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Sample records for surgery treatment patterns

  1. [Emergency Surgery and Treatments for Pneumothorax].

    Science.gov (United States)

    Kurihara, Masatoshi

    2015-07-01

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

  2. Patterns of recurrence and survival after surgery or stereotactic radiotherapy for early stage NSCLC

    NARCIS (Netherlands)

    van den Berg, Liseth L.; Klinkenberg, Theo J.; Groen, Harry J. M.; Widder, Joachim

    Introduction: Surgery is the standard treatment for early stage non-small-cell lung cancer (NSCLC). For medically inoperable patients, stereotactic ablative radiotherapy (SABR) has emerged as widely used standard treatment. The aim of this study was to analyze survival and patterns of tumor

  3. Patterns of recurrence and survival after surgery or stereotactic radiotherapy for early stage NSCLC

    NARCIS (Netherlands)

    van den Berg, Liseth L.; Klinkenberg, Theo J.; Groen, Harry J. M.; Widder, Joachim

    2015-01-01

    Introduction: Surgery is the standard treatment for early stage non-small-cell lung cancer (NSCLC). For medically inoperable patients, stereotactic ablative radiotherapy (SABR) has emerged as widely used standard treatment. The aim of this study was to analyze survival and patterns of tumor recurren

  4. Orthognathic Surgery in Craniofacial Microsomia: Treatment Algorithm

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    Rodrigo Fariña, DDS, Med

    2015-01-01

    Full Text Available Summary: Craniofacial microsomia is a broad term that covers a variety of craniofacial malformation conditions that are caused by alterations in the derivatives of the first and second pharyngeal arches. In general terms, diverse therapeutic alternatives are proposed according to the growth stage and the severity of the alteration. When craniofacial growth has concluded, conventional orthognathic surgery (Le Fort I osteotomy, bilateral sagittal split osteotomy, and genioplasty provides good alternatives for MI and MIIA type cases. Reconstruction of the mandibular ramus and temporomandibular joint before orthognathic surgery is the indicated treatment for cases MIIB and MIII. The goal of this article is to establish a surgical treatment algorithm for orthognathic surgery on patients with craniofacial microsomia, analyzing the points that allow the ideal treatment for each patient to be chosen.

  5. Treatment of nonseptic bursitis with endoscopic surgery

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    Azad Yıldırım

    2015-09-01

    Full Text Available Objective: The aim of this study was to show that endoscopic surgery is a simple and acceptable method for various problems associated with wounds, range of motion and that such surgery ensures an early return to work after treatment of nonresponding nonseptic bursitis. Methods: Thirty-two patients with nonseptic bursitis caused by repeated minor trauma that did not respond to medical treatment from 2008 to 2012 were included in this study. Radiographic [anteroposterior and lateral], ultrasound, macro and microscopic analyses of drainage liquid and aerobic and anaerobic cultures were obtained from the patients for the diagnosis. Results: The mean age was 40.8 years. Fifteen patients had prepatellar bursitis, 13 had olecranon bursitis and 4 had ankle bursitis. Two patients had a history of falling on their knee. The other patients had a history of repetitive stimulation .The mean follow up period was 2.6 years [range. 2-5 years] and no medical complications occurred after the endoscopic surgery; such as scarring, loss of sensation and infection. One recurrence in response to medical treatment was observed. Conclusion: Endoscopic bursectomy is a short and acceptable procedure with excellent results in terms of returning to work early and minimal wound related problems. J Clin Exp Invest 2015; 6 (3: 220-223

  6. Treatment of bronchial ruptures by delayed surgery

    Institute of Scientific and Technical Information of China (English)

    1999-01-01

    Objective:To study the causes that resulted in delayed surgery for bronchial ruptures and the results.Methods:The cases with the bronchial ruptures by the delayed surgery last decade were retrospectively reviewed.The causes and unsatisfactory results were analysed.Results:The severe complications usually occurred after the delayed surgery and the results were not as satisfactory as those by early surgery.Conclusion:The bronchial ruptures ought to be operated in the early stage after being wounded.

  7. Practice patterns in breast cancer surgery: Canadian perspective.

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    Porter, Geoffrey A; McMulkin-Tait, Heather

    2004-01-01

    Breast cancer is a common disease, and the surgical management is continually evolving. The objective of this study was to describe the current breast cancer practice patterns among Canadian surgeons. All active General Surgeons (n=1172), as accredited by the Royal College of Physicians and Surgeons of Canada, were sent a 31-item questionnaire. Anonymous responses were collected and analyzed regarding surgeon demographics, practice, and perceptions regarding surgical care of breast cancer patients. Overall 640 active surgeons responded; of these, 519 (81%) treated breast cancer and formed the study cohort. Practice settings included community (55%), community with university affiliation (28%), and academic (17%). The majority of surgeons (76%) stated that operations/month. Immediate breast reconstruction (IBR) was used by 57% of surgeons. On multivariate analysis, higher surgeon volume of breast cancer cases (p=0.0008), fellowship training in Surgical Oncology (p=0.009), community population (p=0.001), and academic practice setting (p<0.0001) were independently associated with the use of IBR. Of the 640 surgeons who responded, 79% stated that breast cancer surgery should be performed by "most general surgeons." In Canada, most breast cancer surgery was performed by general surgeons who did not appear to have an interest, as defined by training or clinical volume, in breast cancer. Although variability regarding specific surgical issues was found among subgroups of surgeons, the majority of respondents felt that most general surgeons should treat breast cancer.

  8. The current pattern of reconstructive surgery for breast cancer

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    A. Kh. Ismagilov

    2015-01-01

    Full Text Available In Russia, breast cancer (BC occupies a leading place in the pattern of cancers, the incidence of which is 20.9 %, among the female population; in 2013 there were 60,717 new cases, including women under the age of 40 years (15 %. While considering the history of the development of breast surgery from the operation performed by W. S. Halsted to its technique modified by J. L. Madden and the identification of sentinel lymph nodes, we can observe improved quality of life in patients in reference to the lower rate of the manifestation of lymphedemas. However, patients who have undergone this or that mastectomy are observed to have lower self-appraisal scores, a change in their professional sphere, irritability and apprehensiveness Thus, the decreased rate of the manifestation of lymphedema and obvious postoperative traumatization are not the only components of quality of life in patients with BC. According to the data obtained by E. Frank et al. (1978, G.P. Maguire et al. (1978, and F. Meerwein (1981, removal of the breast itself leads to a woman’s loss of femininity, attractiveness, and sexiness, which was also confirmed and reported by L. Aerts et al. (2014. In this connection, classical radical mastectomy begins to give way to organ-sparing treatment. Taking into account that psychotherapy and external prosthetics do not alleviate the above problems and that there are always women with established BC who have contraindications to organ-sparing treatment, breast reconstructive plastic operations arouse more and more interest. Reconstruction of the breast implies restoration of both its shape and contours to be maximally brought closer to its preoperative level. However, with regard to cancer alertness to breast reconstructive surgery, not only aesthetic requirements are imposed. The next step in improving quality of life in patients with BC was the emergence and development of breast-sparing mastectomies, the first point of these

  9. Incidence and pattern of dry eye after cataract surgery.

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    Ngamjit Kasetsuwan

    Full Text Available PURPOSE: To evaluate the incidence and severity pattern of dry eye after phacoemulsification. SETTING: King Chulalongkorn Memorial Hospital, Bangkok, Thailand. DESIGN: Prospective descriptive study. METHODS: Samples were collected from ninety-two uncomplicated cataract patients who were 18 years old or older. Dry eye incidence and pattern were analyzed at days 0, 7, 30 and 90 after phacoemulsification using (1 Ocular Surface Disease Index (OSDI questionnaire, (2 tear break up time (TBUT, (3 Oxford ocular surface staining system, and (4 Schirmer I test without anesthesia. RESULTS: Seven days after phacoemulsification, the incidence of dry eye was 9.8% (95% confidence interval; 3.6-16.0%. The severity of dry eye peaked seven days post-phacoemulsification and was measured by OSDI questionnaire and all three clinical tests. Within thirty days and 3 months post-surgery, both the symptoms and signs showed rapid and gradual improvements, respectively. However, dry eye post-phacoemulsification was not significantly associated with sex and systemic hypertension (P = 0.26, 0.17 and 0.73, respectively. CONCLUSIONS: The incidence of dry eye after phacoemulsification was 9.8%. Symptoms and signs of dry eye occurred as early as seven days post-phacoemulsification and the severity pattern improved over time. We recommend that ophthalmologists should evaluate patients both before and after phacoemulsification to prevent further damage to the ocular surface and able to manage the patient promptly and effectively so the patient will not have a poor quality of life and vision due to dry eye syndrome.

  10. Clinical Features and Surgical Treatment of A-pattern Exotropia

    Institute of Scientific and Technical Information of China (English)

    Jingchang Chen; Guanghuan Mai; Daming Deng; Xiaoming Lin; Yan Guo; Xiao Yang; Chunxiu Yuan

    2004-01-01

    Purpose: To investigate the clinical characteristics and determine the effective surgical managements of A-pattern exotropia.Methods: Thirty-two patients with A-pattern exotropia underwent superior oblique muscle weakening procedures, medial rectus resection or (and) lateral rectus recession. Preand post-operative eye position, deviation angle, superior oblique function and binocular vision were examined and analyzed in the cases.Results: Overaction of the superior oblique muscles (31/32) and underaction of the medial rectus muscle (20/32) were presented in the cases. Postoperatively, a satisfactory ocular alignment was obtained in 28 cases (87.5%), and the A-pattern was corrected in 31 cases (96.9%). Four cases got binocular vision after surgery.Conclusions: As one of the most common forms of A and V patterns, A-pattern exotropia showed clinical characteristics of superior oblique muscle overaction and medial rectus muscle underacion, which should be the primary factors in the etiology of A-pattern exotropia, and superior oblique weakening procedures combined with horizontal surgery should be an effective approach to A-pattern exotropia treatment.

  11. Retinal evaluation and treatment after refractive corneal surgery.

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    Swinger, C A; Kraushar, M F

    1985-08-01

    Refractive corneal surgery (a collective term used to describe a variety of surgical procedures that alter the refractive status of the eye through the surgical modification of corneal curvature) shows promise for use in situations where current methods of optical correction do not meet the patient's needs. This article reviews our experiences with the retinal evaluation of patients who have undergone corneal refractive surgery and offers recommendations for the treatment of retinal pathology after such surgery.

  12. Treatment of Adult Obesity with Bariatric Surgery.

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    Schroeder, Robin; Harrison, T Daniel; McGraw, Shaniqua L

    2016-01-01

    In 2013, approximately 179,000 bariatric surgery procedures were performed in the United States, including the laparoscopic sleeve gastrectomy (42.1%), Roux-en-Y gastric bypass (34.2%), and laparoscopic adjustable gastric banding (14.0%). Choice of procedure depends on the medical conditions of the patient, patient preference, and expertise of the surgeon. On average, weight loss of 60% to 70% of excess body weight is achieved in the short term, and up to 50% at 10 years. Remission of type 2 diabetes mellitus occurs in 60% to 80% of patients two years after surgery and persists in about 30% of patients 15 years after Roux-en-Y gastric bypass. Other obesity-related comorbidities are greatly reduced, and health-related quality of life improves. The Roux-en-Y procedure carries an increased risk of malabsorption sequelae, which can be minimized with nutritional supplementation and surveillance. Overall, these procedures have a mortality risk of less than 0.5%. Cohort studies show that bariatric surgery reduces all-cause mortality by 30% to 50% at seven to 15 years postsurgery compared with patients with obesity who did not have surgery. Dietary changes, such as consuming protein first at every meal, and regular physical activity are critical for patient success after bariatric surgery. The family physician is well positioned to counsel patients about bariatric surgical options, the risks and benefits of surgery, and to provide long-term support and medical management postsurgery.

  13. Analgesic Treatment in Laparoscopic Gastric Bypass Surgery

    DEFF Research Database (Denmark)

    Andersen, Lars P H; Werner, Mads U; Rosenberg, Jacob

    2014-01-01

    This review aimed to present an overview of the randomized controlled trials investigating analgesic regimens used in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Literature search was performed in PubMed and EMBASE databases in August 2013 in accordance to PRISMA guidelines. The litera......This review aimed to present an overview of the randomized controlled trials investigating analgesic regimens used in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Literature search was performed in PubMed and EMBASE databases in August 2013 in accordance to PRISMA guidelines...

  14. Laser tumor treatment in oral and maxillofacial surgery

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    Neukam, F. W.; Stelzle, F.

    Cancer treatment is an integral part of oral and maxillofacial surgery. Oral cancer in particular is a highly prevalent neoplasm. Standard treatment for most of the tumors is radical surgery combined with stage-based neo-/adjuvant therapy. Laser surgery has become a reliable treatment option for oral cancer as well as for precancerous lesions. Widely used lasers in oral and maxillofacial tumor surgery are the CO2 laser, the Er:YAG laser, the Nd:YAG laser and the KTM laser. The use of lasers in tumor surgery has several advantages: remote application, precise cutting, hemostasis, low cicatrization, reduced postoperative pain and swelling, can be combined with endoscopic, microscopic and robotic surgery. However, laser surgery has some major drawbacks: In contrast to conventional incisions with scalpels, the surgeon gets no feedback during laser ablation. There is no depth sensation and no tissue specificity with a laser incision, increasing the risk of iatrogenic damage to nerves and major blood vessels. Future prospects may solve these problems by means of an optical feedback mechanism that provides a tissue-specific laser ablation. First attempts have been made to perform remote optical tissue differentiation. Additionally, real time optical tumor detection during laser surgery would allow for a very precise and straight forward cancer resection, enhancing organ preservation and hence the quality of life for patients with cancer in the head and neck region.

  15. Bleeding in Liver Surgery : Prevention and Treatment

    NARCIS (Netherlands)

    Alkozai, Edris M.; Lisman, Ton; Porte, Robert J.

    Intraoperative blood loss and transfusion of blood products are negatively associated with postoperative outcome after liver surgery. Blood loss can be minimized by surgical methods, including vascular clamping techniques, the use of dissection devices, and the use of topical hemostatic agents.

  16. [Progresses in antiinflamatory treatment in cataract surgery].

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    Stefan, C; Pop, Adina; Cojocaru, Inga

    2011-01-01

    Anti-inflamatory medication is commonly used to reduce inflammation, edema and symptoms associated with allergies, trauma and infections diseases. Topical nonsteroidial anti-inflammatory (NSAIDs) and topical corticosteroids are overview of the role of topical NSAIDs and the progress of their use in eye surgery

  17. The effect of residency and fellowship type on hand surgery clinical practice patterns.

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    Mehta, Karan; Pierce, Paul; Chiu, David T W; Thanik, Vishal

    2015-01-01

    The Accreditation Council for Graduate Medical Education requires accredited fellowship programs to exhibit proficiency in six broadly defined domains; however, core competencies specifically mandated for hand surgery training have yet to be established. Several studies have demonstrated significant disparities in exposure to essential skills and knowledge between orthopedic surgery- and plastic surgery-based hand surgery fellowship programs. To determine whether significant discrepancies also exist after fellowship between hand surgeons trained in orthopedic surgery and those trained in plastic surgery, clinical practice patterns were evaluated. A 20-question survey was created and distributed electronically to American Society for Surgery of the Hand and American Association for Hand Surgery members. Responses were compared using descriptive statistics. Nine hundred eighty-two hand surgeons (76 percent orthopedic and 24 percent plastic) responded, representing a 39 percent response rate. Most plastic surgery hand practices were academic-based (41 percent), whereas orthopedic practices were private (67 percent). More orthopedic hand surgeons worked in multipractitioner practices than plastic surgeons (54 percent versus 30 percent; p digital replantation cases (53 percent versus 22 percent; p < 0.05) but treated significantly fewer open reduction and internal fixation distal radius fractures. Orthopedic and plastic surgery hand surgeons differ significantly in their clinical practice patterns. Differences in clinical exposure during training are reflected in practice and persist over time. Referral patterns and practice situations are also contributors to ultimate practice patterns.

  18. Treatment strategies in surgery for rheumatoid arthritis

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    Trieb, Klemens [Department of Orthopaedics, Klinikum Kreuzschwestern, Grieskirchnerstr 42, 4600 Wels (Austria)], E-mail: klemens.trieb.co@klinikum-wegr.at; Hofstaetter, Stefan G. [Department of Orthopaedics, Klinikum Kreuzschwestern, Grieskirchnerstr 42, 4600 Wels (Austria)

    2009-08-15

    Rheumatoid arthritis due to the chronic inflammation of the synovial joints leads to permanent articular cartilage and bone damage. Subsequent instability and mutilation of the joint might happen, and the resulting joint pain and stiffness cause impaired function. The degree of damage is traditionally assessed by radiograph and represents a clinical tool for the evaluation of both disease progression and the effectiveness of interventional therapy. The classification of destruction is therefore done with radiograph and the assessment of the clinical picture. Depending on the radiologic stage different therapy concepts, ranging from conservative to operative, are established. It is the goal of surgery to restore motion and function in a painless joint. Surgery can be done to prevent the joint from further destruction or to replace the joint after resection. Different concepts based on radiologic findings are presented in this review.

  19. Postoperative pain treatment for ambulatory surgery.

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    Rawal, Narinder

    2007-03-01

    One of the most significant changes in surgical practice during the last two decades has been the growth of ambulatory surgery. Adequate postoperative analgesia is a prerequisite for successful ambulatory surgery. Recent studies have shown that large numbers of patients suffer from moderate to severe pain during the first 24-48 hr. The success of fast-tracking depends to a considerable extent on effective postoperative pain management routines and the cost saving of outpatient surgery may be negated by unanticipated hospital admission for poorly treated pain. Depending on the intensity of postoperative pain current management includes the use of analgesics such as paracetamol, NSAIDs including coxibs and tramadol as single drugs or in combination as part of balanced (multimodal) analgesia. However, in the ambulatory setting many patients suffer from pain at home in spite of multimodal analgesic regimens. Sending patients home with perineural, incisional, and intra-articular catheters is a new and evolving area of postoperative pain management. Current evidence suggests that these techniques are effective, feasible and safe in the home environment if appropriate patient selection routines and organization for follow-up are in place.

  20. Persistent endodontic infection--re-treatment or surgery?

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    Love, Robert M

    2012-04-01

    Management of a tooth with persistent periradicular disease primarily involves management of persistent intraradicular infection. Conventional endodontic re-treatment is the main modality that will manage this condition although endodontic surgery with or without retreatment is a viable option in cases. Case selection involves an appreciation of the disease aetiology and expected outcomes and consideration of patient, tooth and clinician factors. Both conventional endodontic re-treatment and surgery have high long-term success and survival rates and it has been shown that an endodontically treated tooth with persistent periradicular pathology that can be managed by conventional endodontic re-treatment or surgery and restoration has comparable, and potentially more beneficial, outcomes to treatment options involving tooth loss and rehabilitation, such as an implant supported crown. As such endodontic retreatment should be the prime treatment modality unless a tooth has reached a stage where these techniques cannot manage ongoing disease and/or structural integrity.

  1. Female pattern hair loss: Current treatment concepts

    Directory of Open Access Journals (Sweden)

    Quan Q Dinh

    2007-07-01

    Full Text Available Quan Q Dinh, Rodney SinclairDepartment of Dermatology, St Vincent’s Hospital, Fitzroy, Victoria, AustraliaAbstract: Fewer than 45% of women go through life with a full head of hair. Female pattern hair loss is the commonest cause of hair loss in women and prevalence increases with advancing age. Affected women may experience psychological distress and impaired social functioning. In most cases the diagnosis can be made clinically and the condition treated medically. While many women using oral antiandrogens and topical minoxidil will regrow some hair, early diagnosis and initiation of treatment is desirable as these treatments are more effective at arresting progression of hair loss than stimulating regrowth. Adjunctive nonpharmacological treatment modalities such as counseling, cosmetic camouflage and hair transplantation are important measures for some patients. The histology of female pattern hair loss is identical to that of male androgenetic alopecia. While the clinical pattern of the hair loss differs between men, the response to oral antiandrogens suggests that female pattern hair loss is an androgen dependant condition, at least in the majority of cases. Female pattern hair loss is a chronic progressive condition. All treatments need to be continued to maintain the effect. An initial therapeutic response often takes 12 or even 24 months. Given this delay, monitoring for treatment effect through clinical photography or standardized clinical severity scales is helpful.Keywords: female pattern hair loss, androgenetic alopecia

  2. Pre-cataract surgery test using speckle pattern

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    Jutamulia, Suganda; Wihardjo, Erning; Widjaja, Joewono

    2016-11-01

    A laser diode device for pre cataract surgery test is proposed. The operation is based on the speckle generated on the retina by the cataract lens, when the cataract lens is illuminated with a coherent laser light.

  3. [Multimodal treatment of pain and nausea in breast cancer surgery

    DEFF Research Database (Denmark)

    Gartner, R.; Kroman, N.; Callesen, T.;

    2008-01-01

    INTRODUCTION: Every year 4000 women in Denmark undergo surgery for breast cancer. According to published literature approximately 50% suffer from post-operative nausea and vomiting (PONV) and moderate pain. No national guidelines are available regarding the treatment or prevention of pain and PONV...... associated with surgery for these patients. MATERIALS AND METHODS: 116 consecutive patients scheduled for breast cancer surgery were prospectively scored according to pain, PONV and sedation after being introduced to a combined evidence-based, empiric multimodal opioid-sparing prevention and treatment regime...... severe PONV and vomiting resistant to treatment. Upon arrival at the recovery 15% of the patients were in a state of moderate to severe sedation. This number was 1.5% 75 minutes later. CONCLUSION: It is possible with a multimodal opioid-sparing prevention and treatment regime for pain and PONV to gain...

  4. The treatment of tongue haemangioma by plasma knife surgery.

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    Kutluhan, A; Bozdemir, K; Ugras, S

    2008-11-01

    A seven-year-old girl presented with a 4 cm x 2 cm lesion of the tongue which was located at the posterior one-third in the midline. The lesion was excised by plasma knife surgery. No complication, such as bleeding, shortness of breath or infection, occurred after the treatment. Plasma knife surgery is an acceptable choice for selected benign lingual vascular malformations.

  5. Depression Treatment Patterns among Elderly with Cancer

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    Patricia A. Findley

    2012-01-01

    Full Text Available Little is known about cancer treatment patterns among the elderly as depression and cancer in this older population have not been well explored. This study seeks to fill a gap in the literature by using data from the Medicare Current Beneficiary Survey from years 2000–2005 to examine depression treatment patterns among elderly diagnosed with both cancer and depression. Depression treatments examined include antidepressants with and without psychotherapy. We found that of those with both cancer and depression, 57.7% reported antidepressant use only, 19.7% received psychotherapy with or without antidepressants, and 22.6% had no depression treatment. We found those with greater comorbidity, of a minority race, with lower levels of education, and living in rural areas were less likely to receive treatment for depression. These findings highlight the need to address disparities in the treatment of depression in the elderly population with cancer.

  6. Novel Histopathological Patterns in Cortical Tubers of Epilepsy Surgery Patients with Tuberous Sclerosis Complex

    Science.gov (United States)

    Hulshof, Hanna M.; Scholl, Theresa; Iyer, Anand M.; Anink, Jasper J.; van den Ouweland, Ans M. W.; Nellist, Mark D.; Jansen, Floor E.; Spliet, Wim G. M.; Krsek, Pavel; Benova, Barbora; Zamecnik, Josef; Crino, Peter B.; Prayer, Daniela; Czech, Thomas; Wöhrer, Adelheid; Rahimi, Jasmin; Höftberger, Romana; Hainfellner, Johannes A.; Feucht, Martha; Aronica, Eleonora

    2016-01-01

    Tuberous Sclerosis Complex (TSC) is a genetic hamartoma syndrome frequently associated with severe intractable epilepsy. In some TSC patients epilepsy surgery is a promising treatment option provided that the epileptogenic zone can be precisely delineated. TSC brain lesions (cortical tubers) contain dysmorphic neurons, brightly eosinophilic giant cells and white matter alterations in various proportions. However, a histological classification system has not been established for tubers. Therefore, the aim of this study was to define distinct histological patterns within tubers based on semi-automated histological quantification and to find clinically significant correlations. In total, we studied 28 cortical tubers and seven samples of perituberal cortex from 28 TSC patients who had undergone epilepsy surgery. We assessed mammalian target of rapamycin complex 1 (mTORC1) activation, the numbers of giant cells, dysmorphic neurons, neurons, and oligodendrocytes, and calcification, gliosis, angiogenesis, inflammation, and myelin content. Three distinct histological profiles emerged based on the proportion of calcifications, dysmorphic neurons and giant cells designated types A, B, and C. In the latter two types we were able to subsequently associate them with specific features on presurgical MRI. Therefore, these histopathological patterns provide consistent criteria for improved definition of the clinico-pathological features of cortical tubers identified by MRI and provide a basis for further exploration of the functional and molecular features of cortical tubers in TSC. PMID:27295297

  7. Novel Histopathological Patterns in Cortical Tubers of Epilepsy Surgery Patients with Tuberous Sclerosis Complex.

    Directory of Open Access Journals (Sweden)

    Angelika Mühlebner

    Full Text Available Tuberous Sclerosis Complex (TSC is a genetic hamartoma syndrome frequently associated with severe intractable epilepsy. In some TSC patients epilepsy surgery is a promising treatment option provided that the epileptogenic zone can be precisely delineated. TSC brain lesions (cortical tubers contain dysmorphic neurons, brightly eosinophilic giant cells and white matter alterations in various proportions. However, a histological classification system has not been established for tubers. Therefore, the aim of this study was to define distinct histological patterns within tubers based on semi-automated histological quantification and to find clinically significant correlations. In total, we studied 28 cortical tubers and seven samples of perituberal cortex from 28 TSC patients who had undergone epilepsy surgery. We assessed mammalian target of rapamycin complex 1 (mTORC1 activation, the numbers of giant cells, dysmorphic neurons, neurons, and oligodendrocytes, and calcification, gliosis, angiogenesis, inflammation, and myelin content. Three distinct histological profiles emerged based on the proportion of calcifications, dysmorphic neurons and giant cells designated types A, B, and C. In the latter two types we were able to subsequently associate them with specific features on presurgical MRI. Therefore, these histopathological patterns provide consistent criteria for improved definition of the clinico-pathological features of cortical tubers identified by MRI and provide a basis for further exploration of the functional and molecular features of cortical tubers in TSC.

  8. Pattern of Nerve Blocks for Upper Limb Surgery at the University of ...

    African Journals Online (AJOL)

    Pattern of Nerve Blocks for Upper Limb Surgery at the University of Benin Teaching Hospital - A Ten Year Survey. ... Log in or Register to get access to full text downloads. ... Lower limb surgery is amenable to central neural blockade techniques, ... Information about patient demographic characteristics, surgical indication, ...

  9. Impact of preoperative defecation pattern on postoperative constipation for patients undergoing cardiac surgery.

    Science.gov (United States)

    Iyigun, Emine; Ayhan, Hatice; Demircapar, Aslı; Tastan, Sevinc

    2017-02-01

    To analyse the impact of preoperative defecation pattern on postoperative defecation pattern for patients undergoing cardiac surgery. Constipation is a neglected problem that occurs frequently after cardiac surgery. Descriptive study. The study sample comprised 102 patients who underwent cardiac surgery. A Descriptive Information Form, Rome III Diagnostic Criteria, Constipation Severity Instrument, Postoperative Defecation Pattern Evaluation Form and Bristol Stool Form Scale were used for data collection and analysis. The Constipation Severity Instrument scores of just over one-third (37·2%) of the patients who were constipated prior to surgery were higher compared to those who were not constipated. Following cardiac surgery, 39·2% of patients developed constipation and 80% of these patients were constipated prior to cardiac surgery. The findings indicate a significantly high relationship between preoperative and postoperative defecation pattern (r = 0·71, p cardiac surgery. During the preoperative period, clinical nurses may evaluate the patients' defecation patterns using valid and reliable scales and follow the defecation of the patients, especially patients with defecation problems, during the postoperative period. © 2016 John Wiley & Sons Ltd.

  10. Role of surgery in modern treatment of laryngeal carcinoma

    Directory of Open Access Journals (Sweden)

    Jović Rajko M.

    2013-01-01

    Full Text Available The strategy of organ preservation by applying chemoradiotherapy in the treatment of laryngeal carcinoma, which has been extensively used since 1990s, is now being reviewed regarding its further justification. Despite good results in other localization of head and neck cancer, it has not met the expectations in case of laryngeal cancer. One explanation is the lower participation of human papillomavirus type 16 in the etiology of laryngeal cancer. A lot of developing countries base their concept on primary surgery with subsequent radiotherapy, because the cost of operations for cancer of the larynx is much lower than in developed countries. Endoscopic surgery of T1 cancers is feasible in all environments using cold surgery thanks to modern management of anesthesia with the possibility of local application of adrenaline. Its price is € 481.46, and if it is performed through laryngofissure, the price is € 785.46. The introduction of lasers into the treatment would justify the initial investment and extend indications, and the surgery of T1 and T2 cancers with laser application should be the standard practice in all countries and regions dealing with laryngeal pathology. T2 and some T3 cancers can be treated by conservation surgery of the larynx. Most of T3 and T4 cancers are indications for total laryngectomy or near-total laryngectomy in selected cases. If it is the primary surgery, wound healing is good and complications are rare. This greatly reduces the cost of operation, which is €1910.15. Surgery after radiotherapy, particularly after chemoradiotherapy, may result in complications that significantly prolong the treatment and increase its costs. Thus, the biological nature of laryngeal cancer and its specificity make this approach to the treatment of cancer available in all regions of the world.

  11. Comparative study of excitation patterns in the masseter muscle before and after orthognathic surgery.

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    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.

  12. Post-endodontic treatment periodontal surgery: a case report.

    Science.gov (United States)

    Azaripour, Adriano; Willershausen, Ines; Kämmerer, Philipp; Willershausen, Brita

    2013-02-01

    Two patients were diagnosed with combined endodontic-periodontal lesions. Endodontic treatment was performed, followed by surgery. In addition, the regeneration process was supported by the application of an enamel matrix derivate alone or in combination with guided bone regeneration techniques. At recall visits after 24 months, the teeth were asymptomatic and marked bone regeneration had occurred in both patients. The successful post-endodontic treatment of combined endodontic-periodontal lesions, using periodontal surgery and as adjunct guided tissue regenerative techniques, is presented. Further, the possibility of saving teeth, even with severely apparent pathology, should be highlighted.

  13. TREATMENT OF SODIUM DISORDERS AFTER SURGERY OF CRANIOPHARYNGIOMA

    Institute of Scientific and Technical Information of China (English)

    黄文宇; 石祥恩

    2000-01-01

    Objective. To study the treatment of the patients with blood sodium disorder after craniopharyngioma surgery. Method. The blood sodium in 44 patients with craniopharyngiomas was daily examined from operative to post-op erative days. Hypernatremia is defined as [Na] > 145 mmol/1, and hyponatremia as [Na] < 135 mmol/L. Results. Of the 44 patients, 36 developed sodium disorder. Among them, simple hyponatremia was 16 patients, simple hypernatremia was 9 patients, and alternative sodiu m disorder was 11 patients. Conclusion. The blood sodium disorder in patients with craniopharyngiomas after surgery appears to present com plicated changes. Three types of blood sodium disorder could be determined as simple hyponatremia, simple hyperna tremia, and alternative sodium disorder. Treatment of the sodium disorder in patients with craniopharyngiomas after surgery could be carried in accordance with the above three types.

  14. Patterns of relapse following surgery and postoperative intensity modulated radiotherapy for oral and oropharyngeal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Collan, Juhani; Vaalavirta, Leila; Kajanti, Mikael; Tenhunen, Mikko; Saarilahti, Kauko (Dept. of Oncology, Helsinki Univ. Central Hospital, and Univ. of Helsinki, Helsinki (Finland)), E-mail: kauko.saarilahti@hus.fi; Lundberg, Marie; Baeck, Leif; Maekitie, Antti (Dept. of Otorhinolaryngology - Head and Neck Surgery, Helsinki Univ. Central Hospital, and Univ. of Helsinki, Helsinki (Finland))

    2011-10-15

    Background. To investigate the patterns of relapse following intensity modulated radiotherapy (IMRT) given after radical surgery for oral and oropharyngeal squamous cell cancer. Patients and methods. One hundred and two patients with oral or oropharyngeal cancer were treated with radical surgery followed by IMRT up to a mean total dose of 60 Gy between years 2001 and 2007. Thirty-nine of the patients (%) also received concomitant weekly cisplatin. Forty of the patients had oral and 62 had oropharyngeal cancer. Data on the tumour, patient and treatment factors were collected. Following therapy the patients were followed by clinical examination, endoscopy and MRI/CT at 2- to 3-months interval up to 2 years and thereafter at 6-month intervals. Results. The mean follow-up time of the patients was 55 months (range, 26-106 months). The rate for local tumour control for the whole cohort was 92.2%: 87.5% for oral cancer patients and 96.7% for oropharyngeal cancer patients. The 5-year disease specific survival was 90.2% and 5-year overall survival 84.3%. During the follow-up eight locoregional recurrences were observed, three at the primary tumour site and one at regional nodal site and four at both sites. The mean time to primary tumour recurrence was seven months (range, 2-10 months) and to nodal recurrence seven months (range, 2-12 months). Distant metastasis occurred in six (6%) patients. The factors associated with poor prognosis were the primary tumour size and tumour site with oral cancers having worse outcome. The treatment was well tolerated with no unexpected toxicities. The most frequent late toxicity was dysphagia necessitating permanent PEG in five patients. This was correlated with the advanced primary tumour size and resulting in wide tumour excision and reconstruction. Conclusions. Surgery combined with postoperative radiotherapy given as IMRT results in low level of tumour recurrence

  15. [Bariatric and plastic surgery in obese adolescents: an alternative treatment].

    Science.gov (United States)

    Dubern, Béatrice; Tounian, Patrice

    2014-06-01

    The increased frequency of extreme forms of obesity in adolescents and the disappointing results of conventional treatments are now leading pediatricians to consider bariatric or cosmetic surgery as the only real long-term effective therapeutic alternative. The two main techniques currently used for bariatric surgery in adolescents are gastric bypass and adjustable gastric banding. Whatever the technique, weight loss is significant with improvement of comorbidities and quality of life. In addition, the complications are identical to those in adults and equally frequent. However, because of the particularities of this age, caution is still required. Adolescence is indeed characterized by specific nutritional needs, but also changes in body image in which surgery could have a negative effect. Currently, all obese teenagers making a request for bariatric surgery should have a comprehensive assessment with global care for at least 6 months. The indication is then discussed on a case-by-case basis by multidisciplinary teams and experts. To date, the type of surgery (gastric banding, gastric sleeve, or bypass) is still widely discussed. Based on experience with adults, we believe that gastric sleeve and bypass should be preferred. In addition, obesity in adolescents almost always involves psychosocial consequences, while somatic complications are rare. Thus, the care of adipo- or gynecomastia, abdominal fat excess, and concealed penis is essential and therefore justifies cosmetic surgery.

  16. Patterns of cytokeratin expression in monkey and human periodontium following regenerative and conventional periodontal surgery.

    Science.gov (United States)

    Sculean, A; Berakdar, M; Pahl, S; Windisch, P; Brecx, M; Reich, E; Donos, N

    2001-08-01

    displayed the same cytokeratin expression pattern as the non-treated junctional epithelium. No differences regarding the cytokeratin expression pattern of the junctional epithelium were found between the treatments and types of healing (i.e. regenerative, through a new periodontal ligament, or reparative through a long junctional epithelium). In the intact periodontal ligament, the epithelial rests of Malassez displayed a comparable cytokeratin expression pattern to that of the junctional epithelium. However, no expression of cytokeratins was seen in the newly formed periodontal ligament. In such specimens, cytokeratin expression was observed only until the borderline between the regenerated cementum and the epithelial downgrowth. It was concluded that: a) the reformed junctional epithelium, following any type of surgical procedure, displays a similar pattern of cytokeratin expression to the original junctional epithelium; b) in the newly formed periodontal ligament, no expression of cytokeratins is present; and c) the epithelial rests of Malassez do not seem to reform after regenerative periodontal surgery.

  17. Acute Resective Surgery for the Treatment of Refractory Status Epilepticus.

    Science.gov (United States)

    Basha, Maysaa Merhi; Suchdev, Kushak; Dhakar, Monica; Kupsky, William J; Mittal, Sandeep; Shah, Aashit K

    2017-03-29

    To identify the role of acute surgical intervention in the treatment of refractory status epilepticus (RSE). Retrospective review of consecutive patients who underwent epilepsy surgery from 2006 to 2015 was done to identify cases where acute surgical intervention was employed for the treatment of RSE. In addition, the adult and pediatric RSE literature was reviewed for reports of surgical treatment of RSE. Nine patients, aged 20-68 years, with various etiologies were identified to have undergone acute surgical resection for the treatment of RSE, aided by electrocorticography. Patients required aggressive medical therapy with antiepileptic drugs and intravenous anesthetic drugs for 10-54 days and underwent extensive neurodiagnostic testing prior to resective surgery. Eight out of nine patients survived and five patients were seizure-free at the last follow-up. The literature revealed 13 adult and 48 pediatric cases where adequate historical detail was available for review and comparison. We present the largest cohort of consecutive adult patients who underwent resective surgery in the setting of RSE. We also reveal that surgery can be efficacious in aborting status and in some can lead to long-term seizure freedom. Acute surgical intervention is a viable option in prolonged RSE and proper evaluation for such intervention should be conducted, although the timing and type of surgical intervention remain poorly defined.

  18. Flap surgery in treatment of patients with pathology of ankle

    Directory of Open Access Journals (Sweden)

    D. I. Kutyanov

    2013-01-01

    Full Text Available Objective: to determine the capabilities and perspectives of flap surgery in treatment of patients with traumas and diseases of ankle joint region. Material and methods. The results of surgical treatment of 88 such patients. All the patients were treated in the Vreden Russian Research Institute of Traumatology and Orthopedics within the period from 2000 to 2011. All the patients had pedicled flap transfer (46 cases or free tissue transfer (45 cases. 11 patients had additional need in other open orthopedic operations of ankle joint. Besides this, scientific works dealing with the studied problem have been analyzed. Results and conclusions. It has been stated that flap surgery is predominantly used as the only and exhaustive method of treatment of such patients (87,5%. In these situations pedicled flap transfer and free tissue transfer tend to be used in comparatively equal quantities. Flap surgery is now seldom used as a component of complex surgical treatment. It is used only in some cases of bone reconstruction of distal tibia by Ilizarov bone transport, in some cases of tumors of ankle joint as well as in some cases of local infectious complications after internal fixation and total ankle arthroplasty. Patients with the pathology of this kind have a high need in free tissue transfer (from 66,7% to 83,3%. Progressing technology of total ankle arthroplasty will contribute to the frequency of use of flap surgery for patients with pathology of ankle joint.

  19. Automated branching pattern report generation for laparoscopic surgery assistance

    Science.gov (United States)

    Oda, Masahiro; Matsuzaki, Tetsuro; Hayashi, Yuichiro; Kitasaka, Takayuki; Misawa, Kazunari; Mori, Kensaku

    2015-05-01

    This paper presents a method for generating branching pattern reports of abdominal blood vessels for laparoscopic gastrectomy. In gastrectomy, it is very important to understand branching structure of abdominal arteries and veins, which feed and drain specific abdominal organs including the stomach, the liver and the pancreas. In the real clinical stage, a surgeon creates a diagnostic report of the patient anatomy. This report summarizes the branching patterns of the blood vessels related to the stomach. The surgeon decides actual operative procedure. This paper shows an automated method to generate a branching pattern report for abdominal blood vessels based on automated anatomical labeling. The report contains 3D rendering showing important blood vessels and descriptions of branching patterns of each vessel. We have applied this method for fifty cases of 3D abdominal CT scans and confirmed the proposed method can automatically generate branching pattern reports of abdominal arteries.

  20. [Surgery treatment of ectopic adrenocorticotrophic hormone syndrome].

    Science.gov (United States)

    Fan, H; Li, H Z; Xu, W F; Ji, Z G; Zhang, Y S

    2017-08-18

    To investigation the diagnosis and treatment of ectopic adrenocorticotrophic hormone (ACTH) syndrome. The clinical characters of 57 cases of ecotopic ACTH syndrome from Jan. 1996 to Dec. 2016 were collected and analyzed. The 57 cases included 32 males and 25 females. The age ranged from 11 to 68 years (average 32 years). ACTH levels significantly increased from 16.5 to 365.6 pmol/L, with average 77.6 pmol/L (normal range ectopic ACTH syndrome cases (44%) were group A, without identified source of ectopic hormone, were treated with bilateral or unilateral adrenalectomy due to the severity of the disease and difficulty of operation. Group B was composed of 16 cases (28%) diagnosed as ectopic ACTH syndrome by finding ectopic ACTH tumors and surgical resection. Group C included 16 cases (28%) with nonsurgical therapy. Different treatment results and prognosis were analyzed. In the study, 40 cases of the 57 had been followed up for 6 months to 10 years. In group A, of the 25 cases with bilateral or unilateral adrenalectomy, 4 died of diabetes and severe pulmonary infection, 18 survived, and 3 were lost to the follow-up, and the survival rate was 81% (18/22). In group B, of the 16 cases with radical tumor resection, 5 died of tumor recurrence 0.5-6.0 years after operation, 3 survived, and 8 were lost to the follow-up, and the survival rate was 37.5% (3/8). In group C, of the 16 non-operation patients, 4 with radiotherapy and chemotherapy died of metastases, diabetes or pulmonary infection, 6 with chemotherapy died of pulmonary infection within 1 year and the others were lost to the follow-up, and the survival rate was 0. Ectopic ACTH syndrome is difficult to treat. Adrenalectomy is effective for the management of ectopic ACTH syndrome, especially for those patients with severe Cushing's syndrome, but the primary tumor can not be located.

  1. [Treatment of anemia in hip fracture surgery].

    Science.gov (United States)

    García Pascual, E

    2015-06-01

    Repairing hip fractures is one of the most common surgical procedures and has greater morbidity and mortality. This procedure is also a process that involves a greater need for blood products. Numerous factors influence morbidity, mortality and the use of blood products: patient age, concomitant diseases and drug treatments that change hemostasis and hemorrhaging (preoperative, intraoperative and postoperative), which are usually significant. On top of all this is the presence in a high percentage of cases of preoperative anemia, which can have one or more causes. It is therefore essential to establish an appropriate management of perioperative anemia and optimize the transfusion policy. The aim of this review is to briefly analyze the epidemiology of hip fractures as well as establish a basis for treating perioperative anemia and transfusion policies, proposing guidelines and recommendations for clinical management based on the most current studies. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Pattern and Outcome of Conjunctival Surgeries in Jos University ...

    African Journals Online (AJOL)

    Objective: To assess the output, pattern, and outcome of conjunctival ... others to remix, tweak, and build upon the work non‑commercially, as long as the ..... Thomas JO. ... Farah S, Baum TD, Conlon MR, Alfonso EC, Starck T, Albert D.

  3. Dual antiplatelet treatment in patients candidates for abdominal surgery.

    Science.gov (United States)

    Illuminati, Giulio; Ceccanei, Gianluca; Pacilè, Maria A; Pizzardi, Giulia; Palumbo, Piergaspare; Vietri, Francesco

    2013-01-01

    With the increasing diffusion of percutaneous interventions (PCI), surgeons are often faced with the problem of operating on patients under dual antiplatelet treatment. Replacing dual antiplatelet regiment with low molecular weight heparin may expose to the abrupt thrombosis of coronary stent and massive myocardial infarction. The purpose of this study was to test the hypothesis that abdominal operations can be safely performed under dual antiplatelet treatment. Eleven patients underwent 5 colectomies, 3 nefrectomies, 2 gastrectomies and 1 hysterectomy under aspirin and plavix without any significant perioperative hemorrhage. These preliminary results show that abdominal operations can be safely performed under dual antiplatelet regimen. Abdominal surgery, Dual antiplatelet treatment.

  4. [Diverticular disease - clinical patterns and treatment].

    Science.gov (United States)

    Lembcke, Bernhard; Kruis, Wolfgang

    2015-09-01

    Diverticulosis, diverticular disease and diverticulitis have come into focus again because new aspects concerning diagnosis, risk factors and treatment arose only recently which prompted a new Guideline released by the DGVS and DGAV summarising the current evidence. Along with the guideline's essentials for medical practice a diagnosis of diverticulitis is considered unsatisfactory unless a cross-sectional imaging method (either ultrasonography [US] or computed tomography [CT] ) has proven that the clinical findings and inflammation (CRP considered superior to WBC and temperature) are due to diverticular inflammation. For reasons of practicability and considering relevant legislation for radiation exposure protection, US is the primary - and usually effectual - diagnostic method of choice as it is equipotent to CT. While US offers better resolution and enables precise imaging exactly at the location of pain as well as reiterative application, the latter implies advantages in the case of a deep abscess or diverticulitis in difficult locations (e. g. the small pelvis). Clinical evidence and laboratory and imaging findings allow for distinguishing a large number of differential diagnoses and also form the basis of a new classification (classification of diverticular disease, CDD) which comprises all forms of diverticular disease, from diverticulosis to bleeding and to the different facettes of diverticulitis. This classification -which should be applied in any patient with the diagnosis of diverticular disease- is independent of specific diagnostic preferences and applicable both to conservative and operative treatment options. While the number of recurrent episodes is no longer a significant indicator for surgery in diverticulitis, severity and / or complications determine treatment options along with the patients preferences. According to first data, conservative treatment may waive antibiotics under certain circumstances, however they are indispensible in

  5. Multimodal treatment of gastrointestinal tract tumors: consequences for surgery.

    Science.gov (United States)

    Siewert, J Rüdiger; Stein, Hubert J; von Rahden, Burkhard H A

    2005-08-01

    Formerly an exclusive business of surgery, gastrointestinal (GI) tumors are nowadays increasingly approached with multimodal strategies. Neoadjuvant concepts have had a particularly far-reaching impact on surgery and have contributed to improved survival. Modern pre-treatment staging and risk assessment provide the basis for decision on one of three general treatment concepts (1) Early cancers, confined to the mucosal/submucosal layers, are approached with primary surgery, without prior antineoplastic therapy. (2) Systemically metastasized tumors receive merely palliative treatment. (3) Locally advanced cancers are increasingly approached with neoadjuvant strategies. The benefit from these preoperative protocols is proven for diverse entities, but is evidently confined to a specific subgroup patients, i.e., the responders to neoadjuvant treatment. These are the ones benefiting most from subsequent surgical resection, which is required to ensure complete removal of the residual tumor tissue, as complete tumor regression occurs very rarely and cannot be proven without a specimen. The fact that responders will benefit and non-responders will not benefit or will even deteriorate during the neoadjuvant treatment makes early response prediction most demanding. An amazing new approach is the use of position emission tomography with fluro-desoxyglucose (FDG-PET) to assess the "metabolic response," which is possible as early as 14 days after initiation of the neoadjuvant protocol. This strategy offers the chance for modulating the surgical approach in accord i.e., with such metrobolic response termination of the protocol and proceeding to resection in the case of nonresponse. The future of GI cancer surgery is multimodal therapy in a response-based fashion and requires reponse-based trials for further evaluation.

  6. Laparoscopic bariatric surgery for the treatment of severe hypertriglyceridemia.

    Science.gov (United States)

    Hsu, Sung-Yu; Lee, Wei-Jei; Chong, Keong; Ser, Kong-Han; Tsou, Jun-Jiun

    2015-04-01

    It is well established that severe hypertriglyceridemia can lead to pancreatitis. At present, medical treatment for patients with severe hypertriglyceridemia and repeat pancreatitis attacks is not adequate. The aim of this study was to assess the effectiveness of laparoscopic bariatric surgery in these patients. A review of 20 morbidly obese patients with severe hypertriglyceridemia (a triglyceride level of >1000 mg/dL) who received laparoscopic bariatric surgery was performed. The study population comprised 14 males and six females, with an average age of 35.0 years (range 24-52 years), and the mean body mass index was 38.2 kg/m(2) (range 25-53 kg/m(2)). The preoperative mean plasma triglyceride level was 1782.7 mg/dL (range 1043-3884 mg/dL). Four patients had a history of hypertriglyceridemic pancreatitis and 13 patients had associated diabetes. Of the 20 patients, 17 (85%) received gastric bypass, whereas three (15%) received restrictive-type surgery. Laparoscopic access was used in all of the patients. Hypertriglyceridemia in morbidly obese patients was more commonly associated with male sex and a poorly controlled diabetic state. The mean weight reduction was 25.5% 1 year after surgery, with a marked improvement in diabetes management. As early as 1 month following surgery, the plasma mean triglyceride levels had decreased to 254 mg/dL (range 153-519 mg/dL), and this was further reduced to mean levels of 192 mg/dL (range 73-385 mg/dL) 1 year after surgery. One patient developed acute pancreatitis during the perioperative period, but none of the patients suffered an episode of pancreatitis in the follow-up period (from 6 months to 13 years). Bariatric surgery can be successfully used as a metabolic surgery in severe hypertriglyceridemia patients at risk of acute pancreatitis. However, control of triglyceride levels prior to bariatric surgery is indicated. Copyright © 2014. Published by Elsevier Taiwan.

  7. Sub-array patterns of spherical-section phased array for high intensity focused ultrasound surgery

    Institute of Scientific and Technical Information of China (English)

    WANG Xiaodong; WANG Xufei; LU Mingzhu; WAN Mingxi

    2005-01-01

    The sub-array field patterns of spherical-section phased array were implemented for noninvasive ultrasound surgery of liver-tumor. The sub-array approach included field calculation, pseudo-inverse method and genetic algorithm. The sub-arrays uncovered by ribs according to scanned images normally emitted ultrasound. The results from different sub-arrays demonstrated quite satisfied acoustic performances, which included qualified focus size and intensity level for ultrasound surgery with single-focus and multi-foci patterns. Moreover, the patterns could decrease power accumulation on the ribs, and avoid damaging normal tissues. Thus the sub-array method provides a promising tool for phased array ultrasound propagating through strong obstacles like human rib cage, and it may broaden the therapeutic area, make the surgery safer and more flexible.

  8. TREATMENT OF SODIUM DISORDERS AFTER SURGERY OF CRANIOPHARYNGIOMA

    Institute of Scientific and Technical Information of China (English)

    黄文宇; 石祥恩

    2000-01-01

    Objective. To study the treatment of the patients with blood sodium disorder after cramophatyrgioma stagery.Method. The blood sodium in 44 patients with craniopharyngiomas was daily examined from operative to post-op-erative days. Hypematremia is defined as [Na] > 145 mmol/l, and hyponatremia as [Na] < 135 nmml/L.Results. Of the 44 patients, 36 developed sodium disorder. Among them, simple hyponatremia was 16 patients,simple hypematremia was 9 patients, and alternative sodium disorder was 11 patients. Condusion. The blood sodium disorder in patients with craniopharyngiomas after surgery appears to present com-plicated changes. Three types of blood sodium disorder could be determined as simple hyponatremia, simple hyperna-tremia, and alternative sodium disorder. Treatment of the sodium disorder in patients with craniopharyngiomas after surgery could be carried in accordance with the above three types.

  9. Impact of Recurrence and Salvage Surgery on Survival After Multidisciplinary Treatment of Rectal Cancer.

    Science.gov (United States)

    Ikoma, Naruhiko; You, Y Nancy; Bednarski, Brian K; Rodriguez-Bigas, Miguel A; Eng, Cathy; Das, Prajnan; Kopetz, Scott; Messick, Craig; Skibber, John M; Chang, George J

    2017-08-10

    Purpose After preoperative chemoradiotherapy followed by total mesorectal excision for locally advanced rectal cancer, patients who experience local or systemic relapse of disease may be eligible for curative salvage surgery, but the benefit of this surgery has not been fully investigated. The purpose of this study was to characterize recurrence patterns and investigate the impact of salvage surgery on survival in patients with rectal cancer after receiving multidisciplinary treatment. Patients and Methods Patients with locally advanced (cT3-4 or cN+) rectal cancer who were treated with preoperative chemoradiotherapy followed by total mesorectal excision at our institution during 1993 to 2008 were identified. We examined patterns of recurrence location, time to recurrence, treatment factors, and survival. Results A total of 735 patients were included. Tumors were mostly midrectal to lower rectal cancer, with a median distance from the anal verge of 5.0 cm. The most common recurrence site was the lung followed by the liver. Median time to recurrence was shorter in liver-only recurrence (11.2 months) than in lung-only recurrence (18.2 months) or locoregional-only recurrence (24.7 months; P = .001). Salvage surgery was performed in 57% of patients with single-site recurrence and was associated with longer survival after recurrence in patients with lung-only and liver-only recurrence ( P recurrence ( P = .353). Conclusion We found a predilection for lung recurrence in patients with rectal cancer after multidisciplinary treatment. Salvage surgery was associated with prolonged survival in patients with lung-only and liver-only recurrence, but not in those with locoregional recurrence, which demonstrates a need for careful consideration of the indications for resection.

  10. [Bariatric surgery in the treatment of severe obesity].

    Science.gov (United States)

    Dhahri, Abdennaceur; Qassemyar, Quentin; Verhaeghe, Pierre; Desailloud-Godard, Rachel; Badaoui, Rachid; Regimbeau, Jean-Marc

    2009-11-20

    Over the past ten years, the treatment of severe obesity has radically changed through the benefits of bariatric surgery not only on weight loss significant and lasting, but also on reducing mortality, correction of metabolic disorders, reduction of cardiovascular risk and improving the quality of life. Its indication should be multidisciplinary. Laparoscopy has become the rule, reducing the postoperative morbimortality. Four types of intervention are regularly performed in France. We report their principle, their results and major complications.

  11. Nosocomial infections and antibiotic resistance pattern in open-heart surgery patients at Imam Ali Hospital in Kermanshah, Iran.

    Science.gov (United States)

    Heydarpour, Fatemeh; Rahmani, Youssef; Heydarpour, Behzad; Asadmobini, Atefeh

    2017-01-01

    Background: Patients undergoing open heart surgery have a relatively high risk of acquiring nosocomial infections. The development of antibiotic-resistant infections is associated with prolonged hospital stays and mortalities. Objectives: The present study was conducted to investigate nosocomial infections and the antibiotic resistance pattern in bacteria causing these infections in open heart surgery patients at Imam Ali Hospital in Kermanshah in the west of Iran over a 4-year period from March 2011 to March 2014. Materials and methods: The present cross-sectional study was conducted on 135 cases of nosocomial infection among open heart surgery patients. The demographic characteristics and the risk factors of each case of infection were recorded. The antibiotic susceptibility test was carried out using the Minimum Inhibitory Concentration (MIC) method based on the Clinical and Laboratory Standards Institute (CLSI) protocol. The data collected were then analyzed in SPSS-16. Results: Out of the 6,000 patients who underwent open heart surgery during this 4-year period at the selected hospital, nosocomial infections developed in 135 patients (2.25%), 59.3% of whom were female and 40.7% male. Surgery site infection (SSI), pneumonia (PNEU), urinary tract infection (UTI) and blood stream infection (BSI) affected 52.6%, 37%, 9.6% and 0.8% of the cases, respectively. E.coli, Klebsiella spp. and S. aureus were the most common bacteria causing the nosocomial infections. E. coli was most frequently resistant to imipenem (23.3%) Klebsiella spp. to gentamicin (38.5%) S. aureus to co-trimoxazole (54.2%). Conclusion: SSI had a high prevalence in this study. Further studies should therefore be conducted to examine the risk factors associated with SSI in open heart surgery. Various studies have shown that antibiotic resistance patterns are different in different regions. Finding a definitive treatment therefore requires an antibiogram.

  12. Prevention and Treatment of Bacterial Endophthalmitis after Cataract Surgery

    Directory of Open Access Journals (Sweden)

    Lokman Aslan

    2013-10-01

    Full Text Available Postoperative endophthalmitis is a rare but devastating complication of cataract surgery, and requires rapid and effective treatment when it is diagnosed. Today, although improved sterilization conditions and antibiotic prophylaxis reduce the incidence of endophthalmitis, the amount of endophthalmitis hasn%u2019t decreased due to the increasing number of intraocular surgery. The most essential rule for fight with endophthalmitis is to prevent. From the preparation of the patient to staff training, sterilization of surgical instruments, close follow up of high risk patients and postoperative prophylaxis should be considered as a whole. Prophylactic treatment of blepharitis, conjunctivitis and dacryocystitis, cleaning of skin and conjunctiva with an antiseptic solution such as povidone iodine and to use a drape for covering eyebrows and eyelashes reduce the risk of endophthalmitis. Antibiotic prophylaxis during surgery is applied as an introduction in irrigation fluid, subconjunctival and intracameral. The most effective methods are subconjunctival or intracameral antibiotics application. Intravitreal, subconjunctival and topical fortified antibiotic therapy should be initiated as include all possible microbial agents in patients with clinical diagnosis of endophthalmitis until culture results. Systemic use of antibiotics is controversial, but it may be added to treatment in order to control of extraocular spread.

  13. Cortisol levels and sleep patterns in infants with orofacial clefts undergoing surgery

    Directory of Open Access Journals (Sweden)

    Mueller AA

    2014-10-01

    Full Text Available Andreas A Mueller,1,2 Nadeem Kalak,3 Katja Schwenzer-Zimmerer,1,2 Edith Holsboer-Trachsler,3 Serge Brand3,4 1Craniomaxillofacial Surgery, University of Basel and University Hospital of Basel, Basel, Switzerland; 2Hightech Research Center of Craniomaxillofacial Surgery, University of Basel, Basel, Switzerland; 3Psychiatric Clinics of the University of Basel, Center for Affective, Stress, and Sleep Disorders, Basel, Switzerland; 4Department of Sport and Health Science, Division of Sport Science, University of Basel, Basel, Switzerland Background: Traumatic events during early infancy might damage infants’ psychobiological functioning, such as sleep and cortisol secretion. Infants born with orofacial clefts (OFCs undergo functional, anatomical, and aesthetic surgery. The aim of the present study was to determine whether infants with OFC and undergoing OFC surgery show deteriorated sleep and cortisol secretion compared with healthy controls and with their presurgery status.Methods: A total of 27 infants with OFC (mean age: 22 weeks and 30 healthy controls (mean age: 23 weeks took part in the study. For infants with OFC, sleep actigraphy was performed and saliva cortisol was analyzed 5 days before, during, and 5 days after surgery. For controls, sleep and saliva cortisol were assessed similarly, except for the period taken up with surgery.Results: Compared with healthy controls, infants with OFC undergoing OFC surgery did not differ in sleep and cortisol secretion. Their sleep and cortisol secretion did deteriorate during the perisurgical period but recovered 5 days postsurgery. Conclusion: In infants with OFC undergoing corrective surgery, the pattern of results for sleep and cortisol suggests that OFC surgery does not seem to constitute a traumatic event with long-term consequences. Keywords: cortisol, sleep, orofacial cleft, surgery, infants

  14. [Diode laser surgery in the endoscopic treatment of laryngeal paralysis].

    Science.gov (United States)

    Ferri, E; García Purriños, F J

    2006-01-01

    Several surgical procedures have been proposed for the treatment of respiratory distress secondary to bilateral vocal cord paralysis. The aim of all surgical techniques used is to restore a glottic lumen sufficient to guarantee adequate breathing through the natural airway, without tracheotomy and preserving an acceptable phonatory quality. In this study we present our experience from 1998 to 2004 concerning the use of the diode contact laser for a modified Dennis-Kashima posterior endoscopic cordectomy (extended to the false homolateral chord in 3 cases and to the homolateral arytenoid vocal process in 6 cases). 18 patients (15 male, 3 female) were treated; the age range was 35-84 years. The etiology of paralysis varied: iatrogenic post-thyroidectomy and post-thoracic surgery in 5 cases (28%), post-traumatic in 2 cases (11%), secondary to a central lesion in 11 (61%). The operation was carried out with a diode contact laser (60W; 810 nm). Follow-up was 20 months. Dyspnea improved in all patients; the 9 tracheostomized patients were decannulated within 2 months after surgery. Final voice quality was subjectively good in 16 patients (88%). None of patients had any complications after surgery. In conclusion, the endoscopic posterior cordectomy performed by contact diode laser is an effective and reliable method for the treatment of dyspnea secondary to bilateral laryngeal paralysis, guaranteing a sufficient airway without impairing swallowing and maintaining acceptable voice quality.

  15. Sciatica from disk herniation: Medical treatment or surgery?

    Science.gov (United States)

    Legrand, Erick; Bouvard, Béatrice; Audran, Maurice; Fournier, Dominique; Valat, Jean Pierre

    2007-12-01

    Disk-related sciatica is a common disorder that resolves without surgery in 95% of patients within 1 to 12months. Several treatment strategies designed to hasten recovery, enable a return to previous social and occupational activities, and prevent chronicization have been evaluated. Available efficacy data support the use of analgesics, nonsteroidal anti-inflammatory drugs, and epidural steroid injections, which probably relieve the pain and improve the quality of life without radically changing the midterm outcome. After a specialized evaluation of physical, psychological, social, and occupational factors, surgery may be offered to patients with persistent nerve root pain (as opposed to low back pain). The complication rate ranges from 1% to 3%. Surgery is clearly effective, shortening the time to recovery by about 50% compared to nonsurgical treatment. Whether one specific surgical procedure is better than others remains unclear. Methodological weaknesses of studies evaluating the efficacy of percutaneous methods preclude definitive conclusions. Bed rest, systemic glucocorticoid therapy, spinal manipulation, bracing, spinal traction, and physical therapy have no proven effects on the outcome of sciatica.

  16. Outcomes of Cataract Surgery Following Treatment for Retinoblastoma

    Science.gov (United States)

    Kim, Hyeong Min; Lee, Byung Joo; Kim, Jeong Hun

    2017-01-01

    Purpose To evaluate the long-term visual outcomes and complications of cataract surgery in eyes previously treated for retinoblastoma. Methods We reviewed the medical records of patients who underwent cataract extraction and intraocular lens implantation at Seoul National University Children's Hospital for a secondary cataract that developed after retinoblastoma treatment. Results During the period between 1990 and 2014, 208 eyes of 147 patients received eye-salvaging treatment (radiotherapy, chemotherapy, and local therapy) for retinoblastoma at Seoul National University Children's Hospital. Among these eyes, a secondary cataract was detected in 17 eyes of 14 patients, and five eyes of five patients underwent cataract surgery. The median age of cataract formation was 97 months (range, 38 to 153 months). The medial interval between the diagnosis of retinoblastoma and cataract formation was 79 months (range, 29 to 140 months). All patients received posterior chamber intraocular lens insertion after irrigation and aspiration of the lens through a scleral tunnel incision. Anterior vitrectomy and posterior capsulotomy were performed in two eyes and a laser capsulotomy was subsequently performed in one eye. No intraoperative and postoperative complications occurred. The median follow-up after surgery was 36 months (range, 14 to 47 months). The final best corrected visual acuities were improved in all five eyes. No intraocular tumor recurrences or metastases occurred. Conclusions After retinoblastoma regression, cataract extraction in our series was not associated with tumor recurrence or metastasis. Visual improvement was noted in every patient. PMID:28243024

  17. Radiotherapy combined with surgery as treatment for advanced cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Perches, R.D.; Lobaton, A.T.; Garcia, M.C.

    1983-12-01

    Experience obtained in a group of 44 patients with advanced cervical cancer is reported. In this study, patients with residual cancer underwent laparotomy eight weeks after one or two different radiotherapy protocols. Sixty-eight percent of patients underwent radical surgery, 85% of patients pelvic exenterations, and 15% radical hysterectomies. In 27% of patients, no evidence of residual cancer was found in surgical specimens. Radical surgery was well tolerated, and one-third of patients were free of disease for one year or more. Control of disease was obtained in 50% of pelvic extenterations and in 60% of radical hysterectomies, regardless of prognosis, clinical stage or radiotherapy scheme. Although results show an improvement of up to 22% when comparing this to other more conventional treatments, it has been concluded that a wider experience in order to support the findings must be obtained.

  18. Radiotherapy combined with surgery as treatment for advanced cervical cancer

    Energy Technology Data Exchange (ETDEWEB)

    Perches, R.D.; Lobaton, A.T.; Garcia, M.C.

    1983-12-01

    Experience obtained in a group of 44 patients with advanced cervical cancer is reported. In this study, patients with residual cancer underwent laparotomy eight weeks after one or two different radiotherapy protocols. Sixty-eight percent of patients underwent radical surgery, 85% of patients pelvic exenterations, and 15% radical hysterectomies. In 27% of patients, no evidence of residual cancer was found in surgical specimens. Radical surgery was well tolerated, and one-third of patients were free of disease for one year or more. Control of disease was obtained in 50% of pelvic extenterations and in 60% of radical hysterectomies, regardless of prognosis, clinical stage or radiotherapy scheme. Although results show an improvement of up to 22% when comparing this to other more conventional treatments, it has been concluded that we must obtain a wider experience in order to support the findingsmust be obtained.

  19. Radiotherapy combined with surgery as treatment for advanced cervical cancer.

    Science.gov (United States)

    Perches, R D; Lobaton, A T; Garcia, M C

    1983-12-01

    Experience obtained in a group of 44 patients with advanced cervical cancer is reported here. In this study, patients with residual cancer underwent laparotomy eight weeks after one or two different radiotherapy protocols. Sixty-eight percent of patients underwent radical surgery, 85% of patients pelvic exenterations, and 15% radical hysterectomies. In 27% of patients, no evidence of residual cancer was found in surgical specimens. Radical surgery was well tolerated, and one-third of patients were free of disease for one year or more. Control of disease was obtained in 50% of pelvic exenterations and in 60% of radical hysterectomies, regardless of prognosis, clinical stage or radiotherapy scheme. Although results show an improvement of up to 22% when comparing this to other more conventional treatments, we have concluded that we must obtain a wider experience in order to support our findings.

  20. Peripheral nerve surgery for the treatment of postherpetic neuralgia.

    Science.gov (United States)

    Ducic, Ivica; Felder, John Matthew

    2013-10-01

    Postherpetic neuralgia is a chronic pain condition that develops in some patients after the resolution of herpes zoster, and has no medical cure. Medications used to treat chronic pain do not hasten resolution of the disorder and may impair function. In this brief case report, we describe our experience with excision and implantation to muscle of peripheral sensory nerves in the affected dermatomes as a novel surgical treatment to reduce pain and improve quality of life for patients with this condition. Of the 3 treated patients, all had resolution of chronic pain after surgery. It is concluded that peripheral nerve surgery offers a promising option to improve pain and quality of life in postherpetic neuralgia patients, without affecting systemic functioning.

  1. Physiotherapy Practice Patterns for Management of Patients Undergoing Thoracic Surgeries in India: A Survey

    Directory of Open Access Journals (Sweden)

    Sagarika Sultanpuram

    2016-01-01

    Full Text Available Aim. The aim of the current study is to determine the practice patterns of physiotherapists for patients undergoing thoracic surgeries in India. Materials and Methodology. A cross-sectional survey was conducted across India in which 600 questionnaires were sent in emails to physiotherapists. The questionnaire addressed assessment and treatment techniques of thoracic surgery. Results. A total of 234 completed questionnaires were returned with a response rate of 39%, with the majority of responses received from Telangana, Karnataka, and Andhra Pradesh. More than 90% of the responders practiced physical examination, chest expansion, chest X-ray, ABG analysis, pulmonary function test, and SpO2 (oxygen saturation as the assessment measures in both the pre- and the postoperative phase. Breathing exercises, incentive spirometry, thoracic expansion exercises, coughing and huffing, positioning, and modified postural drainage are found to be commonly used physiotherapy interventions, both pre- and postoperatively, with a response rate of more than 90%. A response rate of more than 84.6% indicated that patients are made to dangle their lower limbs over the edge of the bed on the 1st postoperative day. Mobilization, such as walking up to a chair, sit to stand exercises, and perambulation within the patient’s room, was started on the 2nd postoperative day, as stated by more than 65% of the physiotherapists. Staircase climbing was started on the 5th postoperative day. The most commonly used functional evaluation prior to discharge was 6-minute walk test. This was, in fact, practiced by 77.4% of the physiotherapists in their clinical settings. Conclusion. The most predominantly employed assessment measures included were physical examination, chest expansion, ABG analysis, pulmonary function test, chest X-ray, SpO2 (oxygen saturation, peripheral muscle strength, and cardiopulmonary exercise. The physiotherapy interventions most commonly used were breathing

  2. Palmitoylethanolamide in the Treatment of Failed Back Surgery Syndrome

    Directory of Open Access Journals (Sweden)

    Antonella Paladini

    2017-01-01

    Full Text Available Introduction. This observational study was designed to evaluate the efficacy of ultramicronized palmitoylethanolamide (um-PEA (Normast® administration, as add-on therapy for chronic pain, in the management of pain-resistant patients affected by failed back surgery syndrome. Methods. A total of 35 patients were treated with tapentadol (TPD and pregabalin (PGB. One month after the start of standard treatment, um-PEA was added for the next two months. Pain was evaluated by the Visual Analogue Scale (VAS at the time of enrollment (T0 and after one (T1, two (T2, and three (T3 months. Results. After the first month with TDP + PGB treatment only, VAS score decreased significantly from 5.7±0.12 at the time of enrollment (T0 to 4.3 ± 0.11 (T1 (p<0.0001; however, it failed to provide significant subjective improvement in pain symptoms. Addition of um-PEA led to a further and significant decrease in pain intensity, reaching VAS scores of 2.7 ± 0.09 (T2 and 1.7 ± 0.11 (T3, end of treatment (p<0.0001 without showing any side effects. Conclusions. This observational study provides evidence, albeit preliminary, for the efficacy and safety of um-PEA (Normast as part of a multimodal therapeutic regimen in the treatment of pain-resistant patients suffering from failed back surgery syndrome.

  3. Clinical features and treatment of endophthalmitis after cataract surgery.

    Science.gov (United States)

    Zhu, J; Li, Z H

    2015-06-18

    The aim of this study was to investigate the clinical features and treatment results of endophthalmitis after cataract surgery. Five patients with endophthalmitis after phacoemulsification with intraocular lens implantation were enrolled in this study. The pathogenesis, clinical manifestation, and surgical outcomes of 5 patients were compared. Three patients were surgically treated with anterior chamber irrigation and vitrectomy with intravitreal injection. The remaining two patients were medically treated with an intravitreal injection of vancomycin and ceftazidime. Treatment results of the five patients were analyzed. Four patients had positive cultures for bacteria (two cases Staphylococcus epidermidis, one case Enterococcus faecalis, and one case head-like Staphylococcus). The culture of the fifth patient did not have bacterial growth. One year following treatment, four patients had restored visual acuity and a clear vitreous cavity. Retinal detachment and other complications were not observed. The remaining patient had a visual acuity of index at 30 cm one year following treatment. For patients with endophthalmitis after cataract surgery, a biochemical laboratory examination should be promptly performed and should include a bacterial culture and drug sensitivity test. When necessary, vitrectomy combined with an intravitreal injection of vancomycin should be performed to treat the infection early and to help retain useful vision.

  4. [Post-treatment sequelae after breast cancer conservative surgery].

    Science.gov (United States)

    Delay, E; Gosset, J; Toussoun, G; Delaporte, T; Delbaere, M

    2008-04-01

    Thanks to the earlier detection of breast cancer, the advent of neoadjuvant therapy and the development of more effective surgical procedures reducing treatment sequelae, conservative treatment has dramatically expanded over the past 15 years. Several factors have recognized negative aesthetic consequences for breast cancer patients: being overweight, having voluminous or on the contrary, very small breasts, having a tumor located in the lower quadrant, having high breast-tumor: breast-volume ratio. Tissue injuries induced by radiotherapy and chemotherapy, such as shrinking, fibrosis or induration, maximize the deleterious impact of surgery. The results of conservative treatment also deteriorate with time: weight gain is common and may result in increased breast asymmetry. Patients undergoing conservative treatment may experience sequelae including various degrees of the following dimorphisms, all possibly responsible for minor or even major breast deformity: breast asymmetry, loss of the nipple/areola complex, scar shrinkage and skin impairment, irregular shape and position of the nipple and areola. Various sensory symptoms have also been reported following conservative treatment, with patients complaining of hypo- or dysesthesia or even suffering actual pain. Breast lymphedema is also a common incapacitating after-effect that is believed to be largely underdiagnosed in clinical practice. Finally, like mastectomy, conservative breast surgery may induce serious psychological distress in patients who suffer the loss of physical integrity, womanhood or sexual arousal. Clinicians must be aware of the radiological changes indicative of late cancer recurrence. There are four types of modifications as follows: increased breast density, architectural distortion at the surgical site and formation of scar, mammary fat necrosis, and occurrence of microcalcifications. The management of sequelae of conservative breast treatment must therefore involve a multidisciplinary

  5. Surgery is not indicated for the treatment of premature ejaculation.

    Science.gov (United States)

    Anaissie, James; Yafi, Faysal A; Hellstrom, Wayne J G

    2016-08-01

    Premature ejaculation (PE) is considered the most common male sexual disorder, affecting up to 75% of men at some point in their lives. While medical management is the mainstay of therapy, surgical options such as dorsal nerve neurectomy (DNN), hyaluronic acid (HA) gel glans penis augmentation, and circumcision have been studied as alternative forms of treatment. Preliminary studies have suggested that DNN and HA gel glans penis augmentation are relatively safe and effective, but due to a lack of large, multicenter, randomized-control trials with long-term follow-up, the International Society of Sexual Medicine (ISSM) has been unable to endorse DNN or HA gel glans penis augmentation as options in the treatment of PE. Conflicting data regarding the efficacy and safety of circumcision has similarly led to its exclusion from ISSM recommendations for the treatment of PE. Ethical concerns, particularly the fundamental concept of non-maleficence, are also barriers to the implementation of surgery for PE.

  6. Patterns of Apoplectic Dysarthria and Acupuncture Treatment

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jian-bin; HUANG Guo-qi

    2003-01-01

    In accordance with the feature of apoplectic dysarthria, it is divided into three types of labial pattern, lingual pattern and laryngeal pattern.The therapeutic methods are respectively explained with case examples.

  7. Are personality patterns and clinical syndromes associated with patients' motives and percieved outcome of othognathic surgery?

    DEFF Research Database (Denmark)

    Petersen, Jesper Øland; Jensen, J.; Melsen, Birte

    2010-01-01

    A study of surgical-orthodontic patients was performed to assess whether signs of personality patterns and psychologically defined clinical syndromes influenced patients' motives for treatment, perceived oral function, self-concept, social interaction, and overall satisfaction with treatment....

  8. The presentation, incidence, etiology, and treatment of surgical site infections after spinal surgery.

    NARCIS (Netherlands)

    Pull ter Gunne, A.F.; Mohamed, A.S.; Skolasky, R.L.; Laarhoven, C.J.H.M. van; Cohen, D.B.

    2010-01-01

    STUDY DESIGN: Descriptive, retrospective cohort analysis. OBJECTIVE: To evaluate the presentation, etiology, and treatment of surgical site infections (SSI) after spinal surgery. SUMMARY OF BACKGROUND DATA: SSI after spine surgery is frequently seen. Small case control studies have been published

  9. [Hybrid surgery for the treatment of ovarial cysts in newborns].

    Science.gov (United States)

    Kozlov, Iu A; Novozhilov, V A; Rasputin, A A; Syrkin, N V; Podkamenev, A V; Iurkov, P S; Solov'ev, A A; Radikevich, O V

    2013-01-01

    The aim of this study was to evaluate the effect of hybrid technology (laparoscopy and open surgery) for treatment of ovarian cysts in small babies and infants. Between January 2002 and November 2012, we have performed 11 operation for neonatal ovarian cysts repaired through standard circumumbilical incision (Group I) and 16 operation with using combined hybrid laparoscopic-assisted technique (Group II). The circumumbilical incision utilized at our institution is a classic Bianchi procedure. The hybrid approach combined 2 technique - laparoscopic and open. The trocar for optic telescope was inserted through a circumumbilical incision. The one working instrument was introduced into the peritoneal cavity direct through umbilicus. Afterwords, ovarian cyst was deflated with using transabdominal needle aspiration, delivered by an extended umbilical incision and enucleated as in standard open surgery. The two groups were compared for patients demographics, operative report and early postoperative outcomes. All procedures were performed successfully with no complications rate. There were no differences in the preoperative parameters between the two groups. The differences between groups for operative and postoperative results were statistically significant (p<0.05). The mean operative time in Group I was 30.91 min. In contrast, the mean duration of the operation in the Group II was 21.56 min. The mean time to beginning and time of full enteral feeding for patients with hybrid approach were significantly shorter as for patients with umbilical incision (4.06 hours vs 10.91 hours; 13 hours vs 20.55 hours). Prolonged mean postoperative hospital stay were registered in patients of the Group I (6.36 days vs 3.19 days; p<0.05). The postoperative course and follow up was uneventful in the all patients. The experience described in this study confirms that hybrid operation can be applied for treatment of neonatal ovarian cysts with outcomes better than standard open surgery.

  10. Pathophysiology of obesity: why surgery remains the most effective treatment.

    Science.gov (United States)

    Waseem, Talat; Mogensen, Kris M; Lautz, David B; Robinson, Malcolm K

    2007-10-01

    Obesity is a rapidly increasing, worldwide epidemic. Despite recent scientific advances, no currently recommended dietary program or medication results in long-term weight loss of more than 10% of body weight for the vast majority of people who attempt these interventions. Hence, surgical intervention is recommended for patients with a BMI > or =40 kg/m2. Although surgery is an effective, sustainable treatment of obesity, it can be associated with potentially significant perioperative risks and long-term complications. Current research is focused on developing a medical therapy, which produces more effective and sustainable weight loss, yet avoids the risks inherent in major surgery. With a reduced risk profile, such therapy could also be appropriately offered to those who are less obese and, in theory, help those who have BMIs as low as 27 kg/m2. Toward that end, numerous scientists are working to both unravel the pathophysiology of obesity and to determine why surgical intervention is so effective. This review briefly examines the current status of obesity pathophysiology and management, the reasons for failure of conventional medical treatments, and the success of surgical intervention. Finally, future areas of research are discussed.

  11. Prevention and treatment of neurosensory disturbance after lower third molar surgery

    OpenAIRE

    Leung, Yiu-yan; 梁耀殷

    2014-01-01

    Neurosensory deficit is a well-reported complication after lower third molar surgery. It is useful to know the outcomes of the available treatments for neurosensory deficit after third molar surgery. It is more important to prevent nerve injury from third molar surgery. This thesis aims1) to evaluate the outcomes of treatments for neurosensory deficit after lower third molar surgery; 2) to investigate the effect of permanent neurosensory deficit from the patient’s perspective;3) to identify r...

  12. Detecting Tweet-Based Sentiment Polarity of Plastic Surgery Treatment

    Directory of Open Access Journals (Sweden)

    Marvi Jokhio

    2015-10-01

    Full Text Available Sentiment analysis is a growing research these days. Many companies perform this analysis on public opinions to get a general idea about any product or service. This paper presents a novel approach to get views or comments of Twitter users about plastic surgery treatments. The proposed approach uses machine-learning technique embedded with the naïve Bayesian classifier to assign polarities (i.e. positive, negative or neutral to the tweets, collected from ?Twitter micro-blogging website?. The accuracy of the obtained results has been validated using precision, recall and F-score measures. It has been observed from 25000 tweets dataset that people tend to have positive as well as substantial negative opinions regarding particular treatments. The experimental results show the effectiveness of the proposed approach

  13. Stability of bimaxillary surgery on Class III malocclusion treatment

    Directory of Open Access Journals (Sweden)

    Fernando Antonio Gonçalves

    2012-12-01

    Full Text Available OBJECTIVE: To evaluate the stability of bimaxillary surgery in patients with skeletal malocclusion, with the use of rigid internal fixation. METHODS: Lateral cephalograms from 20 patients, 11 males and 9 females, mean age of 26 years and 1 month, were evaluated before surgery, immediately post-operative and at least 6 months after surgery. Nineteen cephalometric measurements were evaluated, and the results were statistically analyzed by means of the Student's t test and the Kruskal-Wallis test. RESULTS: The Le Fort I maxillary advancement surgery showed almost no relapse. There was lack of stability of mandibular setback, with relapse of 37.33% on point B, due to counterclockwise rotation of the mandible between post-operative periods, occurred by better intercuspation after surgery and muscle adaptation. The results showed the same tendencies for both genders. CONCLUSION: It was concluded that on the bimaxillary surgery treatment of Class III malocclusion, the maxillary surgery was very stable, but the mandibular setback recurred. No statistical differences were found in surgical stability between genders.OBJETIVO: avaliar a estabilidade da cirurgia combinada de maxila e mandíbula em pacientes com má oclusão esquelética de Classe III com a utilização de fixação interna rígida. MÉTODOS: utilizaram-se telerradiografias obtidas em norma lateral de 20 pacientes, sendo 11 do sexo masculino e 9 do feminino, com média de idade de 26 anos e 1 mês, avaliados antes da cirurgia, no pós-operatório imediato e no mínimo 6 meses após a cirurgia. Avaliaram-se dezenove grandezas cefalométricas e os resultados foram analisados estatisticamente por meio do teste t de Student e da análise de Kruskal-Wallis. RESULTADOS: a cirurgia de avanço maxilar praticamente não apresentou recidiva. Ocorreu perda de estabilidade do recuo mandibular, com recidiva de 37,33% no ponto B, devido ao giro anti-horário da mandíbula entre os períodos p

  14. [Surgery treatment of vast abdominal hernias with application of unpressed syntetic mesh--preliminary communications].

    Science.gov (United States)

    Waz, Krzyszrof; Buczynowska, Mirosława; Cienciała, Antoni; Friediger, Jerzy; Topa, Jacek; Steczko-Sieczkowska, Małgorzata; Kisiel, Andrzej; Pedziwiatr, Wiesław; Gotfryd-Bugajska, Katarzyna

    2008-01-01

    This presentation present outcome of surgery treatment of vast abdominal hernias occurred in 9 patients with application of unpressed synthetic mesh: Gore-Dualmesh and SurgimeshVN. All of operated hernias was complications post previous surgery. Surgery perfomed by 5 male and 4 female patients. One of implanted mesh was removed due to faecal fistula. Patients were followed for 2 to 12 month.

  15. Patterns and clinical outcomes of lithium treatment

    NARCIS (Netherlands)

    Wilting, I.

    2008-01-01

    Patterns and consequences of lithium use’. In chapter 2.1 we studied lithium use patterns in out-patients within the last decade. In line with the increase in alternatives and the Dutch guidelines, we observed an increase in use of atypical antipsychotics and valproic acid and a decrease in use tric

  16. Altered right ventricular contractile pattern after cardiac surgery: monitoring of septal function is essential.

    Science.gov (United States)

    Nguyen, Tin; Cao, Long; Movahed, Assad

    2014-10-01

    Assessment of right ventricular (RV) function is important in the management of various forms of cardiovascular disease. Accurately assessing RV volume and systolic function is a challenge in day-to-day clinical practice due to its complex geometry. Tricuspid annular plane systolic excursion (TAPSE) and systolic excursion velocity (S') have been reviewed to further assess their suitability and objectivity in evaluating RV function. Multiple studies have validated their diagnostic and prognostic values in numerous pathologic conditions. Diminished longitudinal contraction after cardiothoracic surgery is a well-known phenomenon, but it is not well validated. Despite significant reduction in RV performance along the long-axis assessed by TAPSE and S' after cardiac surgery, RV ejection fractions did not change as well as the left ventricular parameters and exercise capacity. RV contractile patterns were markedly altered with decreased longitudinal shortening and increased transverse shortening, which are likely resulted from the septal damage during cardiac surgery. The septum is essential for RV performance due to its oblique fiber orientation. This allows ventricular twisting, which is a vital mechanism against increased pulmonary vascular resistance. The septum function along with TAPSE and S' should be adequately assessed during cardiac surgery, and evidence of septal dysfunction should lead to reevaluation of myocardial protection methods.

  17. [Treatment strategies for mass casualty incidents and terrorist attacks in trauma and vascular surgery : Presentation of a treatment concept].

    Science.gov (United States)

    Friemert, B; Franke, A; Bieler, D; Achatz, A; Hinck, D; Engelhardt, M

    2017-08-11

    The treatment of patients in the context of mass casualty incidents (MCI) represents a great challenge for the participating rescue workers and clinics. Due to the increase in terrorist activities it is necessary to become familiar with this new kind of threat to civilization with respect to the medical treatment of victims of terrorist attacks. There are substantial differences between a "normal" MCI and a terrorist MCI with respect to injury patterns (blunt trauma vs. penetrating/perforating trauma), the type and form of the incident (MCI=static situation vs. terrorist attack MCI= dynamic situation) and the different security positions (rescue services vs. police services). This article is concerned with question of which changes in the surgical treatment of patients are made necessary by these new challenges. In this case it is necessary that physicians are familiar with the different injury patterns, whereby priority must be given to gunshot and explosion (blast) injuries. Furthermore, altered strategic and tactical approaches (damage control surgery vs. tactical abbreviated surgical care) are necessary to ensure survival for as many victims of terrorist attacks as possible and also to achieve the best possible functional results. It is only possible to successfully counter these new challenges by changing the mindset in the treatment of terrorist MCI compared to MCI incidents. An essential component of this mindset is the acquisition of a maximum of flexibility. This article would like to make a contribution to this problem.

  18. Contact laser surgery in treatment of vocal fold paralysis.

    Science.gov (United States)

    Saetti, R; Silvestrini, M; Galiotto, M; Derosas, F; Narne, S

    2003-02-01

    Vocal fold paralysis is a pathological condition characterised by varying degrees of respiratory distress in relation to the degree of glottic stenosis. Dyspnoea may be present even when resting and may even require emergency tracheotomy. Frequently, the patient arrives for attention after the onset of exertional dyspnoea associated with a certain degree of dysphonia. The causes may be central or peripheral, more commonly iatrogenic following thyroid or tracheal surgery or secondary to injury. The aim of all surgical techniques used in the treatment of vocal fold paralysis is to restore a lumen sufficient to guarantee adequate breathing through the natural airway, without the patient having to permanently maintain the tracheotomy tube, while preserving acceptable phonatory quality. Between 1990 and 2001, at the Padua Hospital Unit of Endoscopic Airway Surgery, 48 patients (27 female, 21 male) were treated for respiratory distress secondary to vocal fold paralysis. At the beginning of this experience, 7 patients underwent arytenoidectomy with the Ossoff technique. In 34 cases, a modified Dennis-Kashima posterior cordectomy was performed. In 7 patients, since widening of the airway was necessary, cordectomy was extended to the false homolateral chord in 5 cases and to the arytenoid vocal process in another 2. In 9 patients, the operation was carried out with a Nd Yag (1064 nm) contact laser; the remaining 39 were treated with a GaArAl (810 nm) diode laser in use since 1995. Satisfactory results were obtained in all patients first treated by us and not already tracheotomised (35). In 23 cases (66%), results were considered "good" since no exertional dyspnoea occurred. In 12 patients (34%), the result was considered "sufficient" since there was no resting dyspnoea and normal everyday activity could be undertaken. Of the 13 patients already tracheotomised on arrival, 11 (85%) were decanulated on average 2 months after surgery. In conclusion, the present results show

  19. Lower limb salvage surgery: modular endoprosthesis in bone tumour treatment.

    Science.gov (United States)

    Orlic, D; Smerdelj, M; Kolundzic, R; Bergovec, M

    2006-12-01

    We retrospectively analysed 90 patients who underwent "en bloc" resection and modular endoprosthesis reconstruction in the lower limbs between 1987-2003. After proximal femur resection, reconstruction was performed with a modular endoprosthesis by Howmedica (KFTR, designed by Kotz) and modular revision endoprosthesis by W. Link or Lima-Lto (Revision system, designed by Wagner). The knee joint was reconstructed with a modular endoprosthesis (Howmedica, KFTR designed by Kotz) after distal femur or proximal tibia resection. Malignant bone tumours were present in 58 patients (64.5%), benign tumours in 16 (17.8%), metastases in 8 (8.9%), tumour-like lesions in 4 (4.4 %) and non-tumour-related destruction of the femur in 4 patients (4.4%). High-grade tumours were found in the majority of malignant bone tumours (70.7%). Treatment complications, which occurred in 26 patients, were: local recurrence of the tumour, deep infection, acetabular destruction following hemiarthroplasty, recurrent dislocations of endoprosthesis, periprosthetic fracture and hardware problems. In total, 23 patients (25.6%) died due to tumours. Endoprostheses should be considered as a treatment of choice for bone tumours in the hip and knee joint region. Advances in limb salvage surgery are, and will long continue to be, a great challenge for orthopaedic oncologists of the 21st century.

  20. Are personality patterns and clinical syndromes associated with patients' motives and perceived outcome of orthognathic surgery?

    Science.gov (United States)

    Øland, Jesper; Jensen, John; Melsen, Birte; Elklit, Ask

    2010-12-01

    A study of surgical-orthodontic patients was performed to assess whether signs of personality patterns and psychologically defined clinical syndromes influenced patients' motives for treatment, perceived oral function, self-concept, social interaction, and overall satisfaction with treatment. The sample consisted of 92 adult surgical-orthodontic patients. They filled out 3 questionnaires from Kiyak et al: one on motives for treatment; another on perceived oral function, self-concept, and social interaction; and a third on satisfaction with treatment outcome. The Millon Clinical Multiaxial Inventory III was used for classification of personality patterns and clinical syndromes. Patients with signs of a schizoid personality pattern expressed stronger presurgical motives than other patients. Concerning self-concept and social interaction, the patients showing signs of personality patterns and clinical syndromes, in general, perceived themselves as worse than the other patients. However, differences were only evident before treatment. Overall satisfaction was independent of the psychological profile. Histrionic and narcissistic personality patterns seemed to be overrepresented among surgical-orthodontic patients compared with the general population. Patients who showed signs of certain personality patterns and clinical syndromes improved most from treatment in terms of self-concept and social interaction, and such traits did not influence their degree of satisfaction. Copyright © 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Surgery Goes Social: The Extent and Patterns of Social Media Utilization by Major Trauma, Acute and Critical Care Surgery Societies.

    Science.gov (United States)

    Khalifeh, Jawad M; Kaafarani, Haytham M A

    2017-01-01

    The evolving influence of social media in trauma, acute, and critical care surgery (TACCS) cannot be ignored. We sought to investigate the extent and patterns of use of social networks by major regional, national and international TACCS societies. The two leading social networking sites, Facebook (FB) and Twitter (TW), were thoroughly examined for the presence of official accounts for each of the major TACCS societies. An official FB or TW account was defined as one which has a blue verified badge and/or is linked the society's official website. For societies with confirmed official accounts, the extent and patterns of use of the two platforms were systematically examined over a 2-week period through: (1) manual inspection of the societies' FB and TW pages, (2) the SQLite database containing downloaded samples of posts, and (3) the TW analytics database, symplur.com. Standardized social media metrics were calculated for each society. Posted content was categorized as being: (1) society news updates, (2) event announcements, or (3) general medical information. From a total of 64 TACCS societies, only 27 (42%) had FB and/or TW accounts. Ten out of the 12 American societies had accounts compared to 13/39 of European, 2/9 of Australasian, and 0/2 of international societies. For the societies with social media presence, the mean numbers of monthly tweets and FB posts per society were 22 and 8, respectively. We summarize the FB and TW activity of the studied TACCS societies. Most tweets/posts were society news updates and event announcements intended to the society's constituents not the general public. A text cloud was constructed to summarize the major featured topics. Less than half of the TACCS societies are currently using social media; those that do are arguably underutilizing its potential. Non-American societies in particular lag behind in their use of social networking.

  2. [Preparation of patients on anticoagulant treatment for invasive surgery].

    Science.gov (United States)

    Brejcha, M; Gumulec, J; Penka, M; Klodová, D; Wróbel, M; Bogoczová, E

    2009-03-01

    The management of warfarin therapy in patients undergoing surgery or other invasive procedures involves a balance between the risk of hemorrhage, and the risk of thrombosis. Risk of hemorrhage and the trombosis depends on the type of procedure and on pre-existing conditions. Procedures with low risk of hemorrhage (dental, dermatologic or ophtalmologic procedures, endoscopy) can be provided with continuing anticoagulant therapy. Surgery with high hemorrhagic risk need stop warfarin and start bridging anticoagulant therapy, such as unfractionated heparin or low molecular weight heparin, prior and after surgery. In patients requiring emergency surgery, vitamin K, prothrombin complex concentrate or fresh frozen plasma can be used to improve coagulation.

  3. EARLY COMPLICATIONS IN BARIATRIC SURGERY: incidence, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Marco Aurelio SANTO

    2013-03-01

    Full Text Available Context Bariatric surgery has proven to be the most effective method of treating severe obesity. Nevertheless, the acceptance of bariatric surgery is still questioned. The surgical complications observed in the early postoperative period following surgeries performed to treat severe obesity are similar to those associated with other major surgeries of the gastrointestinal tract. However, given the more frequent occurrence of medical comorbidities, these patients require special attention in the early postoperative follow-up. Early diagnosis and appropriate treatment of these complications are directly associated with a greater probability of control. Method The medical records of 538 morbidly obese patients who underwent surgical treatment (Roux-en-Y gastric bypass surgery were reviewed. Ninety-three (17.2% patients were male and 445 (82.8% were female. The ages of the patients ranged from 18 to 70 years (average = 46, and their body mass indices ranged from 34.6 to 77 kg/m2. Results Early complications occurred in 9.6% and were distributed as follows: 2.6% presented bleeding, intestinal obstruction occurred in 1.1%, peritoneal infections occurred in 3.2%, and 2.2% developed abdominal wall infections that required hospitalization. Three (0.5% patients experienced pulmonary thromboembolism. The mortality rate was 0,55%. Conclusion The incidence of early complications was low. The diagnosis of these complications was mostly clinical, based on the presence of signs and symptoms. The value of the clinical signs and early treatment, specially in cases of sepsis, were essential to the favorable surgical outcome. The mortality was mainly related to thromboembolism and advanced age, over 65 years. Contexto A cirurgia bariátrica tem mostrado ser o método mais eficaz de tratamento da obesidade grave. No entanto, sua aceitação como terapia padrão-ouro ainda é questionada. As complicações cirúrgicas observadas no início do período p

  4. Patterns of Obesity and Lymph Fluid Level during the First Year of Breast Cancer Treatment: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Mei R. Fu

    2015-09-01

    Full Text Available Obesity is one of the risk factors for developing lymphedema following breast cancer treatment. We prospectively enrolled 140 women and followed the participants for 12 months after surgery to investigate patterns of obesity and lymph fluid level in the first year of cancer treatment. Electrical bioimpedance devices were used to measure weight, BMI, and percent of body fat as well as lymph fluid level. General instructions were given to the participants on maintaining pre-surgery weight. Among the 140 participants, 136 completed the study with 2.9% attrition. More than 60% of the participants were obese (30.8% or overweight (32.4%, while only two participants were underweight and about 35% had normal weight. This pattern of obesity and overweight was consistent at 4–8 weeks and 12 months post-surgery. At 12 months post-surgery, the majority of the women (72.1% maintained pre-surgery weight and 15.4% had >5% weight loss; 12.5% of the women increase >5% of their weight. Significantly more patients in the obesity group had lymphedema defined by L-Dex ratio >7.1 than those in the normal/underweight and overweight group at pre-surgery and 4–8 weeks post-surgery. There was a trend of more patients in the obesity group had L-Dex ratio >7.1 at 12 months post-surgery. Obesity and overweight remain among women at the time of cancer diagnosis and the patterns of obesity and overweight continue during the first year of treatment. General instructions on having nutrition-balanced and portion-appropriate diet and physical activities daily or weekly can be effective to maintain pre-surgery weight.

  5. Diode laser surgery versus scalpel surgery in the treatment of fibrous hyperplasia: a randomized clinical trial.

    Science.gov (United States)

    Amaral, M B F; de Ávila, J M S; Abreu, M H G; Mesquita, R A

    2015-11-01

    Fibrous hyperplasia is treated by surgical incision using a scalpel, together with removal of the source of chronic trauma. However, scalpel techniques do not provide the haemostasis that is necessary when dealing with highly vascular tissues. Diode laser surgery can be used in the management of oral tissues due to its high absorption by water and haemoglobin, and has provided good results in both periodontal surgery and oral lesions. The aim of the present study was to compare the effects of diode laser surgery to those of the conventional technique in patients with fibrous hyperplasia. A randomized clinical trial was performed in which surgical and postoperative evaluations were analyzed. On comparison of the laser-treated (study group) patients to those treated with a scalpel (control group), significant differences were observed in the duration of surgery and the use of analgesic medications. Over a 3-week period, clinical healing of the postoperative wound was significantly faster in the control group as compared to the study group. In conclusion, diode laser surgery proved to be more effective and less invasive when compared to scalpel surgery in the management of fibrous hyperplasia. However, wound healing proved to be faster when using scalpel surgery.

  6. Sinus augmentation surgery after endoscopic sinus surgery for the treatment of chronic maxillary sinusitis: a case report.

    Science.gov (United States)

    Tobita, Takayoshi; Nakamura, Mikiko; Ueno, Takaaki; Sano, Kazuo

    2011-10-01

    Chronic sinusitis develops when the ostiomeatal complex becomes stenosed by the swelling of the sinus mucosa. Previously, the Caldwell-Luc method was performed for the treatment of chronic sinusitis. But postoperative complications, such as discomfort of the buccal skin and recurrence of sinusitis, frequently occurred after the operation. Today, endoscopic sinus surgery (ESS) has become widely used for the treatment of chronic sinusitis. The features of ESS allow for the restoration of the physical function of the sinus membrane and preservation of the physiological environment of the sinus. Therefore, sinus augmentation surgery can be safely performed at an insufficient alveolar bone height below the maxillary sinus when sinusitis is eliminated by the ESS. This article documents a patient history involving chronic sinusitis that was treated by the ESS therapy before sinus augmentation surgery as a pretreatment for insertion of dental implants.

  7. Twenty-four-hour intraocular pressure patterns in a symptomatic patient after ab interno trabeculotomy surgery

    Directory of Open Access Journals (Sweden)

    Mansouri K

    2014-11-01

    Full Text Available Kaweh Mansouri,1 Felipe A Medeiros,2 Robert N Weinreb2 1Glaucoma Sector, Department of Ophthalmology, Geneva University Hospitals, Geneva, Switzerland; 2Hamilton Glaucoma Center and Department of Ophthalmology, University of California, San Diego, La Jolla, CA, USA Abstract: We report the results of repeated ambulatory continuous 24-hour intraocular pressure (IOP monitoring with a contact lens sensor (CLS in a glaucoma patient with ocular pain after ab interno trabeculotomy (Trabectome™ surgery. Our findings show that a combined prostaglandin–pilocarpine treatment reduced nighttime IOP peaks and relieved the patient’s symptoms. Keywords: 24-hour, Trabectome contact lens sensor, prostaglandin–pilocarpine treatment

  8. Conjunctival bacterial flora and antibiotic resistance pattern in patients undergoing cataract surgery

    Directory of Open Access Journals (Sweden)

    Arantes Tiago Eugênio Faria e

    2006-01-01

    Full Text Available PURPOSE: To evaluate the conjunctival bacterial flora and its antibiotic resistance pattern in eyes of patients undergoing cataract surgery. METHODS: From August to October 2004, 50 patients undergoing cataract surgery in the "Fundação Altino Ventura", Recife, Brazil, were prospectively evaluated. Conjunctival material was obtained on the day of surgery, before the application of topical anesthetic, antibiotic or povidone-iodine. The collected material was inoculated and bacterioscopic analysis was carried out. In the cases where there was bacterial growth, antibiotic susceptibility tests and cultures, for isolation and identification of the bacteria, were performed. RESULTS: Of the 50 eyes, 43 (86.0% had positive cultures. The coagulase-negative Staphylococcus (CNS, found in 27 (54.0% eyes, was the most frequent organism. More than 90% of the isolates of this bacterium were susceptible to cephalotin, vancomycin, chloramphenicol, ofloxacin and gatifloxacin; 70 to 90% were susceptible to gentamicin, cefotaxime, oxacillin and ciprofloxacin; and less than 70% were sensible to neomycin. Four (10.5% of the bacterial isolates were resistant to four or more antibiotics, two of them were CNS. CONCLUSION: The most frequent bacterium in the conjunctival flora is the coagulase-negative Staphylococcus. The isolates of this organism showed low susceptibility rate to neomycin, and high susceptibility rates to cephalotin, vancomycin, chloramphenicol, ofloxacin and gatifloxacin.

  9. Bariatric Surgery as Potential Treatment for Nonalcoholic Fatty Liver Disease: A Future Treatment by Choice or by Chance?

    OpenAIRE

    2013-01-01

    Morbid obesity is strongly associated with nonalcoholic fatty liver disease (NAFLD) which is one of the most common causes of chronic liver disease worldwide. The current best treatment of NAFLD and NASH is weight reduction through life style modifications, antiobesity medication, and bariatric surgery. Importantly, bariatric surgery is the best alternative option for weight reduction if lifestyle modifications and pharmacological therapy have not yielded long-term success. Bariatric surgery ...

  10. Aicardi syndrome: epilepsy surgery as a palliative treatment option for selected patients and pathological findings.

    Science.gov (United States)

    Podkorytova, Irina; Gupta, Ajay; Wyllie, Elaine; Moosa, Ahsan; Bingaman, William; Prayson, Richard; Knight, Elia M Pestana

    2016-12-01

    The optimal treatment for medically refractory epilepsy in Aicardi syndrome (AS) is still unclear. Palliative surgical treatment, including vagus nerve stimulation and corpus callosotomy, has therefore been used. There is limited data on the role of resective epilepsy surgery as a treatment choice in patients with AS. Here, we describe the seizures, anatomo-pathological findings, and neurodevelopmental outcome of palliative epilepsy surgery in two children with AS who had resective epilepsy surgery at the Cleveland Clinic. The related literature is also reviewed. Case 1 had a left functional hemispherectomy and was free of seizures and hypsarrhythmia for six months after surgery. Her gross motor skills improved after surgery. Outcome at 43 months was 1-3 isolated spasms per day. Case 2 had a right fronto-parietal lobectomy. Her seizures improved in frequency and severity, but remained daily after epilepsy surgery. Neurodevelopment changes included improved alertness and recognition of caregivers. This patient died 21 months after epilepsy surgery of unclear causes. Surgical pathology in both cases showed focal cortical dysplasia associated with other findings, such as nodular heterotopia and polymicrogyria. Epilepsy surgery could be an alternative palliative treatment choice in selective cases of AS, but studies on a larger patient cohort are needed to identify the possible role of surgery in children with AS. The complexity of the pathological findings may offer an explanation for the severity of seizures in AS.

  11. Bariatric Surgery as Potential Treatment for Nonalcoholic Fatty Liver Disease: A Future Treatment by Choice or by Chance?

    Directory of Open Access Journals (Sweden)

    Shuja Hafeez

    2013-01-01

    Full Text Available Morbid obesity is strongly associated with nonalcoholic fatty liver disease (NAFLD which is one of the most common causes of chronic liver disease worldwide. The current best treatment of NAFLD and NASH is weight reduction through life style modifications, antiobesity medication, and bariatric surgery. Importantly, bariatric surgery is the best alternative option for weight reduction if lifestyle modifications and pharmacological therapy have not yielded long-term success. Bariatric surgery is an effective treatment option for individuals who are grossly obese and associated with marked decrease in obesity-related morbidity and mortality. The most common performed bariatric surgery is Roux-en-Y gastric bypass (RYGB. The current evidence suggests that bariatric surgery in these patients will decrease the grade of steatosis, hepatic inflammation, and fibrosis. NAFLD per se is not an indication for bariatric surgery. Further research is urgently needed to determine (i the benefit of bariatric surgery in NAFLD patients at high risk of developing liver cirrhosis (ii the role of bariatric surgery in modulation of complications of NAFLD like diabetes and cardiovascular disease. The outcomes of the future research will determine whether bariatric surgery will be one of the recommended choice for treatment of the most progressive type of NAFLD.

  12. Bariatric surgery as potential treatment for nonalcoholic fatty liver disease: a future treatment by choice or by chance?

    Science.gov (United States)

    Hafeez, Shuja; Ahmed, Mohamed H

    2013-01-01

    Morbid obesity is strongly associated with nonalcoholic fatty liver disease (NAFLD) which is one of the most common causes of chronic liver disease worldwide. The current best treatment of NAFLD and NASH is weight reduction through life style modifications, antiobesity medication, and bariatric surgery. Importantly, bariatric surgery is the best alternative option for weight reduction if lifestyle modifications and pharmacological therapy have not yielded long-term success. Bariatric surgery is an effective treatment option for individuals who are grossly obese and associated with marked decrease in obesity-related morbidity and mortality. The most common performed bariatric surgery is Roux-en-Y gastric bypass (RYGB). The current evidence suggests that bariatric surgery in these patients will decrease the grade of steatosis, hepatic inflammation, and fibrosis. NAFLD per se is not an indication for bariatric surgery. Further research is urgently needed to determine (i) the benefit of bariatric surgery in NAFLD patients at high risk of developing liver cirrhosis (ii) the role of bariatric surgery in modulation of complications of NAFLD like diabetes and cardiovascular disease. The outcomes of the future research will determine whether bariatric surgery will be one of the recommended choice for treatment of the most progressive type of NAFLD.

  13. Risk factors for treatment failure in surgery for primary hyperparathyroidism

    DEFF Research Database (Denmark)

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

    2016-01-01

    Surgery for primary hyperparathyroidism (pHPT) has a high cure-rate and few complications. Preoperative localization procedures have permitted a dramatic shift from routine bilateral exploration to focused, minimally invasive procedures. At Odense University Hospital, Denmark, the introduction...

  14. [Diverticular bleeding. Diagnostics, non-surgical treatment, indications for surgery].

    Science.gov (United States)

    Labenz, J

    2014-04-01

    Diverticular bleeding is the most common cause of acute severe lower gastrointestinal bleeding. Diagnostic and therapeutic approaches have not been standardized. Development of an evidence-based management algorithm. A systematic search of the literature (PubMed 1998-2013) was carried out and a review with consideration of current guidelines is given. The lifetime risk of clinically relevant bleeding is estimated to be 5 % in persons with colonic diverticula. Patients with clinically suspected diverticular hemorrhage should be admitted to hospital. Diverticular bleeding will cease spontaneously in around 70-90 % of the cases. In patients with severe lower gastrointestinal tract bleeding, defined as instability of the circulation, persistent bleeding after 24 h, drop of the hemoglobin level to ≥ 2 g/dl or the necessity for transfusion, endoscopy of the upper and lower gastrointestinal tract within the first 12-24 h is recommended. In patients with active diverticular bleeding or signs of recent hemorrhage (e.g. visible vessel or adherent clot) endoscopic therapy is strongly recommended because it significantly decreases the rate of early and late rebleeding. Angiography with superselective embolization is a therapeutic option in patients where endoscopy failed. Surgery should be considered in patients with ongoing bleeding and failure of interventional treatment and in patients who suffered from recurrent severe diverticular bleeding. Diverticulosis coli remains the most common cause of lower gastrointestinal bleeding. Colonoscopy is recommended as first-line diagnostic and therapeutic approach. In the vast majority of patients diverticular hemorrhage can be readily managed either conventionally or by interventional therapy.

  15. Effect of air-flow on the evaluation of refractive surgery ablation patterns.

    Science.gov (United States)

    Dorronsoro, Carlos; Schumacher, Silvia; Pérez-Merino, Pablo; Siegel, Jan; Mrochen, Michael; Marcos, Susana

    2011-02-28

    An Allegretto Eye-Q laser platform (Wavelight GmbH, Erlangen, Germany) was used to study the effect of air-flow speed on the ablation of artificial polymer corneas used for testing refractive surgery patterns. Flat samples of two materials (PMMA and Filofocon A) were ablated at four different air flow conditions. The shape and profile of the ablated surfaces were measured with a precise non-contact optical surface profilometer. Significant asymmetries in the measured profiles were found when the ablation was performed with the clinical air aspiration system, and also without air flow. Increasing air-flow produced deeper ablations, improved symmetry, and increased the repeatability of the ablation pattern. Shielding of the laser pulse by the plume of smoke during the ablation of plastic samples reduced the central ablation depth by more than 40% with no-air flow, 30% with clinical air aspiration, and 5% with 1.15 m/s air flow. A simple model based on non-inertial dragging of the particles by air flow predicts no central shielding with 2.3 m/s air flow, and accurately predicts (within 2 μm) the decrease of central ablation depth by shielding. The shielding effects for PMMA and Filofocon A were similar despite the differences in the ablation properties of the materials and the different full-shielding transmission coefficient, which is related to the number of particles ejected and their associated optical behavior. Air flow is a key factor in the evaluation of ablation patterns in refractive surgery using plastic models, as significant shielding effects are found with typical air-flow levels used under clinical conditions. Shielding effects can be avoided by tuning the air flow to the laser repetition rate.

  16. Opioid prescribing patterns after Mohs micrographic surgery and standard excision: a survey of American Society for Dermatologic Surgery members and a chart review at a single institution.

    Science.gov (United States)

    Harris, Kalynne; Calder, Scott; Larsen, Brooke; Duffy, Keith; Bowen, Glen; Tristani-Firouzi, Payam; Hadley, Michael; Endo, Justin

    2014-08-01

    Little is known about postoperative opioid prescribing patterns among dermatologic surgeons. To better understand postoperative opioid prescribing patterns among dermatologic surgeons in the United States. Two-part analysis consisting of a retrospective chart review of 233 dermatologic surgery patients at a single institution and an e-mail survey of American Society for Dermatologic Surgery (ASDS) members. (1) Retrospective review: 35% (82/233) of the patients received an opioid prescription. Larger defect size, repair of the defect, perioral and nasal site, and surgeon A or B performing surgery predicted opioid prescription. (2) E-mail survey: 556 ASDS members practicing within the United States responded. Sixty-four percent (357/556) reported prescribing opioids after ≤10% of cases. Surgeons younger than 55 years old, male surgeons, and surgeons in the southern and western United States were more likely to prescribe opioids after >10% of cases. Seventy-six percent (397/520) believed patients used ≤50% of the opioid pills prescribed. The retrospective review suggests that opioid prescribing is predicted by characteristics of the surgery (i.e., size, defect repair type, and anatomic location) and characteristics of the surgeon (i.e., age, sex, and practice location) with significant heterogeneity in prescribing habits. The national survey results raise the possibility that patients might not take all prescribed opioid pills after dermatologic surgery. Further investigation is warranted to determine how patients are actually using prescription pain pills to balance pain control with patient safety.

  17. Prescription patterns and treatment outcomes of hypertension in ...

    African Journals Online (AJOL)

    Prescription patterns and treatment outcomes of hypertension in urban hospitals of Jos, Plateau State. ... Nigerian Journal of Pharmaceutical Research ... Results of this study revealed several rational and non-rational prescription practices in ...

  18. [The role of surgery in the treatment of small cell lung cancer].

    Science.gov (United States)

    Puma, F; Urbani, M; Santoprete, S; Ricci, F; Sanguinetti, A; Vinci, D; Ottavi, P; Porcaro, G; Daddi, G

    2001-12-01

    Small cell lung cancer (SCLC) is a biologically aggressive tumor with a low long-term survival rate. SCLC is highly responsive to chemotherapy and surgery has a very limited role in its treatment because the disease is usually widely disseminated at the diagnosis. Good results from surgery have been reported in the small subgroup of T1-2 N0 M0 patients. In N1 peripheral SCLC, surgery in combination with other treatments, can obtain fair results. Surgical treatment does not influence the prognosis in SCLC as stage III and IV.

  19. [Bariatric surgery is more efficient than medical treatment in achieving remission in diabetes mellitus type 2].

    Science.gov (United States)

    Klein, Mads; Rosenberg, Jacob; Gögenur, Ismail

    2013-04-01

    Observational studies have shown that bariatric surgery can lead to remission of diabetes mellitus type 2 (DMII), but randomized controlled trials have been lacking. Recently, randomized controlled trials comparing bariatric surgery with optimal medical treatment in patients suffering from poorly controlled DMII, have been performed. These trials show that bariatric surgery in general, and the malabsorptive procedures in particular, are more effective than medical treatment in achieving remission of DMII. These procedures should therefore be considered in the treatment of patients with DMII and obesity.

  20. Prevention and Treatment of Shivering after Intracranial Surgery Using Different Dosages of Tramadol

    Institute of Scientific and Technical Information of China (English)

    Yu-hua Qi; Guo-nian Wang; Shu-yan Wang

    2005-01-01

    @@ During the anesthesia recovery period, shivering is a common uncomfortable complaint of patients increasing oxygen consumption, carbon dioxide production, intraocular and intracranial pressures, all disadvantage for intracranial tumor surgery. The aim of our study is to observe the effect of different dosages of tramadol in the prevention and treatment of shivering after intracranial surgery.

  1. Patterns and prognosis of locally recurrent rectal cancer following multidisciplinary treatment

    Institute of Scientific and Technical Information of China (English)

    Jun Zhao; Chang-Zheng Du; Ying-Shi Sun; Jin Gu

    2012-01-01

    AIM:To investigate the patterns and decisive prognostic factors for local recurrence of rectal cancer treated with a multidisciplinary team (MDT) modality.METHODS:Ninety patients with local recurrence were studied,out of 1079 consecutive rectal cancer patients who underwent curative surgery from 1999 to 2007.For each patient,the recurrence pattern was assessed by specialist radiologists from the MDT using imaging,and the treatment strategy was decided after discussion by the MDT.The associations between clinicopathological factors and long-term outcomes were evaluated using both univariate and multivariate analysis.RESULTS:The recurrence pattern was classified as follows:Twenty-seven (30%) recurrent tumors were evaluated as axial type,21 (23.3%) were anterior type,8 (8.9%) were posterior type,and 13 (25.6%) were lateral type.Forty-one patients had tumors that were evaluated as resectable by the MDT and ultimately received surgery,and R0 resection was achieved in 36 (87.8%) of these patients.The recurrence pattern was closely associated with resectability and R0 resection rate (P < 0.001).The recurrence pattern,interval to recurrence,and RO resection were significantly associated with 5-year survival rate in univariate analysis.Multivariate analysis showed that the R0 resection was the unique independent factor affecting long-term survival.CONCLUSION:The MDT modality improves patient selection for surgery by enabling accurate classification of the recurrence pattern; RO resection is the most significant factor affecting long-term survival.

  2. Bariatric surgery: the challenges with candidate selection, individualizing treatment and clinical outcomes

    Science.gov (United States)

    2013-01-01

    Obesity is recognized as a global health crisis. Bariatric surgery offers a treatment that can reduce weight, induce remission of obesity-related diseases, and improve the quality of life. In this article, we outline the different options in bariatric surgery and summarize the recommendations for selecting and assessing potential candidates before proceeding to surgery. We present current data on post-surgical outcomes and evaluate the psychosocial and economic effects of bariatric surgery. Finally, we evaluate the complication rates and present recommendations for post-operative care. PMID:23302153

  3. Bariatric surgery: the challenges with candidate selection, individualizing treatment and clinical outcomes

    Directory of Open Access Journals (Sweden)

    Neff KJ

    2013-01-01

    Full Text Available Abstract Obesity is recognized as a global health crisis. Bariatric surgery offers a treatment that can reduce weight, induce remission of obesity-related diseases, and improve the quality of life. In this article, we outline the different options in bariatric surgery and summarize the recommendations for selecting and assessing potential candidates before proceeding to surgery. We present current data on post-surgical outcomes and evaluate the psychosocial and economic effects of bariatric surgery. Finally, we evaluate the complication rates and present recommendations for post-operative care.

  4. Adherence to treatment after coronary bypass surgery: Psychological aspects

    Directory of Open Access Journals (Sweden)

    Maria V. Iakovleva

    2016-01-01

    Full Text Available Poor adherence to treatment is a problem of great importance and striking magnitude. Its consequences are increased health care costs and poor health outcomes. It defined the objective of this research, which is the study of psychological characteristics of patients with different degrees of adherence to rehabilitation treatment after coronary bypass surgery. Ninety male and female patients with CHD, aged 46---71, were examined. The study was carried out using the questionnaire of ways of coping and the technique for diagnosing the types of attitude toward the disease, and the study of medical history. The analysis of the types of attitude toward the disease revealed that adherent patients show higher values on the harmonious type; patients with poor adherence show higher values on the apathetic, as well as the melancholic type of attitude toward illness. This study shows that wide range of psychological characteristics is significant for the definition of adherence to treatment. It is essential to consider the patient’s personality and his characteristics, such as attitude toward the disease, because they influence the adherence and, therefore, the effectiveness of therapy in the postoperative period. La escasa adherencia a la terapia es un problema de gran importancia ampliamente extendido. Sus consecuencias son el aumento de costes del tratamiento y su baja eficacia. El objetivo de la investigación fue el estudio de las características psicológicas de pacientes con diferentes grados de adherencia al tratamiento de rehabilitación después de la cirugía de derivación coronaria. Se recogieron datos clínicos de 90 pacientes de ambos sexos con cardiopatía coronaria, sometidos a cirugía de derivación coronaria, con edades comprendidas entre 46-71 a˜nos. Los cuestionarios administrados fueron el cuestionario de estilos de afrontamiento y la técnica de diagnóstico de tipos de actitud hacia la enfermedad. Además se realizó un estudio

  5. Psychological Correlates to Dysfunctional Eating Patterns among Morbidly Obese Patients Accepted for Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Hege Gade

    2014-03-01

    Full Text Available Objective: To examine the relationships between dysfunctional eating patterns, personality, anxiety and depression in morbidly obese patients accepted for bariatric surgery. Design: The study used cross-sectional data collected by running a randomized controlled trial (http://clinicaltrials.gov/ct2/show/NCT01403558. Subjects: A total of 102 patients (69 women, 33 men with a mean (SD age of 42.6 (9.8 years and a mean BMI of 43.5 (4.4 kg/m2 participated. Measurements: Measurements included the NEO-PI-R (personality: neuroticism, extroversion, openness, conscientiousness and agreeableness, the TFEQ-R-21 (dysfunctional eating: emotional eating (EE, uncontrolled eating (UE and cognitive restraint of eating (CR and the HADS (anxiety and depression. Results: The personality traits neuroticism and conscientiousness were more strongly correlated with dysfunctional eating than anxiety and depression. These differences were most pronounced for emotional and cognitive restraint of eating. Emotional eating occurred more often in female than in male patients, a finding that was partially mediated by neuroticism but not by anxiety and depression. Conclusion: Personality traits may be important to address in the clinical management of morbidly obese patients seeking bariatric surgery as neuroticism is particularly salient in female patients displaying an emotional eating behaviour.

  6. Role of laparoscopic surgery in treatment of infertility

    Directory of Open Access Journals (Sweden)

    Ivanka Šijanović

    2012-02-01

    Full Text Available The role of laparoscopy in assisted reproduction is disputed by many. A rising problem of infertility is battled by an increasingnumber of centres for reproductive medicine in the region. Nevertheless,there is a large number of indications and conditionswhere laparoscopic surgery should not be avoided as a therapeuticchoice or an aid in assisted reproductive techniques (ART.The number of centres where laparoscopic surgery is performed is significantly higher than the number of reproductive centres; anumber of gynaecologists educated in laparoscopic gynaecologyis growing, making it more available for patients.

  7. Multidisciplinary Conservative Treatment of Difficult Bile Duct Stones: A Real Alternative to Surgery

    Directory of Open Access Journals (Sweden)

    E. Masci

    1997-01-01

    case of symptomatic hyperamylasemia and 3 cases of macrohematuria. In conclusion, extracorporeal lithotripsy combined with endoscopic and/or percutaneous treatment is a real alternative to surgery for difficult stones.

  8. Pathophysiology and treatment of edema following femoropopliteal bypass surgery

    NARCIS (Netherlands)

    te Slaa, A.; Dolmans, D. E. J. G. J.; Ho, G. H.; Moll, F. L.; van der Laan, L.

    2012-01-01

    Substantial lower-limb edema affects the majority of patients who undergo peripheral bypass surgery. Edema has impairing effects on the microvascular and the macrovascular circulation, causes discomfort and might delay the rehabilitation process of the patient. However, the pathophysiology of this e

  9. Pathophysiology and treatment of edema following femoropopliteal bypass surgery

    NARCIS (Netherlands)

    te Slaa, A.; Dolmans, D. E. J. G. J.; Ho, G. H.; Moll, F. L.; van der Laan, L.

    2012-01-01

    Substantial lower-limb edema affects the majority of patients who undergo peripheral bypass surgery. Edema has impairing effects on the microvascular and the macrovascular circulation, causes discomfort and might delay the rehabilitation process of the patient. However, the pathophysiology of this e

  10. Treatment of Obesity: Weight Loss and Bariatric Surgery

    Science.gov (United States)

    Wolfe, Bruce M.; Kvach, Elizaveta; Eckel, Robert H.

    2016-01-01

    This review focuses on the mechanisms underlying, and indications for, bariatric surgery in the reduction of cardiovascular disease (CVD) as well as other expected benefits of this intervention. The fundamental basis for bariatric surgery for the purpose of accomplishing weight loss is the determination that severe obesity is a disease associated with multiple adverse effects on health which can be reversed or improved by successful weight loss in patients who have been unable to sustain weight loss by non-surgical means. An explanation of possible indications for weight loss surgery as well as specific bariatric surgical procedures is presented, along with review of the safety literature of such procedures. Procedures that are less invasive or those that involve less gastrointestinal rearrangement accomplish considerably less weight loss but have substantially lower perioperative and longer-term risk. The ultimate benefit of weight reduction relates to the reduction of the co-morbidities, quality of life and all-cause mortality. With weight loss being the underlying justification for bariatric surgery in ameliorating CVD risk, current evidence-based research is discussed concerning body fat distribution, dyslipidemia, hypertension, diabetes, inflammation, obstructive sleep apnea and others. The rationale for bariatric surgery reducing CVD events is discussed and juxtaposed with impacts on all-cause mortalities. Given the improvement of established obesity-related CVD risk factors following weight loss, it is reasonable to expect a reduction of CVD events and related mortality following weight loss in populations with obesity. The quality of the current evidence is reviewed and future research opportunities and summaries are stated. PMID:27230645

  11. Gamma knife surgery-induced ependymoma after the treatment of meningioma - a case report.

    Science.gov (United States)

    Wang, Ke; Pan, Li; Che, Xiaoming; Lou, Meiqing

    2012-01-01

    Gamma knife surgery is widely used for a number of neurological disorders. However, little is known about its long-term complications such as carcinogenic risks. Here, we present a case of a radiosurgery-induced ependymoma by gamma knife surgery for the treatment of a spinal meningioma in a 7-year-old patient. In light of reviewing the previous reports, we advocate high caution in making young patients receive this treatment.

  12. Pattern of online communication in teaching a blended oral surgery course.

    Science.gov (United States)

    Marei, H F; Al-Khalifa, K S

    2016-11-01

    To explore the factors that might affect the patterns of interaction amongst dental students that can be found in asynchronous online discussion fora. It is a qualitative study that involved the participation of 71 dental students (42 male and 29 female) who belong to one academic year. Students were participated in asynchronous online discussion fora as a part of a blended oral surgery course that involved both face-to-face lecture and an online learning environment using the Blackboard learning management system. Qualitative analysis of students' pattern of discussion was performed using Transcript Analysis Tool. The total number of postings was 410. Sixty-seven of 71 students participated in the discussion by writing posts, whereas all of the students had accessed all of the postings. A positive correlation between imposing vertical questions and the number of non-referential and referential statements was observed. Regarding horizontal questions, a positive correlation was observed with the number of referential statements, whilst there was a negative correlation with the number of non-referential statements. Asynchronous online discussion fora that are integrated as a part of a whole pedagogical practice may provide an opportunity for promoting learning, especially when consideration is given to the structure of problems, timely feedback by tutors and supportive strategies within the discussion threads. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Superior mesenteric artery syndrome following scoliosis surgery: Its risk indicators and treatment strategy

    Institute of Scientific and Technical Information of China (English)

    Ze-Zhang Zhu; Yong Qiu

    2005-01-01

    AIM: To investigate the risk indicators, pattern of clinical presentation and treatment strategy of superior mesenteric artery syndrome (SMAS) after scoliosis surgery.METHODS: From July 1997 to October 2003, 640 patients with adolescent scoliosis who had undergone surgical treatment were evaluated prospectively, and among them seven patients suffered from SMAS after operation. Each patient was assigned a percentile for weight and a percentile for height. Values of the 5th、 10th、 25th、 50th、 75th、 and 95thpercentiles were selected to divide the observations. The sagittal Cobb angle was used to quantify thoracic or thoracolumbar kyphosis. All the seven patients presented with nausea and intermittent vomiting about 5 d after operation.An upper gastrointestinal barium contrast study showed a straight-line cutoff at the third portion of the duodenum representing extrinsic compression by the superior mesenteric artery (SMA).RESULTS: The value of height in the seven patients with SMAS was above the mean of sex- and age-matchednormal population, and the height percentile ranged from 5% to 50%. On the contrary, the value of weight was below the mean of normal population with the weight percentile ranging from 5% to 25%. Among the seven patients, four had a thoracic hyperkyphosis ranging from 55° to 88°(average 72°), two had a thoracolumbar kyphosis of 25° and 32° respectively. The seven patients were treated with fasting, antiemetic medication, and intravenous fluids infusion. Reduction or suspense of traction was adopted in three patients with SMAS during halo-femoral traction after anterior release of scoliosis. All the patients recovered completely with no sequelae. No one required operative intervention with a laparotomy.CONCLUSION: Height percentile<50% , weight percentile <25%, sagittal kyphosis, heavy and quick halo-femoral traction after spinal anterior release are the potential risk indicators for SMAS in patients undergoing correction surgery

  14. Effect of oxygen treatment on heart rate after abdominal surgery

    DEFF Research Database (Denmark)

    Rosenberg-Adamsen, S; Lie, C; Bernhard, A;

    1999-01-01

    . METHODS: The authors studied the effect of oxygen therapy on arterial oxygen saturation and heart rate in 100 consecutive unselected patients randomly and double blindly allocated to receive air or oxygen therapy between the first and fourth day after major abdominal surgery. RESULTS: The median arterial...... supplementation were found between patients with or without an epidural catheter or between the postoperative day studied. CONCLUSION: Postoperative oxygen therapy increased arterial oxygen saturation and decreased heart rate after uncomplicated abdominal surgery in a consecutive unselected group of patients who......BACKGROUND: Cardiac complications are common during the postoperative period and may be associated with hypoxemia and tachycardia. Preliminary studies in high-risk patients after operation have shown a possible beneficial effect of oxygen therapy on arterial oxygen saturation and heart rate...

  15. Bariatric surgery: a viable treatment option for patients with severe mental illness.

    Science.gov (United States)

    Shelby, Sarah R; Labott, Susan; Stout, Rebecca A

    2015-01-01

    Although bariatric surgery has become a recognized treatment for obesity, its utility among patients with severe psychiatric disorders has not been extensively studied. A few studies have reported similar weight loss outcomes in these patients, but psychiatric status after bariatric surgery has been studied only minimally, and it is unknown if exacerbation of the mental illness affects weight loss. The aim of this study was to shed greater light on the issue of serious mental illness and bariatric surgery. Specifically, do patients with a diagnosis of schizophrenia, bipolar I, and bipolar II have poorer weight loss outcomes postbariatric surgery than the general bariatric surgery population? Also, do patients with these diagnoses experience an exacerbation of psychiatric symptoms after bariatric surgery, and if so, is the exacerbation of these disorders linked to poorer weight loss results? Midwest university medical center. A medical record review of approximately 1500 bariatric patients in a Midwest university medical center was conducted to identify those patients with diagnoses of schizophrenia, bipolar I, and bipolar II. Information was gathered on bariatric surgery outcomes and changes in psychiatric status postsurgery. Eighteen patients were identified as undergoing bariatric surgery and having a diagnosis of schizophrenia, bipolar I, or bipolar II. Weight loss in this group was significant and comparable to expected outcomes of absolute weight lost, changes in body mass index, and percentage excess weight loss for patients in the typical bariatric population. Postsurgery psychiatric status was known on 10 patients. All 10 patients experienced some exacerbation of psychiatric problems yet weight loss outcomes were still as expected. Bariatric surgery is a viable obesity treatment option for patients with schizophrenia, bipolar I, and bipolar II disorders. Symptom exacerbations occurred postsurgery, although it is not clear if these were due to the surgery or

  16. The immune response to surgery and trauma: Implications for treatment.

    Science.gov (United States)

    Marik, Paul E; Flemmer, Mark

    2012-10-01

    Infection after surgery and trauma is a major cause of increased morbidity, mortality, and cost. Alterations of the hosts immune system following these insults is believed to be responsible for the increased risk of infection. The hosts' immune response to tissue injury is widely believed to follow a bimodal response, with the systemic inflammatory response syndrome (SIRS) followed by the compensated anti-inflammatory response syndrome (CARS). Recent data, however, suggests that his paradigm may not be correct. We reviewed the literature to describe the immunological changes following surgery and trauma and possible therapeutic interventions to limit this process. Physical injury related to trauma and surgery increase the expression of T-helper 2 (Th2) lymphocytes which cause impaired cell mediated immunity (CMI). Activation of the hypothalamic-pituitary-adrenal (HPA) axis and sympathoadrenal system (SAS) with the release of cortisol and catecholamines appear to be responsible for altering the Th1/Th2 balance. Decreased expression and signalling of interleukin-12 (IL-12) and increased expression of T regulatory cells (Tregs) appear to play a central role in mediating this immune depression. Furthermore, Th2 cytokines increase the expression of arginase-1 (ARG1) in myeloid-derived suppressor cells (MDSC's) causing an arginine deficient state, which further impairs lymphocyte function. Immunomodulating diets (IMDs) containing supplemental arginine and omega-3 fatty acids have been demonstrated to restore the Th1/Th2 balance after surgical trauma and to reduce the risk of infectious complications. β-adrenergic receptor blockage reverses the Th-1 to Th2 shift and preliminary data suggests that such therapy may be beneficial. Tissue injury following surgery and trauma results in depressed CMI leading to an increased risk of infections. The peri-operative use of IMDs appear to reverse this immunosuppression and decrease the risk of postoperative complications. While

  17. Perioperative growth hormone treatment and functional outcome after major abdominal surgery

    DEFF Research Database (Denmark)

    Kissmeyer-Nielsen, Peter; Jensen, Martin Bach; Laurberg, Søren

    1999-01-01

    OBJECTIVE: To evaluate short- and long-term effects of perioperative human growth hormone (hGH) treatment on physical performance and fatigue in younger patients undergoing a major abdominal operation in a normal postoperative regimen with oral nutrition. SUMMARY BACKGROUND DATA: Muscle wasting...... and functional impairment follow major abdominal surgery. METHODS: Twenty-four patients with ulcerative colitis undergoing ileoanal J-pouch surgery were randomized to hGH (12 IU/day) or placebo treatment from 2 days before to 7 days after surgery. Measurements were performed 2 days before and 10, 30, and 90 days...... after surgery. RESULTS: The total muscle strength of four limb muscle groups was reduced by 7.6% in the hGH group and by 17.1% in the placebo group at postoperative day 10 compared with baseline values. There was also a significant difference between treatment groups in total muscle strength at day 30...

  18. A case description of speech disturbance and treatment following corrective surgery for stress velopharyngeal incompetence.

    Science.gov (United States)

    Macrae, Toby; Stierwalt, Julie A G; Behel, Kensley A

    2015-01-01

    The purpose of this study was to determine the effectiveness of a motor learning guided (MLG) approach to speech treatment in a unique case of speech disturbance following surgery for stress velopharyngeal incompetence (SVPI). The patient was a 20-year-old female college student. Treatment took place over 6 sessions and focused on eliciting productions through a hierarchy of clinician support, with an emphasis on self-evaluation and -correction. Acoustic measurements and ratings from the treating clinician and unfamiliar listeners revealed a speech disturbance following surgery that was corrected following speech treatment. The patient's main difficulty appeared to be in producing the vocalic/postvocalic approximant, /r/, although vowel distortions were also noted. These difficulties may be explained by the structural alteration and formation of scar tissue as a result of surgery. The results provide initial support for an MLG approach to treating an acquired speech disturbance following SVPI surgery; however, additional research is warranted.

  19. Treatment of unfavourable results of flexor tendon surgery: Skin deficiencies

    Directory of Open Access Journals (Sweden)

    David Elliot

    2013-01-01

    Full Text Available We recently reported a small study at the Federation of European Societies for Surgery of the hand, which was entitled ′What is secondary flexor tendon surgery′? This study concluded that ′secondary flexor tendon surgery′ was a generic name encompassing a multitude of pathologies. Between 10% and 15% of cases exhibited pathology of the skin and subcutaneous fat and required flap reconstruction of these tissues. Skin replacement may be used prophylactically at primary surgery or become necessary at secondary surgery after release of scar contractures, to achieve cover of vital structures. The long-term problem of skin deficiency relating to flexor tendon function is one of loss of extension from longitudinal scar shortening of the integument, even if the flexor tendons are primarily concerned with bending the digits, not straightening them. This loss of extension can only be tolerated in a hand to a certain degree without significant loss of function. This paper is largely an analysis of the flaps available and suitable for different degrees of skin deficiency and at different places along the course of the flexor system. It attempts to dispel the idea that ′any flap will do′ provided the flexors are adequately covered.

  20. Current status of bariatric surgery in the treatment of type 2 diabetes.

    Science.gov (United States)

    Pinkney, J; Kerrigan, D

    2004-02-01

    Bariatric surgery (from the Greek words baros meaning 'weight' and iatrikos 'the art of healing') is a rapidly evolving branch of surgical science. The aim is to induce major weight loss in those whose obesity places them at high risk of serious health problems. In an attempt to balance the risks of surgery against the benefits of weight loss, bariatric operations are currently performed only in the morbidly obese, or those with a body mass index (BMI) > 35 kgm(-2) who already have developed comorbidity such as type 2 diabetes. Although weight loss is beneficial for obese patients with diabetes, current medical treatment for obesity is difficult. In contrast, observational studies show a major impact of bariatric surgery on diabetes, raising the question whether this approach should be used more widely to treat diabetes in obese patients? If bariatric surgery were shown to be the best way to treat diabetes in obese subjects the implications for health services would be wide-ranging. Bariatric surgery leads to withdrawal of diabetic treatment in about 60% or more of patients, and reductions of therapy for many others. Although data on bariatric surgery in subjects with diabetes are provocative, most studies have been uncontrolled or flawed in other ways. Most importantly, bariatric surgery has not yet been compared against standard medical treatment for diabetes in randomized controlled trials with diabetes-specific endpoints in all relevant patient groups. Potential indications for bariatric surgery are discussed, and the unanswered questions that need to be addressed by clinical trials are summarized. Although small numbers of patients may be interested in bariatric surgery for type 2 diabetes, current data are insufficient to endorse its wide scale use for this indication. Until essential studies are undertaken the role and economics of bariatric surgery in the diabetic clinic will remain uncertain.

  1. Pattern of liver function tests in morbidly obese Saudi patients undergoing bariatric surgery

    Directory of Open Access Journals (Sweden)

    Ahmad Al Akwaa

    2011-01-01

    Full Text Available Background/Aim: Morbidly obese patients have a high prevalence of fatty liver disease and its serious complications, and high prevalence of abnormal liver function tests (LFT. The LFT can give a clue to the liver damage and correlate with activity. We aim to study the pattern of LFT in morbidly obese Saudi patients undergoing bariatric surgery in Eastern region. Patients and Methods: Medical records of patients undergoing bariatric surgery were reviewed. Demographic data, comorbid conditions, and medications taken were recorded. Intraoperative liver appearance was noted. Patients with alcohol intake or without LFT were excluded. Results: Out of 113 patients, 15 patients were excluded, and of the remaining 98 patients analyzed, 58.2% were females. Mean age was 33.1 ± 8.87 years. Mean body mass index (BMI was 53.7 ± 1.27 kg/m 2 . Abnormal LFT (alanine aminotransaminase (ALT, aspartate aminotransaminase (AST alkaline phosphatase (ALK, and Gamma glutamyl transpeptidase (GTT were observed in 17.3%, with 1.5 to 2 times the upper limit of normal. ALT was most elevated in 12.2%. Abdominal ultrasonography was done in 67 (68.4% patients, of whom 51 (76% had fatty liver. Comorbid conditions including diabetes mellitus, hypertension, hyperlipidemia, bronchial asthma, and obstructive sleep apnea were observed in 51 (51.50% patients, eight of them (16.3% had abnormal LFT. No intraoperative changes of cirrhosis were observed. Conclusion: The prevalence of abnormal LFT is low in morbidly obese patients from the eastern region of Saudi Arabia. A prospective study with a larger sample and liver biopsy, is needed to clarify the findings.

  2. Comparison of the Conventional Surgery and the Surgery Assisted by 3d Printing Technology in the Treatment of Calcaneal Fractures.

    Science.gov (United States)

    Zheng, Wenhao; Tao, Zhenyu; Lou, Yiting; Feng, Zhenhua; Li, Hang; Cheng, Liang; Zhang, Hui; Wang, Jianshun; Guo, Xiaoshan; Chen, Hua

    2017-09-19

    This study was aimed to compare conventional surgery and surgery assisted by 3D printing technology in the treatment of calcaneal fractures. In addition, we also investigated the effect of 3D printing technology on the communication between doctors and patients. we enrolled 75 patients with calcaneal fracture from April 2014 to August 2016. They were divided randomly into two groups: 35 cases of 3D printing group, 40 cases of conventional group. The individual models were used to simulate the surgical procedures and carry out the surgery according to plan in 3D printing group. Operation duration, blood loss volume during the surgery, number of intraoperative fluoroscopy and fracture union time were recorded. The radiographic outcomes Böhler angle, Gissane angle, calcaneal width and calcaneal height and final functional outcomes including VAS and AOFAS score as well as the complications were also evaluated. Besides, we made a simple questionnaire to verify the effectiveness of the 3D-printed model for both doctors and patients. The operation duration, blood loss volume and number of intraoperative fluoroscopy for 3D printing group was 71.4 ± 6.8 minutes, 226.1 ± 22.6 ml and 5.6 ± 1.9 times, and for conventional group was 91.3 ± 11.2 minutes, 288.7 ± 34.8 ml and 8.6 ± 2.7 times respectively. There was statistically significant difference between the conventional group and 3D printing group (p 3D printing group achieved significantly better radiographic results than conventional group both postoperatively and at the final follow-up (p 3D printing model. This study suggested the clinical feasibility of 3D printing technology in treatment of calcaneal fractures.

  3. Common experiences of patients following suboptimal treatment outcomes: implications for epilepsy surgery.

    Science.gov (United States)

    Fernando, Dinusha K; McIntosh, Anne M; Bladin, Peter F; Wilson, Sarah J

    2014-04-01

    Few studies have investigated the patient experience of unsuccessful medical interventions, particularly in the epilepsy surgery field. The present review aimed to gain insight into the patient experience of seizure recurrence after epilepsy surgery by examining the broader literature dealing with suboptimal results after medical interventions (including epilepsy surgery). To capture the patient experience, the literature search focused on qualitative research of patients who had undergone medically unsuccessful interventions, published in English in scholarly journals. Twenty-two studies were found of patients experiencing a range of suboptimal outcomes, including seizure recurrence, cancer recurrence and progression, unsuccessful joint replacement, unsuccessful infertility treatment, organ transplant rejection, coronary bypass graft surgery, and unsuccessful weight-loss surgery. In order of frequency, the most common patient experiences included the following: altered social dynamics and stigma, unmet expectations, negative emotions, use of coping strategies, hope and optimism, perceived failure of the treating team, psychiatric symptoms, and control issues. There is support in the epilepsy surgery literature that unmet expectations and psychiatric symptoms are key issues for patients with seizure recurrence, while other common patient experiences have been implied but not systematically examined. Several epilepsy surgery specific factors influence patient perceptions of seizure recurrence, including the nature of postoperative seizures, the presence of postoperative complications, and the need for increased postoperative medications. Knowledge of common patient experiences can assist in the delivery of patient follow-up and rehabilitation services tailored to differing outcomes after epilepsy surgery.

  4. Bariatric Surgery Is Gaining Ground as Treatment of Obesity After Heart Transplantation: Report of Two Cases.

    Science.gov (United States)

    Tsamalaidze, Levan; Elli, Enrique F

    2017-08-22

    Experience with bariatric surgery in patients after orthotopic heart transplantation (OHT) is still limited. We performed a retrospective review of patients who underwent bariatric surgery after OHT from January 1, 2010 to December 31, 2016. Two post-OHT patients with BMI of 37.5 and 36.2 kg/m² underwent laparoscopic robotic-assisted Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy, respectively. Quality of life substantially improved for both patients. Bariatric surgery is safe and feasible in OHT patients, despite numerous risk factors. Careful selection of patients is required with proper preoperative management and overall care. Due to the complexity of treatment and perioperative care in this specific population, these operations should be done in high-volume centers with multidisciplinary teams composed of bariatric, cardiac transplant surgeons and critical care physicians. Bariatric surgery can be highly effective for treatment of obesity after OHT.

  5. Experience of antireflux surgery application for the treatment of gastroesophageal reflux disease

    Directory of Open Access Journals (Sweden)

    Tolstokorov A.S.

    2015-12-01

    Full Text Available Purpose of the study: post-hoc analysis of mid-term and late results of various types of antireflux surgery performed to treat hiatal hernia. Material and methods. We have studied results of post-surgery examination of 118 patients diagnosed with hiatal hernia, the examination being performed at various time intervals after surgeries. Results. The only benefits of using laparoscopic treatment include cosmetic effect, shorter terms of hospital stay and recovery of person's capacity to work. Conclusion. Analysis of immediate and late results of surgical treatment of gastroesophageal reflux disease as well as frequency of postsurgical relapses provided no certain evidence of significant beneficial effect for choosing laparoscopic surgical methods over traditional open surgery.

  6. Impact of surgical severity and analgesic treatment on plasma corticosterone in rats during surgery

    DEFF Research Database (Denmark)

    Goldkuhl, Renée; Klockars, Anica; Hau, Jann;

    2010-01-01

    of the present investigation was to study the effect of surgical severity and analgesic treatment on circulating corticosterone in male Sprague-Dawley rats. Male rats were treated with either lidocaine infiltrated during surgery, buprenorphine (0.05 or 0.1 mg/kg subcutaneously) or saline subcutaneously. Each...... to saline treatment after catheterisation but not after laparotomy. Buprenorphine treatment reduced the corticosterone levels during the first hour after surgery after both catheterisation and laparotomy. The higher buprenorphine dose led to an earlier and more pronounced reduction, especially after...... laparotomy. In the present study, the corticosterone response during surgery in laboratory rats is correlated with the severity of the procedure, and buprenorphine reduces the surgical stress response more effectively than lidocaine treatment....

  7. Surgery or conservative treatment for rotator cuff tear: a meta-analysis.

    Science.gov (United States)

    Ryösä, Anssi; Laimi, Katri; Äärimaa, Ville; Lehtimäki, Kaisa; Kukkonen, Juha; Saltychev, Mikhail

    2017-07-01

    Comparative evidence on treating rotator cuff tear is inconclusive. The objective of this review was to evaluate the evidence on effectiveness of tendon repair in reducing pain and improving function of the shoulder when compared with conservative treatment of symptomatic rotator cuff tear. Search on CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science and Pedro databases. Randomised controlled trials (RCT) comparing surgery and conservative treatment of rotator cuff tear. Study selection and extraction based on the Cochrane Handbook for Systematic reviews of Interventions. Random effects meta-analysis. Three identified RCTs involved 252 participants (123 cases and 129 controls). The risk of bias was considered low for all three RCTs. For Constant score, statistically insignificant effect size was 5.6 (95% CI -0.41 to 11.62) points in 1-year follow up favouring surgery and below the level of minimal clinically important difference. The respective difference in pain reduction was -0.93 (95% CI -1.65 to -0.21) cm on a 0-10 pain visual analogue scale favouring surgery. The difference was statistically significant (p = 0.012) in 1-year follow up but below the level of minimal clinically important difference. There is limited evidence that surgery is not more effective in treating rotator cuff tear than conservative treatment alone. Thus, a conservative approach is advocated as the initial treatment modality. Implications for Rehabilitation There is limited evidence that surgery is not more effective in treating rotator cuff tear than conservative treatment alone. There was no clinically significant difference between surgery and active physiotherapy in 1-year follow-up in improving Constant score or reducing pain caused by rotator cuff tear. As physiotherapy is less proneness to complications and less expensive than surgery, a conservative approach is advocated as the initial treatment modality to rotator cuff tears.

  8. Evaluation of upper airways after bimaxillary orthognathic surgery in patients with skeletal Class III pattern using cone-beam computed tomography.

    Science.gov (United States)

    Azevêdo, Marília Spínola; Machado, Andre Wilson; Barbosa, Inêssa da Silva; Esteves, Lucas Senhorinho; Rocha, Vanessa Álvares Castro; Bittencourt, Marcos Alan Vieira

    2016-01-01

    It has been suggested that mandibular setback surgery, combined or not with maxillary advancement as a treatment alternative for patients with mandibular prognathism, can induce changes in upper airway space (UAS). Therefore, this study aimed to assess the response of the upper airway in the oropharynx region of patients with Class III skeletal pattern that underwent bimaxillary orthognathic surgery (maxillary advancement and mandibular setback) combined with mentoplasty. The sample comprised 26 cone-beam computed tomography (CBCT) scans of 13 patients. The examination was taken before and after surgery. UAS volume, sagittal area, length and minimal axial area with its width, depth and location, were measured with the aid of Dolphin Imaging™ software version 11.5 Premium. Data were statistically treated by applying Shapiro-Wilk test and Student's paired t-test, considering as statistically significant the results of which p-value was lower than 0.05. No statistically significant differences were found in any measurements evaluated. No significant changes were observed in the oropharynx after bimaxillary orthognathic surgery and mentoplasty.

  9. Evaluation of upper airways after bimaxillary orthognathic surgery in patients with skeletal Class III pattern using cone-beam computed tomography

    Directory of Open Access Journals (Sweden)

    Marília Spínola Azevêdo

    2016-02-01

    Full Text Available Introduction: It has been suggested that mandibular setback surgery, combined or not with maxillary advancement as a treatment alternative for patients with mandibular prognathism, can induce changes in upper airway space (UAS. Therefore, this study aimed to assess the response of the upper airway in the oropharynx region of patients with Class III skeletal pattern that underwent bimaxillary orthognathic surgery (maxillary advancement and mandibular setback combined with mentoplasty. Material and Methods: The sample comprised 26 cone-beam computed tomography (CBCT scans of 13 patients. The examination was taken before and after surgery. UAS volume, sagittal area, length and minimal axial area with its width, depth and location, were measured with the aid of Dolphin ImagingTMsoftware version 11.5 Premium. Data were statistically treated by applying Shapiro-Wilk test and Student's paired t-test, considering as statistically significant the results of which p-value was lower than 0.05. Results: No statistically significant differences were found in any measurements evaluated. Conclusions: No significant changes were observed in the oropharynx after bimaxillary orthognathic surgery and mentoplasty.

  10. Patterns of pharmacologic treatment in US patients with acromegaly.

    Science.gov (United States)

    Broder, Michael S; Chang, Eunice; Ludlam, William H; Neary, Maureen P; Carmichael, John D

    2016-05-01

    To establish a baseline pattern of care across academic and community settings, it is important to examine the contemporary treatment of acromegaly. We characterized medical treatment patterns for acromegaly in the US to develop a basis for tracking concordance with guidelines. Acromegaly patients were identified in two commercial claims databases for this retrospective analysis. Study subjects had ≥2 medical claims with acromegaly (ICD-9-CM code 253.0) and ≥1 claim for pharmacotherapy (bromocriptine, cabergoline, octreotide SA, octreotide LAR, lanreotide, or pegvisomant) in the study timeframe (1 January 2002-31 December 2013). Patients were considered newly treated if they were continuously enrolled for ≥6 months before first observed treatment and had no claim for pharmacologic treatment during that time. Outcomes included various pharmacotherapies, including combination treatments, and differences between lines of therapy. A total of 3150 patients had ≥1 pharmacotherapy (mean age: 46.5 years; 50.1% were female); 1471 were newly treated. Somatostatin receptor ligands (SRLs) were the most common drug class used first line (57.2%); cabergoline (27.8%) was the most common treatment, followed by octreotide LAR (22.3%) and lanreotide (19.7%). SRLs were also the most commonly used second-line (42.8%) and third-line pharmacotherapies (43.9%), with combination therapy (23.2%) and octreotide LAR (19.8%) as the most commonly used treatments, respectively. This study, representing the largest claims-based analysis of acromegaly to date, used two databases across a 12 year period to examine complex treatment patterns in a difficult-to-study disease. Although wide variation in acromegaly treatment patterns exists in US clinical practice, in first-line, second-line, and third-line therapy, SRL was the most commonly used drug class. Drug combinations also varied considerably across lines of therapy. The switching between different monotherapies and varied use of drugs

  11. 78 FR 62506 - TRICARE; Coverage of Care Related to Non-Covered Initial Surgery or Treatment

    Science.gov (United States)

    2013-10-22

    ... treatment, such as physical therapy following a non-covered surgical procedure in an MTF. It would also... treatment, are excluded and could result in less than optimal care (e.g., not receiving necessary physical therapy following surgery) and/or a significant financial hardship for the beneficiary. The Agency did not...

  12. Bariatric surgery and nonalcoholic fatty liver disease: current and potential future treatments

    Directory of Open Access Journals (Sweden)

    Akira eSasaki

    2014-10-01

    Full Text Available Nonalcoholic fatty liver disease (NAFLD and nonalcoholic steatohepatitis (NASH are increasingly common cause of chronic liver disease worldwide. The diagnosis of NASH is challenging as most affected patients are symptom-free and the role of routine screening is not clearly established. Most patients with severe obesity who undergo bariatric surgery have NAFLD, which is associated insulin resistance, type 2 diabetes mellitus (T2DM, hypertension, and obesity-related dyslipidemia. The effective treatment for NAFLD is weight reduction through lifestyle modifications, antiobesity medication, or bariatric surgery. Among these treatments, bariatric surgery is the most reliable method for achieving substantial, sustained weight loss. This procedure is safe when performed by a skilled surgeon, and the benefits include reduced weight, improved quality of life, decreased obesity-related comorbidities, and increased life expectancy. Further research is urgently needed to determine the best use of bariatric surgery with NAFLD patients at high risk of developing liver cirrhosis and its role in modulating complications of NAFLD, such as T2DM and cardiovascular disease. The current evidence suggests that bariatric surgery for patients with severe obesity decreases the grade of steatosis, hepatic inflammation, and fibrosis. However, further long-term studies are required to confirm the true effects before recommending bariatric surgery as a potential treatment for nonalcoholic steatohepatitis.

  13. Meal patterning in the treatment of bulimia nervosa.

    Science.gov (United States)

    Ellison, Jo M; Simonich, Heather K; Wonderlich, Stephen A; Crosby, Ross D; Cao, Li; Mitchell, James E; Smith, Tracey L; Klein, Marjorie H; Crow, Scott J; Peterson, Carol B

    2016-01-01

    This study examined the relationship between changes in meal and snack consumption and eating disorder behaviors in a treatment sample of bulimic adults. Eighty adults with bulimia nervosa (BN) were randomized to one of two treatments. Meal and snack consumption, binge eating frequency, and purging behavior frequency were assessed at baseline, end-of-treatment, and at four month follow-up using the Eating Disorder Examination (EDE). Generalized linear models indicated that increased consumption of evening meals over the course of treatment was related to a significant decrease in the rate of binge eating and purging at four month follow-up; these results remained significant when controlling for changes in depression over the course of treatment. The findings support the importance of focusing efforts on developing a pattern of regular evening meal consumption among individuals in the treatment of BN. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Can Surgery Be Avoided? Exclusive Antibiotic Treatment for Pelvic Actinomycosis

    Science.gov (United States)

    Williams, E. M.; Markey, C. M.; Johnson, A. M.; Morales-Ramirez, P. B.

    2017-01-01

    Pelvic actinomycosis is an uncommon, slowly progressing granulomatous infection that has been associated with the presence of intrauterine devices. Due to its unspecific clinical and radiologic findings, it can mimic pelvic or intra-abdominal malignancy leading to mutilating surgery of high morbidity. Rarely, diagnosis is made preoperatively and in most cases surgical intervention is necessary. The patient in our case is a 42-year-old female with an IUD for 15 years diagnosed with pelvic actinomycosis. Patient was uniquely diagnosed preoperatively through paracentesis and treated conservatively with prolonged antibiotic therapy and without any type of surgical intervention. Follow-up at 1 year showed almost complete radiologic resolution of the inflammatory mass, nutritional recovery, and absence of symptoms. Pelvic actinomycosis can be successfully diagnosed and treated medically without surgical interventions. PMID:28299218

  15. Attitudes and Concerns of Diabetic Patients towards Bariatric Surgery as Treatment of Diabetes.

    Science.gov (United States)

    Chua, Hui Wen; Zhou, Hui Jun; Khoo, Chin Meng; Shabbir, Asim; Lomanto, Davide; So, Jimmy By

    2016-11-01

    Bariatric surgery is increasingly recognised as an effective treatment for type 2 diabetes that significantly improves glycaemic control, even achieving remission. This study examined perceptions and concerns of diabetic patients towards bariatric surgery as a treatment option for diabetes. A total of 150 patients were recruited from a specialised diabetic outpatient clinic and completed a questionnaire (items were rated on a Likert scale from slightly important [lowest score of 1] to extremely important [maximum score of 5]). Logistic regression was performed to identify factors influencing decision for surgery. The 74 males and 76 females had mean age of 50 (range 20 to 78) and body mass index (BMI) of 29.6 kg/m(2) (range 18.1 to 51); 61% considered surgery favourably. Predictive factors for interest in surgery: higher educational levels (OR = 2.3; 95% CI, 1.2 to 4.4), duration of diabetes (OR = 0.4; 95% CI, 0.2 to 1.0) and use of insulin (OR = 2.1; 95% CI, 1.1 to 4.1). Reasons for surgery: desire for remission (Likert scale 4.7 ± 0.7), to prevent complications (Likert scale 4.5 ± 0.9) and to reduce medications (Likert scale 4.3 ± 1.1). For those not keen on surgery, main reasons were fear of surgery (Likert scale 4 ± 1.5) and satisfaction with current therapy (Likert scale 3.7 ± 1.6). Many diabetic patients would consider surgery as an option to improve their metabolic disorder (greater interest in patients with higher educational levels, currently using insulin and with shorter duration of diabetes). Surgical complications, length of recovery and duration of benefits were the main concerns.

  16. Referral patterns and the referral system for oral surgery care. Part 2: The referral system and telemedicine.

    Science.gov (United States)

    Coulthard, P; Kazakou, I; Koran, R; Worthington, H V

    2000-04-08

    To investigate GDP opinions of the current referral system and to investigate the need and demand for telemedicine in oral surgery referrals. Postal questionnaire. 400 GDPs in Greater Manchester. 84% participation rate. 48% were not satisfied overall with the service of their current specialist oral surgery referral site. The principal reason was the length of the waiting time for consultation and treatment. Distance for patients to travel to the specialist unit was also of concern, even though most patients (89%) travelled short distances (return journey of twelve miles or less). 23% of respondents wished to improve their ability to communicate with the oral surgeon and 70% wanted involvement in the patient consultation. Both of these requirements were more likely in younger practitioners. There is a need and demand for change in the referral system for oral surgery specialist care. Telemedicine could conceivably be one way to improve access to specialist oral surgery care.

  17. The 1998, 1999 patterns of care study for breast irradiation after breast-conserving surgery in Korea

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Chang Ok; Cho, Jae Ho [Yonsei University College of Medicine, Seoul (Korea, Republic of); Shin, Hyun Soo [Pochon CHA University College of Medicine, Pochon (Korea, Republic of)] (and others)

    2004-09-15

    To determine the patterns of evaluation and treatment in the patient with early breast cancer treated with conservative surgery and radiotherapy and to improve the radiotherapy techniques, nationwide survey was performed. A web-based database system for Korean Patterns of Care Study (PCS) for 6 common cancers was developed. Two hundreds sixty-one randomly selected records of eligible patients treated between 1998 {approx} 1999 from 15 hospitals were reviewed. The patients ages ranged from 24 to 85 years(median 45 years). Infiltrating ductal carcinoma was most common histologic type (88.9%) followed by medullary carcinoma (4.2%) and infiltrating lobular carcinoma (1.5%). Pathologic T stage by AJCC was T1 in 59.7% of the cases, T2 in 29.5% of the cases, Tis in 8.8% of the cases. Axillary lymph node dissection was performed in 91.2% of the cases and 69.7% were node negative. AJCC stage was 0 in 8.8% of the cases, stage I in 44.9% of the cases, stage IIa in 33.3% of the cases, and stage IIb in 8.4% of the cases. Estrogen and progesteron receptors were evaluated in 71.6%, and 70.9% of the patients, respectively. Surgical methods of breast-conserving surgery was excision/lumpectomy in 37.2%, wide excision in 11.5%, quadrantectomy in 23% and partial mastectomy in 27.5% of the cases. A pathologically confirmed negative margin was obtained in 90.8% of the cases. Pathological margin was involved with tumor in 10 patients and margin was close (less than 2 mm) in 10 patients. All the patients except one received more than 90% of the planned radiotherapy dose. Radiotherapy volume was breast only in 88% of the cases, breast + supraclavicular fossa (SCL) in 5% of the cases, and breast + SCL + posterior axillary boost in 4.2% of the cases. Only one patient received isolated internal mammary lymph node irradiation, Used radiation beam was Co-60 in 8 cases, 4 MV X-ray in 115 cases, 6 MV X-ray in 125 cases, and 10 MV X-ray in 11 cases. The radiation dose to the whole breast was 45

  18. Surgery as an Adjunctive Treatment for Multidrug-Resistant Tuberculosis: An Individual Patient Data Metaanalysis.

    Science.gov (United States)

    Fox, Gregory J; Mitnick, Carole D; Benedetti, Andrea; Chan, Edward D; Becerra, Mercedes; Chiang, Chen-Yuan; Keshavjee, Salmaan; Koh, Won-Jung; Shiraishi, Yuji; Viiklepp, Piret; Yim, Jae-Joon; Pasvol, Geoffrey; Robert, Jerome; Shim, Tae Sun; Shin, Sonya S; Menzies, Dick; Ahuja, S; Ashkin, D; Avendaño, M; Banerjee, R; Bauer, M; Burgos, M; Centis, R; Cobelens, F; Cox, H; D'Ambrosio, L; de Lange, W C M; DeRiemer, K; Enarson, D; Falzon, D; Flanagan, K; Flood, J; Gandhi, N; Garcia-Garcia, L; Granich, R M; Hollm-Delgado, M G; Holtz, T H; Hopewell, P; Iseman, M; Jarlsberg, L G; Kim, H R; Lancaster, J; Lange, C; Leimane, V; Leung, C C; Li, J; Menzies, D; Migliori, G B; Narita, M; Nathanson, E; Odendaal, R; O'Riordan, P; Pai, M; Palmero, D; Park, S K; Pena, J; Pérez-Guzmán, C; Ponce-de-Leon, A; Quelapio, M I D; Quy, H T; Riekstina, V; Royce, S; Salim, M; Schaaf, H S; Seung, K J; Shah, L; Shean, K; Sifuentes-Osornio, J; Sotgiu, G; Strand, M J; Sung, S W; Tabarsi, P; Tupasi, T E; Vargas, M H; van Altena, R; van der Walt, M; van der Werf, T S; Westenhouse, J; Yew, W W

    2016-04-01

    Medical treatment for multidrug-resistant (MDR)-tuberculosis is complex, toxic, and associated with poor outcomes. Surgical lung resection may be used as an adjunct to medical therapy, with the intent of reducing bacterial burden and improving cure rates. We conducted an individual patient data metaanalysis to evaluate the effectiveness of surgery as adjunctive therapy for MDR-tuberculosis. Individual patient data, was obtained from the authors of 26 cohort studies, identified from 3 systematic reviews of MDR-tuberculosis treatment. Data included the clinical characteristics and medical and surgical therapy of each patient. Primary analyses compared treatment success (cure and completion) to a combined outcome of failure, relapse, or death. The effects of all forms of resection surgery, pneumonectomy, and partial lung resection were evaluated. A total of 4238 patients from 18 surgical studies and 2193 patients from 8 nonsurgical studies were included. Pulmonary resection surgery was performed on 478 patients. Partial lung resection surgery was associated with improved treatment success (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.5-5.9; I(2)R, 11.8%), but pneumonectomy was not (aOR, 1.1; 95% CI, .6-2.3; I(2)R, 13.2%). Treatment success was more likely when surgery was performed after culture conversion than before conversion (aOR, 2.6; 95% CI, 0.9-7.1; I(2)R, 0.2%). Partial lung resection, but not pneumonectomy, was associated with improved treatment success among patients with MDR-tuberculosis. Although improved outcomes may reflect patient selection, partial lung resection surgery after culture conversion may improve treatment outcomes in patients who receive optimal medical therapy. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  19. The place of subfascial endoscopic perforator vein surgery (SEPS) in advanced chronic venous insufficiency treatment.

    Science.gov (United States)

    Pesta, Wiesław; Kurpiewski, Waldemar; Kowalczyk, Marek; Szynkarczuk, Rafał; Luba, Magdalena; Zurada, Anna; Grabysa, Radosław

    2011-12-01

    In spite of medical science development and initiation of new technologies in minimally invasive surgery, treatment of advanced chronic venous insufficiency at the 5(th) and 6(th) degree of CEAP classification is still a great clinical challenge. In case of no satisfactory results of non-surgical treatment of recurrent venous ulcers, scientists search for alternative therapeutic methods which could be more effective and lasting. Subfascial endoscopic perforator vein surgery (SEPS) as a method of reducing venous pressure in the superficial venous system could provide healing of the recurrent venous ulcer. In this study we present a review of contemporary opinions about the place and significance of subfascial endoscopic perforator vein surgery as a treatment of advanced chronic venous insufficiency.

  20. Surgery and radiotherapy in the treatment of cutaneous melanoma

    DEFF Research Database (Denmark)

    Testori, A; Rutkowski, P; Marsden, J;

    2009-01-01

    Adequate surgical management of primary melanoma and regional lymph node metastasis, and rarely distant metastasis, is the only established curative treatment. Surgical management of primary melanomas consists of excisions with 1-2 cm margins and primary closure. The recommended method of biopsy...... on individual circumstances. Radiotherapy is indicated as a treatment option in select patients with lentigo maligna melanoma and as an adjuvant in select patients with regional metastatic disease. Radiotherapy is also indicated for palliation, especially in bone and brain metastases....

  1. Radiofrequency Ablation Compared to Surgery for the Treatment of Benign Thyroid Nodules

    Directory of Open Access Journals (Sweden)

    Stella Bernardi

    2014-01-01

    Full Text Available Objective. Benign thyroid nodules are a common occurrence whose only remedy, in case of symptoms, has always been surgery until the advent of new techniques, such as radiofrequency ablation (RFA. This study aimed at evaluating RFA efficacy, tolerability, and costs and comparing them to hemithyroidectomy for the treatment of benign thyroid nodules. Design and Methods. 37 patients who underwent RFA were retrospectively compared to 74 patients surgically treated, either in a standard inpatient or in a short-stay surgical regimen. Efficacy, tolerability, and costs were compared. The contribution of final pathology was also taken into account. Results. RFA reduced nodular volume by 70% after 12 months and it was an effective method for treating nodule-related clinical problems, but it was not as effective as surgery for the treatment of hot nodules. RFA and surgery were both safe, although RFA had less complications and pain was rare. RFA costed €1,661.50, surgery costed €4,556.30, and short-stay surgery costed €4,139.40 per patient. RFA, however, did not allow for any pathologic analysis of the nodules, which, in 6 patients who had undergone surgery (8%, revealed that the nodules harboured malignant cells. Conclusions. RFA might transform our approach to benign thyroid nodules.

  2. Radiofrequency ablation compared to surgery for the treatment of benign thyroid nodules.

    Science.gov (United States)

    Bernardi, Stella; Dobrinja, Chiara; Fabris, Bruno; Bazzocchi, Gabriele; Sabato, Nicoletta; Ulcigrai, Veronica; Giacca, Massimo; Barro, Enrica; De Manzini, Nicolò; Stacul, Fulvio

    2014-01-01

    Objective. Benign thyroid nodules are a common occurrence whose only remedy, in case of symptoms, has always been surgery until the advent of new techniques, such as radiofrequency ablation (RFA). This study aimed at evaluating RFA efficacy, tolerability, and costs and comparing them to hemithyroidectomy for the treatment of benign thyroid nodules. Design and Methods. 37 patients who underwent RFA were retrospectively compared to 74 patients surgically treated, either in a standard inpatient or in a short-stay surgical regimen. Efficacy, tolerability, and costs were compared. The contribution of final pathology was also taken into account. Results. RFA reduced nodular volume by 70% after 12 months and it was an effective method for treating nodule-related clinical problems, but it was not as effective as surgery for the treatment of hot nodules. RFA and surgery were both safe, although RFA had less complications and pain was rare. RFA costed €1,661.50, surgery costed €4,556.30, and short-stay surgery costed €4,139.40 per patient. RFA, however, did not allow for any pathologic analysis of the nodules, which, in 6 patients who had undergone surgery (8%), revealed that the nodules harboured malignant cells. Conclusions. RFA might transform our approach to benign thyroid nodules.

  3. [Catheter-related bladder discomfort after urological surgery: importance of the type of surgery and efficiency of treatment by clonazepam].

    Science.gov (United States)

    Maro, S; Zarattin, D; Baron, T; Bourez, S; de la Taille, A; Salomon, L

    2014-09-01

    Bladder catheter can induce a Catheter-Related Bladder Discomfort (CRBD). Antagonist of muscarinic receptor is the gold standard treatment. Clonazepam is an antimuscarinic, muscle relaxing oral drug. The aim of this study is to look for a correlation between the type of surgical procedure and the existence of CRBD and to evaluate the efficiency of clonazepam. One hundred patients needing bladder catheter were evaluated. Sexe, age, BMI, presence of diabetes, surgical procedure and existence of CRBD were noted. Pain was evaluated with analogic visual scale. Timing of pain, need for specific treatment by clonazepam and its efficiency were noted. Correlation between preoperative data, type of surgical procedure, existence of CRBD and efficiency of treatment were evaluated. There were 79 men and 21 women (age: 65.9 years, BMI: 25.4). Twelve patients presented diabetes. Surgical procedure concerned prostate in 39 cases, bladder in 19 cases (tumor resections), endo-urology in 20 cases, upper urinary tract in 12 cases (nephrectomy…) and lower urinary tract in 10 cases (sphincter, sub-uretral tape). Forty patients presented CRBD, (pain 4.5 using VAS). This pain occurred 0.6 days after surgery. No correlation was found between preoperative data and CRBD. Bladder resection and endo-urological procedures were surgical procedures which procured CRBD. Clonazepam was efficient in 30 (75 %) out of 40 patients with CRBD. However, it was less efficient in case of bladder tumor resection. CRBD is frequent and occurred immediately after surgery. Bladder resection and endo-urology were the main surgical procedures which induced CRBD. Clonazepam is efficient in 75 %. Bladder resection is the surgical procedure which is the most refractory to treatment. 5. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  4. [Treatment outcomes of colon cancer surgery combined with radical lymphadenectomy].

    Science.gov (United States)

    Lipská, L; Visokai, V; Mrácek, M; Levý, M

    2008-05-01

    The authors analyzed a group of 1281 subjects with colorectal cancer operated and followed up in a single institution from I/1992 to VIII/2007. Colon carcinoma patients were assessed separately (C18). Patients with rectal and rectosigmoid tumors are not included in the presentation. A total of 846 patients were operated for colon carcinomas. In 546 subjects, radical R0 resections were achieved. In the R0 group, the male/female ratio is 315/231, age 29-94 years, the mean age of 69 years. The R0 group stratification by TNM classification was: I 17.8%, II 49.6%, III 24.0%, IV 8.1%, TNMx 0.5%. Irrespective of the TNM staging, three-year, five-year and ten-year survival rates were 80%, 71%, and 51%, resp. The median survival time was 9.85 years. Postoperative morality was 5.5%, morbidity 29.8%, anastomic leak occured in 5.7%. Systematic lymph node dissection up to the apical level, had been gradually introduced as an integral part of the R0 surgery. The aim of the study is to analyze outcomes of the colon carcinoma surgical management, combined with radical lymphadenectomy. Furthermore, effects of the extensive procedure on the postoperative morbidity and moratility rates are analyzed as well.

  5. Incidence of and Risk Factors for Postoperative Glaucoma and Its Treatment in Paediatric Cataract Surgery.

    Science.gov (United States)

    Mataftsi, Asimina

    2016-01-01

    Postoperative glaucoma is perhaps the most feared complication after paediatric cataract surgery, as it is difficult to control. Paediatric glaucoma is also challenging to diagnose, and different definitions of glaucoma have led to a rather big range of reported incidences of this disease. It can occur soon after surgery, in which case it is usually closed-angle glaucoma, or it can have a late onset, even more than a decade after surgery, and its aetiopathogenesis remains unclear to this day. There is significant controversy as to what the risk factors are for developing it, especially regarding intraocular lens implantation. The vast majority of studies show that an earlier age at surgery confers a higher risk. Medical and surgical treatment of aphakic/pseudophakic glaucoma can be successful; however, management often requires repeated procedures with or without multiple medications, and the prognosis is guarded. The visual outcome depends on sufficient intraocular pressure control and management of concurrent amblyopia.

  6. Dural Reduction Surgery: A Treatment Option for Frontotemporal Brain Sagging Syndrome.

    Science.gov (United States)

    Mostofi, Emily; Schievink, Wouter I; Sim, Valerie L

    2016-07-01

    Frontotemporal brain sagging syndrome is a dementia associated with hypersomnolence, personality changes, and features of intracranial hypotension on magnetic resonance imaging. The literature is sparse with respect to treatment options; many patients simply worsen. We present a case in which this syndrome responded to lumbar dural reduction surgery. Postoperative magnetic resonance imaging indicated normalization of brain sagging and lumbar intrathecal pressure. Although no evidence of cerebrospinal leak was found, extremely thin dura was noted intraoperatively, suggesting that a thin and incompetent dura could result in this low-pressure syndrome. Clinicians who encounter this syndrome should consider dural reduction surgery as a treatment strategy.

  7. Prescription pattern in the department of surgery in a tribal district hospital of andhra pradesh, India.

    Science.gov (United States)

    Khade, A; Bashir, Msm; Sheethal, A

    2013-07-01

    Usually, surgical management cannot be completed without the use of antimicrobial and analgesic drugs. Irrational prescription may lead to severe postoperative complications. The objective of this study was to evaluate the prescription trend in the surgery department of a tribal district hospital so as to determine the extent of rational use of medicines. It was a retrospective study in which 50 cases were selected randomly. Case records were analyzed for prescription trend. Data was analyzed using Microsoft Office Excel 2007 and values were presented descriptively. Most of the cases were between the age group of 21 and 40 years, 18 cases (36%). Commonest cause of hospitalization was renal calculi (10 (20%)) followed by acute abdomen and abscess (6, (12%)). Total of 255 numbers of drugs were used with an average of 5.1 drugs per patient. Most preferred route was intravenous route (174 drugs, 68.2%). Antimicrobial was the most common (97 (38.0%)) group of drugs followed by analgesic/antipyretics (50 (19.6%)). Among antimicrobials, ciprofloxacin (22 (22.7%)) was the most common drug followed by metronidazole (21 (18.5%)). All the cases were managed by empirical treatment. Two different antimicrobials were prescribed to 20 (40%) of cases. Dosage of 83 (32.6%) drugs was inappropriate while frequency was inappropriate in 26 (10.2%) cases. Urgent steps like specific guidelines, training, and monitoring of drugs use are needed to correct some irrational approaches.

  8. The influence of previous non-surgical re-treatment on the outcome of endodontic surgery.

    Science.gov (United States)

    Taschieri, S; Machtou, P; Rosano, G; Weinstein, T; Del Fabbro, M

    2010-01-01

    The aim of this study was to evaluate retrospectively if the outcome of periradicular surgery at four year follow-up can be affected by a previous orthograde re-treatment. Eighty-one patients with 118 endodontically treated teeth who underwent surgical retreatment were divided in three groups. In group OA endodontic re-treatment was feasible and was attempted but, owing to the persistence of clinical symptoms and radiographic lesion, apical surgery was performed 4.8 ± 3.5 months later. In group OF endodontic re-treatment was feasible but was not performed, with subsequent apical surgery. In group ONF endodontic re-treatment was unfeasible, and apical surgery was performed. The treatment outcome was assessed four years postsurgery according to clinical and radiographic criteria. Seventy-six patients (112 teeth) could be evaluated at four years. In the ONF group five anterior maxillary teeth, belonging to three female patients, failed to heal. Three failures in three patients occurred in the OF group. No failure was recorded in the OA group. Three teeth in three patients were classified as uncertain healing in each group. The outcome of group OA resulted significantly better than the other treatment groups for both tooth-based and patient-based analysis. No significant effect was found as related to jaw, tooth type, presence of a post. A significant relation was found with gender (P=0.04). A negative correlation was found between outcome and age (Pearson's coefficient=-0.09), suggesting that the probability of failure increases with age. Orthograde re-treatment prior to apical surgery could be considered a valid alternative to tooth extraction and not an over-treatment.

  9. Surgical Radiofrequency MAZE III Ablation for Treatment of Atrial Fibrillation During Open Heart Surgery

    Directory of Open Access Journals (Sweden)

    Fariborz Akbarzadeh

    2006-05-01

    Full Text Available Background: Atrial fibrillation is a common arrhythmia in patients with rheumatic mitral and other valve diseases who are candidates for valve repair surgeries. Conversion of rhythm to sinus has positive effects on quality of life and lower use of medications. The aim of this clinical study was to evaluate the effectiveness of the radiofrequency ablation Maze III procedure in the treatment of atrial fibrillation associated with rheumatic heart valve disease. Methods: We applied a modified Cox III Maze procedure using radiofrequency ablation in the treatment of atrial fibrillation associated with rheumatic heart valve disease and evaluated the outcome of 20 patients of atrial fibrillation associated rheumatic valve disease who underwent radiofrequency ablation Maze III procedure plus heart valve surgery. Demographic, echocardiographic, Electrocardiographic and Doppler study data were calculated before surgery, six month and one year after surgery.. Results: No perioperative deaths occurred in the study group. Duration of additional time for doing radiofrequency ablation was about 22 minutes. Freedom from atrial fibrillation was 85% and 75% at six months and one year follow-up respectively... Conclusions: The addition of the radiofrequency ablation Maze procedure to heart valve surgery is safe and effective in the treatment of atrial fibrillation associated with rheumatic heart valve disease.

  10. [Endodontic re-treatment or apical surgery, is an evidence-based choice possible?].

    Science.gov (United States)

    de Lange, J

    2016-02-01

    Treatment of a recurrence after an initial endodontic treatment can consist of endodontic re-treatment or apical surgery. The literature reports comparable success rates for these two options. However, randomised controlled trials that are truly comparable to each other are unavailable as a result of which comparison and an informed choice are not really possible. In addition to the treatment outcome, consideration also has to be given to cost-effectiveness and other patient-related factors, such as pain, swelling and medication. Regarding these considerations, too, little reliable information can be found in the literature. Moreover, factors relating to insurance play an important role in the Netherlands, where only apical surgery is covered by the basic healthcare insurance. In conclusion, all of these factors should be carefully considered before proceeding to an individual treatment strategy.

  11. Treatment of open hand injuries: does timing of surgery matter? A single-centre prospective analysis.

    Science.gov (United States)

    Juon, Bettina H; Iseli, Michelle; Kreutziger, Janett; Constantinescu, Mihai A; Vögelin, Esther

    2014-10-01

    The 6-hour paradigm for surgical treatment of open injuries should be re-evaluated in the era of systematic use of antiseptic solutions and systemic antibiotics. The current study investigates prospectively the impact of timing of surgery on the outcome of open hand injuries. The prospective evaluation included adult patients presenting with open hand injuries between 1 September 2009 and 30 June 2010 to the emergency department of the University Hospital of Berne, Switzerland. Multiple trauma, bilateral hand injuries, bite injuries, and infections were excluded. All patients underwent a standardised treatment protocol with antiseptic solution, sterile dressing, antibiotic prophylaxis, and surgical treatment upon admission. Demographic data, injury details, and delay from trauma to therapy were recorded. Microbiology was gained at surgery. Outcome measurements included infections, complications, pain, and function (clinically, DASH, Mayo score). From 116 patients (mean age 43 years) six patients suffered an infection (5.2%). The observed infections were statistically not associated with delay to surgery, treatment protocol, or to injury complexity. Neither complications, pain, nor functional outcome were statistically associated with delay to surgery, wound disinfection, or administration of antibiotics. In conclusion, early or late timing of surgical treatment of open hand injuries did not show any impact on outcome (infections, complications, pain, function) in this prospective single-centre patient evaluation.

  12. Patterns of Brain Activation and Meal Reduction Induced by Abdominal Surgery in Mice and Modulation by Rikkunshito.

    Science.gov (United States)

    Wang, Lixin; Mogami, Sachiko; Yakabi, Seiichi; Karasawa, Hiroshi; Yamada, Chihiro; Yakabi, Koji; Hattori, Tomohisa; Taché, Yvette

    2015-01-01

    Abdominal surgery inhibits food intake and induces c-Fos expression in the hypothalamic and medullary nuclei in rats. Rikkunshito (RKT), a Kampo medicine improves anorexia. We assessed the alterations in meal microstructure and c-Fos expression in brain nuclei induced by abdominal surgery and the modulation by RKT in mice. RKT or vehicle was gavaged daily for 1 week. On day 8 mice had no access to food for 6-7 h and were treated twice with RKT or vehicle. Abdominal surgery (laparotomy-cecum palpation) was performed 1-2 h before the dark phase. The food intake and meal structures were monitored using an automated monitoring system for mice. Brain sections were processed for c-Fos immunoreactivity (ir) 2-h after abdominal surgery. Abdominal surgery significantly reduced bouts, meal frequency, size and duration, and time spent on meals, and increased inter-meal interval and satiety ratio resulting in 92-86% suppression of food intake at 2-24 h post-surgery compared with control group (no surgery). RKT significantly increased bouts, meal duration and the cumulative 12-h food intake by 11%. Abdominal surgery increased c-Fos in the prelimbic, cingulate and insular cortexes, and autonomic nuclei, such as the bed nucleus of the stria terminalis, central amygdala, hypothalamic supraoptic (SON), paraventricular and arcuate nuclei, Edinger-Westphal nucleus (E-W), lateral periaqueduct gray (PAG), lateral parabrachial nucleus, locus coeruleus, ventrolateral medulla and nucleus tractus solitarius (NTS). RKT induced a small increase in c-Fos-ir neurons in the SON and E-W of control mice, and in mice with surgery there was an increase in the lateral PAG and a decrease in the NTS. These findings indicate that abdominal surgery inhibits food intake by increasing both satiation (meal duration) and satiety (meal interval) and activates brain circuits involved in pain, feeding behavior and stress that may underlie the alterations of meal pattern and food intake inhibition. RKT improves

  13. Patterns of Brain Activation and Meal Reduction Induced by Abdominal Surgery in Mice and Modulation by Rikkunshito.

    Directory of Open Access Journals (Sweden)

    Lixin Wang

    Full Text Available Abdominal surgery inhibits food intake and induces c-Fos expression in the hypothalamic and medullary nuclei in rats. Rikkunshito (RKT, a Kampo medicine improves anorexia. We assessed the alterations in meal microstructure and c-Fos expression in brain nuclei induced by abdominal surgery and the modulation by RKT in mice. RKT or vehicle was gavaged daily for 1 week. On day 8 mice had no access to food for 6-7 h and were treated twice with RKT or vehicle. Abdominal surgery (laparotomy-cecum palpation was performed 1-2 h before the dark phase. The food intake and meal structures were monitored using an automated monitoring system for mice. Brain sections were processed for c-Fos immunoreactivity (ir 2-h after abdominal surgery. Abdominal surgery significantly reduced bouts, meal frequency, size and duration, and time spent on meals, and increased inter-meal interval and satiety ratio resulting in 92-86% suppression of food intake at 2-24 h post-surgery compared with control group (no surgery. RKT significantly increased bouts, meal duration and the cumulative 12-h food intake by 11%. Abdominal surgery increased c-Fos in the prelimbic, cingulate and insular cortexes, and autonomic nuclei, such as the bed nucleus of the stria terminalis, central amygdala, hypothalamic supraoptic (SON, paraventricular and arcuate nuclei, Edinger-Westphal nucleus (E-W, lateral periaqueduct gray (PAG, lateral parabrachial nucleus, locus coeruleus, ventrolateral medulla and nucleus tractus solitarius (NTS. RKT induced a small increase in c-Fos-ir neurons in the SON and E-W of control mice, and in mice with surgery there was an increase in the lateral PAG and a decrease in the NTS. These findings indicate that abdominal surgery inhibits food intake by increasing both satiation (meal duration and satiety (meal interval and activates brain circuits involved in pain, feeding behavior and stress that may underlie the alterations of meal pattern and food intake inhibition

  14. Comorbidities, treatment patterns and cost-of-illness of acromegaly in Sweden: a register-linkage population-based study.

    Science.gov (United States)

    Lesén, Eva; Granfeldt, Daniel; Houchard, Aude; Dinet, Jérôme; Berthon, Anthony; Olsson, Daniel S; Björholt, Ingela; Johannsson, Gudmundur

    2017-02-01

    Acromegaly is a complex endocrine disease with multiple comorbidities. Treatment to obtain biochemical remission includes surgery, medical therapy and radiation. We aimed to describe comorbidities, treatment patterns and cost-of-illness in patients with acromegaly in Sweden. A nationwide population-based study. Patients with acromegaly were identified and followed in national registers in Sweden. Longitudinal treatment patterns were assessed in patients diagnosed between July 2005 and December 2013. The cost-of-illness during 2013 was estimated from a societal perspective among patients diagnosed between 1987 and 2013. Among 358 patients with acromegaly (48% men, mean age at diagnosis 50.0 (s.d. 15.3) years) at least one comorbidity was reported in 81% (n = 290). The most common comorbidities were hypertension (40%, n = 142), neoplasms outside the pituitary (30%, n = 109), hypopituitarism (22%, n = 80) and diabetes mellitus (17%, n = 61). Acromegaly treatment was initiated on average 3.7 (s.d. 6.9) months after diagnosis. Among the 301 treated patients, the most common first-line treatments were surgery (60%, n = 180), somatostatin analogues (21%, n = 64) and dopamine agonists (14%, n = 41). After primary surgery, 24% (n = 44) received somatostatin analogues. The annual per-patient cost was €12 000; this was €8700 and €16 000 if diagnosed before or after July 2005, respectively. The cost-of-illness for acromegaly and its comorbidities was 77% from direct costs and 23% from production loss. The prevalence of comorbidity is high in patients with acromegaly. The most common first-line treatment in acromegalic patients was surgery followed by somatostatin analogues. The annual per-patient cost of acromegaly and its comorbidities was €12 000. © 2017 European Society of Endocrinology.

  15. Three-dimensional treatment planning of orthognathic surgery in the era of virtual imaging.

    NARCIS (Netherlands)

    Swennen, G.R.; Mollemans, W.; Schutyser, F.A.C.

    2009-01-01

    PURPOSE: The aim of this report was to present an integrated 3-dimensional (3D) virtual approach toward cone-beam computed tomography-based treatment planning of orthognathic surgery in the clinical routine. MATERIALS AND METHODS: We have described the different stages of the workflow process for ro

  16. Transcoronary ablation of septal hypertrophy compared with surgery in the treatment of hypertrophic obstructive cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    姜腾勇; 吴学思; 吕强; 孟旭; 贾长琪; 张银

    2004-01-01

    @@ Transcoronary ablation of septal hypertrophy (TASH)can lead to sustained improvement in both hemodynamics and symptoms in patients with hypertrophic obstructive cardiomyopathy ( HOCM ) . 1-4 However, there have been few reports about its efficacy and safety compared with traditional surgical procedures. This study sought to compare TASH with surgery in the treatment of HOCM.

  17. Treatment with corticosteroids and the risk of anastomotic leakage following lower gastrointestinal surgery

    DEFF Research Database (Denmark)

    Eriksen, Tina Fransgård; Lassen, Cecilie Brandt; Gögenur, Ismail

    2014-01-01

    Anastomotic leakage is a serious complication in colorectal surgery. Treatment with corticosteroids is known to impair wound healing but their influence on the healing of a colorectal anastomosis remains unclear, and studies have reported conflicting results. The aim of this study was to evaluate...

  18. Combined orthognathic surgery and prosthetic treatment for class III skeletal malocclusion

    Directory of Open Access Journals (Sweden)

    Luka Dias Wellar

    2013-01-01

    Full Text Available This clinical report discusses the case of a partially edentulous patient with class III skeletal malocclusion, suffering from poor masticatory function and esthetic appearance caused by severe anteroposterior discrepancy between the dental arches and loss of occlusal vertical dimension. The functional and esthetic rehabilitation was performed with orthognathic surgery followed by prosthetic treatment using an overlay removable partial denture. At the end of the treatment, the patient was successfully rehabilitated, both functionally and esthetically, through reestablishment of the occlusal vertical dimension and correction of the anteroposterior discrepancy between the dental arches. The overlay removable partial denture is a simple and time-efficient alternative in the treatment of partially edentulous patients with class III skeletal malocclusions and small anteroposterior discrepancies between dental arches. Additionally, an esthetic smile and functional rehabilitation of the stomatognathic system was satisfactorily obtained with orthognathic surgery followed by prosthetic treatment.

  19. Cortisol levels and sleep patterns in infants with orofacial clefts undergoing surgery

    OpenAIRE

    Mueller AA; Kalak N; Schwenzer-Zimmerer K; Holsboer-Trachsler E; Br; De, S.

    2014-01-01

    Andreas A Mueller,1,2 Nadeem Kalak,3 Katja Schwenzer-Zimmerer,1,2 Edith Holsboer-Trachsler,3 Serge Brand3,4 1Craniomaxillofacial Surgery, University of Basel and University Hospital of Basel, Basel, Switzerland; 2Hightech Research Center of Craniomaxillofacial Surgery, University of Basel, Basel, Switzerland; 3Psychiatric Clinics of the University of Basel, Center for Affective, Stress, and Sleep Disorders, Basel, Switzerland; 4Department of Sport and Health Science, Division of Sport Scienc...

  20. Combined orthognathic surgery and prosthetic treatment for class III skeletal malocclusion

    OpenAIRE

    Luka Dias Wellar; Leandro Reinhardt; Marcos Antonio Torriani; Tatiana Pereira-Cenci; Noéli Boscato

    2013-01-01

    This clinical report discusses the case of a partially edentulous patient with class III skeletal malocclusion, suffering from poor masticatory function and esthetic appearance caused by severe anteroposterior discrepancy between the dental arches and loss of occlusal vertical dimension. The functional and esthetic rehabilitation was performed with orthognathic surgery followed by prosthetic treatment using an overlay removable partial denture. At the end of the treatment, the patient...

  1. Combined endodontic therapy and surgery in the treatment of dens invaginatus Type 3: case report.

    Science.gov (United States)

    da Silva Neto, Ulisses Xavier; Hirai, Vinício Hidemitsu Goto; Papalexiou, Vula; Gonçalves, Silvana Beltrami; Westphalen, Vânia Portela Ditzel; Bramante, Clovis Monteiro; Martins, Wilson Denis

    2005-12-01

    An accurate understanding of the morphology of the root canal system is a prerequisite for successful root canal treatment. Invaginated teeth have a complex root canal configuration that cannot be instrumented effectively and should be treated by both endodontic therapy and surgery. A case of dens invaginatus Type 3 in a maxillary lateral incisor with a periapical lesion and its successful treatment by these combined methods is reported.

  2. Stage III Melanoma in the Axilla: Patterns of Regional Recurrence After Surgery With and Without Adjuvant Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Pinkham, Mark B., E-mail: mark.pinkham@health.qld.gov.au [Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane (Australia); University of Queensland, Brisbane (Australia); Foote, Matthew C. [Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane (Australia); Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane (Australia); Diamantina Institute, Brisbane (Australia); University of Queensland, Brisbane (Australia); Burmeister, Elizabeth [Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane (Australia); Research Centre for Clinical and Community Practice, Griffith University, Brisbane (Australia); Thomas, Janine [Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane (Australia); Meakin, Janelle [Clinical Trials Research Unit, Princess Alexandra Hospital, Brisbane (Australia); Smithers, B. Mark [Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane (Australia); University of Queensland, Brisbane (Australia); Burmeister, Bryan H. [Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane (Australia); Queensland Melanoma Project, Princess Alexandra Hospital, Brisbane (Australia); University of Queensland, Brisbane (Australia)

    2013-07-15

    Purpose: To describe the anatomic distribution of regionally recurrent disease in patients with stage III melanoma in the axilla after curative-intent surgery with and without adjuvant radiation therapy. Methods and Materials: A single-institution, retrospective analysis of a prospective database of 277 patients undergoing curative-intent treatment for stage III melanoma in the axilla between 1992 and 2012 was completed. For patients who received radiation therapy and those who did not, patterns of regional recurrence were analyzed, and univariate analyses were performed to assess for potential factors associated with location of recurrence. Results: There were 121 patients who received adjuvant radiation therapy because their clinicopathologic features conferred a greater risk of regional recurrence. There were 156 patients who received no radiation therapy. The overall axillary control rate was 87%. There were 37 patients with regional recurrence; 17 patients had received adjuvant radiation therapy (14%), and 20 patients (13%) had not. The likelihood of in-field nodal recurrence was significantly less in the adjuvant radiation therapy group (P=.01) and significantly greater in sites adjacent to the axilla (P=.02). Patients with high-risk clinicopathologic features who did not receive adjuvant radiation therapy also tended to experience in-field failure rather than adjacent-field failure. Conclusions: Patients who received adjuvant radiation therapy were more likely to experience recurrence in the adjacent-field regions rather than in the in-field regions. This may not simply reflect higher-risk pathology. Using this data, it may be possible to improve outcomes by reducing the number of adjacent-field recurrences after adjuvant radiation therapy.

  3. Surgery for Breast Cancer

    Science.gov (United States)

    ... Pregnancy Breast Cancer Breast Cancer Treatment Surgery for Breast Cancer Surgery is a common treatment for breast cancer, ... Relieve symptoms of advanced cancer Surgery to remove breast cancer There are two main types of surgery to ...

  4. Treatment patterns and survival outcomes in patients with cervical cancer complicated by complete uterine prolapse: a systematic review of literature.

    Science.gov (United States)

    Matsuo, Koji; Fullerton, Morgan E; Moeini, Aida

    2016-01-01

    Cervical cancer complicated by complete uterine prolapse is a rare clinical entity and uniform management recommendations have yet to be determined. The aim of the current review was to examine the effects of management patterns on survival outcomes in cervical cancer patients with complete uterine prolapse. A systematic review of the literature was conducted using three public search engines. This included case reports with detailed descriptions of tumor characteristics, cancer management, and survival outcomes. Treatment patterns and tumor characteristics were correlated to survival outcomes. There were 78 patients with cervical cancer with complete uterine prolapse. Their mean age was 63.7 years. The median duration of prolapse was 147.9 months and 22.2% of the patients experienced persistent/recurrent prolapse after cancer treatment. The mean tumor size was 8.9 cm and squamous cell carcinoma (83.9%) was the most common histologic type. The majority of patients (56.2%) had stage I cancer. Tumor characteristics were similar across the treatment patterns. Survival outcomes were more favorable with surgery-based treatment (48 patients) than with radiation-based treatment (30 patients): 5-year recurrence-free survival rate 72.0% vs. 62.9% (p = 0.057), and 5-year disease-specific overall survival rate 77.0% vs. 68.2% (p = 0.017). After controlling for age and stage, surgery-based therapy remained an independent prognostic factor for better disease-specific overall survival outcome (hazard ratio 0.32, 95% confidence interval 0.11 - 0.94, adjusted p = 0.039). Although limited in study size, our results at least suggest that surgery-based treatment may have a positive effect on survival outcome in cervical cancer patients with complete uterine prolapse.

  5. Laparoscopic surgery for treatment of incisional lumbar hernia

    Directory of Open Access Journals (Sweden)

    M. Tobias-Machado

    2005-08-01

    Full Text Available OBJECTIVE: To present results obtained with laparoscopic correction of incisional lumbar hernia in patients with minimum follow-up of 1 year. MATERIALS AND METHODS: We prospectively studied 7 patients diagnosed with incisional lumbar hernia after physical examination and computerized tomography. We used laparoscopic transperitoneal access through 3 ports. One polypropylene mesh was introduced in the abdominal cavity and fixed by titanium clamps to the margins of the hernia ring following release of the peritoneum. RESULTS: All cases were successfully completed with no conversion required. Mean surgical time was 120 minutes and discharge from hospital occurred between the 1st and the 2nd postoperative days. There were no intraoperative complications or hernia recurrence in any case. Postoperatively, we had 2 minor complications: one case of seroma that resolved spontaneously after 60 days and one patient presenting lumbar pain that persisted until the 3rd postoperative month. The return to usual activities occurred on average 3 weeks following intervention. Of the 7 patients, 6 were satisfied with the esthetical and functional effect produced by the procedure. CONCLUSIONS: The surgical correction of incisional lumbar hernia by laparoscopic access is an excellent option for a minimally invasive treatment, with adequate long-term results.

  6. From Diagnosis to Treatment: Clinical Applications of Nanotechnology in Thoracic Surgery.

    Science.gov (United States)

    Digesu, Christopher S; Hofferberth, Sophie C; Grinstaff, Mark W; Colson, Yolonda L

    2016-05-01

    Nanotechnology is an emerging field with potential as an adjunct to cancer therapy, particularly thoracic surgery. Therapy can be delivered to tumors in a more targeted fashion, with less systemic toxicity. Nanoparticles may aid in diagnosis, preoperative characterization, and intraoperative localization of thoracic tumors and their lymphatics. Focused research into nanotechnology's ability to deliver both diagnostics and therapeutics has led to the development of nanotheranostics, which promises to improve the treatment of thoracic malignancies through enhanced tumor targeting, controlled drug delivery, and therapeutic monitoring. This article reviews nanoplatforms, their unique properties, and the potential for clinical application in thoracic surgery.

  7. A systematic review and meta-analysis of the effect of prophylactic tranexamic acid treatment in major benign uterine surgery

    DEFF Research Database (Denmark)

    Topsoee, Märta F; Settnes, Annette; Ottesen, Bent;

    2017-01-01

    BACKGROUND: The value of tranexamic acid (TA) treatment as bleeding prophylaxis in major uterine surgery is unclear. OBJECTIVES: To evaluate the antihemorrhagic effect of prophylactic TA treatment in major benign uterine surgery. SEARCH STRATEGY: PubMed, Embase, Cochrane Library, and Web of Science...

  8. The Impact of Collagenase Clostridium histolyticum Introduction on Dupuytren Treatment Patterns in the United States.

    Science.gov (United States)

    Zhao, John Z; Hadley, Scott; Floyd, Emerson; Earp, Brandon E; Blazar, Philip E

    2016-10-01

    The U.S. Food and Drug Administration approved the use of collagenase Clostridium histolyticum (CCH) in the United States in February 2010. This study addresses the impact of that approval on the number of Dupuytren contracture (DC) encounters and treatment patterns in the United States. Using the Intercontinental Marketing Services Health Office-Based Medical Claims database, we identified the monthly number of DC encounters and DC procedures between January 2007 and December 2013. Collagenase Clostridium histolyticum usage data from March 2010 to December 2013 was derived from the U.S. CCH manufacturer's data warehouse. Using the combined data, the yearly increasing trends in DC encounters and treatment volume were compared before and after the introduction of CCH. Time trends in the relative procedure frequencies were then examined. Finally, the presence of seasonal variation was tested for in each treatment type. Dupuytren contracture encounters increased on average by 19,015 per year between 2007 and 2009, whereas between 2011 and 2013, DC encounters increased on average by 34,940 per year. In terms of absolute procedure counts, the surgery trend line began decreasing in 2010 with the release of CCH. Meanwhile, CCH continuously increased between 2010 and 2013, and needle aponeurotomy (NA) remained relatively stable. By the year 2013, minimally invasive techniques (NA and CCH) comprised 39% of all treatment, compared with only 14% in 2007. Lastly, there was a statistically significant seasonal increase in the number of surgical procedures during the wintertime but no seasonal variation in NA or CCH. After the introduction of CCH, the number of Dupuytren encounters increased at a greater annual rate. The introduction and growth of CCH coincided with a decrease in surgery. The number of NA procedures remained steady throughout the study period. The number of open surgery cases followed a predictable seasonal variation with more procedures during the winter months

  9. 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.

  10. The national survey of breast cancer treatment pattern in Korea (1998): the use of breast-conserving treatment

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Hyun Soo; Chang, Sei Kyung [Bundang CHA General Hospital, Sungnam (Korea, Republic of); Lee, Hyung Sik [DongA University, Busan (Korea, Republic of)] (and others)

    2004-09-15

    In order to improve the proper use of radiotherapy and breast-conserving treatment (BCT) in the management of breast cancer, current status of breast cancer treatment in Korea was surveyed nationwide and the use of BCT were evaluated. Patients characteristics and treatment pattern of 1048 breast cancer patients from 27 institutions diagnosed between January, 1998 and June, 1998 were analyzed. The incidence of receiving BCT was analyzed according to the stage, age, geography, type of hospital, and the availability of radiotherapy facility. Radical mastectomy was performed in 64.8% of total patients and 26% of patients received breast-conserving surgery (BCS). The proportions of patients receiving BCT were 47.5% in stage 0, 54.4% in stage I and 20.3% in stage II. Some of the patients (6.6% of stage I, 10.1% of stage II and 66.7% of stage III) not received radiotherapy after BCS. Only 45% of stage III patients received post-operative radiotherapy after radical mastectomy. The proportion of patients receiving BCT was different according to the geography and availability of radiotherapy facilities. Radiotherapy was not fully used in the management of breast cancer, even in the patients received breast-conserving surgery. The proportion of the patients who received BCT was lower than the report of western countries. To improve the application of proper management of breast cancer, every efforts such as a training of physicians, public education, and improving accessibility of radiotherapy facilities should be done. The factors predicting receipt of BCT were accessibility of radiotherapy facility and geography. Also, periodic survey like current research is warranted.

  11. Stereotaxic gamma knife surgery in treatment of critically located pilocytic astrocytoma: preliminary result

    Directory of Open Access Journals (Sweden)

    Hafez Raef FA

    2007-03-01

    Full Text Available Abstract Background Low-grade gliomas are uncommon primary brain tumors, located more often in the posterior fossa, optic pathway, and brain stem and less commonly in the cerebral hemispheres. Case presentations Two patients with diagnosed recurrent cystic pilocytic astrocytoma critically located within the brain (thalamic and brain stem were treated with gamma knife surgery. Gamma knife surgery (GKS did improve the patient's clinical condition very much which remained stable later on. Progressive reduction on the magnetic resonance imaging (MRI studies of the solid part of the tumor and almost disappearance of the cystic component was achieved within the follow-up period of 36 months in the first case with the (thalamic located lesion and 22 months in the second case with the (brain stem located lesion. Conclusion Gamma knife surgery represents an alternate tool in the treatment of recurrent and/or small postoperative residual pilocytic astrocytoma especially if they are critically located

  12. Stereotaxic gamma knife surgery in treatment of critically located pilocytic astrocytoma: preliminary result

    Science.gov (United States)

    Hafez, Raef FA

    2007-01-01

    Background Low-grade gliomas are uncommon primary brain tumors, located more often in the posterior fossa, optic pathway, and brain stem and less commonly in the cerebral hemispheres. Case presentations Two patients with diagnosed recurrent cystic pilocytic astrocytoma critically located within the brain (thalamic and brain stem) were treated with gamma knife surgery. Gamma knife surgery (GKS) did improve the patient's clinical condition very much which remained stable later on. Progressive reduction on the magnetic resonance imaging (MRI) studies of the solid part of the tumor and almost disappearance of the cystic component was achieved within the follow-up period of 36 months in the first case with the (thalamic located lesion) and 22 months in the second case with the (brain stem located lesion). Conclusion Gamma knife surgery represents an alternate tool in the treatment of recurrent and/or small postoperative residual pilocytic astrocytoma especially if they are critically located PMID:17394660

  13. Le Fort II midfacial distraction combined with orthognathic surgery in the treatment of nasomaxillary hypoplasia.

    Science.gov (United States)

    Yu, Hongbo; Dai, Jiewen; Wang, Xudong; Zhang, Wenbin; Shen, Steve Guofang

    2014-05-01

    Patients with nasomaxillary hypoplasia have severe facial concavity and compromised skeletal class III malocclusion. Its treatment is still a challenge to surgeons. Our aim was to evaluate the combination of midfacial distraction and orthognathic surgery in the treatment of nasomaxillary hypoplasia. Four patients with nasomaxillary hypoplasia were enrolled in this study. After Le Fort II osteotomy, the rotational distraction of nasomaxillary complex was performed to rehabilitate facial convexity. Then bilateral sagittal split ramus osteotomy with or without Le Fort I osteotomy was used to correct malocclusion. All patients healed uneventfully, and the maxillae moved forward conspicuously. No obvious pain and severe discomfort were complained during distraction. A significant advancement and downward movement of the maxilla were shown by cephalometric analysis. The combination of midfacial distraction and orthognathic surgery provides us an ideal alternative in the treatment of nasomaxillary hypoplasia.

  14. Successful treatment of 54 patients with acute renal failure after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Lei CHEN

    2015-06-01

    Full Text Available Objectives To evaluate the result of treatment of acute renal failure (ARF in patients after cardiac surgery. Methods The clinical data of 54 cases admitted to the hospital from Jan. 2004 to Jan. 2014 and suffered from ARF after cardiac surgery were retrospectively analyzed. Among 54 cases, there were 35 males and 19 females, aged from one month to 79 years with a median of 52 years. The surgical procedures included coronary artery bypass grafting (CABG, 10 cases, valve surgery (22 cases, combined CABG and valve surgery (4 cases, operation on aorta (14 case, and radical correction of Fallot tetralogy (4 cases. After the operations mentioned above, 50 patients received continuous renal replacement therapy (CRRT, and 4 patients received peritoneal dialysis. Results Nine patients died, the mortality rate was 16.7%. Exploratory hemostasis by thoracotomy was performed in 8 patients, and extubation failure occurred in 4 cases. Of the 9 non-survivors, 6 died from multiple organ failure (MOF, 2 died from cerebral hemorrhage, and one died from acute respiratory failure. Serum creatinine (SCr and blood urea nitrogen (BUN levels declined obviously after CRRT and peritoneal dialysis (P<0.05, and all the patients were shown to have stable hemodynamics in the course of treatment, and no hemorrhage or embolism occurred. Conclusions ARF after cardiac surgery should be detected early and treated in time. CRRT and peritoneal dialysis are safe, convenient and effective procedures, and may decrease the mortality rate in patients with ARF after cardiac surgery. DOI: 10.11855/j.issn.0557-7402.2015.04.13

  15. Is Bariatric Surgery an Effective Treatment for Type II Diabetic Kidney Disease?

    Science.gov (United States)

    Friedman, Allon N; Wolfe, Bruce

    2016-03-07

    Type II diabetic kidney disease is devastating to patients and society alike. This review will evaluate bariatric surgery as a treatment for diabetic kidney disease primarily through its ability to induce and maintain regression of type II diabetes. The review begins by outlining the global challenge of diabetic kidney disease, its link to obesity, and the comparative benefits of bariatric surgery on weight and type II diabetes. It then surveys comprehensively the relevant literature, which reports that although bariatric surgery is associated with reductions in albuminuria, its effect on harder clinical end points like progression of diabetic kidney disease is not known. The review also includes a critical assessment of the risks and costs of bariatric surgery and concludes by acknowledging the major knowledge gaps in the field and providing research strategies to overcome them. Until these knowledge gaps are filled, clinicians will be forced to rely on their own subjective judgment in determining the benefit-risk ratio of bariatric surgery for patients with diabetic kidney disease.

  16. Prevention and treatment of transient dry eye following excimer laser surgery

    Directory of Open Access Journals (Sweden)

    V. V. Pogorelovа

    2015-01-01

    Full Text Available To compare dry eye symptoms after LASIK with mechanical keratome-created flaps and femtosecond laser keratome-created flaps as well as to analyze the efficacy of Systane® Ultra Monodose used to prevent and to treat transient dry eye after excimer laser surgery. Methods: 98 patients (194 eyes with myopia and compound myopic astigmatism who underwent excimer laser surgery were included in the study. In group 1 patients with pre-op dry eye, femtosecond laser-assisted LASIK was performed, Systane® Ultra Monodose was prescribed postoperatively. In group 2 patients with pre-op dry eye, LASIK was performed using mechanical microkeratome, Systane® Ultra Monodose was prescribed postoperatively. In group 3 patients without pre-op dry eye, LASIK was performed using mechanical microkeratome, standard anti-inflammatory therapy without any lubricant eye drops was prescribed. Patients were followed up for 60 days. Results: It was demonstrated that excimer laser surgery provokes transient dry eye in all patients, therefore, artificial tears are required for 2 months and more after the surgery. Post-operative lubricant eye drops use improves tear film stability, tear production, tear osmolarity, and objective signs of dry eye. Femtosecond laser decreases clinical and functional symptoms of transient dry eye as compared with mechanical microkeratome and provides more rapid visual recovery. Conclusion: Systane® Ultra Monodose has both high efficiency and good tolerability. It can be recommended for the prevention and treatment of dry eye following excimer laser surgery.

  17. Prevention and treatment of transient dry eye following excimer laser surgery

    Directory of Open Access Journals (Sweden)

    V. V. Pogorelovа

    2014-01-01

    Full Text Available To compare dry eye symptoms after LASIK with mechanical keratome-created flaps and femtosecond laser keratome-created flaps as well as to analyze the efficacy of Systane® Ultra Monodose used to prevent and to treat transient dry eye after excimer laser surgery. Methods: 98 patients (194 eyes with myopia and compound myopic astigmatism who underwent excimer laser surgery were included in the study. In group 1 patients with pre-op dry eye, femtosecond laser-assisted LASIK was performed, Systane® Ultra Monodose was prescribed postoperatively. In group 2 patients with pre-op dry eye, LASIK was performed using mechanical microkeratome, Systane® Ultra Monodose was prescribed postoperatively. In group 3 patients without pre-op dry eye, LASIK was performed using mechanical microkeratome, standard anti-inflammatory therapy without any lubricant eye drops was prescribed. Patients were followed up for 60 days. Results: It was demonstrated that excimer laser surgery provokes transient dry eye in all patients, therefore, artificial tears are required for 2 months and more after the surgery. Post-operative lubricant eye drops use improves tear film stability, tear production, tear osmolarity, and objective signs of dry eye. Femtosecond laser decreases clinical and functional symptoms of transient dry eye as compared with mechanical microkeratome and provides more rapid visual recovery. Conclusion: Systane® Ultra Monodose has both high efficiency and good tolerability. It can be recommended for the prevention and treatment of dry eye following excimer laser surgery.

  18. Gasless endoscopic surgery through the upper chest in treatment of thyroid tumor

    Institute of Scientific and Technical Information of China (English)

    FANG Ju-gao; FENG Ling; YU Zhen-kun; LI Ping-dong; HAN De-min

    2011-01-01

    Background Recently, there has been a surge of interest in minimally invasive techniques with endoscope in thyroid surgery. The aim of this study was to investigate the possibility of a scarless neck surgery under endoscopy for the treatment of thyroid tumor and to observe the results of this procedure.Methods A total of 68 patients (64 women and 4 men) underwent the surgery. Their ages ranged from 18 to 65 years,with a mean age of (34±3) years. There were 64 cases of thyroid adenoma, and 4 cases of nodular goiter. An incision was made on the surface of the chest bone. The operation cavity was made by dragging the skin. Sixty-four patients underwent partial thyroid lobectomy, four patients underwent thyroid lobectomy.Results All 68 cases showed healing in one stage. None of the cases showed paralysis of the recurrent laryngeal nerve or tumor recurrence within the next 2 to 60 months of follow-up. The patients experienced slight pain after the operation.The patients were satisfied with the cosmetic results of the surgery.Conclusion The gasless endoscopic surgery through the upper chest, which was performed to treat thyroid tumor, did not leave any scar, and was easy to handle, and gave good cosmetic results.

  19. [Genetic algorithm application to multi-focus patterns of 256-element phased array for focused ultrasound surgery].

    Science.gov (United States)

    Xu, Feng; Wan, Mingxi; Lu, Mingzhu

    2008-10-01

    The genetic optimal algorithm and sound field calculation approach for the spherical-section phased array are presented in this paper. The in-house manufactured 256-element phased array focused ultrasound surgery system is briefly described. The on-axis single focus and off-axis single focus are simulated along with the axis-symmetric six-focus patter and the axis-asymmetric four-focus pattern using a 256-element phased array and the genetic optimal algorithm and sound field calculation approach. The experimental results of the described 256-element phased array focused ultrasound surgery system acting on organic glass and phantom are also analyzed. The results of the simulations and experiments confirm the applicability of the genetic algorithm and field calculation approaches in accurately steering three dimensional foci and focus.

  20. 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.

  1. Tricuspid regurgitation following left-sided valve surgery: echocardiographic evaluation and optimal timing of surgical treatment.

    Science.gov (United States)

    Izumi, Chisato

    2015-03-01

    Severe tricuspid regurgitation may often appear and progress late after left-sided valve surgery without left-sided valve dysfunction, significant left heart failure, and pulmonary hypertension. The clinical features, echocardiographic evaluation, treatment, and prognosis of this disease entity have been discussed, but data is limited compared with left-sided valve diseases. Tricuspid annular dilatation associated with atrial fibrillation and right ventricular dysfunction strongly relate to development of isolated tricuspid regurgitation late after left-sided valve surgery. Three-dimensional evaluation may be useful in evaluating tricuspid valve anatomy in more detail. Better prognosis in patients undergoing surgical treatment for severe isolated tricuspid regurgitation than those who were treated medically has been reported; however, the timing of isolated tricuspid valve surgery is often too late. Right ventricular function is a key word for determining the timing of isolated tricuspid valve surgery; however, it is difficult to evaluate by conventional echocardiography. One of the serious issues in the future will be how to accurately evaluate right ventricular function.

  2. Surgery combined with topical photodynamic therapy for the treatment of squamous cell carcinoma of the lip.

    Science.gov (United States)

    Wang, Yuanyuan; Yang, Yadong; Yang, Yunchuan; Lu, Yuangang

    2016-06-01

    Due to the unique location of the squamous cell carcinoma (SCC) of the lip, using a single method such as extended resection or radiotherapy probably causes morphological and functional defects. So we used surgery combined with topical photodynamic therapy (PDT) to treat SCC of the lip. Under local anesthesia with 5% lidocaine, the hyperplastic and ulcerative SCC of the lip were curetted and assisted by topical PDTs after surgery. The 20% 5-aminolevulinic acid cream was used as a photosensitizer and applied evenly to the surface of the tumor lesion for 4h. Then the lesion site was irradiated with a 635-nm laser at 120J/cm(2). A total of five PDTs were performed postoperatively at an interval of 2 weeks. Photos were taken before and after every PDT to compare the skin lesions, treatment effects, and side effects. A long-term follow-up was undertaken to observe tumor recurrence. After surgery combined with five topical PDTs, the SCC of the lip disappeared without the compromised morphology of the lip, significant side effects, or tumor recurrence in one-year follow-up. Surgery combined with topical PDT can reduce the excision size of tumors and play a positive role in the treatment of tumors of special locations.

  3. 5-Aminolevulinic Acid Fluorescence in High Grade Glioma Surgery: Surgical Outcome, Intraoperative Findings, and Fluorescence Patterns

    Directory of Open Access Journals (Sweden)

    Alessandro Della Puppa

    2014-01-01

    Full Text Available Background. 5-Aminolevulinic acid (5-ALA fluorescence is a validated technique for resection of high grade gliomas (HGG; the aim of this study was to evaluate the surgical outcome and the intraoperative findings in a consecutive series of patients. Methods. Clinical and surgical data from patients affected by HGG who underwent surgery guided by 5-ALA fluorescence at our Department between June 2011 and February 2014 were retrospectively evaluated. Surgical outcome was evaluated by assessing the resection rate as gross total resection (GTR>98% and GTR>90%. We finally stratified data for recurrent surgery, tumor location, tumor size, and tumor grade (IV versus III grade sec. WHO. Results. 94 patients were finally enrolled. Overall GTR>98% and GTR>90% was achieved in 93% and 100% of patients. Extent of resection (GTR>98% was dependent on tumor location, tumor grade (P<0.05, and tumor size (P<0.05. In 43% of patients the boundaries of fluorescent tissue exceeded those of tumoral tissue detected by neuronavigation, more frequently in larger (57% (P<0.01 and recurrent (60% tumors. Conclusions. 5-ALA fluorescence in HGG surgery enables a GTR in 100% of cases even if selection of patients remains a main bias. Recurrent surgery, and location, size, and tumor grade can predict both the surgical outcome and the intraoperative findings.

  4. The Prevention and Treatment of Delirium in Elderly Patients Following Hip Fracture Surgery.

    Science.gov (United States)

    Martocchia, Antonio; Curto, Martina; Comite, Fabrizia; Scaccianoce, Sergio; Girardi, Paolo; Ferracuti, Stefano; Nicoletti, Ferdinando; Falaschi, Paolo

    2015-01-01

    Osteoporotic hip fracture needs a specific approach and treatment, since elderly patients are at high risk for adverse outcomes after surgery. In particular, delirium often occurs in the peri-operative period, and it is associated with death, hospital-acquired complications, persistent cognitive impairments, poor functional recovery after surgery and increased healthcare costs. The pre-operative assessment of the risk factors for delirium improves the preventive measures. The delirium diagnostic tools should be included in the standard of orthogeriatric cure for hip fracture. Given the increasing complexity of the clinical pictures, we present a review of the available treatment options for delirium in patients with hip fracture. The metabolic pre-operative disorders and the management of co-morbid diseases are specific targets of treatment in order to optimize the outcomes after surgery. In particular, elderly patients with Alzheimer's disease are highly vulnerable to hip fracture and delirium, and they are severely frail with reduced physiologic reserves. An integrated approach combining environmental and pharmacological strategies is useful in the delirium treatment, with a close collaboration between the orthopedic and geriatric team.

  5. Conservative Treatment of Ankle Osteoarthritis: Can Platelet-Rich Plasma Effectively Postpone Surgery?

    Science.gov (United States)

    Repetto, Ilaria; Biti, Besmir; Cerruti, Paola; Trentini, Roberto; Felli, Lamberto

    Osteoarthritis is the most common and disabling of the orthopedic diseases. Currently, the conservative treatment of osteoarthritis is limited to symptomatic treatment, whose goal is to improve function and pain control. Ankle osteoarthritis is relatively uncommon, in contrast to osteoarthritis of the hip and knee, and the therapeutic options (both pharmacologic and surgical) are limited, with surgery providing poorer and less predictable results. The effectiveness of platelet-rich plasma injections for osteoarthritis is still controversial, especially so for ankle arthritis, owing to the lack of evidence in the present data. We retrospectively evaluated the mid- to long-term clinical results (mean follow-up of 17.7 months) for platelet-rich plasma injections in 20 patients (20 ankles) with ankle osteoarthritis. We evaluated the presence of pain using the visual analog scale, function using the Foot and Ankle Disability Index, and subjective satisfaction. The pre- and post-treatment scores, obtained from the clinical records and from telephone interviews during the follow-up period, were compared using the Student t test. We found a strong positive effect for 4 platelet-rich plasma injections (injected once a week) on pain (p = .0001) and function (p = .001), with 80% of patients very satisfied and satisfied, and only 2 patients (10%) required surgery because of early treatment failure. These results suggest that the use of platelet-rich plasma injection is a valid and safe alternative to postpone the need for surgery.

  6. The influence of surface treatment on the implant roughness pattern

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    Marcio Borges Rosa

    2012-10-01

    Full Text Available An important parameter for the clinical success of dental implants is the formation of direct contact between the implant and surrounding bone, whose quality is directly influenced by the implant surface roughness. A screw-shaped design and a surface with an average roughness of Sa of 1-2 µm showed a better result. The combination of blasting and etching has been a commonly used surface treatment technique. The versatility of this type of treatment allows for a wide variation in the procedures in order to obtain the desired roughness. OBJECTIVES: To compare the roughness values and morphological characteristics of 04 brands of implants, using the same type of surface treatment. In addition, to compare the results among brands, in order to assess whether the type of treatment determines the values and the characteristics of implant surface roughness. MATERIAL AND METHODS: Three implants were purchased directly from each selected company in the market, i.e., 03 Brazilian companies (Biomet 3i of Brazil, Neodent and Titaniumfix and 01 Korean company (Oneplant. The quantitative or numerical characterization of the roughness was performed using an interferometer. The qualitative analysis of the surface topography obtained with the treatment was analyzed using scanning electron microscopy images. RESULTS: The evaluated implants showed a significant variation in roughness values: Sa for Oneplant was 1.01 µm; Titaniumfix reached 0.90 µm; implants from Neodent 0.67 µm, and Biomet 3i of Brazil 0.53 µm. Moreover, the SEM images showed very different patterns for the surfaces examined. CONCCLUSIONS: The surface treatment alone is not able to determine the roughness values and characteristics.

  7. Early Functional Treatment and Modern Cast Making for Indications in Hand Surgery

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    S. Bohr

    2016-01-01

    Full Text Available Cast treatment can serve both as a nonsurgical treatment option and as a means for providing postoperative protection. However, with the duration of immobilization intervals, the benefits of cast treatment, especially in hand surgery, are at risk of being outweighed by undesired drawbacks such as joint stiffening and contracture formation. In order to minimize potential complications commonly associated with cast treatment, efforts to further improve cast making must attempt to reconcile two conflicting objectives: (1 to achieve stability and rigidity at the site of injury (e.g., fracture retention and (2 to allow free range of joint movement as early as possible. In addition, in order to assure patient compliance, modern cast treatments should aim to improve wearing-comfort of the cast. This paper describes modern cast designs for four common types hand injuries, with sample cases highlighting the clinical outcome of each treatment.

  8. Clinical effect of laparoscopic surgery in treatment of common bile duct stones after subtotal gastrectomy

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    LEI Ting

    2017-08-01

    Full Text Available ObjectiveTo investigate the safety and feasibility of laparoscopic surgery in the treatment of common bile duct stones after subtotal gastrectomy. MethodsA retrospective analysis was performed for the clinical data of 46 patients with gallstones and common bile duct stones after subtotal gastrectomy who underwent surgical treatment in Luoyang Central Hospital Affiliated to Zhengzhou University from January 2010 to October 2016. Among these patients, 25 underwent laparoscopic cholecystectomy+common bile duct exploration (laparoscopic group, and 21 underwent open cholecystectomy+common bile duct exploration (open group. The surgical conditions and postoperative complications were compared between the two groups. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsNo patients died during the perioperative period and 2 patients (8.0% in the laparoscopic group were converted to open surgery. There were significant differences between the laparoscopic group and the open group in time to ambulation after surgery (1.2±0.6 d vs 2.4±1.2 d, t=4.395, P<0.001, time to passage of gas by anus after surgery (1.8±0.5 d vs 2.8±0.8 d, t=5.168, P<0.001, and length of postoperative hospital stay (5.2±1.1 d vs 7.5±2.3 d, t=4.439, P<0.001. There were no significant differences between the two groups in time of operation, intraoperative blood loss, hospital costs, T tube placement, and rate of residual stones (all P>0.05. After surgery, 2 patients (8.0% in the laparoscopic group and 3 (14.3% in the open group experienced complications, and there was no significant difference between the two groups (P=0.495. ConclusionLaparoscopic surgery is safe and feasible in the treatment of common bile duct stones after subtotal gastrectomy and has the advantages of minimally invasive surgery.

  9. Biostatistical analysis of treatment results of bacterial liver abscesses using minimally invasive techniques and open surgery

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    Кipshidze A.A.

    2013-12-01

    Full Text Available Today bacterial abscesses remain one of the most difficult complications in surgical hepatology, both traditional and minimally invasive methods of their treatment are used. Bio-statistical analysis is used due to the fact that strong evidences are required for the effectiveness of one or another method of surgical intervention. The estimation of statistical significance of differences between the control and the main group of patients with liver abscesses is given in this paper. Depending on the treatment method patients were divided into two groups: 1 - minimally invasive surgery (89 cases; 2 – laporatomy surgery (74 patients. Data compa¬ri¬son was performed by means of Stjudent's criterion. The effectiveness of method of abscesses drainage using inter¬ventional sonography, outer nazobiliar drainage with reorganization of ductal liver system and abscess cavity with the help of modern antiseptics was considered. The percentage of cured patients was also estimated.

  10. SECONDARY HYPERPARATHYROIDISM AFTER BARIATRIC SURGERY: TREATMENT IS WITH CALCIUM CARBONATE OR CALCIUM CITRATE?

    Science.gov (United States)

    BARETTA, Giorgio Alfredo Pedroso; CAMBI, Maria Paula Carlini; RODRIGUES, Arieli Luz; MENDES, Silvana Aparecida

    2015-01-01

    Background : Bariatric surgery, especially Roux-en-Y gastric bypass, can cause serious nutritional complications arising from poor absorption of essential nutrients. Secondary hyperparathyroidism is one such complications that leads to increased parathyroid hormone levels due to a decrease in calcium and vitamin D, which may compromise bone health. Aim : To compare calcium carbonate and calcium citrate in the treatment of secondary hyperparathyroidism. Method : Patients were selected on the basis of their abnormal biochemical test and treatment was randomly done with citrate or calcium carbonate. Results : After 60 days of supplementation, biochemical tests were repeated, showing improvement in both groups. Conclusion : Supplementation with calcium (citrate or carbonate) and vitamin D is recommended after surgery for prevention of secondary hyperparathyroidism. PMID:26537273

  11. Ventriculoperitoneal Shunting Surgery with Open Distal Shunt Catheter Placement in the Treatment of Hydrocephalus.

    Science.gov (United States)

    Zhang, Yang; Zhu, Xiaobo; Zhao, Jinchuan; Hou, Kun; Gao, Xianfeng; Sun, Yang; Wang, Wei; Zhang, Xiaona

    2015-11-01

    Ventriculoperitoneal shunting (VPS) is a major therapy for hydrocephalus, but has a significant risk of device malfunctioning. In this study, we explored a novel distal shunt catheter placement method in VPS for the treatment of hydrocephalus. Five patients with different etiologies of hydrocephalus underwent VPS with open distant shunt catheter attached outside. We analyzed different variables (age, gender, medical history, clinical presentation, indication for surgery and surgical technique, postoperative complications) and occurrence of shunt failure and infection. All hydrocephalus patients who received the distal shunt catheter placed outside can undergo regular VPS again after the condition improves. The modified VPS in the treatment of hydrocephalus with the distal shunt catheter placed outside could potentially reduce the necessity of repeat surgery for addressing the complications caused by catheter obstruction and infections, reduce the chance of adhesions, and would be of benefit to those patients who need future revisions.

  12. Practice patterns in venous thromboembolism (VTE) prophylaxis in thoracic surgery: a comprehensive Canadian Delphi survey

    Science.gov (United States)

    Agzarian, John; Linkins, Lori-Ann; Schneider, Laura; Hanna, Waël C.; Finley, Christian J.; Schieman, Colin; De Perrot, Marc; Crowther, Mark; Douketis, James

    2017-01-01

    Background The incidence of venous thromboembolic events (VTE) after resection of thoracic malignancies can reach 15%, but prophylaxis guidelines are yet to be established. We aimed to survey Canadian practitioners regarding perioperative risk factors for VTE, impact of those factors on extended prophylaxis selection, type of preferred prophylaxis, and timing of initiation and duration of thromboprophylaxis. Methods A modified Delphi survey was undertaken over three rounds with thoracic surgeons, thoracic anesthesiologists and thrombosis experts across Canada. Participants were asked to rate each parameter on a ten-point scale. Agreement was determined a priori as an item reaching a coefficient of variation of ≤30% (0.3), with the item then discontinued from later rounds. Results In total, 72, 57 and 50 respondents participated in three consecutive rounds, respectively. Consensus was reached on previous VTE, age, cancer diagnosis, thrombophilia, poor mobilization, extended resections, and pre-operative chemotherapy as risk factors. Consensus on risk factors impacting extended prophylaxis decisions was achieved on cancer diagnosis, obesity, previous VTE and poor mobilization. With respect to perioperative prophylaxis, once daily low-molecular-weight heparin (LMWH) was the only parameter that demonstrated agreement as a common practice pattern. No agreement was achieved regarding the role of mechanical prophylaxis, unfractionated heparin (UFH) or timing of initiation of peri-operative treatment. VTE prophylaxis until discharge reached agreement but there was substantial variability regarding the role of extended prophylaxis. Conclusions There is agreement between Canadian clinicians treating patients with thoracic malignancies regarding most risk factors for VTE, but there is no agreement on timing of initiation of prophylaxis, the agents used or factors mandating usage of extended prophylaxis. PMID:28203409

  13. A Case of Syphilitic Uveitis in Which Vitreous Surgery Was Useful for the Diagnosis and Treatment

    Science.gov (United States)

    Kobayashi, Takatoshi; Katsumura, Chihiro; Shoda, Hiromi; Takai, Nanae; Takeda, Sayako; Okamoto, Takako; Maruyama, Koichi; Tada, Rei; Tajiri, Kensuke; Kida, Teruyo; Ikeda, Tsunehiko

    2017-01-01

    Purpose To report a case of atypical syphilitic uveitis complicated with retinal vasculitis, proliferative retinopathy, and vitreous hemorrhage in which vitreous surgery was useful for the diagnosis and treatment. Case Report A 38-year-old female was referred to our hospital after noticing visual disturbance in her right eye. Fundoscopy examination of that eye revealed retinal phlebitis accompanied by retinal hemorrhage and soft exudate, and remarkable exudative changes in the retinal vessels from the upper arcade to the macula region. After a blood examination, a serological test showed positive for syphilis; however, systemic findings were scarce. Syphilitic uveitis was suspected, so we administered treatment for syphilis, anticoagulant treatment for retinal vasculitis, steroids for intraocular inflammation, and photocoagulation for the retinal nonperfusion area. However, her visual acuity (VA) decreased to 30 cm/counting fingers due to vitreous hemorrhage resulting from fibrovascular membrane at the optic disc. Since the vitreous hemorrhage was insufficiently absorbed, vitreous surgery was performed to remove the hemorrhage and fibrovascular tissue. Following surgery, the uveitis and retinal vasculitis subsided, and her corrected VA improved to 0.3. Postoperative examination of a fixed quantity of collected vitreous fluid for syphilis showed a Treponema pallidum hemagglutination value of 5,120 times the normal amount, thus confirming the syphilitic uveitis diagnosis. Conclusions Our findings show that when observing patients with obstructive retinal vasculitis of unknown causes, syphilitic uveitis should be considered as a differential diagnosis, and that vitreous surgery is useful for the diagnosis and treatment of atypical syphilitic uveitis which has progressed to proliferative retinopathy. PMID:28203197

  14. Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial

    OpenAIRE

    Lequin, Michiel B.; Verbaan, Dagmar; Jacobs, Wilco C. H.; Brand, Ronald; Gerrit J. Bouma; Vandertop, William P.; Peul, Wilco C; ,

    2013-01-01

    Objective This study describes the 5 years’ results of the Sciatica trial focused on pain, disability, (un)satisfactory recovery and predictors for unsatisfactory recovery. Design A randomised controlled trial. Setting Nine Dutch hospitals. Participants Five years’ follow-up data from 231 of 283 patients (82%) were collected. Intervention Early surgery or an intended 6 months of conservative treatment. Main outcome measures Scores from Roland disability questionnaire, visual analogue scale (V...

  15. Radiofrequency Ablation Compared to Surgery for the Treatment of Benign Thyroid Nodules

    OpenAIRE

    Stella Bernardi; Chiara Dobrinja; Bruno Fabris; Gabriele Bazzocchi; Nicoletta Sabato; Veronica Ulcigrai; Massimo Giacca; Enrica Barro; Nicolò de Manzini; Fulvio Stacul

    2014-01-01

    Objective. Benign thyroid nodules are a common occurrence whose only remedy, in case of symptoms, has always been surgery until the advent of new techniques, such as radiofrequency ablation (RFA). This study aimed at evaluating RFA efficacy, tolerability, and costs and comparing them to hemithyroidectomy for the treatment of benign thyroid nodules. Design and Methods. 37 patients who underwent RFA were retrospectively compared to 74 patients surgically treated, either in a standard inpatient ...

  16. Thoracic Duct Fistula after Thyroid Cancer Surgery: Towards a New Treatment

    Directory of Open Access Journals (Sweden)

    Jean-François Rodier

    2011-05-01

    Full Text Available The use of somatostatin analogs is a new conservative therapeutic approach for the treatment of chyle fistulas developing after thyroid cancer surgery. The combination therapy with a total parenteral nutrition should avoid the high morbidity of are-intervention with an uncertain outcome. This promising trend is supported by the present case report of a chyle leak occurring after total thyroidectomy with central and lateral neck dissection for a papillary carcinoma, which was treated successfully without immediate or distant sequelae.

  17. Combined drug and surgery treatment of plutonium-contaminated wounds: indications obtained using a rodent model.

    Science.gov (United States)

    Griffiths, Nina M; Coudert, Sylvie; Wilk, Jean Claude; Renault, Daniel; Angulo, Jaime F; Van der Meeren, Anne

    2014-06-01

    There is an important requirement following accidental actinide contamination of wounds to limit the dissemination and retention of such alpha-emitting radionuclides. To reduce wound and systemic contamination, treatment approaches include chelation therapy with or without wound excision. However, it has been hypothesized that wound excision could lead to increased contaminant release and systemic organ retention. This study in the rat addresses this question. Anesthetized rats were contaminated with plutonium nitrate following wounding by deep incision of hind leg muscle. Excision of tissue at the contaminated site was performed 7 d later with or without Diethylene Triamine Pentaacetic Acid (DTPA) treatment (30 μmol kg⁻¹ i.v.). Pu urinary excretion was then measured for a further 3 d, and animals were euthanized at 14 d after contamination. Tissue samples were evaluated for Pu activity and histology. At 7 d after contamination, around 50% of the initial activity remained at the wound site. An average of 16% of this activity was then removed by surgery. Surgery alone resulted in increased urinary excretion, suggesting release from the wound site, but no subsequent increases in organ retention (bone, liver) were observed at 14 d. Indeed, organ Pu activity was slightly reduced. The combination of surgery and DTPA or DTPA treatment alone was much more effective than excision alone as shown by the markedly increased urinary Pu excretion and decreased tissue levels. This is the first report in an experimental rodent model of resection of Pu-contaminated wound. Urinary excretion data provide evidence for the release of activity as a result of surgery, but this does not appear to lead to further Pu organ retention. However, a combination of prior DTPA treatment with wound excision is particularly effective.

  18. Thoracic Duct Fistula after Thyroid Cancer Surgery: Towards a New Treatment?

    Science.gov (United States)

    Rodier, Jean-François; Volkmar, Pierre-Philippe; Bodin, Frédéric; Frigo, Séverine; Ciftci, Sait; Dahlet, Christian

    2011-01-01

    The use of somatostatin analogs is a new conservative therapeutic approach for the treatment of chyle fistulas developing after thyroid cancer surgery. The combination therapy with a total parenteral nutrition should avoid the high morbidity of a re-intervention with an uncertain outcome. This promising trend is supported by the present case report of a chyle leak occurring after total thyroidectomy with central and lateral neck dissection for a papillary carcinoma, which was treated successfully without immediate or distant sequelae. PMID:21734879

  19. Evaluating the different laser fragmentation patterns used in laser cataract surgeries in terms of effective phacoemulsification time and power

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    Huseynova T

    2015-11-01

    Full Text Available Tukezban Huseynova,1 Mariko Mita,2 Christine Carole C Corpuz,1 Yuko Sotoyama,1 Minoru Tomita2,3 1Shinagawa LASIK Center, Tokyo, Japan; 2Tomita Minoru Eye Clinic Ginza, Tokyo, Japan; 3Wenzhou Medical College, Wenzhou, People’s Republic of China Purpose: To evaluate the effects of the different fragmentation patterns for the lens nucleus in terms of the effective phacoemulsification time (EPT and power. Setting: Shinagawa LASIK Center, Tokyo, Japan. Design: Comparison study. Methods: Seventy-one eyes of 71 patients had preoperative lens opacity grading based on the Emery-Little Classification (Grade 1 and Grade 2. Eyes underwent femtosecond laser-assisted cataract surgery (Catalys™ Precision Laser System, for capsulotomy and lens fragmentation. For the lens fragmentation, either the quadrants softened (Quadrant or the quadrants complete (Complete pattern was used. The mean EPT and phacoemulsification (phaco power for each cutting pattern of Grades 1 and 2 cataracts were evaluated. Results: The mean EPT was 28.96 seconds in the Quadrant Group and 16.31 seconds in the Complete Group (P=0.006. The mean phaco power was 8.07% in the Quadrant Group and 4.77% in the Complete Group (P=0.0002. Comparing the Quadrant and Complete Groups of Grade 1 cataract showed no significant difference in EPT (P=0.16, but showed a significant difference in phaco power (P=0.033. Comparing the Quadrant and Complete patterns of Grade 2 cataract showed significant differences in both EPT (P=0.012 and phaco power (P=0.003. Using the Complete pattern showed a 44.7% reduction in EPT and a 40.9% reduction in phaco power when compared to the Quadrant Group. Conclusion: Using the smaller fragmentation pattern in femtosecond laser cataract surgery, the phaco time and power were reduced significantly when compared to the procedure with the larger fragmentation pattern. Keywords: effective phacoemulsification time (EPT, complete and quadrant fragmentation pattern

  20. Within-session communication patterns predict alcohol treatment outcomes.

    Science.gov (United States)

    Houck, Jon M; Moyers, Theresa B

    2015-12-01

    Within-session client speech is theorized to be a key mechanism of behavior change in motivational interviewing (MI), a directional, client-centered approach to behavior change. Client change talk (CT: speech indicating movement toward changing a problematic health behavior) and sustain talk (ST: speech supporting continuing a problematic health behavior) have each shown relationships with outcomes. However, it may be the case that patterns of within-session client speech, rather than counts of client speech, are important for producing change. Recorded initial MI/MET psychotherapy sessions from Project MATCH had been previously rated using the Motivational Interviewing Sequential Code for Observing Process Exchange (MI-SCOPE), a mutually exclusive and exhaustive sequential coding system. From these existing data, session conditional probabilities for transitions of interest (the transition from CT to more CT, and the transition from reflections of CT to CT) were analyzed as empirical Bayes estimates of log-normalized odds ratios. CT frequencies and these log-normalized odds ratios were entered as independent variables into longitudinal generalized estimating equation (GEE) models predicting within-treatment and post-treatment drinking. While all variables were significant predictors of within-treatment drinking, only the CT-CT transition emerged as a significant predictor of decreased drinking after treatment. The momentum of a client's speech about change during an MI session may be a better predictor of outcome than is a simple frequency count of it. Attending not only to the mere occurrence of CT, but also recognizing the importance of consecutive client statements of CT, may improve treatment outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Hair transplantation in women: treating female pattern baldness and repairing distortion and scarring from prior cosmetic surgery.

    Science.gov (United States)

    Epstein, Jeffrey S

    2003-01-01

    The role of hair transplantation in men is well established. In women, the procedure is much less common, but has a definite role in the management of female pattern baldness and the repair of alopecic scarring and hairline distortion as a result of prior facial plastic surgery. When performing hair transplantation in women, there are differences in technique from that used in men to consistently achieve excellent results and minimize complications. Over the past 3 years, I have performed 86 hair transplant procedures on women. Most of these cases were for female pattern baldness. The techniques used and typical results are presented herein. When performed properly for the appropriate indications, hair transplantation is an effective procedure with a very high level of patient satisfaction.

  2. Surgeons' Perspectives on Surgery of Breast Cancer in Iran: The Pattern and Determinants

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    Massoome Najafi

    2015-05-01

    Full Text Available Background: The purpose of this study was to assess Iranian surgeons' perceptions toward mastectomy and breast conserving therapy (BCT and determine the contributing factors.Methods: In this cross-sectional study, a structured questionnaire was devised and hosted on survey.tums.ac.ir and a link to the questionnaire was emailed to surgeons registered in Iranian Medical Council, branch of Tehran. The results of the current study were compared to a similar study which was performed in 2004 on a comparable sample of surgeons in Tehran, Iran.Results: A total 166 surgeons filled out the study questionnaire. Only 24 surgeons declared that they have not performed BCT before. Variables that showed a significant association with performing BCT were attending a breast surgery or surgical oncology fellowship (P = 0.010 and breast surgery workshop (P = 0.042. No associations were observed between performance of BCT and age category (P = 0.951, gender (P = 0.416, duration of practice (P = 0.821, number of breast cancer patients per year (P = 0.083, and setting of practice categorized as teaching – nonteaching hospitals (P = 0.417. Comparing the results of the current study with the study performed in 2004 revealed a significant increase in the frequency of surgeons who performed BCT (85.5% vs 19.3%, respectively (P < 0.001. Participants of the current study were more likely to mention "lack of experience" as the reason for not performing BCT compared to the previous study (P = 0.004.Conclusions: Our results delineated that there was a significant increase in the percentage of surgeons performing BCT compared to the previous study. Factors significantly associated with performing BCT were participating in a surgical oncology or breast surgery fellowship or short courses in breast surgery.

  3. Current role of surgery for the treatment of fulminant Clostridium difficile colitis

    Institute of Scientific and Technical Information of China (English)

    WANG Ming-fei; DING Zhao; ZHAO Jian; JIANG Cong-qing; LIU Zhi-su; QIAN Qun

    2013-01-01

    Objective This review discusses the current status and progress in studies on fulminant Clostridium difficile colitis (FCDC),including the definition,risk factor,diagnostic role of CT,surgical treatment,postoperative mortality,and new therapeutic strategy.Data sources A literature search was conducted mainly in Medline and PubMed published in English between January 2000 and May 2011.The search terms were "fulminant Clostridium difficile colitis","treatment"","surgery" and "mortality".Resulta Recent studies show that the overall mortality rate for FCDC remains high despite early surgical intervention.It has been difficult to identify the real value for surgical intervention in patients with FCDC due to the absence of prospective,randomized studies.Early recognition of patients with FCDC will help a clinician decide the need for treatment in an intensive care setting,multi-disciplinary consultation,and appropriate therapeutic selection.Some studies emphasize the importance of early recognition and emergent surgery at a less severe stage.Monoclonal antibody therapy and intravenous immunoglobulin treatment may be useful for the treatment of FCDC.Conclusions Present studies do not provide strong evidence for guiding the surgical treatment of FCDC; hence,creation of collaborative research networks is crucial in order to undertake large prospective multi-center studies for improvement in overall survival.

  4. The patterns and costs of the Da Vinci robotic surgery system in a large academic institution.

    Science.gov (United States)

    Prewitt, Rhonda; Bochkarev, Victor; McBride, Corrigan L; Kinney, Sonja; Oleynikov, Dmitry

    2008-05-01

    The da Vinci ™Robotic System (dVRS) is the latest advancement in laparoscopic surgery allowing the surgeon more accurate and precise control of instrumentation with an added three-dimensional image. Technology comes with a price, $1.3 million. Due to charitable contributions from the Durham family, the University of Nebraska was the eighth Medical Center in the USA to obtain a dVRS in June 2000. UNMC analyzed 224 dVRS surgical procedures from July 2000 to February 2007. These procedures were designated by surgical service and further scrutinized for length of stay, and cost. We also reviewed trends in operative usage, academic and public relations components with this innovative technology. The dVRS was used for multiple other purposes that were beneficial including research with engineering graduate students, training for surgical residents, display and demos as a means for public relations. Primarily general and urologic surgeons utilized the dVRS. General surgeons were the early adopters of the new technology, the greatest growth and utilization of the equipment has been in urologic procedures, which has outpaced general surgery in the past year. Cost analysis shows a subtle benefit with a reduced length of stay by an average of 4 days. Average direct costs were found to be greater with the dVRS by $1,470. Overall, the effects of the dVRS are vast reaching and are fundamental to the growth of an academic institution and continued progress in minimally invasive surgery.

  5. Patterns of failure after radical surgery among patients with thoracic esophageal squamous cell carcinoma: implications for the clinical target volume design of postoperative radiotherapy.

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    Qi Liu

    Full Text Available BACKGROUND: This study evaluated patterns of treatment failure (especially locoregional failure; LRF after radical esophagectomy and proposes a clinical target volume (CTV for postoperative radiotherapy (PORT among patients with thoracic esophageal squamous cell carcinoma (SCC. METHODS: All patients who were followed up in our center after radical esophagectomy between 2007 and 2011 were retrospectively enrolled. The patterns of first discovered failure were assessed, and LRFs (including anastomotic and regional lymph node recurrences were evaluated to determine whether our proposed PORT CTV encompassed these areas. The clinicopathologic factors predictive of lymphatic recurrence type were analyzed. RESULTS: Of the 414 patients who underwent surgery and were followed up over the study, 207 experienced recurrent or metastatic diseases. The median time to progression was 11.0 months. Of the 173 patients with locoregional recurrence, nodal failure recurred in 160; supraclavicular and superior mediastinal lymph nodes had the highest metastasis rates. All 233 recurrent sites across the 160 patients were located in a standard CTV area, including the bilateral supraclavicular areas, the entire mediastinum, and the left gastric lymphatic drainage region. A total of 203 sites (87.2% were located in either the bilateral supraclavicular areas or the entire mediastinum, and 185 sites (79.4% were located in either the bilateral supraclavicular areas or the upper mediastinum. A multivariate analysis revealed the lymph node metastatic ratio (LNMR and tumor differentiation were risk factors for nodal failure. CONCLUSIONS: Locoregional recurrence (especially lymph node recurrence was the most common and potentially preventable type of initial treatment failure after curative surgery among patients with thoracic esophageal SCC. The proposed PORT CTV covered most LRF sites. The lymphatic drainage regions for PORT are selective, and the supraclavicular and superior

  6. Radiotherapy for locally recurrent rectal cancer treated with surgery alone as the initial treatment

    Energy Technology Data Exchange (ETDEWEB)

    Tanaka, Hidekazu; Yamaguchi, Takahiro; Hachiya, Kae; Okada, Sunaho; Kitahara, Masashi; Matsuyama, Katsuya; Matsuo, Masayuki [Gifu University, Gifu (Japan)

    2017-03-15

    Although the technical developments of radiotherapy have been remarkable, there are currently few reports on the treatment results of radiotherapy for local recurrence of rectal cancer treated with surgery alone as initial treatment in this three-dimensional conformal radiotherapy era. Thus, we retrospectively evaluated the treatment results of radiotherapy for local recurrence of rectal cancer treated with surgery alone as the initial treatment. Thirty-two patients who underwent radiotherapy were enrolled in this study. The dose per fraction was 2.0–3.5 Gy. Because the treatment schedule was variable, the biological effective dose (BED) was calculated. Local control (LC) and overall survival (OS) rates from the completion of radiotherapy were calculated. The 1-, 2-, 3-, 4-, and 5-year LC rates were 51.5%, 24.5%, 19.6%, 19.6%, and 13.1%, respectively. LC rates were significantly higher for the high BED group (≥75 Gy10) than for the lower BED group (<75 Gy10). All patients who reported pain achieved pain relief. The duration of pain relief was significantly higher for the high BED group than for the lower BED group. The 1-, 2-, 3-, 4-, and 5-year OS rates were 82.6%, 56.5%, 45.2%, 38.7%, and 23.2%, respectively. There was a trend toward higher OS rates in with higher BED group compared to lower BED group. For patients with unresectable locally recurrent rectal cancer treated with surgery alone, radiotherapy is effective treatment. The prescribed BED should be more than 75 Gy10, if the dose to the organ at risk is within acceptable levels.

  7. [Peritoneal mesothelioma: treatment with cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy].

    Science.gov (United States)

    Passot, G; Cotte, E; Brigand, C; Beaujard, A-C; Isaac, S; Gilly, F-N; Glehen, O

    2008-01-01

    Diffuse malignant peritoneal mesothelioma is a rare and lethal disease. Locoregional treatments combining cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) seem to improve prognosis. Cytoreductive surgery and HIPEC was performed in 22 patients at the Centre Hospitalier-Lyon Sud between 1989 and 2006. A retrospective analysis of survival was carried out to assess clinical and histological prognostic factors. Nineteen patients with diffuse malignant peritoneal mesothelioma were included (16 epithelial, 3 biphasic and 3 multicystic forms). Sixteen patients presented stage 3 or 4 peritoneal mesothelioma according to the Gilly classification. Optimal cytoreductive surgery was performed for 11 patients (complete macroscopic resection or residual tumor nodules less than 2.5mm). No post-operative deaths occurred but 9 patients (47%) presented grade III or IV post-operative complications. The overall median survival was 36.9 months; completeness of cytoreduction was the only significant prognostic factor. Cytoreductive surgery combined with HIPEC may improve the length of survival for patients with diffuse malignant peritoneal mesothelioma; such patients should be treated in specialized centers.

  8. Traumatic First Time Shoulder Dislocation: Surgery vs Non-Operative Treatment

    Directory of Open Access Journals (Sweden)

    Ioannis Polyzois

    2016-04-01

    Full Text Available Management of first shoulder dislocation following reduction remains controversial. The two main options are immobilisation and arthroscopic stabilisation. The aim of this article is to highlight some of the issues that influence decision making when discussing management options with these patients, including natural history of the first time dislocation, outcomes of surgery and non-operative management particularly on the risk of future osteoarthritis (OA, the effects of delaying surgery and the optimal method of immobilisation. Extensive literature review was performed looking for previous publication addressing 4 points. i Natural history of primary shoulder dislocation ii Effect of surgical intervention on natural history iii Risk of long term osteoarthritis with and without surgical intervention iv Immobilisation techniques post reduction. Individuals younger than 25 years old are likely to re-dislocate with non-operative management. Surgery reduces risk of recurrent instability. Patients with recurrent instability appear to be at a higher risk of OA. Those who have surgical stabilisation do not appear to be at a higher risk than those who dislocate just once, but are less likely to develop OA than those with recurrent instability. Delaying surgery makes the stabilisation more demanding due to elongation of capsule, progressive labro-ligamentous injury, prevalence and severity of glenoid bone loss. Recent studies have failed to match the preliminary outcomes associated with external rotation braces. Defining the best timing and type of treatment remains a challenge and should be tailored to each individual’s age, occupation and degree of physical activity.

  9. Alternative treatment option for hypopharyngeal cancer: clinical outcomes after conservative laryngeal surgery with partial pharyngectomy.

    Science.gov (United States)

    Chung, Eun-Jae; Lee, Jong-Joo; Kim, Hyun-Sung; Lee, Dong-Jin; Jung, Chul-Hoon; Chang, Yong-Joon; Rho, Young-Soo

    2013-08-01

    The oncological and functional outcomes of hypopharyngeal cancer after conservative laryngeal surgery are fairly acceptable, making this a reasonable initial treatment option for selected patients. The purpose of this study was to assess the clinical outcomes of patients with hypopharyngeal squamous cell carcinoma (SCC) treated with conservative laryngeal surgery with partial pharyngectomy. Fifty-eight patients with hypopharyngeal SCC who underwent laryngeal preservation surgery were enrolled. The tumors were classified as cT1 in 5 (8.6%) patients, cT2 in 35 (60.3%), cT3 in 14 (24.1%), and cT4a in 4 (6.9%) patients. Surgical outcomes: 5-year overall and disease-specific survival rates were 78% and 77.6%. Recurrent disease developed in 13 patients (22.4%). Multivariate analysis revealed that level VI metastasis confirmed by histopathological analysis, close (alimentation was achieved within a mean of 26.1 days after surgery. Fifty-one patients (87.9%) could be decannulated after a mean of 43.8 days postoperatively.

  10. 5% Minoxidil: treatment for female pattern hair loss.

    Science.gov (United States)

    Gupta, Aditya K; Foley, Kelly A

    2014-01-01

    Minoxidil is a Health Canada and US FDA-approved medication for hair loss in men and women. While 5% minoxidil foam has been approved for men since 2006, Health Canada and the FDA only approved 5% minoxidil foam for female pattern hair loss (FPHL) in 2014. Recent Phase III clinical trials demonstrated the efficacy of once daily 5% minoxidil foam for treatment of FPHL, where a significant change from baseline in the target area hair count was observed compared to placebo. Similar changes in hair count for 5% foam and twice daily 2% minoxidil solution established noninferiority of the 5% foam formulation. Five percent minoxidil foam provides an additional option for women with FPHL and will soon be available in Canada.

  11. Longitudinal Treatment Outcomes of Microsurgical Treatment of Neurosensory Deficit after Lower Third Molar Surgery: A Prospective Case Series.

    Directory of Open Access Journals (Sweden)

    Yiu Yan Leung

    Full Text Available To prospectively evaluate the longitudinal subjective and objective outcomes of the microsurgical treatment of lingual nerve (LN and inferior alveolar nerve (IAN injury after third molar surgery.A 1-year longitudinal observational study was conducted on patients who received LN or IAN repair after third molar surgery-induced nerve injury. Subjective assessments ("numbness", "hyperaesthesia", "pain", "taste disturbance", "speech" and "social life impact" and objective assessments (light touch threshold, two-point discrimination, pain threshold, and taste discrimination were recorded.12 patients (10 females with 10 LN and 2 IAN repairs were recruited. The subjective outcomes at post-operative 12 months for LN and IAN repair were improved. "Pain" and "hyperaesthesia" were most drastically improved. Light touch threshold improved from 44.7 g to 1.2 g for LN repair and 2 g to 0.5 g for IAN repair.Microsurgical treatment of moderate to severe LN injury after lower third molar surgery offered significant subjective and objective sensory improvements. 100% FSR was achieved at post-operative 6 months.

  12. Bypass surgery versus stenting for the treatment of multivessel disease in patients with unstable angina compared with stable angina

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); P. van den Heuvel; F. Unger (Felix); R. Beyar; W.K. Lindeboom (Wietze); V. de Valk (Vincent); S. Milo; R. Simon (Rudiger); G.F.O. Tyers (Frank); D. Regensburger; P.A. Crean (Peter); I.M. Penn (Ian); E. McGovern; C. van Cauwelaert; P.W.J.C. Serruys (Patrick)

    2002-01-01

    textabstractBACKGROUND: Earlier reports have shown that the outcome of balloon angioplasty or bypass surgery in unstable angina is less favorable than in stable angina. Recent improvements in percutaneous treatment (stent implantation) and bypass surgery (arterial grafts) warrant reevaluation of the

  13. Management of Chyle Leak after Head and Neck Surgery: Review of Current Treatment Strategies

    Science.gov (United States)

    Shi, Haoran; Sinha, Uttam K.

    2017-01-01

    Chyle leak formation is an uncommon but serious sequela of head and neck surgery when the thoracic duct is inadvertently injured, particularly with the resection of malignancy low in the neck. The thoracic duct is the primary structure that returns lymph and chyle from the entire left and right lower half of the body. Chyle extravasation can result in delayed wound healing, dehydration, malnutrition, electrolyte disturbances, and immunosuppression. Prompt identification and treatment of a chyle leak are essential for optimal surgical outcome. In this article we will review the current treatment options for iatrogenic cervical chyle leaks. PMID:28203252

  14. Acoustic pattern evaluation during cementless hip arthroplasty surgery may be a new method for predicting complications

    Science.gov (United States)

    Morohashi, Itaru; Iwase, Hideaki; Kanda, Akio; Sato, Taichi; Homma, Yasuhiro; Mogami, Atsuhiko; Obayashi, Osamu; Kaneko, Kazuo

    2017-01-01

    Background: Although surgeons must perform implantation of the cementless stem during total hip arthroplasty (THA) without complications, assessment is left to the surgeon’s intuitive judgement, which could contain inter/intra-observer bias variety. We therefore asked (1) whether the sound created during the stem implantation could be evaluated objectively and (2) whether those sounds are correlate to the complication specific to the cementless stems. Our hypothesis is that the sounds produced during stem insertion could be quantified and related to the complications. Patients and method: In 71 THAs, we quantified the sound produced during stem insertion and investigated the relationship between these sounds and the occurrence of intraoperative fracture and subsidence. Results: The sound data were divided into two patterns: Patterns A and B. The difference between the peak value (dB) at the most common frequency (near 7 kHz) and the second most common frequency (near 4 kHz) of strikes during the final phase of implantation in Patterns A and B showed a significant difference. Adverse events on intraoperative fracture and subsidence were significantly less common in patients with Pattern A than in those with Pattern B (six of 42 hips with Pattern A and 13 of 29 hips with Pattern B, p = 0.004). Pattern A in predicting a clinical course without those adverse events was 69.2% and the specificity was 68.4%. Positive and negative predictive values were 85.7% and 44.8%, respectively. Conclusion: The sound generated during stem insertion was quantified. Those sound patterns were associated with complications. PMID:28186872

  15. 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.

  16. Periimplantitis Treatment: Long-Term Comparison of Laser Decontamination and Implantoplasty Surgery.

    Science.gov (United States)

    Pommer, Bernhard; Haas, Robert; Mailath-Pokorny, Georg; Fürhauser, Rudolf; Watzek, Georg; Busenlechner, Dieter; Müller-Kern, Michael; Kloodt, Claudia

    2016-10-01

    Periimplantitis is the most frequent cause of late implant failure; however, little is known about the long-term success of periimplantitis treatment and the effectiveness of various therapeutic interventions. A total of 142 patients were referred to the Academy for Oral Implantology in Vienna for the treatment of recurrent periimplantitis around single-tooth implants. Of them, 72 patients (51%) were treated by laser decontamination, 47 patients (33%) by implantoplasty surgery, and 23 patients (16%) by a combination of both approaches. Overall success of periimplantitis therapy was 89% after 9 years of follow-up, and it did not differ significantly between female and male patients (P = 0.426). The number of implant failures that could not be prevented by periimplantitis treatment was 6 after laser decontamination (8%), 6 after implantoplasty surgery (13%), and 4 after a combination of both therapies (17%). Implant loss occurred after 4.9 ± 1.9 years of therapy, on average. No significant difference between the 3 treatment groups could be observed (P = 0.393). The present results suggest that success rates of periimplantitis therapy with either laser decontamination or surgical implantoplasty are high. These success rates do not appear to be associated with patient gender or treatment strategy.

  17. Patterns of care and treatment outcomes for primary thyroid lymphoma: A single institution study

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    Cha, Hye Jung; Kim, Jun Won; Suh, Chang Ok; Kim, Jin Seok; Cheong, June Won; Lee, Jeong Shim; Keum, Ki Chang; Lee, Chang Geol; Cho, Jae Ho [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2013-12-15

    The aim of this study was to analyze the patterns of care and treatment outcomes in patients with primary thyroid lymphoma (PTL) in a single institution. Medical records of 29 patients with PTL treated between April 1994 and February 2012 were retrospectively reviewed. Diagnosis was confirmed by biopsy (n = 17) or thyroidectomy (n = 12). Treatment modality and outcome were analyzed according to lymphoma grade. The median follow-up was 43.2 months (range, 3.8 to 220.8 months). The median age at diagnosis was 57 years (range, 21 to 83 years) and 24 (82.8%) patients were female. Twenty-five (86.2%) patients had PTL with stage IEA and IIEA. There were 8 (27.6%) patients with mucosa-associated lymphoid tissue (MALT) lymphoma and the remaining patients had high-grade lymphoma. Patients were treated with surgery (n = 2), chemotherapy (n = 7), radiotherapy (n = 3) alone, or a combination of these methods (n = 17). Treatment modalities evolved over time and a combination of modalities was preferred, especially for the treatment of high-grade lymphoma in recent years. There was no death or relapse among MALT lymphoma patients. Among high-grade lymphoma patients, 5-year overall survival (OS) and 5-year progression-free survival (PFS) were 75.6% and 73.9%, respectively. Complete remission after initial treatment was the only significant prognostic factor for OS (p = 0.037) and PFS (p = 0.003). Patients with PTL showed a favorable outcome, especially with MALT lymphoma. Radiotherapy alone for MALT lymphoma and chemotherapy followed by radiotherapy for high-grade lymphoma can be effective treatment options for PTL.

  18. Disturbances in the circadian pattern of activity and sleep after laparoscopic versus open abdominal surgery

    DEFF Research Database (Denmark)

    Gögenur, Ismail; Bisgaard, Thue; Burgdorf, Stefan

    2008-01-01

    scale (sleep quality, general well-being and pain) and fatigue was measured by a ten-point fatigue scale. The activity levels of the patients were monitored by actigraphy (a wrist-worn device measuring patient activity). Measures of circadian activity level [interday stability (IS), intraday variability......BACKGROUND: Studies on the circadian variation in bodily functions and sleep are important for understanding the pathophysiological processes in the postoperative period. We aimed to investigate changes in the circadian variation in activity after minimally invasive surgery (laparoscopic...

  19. Plastic surgery in the treatment of primary melanoma of the skin

    Directory of Open Access Journals (Sweden)

    Panajotović Ljubomir

    2003-01-01

    Full Text Available Surgery is still the most effective treatment modality of skin melanoma. The margins of excision are determined by the thickness of primary tumor. From January 1999 to December 2001, 99 patients (57 male and 42 female, of the average age 55, were surgically treated at the Clinic for Plastic Surgery and Burns of the Military Medical Academy. The most usual localization of the primary tumor was the back (23.23%, followed by the forearm, and the lower leg. Regarding the clinical type of the melanoma, nodular melanoma dominated (62.62%. Microscopic staging of the melanoma (classification according to Clark and Breslow, showed that the majority of patients already suffered from the advanced primary disease, which called for radical excision and the choice of reconstructive methods in the closure of post-excision defects. The reconstructive plastic surgical methods enabled the closure of post-excision tissue defects, regardless of their size, structure, and localization. During the closure of post-excision defects, direct wound closure or split skin draft was performed in 76.76% of patients. Flaps were applied in 19.19% of patients with the primary melanoma of the head, face foot, and hand. The sufficiency of the available reconstructive procedures makes plastic surgery irreplaceable in the surgical treatment of the primary melanoma of the skin.

  20. Treatment for isolated loco-regional recurrence of gastric adenocarcinoma: Does surgery play a role?

    Institute of Scientific and Technical Information of China (English)

    Fabio Carboni; Pasquale Lepiane; Roberto Santoro; Riccardo Lorusso; Pietro Mancini; Massimo Carlini; Eugenio Santoro

    2005-01-01

    AIM: To evaluate the role of surgical treatment for isolated loco-regional recurrences of operated gastric adenocarcinoma.METHODS: Among the 837 patients operated for gastric adenocarcinoma between December 1979and April 2004, 713 (85%) underwent resection with curative intent. A retrospective review of a prospectively collected gastric cancer database was carried out.Overall recurrence rate was 44% (315 cases), with 75%occurring within the first 2 years from the operation.Isolated L-R recurrences were observed in 38 (12%)patients. Symptomatic lesions were observed in 27(71%).RESULTS: Six (16%) patients were macroscopically resected with curative intent. The recurrence was located in the gastric stump after a STG in three patients, in theesophagojejunal anastomosis after a TG in two patients and in the gastric bed after a TG in one patient.Surgical procedures consisted of three secondary TG, two esophagojejunal resection and one excision of an extraluminal recurrence. Postoperative complications occurred in two patients (33%), including one anastomotic leakage and one hemorrhage. The latter patient died of sepsis 35 d after the surgery (mortality rate 17%). All patients died of recurrent gastric cancer:2 within 1 year from surgery (8 and 11 mo, respectively),2 after 16 and 17 mo respectively and 1 after 28 mo from the second operation.CONCLUSION: Surgery plays a very limited role in the treatment for isolated loco-regional recurrence of gastric adenocarcinoma.

  1. Gabapentin Does Not Appear to Improve Postoperative Pain and Sleep Patterns in Patients Who Concomitantly Receive Regional Anesthesia for Lower Extremity Orthopedic Surgery: A Randomized Control Trial

    Science.gov (United States)

    Amin, Shawn; Reilly, Mark C.; Shulman, Steven

    2017-01-01

    In recent years, gabapentin has gained popularity as an adjuvant therapy for the treatment of postoperative pain. Numerous studies have shown a decrease in pain score, even with immediate postoperative activity, which is significant for early post-op ambulation and regaining functionality sooner. However, studies have been in conclusive in patients undergoing lower extremity orthopedic surgery. For this reason, we hoped to study the effect of gabapentin on postoperative pain in patients undergoing total knee arthroplasty, total hip arthroplasty, or a hip fracture repair. This was done in the setting of ensuring adequate postoperative analgesia with regional blocks and opioid PCA, as is protocol at our institution. Given the sedative effects of gabapentin and the potential for improving postoperative sleep patterns, we also studied the drug's effect on this aspect of our patient's postoperative course. We utilized the Pittsburg Sleep Quality Index and Visual Analog Scale for pain to obtain a more objective standardized score amongst our study population. Our results indicate that gabapentin does not offer any additional relief in pain or improve sleep habits in patients who have received either a femoral or lumbar plexus block for lower extremity orthopedic surgery. This trial is registered with NCT01546857.

  2. Treatment of severe bone deficiency in acetabular revision surgery using a reinforcement device and bone grafting

    Institute of Scientific and Technical Information of China (English)

    ZHAI Ji-liang; LIN Jin; JIN Jin; QIAN Wen-wei; WENG Xi-sheng

    2011-01-01

    Background Severe acetabular bone deficiency is a major challenge in acetabular revision surgery. Most cases require reconstruction of the acetabulum with bone grafting and a reinforcement device. The purpose of this study was to evaluate the results of this procedure for severe acetabular bone deficiency in acetabular revision surgery.Methods This study involved 12 patients (2 males and 10 females) with severe acetabular bone defects who underwent implantation of a reinforcement device (ring or cage) and bone grafting between February 2003 and October 2008. Using the Paprosky classification, 2 cases were Paprosky ⅡC, 6 were ⅢA, and 4 were ⅢB. The mean age at the time of surgery was 63.0 years (range, 46-78 years). During revision surgery, a reinforcement ring was implanted in 6patients, and a cage in 6 patients. The clinical and radiographic results were evaluated retrospectively. The mean duration of follow-up was 37 months (range, 9-71 months).Results The average Harris Hip Score improved from 35.2 preoperatively to 82.9 at the time of the final follow-up visit.The results were excellent in 8 hips (66.7%), good in 2 (16.7%), and fair in 2 (16.7%). Osteolysis was found in 1 case, but did not worsen. Three patients had yellow wound effusion, with healing after administration of dressing changes,debridement, and antibiotics. Dislocation occurred in a 62-year-old woman. Closed reduction was performed, and dislocation did not recur. There was no evidence of intraoperative acetabular fracture, nerve injury, ectopic ossification,aseptic loosening, or infection.Conclusion Reconstruction with a reinforcement device and bone grafting is an effective approach to the treatment of acetabular bone deficiency in acetabular revision surgery, given proper indications and technique.

  3. Diagnosis and treatment of atypical presentations of hiatal hernia following bariatric surgery.

    Science.gov (United States)

    Flanagin, Brody A; Mitchell, Myrosia T; Thistlethwaite, William A; Alverdy, John C

    2010-03-01

    Bariatric surgery dramatically alters the normal stomach anatomy resulting in a significant incidence of hiatal hernia and gastroesophageal reflux disease. Although the majority of patients remain asymptomatic, many complain of severe heartburn refractory to medical management and additional highly atypical symptoms. Here, we describe the diagnosis and treatment regarding four cases of symptomatic hiatal hernia following bariatric surgery presenting with atypical symptoms in the University Hospital, USA. Four patients presented following laparoscopic Roux-en-Y gastric bypass or duodenal switch/pancreaticobiliary bypass (DS) with disabling and intractable midepigastric abdominal pain characterized as severe and radiating to the jaw, left shoulder, and midscapular area. The pain in all cases was described as paroxysmal and not necessarily associated with eating. All four patients also experienced nausea, vomiting, and failure to thrive at various intervals following laparoscopic bariatric surgery. Routine workup failed to produce any clear mechanical cause of these symptoms. However, complimentary use of multidetector CT and upper gastrointestinal contrast studies eventually revealed the diagnosis of hiatal hernia. Exploration identified the presence of a type I hiatal hernia in all four patients, with the stomach staple lines densely adherent to the diaphragm and parietal peritoneum. Operative intervention led to immediate and complete resolution of symptoms. The presence of a hiatal hernia following bariatric surgery can present with highly atypical symptoms that do not resolve without operative intervention. Recognition of this problem should lead to the consideration of surgery in cases where patients are dependent on artificial nutritional support and whose symptoms are poorly controlled with medication alone.

  4. Practice patterns in the perioperative treatment of patients undergoing septorhinoplasty: a survey of facial plastic surgeons.

    Science.gov (United States)

    Shadfar, Scott; Deal, Allison M; Jarchow, Andrea M; Yang, Hojin; Shockley, William W

    2014-01-01

    IMPORTANCE The common practices used in the perioperative care of patients undergoing septorhinoplasty are diverse and controversial. A consensus statement on the preferred clinical pathway in the perioperative treatment of patients undergoing septorhinoplasty has yet to be approached formally. OBJECTIVES To investigate the perioperative treatment of patients undergoing septorhinoplasty and to identify common practice patterns based on the preferences of leading facial plastic surgeons. DESIGN, SETTING, AND PARTICIPANTS We distributed an online survey to members of the American Academy of Facial Plastic and Reconstructive Surgery. Specifically, fellowship directors and academic contact members were anonymously polled and stratified by the number of septorhinoplasties performed annually. MAIN OUTCOME AND MEASURE A cohesive clinical guide to perioperative treatment after rhinoplasty. RESULTS Of the 92 members surveyed, 67 (73%) successfully completed the survey. The distribution of respondents included 43 academicians (64%) and 24 physicians in private practice (36%). Twenty-eight surgeons (42%) performed fewer than 50 rhinoplasties a year and 39 (58%), more than 50, representing 3510 to 4549 septorhinoplasties in total among respondents. Forty-four surgeons (66%) refrained from using any packing, and 41 (61%) used intranasal splints, with polymeric silicone splints the most popular of these (n = 24 [59%]). Sixty-six surgeons (99%) used external nasal splints, including 49 (74%) who used a thermoplastic splint and 49 (74%) who left the external nasal splint in place for 7 days or longer. The most common postoperative interventions to reduce edema and ecchymosis were elevation of the head of bed by 62 (93%), ice packs by 50 (75%), and Arnica montana by 33 (49%). Only 12 surgeons (18%) used postoperative corticosteroids to reduce edema. Fifty-six respondents (84%) prohibited participation in contact sports until at least 6 weeks after surgery. CONCLUSIONS AND

  5. [Endobronchial surgery and photodynamic therapy for the treatment of multiple primary lung cancer].

    Science.gov (United States)

    Sokolov, V V; Telegina, L V; Trakhtenberg, A Kh; Kolbanov, K I; Pikin, O V; Frank, G A

    2010-01-01

    Endoluminal endoscopic surgery and fotodynamic therapy were used in treatment of 104 patients with multiple primary lung cancer (MPLC), or more exactly, of trachea and lobar and segmental bronchi. Diagnostic division included videobronchoscopy of high resolution in with light and NBI-regimen; autoflourescent and 5-ALA-induced fluorescent videobronchoscopy, endosonography, computed tompgraphy or magnetic resonance imaging of the thorax and epithelial mucine (MUC-1) immunohistochemical analysis of scarificates. Result of treatment strongly depended on the size of primary tumor. Complete regression of cancer was observed for all tumors less then 1 sm in diameter. Endoscopic treatment, including fotodynamic therapy and argon coagulation, proved to be a method of choice in treatment early synchronous or metachronous multiple primary lung cancer in incurable patients.

  6. Analgesic treatment in laparoscopic gastric bypass surgery: a systematic review of randomized trials.

    Science.gov (United States)

    Andersen, Lars P H; Werner, Mads U; Rosenberg, Jacob; Gögenur, Ismail

    2014-03-01

    This review aimed to present an overview of the randomized controlled trials investigating analgesic regimens used in laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. Literature search was performed in PubMed and EMBASE databases in August 2013 in accordance to PRISMA guidelines. The literature search identified nine studies eligible for inclusion. The administration of nonsteroidal anti-inflammatory drugs, local anesthetics (intraperitoneally or subfascially/subcutaneously), transversus abdominis plane block, dexmedetomidine, and ketamine may improve analgesia compared to placebo/controls in LRYGB. None of the studies incorporated multimodal procedure-specific analgesic regimens. The Oxford quality scoring system scores indicated a generally limited methodological quality of the included studies. This review documents a need for high-quality, procedure-specific literature concerning analgesic treatment in LRYGB surgery.

  7. RETROSPECTIVE ANALYSIS OF PATTERN OF SURGERIES IN TERTIARY GOVERNMENT ENT HOSPITAL

    Directory of Open Access Journals (Sweden)

    Surya Prakasa Rao

    2015-02-01

    Full Text Available AIM AND OBJECTIVE: The main aim of this study was to estimate the prevalence of common and rare ear, nose, throat and head and neck disorders which were undertaken for surgery in our hospital during 2013 - 2014. MATERIALS AND METHODS: During the period of 2013 - 2014, around 20 , 000 patients attended to the outpatient department, of which 1400 patients were found to be suffering from ENT diseases which required surgery. Out of the total patients, 657 patients (46.9% had ear problems, 295 patients (21.1 % were suffering with no se diseases, while 255 patients (18.2% had throat symptoms and 193 patients (13.8% with head and neck disorders. Chronic suppurative otitis media was the most common diagnosis in patients with ear symptoms. Among the nasal problems, sinusitis and allergi c nasal polyposis was the most common diagnosis, while tonsillitis is the dominant diagnosis made in patients with throat disorders seen in this study. In the malignant disorders of the throat, carcinoma of larynx and hypopharynx was occupying the highest place. In thyroid disorders, benign tumours were observed to be most common.

  8. Nerve Injuries in Aesthetic Breast Surgery: Systematic Review and Treatment Options.

    Science.gov (United States)

    Ducic, Ivica; Zakaria, Hesham M; Felder, John M; Fantus, Sarah

    2014-08-01

    The risk of nerve injuries in aesthetic breast surgery has not been well explored. The authors conducted a systematic review to provide evidence-based information on the incidence and treatment of nerve injuries resulting from aesthetic breast surgery. A broad literature search of Medline, Embase, and the Cochrane Database of Systematic Reviews was undertaken to identify studies in which nerve injury occurred after breast augmentation or mastopexy. Specific inclusion and exclusion criteria were established before the search was performed. The initial 4806 citations were narrowed by topic, title, and abstract to 53 articles. After full-text review, 36 studies were included. The risk of any nerve injury after breast augmentation ranged from 13.57% to 15.44%. Specific nerve injury rates were calculated for the intercostal cutaneous nerves, branches to the nipple-areola complex, intercostobrachial nerve, long thoracic nerve, and brachial plexus. Also calculated were the total estimated risks of chronic pain, hyperesthesia, hypoesthesia, and numbness. The meta-analysis showed no associations between the rates of breast nerve injury or sensation change and implant size, incision type, or implant position in patients who underwent breast augmentation. The data were insufficient to determine rates of nerve injury in mastopexy. The possibility of nerve injury, sensation change, or chronic pain with breast augmentation is real, and estimating the incidences of these conditions is useful to both patients and surgeons. Optimizing patient outcomes requires timely treatment by a multidisciplinary team and may include peripheral nerve surgery. 3. © 2014 The American Society for Aesthetic Plastic Surgery, Inc.

  9. Treatment of advanced renal cell carcinoma: recent advances and current role of immunotherapy, surgery, and cryotherapy.

    Science.gov (United States)

    Mennitto, Alessia; Verzoni, Elena; Calareso, Giuseppina; Spreafico, Carlo; Procopio, Giuseppe

    2017-01-21

    Renal cell carcinoma (RCC) is the 10th most common cancer in Western countries. The prognosis of metastatic disease is unfavorable but may be different according to several risk factors, such as histology and clinical features (Karnofsky performance status, time from nephrectomy, hemoglobin level, neutrophils and thrombocytes count, lactate dehydrogenase and calcium serum value, sites and extension of the disease). In this review, we focused on some recent developments in the use of immunotherapy, surgery and cryotherapy in the treatment of advanced disease. While RCC is unresponsive to chemotherapy, recent advances have emerged with the development of targeted agents and innovative immunotherapy-based treatments. Surgical resection remains the standard of care for patients with small renal lesions but in patients with significant comorbidities ablative therapies such as cryoablation and radiofrequency ablation may lead to local cancer control and avoid surgical complications and morbidity. In the setting of metastatic RCC, radical nephrectomy, or cytoreductive nephrectomy, is considered a palliative surgery, usually part of a multimodality treatment approach that requires systemic treatments.

  10. Bypass surgery versus stenting for the treatment of multivessel disease in patients with unstable angina compared with stable angina

    OpenAIRE

    de Feyter, Pim; Heuvel, P.; Unger, Felix; Beyar, R; Lindeboom, Wietze; de Valk, Vincent; Milo, S; Simon, Rudiger; Tyers, Frank; Regensburger, D.; Crean, Peter; Penn, Ian; McGovern, E; Cauwelaert, C.; Serruys, Patrick

    2002-01-01

    textabstractBACKGROUND: Earlier reports have shown that the outcome of balloon angioplasty or bypass surgery in unstable angina is less favorable than in stable angina. Recent improvements in percutaneous treatment (stent implantation) and bypass surgery (arterial grafts) warrant reevaluation of the relative merits of either technique in treatment of unstable angina. Methods and Results- Seven hundred fifty-five patients with stable angina were randomly assigned to coronary stenting (374) or ...

  11. The spectrum of Apert syndrome: phenotype, particularities in orthodontic treatment, and characteristics of orthognathic surgery

    Directory of Open Access Journals (Sweden)

    Ehmer Ulrike

    2007-02-01

    Full Text Available Abstract In the PubMed accessible literature, information on the characteristics of interdisciplinary orthodontic and surgical treatment of patients with Apert syndrome is rare. The aim of the present article is threefold: (1 to show the spectrum of the phenotype, in order (2 to elucidate the scope of hindrances to orthodontic treatment, and (3 to demonstrate the problems of surgery and interdisciplinary approach. Children and adolescents who were born in 1985 or later, who were diagnosed with Apert syndrome, and who sought consultation or treatment at the Departments of Orthodontics or Craniomaxillofacial Surgery at the Dental School of the University Hospital of Münster (n = 22; 9 male, 13 female were screened. Exemplarily, three of these patients (2 male, 1 female, seeking interdisciplinary (both orthodontic and surgical treatment are presented. Orthodontic treatment before surgery was performed by one experienced orthodontist (AH, and orthognathic surgery was performed by one experienced surgeon (UJ, who diagnosed the syndrome according to the criteria listed in OMIM™. In the sagittal plane, the patients suffered from a mild to a very severe Angle Class III malocclusion, which was sometimes compensated by the inclination of the lower incisors; in the vertical dimension from an open bite; and transversally from a single tooth in crossbite to a circular crossbite. All patients showed dentitio tarda, some impaction, partial eruption, idopathic root resorption, transposition or other aberrations in the position of the tooth germs, and severe crowding, with sometimes parallel molar tooth buds in each quarter of the upper jaw. Because of the severity of malocclusion, orthodontic treatment needed to be performed with fixed appliances, and mainly with superelastic wires. The therapy was hampered with respect to positioning of bands and brackets because of incomplete tooth eruption, dense gingiva, and mucopolysaccharide ridges. Some teeth did not

  12. Gait Patterns in Twins with Cerebral Palsy: Similarities and Development over Time after Multilevel Surgery

    Science.gov (United States)

    van Drongelen, Stefan; Dreher, Thomas; Heitzmann, Daniel W. W.; Wolf, Sebastian I.

    2013-01-01

    To examine gait patterns and gait quality, 7 twins with cerebral palsy were measured preoperatively and after surgical intervention. The aim was to study differences and/or similarities in gait between twins, the influence of personal characteristics and birth conditions, and to describe the development of gait over time after single event…

  13. Gait Patterns in Twins with Cerebral Palsy: Similarities and Development over Time after Multilevel Surgery

    Science.gov (United States)

    van Drongelen, Stefan; Dreher, Thomas; Heitzmann, Daniel W. W.; Wolf, Sebastian I.

    2013-01-01

    To examine gait patterns and gait quality, 7 twins with cerebral palsy were measured preoperatively and after surgical intervention. The aim was to study differences and/or similarities in gait between twins, the influence of personal characteristics and birth conditions, and to describe the development of gait over time after single event…

  14. Effects of preoperative bromocriptine treatment on prolactin-secreting pituitary adenoma surgery

    Science.gov (United States)

    CAO, YINGXIAO; WANG, FENGJU; LIU, ZHENBO; JIAO, BAOHUA

    2016-01-01

    Pituitary adenomas are benign intracranial endocrine tumors, accounting for ~10% of intracranial tumors. The aim of the present study was to analyze the effects of preoperative treatment with bromocriptine on the surgical treatment and postoperative complications of prolactin-secreting pituitary adenomas (prolactinomas). Data from 102 patients whose prolactinomas were surgically treated between March 2006 and March 2010 were retrospectively reviewed in the present study. The study group included 54 patients who had been treated preoperatively with bromocriptine. The patients were examined by magnetic resonance imaging (MRI) of the head and coronal computed tomography (CT) scanning, after which the pathological diagnosis of prolactinoma was confirmed. A total of 64 patients underwent total resection surgery through the nose and sphenoid sinus, and 25 patients underwent subtotal resection surgery or excision of a large portion of the tumor, leaving only a small quantity of residual tumor or tumor capsule. Patients were followed up for 1–9 months using MRI and measurements of serum prolactin levels. Seven patients were lost to follow-up. The results of the present study demonstrated that patients who were treated with large doses of bromocriptine or used bromocriptine chronically suffered from an increased rate of surgical difficulties and postoperative complications, as compared with the patents who had not been pre-treated with bromocriptine. In conclusion, oral administration of bromocriptine is important in the treatment of prolactinoma tumors. However, large doses or long-term use of bromocriptine may increase difficulties in surgery or postoperative complications, and reduce its ability to treat prolactinonas, as it can lead to hardening of the tumor tissue and capsules, and aggravate pituitary stalk adhesions. PMID:27168837

  15. Efficacy of Surgery Combined with Autologous Bone Marrow Stromal Cell Transplantation for Treatment of Intracerebral Hemorrhage

    Directory of Open Access Journals (Sweden)

    Jianxin Zhu

    2015-01-01

    Full Text Available Bone marrow stromal cells (BMSCs may differentiate into nerve cells under a certain condition; however, the clinical application for treating nervous system disease remains unclear. The aim is to assess the safety profile, feasibility, and effectiveness of surgery combined with autologous BMSCs transplantation for treating ICH. 206 ICH patients who had received surgical procedure were divided into transplantation (n=110 or control group (n=96. For transplantation group, BMSCs were injected into the perihemorrhage area in the base ganglia through an intracranial drainage tube 5.5 (3.01–6.89 days after surgery, followed by a second injection into the subarachnoid space through lumbar puncture 4 weeks later. Neurologic impairment and daily activities were assessed with National Institute Stroke Scale (NIHSS, Barthel index, and Rankin scale before transplantation and 6 months and 12 months after transplantation. Our results revealed that, compared with control group, NIHSS score and Rankin scale were both significantly decreased but Barthel index was increased in transplantation group after 6 months. Interestingly, no significant difference was observed between 12 months and 6 months. No transplantation-related adverse effects were investigated during follow-up assessments. Our findings suggest that surgery combined with autologous BMSCs transplantation is safe for treatment of ICH, providing short-term therapeutic benefits.

  16. [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.

  17. [A successful treatment by surgery for axillary lymph node recurrence of lung cancer].

    Science.gov (United States)

    Oda, Goshi; Kobayashi, Toshiko; Yokosuka, Tetsuya; Yasuno, Masamichi

    2012-11-01

    This case concerns a 78-year-old man, who was diagnosed with lung cancer at the age of 73. He underwent right lobectomy and lymph node dissection, and pathological analysis revealed a poorly differentiated adenocarcinoma, pT1N0M0 pStage IA. 15 months after surgery, computed tomography showed recurrence of lung cancer at the apex of thoracic cavity. He underwent radiation to the recurrence site, and 33 months after surgery, fluorodeoxyglucose uptake was observed at the axillary and infraclavicular lymph nodes in positron emission tomography examination. Treatment with pemetrexed was started because carcinomatous pericarditis was also found. Although pericardial effusion disappeared, the patient complained of the enlarged size of the axillary and infraclavicular lymph nodes and severe numbness in an arm. Beyond lymph node involvement, no other metastatic sites were found. An operation was performed to relieve the pain and the pathological analysis of lymph nodes showed metastases of lung cancer. The operation successfully reduced the pain experienced by the patient. There has been no further recurrence in the 9 months following surgery. Axillary lymph node metastasis is thought to be a distant metastasis; however, this is a case where local control was needed and was effective.

  18. From minimal to maximal surgery in the treatment ofhepatocarcinoma: A review

    Institute of Scientific and Technical Information of China (English)

    Marcos Vinicius Perini; Graham Starkey; Michael A Fink; Ramesh Bhandari; Vijayaragavan Muralidharan; Robert Jones; Christopher Christophi

    2015-01-01

    Hepatocellular carcinoma represents one of the mostchallenging frontiers in liver surgery. Surgeons have toface a broad spectrum of aspects, from the underlyingliver disease to the new surgical techniques. Safe liverresection can be performed in patients with portalhypertension and well-compensated liver function witha 5-year survival rate of 50%, offering good longtermsresults in selected patients. With the advancesin laparoscopic surgery, major liver resections can beperformed with minimal harm, avoiding the woundand leak complications related to the laparotomies.Studies have shown that oncological margins are thesame as in open surgery. In patients submitted to liverresection (either laparoscopic or open) who experiencerecurrence, re-resection or salvage liver transplantationhas been showing to be an alternative approach in wellselected cases. The decision making approach to thecirrhotic patient is becoming more complex and shouldinvolve hepatologists, liver surgeons, radiologists andoncologists. Better understanding of the different riskfactors for recurrence and survival should be aimed inthese multidisciplinary discussions. We here in discussthe hot topics related to surgical risk factors regardingthe surgical treatment of hepatocellular carcinomaanatomical resection, margin status, macrovasculartumor invasion, the place of laparoscopy, salvage livertransplantation and liver transplantation.

  19. Treatment of resectable distal rectal cancer with preoperative chemoradiation and sphincter saving surgery

    Directory of Open Access Journals (Sweden)

    Omrani Pour R

    2000-06-01

    Full Text Available To determine if pre-operative combined chemoradiation therapy increase sphincter preservation in the treatment of low-lying rectal cancer, 15 patients were treated with pre-operative chemoradiation: 5FU plus mitomycin C plus 4500-5000 Rad concurrent external beam radiotherapy between Jan 1997 and Jan 1999. There were 10 men and 5 women (Mean age: 49 y with the diagnosis of invasive resectable primary adenocarcinoma of distal rectum limited to pelvis. Median tumor distance from anal verge was 3.3 cm (Range 0-5 cm and half of the patients were absolute candidate for abdominoperineal resection. After 4-6 weeks, all patients were undergone proctectomy and eventually sphincter preservation surgery was done on 9 patients with colonal anastomosis. Function of sphincter was excellent in 6 of them (66% and good in 3 patients (33%. There was no case of incontinence. Complications of surgery were minimal: One case of stricture (10% and one case of partial rupture of anastomosis (10%. Complete pathologic response was achieved on one patient (6.6% and combined pre-operative chemoradiation has changed the plane of surgery from abdominoperineal resection to sphincter saving in 69.2% of patients.

  20. Treatment of huge hypertensive putaminal hemorrhage by surgery and cerebrospinal fluid drainage.

    Science.gov (United States)

    Zhang, Hong-Tian; Xue, Sha; Li, Pei-Jian; Fu, Yan-Bin; Xu, Ru-Xiang

    2013-09-01

    There is limited information available regarding the treatment of huge hypertensive putaminal hemorrhage (HPH). This study aimed to evaluate our experience of 33 patients with huge HPH who were treated by open surgery (decompressive craniectomy and hematoma evacuation) and external cerebrospinal fluid (CSF) drainage. We reviewed the records of 33 consecutive patients admitted to our hospital with huge HPH (≥ 60 cm(3)). All patients were treated by decompressive craniectomy, hematoma evacuation, and CSF drainage. Data collected included age, gender, blood pressure at admission, Glasgow Coma Scale (GCS) score, intracranial hemorrhage (ICH) location, ICH volume, degree of midline shift, presence/absence of basal cistern obliteration at admission and before surgery, and presence/absence of intraventricular hemorrhage (IVH). Outcome was assessed by the Glasgow Outcome Scale score at 30 days after surgery. The median GCS score was 5.0 at admission, and improved to 8.0 at 1 week after surgery. The median ICH volume was 95 cm(3) before surgery and 4 cm(3) after surgery. IVH was observed in 93.9% of patients. The overall survival rate to discharge was 75.6% (25/33), including 15.1% (4/33) with good function, 36.4% (12/33) with disability, and 24.3% (8/33) in a vegetative state. The mortality rate was 24.3% (8/33). Patients with right-sided ICH had better outcomes than those with left-sided ICH. No patients with GCS score ≤ 6 and ICH volume ≥ 90cm(3) at admission achieved good postoperative function. Operative time was significantly shorter with hematoma evacuation via the transcortical approach than via the transsylvian approach (3.41 ± 0.75 h vs. 4.14 ± 0.59 h, Phuge HPH by decompressive craniectomy, hematoma evacuation, and CSF drainage is life-saving. Patients with GCS score 7-8, ICH volume 60-90 cm(3), and right-sided ICH may achieve good recovery. The transcortical approach appears to be more effective than the transsylvian approach for rapid decompression of

  1. Numbers of Beauty: An Innovative Aesthetic Analysis for Orthognathic Surgery Treatment Planning.

    Science.gov (United States)

    Marianetti, Tito Matteo; Gasparini, Giulio; Midulla, Giulia; Grippaudo, Cristina; Deli, Roberto; Cervelli, Daniele; Pelo, Sandro; Moro, Alessandro

    2016-01-01

    The aim of this study was to validate a new aesthetic analysis and establish the sagittal position of the maxilla on an ideal group of reference. We want to demonstrate the usefulness of these findings in the treatment planning of patients undergoing orthognathic surgery. We took a reference group of 81 Italian women participating in a national beauty contest in 2011 on which we performed Arnett's soft tissues cephalometric analysis and our new "Vertical Planning Line" analysis. We used the ideal values to elaborate the surgical treatment planning of a second group of 60 consecutive female patients affected by skeletal class III malocclusion. Finally we compared both pre- and postoperative pictures with the reference values of the ideal group. The ideal group of reference does not perfectly fit in Arnett's proposed norms. From the descriptive statistical comparison of the patients' values before and after orthognathic surgery with the reference values we observed how all parameters considered got closer to the ideal population. We consider our "Vertical Planning Line" a useful help for orthodontist and surgeon in the treatment planning of patients with skeletal malocclusions, in combination with the clinical facial examination and the classical cephalometric analysis of bone structures.

  2. Numbers of Beauty: An Innovative Aesthetic Analysis for Orthognathic Surgery Treatment Planning

    Directory of Open Access Journals (Sweden)

    Tito Matteo Marianetti

    2016-01-01

    Full Text Available The aim of this study was to validate a new aesthetic analysis and establish the sagittal position of the maxilla on an ideal group of reference. We want to demonstrate the usefulness of these findings in the treatment planning of patients undergoing orthognathic surgery. We took a reference group of 81 Italian women participating in a national beauty contest in 2011 on which we performed Arnett’s soft tissues cephalometric analysis and our new “Vertical Planning Line” analysis. We used the ideal values to elaborate the surgical treatment planning of a second group of 60 consecutive female patients affected by skeletal class III malocclusion. Finally we compared both pre- and postoperative pictures with the reference values of the ideal group. The ideal group of reference does not perfectly fit in Arnett’s proposed norms. From the descriptive statistical comparison of the patients’ values before and after orthognathic surgery with the reference values we observed how all parameters considered got closer to the ideal population. We consider our “Vertical Planning Line” a useful help for orthodontist and surgeon in the treatment planning of patients with skeletal malocclusions, in combination with the clinical facial examination and the classical cephalometric analysis of bone structures.

  3. Postoperative ileus: Impact of pharmacological treatment,laparoscopic surgery and enhanced recovery pathways

    Institute of Scientific and Technical Information of China (English)

    Knut; Magne; Augestad; Conor; P; Delaney

    2010-01-01

    Almost all patients develop postoperative ileus (POI) after abdominal surgery.POI represents the single largest factor influencing length of stay (LOS) after bowel resection,and has great implications for patients and resource utilization in health care.New methods to treat and decrease the length of POI are therefore of great importance.During the past decade,a substantial amount of research has been performed evaluating POI,and great progress has been made in our understanding and treatment of POI.Laparos...

  4. Contemporary Demographic, Treatment, and Geographic Distribution Patterns for Disorders of Sex Development.

    Science.gov (United States)

    Tejwani, Rohit; Jiang, Ruiyang; Wolf, Steven; Adkins, Deanna W; Young, Brian J; Alkazemi, Muhammad; Wiener, John S; Pomann, Gina-Maria; Purves, J Todd; Routh, Jonathan C

    2017-07-01

    This study aimed to describe the demographic characteristics, hospital utilizations, patterns of inpatient surgical management, and the overall state/regional variation in surgery rate among patients with disorders of sex development (DSD). We analyzed the Nationwide Inpatient Sample from 2001 to 2012 for patients younger than 21 years. DSD-related diagnoses and procedures were identified via International Classification of Diseases, Ninth Revision (ICD-9) codes. We identified a total of 43,968 DSD-related admissions. Of these, 73.4% of the admissions were designated as female and 642 (1.9%) were inpatient surgical admissions. Among neonates, less than 1% underwent any type of genital surgery. Nonsurgical admissions were associated with longer length of stay and higher cost. There was no significant regional variation in the rate of DSD surgeries, but we observed higher concentrations of DSD surgeries in states associated with tertiary referral centers.

  5. 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.

  6. Present and future patterns of practice and workforce needs in oral and maxillofacial surgery.

    Science.gov (United States)

    Spencer, A J; Szuster, F S; Brennan, D S

    1992-06-01

    Oral and maxillofacial surgeons have shown curiosity and concern for their present and future patterns of practice and workforce needs. Few oral and maxillofacial surgeons would not have an understanding of how they came to be, or opinions on where the specialty is and appears to be going. Such opinions, however, need to be rigorously tested against the best available information. Quantitative information is the substantive input to decisions on whether oral and maxillofacial surgeons wish to go where they appear to be going, and if so why, and if not, why not? The Oral and Maxillofacial Surgeons 1990 Workforce Study* aimed to provide information relevant to these questions. Oral and maxillofacial surgeons are surprising in both their heterogeneity in patterns of practice and homogeneity in most of the content of services provided. Projections of the workforce indicate that a status quo in recruitment is actually a steady decline in capacity to serve the community, a picture in contrast to the international comparative data and opinion that supports a broadening in the service role of oral and maxillofacial surgeons. The Oral and Maxillofacial Surgeons 1990 Workforce Study offers insights into present and future patterns of practice and workforce needs. Ultimately, however, decision-making in the specialty will reflect additional social, economic and dento-political factors to which the Australian and New Zealand Association of Oral and Maxillo-Facial Surgeons must be the major contributor.

  7. Prevalence, predictors and patterns of postoperative polyuria and hyponatraemia in the immediate course after transsphenoidal surgery for pituitary adenomas.

    Science.gov (United States)

    Hensen, J; Henig, A; Fahlbusch, R; Meyer, M; Boehnert, M; Buchfelder, M

    1999-04-01

    Disturbances of osmoregulation, leading to diabetes insipidus and hyponatraemia are well known complications after surgery in the sella region. This study was performed to examine the prevalence and predictors of polyuria and hyponatraemia after a complete and selective removal of pituitary adenomas was attempted via the transnasal-transsphenoidal approach. 1571 patients with pituitary adenomas (238 Cushing's disease, 405 acromegaly, 534 hormonally inactive adenomas, 358 prolactinoma, 23 Nelson's syndrome, and 13 thyrotropinoma) were daily examined within a 10-day postoperative inpatient observation period. Prevalence of patterns of polyuria (> 2500 ml) and oliguria/hyponatraemia (< 132 mmol/l) were surveyed as well as predictors of postoperative morbidity. 487 patients (31%) developed immediate postoperative hypotonic polyuria, 161 patients (10%) showed prolonged polyuria and 37 patients (2.4%) delayed hyponatraemia. A biphasic (polyuria-hyponatraemia) and triphasic (polyuria-hyponatraemia-polyuria) pattern was seen in 53 (3.4%) and 18 (1.1%) patients, respectively. Forty-one patients (2.6%) displayed immediate postoperative (day 1) hyponatraemia. Altogether, 8.4% of patients developed hyponatraemia at some time up to the 10th day postoperative, with symptomatic hyponatraemia in 32 patients (2.1%). Risk analysis showed that patients with Cushing's disease had a fourfold higher risk of polyuria than patients with acromegaly and a 2.8-fold higher risk for postoperative hyponatraemia. Younger age, male sex, and intrasellar expansion were associated with a higher risk of hypotonic polyuria, but this was not considered clinically relevant. The analysis illustrates that disturbances in osmoregulation resulting in polyuria and pertubations of serum sodium concentration are of very high prevalence and need observation even after selective transsphenoidal surgery for pituitary adenomas, especially in patients with Cushing's disease.

  8. Different activation patterns in the plasma kallikrein-kinin and complement systems during coronary bypass surgery.

    Science.gov (United States)

    Kongsgaard, U E; Smith-Erichsen, N; Geiran, O; Amundsen, E; Mollnes, T E; Garred, P

    1989-07-01

    Components of the plasma kallikrein-kinin and complement systems were determined in patients undergoing open heart surgery with cardiopulmonary bypass. Spontaneous kallikrein activity (KK), plasma prekallikrein (PKK), functional kallikrein inhibition capacity (KKI), C3 activation products (C3-act), and the terminal complement complex (TCC) were measured. A marked, transitory increase in KK and a decrease in PKK were found prior to cardiopulmonary bypass just after heparin injection. An additional decline in PKK and KKI during bypass with a return to near control levels in the postoperative period was observed. C3-act increased in all patients during bypass, reaching a peak value at wound closure. The TCC concentration also increased significantly during cardiopulmonary bypass, returned to control levels in the early postoperative period, and then increased again in the late postoperative period. It is concluded that activation of the kallikrein-kinin system started after injection of heparin, prior to cardiopulmonary bypass. Activation of both the initial and the terminal complement cascade, however, started only after onset of cardiopulmonary bypass.

  9. Pneumonia after Major Cancer Surgery: Temporal Trends and Patterns of Care

    Directory of Open Access Journals (Sweden)

    Vincent Q. Trinh

    2016-01-01

    Full Text Available Rationale. Pneumonia is a leading cause of postoperative complication. Objective. To examine trends, factors, and mortality of postoperative pneumonia following major cancer surgery (MCS. Methods. From 1999 to 2009, patients undergoing major forms of MCS were identified using the Nationwide Inpatient Sample (NIS, a Healthcare Cost and Utilization Project (HCUP subset, resulting in weighted 2,508,916 patients. Measurements. Determinants were examined using logistic regression analysis adjusted for clustering using generalized estimating equations. Results. From 1999 to 2009, 87,867 patients experienced pneumonia following MCS and prevalence increased by 29.7%. The estimated annual percent change (EAPC of mortality after MCS was −2.4% (95% CI: −2.9 to −2.0, P<0.001; the EAPC of mortality associated with pneumonia after MCS was −2.2% (95% CI: −3.6 to 0.9, P=0.01. Characteristics associated with higher odds of pneumonia included older age, male, comorbidities, nonprivate insurance, lower income, hospital volume, urban, Northeast region, and nonteaching status. Pneumonia conferred a 6.3-fold higher odd of mortality. Conclusions. Increasing prevalence of pneumonia after MCS, associated with stable mortality rates, may result from either increased diagnosis or more stringent coding. We identified characteristics associated with pneumonia after MCS which could help identify at-risk patients in order to reduce pneumonia after MCS, as it greatly increases the odds of mortality.

  10. Resistance Pattern of Antibiotics in Patient Underwent Open Heart Surgery With Nosocomial Infection in North of Iran.

    Science.gov (United States)

    Davoudi, Alireza; Najafi, Narges; Alian, Shahriar; Tayebi, Atefe; Ahangarkani, Fatemeh; Rouhi, Samaneh; Heydari, Amirhosein

    2015-08-06

    Patients who undergo cardiac surgery appear to be at increased risk for the development of Nosocomial infections (NIs). The development of antibiotic-resistant infections has been associated with significantly greater hospital mortality rates compared to similar infections caused by antibiotic-sensitive pathogens. The purpose of this study is survey of Nis and antibiotic resistance patterns of causative bacteria among patients who underwent open heart surgery in the north of Iran during a 2-year period between September 2012 and September 2014. In this cross-sectional study we evaluated 187 patients that underwent open heart surgery with NIs. Demographic feature, clinical characteristics and risk factors of each infection were recorded. The antibiotic susceptibility test was performed using the Minimum inhibitory concentration (MIC) method according to the standard protocol of Clinical & Laboratory Standards Institute (CLSI). Detection of Extended-spectrum beta-lactamase (ESBL) producing bacteria was performed by the double-disk synergy (DDS) test; also Methicillin-resistant Staphylococcus (MRSA) strains were identified by MRSA Screen Agar. The collected data were analyzed using the SPSS software (ver. 16) and, descriptive statistics were used. Out Of total of 2253 hospitalized patients who underwent open heart surgery, 187(5.05%) patients had NIs. 51.9% of the patients were female. The rates of surgical site infection (SSI), respiratory tract infection, endocarditis, Urinary tract infection (UTI), blood Infection and mediastinitis were 27.80, 25.66%, 17.64, 17.11% 8.55% and 3.20% respectively. E.coli and S.aureus were the most causative agents of NIs. The rate of ESBL-producing bacteria was 14.28- 71.42% among enterobacteriaceae and the rate of MRSA was 54.2% among S.aureus strains. All isolated Acinetobacter.spp were Multi-drug resistance (MDR). We showed that the rate of NIs among these high-risk patients was in the average level. But the emergence of MRSA and

  11. PHARMACOECONOMIC ASPECTS OF NICOTINE ADDICTION TREATMENT IN PATIENTS WITH ANGINA REQUIRING CARDIAC SURGERY

    Directory of Open Access Journals (Sweden)

    A. V. Rudakova

    2012-01-01

    Full Text Available Smoking is a major risk factor in patients with angina pectoris. Interventions that facilitate the rejection of it are an important part of the treatment. Aim. To analyze the cost effectiveness of the partial agonist of nicotinic receptors, varenicline, in patients with angina who require cardiac interventions. Material and methods. The estimation was conducted using a Markov model based on the results of clinical trials and epidemiological studies. The cost of treatment of complications were calculated on the basis of compulsory medical insurance rates for St. Petersburg in 2011. Results. The varenicline therapy in 70-year-old patients before cardiac surgery reduces hospital mortality at an extremely high cost-effectiveness (the cost of preventing one death - 148.8 thousand rubles. The cost/effectiveness ratio in the analysis for the period of survival of patients in this situation was 31.3 thousand rubles for 1 additional year of life. Life expectancy will be increased by an average of 0.147 years. Analysis for the period of survival of 50-year-old patients has shown that in patients after cardiac surgery cost-effectiveness of varenicline is extremely high (in the analysis from the perspective of the health care system the cost/effectiveness ratio was 36.0 thousand rubles for 1 additional year of life, in the analysis, taking into account the social perspective – 17.9 thousand rubles for 1 additional year of life. Increase in the life expectancy of 50 year-old patients will be 0.291 year in average. Conclusion. Varenicline therapy of patients with angina pectoris is the economy before cardiac surgery , and after their execution, and this applies not only young, but older patients. The desirability of varenicline including to federal and regional programs to reduce cardiovascular morbidity and mortality is shown.

  12. PHARMACOECONOMIC ASPECTS OF NICOTINE ADDICTION TREATMENT IN PATIENTS WITH ANGINA REQUIRING CARDIAC SURGERY

    Directory of Open Access Journals (Sweden)

    A. V. Rudakova

    2015-12-01

    Full Text Available Smoking is a major risk factor in patients with angina pectoris. Interventions that facilitate the rejection of it are an important part of the treatment. Aim. To analyze the cost effectiveness of the partial agonist of nicotinic receptors, varenicline, in patients with angina who require cardiac interventions. Material and methods. The estimation was conducted using a Markov model based on the results of clinical trials and epidemiological studies. The cost of treatment of complications were calculated on the basis of compulsory medical insurance rates for St. Petersburg in 2011. Results. The varenicline therapy in 70-year-old patients before cardiac surgery reduces hospital mortality at an extremely high cost-effectiveness (the cost of preventing one death - 148.8 thousand rubles. The cost/effectiveness ratio in the analysis for the period of survival of patients in this situation was 31.3 thousand rubles for 1 additional year of life. Life expectancy will be increased by an average of 0.147 years. Analysis for the period of survival of 50-year-old patients has shown that in patients after cardiac surgery cost-effectiveness of varenicline is extremely high (in the analysis from the perspective of the health care system the cost/effectiveness ratio was 36.0 thousand rubles for 1 additional year of life, in the analysis, taking into account the social perspective – 17.9 thousand rubles for 1 additional year of life. Increase in the life expectancy of 50 year-old patients will be 0.291 year in average. Conclusion. Varenicline therapy of patients with angina pectoris is the economy before cardiac surgery , and after their execution, and this applies not only young, but older patients. The desirability of varenicline including to federal and regional programs to reduce cardiovascular morbidity and mortality is shown.

  13. National practice patterns and outcomes of pediatric nephrectomy: comparison between urology and general surgery.

    Science.gov (United States)

    Suson, Kristina D; Wolfe-Christensen, Cortney; Elder, Jack S; Lakshmanan, Yegappan

    2015-05-01

    In adults nephrectomy is under the purview of urologists, but pediatric urologists and pediatric general surgeons perform extirpative renal surgery in children. We compared the contemporary performance and outcome of all-cause nephrectomy at pediatric hospitals as performed by pediatric urologists and pediatric general surgeons. We queried the Pediatric Health Information System to identify patients 0 to 18 years old who were treated with nephrectomy between 2004 and 2013 by pediatric urologists and pediatric general surgeons. Data points included age, gender, severity level, mortality risk, complications and length of stay. Patients were compared by APR DRG codes 442 (kidney and urinary tract procedures for malignancy) and 443 (kidney and urinary tract procedures for nonmalignancy). Pediatric urologists performed more all-cause nephrectomies. While pediatric urologists were more likely to operate on patients with benign renal disease, pediatric general surgeons were more likely to operate on children with malignancy. Patients on whom pediatric general surgeons operated had a higher average severity level and were at greater risk for mortality. After controlling for differences patients without malignancy operated on by pediatric urologists had a shorter length of stay, and fewer medical and surgical complications. There was no difference in length of stay, or medical or surgical complications in patients with malignancy. Overall compared to pediatric general surgeons more nephrectomies are performed by pediatric urologists. Short-term outcomes, including length of stay and complication rates, appear better in this data set in patients without malignancy who undergo nephrectomy by pediatric urologists but there is no difference in outcomes when nephrectomy is performed for malignancy. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  14. NASA Model of "Threat and Error" in Pediatric Cardiac Surgery: Patterns of Error Chains.

    Science.gov (United States)

    Hickey, Edward; Pham-Hung, Eric; Nosikova, Yaroslavna; Halvorsen, Fredrik; Gritti, Michael; Schwartz, Steven; Caldarone, Christopher A; Van Arsdell, Glen

    2017-04-01

    We introduced the National Aeronautics and Space Association threat-and-error model to our surgical unit. All admissions are considered flights, which should pass through stepwise deescalations in risk during surgical recovery. We hypothesized that errors significantly influence risk deescalation and contribute to poor outcomes. Patient flights (524) were tracked in real time for threats, errors, and unintended states by full-time performance personnel. Expected risk deescalation was wean from mechanical support, sternal closure, extubation, intensive care unit (ICU) discharge, and discharge home. Data were accrued from clinical charts, bedside data, reporting mechanisms, and staff interviews. Infographics of flights were openly discussed weekly for consensus. In 12% (64 of 524) of flights, the child failed to deescalate sequentially through expected risk levels; unintended increments instead occurred. Failed deescalations were highly associated with errors (426; 257 flights; p < 0.0001). Consequential errors (263; 173 flights) were associated with a 29% rate of failed deescalation versus 4% in flights with no consequential error (p < 0.0001). The most dangerous errors were apical errors typically (84%) occurring in the operating room, which caused chains of propagating unintended states (n = 110): these had a 43% (47 of 110) rate of failed deescalation (versus 4%; p < 0.0001). Chains of unintended state were often (46%) amplified by additional (up to 7) errors in the ICU that would worsen clinical deviation. Overall, failed deescalations in risk were extremely closely linked to brain injury (n = 13; p < 0.0001) or death (n = 7; p < 0.0001). Deaths and brain injury after pediatric cardiac surgery almost always occur from propagating error chains that originate in the operating room and are often amplified by additional ICU errors. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. The nature, patterns, clinical outcomes, and financial impact of intraoperative adverse events in emergency surgery.

    Science.gov (United States)

    Ramly, Elie P; Bohnen, Jordan D; Farhat, Maha R; Razmdjou, Shadi; Mavros, Michael N; Yeh, Daniel D; Lee, Jarone; Butler, Kathryn; De Moya, Marc; Velmahos, George C; Kaafarani, Haytham M A

    2016-07-01

    Little is known about intraoperative adverse events (iAEs) in emergency surgery (ES). We sought to describe iAEs in ES and to investigate their clinical and financial impact. The 2007 to 2012 administrative and American College of Surgeons-National Surgical Quality Improvement Program databases at our tertiary academic center were: (1) linked, (2) queried for all ES procedures, and then (3) screened for iAEs using the ICD-9-CM-based Patient Safety Indicator "accidental puncture/laceration". Flagged cases were systematically reviewed to: (1) confirm or exclude the occurrence of iAEs (defined as inadvertent injuries during the operation) and (2) extract additional variables such as procedure type, approach, complexity (measured by relative value units), need for adhesiolysis, and extent of repair. Univariate and multivariate analyses were performed to assess the independent impact of iAEs on 30-day morbidity, mortality, and hospital charges. Of a total of 9,288 patients, 1,284 (13.8%) patients underwent ES, of which 23 had iAEs (1.8%); 18 of 23 (78.3%) of the iAEs involved the small bowel or spleen, 10 of 23 (43.5%) required suture repair, and 8 of 23 (34.8%) required tissue or organ resection. Compared with those without iAEs, patients with iAEs were older (median age 62 vs 50; P = .04); their procedures were more complex (total relative value unit 46.7, interquartile range [27.5 to 52.6] vs 14.5 [.5 to 30.2]; P 3 hours: 52% vs 8%; P 7 days; odds ratio, 5.60 [1.54 to 20.35]; P = .01]. A trend toward increased mortality did not reach statistical significance. In ES, iAEs are independently associated with significantly higher postoperative morbidity and prolonged LOS. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Endoscopic surgery in the treatment of crista galli pneumatization evolving with localizated frontal headaches

    Directory of Open Access Journals (Sweden)

    Socher, Jan Alessandro

    2014-01-01

    Full Text Available Introduction: The crista galli is part of the ethmoid bone and thus may suffer from the process of pneumatization. Pneumatization occurs in between 3% and 14% of patients, resulting from air cells in the frontal or ethmoid sinuses. Aim: To describe 3 cases of crista galli pneumatization in which the patients developed infection and were treated surgically by endoscopic techniques. Method: We present 3 case studies of patients complaining of severe frontal headaches. The patients underwent ENT evaluation, examination by video-endoscopy, and computed tomography, which identified crista galli pneumatization with mucosal thickening and the presence of fluid. Patients underwent treatment with antibiotics and corticosteroids; however, they showed no symptomatic improvement, displayed recurrence of symptoms, and maintained radiographic changes. Thus, patients then underwent drainage through the crista galli via an endoscopic procedure. Discussion: During surgery, mucopurulence and/or mucosal thickening and edema were identified in the pneumatized crista galli. There were no complications during or after surgery. Postoperatively, headache was improved in patients after a minimum follow-up of 6 months. Conclusion: Crista galli pneumatization can result in infection, simulating rhinosinusitis. When there is little response to drug therapy, endoscopic surgical treatment is required; the current cases demonstrate that this technique is safe and effective.

  17. Pregnancy Rate after Controlled Ovarian Hyperstimulation and Intrauterine Insemination for the Treatment of Endometriosis following Surgery

    Directory of Open Access Journals (Sweden)

    Attila Keresztúri

    2015-01-01

    Full Text Available Objective. To compare pregnancy rate after controlled ovarian hyperstimulation and intrauterine insemination (COH-IUI with no treatment in patients with endometriosis-associated infertility treated with laparoscopy. Design. A clinical cohort study. Setting. University-level tertiary care center. Patients. 238 women with various stages of endometriosis after laparoscopic treatment. Interventions. Either COH-IUI or follow-up for 12 months. Main Outcome Measures. The primary outcome measures were clinical pregnancy and live birth rate. Predictive factors evaluated were female age, maternal BMI, and duration of infertility. Results. The pregnancy rate attained after the integrated laparoscopy–COH-IUI approach was 53.4%, while it was significantly lower (38.5% in the control group. Similarly, a significant difference was observed in live births (48.3% versus 34.2%. Patients with severe endometriosis were less likely to achieve pregnancy (38% and live birth (35% than their counterparts with milder forms (57% and 53%. Conclusions. In patients with endometriosis-based infertility, surgery followed by COH-IUI is more effective than surgery alone.

  18. Comparison of time required for traditional versus virtual orthognathic surgery treatment planning.

    Science.gov (United States)

    Wrzosek, M K; Peacock, Z S; Laviv, A; Goldwaser, B R; Ortiz, R; Resnick, C M; Troulis, M J; Kaban, L B

    2016-09-01

    Virtual surgical planning (VSP) is a tool for predicting complex surgical movements in three dimensions and it may reduce preoperative laboratory time. A prospective study to compare the time required for standard preoperative planning versus VSP was conducted at Massachusetts General Hospital from January 2014 through January 2015. Workflow data for bimaxillary cases planned by both standard techniques and VSP were recorded in real time. Time spent was divided into three parts: (1) obtaining impressions, face-bow mounting, and model preparation; (2) occlusal analysis and modification, model surgery, and splint fabrication; (3) online VSP session. Average times were compared between standard treatment planning (sum of parts 1 and 2) and VSP (sum of parts 1 and 3). Of 41 bimaxillary cases included, 20 were simple (symmetric) and 21 were complex (asymmetry and segmental osteotomies). Average times for parts 1, 2, and 3 were 4.43, 3.01, and 0.67h, respectively. The average time required for standard treatment planning was 7.45h and for VSP was 5.10h, a 31% time reduction (Porthognathic surgery cases.

  19. Treatment for preventing bleeding in people with haemophilia or other congenital bleeding disorders undergoing surgery.

    Science.gov (United States)

    Coppola, Antonio; Windyga, Jerzy; Tufano, Antonella; Yeung, Cindy; Di Minno, Matteo Nicola Dario

    2015-02-09

    of safety assessments, no fatal adverse events were reported. The second primary outcome of blood loss was assessed after surgery and these trials showed the reduction of blood loss and requirement of post-operative replacement treatment in people receiving antifibrinolytic agents compared with placebo. The remaining primary outcome of need for re-intervention was not reported by either trial.Two trials reported on 53 people with haemophilia A and B with inhibitors treated with different regimens of recombinant activated factor VII (rFVIIa) for haemostatic coverage of 33 major and 20 minor surgical interventions. Neither of the included trials specifically addressed any of the review's primary outcomes (mortality, blood loss and need for re-intervention). In one trial a high-dose rFVIIa regimen (90 μg/kg) was compared with a low-dose regimen (35 μg/kg); the higher dose showed increased haemostatic efficacy, in particular in major surgery, with shorter duration of treatment, similar total dose of rFVIIa administered and similar safety levels. In the second trial, bolus infusion and continuous infusion of rFVIIa were compared, showing similar haemostatic efficacy, duration of treatment and safety. There is insufficient evidence from randomised controlled trials to assess the most effective and safe haemostatic treatment to prevent bleeding in people with haemophilia or other congenital bleeding disorders undergoing surgical procedures. Ideally large, adequately powered, and well-designed randomised controlled trials would be needed, in particular to address the cost-effectiveness of such demanding treatments in the light of the increasing present economic constraints, and to explore the new challenge of ageing patients with haemophilia or other congenital bleeding disorders. However, performing such trials is always a complex task in this setting and presently does not appear to be a clinical and research priority. Indeed, major and minor surgeries are effectively

  20. Major complications of bariatric surgery: endoscopy as first-line treatment.

    Science.gov (United States)

    Eisendrath, Pierre; Deviere, Jacques

    2015-12-01

    Leaks are the most frequent early postoperative complication in the two most popular bariatric procedures, Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy. Multimodal therapy based on self-expandable stent insertion 'to cover' the defect is the most widely documented technique to date with a reported success rate >80%. Additional experimental techniques 'to close' the defect or 'to drain' the paradigestive cavity have been reported with encouraging results. The role of endoscopy in early postoperative bleeding is limited to management of bleeds arising from fresh sutures and the diagnosis of chronic sources of bleeding such as marginal ulcer after RYGB. Post-RYGB stricture is a more delayed complication than leaks and the role of endoscopic dilation as a first-line treatment in this indication is well documented. Ring and band placement are outdated procedures for obesity treatment, but might still be an indication for endoscopic removal, a technique which does not compromise further surgery, if needed.

  1. Magnetic resonance-guided focused ultrasound surgery (MRgFUS) treatment for uterine fibroids

    Science.gov (United States)

    Abdullah, BJJ; Subramaniam, RV; Omar, SS; Wragg, P; Ramli, N; Wui, AL; Lee, CC; Yusof, Y

    2010-01-01

    Magnetic Resonance-guided focused Ultrasound Surgery (MRgFUS) is gaining popularity as an alternative to medical and surgical interventions in the management of symptomatic uterine fibroids. Studies have shown that it is an effective non-invasive treatment with minimal associated risks as compared to myomectomy and hysterectomy. MRgFUS can be offered to a majority of patients suffering from symptomatic uterine fibroids. It has been suggested that the use of broader inclusion criteria as well as the mitigation techniques makes it possible to offer MRgFUS to a much larger subset of patients than previously believed. This paper will describe how MRgFUS treatment for uterine fibroids is performed at the University of Malaya Medical Centre, Kuala Lumpur, Malaysia. PMID:21611036

  2. [Laparoscopic diagnosis and treatment of early adhesive small bowel obstruction after gynecological surgery].

    Science.gov (United States)

    Timofeev, M E; Breusenko, V G; Shapoval'iants, S G; Fedorov, E D; Larichev, S E; Kretsu, V N

    2015-01-01

    It is presented the results of diagnostic and curative laparoscopic interventions in 33 patients with acute early adhesive small bowel obstruction. Ileus developed after surgical treatment (laparotomy) of different gynecological diseases. Laparoscopy appeared as the most informative diagnostic method to confirm diagnosis in all patients, to estimate state of abdominal cavity and small pelvis organs what can help to determine method of surgical treatment. Contraindications for laparoscopic surgery were identified in 12 (36.4%) patients and conversion to laparotomy was applied in this group. Postoperative complications were diagnosed in 1 (8.3%) patient. 2 (16.6%) patients died. Early adhesive ileus was resolved laparoscopically in 21 (63.6%) of 33 patients. Recurrent acute early adhesive ileus was detected in 1 (4.7%) patient.

  3. New treatment concept in profile surgery. Perfiloplastia. Nuevo concepto de tratamiento

    Directory of Open Access Journals (Sweden)

    Domingo Francisco Fuentes Febles

    2009-04-01

    Full Text Available Background: Facial profile defects in nose prominence and retrognatia may cause psychological trauma. Aesthetic surgery allows patients with convex profile to recover psychologically and functionally. The possibility of performing both corrections in only one surgery enhances patient’s recovering y and reduces the cost. Objective: To prove the effectiveness of performing profile aesthetic treatment in only one surgery. Method: Descriptive study of 18 patients operated in a period of five years in Cienfuegos hospital Dr. Gustavo Aldereguía Lima. Anterosuperior and basilar osteotomies were performed,as well as rhinoplasty and silicon grafts. Corrections are performed in only one ambulatory surgery. Results: Patients´ ages varied between 18 and 30, including two patients of 40 and 50 years each. There were no complications and all of them were satisfied with the clinic and aesthetic results. Conclusion: Profile plastic surgery can be effectively performed in only one surgical time to fix convex profile.Fundamento: Las personas que poseen perfiles faciales con dificultades de prominencia de la nariz y retrognatia, en muchos casos se sienten como minusválidos y sufren daños psicológicos. La cirugía estética permite recuperar funcional y psíquicamente a los pacientes portadores de un perfil convexo. La posibilidad de realizar las dos correcciones en un solo acto quirúrgico favorece la recuperación del paciente y baja los costos hospitalarios. Objetivo: Demostrar la factibilidad de llevar a efecto el tratamiento quirúrgico de perfiloplastia en un solo tiempo quirúrgico. Métodos: Estudio sobre 18 pacientes, que en un período de cinco años fueron operados en el Hospital provincial “Dr. Gustavo Aldereguía Lima” de Cienfuegos. Se aplicaron los métodos de osteotomía segmentaria anterosuperior y

  4. Executive functioning pattern as a prognostic indicator for shunt implantation surgery in patients with normal pressure hydrocephalus - A preliminary report.

    Science.gov (United States)

    Nowak, Marcin M; Fersten, Ewa; Głowacki, Mariusz

    2016-01-01

    The problem of executive functions in patients with normal pressure hydrocephalus (NPH) was investigated in the study. Executive function parameters were assumed to be among factors that may differentiate the clinical pattern in NPH. Two major indicators of executive functioning, i.e. flexibility and productivity of thinking, were assessed in neuropsychological examination using the Trail Making Test (TMT), Verbal Fluency Test (COWAT), and the Wisconsin Card Sorting Test (WCST). Participants in the study were 18 patients with NPH divided using a set of diagnostic criteria into two subgroups: with idiopathic active hydrocephalus (ACT) or with arrested hydrocephalus (ARR). Executive functioning patterns were found to differentiate between the two NPH subgroups. Namely, patients diagnosed with active hydrocephalus (who qualify for shunt implantation surgery) tended to present lower levels of verbal fluency in all semantic categories, which suggests a decreased productivity of thinking. Besides, ACT patients' performance on the WCST was significantly inferior on two measures: (1) they committed more non-perseverative errors (which indicates their chaotic way of working on the test and the occurrence of random responses) and (2) displayed lower ability of "learning to learn" (which suggests their impaired flexibility of thinking). These aspects of executive function, with productivity and flexibility of thinking first and foremost, seem promising as additional prognostic indicators to consider in patient selection for shunt implantation.

  5. Current indications for low level laser treatment in maxillofacial surgery: a review.

    Science.gov (United States)

    Doeuk, C; Hersant, B; Bosc, R; Lange, F; SidAhmed-Mezi, M; Bouhassira, J; Meningaud, J P

    2015-04-01

    Low level laser treatment (LLLT) is currently being used for various disorders, but with no convincing scientific evidence. Most recently we have noticed an increase in published randomised controlled trials (RCTs) that have focused on its applications in wound healing, scarring, disorders of the temporomandibular joint (TMJ), oral mucositis, and dental pain. Our aim therefore was to assess the scientific evidence about its current efficacy in maxillofacial surgery. We reviewed PubMed from January 2003 to January 2013 using the key phrase "low level laser treatment". Our inclusion criterion was intervention studies in humans of more than 10 patients. We excluded animal studies and papers in languages other than English, French, and German. We found 45 papers that we screened independently. The resulting full texts were scrutinised by two authors who awarded a maximum of 5 points using the Jadad scale for assessing the quality of RCT, and extracted the data according to sample size, variables of LLLT, the authors' conclusions, and the significance of the result. LLLT seems to be effective for the treatment of oral mucositis after treatment for head and neck cancer. However, it cannot yet be considered a valid treatment for disorders of the TMJ. It seems to improve gingival healing, and myofacial and dental pain.

  6. Thyroid Surgery

    Science.gov (United States)

    ... etc.). Surgery is also an option for the treatment of hyperthyroidism (Grave’s disease or a “toxic nodule” (see Hyperthyroidism brochure ), for large and multinodular goiters and for any goiter that may be causing ... MEANS OF TREATMENT? Surgery is definitely indicated to remove nodules suspicious ...

  7. Outcome in adolescent idiopathic scoliosis after brace treatment and surgery assessed by means of the Scoliosis Research Society Instrument 24.

    Science.gov (United States)

    Weigert, Karen Petra; Nygaard, Linda Marie; Christensen, Finn Bjarke; Hansen, Ebbe Stender; Bünger, Cody

    2006-07-01

    A retrospectively designed long-term follow-up study of adolescent idiopathic scoliosis (AIS) patients who had completed treatment, of at least 2 years, by means of brace, surgery, or both brace and surgery. This study is to assess the outcome after treatment for AIS by means of the Scoliosis Research Society Outcome Instrument 24 (SRS 24). One hundred and eighteen AIS patients (99 females and 19 males), treated at the Aarhus University Hospital from January 1, 1987 to December 31, 1997, were investigated with at least 2 years follow-up at the time of receiving a posted self-administered questionnaire. Forty-four patients were treated with Boston brace (B) only, 41 patients had surgery (S), and 33 patients were treated both with brace and surgery (BS). The Cobb angles of the three treatment groups did not differ significantly after completed treatment. The outcome in terms of the total SRS 24 score was not significantly different among the three groups. B patients had a significantly better general (not treatment related) self-image and higher general activity level than the total group of surgically treated patients, while surgically treated patients scored significantly better in post-treatment self-image and satisfaction. Comparing B with BS we found a significantly higher general activity level in B patients, while the BS group had significantly higher satisfaction. There were no significant differences between BS and S patients in any of the domain scores. All treatment groups scored "fair or better" in all domain scores of the SRS 24 questionnaire, except in post-treatment function, where all groups scored worse than "fair". Improvement of appearance by means of surgical correction increases mean scores for post-treatment self-image and post-treatment satisfaction. Double-treatment by brace and surgery does not appear to jeopardize a good final outcome.

  8. Treatment outcomes after adjuvant radiotherapy following surgery for patients with stage I endometrial cancer.

    Science.gov (United States)

    Kim, Jiyoung; Lee, Kyung-Ja; Park, Kyung-Ran; Ha, Boram; Kim, Yi-Jun; Jung, Wonguen; Lee, Rena; Kim, Seung Cheol; Moon, Hye Sung; Ju, Woong; Kim, Yun Hwan; Lee, Jihae

    2016-12-01

    The purpose of this study is to evaluate the treatment outcomes of adjuvant radiotherapy using vaginal brachytherapy (VB) with a lower dose per fraction and/or external beam radiotherapy (EBRT) following surgery for patients with stage I endometrial carcinoma. The subjects were 43 patients with the International Federation of Gynecology and Obstetrics (FIGO) stage I endometrial cancer who underwent adjuvant radiotherapy following surgery between March 2000 and April 2014. Of these, 25 received postoperative VB alone, while 18 received postoperative EBRT to the whole pelvis; 3 of these were treated with EBRT plus VB. The median EBRT dose was 50.0 Gy (45.0-50.4 Gy) and the VB dose was 24 Gy in 6 fractions. Tumor dose was prescribed at a depth of 5 mm from the cylinder surface and delivered twice per week. The median follow-up period for all patients was 57 months (range, 9 to 188 months). Five-year disease-free survival (DFS) and overall survival (OS) for all patients were 92.5% and 95.3%, respectively. Adjuvant radiotherapy was performed according to risk factors and stage IB, grade 3 and lymphovascular invasion were observed more frequently in the EBRT group. Five-year DFS for EBRT and VB alone were 88.1% and 96.0%, respectively (p = 0.42), and 5-year OS for EBRT and VB alone were 94.4% and 96%, respectively (p = 0.38). There was no locoregional recurrence in any patient. Two patients who received EBRT and 1 patient who received VB alone developed distant metastatic disease. Two patients who received EBRT had severe complications, one each of grade 3 gastrointestinal complication and pelvic bone insufficiency fracture. Adjuvant radiotherapy achieved high DFS and OS with acceptable toxicity in stage I endometrial cancer. VB (with a lower dose per fraction) may be a viable option for selected patients with early-stage endometrial cancer following surgery.

  9. Osteopathic Manipulative Treatment Improves Heart Surgery Outcomes: A Randomized Controlled Trial.

    Science.gov (United States)

    Racca, Vittorio; Bordoni, Bruno; Castiglioni, Paolo; Modica, Maddalena; Ferratini, Maurizio

    2017-07-01

    Controlling sternal pain after heart surgery is important to reduce the risk of postoperative complications, but pain is often undertreated because of contraindications and side effects of analgesic drugs. Recently, osteopathic manipulative treatment (OMT) was demonstrated to reduce pain in different clinical contexts, suggesting its potential utility after cardiac surgery. The aim of this open-label, controlled study is to assess whether OMT contributes to sternal pain relief and improves postoperative outcomes. Eighty post-sternotomy adult inpatients were randomly allocated one to one to receive a standardized cardiorespiratory rehabilitation program alone (control group) or combined with OMT. Pain intensity and respiratory functional capacity were quantified by the Visual Analogue Scale score and by a standardized breathing test, at the start and end of rehabilitation. At the start of rehabilitation, the control group and the OMT group had similar Visual Analogue Scale median scores (controls 4, interquartile range [IQR]: 2 to 5; OMT 4, IQR: 3 to 5; p = not significant) and mean inspiratory volumes (controls 825 ± 381 mL; OMT 744 ± 291 mL; p = not significant). At the end of rehabilitation, the OMT group had a lower Visual Analogue Scale median score (controls 3, IQR: 2 to 4; OMT 1, IQR: 1 to 2; p OMT 1,781 ± 633 mL; p OMT group than in the control group (19.1 ± 4.8 versus 21.7 ± 6.3 days; p OMT is effective in inducing pain relief and functional recovery, and significantly improves the management of patients after heart surgery with sternotomy. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Treatment outcome after adjuvant radiotherapy following surgery for patients with stage I endometrial cancer

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    Kim, Ji Young; Lee, Kyung Ja; Park, Kyung Ran [Dept. of Radiation Oncology, Ewha Womans University School of Medicine, Seoul (Korea, Republic of); and others

    2016-12-15

    The purpose of this study is to evaluate the treatment outcomes of adjuvant radiotherapy using vaginal brachytherapy (VB) with a lower dose per fraction and/or external beam radiotherapy (EBRT) following surgery for patients with stage I endometrial carcinoma. The subjects were 43 patients with the International Federation of Gynecology and Obstetrics (FIGO) stage I endometrial cancer who underwent adjuvant radiotherapy following surgery between March 2000 and April 2014. Of these, 25 received postoperative VB alone, while 18 received postoperative EBRT to the whole pelvis; 3 of these were treated with EBRT plus VB. The median EBRT dose was 50.0 Gy (45.0–50.4 Gy) and the VB dose was 24 Gy in 6 fractions. Tumor dose was prescribed at a depth of 5 mm from the cylinder surface and delivered twice per week. The median follow-up period for all patients was 57 months (range, 9 to 188 months). Five-year disease-free survival (DFS) and overall survival (OS) for all patients were 92.5% and 95.3%, respectively. Adjuvant radiotherapy was performed according to risk factors and stage IB, grade 3 and lymphovascular invasion were observed more frequently in the EBRT group. Five-year DFS for EBRT and VB alone were 88.1% and 96.0%, respectively (p = 0.42), and 5-year OS for EBRT and VB alone were 94.4% and 96%, respectively (p = 0.38). There was no locoregional recurrence in any patient. Two patients who received EBRT and 1 patient who received VB alone developed distant metastatic disease. Two patients who received EBRT had severe complications, one each of grade 3 gastrointestinal complication and pelvic bone insufficiency fracture. Adjuvant radiotherapy achieved high DFS and OS with acceptable toxicity in stage I endometrial cancer. VB (with a lower dose per fraction) may be a viable option for selected patients with early-stage endometrial cancer following surgery.

  11. Functional Endoscopic Sinus Surgery as a primary modality of treatment for primary and recurrent nasal polyposis.

    Science.gov (United States)

    Gohar, Mohammad Shahid; Niazi, Saleem Asif; Niazi, Sohail Baber

    2017-01-01

    To describe the efficacy of Functional Endoscopic Sinus Surgery(FESS) in our set up in comparison with other published studies to treat primary and recurrent nasal polyposis. This descriptive study was conducted in 02 years at Ear Nose Throat Department Combined Military Hospital (CMH) Multan from October 2013 to October 2015. Convenient sample comprising 116 patients of both sexes of age group from 18 to 60 years were selected from ENT Out Patient Department, with documented diagnosis of nasal polyposis that underwent functional endoscopic sinus surgery. Out of 116 patients, 15 (12.9%) had recurrent nasal polyposis while 101 (87.1%) had primary nasal polyposis. Patients were assessed clinically. Preoperative nasal endoscopy and CT scan of nose and paranasal sinuses were performed in every patient to assess the extent of disease and evaluate the surgical anatomy. Patients were followed up 03 monthly, 06 monthly and after 01 year. Clinical signs of nasal polyposis were evaluated by nasal endoscopy at each follow up visit. There were 116 patients with documented diagnosis of nasal polyposis. Among these, 75 (64.7%) were male and 41 (35.3%) were female patients. Mean age of presentation in males was 39.1 years and that of females was 36.7 years. Only 15 patients (12.9%) developed recurrent disease within a year. Functional endoscopic sinus surgery is preferred as a primary treatment modality for primary and recurrent nasal polyposis. Mucosal polyps can be carefully debrided, the natural ostia enlarged, the ethmoid sinuses are unroofed, and sphenoid sinuses are opened in nasal cavity and sinus nasal mucosa is mostly preserved due to excellent visualization and surgical technique. Improvement in symptoms with minimal chance of recurrence may be expected in more than 90% patients.

  12. Congenitally missing teeth (hypodontia): A review of the literature concerning the etiology, prevalence, risk factors, patterns and treatment

    Science.gov (United States)

    Rakhshan, Vahid

    2015-01-01

    Congenitally missing teeth (CMT), or as usually called hypodontia, is a highly prevalent and costly dental anomaly. Besides an unfavorable appearance, patients with missing teeth may suffer from malocclusion, periodontal damage, insufficient alveolar bone growth, reduced chewing ability, inarticulate pronunciation and other problems. Treatment might be usually expensive and multidisciplinary. This highly frequent and yet expensive anomaly is of interest to numerous clinical, basic science and public health fields such as orthodontics, pediatric dentistry, prosthodontics, periodontics, maxillofacial surgery, anatomy, anthropology and even the insurance industry. This essay reviews the findings on the etiology, prevalence, risk factors, occurrence patterns, skeletal changes and treatments of congenitally missing teeth. It seems that CMT usually appears in females and in the permanent dentition. It is not conclusive whether it tends to occur more in the maxilla or mandible and also in the anterior versus posterior segments. It can accompany various complications and should be attended by expert teams as soon as possible. PMID:25709668

  13. Congenitally missing teeth (hypodontia: A review of the literature concerning the etiology, prevalence, risk factors, patterns and treatment

    Directory of Open Access Journals (Sweden)

    Vahid Rakhshan

    2015-01-01

    Full Text Available Congenitally missing teeth (CMT, or as usually called hypodontia, is a highly prevalent and costly dental anomaly. Besides an unfavorable appearance, patients with missing teeth may suffer from malocclusion, periodontal damage, insufficient alveolar bone growth, reduced chewing ability, inarticulate pronunciation and other problems. Treatment might be usually expensive and multidisciplinary. This highly frequent and yet expensive anomaly is of interest to numerous clinical, basic science and public health fields such as orthodontics, pediatric dentistry, prosthodontics, periodontics, maxillofacial surgery, anatomy, anthropology and even the insurance industry. This essay reviews the findings on the etiology, prevalence, risk factors, occurrence patterns, skeletal changes and treatments of congenitally missing teeth. It seems that CMT usually appears in females and in the permanent dentition. It is not conclusive whether it tends to occur more in the maxilla or mandible and also in the anterior versus posterior segments. It can accompany various complications and should be attended by expert teams as soon as possible.

  14. Congenitally missing teeth (hypodontia): A review of the literature concerning the etiology, prevalence, risk factors, patterns and treatment.

    Science.gov (United States)

    Rakhshan, Vahid

    2015-01-01

    Congenitally missing teeth (CMT), or as usually called hypodontia, is a highly prevalent and costly dental anomaly. Besides an unfavorable appearance, patients with missing teeth may suffer from malocclusion, periodontal damage, insufficient alveolar bone growth, reduced chewing ability, inarticulate pronunciation and other problems. Treatment might be usually expensive and multidisciplinary. This highly frequent and yet expensive anomaly is of interest to numerous clinical, basic science and public health fields such as orthodontics, pediatric dentistry, prosthodontics, periodontics, maxillofacial surgery, anatomy, anthropology and even the insurance industry. This essay reviews the findings on the etiology, prevalence, risk factors, occurrence patterns, skeletal changes and treatments of congenitally missing teeth. It seems that CMT usually appears in females and in the permanent dentition. It is not conclusive whether it tends to occur more in the maxilla or mandible and also in the anterior versus posterior segments. It can accompany various complications and should be attended by expert teams as soon as possible.

  15. Is transoral robotic surgery a safe and effective multilevel treatment for obstructive sleep apnoea in obese patients following failure of conventional treatment(s?

    Directory of Open Access Journals (Sweden)

    George Garas

    2017-07-01

    Full Text Available A best evidence topic was written according to a structured protocol. The question addressed was whether TransOral Robotic Surgery (TORS is a safe and effective multilevel treatment for Obstructive Sleep Apnoea (OSA in obese patients following failure of conventional treatment(s. A total of 39 papers were identified using the reported searches of which 5 represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. Existing treatments for OSA - primarily CPAP - though highly effective are poorly tolerated resulting in an adherence often lower than 50%. As such, surgery is regaining momentum, especially in those patients failing non-surgical treatment (CPAP or oral appliances. TORS represents the latest addition to the armamentarium of Otorhinolaryngologists - Head and Neck Surgeons for the management of OSA. The superior visualisation and ergonomics render TORS ideal for the multilevel treatment of OSA. However, not all patients are suitable candidates for TORS and its suitability is questionable in obese patients. In view of the global obesity pandemic, this is an important question that requires addressing promptly. Despite the drop in success rates with increasing BMI, the success rate of TORS in non-morbidly obese patients (BMI = 30-35kgm-2 exceeds 50%. A 50% success rate may at first seem low, but it is important to realize that this is a patient cohort suffering from a life-threatening disease and no option left other than a tracheostomy. As such, TORS represents an important treatment in non-morbidly obese OSA patients following failure of conventional treatment(s.

  16. Fusarium Endophthalmitis following Cataract Surgery: Successful Treatment with Intravitreal and Systemic Voriconazole

    Directory of Open Access Journals (Sweden)

    Paulo A. Alves da Costa Pertuiset

    2016-01-01

    Full Text Available Purpose. To report a case of postoperative endophthalmitis caused by Fusarium species successfully treated with intravitreal and systemic voriconazole after treatment failure with amphotericin B. Methods. Clinical case report of a 60-year-old immunocompetent woman who presents with endophthalmitis of unknown origin 4 weeks after uneventful cataract extraction and IOL implantation surgery. IOL explantation, vitrectomy with capsular bag removal, vitreous aspiration for culture, and intravitreal injection of amphotericin B (5 μg/0.1 mL were performed. Diagnosis was established by culturing the vitreous aspirate on a Sabouraud agar medium and staining with lactophenol blue solution. Five days later, there was no clinical response. The decision was made to administer a single dose of intravitreal voriconazole (2.5 μg/0.1 mL and oral voriconazole (200 mg BID for 30 days. Results. Fusarium sp. grew on culture. Treatment with local and systemic voriconazole was started after no improvement with vitrectomy, IOL explantation, and intravitreal amphotericin B. After 1 month of treatment, the infection resolved and best-corrected visual acuity was 20/25. Conclusion. In patients with endophthalmitis caused by Fusarium sp., topical and systemic voriconazole treatment should be considered in cases resistant to intravitreal amphotericin B.

  17. Efficacy and safety of combined piroxicam, dexamethasone, orphenadrine, and cyanocobalamin treatment in mandibular molar surgery

    Directory of Open Access Journals (Sweden)

    Barroso A.B.

    2006-01-01

    Full Text Available Third molar extraction is a common procedure frequently accompanied by moderate or severe pain, and involves sufficient numbers of patients to make studies relatively easy to perform. The aim of the present study was to determine the efficacy and safety of the therapeutic combination of 10 mg piroxicam, 1 mg dexamethasone, 35 mg orphenadrine citrate, and 2.5 mg cyanocobalamin (Rheumazin® when compared with 20 mg piroxicam alone (Feldene® in mandibular third molar surgery. Eighty patients scheduled for removal of the third molar were included in this randomized and double-blind study. They received (vo Rheumazin or Feldene 30 min after tooth extraction and once daily for 4 consecutive days. Pain was determined by a visual analogue scale and by the need for escape analgesia (paracetamol. Facial swelling was evaluated with a measuring tape and adverse effects and patient satisfaction were recorded. There was no statistically significant difference in facial swelling between Rheumazin and Feldene (control group. Both drugs were equally effective in the control of pain, with Rheumazin displaying less adverse effects than Feldene. Therefore, Rheumazin appears to provide a better risk/benefit ratio in the mandibular molar surgery. Since the side effects resulting from nonsteroidal anti-inflammatory drug administration are a severe limitation to the routine use of these drugs in clinical practice, our results suggest that Rheumazin can be a good choice for third molar removal treatment.

  18. Efficacy and safety of combined piroxicam, dexamethasone, orphenadrine, and cyanocobalamin treatment in mandibular molar surgery

    Directory of Open Access Journals (Sweden)

    A.B. Barroso

    Full Text Available Third molar extraction is a common procedure frequently accompanied by moderate or severe pain, and involves sufficient numbers of patients to make studies relatively easy to perform. The aim of the present study was to determine the efficacy and safety of the therapeutic combination of 10 mg piroxicam, 1 mg dexamethasone, 35 mg orphenadrine citrate, and 2.5 mg cyanocobalamin (Rheumazin® when compared with 20 mg piroxicam alone (Feldene® in mandibular third molar surgery. Eighty patients scheduled for removal of the third molar were included in this randomized and double-blind study. They received (vo Rheumazin or Feldene 30 min after tooth extraction and once daily for 4 consecutive days. Pain was determined by a visual analogue scale and by the need for escape analgesia (paracetamol. Facial swelling was evaluated with a measuring tape and adverse effects and patient satisfaction were recorded. There was no statistically significant difference in facial swelling between Rheumazin and Feldene (control group. Both drugs were equally effective in the control of pain, with Rheumazin displaying less adverse effects than Feldene. Therefore, Rheumazin appears to provide a better risk/benefit ratio in the mandibular molar surgery. Since the side effects resulting from nonsteroidal anti-inflammatory drug administration are a severe limitation to the routine use of these drugs in clinical practice, our results suggest that Rheumazin can be a good choice for third molar removal treatment.

  19. Laparoscopic endoscopic cooperative surgery as a minimally invasive treatment for gastric submucosal tumor

    Institute of Scientific and Technical Information of China (English)

    Tsutomu; Namikawa; Kazuhiro; Hanazaki

    2015-01-01

    Laparoscopic wedge resection is a useful procedure fortreating patients with submucosal tumor(SMT) including gastrointestinal stromal tumor(GIST) of the stomach. However, resection of intragastric-type SMTs can be problematic due to the difficulty in accurately judging the location of endoluminal tumor growth, and often excessive amounts of healthy mucosa are removed; thus, full-thickness local excision using laparoscopic and endoscopic cooperative surgery(LECS) is a promising procedure for these cases. Our experience with LECS has confirmed this procedure to be a safe, feasible, and minimally invasive treatment method for gastric GISTs less than 5 cm in diameter, with outcomes similar to conventional laparoscopic wedge resection. The important advantage of LECS is the reduction in the resected area of the gastric wall compared to that in conventional laparoscopic wedge resection using a linear stapler. Early gastric cancer fits the criteria for endoscopic resection; however, if performing endoscopic submucosal dissection is difficult, the LECS procedure might be a good alternative. In the future, LECS is also likely to be indicated for duodenal tumors, as well as gastric tumors. Furthermore, developments in endoscopic and laparoscopic technology have generated various modified LECS techniques, leading to even less invasive surgery.

  20. The efficacy of low-level laser treatment in reducing pain and swelling after endodontic surgery: a systematic review

    Science.gov (United States)

    Moshari, Amirabbas; Vatanpour, Mehdi; Zakershahrak, Mehrsa

    2016-03-01

    Introduction: LLLT in oral cavity believed to reduce pain after endodontic surgery and wisdom tooth removal, to accelerate wound healing and to have an anti-inflammatory and regenerative effect. The aim of this systematic review therefore was to assess the proof available for the efficacy of low-level laser treatment in reducing pain and swelling after endodontic surgery. Methods: The PubMed service of the U.S. National Library of Medicine was searched with applicable search strategies. No language restriction was applied. The last electronic search was accomplished on August 31, 2015. All randomized clinical trials on the efficiency of low-level laser treatment in reducing pain and swelling after endodontic surgery was considered for the Meta-analysis. Quality consideration of the included randomized clinical trials was appraised according to CONSORT guidelines. Results: Only two randomized clinical trials were attained. These studies clarified that laser treatment could reduce pain and swelling, but the results were not significant. Conclusions: Low-level laser therapy can be advantageous for the reduction of postoperative pain but there is no strong confirmation for its efficiency. Its clinical utility and applicability relating to endodontic surgery, Along with the optimal energy dosage and the number of laser treatments needed after surgery, still, demand further research and experiment.

  1. [Current status of thoracoscopic surgery for thoracic and lumbar spine. Part 1: general aspects and treatment of fractures].

    Science.gov (United States)

    Beisse, Rudolf; Verdú-López, Francisco

    2014-01-01

    Thoracoscopic surgery or video-assisted thoracic surgery (VATS) of the thoracic and lumbar spine has greatly evolved since it appeared less than 20 years ago. Nowadays, it is indicated in a large number of processes and injuries. The aim of this article, in its 2 parts, is to review the current status of VATS in treatment of the thoracic and lumbar spine in its entire spectrum. After reviewing the current literature, we develop each of the large groups of indications where VATS is used, one by one. This first part contains a description of general thoracoscopic surgical technique including the necessary prerequisites, transdiaphragmatic approach, techniques and instrumentation used in spine reconstruction, as well as a review of treatment and specific techniques in the management of spinal fractures. Thoracoscopic surgery is in many cases an alternative to conventional open surgery. The transdiaphragmatic approach has made endoscopic treatment of many thoracolumbar junction processes possible, thus widening the spectrum of therapeutic indications. These include the treatment of fractures and deformities, as well as the reconstruction of injured spinal segments and decompression of the spinal canal in any etiological processes if the lesion placement is favourable to antero-lateral approach. Good clinical results of thoracoscopic surgery are supported by the growing experience reflected in a large number of articles. The degree of complications in thoracoscopic surgery is comparable to open surgery, with benefits in morbidity of the approach and subsequent patient recovery. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  2. Prevention and Treatment of Postoperative Infections after Sinus Elevation Surgery: Clinical Consensus and Recommendations

    Directory of Open Access Journals (Sweden)

    Tiziano Testori

    2012-01-01

    Full Text Available Introduction. Maxillary sinus surgery is a reliable and predictable treatment option for the prosthetic rehabilitation of the atrophic maxilla. Nevertheless, these interventions are not riskless of postoperative complications with respect to implant positioning in pristine bone. Aim. The aim of this paper is to report the results of a clinical consensus of experts (periodontists, implantologists, maxillofacial surgeons, ENT, and microbiology specialists on several clinical questions and to give clinical recommendations on how to prevent, diagnose, and treat postoperative infections. Materials and Methods. A panel of experts in different fields of dentistry and medicine, after having reviewed the available literature on the topic and taking into account their long-standing clinical experience, gave their response to a series of clinical questions and reached a consensus. Results and Conclusion. The incidence of postop infections is relatively low (2%–5.6%. A multidisciplinary approach is advisable. A list of clinical recommendation are given.

  3. Embolization followed by surgery for treatment of perimedullary arteriovenous fistula causing acute myelopathy

    Directory of Open Access Journals (Sweden)

    I-Han Hsiao

    2015-01-01

    Conclusions: We initially considered several possible reasons for the return of symptoms: (a Hypoperfusion of the spinal cord; (b mass effect of the occult vein varices; (c residual AVF or vascular remodeling resulting in recurrent cord hypertension; (d Onyx-induced perivascular inflammation resulting in nerves adhering to each other and to occult venous varices. Clinical, surgical, and pathological findings ruled out the first three, leaving Onyx-induced perivascular inflammation as the probable reason. Given our treatment experience and the pros and cons of the two methods, we propose that initial embolization followed by surgery after 5 days to remove occult venous varices is the ideal strategy for treating perimedullary AVF of subtype B.

  4. Re-laparoscopy in the diagnosis and treatment of postoperative complications following laparoscopic colorectal surgery.

    LENUS (Irish Health Repository)

    O'Riordan, J M

    2013-08-01

    Laparoscopic colorectal surgery has increasingly become the standard of care in the management of both benign and malignant colorectal disease. We herein describe our experience with laparoscopy in the management of complications following laparoscopic colorectal surgery.

  5. Surgery vs medical treatment in the management of PFAPA syndrome: a comparative trial.

    Science.gov (United States)

    Erdogan, Firat; Kulak, Kudret; Öztürk, Ozmen; İpek, İlke Özahı; Ceran, Ömer; Seven, Hüseyin

    2016-11-01

    Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome is a common disorder in children but there is little or no consensus on its optimal diagnosis and management. To compare the outcome of different management approaches - medical therapy or tonsillectomy. The medical records of children diagnosed with PFAPA between 2008 and 2013 were retrospectively reviewed according to the modified Thomas test criteria. Patients were divided into two groups: group 1 for medical treatment - corticosteroids, a single intramuscular injection of methylprednisolone, and group 2 for surgery - tonsillectomy alone or tonsillectomy plus adenoidectomy .The course of the disease including the number and duration of episodes and the presence of remission, was documented. 105 patients (30 in group 1, 75 in group 2) met the study's inclusion criteria. Groups 1 and 2 were followed up for a mean (SD) of 23.6 (11.0) and 24 (10.3) months, respectively. At the end of the follow-up period, the number of episodes was 5.8 (6.3) vs 1.8 (1.9) (P<0.01) and their duration was 2.2 (1.3) vs 1.1 (0.8) days (P=0.03), both of which were significantly lower in group 2.The need for hospitalization during this period was significantly lower for group 2 at 1.1 (2.0) vs 0.1 (0.3) (P<0.01) and the remission rate in group 2 was significantly higher than in group 1 (98.6% vs 56.6%, P<0.01). This study demonstrated that surgery is superior to medical treatment for PFAPA in terms of increased remission rates and a decrease in the number and duration of episodes.

  6. Metabolic surgery: gastric bypass for the treatment of type 2 diabetes mellitus.

    Science.gov (United States)

    Quevedo, Maria Del Pilar; Palermo, Mariano; Serra, Edgardo; Ackermann, Marianela A

    2017-01-01

    Type 2 diabetes mellitus (T2DM) is one of the largest health emergencies of the 21st century given the worldwide increase of obesity during the last decades and its close association. T2DM is an inherited, polygenic and chronic disease caused by the interaction between several genetic variants in genes and the environment. The continuous search for new and more effective tools to achieve appropriate glycemic control became imperative in order to reduce long-term complications and mortality rates related to T2DM. Treatment options includes lifestyle modifications and several pharmacotherapies as first step in the therapeutical algorithm, but high corps of evidence have shown that gastrointestinal (GI) operations, especially those that involve food rerouting through the GI tract, are safe interventions and achieve superior outcomes for improvement in glucose metabolism when comparing with optimal medical and lifestyle changes. GI Surgery, specially Roux-en-Y gastric bypass (RYGB), is currently the most accepted surgical procedure to treat T2DM, and has also demonstrated to reduce significantly other cardiovascular risk factors (lipids and blood pressure control) when compared with optimal medical treatment, with good long-term effects on cardiovascular risks and mortality. Although the most effective technique in achieving diabetes remission is biliopancreatic diversion, the effectiveness-adverse effects balance is superior for RYGB. For these reasons, metabolic surgery (which was defined as "the operative manipulation of a normal organ or organ system to achieve a biological result for a potential health gain") has been considered and accepted as a new step in the therapeutic algorithm for T2DM when optimal lifestyle and medical interventions don't achieve optimal glycemic goals.

  7. [Prevention, diagnosis and treatment of perioperative complications of bariatric and metabolic surgery].

    Science.gov (United States)

    Wu, Haifu; Zhong, Ming; Zhou, Di; Shi, Chenye; Jiao, Heng; Wu, Wei; Chang, Xinxia; Cang, Jing; Bian, Hua

    2017-04-25

    Surgical operation in treating obesity and type 2 diabetes is popularizing rapidly in China. Correct prevention and recognition of perioperation-related operative complications is the premise of ensuring surgical safety. Familiar complications of the operation include deep venous thrombosis, pulmonary artery embolism, anastomotic bleeding, anastomotic fistula and marginal ulcer. The prevention of deep venous thrombosis is better than treatment. The concrete measures contain physical prophylaxis (graduated compression stocking and intermittent pneumatic compression leg sleeves) and drug prophylaxis (unfractionated heparin and low molecular heparin), and the treatment is mainly thrombolysis or operative thrombectomy. The treatment of pulmonary artery embolism includes remittance of pulmonary arterial hypertension, anticoagulation, thrombolysis, operative thrombectomy, interventional therapy and extracorporeal membrane oxygenation (ECMO). Hemorrhage is a rarely occurred but relatively serious complication after bariatric surgery. The primary cause of anastomotic bleeding after laparoscopic gastric bypass is incomplete hemostasis or weak laparoscopic repair. The common bleeding site in laparoscopic sleeve gastrectomy is gastric stump and close to partes pylorica, and the bleeding may be induced by malformation and weak repair technique. Patients with hemodynamic instability caused by active bleeding or excessive bleeding should timely received surgical treatment. Anastomotic fistula in gastric bypass can be divided into gastrointestinal anastomotic fistula and jejunum-jejunum anastomotic fistula. The treatment of postoperative anastomotic fistula should vary with each individual, and conservative treatment or operative treatment should be adopted. Anastomotic stenosis is mainly related to the operative techniques. Stenosis after sleeve gastrectomy often occurs in gastric angle, and the treatment methods include balloon dilatation and stent implantation, and surgical

  8. Through Thick and Thin: Identifying Barriers to Bariatric Surgery, Weight Loss Maintenance, and Tailoring Obesity Treatment for the Future

    Directory of Open Access Journals (Sweden)

    Donevan Westerveld

    2016-01-01

    Full Text Available More than one-third of the adults in the United States are obese. This complex metabolic disorder is associated with multiple comorbidities and increased all-cause mortality. Bariatric surgery has been shown to be more effective than medical therapy and has been associated with weight loss maintenance and decreased mortality. In spite of these well-established benefits, less than 1% of candidates undergo surgery due to multiple factors, such as patient and physician perceptions and attitudes, patient-physician interaction, lack of resources, and cost burden. Furthermore, even in patients who do undergo bariatric surgery and/or alternate weight loss interventions, long-term weight control is associated with high-risk failure and weight regain. In this review, we highlight some of the current barriers to bariatric surgery and long-term weight loss maintenance and underscore the importance of an individualized multidisciplinary longitudinal strategy for the treatment of obesity.

  9. Outcome in adolescent idiopathic scoliosis after brace treatment and surgery assessed by means of the Scoliosis Research Society Instrument 24

    OpenAIRE

    Weigert, Karen Petra; Nygaard, Linda Marie; Christensen, Finn Bjarke; Hansen, Ebbe Stender; Bünger, Cody

    2005-01-01

    A retrospectively designed long-term follow-up study of adolescent idiopathic scoliosis (AIS) patients who had completed treatment, of at least 2 years, by means of brace, surgery, or both brace and surgery. This study is to assess the outcome after treatment for AIS by means of the Scoliosis Research Society Outcome Instrument 24 (SRS 24). One hundred and eighteen AIS patients (99 females and 19 males), treated at the Aarhus University Hospital from January 1, 1987 to December 31, 1997, were...

  10. Treatment of female pattern hair loss with oral antiandrogens

    NARCIS (Netherlands)

    Sinclair, R; Wewerinke, M; Jolley, D

    2005-01-01

    Background It has not been conclusively established that female pattern hair loss (FPHL) is either due to androgens or responsive to oral antiandrogen therapy. Objectives To evaluate the efficacy of oral antiandrogen therapy in the management of women with FPHL using standardized photographic techni

  11. Lithium in older patients: treatment patterns and somatic adverse effects

    NARCIS (Netherlands)

    van Melick, E.J.M.

    2014-01-01

    Lithium has been used in psychiatry for over 60 years and is still one of the first-line treatments in bipolar disorder. It is also used as augmentation to antidepressants in treatment resistant depression. Age-dependent changes in lithium pharmacokinetics and pharmacodynamics may influence lithium

  12. Failure pattern and salvage treatment after radical treatment of head and neck cancer

    DEFF Research Database (Denmark)

    Pagh, Anja; Grau, Cai; Overgaard, Jens

    2016-01-01

    Purpose The aim of the study was to test the hypothesis that head and neck cancer (HNC) patients benefit from specialized follow-up (FU), as this strategy ensures timely detection of relapses for successful salvage treatment. This was done by evaluation of the pattern of failure, the temporal...... recordings of recurrent disease in 567 patients with primary tumors of the larynx, pharynx, oral cavity, nasal cavity, paranasal sinuses and salivary glands. A review of medical records was performed in order to update and supplement the database. Results Failures of the 567 patients were primarily in T...... in terms of a complete response. Permanent tumor control was observed in 128 patients (23%) after one or two salvage attempts. The highest salvage rate was recorded in patients with primary glottic carcinoma (41%) and the lowest among hypopharyngeal cancers (2%). Asymptomatic recurrence was recorded in 12...

  13. National Utilization Patterns of Steroid Injection and Operative Intervention for Treatment of Common Hand Conditions

    Science.gov (United States)

    Sears, Erika D.; Swiatek, Peter R.; Chung, Kevin C

    2015-01-01

    Purpose To conduct a population-level analysis of practice trends and probability of surgery based on the number of steroid injections for common hand conditions. Methods Patients at least 18 years old receiving injection or surgery for carpal tunnel syndrome (CTS), trigger finger (TF), or De Quervain tenovaginitis (DQ) were identified for inclusion using the 2009–2013 Truven MarketScan databases. The number of injections performed was counted, and time between injection and operation was calculated for patients receiving both treatments. A multivariable logistic regression model was created to evaluate the odds of undergoing surgery based on the number of injections performed, controlling for patient age, sex, comorbidities, and insurance type. Results The study sample included 251,030 patients who underwent steroid injection or operative release for CTS (n=129,917), TF (n=102,778), and DQ (n=18,335). The majority of CTS patients were managed with immediate surgery (71%), whereas most patients with TF and DQ were managed initially with injection (74% and 84%, respectively). Among patients receiving both an injection and an operation, a single injection was the most common practice prior to surgery (69%, 58%, and 67% of patients with CTS, TF, and DQ, respectively). Multiple injections for DQ and TF were associated with relatively low predicted probability of surgery (17% and 26%, respectively, after 2 injections). However, the predicted probability of surgery after two injections was higher in patients with CTS (44%). Conclusions Given the associated probability of surgery after multiple injections for the three hand conditions examined, the practice of repeat injections should be critically examined to determine whether underuse or overuse is present and whether efficiency and resource utilization can be improved upon. Level of Evidence Level II (retrospective prognostic study) PMID:26774548

  14. Treatment of pectus excavatum recurring after open surgery using Nuss procedure: A case report

    Directory of Open Access Journals (Sweden)

    Yucel Akkas

    2016-12-01

    Full Text Available We would like to report a 14-year-old male patient with pectus excavatum that recurred 10 years later after Ravitch surgery who was successfully operated using Nuss procedure. The patient underwent pectus excavatum surgery using Nuss procedure. The patient was discharged from the hospital at post-operative 5.day. The bar is planned to be removed in post-operative 3.year. In conclusion, surgery of pectus excavatum that recurred after open surgery is risky. Nuss procedure, which is a minimally-invasive technique, is a safe procedure that can be successfully applied in recurring cases due to short time of surgery and minimal blood loss.

  15. Normobaric hyperoxia for treatment of pneumocephalus after posterior fossa surgery in the semisitting position: a prospective randomized controlled trial.

    Directory of Open Access Journals (Sweden)

    Bujung Hong

    Full Text Available Supratentorial pneumocephalus after posterior fossa surgery in the semisitting position may lead to decreased alertness and other symptoms. We here aimed to prove the efficacy of normobaric hyperoxia on the absorption of postoperative pneumocephalus according to a standardized treatment protocol.We enrolled 44 patients with postoperative supratentorial pneumocephalus (> 30 ml after posterior fossa surgery in a semisitting position. After randomisation procedure, patients received either normobaric hyperoxia at FiO2 100% over an endotracheal tube for 3 hours (treatment arm or room air (control arm. Routine cranial CT scans were performed immediately (CT1 and 24 hours (CT2 after completion of surgery and were rated without knowledge of the therapy arm. Two co-primary endpoints were assessed: (i mean change of pneumocephalus volume, and (ii air resorption rate in 24 hours. Secondary endpoints were subjective alertness (Stanford Sleepiness Scale postoperatively and attention (Stroop test, which were evaluated preoperatively and 24 hours after surgery. The mean change in pneumocephalus volume was higher in patients in the treatment arm as compared to patients in the control arm (p = 0.001. The air resorption rate was higher in patients in the treatment arm as compared to patients in the control arm (p = 0.0015. Differences were more pronounced in patients aged 52 years and older. No difference between patients in treatment arm and control arm was observed for the Stroop test. The distribution of scores in the Stanford Sleepiness Scale differed in the treatment arm as compared to the control arm, and there was a difference in mean values (p = 0.015.Administration of normobaric hyperoxia at FiO2 100% via an endotracheal tube for 3 hours is safe and efficacious in the treatment of pneumocephalus after posterior fossa surgery in the semisitting position. Largest benefit was found in elderly patients and particularly in older men.German Clinical Trials

  16. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Soft Tissue Surgery Dental Implant Surgery Facial Cosmetic Surgery Head, Neck and Oral Pathology Obstructive Sleep Apnea TMJ and Facial Pain Treatment of Facial Injury Wisdom Teeth Management Procedures Administration of Anesthesia Administration of Anesthesia Oral ...

  17. Cavus Foot Surgery

    Science.gov (United States)

    ... All Site Content AOFAS / FootCareMD / Treatments Cavus Foot Surgery Page Content What is a cavus foot? A ... problems. What are the goals of cavus foot surgery? The main goal of surgery is to reduce ...

  18. Endodontic surgery.

    Science.gov (United States)

    Chong, B S; Rhodes, J S

    2014-03-01

    A better understanding of endodontic disease and the causes of treatment failure has refined the role of surgery in endodontics. The advent of newer materials, advances in surgical armamentarium and techniques have also led to an improved endodontic surgical outcome. The aim of this article is to provide a contemporary and up-to-date overview of endodontic surgery. It will focus primarily on the procedures most commonly performed in endodontic surgery.

  19. Patient satisfaction and treatment outcome of fungus ball rhinosinusitis treated by functional endoscopic sinus surgery.

    Science.gov (United States)

    Lai, Jui-Chung; Lee, Hong-Shen; Chen, Mu-Kuan; Tsai, Yao-Lung

    2011-02-01

    Fungal rhinosinusitis is an important clinical problem with diverse manifestations. Although many literatures had found low recurrence rate after surgical treatment of fungus ball rhinosinusitis, patient satisfaction and treatment outcomes (symptom-free and symptom improvement rate, etc.) for fungus ball sinusitis are not yet well established. The purpose of this study is to estimate the patient satisfaction and treatment outcome in patients with fungus ball rhinosinusitis undergoing functional endoscopic sinus surgery (FESS). Medical records of consecutive patients with diagnosed fungus ball rhinosinusitis treated by FESS between 1995 and 2005 were reviewed retrospectively. The post-operative improvement in individual symptom was assessed by chart review and telephone visiting. Ninety consecutive patients (21 men and 69 women) were eligible for the study. Six patients (7%) presented bilateral fungus ball rhinosinusitis. Multiple paranasal sinus fungus ball involvements were found in 48 patients (53%). Complete resolution of complaints with respect to nasal discharge, postnasal drip, cough with sputum, nasal bleeding, fetid odor of nose, olfactory dysfunction, nasal obstruction, headache, and facial pain or pressure were described in 74 patients (82%). The overall patient satisfaction rate was 96%. The estimated recurrence rate of fungus ball rhinosinusitis treated with FESS was 3%, with a mean follow-up of 81 months. Treatment protocol of fungus ball rhinosinusitis with FESS and without postoperative antifungal drugs is efficient because of very low recurrence rate, high patient satisfaction, and very high symptom-free rate. Furthermore, the obvious difference of symptom-free rate between fungus ball rhinosinusitis and chronic rhinosinusitis highlights the need of further studies to discover the pathophysiology of fungal sinusitis.

  20. Shock wave therapy versus conventional surgery in the treatment of calcifying tendinitis of the shoulder.

    Science.gov (United States)

    Rompe, J D; Zoellner, J; Nafe, B

    2001-06-01

    A prospective quasirandomized study was performed to compare the effects of surgical extirpation (Group I, 29 patients) with the outcome after high-energy extracorporeal shock wave therapy (Group II, 50 patients; 3,000 impulses of an energy flux density of 0.6 mJ/mm2) in patients with a chronic calcifying tendinitis in the supraspinatus tendon. Symptoms and demographic data of the two groups were comparable. According to the University of California Los Angeles Rating System, the mean score in Group I was 30 points with 75% good or excellent results after 12 months, and 32 points with 90% good or excellent results after 24 months. Radiologically, there was no calcific deposit in 85% of the patients after 1 year. In Group II, the mean score was 28 points with 60% good or excellent results after 12 months, and 29 points with 64% good or excellent results after 2 years. Radiologically, complete elimination of the deposit was observed in 47% of the patients after 1 year. Clinically, according to the University of California Los Angeles score, there was no significant difference between both groups at 1 year. At 2 years, there was a significantly better result in Group II. Both groups then were subdivided into patients who had a homogenous deposit as seen on radiographs and patients who had an inhomogenous deposit before treatment. Surgery was superior compared with high-energy shock wave therapy for patients with homogenous deposits. For patients with inhomogenous deposits, high-energy extracorporeal shock wave therapy was equivalent to surgery and should be given priority because of its noninvasiveness.

  1. Meta-analysis of robotic and laparoscopic surgery for treatment of rectal cancer

    Institute of Scientific and Technical Information of China (English)

    Shuang Lin; Hong-Gang Jiang; Zhi-Heng Chen; Shu-Yang Zhou; Xiao-Sun Liu; Ji-Ren Yu

    2011-01-01

    AIM: To conduct a meta-analysis to determine the relative merits of robotic surgery (RS) and laparoscopic surgery (LS) for rectal cancer. METHODS: A literature search was performed to identify comparative studies reporting perioperative outcomes for RS and LS for rectal cancer. Pooled odds ratios and weighted mean differences (WMDs) with 95% confidence intervals (95% Cis) were calculated using either the fixed effects model or random effects model.RESULTS: Eight studies matched the selection criteria and reported on 661 subjects, of whom 268 underwent RS and 393 underwent LS for rectal cancer. Compared the perioperative outcomes of RS with LS, reports of RS indicated favorable outcomes considering conversion (WMD: 0.25; 95% CI: 0.11-0.58; P = 0.001). Meanwhile,operative time (WMD: 27.92, 95% CI: -13.43 to 69.27; P = 0.19); blood loss (WMD: -32.35, 95% CI: -86.19 to 21.50; P = 0.24); days to passing flatus (WMD: -0.18, 95% CI: -0.96 to 0.60; P = 0.65); length of stay (WMD: -0.04; 95% CI: -2.28 to 2.20; P = 0.97); complications (WMD: 1.05; 95% CI: 0.71-1.55; P = 0.82) and pathological details, including lymph nodes harvested (WMD: 0.41, 95% CI: -0.67 to 1.50; P = 0.46), distal resection margin (WMD: -0.35, 95% CI: -1.27 to 0.58; P = 0.46), and positive circumferential resection margin (WMD: 0.54, 95% CI: 0.12-2.39; P = 0.42) were similar between RS and LS. CONCLUSION: RS for rectal cancer is superior to LS in terms of conversion. RS may be an alternative treatment for rectal cancer. Further studies are required.

  2. Does MIS Surgery Allow for Shorter Constructs in the Surgical Treatment of Adult Spinal Deformity?

    Science.gov (United States)

    Uribe, Juan S; Beckman, Joshua; Mummaneni, Praveen V; Okonkwo, David; Nunley, Pierce; Wang, Michael Y; Mundis, Gregory M; Park, Paul; Eastlack, Robert; Anand, Neel; Kanter, Adam; Lamarca, Frank; Fessler, Richard; Shaffrey, Chris I; Lafage, Virginie; Chou, Dean; Deviren, Vedat

    2017-03-01

    The length of construct can potentially influence perioperative risks in adult spinal deformity (ASD) surgery. A head-to-head comparison between open and minimally invasive surgery (MIS) techniques for treatment of ASD has yet to be performed. To examine the impact of MIS approaches on construct length and clinical outcomes in comparison to traditional open approaches when treating similar ASD profiles. Two multicenter databases for ASD, 1 involving MIS procedures and the other open procedures, were propensity matched for clinical and radiographic parameters in this observational study. Inclusion criteria were ASD and minimum 2-year follow-up. Independent t -test and chi-square test were used to evaluate and compare outcomes. A total of 1215 patients were identified, with 84 patients matched in each group. Statistical significance was found for mean levels fused (4.8 for circumferential MIS [cMIS] and 10.1 for open), mean interbody fusion levels (3.6 cMIS and 2.4 open), blood loss (estimated blood loss 488 mL cMIS and 1762 mL open), and hospital length of stay (6.7 days cMIS and 9.7 days open). There was no significant difference in preoperative radiographic parameters or postoperative clinical outcomes (Owestry Disability Index and visual analog scale) between groups. There was a significant difference in postoperative lumbar lordosis (43.3° cMIS and 49.8° open) and pelvic incidence-lumbar lordosis correction (10.6° cMIS and 5.2° open) in the open group. There was no significant difference in reoperation rate between the 2 groups. MIS techniques for ASD may reduce construct length, reoperation rates, blood loss, and length of stay without affecting clinical and radiographic outcomes when compared to a similar group of patients treated with open techniques.

  3. Treatment of diffuse malignant peritoneal mesothelioma (DMPM) by cytoreductive surgery and HIPEC.

    Science.gov (United States)

    Robella, M; Vaira, M; Mellano, A; Marsanic, P; Cinquegrana, A; Borsano, A; Barbera, M; Caneparo, A; Siatis, D; Sottile, A; De Simone, M

    2014-02-01

    Diffuse malignant peritoneal mesothelioma (DMPM) is a rare and locally aggressive tumor with poor prognosis, related in most cases to asbestos exposure. It is increasing in frequency, but currently no standard therapy is available. The biology of this disease is still poorly understood. Several highly specialized centers have recently reported improved survival by means of an innovative local-regional approach. The purpose of this article is to evaluate the survival benefit and the morbidity rate of patients affected by DMPM treated at our institution by cytoreductive surgery (CRS) associated with hyperthermic intraperitoneal perioperative chemotherapy (HIPEC). This study includes 42 patients affected by DMPM treated by an uniform approach consisting of cytoreductive surgery associated with HIPEC using cisplatin and doxorubicin. The primary end point was overall survival and morbidity rate. The secondary end point was evaluation of prognostic variables for overall survival. The median follow-up period was 72 months (range 1-235 months). Thirty-five patients (83.3%) presented epithelial tumors and 7 were affected by multicystic mesothelioma. The mean peritoneal cancer index (PCI) was 13. Thirty-eight patients (90.4%) had complete cytoreduction (CC-0/1). The overall morbidity rate was 35.7% associated to a perioperative mortality of 7.1%. Median overall survival rate was 65 months with a 1- and 5-year survival rates of 63% and 44%, respectively. The treatment of DMPM by CRS+HIPEC in selected patients is a feasible technique that allows to achieve encouraging results in terms of overall survival rate, with an acceptable morbidity rate. Further investigations are needed to clarify the role and the timing of this promising technique.

  4. Trends in the treatment of coronary disease today. Selective use of PTCA and bypass surgery.

    Science.gov (United States)

    Jones, E L; Craver, J M; Guyton, R A; Bone, D K; Hatcher, C R

    1983-01-01

    Selection and treatment of patients with ischemic heart disease is presently undergoing an evolutionary trend. Percutaneous transluminal coronary angioplasty (PTCA) has been recommended as the initial procedure for many patients with coronary artery disease (CAD), thus possibly redefining candidates for coronary bypass surgery (CABS). Between October 1980 and June 1982, 777 patients having PTCA and 2068 patients having CABS were analyzed for differences in clinical presentation, complications, and early outcome. Patients having CABS were significantly older, had a higher incidence of hypertension (46% vs. 32%), more multivessel disease (80% vs. 12%), and poorer left ventricular function (nl. wall motion = 88% vs. 52%). The incidence of myocardial infarction in patients after PTCA was 1.0% (8/777). Emergency CAB was required in 5.3% of patients following PTCA. There were no deaths following the angioplasty procedure and 25 deaths in 2068 patients having CABS (hospital mortality rate = 1.2%). Since 1973, there has been a progressive decline in hospital mortality rate (now, less than 1%), postoperative infarction (now, 3%), requirement for inotropic drugs (now, 5%) and frequency of IABP (less than 1%). Increasing ability to achieve complete revascularization now means improved survival and freedom from angina with CAB surgery. PTCA and CAB are both procedures that may be used effectively for selected patients, depending on clinical presentation, extent of CAD, and left ventricular function (LVF). Careful patient selection affords the opportunity for use of PTCA in patients with single-vessel disease (SVD) and good LVF and CABS in patients with multivessel disease, regardless of LVF. Symptomatic patients with SVD and total vessel occlusion are not candidates for PTCA. Our data demonstrate that both PTCA and CABS may be accomplished with very low perioperative complications and hospital mortality. PMID:6222708

  5. Multiple burr hole surgery as a treatment modality for pediatric moyamoya disease

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    Ravindranath Kapu

    2010-01-01

    Full Text Available Objective : To re-emphasize that indirect revascularization surgery alone, where multiple burr holes and arachnoid openings are made over both cerebral hemispheres, is beneficial in the treatment of moyamoya disease (MMD in children. Clinical Presentation : We report a 10-year-old boy who presented with complaints of episodic headache for the last 5 years. At the peak of his headache he had visual disturbances and acute onset weakness of left-sided limbs, recovering within a few minutes. He had no focal neurological deficits. Radiological investigations revealed abnormal findings, demonstrating the features of MMD. Surgical Management : He underwent bilateral multiple burr holes, dural and arachnoid opening over the frontal, parietal and temporal regions of each hemisphere. The elevated periosteal flap was placed in contact with the exposed brain through each burr hole. Results : On 6-months follow-up he had only one episode of transient ischemic attack. Postoperative four vessel angiogram demonstrated excellent cerebral revascularization around the burr hole sites, and single photon emission computerized tomography imaging showed hypoperfusion in the right temporo-occipital area suggestive of an old infarct with no other perfusion defect in the rest of the brain parenchyma. Conclusion : In children with MMD this relatively simple surgical technique is effective and safe, and can be used as the only treatment without supplementary revascularization procedures. This procedure can be done in a single stage on both sides and the number of burr holes made over each hemisphere depends on the extent of the disease.

  6. Factors related to the local treatment failure of γ knife surgery for metastatic brain tumors.

    Science.gov (United States)

    Woo, Hyun Jin; Hwang, Sung Kyoo; Park, Seong Hyun; Hwang, Jeong Hyun; Hamm, In Suk

    2010-11-01

    Radiosurgery (RS) is regarded as a standard therapy for metastatic brain tumors, but local failure requiring repeated therapy for the same lesion remains an unsolved problem. The authors analyzed outcomes of gamma knife surgery (GKS) for metastatic lesions to identify factors of local treatment failure. The hospital records of 103 patients with a metastatic brain tumor and monitored for more than 6 months were analyzed. Lesion response to RS was analyzed in 77 patients with available gamma plan data. Local treatment failure was defined as lesion regrowth or repeat GKS within 6 months. In cases with multiple lesions, largest masses were evaluated. Primary sites, metastatic location, Karnofsky scale, tumor size, number of metastatic lesions, and various radiosurgical prescription parameters, namely, Paddick's conformity index (CI), Radiation Therapy Oncology Group (RTOG)-CI, and gradient index, were analyzed. Of the 103 study subjects, 58 were male and 45 were female. Primary sites were lung (n = 58), breast (n = 12), colon (n = 6), kidney (n = 7), rectum (n = 6), and others (n = 14). Median survival duration from the diagnosis of brain metastasis was 25 months. Local treatment failure occurred in 14 of 77 the patients (77 lesions) with available gamma plan data. A lung cancer primary site was found to have a lower GKS failure rate than a breast or a renal site (p < 0.05). Lesions with a high Paddicks' CI or a low RTOG-CI had a higher rate of treatment failure (p < 0.05). Multivariate analysis revealed that primary tumor site and Paddick's CI were related to treatment failure (p < 0.05). Brain metastases from renal and breast cancers had higher rates of local GKS treatment failure than those from lung cancer. Furthermore, high Paddick's CI revealed higher rate of local recurrence, and was not contributory to prevent local treatment failure. However, the enlargement of the diameter of the tumor after RS in the early follow

  7. Two-year treatment patterns and costs in glaucoma patients initiating treatment with prostaglandin analogs

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    Jordana K Schmier

    2010-09-01

    Full Text Available Jordana K Schmier1, Edmund C Lau2, David W Covert31Exponent, Alexandria, VI, USA; 2Exponent, Menlo Park, CA, USA; 3Alcon Research Ltd, Fort Worth, TX, USAObjective: To determine treatment patterns and costs over a two-year period among new initiators of topical prostaglandin analogs in a managed care population by retrospective cohort analysis of an insurance claims database.Methods: Patients who initiated therapy with a prostaglandin analog between September 2006 and March 2007 were identified. The use of monotherapy and adjunctive therapies were compared by index prostaglandin. Days to initiation of adjunctive therapy and rates of glaucoma surgical procedures were also calculated. Medical costs (antiglaucoma medications and ophthalmic visits over the two-year period were estimated.Results: The analysis identified 5018 patients with at least one prostaglandin analog prescription (bimatoprost, n = 747; latanoprost, n = 1651; benzalkonium chloride (BAK-free travoprost, n = 203. The majority (51%–54% had repeat prescriptions. Among those with repeat prescriptions, 52% were female (not significant and mean age was 64 years (P < 0.01. Rates of adjunctive therapy use varied across groups (bimatoprost 51%, latanoprost 37%, and BAK-free travoprost 35%, P < 0.0001. Median and mean days to initiation of adjunctive therapy were 83 and 140 for bimatoprost, 101 and 181 for latanoprost, and 113 and 221 for BAK-free travoprost. Two-year medical costs were $3147, $2843, and $2557 for patients initiating treatment with bimatoprost, latanoprost, and BAK-free travoprost, respectively. Use of glaucoma surgical procedures across the treatment groups was similar over the two-year period.Conclusions: Over a two-year period, the rate and time to initiation of adjunctive therapy use, as well as medical costs, varied between index prostaglandins. However, the rate of glaucoma surgical interventions did not vary significantly across index medications.Keywords: costs

  8. Patterns of pre-treatment drug abuse, drug treatment history and characteristics of addicts in methadone maintenance treatment in Iran

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    Shekarchizadeh Hajar

    2012-06-01

    Full Text Available Abstract Background Opiates are the main drugs of abuse, and Methadone Maintenance Treatment (MMT is the most widely administered drug addiction treatment program in Iran. Our study aimed to investigate patterns of pre-treatment drug abuse, addiction treatment history and characteristics of patients in MMT in Tehran. Methods We applied a stratified cluster random sampling technique and conducted a cross-sectional survey utilizing a standard patient characteristic and addiction history form with patients (n = 810 in MMT. The Chi-square test and t-test served for statistical analyses. Results A clear majority of the participants were men (96%, more than 60% of whom were between 25 and 44 years of age, educated (89% had more than elementary education, and employed (>70%. The most commonly reported main drugs of abuse prior to MMT entry were opium (69% and crystalline heroin (24%. The patients’ lifetime drug experience included opium (92%, crystalline heroin (28%, cannabis (16%, amphetamines (15%, and other drugs (33%. Crystalline heroin abusers were younger than opium users, had begun abusing drugs earlier, and reported a shorter history of opiate addiction. Conclusion Opium and crystalline heroin were the main drugs of abuse. A high rate of addiction using more dangerous opiate drugs such as crystalline heroin calls for more preventive efforts, especially among young men.

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

    LENUS (Irish Health Repository)

    Kavanagh, Dara O

    2012-05-01

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

  10. A systematic review of transarterial embolization versus emergency surgery in treatment of major nonvariceal upper gastrointestinal bleeding.

    Science.gov (United States)

    Beggs, Andrew D; Dilworth, Mark P; Powell, Susan L; Atherton, Helen; Griffiths, Ewen A

    2014-01-01

    Emergency surgery or transarterial embolization (TAE) are options for the treatment of recurrent or refractory nonvariceal upper gastrointestinal bleeding. Surgery has the disadvantage of high rates of postoperative morbidity and mortality. Embolization has become more available and has the advantage of avoiding laparotomy in this often unfit and elderly population. To carry out a systematic review and meta-analysis of all studies that have directly compared TAE with emergency surgery in the treatment of major upper gastrointestinal bleeding that has failed therapeutic upper gastrointestinal endoscopy. A literature search of Ovid MEDLINE, Embase, and Google Scholar was performed. The primary outcomes were all-cause mortality and rates of rebleeding. The secondary outcomes were length of stay and postoperative complications. A total of nine studies with 711 patients (347 who had embolization and 364 who had surgery) were analyzed. Patients in the TAE group were more likely to have ischemic heart disease (odds ratio [OR] =1.99; 95% confidence interval [CI]: 1.33, 2.98; P=0.0008; I (2)=67% [random effects model]) and be coagulopathic (pooled OR =2.23; 95% CI: 1.29, 3.87; P=0.004; I (2)=33% [fixed effects model]). Compared with TAE, surgery was associated with a lower risk of rebleeding (OR =0.41; 95% CI: 0.22, 0.77; P<0.0001; I (2)=55% [random effects]). There was no difference in mortality (OR =0.70; 95% CI: 0.48, 1.02; P=0.06; I (2)=44% [fixed effects]) between TAE and surgery. When compared with surgery, TAE had a significant increased risk of rebleeding rates after TAE; however, there were no differences in mortality rates. These findings are subject to multiple sources of bias due to poor quality studies. These findings support the need for a well-designed clinical trial to ascertain which technique is superior.

  11. A systematic review of transarterial embolization versus emergency surgery in treatment of major nonvariceal upper gastrointestinal bleeding

    Directory of Open Access Journals (Sweden)

    Beggs AD

    2014-04-01

    Full Text Available Andrew D Beggs,1 Mark P Dilworth,1 Susan L Powell,2 Helen Atherton,3 Ewen A Griffiths41Academic Department of Surgery, School of Cancer Sciences, University of Birmingham, 2Department of Geriatric Medicine, Heart of England NHS Foundation Trust, Solihull Hospital, Birmingham, 3Department of Primary Health Care Health Sciences, University of Oxford, Oxford, 4Department of Upper Gastrointestinal Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UKBackground: Emergency surgery or transarterial embolization (TAE are options for the treatment of recurrent or refractory nonvariceal upper gastrointestinal bleeding. Surgery has the disadvantage of high rates of postoperative morbidity and mortality. Embolization has become more available and has the advantage of avoiding laparotomy in this often unfit and elderly population.Objective: To carry out a systematic review and meta-analysis of all studies that have directly compared TAE with emergency surgery in the treatment of major upper gastrointestinal bleeding that has failed therapeutic upper gastrointestinal endoscopy.Methods: A literature search of Ovid MEDLINE, Embase, and Google Scholar was performed. The primary outcomes were all-cause mortality and rates of rebleeding. The secondary outcomes were length of stay and postoperative complications.Results: A total of nine studies with 711 patients (347 who had embolization and 364 who had surgery were analyzed. Patients in the TAE group were more likely to have ischemic heart disease (odds ratio [OR] =1.99; 95% confidence interval [CI]: 1.33, 2.98; P=0.0008; I2=67% [random effects model] and be coagulopathic (pooled OR =2.23; 95% CI: 1.29, 3.87; P=0.004; I2=33% [fixed effects model]. Compared with TAE, surgery was associated with a lower risk of rebleeding (OR =0.41; 95% CI: 0.22, 0.77; P<0.0001; I2=55% [random effects]. There was no difference in mortality (OR =0.70; 95% CI: 0.48, 1.02; P=0.06; I2=44% [fixed effects] between

  12. Traumatic Rib Injury: Patterns, Imaging Pitfalls, Complications, and Treatment.

    Science.gov (United States)

    Talbot, Brett S; Gange, Christopher P; Chaturvedi, Apeksha; Klionsky, Nina; Hobbs, Susan K; Chaturvedi, Abhishek

    2017-01-01

    The ribs are frequently affected by blunt or penetrating injury to the thorax. In the emergency department setting, it is vital for the interpreting radiologist to not only identify the presence of rib injuries but also alert the clinician about organ-specific injury, specific traumatic patterns, and acute rib trauma complications that require emergent attention. Rib injuries can be separated into specific morphologic fracture patterns that include stress, buckle, nondisplaced, displaced, segmental, and pathologic fractures. Specific attention is also required for flail chest and for fractures due to pediatric nonaccidental trauma. Rib fractures are associated with significant morbidity and mortality, both of which increase as the number of fractured ribs increases. Key complications associated with rib fracture include pain, hemothorax, pneumothorax, extrapleural hematoma, pulmonary contusion, pulmonary laceration, acute vascular injury, and abdominal solid-organ injury. Congenital anomalies, including supernumerary or accessory ribs, vestigial anterior ribs, bifid ribs, and synostoses, are common and should not be confused with traumatic pathologic conditions. Nontraumatic mimics of traumatic rib injury, with or without fracture, include metastatic disease, primary osseous neoplasms (osteosarcoma, chondrosarcoma, Ewing sarcoma, Langerhans cell histiocytosis, and osteochondroma), fibrous dysplasia, and Paget disease. Principles of management include supportive and procedural methods of alleviating pain, treating complications, and stabilizing posttraumatic deformity. By recognizing and accurately reporting the imaging findings, the radiologist will add value to the care of patients with thoracic trauma. Online supplemental material is available for this article. (©)RSNA, 2017.

  13. Causes, Timing, and Impact of Dual Antiplatelet Therapy Interruption for Surgery (from the Patterns of Non-adherence to Anti-platelet Regimens In Stented Patients Registry).

    Science.gov (United States)

    Schoos, Mikkel; Chandrasekhar, Jaya; Baber, Usman; Bhasin, Aarti; Sartori, Samantha; Aquino, Melissa; Vogel, Birgit; Farhan, Serdar; Sorrentino, Sabato; Kini, Annapoorna; Kruckoff, Mitchell; Moliterno, David; Henry, Timothy D; Weisz, Giora; Gibson, C Michael; Iakovou, Ioannis; Colombo, Antonio; Steg, P Gabriel; Witzenbichler, Bernhard; Chieffo, Alaide; Cohen, David; Stuckey, Thomas; Ariti, Cono; Dangas, George; Pocock, Stuart; Mehran, Roxana

    2017-09-15

    Temporary interruption of dual antiplatelet therapy (DAPT) is not infrequently required in patients undergoing percutaneous coronary intervention (PCI). We sought to describe the procedures and outcomes associated with DAPT interruption in patients treated with DAPT following successful PCI from the Patterns of non-adherence to anti-platelet regimens in stented patients registry (n = 5018). DAPT interruption was prespecified as physician recommended cessation for antiplatelet agent was interrupted in 57.2% cases and interruption was frequently recommended by noncardiologists (51.3%). Where type of surgery was reported, majority of DAPT interruptions occurred for minor surgery (68.4% vs 31.6%) and a similar cessation pattern of single versus dual antiplatelet cessation was observed regardless of minor or major surgery. Subsequent to DAPT interruption, 12 patients (2.4%) experienced 1 thrombotic event each, of which 5 (1.0%) occurred during the interruption period. All events occurred in patients who either stopped both agents (8 of 12) or clopidogrel-only (4 of 12), with no events occurring due to aspirin cessation alone. In conclusion, in the Patterns of Non-adherence to Anti-platelet Regiments in Stented Patients registry, 1 in 10 patients were recommended DAPT interruption for surgery within 2 years of PCI. Interruption was more common for a single agent rather than both antiplatelet agents regardless of severity of surgery, and was frequently recommended by noncardiologists. Only 1% of patients with DAPT interruption experienced a subsequent thrombotic event during the interruption period, which mainly occurred in patients stopping both antiplatelet agents. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Treatment procedures and referral patterns of general dentists in Lithuania

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    Vilija Berlin

    2015-11-01

    Conclusions: There is a clear need for Lithuanian dental practitioners to refer patients to all types of dental specialists. Undergraduate dental education program and postgraduate training should be more directed toward the extraction of teeth and roots, treatment of young children and provision of dental prostheses to patients.

  15. Resection And Reconstructive-plastic Surgery In Treatment Of Extended And Multifocal Cicatrical Tracheal Stenosis

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    Otabek Eshonkhodjaev

    2015-12-01

    Full Text Available Background. Main issues of treatment of patients with cicatricial stenosis of trachea (CST are to increase its efficacy and safety, as well as to determine indications and contraindications for circular resection and reconstructive interventions on the trachea in patients with extended lesions of trachea, with stenoses involving subvocal cords part of larynx and well as multifocal narrowing of the trachea which could improve treatment results and quality of life of patients, to gain recovery and reduce disability and mortality.Material and methods. One hundred two patients aged from 11 to 62 years with CST were surgically treated. Stenotic site length in patients varied from 0,3 to 7 cm. Most frequently (64,2%, CST length of more than 2 cm was observed. In critical and decompensated stenosis with diameter of CST up to 5 mm with the threat of asphyxiation by the first stage we used endoscopic laser-and electric destruction of constriction followed by restricted zone bouging. If long-term rehabilitation was necessary and in case of absence of the conditions to the implementation of circular tracheal resection, we used tracheal stents. Circular resection of the trachea was performed in 24 patients. In case of contraindications, 28 patients underwent reconstructive plastic surgery with dissection the stenosis, excision of scar tissue and formation of trachea lumen in T-tube. After removing T-tube plasty of anterior tracheal wall and of soft tissues of the neck defects was performed using local tissues and grafts with microsurgical techniques.Results. Long-term results of treatment evaluated and studied in a period of 6 months to 5 years in 89 (87.3% patients. 13 patients continues to one of the stages of complex treatment. Еhe patients are under dynamic endoscopic control. Good results were achieved in the treatment of 71 patients (79.8%, satisfactory - in 12 (13.4%, unsatisfactory results in 6 (6.7% patients.Conclusions. 1. Patients with CST

  16. [Breast lesions of a metastatic melanoma on a radiotherapy territory: Treatment by vemurafenib and carcinologic surgery].

    Science.gov (United States)

    Fernandez, J; Montaudié, H; Courdi, A; Georgiou, C; Camuzard, O; Chignon-Sicard, B

    2016-02-01

    This article describes the unique case of a female patient who presented distant melanoma metastasis on the breast while having irradiation therapy for breast cancer. This happened eight months after the initial treatment for a melanoma of the back (under the right scapula). Furthermore, this case report demonstrates the efficiency of Vemurafenib® as a treatment for late stage melanomas. The patient was a 47-year-old female that had a superficial spreading melanoma under the right scapula (Breslow 1.02mm) that was treated with 2cm skin excision and sentinel lymph node sampling that was negative. The melanoma was positive for the BRAF600E mutation. One month after this incident, the patient developed breast cancer that was treated with conservative surgery and radiotherapy. Three months after the end of the irradiation treatment, she developed multiple melanoma metastasis on the skin of the breast. Our multidisciplinary team decided to initiate a treatment with vemurafenib. The patient showed an excellent response, so the surgical team completed the treatment with a radical mastectomy and immediate reconstruction with a pedicled latissimus dorsi flap. The histologic report of the mastectomy specimen showed no sign of melanocytic proliferation, that demonstrates the efficacy of vemurafenib. The patient showed no relapse after two years of follow-up. The speed of development and location of cutaneous metastases in this case brought us to think about the effects of radiation therapy on the skin. Radiation therapy causes acute complications (radiodermatitis) by cellular and molecular mechanisms. Moreover, depressed immunity is found after irradiation. Association of these mecanisms could explain the appearance of these metastases in irradiation field. The efficiency of vemurafenib found in our case is consistent with what is described in literature, especially with the improvement in median overall survival. This case demonstrates a unique case of distant melanoma

  17. Treatment complications among long-term survivors of cervical cancer: treated by surgery or radiotherapy

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    Kamal A. Elghamrawi

    2011-11-01

    Full Text Available This study assesses the morbidity and complications of treatment among long-term survivors of cervical cancer. Ninety-eight female patients who were diagnosed and treated from invasive carcinoma of the cervix uteri 5 years or more are included in this study. All the cases were free of disease and had survived up to December 2010. Forty-one cases were treated with radical hysterectomy with removal of the lymph nodes (Wertheim’s surgery (42%. Radical radiation therapy was given to 57 cases (58% according to our treatment protocol; weekly cisplatin was given concomitantly with radiation. Although urinary adverse effects were more prevalent among the radiation group, the difference was not statistically significant. Bowel dysfunction was more prevalent and statistically significant (p\\0.001 among the radiotherapy arm. Dysfunctions recorded included change in bowel habit, diarrhea, constipation, tenesmus, soiling of clothes and or flatulence. However, their severity was grade 1–2 only. The frequency of small intestinal obstruction was comparable in both arms. Pelvic vein thromboses had a tendency to occur among the surgical group especially in obese females (p value 0.005. The frequency of sexual dysfunction was comparable in both groups with no statistical difference. It was age related. The younger the patients’ ages, the more was the sexual complaint irrespective to the treatment modality. Sexual problems included dyspareunia from vaginal stenosis shortening or dryness, vulval soreness from itching and dryness. Bearing in mind that many patients had more than one health complaint. The remaining cases denied the presence of any complications and stated that they had a normal life style.

  18. Gender differences in personality patterns and smoking status after a smoking cessation treatment.

    Science.gov (United States)

    Piñeiro, Bárbara; López-Durán, Ana; Fernández Del Río, Elena; Martínez, Ursula; Becoña, Elisardo

    2013-04-08

    The lack of conclusive results and the scarce use of the Millon Clinical Multiaxial Inventory-III (MCMI-III) in the study of the relationship between smoking and personality are the reasons that motivated the study reported here. The aim of the present study was to analyze the influence of personality patterns, assessed with the MCMI-III, and of nicotine dependence on treatment outcomes at the end of the treatment and at 12 months follow-up in men and women smokers receiving cognitive-behavioral treatment for smoking cessation. The sample was made up of 288 smokers who received cognitive-behavioral treatment for smoking cessation. Personality patterns were assessed with the Millon Clinical Multiaxial Inventory-III (MCMI-III). Abstinence at the end of the treatment and at 12-month follow-up was validated with the test for carbon monoxide in expired air. The results showed significant differences by personality patterns that predict nicotine dependence (Narcissistic and Antisocial in men and Schizoid in women). At the end of the treatment it is more likely that quit smoking males with a Compulsive pattern and less likely in those scoring high in Depressive, Antisocial, Sadistic, Negativistic, Masochistic, Schizotypal and Borderline. In women, it is less likely that quit smoking those with the Schizoid pattern. At 12 months follow-up it is more likely that continue abstinent those males with a high score in the Compulsive pattern. Furthermore, nicotine dependence was an important variable for predicting outcome at the end of the treatment and smoking status at 12 months follow-up in both men and women. We found substantial differences by gender in some personality patterns in a sample of smokers who received cognitive-behavioral treatment for smoking cessation. We should consider the existence of different personality patterns in men and women who seek treatment for smoking cessation.

  19. The role of surgery for treatment of low back pain: insights from the randomized controlled Spine Patient Outcomes Research Trials

    Directory of Open Access Journals (Sweden)

    Peter Abraham

    2016-01-01

    Full Text Available Low back pain (LBP is a common medical problem with high morbidity and healthcare costs. The optimal management strategy, including the role of surgical intervention, remains controversial. The Spine Patient Outcomes Research Trials were randomized controlled studies conducted to assess the effectiveness of surgery for three of the most common conditions implicated in LBP: Intervertebral disc herniation, degenerative spondylolisthesis, and spinal stenosis. Despite challenges in data interpretation related to patient cross over, these studies support the efficacy of surgery as treatment for these three common conditions.

  20. Clinical outcome of salvage neck dissections in head and neck cancer in relation to initial treatment, extent of surgery and patient factors

    NARCIS (Netherlands)

    van den Bovenkamp, K.; Noordhuis, M.G.; Oosting, S.F.; van der Laan, B.F.A.M.; Roodenburg, J.L.; Bijl, H.P.; Halmos, G.B.; Plaat, B.E.C.

    ObjectiveSalvage surgery has a higher complication rate compared to primary surgical treatment. We evaluated clinical outcome of salvage neck dissections in relation to initial treatment modality, extent of surgery and patient-related factors. DesignSingle institution consecutive case series.

  1. Associations between dietary patterns and semen quality in men undergoing IVF/ICSI treatment

    NARCIS (Netherlands)

    Vujkovic, M.; Vries, de J.H.M.; Dohle, G.R.; Bonsel, G.J.; Lindemans, J.; Macklon, N.S.; Spek, van der P.J.; Steegers, E.A.P.; Steegers-Theunissen, R.P.M.

    2009-01-01

    BACKGROUND: This study investigates whether dietary patterns, substantiated by biomarkers, are associated with semen quality. METHODS: In 161 men of subfertile couples undergoing in vitro fertilization treatment in a tertiary referral clinic in Rotterdam, the Netherlands, we assessed nutrient intake

  2. Associations between dietary patterns and semen quality in men undergoing IVF/ICSI treatment

    NARCIS (Netherlands)

    Vujkovic, M.; Vries, de J.H.M.; Dohle, G.R.; Bonsel, G.J.; Lindemans, J.; Macklon, N.S.; Spek, van der P.J.; Steegers, E.A.P.; Steegers-Theunissen, R.P.M.

    2009-01-01

    BACKGROUND: This study investigates whether dietary patterns, substantiated by biomarkers, are associated with semen quality. METHODS: In 161 men of subfertile couples undergoing in vitro fertilization treatment in a tertiary referral clinic in Rotterdam, the Netherlands, we assessed nutrient

  3. Associations between dietary patterns and semen quality in men undergoing IVF/ICSI treatment

    NARCIS (Netherlands)

    Vujkovic, M.; de Vries, J. H.; Dohle, G. R.; Bonsel, G. J.; Lindemans, J.; Macklon, N. S.; van der Spek, P. J.; Steegers, E. A. P.; Steegers-Theunissen, R. P. M.

    This study investigates whether dietary patterns, substantiated by biomarkers, are associated with semen quality. In 161 men of subfertile couples undergoing in vitro fertilization treatment in a tertiary referral clinic in Rotterdam, the Netherlands, we assessed nutrient intakes and performed

  4. Who seeks bariatric surgery? Psychosocial functioning among adolescent candidates, other treatment-seeking adolescents with obesity and healthy controls.

    Science.gov (United States)

    Call, C C; Devlin, M J; Fennoy, I; Zitsman, J L; Walsh, B T; Sysko, R

    2017-08-25

    Limited data are available on the characteristics of adolescents with obesity who seek bariatric surgery. Existing data suggest that adolescent surgery candidates have a higher body mass index (BMI) than comparison adolescents with obesity, but the limited findings regarding psychosocial functioning are mixed. This study aimed to compare BMI and psychosocial functioning among adolescent bariatric surgery candidates, outpatient medical-treatment-seeking adolescents with obesity (receiving lifestyle modification), and adolescents in the normal-weight range. All adolescents completed self-report measures of impulsivity, delay discounting, depression, anxiety, stress, eating pathology, family functioning and quality of life, and had their height and weight measured. Adolescent surgical candidates had higher BMIs than both comparison groups. Surgical candidates did not differ from medical-treatment-seeking adolescents with obesity on any measure of psychosocial functioning, but both groups of adolescents with obesity reported greater anxiety and eating pathology and poorer quality of life than normal-weight adolescents. Quality of life no longer differed across groups after controlling for BMI, suggesting that it is highly related to weight status. Adolescents with obesity may experience greater anxiety, eating pathology, and quality of life impairments than their peers in the normal-weight range regardless of whether they are seeking surgery or outpatient medical treatment. Clinical implications and directions for future research are discussed. © 2017 World Obesity Federation.

  5. CARDIOTHORACIC SURGERY

    African Journals Online (AJOL)

    lbadan, Nigeria. Reprint requests to: Dr. V. O. Adegboye, Department Of Surgery, University College Hospital, Iberian,. Nigeria. ... been shown to be related to the rate of bleeding. .... patients after an interval of conservative/medical treatment.

  6. GENERAL SURGERY

    African Journals Online (AJOL)

    The traditional operative approach is an open surgical one to drain the cysts and ... early outcomes of laparoscopic treatment of liver hydatid cysts at our institution. .... O. Radical vs. conservative surgery for hydatid liver cysts: Experience from ...

  7. Opioid Treatment Patterns Following Prescription of Immediate-Release Hydrocodone.

    Science.gov (United States)

    Ben-Joseph, Rami; Bell, Jill A; Brixner, Diana; Kansal, Anuraag; Paramore, Clark; Chitnis, Abhishek; Holly, Pamela; S Burgoyne, Douglas

    2016-04-01

    Immediate-release (IR) hydrocodone is the most widely prescribed opioid in the United States; however, little is known about the utilization patterns and duration of opioid use among patients prescribed IR hydrocodone. A better understanding of the use of IR hydrocodone would result in more appropriate prescribing patterns of extended-release opioids. To assess downstream length of opioid therapy and utilization patterns of extended-release/long-acting (ER/LA) opioids among patients on IR hydrocodone to provide a better understanding of how IR and ER/LA opioids are used to manage pain. Retrospective analysis using health care claims from the Truven MarketScan Commercial, Medicare Supplemental, and Medicaid databases was performed. Patients prescribed IR hydrocodone during the 6-month baseline period (July 2011-December 2011) and with continuous enrollment for a 12-month follow-up period (2012) post-index date (January 1, 2012) were selected. Downstream length of therapy, defined as number of days supplied with opioids, and downstream use of ER/LA opioids during follow-up were examined by average pills per month (≤ 60 vs. > 60 pills per month) and days supply ( 60 pills per month than with ≤ 60 pills per month (7.8% vs. 1.2%, respectively, P 60 pills per month than with ≤ 60 pills per month. All results were consistent when examined by levels of days supply. A majority of the population prescribed IR hydrocodone was not prescribed opioid therapy beyond 2 months on average in the 1-year follow-up period. Only a small subset of patients with increased pills per month or days supply of IR hydrocodone in the baseline period continued to be high utilizers in the following year, averaging nearly 8 months of prescribed opioid use. A limited proportion of patients prescribed IR hydrocodone converted to ER/LA opioids. This knowledge can assist policymakers and physicians, providing an opportunity to identify small subsets of patients to improve ER/LA opioid prescribing

  8. Early Surgery versus Initial Conservative Treatment in Patients with Traumatic Intracerebral Hemorrhage (STITCH[Trauma]): The First Randomized Trial.

    Science.gov (United States)

    Mendelow, A David; Gregson, Barbara A; Rowan, Elise N; Francis, Richard; McColl, Elaine; McNamee, Paul; Chambers, Iain R; Unterberg, Andreas; Boyers, Dwayne; Mitchell, Patrick M

    2015-09-01

    Intraparenchymal hemorrhages occur in a proportion of severe traumatic brain injury TBI patients, but the role of surgery in their treatment is unclear. This international multi-center, patient-randomized, parallel-group trial compared early surgery (hematoma evacuation within 12 h of randomization) with initial conservative treatment (subsequent evacuation allowed if deemed necessary). Patients were randomized using an independent randomization service within 48 h of TBI. Patients were eligible if they had no more than two intraparenchymal hemorrhages of 10 mL or more and did not have an extradural or subdural hematoma that required surgery. The primary outcome measure was the traditional dichotomous split of the Glasgow Outcome Scale obtained by postal questionnaires sent directly to patients at 6 months. The trial was halted early by the UK funding agency (NIHR HTA) for failure to recruit sufficient patients from the UK (trial registration: ISRCTN19321911). A total of 170 patients were randomized from 31 of 59 registered centers worldwide. Of 82 patients randomized to early surgery with complete follow-up, 30 (37%) had an unfavorable outcome. Of 85 patients randomized to initial conservative treatment with complete follow-up, 40 (47%) had an unfavorable outcome (odds ratio, 0.65; 95% confidence interval, CI 0.35, 1.21; p=0.17), with an absolute benefit of 10.5% (CI, -4.4-25.3%). There were significantly more deaths in the first 6 months in the initial conservative treatment group (33% vs. 15%; p=0.006). The 10.5% absolute benefit with early surgery was consistent with the initial power calculation. However, with the low sample size resulting from the premature termination, we cannot exclude the possibility that this could be a chance finding. A further trial is required urgently to assess whether this encouraging signal can be confirmed.

  9. Trends in diabetes treatment patterns among primary care providers.

    Science.gov (United States)

    Decker, Sandra L; Burt, Catharine W; Sisk, Jane E

    2009-01-01

    Using data from the National Ambulatory Medical Care Survey, logit models tested for trends in the probability that visits by adult diabetes patients to their primary care providers included recommended treatment measures, such as a prescription for an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin-II receptor blocker (ARB), blood pressure measurement, and diet/nutrition or exercise counseling. Results indicated that the probability that visits included prescription of an ACE or ARB and blood pressure measurement increased significantly over the 1997-2005 period, while the probability that visits documented provision of exercise counseling rose since 2001.

  10. [Brain metastases: Focal treatment (surgery and radiation therapy) and cognitive consequences].

    Science.gov (United States)

    Reygagne, Emmanuelle; Du Boisgueheneuc, Foucaud; Berger, Antoine

    2017-04-01

    Brain metastases represent the first cause of malignant brain tumor. Without radiation therapy, prognosis was poor with fast neurological deterioration, and a median overall survival of one month. Nowadays, therapeutic options depend on brain metastases presentation, extra brain disease, performance status and estimated prognostic (DS GPA). Therefore, for oligometastatic brain patients with a better prognosis, this therapeutic modality is controversial. In fact, whole-brain radiation therapy improves neurological outcomes, but it can also induce late neuro-cognitive sequelae for long-term survivors of brain metastases. Thus, in this strategy for preserving good cognitive functions, stereotactic radiation therapy is a promising treatment. Delivering precisely targeted radiation in few high-doses in one to four brain metastases, allows to reduce radiation damage to normal tissues and it should allow to decrease radiation-induced cognitive decline. In this paper, we will discuss about therapeutic strategies (radiation therapy and surgery) with their neuro-cognitive consequences for brain metastases patients and future concerning preservation of cognitive functions. Copyright © 2016 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

  11. Visual Hallucinations in an Old Patient after Cataract Surgery and Treatment.

    Science.gov (United States)

    Ozcan, Halil; Yucel, Atakan; Ates, Orhan

    2016-02-01

    Sensory visual pathologies, accompanying simple or complex visual hallucinations that occur in visually-impaired individuals due to ophthalmologic or brain pathologies related to visual pathways in patients without mental disorders, are defined as Charles Bonnet syndrome. Between 10% and 60% of the patients having age-related eye diseases involving retina, cornea and the lens, commonly with macular degeneration experience complex visual hallucinations depending on the severity of visual problems. The neurophysiology of the visual hallucinations in Charles Bonnet Syndrome is not clearly known, and they may differ in content and severity over time. In differential diagnoses of Charles Bonnet Syndrome, many aetiologies (drugs, uraemia, exposure to toxic materials, neurodegenerative and psychiatric conditions) need to be ruled out. In the treatment of Charles Bonnet syndrome, first the management of the reason of visual loss should be clarified if possible. If needed, neuroleptics, anticonvulsants, antidepressants, benzodiazepines, cognitive enhancer agents such as cholinesterase inhibitors can be used also. In this case, an 83-year-old female patient experiencing visual hallucinations as burning candles in both eyes' visual field after left eye cataract surgery, treated with 0.5 milligram/day risperidone will be presented.

  12. Multimodal analgesic treatment in video-assisted thoracic surgery lobectomy using an intraoperative intercostal catheter.

    Science.gov (United States)

    Wildgaard, Kim; Petersen, Rene H; Hansen, Henrik J; Møller-Sørensen, Hasse; Ringsted, Thomas K; Kehlet, Henrik

    2012-05-01

    No golden standard for analgesia in video-assisted thoracic surgery (VATS) lobectomy exists. A simple multimodal approach using an intercostal catheter (ICC) may be of benefit since acute post-operative pain following VATS lobectomy primarily originates from the chest drain area. Prospective observational cohort. Forty-eight consecutive patients received a standardized regimen consisting of paracetamol, non-steroidal anti-inflammatory drug and gabapentin. Further, surgeons performed a single-shot paravertebral block (PVB) at five levels (15 ml of 0.5% bupivacaine) and inserted an ICC at the drain site level for continuous delivery of 6 ml of 0.25% bupivacaine h(-1). Pain scores at rest, mobilization and with the extended arms were followed until discharge or for 4 days. Forty-eight patients, mean age 64 years (CI: 61-68), were included. The mean time for the PVB and ICC placement was 5 min (CI: 4.7-5.9). The mean pain score at rest using a numerical rating scale (NRS, 0-10) was 85% of patients reporting satisfactory or very satisfactory pain treatment all days. Acute pain after VATS lobectomy may be adequately controlled using a multimodal non-opioid regime including PVB and an ICC. The low pain scores and reduced time used inserting the ICC may present an alternative to continuous epidural analgesia or conventional PVB.

  13. Twenty years of vasoplegic syndrome treatment in heart surgery. Methylene blue revised

    Science.gov (United States)

    Evora, Paulo Roberto Barbosa; Alves, Lafaiete; Ferreira, Cesar Augusto; Menardi, Antônio Carlos; Bassetto, Solange; Rodrigues, Alfredo José; Scorzoni, Adilson; Vicente, Walter Vilella de Andrade

    2015-01-01

    Objective This study was conducted to reassess the concepts established over the past 20 years, in particular in the last 5 years, about the use of methylene blue in the treatment of vasoplegic syndrome in cardiac surgery. Methods A wide literature review was carried out using the data extracted from: MEDLINE, SCOPUS and ISI WEB OF SCIENCE. Results The reassessed and reaffirmed concepts were 1) MB is safe in the recommended doses (the lethal dose is 40 mg/kg); 2) MB does not cause endothelial dysfunction; 3) The MB effect appears in cases of NO up-regulation; 4) MB is not a vasoconstrictor, by blocking the cGMP pathway it releases the cAMP pathway, facilitating the norepinephrine vasoconstrictor effect; 5) The most used dosage is 2 mg/kg as IV bolus, followed by the same continuous infusion because plasma concentrations sharply decrease in the first 40 minutes; and 6) There is a possible "window of opportunity" for MB's effectiveness. In the last five years, major challenges were: 1) Observations about side effects; 2) The need for prophylactic and therapeutic guidelines, and; 3) The need for the establishment of the MB therapeutic window in humans. Conclusion MB action to treat vasoplegic syndrome is time-dependent. Therefore, the great challenge is the need, for the establishment the MB therapeutic window in humans. This would be the first step towards a systematic guideline to be followed by possible multicenter studies. PMID:25859872

  14. Twenty years of vasoplegic syndrome treatment in heart surgery. Methylene blue revised

    Directory of Open Access Journals (Sweden)

    Paulo Roberto Barbosa Evora

    2015-02-01

    Full Text Available Objective: This study was conducted to reassess the concepts established over the past 20 years, in particular in the last 5 years, about the use of methylene blue in the treatment of vasoplegic syndrome in cardiac surgery. Methods: A wide literature review was carried out using the data extracted from: MEDLINE, SCOPUS and ISI WEB OF SCIENCE. Results: The reassessed and reaffirmed concepts were 1 MB is safe in the recommended doses (the lethal dose is 40 mg/kg; 2 MB does not cause endothelial dysfunction; 3 The MB effect appears in cases of NO up-regulation; 4 MB is not a vasoconstrictor, by blocking the cGMP pathway it releases the cAMP pathway, facilitating the norepinephrine vasoconstrictor effect; 5 The most used dosage is 2 mg/kg as IV bolus, followed by the same continuous infusion because plasma concentrations sharply decrease in the first 40 minutes; and 6 There is a possible "window of opportunity" for MB's effectiveness. In the last five years, major challenges were: 1 Observations about side effects; 2 The need for prophylactic and therapeutic guidelines, and; 3 The need for the establishment of the MB therapeutic window in humans. Conclusion: MB action to treat vasoplegic syndrome is time-dependent. Therefore, the great challenge is the need, for the establishment the MB therapeutic window in humans. This would be the first step towards a systematic guideline to be followed by possible multicenter studies.

  15. VAC therapy for the treatment of complex wounds after cardio-thoracic surgery.

    Science.gov (United States)

    De Caridi, Giovanni; Serra, Raffaele; Massara, Mafalda; Barone, Mario; Grande, Raffaele; Butrico, Lucia; Mastroroberto, Pasquale; de Franciscis, Stefano; Monaco, Francesco

    2016-10-01

    The aim of this study is to report our experience about the treatment of complex sternal and thoracic wounds following cardiothoracic surgery, using vacuum-assisted closure (VAC therapy. Twelve patients presenting with sternal (five cases) and thoracic (seven cases) wounds that were difficult to heal were treated through VAC therapy after the first surgical debridement. The duration of VAC application ranged from 12 to 36 days with an average hospital stay of 24·6 ± 11·4 days. During a mean follow-up of 12 months, we observed complete wound healing in seven cases (58·3%), in an average period of 25·5 ± 14·3 days; one patient died during follow-up, two patients were lost to follow-up and two patients required definitive surgical closure of the wound cavity. In conclusion, VAC therapy promotes faster wound healing, with shorter hospital stay and subsequent lesser in-hospital cost, reducing the mortality rate in the long run. It also promotes early rehabilitation and alleviates the need for a second procedure, thus improving patient satisfaction, with minimal discomfort or inconvenience.

  16. Cutting Edge Treatment: Pain and Surgery in the Ashley X Case

    Science.gov (United States)

    Sobsey, Dick

    2009-01-01

    Pain and surgery are phenomena that have frequently been mentioned in the discussions of the Ashley X case. This article describes how pain and surgery have been used selectively to argue for or against the Ashley X procedures. Few if any of the many publications discussing the merits of the Ashley-X procedures can be said to strike a reasonable…

  17. Effects of conventional versus laparoscopic surgery in treatment of congenital bile duct dilatation: a comparative analysis

    Directory of Open Access Journals (Sweden)

    CHEN Houbin

    2015-06-01

    Full Text Available ObjectiveTo compare the clinical effects of conventional versus laparoscopic surgery in adults with congenital bile duct dilatation. MethodsA retrospective analysis was performed on the clinical data of 37 patients with congenital bile duct dilation who were treated in our hospital from February 2011 to February 2013. All the 37 cases underwent bile duct cyst resection and common hepatic duct-jejunal Roux-en-Y anastomosis; 20 of them (study group underwent laparoscopic surgery, while the other 17 cases (control group underwent open surgery. The mean operative time, mean intraoperative blood loss, mean length of hospital stay after surgery, mean time to first flatus after surgery, and postoperative complications were compared between the two groups. Comparison of continuous data between the two groups was made by t test, while comparison of categorical data was made by chi-square test. ResultsCompared with the control group, the study group had a significantly longer operative time (P<0.05 but significantly less mean intraoperative blood loss, mean length of hospital stay after surgery, and mean time to first flatus after surgery (P<0.05. The incidence of postoperative complications showed no significant difference between the two groups (P>0.05. ConclusionCompared with conventional surgery, laparoscopic bile duct cyst resection and common hepatic duct-jejunal Roux-en-Y anastomosis is less invasive and safer and leads to faster recovery in adults with congenital bile duct dilation, and it is worthy of clinical application.

  18. [Feasibility and cosmetic outcome of oncoplastic surgery in breast cancer treatment].

    Science.gov (United States)

    Sherwell-Cabello, Santiago; Maffuz-Aziz, Antonio; Villegas-Carlos, Felipe; Domínguez-Reyes, Carlos; Labastida-Almendaro, Sonia; Rodríguez-Cuevas, Sergio

    2015-01-01

    Breast cancer is the leading oncological cause of death in Mexican women over 25 years old. Given the need to improve postoperative cosmetic results in patients with breast cancer, oncoplastic surgery has been developed, which allows larger tumour resections and minor cosmetic alterations. To determine the oncological feasibility and cosmetic outcome of oncoplastic surgery at the Instituto de Enfermedades de la Mama, FUCAM, AC. A review was conducted from January 2010 to July 2013, which included patients with breast cancer diagnosis treated with conventional breast-conserving surgery or with oncoplastic surgery in the Institute of Diseases of the Breast, FUCAM AC. Clinical and histopathological parameters were compared between the two groups, and a questionnaire of cosmetic satisfaction and quality of life was applied. Of the 171 patients included, 95 of them were treated with conventional breast-conserving surgery and 76 with oncoplastic surgery. Pathological tumour size was significantly larger in patients treated with oncoplastic surgery (p = 0.002). There were no differences found between the groups as regards the number of patients with positive surgical margin, the rate of complications, and cosmetic satisfaction. This study demonstrates the oncological feasibility and high cosmetic satisfaction of oncoplastic surgery with minimal psycho-social impact on patients. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  19. [Post-operative residual astigmatism after cataract surgery: Current surgical methods of treatment].

    Science.gov (United States)

    Pisella, P-J

    2012-03-01

    Residual astigmatism after cataract surgery can be corrected by three different techniques: classic limbal relaxing incisions, easy to perform but with limited precision; laser refractive surgery (PRK or Lasik), additionally allowing for correction of spherical equivalent; and more recently the use of a piggyback toric intraocular lens in the ciliary sulcus.

  20. EEG power asymmetry and functional connectivity as a marker of treatment effectiveness in DBS surgery for depression.

    Science.gov (United States)

    Quraan, Maher A; Protzner, Andrea B; Daskalakis, Zafiris J; Giacobbe, Peter; Tang, Chris W; Kennedy, Sidney H; Lozano, Andres M; McAndrews, Mary P

    2014-04-01

    Recently, deep brain stimulation (DBS) has been evaluated as an experimental therapy for treatment-resistant depression. Although there have been encouraging results in open-label trials, about half of the patients fail to achieve meaningful benefit. Although progress has been made in understanding the neurobiology of MDD, the ability to characterize differences in brain dynamics between those who do and do not benefit from DBS is lacking. In this study, we investigated EEG resting-state data recorded from 12 patients that have undergone DBS surgery. Of those, six patients were classified as responders to DBS, defined as an improvement of 50% or more on the 17-item Hamilton Rating Scale for Depression (HAMD-17). We compared hemispheric frontal theta and parietal alpha power asymmetry and synchronization asymmetry between responders and non-responders. Hemispheric power asymmetry showed statistically significant differences between responders and non-responders with healthy controls showing an asymmetry similar to responders but opposite to non-responders. This asymmetry was characterized by an increase in frontal theta in the right hemisphere relative to the left combined with an increase in parietal alpha in the left hemisphere relative to the right in non-responders compared with responders. Hemispheric mean synchronization asymmetry showed a statistically significant difference between responders and non-responders in the theta band, with healthy controls showing an asymmetry similar to responders but opposite to non-responders. This asymmetry resulted from an increase in frontal synchronization in the right hemisphere relative to the left combined with an increase in parietal synchronization in the left hemisphere relative to the right in non-responders compared with responders. Connectivity diagrams revealed long-range differences in frontal/central-parietal connectivity between the two groups in the theta band. This pattern was observed irrespective of

  1. Plastic and Reconstructive Surgery in the Treatment of Oncological Perineal and Genital Defects

    Directory of Open Access Journals (Sweden)

    Rebekka eBrodbeck

    2015-10-01

    Full Text Available Defects of the perineum may result from ablative procedures of different malignancies. The evolution of more radical excisional surgery techniques resulted in an increase in large defects of the perineum. The perineogenital region per se has many different functions for urination, bowel evacuation, sexuality and reproduction. Up-to-date individual and interdisciplinary surgical treatment concepts are necessary to provide optimum oncological as well as quality of life outcome.Not only the reconstructive method but also the timing of the reconstruction is crucial. In cases of postresectional exposition of e. g. pelvic or femoral vessels or intrapelvic and intra-abdominal organs, simultaneous flap procedure is mandatory. In particular, the reconstructive armamentarium of the plastic surgeon should not only include pedicled, but also free microsurgical flaps so that no compromise in terms of the extent of the oncological resection has to be accepted. For intra-abdominally and/or pelvic tumors of the rectum, the anus or the female reproductive system, which were resected through an abdominally and a sacrally surgical access, simultaneous VRAM flap reconstruction is recommendable. In terms of soft tissue sarcoma of the pelvic / caudal abdomen / proximal thigh region, two-stage reconstructions are possible.This review focuses on the treatment of perineum, genitals and pelvic floor defects after resection of malignant tumors, giving a distinct overview of the different type of defects faced in this region and describing a number of reconstructive techniques, especially VRAM flap and pedicled flaps like ALT flap or free flaps. Finally, this review outlines some considerations concerning timing of the different operative steps.

  2. Long-term results of endoscopic sinus surgery-oriented treatment for chronic rhinosinusitis with asthma.

    Science.gov (United States)

    Chen, Feng-Hong; Zuo, Ke-Jun; Guo, Yu-Biao; Li, Zhi-Ping; Xu, Geng; Xu, Rui; Shi, Jian-Bo

    2014-01-01

    The aims of this study were to evaluate the efficacy of functional endoscopic sinus surgery (FESS)-oriented multimodality treatment in chronic rhinosinusitis (CRS) patients with asthma and its impact on asthma. Prospective, nonrandomized cohort. Twenty-seven CRS patients with asthma who underwent FESS with postoperative topical corticosteroid spray were evaluated preoperatively; 25 of them were evaluated 1 year and 3 years postoperatively. CRS was evaluated by visual analogue scale, clinical control of CRS, and objective measurement endoscopy Lund-Kennedy scores. Asthma was assessed by subjective asthma control test and asthma control level, also by objective antiasthma medication use and pulmonary function tests. VAS scores of general symptoms (8.09 ± 0.87 preoperatively) were significantly improved at 1 year (2.94 ± 2.21) and 3 years (3.77 ± 2.16) postoperation (P = .000). No difference in these items was found between 1 year and 3 years (P = .463). Endoscopy Lund-Kennedy scores at 1 year (4.34 ± 3.09) and 3 years (5.80 ± 3.38) postoperatively were significantly better (9.33 ± 2.03 preoperatively, P = .000), and there was no difference between 1 year and 3 years of follow-up (P > .05). Significantly, asthma control level improved postoperatively (P = .025). However, antiasthma drug and pulmonary function showed no significant change postoperatively (P > .05). FESS-oriented multimodality treatment improves CRS with asthma significantly and persistently. Asthma control level improved. Antiasthma medication use and pulmonary function remained stable. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  3. Radiofrequency ablation for the treatment of weight regain after Roux-en-Y gastric bypass surgery.

    Science.gov (United States)

    Abrams, Julian A; Komanduri, Sri; Shaheen, Nicholas J; Wang, Zengri; Rothstein, Richard I

    2017-07-13

    Roux-en-Y gastric bypass (RYGB) surgery is an established modality for the treatment of morbid obesity. However, approximately one-quarter of patients experience weight regain after initially successful weight loss. Endoscopic therapy targeting the gastric remnant pouch represents a novel potential strategy to re-induce weight loss in this population. We performed a pilot trial of radiofrequency ablation (RFA) of the gastric remnant pouch after RYGB to determine feasibility, safety, and efficacy for weight loss. We identified patients who had undergone RYGB, achieved >40% excess body weight loss (EBWL), and then regained >25% of lost weight. RFA was applied to the gastrojejunal anastomosis and the entire surface area of the gastric remnant pouch. Treatment was repeated at 4 and 8 months if patients did not meet specified weight loss targets. Weekly weights were obtained for 12 months. The primary efficacy outcome was percent EBWL at 12 months, compared with baseline. Twenty-five patients were enrolled at 4 centers. Mean (± standard deviation [SD]) age was 45.4 ± 9.1 years, and 84% (21/25) were female. Mean (± SD) baseline body mass index was 40.2 ± 7.8. Twenty-two of 25 patients completed 12 months of follow-up. At 12 months, median (± SD) EBWL was 18.4% (interquartile ratio 10.8, 33.7; P weight loss was seen at 3.5 months (P weight loss over the 12-month period (P = .013). Two patients had serious adverse events requiring hospitalization. RFA of the gastric remnant pouch in patients with weight regain after RYGB resulted in significant reductions in excess body weight with an acceptable safety profile. Continued weight loss was observed after each RFA treatment. Further clinical trials in well-selected populations are warranted to determine the optimal number and frequency of RFA treatments and to assess durability of weight loss. (Clinical trial registration number: NCT01910688.). Copyright © 2017 American Society for Gastrointestinal Endoscopy

  4. Treatment of arteriovenous malformations with linear accelerator-based radiosurgery compared with Gamma Knife surgery.

    Science.gov (United States)

    Orio, Peter; Stelzer, Keith J; Goodkin, Robert; Douglas, James G

    2006-12-01

    The authors sought to compare the outcomes of patients with arteriovenous malformations (AVMs) treated by Gamma Knife surgery (GKS) with those of patients treated by linear accelerator-based (LINAC) radiosurgery. One hundred and eighty-seven patients with AVMs were treated at our institution between 1992 and 2003. Ninety-one patients were treated with GKS and 96 patients were treated with LINAC radiosurgery. Patient and treatment characteristics in the two groups included the following. In the LINAC group, the median age was 33 years (range 9-66 years); the median dose was 16 Gy (70% isodose line); the median treated AVM volume was 5.5 cm3; and 46% of patients in this group were treated after hemorrhage. In the GKS group, the median age was 38 years (range 6-63 years); the median dose was 20 Gy (50% isodose line); the median treated AVM volume was 4.3 cm3; and 44% of patients in this group were treated after hemorrhage. Obliteration of AVMs was determined by performing computed tomography (CT) angiography and/or magnetic resonance (MR) angiography and angiography. Patient follow-up evaluation included obtaining an MR angiogram/MR image or CT angiogram at 6 months, at 1 year, and then annually thereafter. Angiography was performed to confirm obliteration when MR angiography and/or CT angiography no longer revealed evidence of an AVM. The 5-year estimated AVM obliteration rate was 66% in the entire patient group; the LINAC group was 60%; the GKS group was 72%; this difference was not statistically significant (p = 0.97). Twelve patients who underwent treatment with LINAC radiosurgery underwent retreatment with GKS and one was retreated with LINAC radiosurgery. The obliteration rate was 82%. Six patients treated with GKS were retreated with GKS, but the follow-up time is of short duration. Chronic toxicity occurred in 8% of both the GKS and the LINAC groups (p = 0.61). Posttreatment hemorrhage during the time of risk before AVM obliteration was 13% in the GKS group

  5. Voice Quality After Treatment of Early Vocal Cord Cancer: A Randomized Trial Comparing Laser Surgery With Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Aaltonen, Leena-Maija, E-mail: leena-maija.aaltonen@hus.fi [Department of Otorhinolaryngology–Head and Neck Surgery, Helsinki University Central Hospital, and University of Helsinki, Helsinki (Finland); Rautiainen, Noora; Sellman, Jaana [Institute of Behavioural Sciences, University of Helsinki, Helsinki (Finland); Saarilahti, Kauko [Department of Oncology, Helsinki University Central Hospital, and University of Helsinki, Helsinki (Finland); Mäkitie, Antti; Rihkanen, Heikki [Department of Otorhinolaryngology–Head and Neck Surgery, Helsinki University Central Hospital, and University of Helsinki, Helsinki (Finland); Laranne, Jussi; Kleemola, Leenamaija [Department of Otorhinolaryngology–Head and Neck Surgery, Tampere University Hospital, and University of Tampere, Tampere (Finland); Wigren, Tuija [Department of Oncology, Tampere University Hospital, and University of Tampere, Tampere (Finland); Sala, Eeva [Department of Otorhinolaryngology–Head and Neck Surgery, Turku University Hospital, and University of Turku, Turku (Finland); Lindholm, Paula [Department of Oncology, Turku University Hospital, and University of Turku, Turku (Finland); Grenman, Reidar [Department of Otorhinolaryngology–Head and Neck Surgery, Turku University Hospital, and University of Turku, Turku (Finland); Joensuu, Heikki [Department of Oncology, Helsinki University Central Hospital, and University of Helsinki, Helsinki (Finland)

    2014-10-01

    Objective: Early laryngeal cancer is usually treated with either transoral laser surgery or radiation therapy. The quality of voice achieved with these treatments has not been compared in a randomized trial. Methods and Materials: Male patients with carcinoma limited to 1 mobile vocal cord (T1aN0M0) were randomly assigned to receive either laser surgery (n=32) or external beam radiation therapy (n=28). Surgery consisted of tumor excision with a CO{sub 2} laser with the patient under general anaesthesia. External beam radiation therapy to the larynx was delivered to a cumulative dose of 66 Gy in 2-Gy daily fractions over 6.5 weeks. Voice quality was assessed at baseline and 6 and 24 months after treatment. The main outcome measures were expert-rated voice quality on a grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, videolaryngostroboscopic findings, and the patients' self-rated voice quality and its impact on activities of daily living. Results: Overall voice quality between the groups was rated similar, but voice was more breathy and the glottal gap was wider in patients treated with laser surgery than in those who received radiation therapy. Patients treated with radiation therapy reported less hoarseness-related inconvenience in daily living 2 years after treatment. Three patients in each group had local cancer recurrence within 2 years from randomization. Conclusions: Radiation therapy may be the treatment of choice for patients whose requirements for voice quality are demanding. Overall voice quality was similar in both treatment groups, however, indicating a need for careful consideration of patient-related factors in the choice of a treatment option.

  6. Pouch Salvage Surgery for Treatment of Colitis and Familial Adenomatous Polyposis: Report of Five Cases

    Directory of Open Access Journals (Sweden)

    Derakhshani

    2016-08-01

    Full Text Available Introduction The restorative proctocolectomy (RPC with ileal pouch-anal anastomosis (IPAA is currently the preferred surgical method for most patients with ulcerative colitis and familial adenomatous polyposis and sometimes, functional bowel diseases. Infection around the pouch, remaining rectal stump, stricture at anastomosis site, pouch dysfunction and refractory pouchitis can lead to pouch failure. Pouch salvage surgery could prevent pouch failure in some cases. Case Presentation In this report, five patients were introduced, who underwent pouch salvage surgery after RPC/IPAA surgery failure. Two of the patients were male and three were female and the relevant age range was 16 to 41. Initially, RPC/IPAA surgery was performed on these five patients. Four of the patients underwent RPC/IPAA surgery as a result of ulcerative colitis and, one of the patients as a result of familial adenomatous polyposis. However, due to pouch failure from the RPC/IPAA surgery, pouch-salvage surgery was performed on each of these five patients. Two of the patients underwent pouch-salvage surgery due to infection and pouch fistula, and the other three underwent this surgery due to the remaining rectal stump, anastomosis stenosis and pouch dysfunction. The average time for when pouch-salvage surgery was performed was 3.5 years (three months to five years after the initial operation and the patients were under follow-up care for two to seven years. Conclusions After performing pouch salvage operation, pouch function was acceptable in all patients and we could close ileostomies of all of them.

  7. Patterns of care and treatment outcomes of patients with Craniopharyngioma in the national cancer database.

    Science.gov (United States)

    Rao, Yuan J; Hassanzadeh, Comron; Fischer-Valuck, Benjamin; Chicoine, Michael R; Kim, Albert H; Perkins, Stephanie M; Huang, Jiayi

    2016-12-23

    To investigate the patterns of care and outcomes in patients with craniopharyngioma in the National Cancer Data Base (NCDB). This study included 697 patients (166 pediatric and 531 adult cases) treated for craniopharyngioma between 2004 and 2012 in the NCDB. Adjuvant radiotherapy (RT) was defined if within 6 months of surgery. Limited surgery (LS) was defined as biopsy or subtotal resection. Proportional-hazards models were used to evaluate associations between covariates and overall survival (OS). A time-dependent analysis of RT was performed to account for early deaths after surgery. Median follow-up was 46 months. Overall, 21% of patients received adjuvant RT. Of patients with known surgical extent (n = 195), 71% had LS. Utilization of adjuvant RT increased from 18% in 2004-2007 to 24% in 2008-2012. Patterns of care regarding adjuvant RT or LS were not significantly different between adult and pediatric patients. Tumor size, low comorbidity, and LS were associated with increased utilization of adjuvant RT. The 5-year OS among patients treated with LS, LS+RT, and gross total resection were 75, 85, and 82% (p = 0.02). On multivariate analysis of the 195 patients with known surgical extent, LS+RT was associated with improved OS compared to LS (HR 0.22, 95% CI 0.05-0.99, p = 0.04), but was not significant when early deaths (<2 months from surgery) were removed to adjust for immortal-time bias. Medical practice regarding surgical approach and adjuvant RT are similar for pediatric and adult craniopharyngiomas. Immortal-time bias may confound assessment of OS for adjuvant RT. Prospective studies comparing adjuvant RT versus observation after LS are warranted.

  8. Safety and efficacy of prothrombin complex concentrate as first-line treatment in bleeding after cardiac surgery.

    Science.gov (United States)

    Cappabianca, Giangiuseppe; Mariscalco, Giovanni; Biancari, Fausto; Maselli, Daniele; Papesso, Francesca; Cottini, Marzia; Crosta, Sandro; Banescu, Simona; Ahmed, Aamer B; Beghi, Cesare

    2016-01-06

    Bleeding after cardiac surgery requiring surgical reexploration and blood component transfusion is associated with increased morbidity and mortality. Although prothrombin complex concentrate (PCC) has been used satisfactorily in bleeding disorders, studies on its efficacy and safety after cardiopulmonary bypass are limited. Between January 2005 and December 2013, 3454 consecutive cardiac surgery patients were included in an observational study aimed at investigating the efficacy and safety of PCC as first-line coagulopathy treatment as a replacement for fresh frozen plasma (FFP). Starting in January 2012, PCC was introduced as solely first-line treatment for bleeding following cardiac surgery. After one-to-one propensity score-matched analysis, 225 pairs of patients receiving PCC (median dose 1500 IU) and FFP (median dose 2 U) were included. The use of PCC was associated with significantly decreased 24-h post-operative blood loss (836 ± 1226 vs. 935 ± 583 ml, p surgery setting, the use of PCC compared with FFP was associated with decreased post-operative blood loss and RBC transfusion requirements. However, PCC administration may be associated with a higher risk of post-operative AKI.

  9. [Lumbar disc herniation: Natural history, role of physical examination, timing of surgery, treatment options and conflicts of interests].

    Science.gov (United States)

    Delgado-López, Pedro David; Rodríguez-Salazar, Antonio; Martín-Alonso, Javier; Martín-Velasco, Vicente

    Indication for surgery in lumbar disc herniation (LDH) varies widely depending on the geographical area. A literature review is presented on the natural history, role of physical examination, timing of surgery, evidence-based treatment, and conflicts of interests in LDH. Surgery is shown to provide significant faster relief of pain compared to conservative therapy, although the effect fades after a year. There is no treatment modality better than the rest in terms of pain control and neurological recovery, nor is there a surgical technique clearly superior to simple discectomy. The lack of sound scientific evidence on the surgical indication may contribute to its great geographical variability. Since LDH has a favourable natural history, neuroimaging and surgery should not be considered until after a 6-week period. It is necessary to specify and respect the surgical indications for LDH, avoiding conflicts of interests. Copyright © 2016 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Changes in the pattern of patients receiving surgical-orthodontic treatment

    Science.gov (United States)

    Proffit, William R.; Jackson, Tate H.; Turvey, Timothy A.

    2014-01-01

    Introduction The characteristics of patients who seek and accept orthognathic surgery appear to be changing over time but have not been well documented in the 21st century. Methods Records for patients who had orthognathic surgery at the University of North Carolina from 1996 to 2000 and from 2006 to 2010 were reviewed to collect data for changes in the prevalence of patients with mandibular deficiency (Class II), maxillary deficiency or mandibular prognathism (Class III), long face, and asymmetry problems. The changes were compared with those in previous time periods and at other locations. Results Between 1996 and 2000 and between 2006 and 2010, the percentage of Class III patients increased from 35% to 54%, and the percentage of Class II patients decreased from 59% to 41%, while the percentages for long face and asymmetry showed little change. The decrease in Class II patients was accentuation of a long-term trend; the increase in Class III patients occurred only after the turn of the century. Conclusions A similar but less-marked change has been noted at some but not all other locations in the United States. It appears to be related primarily to an increase in the numbers of African Americans, Native Americans, Hispanics, and Asians who now are seeking surgical treatment, but it also has been affected by changes in where orthognathic surgery is performed, decisions by third-party payers (insurance and Medicaid) about coverage for treatment, and the availability of nonsurgical orthodontic treatment options for Class II patients. PMID:23726329

  11. The influence of methods of bariatric surgery for treatment of type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Bužga M

    2016-04-01

    Full Text Available Marek Bužga,1 Petra Maresova,2 Adela Seidlerová,1 Pavel Zonča,1 Pavol Holéczy,1 Kamil Kuča2,3 1Research Obesity Center, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; 2Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, Czech Republic; 3Biomedical Research Center, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic Abstract: The constantly growing incidence of obesity represents a risk of health complications for individuals, and is a growing economic burden for health care systems and society. The aim of this study was to evaluate the efficacy of bariatric surgery, specifically laparoscopic greater curve plication, laparoscopic sleeve gastrectomy, and Roux-en-Y gastric bypass, in patients with type 2 diabetes mellitus. The effect of bariatric surgery on the changes in blood pressure before, and 12 months after, surgery and in pharmacotherapy in the 12 months after surgery was analyzed. For achieving this purpose, 74 patients from the Obesity and Surgery Department of Vitkovice Hospital in Ostrava in the Czech Republic, were monitored. They were operated in 2011 and 2012. The Bonferroni method was used to test hypotheses about the impact of surgery on blood pressure and pharmacotherapy. One year after the surgery, systolic and diastolic blood pressure values decreased, both with no statistically significant difference between surgery types. Improvement was observed in 68% of cases, with 25% of patients discontinuing pharmacotherapy entirely. Keywords: type 2 diabetes mellitus, bariatric surgery, blood pressure, pharmacotherapy

  12. Feasibility and Efficacy of Defatted Human Milk in the Treatment for Chylothorax After Cardiac Surgery in Infants.

    Science.gov (United States)

    Fogg, Kristi L; DellaValle, Diane M; Buckley, Jason R; Graham, Eric M; Zyblewski, Sinai C

    2016-08-01

    Chylothorax is a well-described complication after cardiothoracic surgery in children. Medical nutritional therapy for chylothorax includes medium-chain triglyceride (MCT) formulas and reduction in enteral long-chain triglyceride intake to reduce chyle production. Human milk is usually eliminated from the diet of infants with chylothorax because of its high long-chain triglyceride content. However, given the immunologic properties of human milk, young infants with chylothorax may benefit from using human milk over human milk substitutes. We performed a retrospective cohort study to describe the feasibility and efficacy of defatted human milk (DHM) for the treatment for chylothorax in infants after cardiac surgery and to compare growth outcomes between infants treated with DHM (n = 14) versus MCT formula (n = 21). There were no differences in mortality or length of hospital stay between the DHM and MCT formula treatment groups. The DHM treatment group had a significantly higher weight-for-age z-score at hospital discharge compared to the MCT formula group with median z-scores of -1 (-2 to 0.5) and -1.5 (-2 to 0), respectively (p = 0.02). In infants with chylothorax after cardiac surgery, DHM is a safe and feasible medical nutritional treatment and may have potential benefits for improved nutrition and growth.

  13. Comparative Effects of Snoring Sound between Two Minimally Invasive Surgeries in the Treatment of Snoring: A Randomized Controlled Trial

    Science.gov (United States)

    Lee, Li-Ang; Yu, Jen-Fang; Lo, Yu-Lun; Chen, Ning-Hung; Fang, Tuan-Jen; Huang, Chung-Guei; Cheng, Wen-Nuan; Li, Hsueh-Yu

    2014-01-01

    Background Minimally invasive surgeries of the soft palate have emerged as a less-invasive treatment for habitual snoring. To date, there is only limited information available comparing the effects of snoring sound between different minimally invasive surgeries in the treatment of habitual snoring. Objective To compare the efficacy of palatal implant and radiofrequency surgery, in the reduction of snoring through subjective evaluation of snoring and objective snoring sound analysis. Patients and Method Thirty patients with habitual snoring due to palatal obstruction (apnea-hypopnea index ≤15, body max index ≤30) were prospectively enrolled and randomized to undergo a single session of palatal implant or temperature-controlled radiofrequency surgery of the soft palate under local anesthesia. Snoring was primarily evaluated by the patient with a 10 cm visual analogue scale (VAS) at baseline and at a 3-month follow-up visit and the change in VAS was the primary outcome. Moreover, life qualities, measured by snore outcomes survey, and full-night snoring sounds, analyzed by a sound analytic program (Snore Map), were also investigated at the same time. Results Twenty-eight patients completed the study; 14 received palatal implant surgery and 14 underwent radiofrequency surgery. The VAS and snore outcomes survey scores were significantly improved in both groups. However, the good response (postoperative VAS ≤3 or postoperative VAS ≤5 plus snore outcomes survey score ≥60) rate of the palatal implant group was significantly higher than that of the radiofrequency group (79% vs. 29%, P = 0.021). The maximal loudness of low-frequency (40–300 Hz) snores was reduced significantly in the palatal implant group. In addition, the snoring index was significantly reduced in the radiofrequency group. Conclusions Both palatal implants and a single-stage radiofrequency surgery improve subjective snoring outcomes, but palatal implants have a greater effect on most measures

  14. National Practice Pattern and Time Trends in Treatment of Upper Urinary Tract Calculi in Korea: a Nationwide Population-Based Study.

    Science.gov (United States)

    Park, Jinsung; Suh, Beomseok; Lee, Myung Shin; Woo, Seung Hyo; Shin, Dong Wook

    2016-12-01

    Despite high prevalence of upper urinary tract calculi (UUTC), there are few studies regarding patterns of care in Asian populations. We investigated treatment patterns and time trends in patients with newly diagnosed UUTC in Korea using the National Health Insurance database that includes de-identified claims from a random 2% sample of the entire population (> 1 million people). A total of 14,282 patients who received active treatments, including shock wave lithotripsy (SWL), ureteroscopic surgery (URS), percutaneous nephrolithotomy (PNL), and uretero/pyelolithotomy (UPL), for newly diagnosed UUTC between 2003 and 2013 were included. The number of primary and all treated cases of UUTC significantly (43% and 103.3%, respectively) increased over the 10-year period. While patients undergoing SWL, URS, PNL, and UPL as primary treatment increased by 43.7%, 31.9%, 87.5%, and 0%, respectively, the relative proportion undergoing each treatment remained constant over the 10 years (SWL > 90%, URS 4.5% to 7.8%, PNL 0.4% to 1.0%, and UPL 40 years (compared to age PNL, and UPL, rather than SWL, while patients living in urban or suburban/rural areas (compared to metropolitan) were significantly less likely to undergo URS and PNL. In summary, the majority of Korean patients underwent SWL as primary treatment for UUTC, and the predominant use of SWL remained steady over a 10-year period in Korea. Our results will be valuable in examining treatment patterns and time trends in Korean UUTC patients.

  15. The tear substitutive therapy for prophylaxis and treatment of dry eye after cataract surgery

    Directory of Open Access Journals (Sweden)

    V. N. Trubilin

    2013-01-01

    Full Text Available Purpose: To study the efficiency of tear substitutes based on hyaluronic acid at the patients after phacoemulsification for prophylaxis and postoperative therapy of dry eye syndrome.Methods: 168 patients (168 eyes were examined before cataract surgery. The average age was 69.2±5.7 years old. Patients were divided into four groups according to the presence of eye dry syndrome and following tear substitutive therapy. 55 patients with a mild case of DES (the first group were treated with Vismed® eye drops 1 drop given 3 times a day for 1 week before surgery and postoperatively. 10 patients with a moderate case of DES (second group were treated with Vismed gel® to use with the same periodicity. Patients without DES were divided into two groups: 50 of them (third group were treated to use Vismed® 1 drop 3 times a day postoperatively, the rest 53 didn’t undergo the course of treatment — «checkout group». The observation period was 45 days after operation. The study of tear secretion and osmolarity of tear fluid was performed before and after operative period.Results: 65 patients were first diagnosed a mild or moderate case of DES. On the third day after operation every group showed the increase of tear osmolarity, it was especially noticable among the patients of «checkout group» from 294 to 314 mOsm / l at the average. On the seventh day after operation all groups showed further negative dynamics, and in the «checkout» group comparing to initial indices was registered noticable worsening of the studied parameters (р≤0.05. By the 14th day after phacoemulsification patients from the 1st and the 3rd groups displayed the tendency to restoration of indices to the preoperative values. Indices of osmolarity and tear secretion restored among the patients from the 1st and the 2nd groups by the 21st day and even improved in comparison to the preoperative values of group 3. Meanwhile, «checkout» group’s indices fell to a level

  16. Children Thyroid Cancer treatment in Saint-Petersburg Endocrine SurgeryCenter and Mayo Clinic

    Directory of Open Access Journals (Sweden)

    Aleksandr Filippovich Romanchishen

    2015-02-01

    Full Text Available IntroductionThyroid cancer (TC is the most often malignant tumor in childhood and made 1.5 – 3.0% of all children population or 45.3% of pediatric endocrine epithelial cancers. A lot of questions concerning to volume of thyroid surgery, postoperative radio iodine therapy (RIT needs to be discussed.AimEstimation of childhood sporadic thyroid cancer specificity and comparison of children and adolescents treatment in Saint-Petersburg Endocrine Surgery Center (Russia and Mayo Clinic (USA.Material and methodsDuring 1970 –2011 in the Saint-Petersburg Center (1 group were operated 105 TC children and adolescent (up to 20 yeas and in Mayo Clinic – 188 (2 group in  1940 – 2000 period. Since of 80-s in those clinics were used the same perioperative examinations, like TSH, T4, T3 blood levels, USG, fine needles aspiration biopsy, CT and morphological examinations.Results and discussionAverage age of the Saint-Petersburg Center and Rochester patients was the same and achieve 16.3±0.3 and 16.0±0.5, accordingly. In both groups has prevailed girls: in the 1 group they made 73.3% (M:F 1:2.7 and in the 2 – 70.7% (M:F 1:2.4. Childhood differentiated TC were associated with aggressive behavior: regional metastases were found in 53.0% and 81.4%, extrathyroid TC spreading – in 9.6 and 19.7%, distant metastases - in 9.6 and 4.8%, accordingly. In our Center (1 group we have performed hemithyroidectomies and subtotal Thyroidectomies in 58.1% with ipsilateral central neck dissection (CND. In Mayo Clinic in all TC cases were performed thyroidectomy (TE since 1950. TC relapses we have no   observed in 1 group and they have place in 6.9% 2 group patients, recurring lymphatic metastases – in 8.4% and 20.7%, accordingly. Radioiodine therapy (RIT has performed in 21.1% and 25.5% operated children.In 1 group 95 (96.0 % of 99 operated were alive during 5 – 36 years, in the 2– only in two cases reason of death was TC, but in 14 – other malignant tumor

  17. Patterns of progression, treatment of progressive disease and post-progression survival in the New EPOC study.

    Science.gov (United States)

    Pugh, Siân A; Bowers, Megan; Ball, Alexandre; Falk, Stephen; Finch-Jones, Meg; Valle, Juan W; O'Reilly, Derek A; Siriwardena, Ajith K; Hornbuckle, Joanne; Rees, Myrddin; Rees, Charlotte; Iveson, Tim; Hickish, Tamas; Maishman, Tom; Stanton, Louise; Dixon, Elizabeth; Corkhill, Andrea; Radford, Mike; Garden, O James; Cunningham, David; Maughan, Tim S; Bridgewater, John A; Primrose, John N

    2016-08-09

    The addition of cetuximab (CTX) to perioperative chemotherapy (CT) for operable colorectal liver metastases resulted in a shorter progression-free survival. Details of disease progression are described to further inform the primary study outcome. A total of 257 KRAS wild-type patients were randomised to CT alone or CT with CTX. Data regarding sites and treatment of progressive disease were obtained for the 109 (CT n=48, CT and CTX n=61) patients with progressive disease at the cut-off date for analysis of November 2012. The liver was the most frequent site of progression (CT 67% (32/48); CT and CTX 66% (40/61)). A higher proportion of patients in the CT and group had multiple sites of progressive disease (CT 8%, 4/48; CT and CTX 23%, 14/61 P=0.04). Further treatment for progressive disease is known for 84 patients of whom 69 received further CT, most frequently irinotecan based. Twenty-two patients, 11 in each arm, received CTX as a further line agent. Both the distribution of progressive disease and further treatment are as expected for such a cohort. The pattern of disease progression seen is consistent with failure of systemic micrometastatic disease control rather than failure of local disease control following liver surgery.

  18. Operative Treatments for Reflux After Bariatric Surgery: Current and Emerging Management Options.

    Science.gov (United States)

    Treitl, Daniela; Nieber, Derek; Ben-David, Kfir

    2017-03-01

    Gastroesophageal reflux disease (GERD) is a common disorder that has a well-established connection with obesity. To ameliorate the morbidity associated with obesity, bariatric procedures have become an established pathway to accomplish sustained weight loss. In some procedures, such as with the Roux-en-Y gastric bypass surgery, weight loss is also accompanied by the resolution of GERD symptoms. However, other popular bariatric surgeries, such as the sleeve gastrectomy, have a controversial impact on their effect on reflux. Consequently, increased attention has been given to the development of strategies for the management of de novo or recurrent reflux after bariatric surgery. This article aims to discuss medical and surgical strategies for reflux after bariatric surgery, and their outcomes.

  19. Efficacy and safety of oxaliplatin chemotherapy programs as adjuvant treatment in colorectal cancer after surgery

    Institute of Scientific and Technical Information of China (English)

    杨莉萍

    2013-01-01

    Objective To compare the efficacy and safety of 5-fluorouracil and calcium folinatc combined with oxaliplatin(FOLFOX) program with capecitabine regimen combined oxaliplatin(XELOX) program as adjuvant chemotherapy in advanced colorectal cancer after surgery.

  20. Long-term outcome of endovascular treatment versus medical care for carotid artery stenosis in patients not suitable for surgery and randomised in the Carotid and Vertebral Artery Transluminal Angioplasty study (CAVATAS).

    LENUS (Irish Health Repository)

    Ederle, Jörg

    2009-01-01

    Optimal treatment of carotid stenosis in patients not suitable for surgery is unclear. The Carotid and Vertebral Artery Transluminal Angioplasty study contained a trial comparing medical and endovascular treatment in patients not suitable for surgery.

  1. Choosing surgery

    DEFF Research Database (Denmark)

    Thorstensson, Carina; Lohmander, L; Frobell, Richard

    2009-01-01

    ABSTRACT: BACKGROUND: The objective was to understand patients' views of treatment after acute anterior cruciate ligament (ACL) injury, and their reasons for deciding to request surgery despite consenting to participate in a randomised controlled trial (to 'cross-over'). METHODS: Thirty-four in......-depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery. Of these, 11 were interviewed...... before surgery, and 11 were interviewed at least 6 months after surgery. To provide additional information, 12 patients were interviewed before randomisation. Interviews were audio-recorded, transcribed and analysed using the Framework approach. RESULTS: Strong preference for surgery was commonplace...

  2. Response to treatment and interval to surgery after preoperative short-course radiotherapy in rectal cancer.

    Science.gov (United States)

    García-Cabezas, Sonia; Rodríguez-Liñán, Milagrosa; Otero-Romero, Ana M; Bueno-Serrano, Carmen M; Gómez-Barbadillo, José; Palacios-Eito, Amalia

    2016-10-01

    Preoperative short-course radiotherapy with immediate surgery improves local control in patients with rectal cancer. Tumor responses are smaller than those described with radiochemotherapy. Preliminary data associate this lower response to the short period until surgery. The aim of this study is to analyze the response to preoperative short-course radiotherapy and its correlation with the interval to surgery especially analyzing patients with mesorectal fascia involvement. A total of 155 patients with locally advanced rectal cancer treated with preoperative radiotherapy (5×5Gy) were retrospectively analyzed. Tumor response in terms of rates of complete pathological response, downstaging, tumor regression grading and status of the circumferential resection margin were quantified. The mean interval from radiotherapy to surgery was 23 days. The rate of complete pathological response was 2.2% and 28% experienced downstaging (stage decreased). No differences between these rates and interval to surgery were detected. Eighty-eight patients had magnetic resonance imaging for staging (in 31 patients the mesorectal fascia was involved).The mean time to surgery in patients with involvement of the fascia and R0 surgery was 27 days and 16 days if R1 (P=.016). The cutoff of 20 days reached the highest probability of achieving a free circumferential resection margin between patients with mesorectal fascia involvement, with no statistically significant differences: RR 3.036 95% CI=(0.691-13.328), P=.06. After preoperative short-course radiotherapy, an interval>20 days enhances the likelihood of achieving a free circumferential resection margin in patients with mesorectal fascia involvement. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Results of the surgical treatment of non-advanced megaesophagus using Heller-Pinotti's surgery: Laparotomy vs. Laparoscopy

    Directory of Open Access Journals (Sweden)

    Luiz Roberto Lopes

    2011-01-01

    Full Text Available INTRODUCTION: Dysphagia is the important symptom in achalasia, and surgery is the most common treatment. The Heller-Pinotti technique is the method preferred by Brazilian surgeons. For many years, this technique was performed by laparotomy, and now the laparoscopic method has been introduced. The objective was to evaluate the immediate and long-term results of patients submitted to surgery by either laparotomy or laparoscopy. MATERIALS AND METHODS: A total of 67 patients submitted to surgery between 1994 and 2001 with at least 5 years of follow-up were evaluated retrospectively and divided into two groups: laparotomy (41 patients and laparoscopy (26 patients. Chagas was the etiology in 76.12% of cases. Dysphagia was evaluated according to the classification defined by Saeed et al. RESULTS: There were no cases of conversion to open surgery. The mean duration of hospitalization was 3.32 days for laparotomy and 2.54 days for laparoscopy (p<0.05. An improvement in dysphagia occurred with both groups reporting good or excellent results (laparotomy: 73.17% and laparoscopy: 73.08%. Mean duration of follow-up was 8 years. CONCLUSIONS: There was no difference between the two groups with respect to relief from dysphagia, thereby confirming the safety and effectiveness of the Heller-Pinotti technique, which can be performed by laparotomy or laparoscopy, depending on the surgeon's experience.

  4. Efficacy and safety of noninvasive positive pressure ventilation in the treatment of acute respiratory failure after cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    ZHU Guang-fa; WANG Di-jia; LIU Shuang; JIA Ming; JIA Shi-jie

    2013-01-01

    Background Although noninvasive positive pressure ventilation (NPPV) has been successfully used for various kinds of acute respiratory failure,the data are limited regarding its application in postoperative respiratory failure after cardiac surgery.Therefore,we conducted a prospective randomized control study in a university surgical intensive care unit to evaluate the efficacy and safety of NPPV in the treatment of acute respiratory failure after cardiac surgery,and explore the predicting factors of NPPV failure.Methods From September 2011 to November 2012 patients with acute respiratory failure after cardiac surgery who had indication for the use of NPPV were randomly divided into a NPPV treatment group (NPPV group) and the conventional treatment group (control group).The between-group differences in the patients' baseline characteristics,re-intubation rate,tracheotomy rate,ventilator associated pneumonia (VAP) incidence,in-hospital mortality,mechanical ventilation time after enrollment (MV time),intensive care unit (ICU) and postoperative hospital stays were compared.The factors that predict NPPV failure were analyzed.Results During the study period,a total of 139 patients who had acute respiratory failure after cardiac surgery were recorded,and 95 of them met the inclusion criteria,which included 59 males and 36 females with a mean age of (61.5±11.2) years.Forty-three patients underwent coronary artery bypass grafting (CABG),23 underwent valve surgery,13 underwent CABG+valve surgery,13 underwent major vascular surgery,and three underwent other surgeries.The NPPV group had 48 patients and the control group had 47 patients.In the NPPV group,the re-intubation rate was 18.8%,tracheotomy rate was 12.5%,VAP incidence was 0,and the in-hospital mortality was 18.8%,significantly lower than in the control group 80.9%,29.8%,17.0% and 38.3% respectively,P <0.05 or P <0.01.The MV time and ICU stay (expressed as the median (P25,P75)) were 18.0 (9

  5. Post-bariatric surgery body contouring treatment in the public health system: cost study and perception by patients.

    Science.gov (United States)

    Vilà, Jordi; Balibrea, José María; Oller, Benjamí; Alastrué, Antonio; Poyatos, Jordi Vilà; Balibrea del Castillo, José María; Sales, Benjamí Oller; Vidal, Antonio Alastrué

    2014-09-01

    Post-bariatric, body contouring surgery to treat the sequelae of massive weight loss is an undervalued topic by patients and in most of the literature. The objective of this study was to determine the mean cost per patient of this treatment in a public morbid obesity unit, and compare it with the perception by the patients. Costs were estimated using a specific Diagnosis-Related Group-based method and a questionnaire in a sample of 100 patients who had completed body contouring treatment. This study included 23 men and 77 women with a mean age of 48.5 years, a mean reduction of body mass index of 20.77 kg/m, and a median follow-up of 58 months. These patients had undergone surgery, as needed, as follows: on the lower part of the trunk (109 operations; mean cost, &OV0556;6348.6), cruroplasty (43 operations; mean cost, &OV0556;3490), brachioplasty (28 operations; mean cost &OV0556;3150), and the upper part of the trunk (10 operations; mean cost, &OV0556;4290). The rate of complications has been high (up to 50 percent) and, although the more severe complications are rare (10.5 percent Clavien grade IIIb), these represent high costs (mean, &OV0556;24462.6). Forty-five patients answered the questionnaire. Although they think that this surgery improves their quality of life, they have undervalued its total cost (17.58 percent; &OV0556;2034) (p = 0.16). The average cost of post-bariatric surgery body contouring treatment in this unit is &OV0556;8263.95 (1.66 operations per patient). The severe complications increase by 2.96 times the average cost per patient.

  6. Laparoscopic surgery in the treatment of incarcerated indirect inguinal hernia in children

    Science.gov (United States)

    Yin, Yiyu; Zhang, Hongwei; Zhang, Xiang; Sun, Fang; Zou, Huaxin; Cao, Hui; Wen, Cheng

    2016-01-01

    We aimed to explore the feasibility and the safety of the laparoscopic surgery for incarcerated indirect inguinal hernia (IIH) in children. From January 2012 to December 2014, 64 children were enrolled into this study. All 64 patients received laparoscopic surgery and we reviewed their perioperative and postoperative follow-up studies. In addition, we enrolled 60 cases of children who received traditional surgery of IIH administered through minimally invasive surgery as the control group. Results from the present study showed that the mean operation time for the laparoscopic group was 41.5 min (range, 15–80 min) which was significantly shorter than the control group. Nine cases developed incarcerated intestine necrosis, expanded umbilical incision and parallel resection anastomosis. They received laparoscopic hernia sac high ligation. Only 5 cases developed scrotum edema after the surgery. The postoperative length of the stay ranged from 2 to 7 days (average, 3.2). The postoperative follow-up was from 6 months to 1 year and no relapse or secondary testicular atrophy was observed in the laparoscopic group. The operation time, incidence of postoperative complications and length of stay in the laparoscopic group were decreased compared to the control group, and differences were statistically significant (Phernia is safe and feasible and produced better results compared with the alternative. PMID:28105089

  7. Cost-effectiveness of Early Surgery versus Conservative Treatment with Optional Delayed Meniscectomy for Patients over 45 years with non-obstructive meniscal tears (ESCAPE study) : Protocol of a randomised controlled trial

    NARCIS (Netherlands)

    Van De Graaf, Victor A.; Scholtes, Vanessa A B; Wolterbeek, Nienke; Noorduyn, Julia C A; Neeter, Camille; Van Tulder, Maurits W.; Saris, Daniël B F; De Gast, Arthur; Poolman, Rudolf W.

    2016-01-01

    Introduction Recent studies show similar outcome between surgery and conservative treatment in patients with non-obstructive meniscal tears. However, surgery is still often preferred over conservative treatment. When conservative treatment is non-inferior to surgery, shifting the current standard

  8. Cost-effectiveness of Early Surgery versus Conservative Treatment with Optional Delayed Meniscectomy for Patients over 45 years with non-obstructive meniscal tears (ESCAPE study): protocol of a randomised controlled trial

    NARCIS (Netherlands)

    van de Graaf, Victor A.; Scholtes, Vanessa A.B.; Wolterbeek, Nienke; Noorduyn, Julia C.A.; Neeter, Camille; van Tulder, Maurits W.; Saris, Daniël B.F.; de Gast, Arthur; Poolman, Rudolf W.

    2016-01-01

    Introduction Recent studies show similar outcome between surgery and conservative treatment in patients with non-obstructive meniscal tears. However, surgery is still often preferred over conservative treatment. When conservative treatment is non-inferior to surgery, shifting the current standard

  9. Patients experiences of negative pressure wound therapy at home for the treatment of deep perivascular groin infection after vascular surgery.

    Science.gov (United States)

    Monsen, Christina; Acosta, Stefan; Kumlien, Christine

    2017-05-01

    To explore experiences of negative pressure wound therapy at home, in patients with deep perivascular groin infection after vascular surgery and management in daily life. Deep surgical site infection after vascular surgery with exposed vessels often requires long-term treatment with negative pressure wound therapy, and continued therapy at home has become routine. An explorative qualitative study. Nine men and six women with a deep surgical site infection in the groin after vascular surgery, treated in their home with negative pressure wound therapy, were interviewed. The interviews were analysed using manifest and latent content analysis. Undergoing negative pressure wound therapy at home meant a transition from being a dependent patient to a person who must have self-care competence and be involved in their own care. A need to feel prepared for this before discharge from hospital was expressed. Lack of information and feelings of uncertainty prolonged the time before feeling confident in managing the treatment. The informants gradually accepted the need to be tied up to a machine, became competent in its management and found solutions to perform everyday tasks. Overall, it was a relief to be treated at home. Several benefits of negative pressure wound therapy at home were expressed. However, unnecessary stress and anxiety were experienced due to a lack of information on the treatment and instruction concerning the equipment. Adequate information and education must therefore be provided to facilitate the transition from a patient to a person with self-care competence and ability to manage this treatment at home. The findings revealed a need for more support and knowledge in their transition from hospital care to home care with negative pressure wound therapy. Routines must be established that ensure patient safety and security in treatment at home. © 2016 John Wiley & Sons Ltd.

  10. Splenectomy with chemotherapy vs surgery alone as initial treatment for splenic marginal zone lymphoma

    Institute of Scientific and Technical Information of China (English)

    Rajko Milosevic; Milena Todorovic; Bela Balint; Miodrag Jevtic; Miodrag Krstic; Elizabeta Ristanovic; Nebojsa Antonijevic; Mirjana Pavlovic; Maja Perunicic; Milan Petrovic; Biljana Mihaljevic

    2009-01-01

    AIM:To evaluate the clinical characteristics of splenic marginal-zone lymphoma (SMZL) following antigen expression and the influence of therapeutic approaches on clinical outcome and overall survival (OS).METHODS:A total of 30 patients with typical histological and immunohistochemical SMZL patterns were examined.Splenectomy plus chemotherapy was applied in 20 patients,while splenectomy as a single treatment-option was performed in 10 patients.Prognostic factor and overall survival rate were analyzed.RESULTS:Complete remission (CR) was achieved in 20 (66.7%),partial remission (PR) in seven (23.3%),and lethal outcome due to disease progression occurred in three (10.0%) patients.Median survival of patients with a splenectomy was 93.0 mo and for patients with splenectomy plus chemotherapy it was 107.5 mo (Log rank=0.056,P>0.05).Time from onset of first symptoms to the beginning of the treatment (mean 9.4 mo) was influenced by spleen dimensions,as measured by computerized tomography and ultra-sound (t=2.558,P=0.018).Strong positivity (+++) of CD20 antigen expression in splenic tissue had a positive influence on OS (Log rank = 5.244,P 0.05) effects on the OS.The expression of other antigens (immunohistochemistry) also had no effect on survival-rate,as measured by a χ2 test (P > 0.05).CONCLUSION:Initial splenectomy combined with chemotherapy has been shown to be beneficial due to its advanced remission rate/duration;however,a larger controlled clinical study is required to confirm our findings.

  11. Evaluation of the walking pattern in clubfoot patients who received early intensive treatment

    DEFF Research Database (Denmark)

    Alkjaer, T; Pedersen, E N; Simonsen, E B

    2000-01-01

    joint in the clubfeet could possibly be owing to weaker plantar flexors. In conclusion, gait analysis can be an important tool when evaluating treatment for clubfoot. However, further investigation is needed to determine whether the higher hip and knee joint moments observed in subjects with clubfoot......The walking pattern in a group of nine adult male subjects who had received early intensive treatment for congenital clubfoot was evaluated and compared to the walking pattern in a control group of 15 adult healthy male subjects. All subjects were filmed with a five-camera video system...

  12. Treatment Approach to Small Inadvertent Injury of the Crystalline Lens Anterior Capsule During Iridodialysis Repair Surgery

    Directory of Open Access Journals (Sweden)

    Gökçen Gökçe

    2013-01-01

    Full Text Available A 22-year-old man presented to our ophthalmology department with photophobia. On ophthalmic examination, iridodialysis secondary to blunt trauma that occurred 5 years ago was diagnosed. During iridodialysis repair surgery, long curved double-armed needle of 10-0 polypropylene suture (PC-9 inserted into the 19 gauge side port turned down inadvertently by its own weight, resulting in crystalline lens anterior capsule perforation. Postoperative clinical observation revealed no lens opacification affecting visual acuity. This case report showed that lens aspiration surgery should be postponed if the capsule injury is small.(Turk J Ophthalmol 2013; 43: 61-3

  13. Persistent pain and neurosensory disturbance after dental implant surgery: prevention and treatment.

    Science.gov (United States)

    Al-Sabbagh, Mohanad; Okeson, Jeffrey P; Bertoli, Elizangela; Medynski, Denielle C; Khalaf, Mohd W

    2015-01-01

    Nerve trauma caused by dental implant placement is associated with altered sensation and chronic pain. Complete or partial loss of sensation is often reported by patients who have experienced nerve trauma during implant surgery. Some patients report persistent pain and neurosurgery disturbance long after the normal healing time has passed. In addition, neuropathic pain is reported after implant surgery. Practitioners who place dental implants must be familiar with the differential diagnosis, prevention, and management of neuropathic pain. This article provides insights into the prevention and management of neurosensory deficits and chronic persistent neuropathic pain and considerations for patient referral.

  14. The Nursing Treatment of Mediastinal Disease in Surgery Period%纵隔疾病围手术期的护理

    Institute of Scientific and Technical Information of China (English)

    庞会娟

    2014-01-01

    目的:探讨纵隔疾病围手术期的护理对策。方法针对收治入院的30例纵隔肿瘤切除患者术前给予心理护理的临床资料进行分析。结果经过行外科手术治疗30例患者手术顺利,切口Ⅰ期愈合,无术后并发症的发生。结论严密的围手术期护理对提高手术成功率,减少术后并发症起到了重要作用,促进患者早日康复出院。%Objective Make a discussion on the nursery treatment of mediastinal disease in surgery period.MethodsAnalyzing the clinical data taken from 30 hospitalized patients who have received psychological care before they were operated with mediastinal cancer surgery.Results Having been operated surgery,30patients got satisfactory results and the wound were healed during first phrase and no complications occurred.Conclusion Strict nursery treatment and care in surgical period make significance in improving the surgical successful probabilities, decrease the occurrence of complications and aid patients with being into rehab.

  15. A 3D computer-aided design system applied to diagnosis and treatment planning in orthodontics and orthognathic surgery.

    Science.gov (United States)

    Motohashi, N; Kuroda, T

    1999-06-01

    The purpose of this article is to describe a newly developed 3D computer-aided design (CAD) system for the diagnostic set-up of casts in orthodontic diagnosis and treatment planning, and its preliminary clinical applications. The system comprises a measuring unit which obtains 3D information from the dental model using laser scanning, and a personal computer to generate the 3D graphics. When measuring the 3D shape of the model, to minimize blind sectors, the model is scanned from two different directions with the slit-ray laser beam by rotating the mounting angle of the model on the measuring device. For computed simulation of tooth movement, the representative planes, defined by the anatomical reference points, are formed for each individual tooth and are arranged along a guideline descriptive of the individual arch form. Subsequently, the 3D shape is imparted to each of the teeth arranged on the representative plane to form an arrangement of the 3D profile. When necessary, orthognathic surgery can be simulated by moving the mandibular dental arch three-dimensionally to establish the optimum occlusal relationship. Compared with hand-made set-up models, the computed diagnostic cast has advantages such as high-speed processing and quantitative evaluation on the amount of 3D movement of the individual tooth relative to the craniofacial plane. Trial clinical applications demonstrated that the use of this system facilitated the otherwise complicated and time-consuming mock surgery for treatment planning in orthognathic surgery.

  16. Classification and discrimination of pediatric patients undergoing open heart surgery with and without methylprednisolone treatment by cytomics

    Science.gov (United States)

    Bocsi, Jozsef; Mittag, Anja; Pierzchalski, Arkadiusz; Osmancik, Pavel; Dähnert, Ingo; Tárnok, Attila

    2011-02-01

    Introduction: Methylprednisolone (MP) is frequently preoperatively administered in children undergoing open heart surgery. The aim of this medication is to inhibit overshooting immune responses. Earlier studies demonstrated cellular and humoral immunological changes in pediatric patients undergoing heart surgeries with and without MP administration. Here in a retrospective study we investigated the modulation of the cellular immune response by MP. The aim was to identify suitable parameters characterizing MP effects by cluster analysis. Methods: Blood samples were analysed from two aged matched groups with surgical correction of septum defects. Group without MP treatment consisted of 10 patients; MP was administered on 21 patients (median dose: 11mg/kg) before cardiopulmonary bypass (CPB). EDTA anticoagulated blood was obtained 24 h preoperatively, after anesthesia, at CPB begin and end (CPB2), 4h, 24h, 48h after surgery, at discharge and at out-patient followup (8.2; 3.3-12.2 month after surgery; median and IQR). Flow cytometry showed the biggest MP relevant changes at CPB2 and 4h postoperatively. They were used for clustering analysis. Classification was made by discriminant analysis and cluster analysis by means of Genes@work software. Results & conclusion: 146 parameters were obtained from analysis. Cross-validation revealed several parameters being able to discriminate between MP groups and to identify immune modulation. MP administration resulted in a delayed activation of monocytes, increased ratio of neutrophils, reduced T-lymphocytes counts. Cluster analysis demonstrated that classification of patients is possible based on the identified cytomics parameters. Further investigation of these parameters might help to understand the MP effects in pediatric open heart surgery.

  17. Condylectomy and “surgery first” approach: An expedited treatment for condylar hyperplasia in a patient with facial asymmetry

    Science.gov (United States)

    López, Diego Fernando; Aristizábal, Juan Fernando; Martínez-Smit, Rosana

    2017-01-01

    ABSTRACT Condylar Hyperplasia (CH) is a self-limiting pathology condition that produces severe facial deformity at the expense of mandibular asymmetry. In this case report a 15-year-old female patient was diagnosed with Unilateral Condylar Hiperplasia (UCH) by mean of single-photon emission computed tomography (SPECT) and histological study. A high condylectomy in the right condyle was performed to stop the active status of the hyperplasia. A month after condylectomy, orthognathic jaw impaction and asymmetric mandibular setback surgery was performed with the Surgery First Approach (SFA). After 10 days, orthodontic appointments were made every two weeks during 4 months. The active phase of treatment lasted 14 months. Excellent facial and occlusal outcomes were obtained and after 24 months in retention the results remained stable.

  18. Prolonged conservative treatment or 'early' surgery in sciatica caused by a lumbar disc herniation: Rationale and design of a randomized trial [ISRCT 26872154

    NARCIS (Netherlands)

    W.C. Peul (Wilco); H.C. van Houwelingen (Hans); W.B. van den Hout (Wilbert); R. Brand (René); J.A.H. Eekhof (Just); J.T.J. Tans (Th); R.T.W.M. Thomeer (Raph); B.W. Koes (Bart)

    2005-01-01

    textabstractBackground: The design of a randomized multicenter trial is presented on the effectiveness of a prolonged conservative treatment strategy compared with surgery in patients with persisting intense sciatica (lumbosacral radicular syndrome). Methods/design: Patients presenting themselves to

  19. Report of congenital colonobladder fitula with atresia ani in a lamb and treatment by surgery

    Directory of Open Access Journals (Sweden)

    Mohsen Vahar

    2015-06-01

    Full Text Available Colonobladder fistula and anal atresia, including congenital malformations in animals, occur due to genetics, environmental factors and vascular insufficiency. A male lamb was brought to a private veterinary clinic in Amol city, Mazandaran province, Iran. The lamb had clinical symptoms such as lethargy, dehydration, closed anus and watery feces in the genital organ. After taking radiograph and clinical examinations, it was found that the lamb was suffering from both colonobladder fistula and anal atresia; and emergency surgery was done. First, aseptic conditions and analgesia at the lumbosacral region of the trunk were put into practice and after cutting the abdominal muscles, accumulated feces in intestine were removed via an intestinal incision. The intestine was separated from the bladder via an incision and the bladder was sutured. Then, after creating an artificial hole in the base of the tail as the animal's new anus, the intestine was sutured to the original anus. At the end of surgery, serum therapy with sugar-salt dextrose 5% NaCl 0.9% solution and antibiotic therapy with penicillin and streptomycin were performed. This report is the first report of an unusual lamb with anal atresia and colonobladder fistula in the north of Iran. This surgery was achievable and is an obligatory surgery in affected animal rather than alternative euthanasia.

  20. Two successful neonatal extracorporeal membrane oxygenation treatment for severe heart failure after cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    TAN Lin-hua; DU Li-zhong; HE Xiao-jun; SUN Mei-yue; ZHANG Ze-wei; LIN Ru

    2009-01-01

    @@ Extracorporeal membrane oxygenation(ECMO)can play an important role by providing short-term circulatory support to enable myocardial recovery in patients with life-threatening heart failure.Currently,over 4000 children who received ECMO for cardiac support have been reported to the Extracorporeal Life Support Registry,with the majority of patients placed on ECMO following cardiac surgery.

  1. Surgical treatment of locally advanced anal cancer after male-to-female sex reassignment surgery

    Institute of Scientific and Technical Information of China (English)

    Marco Caricato; Fabio Ausania; Giovanni Francesco Marangi; Ilaria Cipollone; Gerardo Flammia; Paolo Persichetti; Lucio Trodella; Roberto Coppola

    2009-01-01

    We present a case of a transsexual patient who underwent a partial pelvectomy and genital reconstruction for anal cancer after chemoradiation. This is the first case in literature reporting on the occurrence of anal cancer after male-to-female sex reassignment surgery. We describe the surgical approach presenting our technique to avoid postoperative complications and preserve the sexual reassignment.

  2. The Dutch multicenter experience of the Endo-Sponge treatment for anastomotic leakage after colorectal surgery

    NARCIS (Netherlands)

    P.J. van Koperen; M.I. van Berge Henegouwen; C. Rosman; C.M. Bakker; P. Heres; J.F.M. Slors; W.A. Bemelman

    2009-01-01

    Anastomotic leakage is a feared complication following colorectal surgery and is associated with early and long-term morbidity and mortality. The presacral cavity as the result of leakage can be treated with an endo-sponge (B-Braun Medical). The aim of this study was to assess the effectiveness of e

  3. Effects of growth hormone (GH) treatment on body fluid distribution in patients undergoing elective abdominal surgery

    DEFF Research Database (Denmark)

    Møller, Jacob; Jensen, Martin Bach; Frandsen, E.

    1998-01-01

    ) aged 19-47 years were in a double-blinded study randomly assigned to receive either placebo (n = 12) or GH (n = 12) 6 i.u. s.c. twice daily from 2 days before until 7 days after ileo-anal J pouch surgery. Extracellular and plasma volume (ECV, PV) were determined using 82Br and 125I albumin dilution...

  4. Nationwide trends in surgery and radioiodine treatment for benign thyroid disease during iodization of salt

    DEFF Research Database (Denmark)

    Cerqueira, C.; Knudsen, N.; Ovesen, L.

    2010-01-01

    Objective: Iodization of salt was introduced in Denmark in 1998 because of mild-to-moderate iodine deficiency (ID). The aim of this study was to analyze the utilization rate of surgery and radioiodine therapy for benign thyroid disorders before and after the introduction of iodization, and to stu...

  5. Comparison of Video-Assisted Thoracoscopic Surgery and Intrapleural Urokinase as an Initial Treatment for Parapneumonic Effusion and Thoracic Empyema

    Directory of Open Access Journals (Sweden)

    Shungo Yukumi

    2014-05-01

    Full Text Available Introduction: The treatment of complicated parapneumonic effusion (PPE and thoracic empyema (TE is controversial; and the choice of treatment after confirming the failure of simple drainage remains unclear. The purpose of this study was to compare the outcomes of intrapleural urokinase (UK administration and video-assisted thoracoscopic surgery (VATS as initial treatment options for PPE and TE. Materials and Methods: We retrospectively reviewed and compared the data of 20 patients with PPE and TE diagnosed between January 2010 and December 2012 at our hospital, dividing them on the basis of the initial treatment into a video-assisted thoracoscopic surgery (VATS group (n=9 and UK group (n=11. Results: Age was the only statistically different parameter between both groups (P=0.025; with the mean age of the VATS and UK groups being 64 and 76 years, respectively. There was no significant difference in the duration of drainage or success rate between the UK or VATS groups. Although no statistically significant differences (P=0.20 were observed, duration of hospital stay was longer in the UK group (21 and 28 day for VATS and UK, respectively. Conclusion: VATS for PPE and TE may shorten the duration of hospital stay.However, UK administration may be used for selective patients because it is considered to yield outcomes similar to VATS.

  6. Prevalence and pattern of growth abnormalities in children with extrahepatic portal vein obstruction: Response to shunt surgery

    Directory of Open Access Journals (Sweden)

    Toufeeq Ahmad Mir

    2016-01-01

    Full Text Available Objective: Growth retardation is common in children with extrahepatic portal vein obstruction (EHPVO and growth hormone (GH resistance may play a dominant role. The aim of this study was to ascertain growth parameters and growth-related hormones in children with EHPVO, comparing with controls and to study the response of shunt surgery on growth parameters. Materials and Methods: The auxological and growth-related hormone profile (GH; insulin-like growth factor binding protein-3 [IGFBP-3] and IGF-1 of thirty children with EHPVO were compared with controls. The effect of shunt surgery on growth parameters in 12 children was also studied. Results: The mean height standard deviation score (HSDS of cases (−1.797 ± 1.146 was significantly lower than that of controls (−0.036 ± 0.796; the mean weight SDS of cases (−1.258 ± 0.743 was also lower than that of controls (−0.004 ± 0.533. The mean GH level of cases (5.00 ± 6.46 ng/ml was significantly higher than that of controls (1.78 ± 2.04 ng/ml. The mean IGF-1 level of cases (100.25 ± 35.93 ng/ml was significantly lower as compared to controls (233.53 ± 115.06 ng/ml as was the mean IGFBP-3 level (2976.53 ± 1212.82 ng/ml in cases and 5183.28 ± 1531.28 ng/ml in controls. In 12 patients who underwent shunt surgery, growth parameters significantly improved. Conclusions: Marked decrease in weight and height SDSs associated with GH resistance is seen in children with EHPVO, which improves with shunt surgery.

  7. Hypertension in a female nursing staff-pattern of occurrence, diagnosis, and treatment

    OpenAIRE

    Estela Maria Motta Lima Leão de Aquino; Lucélia Batista Neves Cunha Magalhães; Maria Jenny Araújo; Maria da Conceição Chagas de Almeida; Jackline Pereira Leto

    2001-01-01

    OBJECTIVE: To report the pattern of occurrence, diagnosis, and treatment of hypertension in a female nursing staff of an emergency hospital. METHODS: We carried out a cross-sectional study that included interviews and blood pressure measurements of 494 nursing professionals at an emergency hospital in the city of Salvador, in the state of Bahia, Brazil. We considered hypertensive all individual with blood pressure > or = 140/90 mmHg or normal pressure if on regular treatment. RESULTS: We fo...

  8. Repeat transsphenoidal surgery for the treatment of remaining or recurring pituitary tumors in acromegaly.

    Science.gov (United States)

    Yamada, Shozo; Fukuhara, Noriaki; Oyama, Kenichi; Takeshita, Akira; Takeuchi, Yasuharu

    2010-10-01

    Acromegaly is a disorder characterized by hypersecretion of growth hormone caused by a growth hormone-secreting pituitary adenoma. To evaluate the long-term efficacy and safety of repeat transsphenoidal surgery for persistent or recurrent acromegaly. We retrospectively reviewed records for 53 acromegalic patients who underwent repeat transsphenoidal surgery for persistent or progressive acromegaly at Toranomon Hospital between 1987 and 2006. Multivariate logistic regression was performed to evaluate preoperative factors influencing the surgical outcome. Thirty-one patients (58.5%) met the criteria for cure on long-term follow-up endocrine findings. Furthermore, 17 patients were well controlled with normal insulin-like growth factor I levels without (2 patients) or with medication (15 patients), whereas insulin-like growth factor I levels were still above normal in 5 patients after postoperative adjuvant therapy. Only 1 patient was undergoing additional hormonal replacement after surgery, although transient cerebrospinal fluid leak, transient abducens nerve palsy, severe nasal bleeding, and pituitary abscess occurred in each patient, respectively. Multivariate analysis clarified that a favorable surgical outcome was achieved in patients without cavernous sinus invasion (hazard ratio 12.56), tumor segmentation (hazard ratio 5.82), or in those older than 40 years old (hazard ratio 3.21). Repeat surgery can be performed safely with an approximately 60% long-term cure rate in this series. Reoperation should therefore be considered for persistent or recurrent disease in acromegalic patients in whom adjuvant therapy is not effective enough or cannot be accepted. The careful study of initial or preoperative magnetic resonance imaging and the use of micro-Doppler, endoscope, and eye movement monitoring device during surgery can help increase cure rate with a lower complication rate.

  9. The Effectiveness of Motivational Interviewing on Adherence to Treatment in Obese Patients Undergoing Sleeve Gastrectomy Surgery

    Directory of Open Access Journals (Sweden)

    2017-03-01

    Full Text Available Abstract Background & aim: Adherence is the degree of patient's success to do the health experts recommendations. The aim of present research was study the effects of motivational interviewing on adherence to in obese patients undergoing sleeve gastrectomy surgery. Methods: The design of present semi- experimental study was pre-test, post-test with control group. The statistical population included all obese patients (BMI≥35 that undergone laparoscopic sleeve gastrectomy surgery in Shiraz Ghadir Mother & Child Subspecialty Hospital, during the winter of 1394 and the spring of 1395. 30 of them were selected by using available sampling method and they randomly were asssigned to experimental (n=15 and control groups (n=15. The post bariatic surgery self-management behaviors questionnaire was used to collect data in two steps (pre-test and post-test. Motivational interviewing was implemented for the experimental group in four weeks (each week a 1/5 hour session. Data were analysed by using multivariate covariance analysis (MANCOVA. Results: MANCOVA results show that motivational interviewing led to a statistically significant difference between pre-test and post-test BSSQ total scores (P0/07. Conclusion: According to this study results, implementation of motivational interviewing is effective and appropriate in order to enhance adherence and self-management behaviors, achieve favorable weight loss & reduce postoperative complications, in obese patients undergoing sleeve gastrectomy surgery, but it appears that longer interventions are necessary to increase the rate of physical activity. Keywords: Motivational Interviewing, Adherence, Obese Patients, Sleeve Gastrectomy Surgery

  10. Secular, Spiritual and religious Existential concerns during final diagnostics and treatment period – The lived experiences of women undergoing ovarian cancer surgery

    DEFF Research Database (Denmark)

    Hounsgaard, Lise; Seibæk, L.; Hvidt, N. C.

    2013-01-01

    Introduction. This paper deals with secular, spiritual, and religious existential concerns during severe illness. Materials and Methods. Qualitative research interviews were made before and after surgery with women who underwent final diagnostics, surgery, and chemotherapy for ovarian cancer...... a woman with ovarian cancer during her first treatment period. Although the women experienced their health to be seriously threatened, they also felt hope, will, and courage. The diagnostic procedures and treatment had comprehensive impact on their lives. However, hope and spirituality were important...

  11. POSSIBILITIES OF THE MINIMALLY INVASIVE SURGERY IN THE TREATMENT OF SEVERE FOREFOOT DEFORMITIES IN THE RHEUMATOID ARTHRITIS PATIENTS

    Directory of Open Access Journals (Sweden)

    S. Y. Berezhnoy

    2016-01-01

    Full Text Available Introduction. Approximately 90% of the rheumatoid arthritis patients present with foot symptoms. Rheumatoid foot is characterized by toe dislocations and chronic wounds due to the corticosteroid treatment. In case of surgical intervention metatarsophalangeal joints excision arthroplasty remains the standard. To perform second through fifth metatarsal head resection extensive transverse plantar or longitudinal dorsal incisions are routinely used. The rate of the wound-healing problems after rheumatoid foot surgeries is 23-45%. The purpose of this study was to demonstrate the possibilities and advantages of the rheumatoid arthritis patients with severe forefoot deformities minimally invasive surgical treatment and to develop mini-invasive approach for central metatarsal heads resection. Material and methods. By the example of 23 rheumatoid arthritis female patients (30 feet surgical treatment possibilities of percutaneous techniques in severe forefoot deformities correction were demonstrated. The average age of the group was 54.5 years (range, 39 to 72. There were 24 primary surgeries and 6 repeated. Four feet had chronic wounds. Percutaneous techniques were used to correct all the forefoot deformities components but central metatarsal head resections (7 cases. To make them minimally invasive plantar approach has been developed. Surgical technique of the central metatarsal heads resection using proposed approach was presented. Decision-making algorithm for choosing appropriate surgical technique (to perform first metatarsophalangeal arthrodesis with central metatarsal heads resection or joint-preserving surgery was proposed, including functional test, performed under fluoroscopic control and tricks for the dislocated fifth toe reduction. Results. The mean follow-up was 12 months (range, 3 to 52. The average hospital stay was 1.23 days. No infectious or wound-healing problems were noted. Chronic wounds have healed in four weeks after surgery

  12. Associations between dietary patterns and semen quality in men undergoing IVF/ICSI treatment

    NARCIS (Netherlands)

    Vujkovic, M.; de Vries, J. H.; Dohle, G. R.; Bonsel, G. J.; Lindemans, J.; Macklon, N. S.; van der Spek, P. J.; Steegers, E. A. P.; Steegers-Theunissen, R. P. M.

    2009-01-01

    This study investigates whether dietary patterns, substantiated by biomarkers, are associated with semen quality. In 161 men of subfertile couples undergoing in vitro fertilization treatment in a tertiary referral clinic in Rotterdam, the Netherlands, we assessed nutrient intakes and performed princ

  13. Cerebral aneurysm treatment in India: Results of a national survey regarding practice patterns in India

    Directory of Open Access Journals (Sweden)

    Sudheer Ambekar

    2016-01-01

    Conclusion: Our study demonstrates the prevailing practice patterns in the management of IAs in India. Surgical clipping is the preferred treatment of choice for anterior circulation aneurysms and EVT for aneurysms along the posterior circulation. Corticosteroids and prophylactic "triple-H" therapy are still used by a large proportion of physicians.

  14. Effects of different levels of positive airway pressure on breathing pattern and heart rate variability after coronary artery bypass grafting surgery

    Directory of Open Access Journals (Sweden)

    C.B.F. Pantoni

    2011-01-01

    Full Text Available The application of continuous positive airway pressure (CPAP produces important hemodynamic alterations, which can influence breathing pattern (BP and heart rate variability (HRV. The aim of this study was to evaluate the effects of different levels of CPAP on postoperative BP and HRV after coronary artery bypass grafting (CABG surgery and the impact of CABG surgery on these variables. Eighteen patients undergoing CABG were evaluated postoperatively during spontaneous breathing (SB and application of four levels of CPAP applied in random order: sham (3 cmH2O, 5 cmH2O, 8 cmH2O, and 12 cmH2O. HRV was analyzed in time and frequency domains and by nonlinear methods and BP was analyzed in different variables (breathing frequency, inspiratory tidal volume, inspiratory and expiratory time, total breath time, fractional inspiratory time, percent rib cage inspiratory contribution to tidal volume, phase relation during inspiration, phase relation during expiration. There was significant postoperative impairment in HRV and BP after CABG surgery compared to the preoperative period and improvement of DFAα1, DFAα2 and SD2 indexes, and ventilatory variables during postoperative CPAP application, with a greater effect when 8 and 12 cmH2O were applied. A positive correlation (P < 0.05 and r = 0.64; Spearman was found between DFAα1 and inspiratory time to the delta of 12 cmH2O and SB of HRV and respiratory values. Acute application of CPAP was able to alter cardiac autonomic nervous system control and BP of patients undergoing CABG surgery and 8 and 12 cmH2O of CPAP provided the best performance of pulmonary and cardiac autonomic functions.

  15. Interval From Imaging to Treatment Delivery in the Radiation Surgery Age: How Long Is Too Long?

    Energy Technology Data Exchange (ETDEWEB)

    Seymour, Zachary A., E-mail: seymourz@radonc.ucsf.edu [Department of Radiation Oncology, University of California at San Francisco, San Francisco, California (United States); Fogh, Shannon E.; Westcott, Sarah K.; Braunstein, Steve [Department of Radiation Oncology, University of California at San Francisco, San Francisco, California (United States); Larson, David A. [Department of Radiation Oncology, University of California at San Francisco, San Francisco, California (United States); Department of Neurological Surgery, University of California at San Francisco, San Francisco, California (United States); Barani, Igor J.; Nakamura, Jean; Sneed, Penny K. [Department of Radiation Oncology, University of California at San Francisco, San Francisco, California (United States)

    2015-09-01

    Purpose: The purpose of this study was to evaluate workflow and patient outcomes related to frameless stereotactic radiation surgery (SRS) for brain metastases. Methods and Materials: We reviewed all treatment demographics, clinical outcomes, and workflow timing, including time from magnetic resonance imaging (MRI), computed tomography (CT) simulation, insurance authorization, and consultation to the start of SRS for brain metastases. Results: A total of 82 patients with 151 brain metastases treated with SRS were evaluated. The median times from consultation, insurance authorization, CT simulation, and MRI for treatment planning were 15, 7, 6, and 11 days to SRS. Local freedom from progression (LFFP) was lower in metastases with MRI ≥14 days before treatment (P=.0003, log rank). The 6- and 12-month LFFP rate were 95% and 75% for metastasis with interval of <14 days from MRI to treatment compared to 56% and 34% for metastases with MRI ≥14 days before treatment. On multivariate analysis, LFFP remained significantly lower for lesions with MRI ≥14 days at SRS (P=.002, Cox proportional hazards; hazard ratio: 3.4, 95% confidence interval: 1.6-7.3). Conclusions: Delay from MRI to SRS treatment delivery for brain metastases appears to reduce local control. Future studies should monitor the timing from imaging acquisition to treatment delivery. Our experience suggests that the time from MRI to treatment should be <14 days.

  16. The recurrence pattern following delayed breast reconstruction after mastectomy for breast cancer suggests a systemic effect of surgery on occult dormant micrometastases.

    Science.gov (United States)

    Dillekås, Hanna; Demicheli, Romano; Ardoino, Ilaria; Jensen, Svein A H; Biganzoli, Elia; Straume, Oddbjørn

    2016-07-01

    The purpose of this study was to characterize the recurrence dynamics in breast cancer patients after delayed reconstruction. We hypothesized that surgical reconstruction might stimulate dormant micrometastases and reduce time to recurrence. All mastectomy breast cancer patients with delayed surgical reconstruction at Haukeland University Hospital, between 1977 and 2007, n = 312, were studied. Our control group consisted of 1341 breast cancer patients without reconstruction. For each case, all patients in the control group with identical T and N stages and age ±2 years were considered. A paired control was randomly selected from this group. 10 years after primary surgery, 39 of the cases had relapsed, compared to 52 of the matched controls. The reconstructed group was analyzed for relapse dynamics after mastectomy; the first peak in relapses was similarly timed, but smaller than for the controls, while the second peak was similar in time and size. Second, the relapse pattern was analyzed with reconstruction as the starting point. A peak in recurrences was found after 18 months, and a lower peak at the 5th-6th year. The height of the peak correlated with the extent of surgery and initial T and N stages. Timing of the peak was not affected, neither was the cumulative effect. The relapse pattern, when time origin is placed both at mastectomy and at reconstruction, is bimodal with a peak position at the same time points, at 2 years and at 5-6 years. The timing of the transition from dormant micrometastases into clinically detectable macrometastases might be explained by an enhancing effect of surgery.

  17. Biologic treatment or immunomodulation is not associated with postoperative anastomotic complications in abdominal surgery for Crohn's disease

    DEFF Research Database (Denmark)

    El-Hussuna, Alaa Abdul-Hussein H; Andersen, Jens; Bisgaard, Thue

    2012-01-01

    Objectives: There are concerns that biologic treatments or immunomodulation may negatively influence anastomotic healing. This study investigates the relationship between these treatments and anastomotic complications after surgery for Crohn's disease. Patients and methods. Retrospective study...... complications were more frequent after a colo-colic anastomosis than after an entero-enteric or entero-colic (33% vs. 12% (p=0.013)). Patients with anastomotic complications were older (40 years vs. 35 years (p=0.014)), had longer disease duration (7.5 years vs. 4 years (p=0.04)), longer operation time (155 min...... vs. 115 min (p=0.018)) and more operative bleeding (200 ml vs. 130 ml (p=0.029)). Multivariate analysis revealed preoperative treatment with prednisolone 20 mg or more, operation time and a colo-colic anastomosis as negative predictors of anastomotic complications. Conclusions: Preoperative biologic...

  18. Quality of life assessment by applying EORTC questionnaires to rectal cancer patients after surgery and neoadjuvant and adjuvant treatment

    Directory of Open Access Journals (Sweden)

    Juan Ignacio Arraras

    2013-06-01

    Full Text Available Background: Quality of Life (QoL is a key element in rectal cancer (RC patients. Aims: this study assesses QoL in a sample of RC patients in their treatment follow-up period, and compares surgery modalities. Patients and methods: eighty four locally advanced RC patients who had received surgery and neoadjuvant chemoradiotherapy were included in the study. Of these, 70 had adjuvant chemotherapy. All patients completed the EORTC QLQ-C30 and the QLQ-CR29 once at least one year after completion of their treatment. Low anterior resection (LAR patients also completed a Functional Evaluation questionnaire. Results: QoL scores in the EORTC questionnaires for the sample as a whole were high in most dimensions, in line with the general population's QoL values, although moderate limitations (> 30 points were observed in urinary frequency, flatulence, impotence and sexual function. The scores for the Functional Evaluation were adequate (mean combined bowel function score of 18.2. LAR patients had a higher stool frequency than those with abdominoperineal resection (APR; p < 0.001. No differences in body image were found amongst LAR and APR patients. LAR patients with a lower anastomosis had higher faecal incontinence (p = 0.02, whereas those with a reservoir had better emotional functioning (p = 0.04 and higher faecal incontinence (p = 0.03. Conclusions: QoL scores and functional evaluation indicated patients had adapted to their disease and treatment. The few differences in QoL found between surgery modalities are in line with other recent studies and in contrast with earlier ones that suggested a lower QoL in APR patients.

  19. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis: initial experience in Oaxaca, Mexico.

    Science.gov (United States)

    García-Matus, Rolando; Hernández-Hernández, Carlos Alberto; Leyva-García, Omar; Vásquez-Ciriaco, Sergio; Flores-Ayala, Guillermo; Navarro-Hernández, Quetzalli; Pérez-Bustamante, Gerardo; Valencia-Mijares, Norma Miriam; Esquivel, Jesus

    2012-09-01

    Peritoneal carcinomatosis (PC) has been traditionally considered a terminal disease with median survivals reported in the literature of 6 to 12 months. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) are playing an ever increasing role in the treatment of these patients. Excellent results have been achieved in well-selected patients but there is a very steep learning curve when starting a new program. A program for peritoneal surface malignancies in which patients with PC of gastrointestinal or gynecological origin were treated using multimodality therapy with combinations of systemic therapy, cytoreductive surgery (CRS), and HIPEC was initiated in December 2007 at "Hospital Regional de Alta Especialidad de Oaxaca," Mexico. We present the results of our initial experience. From December 2007 to February 2011, 26 patients were treated with CRS and HIPEC. There were 21 female patients. Most common indication (46%) was recurrent ovarian cancer. Mean duration of surgery was 260 minutes. Mean Peritoneal Cancer Index was 9. Twenty-three (88.5%) patients had a complete cytoreduction. Major morbidity and mortality rates were 19.5 and 3.8 per cent, respectively. Mean hospital stay was 8 days. At a mean follow-up of 20 months, median survival has not been reached. Rigorous preoperative workup, strict selection criteria, and mentoring from an experienced cytoreductive surgeon are mandatory and extremely important when starting a center for PC.

  20. Pattern of primary tuberculosis drug resistance and associated treatment outcomes in Transnistria, Moldova.

    Science.gov (United States)

    Dolgusev, O; Obevzenco, N; Padalco, O; Pankrushev, S; Ramsay, A; Van den Bergh, R; Manzi, M; Denisiuk, O; Zachariah, R

    2014-10-21

    This cohort study assessed drug susceptibility testing (DST) patterns and associated treatment outcomes from Transnistria, Moldova, from 2009 to 2012. Of 1089 newly registered tuberculosis (TB) patients with available DST results, 556 (51%) had some form of drug resistance, while 369 (34%) had multidrug-resistant TB (MDR-TB). There were four cases of extensively drug-resistant TB. MDR-TB patients had poor treatment success (45%); human immunodeficiency virus positivity and a history of incarceration were associated with an unfavourable treatment outcome. This first study from Trans-nistria shows a high level of drug-resistant TB, which constitutes a major public health problem requiring urgent attention.

  1. Factors associated with the failure of arthroscopic surgery treatment in patients with femoroacetabular impingement: A cohort study.

    Science.gov (United States)

    Martínez, D; Gómez-Hoyos, J; Márquez, W; Gallo, J

    2015-01-01

    The aim of this study was to evaluate the association of the anatomical and functional characteristics with therapeutic failure in patients with femoroacetabular impingement, who underwent hip arthroscopy. A cohort study was performed on 179 patients with femoroacetabular impingement who underwent hip arthroscopy between 2004 and 2012. The demographic, anatomical, functional, and clinical information were recorded. A logistic regression model and ANCOVA were used in order to compare the described characteristics with the treatment outcomes of the hip arthroscopy. The median time of follow-up for symptoms was 13 months (8-30), and the mean time of follow-up after surgery was 23.83 ± 9.8 months. At the end of the follow-up 3.91% of the patients were considered as a therapeutic failure. The WOMAC score in pain and functional branches, as well as the total WOMAC score, showed significant differences (P<.05). The mean WOMAC score was higher (0 to 100 with 0 being a perfect score) in the group of patients who failed after surgery as compared with the group who meet the requirements for a successful treatment, 65.9 vs 48.8, respectively (mean difference 17.0; 95% CI; 1.3-32.6; P=.033). The poor functional state prior to arthroscopic treatment of femoroacetabular impingement, mainly due to preoperative pain, assessed using the WOMAC scale, is associated with a higher therapeutic failure rate. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  2. Effect of Diclofenac with B Vitamins on the Treatment of Acute Pain Originated by Lower-Limb Fracture and Surgery

    Directory of Open Access Journals (Sweden)

    Héctor A. Ponce-Monter

    2012-01-01

    Full Text Available The aim of this study was to compare the efficacy of diclofenac, for the treatment of acute pain originated by lower-limb fracture and surgery, with that of diclofenac plus B vitamins. This was a single-center, prospective, randomized, and double-blinded clinical trial. Patients with lower-limb closed fractures rated their pain on a 10 cm visual analog scale (VAS. Patients were then randomized to receive diclofenac or diclofenac plus B vitamins (thiamine, pyridoxine, and cyanocobalamin intramuscularly twice daily. Patient evaluations of pain intensity were recorded throughout two periods: twenty-four hours presurgery and twenty-four hours postsurgical. One hundred twenty-two patients completed the study. The subjects' assessments of limb pain on the VAS showed a significant reduction from baseline values regardless of the treatment group. Diclofenac plus B vitamins combination was more effective to reduce the pain than diclofenac alone. The results showed that the addition of B vitamins to diclofenac increased its analgesic effect. The novelty of this paper consists in that diclofenac and diclofenac plus B vitamins were useful for treatment of acute pain originated by lower-limb fracture and surgery.

  3. Effect of Diclofenac with B Vitamins on the Treatment of Acute Pain Originated by Lower-Limb Fracture and Surgery

    Science.gov (United States)

    Ponce-Monter, Héctor A.; Ortiz, Mario I.; Garza-Hernández, Alexis F.; Monroy-Maya, Raúl; Soto-Ríos, Marisela; Carrillo-Alarcón, Lourdes; Reyes-García, Gerardo; Fernández-Martínez, Eduardo

    2012-01-01

    The aim of this study was to compare the efficacy of diclofenac, for the treatment of acute pain originated by lower-limb fracture and surgery, with that of diclofenac plus B vitamins. This was a single-center, prospective, randomized, and double-blinded clinical trial. Patients with lower-limb closed fractures rated their pain on a 10 cm visual analog scale (VAS). Patients were then randomized to receive diclofenac or diclofenac plus B vitamins (thiamine, pyridoxine, and cyanocobalamin) intramuscularly twice daily. Patient evaluations of pain intensity were recorded throughout two periods: twenty-four hours presurgery and twenty-four hours postsurgical. One hundred twenty-two patients completed the study. The subjects' assessments of limb pain on the VAS showed a significant reduction from baseline values regardless of the treatment group. Diclofenac plus B vitamins combination was more effective to reduce the pain than diclofenac alone. The results showed that the addition of B vitamins to diclofenac increased its analgesic effect. The novelty of this paper consists in that diclofenac and diclofenac plus B vitamins were useful for treatment of acute pain originated by lower-limb fracture and surgery. PMID:22135737

  4. [Better quality of life after surgery treatment in patients with colitis ulcerosa: what is the price].

    Science.gov (United States)

    Szepes, Zoltán; Molnár, Tamás; Farkas, Klaudia; Horváth, Gábor; Nagy, Ferenc; Nyári, Tibor; Wittmann, Tibor

    2010-08-01

    Exacerbations of ulcerative colitis (UC) have a great impact on patients' quality of life. Only a few data is available about the effect of surgery on the quality of life in patients with UC. of our study was to evaluate the outcome and the impact of surgery on the quality of life of patients with UC. 183 UC patients [mean age at the diagnosis: 33.23 years (12-69 years), female/male ratio: 95/88] were hospitalized in our tertiary clinic because of exacerbation of UC requiring parenteral corticosteroid therapy between 1998 and 2007. Data of 46 patients undergoing colectomy were analyzed retrospectively. Outcome of surgery, frequency of early and late complications, the alteration of the number of hospitalizations and outpatient visits, the number of medication, the income and the disability grade were assessed in detail. The patients were also asked to complete questionnaires to compare their quality of life before and after colectomy. The follow up period was 3.3 years. Data were analyzed using two-sample t-test and one-way analysis of variance. P value lower than 0.05 was considered statistically significant. 74% of the colectomized patients underwent ileal pouch anal anastomosis procedure, 11 patients needed definitive ileostomy and in one case, ileorectal anastomosis was requested by the patient. Early complications occurred in 24, late complications in 23 patients (pouchitis in 13 cases). The need for hospitalization and the number of medication decreased significantly, while significant improvement was shown in the patients' quality of life after colectomy compared to the preoperative condition. Colectomy did not have an impact on the patients' income in 64.5% of the cases and no alteration of the disability grade was detected in 32% of the patients. Our results show that surgery may results in a good quality of life in the majority of the patients, however, further management may be necessary due to the late postoperative complications.

  5. Tramadol versus ketorolac in the treatment of postoperative pain following maxillofacial surgery.

    Science.gov (United States)

    Shankariah, Manjunath; Mishra, Madan; Kamath, Rajay A D

    2012-09-01

    Pain plagues daily activity and hence its management would require alleviation at both the mental and physical planes, thus, bringing about comfort. It includes delivering analgesics in parenteral or oral form, or patches depending on the intensity and availability. Best analgesic regimens are ones that offer broad coverage, easy to administer, safe and economical. A drug seemingly appropriate to treat moderate to severe pain would be Tramadol hydrochloride, a centrally acting synthetic opioid analgesic with lower opiate-like dependence than Morphine. Ketorolac, a pyrrolo-pyrrole derivative, possesses analgesic, anti-inflammatory and anti-pyretic activity would also appear equally suitable. Fifty adult ASA grade I and II patients undergoing surgery under GA in the Department of Oral & Maxillofacial Surgery, College of Dental Sciences, Davangere, were included. Ketorolac (30 mg IM) for 25 patients and Tramadol (100 mg IM) for 25 patients were administered at the time of skin closure and repeated after 8 and 16 h from the conclusion of surgery. Pain, using the VAS at the 2nd, 4th, 6th, 12th and 24th post-operative hour, was assessed and compared using χ(2)-test. Vitals were monitored and adverse events were looked for. Though both the drugs resulted in significant decrease in pain intensity from the 2nd to 24th post-operative hour, Tramadol always resulted in better pain control than Ketorolac at every post-operative hour (P < 0.050). To conclude, intramuscular Tramadol seemed useful in controlling pain following surgery, with better levels of tolerance than intramuscular Ketorolac. However, both the drugs produced mild side effects but did not appear to influence the outcome.

  6. Treatment of acute infectious endophthalmitis by vitrectomy surgery with silicon oil tamponade

    Directory of Open Access Journals (Sweden)

    Xiao-Dong Han

    2015-09-01

    Full Text Available AIM: To observe theclinical effect of acute infectious endophthalmitis by vitrectomy surgery with silicon oil tamponade.METHODS:The clinical data of 23 patients(23 eyesdiagnosed with acute endophthalmitis in our hospital from January, 2008 to February, 2013 were retrospectively analyzed, excluding the patients with intraocular foreign body. All the patients were undergone routine closed three-channel vitrectomy with silicon oil, including 6 eyes(complicated with traumatic cataractwith Ⅰ lensectomy and Ⅰ intraocular lens(IOLimplantation, 3 eyes(complicated with traumatic cataractwith Ⅰ lensectomy and Ⅱ IOL implantation, 4 eyes(complicated with cataract during silicon oil tamponadewith Ⅱ lensectomy and Ⅱ IOL implantation, 5 eyes(4 eyes with traumatic endophthalmitis and 1 eye with entophthalmia caused by glaucoma filtering bleb leakingreserved lens, 1 eye(post-cataract surgery entophthalmiawith Ⅰ IOL explantation and Ⅱ IOL implantation, and 4 eyes(post-cataract surgery entophthalmiareserved lens. RESULTS:Within follow-up 6~24mo, inflammation after vitrectomy surgery with silicon oil tamponade was controlled in all the 23 patients(23 eyes. Final visual acuity was improved in 21 eyes(91%. The intraocular pressure(IOPof 2 eyes were over 30mmHg. IOP of 1 eye was controlled after silicon oil removed, and IOP of the other eye after silcon oil extraction was still high and needed to be controlled by IOP lowering drugs. CONCLUSION: The patients of acuteinfectious endophthalmitis should undergo vitrectomy with silicon oil tamponade as early as possible, which can effectively controli endophthalmitis and improve visual acuity.

  7. Surgery for Testicular Cancer

    Science.gov (United States)

    ... Stage Testicular Cancer Treating Testicular Cancer Surgery for Testicular Cancer Surgery is typically the first treatment for all ... Testicular Cancer, by Type and Stage More In Testicular Cancer About Testicular Cancer Causes, Risk Factors, and Prevention ...

  8. Paracetamol versus metamizol in the treatment of postoperative pain after breast surgery: a randomized, controlled trial.

    Science.gov (United States)

    Ohnesorge, Henning; Bein, Berhold; Hanss, Robert; Francksen, Helga; Mayer, Laura; Scholz, Jens; Tonner, Peter H

    2009-08-01

    Intravenously administered paracetamol is an effective analgesic in postoperative pain management. However, there is a lack of data on the effect of intravenous (i.v.) paracetamol on pain following soft tissue surgery. Eighty-seven patients undergoing elective breast surgery with total i.v. anaesthesia (propofol/remifentanil) were randomized to three groups. Group para received 1 g i.v. paracetamol 20 min before and 4, 10 and 16 h after the end of the operation. Group meta and plac received 1 g i.v. metamizol or placebo, respectively, scheduled at the same time points. All patients had access to i.v. morphine on demand to achieve adequate pain relief. No significant difference in total morphine consumption between groups was detectable. The proportion of patients who did not receive any morphine in the postoperative period was significantly higher in group para (42%) than in group plac (4%). Ambulation was significantly (P metamizol provided a significant reduction in total postoperative morphine consumption compared with placebo in the management of postoperative pain after elective breast surgery. Administration of paracetamol resulted in a significant reduction in the number of patients needing opioid analgesics to achieve adequate postoperative pain relief.

  9. Antisepsis and genital hygiene in scrotal surgery: liability claims in the event of treatment errors.

    Science.gov (United States)

    Brühl, Peter

    2007-09-13

    Systematic observance of infection control principles in surgery, whether conducted on an inpatient or outpatient basis, is an indispensable precondition for quality management. In Germany, the introduction of the Protection against Infection Act (IfSG) on 1 January 2001 represented a milestone for regulation of the framework conditions in outpatient surgery. Once again, infection control issues were the main focus of attention. Section 36(1) IfSG stipulates that infection control policies specify in-house procedures for infection prophylaxis in agreement with quality assurance measures. On 1 January 2004 this was further reinforced, inter alia, by means of a new tripartite contract based on Section 115b of Book 5 of the German Code of Social Law (SGB V). Since experience shows that incidents are more likely to result in liability claims the smaller the operation and the more unexpected the complications from a lay person's perspective, surgery carried out on patients who spend the night before and after the operation outside the hospital or clinic is becoming a particularly liability-prone area. In the event of a postoperative infection, often involving a protracted hospital stay and in some cases considerable permanent damage, the patient often cites an infection control error. This paper highlights by way of example some liability aspects whose observance as a matter of principle can reduce the liability risk for the physician.

  10. A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

    DEFF Research Database (Denmark)

    Mathiesen, Ole; Dahl, Benny; Thomsen, Berit A

    2013-01-01

    PURPOSE: Major spine surgery with multilevel instrumentation is followed by large amount of opioid consumption, significant pain and difficult mobilization in a population of predominantly chronic pain patients. This case-control study investigated if a standardized comprehensive pain and postope......PURPOSE: Major spine surgery with multilevel instrumentation is followed by large amount of opioid consumption, significant pain and difficult mobilization in a population of predominantly chronic pain patients. This case-control study investigated if a standardized comprehensive pain...... in a post-intervention group of 41 consecutive patients undergoing multilevel (median 10) instrumented spinal fusions and compared with 44 patients in a pre-intervention group. RESULTS: Compared to patients in the pre-intervention group, patients treated according to the new protocol consumed less opioid...... and dizziness on POD 1-6. CONCLUSIONS: In this study of patients scheduled for multilevel spine surgery, it was demonstrated that compared to a historic group of patients receiving usual care, a comprehensive and standardized multimodal pain and PONV protocol significantly reduced opioid consumption, improved...

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    multidisciplinary team (MDT) decisions. MATERIALS AND METHODS: Four hundred eighteen women diagnosed with ovarian cancers (n = 351) or borderline tumors (n = 66) were selected for primary debulking surgery from January 2008 to July 2013. At an MDT meeting, women were allocated into 3 groups named "pre-COVA" 1 to 3...... classifying the expected extent of the primary surgery and need for postoperative care. On the basis of the operative procedures performed, women were allocated into 1 of the 3 corresponding COVA 1 to 3 groups. The outcome measure was the predictive value of the pre-COVA score compared with the actual COVA...... performed. RESULTS: The MDT meeting allocated 213 women (51%) to pre-COVA 1, 136 (33%) to pre-COVA 2, and 52 (12%) to pre-COVA 3. At the end of surgery, 168 (40%) were classified as COVA 1, 158 (38%) were classified as COVA 2, and 28 (7%) were classified as COVA 3. Traced individually, 212 (51%) patients...

  12. Microinvasive surgery in the treatment of retinal detachment associated with an optic disk pit: 2 cases report

    Directory of Open Access Journals (Sweden)

    S. V. Sdobnokova

    2012-01-01

    Full Text Available We report two cases of an 18-year-old boy with a left optic disc pit and associated retinal edema of the macula and 47-year-old woman with an optic disk pit and associated retinal detachment of the macula. First was treated by intravitreal injection of Lucentis. Woman was treated by gas tamponade as a primary procedure. Both procedures resulted in complete resolution of subretinal fluid andincrease of visual acuity. We conclude that microinvasive surgery can be effective treatment of this disease.

  13. Microinvasive surgery in the treatment of retinal detachment associated with an optic disk pit: 2 cases report

    Directory of Open Access Journals (Sweden)

    S. V. Sdobnokova

    2014-07-01

    Full Text Available We report two cases of an 18-year-old boy with a left optic disc pit and associated retinal edema of the macula and 47-year-old woman with an optic disk pit and associated retinal detachment of the macula. First was treated by intravitreal injection of Lucentis. Woman was treated by gas tamponade as a primary procedure. Both procedures resulted in complete resolution of subretinal fluid andincrease of visual acuity. We conclude that microinvasive surgery can be effective treatment of this disease.

  14. Practice patterns and outcomes of pediatric partial nephrectomy in the United States: Comparison between pediatric urology and general pediatric surgery.

    Science.gov (United States)

    Suson, Kristina D; Wolfe-Christensen, Cortney; Elder, Jack S; Lakshmanan, Yegappan

    2015-08-01

    In the United States, both pediatric urologists (PUROs) and general pediatric surgeons (GPSs) perform nephrectomies in children, with PUROs performing more nephrectomies overall, most commonly for benign causes. GPSs perform more nephrectomies for malignant causes. We questioned whether the same trends persisted for partial nephrectomy. We hypothesized that PUROs performed more partial nephrectomies for all causes, including malignancy. Our primary aim was to characterize the number of partial nephrectomies performed by PUROs and GPSs. We also compared short-term outcomes between subspecialties. We analyzed the Pediatric Health Information System (PHIS), a database encompassing data from 44 children's hospitals. Patients were ≤18 years old and had a partial nephrectomy (ICD-9 procedure code 554) carried out by PUROs or GPSs between 1 January, 2004 and June 30, 2013. Queried data points included surgeon subspecialty, age, gender, 3M™ All Patient Refined Diagnosis Related Groups (3M™ APR DRG) code, severity level, mortality risk, length of stay (LOS), and medical/surgical complication flags. Data points were compared in patients on whom PUROs and GPSs had operated. Statistical analysis included the Student t test, chi-square test, analysis of covariance, and logistic regression. Results are presented in the table. While PUROs performed the majority of partial nephrectomies, GPSs operated more commonly for malignancy. For surgeries performed for non-malignant indications, PURO patients had a shorter LOS and lower complication rate after controlling for statistically identified covariates. There was no difference in LOS or complication rate for patients with malignancy. A Pediatric Health Information System study of pediatric nephrectomy demonstrated PUROs performed more nephrectomies overall, but GPSs performed more surgeries for malignancy. The difference was less dramatic for partial nephrectomies (63% GPS, 37% PURO) than for radical nephrectomies (90% GPS, 10

  15. Cancer Surgery: Physically Removing Cancer

    Science.gov (United States)

    ... in cancer diagnosis, staging, treatment and symptom relief. Robotic surgery. In robotic surgery, the surgeon sits away from the operating table ... to maneuver surgical tools to perform the operation. Robotic surgery helps the surgeon operate in hard-to-reach ...

  16. 1. Microscopic Surgery(Less Invasive Treatment Strategy for Cerebrovascular Disease,Cardiovascular System(5))

    OpenAIRE

    堀, 智勝; 林, 基弘; 比嘉, 隆; Tomokatsu, HORI; Motohiro, HAYASHI; Takashi, HIGA

    2004-01-01

    Nonsurgical treatments of cerebrovascular diseases have been established now in our department including endovascular treatment of cerebral aneurysm/arteriovenous malformations, and gammaknife treatment of arteriovenous malformation. In spite of these tremendous progresses of nonsurgical treatments, microsurgical management of difficult aneurysms and arteriovenous malformations have not diminished in our department. Difficult type of large neck aneurysms of posterior circulation, of anterior ...

  17. [Current status of thoracoscopic surgery for thoracic and lumbar spine. Part 2: treatment of the thoracic disc hernia, spinal deformities, spinal tumors, infections and miscellaneous].

    Science.gov (United States)

    Verdú-López, Francisco; Beisse, Rudolf

    2014-01-01

    Thoracoscopic surgery or video-assisted thoracic surgery (VATS) of the thoracic and lumbar spine has evolved greatly since it appeared less than 20 years ago. It is currently used in a large number of processes and injuries. The aim of this article, in its two parts, is to review the current status of VATS of the thoracic and lumbar spine in its entire spectrum. After reviewing the current literature, we developed each of the large groups of indications where VATS takes place, one by one. This second part reviews and discusses the management, treatment and specific thoracoscopic technique in thoracic disc herniation, spinal deformities, tumour pathology, infections of the spine and other possible indications for VATS. Thoracoscopic surgery is in many cases an alternative to conventional open surgery. The transdiaphragmatic approach has made endoscopic treatment of many thoracolumbar junction processes possible, thus widening the spectrum of therapeutic indications. These include the treatment of spinal deformities, spinal tumours, infections and other pathological processes, as well as the reconstruction of injured spinal segments and decompression of the spinal canal if lesion placement is favourable to antero-lateral approach. Good clinical results of thoracoscopic surgery are supported by growing experience reflected in a large number of articles. The degree of complications in thoracoscopic surgery is comparable to open surgery, with benefits in regard to morbidity of the approach and subsequent patient recovery. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  18. Meta-STEPP: subpopulation treatment effect pattern plot for individual patient data meta-analysis.

    Science.gov (United States)

    Wang, Xin Victoria; Cole, Bernard; Bonetti, Marco; Gelber, Richard D

    2016-09-20

    We have developed a method, called Meta-STEPP (subpopulation treatment effect pattern plot for meta-analysis), to explore treatment effect heterogeneity across covariate values in the meta-analysis setting for time-to-event data when the covariate of interest is continuous. Meta-STEPP forms overlapping subpopulations from individual patient data containing similar numbers of events with increasing covariate values, estimates subpopulation treatment effects using standard fixed-effects meta-analysis methodology, displays the estimated subpopulation treatment effect as a function of the covariate values, and provides a statistical test to detect possibly complex treatment-covariate interactions. Simulation studies show that this test has adequate type-I error rate recovery as well as power when reasonable window sizes are chosen. When applied to eight breast cancer trials, Meta-STEPP suggests that chemotherapy is less effective for tumors with high estrogen receptor expression compared with those with low expression. Copyright © 2016 John Wiley & Sons, Ltd.

  19. [Patterns and personality disorders in persons with cocaine dependence in treatment].

    Science.gov (United States)

    López Durán, Ana; Becoña Iglesias, Elisardo

    2006-08-01

    The aim of the present study is to determine patterns and personality disorder in subjects under cocaine dependence treatment using MCMI-II, and their relationship with sociodemographic variables and consumption characteristics. We assess 102 subjects under cocaine dependence treatment in Drug Abuse Centers in Galicia (Spain). The results indicate that the most prevalent basic scales of personality are the passive-aggressive, antisocial, narcisism and histrionic. Borderline and paranoid scales are the most prevalent with regard to the pathological personality scales. These results coincide with other international and national studies. We conclude pointing out the necessity to carry out studies with wider cocaine dependence samples in treatment, and the specific inclusion criteria should be established in the study. We also indicate the importance of carrying out a previous assessment of all demanding treatment subjects to design the objectives of the mentioned treatment.

  20. The treatment patterns, efficacy, and safety of nab (®)-paclitaxel for the treatment of metastatic breast cancer in the United States: results from health insurance claims analysis

    National Research Council Canada - National Science Library

    Liang, Caihua; Li, Ling; Fraser, Cindy Duval; Ko, Amy; Corzo, Deyanira; Enger, Cheryl; Patt, Debra

    2015-01-01

    ...). This analysis was designed to characterize the treatment patterns, efficacy, and safety of nab-paclitaxel for MBC treatment using health claims data from US health plans associated with Optum. Women aged...

  1. Time Interval From Breast-Conserving Surgery to Breast Irradiation in Early Stage Node-Negative Breast Cancer: 17-Year Follow-Up Results and Patterns of Recurrence

    Energy Technology Data Exchange (ETDEWEB)

    Vujovic, Olga, E-mail: olga.vujovic@lhsc.on.ca [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Yu, Edward [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Cherian, Anil [Station Health Centre, Royal Air Force Lossiemouth, Moray (United Kingdom); Dar, A. Rashid [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada); Stitt, Larry [Department of Biometry, London Regional Cancer Program, London, Ontario (Canada); Perera, Francisco [Department of Radiation Oncology, London Regional Cancer Program, London, Ontario (Canada)

    2015-02-01

    Purpose: A retrospectivechart review was conducted to determine whether the time interval from breast-conserving surgery to breast irradiation (surgery-radiation therapy interval) in early stage node-negative breast cancer had any detrimental effects on recurrence rates. Methods and Materials: There were 566 patients with T1 to T3, N0 breast cancer treated with breast-conserving surgery and breast irradiation and without adjuvant systemic treatment between 1985 and 1992. The surgery-to-radiation therapy intervals used for analysis were 0 to 8 weeks (201 patients), >8 to 12 weeks (233 patients), >12 to 16 weeks (91 patients), and >16 weeks (41 patients). Kaplan-Meier estimates of time to local recurrence, disease-free survival, distant disease-free survival, cause-specific survival, and overall survival rates were calculated. Results: Median follow-up was 17.4 years. Patients in all 4 time intervals were similar in terms of characteristics and pathologic features. There were no statistically significant differences among the 4 time groups in local recurrence (P=.67) or disease-free survival (P=.82). The local recurrence rates at 5, 10, and 15 years were 4.9%, 11.5%, and 15.0%, respectively. The distant disease relapse rates at 5, 10, and 15 years were 10.6%, 15.4%, and 18.5%, respectively. The disease-free failure rates at 5, 10, and 15 years were 20%, 32.3%, and 39.8%, respectively. Cause-specific survival rates at 5, 10, and 15 years were 92%, 84.6%, and 79.8%, respectively. The overall survival rates at 5, 10, and 15 years were 89.3%, 79.2%, and 66.9%, respectively. Conclusions: Surgery-radiation therapy intervals up to 16 weeks from breast-conserving surgery are not associated with any increased risk of recurrence in early stage node-negative breast cancer. There is a steady local recurrence rate of 1% per year with adjuvant radiation alone.

  2. Mastectomy or breast conserving surgery? Factors affecting type of surgical treatment for breast cancer – a classification tree approach

    Directory of Open Access Journals (Sweden)

    O'Neill Terry

    2006-04-01

    Full Text Available Abstract Background A critical choice facing breast cancer patients is which surgical treatment – mastectomy or breast conserving surgery (BCS – is most appropriate. Several studies have investigated factors that impact the type of surgery chosen, identifying features such as place of residence, age at diagnosis, tumor size, socio-economic and racial/ethnic elements as relevant. Such assessment of "propensity" is important in understanding issues such as a reported under-utilisation of BCS among women for whom such treatment was not contraindicated. Using Western Australian (WA data, we further examine the factors associated with the type of surgical treatment for breast cancer using a classification tree approach. This approach deals naturally with complicated interactions between factors, and so allows flexible and interpretable models for treatment choice to be built that add to the current understanding of this complex decision process. Methods Data was extracted from the WA Cancer Registry on women diagnosed with breast cancer in WA from 1990 to 2000. Subjects' treatment preferences were predicted from covariates using both classification trees and logistic regression. Results Tumor size was the primary determinant of patient choice, subjects with tumors smaller than 20 mm in diameter preferring BCS. For subjects with tumors greater than 20 mm in diameter factors such as patient age, nodal status, and tumor histology become relevant as predictors of patient choice. Conclusion Classification trees perform as well as logistic regression for predicting patient choice, but are much easier to interpret for clinical use. The selected tree can inform clinicians' advice to patients.

  3. Clinical Observation on the Treatment of Relapsed Lumbar Disc Herniation after Disc Surgery by Acupuncture plus Medication

    Institute of Scientific and Technical Information of China (English)

    吴耀持; 汪崇淼; 张峻峰; 李石胜; 洪珏

    2010-01-01

    Objective:This study was to observe the therapeutic effect of electro-acupuncture combined with Chinese herbal fumigation and application in the treatment of relapsed lumbar disc herniation after lumbar disc surgery.Methods:Eighty-four subjects were randomized into a treatment group and a control group.The treatment group(44subjects)received electroacupuncture plus herbal fumigation and application therapy.The control group(40 subjects)only received electroacupuncture therapy.The therapeutic results were observed and compared afterwards.Results:The total effective rate was 90.9% in the treatment group and 82.5% in the control group.and the difierence was statistically significant(P<0.05).Conclusion:The combined therapy of electroacupuncture with Chinese herbal fumigation and application has better therapeutic effect than mono-electroacupuncture in the treatment of post-surgery relapsed lumbar disc herniation.%目的:观察电针配合中药外熏外敷治疗腰椎间盘突出症术后复发的临床疗效.方法:将84例病人随机分成治疗组和对照组,治疗组44例运用电针结合中药熏敷治疗,对照组40例单用电针进行治疗,观察并比较两组临床疗效.结果:治疗组总有效率为90.9%,对照组总有效率为82.5%,两组有显著性差异(P<0.05).结论:电针结合中药熏敷用于腰椎间盘突出症术后复发患者的治疗,其临床疗效要优于单纯电针治疗.

  4. The vacuum-assisted closure system for the treatment of deep sternal wound infections after cardiac surgery.

    Science.gov (United States)

    Fleck, Tatjana M; Fleck, Michael; Moidl, Reinhard; Czerny, Martin; Koller, Rupert; Giovanoli, Pietro; Hiesmayer, Michael J; Zimpfer, Daniel; Wolner, Ernst; Grabenwoger, Martin

    2002-11-01

    The VAC system (vacuum-assisted wound closure) is a noninvasive active therapy to promote healing in difficult wounds that fail to respond to established treatment modalities. The system is based on the application of negative pressure by controlled suction to the wound surface. The method was introduced into clinical practice in 1996. Since then, numerous studies proved the effectiveness of the VAC System on microcirculation and the promotion of granulation tissue proliferation. Eleven patients (5 men, 6 women) with a median age of 64.4 years (range 50 to 78 years) with sternal wound infection after cardiac surgery (coronary artery bypass grafting = 5, aortic valve replacement = 5, ascending aortic replacement = 1) were fitted with the VAC system by the time of initial surgical debridement. Complete healing was achieved in all patients. The VAC system was removed after a mean of 9.3 days (range 4 to 15 days), when systemic signs of infection resolved and quantitative cultures were negative. In 6 patients (54.5%), the VAC system was used as a bridge to reconstructive surgery with a pectoralis muscle flap, and in the remaining 5 patients (45.5%), primary wound closure could be achieved. Intensive care unit stay ranged from 1 to 4 days (median 1 day). Duration of hospital stay varied from 13 to 45 days (median 30 days). In-hospital mortality was 0%, and 30-day survival was 100%. The VAC system can be considered as an effective and safe adjunct to conventional and established treatment modalities for the therapy of sternal wound infections after cardiac surgery.

  5. The index of orthognathic functional treatment need accurately prioritises those patients already selected for orthognathic surgery within the NHS.

    Science.gov (United States)

    Shah, Rupal; Breeze, John; Chand, Mohit; Stockton, Peter

    2016-06-01

    The index of orthognathic functional treatment need (IOFTN) is a newly-proposed system to help to prioritise patients for orthognathic treatment. The five categories are similar to those used in orthodontics, but include additional parameters such as sleep apnoea and facial asymmetry. The aim of this audit was to validate the index and find out the potential future implications, should such a system ever be adopted by commissioners. We calculated the IOFTN category of 100 consecutive patients who had orthognathic surgery between 2010-14 using clinical notes, photographs, study models, and radiographs, and determined the number in categories 4 or 5, analogous to the current indications for orthodontic treatment within the NHS. Sufficient clinical information was available to categorise 59/100 patients, and 56 of the 59 (95%) were in either category 4 or 5. All three of the remaining patients (in categories 1-3) who were operated on were treated because of the anticipated favourable impact on their quality of life. The IOFTN has been proposed for use in future commissioning of orthognathic services within the NHS, and this study has confirmed its efficacy in prioritising treatment accurately, with 95% of patients being in categories 4 or 5. We recommend that the orthognathic treatment index be adapted to include additional psychosocial assessment so that patients who fall into the lower functional categories are not automatically excluded from this potentially life-changing treatment.

  6. Current status of ultrasound-guided surgery in the treatment of breast cancer.

    Science.gov (United States)

    Volders, José H; Haloua, Max H; Krekel, Nicole Ma; Meijer, Sybren; van den Tol, Petrousjka M

    2016-02-10

    The primary goal of breast-conserving surgery (BCS) is to obtain tumour-free resection margins. Margins positive or focally positive for tumour cells are associated with a high risk of local recurrence, and in the case of tumour-positive margins, re-excision or even mastectomy are sometimes needed to achieve definite clear margins. Unfortunately, tumour-involved margins and re-excisions after lumpectomy are still reported in up to 40% of patients and additionally, unnecessary large excision volumes are described. A secondary goal of BCS is the cosmetic outcome and one of the main determinants of worse cosmetic outcome is a large excision volume. Up to 30% of unsatisfied cosmetic outcome is reported. Therefore, the search for better surgical techniques to improve margin status, excision volume and consequently, cosmetic outcome has continued. Nowadays, the most commonly used localization methods for BCS of non-palpable breast cancers are wire-guided localization (WGL) and radio-guided localization (RGL). WGL and RGL are invasive procedures that need to be performed pre-operatively with technical and scheduling difficulties. For palpable breast cancer, tumour excision is usually guided by tactile skills of the surgeon performing "blind" surgery. One of the surgical techniques pursuing the aims of radicality and small excision volumes includes intra-operative ultrasound (IOUS). The best evidence available demonstrates benefits of IOUS with a significantly high proportion of negative margins compared with other localization techniques in palpable and non-palpable breast cancer. Additionally, IOUS is non-invasive, easy to learn and can centralize the tumour in the excised specimen with low amount of healthy breast tissue being excised. This could lead to better cosmetic results of BCS. Despite the advantages of IOUS, only a small amount of surgeons are performing this technique. This review aims to highlight the position of ultrasound-guided surgery for malignant breast

  7. Neoadjuvant chemoradiotherapy and surgery as treatment for oral maxillary squamous cell carcinoma in a dog.

    Science.gov (United States)

    Mestrinho, L A; Bernardo, E; Niza, M M R E; Lloret, A; Buracco, P

    2012-07-01

    A gingival maxillary squamous cell carcinoma was diagnosed in a 12-year-old male Yorkshire Terrier. After a complete diagnostic work-up, including a computed tomography scan, the tumour was staged as T3bN1aM0 and considered non-resectable at presentation. The combination of neoadjuvant megavoltage radiotherapy and neoadjuvant and adjuvant chemotherapy with carboplatin and doxorubicin decreased the size of the tumour, allowing for surgery. The dog was free from local disease for 421 days after which it was euthanased at the owners' request.

  8. Intravenous iron sucrose for treatment of anemia in gynecology patients awaiting surgery

    Directory of Open Access Journals (Sweden)

    Animesh Gandhi

    2016-10-01

    Conclusions: Parenteral iron therapy was not safe in the past but iron sucrose has made it the safest and effective therapy. Parenteral iron therapy can be used for patients with Hb level between 6-8mg/dl It is highly efficacious and reliable way to achieve the desired Hb level patient compliance is assured with intravenous iron sucrose patient can be satisfactorily posted for surgery within a period of 3 weeks i.e. within her next menstrual period by reliably and effectively correcting her anemia with intravenous iron sucrose. [Int J Reprod Contracept Obstet Gynecol 2016; 5(10.000: 3453-3460

  9. Self-expanding metallic stent as a bridge to surgery in the treatment of left colon cancer obstruction: Cost-benefit analysis and oncologic results.

    Science.gov (United States)

    Flor-Lorente, Blas; Báguena, Gloria; Frasson, Matteo; García-Granero, Alvaro; Cervantes, Andrés; Sanchiz, Vicente; Peña, Andres; Espí, Alejandro; Esclapez, Pedro; García-Granero, Eduardo

    2017-03-01

    The use of a self-expanding metallic stent as a bridge to surgery in acute malignant left colonic obstruction has been suggested as an alternative treatment to emergency surgery. The aim of the present study was to compare the morbi-mortality, cost-benefit and long-term oncological outcomes of both therapeutic options. This is a prospective, comparative, controlled, non-randomized study (2005-2010) performed in a specialized unit. The study included 82 patients with left colon cancer obstruction treated by stent as a bridge to surgery (n=27) or emergency surgery (n=55) operated with local curative intention. The main outcome measures (postoperative morbi-mortaliy, cost-benefit, stoma rate and long-term oncological outcomes) were compared based on an "intention-to-treat" analysis. There were no significant statistical differences between the two groups in terms of preoperative data and tumor characteristics. The technically successful stenting rate was 88.9% (11.1% perforation during stent placement) and clinical success was 81.4%. No difference was observed in postoperative morbi-mortality rates. The primary anastomosis rate was higher in the bridge to surgery group compared to the emergency surgery group (77.8% vs. 56.4%; P=.05). The mean costs in the emergency surgery group resulted to be €1,391.9 more expensive per patient than in the bridge to surgery group. There was no significant statistical difference in oncological long-term outcomes. The use of self-expanding metalllic stents as a bridge to surgery is a safe option in the urgent treatment of obstructive left colon cancer, with similar short and long-term results compared to direct surgery, inferior mean costs and a higher rate of primary anastomosis. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Magnetic resonance-guided focused ultrasound surgery for the noninvasive curative ablation of tumors and palliative treatments: a review.

    Science.gov (United States)

    Kopelman, Doron; Papa, Moshe

    2007-05-01

    This article reviews and discusses the up-to-date data on and feasibility of focused ultrasound surgery. This technique uses high-energy ultrasound beams that can be directed to penetrate through the skin and various soft tissues, focus on the target, and destroy tumors by increasing the temperature at the targeted tissue volume. The boundaries of the treatment area are sharply demarcated (focused) without causing damage to the surrounding organs. Although the idea of using sound waves to ablate tumors was first demonstrated in the 1940 s, only recent developments have enabled this technology to become more controlled and, hence, more feasible. The major breakthrough toward its clinical use came with coupling the thermal ablative process to advanced imaging. The development of magnetic resonance as the foundation to guide and evaluate the end results of focused ultrasound surgery treatment, the image guidance of the ultrasound beam, and the development of a reliable method for tissue temperature measurement and real-time feedback of the extent of tissue destruction have pushed this novel technology forward in oncological practice.

  11. A comparison of surgery versus transcatheter angiographic embolization in the treatment of nonvariceal upper gastrointestinal bleeding uncontrolled by endoscopy.

    Science.gov (United States)

    Ang, Daphne; Teo, Eng Kiong; Tan, Andrew; Ibrahim, Salleh; Tan, Poh Seng; Ang, Tiing Leong; Fock, Kwong Ming

    2012-08-01

    Patients with recurrent nonvariceal upper gastrointestinal bleeding who have failed endoscopic therapy pose a challenge. Percutaneous transcatheter angiographic embolization (TAE) is an alternative to surgery but remains controversial. This study compares the treatment outcomes in patients with recurrent nonvariceal upper gastrointestinal bleeding. A retrospective single-centre study of consecutive patients who underwent TAE (January 2007-December 2010) compared with patients treated surgically (January 2004-December 2010) was conducted. Patient demographics, comorbidities, rebleeding rates, length of stay and mortality were compared. Thirty [23 men; age (SD) 66.5±15.6 years] and 63 [41 men; age (SD) 68.2±15.0 years, NS] patients underwent TAE and surgery after a mean (SD) of 1.7±1.0 and 2.1±1.1 (NS) gastroscopies, respectively, for gastric ulcers (n=28), duodenal ulcers (n=53), small-bowel diverticuli (n=7), jejunal ulcer (n=1) and gastric Dieulafoy's lesions (n=2). Ten (33.3%) and 44 (69.8%) patients who underwent TAE and surgery, respectively, had an American Society of Anesthesiologists status of at least 2 (P=0.001). Higher rebleeding rates were observed after TAE compared with surgery [n=14 (46.7%) vs. 8 (12.7%), P=0.001]; however, there were no significant differences in 30-day mortality (16.7 vs. 19.0%, NS), complication rates (46.7 vs. 60.3%, NS) and length of stay (45.1±9.8 vs. 25.5±18.1 days, P=0.06). Twenty-four out of 30 patients (80%) who underwent TAE achieved haemostasis after a median (SD) of 2.0 (1.2) TAE procedures. Rebleeding occurred in five out of seven patients (71%) who underwent TAE for small-bowel diverticular bleeding. TAE averted the need for surgery in high-risk patients. Its role in low surgical risk patients or patients with small-bowel diverticular bleeding requires further study.

  12. Practice patterns of cataract surgeons at academic medical centers for the management of inadequate capsule support for intracapsular or sulcus intraocular lens placement during cataract surgery.

    Science.gov (United States)

    Sorenson, Rebecca; Scott, Ingrid U; Tucker, Steven H; Chinchilli, Vernon M; Papachristou, George C

    2016-02-01

    To determine practice patterns with regard to intraocular lens (IOL) placement during cataract surgery when there is inadequate capsule support for intracapsular or sulcus IOL placement. Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA. Cross-sectional study of anonymous survey results. An online survey was e-mailed to the coordinators of all Accreditation Council for Graduate Medical Education-accredited ophthalmology residency programs with a request to forward to all faculty who perform cataract surgery. Sixty-seven (57.2%) of 117 confirmed survey recipients participated. Thirty-six (62.1%) said they felt comfortable placing scleral-fixated posterior chamber IOLs (PC IOLs) independently. Faced with inadequate capsule support, 58.6% would place a primary anterior chamber IOL (AC IOL), 29.3% would place a primary scleral-fixated PC IOL, and 5.3% would leave the patient aphakic for secondary scleral-fixated PC IOL placement. Surgeons not comfortable placing scleral-fixated PC IOLs were most likely to choose primary AC IOLs (77.3%). Surgeons comfortable placing scleral-fixated PC IOLs were more evenly divided between primary AC IOLs (47.2%) and scleral-fixated PC IOLs (41.7%). Among surgeons who favored primary scleral-fixated PC IOLs, 63.7% cited a decreased risk for long-term complications as their reason for IOL choice; 50.0% of surgeons who favored primary AC IOLs cited avoidance of a second surgery. In general, primary AC IOL placement was preferred in the setting of inadequate capsule support, although less so among surgeons who were comfortable placing scleral-fixated PC IOLs. Lack of comfort with scleral-fixated PC IOL placement suggests a potential unmet training need in residency and fellowship programs. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  13. Timing of three-dimensional virtual treatment planning of orthognathic surgery: a prospective single-surgeon evaluation on 350 consecutive cases.

    Science.gov (United States)

    Swennen, Gwen R J

    2014-11-01

    The purpose of this article is to evaluate the timing for three-dimensional (3D) virtual treatment planning of orthognathic surgery in the daily clinical routine. A total of 350 consecutive patients were included in this study. All patients were scanned following the standardized "Triple CBCT Scan Protocol" in centric relation. Integrated 3D virtual planning and actual surgery were performed by the same surgeon in all patients. Although clinically acceptable, still software improvements especially toward 3D virtual occlusal definition are mandatory to make 3D virtual planning of orthognathic surgery less time-consuming and more user-friendly to the clinician.

  14. 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: ...

  15. Early treatment of patient with Class III skeletal and dental patterns

    Directory of Open Access Journals (Sweden)

    Marcos Alan Vieira Bittencourt

    2015-12-01

    Full Text Available Abstract Class III skeletal pattern is characterized by disharmony between maxillary and mandibular basal bones anteroposteriorly, and might or might not be associated with dental changes. In general, facial esthetics is hindered significantly, which most of times is the reason why patients or patient's guardians seek treatment. This case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO in partial fulfillment of the requirements for Diplomate recertification and revalidation.

  16. [Establishment of diagnosis and treatment patterns of holistic integrated medicine for neuro-ophthalmology].

    Science.gov (United States)

    Wang, Yanling

    2014-12-01

    Neuro-ophthalmology, as an interdisciplinary, covers at least three disciplines- ophthalmology, neurology and neurosurgery. With limited knowledge in each discipline, doctors often make misdiagnoses for neuro-ophthalmology diseases. Therefore, it is imperative to abandon the distinction between disciplines and combine all the knowledge to diagnose and treat patients in patterns of holistic integrated medicine in order to effectively improve the diagnosis and treatment of neuro-ophthalmology.

  17. Inferior Turbinate Size and CPAP Titration Based Treatment Pressures: No Association Found among Patients Who Have Not Had Nasal Surgery

    Science.gov (United States)

    Camacho, Macario; Zaghi, Soroush; Tran, Daniel; Song, Sungjin A.; Chang, Edward T.; Certal, Victor

    2016-01-01

    Objective. To evaluate the effect of turbinate sizes on the titrated continuous positive airway pressure (CPAP) therapeutic treatment pressures for patients with obstructive sleep apnea (OSA) who have not had nasal surgery. Study Design. Retrospective case series. Methods. A chart review was performed for 250 consecutive patients. Results. 45 patients met inclusion criteria. The mean ± standard deviation (M ± SD) for age was 54.6 ± 22.4 years and for body mass index was 28.5 ± 5.9 kg/m2. The Spearman's rank correlation coefficient (rs) between CPAP therapeutic treatment pressures and several variables were calculated and were weakly correlated (age rs = 0.29, nasal obstruction rs = −0.30), moderately correlated (body mass index rs = 0.42 and lowest oxygen saturation rs = −0.47), or strongly correlated (apnea-hypopnea index rs = 0.60 and oxygen desaturation index (rs = 0.62)). No statistical significance was found with one-way analysis of variance (ANOVA) between CPAP therapeutic treatment pressures and inferior turbinate size (right turbinates p value = 0.2012, left turbinate p value = 0.3064), nasal septal deviation (p value = 0.4979), or mask type (p value = 0.5136). Conclusion. In this study, CPAP titration based therapeutic treatment pressures were not found to be associated with inferior turbinate sizes; however, the CPAP therapeutic treatment pressures were strongly correlated with apnea-hypopnea index and oxygen desaturation index. PMID:26904126

  18. Inferior Turbinate Size and CPAP Titration Based Treatment Pressures: No Association Found among Patients Who Have Not Had Nasal Surgery

    Directory of Open Access Journals (Sweden)

    Macario Camacho

    2016-01-01

    Full Text Available Objective. To evaluate the effect of turbinate sizes on the titrated continuous positive airway pressure (CPAP therapeutic treatment pressures for patients with obstructive sleep apnea (OSA who have not had nasal surgery. Study Design. Retrospective case series. Methods. A chart review was performed for 250 consecutive patients. Results. 45 patients met inclusion criteria. The mean ± standard deviation (M ± SD for age was 54.6±22.4 years and for body mass index was 28.5±5.9 kg/m2. The Spearman’s rank correlation coefficient (rs between CPAP therapeutic treatment pressures and several variables were calculated and were weakly correlated (age rs=0.29, nasal obstruction rs=-0.30, moderately correlated (body mass index rs=0.42 and lowest oxygen saturation rs=-0.47, or strongly correlated (apnea-hypopnea index rs=0.60 and oxygen desaturation index (rs=0.62. No statistical significance was found with one-way analysis of variance (ANOVA between CPAP therapeutic treatment pressures and inferior turbinate size (right turbinates p value = 0.2012, left turbinate p value = 0.3064, nasal septal deviation (p value = 0.4979, or mask type (p value = 0.5136. Conclusion. In this study, CPAP titration based therapeutic treatment pressures were not found to be associated with inferior turbinate sizes; however, the CPAP therapeutic treatment pressures were strongly correlated with apnea-hypopnea index and oxygen desaturation index.

  19. Acne treatment patterns, expectations, and satisfaction among adult females of different races/ethnicities

    Directory of Open Access Journals (Sweden)

    Rendon MI

    2015-05-01

    Full Text Available Marta I Rendon,1 David A Rodriguez,2 Ariane K Kawata,3 Arnold N Degboe,4 Teresa K Wilcox,3 Caroline T Burk,5 Selena R Daniels,4 Wendy E Roberts6 1Rendon Center for Dermatology and Aesthetic Medicine, Boca Raton, FL, USA; 2Dermatology Associates and Research, Coral Gables, FL, USA; 3Evidera, Bethesda, MD, USA; 4Allergan Inc., Irvine, CA, USA; 5Health Outcomes Consultant, Laguna Beach, CA, USA; 6Generational and Cosmetic Dermatology, Rancho Mirage, CA, USA Background: Limited data are available on acne treatment patterns, expectations, and satisfaction in the adult female subpopulation, particularly among different racial and ethnic groups. Objective: Describe acne treatment patterns and expectations in adult females of different racial/ethnic groups and analyze and explore their potential effects on medication compliance and treatment satisfaction. Methods: A cross-sectional, Web-based survey was administered to US females (25–45 years with facial acne (≥25 visible lesions. Data collected included sociodemographics, self-reported clinical characteristics, acne treatment use, and treatment expectations and satisfaction. Results: Three hundred twelve subjects completed the survey (mean age, 35.3±5.9 years, comprising black (30.8%, Hispanic (17.6%, Asian/other (17.3%, and white (34.3%. More than half of the subjects in each racial group recently used an acne treatment or procedure (black, 63.5%; Hispanic, 54.5%; Asian/other, 66.7%; white, 66.4%. Treatment use was predominantly over-the-counter (OTC (47.4% versus prescription medications (16.6%. OTC use was highest in white subjects (black, 42.7%; Hispanic, 34.5%; Asian/other, 44.4%; white, 59.8%; P<0.05. The most frequently used OTC treatments in all racial/ethnic groups were salicylic acid (SA (34.3% and benzoyl peroxide (BP (32.1%. Overall, compliance with acne medications was highest in white versus black (57.0±32.4 vs 42.7±33.5 days, P>0.05, Hispanic (57.0±32.4 vs 43.2±32.9 days, P>0

  20. [Minimally invasive surgery and robotic surgery: surgery 4.0?].

    Science.gov (United States)

    Feußner, H; Wilhelm, D

    2016-03-01

    Surgery can only maintain its role in a highly competitive environment if results are continuously improved, accompanied by further reduction of the interventional trauma for patients and with justifiable costs. Significant impulse to achieve this goal was expected from minimally invasive surgery and, in particular, robotic surgery; however, a real breakthrough has not yet been achieved. Accordingly, the new strategic approach of cognitive surgery is required to optimize the provision of surgical treatment. A full scale integration of all modules utilized in the operating room (OR) into a comprehensive network and the development of systems with technical cognition are needed to upgrade the current technical environment passively controlled by the surgeon into an active collaborative support system (surgery 4.0). Only then can the true potential of minimally invasive surgery and robotic surgery be exploited.

  1. Increased risk of anastomotic leakage with diclofenac treatment after laparoscopic colorectal surgery

    DEFF Research Database (Denmark)

    Klein, Mads; Andersen, Lars Peter Holst; Harvald, Thomas

    2009-01-01

    BACKGROUND: Over a period our department experienced an unexpected high frequency of anastomotic leakages. After diclofenac was removed from the postoperative analgesic regimen, the frequency dropped. This study aimed to evaluate the influence of diclofenac on the risk of developing anastomotic...... leakage after laparoscopic colorectal surgery. METHODS: This was a retrospective case-control study based on 75 consecutive patients undergoing laparoscopic colorectal resection with primary anastomosis. In period 1, patients received diclofenac 150 mg/day. In period 2, diclofenac was withdrawn...... and the patients received an opioid analgesic instead. The primary outcome parameter was clinically significant anastomotical leakage verified at reoperation. RESULTS: 1/42 patients in the no-diclofenac group compared with 7/33 in the diclofenac group had an anastomotic leakage after operation (p = 0...

  2. Pattern of Lower Third Impaction and Outcome of Treatment in a ...

    African Journals Online (AJOL)

    DELL

    Background: Third molar surgery is the commonest dentoalveolar surgery in clinical practice and .... The second molar tooth was extracted due to pain from the pressure resorption ... increased time to extract and more post-operative swelling.

  3. Endoscopic plasma argon coagulation in treatment of weight regain after bariatric surgery: what does the patient think about this?

    Science.gov (United States)

    Marchesini, Simone Dallegrave; Baretta, Giorgio Alfredo Pedroso; Cambi, Maria Paula Carlini; Marchesini, João Batista

    2014-01-01

    Bariatric surgery, especially Roux-en-Y gastric bypass is an effective treatment for refractory morbid obesity, causing the loss of 75% of initial excess weight. After the surgery, however, weight regain can occur in 10-20% of cases. To help, endoscopic argon plasma coagulation (APC) is used to reduce the anastomotic diameter. Many patients who undergo this treatment, are not always familiar with this procedure and its respective precautions. The aim of this study was to determine how well the candidate for APC understands the procedure and absorbs the information provided by the multidisciplinary team. We prepared a questionnaire with 12 true/false questions to evaluate the knowledge of the patients about the procedure they were to undergo. The questionnaire was administered by the surgeon during consultation in the preoperative period. The patients were invited to fill out the questionnaire. We found out that the majority learned about the procedure through the internet. They knew it was an outpatient treatment, where the anesthesia was similar to that for endoscopy, and that they would have to follow a liquid diet. But none of them knew that the purpose of this diet was to improve local wound healing. Bariatric patients who have a second chance to resume weight loss, need continuous guidance. The internet should be used by the multidisciplinary team to promote awareness that APC will not be sufficient for weight loss and weight-loss maintenance in the long term. Furthermore, there is a need to clarify again the harm of drinking alcohol in the process of weight loss, making its curse widely known.

  4. Treatment patterns in major depressive disorder after an inadequate response to first-line antidepressant treatment

    Directory of Open Access Journals (Sweden)

    Garcia-Toro Mauro

    2012-09-01

    Full Text Available Abstract Background The aim of the study was to determine the most common pharmacological strategies used in the management of major depressive disorder (MDD after an inadequate response to first-line antidepressant treatment in clinical practice. Methods Multicenter, non-interventional study in adult outpatients with a DSM-IV-TR diagnosis of MDD and inadequate response to first-line antidepressant medication. Multiple logistic regression analyses were performed to identify independent factors associated with the adoption of a specific second-line strategy. Results A total of 273 patients were analyzed (mean age: 46.8 years, 67.8% female. Baseline mean Montgomery-Asberg Depression Rating Scale total score was 32.1 (95%CI 31.2-32.9. The most common strategies were: switching antidepressant medication (39.6%, augmentation (18.8%, and combination therapy (17.9%. Atypical antipsychotic drugs were the most commonly used agent for augmenting antidepressant effect. The presence of psychotic symptoms and the number of previous major depressive episodes were associated with the adoption of augmenting strategy (OR = 3.2 and 1.2, respectively. Conclusion The switch to another antidepressant agent was the most common second-line therapeutic approach. Psychiatrists chose augmentation based on a worse patients’ clinical profile (number of previous episodes and presence of psychotic symptoms.

  5. A Population-Based Study of Peyronie's Disease: Prevalence and Treatment Patterns in the United States

    Directory of Open Access Journals (Sweden)

    Dana Britt DiBenedetti

    2011-01-01

    Full Text Available Purpose. To estimate the US prevalence of Peyronie's disease (PD from patient-reported data and to identify diagnosis and treatment patterns. Methods. 11,420 US males ≥18 years old completed a brief web-based survey regarding the presence of PD, past treatments, and penile symptoms (Phase 1. Phase 1 respondents with PD diagnosis, history of treatment, or PD-related symptoms then completed a disease-specific survey (Phase 2. Results. Estimated prevalence of PD ranged from 0.5% (diagnosis of PD to 13% (diagnosis, treatment, or penile symptoms. Thirty-six percent of Phase 2 participants reported that penile symptoms interfered with sexual activities. Of participants who sought treatment for penile symptoms (=128, 73% initially saw a primary care physician, 74% did not receive treatment from their first doctor, and 92% were not diagnosed with PD. Conclusions. PD may be underdiagnosed/undertreated in the US. Improved awareness is needed of PD symptoms and treatment options among health care professionals.

  6. A Population-Based Study of Peyronie's Disease: Prevalence and Treatment Patterns in the United States

    Science.gov (United States)

    DiBenedetti, Dana Britt; Nguyen, Dat; Zografos, Laurie; Ziemiecki, Ryan; Zhou, Xiaolei

    2011-01-01

    Purpose. To estimate the US prevalence of Peyronie's disease (PD) from patient-reported data and to identify diagnosis and treatment patterns. Methods. 11,420 US males ≥18 years old completed a brief web-based survey regarding the presence of PD, past treatments, and penile symptoms (Phase 1). Phase 1 respondents with PD diagnosis, history of treatment, or PD-related symptoms then completed a disease-specific survey (Phase 2). Results. Estimated prevalence of PD ranged from 0.5% (diagnosis of PD) to 13% (diagnosis, treatment, or penile symptoms). Thirty-six percent of Phase 2 participants reported that penile symptoms interfered with sexual activities. Of participants who sought treatment for penile symptoms (n = 128), 73% initially saw a primary care physician, 74% did not receive treatment from their first doctor, and 92% were not diagnosed with PD. Conclusions. PD may be underdiagnosed/undertreated in the US. Improved awareness is needed of PD symptoms and treatment options among health care professionals. PMID:22110491

  7. Clinical Treatment of Postoperative Hemorrhage of Gastric Surgery of General Surgery%普外科胃部手术后并发出血的临床治疗措施分析

    Institute of Scientific and Technical Information of China (English)

    陈雷

    2015-01-01

    Objective To explore the clinical treatment of general surgery after gastric surgery complicated by bleeding.Methods 100 cases of hemorrhagic complications after general surgery patients, divided into an experimental group and a control group of patients to surgical Methods for treatment of the experimental group, the control group of patients taking non-surgical Methods for treatment of patients with different groups Comparative analysis of treatment effects after treatment for.Results Surgical treatment to take the experimental group and take non-surgical treatment of the control group no significant difference in the effect of treatment by the (P>0.05).Conclusion Depending on the situation after the general surgery patients with bleeding gastric surgery should be given appropriate treatment, timely and effective treatment for patients, ensure patient outcomes after treatment.%目的 探究普外科胃部手术之后并发出血的临床治疗措施.方法 选取100例普外科手术之后并发出血的患者,分为实验组以及对照组,实验组的患者采取手术的方法进行治疗,对照组的患者采取非手术的方法进行治疗,对两组患者经不同治疗方法治疗后的效果作比较分析.结果 采取手术治疗的实验组与采取非手术治疗的对照组经治疗后的效果没有明显的差异(P>0.05).结论 根据普外科胃部手术之后并发出血的患者的不同情况,应给予合适的治疗方法,及时并且有效的为患者进行治疗,保证患者治疗后的效果.

  8. Applications of Video-assisted Thoracic Surgery for the Diagnosis and Treatment 
of Patients with Small Pulmonary Nodules

    Directory of Open Access Journals (Sweden)

    Liqun SHAN

    2013-07-01

    Full Text Available Background and objective Chest computed tomography (CT, particularly thin-slice high resolution CT, has low sensitivity and specificity for detecting pulmonary nodules <10 mm in size. This limitation leads to challenges in clinical diagnosis and treatment of small pulmonary nodules. This study introduces the use of video-assisted thoracoscopic surgery (VATS for the diagnosis and treatment of small pulmonary nodules. Methods From November 2009 to May 2012, 64 patients with small pulmonary nodules without prior preoperative pathologic diagnosis were treated by pulmonary wedge resection through VATS. The diagnosis of small pulmonary nodules was established from rapid frozen section. The type of operation depends on the pathology and the condition of the patients. Twenty patients with primary lung cancer were subjected to lobectomy and radical resection of the lymph nodes by complete thoracospic lobectomy or video-assisted thoracoscopic invasive lobectomy. Pulmonary wedge resection was performed in 44 patients, among whom 21 have benign nodule, 18 have precancerous lesion, 3 have metastatic nodule, and 2 have primary lung cancer for which lobectomy was not fit. Results Confirmative diagnosis is difficult to obtain among patients with small pulmonary nodules. VATS is effective in the diagnosis and treatment of small pulmonary nodules. With VATS, patients with benign small pulmonary nodules can be cured, and patients with primary lung cancer can receive definite diagnosis and effective treatment in time. Conclusion CT-guided hook-wire fixation is useful in precise lesion localization for surgical resection.

  9. Differences in the pattern of drug use between male and female adolescents in treatment

    Directory of Open Access Journals (Sweden)

    Giusti Jackeline S

    2002-01-01

    Full Text Available INTRODUCTION/OBJECTIVES: The pattern of drug use among adolescents is not well known. Epidemiologic studies have reported no difference in the prevalence of drug use between genders. The present study wanted to assess the difference in drug use between genders in adolescents. The following variables were assessed: gender ratio of those looking for treatment; age they looked for treatment; age of the first drug use; substances used; with whom they first used drugs; pattern of drug use; possibly-related behavior (illegal acts, problems with the police and school delay. METHODS: Medical records of adolescents treated between 1993 and 2000 in a public medical center of the city São Paulo were analyzed. RESULTS: One-hundred and five medical records of adolescents aged 10 to 17 were reviewed. There were no differences between genders according to: age they looked for treatment; age of the first drug use; substances used; and illegal acts. There was a higher prevalence of male adolescents regarding to problems with the police and school delay. CONCLUSIONS: Data suggest that the behavioral consequences of drug use in female adolescents are less evident than in male adolescents, what could explain the lower frequency in which female adolescents had specialized treatment.

  10. Synergistic effects of compound physical factor treatment on neurological outcome after peripheral nerve entrapment surgery A randomized controlled study

    Institute of Scientific and Technical Information of China (English)

    Gaofeng Li; Dehu Tian; Jianli Yu; Wenzhi Li; Jie Meng

    2008-01-01

    BACKGROUND: Iatrophysics can improve the velocity of local microcirculation at peripheral nerve injured sites and promote the recovery from injury. Research has shown that simultaneous application of two physical factors has synergistic effects on the recovery of peripheral nerve function.OBJECTIVE: To treat patients that received peripheral nerve entrapment surgery with comprehensive rehabilitation by decimeter wave therapy and electrical stimulation, and to observe the clinical effects of promoting nerve function recovery. DESIGN: Randomized controlled study.SETTINGS: Department of Orthopaedics, the Third Hospital of Baoding; Department of Hand Surgery, the Third Hospital of Hebei Medical University; Woman-Children Healthcare Center, Southern District, Baoding. PARTICIPANTS: A total of 124 patients, who received peripheral nerve entrapment surgery, were selected from the Department of Orthopaedics, the Third Hospital of Baoding between July 2001 and May 2007. All patients met the diagnostic standard of peripheral nerve entrapment syndrome defined by Doctor Chen in 1995. All subjects gave informed consent for treatments and conditions involved. The experiment was approved by a local ethics committee. All patients were randomly divided into four groups: electrical stimulation group, decimeter wave group, compound physical factor group, and control group, with 31 subjects in each group. METHODS: Patients received neurolysis at an appropriate interval after hospitalization. ① Multi-form wave therapeutic equipment made in China was used to treat patients in the electrical stimulation group after neurolysis. Wave form, stimulus width, interval time, and stimulus intensity were regulated based on the grade of nerve injury. The details were as follows: mild nerve injury: 50–100-ms stimulus width and 1 500–2 000-ms intervals; moderate nerve injury: 100–200-ms stimulus width and 3 000–4 000-ms intervals; severe nerve injury: 200–300-ms stimulus width and 3 000

  11. Er:YAG and Nd:YAG laser in treatment of patients with contraindications of conventional dental and maxillofacial surgery

    Science.gov (United States)

    Smucler, Roman; Mazanek, Jiri

    2000-03-01

    In clinical praxis we must treat patients with some relative or absolute contraindications every day. Need of hospitalization, antibiotics, hemostyptics and complex examinations makes dentoalveolar and maxillofacial surgery in those cases quite expensive. Combination of Nd:YAG and Er:YAG laser gives us new possibilities. We can help some untreatable patients or transfer care from hospital to dental office. We have been trying to solve contraindications for laser therapy five years. In the center of our work are disorders of blood coagulation, immunity and metabolism. Nd:YAG laser is very useful in coagulation and vaporization of dental gum hypertrophies, benign and malign tumors in case of chronic anticoagulation therapy and immunosupress / in combination for example- after heart transplantation /. Special chapter is the care of patients with disseminated tumors. Er:YAG laser large solve big lesions because of minimal invasivity of course but for small benign tumors are recidives is ideal. Better and quicker healing make new standard of patients' cooperation. Generally fashionable and more comfortable laser treatment minimize need of general anesthesia. After five years we use complex laser therapy in our routine. Aim of our new work is to find ideal combination of cutting lasers to minimize classical complications of laser surgery / carbonization, long and secondary healing /.

  12. Structural equation modeling: a study of the impact of the breast cancer psychosocial pathway (diagnosis, surgery and treatment

    Directory of Open Access Journals (Sweden)

    Ivone Patrão

    Full Text Available Objective: Women diagnosed with breast cancer are confronted with different stressors throughout the illness trajectory, e.g. awaiting diagnosis, having surgery, anticipating the possibility that the cancer has spread and coping with side effects. The aim of this study was to assess the impact of the psychosocial pathway of breast cancer. Methods: A total of 360 women diagnosed with breast cancer were evaluated, on 3 separate occasions, regarding: distress, emotional control, neuroticism, social support, coping, quality of life (QoL and demographic characteristics. We used structural equation modeling (SEM to examine the relationships among all the variables. Results: The emotional, cognitive response, and the QoL suffered significant changes concerning diagnosis (time 1, surgery (time 2 and treatments (time 3. Furthermore, results indicate that an adapted emotional response is associated to efficient coping strategy, and satisfaction with the perceived social support and good QoL. This is particularly the case when women are undergoing a psychological intervention. Conclusion: To help breast cancer patients adjust to their situation the clinical psychologist should encourage the patient to adopt more efficient coping strategies. By doing so, patients may indeed experience less psychological distress and a higher quality of life, thereby increasing their overall sense of well-being.

  13. Surgery for complex perineal fistula following rectal cancer treatment using biological mesh combined with gluteal perforator flap.

    Science.gov (United States)

    Musters, G D; Lapid, O; Bemelman, W A; Tanis, P J

    2014-10-01

    Three patients with complex perineal fistula after extensive pelvic surgery and radiotherapy underwent surgical treatment combining a biological mesh for pelvic floor reconstruction and a unilateral superior gluteal artery perforator (SGAP) flap for filling of the perineal defect. All patients had both fecal and urinary diversion. Two fistulas originated from the small bowel, necessitating parenteral feeding, and one from the bladder. Symptoms included severe sacral pain and skin maceration. After laparotomy with complete debridement of the pelvic cavity, the pelvic floor was reconstructed by stitching a biological mesh at the level of the pelvic outlet. Subsequently, patients were turned to prone position, and perineal reconstruction was completed by rotating a SGAP flap into the defect between the biomesh and the perineal skin. Operating time ranged from 10 to 12.5 h, and hospital stay lasted from 9 to 23 days. The postoperative course was uneventful in all three patients. Reconstruction of large pelvic defects with a combination of biological mesh and SGAP flap is a viable alternative to a rectus abdominis musculocutaneous flap and may be preferable after extensive pelvic surgery with ostomy.

  14. [Hormonal treatments for hemorrhaging secondary to fibroids. An alternative or complement to surgery?].

    Science.gov (United States)

    Cancelo Hidalgo, María Jesús

    2013-07-01

    The main objective of treatment in women with uterine fibroids is the control of associated symptoms such as abnormal uterine bleeding, pain and pressure. Although the cost and potential adverse effects of the long-term use of medical treatment may limit its use for a long time, this alternative should be considered before indicating surgical treatment. At present, we have a considerable variety of drugs that, although not specific treatments for fibroids, may be used for the short to medium-term management of bleeding; however, we have still not found an alternative that eliminates the need for invasive treatments. Further research in this field is therefore warranted. Given the heterogeneity of fibroids and the lack of effective treatments in controlling their growth, the identification of signals that stimulate the onset and growth of these fibroids opens doors to the development of new therapies. In the future we may be able to differentiate classes of fibroids by molecular techniques and thereby implement specific treatments that control their development and their associated symptoms. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  15. The reasonable timing of the adjuvant radiotherapy in the treatment of uterine carcinosarcoma according to the surgical intent: suggestion based on progression patterns

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Jeong Il; Choi, Doo Ho; Huh, Seung Jae; Park, Won; Oh, Dong Ryul; Bae, Duk Soo [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2013-06-15

    We designed this study to identify and suggest the reasonable timing of adjuvant radiotherapy in the treatment of uterine carcinosarcoma according to the surgical intent and patterns of progression. We retrospectively analyzed a total of 50 carcinosarcoma patients diagnosed between 1995 and 2010. Among these 50 patients, 32 underwent curative surgery and 13 underwent maximal tumor debulking surgery. The remaining five patients underwent biopsy only. Twenty-six patients received chemotherapy, and 15 patients received adjuvant radiotherapy. The median follow-up period was 17.3 months. Curative resection (p < 0.001) and stage (p < 0.001) were statistically significant factors affecting survival. During follow-up, 30 patients showed progression. Among these, eight patients (16.0%) had loco-regional progression only. The patients who had received adjuvant radiotherapy did not show loco-regional progression, and radiotherapy was a significant negative risk factor for loco-regional progression (p = 0.01). The time to loco-regional progression was much earlier for non-curative than curative resection (range, 0.7 to 7.6 months vs. 7.5 to 39.0 months). Adjuvant radiotherapy in the treatment of carcinosarcoma might be related to a low loco-regional progression rate. Radiotherapy should be considered in non-curatively resected patients as soon as possible.

  16. Radiotherapy in prostate cancer treatment: Results of the patterns of care study in Korea

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Ah Ram; Park, Won [Division for Urologic Cancer, Korean Radiation Oncology Group, Seoul (Korea, Republic of)

    2017-03-15

    The purpose of this study was to describe treatment patterns of radiotherapy (RT) for prostate cancer in Korea. A questionnaire about radiation treatment technique and principles in 2013 was sent to 83 radiation oncologists and data from 57 hospitals were collected analyzed to find patterns of RT for prostate cancer patients in Korea. The number of patients with prostate cancer treated with definitive RT ranged from 1 to 72 per hospital in 2013. RT doses and target volumes increased according to risk groups but the range of radiation doses was wide (60 to 81.4 Gy) and the fraction size was diverse (1.8 to 5 Gy). Intensity-modulated radiation therapy was used for definitive treatment in 93.8% of hospitals. Hormonal therapy was integrated with radiation for intermediate (63.2%) and high risk patients (77.2%). Adjuvant RT after radical prostatectomy was performed in 46 hospitals (80.7%). Indications of adjuvant RT included positive resection margin, seminal vesicle invasion, and capsular invasion. The total dose for adjuvant RT ranged from 50 to 72 Gy in 24–39 fractions. Salvage RT was delivered with findings of consecutive elevations in prostate-specific antigen (PSA), PSA level over 0.2 ng/mL, or clinical recurrence. The total radiation doses ranged from 50 to 80 Gy with a range of 1.8 to 2.5 Gy per fraction for salvage RT. This nationwide patterns of care study suggests that variable radiation techniques and a diverse range of dose fractionation schemes are applied for prostate cancer treatment in Korea. Standard guidelines for RT in prostate cancer need to be developed.

  17. [Uterus preserving surgery versus vaginal hysterectomy in treatment of uterine descent: a systematic review].

    NARCIS (Netherlands)

    Detollenaere, R.J.; Boon, J. den; Vierhout, M.E.; Eijndhoven, H.W. van

    2011-01-01

    OBJECTIVE: To compare the outcomes of uterus preserving procedures and vaginal hysterectomy in treatment of uterine prolapse. DESIGN: Systematic review. METHOD: We searched in Pubmed, Embase, the Cochrane Library and the reference lists of relevant publications for articles comparing uterus

  18. Video-assisted thoracoscopic surgery or transsternal thymectomy in the treatment of myasthenia gravis?

    Science.gov (United States)

    Zahid, Imran; Sharif, Sumera; Routledge, Tom; Scarci, Marco

    2011-01-01

    A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was how video-assisted thoracoscopic surgery (VATS) compares to median sternotomy in the surgical management of patients with myasthenia gravis (MG)? Overall 74 papers were found using the reported search, of which 15 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results are tabulated. We conclude that VATS produces equivalent postoperative mortality and complete stable remission (CSR) rates, with superior results in terms of hospital stay, operative blood loss and patient satisfaction at the expense of a doubling of operative time. Six studies comparing VATS and transsternal sternotomy in non-thymomatous myasthenia gravis (NTMG) patients found VATS to have lower operative blood loss (73.8±70.7 vs. 155.3±91.7 ml; P0.05). One study comparing video-assisted thoracoscopic extended thymectomy to transsternal thymectomy in only thymoma-associated myasthenia gravis (T-MG) patients found equivalent CSR (11.3 vs. 8.7%, P=0.1090) at six-year follow-up. Thymoma recurrence rate (9.64%) was not significantly different (P=0.1523) between the two groups. Eight studies comparing VATS and transsternal approach in mixed T-MG and NTMG patients found a lower hospital stay (1.9±2.6 vs. 4.6±4.2 days, P<0.001), reduced need for postoperative medication (76.5 vs. 35.7%, P=0.022), lower intensive care unit stay (1.5 vs. 3.2 days, P=0.018), greater symptom improvement (100 vs. 77.9%, P=0.019) and better cosmetic satisfaction (100 vs. 83, P=0.042) with VATS. In concordance with NTMG and T-MG alone patient groups, VATS and transsternal methods had equivalent complication rates (23 vs. 19%, P=0.765) with no mortalities in either group. Even though VATS has a longer operative time (268±51 vs. 177±92 min, P<0.05), its improved cosmesis, reduced need

  19. Outcome of Endoscopic Sinus Surgery in the Treatment of Chronic Rhinosinusitis.

    Science.gov (United States)

    Rahman, T; Alam, M M; Ahmed, S; Karim, M A; Rahman, M; Wahiduzzaman, M

    2016-04-01

    This prospective study was conducted to compare the outcome of endoscopic sinus surgery (ESS) using SNOT-20 score chart (subjective) and Lund & Kennedy scoring chart (objective) and carried out in the Department of Otolaryngology & Head-Neck Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Dhaka Medical College Hospital (DMCH) & Shaheed Suhrawardy Medical College Hospital (ShSMCH) from July 2010 to March 2012. Total 73 admitted cases were selected purposively for ESS, male 53(72.60%) and female 20(27.40%). Among the study participants 10(13.7%) had chronic rhinosinusitis with bilateral polyposis and 26(35.62%) had chronic rhinosinusitis with unilateral polyposis and 12(16.44%) had bilateral chronic rhinosinusitis without polyposis and 25(34.25%) had unilateral chronic rhinosinusitis without polyposis. Surgical procedures done among the patients were Uncinectomy (infundibulectomy), Middle Meatal Antrostomy; Anterior Ethmoidectomy; Sphenoidotomy, Associated septoplasty and no significant per or post operative complications were noted. In Chronic rhinosinusitis (CRS) with polyposis pre operative SNOT-20 mean and SD 1.322±0.341 and post ESS snot-20 mean and SD 0.3472±0.0755, CRS without polyposis pre operative SNOT-20 mean and SD 0.9297±0.86 and post ESS SNOT-20 mean and SD 1986±0.0558. In CRS with polyposis pre operative Lund & Kennedy score of endoscopic assessment, mean and SD 5.333±2.255 and post ESS mean and SD 1.31±1.009. In CRS without polyposis pre op Lund & Kennedy score mean and SD 3.108±1.074 and post ESS mean and SD 0.76±0.641.Post ESS SNOT-20 in CRS with Polyposis, 't' test result was 27.58 which was significant (ptreatment of CRS with or without polyposis had statistically significant role. Symptomatic relief and quality of life improvement after ESS was compared by improvement in post operative scores of SNOT-20 & Lund-Kennedy score of endoscopic assessment. Post operative lower values were considered to be better improvement

  20. Diversity of fecal coliforms and their antimicrobial resistance patterns in wastewater treatment model plant.

    Science.gov (United States)

    Luczkiewicz, A; Fudala-Ksiazek, S; Jankowska, K; Quant, B; Olańczuk-Neyman, K

    2010-01-01

    The occurrence of resistance patterns among wastewater fecal coliforms was determined in the study. Susceptibility of the isolates was tested against 19 antimicrobial agents: aminoglycosides, aztreonam, carbapenems, cephalosporines, beta-lactam/beta-lactamase inhibitors, penicillines, tetracycline, trimethoprim/sulfamethoxazole, and fluoroquinolones. Additionally the removal of resistant isolates was evaluated in the laboratory-scale wastewater treatment model plant (M-WWTP), continuously supplied with the wastewater obtained from the full-scale WWTP. Number of fecal coliforms in raw (after mechanical treatment) and treated wastewater, as well as in aerobic chamber effluent was determined using selective medium. The selected strains were identified and examined for antibiotic resistance using Phoenix Automated Microbiology System (BD Biosciences, USA). The strains were identified as Escherichia coli (n=222), Klebsiella pneumoniae ssp. ozaenae (n=9), and Pantoea agglomerans (n=1). The isolate of P. agglomerans as well as 48% of E. coli isolates were sensitive to all antimicrobials tested. The most frequent resistance patterns were found for ampicillin: 100% of K. pneumoniae ssp. ozaenae and 41% of E. coli isolates. Among E. coli isolates 12% was regarded as multiple antimicrobial resistant (MAR). In the studied M-WWTP, the applied activated sludge processes reduced considerably the number of fecal coliforms, but increased the ratio of antimicrobial-resistant E. coli isolates to sensitive ones, especially among strains with MAR patterns.

  1. Mexican use of lead in the treatment of empacho: community, clinic, and longitudinal patterns.

    Science.gov (United States)

    Baer, R D; Garcia de Alba, J; Leal, R M; Plascencia Campos, A R; Goslin, N

    1998-11-01

    This paper discusses research designed to investigate community, clinic, and longitudinal patterns in use of lead as a treatment for empacho, a folk illness manifest by gastrointestinal symptoms. The same questionnaire used in a clinic-based study seven years previously in Guadalajara, Mexico, was used to interview a randomly selected community sample: in addition, the study was repeated at the same clinic sites that had been studied previously. The goals were to investigate: (1) What are community wide prevalences of empacho and use of lead based remedies? (2) To what extent are current patterns of use of lead for treatment of empacho in clinic-based samples similar to those seven years ago. The attributable risk to the population as a whole from use of lead based remedies was found to be 11% of the households of Guadalajara. Essentially this same estimate was seen for the 1987 and 1994 clinic populations. Interestingly, while percentages of lead users have declined since 1987, twice as great a percentage of informants reported treating empacho. Other patterns originally identified in 1987 persisted in 1994; lead use continues to be associated with lower levels of parental education and income.

  2. Tuina Treatment of Infantile Torticollis by Syndrome Differentiation and Pattern Classification

    Institute of Scientific and Technical Information of China (English)

    SUN An-da; HUANG Guo-ai

    2004-01-01

    将500例小儿肌性斜颈患者分为卵圆形肿块,条索形肿块和非肿块型,采用点摩法、按揉法、弹拨捻转法、拨伸旋转法和扳拉法等推拿手法治疗,并根据不同证型予以相应手法.治疗时间最短者20 d,最长者120 d,总有效率99.4%.%After classified into ovary mass pattern, cord-like mass pattern and non-mass pattern, 500 cases of the patients sick with infantile torticollis were treated by Tuina manipulations of pressing and rubbing method, pressing and kneading method, plucking and twisting method, extending and rotating method and the pulling method, with the corresponding manual techniques upon different pattern. The treatment ranged from 20 days to 120 days and the total effective rate was 99.4%.

  3. Temperament and character dimensions in patients with social phobia: patterns of change following treatments?

    Science.gov (United States)

    Mörtberg, Ewa; Bejerot, Susanne; Aberg Wistedt, Anna

    2007-07-30

    The aim of this study was to examine Temperament and Character Inventory (TCI) profiles in patients with social phobia (DSM-IV) and to outline patterns of change following intensive group cognitive therapy (IGCT), individual cognitive therapy (ICT) and treatment as usual (TAU). One hundred patients recruited by advertisements in local papers were randomized to IGCT, ICT and TAU. Patients (n=59) who completed diagnostic evaluation and TCI assessments at baseline and 1-year follow-up were examined in this study. Patients differed from healthy controls in novelty seeking (NS), harm avoidance (HA), self-directedness (SD), cooperativeness (C), and self-transcendence (ST). Treatments overall were associated with decrease in HA, while increase in SD was observed after psychotherapy only. Reduced social anxiety was correlated with decrease in HA and increase in SD. High HA at baseline was related to poor treatment outcome in all treatments. To conclude, patients with social phobia show a temperamental vulnerability for developing anxiety and character traits associated with personality disorders. Successful treatment is related to decrease in HA and increase in SD. High HA at baseline may suggest a need for extensive treatment in order to achieve remission.

  4. Muscle strength and function of shoulders with Bankart lesion after successful arthroscopic treatment: interlimb comparison 24 months after surgery.

    Science.gov (United States)

    Tahta, Mesut; Akmeşe, Ramazan; Özberk, Zekiye Nisa; Coşkun, Ozlem Oner; Işik, Çetin; Korkusuz, Feza; Bozkurt, Murat

    2013-12-01

    The purpose of this study was to examine outcomes following arthroscopic Bankart repair with the focus on strength after the repair. 56 shoulders with Bankart lesion were operated on arthroscopically. Gender, mechanism of the first dislocation, number of dislocations, dominant side, operated side and the number of anchors used for surgery were recorded. DASH and Oxford instability scoring systems were applied preoperatively and compared to scores at the 24-month follow-up. The scoring systems were also applied to contralateral shoulders at the 24th month of follow-up. Range of motion was measured with a goniometer. Muscle strength was analyzed with a dynamometer simultaneously with the muscle activity of four perishoulder muscles. The data were recorded with surface EMG. Range of motion, muscle strength and activity were evaluated according to the contralateral shoulder at the 24th month of follow-up. Male/female ratio was 42/14 with a mean age of 32 years. The mean number of dislocations was 3 ± 1 and all were traumatic dislocations. The number of mean anchors used was 3.1 and the mean follow-up period was 24 months. In clinical evaluation, the preoperative and postoperative results of the DASH and Oxford instability scores of the unstable shoulders were significantly different. In the comparison between the operated and contralateral shoulders, there was no significant difference in DASH and Oxford instability scores at the 24th month of follow-up. There was no significant loss of range of motion. Only internal rotation strength was significantly reduced and there was no significant change in the EMG patterns. Although good clinical results can be achieved, internal rotation strength is reduced after arthroscopic surgery, but daily activities are not affected. There is no guarantee for patients of excellent recovery. Level III cohort study.

  5. ADMINISTRATION OF LACTULOSE IN COMPLEX PEHABILITATION TREATMENT AFTER RADICAL AND RECONSTRUCTIVE RESTORATIVE SURGERY OF BOWELS IN CHILDREN

    Directory of Open Access Journals (Sweden)

    I.V. Kirgizov

    2009-01-01

    Full Text Available The results of treatment of children (n = 64 of 1,5–17 years old, receiving rehabilitation course after reconstructive — restorative surgery of bowels are presented in this article. It was shown, that prolonged (1 month and more administration of lactulose (Duphalac results in improvement of motor and evacuation function of bowel, and decreases «sensor inability» of reduced parts of bowel. As a result, lactulose stimulates functioning of «obturative apparatus of neoampula» (voluntary evacuation, retention of intestinal contents, that favors to increase of quality of life and social rehabilitation of children in outlying post surgical period.Key words: children, post surgical rehabilitation, «idiopathic megacolon»syndrome, Hirschsprung's disease, anorectal malformations,lactulose.(Voprosy sovremennoi pediatrii — Current Pediatrics. 2009;8(2:34-37

  6. Prescription of Chinese Herbal Medicine and Selection of Acupoints in Pattern-Based Traditional Chinese Medicine Treatment for Insomnia: A Systematic Review

    OpenAIRE

    Wing-Fai Yeung; Ka-Fai Chung; Maggie Man-Ki Poon; Fiona Yan-Yee Ho; Shi-Ping Zhang; Zhang-Jin Zhang; Eric Tat-Chi Ziea; Vivian Wong Taam

    2012-01-01

    Traditional Chinese medicine (TCM) treatments are often prescribed based on individuals' pattern diagnoses. A systematic review of Chinese and English literatures on TCM pattern differentiation, treatment principle, and pattern-based treatment for insomnia has therefore been conducted. A total of 227 studies, 17916 subjects, and 87 TCM patterns were analyzed. There was a limited consistency in pattern-based TCM treatment of insomnia across practitioners. Except for Gui Pi Tang, An Shen Ding Z...

  7. Prebiotic and Synbiotic Treatment before Colorectal Surgery--Randomised Double Blind Trial.

    Science.gov (United States)

    Krebs, Bojan

    2016-04-01

    The aim of our study was to demonstrate higher concentrations of lactic acid bacteria (LAB) on the colonic mucosa in operated colorectal cancer patients treated with oral intake of synbiotics or prebiotics preoperatively. We also tried to prove that the systemic inflammatory response after surgery is not so severe in patients who took synbiotics or prebiotics, furthermore these patients have less postoperative complications and a favorable postoperative course. 73 patients with preceding colorectal operations were recruited. They were randomized into three groups. One group received preoperatively prebiotics, the second synbiotics in and third was preoperatively cleansed. We have defined the number of four different probiotic bacteria on colonic mucosa with polymerase chain reaction (PCR). Serum levels of interleukin-6, CRP, fibrinogen, white cell count and differential blood count were measured pre- and postoperatively to determine systemic inflammatory response. We succeed in confirming that in the synbiotic group there were considerably more LAB presented on the mucosa. They did pass the upper gastrointestinal tract and were isolated in colonic mucosa. On the other hand, we did not find any statistical differences in systemic inflammatory response measured by upper factors and no differences in postoperative course and complications rate between all three groups.

  8. Nephron-sparing surgery for treatment of reninoma: a rare renin secreting tumor causing secondary hypertension

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    Fabio Cesar Miranda Torricelli

    2015-02-01

    Full Text Available Main findings A 25-year-old hypertensive female patient was referred to our institution. Initial workup exams demonstrated a 2.8 cm cortical lower pole tumor in the right kidney. She underwent laparoscopic partial nephrectomy without complications. Histopathologic examination revealed a rare juxtaglomerular cell tumor known as reninoma. After surgery, she recovered uneventfully and all medications were withdrawn. Case hypothesis Secondary arterial hypertension is a matter of great interest to urologists and nephrologists. Renovascular hypertension, primary hyperadosteronism and pheocromocytoma are potential diagnosis that must not be forgotten and should be excluded. Although rare, chronic pyelonephritis and renal tumors as rennin-producing tumors, nephroblastoma, hypernephroma, and renal cell carcinoma might also induce hypertension and should be in the diagnostic list of clinicians. Promising future implications Approximately 5% of patients with high blood pressure have specific causes and medical investigation may usually identify such patients. Furthermore, these patients can be successfully treated and cured, most times by minimally invasive techniques. This interesting case might expand knowledge of physicians and aid better diagnostic care in future medical practice.

  9. Surgical treatment of a calcified Rathke's cleft cyst with endoscopic extended transsphenoidal surgery--case report.

    Science.gov (United States)

    Arai, Takao; Horiguchi, Kentaro; Saeki, Naokatsu; Oka, Hidehiro; Saito, Takatoshi; Takahashi-Fujigasaki, Junko; Sakamoto, Hiroki; Kato, Naoki; Dobashi, Hisashi; Tanaka, Toshihide; Hasegawa, Yuzuru; Abe, Toshiaki

    2011-01-01

    A 34-year-old male presented with a rare case of Rathke's cleft cyst (RCC) with calcification manifesting as persistent high fever and impaired consciousness. Physical findings revealed panhypopituitarism and bitemporal hemianopsia. Computed tomography showed mass lesions with marked calcification within the sella turcica and the suprasellar region. Magnetic resonance imaging showed solid and cystic components compressing the optic nerve. The preoperative diagnosis was craniopharyngioma. Initial endonasal transsphenoidal surgery (TSS) was performed with a surgical microscope, but the mass was extremely hard, so only partial removal was possible. Second endonasal extended TSS was performed with a neuroendoscope. The solid components were totally removed, but calcifications adhering to the optic nerve could not be removed completely. The histological diagnosis was RCC with marked granulation reaction. RCC with calcification is rare and difficult to differentiate from craniopharyngioma on neuroimages. Extremely thick calcification of the sella turcica enclosing granulation tissue and the cyst similar to armor, here called "armor-like calcification," is a characteristic imaging finding of RCC with calcification. The most important aspect is choosing a surgical approach to carefully and effectively relieve pressure upon the optic nerve. Endonasal extended TSS with an endoscope was effective in the present case.

  10. Effects of Dynamic Changes in Ultrasound Attenuation and Blood Perfusion on Lesion Formation of Multiple focus Pattern during Ultrasound Surgery

    Institute of Scientific and Technical Information of China (English)

    ZHANG Chen-xi; BAI Jing-feng; CHEN Ya-zhu

    2007-01-01

    A nonlinear finite-element program was developed to simulate the dynamic evolution of coagulation in tissue considering temperature and thermal-dose dependence of the ultrasound attenuation and blood perfusion rate.The effects of these dynamic parameters on the lesion formation were investigated in the particular case of ultrasound hepatic ablation with bi-focus intensity pattern.The results of simulations were compared that incorporate dynamic changes of ultrasound attenuation and perfusion and results that neglect these effects.The result shows that thermal-dose-dependent ultrasound attenuation is the dominating factor in the full dynamic model.If the dynamic ultrasound attenuation is ignored, a relatively significant underestimation of the temperature rise appears in the focal plane and the region next to the focal plane, resulting in an underestimation in predicting diameter of coagulation.Higher heating intensity leads to greater underestimation.

  11. Efficacy of patterned scan laser in treatment of macular edema and retinal neovascularization

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    Dimple Modi

    2009-08-01

    Full Text Available Dimple Modi, Paulpoj Chiranand, Levent AkdumanSaint Louis University School of Medicine, Department of Ophthalmology, Saint Louis University Eye Institute, St. Louis, Missouri, USAPurpose: To analyze the benefits, efficacy, and complications of the PASCAL® photocoagulation laser system (OptiMedica, Santa Clara, CA, USA in patients treated at our institution.Methods: We conducted a retrospective chart review of 19 patients (28 eyes who underwent laser treatment using the PASCAL® photocoagulation system from November 2006 to November 2007. These 28 eyes were divided into two groups; group 1 eyes underwent macular grid laser and group 2 eyes underwent panretinal photocoagulation. Treatment was performed for macular edema or for iris or retinal neovascularization. Outcomes measured included best-corrected visual acuity (BCVA, efficacy of laser treatment, complications, duration of the procedure, and pain perception, which were noted in the charts for panretinal treatments.Results: Follow-up was 5.9 ± 2.6 months for group 1 and 5.9 ± 4.0 months for group 2. In group 1, 9/28 eyes required a second treatment for remaining edema. BCVA was stable or better in 66% (14/21 and average central foveal thickness on ocular coherence tomography improved in 71% (15/21. Time to completion for a number of laser patterns for grid photocoagulation was felt to be too long for completing the total pattern safely, although we have not noted any related complications. In group 2, the neovascularization regressed at least partially in 3/7 patients. Patient-reported pain perception was 3.6 on a scale of 1 to 10 for group 2. Occasional hemorrhages occurred secondary to irregular laser uptake at different spots in the patterns. We observed no visual outcome consequences because of these hemorrhages during follow-up.Conclusions: Retinal photocoagulation by the PASCAL® laser has comparable efficacy to historical results with conventional retinal photocoagulation in short

  12. One-off surgery of posterior reduction and fixation for the treatment of basilar invagination with atlantoaxial dislocation

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    LIU Jia-gang

    2012-08-01

    Full Text Available Objective To investigate the surgical treatment and clinical results for the primary basilar invagination (BI with atlantoaxial dislocation (AAD. Methods A retrospective study was performed. The study included 89 patients who had primary BI and AAD were surgically treated in our hospital from January 2008 to December 2011. There were 28 males and 61 females, aged between 10 and 69 years (mean 45.42 years. All patients were treated by the same 3-step surgical method. The first step, reduction of the AAD was performed by homemade odontoid repositor intraoperatively through posterior approach; the second step, AO stainless steel plates were fixed between the occiput and C2, 3 lateral mass screws; and the third step, occipitocervical fusion were completed by autologous iliac crest graft. Operation effect was recorded during follow-up period. Results Follow-up period was 6 to 48 months. Clinical symptoms were improved in 82.93% patients after the surgery. Japanse Orthopaedic Association (JOA score increased from preoperative (8.80 ± 1.36 points to postoperative (15.35 ± 1.47 points (t = 17.225, P = 0.001. In general, satisfactory decompression and bony fusion were shown on postoperative radiological examinations for all patients. Compared with pretreatment data, the postoperative imaging measurement showed that the mean data of atlanto-dental interval (ADI, 9.22 mm vs 3.72 mm and vertical dimension from the top of odontoid process to Chamberlain line (10.41 mm vs 3.23 mm were all reduced, and the cervicomedullary angle (130° vs 150° and space available of spinal cord (SAC, 11.13 mm vs 15.54 mm were all improved. Conclusion The one-off surgery of posterior reduction technique and fixing between occiput and C2, 3 lateral mass screws is a safe, easy, and effective treatment for patients with p

  13. Multidisciplinary treatment of patients after a surgery due to cancers in the facial area: a clinical reports.

    Science.gov (United States)

    Rolski, D; Dolegacz, A; Górska, R; Mierzwińska-Nastalska, E

    2006-01-01

    Prosthetic rehabilitation of patients after surgical removal of carcinoma in the facial skeleton is one of the most difficult problems in therapy of the stomatognathic system, due to increasing incidence of head and neck carcinoma. Significant deformations of tissues, development of dysfunctions of the stomatognathic system with concurrent biological unbalance of the oral cavity enviroment are frequently a consequence of the treatment. Cicatricial scars, contraction of the oral crevice and limitation of mobility of the tongue are noted in numerous cases. Deformations of the facial area of the skull and of structures of the temporo-mandibular joint are also the reasons of occlusion and articulation disturbances. Two cases of surgery due to carcinoma in the facial skeleton that have required combined and stepwise multispecialistic treatment performed at Department of Prosthetic Dentistry and Department of Periodontology and Oral Disease, Dental Institute, Medical University of Warsaw are presented. The therapy has involved treatment of periodontitis and applying appropriate construction of prostheses that would relieve periodontium and splinting teeth.

  14. Role of damage control surgery in the treatment of Hinchey III and IV sigmoid diverticulitis: a tailored strategy.

    Science.gov (United States)

    Cirocchi, Robe