surgery (T4) and end of the surgery (T5). There were progressive decreases in both RrSO2 and LrSO2 levels in both groups, which were not statistically significant at T1, T2, T3, T4. The RrSO2 levels of Group L at T5 were significantly lower than that of Group O. One patient in Group L had an rSO2 value <80% of the baseline value. Carbon dioxide insufflation during pneumoperitoneum in pediatric patients may not affect cerebral oxygenation under laparoscopic surgery. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  11. Effects of carbon dioxide insufflation on regional cerebral oxygenation during laparoscopic surgery in children: a prospective study.

    Science.gov (United States)

    Tuna, Ayca Tas; Akkoyun, Ibrahim; Darcin, Sevtap; Palabiyik, Onur

    2016-01-01

    Laparoscopic surgery has become a popular surgical tool when compared to traditional open surgery. There are limited data on pediatric patients regarding whether pneumoperitoneum affects cerebral oxygenation although end-tidal CO2 concentration remains normal. Therefore, this study was designed to evaluate the changes of cerebral oxygen saturation using near-infrared spectroscope during laparoscopic surgery in children. The study comprised forty children who were scheduled for laparoscopic (Group L, n=20) or open (Group O, n=20) appendectomy. Hemodynamic variables, right and left regional cerebral oxygen saturation (RrSO2 and LrSO2), fraction of inspired oxygen, end-tidal carbon dioxide pressure (PETCO2), peak inspiratory pressure (Ppeak), respiratory minute volume, inspiratory and end-tidal concentrations of sevoflurane and body temperature were recorded. All parameters were recorded after anesthesia induction and before start of surgery (T0, baseline), 15min after start of surgery (T1), 30min after start of surgery (T2), 45min after start of surgery (T3), 60min after start of surgery (T4) and end of the surgery (T5). There were progressive decreases in both RrSO2 and LrSO2 levels in both groups, which were not statistically significant at T1, T2, T3, T4. The RrSO2 levels of Group L at T5 were significantly lower than that of Group O. One patient in Group L had an rSO2 value <80% of the baseline value. Carbon dioxide insufflation during pneumoperitoneum in pediatric patients may not affect cerebral oxygenation under laparoscopic surgery. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  12. Sexual dysfunction following surgery for rectal cancer - a clinical and neurophysiological study

    Directory of Open Access Journals (Sweden)

    Sperduti Isabella

    2009-09-01

    Full Text Available Abstract Background Sexual dysfunction following surgery for rectal cancer may be frequent and often severe. The aim of the present study is to evaluate the occurrence of this complication from both a clinical point of view and by means of neurophysiological tests. Methods We studied a group of 57 patients submitted to rectal resection for adenocarcinoma. All the patients underwent neurological, psychological and the following neurophysiological tests: sacral reflex (SR, pudendal somatosensory evoked potentials (PEPs, motor evoked potential (MEPs and sympathetic skin responses (SSRs. The results were compared with a control group of 67 rectal cancer patients studied before surgery. Only 10 of these patients could be studied both pre- and postoperatively. 10 patients submitted to high dose preoperative chemoradiation were studied to evaluate the effect of this treatment on sexual function. Statistical analysis was performed by means of the two-tailed Student's t test for paired observations and k concordance test. Results 59.6% of patients operated reported sexual dysfunction, while this symptom occurred in 16.4% in the control group. Moreover, a significantly higher rate of alterations of the neurophysiological tests and longer mean latencies of the SR, PEPs, MEPs and SSRs were observed in the patients who had undergone resection. In the 10 patients studied both pre and post-surgery impotence occurred in 6 of them and the mean latencies of SSRs were longer after operation. In the 10 patients studied pre and post chemoradiation impotence occurred in 1 patient only, showing the mild effect of these treatments on sexual function. Conclusion Patients operated showed severe sexual dysfunctions. The neurophysiological test may be a useful tool to investigate this complication. The neurological damage could be monitored to decide the rehabilitation strategy.

  13. Sexual dysfunction following surgery for rectal cancer - a clinical and neurophysiological study.

    Science.gov (United States)

    Pietrangeli, Alberto; Pugliese, Patrizia; Perrone, Maria; Sperduti, Isabella; Cosimelli, Maurizio; Jandolo, Bruno

    2009-09-17

    Sexual dysfunction following surgery for rectal cancer may be frequent and often severe. The aim of the present study is to evaluate the occurrence of this complication from both a clinical point of view and by means of neurophysiological tests. We studied a group of 57 patients submitted to rectal resection for adenocarcinoma. All the patients underwent neurological, psychological and the following neurophysiological tests: sacral reflex (SR), pudendal somatosensory evoked potentials (PEPs), motor evoked potential (MEPs) and sympathetic skin responses (SSRs). The results were compared with a control group of 67 rectal cancer patients studied before surgery. Only 10 of these patients could be studied both pre- and postoperatively. 10 patients submitted to high dose preoperative chemoradiation were studied to evaluate the effect of this treatment on sexual function. Statistical analysis was performed by means of the two-tailed Student's t test for paired observations and k concordance test. 59.6% of patients operated reported sexual dysfunction, while this symptom occurred in 16.4% in the control group. Moreover, a significantly higher rate of alterations of the neurophysiological tests and longer mean latencies of the SR, PEPs, MEPs and SSRs were observed in the patients who had undergone resection. In the 10 patients studied both pre and post-surgery impotence occurred in 6 of them and the mean latencies of SSRs were longer after operation. In the 10 patients studied pre and post chemoradiation impotence occurred in 1 patient only, showing the mild effect of these treatments on sexual function. Patients operated showed severe sexual dysfunctions. The neurophysiological test may be a useful tool to investigate this complication. The neurological damage could be monitored to decide the rehabilitation strategy.

  14. Health-related quality of life of patients following selected types of lumbar spinal surgery: A pilot study

    Directory of Open Access Journals (Sweden)

    Androwich Ida

    2007-12-01

    Full Text Available Abstract Background Over 500,000 spinal surgeries are performed annually in the United States. Although pain relief and improved health-related quality of life (HRQOL are expectations following lumbar spinal surgery, there is limited research regarding this experience from the individual's perspective. In addition, no studies have examined the HRQOL of persons who have had this surgery using a comprehensive approach. The intent of this study was to address this deficiency by an assessment of both the individual and environmental factors that impact perceived HRQOL using the Wilson and Cleary Model for Health-Related Quality of Life in persons who have undergone lumbar spinal surgery. Methods This was a pilot study of 57 adult patients undergoing elective lumbar spinal surgery for either herniated disk and/or degenerative changes. Individuals completed questionnaires measuring perceived pain, mood, functional status, general health perceptions, social support and HRQOL preoperatively and three months following surgery. Descriptive statistics, dependent t-tests, and MANOVAs were used to describe and compare the differences of the study variables over time. Results Preliminary results indicate overall perceived physical HRQOL was significantly improved postoperatively (t [56] = 6.45, p Conclusion Although perceived physical HRQOL was significantly improved three months postoperatively, fatigue and lack of vigor were issues for subjects postoperatively. Excessive fatigue and low vigor may have implications for successful rehabilitation and return to work for patients following lumbar spinal surgery. Further research is needed with a larger sample size and subgroup analyses to confirm these results.

  15. Multicenter prospective study of magnetic resonance imaging prior to breast-conserving surgery for breast cancer

    Institute of Scientific and Technical Information of China (English)

    Liu Qian; Liu Yinhua; Xu Ling; Duan Xuening; Li Ting; Qin Naishan; Kang Hua

    2014-01-01

    Background This multicenter prospective study aimed to assess the utility of dynamic enhanced magnetic resonance imaging (MRI) prior to breast-conserving surgery for breast cancer.Methods The research subjects were drawn from patients with primary early resectable breast cancer treated in the breast disease centers of six three-level hospitals in Beijing from 1 January 2010 to 31 December 2012.The participants were allocated to a breast-conserving surgery group (breast-conserving group) or a total mastectomy group (total mastectomy group).Enhanced MRI was used to measure breast volume,longest diameter of tumor and tumor volume.The correlations between these measurements and those derived from histopathologic findings were assessed.The relationships between the success rate of breast-conserving surgery and MRI-and pathology-based measurement results were statistically analyzed in the breast-conserving group.Results The study included 461 cases in the total mastectomy group and 195 in the breast-conserving group.Allocation to these groups was based on clinical indications and patient preferences.The cut-off for concurrence between MRI-and pathology-based measurements of the longest diameter of tumor was set at 0.3 cm.In the total mastectomy group,the confidence interval for 95% concurrence of these measurements was 35.41%-44.63%.Correlation coefficients for MRI and histopathology-based measurements of breast volume,tumor volume and tumor volume/breast volume ratio were r=0.861,0.569,and 0.600,respectively (all P <0.001).In the breast-conserving group,with 0.30 cm taken as the cut-off for concurrence,the 95% confidence interval for MRI and pathology-based measurements of the longest diameter of tumor was 29.98%-44.01%.The subjective and objective success rates for breast-conserving surgery were 100% and 88.54%,respectively.Conclusions There were significant correlations between dynamic enhanced MRI-and histopathology-based measurements of the longest

  16. The association between nurse-administered midazolam following cardiac surgery and incident delirium: an observational study.

    Science.gov (United States)

    Taipale, Priscilla G; Ratner, Pamela A; Galdas, Paul M; Jillings, Carol; Manning, Deborah; Fernandes, Connie; Gallaher, Jaime

    2012-09-01

    Post-operative delirium after cardiac surgery is an adverse event that affects patients' recovery and complicates the delivery of nursing care. Numerous risk factors for delirium are uncontrollable; however, nurses' pro re nata drug administration of sedatives may be a controllable risk factor. This study examined the relationship between nurses' pro re nata administration of midazolam hydrochloride to cardiac surgery patients and the development of post-operative delirium. Observational study. Cardiac surgery intensive care and nursing units of a tertiary care center in Vancouver, Canada. 122 male and female patients requiring non-emergent surgery for coronary artery disease or valvular heart disease who did not have pre-existing cognitive impairment, severe hearing or visual impairment, substance misuse, alcohol intake exceeding 7 drinks per week, or renal impairment requiring hemodialysis. Patients were assessed for delirium, on three occasions, with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) during the first 72 h after surgery and through reviews of physicians' notes. Risk factor and midazolam dosage data were collected from medical records. 77.9% of the patients in this sample received midazolam hydrochloride post-operatively. The prevalence of delirium ranged from 37.7% to 44.3%. Almost all of the dosages of midazolam (85-87%) were given before the first indication of delirium; that is, most of the patients had received their entire dosage before the first signs of delirium were detected. Bivariate analysis with logistic regression models revealed that for every additional milligram of midazolam administered, the patients were 7-8% more likely to develop delirium. Multivariate logistic regression models demonstrated that the magnitude of the association between midazolam dosage and delirium was not confounded by established risk factors including age and peripheral vascular disease. Nurses play an important role in the prediction

  17. Bariatric surgery outcomes: a single-center study in the United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Abusnana S

    2015-09-01

    Full Text Available Salah Abusnana,1 Sarah Abdi,1 Brigette Tagure,1 Murtada Elbagir,1 Almantas Maleckas2 1Rashid Center for Diabetes and Research, Ministry of Health, Ajman, United Arab Emirates; 2Kaunas University of Medicine, Kaunas, LithuaniaBackground: Bariatric surgery has become an attractive treatment for severe obesity over the last decade, due to its impacts on weight loss and remission of type 2 diabetes and metabolic syndrome. In the United Arab Emirates, a country where the rate of obesity is dramatically increasing bariatric surgery has gained popularity in recent years; however, published data on its outcomes in the Emirati population are lacking.Methods: We retrospectively reviewed the medical records of 95 patients who underwent bariatric surgery (ie, laparoscopic Roux-en-Y gastric bypass [RYGB] or laparoscopic sleeve gastrectomy at the Rashid Center for Diabetes and Research in Ajman, United Arab Emirates. Weight outcomes and metabolic marker data were abstracted at baseline and at 3, 6, and 12 months postoperatively.Results: Laparoscopic RYGB was the main procedure performed by our bariatric unit. All variables demonstrated postoperative improvement. An average excess weight loss of 68% was observed at 12 months. Fat mass was the body component that decreased the most, with an average reduction of 46%. Additionally, lipid profiles were significantly different (P<0.01 at 12 months, with triglyceride levels improving by 27% and low-density lipoprotein levels improving by 21%. Similarly, glycated hemoglobin (HbA1c levels decreased significantly (P<0.001 in patients with type 2 diabetes, with an average reduction of 73%.Conclusion: Our results show that a substantial short-term reduction in weight and significant improvements in metabolic markers followed bariatric surgery in severely obese Emirati patients. Our results are consistent with the outcomes of other internationally published studies. Additional studies are warranted to determine whether

  18. Patient expectations of functional outcomes after rectal cancer surgery: a qualitative study.

    Science.gov (United States)

    Park, Jason; Neuman, Heather B; Bennett, Antonia V; Polskin, Lily; Phang, P Terry; Wong, W Douglas; Temple, Larissa K

    2014-02-01

    Rectal cancer patients' expectations of health and function may affect their disease- and treatment-related experience, but how patients form expectations of postsurgery function has received little study. We used a qualitative approach to explore patient expectations of outcomes related to bowel function after sphincter-preserving surgery for rectal cancer. This was a cohort study of patients who were about to undergo sphincter-preserving surgery for rectal cancer. The study was conducted through individual telephone interviews with participants. Twenty-six patients (14 men and 12 women) with clinical TNM stage I to III disease were enrolled. The semistructured interview script contained open-ended questions on patient expectations of postoperative bowel function and its perceived impact on daily function and life. Two researchers analyzed the interview transcripts for emergent themes using a grounded theory approach. Participant expectations of bowel function reflected 3 major themes: 1) information sources, 2) personal attitudes, and 3) expected outcomes. The expected outcomes theme contained references to specific symptoms and participants' descriptions of the certainty, importance, and imminence of expected outcomes. Despite multiple information sources and attempts at maintaining a positive personal attitude, participants expressed much uncertainty about their long-term bowel function. They were more focused on what they considered more important and imminent concerns about being cancer free and getting through surgery. This study was limited by context in terms of the timing of interviews (relative to the treatment course). The transferability to other contexts requires further study. Patient expectations of long-term functional outcomes cannot be considered outside of the overall context of the cancer experience and the relative importance and imminence of cancer- and treatment-related events. Recognizing the complexities of the expectation formation

  19. Incidence and risk factors for postoperative cognitive dysfunction in older adults undergoing major noncardiac surgery: A prospective study.

    Science.gov (United States)

    Shoair, Osama A; Grasso Ii, Mario P; Lahaye, Laura A; Daniel, Ronsard; Biddle, Chuck J; Slattum, Patricia W

    2015-01-01

    Postoperative cognitive dysfunction (POCD) is a decline in cognitive function that occurs after surgery. The purpose of this study was to estimate the incidence and identify potential risk factors of POCD in older adults undergoing major noncardiac surgery. A total of 69 patients aged 65 years or older undergoing major noncardiac surgery were enrolled. Patients' cognitive function was assessed before and 3 months after surgery using a computerized neurocognitive battery. A nonsurgical control group of 54 older adults was recruited to adjust for learning effects from repeated administration of neurocognitive tests. Data about potential risk factors for POCD were collected before, during, and after surgery, including patient, medication, and surgery factors. The incidence of POCD was calculated using the Z-score method. A multivariable logistic regression model was used to identify risk factors for POCD. POCD was present in eleven patients (15.9%, 95% confidence interval [CI] = 7.3-24.6) 3 months after major noncardiac surgery. Carrying the apolipoprotein E4 (APOE4) genotype (odds ratio [OR] = 4.74, 95% CI = 1.09-22.19), using one or more highly anticholinergic or sedative-hypnotic drugs at home prior to surgery (OR = 5.64, 95% CI = 1.35-30.22), and receiving sevoflurane for anesthesia (OR = 6.43, 95% CI = 1.49-34.66) were associated with the development of POCD. POCD was observed in 15.9% of older adults after major noncardiac surgery. Risk factors for POCD in these patients were carrying the APOE4 genotype, using one or more highly anticholinergic or sedative-hypnotic drugs prior to surgery, and receiving sevoflurane for anesthesia.

  20. The structure, organisation and perioperative management of ambulatory surgery and anaesthesia in France: Methodology of the SFAR-OPERA study.

    Science.gov (United States)

    Albaladejo, Pierre; Aubrun, Frédéric; Samama, Charles-Marc; Jouffroy, Laurent; Beaussier, Marc; Benhamou, Dan; Romegoux, Pauline; Skaare, Kristina; Bosson, Jean-Luc; Ecoffey, Claude

    2016-11-29

    The organization of health care establishments and perioperative care are essential for ensuring the quality of care and safety of patients undergoing outpatient surgery. In order to correctly inventory these organizations and practices, in 2013-2014, the French society of anaesthesia and intensive care organized an extensive practical survey in French ambulatory surgery units entitled the "OPERA" study (Organisation periopératoire de l'anesthésie en chirurgie ambulatoire). From among all of the ambulatory surgery centres listed by the Agences régionales de santé (Regional health agencies, France), 206 public and private centres were randomly selected. A structural (typology, organization) survey and a medical-practice survey (focusing on the management of postoperative pain, nausea and vomiting as well as the prevention of venous thromboembolism) were collected and managed by a prospective audit of practices occurring on two randomly selected days. The latter was further accompanied by an additional audit specifically focussing on ten representative procedures: (1) stomatology surgery (third molar removal); (2) knee arthroscopy; (3) surgery of the abdominal wall (including inguinal hernia); (4) perianal surgery; (5) varicose vein surgery; (6) digestive laparoscopy-cholecystectomy; (7) breast surgery (tumourectomy); (8) uterine surgery; (9) hallux valgus and (10) hand surgery (excluding carpal tunnel). Over the 2 days of observation, 7382 patients were included comprising 2174 patients who underwent one of the procedures from the above list. The analysis of these data will provide an overview of the organization of health establishments, the modalities thus supported and compliance with standards.

  1. Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: A randomized controlled pilot study

    NARCIS (Netherlands)

    Dronkers, J.J.; Lamberts, H.; Reutelingsperger, I.M.M.D.; Naber, R.H.; Dronkers-Landman, C.M.; Veldman, A.; Meeteren, N.L.U. van

    2010-01-01

    Objective: Investigation of the feasibility and preliminary effect of a short-term intensive preoperative exercise programme for elderly patients scheduled for elective abdominal oncological surgery. Design: Single-blind randomized controlled pilot study. Setting: Ordinary hospital in the Netherland

  2. Comparative Study Between Two Flaps—Trapezoidal flap (TZF) and Ocshenbein-Leubke Flap (OLF) in Periapical Surgeries

    National Research Council Canada - National Science Library

    Ahmed, Mohd Viqar; Rastogi, Sanjay; Baad, Rajendra K; Gupta, Anurag K; Nishad, Sumita G; Bansal, Mansi; Kumar, Sanjeev; Oswal, Rakesh; Mahendra, P; Bhatnagar, Alok

    2013-01-01

    .... The large variety of flaps available for periapical surgeries reflects the number of variables to be considered before choosing an appropriate flap design. In this study; Ocshenbein-Leubke (OL) and trapezoidal (TZ...

  3. Patients with chronic pain after abdominal surgery show less preoperative endogenous pain inhibition and more postoperative hyperalgesia: a pilot study.

    NARCIS (Netherlands)

    Wilder-Smith, O.H.G.; Schreyer, T.; Scheffer, G.J.; Arendt-Nielsen, L.

    2010-01-01

    Chronic pain is common and undesirable after surgery. Progression from acute to chronic pain involves altered pain processing. The authors studied relationships between presence of chronic pain versus preoperative descending pain control (diffuse noxious inhibitory controls; DNICs) and postoperative

  4. Impact of Trichiasis Surgery on Quality of Life: A Longitudinal Study in Ethiopia.

    Directory of Open Access Journals (Sweden)

    Esmael Habtamu

    2016-04-01

    Full Text Available Trachomatous trichiasis significantly reduces vision and health related quality of life (QoL. Although trichiasis surgery is widely performed to treat trichiasis, there is little data on the effect of surgery on QoL. We measured the impact of trichiasis surgery on vision and health related QoL in a longitudinal study from Amhara Region, Ethiopia.We recruited 1000 adult participants with trichiasis (cases and 200 comparison participants, matched to every fifth trichiasis case on age (+/- two years, sex and location. Vision-related quality of life (VRQoL and health-related quality of life (HRQoL were measured using the WHO/PBD-VF20 and WHOQOL-BREF questionnaires respectively, at enrolment and 12 months after enrolment. All trichiasis cases received free standard trichiasis surgery immediately after enrolment. The mean difference in QoL scores between enrolment and follow-up for cases and comparison participants, and the difference-in-differences by baseline trichiasis status was analysed using random effects linear regression, the later adjusted for age, sex and socioeconomic status. At 12-months follow-up, data was collected from 980 (98% and 198 (98% trichiasis cases and comparison participants respectively. At this follow-up visit, VRQoL and HRQoL scores of trichiasis cases improved substantially in all subscales and domains by 19.1-42.0 points (p<0.0001 and 4.7-17.2 points (p<0.0001, respectively. In contrast, among the comparison participants, there was no evidence of improvement in VRQoL and HRQoL domain scores during follow-up. The improvement in VRQoL and HRQoL in cases was independent of the presence of visual acuity improvement at 12 months.Trichiasis surgery substantially improves both VRQoL and HRQoL regardless of visual acuity change. Unprecedented effort is needed to scale-up trichiasis surgical programmes not only to prevent the risk of sight loss but also to improve overall wellbeing and health perception of affected individuals.

  5. Impact of Trichiasis Surgery on Quality of Life: A Longitudinal Study in Ethiopia

    Science.gov (United States)

    Habtamu, Esmael; Wondie, Tariku; Aweke, Sintayehu; Tadesse, Zerihun; Zerihun, Mulat; Mohammed, Aderajew; Zewudie, Zebideru; Callahan, Kelly; Emerson, Paul M.; Bailey, Robin L.; Mabey, David C. W.; Rajak, Saul N.; Kuper, Hannah; Polack, Sarah; Weiss, Helen A.; Burton, Matthew J.

    2016-01-01

    Background Trachomatous trichiasis significantly reduces vision and health related quality of life (QoL). Although trichiasis surgery is widely performed to treat trichiasis, there is little data on the effect of surgery on QoL. We measured the impact of trichiasis surgery on vision and health related QoL in a longitudinal study from Amhara Region, Ethiopia. Methodology/Principal Findings We recruited 1000 adult participants with trichiasis (cases) and 200 comparison participants, matched to every fifth trichiasis case on age (+/- two years), sex and location. Vision-related quality of life (VRQoL) and health-related quality of life (HRQoL) were measured using the WHO/PBD-VF20 and WHOQOL-BREF questionnaires respectively, at enrolment and 12 months after enrolment. All trichiasis cases received free standard trichiasis surgery immediately after enrolment. The mean difference in QoL scores between enrolment and follow-up for cases and comparison participants, and the difference-in-differences by baseline trichiasis status was analysed using random effects linear regression, the later adjusted for age, sex and socioeconomic status. At 12-months follow-up, data was collected from 980 (98%) and 198 (98%) trichiasis cases and comparison participants respectively. At this follow-up visit, VRQoL and HRQoL scores of trichiasis cases improved substantially in all subscales and domains by 19.1–42.0 points (p<0.0001) and 4.7–17.2 points (p<0.0001), respectively. In contrast, among the comparison participants, there was no evidence of improvement in VRQoL and HRQoL domain scores during follow-up. The improvement in VRQoL and HRQoL in cases was independent of the presence of visual acuity improvement at 12 months. Conclusions/Significance Trichiasis surgery substantially improves both VRQoL and HRQoL regardless of visual acuity change. Unprecedented effort is needed to scale-up trichiasis surgical programmes not only to prevent the risk of sight loss but also to improve

  6. Endoscopic sinus surgery in chronic rhinosinusitis and nasal polyposis: a comparative study.

    Science.gov (United States)

    Nair, Satish; Dutta, Angshuman; Rajagopalan, Ramakrishnan; Nambiar, Sapna

    2011-01-01

    Nasal polyposis are common presentations in patients of chronic rhinosinusitis and are considered to be associated with more severe forms of disease with poor treatment outcome. The presentation and treatment outcome after endoscopic sinus surgery in patients of chronic rhinosinusitis and nasal polyposis have been analysed in this study. A prospective analysis of 90 patients of chronic rhinosinusitis who were classified into two groups depending on presence and absence of nasal polyps was performed in the study. The two groups were evaluated using subjective (patient complaints) and objective (computed tomography scan and endoscopy scores) criteria. Preoperative data were compared with data obtained 12 months post endoscopic sinus surgery. The study included 38 patients of chronic rhinosinusitis and 52 patients of nasal polyps. The patients of nasal polyp group presented with increased severity of symptoms of nasal blockage, nasal discharge and reduced sense of smell as compared to the chronic rhinosinusitis group who had significantly higher presentation of headache and facial pain. The preoperative CT scan revealed significantly higher bilateral disease with increased involvement of multiple sinuses in nasal polyp group. Post endoscopic sinus surgery both the groups showed significant improvement in their symptoms with the nasal polyp group demonstrating reduction in improvement on 1 year follow up. In our study we have found the patients with chronic rhinosinusitis and nasal polyp have varied severity of symptoms with the nasal polyp group having higher nasal symptoms and increased severity as compared to chronic rhinosinusitis group. Though the universal rationale of management by adequate drainage and ventilation of sinus is similar in both groups, there is a reduction in both objective and subjective scores during 1 year follow up in the nasal polyp group.

  7. Performance analysis of UWB radio systems under cass a impulsive noise environment

    Institute of Scientific and Technical Information of China (English)

    JIA Lin; ZHANG Zhong-zhao

    2006-01-01

    The performance of UWB (Ultrawide Bandwidth) radio systems under class A impulsive noise environment is studied in this paper. First, while employing the Middleton's class A model as a model of impulsive noise, the statistical characteristics of in-phase and quadrature components of impulsive noise is investigated. It is proven that, unlike Gaussian noise, they are dependent especially due to the fact that impulsive indices are small. Next, using this above dependence, a novel UWB radio receiver designed for impulsive noise is proposed and the exact expression for theaverage BER ( Bit Error Rate) of this receiver as a function of SNR( Signal to Noise Power Ratio) and threshold value is derived. Then, the optimum threshold value is discussed and the performance of UWB radio systems with the proposed receiver designed for impulsive noise and with the conventional receiver designed for Gaussian noise under impulsive noise environment is estimated. Numerical results are compared and show that the influence of impulsiveness index and threshold value on the performance of UWB radio systems is quite large and that the performance achieved by the proposed UWB radio receiver is much superior to that of the conventional UWB radio receiver under class A impulsive noise environment.

  8. Cutaneous and Labyrinthine Tolerance of Bioactive Glass S53P4 in Mastoid and Epitympanic Obliteration Surgery: Prospective Clinical Study

    Directory of Open Access Journals (Sweden)

    Daniele Bernardeschi

    2015-01-01

    Full Text Available Objective. To evaluate the cutaneous and the inner ear tolerance of bioactive glass S53P4 when used in the mastoid and epitympanic obliteration for chronic otitis surgery. Material and Methods. Forty-one cases have been included in this prospective study. Cutaneous tolerance was clinically evaluated 1 week, 1 month, and 3 months after surgery with a physical examination of the retroauricular and external auditory canal (EAC skin and the presence of otalgia; the inner ear tolerance was assessed by bone-conduction hearing threshold 1 day after surgery and by the presence of vertigo or imbalance. Results. All surgeries but 1 were uneventful: all patients maintained the preoperative bone-conduction hearing threshold except for one case in which the round window membrane was opened during the dissection of the cholesteatoma in the hypotympanum and this led to a dead ear. No dizziness or vertigo was reported. Three months after surgery, healing was achieved in all cases with a healthy painless skin. No cases of revision surgery for removal of the granules occurred in this study. Conclusion. The bioactive glass S53P4 is a well-tolerated biomaterial for primary or revision chronic otitis surgery, as shown by the local skin reaction which lasted less than 3 months and by the absence of labyrinthine complications.

  9. Attention Deficit Hyperactivity Disorder Prevalence and Correlates Pre- and Post-Bariatric Surgery: A Comparative Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Friedrich Nielsen

    2017-01-01

    Full Text Available Objective: Previous research shows an association between obesity and attention deficit hyperactivity disorder (ADHD. The present study compares pre- and post-bariatric surgery patients using the internationally used Conners' Adult ADHD Rating Scale (CAARS™ to screen for ADHD. Methods: Matched samples pre- (N = 120 and post-bariatric surgery (N = 128 were compared using self-rating instruments to assess ADHD-relevant symptomatology, depression, eating-related psychopathology, and BMI. Results: Prevalence of probable ADHD did not differ between groups using the CAARS Index Scale T-scores; however, CAARS subscales Inattention/Memory and Self-Concept showed significantly lower scores in post-surgery patients. All CAARS subscales correlated significantly with each other, with depression and eating-related psychopathology. There was no correlation between ADHD and excess BMI loss in post-surgery patients. Conclusion: The findings suggest that a considerable number of patients before and after bariatric surgery screened positive for ADHD. It can be hypothesized that some core ADHD symptoms improve after surgery. Future studies are warranted to investigate the influence of ADHD on long-term surgery outcomes.

  10. A prospective cohort study comparing early opioid requirement between Chinese from Hong Kong and Caucasian Australians after major abdominal surgery

    DEFF Research Database (Denmark)

    Konstantatos, A H; Imberger, G; Angliss, M

    2012-01-01

    The relationship between ethnicity and early opioid consumption is not well understood. Our prospective cohort study tested whether Chinese patients in Hong Kong require less opioid after major abdominal surgery compared with Caucasian patients in Australia.......The relationship between ethnicity and early opioid consumption is not well understood. Our prospective cohort study tested whether Chinese patients in Hong Kong require less opioid after major abdominal surgery compared with Caucasian patients in Australia....

  11. 不同图式间CASS地形图自动缩编的实现%The Realization of CASS Graph Automatic Downsizing between Different Schema

    Institute of Scientific and Technical Information of China (English)

    赵卫常

    2012-01-01

    In this paper, the author develops CASS software secondarily using AutoLISP, elaborates automatic downsizing of surveying and mapping graph from large scale to small and medium scale between different schemas. The author also chooses surveying and mapping graph through the classification function of AutoLISP, executes symbol conversion of different coding according to CASS software in order to realize the function of scale conversion.%应用AutoLISP对CASS软件进行二次开发,就实现采用不同图式的地形图从大比例尺到中小比例尺的自动缩编进行了阐述.通过AutoLISP的分类选取功能对地形图分别进行选择,再依据CASS软件对不同符号的编码进行符号转换,实现地形图的比例尺变换功能.

  12. The use of VR distraction to decrease pain after laparoscopic bariatric surgery: a case study.

    Science.gov (United States)

    Hoyus, Kattia Cabas; Cardenas-López, Georgina; Maldonado, Jose Gutierrez; Ruiz-Esquivel, Ma Fernanda; Torres-Villalobos, Gonzalo

    2012-01-01

    One of the advantages of laparoscopic bariatric surgery is the reduced level of postoperative pain. In some cases, however, the pain level may be high. This is a challenge for specialists. This case study explores the use of VR distraction in an 18 year-old patient who had undergone laparoscopic bariatric surgery and who reported pain during the postoperative period. The study was conducted in a Level III Private Hospital in Mexico City where the patient was hospitalized. The patient was administered standard analgesic during VR distraction, which lasted a total of 40 minutes divided into two sessions. The scores of three visual analogue scales and catastrophism were the dependent variables of this study. The scales were administered before and after the VR distraction intervention. The patient reported lower pain levels after VR distraction and reductions in some components of catastrophism. This study proves that VR distraction can be effective not only in reducing the physical component of pain (a notion that is already well established) but also the cognitive/affective component. More controlled studies of the issue are required.

  13. [Two French pioneers of plastic surgery: François Dubois and Raymond Passot].

    Science.gov (United States)

    Derquenne, François

    2015-01-01

    After World War, especially during the interwar years, new plastic surgical techniques were highly developed by I two French surgeons: Dr Raymond Passot, a pupil of Pr Hippolyte Morestin, Head of surgery department in Val-de-Grâce military hospital, Father of the Gueules cassées and Dr François Dubois, a pupil of Pr Sébileau, head of ear nose throat disorders department at Lariboisière Hospital in Paris. By the way of papers, publications and interviews to media, they described new French cosmetic techniques (rhitidectomy, sutures, liposuccion) and extensively developed this outpatient surgery. They used to renove famous actresse's and actors' face and nose and those of hundreds of patients. They participate to French societies of plastic surgery meetings and publications. Their enthusiastic dare largely participated to the current success of cosmetic surgery in France.

  14. Awareness during anaesthesia for surgery requiring evoked potential monitoring: A pilot study

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    Pritish J Korula

    2017-01-01

    Full Text Available Background: Evoked potential monitoring such as somatosensory-evoked potential (SSEP or motor-evoked potential (MEP monitoring during surgical procedures in proximity to the spinal cord requires minimising the minimum alveolar concentrations (MACs below the anaesthetic concentrations normally required (1 MAC to prevent interference in amplitude and latency of evoked potentials. This could result in awareness. Our primary objective was to determine the incidence of awareness while administering low MAC inhalational anaesthetics for these unique procedures. The secondary objective was to assess the adequacy of our anaesthetic technique from neurophysiologist′s perspective. Methods: In this prospective observational pilot study, 61 American Society of Anesthesiologists 1 and 2 patients undergoing spinal surgery for whom intraoperative evoked potential monitoring was performed were included; during the maintenance phase, 0.7-0.8 MAC of isoflurane was targeted. We evaluated the intraoperative depth of anaesthesia using a bispectral (BIS index monitor as well as the patients response to surgical stimulus (PRST scoring system. Post-operatively, a modified Bruce questionnaire was used to verify awareness. The adequacy of evoked potential readings was also assessed. Results: Of the 61 patients, no patient had explicit awareness. Intraoperatively, 19 of 61 patients had a BIS value of above sixty at least once, during surgery. There was no correlation with PRST scoring and BIS during surgery. Fifty-four out of 61 patient′s evoked potential readings were deemed ′good′ or ′fair′ for the conduct of electrophysiological monitoring. Conclusions: This pilot study demonstrates that administering low MAC inhalational anaesthetics to facilitate evoked potential monitoring does not result in explicit awareness. However, larger studies are needed to verify this. The conduct of SSEP electrophysiological monitoring was satisfactory with the use of this

  15. Postoperative Pain, an Unmet Problem in Day or Overnight Italian Surgery Patients: A Prospective Study

    OpenAIRE

    Campagna, Sara; Antonielli D'Oulx, Maria Delfina; Paradiso, Rosetta; Perretta, Laura; Re Viglietti, Silvia; Berchialla, Paola; Dimonte, Valerio

    2016-01-01

    Background. Because of economic reasons, day surgery rates have steadily increased in many countries and the trend is to perform around 70% of all surgical procedures as day surgery. Literature shows that postoperative pain treatment remains unfulfilled in several fields such as orthopedic and general surgery patients. In Italy, the day surgery program is not yet under governmental authority and is managed regionally by local practices. Aim. To investigate the trends in pain intensity and its...

  16. A multi-centric prospective study: Anxiety and associated factors among parents of children undergoing mild surgery in ENT

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    Mehmet Akdağ

    2014-06-01

    Full Text Available Objective: The aim of this study to evaluate the anxiety and expectancy among parents of children undergoing surgery in the multi-centric surgery units. Methods: Following approval from the ethics committee, a questionnaire was given to the parents of 123 children who were undergoing surgery in the multi-centric surgery units. The parents were informed that their answers would not affect the care given to their children. The questionnaire was evaluated using the State-Trait Anxiety Inventory (STAI-I and STAI-II. Results: The STAI results indicated that the parents’ anxiety level increased before their children underwent surgery. In addition, there was a negative correlation between STAI-II scores and high levels of wealth (p= 0.004. Also, those with steady employment and higher levels of education had lower anxiety levels and difference was significant (p=0.001. The state anxiety levels were unaffected by family income and education, but the trait anxiety levels decreased with increasing income and education. Mothers were less anxious if their child had undergone surgery in the past, while this result was not significant statistically (p>0.05. Parents were most commonly concerned with possible complications from the surgery and/or anesthesia. Conclusion: Results of our study indicate that parents of children undergoing surgery that have steady employment, to be informed, previously has been administered anesthesia or surgery, high level of wealth and education was observed less anxiety than others. J Clin Exp Invest 2014; 5 (2: 206-210

  17. MR monitoring of focused ultrasonic surgery of renal cortex: experimental and simulation studies.

    Science.gov (United States)

    Hynynen, K; Damianou, C A; Colucci, V; Unger, E; Cline, H H; Jolesz, F A

    1995-01-01

    The aim of the study was to test the hypothesis that magnetic resonance (MR) imaging-guided and -monitored noninvasive ultrasonic surgery can be performed in highly perfused tissues from outside the body. A simulation study was performed to evaluate the optimal sonication parameters. An MR-compatible positioning device was then used to manipulate a focused ultrasound transducer in an MR imager, which was used to sonicate kidneys of five rabbits at various power levels and different durations. Temperature elevation during sonication was monitored with a T1-weighted spoiled gradient-echo sequence. The simulation study demonstrated that a sharply focused transducer and relatively short sonication times (30 seconds or less) are necessary to prevent damage to the overlying skin and muscle tissue, which have a much lower blood perfusion rate than kidney. The experiments showed that the imaging sequence was sensitive enough to show temperature elevation during sonication, thereby indicating the location of the beam focus. Histologic evaluations showed that kidney necrosis could be consistently induced without damage to overlying skin and muscle. The study demonstrated that highly perfused tissues such as the renal cortex can be coagulated from outside the body with focused ultrasound and that MR imaging can be used to guide and monitor this surgery.

  18. Presurgical chemotherapy compared with immediate surgery and adjuvant chemotherapy for nonmetastatic osteosarcoma: Pediatric Oncology Group Study POG-8651.

    Science.gov (United States)

    Goorin, Allen M; Schwartzentruber, Douglas J; Devidas, Meenakshi; Gebhardt, Mark C; Ayala, Alberto G; Harris, Michael B; Helman, Lee J; Grier, Holcombe E; Link, Michael P

    2003-04-15

    Successful therapeutic interventions to prevent disease progression in patients with nonmetastatic osteosarcoma have included surgery with adjuvant chemotherapy. Presurgical chemotherapy has been advocated for these patients because of putative improvement in event-free survival (EFS). The advantages of presurgical chemotherapy include early administration of systemic chemotherapy, shrinkage of primary tumor, and pathologic identification of risk groups. The theoretic disadvantage is that it exposes a large tumor burden to marginally effective chemotherapy. The contribution of chemotherapy and surgery timing has not been tested rigorously. Between 1986 and 1993, we conducted a prospective trial in patients with nonmetastatic osteosarcoma who were assigned randomly to immediate surgery or presurgical chemotherapy. Except for the timing of surgery (week 0 or 10), patients received 44 weeks of identical combination chemotherapy that included high-dose methotrexate with leucovorin rescue, doxorubicin, cisplatin, bleomycin, cyclophosphamide, and dactinomycin. One hundred six patients were enrolled onto this study. Six were excluded from analysis. Of the remaining 100 patients, 45 were randomly assigned to immediate chemotherapy, and 55 were randomly assigned to immediate surgery. Sixty-seven patients remain disease-free. At 5 years, the projected EFS +/- SE is 65% +/- 6% (69% +/- 8% for immediate surgery and 61% +/- 8% for presurgical chemotherapy; P =.8). The treatment arms had similar incidence of limb salvage (55% for immediate surgery and 50% for presurgical chemotherapy). Chemotherapy was effective in both treatment groups. There was no advantage in EFS for patients given presurgical chemotherapy.

  19. HYDROLOGY, Cass COUNTY, IN

    Data.gov (United States)

    Federal Emergency Management Agency, Department of Homeland Security — Hydrology data include spatial datasets and data tables necessary for documenting the hydrologic procedures for estimating flood discharges for a flood insurance...

  20. Psychosocial predictors of quality of life and weight loss two years after bariatric surgery: Results from the Toronto Bari-PSYCH study.

    Science.gov (United States)

    Sockalingam, Sanjeev; Hawa, Raed; Wnuk, Susan; Santiago, Vincent; Kowgier, Matthew; Jackson, Timothy; Okrainec, Allan; Cassin, Stephanie

    2017-07-01

    Studies exploring the impact of pre-surgery psychiatric status as a predictor of health related quality of life (QOL) after bariatric surgery have been limited to short-term follow-up and variable use of psychosocial measures. We examined the effect of pre-operative psychiatric factors on QOL and weight loss 2-years after surgery. 156 patients participated in this prospective cohort study, the Toronto Bariatric Psychosocial Cohort Study, between 2010 and 2014. Patients were assessed pre-surgery for demographic factors, weight, psychiatric diagnosis using the MINI International Neuropsychiatric Interview and symptom measures for QOL, depression and anxiety at pre-surgery and at 1 and 2years post-surgery. At 2-years post-bariatric surgery, patients experienced a significant decrease in mean weight (-48.43kg, 95% [-51.1, -45.76]) and an increase only in physical QOL (+18.91, 95% [17.01, 20.82]) scores as compared to pre-surgery. Multivariate regression analysis identified pre-surgery physical QOL score (psurgery weight (psurgery. Bariatric surgery had a sustained impact on physical QOL but not mental QOL at 2-years post-surgery. A history of mood disorder unexpectedly increased physical QOL scores and weight loss following surgery. Further research is needed to determine if these results are due to bariatric surgery candidate selection within this program. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Comparison of commercial fibrin sealants in facelift surgery: a prospective study

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    Botti G

    2013-11-01

    Full Text Available Giovanni Botti,1 Michele Pascali,2 Chiara Botti,1 Florian Bodog,3 Pietro Gentile,2 Valerio Cervelli2 1Villa Bella Clinic, Salò, 2Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Italy; 3University of Oradea, Oradea, Romania Background: The aim of this study was to compare the effects of two types of fibrin glue in patients undergoing facelift surgery. Methods: A prospective, controlled "right-left side" study was carried out in 20 patients. The two fibrin sealants used were Quixil® and Tissucol®. The two sealants were used at the same time, ie, one on one side of the face and the other on the contralateral side. Comparisons were made with regard to rates of hematoma and seroma, degree of induration, edema, ecchymosis, pain levels, and patient satisfaction. Results: The results were almost equivalent. The only exception was a significant (40 mL hematoma in a patient treated with Quixil. Bleeding was most likely due to a sudden rise in blood pressure during the immediate postoperative period. However, it must be emphasized that, while Tissucol actually seals the undermined area, thus virtually eliminating the dead space, Quixil acts differently, in that its effectiveness in preventing hematoma is linked mainly to its hemostatic effect. Conclusion: The two fibrin sealants used were nearly identical with regard to patient safety and quality of the result. Nevertheless, it is noted that, while Tissucol has both hemostatic and "gluing" effects, Quixil is mainly effective in securing hemostasis. Keywords: facelift surgery, rhytidectomy, fibrin sealants, hematoma

  2. Continuous spinal anesthesia versus combined spinal epidural block for major orthopedic surgery: prospective randomized study

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    Full Text Available CONTEXT AND OBJECTIVES: In major orthopedic surgery of the lower limbs, continuous spinal anesthesia (CSA and combined spinal epidural anesthesia (CSE are safe and reliable anesthesia methods. In this prospective randomized clinical study, the blockading properties and side effects of CSA were compared with single interspace CSE, among patients scheduled for major hip or knee surgery. DESIGN AND SETTING: Prospective clinical study conducted at the Institute for Regional Anesthesia, Hospital de Base, São José do Rio Preto. METHODS: 240 patients scheduled for hip arthroplasty, knee arthroplasty or femoral fracture treatment were randomly assigned to receive either CSA or CSE. Blockades were performed in the lateral position at the L3-L4 interspace. Puncture success, technical difficulties, paresthesia, highest level of sensory and motor blockade, need for complementary doses of local anesthetic, degree of technical difficulties, cardiocirculatory changes and postdural puncture headache (PDPH were recorded. At the end of the surgery, the catheter was removed and cerebrospinal fluid leakage was evaluated. RESULTS: Seven patients were excluded (three CSA and four CSE. There was significantly lower incidence of paresthesia in the CSE group. The resultant sensory blockade level was significantly higher with CSE. Complete motor blockade occurred in 110 CSA patients and in 109 CSE patients. Arterial hypotension was observed significantly more often in the CSE group. PDPH was observed in two patients of each group. CONCLUSION: Our results suggest that both CSA and CSE provided good surgical conditions with low incidence of complications. The sensory blockade level and hemodynamic changes were lower with CSA.

  3. Electrophysiological and MRI study on poor outcome after surgery for cervical myelopathy

    Energy Technology Data Exchange (ETDEWEB)

    Kameyama, Osamu; Kawakita, Hirofumi; Ogawa, Ryokei [Kansai Medical Univ., Moriguchi, Osaka (Japan)

    1995-11-01

    Occasionally, the outcome from laminoplasty for cervical spondylosis is disappointing despite an adequate operation. Before surgery, it is difficult to diagnose the pathological extent of the involvement of the spinal cord. The purpose of this study is to determine the efficacy of magnetic resonance imaging (MRI) and of the motor evoked potentials (MEPs) for the indication of the surgery and prognosis. Retrospectively, we investigated the MEPs and the MRI of 31 patients in surgery for cervical myelopathy, involving 21 with cervical spondylosis and 10 with ossification of the posterior longitudinal ligamentum, and compared the findings from those with a poor outcome (n=3l) with the findings from those with a good outcome (n=32). The MEPs from the thenar muscle and the tibialis anterior were evoked by transcranial magnetic brain stimulation. In the poor-outcome patients, the spinal canal was narrow and lumbar spinal canal stenosis was seen in 5 cases which required lumbar laminectomy. Before operation, the MEPs from the thenar muscle could not be evoked in 5 cases while there was a remarkably prolonged central motor conduction time in the other 26 cases. MRI revealed the deformed spinal cord in the involved area, and the signal intensity of the involved spinal cord in the T2 weighted image was remarkably high. The signal intensity ratio was significantly higher in the poor-outcome patients than in the good-outcome patients. This study suggested that a high signal intensity in the T2 weighted image and a prolonged conduction time or absence of MEPs largely corresponded to the clinical and other investigative features of myelopathy responsible for a poor outcome. (author).

  4. Is the routine drainage after surgery for thyroid necessary? - A prospective randomized clinical study [ISRCTN63623153

    Directory of Open Access Journals (Sweden)

    Chintamani

    2005-05-01

    Full Text Available Abstract Background Drains are usually left after thyroid surgery to prevent formation of hematoma and seroma in the thyroid bed. This is done to reduce complications and hospital stay. Objective evaluation of the amount collected in the thyroid bed by ultrasonography (USG can help in assessing the role of drains. Methods A randomized prospective control study was conducted on 94 patients undergoing 102 thyroid surgeries, over a period of fifteen months. Patients included in the study were randomly allocated to drain and non-drain group on the basis of computer generated random number table. The surgeon was informed of the group just before the closure of the wound Postoperatively USG neck was done on first and seventh postoperative day by the same ultrasonologist each time. Any swelling, change in voice, tetany and tingling sensation were also recorded. The data was analyzed using two-sample t-test for calculating unequal variance. Results Both groups were evenly balanced according to age, sex, and size of tumor, type of procedure performed and histopathological diagnosis. There was no significant difference in collection of thyroid bed assessed by USG on D1 & D7 in the two groups (p = 0.313 but the hospital stay was significantly reduced in the non-drain group (p = 0.007. One patient in the drain group required needle aspiration for collection in thyroid bed. No patient in either group required re-operation for bleeding or haematoma. Conclusion Routine drainage of thyroid bed following thyroid surgery may not be necessary. Not draining the wound results in lesser morbidity and decreased hospital stay.

  5. A COMPARA TIVE STUDY OF MANUAL INCISION WITH RADIOSURGERY INCISION INDACRYOCYSTORHYNOSTOMY SURGERY

    Directory of Open Access Journals (Sweden)

    Shailly

    2015-03-01

    Full Text Available MATERIAL & METHODS : This randomized , prospective study was carried out on patient attending out patients department of ophthalmology L . L . R . hospital ( G S V M Medical College Kanpur during the time period of 2 years . Detailed history , general examination & ophthalmic examination done . Then they under went Dacryocystorhinostomy surgery . These patients divided into two groups the Group ‘A’ and Group ‘B’ . Group . A patients underwent the dacryocystorhinostomy surgery with manual scalpel incision and Group B patients underwent the surgery with radiofrequency tools . The subsequent follow up was done at the intervals at one week , 3 weeks , 6 weeks and 6 months . Some w ere followed more frequently whenever needed . RESULTS : The present study was conducted on 118 eyes of 102 patients , o f these 56 eyes ( 48 patients received skin incision with manual scalpel ( Group ‘A’ and 62 eyes ( 54 patients received skin incision with r adiofrequency knife ( Group ‘B’ . The intraoperative bleeding and mean surgical time per case was less with rad i frequency knife that is in group B . There was also faster wound healing with more numbers cases of excellent scar quality on postoperative follo w up in Group B . DISCUSSION : Intraoperative average numbers of gauze pieces used per case was less in Group B because of electrocoagulation action of radiofrequency tools . That is why the mean surgical time per case was less in Group B . Patients was compar ed for scar quality by giving them scores according to Manchester scar scale score and60% patients in Group B achieves excellent scar quality scores in comparison to group A in which only 48% patients achieves excellent scar quality scores . CONCLUSION : There is less intraoperative bleeding and less mean surgical time per case and faster healing with excellent scar quality postoperatively in early and late follow ups with radiofrequency tools than manual scalpel .

  6. A Study of Occupational Radiation Dosimetry During Fluoroscopically Guided Simulated Urological Surgery in the Lithotomy Position.

    Science.gov (United States)

    Horsburgh, Ben A; Higgins, Mike

    2016-12-01

    To quantify through environmental audit the radiation dose that urologists receive during surgery in the lithotomy position, and to quantify the dose reduction achieved by altering exposure techniques and personal protective equipment use. Simulated surgery in the lithotomy position using an anthropomorphic phantom as a patient and a SimMan(®) mannequin as the surgeon. Pulsed fluoroscopy, focus-to-skin distance (FSD), collimation, and addition of a lead shield at the table end were individually and collectively introduced after a control study. Scattered X-ray dose rates to the simulated surgeon's eye, thyroid, trunk, external genitalia, and leg were measured with each of the technique adjustments. The absorbed dose in air at the phantom skin was measured throughout. Results were compared to discover surgeon dose rates with technique alteration. Increasing FSD leads to a rise in surgeon eye dose, and table end lead protection increases the patient skin dose. Use of all the dose-reduction techniques together reduces the dose to the patient, and a surgeon's trunk dose is decreased by 95%, external genitalia dose by 99%, and leg dose by 97%. Sitting to perform fluoroscopically guided surgery in the lithotomy position increases surgeon dose by a median value of 17%, with the external genitalia dose increased by 78% compared with the standing position. This study describes effective methods of dose reduction that are easy to instigate. The resulting reduction in radiation dose during urology procedures meets the requirements of international guidelines and legislation. This change in practice improves patient care and reduces risk to urologists from occupational exposure to radiation. By combining all of the dose-reduction techniques, urologists should never reach the threshold for deterministic radiation effects to their eyes during their career, and they will have a significantly lower chance of stochastic risks such as cancer.

  7. A study of a pre-operative intervention in patients with diabetes undergoing cardiac surgery.

    Science.gov (United States)

    Lee, G A; Wyatt, S; Topliss, D; Walker, K Z; Stoney, R

    2014-01-01

    Coronary heart disease is common in Type 2 diabetes and often requires cardiac surgery. However poorer outcomes have been reported including increased rates of post-operative infection and prolonged hospital stay. The aim of the study was to determine the feasibility and acceptability of a specialist consultation model (pre-operative medical and educational intervention) for type 2 diabetes in the cardiac surgery setting. Twenty four patients were assigned usual care or to the intervention group. The intervention group were assessed by a diabetes clinical nurse consultant, dietitian, and endocrinologist during a pre-operative visit. Specific diabetes questionnaires were administered, education was delivered, and protocol-driven changes to the medical regimen were instituted. Length of stay, incidence of post-operative complications, and number of post-operative inpatient review endocrinology visits required were recorded. Twenty four patients with a pre-operative HbA(1c) greater than 6.5% (48 mmol/mol) were studied (17 males and 7 females). In the usual care group (n = 15), HbA(1c) pre-operatively was 7.2% (55.2 mmol/mol) compared to 10.1% (86.9 mmol/mol) in the intervention group (n = 9). Six weeks post-operatively HbA(1c) fell significantly in the intervention group by 1.9% (to 8.2% [66.1 mmol/mol]) compared to a reduction of 1.2% (to 7.0% [53 mmol/mol]) in the usual care group (p cardiac surgery.

  8. Lower Risk of Stroke after Deformity Surgery: Long Term Benefit Demonstrated by a National Cohort Study

    Directory of Open Access Journals (Sweden)

    Liang-Chung Huang

    2015-10-01

    Full Text Available Objectives: This study aimed to investigate the long-term risk of stroke in adult patients with spinal deformity. Specifically, the study addressed the possible protective effect of surgery for spinal deformity against stroke. Methods: Using the National Health Insurance Research Database (NHIRD, a monopolistic national database in Taiwan, this retrospective cohort study analyzed the incidence of stroke in patients with adult spinal deformity (ASD in a 11-year period. A total of 13,503 patients, between 55 and 75 years old, were identified for the diagnosis of ASD. The patients were grouped into two: the surgical group (n = 10,439 who received spinal fusion surgery, and the control group (n = 2124 who received other medical treatment. The incidence rates of all subsequent cerebrovascular accidents, including ischemic and hemorrhagic strokes, were calculated. Hazard ratios for stroke were calculated use a full cohort and a propensity score matched cohort. Adjustments for co-morbidities that may predispose to stroke, including hypertension, diabetes mellitus, arrhythmia and coronary heart disease were conducted. Kaplan-Meier and Cox regression analyses were performed to compare the risk of stroke between the two groups. Results: During the total observation period of 50,450 person-years, the incidence rate of stroke in the surgical group (15.55 per 1000 person-years was significantly lower than that of the control group (20.89 per 1000 person-years, p < 0.001. Stroke was more likely to occur in the control group than in the surgical group (crude hazard ratio 1.34, p < 0.001; adjusted HR 1.28, p < 0.001, by a propensity score matched model. Conclusions: In this national cohort of more than 13,000 ASD patients covering 10 years, stroke was approximately 25% less likely to happen in patients who underwent spinal fusion surgery than those who received medical management. Therefore, spinal fusion surgery may provide a protective effect against stroke

  9. Antibacterial-Coated Suture in Reducing Surgical Site Infection in Breast Surgery: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Enora Laas

    2012-01-01

    Full Text Available Background. To reduce the incidence of microbial colonization of suture material, Triclosan- (TC-coated suture materials have been developed. The aim of this study was to assess the incidence of suture-related complications (SRC in breast surgery with and without the use of TC-coated sutures. Methods. We performed a study on two consecutive periods: 92 patients underwent breast surgery with conventional sutures (Group 1 and 98 with TC-coated sutures (Group 2. We performed subgroups analyses and developed a model to predict SRC in Group 1 and tested its clinical efficacy in Group 2 using a nomogram-based approach. Results. The SRC rates were 13% in Group 1 and 8% in Group 2. We found that some subgroups may benefit from TC-coated sutures. The discrimination obtained from a logistic regression model developed in Group 1 and based on multifocality, age and axillary lymphadenectomy was 0.88 (95% CI 0.77–0.95 (. There was a significant difference in Group 2 between predicted probabilities and observed percentages (. The predicted and observed proportions of complications in the high-risk group were 38% and 13%, respectively. Conclusion. This study used individual predictions of SRC and showed that using TC-coated suture may prevent SRC. This was particularly significant in high-risk patients.

  10. Use of Cortical Bone Screws in Maxillofacial Surgery - A Prospective Study

    Science.gov (United States)

    Satish, Madatanapalli; Rahman, NM Mujeeb; Reddy, V Sridhar; Yuvaraj, A; Muliyar, Sabir; Razak, P Abdul

    2014-01-01

    Background: The aim of this study is to evaluate the various applications of cortical bone screws in oral and maxillofacial surgery. Materials & Methods: The study was conducted in a teaching hospital located in, Bangalore, India, on 20 patients. These patients were categorized into three groups depending on the applications of these screws like, for achieving intermaxillary fixation in Group-1, for treatment of simple, undisplaced fractures by “Tension wire” method in Group-2, and further application of these screws were evaluated in Group-3. Different parameters were used to evaluate the efficacy of these screws. Results: In Group-1(n=12) there was satisfactory occlusion in all the patients with minimal incidence of complications. In Group-2 (n=4) post-operative reduction and fixation was satisfactory and in Group-3 (n=4) the function of these screws was satisfactory when it was used for vestibuloplasty and also as a suspension wiring in treatment of comminuted fracture of zygoma with minimal incidence of complications. Conclusion: Use of cortical bone screws is a valid alternative for achieving intermaxillary fixation, reduction and fixation of simple, undisplaced or minimally displaced fractures through Tension wire method owing to its simplicity, economy and ease of use, and as a fixation method for apically positioned flap in vestibuloplasty procedure. How to cite the article: Satish M, Rahman NM, Reddy VS, Yuvaraj A, Muliyar S, Razak PA. Use of Cortical Bone Screws in Maxillofacial Surgery - A Prospective Study. J Int Oral Health 2014;6(2):62-7. PMID:24876704

  11. Retrospective cohort study of an enhanced recovery programme in oesophageal and gastric cancer surgery.

    Science.gov (United States)

    Gatenby, P A C; Shaw, C; Hine, C; Scholtes, S; Koutra, M; Andrew, H; Hacking, M; Allum, W H

    2015-10-01

    Introduction Enhanced recovery programmes have been established in some areas of elective surgery. This study applied enhanced recovery principles to elective oesophageal and gastric cancer surgery. Methods An enhanced recovery programme for patients undergoing open oesophagogastrectomy, total and subtotal gastrectomy for oesophageal and gastric malignancy was designed. A retrospective cohort study compared length of stay on the critical care unit (CCU), total length of inpatient stay, rates of complications and in-hospital mortality prior to (35 patients) and following (27 patients) implementation. Results In the cohort study, the median total length of stay was reduced by 3 days following oesophagogastrectomy and total gastrectomy. The median length of stay on the CCU remained the same for all patients. The rates of complications and mortality were the same. Conclusions The standardised protocol reduced the median overall length of stay but did not reduce CCU stay. Enhanced recovery principles can be applied to patients undergoing major oesophagogastrectomy and total gastrectomy as long as they have minimal or reversible co-morbidity.

  12. Bone-anchored hearing device surgery: Linear incision without soft tissue reduction. A prospective study.

    Science.gov (United States)

    Altuna, Xabier; Navarro, Juan José; Palicio, Idoia; Álvarez, Leire

    2015-01-01

    The classic surgical procedure for percutaneous bone-anchored hearing devices involves removal of a large area of subcutaneous tissue down to the periosteum. This leads to alopecia and raises the risk of devascularization of the overlying skin with the potential for infection and scarring. The objective of this study was to determine the results of implant placement using a single, linear incision with no underlying soft tissue reduction. A prospective study was conducted in our hospital over a period of 14 months in all consecutive surgeries performed using this technique in adults. Patients were reviewed regularly (week 1, week 3, weeks 4-6 and months 3, 6 and 12) to assess wound healing including evaluation with the Holgers scale. Corresponding to 34 patients, 34 cases were consecutively enrolled in this study. We found that 15% of the patients had minor skin reactions during the first visit (Holgers grade 1 or 2); this number raised to 20% in week 3, but at week 4 only 1 patient had a reaction score of 1 (which was solved by week 6). None of the cases required revision surgery and all skin reactions were treated topically. Our results suggest that the tissue preservation technique is a simple and effective insertion technique with a favourable healing process and cosmesis. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  13. Prospective study of use of perioperative antimicrobial therapy in general surgery.

    LENUS (Irish Health Repository)

    Fennessy, Brendan G

    2012-02-03

    BACKGROUND: Perioperative antimicrobial therapy has demonstrated efficacy in reducing the rate of surgical site infections in clinical trials. With the emergence of antibiotic resistance, the risk of reaction, and the inevitable financial repercussions, use of prophylactic antibiotics is not a panacea, and their misuse may have considerable implications. The aim of this study was to assess the use of antibiotics in the perioperative period in both general and vascular surgery procedures. METHODS: A prospective study was undertaken of 131 patients with a mean age of 43 years (range one month-88 years), of whom 68 (51%) were male, who underwent twenty-seven different general or vascular surgery procedures over a four-week period. Each patient was evaluated from the time of antibiotic commencement through their operative procedure until the treatment was discontinued. RESULTS: A total of 73 patients (54%) received ten antibiotics, with 71 (97%) of these uses being prophylactic. Of the 15 appendectomies performed for uncomplicated appendicitis, the mean number of prophylactic antibiotic doses was 5.3 (range 1-12). Where they were documented, written postoperative directives were not adhered to in 18\\/27 prescriptions (66%). CONCLUSION: This study has demonstrated a lack of adherence to guidelines in the perioperative administration of antimicrobial agents. In addition, it calls attention to the economic implications of unnecessary prophylaxis.

  14. A comparative effectiveness trial of postoperative management for lumbar spine surgery: changing behavior through physical therapy (CBPT) study protocol.

    Science.gov (United States)

    Archer, Kristin R; Coronado, Rogelio A; Haug, Christine M; Vanston, Susan W; Devin, Clinton J; Fonnesbeck, Christopher J; Aaronson, Oran S; Cheng, Joseph S; Skolasky, Richard L; Riley, Lee H; Wegener, Stephen T

    2014-10-01

    The United States has the highest rate of lumbar spine surgery in the world, with rates increasing over 200% since 1990. Medicare spends over $1 billion annually on lumbar spine surgery. Despite surgical advances, up to 40% of patients report chronic pain and disability following surgery. Our work has demonstrated that fear of movement is a risk factor for increased pain and disability and decreased physical function in patients following lumbar spine surgery for degenerative conditions. Cognitive-behavioral therapy and self-management treatments have the potential to address psychosocial risk factors and improve outcomes after spine surgery, but are unavailable or insufficiently adapted for postoperative care. Our research team developed a cognitive-behavioral based self-management approach to postoperative rehabilitation (Changing Behavior through Physical Therapy (CBPT)). Pilot testing of the CBPT program demonstrated greater improvement in pain, disability, physical and mental health, and physical performance compared to education. The current study compares which of two treatments provided by telephone - a CBPT Program or an Education Program about postoperative recovery - are more effective for improving patient-centered outcomes in adults following lumbar spine surgery for degenerative conditions. A multi-center, comparative effectiveness trial will be conducted. Two hundred and sixty patients undergoing lumbar spine surgery for degenerative conditions will be recruited from two medical centers and community surgical practices. Participants will be randomly assigned to CBPT or Education at 6 weeks following surgery. Treatments consist of six weekly telephone sessions with a trained physical therapist. The primary outcome will be disability and secondary outcomes include pain, general health, and physical activity. Outcomes will be assessed preoperatively and at 6 weeks, 6 months and 12 months after surgery by an assessor masked to group allocation

  15. Postoperative antibiotic prophylaxis in clean-contaminated head and neck oncologic surgery: a retrospective cohort study.

    Science.gov (United States)

    Busch, C-J; Knecht, R; Münscher, A; Matern, J; Dalchow, C; Lörincz, B B

    2016-09-01

    Antibiotic prophylaxis is commonly used in head and neck oncologic surgery, due to the clean-contaminated nature of these procedures. There is a wide variety in the use of prophylactic antibiotics regarding the duration of application and the choice of agent. The purpose of this study was to determine whether short-term or long-term antibiotic prophylaxis has an impact on the development of head and neck surgical wound infection (SWI). Retrospective chart review was carried out in 418 clean-contaminated head and neck surgical oncology cases at our department. More than 50 variables including tumour type and stage, type of surgical treatment, co-morbidities, duration and choice of antibiotic prophylaxis, and the incidence of SWI were analysed. Following descriptive data analysis, Chi square test by Pearson and Fisher's exact test were used for statistical evaluation. Fifty-eight of the 418 patients (13.9 %) developed SWI. Patients with advanced disease and tracheotomy showed a significantly higher rate of SWI than those with early stage disease and without tracheotomy (p = 0.012 and p = 0.00017, respectively). However, there was no significant difference between the SWI rates in the short term and long term treatment groups (14.6 and 13.2 %, respectively; p = 0.689). Diabetes and body weight were not found to be risk factors for SWI. Long-term antibiotic prophylaxis was not associated with a decrease in SWI in the entire cohort of patients undergoing clean-contaminated major head and neck oncologic surgery. Our data confirmed the extent of surgery and tracheotomy as being risk factors for postoperative SWI.

  16. Hemodynamic challenge to early mobilization after cardiac surgery: A pilot study

    Directory of Open Access Journals (Sweden)

    Tiziano Cassina

    2016-01-01

    Full Text Available Background: Active mobilization is a key component in fast-track surgical strategies. Following major surgery, clinicians are often reluctant to mobilize patients arguing that circulatory homeostasis would be impaired as a result of myocardial stunning, fluid shift, and autonomic dysfunction. Aims: We examined the feasibility and safety of a mobilization protocol 12-24 h after elective cardiac surgery. Setting and Design: This observational study was performed in a tertiary nonacademic cardiovascular Intensive Care Unit. Materials and Methods: Over a 6-month period, we prospectively evaluated the hemodynamic response to a two-staged mobilization procedure in 53 consecutive patients. Before, during, and after the mobilization, hemodynamics parameters were recorded, including the central venous oxygen saturation (ScvO 2 , lactate concentrations, mean arterial pressure (MAP, heart rate (HR, right atrial pressure (RAP, and arterial oxygen saturation (SpO 2 . Any adverse events were documented. Results: All patients successfully completed the mobilization procedure. Compared with the supine position, mobilization induced significant increases in arterial lactate (34.6% [31.6%, 47.6%], P = 0.0022 along with reduction in RAP (−33% [−21%, −45%], P 10% and nine of them (17% required treatment. Hypotensive patients experienced a greater decrease in ScvO 2 (−18 ± 5% vs. −9 ± 4%, P = 0.004 with similar changes in RAP and HR. All hemodynamic parameters, but arterial lactate, recovered baseline values after resuming the horizontal position. Conclusions: Early mobilization after cardiac surgery appears to be a safe procedure as far as it is performed under close hemodynamic and clinical monitoring in an intensive care setting.

  17. Predictive factors for bleeding-related re-exploration after cardiac surgery: A prospective cohort study.

    Science.gov (United States)

    Lopes, Camila T; Brunori, Evelise H Fadini Reis; Santos, Vinicius Batista; Moorhead, Sue A; Lopes, Juliana de Lima; de Barros, Alba L Bottura Leite

    2016-04-01

    Bleeding-related re-exploration is a life-threatening complication after cardiac surgery. Nurses must be aware of important risk factors for this complication so that their assessment, monitoring and evaluation activities can be prioritized, focused and anticipated. To identify the predictive factors for bleeding-related re-exploration after cardiac surgery and to describe the sources of postoperative bleeding. This is a prospective cohort study at a tertiary cardiac school-hospital in São Paulo/SP, Brazil. Adult patients (n=323) submitted to surgical correction of acquired cardiac diseases were included. Potential risk factors for bleeding-related re-exploration within the 24 hours following admission to the intensive care unit were investigated in the patients' charts. A univariate analysis and a multiple analysis through logistic regression were conducted to identify the outcome predictors. The area under the receiver-operating characteristic curve was calculated as a measure of accuracy considering the cut-off points with the highest sensitivity and specificity. The univariate factors significantly associated with bleeding-related re-exploration were a lower preoperative platelet count, a lower number of bypasses in coronary artery bypass surgery and postoperatively, a lower body temperature, infusion of lower intravenous volume, a higher positive end-expiratory pressure during mechanical ventilation and transfusion of blood products. The independent predictors of bleeding-related re-exploration included postoperative red blood cell transfusion, and transfusion of fresh frozen plasma, platelet or cryoprecipitate units. These predictors had a sensitivity of 87.5%, a specificity of 99.28% and an accuracy of 97.93%. Blood product transfusion postoperatively is an independent predictor of bleeding-related re-exploration. Surgical errors prevailed as sources of bleeding. © The European Society of Cardiology 2015.

  18. [Prophylactic surgery in patients mutated BRCA or high risk: retrospective study of 61 patients in the ICO].

    Science.gov (United States)

    Oger, A S; Classe, J M; Ingster, O; Morin-Meschin, M E; Sauterey, B; Lorimier, G; Wernert, R; Paillocher, N; Raro, P

    2015-02-01

    Genetic predisposition is involved in only 10% of patients with breast cancer. This study was to evaluate the impact of prophylactic surgery. This is a retrospective study of 61 patients who received prophylactic breast surgery. Data collection was carried out through the computer file of the ICO. The inclusion criteria were: patients who benefited from a bilateral prophylactic mastectomy. There were no exclusion criteria. Patients received a satisfaction questionnaire to complete. Our study included 61 patients, 67% had a history of breast cancer. Bilateral prophylactic surgery was performed in 40 patients. It was made an average of two interventions, 44.3% of them presented postoperative complications, 18% recovery. Forty-three patients were satisfied with the medical information before surgery. The end result matched the expectations of 54.4% and 67.4% of patients would be ready to start. It was found pain associated with breast surgery in 56.5% of patients and almost half reported a change in their sexual life. Prophylactic mastectomy is the most effective technique to prevent the risk of breast cancer. The consequences of such an action are important. It is necessary to better select patients who would benefit most from this type of surgery. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. Melatonin versus midazolam premedication in children undergoing surgery: A pilot study.

    Science.gov (United States)

    Gitto, Eloisa; Marseglia, Lucia; D'Angelo, Gabriella; Manti, Sara; Crisafi, Caterina; Montalto, Angela Simona; Impellizzeri, Pietro; Reiter, Russel J; Romeo, Carmelo

    2016-03-01

    Melatonin has been proposed as a premedication alternative to midazolam, preceding anaesthesia induction. However, to our knowledge, data concerning interaction between melatonin and intravenous anaesthetic drugs in children are not available. The aim of this prospective, randomized, double-blind pilot study was to investigate the possible effect of melatonin premedication, in comparison to midazolam, on the required infusion of propofol in children undergoing surgery. As a secondary outcome, the effect of oral melatonin on the preoperative sedation level and on the post anaesthesia recovery score was evaluated. Children between the age of 5 and 14 years, scheduled for elective surgery, were prospectively enrolled between January 2012 and December 2013, and randomly assigned to two groups based on whether they received oral melatonin (0.5 mg/kg) or oral midazolam (0.5 mg/kg) premedication before induction of anaesthesia with propofol. Degree of sedation before and after anaesthesia was also evaluated. Ninety-two patients were studied, 46 for each group. We found that oral administration of melatonin significantly reduced doses of propofol required for induction of anaesthesia in paediatric patients, more than midazolam (P midazolam. These data support the use of melatonin as a premedicant in paediatric surgical patients. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  20. Correlates of non-technical skills in surgery: a prospective study

    Science.gov (United States)

    Gillespie, Brigid M; Harbeck, Emma; Steel, Catherine; Fairweather, Nicole; Chaboyer, Wendy

    2017-01-01

    Background Communication and teamwork failures have frequently been identified as the root cause of adverse events and complications in surgery. Few studies have examined contextual factors that influence teams’ non-technical skills (NTS) in surgery. The purpose of this prospective study was to identify and describe correlates of NTS. Methods We assessed NTS of teams and professional role at 2 hospitals using the revised 23-item Non-TECHnical Skills (NOTECHS) and its subscales (communication, situational awareness, team skills, leadership and decision-making). Over 6 months, 2 trained observers evaluated teams’ NTS using a structured form. Interobserver agreement across hospitals ranged from 86% to 95%. Multiple regression models were developed to describe associations between operative time, team membership, miscommunications, interruptions, and total NOTECHS and subscale scores. Results We observed 161 surgical procedures across 8 teams. The total amount of explained variance in NOTECHS and its 5 subscales ranged from 14% (adjusted R2 0.12, p<0.001) to 24% (adjusted R2 0.22, p<0.001). In all models, inverse relationships between the total number of miscommunications and total number of interruptions and teams’ NTS were observed. Conclusions Miscommunications and interruptions impact on team NTS performance. PMID:28137931

  1. Controlled study of conventional surgery and ultrasound guided foam sclerotherapy for the treatment of primary SVI of lower limbs

    Institute of Scientific and Technical Information of China (English)

    Raguram Ganesamoni; Mazda Turel; Sunil Agarwalt; Edwin Stephen; Vinu Moses; Thomas Mam-men

    2009-01-01

    Objective: To compare conventional surgery and ultrasound guided foam sclerotherapy for primary superficial venous insufficiency(SVI) with respect to obliteration of superficial venous system, clinical outcome and cost. Methods: The study was conducted between September 2005 and March 2006, in Surgery department of Christian Medical College Hospital, Vellore. All patients with symptomatic primary venous insufficiency of lower limbs requiring definitive management were randomized to conventional surgery (n = 30) or ultrasound guided foam scleretherapy (n = 30). Obliteration of superficial venous system at 3 months, clinical outcome and costs were registered. Results: Superficial venous system was obliterated in all the patients of both the groups at 3 months. Improvement in clinical scores and complication rates was similar in both the groups. The foam scleretherapy group had less analgesic requirement, earlier return to work and lower cost. Conclusion: Foam sclerotherapy is a cheaper alternative to surgery for primary venous insufficiency with respect to early measures of clinical outcome.

  2. Increasing Department of Surgery Productivity: A Study on the Effects of Adding an Ambulatory Surgery Room to Tripler Army Medical Center

    National Research Council Canada - National Science Library

    Vaseliades, Aristotle A

    2006-01-01

    ...) to increase productivity in terms of relative value units (RVUs). Tripler Army Medical Center submitted 12 initiatives, one of which was the implementation of an ambulatory surgery room within the Department of Surgery...

  3. Is Preventative Long-Segment Surgery for Multi-Level Spondylolysis Necessary? A Finite Element Analysis Study.

    Directory of Open Access Journals (Sweden)

    Jianqiang Mo

    Full Text Available For multi-level spondylolysis patients, surgeons commonly choose to fix all the segments with pars interarticularis defect even those without slippage and not responsible for clinical symptoms. In this study, we tried to study the necessity of the preventative long-segment surgery for the defected segment without slippage in treatment of multi-level spondylolysis patients from a biomechanical perspective.We established a bi-level spondylolysis model with pars defects at L4 and L5 segments, and simulated posterior lumbar interbody fusion (PLIF and pedicle screw fixation at L5-S1 level. Then we compared the biomechanical changes at L4 segment before and after surgery in neutral, flexion, extension, lateral bending and axial rotation position.The stress on L4 pars interarticularis was very similar before and after surgery, and reached the highest in axial rotation. The L3-L4 intradiscal pressure was almost the same, while L4-L5 intradiscal pressure changed a little in lateral bending (increase from 1.993 to 2.160 MPa and axial rotation (decrease from 1.639 to 1.307 MPa after surgery. The PLIF surgery caused a little increase of range of motion at adjacent L4-L5 and L3-L4 levels, but the change is very tiny (1 degree.The PLIF surgery will not cause significant biomechanical change at adjacent segment with pars defect in multi-level spondylolysis. On the contrary, excessive long-segment surgery will damage surrounding soft tissues which are important for maintaining the stability of spine. So a preventative long-segment surgery is not necessary for multi-level spondylolysis as long as there are no soft tissue degeneration signs at adjacent level.

  4. Lung surgery

    Science.gov (United States)

    ... Pneumonectomy; Lobectomy; Lung biopsy; Thoracoscopy; Video-assisted thoracoscopic surgery; VATS ... You will have general anesthesia before surgery. You will be asleep and unable to feel pain. Two common ways to do surgery on your lungs are thoracotomy and video- ...

  5. Turbinate surgery

    Science.gov (United States)

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery; Nasal obstruction - turbinate surgery ... There are several types of turbinate surgery: Turbinectomy: All or ... This can be done in several different ways, but sometimes a ...

  6. Cataract Surgery

    Science.gov (United States)

    ... and Videos: What Do Cataracts Look Like? Cataract Surgery Written By: Kierstan Boyd Reviewed By: Elena M ... how they work. What to expect with cataract surgery Before surgery: Your ophthalmologist will measure your eye ...

  7. A stepped strategy that aims at the nationwide implementation of the Enhanced Recovery After Surgery programme in major gynaecological surgery: study protocol of a cluster randomised controlled trial.

    Science.gov (United States)

    de Groot, Jeanny Ja; Maessen, José Mc; Slangen, Brigitte Fm; Winkens, Bjorn; Dirksen, Carmen D; van der Weijden, Trudy

    2015-07-30

    Enhanced Recovery After Surgery (ERAS) programmes aim at an early recovery after surgical trauma and consequently at a reduced length of hospitalisation. This paper presents the protocol for a study that focuses on large-scale implementation of the ERAS programme in major gynaecological surgery in the Netherlands. The trial will evaluate effectiveness and costs of a stepped implementation approach that is characterised by tailoring the intensity of implementation activities to the needs of organisations and local barriers for change, in comparison with the generic breakthrough strategy that is usually applied in large-scale improvement projects in the Netherlands. All Dutch hospitals authorised to perform major abdominal surgery in gynaecological oncology patients are eligible for inclusion in this cluster randomised controlled trial. The hospitals that already fully implemented the ERAS programme in their local perioperative management or those who predominantly admit gynaecological surgery patients to an external hospital replacement care facility will be excluded. Cluster randomisation will be applied at the hospital level and will be stratified based on tertiary status. Hospitals will be randomly assigned to the stepped implementation strategy or the breakthrough strategy. The control group will receive the traditional breakthrough strategy with three educational sessions and the use of plan-do-study-act cycles for planning and executing local improvement activities. The intervention group will receive an innovative stepped strategy comprising four levels of intensity of support. Implementation starts with generic low-cost activities and may build up to the highest level of tailored and labour-intensive activities. The decision for a stepwise increase in intensive support will be based on the success of implementation so far. Both implementation strategies will be completed within 1 year and evaluated on effect, process, and cost-effectiveness. The primary

  8. Neuronavigation in a developing country: A pilot study of efficacy and limitations in intracranial surgery

    Directory of Open Access Journals (Sweden)

    Dwarakanath S

    2007-01-01

    Full Text Available Context: Neuronavigation provides a patient-specific, three-dimensional (3-D anatomy for preoperative planning and intraoperative navigation. However, the initial and maintenance costs are quite prohibitive, especially in the Indian scenario. Aims : To study the efficacy and limitations of neuronavigation, especially in the Indian scenario. Settings and Design: A prospective nonrandomized study. Materials and Methods : A total of 121 patients underwent intracranial surgery from 2002-2006, in which neuronavigation was used. In this, the initial part, we studied the efficacy and limitations of neuronavigation in the initial 37 patients. The efficacy of the image guidance was graded according to a point′s scale in which points were awarded ranging from 0 to 3. Cranial image guided score (IGS was calculated by the summation of grading during designing the flap/burr hole, delineation of the intraoperative anatomy, navigation and access to the lesion and resection / biopsy of the lesion or completion of the procedure. The scoring ranged from 0-12 and the utility of IGS in cranial neurosurgical procedures was calculated based on the total points for each surgery. Results and Conclusion : Cranial image guidance was useful in a variety of operative steps. Intraoperative approach and navigation was relatively easier with an increase in perception of safety. Limitations of IGS include learning curve, cost and the phenomenon of brain shift. Drawbacks of the study included that this was a subjective rather than a truly objective study and the relatively lesser number of patients. We hope to conduct a larger study with randomization but the question of ethical approval would be a primary concern.

  9. Systematic Video Documentation in Laparoscopic Colon Surgery Using a Checklist: A Feasibility and Compliance Pilot Study.

    Science.gov (United States)

    O'Mahoney, Paul R A; Trencheva, Koiana; Zhuo, Changhua; Shukla, Parul J; Lee, Sang W; Sonoda, Toyooki; Milsom, Jeffrey W

    2015-09-01

    High-quality images can be readily captured during laparoscopic colon surgery, but there are no guidelines for documentation of these video data or how to best measure surgical quality from an operative video. This study evaluates the feasibility and compliance in documenting key steps during laparoscopic right hemicolectomy and sigmoid colectomy. A retrospective review of previously recorded videos of patients undergoing laparoscopic right hemicolectomy or sigmoid colectomy from September to December 2011 in a single institution was performed. Patients' demographics, intraoperative features, postoperative complications, and variables for video recording and editing were collected. Compliance of key surgical steps was assessed using a checklist by two independent surgeons. Sixteen laparoscopic operations (seven right hemicolectomies and nine sigmoid colectomies) were recorded. Twelve (75%) were laparoscopic-assisted, and four (25%) were hand-assisted laparoscopic operations. Compliance with key surgical steps in laparoscopic right hemicolectomy and sigmoid colectomy was demonstrated in the majority of patients, with steps ranging in compliance from 42.9% to 100% and from 77.8% to 100%, respectively. The edited video had a median duration of 3 minutes 47 seconds (range, 1 minute 44 seconds-5 minutes 38 seconds) with a production time of nearly 1 hour and a resolution of 1440 × 1080 pixels. Key surgical steps during laparoscopic right hemicolectomy and sigmoid colectomy can be documented and edited into a short representative video. Standardization of this process should allow video documentation to improve quality in laparoscopic colon surgery.

  10. Venous coronary artery bypass surgery: a more than 20-year follow-up study.

    Science.gov (United States)

    van Brussel, B L; Voors, A A; Ernst, J M P G; Knaepen, P J; Plokker, H W M

    2003-05-01

    Atherosclerosis in venous coronary artery bypass grafts begins early and accelerates from the fifth post-operative year. We studied the influence of 18 variables existing at the time of operation, and of 'classical' risk factors present at 1 and 5 years after operation on the long-term outcome of this type of surgery. Four hundred twenty-eight consecutive patients who underwent isolated venous coronary bypass surgery between April 1, 1976 and April 1, 1977 were followed prospectively. Follow-up was 99.3% complete with a mean duration of 22.8 years for the survivors. Multivariate analysis was performed using the Cox regression model. Actuarial survival after 5, 10, 15 and 20 years is 95, 83, 63 and 47%, respectively. The cumulative probability of event-free survival for cardiac death, acute myocardial infarction and re-intervention at 5, 10, 15 and 20 years, respectively, are 98, 90, 74, 60%; 99, 91, 83, 77%; and 97, 86, 67, 57%. Age and left ventricular functions are continuous incremental risk factors for mortality. Left ventricular function and completeness of revascularization, and age and vessel disease are independent predictors of cardiac death and re-intervention, respectively. Hypertension, diabetes mellitus, hypertriglyceridemia, obesity and smoking, present after operation have an independent influence on the occurrence of cardiac events. Risk factors (still) existing 1 and 5 years after operation have a negative influence on the long-term results. This emphasizes the need of treatment of these 'classical' risk factors still present after operation.

  11. UBM-guided chamber angle surgery for glaucoma management: an experimental study.

    Science.gov (United States)

    Dietlein, T S; Engels, B F; Jacobi, P C; Krieglstein, G K

    2003-04-01

    The aim of this experimental study was to investigate the potential of ultrasound bimicroscopy (UBM)-guided chamber angle surgery as an alternative or supplement to gonioscopy and intraocular microendoscopy for intraoperative control. In 15 porcine cadaver eyes, mechanical goniopuncture or punctual Er:YAG laser trabecular ablation was performed without operating microscope or gonioscopy, but with real-life ultrasound biomicroscopy monitoring with a 50 MHz transducer. Intraoperative localization of the microsurgical instruments and tissue-instrument contact were qualitatively evaluated. The instruments could be clearly visualized within the chamber angle and disturbing artefacts were only minimal when using mechanically fixed instruments in slow motion. Topographic localization, tissue contact, and penetration depth of the instruments entering the scleral were well illustrated as far as the technical resolution limits of UBM would allow. UBM can be used intraoperatively to monitor the correct manoeuvring of microsurgical instruments in selected ab interno procedures. Some adaptations and further modifications of the technique presented here will be necessary before UBM-guided surgery can be considered for clinical use in humans.

  12. Retrospective study on therapy options of brain metastases surgery versus stereotactic radiotherapy with the linear accelerator

    CERN Document Server

    Fortunati, M K S

    2001-01-01

    Background: in the therapy of brain metastases there has been a great progress in the last years. It was shown, that more aggressive therapies can not only extend the survival of the patients, but also improve quality of life. The major question of this study was, whether surgery or stereotactic radiotherapy with the linear accelerator show better results in behalf of the survival. Beside this major question many parameters regarding the patient or his primary cancer were examined. Methods: from the 1st of January 1995 until the 30th of June 2000 233 patients with one or more brain metastases have been treated in the Wagner Jauregg Landesnervenkrankenhaus Oberoesterreich (WJ LNKH OeO). The LINAC has been established on the 1st of July 1997. The patients have been distributed in three groups: 1. LINAC-group: 81 patients have been treated from the 1st of July 1997 until the 30th of June 2000 with the LINAC. 2. Surgery-group: 81 patients have been operated from the 1st of July 1997 until the 30th June 2000. 3 Co...

  13. Clinical evaluation of the centrifugal pump in open heart surgery: a comparative study of different pumps.

    Science.gov (United States)

    Takarabe, K; Yoshikai, M; Murayama, J; Hamada, M; Ito, T

    1997-07-01

    The centrifugal pump is now widely used in open heart surgery for its clinical benefits related to the blood elements and the coagulation system. The purpose of this study was to compare the clinical performances of and the outcomes offered by 4 types of centrifugal pumps. For each pump, we investigated the effects on the blood elements, coagulation system, complements, and immunoglobulins during open heart surgery. Four types of centrifugal pumps were used: the HPM-15 (Nikkiso Co.), the Capiox (Terumo Co.), the Lifestream (St. Jude Medical Co.), and the BP-80 (Medtronic, BioMedicus Co.). The platelet count, lactate dehydrogenase (LDH), antithrombin III (AT III), thrombin-antithrombin complex (TAT), complements (C3, C4, and CH50), and immunoglobulins (IgG, IgA, and IgM) were measured before and after cardiopulmonary bypass (CPB). The platelet count was decreased more significantly by the HPM-15 than by any of the other pumps. The other parameters showed no difference among the 4 pumps. In clinical use, each of the 4 types of centrifugal pumps was safe.

  14. Transoral robotic-assisted skull base surgery to approach the sella turcica: cadaveric study.

    Science.gov (United States)

    Chauvet, Dorian; Missistrano, Antoine; Hivelin, Mikaël; Carpentier, Alexandre; Cornu, Philippe; Hans, Stéphane

    2014-10-01

    Transoral robotic surgery (TORS) offers new possibilities that have not been experimented in the field of minimally invasive skull base neurosurgery. We propose to evaluate the feasibility of transoral approach to the sella turcica with the da Vinci system on cadavers. We performed four robot-assisted dissections on human fresh cadavers in order to reach the pituitary fossa by the oral cavity. Cavum mucosa dissection was performed by the head and neck surgeon at the console and then the sphenoid was drilled by the neurosurgeon at the bedside, with intraoperative fluoroscopy and a "double surgeon" control. Mucosa closure was attempted with robotic arms. We succeeded in performing a sellar opening in all cadavers with a minimally invasive approach, as the hard palate was never drilled. The video endoscope offered a large view inside the sphenoidal sinus, as observed in transnasal endoscopy, but with 3D visualization. The camera arm could be inserted into the sphenoidal sinus, and instrument arms in the pituitary fossa. Operative time to reach the pituitary fossa was approximately 60 min in all procedures: 20 min of initial setup, 10 min of mucosal dissection, and 30 min of sphenoid surgery. New anatomical landmarks were defined. Advantages and pitfalls of such an unpublished technique were discussed. This is the first cadaveric study reported da Vinci robotic transoral approach to the sella turcica with a minimally invasive procedure. This innovative technique may modify the usual pituitary adenoma removal as the sella is approached infero-superiorly.

  15. Management of postoperative pain in abdominal surgery in Spain. A multicentre drug utilization study

    Science.gov (United States)

    Vallano, Antonio; Aguilera, Cristina; Arnau, Josep Maria; Baños, Josep-Eladi; Laporte, Joan-Ramon

    1999-01-01

    Participating centres: Hospital Universitario San Juan, Alicante: Maria Jesús Olaso, Javier Agulló, Clara Faura. Hospital Torrecárdenas, Almería: Carmen Fernández Sánchez, Miguel Lorenzo Campos, Juan Manuel Rodríguez Alonso. Hospital Quirúrgic Adriano, Barcelona: Carmen Alerany Pardo, Paquita Alvarez González, Teresa Martín Benito. Hospital Universitari del Mar-IMIM, Barcelona: Magí Farré, Maite Terán. Corporació Sanitària Parc Taulí, Sabadell: Montserrat Cañellas, Sergio Zavala, Josep Planell. Hospital Universitari de la Santa Creu i Sant Pau: Gonzalo Calvo, Rosa Morros, Silvia Mateo. Hospital General Vall d’Hebron, Barcelona: Carmen Bosch, María José Martínez. Hospital Universitario Virgen de la Victoria, Málaga: Maribel Lucena, José Antonio González, Gabriel Carranque. Hospital Clínico Universitario San Carlos, Madrid: Emilio Vargas, Amparo Gil López-Oliva, Míriam García Mateos. Hospital Universitario Marqués de Valdecilla, Santander: Mario González, Antonio Cuadrado. Hospital Universitario Virgen de la Macarena, Sevilla: Juan Antonio Durán, Pilar Máyquez, María Isabel Serrano. Hospital Universitario Virgen del Rocío, Sevilla: Jaume Torelló, Juan Ramón Castillo, María de las Nieves Merino. Aims Postoperative pain is common in hospital-admitted patients. Its management is determined by different therapeutic traditions and by the attitudes of health professionals in each hospital. The aim of this study was to describe the patterns of prescription and administration of analgesic drugs used for postoperative pain after abdominal surgery in Spanish hospitals, to know the prevalence and the severity of postoperative pain, and to determine the extent of variability in the management of postoperative pain among the participating centres. Methods The study was a multicentre descriptive cross-sectional drug utilization study in 12 Spanish hospitals. The subjects were an unselected sample of consecutive patients undergoing abdominal

  16. Ontology for assessment studies of human-computer-interaction in surgery.

    Science.gov (United States)

    Machno, Andrej; Jannin, Pierre; Dameron, Olivier; Korb, Werner; Scheuermann, Gerik; Meixensberger, Jürgen

    2015-02-01

    New technologies improve modern medicine, but may result in unwanted consequences. Some occur due to inadequate human-computer-interactions (HCI). To assess these consequences, an investigation model was developed to facilitate the planning, implementation and documentation of studies for HCI in surgery. The investigation model was formalized in Unified Modeling Language and implemented as an ontology. Four different top-level ontologies were compared: Object-Centered High-level Reference, Basic Formal Ontology, General Formal Ontology (GFO) and Descriptive Ontology for Linguistic and Cognitive Engineering, according to the three major requirements of the investigation model: the domain-specific view, the experimental scenario and the representation of fundamental relations. Furthermore, this article emphasizes the distinction of "information model" and "model of meaning" and shows the advantages of implementing the model in an ontology rather than in a database. The results of the comparison show that GFO fits the defined requirements adequately: the domain-specific view and the fundamental relations can be implemented directly, only the representation of the experimental scenario requires minor extensions. The other candidates require wide-ranging extensions, concerning at least one of the major implementation requirements. Therefore, the GFO was selected to realize an appropriate implementation of the developed investigation model. The ensuing development considered the concrete implementation of further model aspects and entities: sub-domains, space and time, processes, properties, relations and functions. The investigation model and its ontological implementation provide a modular guideline for study planning, implementation and documentation within the area of HCI research in surgery. This guideline helps to navigate through the whole study process in the form of a kind of standard or good clinical practice, based on the involved foundational frameworks

  17. Algorithm for planning a double-jaw orthognathic surgery using a computer-aided surgical simulation (CASS) protocol. Part 2: three-dimensional cephalometry.

    Science.gov (United States)

    Xia, J J; Gateno, J; Teichgraeber, J F; Yuan, P; Li, J; Chen, K-C; Jajoo, A; Nicol, M; Alfi, D M

    2015-12-01

    Three-dimensional (3D) cephalometry is not as simple as just adding a 'third' dimension to a traditional two-dimensional cephalometric analysis. There are more complex issues in 3D analysis. These include how reference frames are created, how size, position, orientation and shape are measured, and how symmetry is assessed. The main purpose of this article is to present the geometric principles of 3D cephalometry. In addition, the Gateno-Xia cephalometric analysis is presented; this is the first 3D cephalometric analysis to observe these principles.

  18. Intraoperative assistive technologies and extent of resection in glioma surgery: a systematic review of prospective controlled studies.

    Science.gov (United States)

    Barbosa, Breno José Alencar Pires; Mariano, Eric Domingos; Batista, Chary Marquez; Marie, Suely Kazue Nagahashi; Teixeira, Manoel Jacobsen; Pereira, Carlos Umberto; Tatagiba, Marcos Soares; Lepski, Guilherme Alves

    2015-04-01

    Several studies published to date about glioma surgery have addressed the validity of using novel technologies for intraoperative guidance and potentially improved outcomes. However, most of these reports are limited by questionable methods and/or by their retrospective nature. In this work, we performed a systematic review of the literature to address the impact of intraoperative assistive technologies on the extent of resection (EOR) in glioma surgery, compared to conventional unaided surgery. We were also interested in two secondary outcome variables: functional status and progression-free survival. We primarily used PubMed to search for relevant articles. Studies were deemed eligible for our analysis if they (1) were prospective controlled studies; (2) used EOR as their primary target outcome, assessed by MRI volumetric analysis; and (3) had a homogeneous study population with clear inclusion criteria. Out of 493 publications identified in our initial search, only six matched all selection criteria for qualitative synthesis. Currently, the evidence points to 5-ALA, DTI functional neuronavigation, neurophysiological monitoring, and intraoperative MRI as the best tools for improving EOR in glioma surgery. Our sample and conclusions were limited by the fact that studies varied in terms of population characteristics and in their use of different volumetric analyses. We were also limited by the low number of prospective controlled trials available in the literature. Additional evidence-based high-quality studies assessing cost-effectiveness should be conducted to better determine the benefits of intraoperative assistive technologies in glioma surgery.

  19. Surgical Site Infections Following Bimaxillary Orthognathic, Osseous Genioplasty, and Intranasal Surgery: A Retrospective Cohort Study.

    Science.gov (United States)

    Posnick, Jeffrey C; Choi, Elbert; Chavda, Anish

    2017-03-01

    Frequency estimates of surgical site infection (SSI) after orthognathic surgery vary considerably. The purpose of this study was to determine the incidence and site of SSIs and associated risk factors after bimaxillary orthognathic, osseous genioplasty, and intranasal surgery. The authors executed a retrospective cohort study of patients with a bimaxillary developmental dentofacial deformity (DFD) and symptomatic chronic obstructive nasal breathing. All patients underwent at a minimum Le Fort I osteotomy, bilateral sagittal ramus osteotomies (SROs), septoplasty, inferior turbinate reduction, and osseous genioplasty. The primary outcome variable studied was the incidence and site of SSI. Predictor variables were type and extent of prophylactic antibiotic used, demographic (age and gender), and anatomic (pattern of DFD, surgical site, and presence of third molar). Two hundred sixty-two patients met the inclusion criteria. Their average age at surgery was 25 years (range, 13 to 63 yr) and there were 134 female patients (51%). The major presenting patterns of DFD included long face (30%) and maxillary deficiency (25%). Forty percent of patients undergoing an SRO and 47% of those undergoing a Le Fort I osteotomy underwent simultaneous removal of a third molar. Ninety percent of patients received cefazolin or cephalexin antibiotics. Overall, 5 of 1,048 (0.5%) osteotomy sites sustained an infection, including 1 chin and 4 ramus SSIs. There were no delays in bone healing. Fixation hardware removal was not required in any patient who developed an infection. Two of the 25 patients (8%) given clindamycin prophylaxis developed an SSI, whereas 3 of 237 patients (1%) receiving cefazolin did. Three of the 4 patients who developed an SRO SSI underwent simultaneous removal of an erupted or partially erupted mandibular third molar (P < .05). In this study, the incidence of SSI was limited to 1% of patients who were given cefazolin or cephalexin extended for 5 days. The removal of

  20. Ventilator-associated pneumonia in patients undergoing major heart surgery: an incidence study in Europe.

    Science.gov (United States)

    Hortal, Javier; Muñoz, Patricia; Cuerpo, Gregorio; Litvan, Hector; Rosseel, Peter M; Bouza, Emilio

    2009-01-01

    Patients undergoing major heart surgery (MHS) represent a special subpopulation at risk for nosocomial infections. Postoperative infection is the main non-cardiac complication after MHS and has been clearly related to increased morbidity, use of hospital resources and mortality. Our aim was to determine the incidence, aetiology, risk factors and outcome of ventilator-associated pneumonia (VAP) in patients who have undergone MHS in Europe. Our study was a prospective study of patients undergoing MHS in Europe who developed suspicion of VAP. During a one-month period, participating units submitted a protocol of all patients admitted to their units who had undergone MHS. Overall, 25 hospitals in eight different European countries participated in the study. The number of patients intervened for MHS was 986. Fifteen patients were excluded because of protocol violations. One or more nosocomial infections were detected in 43 (4.4%) patients. VAP was the most frequent nosocomial infection (2.1%; 13.9 episodes per 1000 days of mechanical ventilation). The microorganisms responsible for VAP in this study were: Enterobacteriaceae (45%), Pseudomonas aeruginosa (20%), methicillin-resistant Staphylococcus aureus (10%) and a range of other microorganisms. We identified the following significant independent risk factors for VAP: ascending aorta surgery (odds ratio (OR) = 6.22; 95% confidence interval (CI) = 1.69 to 22.89), number of blood units transfused (OR = 1.08 per unit transfused; 95% CI = 1.04 to 1.13) and need for re-intervention (OR = 6.65; 95% CI = 2.10 to 21.01). The median length of stay in the intensive care unit was significantly longer (P < 0.001) in patients with VAP than in patients without VAP (23 days versus 2 days). Death was significantly more frequent (P < 0.001) in patients with VAP (35% versus 2.3%). Patients undergoing aortic surgery and those with complicated post-intervention courses, requiring multiple transfusions or re-intervention, constitute a high

  1. A qualitative study of Functioning, Disability, and Rehabilitation of patients after hip fracture surgery

    DEFF Research Database (Denmark)

    Ehlers, Monica Milter

    2013-01-01

    on the Model of the International Classification of Functioning, Disability and Health (The ICF model) (Figure 1) and White Paper of the Rehabilitation Concept. The method of the project is qualitative, and the design used to answer the research questions is qualitative deductive content analysis (Figure 2......A qualitative study of functioning, disability, and rehabilitation of patients after hip fracture surgery Monica Milter Ehlers PhD student, MSc in Nursing Merete Bender Bjerrum* PhD, MA, Associate Professor Claus Vinther Nielsen* Professor, PhD, MD, Specialist in Clinical Social Medicine...... fracture patients consists primarily of muscle training and daily mobilisation. Patients' functioning, disability, and involvement in their rehabilitation process have not been investigated in scientific studies. Aims To establish a specific research-based knowledge for functioning, disability...

  2. The fate of titanium miniplates and screws used in maxillofacial surgery: a 10 year retrospective study.

    LENUS (Irish Health Repository)

    O'Connell, J

    2012-01-31

    The objective of this 10 year, retrospective study is to evaluate the indications for the removal of titanium miniplates following osteosynthesis in maxillofacial trauma and orthognathic surgery. All patients who had miniplates placed in a Regional Oral and Maxillofacial Department between January 1998 and October 2007 were included. The following variables were recorded: patient gender and age, number of plates inserted, indications for plate placement, location of plates, number and location of plates removed, indications for plate removal, time between insertion and removal, medical co-morbidities, and the follow-up period. During the 10 years of the study, 1247 titanium miniplates were placed in 535 patients. A total of 32 (3%) plates were removed from 30 patients. Superficial infection accounted for 41% of all plates removed. All complications were minor and most plates were removed within the first year of insertion. A low removal rate of 3% suggests that the routine removal of asymptomatic titanium miniplates is not indicated.

  3. SURGICAL AND VISUAL OUTCOME OF PHACOEMULSIFICATION SURGERY (ROUTINE AND MICRO - PHACO (BIMANUAL PHACO: A COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Sudha

    2015-03-01

    Full Text Available Cataract surgery has evolved over the past few decades with progressive decrease in the size of the incision. Originally from 12 mm intracapsular incision to bimanual phacoemulsification (Micro - Phaco that has incision size of just 700 microns. In the pres ent comparative PROSPECTIVE study best corrected visual acuity postoperatively and surgically induced astigmatism were compared in routine Phacoemulsification technique and bimanual phaco (Micro - Phaco 60 eyes were studied. There was no statistically signi ficant difference in postoperative best corrected visual acuity (BCVA of patients operated with Micro - Phaco or routine Phacoemulsification. There was difference in surgically induced astigmatism (SIA ; average SIA in microphaco was 0.5972 as against 0.832 8 in routine Phacoemulsification.

  4. Hemostatic function to regulate perioperative bleeding in patients undergoing spinal surgery: A prospective observational study

    OpenAIRE

    KIMURA, Atsushi; Ohmori, Tsukasa; Sakata, Asuka; Endo, Teruaki; Inoue, Hirokazu; Nishimura, Satoshi; Takeshita, Katsushi

    2017-01-01

    Although bleeding is a common complication of surgery, routine laboratory tests have been demonstrated to have a low ability to predict perioperative bleeding. Better understanding of hemostatic function during surgery would lead to identification of high-risk patients for bleeding. Here, we aimed to elucidate hemostatic mechanisms to determine perioperative bleeding. We prospectively enrolled 104 patients undergoing cervical spinal surgery without bleeding diathesis. Blood sampling was perfo...

  5. Trochanteric osteotomy versus posterolateral approach: function the first year post surgery. A pilot study

    Directory of Open Access Journals (Sweden)

    van Biezen Frans C

    2011-06-01

    Full Text Available Abstract Background Although no prospective studies have compared functional results of trochanteric osteotomy and a non-trochanteric approach, most surgeons feel that trochanteric osteotomy is outdated in simple hip arthroplasty. Reasons not to perform an osteotomy include the fear of longer rehabilitation and worse (final functional outcome. Method This prospective study examines differences in rehabilitation between posterolateral and trochanteric approach one year post-surgery using questionnaires (WOMAC, SF-36, HHS and functional tests (walking, climbing stairs, rising from sitting, and strength tests. Of the 109 patients 24 had a trochanteric osteotomy: the selected approach was based on the surgeon's preference. The trochanteric osteotomy group included more patients with developmental dysplasia of the hip. Before the start of the study no power analysis was performed. Results Data from the questionnaires showed no significant differences between the two groups at 3, 6 and 12-months follow-up. At 3-months follow-up patients in the trochanteric osteotomy group scored lower on the functional tests. This difference had disappeared at 6 and 12-months follow-up, except for abduction force which remained lower in the trochanteric osteotomy group in patients with a non union of the TO. Conclusion For simple hip arthroplasty an approach without osteotomy seems a logical choice. Although the power of this study is low, in experienced hands trochanteric osteotomy seems to give good functional results at 6-12 months post surgery if trochanteric union is obtained. Therefore, one should not hesitate to perform an osteotomy in difficult cases.

  6. Relationships betveen pain intensity and heart rate variability in patients after abdominal surgery: a pilot study

    Institute of Scientific and Technical Information of China (English)

    CHANG Ling-hua; MA Tso-chiang; TSAY Shiow-luan; JONG Gwo-ping

    2012-01-01

    Background A link between postoperative pain intensity and heart rate variability (HRV) had not been well established.This study aimed to investigate the correlation between post-operative pain intensity and HRV.Methods The subjects in this cross-sectional correlation study comprised of patients who had undergone abdominal surgery in a regional teaching hospital in central Taiwan during the period July 2009-November 2009.The visual analogue scale (VAS) and the short-form McGill pain questionnaire (SF-MPQ) were used to measure post-operative pain.HRV was measured as the standard deviation of normal RR interval,and by power spectral analysis that included high frequency (HF),low frequency (LF),very low frequency power,and LF/HF ratio.Results Atotal of 34 subjects were included in this study.We found that the day after the surgery,the mean VAS score was 47.50±20.98 and the mean SF-MPQ score was 18.06±8.90,indicating a moderate degree of pain.Moderate to severe degrees of tenderness were reported by 70.6% of the patients,moderate to severe degrees of gnawing pain were experienced by 67.7% of the patients,moderate to severe degrees of tiring-exhaustion pain were reported by 64.7% of the patients,and 41.2% of the patients who experienced moderate to severe pain believed that the pain was punishing-cruel.The standard deviation of normal RR interval and high frequency values obtained from male patients or married patients were higher than female patients or unmarried (P <0.05).The correlation of the standard deviation of normal RR interval,high frequency,very low frequency value and patient's age were negative (p <0.05).The total SF-MPQ pain scores positively correlated with the LF/HF ratio (P <0.05).Conclusions The multidimensional pain assessment tool (SF-MPQ) reflects better the patients' post-operative pain than the single-dimensional assessment tool (VAS).HRV positively correlated with SF-MPQ scores in patients after abdominal surgery.

  7. Pomegranate Supplementation Protects against Memory Dysfunction after Heart Surgery: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Susan A. Ropacki

    2013-01-01

    Full Text Available Memory dysfunction is a common complaint following heart surgery and may be related to a diffuse ischemic state induced by microemboli dislodged during the procedure. Ischemia can induce damage by a number of mechanisms, including oxidative stress. Because pomegranates contain a variety of polyphenols with antioxidant and other potentially beneficial effects, we tested whether supplementation with a pomegranate extract before and after heart surgery could protect against postoperative cognitive dysfunction. Patients undergoing elective coronary artery bypass graft and/or valve surgery were given either 2 g of pomegranate extract (in 2 POMx pills or placebo (pills containing no pomegranate ingredients per day from one week before surgery to 6 weeks after surgery. The patients were also administered a battery of neuropsychological tests to assess memory function at 1 week before surgery (baseline, 2 weeks after surgery, and 6 weeks after surgery. The placebo group had significant deficits in postsurgery memory retention, and the pomegranate treatment not only protected against this effect, but also actually improved memory retention performance for up to 6 weeks after surgery as compared to presurgery baseline performance.

  8. Weight Loss Surgery (Bariatric Surgery) (For Parents)

    Science.gov (United States)

    ... to Be Smart About Social Media Weight Loss Surgery (Bariatric Surgery) KidsHealth > For Parents > Weight Loss Surgery (Bariatric Surgery) ... bariatric surgery might be an option. About Bariatric Surgery Bariatric surgery had its beginnings in the 1960s, ...

  9. "...they should be offering it": a qualitative study to investigate young peoples' attitudes towards chlamydia screening in GP surgeries

    Directory of Open Access Journals (Sweden)

    Wallace Louise M

    2010-10-01

    Full Text Available Abstract Background Despite the known health and healthcare costs of untreated chlamydia infection and the efforts of the National Chlamydia Screening Programme (NCSP to control chlamydia through early detection and treatment of asymptomatic infection, the rates of screening are well below the 2010-2011 target rate of 35%. General Practitioner (GP surgeries are a key venue within the NCSP however; previous studies indicate that GP surgery staff are concerned that they may offend their patients by offering a screen. This study aimed to identify the attitudes to, and preferences for, chlamydia screening in 15-24 year old men and women attending GP surgeries (the target group. Methods We undertook 36 interviews in six surgeries of differing screening rates. Our participants were 15-24 year olds attending a consultation with a staff member. Data were analysed thematically. Results GP surgeries are acceptable to young people as a venue for opportunistic chlamydia screening and furthermore they think it is the duty of GP surgery staff to offer it. They felt strongly that it is important for surgery staff to have a non-judgemental attitude and they did not want to be singled out as 'needing' a chlamydia screen. Furthermore, our sample reported a strong preference for being offered a screen by staff and providing the sample immediately at the surgery rather than taking home a testing kit. The positive attitude and subjective norms demonstrated by interviewees suggest that young peoples' behaviour would be to accept a screen if it was offered to them. Conclusion Young people attending GP surgeries have a positive attitude towards chlamydia screening and given the right environment are likely to take up the offer in this setting. The right environment involves normalising screening by offering a chlamydia screen to all 15-24 year olds at every interaction with staff, offering screening with a non-judgemental attitude and minimising barriers to screening

  10. A PROSPECTIVE OBSERVATIONAL STUDY REGARDING PREVALENCE OF DRY EYE DISEASE IN POST-OPERATIVE CATARACT SURGERY PATIENTS OF 140 CASES.

    Directory of Open Access Journals (Sweden)

    S. Srinivasan

    2017-02-01

    Full Text Available BACKGROUND Dry eye disease is one of the most common ocular surface disorder with large number of studies carried out in various countries estimate the prevalence of dry eye disease to be between 5-34%. The prevalence of dry eye increases with age. As per Breaver Dam study regarding dry eye the prevalence of DED 13.3%. Dry eye was apparently higher in women than men. Studies have shown that cataract surgery worsen dry eye symptoms in patients with preexisting dry eye symptoms as well as without preexisting DES, mostly dry eye symptoms last for two months of post cataract surgery period. MATERIALS AND METHODS The prospective observational study was conducted in Department of Ophthalmology, Government Vellore Medical College and Hospital, Vellore. The total number of cataract surgery performed cases were 140 in number. The study period was four months, conducted in tertiary eye center. The Cataract patients were preoperatively at normal tear secretions. Post cataract surgery period from first POD, one week POD, four weeks, six weeks, two months and three months POD examined by slit lamp, Schirmer's test I, TBUT and corneal sensitivity test were performed. RESULTS Our study revealed that increased prevalence in female sex with increased age group range from 51-70 years showed post cataract surgery period dryness of eye. The ratio of Post cataract surgery DED in male and female is 13:29. This shows increased female sex prevalence of postoperative DED. In our study, the prevalence of post cataract surgery dry eye disease was 30%. CONCLUSION 73% cataract surgeries is now clear corneal cataract surgery and this procedure cuts a large part of corneal nerves. The nerve essential for tear production gets disturbed leading to dryness and hence decreased visual function. The corneal nerves are important in self-regulation of tears since they provide the sensation in the feedback loop that signals tear production. When the functions of the nerves get blocked

  11. Using qualitative methods to understand the determinants of patients' willingness to pay for cataract surgery: a study in Tanzania.

    Science.gov (United States)

    Geneau, Robert; Massae, Patrick; Courtright, Paul; Lewallen, Susan

    2008-02-01

    Cataract is the leading cause of avoidable blindness in Africa. There are various documented barriers to the uptake of cataract surgery, cost being one of them. There is, however, little evidence regarding patients' willingness to pay (WTP) for cataract surgery in Africa and the best way to measure it. We conducted a grounded theory study in order to understand better cataract patients' WTP for surgery in Tanzania. A total of 47 cataract patients from three regions of Tanzania were interviewed. The interviews were tape-recorded and transcribed verbatim. The coding process involved identifying emerging themes and categories and their interconnection. Our study reveals that the main factors behind patients' WTP for cataract surgery are (1) the level of perceived need for sight and cataract surgery; (2) the decision-making processes at the family level and (3) the characteristics of local eye care programs. Our study shows that WTP concerns not only the patients but also their relatives. For most patients and families, the amount of $20-$30 is deemed reasonable for a sight-restoring procedure. It does not appear realistic for eye care program managers to charge the real cost of cataract surgery at present (about US $70-in Kilimanjaro). However, eye care programs can influence WTP for cataract surgery by providing quality services and by offering adequate counseling about the procedure. The qualitative findings enriched the interpretation of a previously reported quantitative survey and yield implications for both researchers and decision-makers using or relying on WTP methodologies in developing countries.

  12. A Study of the Morbidity Involved in Whole Rib Harvesting and In Situ Splitting Rib Harvesting Surgery.

    Science.gov (United States)

    Zhang, Lu; Sun, Xiao-Ming; Jin, Rong; Shi, Yao-Ming; Sun, Bao-Shan; Zhang, Ying; Zhang, Yu-Guang

    2016-06-01

    Although there have been several reports that detail the in situ rib splitting harvesting surgical procedure, there are limited published studies evaluating this procedure and the traditional whole rib harvesting approach. In this study, the authors conducted a retrospective controlled study on the complications related to the 2 rib harvesting approaches. From March 2012 to May 2014, 24 patients were treated with rib grating, of whom 9 patients received conventional rib harvesting surgery and 15 patients received in situ splitting harvesting surgery. In all patients, a 3-dimensional computed tomography study of the chest was performed 7 days postoperatively. Postoperative complications were assessed and postoperative pain was assessed using a visual analog scale after the first 24, 48, and 72 hours after the surgery. The complication rate for in situ splitting rib harvesting was 6.67% versus 44.44% for patients treated with whole rib grafting surgery. After 48 and 72 hours, the visual analog scale scores in patients treated with in situ splitting rib grafts were significantly lower than the patients treated with traditional surgery. The in situ splitting approach for obtaining a rib results in a clinically significant reduction in complications compared with the traditional approach.

  13. Astigmatism management in cataract surgery with Precizon® toric intraocular lens: a prospective study

    Science.gov (United States)

    Vale, Carolina; Menezes, Carlos; Firmino-Machado, J; Rodrigues, Pedro; Lume, Miguel; Tenedório, Paula; Menéres, Pedro; Brochado, Maria do Céu

    2016-01-01

    Purpose The purpose of this study was to evaluate the visual and refractive outcomes and rotational stability of the new aspheric Precizon® toric intraocular lens (IOL) for the correction of corneal astigmatism in cataract surgery. Setting Department of Ophthalmology, Hospital Geral de Santo António – Centro Hospitalar do Porto, EPE and Hospital de Pedro Hispano, Matosinhos, Portugal. Design This was a prospective clinical study. Patients and methods A total of 40 eyes of 27 patients with corneal astigmatism greater than 1.0 diopter (D) underwent cataract surgery with implantation of Precizon® toric IOL. IOL power calculation was performed using optical coherence biometry (IOLMaster®). Outcomes of uncorrected (UDVA) and best-spectacle corrected distance visual acuities (BCDVA), refraction, and IOL rotation were analyzed at the 1st week, 1st, 3rd, and 6th month’s evaluations. Results The median postoperative UDVA was better than preoperative best-spectacle corrected distance visual acuity (0.02 [0.06] logMAR vs 0.19 [0.20] logMAR, P<0.001). At 6 months, postoperative UDVA was 0.1 logMAR or better in 95% of the eyes. At last follow-up, the mean spherical equivalent was reduced from −3.35±3.10 D to −0.02±0.30 D (P<0.001) with 97.5% of the eyes within ±0.50 D of emmetropia. The mean preoperative keratometric cylinder was 2.34±0.95 D and the mean postoperative refractive cylinder was 0.24±0.27 D (P<0.001). The mean IOL rotation was 2.43°±1.55°. None of the IOLs required realignment. Conclusion Precizon® toric IOL revealed very good rotational stability and performance regarding predictability, efficacy, and safety in the correction of preexisting regular corneal astigmatism associated with cataract surgery. PMID:26855559

  14. Health-related quality of life after bariatric surgery: a systematic review of prospective long-term studies.

    Science.gov (United States)

    Andersen, John Roger; Aasprang, Anny; Karlsen, Tor-Ivar; Natvig, Gerd Karin; Våge, Villy; Kolotkin, Ronette L

    2015-01-01

    Impaired health-related quality of life (HRQoL) is common in bariatric surgery candidates and is often one of the motivating factors for seeking bariatric surgery. Although many studies have reported changes in HRQoL after bariatric surgery, few are long-term prospective studies and no systematic review has been conducted. A systematic database search identified studies reporting HRQoL preoperatively and≥5 years after bariatric surgery. Change in HRQoL over time was the outcome variable, divided into primary and secondary outcomes. Seven prospective cohort studies met the inclusion criteria. Eight HRQoL measures and 6 surgical methods were identified. Long-term follow-up time ranged from 5-10 years, sample sizes from 44 to 655 patients, and follow-up rates from 61% to 92%. None of the 7 studies were randomized controlled trials, and only 2 studies used control groups. Six of 7 studies showed statistically significant improvements in all of the primary outcomes, and 1 study showed statistically significant improvements in 1 of 2 primary outcomes. Of the statistically significant HRQoL improvements, 92% were clinically meaningful. Peak improvements in primary HRQoL outcomes were typically observed during the first years of follow-up, followed by a gradual decline that seemed to stabilize 5 years postoperatively. Long-term HRQoL scores typically remained improved relative to preoperative scores but were somewhat below population norm scores. In conclusion, while bariatric surgery candidates reported impaired HRQoL presurgically, their HRQoL improved considerably after bariatric surgery and much of the initial HRQoL improvements were maintained over the long term.

  15. Studies on correlation of positive surgical margin with clinicopathological factors and prognoses in breast conserving surgery

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko [Kumamoto City Hospital (Japan)

    1999-09-01

    Out of 484 cases with breast conserving surgery between April 1989 and March 1999, surgical procedures of 34 cases were changed to total mastectomy due to positive surgical margins. In this study we evaluated a clinical significance of surgical margin in relation to clinicopathological factors and prognoses. Ninety-nine cases (20.5%) had positive margins that were judged when cancer cells existed within 5 mm from margin. In multivariate analysis of factors for surgical margin, EIC-comedo status, ly, located site, proliferative activity, and age were significant and independent factors. Regarding local recurrence, positive margin, age, ER and proliferative activity were significant factors in multivariate analysis, especially in cases not receiving postoperative radiation therapy. Radiation therapy may be beneficial for patients with positive surgical margin. And patients with breast recurrence alone had significantly higher survival rates. Therefore, it is suggested that surgical margin may not reflect survival, although it is a significant factor for local recurrence. (author)

  16. A randomized pilot study on single-port versus conventional laparoscopic rectal surgery

    DEFF Research Database (Denmark)

    Bulut, O; Aslak, K K; Levic, K

    2015-01-01

    -reactive protein (CRP), interleukin-6 (IL-6) and tissue inhibitor of metalloproteinases-1 (TIMP-1) were determined. Blood samples were collected preoperatively (baseline), and 6, 24, 48, 72 and 96 h after skin incision. RESULTS: Pain scores were significantly reduced in the single-port group on postoperative days...... groups for plasma IL-6 and TIMP-1 at all time points, while the CRP levels were significantly lower in the single-port group at 6 (p after skin incision. Abdominal incisions lengths were significantly shorter in the single-port group (p = 0.001). There was no significant...... of the present study was to compare single-port and conventional laparoscopic surgery for rectal cancer in terms of short-term outcomes including postoperative pain and trauma-induced changes in certain bioactive substances. METHODS: Patients with non-metastasized rectal cancer were prospectively randomized...

  17. Constraints for the subsurface structure at the Abydos site on 67P/Churyumov-Gerasimenko resulting from CASSE listening to the MUPUS insertion phase

    Science.gov (United States)

    Knapmeyer, M.; Fischer, H. H.; Joerg, K.; Seidensticker, K. J.

    2016-12-01

    During the more than 3 hours of the MUPUS PEN insertion phase at Abydos, the Comet Acoustic Surface Sounding Experiment (CASSE), part of SESAME, recorded hammer strokes of MUPUS with all three accelerometers, which are housed in Philae's feet. Stroke times recorded in the MUPUS housekeeping data, the identification of two adjacent strokes in a single recording, and laboratory experiments concerning the properties of sound transmission through Philae's legs and feet foster the identification of the recorded signals as hammer strokes, and as elastic waves transmitted through the comet. A hammer stroke exerted on a surface dominantly excites surface waves of the Rayleigh type. By comparison of arrival times at the individual feet, we estimate the propagation velocity of these Rayleigh waves to be at least 80 m/s. With the bulk density of 533 ± 6 kg/m3 as derived from tracking Rosetta (Pätzold et al., Nature, vol. 530, 2016), this velocity translates into a shear modulus of the comet material of at least 3.2 MPa. Shear modulus scales with velocity squared, so when taking into account the formal uncertainties arising from the arrival time inversion, the shear modulus may easily be as large as 10 MPa. This is still low compared to solid rock or monocrystalline ice, but is compatible with highly porous materials. The recorded signals are only weakly dispersive: Energy at frequencies below approx. 200 Hz arrives slightly later than at higher frequencies. This indicates the presence of a surface layer, to which the above propagation velocity and shear modulus apply, on top of a material with an even lower propagation velocity and shear modulus. The boundary between the two materials is likely more than 20 cm below the surface. We conclude that the results of CASSE listening to MUPUS support the hypothesis of surficial sintering at least for the Abydos site on 67P/Churyumov-Gerasimenko.

  18. 法经济学视角下的生命价值评估法律与监管--读凯斯·R.·桑斯坦的《生命、生命年和支付意愿》%Study on Several Core Issues of U.S. Evaluation System---Reading Cass R. Sunstein’s Lives,Life-Years,and Willingness to Pay

    Institute of Scientific and Technical Information of China (English)

    周乾; 吴秀尧

    2016-01-01

    In the United States,courts and government agencies are the main sectors and the tools they employ are tort law and regulatory policy. Sunstein examined the relationship between the value of statistical life and the value of statistical life-year ,and relationship between willingness to pay,willingness to accept and quality-adjusted life years,then he concluded that the best approach may be using willingness to pay to measure the value of statistical life years,and in the appropriate circumstances to make assignments or other adjustments. The questions he discussed are the core issues of monetary assessment system of value of life and theoretical significance for studying the U.S. Evaluation System of Value of Life and China's judicial and administrative practice.%在美国,法院和政府机构是评估生命价值的主要部门,其使用的工具分别是侵权法和监管政策。桑斯坦考察了统计学上生命的价值与统计学上生命年的价值之间,以及支付意愿、接受意愿和质量调整生命年之间的关系,并得出以下结论,即最好的方法可能是使用支付意愿来衡量统计学上生命年的价值,然后在合适的情形下做出分配或其他调整。他讨论的问题都是货币化评估生命价值的核心问题,对于研究美国生命价值评估体系并对我国司法和行政实践具有主要的理论意义。

  19. A study of patient satisfaction after cataract surgery with implantation of different types of intraocular lenses

    Directory of Open Access Journals (Sweden)

    Wei Ching-Kuo

    2012-10-01

    Full Text Available Abstract Background The implementation of capitated payment has driven medical institutions through developing balance billing for medical services. By exploring the patients’ decision-making factors on different self-pay items, a reference for the pricing and sales strategy for the related products can be formed. The major purposes of this study were to analyze the determinants of preoperative selection and postoperative satisfaction with implantation of different types of intraocular lenses in cataract surgery. Methods This cross-sectional study consisted of 127 patients that were 50 years of age and older, and who had phacoemulsification with intraocular lens implantation in both eyes. Data were collected by using a structured questionnaire. The following parameters were measured: access to medical care, attitude towards receiving medical products at one’s own expense, overall patient satisfaction and postoperative visual clarity. Results The results showed that the patient’s gender, educational level and economic status influenced the type of intraocular lens chosen. Patients in the insurance group cared about access to medical care, and patients in the balance billing group cared about product differentiation. ANOVA results showed no statistically significant differences in the overall satisfaction of the patients among the groups with different types of intraocular lenses. Patients that received cataract surgery with implantation of multifocal intraocular lenses had better vision when trying to view smaller objects and when looking at objects under strong light. Conclusions Manufacturers should increase the number of differences between their products, and health care providers can then recommend the appropriate intraocular lens in accordance with the needs or demands of their patients, and also by keeping in mind the financial constraints of their patients.

  20. COMPARATIVE STUDY OF CAUDAL ROPIVACAINE WITH CAUDAL ROPIVACAINE AND DEXMEDETOMIDINE IN PEDIATRIC LOWER ABDOMINAL SURGERIES

    Directory of Open Access Journals (Sweden)

    Monika

    2014-03-01

    Full Text Available PURPOSE: The objectives of this study were to compare the effects of caudal dexmedetomidine combined with Ropivacaine to provide postoperative analgesia in children and also to establish its safety in the pediatric patients. METHODS: In a randomized, prospective, parallel group, double-blinded study, 80 children of 1 year to 6years posted for lower abdominal surgeries were recruited and allocated into two groups: Group RD (n=40 received 0.25% Ropivacaine 1 ml/kg with dexmedetomidine2 μg/kg, making the volume to 0.5 ml and Group R (n=40 received 0.25% Ropivacaine1 ml/kg + 0.5 ml normal saline. Induction of anesthesia was achieved with Inj. Ketamine 2mg/kg + Inj. Succinylcholine 2mg/kg. Intubated with appropriate-sized Endotracheal tube and caudal block was performed in all patients. Maintained with 66% nitrous oxide in Oxygen and isoflurane 0.2-0.4%.Post-operative pain assessed with FLACC score. RESULTS: The duration of postoperative analgesia recorded a mean of 339 minutes (5.6hrs ± 2.4 hrs. in Group R compared with 884 minutes (14.7 hrs. ±5hrs in Group RD, with a p value of <0.001. Group RD patients achieved a statistically significant higher FLACC score compared with Group RD patients. The peri-operative hemodynamics were stable among both the groups. CONCLUSION: Caudal dexmedetomidine (2 μg/kg with 0.25%Ropivacaine (1 ml/kg for pediatric lower abdominal surgeries provides significant postoperative pain relief and better quality of sleep and a prolonged duration of arousable sedation.

  1. Variables Influencing the Depth of Conscious Sedation in Plastic Surgery: A Prospective Study

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    Kim, Wonwoo; Park, Hyochun; Kim, Hoonnam

    2017-01-01

    Background Conscious sedation has been widely utilized in plastic surgery. However, inadequate research has been published evaluating adequate drug dosage and depth of sedation. In clinical practice, sedation is often inadequate or accompanied by complications when sedatives are administered according to body weight alone. The purpose of this study was to identify variables influencing the depth of sedation during conscious sedation for plastic surgery. Methods This prospective study evaluated 97 patients who underwent plastic surgical procedures under conscious sedation. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and glucose levels were measured. Midazolam and ketamine were administered intravenously according to a preset protocol. Bispectral index (BIS) recordings were obtained to evaluate the depth of sedation 4, 10, 15, and 20 minutes after midazolam administration. Associations between variables and the BIS were assessed using multiple regression analysis. Results Alcohol intake and female sex were positively associated with the mean BIS (P<0.01). Age was negatively associated with the mean BIS (P<0.01). Body mass index (P=0.263), creatinine clearance (P=0.832), smoking history (P=0.398), glucose (P=0.718), AST (P=0.729), and ALT (P=0.423) were not associated with the BIS. Conclusions Older patients tended to have a greater depth of sedation, whereas females and patients with greater alcohol intake had a shallower depth of sedation. Thus, precise dose adjustments of sedatives, accounting for not only weight but also age, sex, and alcohol consumption, are required to achieve safe, effective, and predictable conscious sedation. PMID:28194341

  2. The effectiveness of Google GLASS as a vital signs monitor in surgery: A simulation study.

    Science.gov (United States)

    Iqbal, Mohammed Husnain; Aydin, Abdullatif; Lowdon, Alexandra; Ahmed, Hamza Ibn; Muir, Gordon H; Khan, M Shamim; Dasgupta, Prokar; Ahmed, Kamran

    2016-12-01

    To assess the effectiveness of the Google GLASS as a vital signs monitor in a surgical setting and identify potential uses. This prospective, observational and comparative study recruited novice (n = 24), intermediate (n = 8) and expert urologists (n = 5). All candidates performed a procedure on the GreenLight Simulator within a simulated setting using a standard vital signs monitor and then the Google GLASS. The time taken to respond to abnormal vital signs during both sessions was recorded. A quantitative survey was used to assess the usability and acceptability of the Google GLASS surgery. The majority (84%) of participants responded quicker to abnormal signs with the Google GLASS compared to a standard monitor (p = 0.0267). The average simulation score during a standard-monitor and GLASS-session scored to be statistically insignificant (p = 0.253). All parameters of simulation were also similar in both sessions including average sweep speed (p = 0.594), average blood loss (p = 0.761) and average grams vaporised (p = 0.102). Surgical performance between both sessions was similar and not hampered by the use of Google GLASS. Furthermore, 81% of candidates stated the GLASS was comfortable to wear during the procedure. This study has demonstrated that head-mounted displays such as the Google GLASS are potentially useful in surgery to aid patient care without hampering the surgeons view. It is hoped that the innovation and evolution of these devices triggers the potential future application of such devices within the medical field. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  3. Visual Outcome of Phacoemulsification versus Small Incision Cataract Surgery in Pseudoexfoliation Syndrome – A Pilot Study

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    Gadewar, Shveta Bhimashankar

    2017-01-01

    Introduction Available data has highlighted the efficacy of both Phacoemulsification (PHACO) and Small Incision Cataract Surgery (SICS) in the presence of Pseudoexfoliation (PEX) syndrome. In developing countries, both are commonly performed procedures for cataract extraction. But, no direct comparison between these two procedures is available in the setting of PEX syndrome. With this lacuna in mind, this pilot study decided to compare the visual outcomes of both these techniques in the setting of PEX syndrome. Aim To compare and analyze the efficacy and safety of PHACO versus SICS in patients of PEX syndrome who underwent cataract surgery. Materials and Methods A prospective, conveniently sampled, observational, pilot study was conducted over six months in ophthalmology department of a tertiary eye institute in India. A total of 200 eyes of 100 patients conforming to pre-defined criteria were conveniently sampled and allotted to two groups of 50 patients each. First group underwent PHACO and second underwent SICS. The demographic profile, pre-operative, intra-operative and post-operative details and complications as well as visual acuity were recorded. Data obtained was analyzed using chi-square test. Statistical significance was set at 95% Confidence Intervals (CI), i.e., at a p-value of <0.05. Results Of 76 males and 24 females, the mean age was 67.95 years. No statistically significant differences were observed between PHACO and SICS groups with regards to intra-operative complications {overall n=13 in PHACO versus n=21 in SICS, p=0.13}. Controlled sphincterotomy was required in a significantly higher number of SICS cases (p=0.03). No statistically significant differences were observed in terms of post-operative complications (overall n=5 in PHACO versus n=10 in SICS, p=0.26). Conclusion With careful pre-operative assessment, due to intra-operative modifications and surgical expertise, both PHACO and SICS are apparently safe procedures in PEX syndrome.

  4. Pediatric cardiac surgery Parent Education Discharge Instruction (PEDI) program: a pilot study.

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    Staveski, Sandra L; Zhelva, Bistra; Paul, Reena; Conway, Rosalind; Carlson, Anna; Soma, Gouthami; Kools, Susan; Franck, Linda S

    2015-01-01

    In developing countries, more children with complex cardiac defects now receive treatment for their condition. For successful long-term outcomes, children also need skilled care at home after discharge. The Parent Education Discharge Instruction (PEDI) program was developed to educate nurses on the importance of discharge teaching and to provide them with a structured process for conducting parent teaching for home care of children after cardiac surgery. The aim of this pilot study was to generate preliminary data on the feasibility and acceptability of the nurse-led structured discharge program on an Indian pediatric cardiac surgery unit. A pre-/post-design was used. Questionnaires were used to evaluate role acceptability, nurse and parent knowledge of discharge content, and utility of training materials with 40 nurses and 20 parents. Retrospective audits of 50 patient medical records (25 pre and 25 post) were performed to evaluate discharge teaching documentation. Nurses' discharge knowledge increased from a mean of 81% to 96% (P = .001) after participation in the training. Nurses and parents reported high levels of satisfaction with the education materials (3.75-4 on a 4.00-point scale). Evidence of discharge teaching documentation in patient medical records improved from 48% (12 of 25 medical records) to 96% (24 of 25 medical records) six months after the implementation of the PEDI program. The structured nurse-led parent discharge teaching program demonstrated feasibility, acceptability, utility, and sustainability in the cardiac unit. Future studies are needed to examine nurse, parent, child, and organizational outcomes related to this expanded nursing role in resource-constrained environments. © The Author(s) 2014.

  5. A comparative study on Benzydamine HCL 0.5% and Acetaminophen Codeine in pain reduction following periodontal surgery

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    Khoshkhoonejad AA.

    2004-07-01

    Full Text Available Statement of Problem: Systemic analgesics are frequently prescribed for pain reduction following periodontal surgery. This type of treatment, however, brings about some disadvantages due to its late effect and inherent side effects. Benzydamine hydrochloride mouth wash is a non steroidal anti-inflammatory drug with local anaesthetic properties. Side effects of benzydamine are minor such as tissue numbness, burning and stinging. It brings relief to pain and inflammation rapidly. Purpose: The goal of this study was to compare benzydamine HCL 0.15% and Acetaminophen codeine as analgesics following periodontal surgery. Materials and Methods: This clinical study was performed on 18 patients referred to periodontics Department, Faculty of Dentistry, Tehran University of Medical Sciences. All patients were affected with chronic mild or moderate periodontitis and required surgery at least at two oral sites with similar lesions. Each patient received benzdamine HCL after first surgery and Acetaminophen codein following second operation. Pain reduction was evaluated by Visual Analog Scale (VAS. Data were analyzed with Wilcoxon-Signed and Mann-Whitney non-parametric tests. Results: Analgesic effect of Acetaminophene codeine was significantly more than that of benzydamine HCL following Reriodontal surgery (P=0.008. No significant difference was found between analgesic effects of Acetaminophene codeine and benzydamine HCL in patients with chronic mild periodontitis (P=0.9, and in cases that osteoplasty (P=0-31 or no osseous surgery (P=0.18 were performed. Conclusion: In cases with mild post-operative pain following periodontal surgery, Benzydamine HCL and be prescribed as an analgesic. However, in other cases this mouth wash should be prescribed along with Acetaminophene codein to reduce systemic drugs consumption.

  6. Plastic Surgery Inclusion in the Undergraduate Medical Curriculum: Perception, Challenges, and Career Choice-A Comparative Study.

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    Farid, M; Vaughan, R; Thomas, S

    2017-01-01

    The undergraduate medical curriculum has been overcrowded with core learning outcomes with no formal exposure to plastic surgery. The aim of this study was to compare medical students from two educational settings for the basic understanding, preferred learning method, and factors influencing a career choice in plastic surgery. A prospective cohort study based on a web-based anonymous questionnaire sent to final year medical students at Birmingham University (United Kingdom), McGill University (Canada), and a control group (non-medical staff). The questions were about plastic surgery: (1) source of information and basic understanding; (2) undergraduate curriculum inclusion and preferred learning methods; (3) factors influencing a career choice. A similar questionnaire was sent to non-medical staff (control group). The data was analysed based on categorical outcomes (Chi-square χ2) and level of significance p ≤ 0.05. Questionnaire was analysed for 243 students (Birmingham, n = 171/332, 52%) (McGill n = 72/132, 54%). Birmingham students (14%) considered the word "plastic" synonymous with "cosmetic" more than McGill students (4%, p inclusion. The preferred learning method was lectures for McGill students (61%, p inclusion in the undergraduate curriculum. There was a difference for plastic surgery source of information, operations, and preferred method of learning for students. The study highlighted the urgent need to reform plastic surgery undergraduate teaching in collaboration with national educational bodies worldwide.

  7. Plastic Surgery Inclusion in the Undergraduate Medical Curriculum: Perception, Challenges, and Career Choice—A Comparative Study

    Science.gov (United States)

    Vaughan, R.; Thomas, S.

    2017-01-01

    Objective The undergraduate medical curriculum has been overcrowded with core learning outcomes with no formal exposure to plastic surgery. The aim of this study was to compare medical students from two educational settings for the basic understanding, preferred learning method, and factors influencing a career choice in plastic surgery. Design and Setting A prospective cohort study based on a web-based anonymous questionnaire sent to final year medical students at Birmingham University (United Kingdom), McGill University (Canada), and a control group (non-medical staff). The questions were about plastic surgery: (1) source of information and basic understanding; (2) undergraduate curriculum inclusion and preferred learning methods; (3) factors influencing a career choice. A similar questionnaire was sent to non-medical staff (control group). The data was analysed based on categorical outcomes (Chi-square χ2) and level of significance p ≤ 0.05. Results Questionnaire was analysed for 243 students (Birmingham, n = 171/332, 52%) (McGill n = 72/132, 54%). Birmingham students (14%) considered the word “plastic” synonymous with “cosmetic” more than McGill students (4%, p inclusion. The preferred learning method was lectures for McGill students (61%, p inclusion in the undergraduate curriculum. There was a difference for plastic surgery source of information, operations, and preferred method of learning for students. The study highlighted the urgent need to reform plastic surgery undergraduate teaching in collaboration with national educational bodies worldwide. PMID:28630768

  8. Efficacy of low level laser therapy in reducing postoperative pain after endodontic surgery-- a randomized double blind clinical study.

    Science.gov (United States)

    Kreisler, M B; Haj, H Al; Noroozi, N; Willershausen, B d'Hoedt

    2004-01-01

    The aim of the study was to evaluate the effect of low level laser application on postoperative pain after endodontic surgery in a double blind, randomized clinical study. Fifty-two healthy adults undergoing endodontic surgery were included into the study. Subsequently to suturing, 26 patients had the operation site treated with an 809 nm-GaAlAs-laser (oralaser voxx, Oralia GmbH, Konstanz, Germany) at a power output of 50 mW and an irradiation time of 150 s. Laser treatment was simulated in further 26 patients. Patients were instructed to evaluate their postoperative pain on 7 days after surgery by means of a visual analogue scale (VAS). The results revealed that the pain level in the laser group was lower than in the placebo group throughout the 7 day follow-up period. The differences, however, were significant only on the first postoperative day (Mann-Whitney U-test, p<0.05). Low level laser therapy can be beneficial for the reduction of postoperative pain. Its clinical efficiency and applicability with regard to endodontic surgery, however require further investigation. This is in particular true for the optimal energy dosage and the number of laser treatments needed after surgery.

  9. The Beneficial Effect of Hypnosis in Elective Cardiac Surgery: A Preliminary Study.

    Science.gov (United States)

    Akgul, Ahmet; Guner, Beyhan; Çırak, Musa; Çelik, Derya; Hergünsel, Oya; Bedirhan, Sevim

    2016-10-01

    Background Single-session hypnosis has never been evaluated as a premedication technique in patients undergoing coronary artery bypass grafting (CABG). The aim of the present study was to evaluate the beneficial effects of clinical hypnotherapy on perioperative anxiety, pain perception, sedation, and necessity for ventilator assistance in patients undergoing CABG. Methods Double-blind, randomized, clinical trial was performed. Forty-four patients undergoing CABG surgery were randomized into two groups. The patients in group A received preprocedural hypnosis by an anesthesiologist. Patients in group B (control) had only information on the surgical intervention by the same anesthesiologist. State-Trait-Anxiety Index-I (STAI-I) and Beck Depression Inventory (BDI) were performed preoperatively in both groups. Visual analog scale (VAS) and Ramsay sedation scale (RSS) were evaluated on 0th, 1st, 2nd, 4th, 6th, 8th, 10th, 12th, and 24th hours, postoperatively. Postoperative anxiety level, analgesic drug consumption, and duration of ventilator assistance and intensive care unit (ICU) stay were also documented. Results When anxiety and depression levels were compared, significantly lower STA-I and BDI values were detected in group A after hypnotherapy (p = 0.001, p = 0.001, respectively). Significantly less total doses of remifentanil (34.4 ± 11.4 vs. 50.0 ± 13.6 mg) and morphine (4.9 ± 3.3 vs. 13.6 ± 2.7 mg) were administered in group A in the postoperative period. Ventilator assistance duration (6.8 ± 2.0 vs. 8.9 ± 2.7 hours) was also shorter in group A when compared with that in group B (p = 0.007). Conclusion Hypnosis session prior to surgery was an effective complementary method in decreasing presurgical anxiety, and it resulted in better pain control as well as reduced ventilator assistance following CABG surgery. Georg Thieme Verlag KG Stuttgart · New York.

  10. Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care.

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    Ian J Douglas

    2015-12-01

    Full Text Available Bariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence of the long-term effects of contemporary surgery on a broad range of clinical outcomes in large populations treated in routine clinical practice is lacking. The objective of this study was to measure the association between bariatric surgery, weight, body mass index, and obesity-related co-morbidities.This was an observational retrospective cohort study using data from the United Kingdom Clinical Practice Research Datalink. All 3,882 patients registered in the database and with bariatric surgery on or before 31 December 2014 were included and matched by propensity score to 3,882 obese patients without surgery. The main outcome measures were change in weight and body mass index over 4 y; incident diagnoses of type 2 diabetes mellitus (T2DM, hypertension, angina, myocardial infarction (MI, stroke, fractures, obstructive sleep apnoea, and cancer; mortality; and resolution of hypertension and T2DM. Weight measures were available for 3,847 patients between 1 and 4 mo, 2,884 patients between 5 and 12 mo, and 2,258 patients between 13 and 48 mo post-procedure. Bariatric surgery patients exhibited rapid weight loss for the first four postoperative months, at a rate of 4.98 kg/mo (95% CI 4.88-5.08. Slower weight loss was sustained to the end of 4 y. Gastric bypass (6.56 kg/mo and sleeve gastrectomy (6.29 kg/mo were associated with greater initial weight reduction than gastric banding (2.77 kg/mo. Protective hazard ratios (HRs were detected for bariatric surgery for incident T2DM, 0.68 (95% CI 0.55-0.83; hypertension, 0.35 (95% CI 0.27-0.45; angina, 0.59 (95% CI 0.40-0.87;MI, 0.28 (95% CI 0.10-0.74; and obstructive sleep apnoea, 0.55 (95% CI 0.40-0.87. Strong associations were found between bariatric surgery and the resolution of T2DM, with a HR of 9.29 (95% CI 6.84-12.62, and between bariatric surgery and the resolution of hypertension, with a HR of 5.64 (95% CI

  11. Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care

    Science.gov (United States)

    Douglas, Ian J.; Bhaskaran, Krishnan; Batterham, Rachel L.; Smeeth, Liam

    2015-01-01

    Background Bariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence of the long-term effects of contemporary surgery on a broad range of clinical outcomes in large populations treated in routine clinical practice is lacking. The objective of this study was to measure the association between bariatric surgery, weight, body mass index, and obesity-related co-morbidities. Methods and Findings This was an observational retrospective cohort study using data from the United Kingdom Clinical Practice Research Datalink. All 3,882 patients registered in the database and with bariatric surgery on or before 31 December 2014 were included and matched by propensity score to 3,882 obese patients without surgery. The main outcome measures were change in weight and body mass index over 4 y; incident diagnoses of type 2 diabetes mellitus (T2DM), hypertension, angina, myocardial infarction (MI), stroke, fractures, obstructive sleep apnoea, and cancer; mortality; and resolution of hypertension and T2DM. Weight measures were available for 3,847 patients between 1 and 4 mo, 2,884 patients between 5 and 12 mo, and 2,258 patients between 13 and 48 mo post-procedure. Bariatric surgery patients exhibited rapid weight loss for the first four postoperative months, at a rate of 4.98 kg/mo (95% CI 4.88–5.08). Slower weight loss was sustained to the end of 4 y. Gastric bypass (6.56 kg/mo) and sleeve gastrectomy (6.29 kg/mo) were associated with greater initial weight reduction than gastric banding (2.77 kg/mo). Protective hazard ratios (HRs) were detected for bariatric surgery for incident T2DM, 0.68 (95% CI 0.55–0.83); hypertension, 0.35 (95% CI 0.27–0.45); angina, 0.59 (95% CI 0.40–0.87);MI, 0.28 (95% CI 0.10–0.74); and obstructive sleep apnoea, 0.55 (95% CI 0.40–0.87). Strong associations were found between bariatric surgery and the resolution of T2DM, with a HR of 9.29 (95% CI 6.84–12.62), and between bariatric surgery and the resolution of

  12. Is surgery recommended in adults with neglected congenital muscular torticollis? A prospective study

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    Sharifi Reza

    2008-11-01

    Full Text Available Abstract Background Congenital muscular torticollis is the third most common congenital musculoskeletal anomaly after dislocation of the hip and clubfoot. When diagnosed early, it is obvious that it can be managed with good or excellent results. The aim of this prospective study was to determine the efficacy of surgery in neglected adult cases. Methods From January 2003 to June 2007, 18 adult skeletally matured patients were surgically treated for neglected congenital muscular torticollis and prospectively followed (at least one year. Bipolar release was performed in all patients. Radiography and the modified Lee's scoring system which included function and cosmesis, were used to measure the surgical results. Complications were also recorded. Results Four cases were lost during follow-up. Of the remaining 14 patients, 10 cases were males and 4 females. The age at operation ranged from 18 to 32 (average 21.9 years. The mean follow-up period was 2.5 years (range 1–5 years. Excellent results were noted in 7 patients, good in 5, and poor in 2 patients. Significant improvement (>10° of the cervico-thoracic scoliosis was noted only in 3 of 10 patients. Conclusion Patients with congenital muscular torticollis can benefit from surgical treatment even in adulthood. Surgical bipolar sectioning of the sternocleidomastoid muscle should be considered even in adults with irreversible facial and skeletal deformities. The surgery restores the range of neck motion and resolves the head tilt; therefore it can improve the quality of life. This procedure is an effective and relatively complication-free method.

  13. A peripherally inserted central catheter line, inserted the day before surgery, decreases the time from induction to incision for spinal deformity surgery and safely provides central venous access during surgery: a pilot study.

    Science.gov (United States)

    Stuedemann, Anne E; Schwend, Richard M; Thomas, Valorie K; Leamon, Julia M; Lightner, Tammy S

    2017-02-24

    Pediatric patients undergoing surgery for spinal deformity may benefit from central venous access to provide intraoperative monitoring and fluid resuscitation. For pediatric surgical patients requiring central access, we hypothesized that placing a peripherally inserted central catheter (PICC) line preoperatively should decrease time from induction of anesthesia to incision and result in improved patient safety and decreased operating room charges. This was a retrospective, nonrandomized, and case comparison study. Clinical records of all children with adolescent idiopathic scoliosis or neuromuscular scoliosis treated surgically by the senior author between December 2007 and April 2012 were reviewed. Control group patients had a central venous catheter (CVC) placed by the anesthesiologist after induction of anesthesia. The trial group had a PICC placed under local anesthesia the day before surgery by an experienced vascular access team. The time from induction of anesthesia to the time for the surgical incision was determined for each study group. The CVC line placement charges were determined by the operating room time charges at $214/min. Charges saved were the mean time difference multiplied by the operating room time charge, less the charge for PICC line insertion ($1282). There were 29 neuromuscular patients, the mean age was 13 years (SD: 4 years). The mean time from induction to incision for the PICC group was 91 min [95% confidence interval (CI): 67-115 min] and for the CVC group 113 min (95% CI: 99-127 min, P=0.083). For this mean time difference of 22 min, the estimated cost savings would be $3426 per patient. There were 59 patients with adolescent idiopathic scoliosis, the mean age was 14 years (SD: 2 years). The mean time from induction to incision for the PICC group was 78 min (95% CI: 74-82 min) and for the CVC group 106 min (95% CI: 96-116  min, P≤0.001). For this mean time difference of 28 min, the estimated cost savings would

  14. Left atrial longitudinal strain parameters predict postoperative persistent atrial fibrillation following mitral valve surgery: a speckle tracking echocardiography study.

    Science.gov (United States)

    Candan, Ozkan; Ozdemir, Nihal; Aung, Soe Moe; Dogan, Cem; Karabay, Can Yucel; Gecmen, Cetin; Omaygenç, Onur; Güler, Ahmet

    2013-10-01

    Postoperative atrial fibrillation (POAF) is common after cardiac surgery and is associated with increased morbidity, mortality, and prolonged hospital stay. Speckle tracking echocardiography (STE) has been applied recently for evaluation of LA function. The purpose of this study was to examine whether left atrial longitudinal strain measured by STE is a predictor for the development of POAF following mitral valve surgery for severe mitral regurgitation. We studied 53 patients undergoing mitral valve surgery in sinus rhythm at the time of surgery. Echocardiography with evaluation of LA strain by STE was performed. Detection of POAF was based on documentation of AF episodes by continuous telemetry throughout hospitalization. Patients who did not develop POAF were taken as group 1 and those who had POAF constituted group 2. The echocardiographic and clinical predictors of POAF were investigated. POAF occurred in 28.3% of subjects. Mean age, LAVi and BNP were found higher in group 2 while peak atrial longitudinal strain (PALS) (13.9 ± 3.8% vs. 24.8 ± 7.3%; P longitudinal strain was found to predict POAF in patients undergoing mitral valve surgery. It could be used to better identify patients at greater risk of developing POAF, and thus to guide in risk stratification and to take appropriate intensive prophylactic therapy.

  15. Pain management using acetaminophen throughout postoperative course of laparoscopic colorectal surgery: A case-matched control study.

    Science.gov (United States)

    Naito, Masanori; Sato, Takeo; Nakamura, Takatoshi; Yamanashi, Takahiro; Miura, Hirohisa; Tsutsui, Atsuko; Watanabe, Masahiko

    2017-05-01

    The main advantage of laparoscopic surgery is that it is minimally invasive because of the use of small incisions. An approach using small incisions offers many benefits including attenuation of surgical wound pain. However, the presence of postoperative pain may undermine the advantages of laparoscopic surgery as a minimally invasive technique. In addition, perioperative pain management is an important factor affecting recovery after surgery. This study investigated the usefulness of a multimodal approach to postoperative pain management with acetaminophen as a baseline analgesic after minimally invasive laparoscopic colorectal surgery. The study included 40 patients who underwent laparoscopic colorectal surgery for colorectal cancer. 20 patients received acetaminophen as a baseline analgesic for postoperative pain management and 20 received epidural anesthesia. The urethral catheter could be removed earlier in the acetaminophen group (2.1 ± 0.22 days postoperatively) compared with the epidural group (4.1 ± 0.45days postoperatively). The frequencies of vertigo were significantly lower in the acetaminophen than epidural group (10.0% and 45.0%, respectively). The frequencies of the use of analgesics on an as-needed basis for postoperative pain relief as well as the variabilities in these frequencies, although not significantly different between the acetaminophen and epidural groups, were lower in the acetaminophen group than the epidural group. We herein demonstrated that postoperative pain management with acetaminophen as a baseline analgesic, and without the use of epidural anesthesia, is a safe and useful analgesic modality.

  16. Self-assessment of facial form oral function and psychosocial function before and after orthognathic surgery: A retrospective study

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    Narayanan Vinod

    2008-01-01

    Full Text Available Orthognathic surgery is a well-accepted treatment for patients with skeletal discrepancies. The primary motivation of many patients who seek orthognathic surgery is esthetics and not for correction of functional disability. The treatment is incomplete if the surgeon attempts to correct the physical deformity alone without adequate understanding and regard for the emotional framework. The purpose of this study is aimed at patient′s self-perceptions of facial form oral function and psychosocial function before and after orthognathic surgery. Fifty patients were included in the study, of which 21 were used as control. Twenty-two questions were asked to evaluate the problem in all four areas as mentioned earlier. Each question takes a score from one to five. In group I, the internal consistency of each scale indicates moderate to high internal reliability, ranging from α = 0.71 for general health to α = 0.88 for psychosocial problem. In group II, except for functional problems, the internal consistency of each scale has moderate to high reliability. The psychological wellbeing of an orthognathic surgery patient is enhanced by careful preoperative counseling regarding the expected surgical treatment objectives, the operative course, and the expected postoperative sequelae. Patients who undergo orthognathic surgery readily accept the changes in their postoperative appearance and are satisfied with achieved results.

  17. INCIDENCE AND RISK FACTORS FOR EARLY SURGICAL SITE INFECTION IN ELECTIVE ORTHOPAEDIC IMPLANT SURGERIES: A PROSPECTIVE STUDY

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    Suneet

    2015-02-01

    Full Text Available BACKGROUND : Surgical site infections in orthopaedic implant surgery is devasting complication range from 1 - 2% to 22%. It leads to increase case cost , prolongs antibiotic use/abuse , increases morbidity and rehabilitation. METHOD : This prospective cross sectional study was conducted on 624 patients with closed fracture cases undergoing clean and elective orthopaedic implant surgeries admitted at Gandhi Medical College and Hamidia Hospital , Bhopal (Madhya Pradesh , India between ‘1st November 2013 to 31st October 2014’. RESULTS : The surgical site infection was diagnosed in 43 (6.89% pati ents within 30 days after surgery. Klebsiella was most common infective organism islolated in 39.53% cases. On data analysis SSI was significantly associated with increasing age , duration of hospital stay more than 7 days , duration of surgery more than 120 minutes , pre - operative Hb less than 12 gm% , diabetes mellitus , use of intra - operative negative suction and tourniquet. CONCLUSION : Incidence of SSI in implants surgeries are quite high , proper measure are needed to control it. In this study gram negative organism has emerged as major threat in contrast to staphylococcus aureus.

  18. Micro-economic impact of congenital heart surgery: results of a prospective study from a limited-resource setting.

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    Manu Raj

    Full Text Available The microeconomic impact of surgery for congenital heart disease is unexplored, particularly in resource limited environments. We sought to understand the direct and indirect costs related to congenital heart surgery and its impact on Indian households from a family perspective.Baseline and first follow-up data of 644 consecutive children admitted for surgery for congenital heart disease (March 2013 - July 2014 in a tertiary referral hospital in Central Kerala, South India was collected prospectivelyfrom parents through questionnaires using a semi-structured interview schedule.The median age was 8.2 months (IQR: 3.0- 36.0 months. Most families belonged to upper middle (43.0% and lower middle (35.7% socioeconomic class. Only 3.9% of families had some form of health insurance. The median expense for the admission and surgery was INR 201898 (IQR: 163287-266139 [I$ 11989 (IQR: 9696-15804], which was 0.93 (IQR: 0.52-1.49 times the annual family income of affected patients. Median loss of man-days was 35 (IQR: 24-50 and job-days was 15 (IQR: 11-24. Surgical risk category and hospital stay duration significantly predicted higher costs. One in two families reported overwhelming to high financial stress during admission period for surgery. Approximately half of the families borrowed money during the follow up period after surgery.Surgery for congenital heart disease results in significant financial burden for majority of families studied. Efforts should be directed at further reductions in treatment costs without compromising the quality of care together with generating financial support for affected families.

  19. Micro-economic impact of congenital heart surgery: results of a prospective study from a limited-resource setting.

    Science.gov (United States)

    Raj, Manu; Paul, Mary; Sudhakar, Abish; Varghese, Anu Alphonse; Haridas, Aareesh Chittulliparamb; Kabali, Conrad; Kumar, Raman Krishna

    2015-01-01

    The microeconomic impact of surgery for congenital heart disease is unexplored, particularly in resource limited environments. We sought to understand the direct and indirect costs related to congenital heart surgery and its impact on Indian households from a family perspective. Baseline and first follow-up data of 644 consecutive children admitted for surgery for congenital heart disease (March 2013 - July 2014) in a tertiary referral hospital in Central Kerala, South India was collected prospectivelyfrom parents through questionnaires using a semi-structured interview schedule. The median age was 8.2 months (IQR: 3.0- 36.0 months). Most families belonged to upper middle (43.0%) and lower middle (35.7%) socioeconomic class. Only 3.9% of families had some form of health insurance. The median expense for the admission and surgery was INR 201898 (IQR: 163287-266139) [I$ 11989 (IQR: 9696-15804)], which was 0.93 (IQR: 0.52-1.49) times the annual family income of affected patients. Median loss of man-days was 35 (IQR: 24-50) and job-days was 15 (IQR: 11-24). Surgical risk category and hospital stay duration significantly predicted higher costs. One in two families reported overwhelming to high financial stress during admission period for surgery. Approximately half of the families borrowed money during the follow up period after surgery. Surgery for congenital heart disease results in significant financial burden for majority of families studied. Efforts should be directed at further reductions in treatment costs without compromising the quality of care together with generating financial support for affected families.

  20. Radiological findings in patients undergoing revision endoscopic sinus surgery: a retrospective case series study

    Directory of Open Access Journals (Sweden)

    Eweiss Ahmed Z

    2011-05-01

    Full Text Available Abstract Background Functional endoscopic sinus surgery (FESS is now a well-established strategy for the treatment of chronic rhinosinusitis which has not responded to medical treatment. There is a wide variation in the practice of FESS by various surgeons within the UK and in other countries. Objectives To identify anatomic factors that may predispose to persistent or recurrent disease in patients undergoing revision FESS. Methods Retrospective review of axial and coronal CT scans of patients undergoing revision FESS between January 2005 and November 2008 in a tertiary referral centre in South West of England. Results The CT scans of 63 patients undergoing revision FESS were reviewed. Among the patients studied, 15.9% had significant deviation of the nasal septum. Lateralised middle turbinates were present in 11.1% of the studied sides, and residual uncinate processes were identified in 57.1% of the studied sides. There were residual cells in the frontal recess in 96% of the studied sides. There were persistent other anterior and posterior ethmoidal cells in 92.1% and 96% of the studied sides respectively. Conclusions Analysis of CT scans of patients undergoing revision FESS shows persistent structures and non-dissected cells that may be responsible for persistence or recurrence of rhinosinusitis symptoms. Trials comparing the outcome of conservative FESS techniques with more radical sinus dissections are required.

  1. Corrective Jaw Surgery

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    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  2. Dental Implant Surgery

    Science.gov (United States)

    ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  3. A comparative study of the effect of caudal dexmedetomidine versus morphine added to bupivacaine in pediatric infra-umbilical surgery

    Directory of Open Access Journals (Sweden)

    Hossam A El Shamaa

    2014-01-01

    Full Text Available Background: One of the most commonly used regional anesthetic techniques in pediatric surgeries is the caudal epidural block. Its main disadvantage remains the short duration of action. Hence, different additives have been used. Dexmedetomidine is a potent as well as highly selective α2 adrenergic receptor agonist. The aim of this randomized, double-blinded, study was to compare the duration of postoperative analgesia of caudal dexmedetomidine versus morphine in combination with bupivacaine in pediatric patients undergoing lower abdominal or perineal surgery. Patients and Methods: A total of 50 pediatric patients 1-5 years old The American Society of Anesthesiologists status I, II scheduled for lower abdominal and perineal surgeries were included in the study. The patients were enrolled into 2 equal groups: Group A patients (n = 25 received dexmedetomidine with bupivacaine while Group B patients (n = 25 received morphine with bupivacaine. Patients were placed in a supine position then inhalational general anesthesia was induced, and laryngeal mask airway (LMA was placed. Patients were then given caudal epidural analgesia. By the end of surgery reversal of muscle relaxation was done and the LMA was removed. Post-operatively, the sedation as well as pain score were observed and recorded. Results: The current study showed that minor complications were recorded in the post-anesthesia care unit; in addition, significantly longer periods of analgesia and sedation were detected in Group A. However, no significant differences in demographic data, as well as in the duration of surgery, and the time of emergence from anesthesia and patient condition during recovery were detected. Conclusion: The present study suggested that use of dexmedetomidine, during single dose injection, as an additive to the local anesthetic bupivacaine in caudal epidural analgesia prolongs the duration of post-operative analgesia following lower abdominal as well as perineal

  4. GPS与CASS6.0、AutoCAD软件在景东县集体林权制度改革中的综合运用%Integrated Utilization of Software GPS and CASS6.0 as well as AutoCAD in the Reform of Collective Forest Property Right System in Jingdong County

    Institute of Scientific and Technical Information of China (English)

    诸良富

    2009-01-01

    为了解决景东县深化集体林权制度主体改革中时间紧、任务重、技术难度大、技术力量弱等实际问题,将GPS与CASS6.0、AutoCAD软件综合运用,使得外业工作速度加快,质量提高,每个技术员从一天只能勘查10~20宗林地提高到30~50宗林地,并且节省了人力、资金和时间,资料规范整齐,实现无纸化办公,档案管理方便.%In order to solve the actual problems in deepening the reform of collective forest property right system concerning critical time, heaven task, difficult technique, and poor technical ability, the software GPS and CASS6.0 as well as AutoCAD are comprehensively utilized to make the fieldwork fast speed and high quality. A technician can survey 30- 50 clans per day instead of original 10- 20 clans per day in detail. Moreover, the utilization can save human force, fund and time, and obtain standard materials to realize doing office work with no- paper and convenient file management as a result

  5. Supplemental Perioperative Oxygen to Reduce Surgical Site Infection After High-Energy Fracture Surgery (OXYGEN Study).

    Science.gov (United States)

    OʼToole, Robert V; Joshi, Manjari; Carlini, Anthony R; Sikorski, Robert A; Dagal, Armagan; Murray, Clinton K; Weaver, Michael J; Paryavi, Ebrahim; Stall, Alec C; Scharfstein, Daniel O; Agel, Julie; Zadnik, Mary; Bosse, Michael J; Castillo, Renan C

    2017-04-01

    Supplemental perioperative oxygen (SPO) therapy has been proposed as one approach for reducing the risk of surgical site infection (SSI). Current data are mixed regarding efficacy in decreasing SSI rates and hospital inpatient stays in general and few data exist for orthopaedic trauma patients. This study is a phase III, double-blind, prospective randomized clinical trial with a primary goal of assessing the efficacy of 2 different concentrations of perioperative oxygen in the prevention of SSIs in adults with tibial plateau, pilon (tibial plafond), or calcaneus fractures at higher risk of infection and definitively treated with plate and screw fixation. Patients are block randomized (within center) in a 1:1 ratio to either treatment group (FiO2 80%) or control group (FiO2 30%) and stratified by each study injury location. Secondary objectives of the study are to compare species and antibacterial sensitivities of the bacteria in patients who develop SSIs, to validate a previously developed risk prediction model for the development of SSI after fracture surgery, and to measure and compare resource utilization and cost associated with SSI in the 2 study groups. SPO is a low cost and readily available resource that could be easily disseminated to trauma centers across the country and the world if proved to be effective.

  6. Study on the relationship between the serum VEGF, MMP, MK and recurrence and metastasis after gastric cancer surgery

    Institute of Scientific and Technical Information of China (English)

    Bo Li; Lan Zhou

    2016-01-01

    Objective:To study and investigate the relationship between the serum vascular endothelial growth factor (VEGF), matrix metalloproteinase (MMP), midkine (MK) and recurrence and metastasis after gastric cancer surgery.Methods:A total of 78 patients with recurrence and metastasis after gastric cancer surgery in our hospital from January 212 to June 2015 were selected as Group A, 78 patients without recurrence and metastasis at the same time were selected as Group B and 78 healthy persons were selected as Group C. Then the serum VEGF, MMP and MK levels of the 3 groups were compared. The detection levels of local recurrence, regional lymphatic metastasis and distant metastasis in Group A were also compared, and the relationship between the serum VEGF, MMP, MK and recurrence and metastasis after gastric cancer surgery was analyzed by the Logistic analysis.Results:The serum VEGF, MMP and MK indexes of Group A were all higher than those of Group B and Group C. The levels of Group B and Group C had no significant differences. Meanwhile, in Group A, the detection levels of regional lymphatic metastasis and distant metastasis were all higher than those of patients with local recurrence. According to the Logistic analysis, the above indexes all had close relationship with the recurrence and metastasis after gastric cancer surgery.Conclusions:The serum VEGF, MMP and MK of patients with recurrence and metastasis after gastric cancer surgery show higher expression state, and those indexes all have close relationship with the disease.

  7. The effect of endotracheal tube cuff pressure change during gynecological laparoscopic surgery on postoperative sore throat: a control study.

    Science.gov (United States)

    Geng, Guiqi; Hu, Jingyi; Huang, Shaoqiang

    2015-02-01

    Postoperative respiratory complications related to endotracheal intubation usually present as cough, sore throat, hoarseness. The aim of the study was to examine the effects of endotracheal tube cuff pressure changes during gynecological laparoscopic surgery on postoperative sore throat rates. Thirty patients who underwent gynecological laparoscopic surgery and 30 patients who underwent laparotomy under general anesthesia with endotracheal intubation were included. After induction of general anesthesia and endotracheal intubation, the cuff was inflated to 25 mmHg. At 5, 15, 30, 45 and 60 min after endotracheal intubation, cuff pressure and peak airway pressure were recorded. At 2 and 24 h after surgery, the patients were assessed for complaints of a sore throat. In patients who underwent laparotomy, cuff pressure and peak airway pressure did not change significantly at different time points after intubation. In patients who received laparoscopic surgery, cuff pressure and peak airway pressure were significantly increased compared to initial pressure at all examined time points. In both groups, the endotracheal tube cuff pressure and peak airway pressure were significantly correlated (R=0.9431, Psore throat scores at both 2 and 24 h after surgery (Ppressure and cuff pressure, resulting in increased incidence of postoperative sore throat.

  8. The influence of country of origin on engagement in self-care behaviours following heart surgery: a descriptive correlational study.

    Science.gov (United States)

    Fredericks, Suzanne

    2012-08-01

    The aim of this study was to determine whether an individual's country of origin influenced performance of self-care behaviours after heart surgery. Patients are required to perform self-care behaviours following cardiovascular surgery. Usual care encompasses a patient education initiative that addresses self-care behaviour performance. Within Canada, current heart surgery patient education efforts have been designed and evaluated using homogenous samples that self-identify their country of origin as England, Ireland or Scotland. However, approximately 42·6% of Canadian cardiovascular surgical patients self-identify their country of origin as India or China. Thus, current cardiovascular surgery patient education initiatives may not be applicable to all patients undergoing heart surgery, which may result in decreased patient outcomes such as performance of self-care behaviours. This descriptive study. A convenience sample of 90 patients who underwent heart surgery at one of two university-affiliated teaching hospitals, representing individuals of diverse backgrounds. Point-biserial correlational analysis was conducted to determine the relationship between country of origin and performance of self-care behaviours. Findings indicate individuals who self-identified their country of origin as England or Ireland were associated with a higher score on the number of self-care behaviours performed (p study provides preliminary evidence to suggest country of origin influences the amount of self-care behaviours individuals will perform. Patient education initiatives should incorporate the values, beliefs, attitudes and customs reflective of an individual's country of origin to enhance the likelihood of producing desired outcomes. © 2012 Blackwell Publishing Ltd.

  9. Assessment of anti-inflammatory and anti-arthritic properties of Acmella uliginosa (Sw.) Cass. based on experiments in arthritic rat models and qualitative gas chromatography-mass spectrometry analyses

    Science.gov (United States)

    Paul, Subhashis; Sarkar, Sudeb; Dutta, Tanmoy; Bhattacharjee, Soumen

    2016-01-01

    Aim: The principle objective of the study was to explore the anti-arthritic properties of Acmella uliginosa (AU) (Sw.) Cass. flower in a rat model and to identify potential anti-inflammatory compounds derived from flower extracts. The synergistic role played by a combination of AU flower and Aloe vera (AV) gel crude extracts was also investigated. Materials and Methods: Male Wistar rats induced with Freund’s complete adjuvant (FCA) were used as a disease model of arthritic paw swelling. There were three experimental and two control groups, each consisting of five rats. Paw circumference and serum biochemical parameters were evaluated to investigate the role of the flower extracts in disease amelioration through a feeding schedule spanning 21 days. Gas chromatography/mass spectrometry (GC/MS) analyses were performed to search for the presence of anti-inflammatory compounds in the ethanolic and n-hexane solvent extracts of the flower. Results: As a visual cue to the experimental outcomes, FCA-induced paw swelling decreased to the normal level; and hemoglobin, serum protein, and albumin levels were significantly increased in the treated animals. The creatinine level was estimated to be normal in the experimental rats after the treatment. The combination of AU and AV showed the best recovery potential in all the studied parameters, confirming the synergistic efficacy of the herbal formulation. GC/MS analyses revealed the presence of at least 5 anti-inflammatory compounds including 9-octadecenoic acid (Z)-, phenylmethyl ester, astaxanthin, à-N-Normethadol, fenretinide that have reported anti-inflammatory/anti-arthritic properties. Conclusion: Our findings indicated that the crude flower homogenate of AU contains potential anti-inflammatory compounds which could be used as an anti-inflammatory/anti-arthritic medication. PMID:27366352

  10. Comparison of Topping-off and posterior lumbar interbody fusion surgery in lumbar degenerative disease:a retrospective study

    Institute of Scientific and Technical Information of China (English)

    LIU Hai-ying; ZHOU Jian; WANG Bo; WANG Hui-min; JIN Zhao-hui; ZHU Zhen-qi; MIAO Ke-nan

    2012-01-01

    Background Topping-off surgery is a newly-developed surgical technique which combines rigid fusion with an interspinous process device in the adjacent segment to prevent adjacent segment degeneration.There are few reports on Topping-off surgery and its rationality and indications remains highly controversial.Our study aims to investigate the short-term and mid-term clinical results of Topping-off surgery in preventing adjacent segment degeneration when mild or moderate adjacent segment degeneration existed before surgery.Methods The 25 cases that underwent L5-S1 posterior lumbar interbody fusion(PLIF)+L4-L5 interspinous process surgeries between April 2008 and March 2010 formed Topping-off group.The 42 cases undergoing L5-S1 PLIF surgery formed PLIF group.Both groups matched in gender,age,body mass index and Pfirrmann grading(4 to 6).The patients were evaluated with visual analogue scale(VAS)and Japanese orthopaedic association(JOA)scores before surgery and in the last follow-up.Modic changes of endplates were recorded.Results The follow-up averaged 24.8 and 23.7 months.No symptomatic or radiological adjacent segment degeneration was observed.There was no significant difference in intraoperative blood loss or postoperative drainage.VAS and lumbar JOA scores improved significantly in both groups(t=12.1 and 13.5,P<0.05).Neither anterior nor posterior disc height was significantly changed.Segmental lordosis of L4-L5 and total lordosis were all increased significantly(Topping-off group:t=-2.30 and-2.24,P<0.05;PLIF group:t=-2.76 and-1.83,P<0.01).In the hyperextension and hyperflexion view,Topping-off group's range of motion(ROM)and olisthesis in the L4-L5 segment did not significantly change in flexion,but decreased in extension.In PLIF group,ROM(t=-7.82 and-4.90,P<0.01)and olisthesis(t=-15.67and-18.58,P<0.01)both significantly increased in extension and flexion.Conclusions Compared with single segment PLIF surgery,Topping-off surgery can achieve similar

  11. Italian multicenter study on infection hazards during dental practice: Control of environmental microbial contamination in public dental surgeries

    Science.gov (United States)

    Castiglia, Paolo; Liguori, Giorgio; Montagna, Maria Teresa; Napoli, Christian; Pasquarella, Cesira; Bergomi, Margherita; Fabiani, Leila; Monarca, Silvano; Petti, Stefano

    2008-01-01

    Background The present study assessed microbial contamination in Italian dental surgeries. Methods An evaluation of water, air and surface microbial contamination in 102 dental units was carried out in eight Italian cities. Results The findings showed water microbial contamination in all the dental surgeries; the proportion of water samples with microbial levels above those recommended decreased during working. With regard to Legionella spp., the proportion of positive samples was 33.3%. During work activity, the index of microbial air contamination (IMA) increased. The level of microbial accumulation on examined surfaces did not change over time. Conclusion These findings confirm that some Italian dental surgeries show high biocontamination, as in other European Countries, which highlights the risk of occupational exposure and the need to apply effective measures to reduce microbial loads. PMID:18644099

  12. Monitoring respiration and oxygen saturation in patients during the first night after elective bariatric surgery: A cohort study.

    Science.gov (United States)

    Wickerts, Liselott; Forsberg, Sune; Bouvier, Frederic; Jakobsson, Jan

    2017-01-01

    Background: Obstructive sleep apnoea and obese hypoventilation is not uncommon in patients with obesity. Residuals effect from surgery/anaesthesia and opioid analgesics may worsen respiration during the first nights after bariatric surgery. The aim of this observational study was to monitor respiration on the first postoperative night following elective bariatric surgery. Methods: This observational study aimed to determine the incidence and severity of hypo/apnoea in low risk obsess patients undergoing elective bariatric surgery in general anesthaesia. Patients with known or suspected sleep respiratory disturbances was not included. ESS was scored prior to surgery. Oxygen desaturation was analyzed by continuous respiratory monitoring. Mean oxygen saturation (SpO2), nadir SPo2, apnoea/hypopnea index and oxygen desaturation index was assess by standard tools. Results: 45 patients were monitored with portable polygraphy equipment (Embletta, ResMed) during the first postoperative night at the general ward following elective laparoscopic bariatric surgery. The prop ESS was 0-5 in 22, 6-10 in 14 and 11-16 in 6 of the patients studied (missing data 3). Mean SpO2 was 93%; 10 patients had a mean SpO2 of less than 92% and 4 of less than 90%. The lowest mean SpO2 was 87%. There were 16 patients with a nadir SpO2 of less than 85%, lowest nadir SpO2 being 63%. An Apnoea Hypo/apnoea Index (AHI) > 5 was found in 2 patients only (AHI 10 and 6), and an Oxygen Desaturation index (ODI) > 5 was found in 3 patients (24, 10 and 6, respectively). 3 patients had more prolonged (> 30 seconds) apnoea with nadir SpO2 81%, 83% and 86%. ESS score and type of surgery did not impact on respiration/oxygenation during the observation period. Conclusions: A low mean SpO2 and episodes of desaturation were not uncommon during the first postoperative night following elective bariatric surgery in patients without history of night time breathing disturbance. AHI and/or ODI of more than 5 were only

  13. Who Needs to Be Allocated in ICU after Thoracic Surgery? An Observational Study

    Directory of Open Access Journals (Sweden)

    Liana Pinheiro

    2016-01-01

    Full Text Available Background. The effective use of ICU care after lung resections has not been completely studied. The aims of this study were to identify predictive factors for effective use of ICU admission after lung resection and to develop a risk composite measure to predict its effective use. Methods. 120 adult patients undergoing elective lung resection were enrolled in an observational prospective cohort study. Preoperative evaluation and intraoperative assessment were recorded. In the postoperative period, patients were stratified into two groups according to the effective and ineffective use of ICU. The use of ICU care was considered effective if a patient experienced one or more of the following: maintenance of controlled ventilation or reintubation; acute respiratory failure; hemodynamic instability or shock; and presence of intraoperative or postanesthesia complications. Results. Thirty patients met the criteria for effective use of ICU care. Logistic regression analysis identified three independent predictors of effective use of ICU care: surgery for bronchiectasis, pneumonectomy, and age ≥ 57 years. In the absence of any predictors the risk of effective need of ICU care was 6%. Risk increased to 25–30%, 66–71%, and 93% with the presence of one, two, or three predictors, respectively. Conclusion. ICU care is not routinely necessary for all patients undergoing lung resection.

  14. Who Needs to Be Allocated in ICU after Thoracic Surgery? An Observational Study

    Science.gov (United States)

    Pinheiro, Liana; Faresin, Sonia Maria

    2016-01-01

    Background. The effective use of ICU care after lung resections has not been completely studied. The aims of this study were to identify predictive factors for effective use of ICU admission after lung resection and to develop a risk composite measure to predict its effective use. Methods. 120 adult patients undergoing elective lung resection were enrolled in an observational prospective cohort study. Preoperative evaluation and intraoperative assessment were recorded. In the postoperative period, patients were stratified into two groups according to the effective and ineffective use of ICU. The use of ICU care was considered effective if a patient experienced one or more of the following: maintenance of controlled ventilation or reintubation; acute respiratory failure; hemodynamic instability or shock; and presence of intraoperative or postanesthesia complications. Results. Thirty patients met the criteria for effective use of ICU care. Logistic regression analysis identified three independent predictors of effective use of ICU care: surgery for bronchiectasis, pneumonectomy, and age ≥ 57 years. In the absence of any predictors the risk of effective need of ICU care was 6%. Risk increased to 25–30%, 66–71%, and 93% with the presence of one, two, or three predictors, respectively. Conclusion. ICU care is not routinely necessary for all patients undergoing lung resection. PMID:27493477

  15. Study on the feasibility of provision of distance learning programmes in surgery to Malawi.

    Science.gov (United States)

    Mains, Edward A A; Blackmur, James P; Dewhurst, David; Ward, Ross M; Garden, O James; Wigmore, Stephen J

    2011-12-01

    Medical educational opportunities and resources are considerably limited in the developing world. The expansion of computing and Internet access means that there exists a potential to provide education to students through distance learning programmes. This study investigated the feasibility of providing distance learning course in surgery in Malawi. The study investigated the user requirements, technical requirements and Internet connections in two teaching hospitals in Malawi. In addition the appropriateness of current course material from the Edinburgh Surgical Sciences Qualification to Malawi trainees was assessed. The study found a high degree of interest from Malawian trainees in distance learning. The provision of basic science modules such as anatomy and physiology and the ability to access journals were considered highly desirable. The current ESSQ course would require extensive re-modelling to make it suitable to an African trainee's requirements. Internet speeds remain slow and access is currently expensive. There is considerable interest in distance learning programmes in Malawi but access to them is limited partly because of slow and expensive Internet access. Understanding the needs of trainees in countries such as Malawi will allow better direction of educational aid and resources to support surgical training. Copyright © 2010 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  16. The effect of patient position during trauma surgery on fat embolism syndrome: An experimental study

    Directory of Open Access Journals (Sweden)

    Khalid A Syed

    2014-01-01

    Full Text Available Background: The aim of this study was to compare the effect of supine versus lateral position on clinical signs of fat embolism during orthopedic trauma surgery. Dogs served as the current study model, which could be extended and/or serve as a basis for future in vivo studies on humans. It was hypothesized that there would be an effect of position on clinical signs of fat embolism syndrome in a dog model. Materials and Methods: 12 dogs were assigned to supine ( n = 6 and lateral ( n = 6 position groups. Airway pressures, heart rate, blood pressure, cardiac output, pulmonary artery pressure, pulmonary artery wedge pressure, right atrial pressure, arterial and venous blood gases, white blood count, platelet count and neutrophil count were obtained. Dogs were then subjected to pulmonary contusion in three areas of one lung. Fat embolism was generated by reaming one femur and tibia, followed by pressurization of the canal. Results: No difference was found in any parameters measured between supine and lateral positions at any time (0.126 > P < 0.856. Conclusions: The position of trauma patients undergoing reamed intramedullary nailing did not alter the presentation of the features of the lung secondary to fat embolism.

  17. Two stage study of wound microorganisms affecting burns and plastic surgery inpatients.

    Science.gov (United States)

    Miranda, Benjamin H; Ali, Syed N; Jeffery, Steven L A; Thomas, Sunil S

    2008-01-01

    This study was designed to identify wound microorganisms and the reasons for differing prevalence between the wards, burns unit and intensive care unit (ICU) in a regional centre for burns and plastic surgery. Antibiotic sensitivities of the 10 most prevalent microorganisms cultured from inpatient wound swabs were also investigated. Inpatient wound swab data were collected retrospectively using notes and departmental database information between January and June 2007. Data were analyzed using chi-squared tests and P-values. Eight hundred five positive wound swabs from 204 swab positive inpatients were analyzed. Stage 1 of this study demonstrated 917 positive swab episodes and 30 varieties of organism. The five most prevalent organisms cultured were Staphylococcus (23.9%), Acinetobacter (21.2%), Methicillin Resistant Staphylococcus aureus (MRSA) (20.8%), Pseudomonas (9.7%) and Enterococcus (5.2%). Stage 2 revealed that Acinetobacter baumanni (ABAU) was significantly more prevalent in military over civilian inpatients (P PAER) was significantly more prevalent in military inpatients over civilian inpatients (P PAER were significantly more prevalent in the ICU setting. Furthermore, military inpatient wounds grew more ABAU, MRSA, and PAER than civilians, probably due to the longer inpatient stay, dirty nature of wounds, site and complex mechanism of injury. Finally, this study suggests that ABAU was brought into the unit by military patients.

  18. Cardiac-surgery associated acute kidney injury requiring renal replacement therapy. A Spanish retrospective case-cohort study

    Directory of Open Access Journals (Sweden)

    Garcia-Fernandez Nuria

    2009-09-01

    Full Text Available Abstract Background Acute kidney injury is among the most serious complications after cardiac surgery and is associated with an impaired outcome. Multiple factors may concur in the development of this disease. Moreover, severe renal failure requiring renal replacement therapy (RRT presents a high mortality rate. Consequently, we studied a Spanish cohort of patients to assess the risk factors for RRT in cardiac surgery-associated acute kidney injury (CSA-AKI. Methods A retrospective case-cohort study in 24 Spanish hospitals. All cases of RRT after cardiac surgery in 2007 were matched in a crude ratio of 1:4 consecutive patients based on age, sex, treated in the same year, at the same hospital and by the same group of surgeons. Results We analyzed the data from 864 patients enrolled in 2007. In multivariate analysis, severe acute kidney injury requiring postoperative RRT was significantly associated with the following variables: lower glomerular filtration rates, less basal haemoglobin, lower left ventricular ejection fraction, diabetes, prior diuretic treatment, urgent surgery, longer aortic cross clamp times, intraoperative administration of aprotinin, and increased number of packed red blood cells (PRBC transfused. When we conducted a propensity analysis using best-matched of 137 available pairs of patients, prior diuretic treatment, longer aortic cross clamp times and number of PRBC transfused were significantly associated with CSA-AKI. Patients requiring RRT needed longer hospital stays, and suffered higher mortality rates. Conclusion Cardiac-surgery associated acute kidney injury requiring RRT is associated with worse outcomes. For this reason, modifiable risk factors should be optimised and higher risk patients for acute kidney injury should be identified before undertaking cardiac surgery.

  19. Delirium in cardiac surgery : a study on risk-assessment and long-term consequenses

    NARCIS (Netherlands)

    Koster, Sandra

    2011-01-01

    BACKGROUND: Delirium or acute confusion is a temporary mental disorder, which occurs frequently among hospitalized elderly patients. Patients who undergo cardiac surgery have an increased risk of developing delirium. Delirium is associated with many negative consequences. Therefore, prevention or ea

  20. Custodiol versus blood cardioplegia in pediatric cardiac surgery, two-center study

    Directory of Open Access Journals (Sweden)

    Ebtehal A. Qulisy

    2016-05-01

    Conclusions: Custodial cardioplegia is associated with less optimal myocardial protection and higher adverse outcomes compared to cold blood cardioplegia in children undergoing cardiac surgery. A randomized comparison is warranted.

  1. Delirium in cardiac surgery. A study on risk-assessment and long-term consequences

    NARCIS (Netherlands)

    Hogen-Koster, S.

    2011-01-01

    BACKGROUND: Delirium or acute confusion is a temporary mental disorder, which occurs frequently among hospitalized elderly patients. Patients who undergo cardiac surgery have an increased risk of developing delirium. Delirium is associated with many negative consequences. Therefore, prevention or

  2. Partial replacement of dried Leucaena leucocephala (Lam.) de Wit leaves for noug (Guizotia abyssinica) (L.f.) Cass. seed cake in the diet of highland sheep fed on wheat straw.

    Science.gov (United States)

    Tesfay, Temesgen; Tesfay, Yayneshet

    2013-02-01

    This study investigated the effect of replacing noug (Guizotia abyssinica) (L.f.) Cass. seed cake by dried Leucaena leucocephala (Lam.) de Wit leaves on feed intake, live weight gain, nutrient digestibility, and nitrogen balance of highland sheep in Tigray Region in northern Ethiopia. Twenty intact yearling male highland sheep weighing 16.9 ± 1.62 kg were used in a randomized complete block design and included the following four treatments: T1 (control, wheat straw ad libitum + 200 g noug seed cake (NSC) + 150 g wheat bran (WB)); T2 (wheat straw ad libitum + 170 g NSC + 44.3 g dried L. leucocephala (DLL) + 150 g WB); T3 (wheat straw ad libitum + 140 g NSC + 87.3 g DLL + 150 g WB); and T4 (wheat straw ad libitum + 110 g NSC + 130.2 g DLL + 150 g WB). Sheep fed on T4 diet consumed higher total dry matter (658 g/head/day) and recorded the highest average daily weight gain (59 g/head/day). Sheep fed on T4 diet had higher dry matter (61 %), organic matter (63 %), and crude protein (75 %) digestibility values than the other treatments. Sheep fed on T3 diet demonstrated higher feed conversion ratio (11.93) than sheep kept on the other treatments. All sheep exhibited positive nitrogen balance, with the highest nitrogen retention being measured in T4 (12 g/head/day). It is concluded that partially replacing NSC by DLL can improve total dry matter intake, digestibility of nutrients, and body weight gain in highland sheep fed on wheat straw as the basal diet.

  3. Ultra Low-Dose Naloxone and Tramadol/Acetaminophen in Elderly Patients Undergoing Joint Replacement Surgery: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Ngozi N Imasogie

    2009-01-01

    Full Text Available OBJECTIVE: A pilot study was conducted to assess whether both the rationale and feasibility exist for future randomized clinical trials to evaluate the combined use of naloxone infusion and tramadol/acetaminophen as opioid-sparing drugs in elderly patients undergoing lower extremity joint replacement surgery.

  4. Video-assisted thoracic surgery reduces early postoperative stress. A single-institutional prospective randomized study

    Science.gov (United States)

    Asteriou, Christos; Lazopoulos, Achilleas; Rallis, Thomas; Gogakos, Apostolos S; Paliouras, Dimitrios; Tsakiridis, Kosmas; Zissimopoulos, Athanasios; Tsavlis, Drosos; Porpodis, Konstantinos; Hohenforst-Schmidt, Wolfgang; Kioumis, Ioannis; Organtzis, John; Zarogoulidis, Konstantinos; Zarogoulidis, Paul; Barbetakis, Nikolaos

    2016-01-01

    Background Video-assisted thoracic surgery (VATS) has been shown to effectively reduce postoperative pain, enhance mobilization of the patients, shorten in-hospital length of stay, and minimize postoperative morbidity rates. The aim of this prospective study is to evaluate neuroendocrine and respiratory parameters as stress markers in cancer patients who underwent lung wedge resections, using both mini muscle-sparing thoracotomy and VATS approach. Methods The patients were randomly allocated into two groups: Group A (n=30) involved patients who were operated on using the VATS approach, while in group B (n=30), the mini muscle-sparing thoracotomy approach was used. Neuroendocrine and biological variables assessed included blood glucose levels, C-reactive protein (CRP) levels, cortisol, epinephrine, and adrenocorticotropic hormone (ACTH) levels. Arterial oxygen (PaO2) and carbon dioxide (PaCO2) partial pressure were also evaluated. All parameters were measured at the following time points: 24 hours preoperatively (T1), 4 hours (T2), 24 hours (T3), 48 hours (T4), and 72 hours (T5), after the procedure. Results PaO2 levels were significantly higher 4 and 24 hours postoperatively in group A vs group B, respectively (T2: 94.3 vs 77.9 mmHg, P=0.015, T3: 96.4 vs 88.7 mmHg, P=0.034). Blood glucose (T2: 148 vs 163 mg/dL, P=0.045, T3: 133 vs 159 mg/dL, P=0.009) and CRP values (T2: 1.6 vs 2.5 mg/dL, P=0.024, T3: 1.5 vs 2.1 mg/dL, P=0.044) were found increased in both groups 4 and 24 hours after the procedure. However, their levels were significantly lower in the VATS group of patients. ACTH and cortisol values were elevated immediately after the operation and became normal after 48 hours in both groups, without significant difference. Postoperative epinephrine levels measured in group A vs group B, respectively, (T2: 78.9 vs 115.6 ng/L, P=0.007, T3: 83.4 vs 122.5 ng/L, P=0.012, T4: 67.4 vs 102.6 ng/L, P=0.021). The levels were significantly higher in group B. Conclusion This

  5. Gamma Knife surgery for patients with facial nerve schwannomas: a multiinstitutional retrospective study in Japan.

    Science.gov (United States)

    Hasegawa, Toshinori; Kato, Takenori; Kida, Yoshihisa; Hayashi, Motohiro; Tsugawa, Takahiko; Iwai, Yoshiyasu; Sato, Mitsuya; Okamoto, Hisayo; Kano, Tadashige; Osano, Seiki; Nagano, Osamu; Nakazaki, Kiyoshi

    2016-02-01

    The aim of this study was to explore the efficacy and safety of stereotactic radiosurgery for patients with facial nerve schwannomas (FNSs). This study was a multiinstitutional retrospective analysis of 42 patients with FNSs treated with Gamma Knife surgery (GKS) at 1 of 10 medical centers of the Japan Leksell Gamma Knife Society (JLGK1301). The median age of the patients was 50 years. Twenty-nine patients underwent GKS as the initial treatment, and 13 patients had previously undergone surgery. At the time of the GKS, 33 (79%) patients had some degree of facial palsy, and 21 (50%) did not retain serviceable hearing. Thirty-five (83%) tumors were solid, and 7 (17%) had cystic components. The median tumor volume was 2.5 cm(3), and the median prescription dose to the tumor margin was 12 Gy. The median follow-up period was 48 months. The last follow-up images showed partial remission in 23 patients and stable tumors in 19 patients. Only 1 patient experienced tumor progression at 60 months, but repeat GKS led to tumor shrinkage. The actuarial 3- and 5-year progression-free survival rates were 100% and 92%, respectively. During the follow-up period, 8 patients presented with newly developed or worsened preexisting facial palsy. The condition was transient in 3 of these patients. At the last clinical follow-up, facial nerve function improved in 8 (19%) patients, remained stable in 29 (69%), and worsened in 5 (12%; House-Brackmann Grade III in 4 patients, Grade IV in 1 patient). With respect to hearing function, 18 (90%) of 20 evaluated patients with a pure tone average of ≤ 50 dB before treatment retained serviceable hearing. GKS is a safe and effective treatment option for patients with either primary or residual FNSs. All patients, including 1 patient who required repeat GKS, achieved good tumor control at the last follow-up. The incidence of newly developed or worsened preexisting facial palsy was 12% at the last clinical follow-up. In addition, the risk of hearing

  6. Contaminated heparin and outcomes after cardiac surgery: a retrospective propensity-matched cohort study.

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    Heiko A Kaiser

    Full Text Available During 2007 and 2008 it is likely that millions of patients in the US received heparin contaminated (CH with oversulfated chondroitin sulfate, which was associated with anaphylactoid reactions. We tested the hypothesis that CH was associated with serious morbidity, mortality, intensive care unit (ICU stay and heparin-induced thrombocytopenia following adult cardiac surgery.We conducted a single center, retrospective, propensity-matched cohort study during the period of CH and the equivalent time frame in the three preceding or the two following years. Perioperative data were obtained from the institutional record of the Society of Thoracic Surgeons National Database, for which the data collection is prospective, standardized and performed by independent investigators. After matching, logistic regression was performed to evaluate the independent effect of CH on the composite adverse outcome (myocardial infarction, stroke, pneumonia, dialysis, cardiac arrest and on mortality. Cox regression was used to determine the association between CH and ICU length of stay. The 1∶5 matched groups included 220 patients potentially exposed to CH and 918 controls. There were more adverse outcomes in the exposed cohort (20.9% versus 12.0%; difference  =  8.9%; 95% CI 3.6% to 15.1%, P < 0.001 with an odds ratio for CH of 2.0 (95% CI, 1.4 to 3.0, P < 0.001. In the exposed group there was a non-significant increase in mortality (5.9% versus 3.5%, difference = 2.4%; 95% CI, -0.4 to 3.5%, P  =  0.1, the median ICU stay was longer by 14.1 hours (interquartile range -26.6 to 79.8, S = 3299, P = 0.0004 with an estimated hazard ratio for CH of 1.2 (95% CI, 1.0 to 1.4, P = 0.04. There was no difference in nadir platelet counts between cohorts.The results from this single center study suggest the possibility that contaminated heparin might have contributed to serious morbidity following cardiac surgery.

  7. Patient safety issues in office-based surgery and anaesthesia in Switzerland: a qualitative study.

    Science.gov (United States)

    McLennan, Stuart; Schwappach, David; Harder, Yves; Staender, Sven; Elger, Bernice

    2017-08-01

    To identify the spectrum of patient safety issues in office-based surgery and anaesthesia in Switzerland. Purposive sample of 23 experts in surgery and anaesthesia and quality and regulation in Switzerland. Data were collected via individual qualitative interviews using a researcher-developed semi-structured interview guide between March 2016 and September 2016. Interviews were transcribed and analysed using conventional content analysis. Issues were categorised under the headings "structure", "process", and "outcome". Experts identified two key overarching patient safety and regulatory issues in relation to office-based surgery and anaesthesia in Switzerland. First, experts repeatedly raised the current lack of data and transparency of the setting. It is unknown how many surgeons are operating in offices, how many and what types of operations are being done, and what the outcomes are. Secondly, experts also noted the limited oversight and regulation of the setting. While some standards exists, most experts felt that more minimal safety standards are needed regarding the requirements that must be met to do office-based surgery and what can and cannot be done in the office-based setting are needed, but they advocated a self-regulatory approach. There is a lack of empirical data regarding the quantity and quality office-based surgery and anaesthesia in Switzerland. Further research is needed to address these research gaps and inform health policy in relation to patient safety in office-based surgery and anaesthesia in Switzerland. Copyright © 2017. Published by Elsevier GmbH.

  8. Clinical anatomic study of the lower lumbar anterolateral vein: with respect to retroperitoneal endoscopic surgery

    Institute of Scientific and Technical Information of China (English)

    LU Sheng; XU Yong-qing; DING Zi-hai; WANG Yue-li; SHI Ji-hong; ZHONG Shi-zhen

    2008-01-01

    To study the anatomy of veins of the lower lumbar spine and provide the anatomic basement for laparoscopic lumbar surgery.Methods:A total of 15 formaldehyde-preserved cadavers were studied with special attention to the variety and surrounding structure of ascending lumbar vein(ALV)and iliolumbar veins(ILV),and their relationship with lumbar plexus.Results:ALV and ILV can be found on every sides,which have four variants including separate entry and common entry. The ascending vein and iliolumbar vein separately enter common iliac vein in 18 cases, and as a common stem enter the common iliac vein in 12 cases. Retracting common iliac vein medially both the ascending lumbar and the iliolumbar veins are always at risk of avulsion on exposure of the disc space. The injury of obturator nerve and lumbosacral trunk of lumbar plexus should be avoided.Conclusion:Awareness of these anatomic variation can prevent the hemorrhage and be helpful for the surgeon in performing a careful ligation of these veins before medial retraction of the common iliac vein. Our findings emphasize the need for proper dissection of ALV and ILV before ligature during exposure of the lower lumbar spine.

  9. The use of a surgical incision management system on vascular surgery incisions: a pilot study.

    Science.gov (United States)

    Weir, Gregory

    2014-06-01

    Health care-associated infections in hospitals, including surgical site infections, contribute significantly to morbidity as well as mortality. Surgical incision management (SIM) using negative pressure wound therapy (Prevena™ Incision Management System, Kinetic Concepts, Inc., San Antonio, TX, USA) is designed to cover and protect closed surgical incisions from external factors including infectious sources and local trauma, while negative pressure removes fluid and infectious material from the surgical incision. A prospective case-control study assessed wound complications in patients undergoing vascular bypass procedures, where both femoral areas were incised to gain access to the femoral arteries. SIM was placed on one femoral area while a standard postoperative wound dressing was placed on the contralateral femoral area. Eight patients were included in this pilot study. All of them required bilateral femoral artery access. During the follow-up period patients were monitored for wound complications. All wound complications requiring surgical intervention were considered significant. No significant wound complications occurred in wounds treated with SIM, compared with three significant complications in control wounds. These preliminary data would suggest a potential reduction in wound complications and no observed increase in haemorrhage in high-risk patients with severe co-morbidities undergoing vascular surgery.

  10. The Study of Wound Infection Rate Due to Midsternatomy after Heart Surgeries

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    R. Safiarian

    2011-01-01

    Full Text Available Introduction & Objective: Sternal wound infection and dehiscence are feared complications observed in 0.4-5% of cardiac operations. Even nowadays the mortality remains as high as 20-40%. The aim of the current study was to determine the rate of sternal wound infection. Material and Methods: The outcomes of 388 patients undergoing cardiac surgery during a 7 month follow up were analyzed and their risk factors such as obesity, diabetes, cigarette smoking, blood transfusion, renal failure, hypertension, COPD, preoperative ejection fraction, aortic clamping time, and time of cardio pulmonary bypass were evaluated. The data was analyzed by t-test & 2 statistical tests. Results: The present study revealed that 3 patients developed wound infection and dehiscence and its incidence was 0.74% (P=0.042. There was not any significant relationship between wound infection and the other risk factors (P>0.05. Conclusions: Our results indicate that ejection fraction preoperatively is very important in sternal wound infection. (Sci J Hamadan Univ Med Sci 2011;17(4:39-42

  11. Evaluation of peripheral muscle strength of patients undergoing elective cardiac surgery: a longitudinal study

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    Kelli Maria Souza Santos

    2014-09-01

    Full Text Available Introduction: Peripheral muscle strength has been little explored in the literature in the context of cardiac rehabilitation. Objective: To evaluate the peripheral muscle strength of patients undergoing elective cardiac surgery. Methods: This was a longitudinal observational study. The peripheral muscle strength was measured using isometric dynamometry lower limb (knee extensors and flexors at three different times: preoperatively (M1, the day of discharge (M2 and hospital discharge (M3. Participants received physiotherapy pre and postoperatively during the days of hospitalization during the morning and afternoon. Results: Twenty-two patients were evaluated. The values of peripheral muscle strength of knee extensors preoperative found were about 50% lower than those predicted for the healthy population. When comparing muscle strength prior (M1, with the remaining evaluation, found himself in a fall of 29% for the movement of knee extension and 25% for knee flexion in M2 and a decrease of 10% movement for knee extension and 13% for knee flexion in M3 when comparing with M1. Conclusion: The values of peripheral muscle strength prior of the study patients were lower than predicted for the healthy population of the same age. After the surgical event this reduction is even more remarkable, being reestablished until the time of discharge, to values close to baseline.

  12. [Relevance of preoperative anxiety for postoperative outcome in urological surgery patients: A prospective observational study].

    Science.gov (United States)

    Laufenberg-Feldmann, R; Kappis, B; Schuster, M; Ferner, M

    2016-04-01

    Preoperative anxiety is not systematically assessed during premedication appointments, although it may influence the postoperative course and outcome. The aim of this study was to assess preoperative anxiety in a sample of patients before major urological surgery and to characterize the impact on postoperative pain. An additional aim was to analyze the agreement between patients' self-ratings and physicians' anxiety ratings. In all, 127 male and 27 female patients participated in a prospective observational study. Preoperative anxiety was assessed with two validated instruments - the APAIS (Amsterdam Preoperative Anxiety and Information Scale) and the State Scale of the STOA questionnaire (State-Trait Operation Anxiety) - during the premedication appointment. Physicians provided their subjective ratings on patients' anxiety and need for information using the APAIS. The predictive value of preoperative anxiety for postoperative pain was evaluated. Nearly four out of ten patients were identified as "anxiety cases"; thereof women were more afraid than men were. Preoperative anxiety was not correctly assessed by physicians, who overestimated patients' anxiety. In female patients, preoperative anxiety was predictive of increased postoperative pain scores. Preoperative anxiety is a frequent concern and often not correctly assessed by physicians. The use of scoring systems to detect preoperative anxiety is useful in clinical routine and helps to decide on therapeutic interventions.

  13. The effect of laparoscopic surgery in stage II and III right-sided colon cancer: a retrospective study

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    Kye Bong-Hyeon

    2012-05-01

    Full Text Available Abstract Background This retrospective study compared the clinicopathological results among three groups divided by time sequence to evaluate the impact of introducing laparoscopic surgery on long-term oncological outcomes for right-sided colon cancer. Methods From April 1986 to December 2006, 200 patients who underwent elective surgery with stage II and III right-sided colon cancer were analyzed. The period for group I referred back to the time when laparoscopic approach had not yet been introduced. The period for group II was designated as the time when first laparoscopic approach for right colectomy was carried out until we overcame its learning curve. The period for group III was the period after overcoming this learning curve. Results When groups I and II, and groups II and III were compared, overall survival (OS did not differ significantly whereas disease-free survival (DFS in groups I and III were statistically higher than in group II (P = 0.042 and P = 0.050. In group III, laparoscopic surgery had a tendency to provide better long-term OS ( P = 0.2036 and DFS ( P = 0.2356 than open surgery. Also, the incidence of local recurrence in group III (2.6% was significantly lower than that in groups II (7.4% and I (12.1% ( P = 0.013. Conclusions Institutions should standardize their techniques and then provide fellowship training for newcomers of laparoscopic colon cancer surgery. This technique once mastered will become the gold standard approach to colon surgery as it is both safe and feasible considering the oncological and technical aspects.

  14. A comparative study on lecture based versus case based education on teaching general surgery to medical students

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    M. Moazeni Bistegani

    2013-06-01

    Full Text Available Introduction : various methods of teaching have different learning outcomes. Using a combination of teaching and training methods of training may boost education. This study compared lecture based and case based teaching as a combined approach in learning general surgery by medical students. Methods: This study was a quasi-experimental performed on two consecutive groups of 33 and 36 students who were studying general surgery course. The two styles of teaching were lecture-based and real case teaching methods. The final exam included twenty multiple choice questions. The mean scores of each group of students were collected and analyzed accordingly with descriptive tests, Fisher’s test and T-test. Results: The mean final mark of students' who received real case based education was 16.8/20 ± 1.8 and for the lecture group was 12.7± 1.7. There was a significant difference between the two groups (P <0.0001. In both groups, there were significant differences in the mean scores of questions with taxonomy two and three, but not in the questions with taxonomy one. Students' evaluation score of the teacher of the real case group increased by 1.7/20 (8.7% in the case based group compared to the lecture group. Conclusions: Case based teaching of general surgery led to a better outcome and students were more satisfied. It is recommended that case based education of surgery be encouraged.

  15. Nose Surgery

    Science.gov (United States)

    ... Patient Health Home Copyright © 2017 American Academy of Otolaryngology–Head and Neck Surgery. Reproduction or republication strictly ... Terms of Use © Copyright 2017. American Academy of Otolaryngology — Head and Neck Surgery 1650 Diagonal Rd Alexandria, ...

  16. After Surgery

    Science.gov (United States)

    ... side effects. There is usually some pain with surgery. There may also be swelling and soreness around ... the first few days, weeks, or months after surgery. Some other questions to ask are How long ...

  17. [Thymus surgery in a general surgery department].

    Science.gov (United States)

    Mega, Raquel; Coelho, Fátima; Pimentel, Teresa; Ribero, Rui; Matos, Novo de; Araújo, António

    2005-01-01

    Evaluation of thymectomy cases between 1990-2003, in a General Surgery Department. Evaluation of the therapeutic efficacy in Miastenia Gravis patients. Retrospective study based on evaluation of data from Serviço de Cirurgia, Neurologia and Consult de Neurology processes, between 1990-2003, of 15 patients submitted to total thymectomy. 15 patients, aged 17 to 72, 11 female and 4 male. Miastenia Gravis was the main indication for surgery, for uncontrollable symptoms or suspicion of thymoma. In patients with myasthenia, surgery was accomplish after compensation of symptoms. There weren't post-surgery complications. Pathology were divided in thymic hyperplasia and thymoma. Miastenia patients have there symptoms diminished or stable with reduction or cessation of medical therapy. Miastenia was the most frequent indication for thymectomy. Surgery was good results, with low morbimortality, as long as the protocols are respected.

  18. Estudo dos movimentos torcionais em cirurgia refrativa Study of torsional movements in refractive surgery

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    Guilherme José Nunes Marques Rocha

    2005-12-01

    Full Text Available OBJETIVO: Verificar a ocorrência de movimentos torcionais do globo ocular no momento da cirurgia refrativa em pacientes astigmatas e suas possíveis conseqüências no resultado da cirurgia. MÉTODOS: Estudo prospectivo de 49 olhos de 40 pacientes atendidos no Hospital de Olhos do Paraná, portadores de astigmatismo, e que seriam submetidos à cirurgia refrativa. A técnica cirúrgica utilizada em todos os pacientes foi o LASIK. Os pacientes foram divididos em dois grupos, de acordo com o poder do astigmatismo, que variou no primeiro grupo 0,25 a 2,00D; e no segundo grupo de 2,25 a 6,00D. Todos os pacientes foram examinados para avaliar a ocorrência de torção do globo ocular no momento da cirurgia, e com base nestes dados foi corrigido o eixo do tratamento por meio de programa específico do aparelho de laser. Os resultados dos dois grupos foram analisados e comparados estatisticamente. Os resultados foram relacionados com os dados existentes sobre influência da variação do eixo do tratamento com o resultado da cirurgia. RESULTADOS: Observou-se torção média de 3,5º+/- no grupo A; e de 4,5º+/- no grupo B. Não houve diferença estatística significativa entre os grupos. CONCLUSÕES: Os movimentos torcionais ocorrem de forma significativa em quase todos os pacientes submetidos à cirurgia refrativa e portanto, devem ser sempre corrigidos para se evitar redução na eficiência do tratamento. Isto é especialmente importante nos casos de cirurgia personalizada.PURPOSE: To observe torsional movements of the eye in refractive surgery, and their possible consequences in the surgery outcome. METHODS: In a prospective study, 49 eyes of 40 patients were submitted to surgical correction of astigmatism, by the LASIK technique. Patients were divided in two groups based on the cylindric power. Group A from -0.25 to -2.00D; group B from -2.25 to -6.00D. The occurrence of torsional movements was recorded in all patients, and based on this, the axis

  19. A post cardiac surgery intervention to manage delirium involving families: a randomized pilot study.

    Science.gov (United States)

    Mailhot, Tanya; Cossette, Sylvie; Côté, José; Bourbonnais, Anne; Côté, Marie-Claude; Lamarche, Yoan; Denault, André

    2017-07-01

    As many delirium manifestations (e.g., hallucinations or fears) are linked to patients' experiences and personality traits, it is suggested that interventions should be tailored to optimize its management. The inclusion of family members, as part of an intervention, has recently emerged as a solution to developing individualised patient care, but has never been assessed in post-cardiac surgery intensive care unit where almost half of patients will present with delirium. To assess the feasibility, acceptability and preliminary efficacy of an nursing intervention involving family caregivers (FC) in delirium management following cardiac surgery. A randomized pilot study. A total of 30 patient/FC dyads were recruited and randomized to usual care (n = 14) or intervention (n = 16). The intervention was based on the Human Caring Theory, a mentoring model, and sources informing self-efficacy. It comprised seven planned encounters spread over 3 days between an intervention nurse and the FC, each including a 30-min visit at the patient's bedside. During this bedside visit, the FC used delirium management strategies, e.g. reorient the person with delirium. The primary indicator of acceptability was to obtain consent from 75% of approached FCs. The preliminary effect of the intervention on patient outcomes was assessed on (1) delirium severity using the Delirium Index, (2) occurrence of complications, such as falls, (3) length of postoperative hospital stay and (4) psycho-functional recovery using the Sickness Impact Profile. The preliminary effect on FC outcomes was assessed on FC anxiety and self-efficacy. Data were analysed using descriptive statistics, ANCOVAs and logistic regressions. The primary indicator of obtaining consent from FC was achieved (77%). Of the 14 dyads, thirteen (93%) dyads received all seven encounters planned in the experimental intervention. Intervention group patients presented better psycho-functional recovery scores when compared with

  20. A study of the prevalence of musculoskeletal disorders in surgeons performing minimally invasive surgery.

    Science.gov (United States)

    Gutierrez-Diez, Maria C; Benito-Gonzalez, Maria A; Sancibrian, Ramon; Gandarillas-Gonzalez, Marco A; Redondo-Figuero, Carlos; Manuel-Palazuelos, Jose C

    2017-09-15

    Minimally invasive surgery (MIS) has shown significant benefits for patients and healthcare systems. However, due to the poor ergonomic adaptation of operating rooms and surgical instruments, most surgeons suffer from pain caused by musculoskeletal disorders (MSDs). A descriptive survey on MIS surgeons working in different surgical specialties has been carried out in Hospital Valdecilla (Spain). The aim is to determine the prevalence of MSDs using a personal interview and the standardized Nordic questionnaire. The study determines the prevalence of MSDs in different parts of the body and their relationship with epidemiological and labor variables. A questionnaire was filled out by 129 surgeons. 90% of surgeons reported MSDs. The higher prevalence appears in the most experienced surgeons. The most affected zones are the lower back (54%), neck (51%), upper back (44%), lower extremities (42%), right shoulder (29%) and right hand (28%). The prevalence of MSDs is higher in MIS surgeons than in any other occupational group. The most vulnerable group is experienced surgeons and there is a potential risk that symptoms will be increased in the future. Muscle strength is revealed as a protective factor against MSDs.

  1. Magnifying loupes versus surgical microscope in endodontic surgery: a four-year retrospective study.

    Science.gov (United States)

    Taschieri, Silvio; Weinstein, Tommaso; Tsesis, Igor; Bortolin, Monica; Del Fabbro, Massimo

    2013-08-01

    The purpose of this retrospective study was to evaluate the 4-year outcome of endodontic microsurgery using two different magnification devices. One-hundred and two teeth in 65 patients were included according to specific selection criteria. Endodontic surgery was performed under surgical microscope as magnification device in 63 teeth in 36 patients, while 39 teeth in 29 patients were treated under magnifying loupes. Thirteen patients did not attend the 4-year follow up. The overall success rate on a patient basis was 91.7% at the 1-year and 90.5% at the 4-year follow up for the group using loupes, while for the group using microscope it was 91.4% at the 1-year and 93.3% at the 4-year follow up. The relative risk was 2.07 (95% confidence interval: 0.31, 13.95) in favour of the group in which microscope was used. No statistically significant difference was found in the treatment outcomes relating to the type of magnification device. © 2011 The Authors. Australian Endodontic Journal © 2011 Australian Society of Endodontology.

  2. Clinical study of simultaneous lung volume reduction surgery during resection of pulmonary or esophageal neoplasms

    Institute of Scientific and Technical Information of China (English)

    TANG Yi-jun; WANG Chao-yang; WANG Cheng-de; DONG Yao-zhong

    2009-01-01

    Background If the emphysema lesions are not symmetrical, unilateral lung volume reduction surgery (LVRS) can be carried out on the more severe side. The aim of this research was to evaluate the feasibility and effects of LVRS performed simultaneously with resection of pulmonary and esophageal neoplasms.Methods Forty-five patients with pulmonary neoplasm and 37 patients with esophageal neoplasm were randomly assigned to group A or group B. In group A, LVRS was performed simultaneously on the same side as thoracotomy. In group B, only tumor resection was performed. The nonfunctional lung area was determined by preoperative chest computed tomography and lung ventilation/perfusion scan. The lung volume removed was about 20% to 30% of the lobes on one side. Preoperative and postoperative indexes including pulmonary function testing variables, arterial blood gas analysis variables, dyspnea scale, 6-minute walk distance, etc., were compared between the groups.Results There were no surgical deaths in this study. The postoperative forced vital capacity in 1 second, PaO_2, PaCO_2,dyspnea scale, and 6-minute walk distance were improved significantly in group A, whereas these indexes did not change or decreased slightly in group B.Conclusions For tumor patients who have associated emphysema, simultaneous LVRS not only increases the chance of receiving surgical therapy, but also improves the postoperative quality of life of the patient. LVRS has expanded thesurgical indication for tumor patients.

  3. Comparative study of excitation patterns in the masseter muscle before and after orthognathic surgery.

    Science.gov (United States)

    Eckardt, L; Harzer, W; Schneevoigt, R

    1997-12-01

    This study was designed to inquire into changes occurring in the electromyographic activity throughout the masseter muscle after orthognathic surgical treatment of various bite anomalies. A total of 32 adult patients showing distinct class II (n = 15) or class III malocclusions (n = 17) were entered into the investigation. All patients had monopolar surface electromyograms of the masseter muscle taken prior to presurgical orthodontic treatment and after removal of their orthodontic appliances after surgery. Twenty eugnathic adult patients served as controls. Unlike bipolar lead readings, simultaneous sampling from 16 electrodes permits the registration of the overall excitation pattern in the entire muscle. Recordings were taken during clenching, chewing and protrusion of the lower jaw against a defined force. Comparison with preoperative EMGs proved postsurgical distribution of excitation in class 11 patients to approximate the excitation pattern of eugnathic patients. By contrast, correction in class III malocclusions produced a shift in excitation maxima in the sense of a cranial advance. Harmonization, as evident in class II patients, did not occur. The postoperative discords in masseter excitation patterns, as observed after correction of class III anomalies, are indicative of the risk of relapse and the prolonged phase of retention associated with these conditions.

  4. Studies on nutritional status in general surgery patients by clinical, anthropometric, and laboratory parameters.

    Science.gov (United States)

    Butters, M; Straub, M; Kraft, K; Bittner, R

    1996-06-01

    We assessed the nutritional status of general surgery patients with and without cancer from a western European population in this prospective study. Anamnestic (weight development, abdominal complaints) and anthropometric (fat tissue measurements) data were collected on six groups of patients: cancer of the stomach (n = 13), pancreas (n = 13), colorectal (n = 23), breast (n = 12), and two control groups with benign diseases, ages 20-45 and 50-75 y. From these data, body mass index and ideal body weight were calculated. Concentrations of albumin, transferrin, retinol-binding protein, prealbumin, and creatinine height index were determined by biochemical tests. A weight loss of more than 10% was found in only 31% of gastric and 61% of pancreatic cancer patients. Significant values from anthropometric data were also found only in these groups. In biochemical tests, only the creatinine height index was reduced in all patients with pancreatic cancer. The remaining laboratory changes were so unspecific in all other parameters that no conclusions could be drawn as to the status of the patient's nutritional condition. For the evaluation of nutritional status, only relatively simple and inexpensive anamnestic and anthropometric measurements are necessary.

  5. Study into the displacement of tumor localization needle during navigated breast cancer surgery

    Science.gov (United States)

    Yan, Christina; Ungi, Tamas; Gauvin, Gabrielle; Jabs, Doris; Lasso, Andras; Engel, Jay; Rudan, John; Fichtinger, Gabor

    2017-03-01

    PURPOSE: Early stage breast cancer is typically treated with lumpectomy. During lumpectomy, electromagnetic tracking can be used to monitor tumor position using a localization needle with an electromagnetic sensor fixed on the needle shaft. This needle is stabilized in the tumor with tissue locking wire hooks, which are deployed once the needle is inserted. The localization needle may displace from its initial position of insertion due to mechanical forces, providing false spatial information about the tumor position and increasing the probability of an incomplete resection. This study investigates whether gravitational and mechanical forces affected the magnitude of needle displacement. METHODS: Ten ultrasound scans were evaluated to measure needle displacement in vivo. Needle position was approximated by the distance between the needle tip and the tumor boundary on a 2D ultrasound image, and needle displacement was defined by the change in position. The angle between the localization needle and the coronal plane was computed in an open-source platform. RESULTS: A significant relationship (p = 0.04) was found between the needle to coronal plane angle and increased needle displacement. Needles inserted vertically, pointing towards the operating room ceiling, tended to exhibit greater needle displacement. Average needle displacement was 1.7 +/-1.2 mm. CONCLUSION: Angle between the needle and the horizontal plane has been shown to affect needle displacement, and should be taken into consideration when inserting the localization needle. Future works can be directed towards improving the clinical workflow and mechanical design of the localization needle to reduce slippage during surgery.

  6. Efficiency of Calatonia on clinical parameters in the immediate post-surgery period: a clinical study

    Directory of Open Access Journals (Sweden)

    Elaine Ferreira Lasaponari

    2013-09-01

    Full Text Available OBJECTIVE: to assess the efficiency of the Calatonia technique about clinical parameters and pain in the immediate post-surgical phase. METHOD: a randomised study was carried out with 116 patients subjected to a cholecystectomy, by laparoscopy, divided into an experimental group (58 patients and a placebo group (58 patients. The experimental group received the Calatonia technique, while the placebo was only subjected to non-intentional touches. RESULTS: The placebo group and the experimental group were considered homogeneous in terms of the variables: sex, age, physical status classification, duration of surgical procedures and also the time spent recovering in the Post-Anaesthetic Recovery Room. The only variable to show a statistically significant difference was the axillary temperature of the body. In relation to pain, the experimental group showed significant results, and hence it is possible to deduce that the relaxation caused by the Calatonia technique brought some relief of the general situation of pain. CONCLUSION: The application of Calatonia can take up the function of a resource complementary to assistance in the period immediately after surgery. Brazilian Register of Clinical Trials, UTN U1111-1129-9629.

  7. Influence of bariatric surgery on quality of life, body image, and general self-efficacy within 6 and 24 months-a prospective cohort study.

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    Nickel, Felix; Schmidt, Lukas; Bruckner, Thomas; Büchler, Markus W; Müller-Stich, Beat-Peter; Fischer, Lars

    2017-02-01

    It has been proven that bariatric surgery affects weight loss. Patients with morbid obesity have a significantly lower quality of life (QOL) and body image compared with the general population. To evaluate QOL, body image, and general self-efficacy (GSE) in patients with morbid obesity undergoing bariatric surgery within clinical parameters. Monocentric, prospective, longitudinal cohort study. Patients completed the short form 36 (SF-36) for QOL, body image questionnaire, and GSE scale 3 times: before surgery and within 6 months and 24 months after surgery. Influence of gender, age, and type of procedure, either laparoscopic sleeve gastrectomy (SG) or laparoscopic Roux-en-Y gastric bypass, were analyzed. Thirty patients completed the questionnaires before and within 6 and 24 months after surgery. SF-36 physical summary score improved significantly from 34.3±11.0 before surgery to 46.0±10.4 within 6 months (Psurgery. SF-36 mental summary score improved significantly from 42.1±14.7 before surgery to 52.3±8.4 within 6 months (Psurgery. There were no significant differences between gender, age, and type of operation. Body image and GSE improved significantly after bariatric surgery (Pbariatric surgery. Improvements were independent of gender, age, and type of operation. Mental QOL was influenced by body image and GSE. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  8. Study on the influence of retroperitoneal laparoscopic surgery for the body antioxidant capacity and pain stress state of patients with localized renal carcinoma

    Institute of Scientific and Technical Information of China (English)

    Yang-Tao Xu; Yan Pan; Zhi-Qing Sun; Chen-Xi Liu

    2016-01-01

    Objective:To study and analyze the influence of retroperitoneal laparoscopic surgery for the body antioxidant capacity and pain stress state of patients with localized renal carcinoma. Methods:A total of 56 patients with localized renal carcinoma in our hospital from January 2014 to August 2015 who were treated with surgery were divided into two groups according to the differences of surgery, 28 cases in control group were treated with open surgery, 28 cases in observation group were treated with retroperitoneal laparoscopic surgery, then the related indexes of antioxidant capacity and pain stress state of two groups before the surgery and at first, fifth and tenth day after the surgery were compared. Results:The related indexes of antioxidant capacity and pain stress state of two groups before the surgery all had no significant differences, while the related indexes of antioxidant capacity and pain stress state of observation group at first, fifth and tenth day after the surgery were all better than those of control group, the differences were all significant. Conclusion:The influence of retroperitoneal laparoscopic surgery for the body antioxidant capacity and pain stress state of patients with localized renal carcinoma is more active, so it is more suitable for the treatment of localized renal carcinoma.

  9. Cotton-derived oxidized cellulose in minimally invasive thoracic surgery: a clinicopathological study.

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    Witte, Biruta; Kroeber, Stefan M; Hillebrand, Hubertus; Wolf, Michael; Huertgen, Martin

    2013-01-01

    The aim of this study was to identify resorption, clinical performance, and safety of cotton-derived oxidized cellulose gauze applied as a hemostat in minimally invasive oncologic thoracic surgery. This is a pilot prospective noncomparative observational human in vivo study. A piece of cotton-derived oxidized cellulose gauze measuring 5 × 20 cm was inserted into the subcarinal space of patients with potentially resectable lung carcinoma at the time of video-assisted mediastinoscopic lymphadenectomy and reexamined several days later for macroscopic and histologic evaluation at the time of subsequent lung resection. The primary endpoint was the local situation at the implantation site described by cellulose remnants, fluid collections, and adhesions. The secondary endpoint was safety, described by the number of adverse events and surgical reinterventions. Twenty-five consecutive eligible patients with potentially resectable lung carcinoma were included. The desired hemostatic effect was achieved in all cases. No adverse events were observed. At re-exploration 10.5 (5-28) days later, the cellulose gauze was found to lose its solid structure from the fifth day on. Remnants were last detected 14 days after insertion. The implantation site exhibited no inflammatory changes and a remarkable small amount of fluid collections and adhesions. Mediastinal application of cotton-derived oxidized cellulose is safe and effective. A piece of gauze measuring 5 × 20 cm seems to be absorbed completely within 15 days, thus precluding any interference with oncologic restaging and follow-up. The absence of relevant adhesions facilitates further surgical procedures. Larger comparative confirmatory studies are required. For large-scale resorption studies, our clinical model should be translated into a porcine model.

  10. A COMPARATIVE STUDY OF THE AMOUNT OF ASTIGMATISM FOLLOWING CONVENTIONAL EXTRACAPSULAR CATARACT EXTRACTION AND MANUAL SMALL INCISION CATARACT SURGERY

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    Rajkumari Bigyabati

    2016-06-01

    Full Text Available BACKGROUND Cataract is the principal cause of avoidable blindness in India and throughout the world. Surgical removal of the cataractous lens remains the only effective treatment for management of cataract blindness. The success of cataract surgery is determined by best and earliest visual recovery. But the occurrence of postoperative astigmatism has become a major hurdle in achieving this goal. AIMS The study was designed to compare the amount of astigmatism following conventional extracapsular cataract extraction (ECCE and manual small incision cataract surgery (SICS. MATERIALS AND METHODS The study was carried out in 100 eyes of 75 patients aged between 50 and 80 years admitted for cataract surgery. Out of these, 50 eyes were operated by conventional extracapsular cataract extraction and 50 eyes by manual small incision cataract surgery. The patients were followed up at 2 nd , 4 th , 6 th and 8 th weeks. At each follow-up visual acuity, refraction and acceptance and keratometry were recorded and the findings analysed for astigmatism. RESULTS In the current study, the mean (SD astigmatism developed at the end of the 2 nd , 4 th and 6 th of follow-up was significantly lower in the SICS group as compared to the ECCE group (P<0.000. At the end of 8 weeks of follow-up, the mean (SD astigmatism of the SICS group was 0.64±0.56 D as compared to the mean (SD of the ECCE group of 1.39±86 D and the difference was found to be significant (p<0.014. CONCLUSION The current study concludes that manual small incision cataract surgery is a better technique to control postoperative astigmatism than conventional extracapsular cataract extraction.

  11. Changes in retinal nerve fiber layer thickness after spinal surgery in the prone position: a prospective study

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    Baran Gencer

    2015-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: Changes in ocular perfusion play an important role in the pathogenesis of ischemic optic neuropathy. Ocular perfusion pressure is equal to mean arterial pressure minus intraocular pressure. The aim of this study was to evaluate the changes in the intraocular pressure and the retinal nerve fiber layer thickness in patients undergoing spinal surgery in the prone position. METHODS: This prospective study included 30 patients undergoing spinal surgery. Retinal nerve fiber layer thickness were measured one day before and after the surgery by using optical coherence tomography. Intraocular pressure was measured by tonopen six times at different position and time-duration: supine position (baseline; 10 min after intubation (Supine 1; 10 (Prone 1, 60 (Prone 2, 120 (Prone 3 min after prone position; and just after postoperative supine position (Supine 2. RESULTS: Our study involved 10 male and 20 female patients with the median age of 57 years. When postoperative retinal nerve fiber layer thickness measurements were compared with preoperative values, a statistically significant thinning was observed in inferior and nasal quadrants (p = 0.009 and p = 0.003, respectively. We observed a statistically significant intraocular pressure decrease in Supine 1 and an increase in both Prone 2 and Prone 3 when compared to the baseline. Mean arterial pressure and ocular perfusion pressure were found to be significantly lower in Prone 1, Prone 2 and Prone 3, when compared with the baseline. CONCLUSIONS: Our study has shown increase in intraocular pressure during spinal surgery in prone position. A statistically significant retinal nerve fiber layer thickness thinning was seen in inferior and nasal quadrants one day after the spinal surgery.

  12. The effect of a bioresorbable matrix barrier in endodontic surgery on the rate of periapical healing: an in vivo study.

    Science.gov (United States)

    Garrett, Katherine; Kerr, Mark; Hartwell, Gary; O'Sullivan, Sean; Mayer, Peter

    2002-07-01

    The purpose of this prospective clinical study was to assess the rate of healing of periapical bony defects created at the time of endodontic periapical surgery by measuring the densitometric ratio change in periapical osseous tissues, after periapical endodontic surgery was performed, by using or not using Guidor bioresorbable membrane material. Periapical surgeries were performed on 25 patients where nonsurgical root canal therapy had failed and a periapical lesion was present. For inclusion in the study, the osseous defect to be analyzed had to be confined to the apical area, with bone covering the entire root surface coronally, and an intact lingual cortical plate had to be present. A series of radiographs at the 3-, 6-, and 12-month recalls were compared with the radiograph taken immediately after surgery by using digital imaging and a densitometric ratio that gave a numerical estimation of osseous healing. Using repeated-measure ANOVA, it was shown that there was no statistical difference between the rate of healing in those cases where a Guidor resorbable membrane was used and those cases where no membrane was used. The results suggest that placement of a guided tissue membrane over the bony opening created during an endodontic periapical surgical procedure has no beneficial effect on the rate of healing and the added expense to the patient would not be warranted in these cases.

  13. Tissue Discrimination by Uncorrected Autofluorescence Spectra: A Proof-of-Principle Study for Tissue-Specific Laser Surgery

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    Katja Tangermann-Gerk

    2013-10-01

    Full Text Available Laser surgery provides a number of advantages over conventional surgery. However, it implies large risks for sensitive tissue structures due to its characteristic non-tissue-specific ablation. The present study investigates the discrimination of nine different ex vivo tissue types by using uncorrected (raw autofluorescence spectra for the development of a remote feedback control system for tissue-selective laser surgery. Autofluorescence spectra (excitation wavelength 377 ± 50 nm were measured from nine different ex vivo tissue types, obtained from 15 domestic pig cadavers. For data analysis, a wavelength range between 450 nm and 650 nm was investigated. Principal Component Analysis (PCA and Quadratic Discriminant Analysis (QDA were used to discriminate the tissue types. ROC analysis showed that PCA, followed by QDA, could differentiate all investigated tissue types with AUC results between 1.00 and 0.97. Sensitivity reached values between 93% and 100% and specificity values between 94% and 100%. This ex vivo study shows a high differentiation potential for physiological tissue types when performing autofluorescence spectroscopy followed by PCA and QDA. The uncorrected autofluorescence spectra are suitable for reliable tissue discrimination and have a high potential to meet the challenges necessary for an optical feedback system for tissue-specific laser surgery.

  14. Tissue discrimination by uncorrected autofluorescence spectra: a proof-of-principle study for tissue-specific laser surgery.

    Science.gov (United States)

    Stelzle, Florian; Knipfer, Christian; Adler, Werner; Rohde, Maximilian; Oetter, Nicolai; Nkenke, Emeka; Schmidt, Michael; Tangermann-Gerk, Katja

    2013-10-11

    Laser surgery provides a number of advantages over conventional surgery. However, it implies large risks for sensitive tissue structures due to its characteristic non-tissue-specific ablation. The present study investigates the discrimination of nine different ex vivo tissue types by using uncorrected (raw) autofluorescence spectra for the development of a remote feedback control system for tissue-selective laser surgery. Autofluorescence spectra (excitation wavelength 377 ± 50 nm) were measured from nine different ex vivo tissue types, obtained from 15 domestic pig cadavers. For data analysis, a wavelength range between 450 nm and 650 nm was investigated. Principal Component Analysis (PCA) and Quadratic Discriminant Analysis (QDA) were used to discriminate the tissue types. ROC analysis showed that PCA, followed by QDA, could differentiate all investigated tissue types with AUC results between 1.00 and 0.97. Sensitivity reached values between 93% and 100% and specificity values between 94% and 100%. This ex vivo study shows a high differentiation potential for physiological tissue types when performing autofluorescence spectroscopy followed by PCA and QDA. The uncorrected autofluorescence spectra are suitable for reliable tissue discrimination and have a high potential to meet the challenges necessary for an optical feedback system for tissue-specific laser surgery.

  15. Liposome bupivacaine for improvement in economic outcomes and opioid burden in GI surgery: IMPROVE Study pooled analysis

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    Cohen SM

    2014-06-01

    Full Text Available Stephen M Cohen,1 Jon D Vogel,2 Jorge E Marcet,3 Keith A Candiotti4 1Atlanta Colon and Rectal Surgery, PA, Atlanta, GA, USA; 2General Surgery Clinic, University of Colorado, Aurora, CO, USA; 3Department of Surgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA; 4Department of Anesthesiology, University of Miami Leonard Miller School of Medicine, Miami, FL, USA Abstract: Postsurgical pain management remains a significant challenge. Liposome bupivacaine, as part of a multimodal analgesic regimen, has been shown to significantly reduce postsurgical opioid consumption, hospital length of stay (LOS, and hospitalization costs in gastrointestinal (GI surgery, compared with intravenous (IV opioid-based patient-controlled analgesia (PCA. Pooled results from open-label studies comparing a liposome bupivacaine-based multimodal analgesic regimen with IV opioid PCA were analyzed. Patients (n=191 who underwent planned surgery and received study drug (IV opioid PCA, n=105; multimodal analgesia, n=86 were included. Liposome bupivacaine-based multimodal analgesia compared with IV opioid PCA significantly reduced mean (standard deviation [SD] postsurgical opioid consumption (38 [55] mg versus [vs] 96 [85] mg; P<0.0001, postsurgical LOS (median 2.9 vs 4.3 days; P<0.0001, and mean hospitalization costs (US$8,271 vs US$10,726; P=0.0109. The