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Sample records for surgical diagnostic work-up

  1. Diagnostic work-up in cardiomyopathies

    DEFF Research Database (Denmark)

    Rapezzi, Claudio; Arbustini, Eloisa; Caforio, Alida L P

    2013-01-01

    a framework for the clinical approach to diagnosis in cardiomyopathies based on the recognition of diagnostic 'red flags' that can be used to guide rational selection of specialized tests including genetic analysis. The basic premise is that the adoption of a cardiomyopathy-specific mindset which combines...

  2. Splenomegaly - Diagnostic validity, work-up, and underlying causes

    DEFF Research Database (Denmark)

    Curovic Rotbain, Emelie; Lund Hansen, Dennis; Schaffalitzky de Muckadell, Ove

    2017-01-01

    to an internal medical department and can be caused by a large spectrum of diseases, including haematological diseases and liver cirrhosis. However, some patients remain without a causal diagnosis, despite extensive medical work-up. PATIENTS AND METHODS: We identified 129 patients through the DNRP, that had been...... given the ICD-10 splenomegaly diagnosis code in 1994-2013 at Odense University Hospital, Denmark, excluding patients with prior splenomegaly, malignant haematological neoplasia or liver cirrhosis. Medical records were reviewed for validity of the splenomegaly diagnosis, diagnostic work...... significant under-coding, it should be considered if supplementary data sources should be used in addition, in order to attain a more representative population. Haematological diseases were the most common cause, however in a large fraction of patients no causal diagnosis was found....

  3. MDCT diagnostic work-up of patients with subarachnoid haemorrhage

    International Nuclear Information System (INIS)

    Phanis, S.; Nikolopoulos, P.; Veliou, K.; Tsampoulas, C.; Efremidis, S.

    2006-01-01

    Full text: Our presentation is intended to analyze our experience over the last two years, in the expeditious work up of patients with subarachnoid haemorrhage, as well as patients whose clinical symptoms combined with radiological findings are highly suspicious of an aneurysm, acute arterial occlusion, cerebral vascular malformation, venous occlusion, dissection of the internal carotid artery or vertebral artery. 276 CT Angiographies of the brain have been performed and recorded over the last two years in our Department, on a 16 Detector Philips MX8000IDT Computed Tomograph. The patients are referred to our Department from the Emergency Department of our Hospital, as well as from Hospitals all over Northwestern Greece. The CT Angiographies are performed with examination protocols, which we will analyze thoroughly in our presentation. The primary data are then studied in workstations away from the main console of the Computed Tomograph. The study of the primary data consists in multiplanar reconstructions with the Maximum Intensity Algorithm, as well as Volume Rendering and three Dimensional Reconstruction. The stages we follow for these procedures will be presented as well as the procedures for the removal of bone structures, with the intention of the best possible angiographic results. Of the 276 patients 40 were diagnosed with an aneurysm,19 with a venous angioma, 2 with a vascular malformation, 3 with venous occlusion and 2 with dissection, a total of 66/276 with aneurysms and vascular malformations. These patients were subsequently referred to the Neurosurgery Clinic or to the Department of Interventional Radiology for further treatment. The remaining 210 patients, underwent in the following days of their hospitalization a Digital Subtraction Angiography, and in 16 (7.6%) of them a small aneurysm, 3-5 mm was diagnosed. The aneurysm was detected in a second reading of the CT Angiography in 8 patients (3.8%). The CT Angiography in patients with subarachnoid

  4. Children's Headache: Drawings in the Diagnostic Work Up.

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    Mazzotta, Silvia; Pavlidis, Elena; Cordori, Cecilia; Spagnoli, Carlotta; Pini, Luigi Alberto; Pisani, Francesco

    2015-08-01

    This study aims to evaluate the drawings effectiveness in childhood headache assessment. Headache is a common cause of pain in children. Although drawings have been used in childhood to recognize psychological insights and pain perception, they were rarely used for headache characterization. We collected drawings from 67 subjects with cephalalgia during a 22-month timeframe. The clinical diagnosis was made according to the 2nd edition of The International Headache Classification. Drawings were independently categorized as migraine or tension-type headache (TTH) by two child neuropsychiatrists blinded to the clinical data. Cohen kappa for interrater agreement, sensitivity, specificity, and positive predictive value (PPV) were calculated. Subjects were also divided into three age groups to assess the influence of age. Finally, a control group of 90 subjects was collected and K-means cluster analysis was performed. The drawings had a sensitivity of 85.71 and 81.48%, a specificity of 81.48 and 85.71%, and a PPV of 85.71 and 81.48%, for migraine and TTH diagnosis, respectively. Drawings by the older age group showed the highest predictability degree. Finally, by mean of cluster analysis, 59 of the 67 patients were correctly classified, whereas control subjects were similarly distributed between the two clusters. Drawings are a useful instrument for migraine and TTH differential diagnosis. Thus, we suggest their inclusion in childhood headache diagnostic assessment. Georg Thieme Verlag KG Stuttgart · New York.

  5. The diagnostic work up of growth failure in secondary health care ; An evaluation of consensus guidelines

    NARCIS (Netherlands)

    Grote, F.K.; Oostdijk, W.; Muinck Keizer-Schrama, S.M.P.F. de; Dommelen, P. van; Buuren, S. van; Dekker, F.W.; Ketel, A.G.; Moll, H.A.; Wit, J.M.

    2008-01-01

    Background: As abnormal growth might be the first manifestation of undetected diseases, it is important to have accurate referral criteria and a proper diagnostic work-up. In the present paper we evaluate the diagnostic work-up in secondary health care according to existing consensus guidelines and

  6. GPs' perspectives on the diagnostic work-up in patients with shoulder pain: a qualitative study.

    Science.gov (United States)

    Ottenheijm, Ramon P G; Hesselmans, Nicolle J J M; Kemper, Anouk; Moser, Albine; de Bie, Rob A; Dinant, Geert-Jan; Cals, Jochen W L

    2014-06-01

    The diagnostic work-up of patients with shoulder pain in general practice is complex. General practitioners' (GPs) guidelines advise a pragmatic diagnostic work-up in which additional imaging has a limited role. However, diagnostic ultrasounds are increasingly ordered by GPs, which seems to reflect complexity in management of shoulder pain. This study aimed to explore GPs' perspectives on the diagnostic work-up of patients with shoulder pain. This study has a qualitative exploratory design with an inductive approach and was carried out in Dutch general practice. The study population consisted of 18 Dutch GPs who were sampled purposefully with a spread in clinical experience and ordering diagnostic ultrasound. Data were gathered by means of semi-structured interviews and analysed following principles of the constant comparative method. Three main categories with subcategories emerged that captured the diagnostic work-up of shoulder pain: variety in diagnostic classifications [(non-)specific diagnosis and interdisciplinary differences], establishing strategies for diagnostic work-up (use of existing tools and motives to deviate from existing tools), and strategies dealing with diagnostic uncertainties (accepting diagnostic uncertainties, diagnostic imaging tests, and interdisciplinary consultation and referral). Despite the availability of evidence-based shoulder guidelines, GPs experience uncertainties during diagnostic work-up and apply different strategies when dealing with these uncertainties. At some point, GPs as well as patients seem to have a need for a specific diagnosis. Currently, there appears to be little agreement if, or in which phase of shoulder pain, diagnostic ultrasound is useful or indicated. © 2014 John Wiley & Sons, Ltd.

  7. Effect of radiologists' diagnostic work-up volume on interpretive performance.

    Science.gov (United States)

    Buist, Diana S M; Anderson, Melissa L; Smith, Robert A; Carney, Patricia A; Miglioretti, Diana L; Monsees, Barbara S; Sickles, Edward A; Taplin, Stephen H; Geller, Berta M; Yankaskas, Bonnie C; Onega, Tracy L

    2014-11-01

    To examine radiologists' screening performance in relation to the number of diagnostic work-ups performed after abnormal findings are discovered at screening mammography by the same radiologist or by different radiologists. In an institutional review board-approved HIPAA-compliant study, the authors linked 651 671 screening mammograms interpreted from 2002 to 2006 by 96 radiologists in the Breast Cancer Surveillance Consortium to cancer registries (standard of reference) to evaluate the performance of screening mammography (sensitivity, false-positive rate [ FPR false-positive rate ], and cancer detection rate [ CDR cancer detection rate ]). Logistic regression was used to assess the association between the volume of recalled screening mammograms ("own" mammograms, where the radiologist who interpreted the diagnostic image was the same radiologist who had interpreted the screening image, and "any" mammograms, where the radiologist who interpreted the diagnostic image may or may not have been the radiologist who interpreted the screening image) and screening performance and whether the association between total annual volume and performance differed according to the volume of diagnostic work-up. Annually, 38% of radiologists performed the diagnostic work-up for 25 or fewer of their own recalled screening mammograms, 24% performed the work-up for 0-50, and 39% performed the work-up for more than 50. For the work-up of recalled screening mammograms from any radiologist, 24% of radiologists performed the work-up for 0-50 mammograms, 32% performed the work-up for 51-125, and 44% performed the work-up for more than 125. With increasing numbers of radiologist work-ups for their own recalled mammograms, the sensitivity (P = .039), FPR false-positive rate (P = .004), and CDR cancer detection rate (P women recalled per cancer detected from 17.4 for 25 or fewer mammograms to 24.6 for more than 50 mammograms. Increases in work-ups for any radiologist yielded significant

  8. Effect of Radiologists’ Diagnostic Work-up Volume on Interpretive Performance

    Science.gov (United States)

    Anderson, Melissa L.; Smith, Robert A.; Carney, Patricia A.; Miglioretti, Diana L.; Monsees, Barbara S.; Sickles, Edward A.; Taplin, Stephen H.; Geller, Berta M.; Yankaskas, Bonnie C.; Onega, Tracy L.

    2014-01-01

    Purpose To examine radiologists’ screening performance in relation to the number of diagnostic work-ups performed after abnormal findings are discovered at screening mammography by the same radiologist or by different radiologists. Materials and Methods In an institutional review board–approved HIPAA-compliant study, the authors linked 651 671 screening mammograms interpreted from 2002 to 2006 by 96 radiologists in the Breast Cancer Surveillance Consortium to cancer registries (standard of reference) to evaluate the performance of screening mammography (sensitivity, false-positive rate [FPRfalse-positive rate], and cancer detection rate [CDRcancer detection rate]). Logistic regression was used to assess the association between the volume of recalled screening mammograms (“own” mammograms, where the radiologist who interpreted the diagnostic image was the same radiologist who had interpreted the screening image, and “any” mammograms, where the radiologist who interpreted the diagnostic image may or may not have been the radiologist who interpreted the screening image) and screening performance and whether the association between total annual volume and performance differed according to the volume of diagnostic work-up. Results Annually, 38% of radiologists performed the diagnostic work-up for 25 or fewer of their own recalled screening mammograms, 24% performed the work-up for 0–50, and 39% performed the work-up for more than 50. For the work-up of recalled screening mammograms from any radiologist, 24% of radiologists performed the work-up for 0–50 mammograms, 32% performed the work-up for 51–125, and 44% performed the work-up for more than 125. With increasing numbers of radiologist work-ups for their own recalled mammograms, the sensitivity (P = .039), FPRfalse-positive rate (P = .004), and CDRcancer detection rate (P work-ups for any radiologist yielded significant increases in FPRfalse-positive rate (P = .011) and CDRcancer detection rate (P

  9. Diagnostic work-up and loss of tuberculosis suspects in Jogjakarta, Indonesia.

    Science.gov (United States)

    Ahmad, Riris Andono; Matthys, Francine; Dwihardiani, Bintari; Rintiswati, Ning; de Vlas, Sake J; Mahendradhata, Yodi; van der Stuyft, Patrick

    2012-02-15

    Early and accurate diagnosis of pulmonary tuberculosis (TB) is critical for successful TB control. To assist in the diagnosis of smear-negative pulmonary TB, the World Health Organisation (WHO) recommends the use of a diagnostic algorithm. Our study evaluated the implementation of the national tuberculosis programme's diagnostic algorithm in routine health care settings in Jogjakarta, Indonesia. The diagnostic algorithm is based on the WHO TB diagnostic algorithm, which had already been implemented in the health facilities. We prospectively documented the diagnostic work-up of all new tuberculosis suspects until a diagnosis was reached. We used clinical audit forms to record each step chronologically. Data on the patient's gender, age, symptoms, examinations (types, dates, and results), and final diagnosis were collected. Information was recorded for 754 TB suspects; 43.5% of whom were lost during the diagnostic work-up in health centres, 0% in lung clinics. Among the TB suspects who completed diagnostic work-ups, 51.1% and 100.0% were diagnosed without following the national TB diagnostic algorithm in health centres and lung clinics, respectively. However, the work-up in the health centres and lung clinics generally conformed to international standards for tuberculosis care (ISTC). Diagnostic delays were significantly longer in health centres compared to lung clinics. The high rate of patients lost in health centres needs to be addressed through the implementation of TB suspect tracing and better programme supervision. The national TB algorithm needs to be revised and differentiated according to the level of care.

  10. Diagnostic work-up and loss of tuberculosis suspects in Jogjakarta, Indonesia

    Directory of Open Access Journals (Sweden)

    Ahmad Riris

    2012-02-01

    Full Text Available Abstract Background Early and accurate diagnosis of pulmonary tuberculosis (TB is critical for successful TB control. To assist in the diagnosis of smear-negative pulmonary TB, the World Health Organisation (WHO recommends the use of a diagnostic algorithm. Our study evaluated the implementation of the national tuberculosis programme's diagnostic algorithm in routine health care settings in Jogjakarta, Indonesia. The diagnostic algorithm is based on the WHO TB diagnostic algorithm, which had already been implemented in the health facilities. Methods We prospectively documented the diagnostic work-up of all new tuberculosis suspects until a diagnosis was reached. We used clinical audit forms to record each step chronologically. Data on the patient's gender, age, symptoms, examinations (types, dates, and results, and final diagnosis were collected. Results Information was recorded for 754 TB suspects; 43.5% of whom were lost during the diagnostic work-up in health centres, 0% in lung clinics. Among the TB suspects who completed diagnostic work-ups, 51.1% and 100.0% were diagnosed without following the national TB diagnostic algorithm in health centres and lung clinics, respectively. However, the work-up in the health centres and lung clinics generally conformed to international standards for tuberculosis care (ISTC. Diagnostic delays were significantly longer in health centres compared to lung clinics. Conclusions The high rate of patients lost in health centres needs to be addressed through the implementation of TB suspect tracing and better programme supervision. The national TB algorithm needs to be revised and differentiated according to the level of care.

  11. The diagnostic work up of growth failure in secondary health care; An evaluation of consensus guidelines

    Directory of Open Access Journals (Sweden)

    Dekker Friedo W

    2008-05-01

    Full Text Available Abstract Background As abnormal growth might be the first manifestation of undetected diseases, it is important to have accurate referral criteria and a proper diagnostic work-up. In the present paper we evaluate the diagnostic work-up in secondary health care according to existing consensus guidelines and study the frequency of underlying medical disorders. Methods Data on growth and additional diagnostic procedures were collected from medical records of new patients referred for short stature to the outpatient clinics of the general paediatric departments of two hospitals (Erasmus MC – Sophia Children's Hospital, Rotterdam and Spaarne Hospital, Haarlem between January 1998 and December 2002. As the Dutch Consensus Guideline (DCG is the only guideline addressing referral criteria as well as diagnostic work-up, the analyses were based on its seven auxological referral criteria to determine the characteristics of children who are incorrectly referred and the adequacy of workup of those who are referred. Results Twenty four percent of children older than 3 years were inappropriately referred (NCR. Of the correctly referred children 74–88% were short corrected for parental height, 40–61% had a height SDS Conclusion Existing guidelines for workup of children with suspected growth failure are poorly implemented. Although poorly implemented the DCG detects at least 5% pathologic causes of growth failure in children referred for short stature. New guidelines for referral are required with a better sensitivity and specificity, wherein distance to target height should get more attention. The general diagnostic work up for short stature should include testing for celiac disease in all children and for Turner syndrome in girls.

  12. How to tackle tremor – systematic review of the literature and diagnostic work-up

    Directory of Open Access Journals (Sweden)

    Arthur W.G. Buijink

    2012-10-01

    Full Text Available BackgroundTremor is the most prevalent movement disorder in clinical practice. It is defined as involuntary, rhythmic, oscillatory movements. The diagnostic process of patients with tremor can be laborious and challenging, and a clear, systematic overview of available diagnostic techniques is lacking. Tremor can be a symptom of many diseases, but can also represent a distinct disease entity.ObjectiveThe objective of this review is to give a clear, systematic and step-wise overview of the diagnostic work-up of a patient with tremor. The clinical relevance and value of available laboratory tests in patients with tremor will be explored.MethodsWe systematically searched through EMBASE. The retrieved articles were supplemented by articles containing relevant data or provided important background information. Studies that were included investigated the value and/or usability of diagnostic tests for tremor.ResultsIn most patients, history and clinical examination by an experienced movement disorders neurologist are sufficient to establish a correct diagnosis, and further ancillary examinations will not be needed. Ancillary investigation should always be guided by tremor type(s present and other associated signs and symptoms. The main ancillary examination techniques currently are electromyography and SPECT imaging. Unfortunately, many techniques have not been studied in large prospective, diagnostic studies to be able to determine important variables like sensitivity and specificity.ConclusionWhen encountering a patient with tremor, history and careful clinical examination should guide the diagnostic process. Adherence to the diagnostic work-up provided in this review will help the diagnostic process of these patients.

  13. [Functional childhood gastrointestinal disorders. III. Constipation and solitary encopresis; diagnostic work-up and therapy].

    Science.gov (United States)

    van Ginkel, R; Büller, H A; Heymans, H S; Taminiau, J A; Boeckxstaens, G E; Benninga, M A

    2003-06-28

    A detailed medical history in combination with a thorough physical examination, including rectal examination, form the cornerstone in the diagnostic work-up for children with functional defecation disorders. Additional investigations are often not informative and have only minor diagnostic or therapeutic implications. Medical therapy in children with functional constipation and solitary encopresis is primarily based on clinical experience. In both patient groups, the role of education, the use of diary cards and toilet training is important. In some patients behaviour interventions are important. Oral laxatives are the basis of treatment of children with functional constipation, whereas they are contra-indicated in children with solitary encopresis. In both groups, biofeedback training appears to be of little additional benefit. Long-term follow-up of children with functional defecation disorders shows that complaints continue far beyond puberty in many children.

  14. Effects of Diagnostic Work-Up on Medical Decision-Making for Canine Urinary Tract Infection

    DEFF Research Database (Denmark)

    Sørensen, T M; Bjørnvad, C R; Cordoba, G

    2018-01-01

    dipstick (99%), microscopic examination of urine (80%) and bacterial culture (56%). Fifty-one percent of dogs had urinary tract infection (UTI) based on reference QBC. Appropriate DTT was made for 62% of the dogs, while 36% were over-prescribed and 2% under-prescribed. Inappropriate use of second......-line agents was found in 57% of the UTI cases. Performing microscopy-but not culture-significantly impacted DTT (P = 0.039) while no difference was seen in COT (P = 0.67). The accuracy of in-house microscopy and culture were 64.5 and 77%, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: Over......-prescription of antibiotics was common among dogs with suspected UTI, regardless of the diagnostic work-up performed. Test inaccuracy under practice conditions and incoherence between diagnostic test results and decision-making both explained inappropriate and unnecessary use of antibiotics....

  15. Non-traumatic cortical subarachnoid haemorrhage: diagnostic work-up and aetiological background

    Energy Technology Data Exchange (ETDEWEB)

    Spitzer, C.; Kosinski, C.M. [University Hospital of RWTH Aachen, Department of Neurology, Aachen (Germany); Mull, M. [University Hospital of RWTH Aachen, Department of Neuroradiology, Aachen (Germany); Rohde, V. [University Hospital of RWTH Aachen, Department of Neurosurgery, Aachen (Germany)

    2005-07-01

    Only 15% of all subarachnoid haemorrhages (SAHs) are not of aneurysmal origin. Among those, circumscribed SAHs along the cortical convexity are rare and have only been described in singular case reports so far. Here, we present a collection of 12 cases of SAH along the convexity, of non-traumatic origin. Over a period of 10 years, 12 cases of circumscribed SAH along the convexity were identified at our clinic. The clinical presentations, neuroradiological SAH characteristics, further diagnostic work-up to identify the underlying aetiologies, the therapy and clinical outcome were analysed. The patients' chief complaints were unspecific cephalgia, focal or generalised seizures and focal neurological deficits. Typical signs of basal SAH, such as nuchal rigidity, thunderclap-headache or alteration of consciousness, were rare. Magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) revealed different aetiologies, namely postpartal posterior encephalopathy (three), cerebral vasculitis (two), dural sinus thrombosis (two), cortical venous thrombosis (one), intracerebral abscesses (one) and cerebral cavernoma (one). Two cases remained unresolved. Treatment of the underlying disease and symptomatic medication led to good clinical outcome in almost all cases. On the basis of these findings, we demonstrate that the clinical presentation, localisation and aetiology of cortical SAH differ clearly from other SAHs. A diagnostic work-up with MRI and eventually DSA is essential. Mostly, the causative disease can be identified, and specific treatment allows a favourable outcome. (orig.)

  16. TU-D-209-01: Dosimetry of Diagnostic Work Up Mammography

    Energy Technology Data Exchange (ETDEWEB)

    Jallow, N [Emory University, Atlanta, GA (United States); Sechopoulos, I [Radboud University Medical Centre, Nijmegen (Netherlands)

    2016-06-15

    Purpose: To investigate patient average glandular dose (AGD) characteristics of diagnostic mammography. Methods: The techniques used to image 14420 patients who received diagnostic work up mammography from October 2008 to December 2014 at one academic hospital were retrospectively collected. The most common diagnostic views and the techniques used for each according to compressed breast thickness were determined. For all techniques, 1st half value layer and air kerma output per tube current-exposure time product were measured; then the incident air kerma for each acquisition was calculated. The values for normalized glandular dose (DgN) were obtained with a validated Monte Carlo simulation of mammographic acquisition. The mono-energetic DgN results were combined according to relative fluence using the TASMICS model to obtain DgN coefficients for each spectrum. The spectral DgN and calculated incident air kerma were used to estimate AGD of patients with breast thickness ranging from 2 to 8 cm. Results: The most common views utilized during diagnostic mammography were magnification craniocaudal (24%), magnification mediolateral (19%), spot craniocaudal (28%), and spot mediolateral oblique (24%). The AGD increased with increasing breast thickness for both the magnification and spot views. The AGD for a 5.5 cm thick breast was approximately 6.8 mGy and 2.2 mGy for the magnification and spot views, respectively. The AGD ranged from 3.6 mGy to 6.8 mGy for the magnification views and from 1.0 mGy to 3.1 mGy for spot views. The difference in AGD between the two magnification views or the two spot views was not significant. Conclusion: These results provide information on breast dose to which screening recalled women are exposed to. In addition to understanding the dose used for common clinical imaging tests, this data could be used when comparing use of mammography for diagnostic workup to other potential modalities, such as breast tomosynthesis and breast CT.

  17. TU-D-209-01: Dosimetry of Diagnostic Work Up Mammography

    International Nuclear Information System (INIS)

    Jallow, N; Sechopoulos, I

    2016-01-01

    Purpose: To investigate patient average glandular dose (AGD) characteristics of diagnostic mammography. Methods: The techniques used to image 14420 patients who received diagnostic work up mammography from October 2008 to December 2014 at one academic hospital were retrospectively collected. The most common diagnostic views and the techniques used for each according to compressed breast thickness were determined. For all techniques, 1st half value layer and air kerma output per tube current-exposure time product were measured; then the incident air kerma for each acquisition was calculated. The values for normalized glandular dose (DgN) were obtained with a validated Monte Carlo simulation of mammographic acquisition. The mono-energetic DgN results were combined according to relative fluence using the TASMICS model to obtain DgN coefficients for each spectrum. The spectral DgN and calculated incident air kerma were used to estimate AGD of patients with breast thickness ranging from 2 to 8 cm. Results: The most common views utilized during diagnostic mammography were magnification craniocaudal (24%), magnification mediolateral (19%), spot craniocaudal (28%), and spot mediolateral oblique (24%). The AGD increased with increasing breast thickness for both the magnification and spot views. The AGD for a 5.5 cm thick breast was approximately 6.8 mGy and 2.2 mGy for the magnification and spot views, respectively. The AGD ranged from 3.6 mGy to 6.8 mGy for the magnification views and from 1.0 mGy to 3.1 mGy for spot views. The difference in AGD between the two magnification views or the two spot views was not significant. Conclusion: These results provide information on breast dose to which screening recalled women are exposed to. In addition to understanding the dose used for common clinical imaging tests, this data could be used when comparing use of mammography for diagnostic workup to other potential modalities, such as breast tomosynthesis and breast CT.

  18. Contribution of ictal- and interictal brain SPECT to the diagnostic work-up of epileptic patients

    International Nuclear Information System (INIS)

    Dondi, M.; Salgarello, M.; Zoboli, S.; Cidda, C.; Nanni, C.; Rubboli, G.; Meletti, S.; Volpi, L.; Tassinari, C.A.

    2002-01-01

    Aim of the study: We aimed at assessing the contribution of brain SPECT to the diagnostic work-up of patients admitted to the Intensive Epilepsy Monitoring Unit (IEMU) by evaluating concordance of SPECT results with clinical diagnosis (DX) at IEMU admittance (Adm-DX) and at hospital discharge (Disch-DX). Materials and methods: 48 consecutive patients were enrolled in this study and submitted to both ictal and inter-ictal brain SPECT, carried out by means of a three-head system. Before ictal studies, patients were video-EEG monitored in the IEMU. 740 MBq of Tc99m ECD were injected during seizures and imaging performed within 45-60 minutes. For interictal studies, injection was given after at least a 24-hours seizure-free interval. Slices were reconstructed along the orbito-meatal line as well as along the temporal cut. Possible epileptic foci were identified by visual comparison of ictal and interictal studies. Clinical data: Out of the 48 cases, 27 were diagnosed as temporal lobe epilepsies (TLE). Of these, 15 had an Adm-DX of lateralization, whereas 12 were not lateralized according to standardized clinical and EEG criteria. Frontal lobe epilepsy (FLE) was diagnosed in 11 patients, another group of 3 was classified as cryptogenetic (CRYP), while the remaining 7 cases did not fall into any of the previous groups (OTH). SPECT results: in TLE, ictal/interictal SPECT results were congruent with Adm-Dx in 13/27 cases (48%) whereas congruence was found with 25 out of 27 (92%) of Disch-DX. In FLE, concordance between SPECT and clinical diagnosis remained unchanged (9/11 in comparison to either Adm-DX or Disch-DX). CRYPT patients had no lateralization at Adm-DX, while Dis-DX was concordant with SPECT in 2/3 cases. The group labeled as OTH showed concordance SPECT with Adm-DX in 0/7 cases, as opposed to 5/7 of Disch-DX. On the whole, SPECT results were concordant with Adm-DX in 34/48 cases (71%) but concordance was much higher with Dis-DX (41/48; 85%). Conclusions: Brain

  19. Feasibility of dynamic MR-hysterosalpingography for the diagnostic work-up of infertile women

    International Nuclear Information System (INIS)

    Winter, Leopold; Gluecker, Thomas; Steinbrich, Wolfgang; Pegios, Wassilios; Steimann, Sabine; De Geyter, Christian; Froehlich, Johannes M.

    2010-01-01

    Background: Tubal disturbances often contribute to infertility. Conventional hysterosalpingography (HSG) is considered as standard in the assessment of the patency of the fallopian tubes, but requires ionizing radiation and is restricted to the imaging of endoluminal structures. Purpose: To evaluate dynamic magnetic resonance-HSG (dMR-HSG) in the diagnostic work-up in patients with infertility. Material and Methods: Thirty-seven consecutive infertile women underwent dMR-HSG: 20 ml of gadolinium-polyvidone solution (18.4 mM Dotarem 1:20 with polyvidone) were injected intracervically through a 5-Charriere balloon catheter while acquiring five consecutive flash-3D T1-weighted MR sequences with fat saturation. Two experienced readers assessed image quality and anatomic-pathologic correlations prospectively. The relevance of results was evaluated in the clinical context of each patient. Patient comfort was evaluated with a standardized questionnaire. Results: dMR-HSG was successfully completed in 33/37 patient with an average study time of 45 min. In 4 of 37 patients the catheter became dislodged during the examination, resulting in two complete diagnostic failures. Failure in another two patients was due to preliminary termination because of excessive pain and discomfort during the application of the contrast solution. The uterine cavity was completely visualized and bilateral fallopian tube patency was confirmed by dMR-HSG in 27 of 33 patients. Bilateral tubal occlusion was diagnosed in one of the remaining six patients and was confirmed by laparoscopy. Successful selective tubal catheterization was performed in one additional patient with unilateral and one patient with bilateral fallopian tube occlusion. In three cases, the catheter became dislocated at the end of the examination without demonstration of tubal patency. Since all three patients refused diagnostic laparoscopy and conventional HSG, possible bilateral occlusions of the fallopian tubes could not be

  20. Feasibility of dynamic MR-hysterosalpingography for the diagnostic work-up of infertile women

    Energy Technology Data Exchange (ETDEWEB)

    Winter, Leopold; Gluecker, Thomas; Steinbrich, Wolfgang; Pegios, Wassilios (Dept. of Radiology, Univ. Hospital Basel (Switzerland)), e-mail: winterl@uhbs.ch; Steimann, Sabine; De Geyter, Christian (Women' s Hospital, Univ. Hospital Basel (Switzerland)); Froehlich, Johannes M. (Guerbet AG, Zuerich (Switzerland))

    2010-07-15

    Background: Tubal disturbances often contribute to infertility. Conventional hysterosalpingography (HSG) is considered as standard in the assessment of the patency of the fallopian tubes, but requires ionizing radiation and is restricted to the imaging of endoluminal structures. Purpose: To evaluate dynamic magnetic resonance-HSG (dMR-HSG) in the diagnostic work-up in patients with infertility. Material and Methods: Thirty-seven consecutive infertile women underwent dMR-HSG: 20 ml of gadolinium-polyvidone solution (18.4 mM Dotarem 1:20 with polyvidone) were injected intracervically through a 5-Charriere balloon catheter while acquiring five consecutive flash-3D T1-weighted MR sequences with fat saturation. Two experienced readers assessed image quality and anatomic-pathologic correlations prospectively. The relevance of results was evaluated in the clinical context of each patient. Patient comfort was evaluated with a standardized questionnaire. Results: dMR-HSG was successfully completed in 33/37 patient with an average study time of 45 min. In 4 of 37 patients the catheter became dislodged during the examination, resulting in two complete diagnostic failures. Failure in another two patients was due to preliminary termination because of excessive pain and discomfort during the application of the contrast solution. The uterine cavity was completely visualized and bilateral fallopian tube patency was confirmed by dMR-HSG in 27 of 33 patients. Bilateral tubal occlusion was diagnosed in one of the remaining six patients and was confirmed by laparoscopy. Successful selective tubal catheterization was performed in one additional patient with unilateral and one patient with bilateral fallopian tube occlusion. In three cases, the catheter became dislocated at the end of the examination without demonstration of tubal patency. Since all three patients refused diagnostic laparoscopy and conventional HSG, possible bilateral occlusions of the fallopian tubes could not be

  1. The Appropriate Use of Neuroimaging in the Diagnostic Work-Up of Dementia

    Science.gov (United States)

    2014-01-01

    Background Diagnosis of dementia is challenging and requires both ruling out potentially treatable underlying causes and ruling in a diagnosis of dementia subtype to manage patients and suitably plan for the future. Objectives This analysis sought to determine the appropriate use of neuroimaging during the diagnostic work-up of dementia, including indications for neuroimaging and comparative accuracy of alternative technologies. Data Sources A literature search was performed using Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid Embase, the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database, for studies published between 2000 and 2013. Review Methods Data on diagnostic accuracy and impact on clinical decision making were abstracted from included studies. Quality of evidence was assessed using GRADE. Results The search yielded 5,374 citations and 15 studies were included. Approximately 10% of dementia cases are potentially treatable, though less than 1% reverse partially or fully. Neither prediction rules nor clinical indications reliably select the subset of patients who will likely benefit from neuroimaging. Clinical utility is highest in ambiguous cases or where dementia may be mixed, and lowest for clinically diagnosed Alzheimer disease or clinically excluded vascular dementia. There is a lack of evidence that MRI is superior to CT in detecting a vascular component to dementia. Accuracy of structural imaging is moderate to high for discriminating different types of dementia. Limitations There was significant heterogeneity in estimates of diagnostic accuracy, which often prohibited a statistical summary of findings. The quality of data reported by studies prohibited calculation of likelihood ratios in the present analysis. No studies from primary care were found; thus, generalizability beyond tertiary care settings may be limited. Conclusions A diagnosis of reversible dementia is rare. Imaging has the most

  2. Superficial artery aneurysms underlying nummular headache--2 cases and proposed diagnostic work-up.

    Science.gov (United States)

    López-Ruiz, Pedro; Cuadrado, María-Luz; Aledo-Serrano, Angel; Alonso-Oviés, Almudena; Porta-Etessam, Jesús; Ganado, Tomás

    2014-01-01

    Nummular headache, considered a primary headache in the 3rd edition of the International Classification of Headache Disorders, has nonetheless been attributed in several occasions to underlying epicranial anomalies. Vascular imaging of the head in 2 patients with nummular headache revealed fusiform aneurysms of the scalp vessel in close relation to the painful area. One of the patients underwent surgical resection of the aneurysm with excellent response. A response to triptans was noted in both. In selected patients with nummular headache, vascular imaging of the scalp may reveal anomalies amenable to surgical treatment or triptan administration, sometimes resulting in disappearance of the pain. © 2014 American Headache Society.

  3. Diagnostic work-up and loss of tuberculosis suspects in Jogjakarta, Indonesia

    NARCIS (Netherlands)

    R.A. Ahmad (Riris); F. Matthys (Francine); B. Dwihardiani (Bintari); N. Rintiswati (Ning); S.J. de Vlas (Sake); Y. Mahendradhata (Yodi); P. van der Stuyft (Patrick)

    2012-01-01

    textabstractBackground: Early and accurate diagnosis of pulmonary tuberculosis (TB) is critical for successful TB control. To assist in the diagnosis of smear-negative pulmonary TB, the World Health Organisation (WHO) recommends the use of a diagnostic algorithm. Our study evaluated the

  4. Cetrorelix suppression test in the diagnostic work-up of severe hyperandrogenism in adolescence.

    NARCIS (Netherlands)

    Man, M. de; Derksen, E.; Pieters, G.F.F.M.; Boer, H. de

    2008-01-01

    Conventional diagnostic procedures failed to provide a definitive diagnosis in a 15 year-old girl presenting with severe hirsutism, oligomenorrhea, and markedly elevated serum testosterone levels. To examine whether androgen overproduction was luteinizing hormone (LH) dependent and thus likely of

  5. Cost-effectiveness of functional cardiac imaging in the diagnostic work-up of coronary heart disease.

    Science.gov (United States)

    Pletscher, Mark; Walker, Simon; Moschetti, Karine; Pinget, Christophe; Wasserfallen, Jean-Blaise; Greenwood, John P; Schwitter, Juerg; Girardin, François R

    2016-07-01

    The aim of this study was to assess the cost-effectiveness of eight common diagnostic work-up strategies for coronary heart disease (CHD) in patients with stable angina symptoms in Switzerland. A decision analytical model was used to perform a cost-effectiveness comparison of eight common multitest strategies to diagnose CHD using combinations of four diagnostic techniques: exercise treadmill test (ETT), single-photon emission computed tomography (SPECT), cardiac magnetic resonance imaging (CMR), and coronary angiography (CA). We used a Markov state transition model to extrapolate the results over a life-time horizon, from a third-party payer perspective. We used a CHD prevalence rate of 39% in patients and a base-case scenario with 60-year-old male patients with intermediate symptom severity Canadian Cardiovascular Society grading of angina pectoris 2 and at least one cardiovascular (CV) risk factor but without a history of myocardial infarction and without need for revascularization. Among the eight work-up strategies, one strategy was dominant, i.e. least costly and most effective: ETT followed by CMR if the ETT result was inconclusive and then CA if the CMR result was positive or inconclusive. The CMR features a favourable balance between false-negative diagnoses, associated with an elevated risk of CV events, and false-positive diagnoses, leading to unnecessary CA and related mortality. Key parameters guiding the diagnostic strategy are the prevalence of CHD in patients with angina symptoms and the diagnostic costs of CA and CMR. Cardiac magnetic resonance imaging appears to be a cost-effective work-up strategy compared with other regimens using SPECT or direct CA. Cardiac magnetic resonance imaging should be more widely recommended as a diagnostic procedure for patients with suspected angina symptoms.

  6. Abdominal ultrasonography in the diagnostic work-up in children with recurrent abdominal pain

    DEFF Research Database (Denmark)

    Wewer, Anne Vibeke; Strandberg, C; Pærregaard, Anders

    1997-01-01

    We report on our experience with routine abdominal ultrasonography in 120 children (aged 3-15 years) with recurrent abdominal pain, in order to determine the diagnostic value of this investigation. Eight children (7%) revealed sonographic abnormalities: gallbladder stone (n = 2), splenomegaly (n...... = 1) and urogenital abnormalities (n = 5). The recurrent abdominal pain could be explained by these findings in only two (may be three) cases. CONCLUSION: The diagnostic value of abdominal ultrasonography in unselected children with recurrent abdominal pain is low. However, the direct visualization...... of the abdominal structures as being normal may be helpful to the parents and the child in their understanding and acceptance of the benign nature of recurrent abdominal pain....

  7. Molecular biomarkers have the potential to improve the diagnostic work-up of pancreatic cystic lesions

    DEFF Research Database (Denmark)

    Plougmann, Julie Isabelle; Klausen, Pia; Karstensen, John Gásdal

    2017-01-01

    of diagnostic tools are used to predict the malignant potential of these cysts, but specificity and sensitivity are limited. Thus, many patients undergo unnecessary operations for benign cysts. Balancing the risks of watchful waiting with those of operative management is key in managing these lesions. During...... the last decade, genetic changes of pancreatic cysts have been examined extensively to estimate their malignant potential. In this review, we provide an overview of the latest molecular and genetic aspects of pancreatic cysts and how they may contribute to the differential diagnosis in patients...

  8. The Appropriate Use of Neuroimaging in the Diagnostic Work-Up of Dementia

    Science.gov (United States)

    Bermingham, SL

    2014-01-01

    Background Structural brain imaging is often performed to establish the underlying causes of dementia. However, recommendations differ as to who should receive neuroimaging and whether computed tomography (CT) or magnetic resonance imaging (MRI) should be used. Objectives This study aimed to determine the cost-effectiveness in Ontario of offering structural imaging to all patients with mild to moderate dementia compared with offering it selectively according to guidelines from the Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCC). We compared the cost-effectiveness of CT and MRI as first-line strategies. Methods We performed a systematic literature search (2000 to 2013) to identify cost-effectiveness studies of clinical prediction rules and structural imaging modalities. Studies were assessed for quality and applicability to Ontario. We also developed a model to evaluate the cost-effectiveness of clinical guidelines (image all versus according to CCC) and modalities (CT versus MRI). Transition probabilities, utilities, and costs were obtained from published literature or expert opinion. Results were expressed in terms of costs and quality adjusted life years (QALYs). Results No relevant cost-effectiveness analyses were identified in the published literature. According to the base-case results of our model, the most effective and cost-effective strategy is to image patients who meet CCC criteria with CT and to follow-up with MRI for suspected cases of space-occupying lesions (SOL). However, the results were sensitive to the specificity of MRI for detecting vascular causes of dementia. At a specificity of 64%, the most cost-effective strategy is CCC followed by MRI. Limitations Studies used to estimate diagnostic accuracy were limited by a lack of a gold standard test for establishing the cause of dementia. The model does not include costs to patients and their families, nor does it account for patient preferences about diagnostic

  9. Role of 3.0 Tesla magnetic resonance hysterosalpingography in the diagnostic work-up of female infertility.

    Science.gov (United States)

    Cipolla, Valentina; Guerrieri, Daniele; Pietrangeli, Daniela; Santucci, Domiziana; Argirò, Renato; de Felice, Carlo

    2016-09-01

    Imaging evaluation plays a crucial role in the diagnostic work-up of female infertility. In recent years, the possibility to evaluate tubal patency using 1.5 Tesla magnetic resonance (1.5T MR) has been studied. To assess the feasibility of 3.0 Tesla magnetic resonance (3.0T MR) hysterosalpingography and its role in the diagnostic work-up of female infertility and to evaluate if this fast "one-stop-shop" imaging approach should be proposed as a first-line examination. A total of 116 infertile women were enrolled in this prospective study; all underwent 3.0T MR hysterosalpingography. After standard imaging of the pelvis, tubal patency was assessed by acquiring 3D dynamic time-resolved T1-weighted (T1W) sequences during manual injection of 4-5 mL of contrast solution consisting of gadolinium and normal sterile saline. Images were evaluated by two radiologists with different experience in MR imaging (MRI). The examination was successfully completed in 96.5% of cases, failure rate was 3.5%. Dynamic sequences showed bilateral tubal patency in 64.3%, unilateral tubal patency in 25.9%, and bilateral tubal occlusion in 9.8%. Extratubal abnormalities were found in 69.9% of patients. Comprehensive analysis of morphological and dynamic sequences showed extratubal abnormalities in 43.1% of patients with bilateral tubal patency. 3.0T MR hysterosalpingography is a feasible, simple, fast, safe, and well-tolerated examination, which allows evaluation of tubal patency and other pelvic causes of female infertility in a single session, and it may thus represent a "one-stop-shop" solution in female infertility diagnostic work-up. © The Foundation Acta Radiologica 2015.

  10. Diagnostic work-up of neurological syndromes in a rural African setting: knowledge, attitudes and practices of health care providers.

    Directory of Open Access Journals (Sweden)

    Alain Mpanya

    Full Text Available BACKGROUND: Neurological disorders of infectious origin are common in rural sub-Saharan Africa and usually have serious consequences. Unfortunately, these syndromes are often poorly documented for lack of diagnostic tools. Clinical management of these diseases is a major challenge in under-equipped rural health centers and hospitals. We documented health care provider knowledge, attitudes and practices related to this syndrome in two rural health zones in Bandundu Province, Democratic Republic of Congo. METHODS: We used a qualitative research approach combining observation, in-depth interviews and focus group discussions. We observed 20 patient-provider contacts related to a neurological syndrome, conducted 12 individual interviews and 4 focus group discussions with care providers. All interviews were audiotaped and the transcripts were analyzed with the software ATLAS.ti. RESULTS: Care providers in this region usually limit their diagnostic work-up to clinical examination primarily because of the financial hurdles in this entirely out-of-pocket payment system. The patients prefer to purchase drugs rather than diagnostic tests. Moreover the general lack of diagnostic tools and the representation of the clinician as a "diviner" do not enhance any use of laboratory or other diagnostic methods. CONCLUSION: Innovation in diagnostic technology for neurological disorders is badly needed in Central-Africa, but its uptake in clinical practice will only be a success if tools are simple, affordable and embedded in a patient-centered approach.

  11. Tailoring Stress Incontinence Surgery : “How to install proper diagnostic work-up and individualised treatment”

    NARCIS (Netherlands)

    Houwert, R.M.

    2009-01-01

    In this thesis a different principle to determine the value of diagnostic parameters and to install the proper, individualized, surgical treatment for stress urinary incontinence is presented. The aim of the first part of this thesis was to evaluate the value of urodynamic investigation (UDI) in the

  12. The use of 4D-CTA in the diagnostic work-up of brain arteriovenous malformations

    Energy Technology Data Exchange (ETDEWEB)

    Willems, Peter W.A. [Toronto Western Hospital, UHN, Division of Neuroradiology, Department of Medical Imaging, Toronto, Ontario (Canada); Leiden University Medical Center, Department of Radiology, Leiden (Netherlands); Taeshineetanakul, Patamintita; Terbrugge, Karel G.; Krings, Timo [Toronto Western Hospital, UHN, Division of Neuroradiology, Department of Medical Imaging, Toronto, Ontario (Canada); Schenk, Barry; Brouwer, Patrick A. [Leiden University Medical Center, Department of Radiology, Leiden (Netherlands)

    2012-02-15

    We aimed to evaluate the use of time-resolved whole-head CT angiography (4D-CTA) in patients with an untreated arteriovenous malformation of the brain (bAVM), as demonstrated by catheter angiography (DSA). Seventeen patients with a DSA-proven bAVM were enrolled. These were subjected to 4D-CTA imaging using a 320 detector row CT scanner. Using a standardized scoring sheet, all studies were analyzed by a panel of three readers. This panel was blind to the DSA results at the time of reading the 4D-CTA. 4D-CTA detected all bAVMs. With regard to the Spetzler-Martin grade, 4D-CTA disagreed with DSA in only one case, where deep venous drainage was missed. Further discrepancies between 4D-CTA and DSA analyses included underestimation of the nidus size in small lesions (four cases), misinterpretation of a feeding vessel (one case), misinterpretation of indirect feeding through pial collaterals (three cases) and oversight of mild arterial enlargement (two cases). 4D-CTA correctly distinguished low-flow from high-flow lesions and detected dural/transosseous feeding (one case), venous narrowing (one case) and venous pouches (nine cases). In this series, 4D-CTA was able to detect all bAVMs. Although some angioarchitectural details were missed or misinterpreted when compared to DSA, 4D-CTA evaluation was sufficiently accurate to diagnose the shunt and classify it. Moreover, 4D-CTA adds cross-sectional imaging and perfusion maps, helpful in treatment planning. 4D-CTA appears to be a valuable new adjunct in the non-invasive diagnostic work-up of bAVMs and their follow-up when managed conservatively. (orig.)

  13. The use of 4D-CTA in the diagnostic work-up of brain arteriovenous malformations

    International Nuclear Information System (INIS)

    Willems, Peter W.A.; Taeshineetanakul, Patamintita; Terbrugge, Karel G.; Krings, Timo; Schenk, Barry; Brouwer, Patrick A.

    2012-01-01

    We aimed to evaluate the use of time-resolved whole-head CT angiography (4D-CTA) in patients with an untreated arteriovenous malformation of the brain (bAVM), as demonstrated by catheter angiography (DSA). Seventeen patients with a DSA-proven bAVM were enrolled. These were subjected to 4D-CTA imaging using a 320 detector row CT scanner. Using a standardized scoring sheet, all studies were analyzed by a panel of three readers. This panel was blind to the DSA results at the time of reading the 4D-CTA. 4D-CTA detected all bAVMs. With regard to the Spetzler-Martin grade, 4D-CTA disagreed with DSA in only one case, where deep venous drainage was missed. Further discrepancies between 4D-CTA and DSA analyses included underestimation of the nidus size in small lesions (four cases), misinterpretation of a feeding vessel (one case), misinterpretation of indirect feeding through pial collaterals (three cases) and oversight of mild arterial enlargement (two cases). 4D-CTA correctly distinguished low-flow from high-flow lesions and detected dural/transosseous feeding (one case), venous narrowing (one case) and venous pouches (nine cases). In this series, 4D-CTA was able to detect all bAVMs. Although some angioarchitectural details were missed or misinterpreted when compared to DSA, 4D-CTA evaluation was sufficiently accurate to diagnose the shunt and classify it. Moreover, 4D-CTA adds cross-sectional imaging and perfusion maps, helpful in treatment planning. 4D-CTA appears to be a valuable new adjunct in the non-invasive diagnostic work-up of bAVMs and their follow-up when managed conservatively. (orig.)

  14. Mandatory imaging cuts costs and reduces the rate of unnecessary surgeries in the diagnostic work-up of patients suspected of having appendicitis

    Energy Technology Data Exchange (ETDEWEB)

    Lahaye, M.J.; Lambregts, D.M.J.; Mutsaers, E.; Beets-Tan, R.G.H. [Maastricht University Medical Centre, Department of Radiology, Maastricht (Netherlands); Essers, B.A.B. [Maastricht University Medical Centre, Department of Epidemiology and Medical Technology, Maastricht (Netherlands); Breukink, S.; Beets, G.L. [Maastricht University Medical Centre, Department of Surgery, Maastricht (Netherlands); Cappendijk, V.C. [Jeroen Bosch Hospital, Department of Radiology, ' s Hertogenbosch (Netherlands)

    2015-05-01

    To evaluate whether mandatory imaging is an effective strategy in suspected appendicitis for reducing unnecessary surgery and costs. In 2010, guidelines were implemented in The Netherlands recommending the mandatory use of preoperative imaging to confirm/refute clinically suspected appendicitis. This retrospective study included 1,556 consecutive patients with clinically suspected appendicitis in 2008-2009 (756 patients/group I) and 2011-2012 (800 patients/group II). Imaging use (none/US/CT and/or MRI) was recorded. Additional parameters were: complications, medical costs, surgical and histopathological findings. The primary study endpoint was the number of unnecessary surgeries before and after guideline implementation. After clinical examination by a surgeon, 509/756 patients in group I and 540/800 patients in group II were still suspected of having appendicitis. In group I, 58.5% received preoperative imaging (42% US/12.8% CT/3.7% both), compared with 98.7% after the guidelines (61.6% US/4.4% CT/ 32.6% both). The percentage of unnecessary surgeries before the guidelines was 22.9%. After implementation, it dropped significantly to 6.2% (p<0.001). The surgical complication rate dropped from 19.9% to 14.2%. The average cost-per-patient decreased by 594 EUR from 2,482 to 1,888 EUR (CL:-1081; -143). Increased use of imaging in the diagnostic work-up of patients with clinically suspected appendicitis reduced the rate of negative appendectomies, surgical complications and costs. (orig.)

  15. The use of a rapid D-dimer blood test in the diagnostic work-up for pulmonary embolism: a management study

    NARCIS (Netherlands)

    de Groot, M. R.; van Marwijk Kooy, M.; Pouwels, J. G.; Engelage, A. H.; Kuipers, B. F.; Büller, H. R.

    1999-01-01

    D-dimer assays have a potential to rule out pulmonary embolism in case of a normal test result. We studied the clinical utility of incorporating the SimpliRED D-dimer test result and clinical probability in the routine diagnostic work-up of patients with suspected acute pulmonary embolism. In a

  16. Contribution of CSF cytology in the diagnostic work-up of breast cancer patients with neurological symptoms: a retrospective analysis over two decades.

    NARCIS (Netherlands)

    Wauters, Carla; Poelen, J.; Mulder, I.; Venderink, D.; Strobbe, L.J.; Wesseling, P.

    2012-01-01

    The aim of this study was to evaluate the contribution of cytological analysis of cerebrospinal fluid (CSF) in the diagnostic work-up of breast cancer patients who present with neurological symptoms suspected for central nervous system (CNS) metastases. In the period 1989-2009, a total of 81

  17. Non-invasive diagnostic work-up of patients with clinically suspected pulmonary embolism; results of a management study

    NARCIS (Netherlands)

    ten Wolde, M.; Hagen, P. J.; Macgillavry, M. R.; Pollen, I. J.; Mairuhu, A. T. A.; Koopman, M. M. W.; Prins, M. H.; Hoekstra, O. S.; Brandjes, D. P. M.; Postmus, P. E.; Büller, H. R.

    2004-01-01

    Background: Clinicians often deviate from the recommended algorithm for the diagnosis of pulmonary embolism consisting of ventilation-perfusion scintigraphy and pulmonary angiography. Objectives: To assess the safety and feasibility of a diagnostic algorithm which reduces the need for lung

  18. Diagnostic work up for language testing in patients undergoing awake craniotomy for brain lesions in language areas.

    Science.gov (United States)

    Bilotta, Federico; Stazi, Elisabetta; Titi, Luca; Lalli, Diana; Delfini, Roberto; Santoro, Antonio; Rosa, Giovanni

    2014-06-01

    Awake craniotomy is the technique of choice in patients with brain tumours adjacent to primary and accessory language areas (Broca's and Wernicke's areas). Language testing should be aimed to detect preoperative deficits, to promptly identify the occurrence of new intraoperative impairments and to establish the course of postoperative language status. Aim of this case series is to describe our experience with a dedicated language testing work up to evaluate patients with or at risk for language disturbances undergoing awake craniotomy for brain tumour resection. Pre- and intra operative testing was accomplished with 8 tests. Intraoperative evaluation was accomplished when patients were fully cooperative (Ramsey awake craniotomy for brain tumour resection with preoperative language disturbances or at risk for postoperative language deficits. This approach allows a systematic evaluation and recording of language function status and can be accomplished even when a neuropsychologist or speech therapist are not involved in the operation crew.

  19. Accuracy of FDG-PET-CT in the Diagnostic Work-up of Vascular Prosthetic Graft Infection

    NARCIS (Netherlands)

    Bruggink, J. L. M.; Glaudemans, A. W. J. M.; Saleem, B. R.; Meerwaldt, R.; Alkefaji, H.; Prins, T. R.; Start, R. H. J. A.; Zeebregts, C. J.

    Objectives: To investigate the diagnostic accuracy of fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) compared with computed tomography (CT) scanning and added value of fused FDG-PET CT in diagnosing vascular prosthetic graft infection. Design: Prospective cohort study with

  20. Mammographic findings of women recalled for diagnostic work-up in digital versus screen-film mammography in a population-based screening program

    International Nuclear Information System (INIS)

    Lipasti, Seppo; Pamilo, Martti; Anttila, Ahti

    2010-01-01

    Background: Limited information is available concerning differences in the radiological findings of women recalled for diagnostic work-up in digital mammography (DM) versus screen-film mammography (SFM) screening. Purpose: To compare the radiological findings, their positive predictive values (PPVs) for cancer and other process indicators of DM screening performed by computed radiography (CR) technology and SFM screening in a population-based program. Material and Methods: The material consisted of women, 50-59 years of age, who were invited for screening: 30 153 women with DM in 2007-2008 and 32 939 women with SFM in 1999-2000. The attendance rate was 77.7% (23 440) in the DM arm and 83.8% (27 593) in the SFM arm. In the DM arm, 1.71% of those screened (401) and in the SFM arm 1.59% (438) were recalled for further work-up. The images resulting in the recall were classified as: 1) tumor-like mass, 2) parenchymal distortion/asymmetry, 3) calcifications, and 4) combination of mass and calcifications. The distributions of the various radiological findings and their PPVs for cancer were compared in both study groups. The recall rates, cancer detection rates, test specificities, and PPVs of the DM and SFM groups were also compared. Results: Women were recalled for diagnostic work-up most often due to tumor-like mass. It was more common in SFM (1.08% per woman screened) than in DM (0.93%). The second most common finding was parenchymal distortion and asymmetry, more often in DM (0.58%) than in SFM (0.37%). Calcifications were the third most common finding. DM exposed calcifications more often (0.49%) than SFM (0.26%). The PPVs for cancer of the recalls were higher in DM than in SFM in all subgroups of radiological findings. The test specificities were similar (DM 98.9%, SFM 98.8%). Significantly more cancers were detected by DM (cancer detection rate 0.623% per woman screened, n=146) than by SFM (cancer detection rate 0.406% per woman screened, n=112). The PPVs for

  1. Diagnostic Performance of F-18 FDG PET/CT in Patients with Cancer of Unknown Primary: Additional Benefit over CT-Based Conventional Work up

    Directory of Open Access Journals (Sweden)

    Mehrdad Bakhshayeshkaram

    2016-01-01

    Full Text Available Background: In the era of well-developed site-specific treatment strategies in cancer, identification of occult primary is of paramount importance in CUP patients. Furthermore, exact determination of the extent of the disease may help in optimizing treatment planning. The aim of the present study was to investigate additional value of F-18 FDG PET/CT in patients with cancer of unknown primary (CUP as an appropriate imaging tool in early phase of initial standard work up.Materials and Methods: Sixty-two newly diagnosed CUP patients with inconclusive diagnostic CT scan of chest, abdomen and pelvis referring for F-18 FDG PET/CT were enrolled in this study. Standard of reference was defined as histopathology, other diagnostic procedures and a 3-month formal clinical follow up. The results of PET/CT were categorized as suggestion for primary site and additional metastasis and classified as true positive, false positive, false negative and true negative. The impact of additional metastasis revealed by F-18 FDG PET/CT on treatment planning and the time contribution of F-18 FDG PET/CT in diagnostic pathway was investigated.Results: Sixty-two patients with mean age of 62 (30 men, 32 women, PET/CT correctly identified primary origin in 32% with false positive rate of 14.8%. No primary lesion was detected after negative PET/CT according to standard of reference. Sensitivity, Specificity and accuracy were 100%, 78% and 85%, respectively. Additional metastatic site was found in 56% with 22% impact on treatment planning. Time contribution for PET/CT was 10% of total diagnostic pathway.Conclusion: Providing higher detection rate of primary origin with excellent diagnostic performance, shortening the diagnostic pathway and improving treatment planning, F-18 FDG PET/CT may play a major role in diagnostic work up of CUP patients and may be recommended as an alternative imaging tool in early phase of investigation.

  2. An audit to investigate the impact of false positive breast screening results and diagnostic work-up on re-engagement with subsequent routine screening

    International Nuclear Information System (INIS)

    Nightingale, Julie M.; Borgen, Rita; Porter-Bennett, Lisa; Szczepura, Katy

    2015-01-01

    Introduction: Women attending breast screening may have suspicious mammographic findings that are subsequently found at assessment clinic to be normal (false positive, FP). A false positive diagnosis is not harmless, with short and long term negative psychosocial consequences reported. Women are at increased relative risk of breast cancer therefore their attendance at subsequent screening is essential. Aims: To assess the impact of FP breast screening diagnosis and diagnostic work-up on re-attendance rates across four consecutive screening rounds at a typical breast screening centre. Method: Diagnostic interventions and screening re-attendance rates at one prior and two consecutive rounds were analysed for women receiving an FP diagnosis between 2004 and 2006. Results: 397 women (5.57%) were referred for further assessment, including 228 (57.43%) false positives. 34 eligible women failed to re-attend routine screening (+3 years), with 17 failing to re-attend subsequently (+6 years). 70.6% (24/34) of non-attenders had attended at least two screening rounds prior to FP assessment. 75% of FP women had an imaging-only assessment with 17.5% (30/171) failing to re-attend, and 25% received a biopsy, with 7% (4/57) failing to re-attend subsequently. Conclusion: This study is unique as it follows FP women through four consecutive screening rounds. FP non-attendance rates were considerably lower compared to the general screening population, with diagnostic work-up having limited influence. FP non-attendance may appear insignificant in comparison to total screened population, but these women are at greater risk of subsequent cancer so should be actively encouraged to re-engage with the screening programme

  3. The Added Diagnostic Value of 18F-Fluorodihydroxyphenylalanine PET/CT in the Preoperative Work-Up of Small Bowel Neuroendocrine Tumors.

    Science.gov (United States)

    Addeo, Pietro; Poncet, Gilles; Goichot, Bernard; Leclerc, Loic; Brigand, Cécile; Mutter, Didier; Romain, Benoit; Namer, Izzie-Jacques; Bachellier, Philippe; Imperiale, Alessio

    2018-04-01

    The precise localization of the primary tumor and/or the identification of multiple primary tumors improves the preoperative work-up in patients with small bowel (SB) neuroendocrine tumor (NET). The present study assesses the diagnostic value of 18 F-fluorodihydroxyphenylalanine ( 18 F-FDOPA) positron emission tomography/computed tomography (PET/CT) during the preoperative wok-up of SB NETs. Between January 2010 and June 2017, all consecutive patients with SB NETs undergoing preoperative 18 F-FDOPA PET/CT and successive resection were analyzed. Preoperative work-up included computed tomography (CT), somatostatin receptor scintigraphy (SRS), and 18 F-FDOPA PET/CT. Sensitivity and accuracy ratio for primary and multiple tumor detection were compared with data from surgery and pathology. There were 17 consecutive patients with SB NETs undergoing surgery. Nine patients (53%) had multiple tumors, 15 (88%) metastatic lymph nodes, 3 (18%) peritoneal carcinomatosis, and 9 patients (53%) liver metastases. A total of 70 SB NETs were found by pathology. Surgery identified the primary in 17/17 (100%) patients and recognized seven of 9 patients (78%) with multiple synchronous SB. Preoperatively, 18 F-FDOPA PET/CT displayed a statistically significant higher sensitivity for primary tumor localization (100 vs. 23.5 vs. 29.5%) and multiple tumor detection (78 vs. 22 vs. 11%) over SRS and CT. Compared with pathology, 18 F-FDOPA PET/CT displayed the highest accuracy ratio for number of tumor detected over CT and SRS (2.0 ± 2.2 vs. 0.4 ± 0.7 vs. 0.6 ± 1.5, p = 0.0003). 18 F-FDOPA PET/CT significantly increased the sensitivity and accuracy for primary and multiple SB NET identification. 18 F-FDOPA PET/CT should be included systematically in the preoperative work-up of SB NET.

  4. The Challenge of Prenatal Diagnostic Work-Up of Maternally Inherited X-Linked Opitz G/BBB: Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Marialuigia Spinelli

    2015-01-01

    Full Text Available Background. Prenatal diagnosis of Optiz G/BBB syndrome (OS is challenging because the characteristic clinical features, such as facial and genitourinary anomalies, may be subtle at sonography and rather unspecific. Furthermore, molecular testing of the disease gene is not routinely performed, unless a specific diagnosis is suggested. Method. Both familial and ultrasound data were used to achieve the diagnosis of X-linked OS (XLOS, which was confirmed by molecular testing of MID1 gene (Xp22.3 at birth. Results. Sequencing of MID1 gene disclosed the nucleotide change c.1285 +1 G>T, previously associated with XLOS. Conclusions. This case illustrates current challenges of the prenatal diagnostic work-up of XLOS and exemplifies how clinical investigation, including family history, and accurate US foetal investigations can lead to the correct diagnosis.

  5. Diagnostic work-up of pulmonary nodules. Management of pulmonary nodules detected with low-dose CT screening; Abklaerung von Lungenrundherden. Management durch Frueherkennungsuntersuchungen detektierter pulmonaler Rundherde

    Energy Technology Data Exchange (ETDEWEB)

    Wormanns, D. [Evangelische Lungenklinik Berlin, Berlin (Germany)

    2016-09-15

    Pulmonary nodules are the most frequent pathological finding in low-dose computed tomography (CT) scanning for early detection of lung cancer. Early stages of lung cancer are often manifested as pulmonary nodules; however, the very commonly occurring small nodules are predominantly benign. These benign nodules are responsible for the high percentage of false positive test results in screening studies. Appropriate diagnostic algorithms are necessary to reduce false positive screening results and to improve the specificity of lung cancer screening. Such algorithms are based on some of the basic principles comprehensively described in this article. Firstly, the diameter of nodules allows a differentiation between large (>8 mm) probably malignant and small (<8 mm) probably benign nodules. Secondly, some morphological features of pulmonary nodules in CT can prove their benign nature. Thirdly, growth of small nodules is the best non-invasive predictor of malignancy and is utilized as a trigger for further diagnostic work-up. Non-invasive testing using positron emission tomography (PET) and contrast enhancement as well as invasive diagnostic tests (e.g. various procedures for cytological and histological diagnostics) are briefly described in this article. Different nodule morphology using CT (e.g. solid and semisolid nodules) is associated with different biological behavior and different algorithms for follow-up are required. Currently, no obligatory algorithm is available in German-speaking countries for the management of pulmonary nodules, which reflects the current state of knowledge. The main features of some international and American recommendations are briefly presented in this article from which conclusions for the daily clinical use are derived. (orig.) [German] Lungenrundherde sind die haeufigsten pathologischen Befunde bei Untersuchungen mit der Niedrigdosis-CT zur Lungenkrebsfrueherkennung. Fruehstadien des Lungenkarzinoms manifestieren sich meist als Rundherd

  6. The role of routine preoperative EUS when performed after contrast enhanced CT in the diagnostic work-up in patients suspected of pancreatic or periampullary cancer.

    Science.gov (United States)

    Cieslak, Kasia P; van Santvoort, Hjalmar C; Vleggaar, Frank P; van Leeuwen, Maarten S; ten Kate, Fibo J; Besselink, Marc G; Molenaar, I Quintus

    2014-01-01

    In patients suspected of pancreatic or periampullary cancer, abdominal contrast-enhanced computed tomography (CT) is the standard diagnostic modality. A supplementary endoscopic ultrasonography (EUS) is often performed, although there is only limited evidence of its additional diagnostic value. The aim of the study is to evaluate the additional diagnostic value of EUS over CT in deciding on exploratory laparotomy in patients suspected of pancreatic or periampullary cancer. We retrospectively analyzed 86 consecutive patients who routinely underwent CT and EUS before exploratory laparotomy with or without pancreatoduodenectomy for suspected pancreatic or periampullary carcinoma between 2007 and 2010. Primary outcomes were visibility of a mass, resectability on CT/EUS and resection with curative intent. A mass was visible on CT in 72/86 (84%) patients. In these 72 patients, EUS demonstrated a mass in 64/72 (89%) patients. Resectability was accurately predicted by CT in 65/72 (90%) and by EUS in 58/72 (81%) patients. In 14/86 (16%) patients no mass was seen on CT. EUS showed a mass in 12/14 (86%) of these patients. A malignant lesion was histological proven in 11/12 (92%) of these patients. Overall, resectability was accurately predicted by CT and EUS in 90% (77/86) and 84% (72/86), respectively. In patients with a visible mass on CT, suspected for pancreatic or periampullary cancer, EUS has no additional diagnostic value, does not influence the decision to perform laparotomy and should therefore not be performed routinely. In patients without a visible mass on CT, EUS is useful to confirm the presence of a tumor. Copyright © 2014 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  7. High prevalence of Strongyloides stercoralis in school-aged children in a rural highland of north-western Ethiopia: the role of intensive diagnostic work-up.

    Science.gov (United States)

    Amor, Aranzazu; Rodriguez, Esperanza; Saugar, José M; Arroyo, Ana; López-Quintana, Beatriz; Abera, Bayeh; Yimer, Mulat; Yizengaw, Endalew; Zewdie, Derejew; Ayehubizu, Zimman; Hailu, Tadesse; Mulu, Wondemagegn; Echazú, Adriana; Krolewieki, Alejandro J; Aparicio, Pilar; Herrador, Zaida; Anegagrie, Melaku; Benito, Agustín

    2016-12-01

    Soil-transmitted helminthiases (hookworms, Ascaris lumbricoides and Trichuris trichiura) are extremely prevalent in school-aged children living in poor sanitary conditions. Recent epidemiological data suggest that Strongyloides stercoralis is highly unreported. However, accurate data are essential for conducting interventions aimed at introducing control and elimination programmes. We conducted a cross-sectional survey of 396 randomly selected school-aged children in Amhara region in rural area in north-western Ethiopia, to assess the prevalence of S. stercoralis and other intestinal helminths. We examined stools using three techniques: conventional stool concentration; and two S. stercoralis-specific methods, i.e. the Baermann technique and polymerase chain reaction. The diagnostic accuracy of these three methods was then compared. There was an overall prevalence of helminths of 77.5%, with distribution differing according to school setting. Soil-transmitted helminths were recorded in 69.2%. Prevalence of S. stercoralis and hookworm infection was 20.7 and 54.5%, respectively, and co-infection was detected in 16.3% of cases. Schistosoma mansoni had a prevalence of 15.7%. Prevalence of S. stercoralis was shown 3.5% by the conventional method, 12.1% by the Baermann method, and 13.4% by PCR, which thus proved to be the most sensitive. Our results suggest that S. stercoralis could be overlooked and neglected in Ethiopia, if studies of soil-transmitted helminths rely on conventional diagnostic techniques alone. A combination of molecular and stool microscopy techniques yields a significantly higher prevalence. In view of the fact that current control policies for triggering drug administration are based on parasite prevalence levels, a comprehensive diagnostic approach should instead be applied to ensure comprehensive control of helminth infections.

  8. Diagnostic management of patients with SAPHO syndrome: use of MR imaging to guide bone biopsy at CT for microbiological and histological work-up

    International Nuclear Information System (INIS)

    Kirchhoff, Timm; Rosenthal, Herbert; Prokop, Mathias; Chavan, Ajay; Galanski, Michael; Merkesdal, Sonja; Wagner, Annette; Zeidler, Henning; Mai, Uwe; Hammer, Michael

    2003-01-01

    Propionibacterium acnes (P. acnes) is suspected to be involved in the pathophysiology of SAPHO syndrome, since it has been isolated repeatedly through open surgical bone biopsy. This study demonstrates the role of MRI in identifying inflamed bone areas in patients with SAPHO syndrome and the role of CT-guided bone biopsies in obtaining samples from these areas for microbiological and histopathological investigations, thus obviating open surgery. Fourteen consecutive patients with SAPHO syndrome were investigated by MRI to identify acute inflammatory changes in hyperostotic periarticular bone. The CT-guided biopsies for microbiological investigations were taken from the areas identified. Patients positive for P. acnes were started on long-term antibiotic therapy according to antibiotic susceptibility. On MRI the inflammatory changes appeared as hyperintense areas on fat-saturated T2 fast-spin-echo (FSE) images and showed signal increase on fat-saturated T1 SE images after Gd-DTPA. With MR localization CT-guided bone biopsies yielded P. acnes in 8 patients. No bacteria could be isolated from the remaining 6 patients. Acute inflammatory bone changes in SAPHO syndrome are well localized by MRI. With MR localization, CT-guided bone biopsies offer a minimally invasive alternative to open surgery in the detection of. P. acnes leading to the institution of a specific antibiotic therapy. (orig.)

  9. Zenker's Diverticulum: Diagnostic Approach and Surgical Management

    Directory of Open Access Journals (Sweden)

    Carlos M. Nuño-Guzmán

    2014-11-01

    Full Text Available Zenker's diverticulum (ZD, also known as cricopharyngeal, pharyngoesophageal or hypopharyngeal diverticulum, is a rare condition characterized by an acquired outpouching of the mucosal and submucosal layers originating from the pharyngoesophageal junction. This false and pulsion diverticulum occurs dorsally at the pharyngoesophageal wall between the inferior pharyngeal constrictor and the cricopharyngeus muscle. The pathophysiology of ZD involves altered compliance of the cricopharyngeus muscle and raised intrabolus pressure. Decreased compliance of the upper esophageal sphincter and failure to open completely for effective bolus clearance both lead to an increase in the hypopharyngeal pressure gradient. Different open surgical techniques and transoral endoscopic approaches have been described for the management of ZD, although there is no consensus about the best option. We report the case of a 61-year-old patient with a 7-year history of dysphagia and odynophagia for solid food, which after 2 months progressed to dysphagia for liquids and after 4 months to regurgitation 2-6 h after meals. The patient experienced a 12-kg weight loss. Diagnosis was established by esophagogram, which showed a diverticulum through the posterior pharyngeal wall, suggestive of a ZD. Esophagogastroduodenoscopy showed a pouch with erythematous mucosa. Under general anesthesia, diverticulectomy and myotomy were performed. After an uneventful recovery and adequate oral intake, the patient remains free of symptoms at 4 months of follow-up.

  10. Is there an added value of faecal calprotectin and haemoglobin in the diagnostic work-up for primary care patients suspected of significant colorectal disease? A cross-sectional diagnostic study

    NARCIS (Netherlands)

    Elias, Sjoerd G.; Kok, Liselotte; de Wit, NJ; Witteman, Ben J. M.; Goedhard, Jelle G.; Romberg-Camps, Marielle J. L.; Muris, Jean W. M.; Moons, Karel G. M.

    2016-01-01

    Background The majority of primary care patients referred for bowel endoscopy do not have significant colorectal disease (SCD), and are – in hindsight – unnecessarily exposed to a small but realistic risk of severe endoscopy-associated complications. We developed a diagnostic strategy to better

  11. Experience in the diagnostic and surgical treatment of pancreatic pseudocysts

    Directory of Open Access Journals (Sweden)

    N. G. Golovko

    2015-10-01

    Full Text Available Actuality. Problem of surgical treatment of pancreatic pseudocysts is actual and debatable. The incidence of pancreatic pseudocysts is 0.5–1 per 100 000 adults per year, and in the overall incidence it reaches 1.6% –4.5%. Aim. Surgical treatment results of 34 patients with pancreatic pseudocysts were analyzed to improve results of diagnostic and surgical management of pancreatic pseudocests. Methods and results. Ultrasound scan combined with computer tomography were used for pancreatic pseudocysts diagnostic. Pancreatic pseudocysts surgical treatment was performed by minimally invasive percutaneous techniques and laparotomic surgery. Laparotomy operations were performed in 27 patients. The structure of operations was follow: external drainage of pseudocysts - 11 patients, 2 of them by minilaparotomy access, pseudocyst jejunostomy by Roux – 9 patients, pseudocyst jejunostomy with entero-enteroanastamosis by Brown – 3 patients, pseudocyst gastrostomy and pseudocyst duodenostomy – in 2 patients. Percutaneous external drainage of pancreatic pseudocysts under ultrasound control was performed in 7 patients. Indications for external percutaneous needle drainage of pancreatic pseudocysts under ultrasound control were: presence of a secure acoustic windows, lack of communication with the pancreatic pseudocysts ductal system, pseudocyst cavity diameter greater than 60 mm with wall thickness more than 3–4 mm, presence of the severe comorbidity and high operational and anesthetic risk (III–IV class ASA. Conclusions. Analysis of early treatment results (3–6 months found that pancreatic pseudocysts minimally invasive percutaneous puncture external drainage use in combination with ultrasound control, in addition to laparotomic operation, allows to achieve excellent and good results in 91.1% of patients.

  12. Neuroradiologic work-up of brain tumors

    International Nuclear Information System (INIS)

    Fishbein, D.S.

    1988-01-01

    The presence of an intracranial tumor may be suspected or deduced from the clinical history and examination, or it may be discovered incidentally during investigation of another disorder. Once the suggestion is raised, a variety of neuroradiologic techniques are available to define the extent and nature of the lesion. The studies performed may allow a tissue diagnosis to be presumed, may serve as a guide to proposed surgical therapy, or may allow the course of a previously diagnosed lesion to be followed. This chapter discusses the utility of common neuroradiologic techniques and their specific indications in the work-up of intracranial tumors. Emphasis is placed upon tests that are most frequently utilized and have the greatest value

  13. First branchial arch fistula: diagnostic dilemma and improvised surgical management.

    Science.gov (United States)

    Prabhu, Vinod; Ingrams, Duncan

    2011-01-01

    First branchial cleft anomalies are uncommon, and only sporadic case reports are published in the literature. They account for 1% to 8% of all the branchial abnormalities. The often variable presentation and tract siting of first arch fistulae have led to misdiagnosis. The misdiagnosis results in inappropriate/ineffective treatment and recurrence of the sinus tract. We present a 19-year-old woman who presented to the ENT outpatient department with episodic discharge from a long-standing fistula anterior to the left sternomastoid muscle. This was associated with repeated episodes of ipsilateral tonsillitis. In relation to the history and because of the position of the fistula, a diagnosis of second branchial arch fistula was made. An attempt at excision was unfortunately followed by early recurrence of discharge. At review following the procedure, a defect of the left tympanic membrane in the form of a fibrous band was noted, and a revised diagnosis of first branchial arch sinus was made. Wide surgical excision of the tract with partial parotidectomy was performed. An uneventful postoperative course followed, with no recurrence of symptoms after 24 months of review. We discuss the case, the diagnostic pathway, and the wide local excision technique used for removal of branchial fistulae. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. Surgical requirements for radiological diagnostics of liver pathologies

    International Nuclear Information System (INIS)

    Gruenberger, T.

    2004-01-01

    Radiology is an essential preoperative tool for a liver surgeon to plan extent of resection and potential difficulties during liver surgery. Primary goal in defining liver pathologies is a careful patients' history, a clinical evaluation and reviewing at least one radiological film one could acquire. Don't rely on written reports that may direct you in a useless track. This overview tries to address the essential radiological requests of a surgeon in defining liver tumors ethiology and best optional treatment. Major advances in radiologic diagnostics led to an improvement in the adequate staging of a given liver pathology. Therefore we are nowadays able to inform our patients about possible treatment options without leaving a big gap to possible intra-operative findings which may alter the therapy. Surgical exploration to define therapeutic strategies becomes fundamental only in a minority of patients with unclear preoperative imaging studies. Interdisciplinary groups should define future strategies in a patient with a given liver pathology. Specialisation has defined the hepatobiliary surgeon which should be consulted in case of a liver or biliary tumor to guide possible therapeutic treatment options. (orig.) [de

  15. Pre-surgical radiologic diagnostics of pancreas diseases

    International Nuclear Information System (INIS)

    Seifried, C.

    1979-01-01

    At the example of a comparative study with 112 patients it should be demonstrated that the different radiologic techniques are complementary in pancreas diagnostics with respect to their indication and proposition. The study yields the following procedure for the pancreas diagnostics: cysts and pancreatites are diagnosed by means of sonography and computed tomography. Stomach-colon-barium passage and intravenous cholangio cholecystography can be applied for clarification of functional reactions on the stomach-colon regions, respectively the biliary region. Only in a complicated process, e.g. in a sustaining tumor suspicion or before surgery should angiography be used. In pancreatitis also the endoscopic retrograde cholangio-pancreatiography is used. Tumors are generally submitted to angiography for clarification of diagnosis, resiscivity, and vessel conditions. (orig./MG) [de

  16. Value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules.

    Science.gov (United States)

    Schwarz, Carsten; Schönfeld, Nicolas; Bittner, Roland C; Mairinger, Thomas; Rüssmann, Holger; Bauer, Torsten T; Kaiser, Dirk; Loddenkemper, Robert

    2013-01-01

    The diagnostic value of flexible bronchoscopy in the pre-operative work-up of solitary pulmonary nodules (SPN) is still under debate among pneumologists, radiologists and thoracic surgeons. In a prospective observational manner, flexible bronchoscopy was routinely performed in 225 patients with SPN of unknown origin. Of the 225 patients, 80.5% had lung cancer, 7.6% had metastasis of an extrapulmonary primary tumour and 12% had benign aetiology. Unsuspected endobronchial involvement was found in 4.4% of all 225 patients (or in 5.5% of patients with lung cancer). In addition, flexible bronchoscopy clarified the underlying aetiology in 41% of the cases. The bronchoscopic biopsy results from the SPN were positive in 84 (46.5%) patients with lung cancer. Surgery was cancelled due to the results of flexible bronchoscopy in four cases (involvement of the right main bronchus (impaired pulmonary function did not allow pneumonectomy) n=1, small cell lung cancer n=1, bacterial pneumonia n=2), and the surgical strategy had to be modified to bilobectomy in one patient. Flexible bronchoscopy changed the planned surgical approach in five cases substantially. These results suggest that routine flexible bronchoscopy should be included in the regular pre-operative work-up of patients with SPN.

  17. Differential diagnostic value of procalcitonin in surgical and medical patients with septic shock.

    Science.gov (United States)

    Clec'h, Christophe; Fosse, Jean-Philippe; Karoubi, Philippe; Vincent, Francois; Chouahi, Imad; Hamza, Lilia; Cupa, Michel; Cohen, Yves

    2006-01-01

    To assess whether different diagnostic and prognostic cutoff values of procalcitonin should be considered in surgical and in medical patients with septic shock. Prospective observational study. Intensive care unit of the Avicenne teaching hospital, France. All patients with septic shock or noninfectious systemic inflammatory response syndrome within 48 hrs after admission. None. Patients were allocated to one of the following groups: group 1 (surgical patients with septic shock), group 2 (surgical patients with noninfectious systemic inflammatory response syndrome), group 3 (medical patients with septic shock), and group 4 (medical patients with noninfectious systemic inflammatory response syndrome). Procalcitonin at study entry was compared between group 1 and group 2 and between group 3 and group 4 to determine the diagnostic cutoff value in surgical and in medical patients, respectively. Procalcitonin was compared between survivors and nonsurvivors from group 1 and group 3 to determine its prognostic cutoff value. One hundred forty-three patients were included: 31 in group 1, 36 in group 2, 36 in group 3, and 40 in group 4. Median procalcitonin levels (ng/mL [interquartile range]) were higher in group 1 than in group 3 (34.00 [7.10-76.00] vs. 8.40 [3.63-24.70], p = .01). In surgical patients, the best diagnostic cutoff value was 9.70 ng/mL, with 91.7% sensitivity and 74.2% specificity. In medical patients, the best diagnostic cutoff value was 1.00 ng/mL, with 80% sensitivity and 94% specificity. Procalcitonin was a reliable early prognostic marker in medical but not in surgical patients with septic shock. A cutoff value of 6.00 ng/mL had 76% sensitivity and 72.7% specificity for separating survivors from nonsurvivors. The diagnostic cutoff value of procalcitonin was higher in surgical than in medical patients. Early procalcitonin was of prognostic interest in medical patients.

  18. Image standards in Tissue-Based Diagnosis (Diagnostic Surgical Pathology

    Directory of Open Access Journals (Sweden)

    Vollmer Ekkehard

    2008-04-01

    Full Text Available Abstract Background Progress in automated image analysis, virtual microscopy, hospital information systems, and interdisciplinary data exchange require image standards to be applied in tissue-based diagnosis. Aims To describe the theoretical background, practical experiences and comparable solutions in other medical fields to promote image standards applicable for diagnostic pathology. Theory and experiences Images used in tissue-based diagnosis present with pathology – specific characteristics. It seems appropriate to discuss their characteristics and potential standardization in relation to the levels of hierarchy in which they appear. All levels can be divided into legal, medical, and technological properties. Standards applied to the first level include regulations or aims to be fulfilled. In legal properties, they have to regulate features of privacy, image documentation, transmission, and presentation; in medical properties, features of disease – image combination, human – diagnostics, automated information extraction, archive retrieval and access; and in technological properties features of image acquisition, display, formats, transfer speed, safety, and system dynamics. The next lower second level has to implement the prescriptions of the upper one, i.e. describe how they are implemented. Legal aspects should demand secure encryption for privacy of all patient related data, image archives that include all images used for diagnostics for a period of 10 years at minimum, accurate annotations of dates and viewing, and precise hardware and software information. Medical aspects should demand standardized patients' files such as DICOM 3 or HL 7 including history and previous examinations, information of image display hardware and software, of image resolution and fields of view, of relation between sizes of biological objects and image sizes, and of access to archives and retrieval. Technological aspects should deal with image

  19. Three-dimensional imaging of acetabular dysplasia: diagnostic value and impact on surgical type classification

    International Nuclear Information System (INIS)

    Smet, Maria-Helena; Marchal, Guy J.; Baert, Albert L.; Hoe, Lieven van; Cleynenbreugel, Johan van; Daniels, Hans; Molenaers, Guy; Moens, Pierre; Fabry, Guy

    2000-01-01

    Objective: To investigate the diagnostic value and the impact on surgical type classification of three-dimensional (3D) images for pre-surgical evaluation of dysplastic hips. Materials and methods: Three children with a different surgical type of hip dysplasia were investigated with helical computed tomography. For each patient, two-dimensional (2D) images, 3D, and a stereolithographic model of the dysplastic hip were generated. In two separate sessions, 40 medical observers independently analyzed the 2D images (session 1), the 2D and 3D images (session 2), and tried to identify the corresponding stereolithographic hip model. The influence of both image presentation (2D versus 3D images) and observer (degree of experience, radiologist versus orthopedic surgeon) were statistically analyzed. The SL model choice reflected the impact on surgical type classification. Results: Image presentation was a significant factor whereas the individual observer was not. Three-dimensional images scored significantly better than 2D images (P=0.0003). Three-dimensional imaging increased the correct surgical type classification by 35%. Conclusion: Three-dimensional images significantly improve the pre-surgical diagnostic assessment and surgical type classification of dysplastic hips

  20. Three-dimensional imaging of acetabular dysplasia: diagnostic value and impact on surgical type classification

    Energy Technology Data Exchange (ETDEWEB)

    Smet, Maria-Helena E-mail: marleen.smet@uz.kuleuven.ac.be; Marchal, Guy J.; Baert, Albert L.; Hoe, Lieven van; Cleynenbreugel, Johan van; Daniels, Hans; Molenaers, Guy; Moens, Pierre; Fabry, Guy

    2000-04-01

    Objective: To investigate the diagnostic value and the impact on surgical type classification of three-dimensional (3D) images for pre-surgical evaluation of dysplastic hips. Materials and methods: Three children with a different surgical type of hip dysplasia were investigated with helical computed tomography. For each patient, two-dimensional (2D) images, 3D, and a stereolithographic model of the dysplastic hip were generated. In two separate sessions, 40 medical observers independently analyzed the 2D images (session 1), the 2D and 3D images (session 2), and tried to identify the corresponding stereolithographic hip model. The influence of both image presentation (2D versus 3D images) and observer (degree of experience, radiologist versus orthopedic surgeon) were statistically analyzed. The SL model choice reflected the impact on surgical type classification. Results: Image presentation was a significant factor whereas the individual observer was not. Three-dimensional images scored significantly better than 2D images (P=0.0003). Three-dimensional imaging increased the correct surgical type classification by 35%. Conclusion: Three-dimensional images significantly improve the pre-surgical diagnostic assessment and surgical type classification of dysplastic hips.

  1. The Diagnostic Work-Up of Eating Disorders

    DEFF Research Database (Denmark)

    Sjögren, Magnus

    2015-01-01

    Background: The mortality of Anorexia Nervosa (AN) is the highest among all psychiatric disorders, and Eating Disorders (ED) overall pose serious health threats to a significant proportion of the population. In spite of an increasing recognition of the clinical impact of ED, often, the general re...

  2. Idiopathic interstitial pneumonias. From classification to diagnostic work-up

    International Nuclear Information System (INIS)

    Mueller-Mang, C.; Bankier, A.; Stiebellehner, L.; Schmid, K.

    2007-01-01

    Idiopathic interstitial pneumonias (IIP) comprise seven entities with distinct histologic patterns. In their idiopathic form IIP are rare diseases. They are, nevertheless, considered prototypes of the much more common secondary interstitial pneumonias. The advent of high-resolution computed tomography (HRCT) has had a profound impact on the imaging of IIP, because the detailed delineation of the lung anatomy allows a close correlation between the histologic patterns of IIP and the CT features. On the basis of CT morphology and in the correct clinical context, the radiologist can achieve an accurate diagnosis in many cases. However, due to overlap between the various entities, complementary lung biopsy is recommended in virtually all cases. This article reviews the CT pattern of IIP and offers relevant clinical and histological information for the purpose of enabling the radiologist to understand and participate in the multidisciplinary concept of IIP. (orig.) [de

  3. Communicating diagnostic uncertainty in surgical pathology reports: disparities between sender and receiver.

    Science.gov (United States)

    Lindley, Sarah W; Gillies, Elizabeth M; Hassell, Lewis A

    2014-10-01

    Surgical pathologists use a variety of phrases to communicate varying degrees of diagnostic certainty which have the potential to be interpreted differently than intended. This study sought to: (1) assess the setting, varieties and frequency of use of phrases of diagnostic uncertainty in the diagnostic line of surgical pathology reports, (2) evaluate use of uncertainty expressions by experience and gender, (3) determine how these phrases are interpreted by clinicians and pathologists, and (4) assess solutions to this communication problem. We evaluated 1500 surgical pathology reports to determine frequency of use of uncertainty terms, identified those most commonly used, and looked for variations in usage rates on the basis of case type, experience and gender. We surveyed 76 physicians at tumor boards who were asked to assign a percentage of certainty to diagnoses containing expressions of uncertainty. We found expressions of uncertainty in 35% of diagnostic reports, with no statistically significant difference in usage based on age or gender. We found wide variation in the percentage of certainty clinicians assigned to the phrases studied. We conclude that non-standardized language used in the communication of diagnostic uncertainty is a significant source of miscommunication, both amongst pathologists and between pathologists and clinicians. Copyright © 2014 The Authors. Published by Elsevier GmbH.. All rights reserved.

  4. Bodypacking - An increasing problem in the Netherlands: Conservative or surgical treatment?

    NARCIS (Netherlands)

    van Geloven, A. A. W.; van Lienden, K. P.; Gouma, D. J.

    2002-01-01

    Objective: Evaluation of diagnostic work-up and treatment of bodypackers. Identification of predictive factors for surgical treatment. Design: Retrospective descriptive study. Setting: Teaching hospital, The Netherlands. Patients: All 40 consecutive patients, admitted during the period 1995-99

  5. Surgical abdomen in patients with nephrotic syndrome: complexities of differential diagnostics. 2 case reports

    OpenAIRE

    Nogaibayeva, A.; Moldakhmetova, S.; Tuganbekova, S.; Krivoruchko, N.

    2014-01-01

    INTROduCTIONANdAIMS: Differential-diagnostic search is very important at the stage of abdominal nephrotic crisis for determination of therapy tactics; as the probability of development of acute surgical pathology is very high, due to connection of infectious complications on a background of the basic pathology and immunosupression. We report 2 patients with acute onset of abdominal pain on a background of severe nephrotic syndrome (NS). METHOdS: Case 1: 20-years old man with bioptic diagnosis...

  6. Etiopathogenesis, diagnostics and history of surgical treatment of stress urinary incontinence.

    Science.gov (United States)

    Jovan, Hadži-Djokić; Uroš, Babić; Aleksandar, Argirović; Miodrag, Aćimović; Milan, Radovanović; Bogomir, Milojević; Tomisla, Pejčić; Zoran, Džamić

    2014-01-01

    Urinary incontinence represents involuntary urine leakage into the urethra. This pathological condition represents a major medical, social and hygienic problem. The paper presents risk factors for development of the disorder, as well as diagnostic methods applied in evaluation of the female patients. Chronological review of diverse surgical techniques used in treatment of stress urinary incontinence reported in the published scientific papers is also presented. Review of the literature data was also performed. Sling procedures with application of suburethral loops have been used since the beginning of the last century in treatment of this disorder. Surgical treatment of stress urinary incontinence is applied when conservative treatment fails to give any effects according to strictly defined indications. During the last 100 years, surgical techniques have undergone different improvements and the results have also been significantly improved.

  7. Assessment of surgical portosystemic shunts and associated complications: The diagnostic and therapeutic role of radiologists

    Energy Technology Data Exchange (ETDEWEB)

    Taslakian, Bedros, E-mail: btaslakian@gmail.com [Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020—PO Box: 11-0236, Beirut (Lebanon); Faraj, Walid, E-mail: wf07@aub.edu.lb [Department of General Surgery, American University of Beirut Medical Center, Riad El-Solh 1107 2020—PO Box: 11-0236, Beirut (Lebanon); Khalife, Mohammad, E-mail: mk12@aub.edu.lb [Department of General Surgery, American University of Beirut Medical Center, Riad El-Solh 1107 2020—PO Box: 11-0236, Beirut (Lebanon); Al-Kutoubi, Aghiad, E-mail: mk00@aub.edu.lb [Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020—PO Box: 11-0236, Beirut (Lebanon); El-Merhi, Fadi, E-mail: fe19@aub.edu.lb [Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020—PO Box: 11-0236, Beirut (Lebanon); Saade, Charbel, E-mail: cs39@aub.edu.lb [Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020—PO Box: 11-0236, Beirut (Lebanon); Hallal, Ali, E-mail: ah05@aub.edu.lb [Department of General Surgery, American University of Beirut Medical Center, Riad El-Solh 1107 2020—PO Box: 11-0236, Beirut (Lebanon); Haydar, Ali, E-mail: ah24@aub.edu.lb [Department of Radiology, American University of Beirut Medical Center, Riad El-Solh 1107 2020—PO Box: 11-0236, Beirut (Lebanon)

    2015-08-15

    Highlights: • Portal hypertension is the pathological increase in portal venous pressure. • Surgical portosystemic shunting is an accepted methods to decrease portal venous pressure. • Surgical portosystemic shunts are divided into selective and nonselective. • Shunt thrombosis is a serious complication, resulting in shunt dysfunction. • Imaging is essential in the assessment of the shunt function and anatomy. - Abstract: Surgical portosystemic shunting, the formation of a vascular connection between the portal and systemic venous circulation, has been used as a treatment to reduce portal venous pressure. Although the use of portosystemic shunt surgery in the management of portal hypertension has declined during the past decade in favour of alternative therapies, and subsequently surgeons and radiologists became less familiar with the procedure, it remains a well-established treatment. Knowledge of different types of surgical portosystemic shunts, their pathophysiology and complications will help radiologists improve communication with surgeons and enhance their understanding of the diagnostic and therapeutic role of radiology in the assessment and management of these shunts. Optimal assessment of the shunt is essential to determine its patency and allow timely intervention. Both non-invasive and invasive imaging modalities complement each other in the evaluation of surgical portosystemic shunts. Interventional radiology plays an important role in the management of complications, such as shunt thrombosis and stenosis. This article describes the various types of surgical portosystemic shunts, explains the anatomy and pathophysiology of these shunts, illustrates the pearls and pitfalls of different imaging modalities in the assessment of these shunts and demonstrates the role of radiologists in the interventional management of complications.

  8. Assessment of surgical portosystemic shunts and associated complications: The diagnostic and therapeutic role of radiologists

    International Nuclear Information System (INIS)

    Taslakian, Bedros; Faraj, Walid; Khalife, Mohammad; Al-Kutoubi, Aghiad; El-Merhi, Fadi; Saade, Charbel; Hallal, Ali; Haydar, Ali

    2015-01-01

    Highlights: • Portal hypertension is the pathological increase in portal venous pressure. • Surgical portosystemic shunting is an accepted methods to decrease portal venous pressure. • Surgical portosystemic shunts are divided into selective and nonselective. • Shunt thrombosis is a serious complication, resulting in shunt dysfunction. • Imaging is essential in the assessment of the shunt function and anatomy. - Abstract: Surgical portosystemic shunting, the formation of a vascular connection between the portal and systemic venous circulation, has been used as a treatment to reduce portal venous pressure. Although the use of portosystemic shunt surgery in the management of portal hypertension has declined during the past decade in favour of alternative therapies, and subsequently surgeons and radiologists became less familiar with the procedure, it remains a well-established treatment. Knowledge of different types of surgical portosystemic shunts, their pathophysiology and complications will help radiologists improve communication with surgeons and enhance their understanding of the diagnostic and therapeutic role of radiology in the assessment and management of these shunts. Optimal assessment of the shunt is essential to determine its patency and allow timely intervention. Both non-invasive and invasive imaging modalities complement each other in the evaluation of surgical portosystemic shunts. Interventional radiology plays an important role in the management of complications, such as shunt thrombosis and stenosis. This article describes the various types of surgical portosystemic shunts, explains the anatomy and pathophysiology of these shunts, illustrates the pearls and pitfalls of different imaging modalities in the assessment of these shunts and demonstrates the role of radiologists in the interventional management of complications

  9. Medical capsule robots: A renaissance for diagnostics, drug delivery and surgical treatment.

    Science.gov (United States)

    Mapara, Sanyat S; Patravale, Vandana B

    2017-09-10

    The advancements in electronics and the progress in nanotechnology have resulted in path breaking development that will transform the way diagnosis and treatment are carried out currently. This development is Medical Capsule Robots, which has emerged from the science fiction idea of robots travelling inside the body to diagnose and cure disorders. The first marketed capsule robot was a capsule endoscope developed to capture images of the gastrointestinal tract. Today, varieties of capsule endoscopes are available in the market. They are slightly larger than regular oral capsules, made up of a biocompatible case and have electronic circuitry and mechanisms to capture and transmit images. In addition, robots with diagnostic features such as in vivo body temperature detection and pH monitoring have also been launched in the market. However, a multi-functional unit that will diagnose and cure diseases inside the body has not yet been realized. A remote controlled capsule that will undertake drug delivery and surgical treatment has not been successfully launched in the market. High cost, inadequate power supply, lack of control over drug release, limited space for drug storage on the capsule, inadequate safety and no mechanisms for active locomotion and anchoring have prevented their entry in the market. The capsule robots can revolutionize the current way of diagnosis and treatment. This paper discusses in detail the applications of medical capsule robots in diagnostics, drug delivery and surgical treatment. In diagnostics, detailed analysis has been presented on wireless capsule endoscopes, issues associated with the marketed versions and their corresponding solutions in literature. Moreover, an assessment has been made of the existing state of remote controlled capsules for targeted drug delivery and surgical treatment and their future impact is predicted. Besides the need for multi-functional capsule robots and the areas for further research have also been

  10. Morphological, diagnostic and surgical features of ectopic thyroid gland: a review of literature.

    Science.gov (United States)

    Guerra, Germano; Cinelli, Mariapia; Mesolella, Massimo; Tafuri, Domenico; Rocca, Aldo; Amato, Bruno; Rengo, Sandro; Testa, Domenico

    2014-01-01

    Ectopic thyroid tissue remains a rare developmental abnormality involving defective or aberrant embryogenesis of the thyroid gland during its passage from the floor of the primitive foregut to its usual final position in pre-tracheal region of the neck. Its specific prevalence accounts about 1 case per 100.000-300.000 persons and one in 4.000-8.000 patients with thyroid disease show this condition. The cause of this defect is not fully known. Despite genetic factors have been associated with thyroid gland morphogenesis and differentiation, just recently some mutation has been associated with human thyroid ectopy. Lingual region in the most common site of thyroid ectopy but ectopic thyroid tissue were found in other head and neck locations. Nevertheless, aberrant ectopic thyroid tissue has been found in other places distant from the neck region. Ectopic tissue is affected by different pathological changes that occur in the normal eutopic thyroid. Patients may present insidiously or as an emergency. Diagnostic management of thyroid ectopy is performed by radionuclide thyroid imaging, ultrasonography, CT scan, MRI, biopsy and thyroid function tests. Asymptomatic euthyroid patients with ectopic thyroid do not usually require therapy but are kept under observation. For those with symptoms, treatment depends on size of the gland, nature of symptoms, thyroid function status and histological findings. Surgical excision is often required as treatment for this condition. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  11. Interstitial lung disease: Diagnostic accuracy and safety of surgical lung biopsy

    Directory of Open Access Journals (Sweden)

    Miguel Guerra

    2009-05-01

    Full Text Available This study reports our experience, diagnostic accuracy and safety of surgical lung biopsy in patients with interstitial lung diseases. From January 1998 – December 2007 surgical lung biopsy was performed in 53 patients (22 female [41.5%]; age 47.2 ± 13 years. A total of 37 patients (69.8% underwent videothoracoscopic lung biopsy and minithoracotomy was performed in 16 patients (30.2%. Right lung was the choice in 47 patients (88.7%. Postoperative complications were rare (9.4% and included three prolonged air leaks (5.7%, one pneumothorax re-quiring a chest drain (1.9%, and one haemothorax requiring reoperation (1.9%. One patient died of cardiac arrest of unknown cause. Average chest tube duration was 4.4 ± 3 days and average hospital stay 5.4 ± 4 days. Lung biopsy contributed to the diagnosis in 50 patients (94.3%. In conclusion, the potential benefits of diagnostic surgical lung biopsy must be considered against the risks of the procedure especially in patients with severe cardiopulmonary dysfunction. Resumo: Os autores descrevem a sua casuística de biópsias pulmonares cirúrgicas em doentes com doença pulmonar intersticial, de forma a determinar a acuidade diagnóstica, os riscos e a morbimortalidade associados ao procedimento. Entre Janeiro de 1998 e Dezembro de 2007, 53 doentes (idade média de 47,2 ± 13 anos foram referenciados para a realização de biópsia pulmonar cirúrgica, dos quais 22 eram mulheres (41,5%. As biópsias pulmonares foram realizadas quer por videotoracoscopia (37 doentes, 69,8%, quer por minitoracotomia (16 doentes, 30,2%. Foi escolhido o pulmão direito para biopsar em 88,7% dos casos. Registaram-se complicações pós-operatórias em 5 doentes (9,4%: fuga aérea prolongada em 3 doentes (5,7%, persistência de loca de pneumotórax num doente (1,9% e hemorragia com necessidade de revisão de hemostase noutro doente (1,9%. Ocorreu um

  12. Evaluation of the Effect of Diagnostic Molecular Testing on the Surgical Decision-Making Process for Patients With Thyroid Nodules.

    Science.gov (United States)

    Noureldine, Salem I; Najafian, Alireza; Aragon Han, Patricia; Olson, Matthew T; Genther, Dane J; Schneider, Eric B; Prescott, Jason D; Agrawal, Nishant; Mathur, Aarti; Zeiger, Martha A; Tufano, Ralph P

    2016-07-01

    Diagnostic molecular testing is used in the workup of thyroid nodules. While these tests appear to be promising in more definitively assigning a risk of malignancy, their effect on surgical decision making has yet to be demonstrated. To investigate the effect of diagnostic molecular profiling of thyroid nodules on the surgical decision-making process. A surgical management algorithm was developed and published after peer review that incorporated individual Bethesda System for Reporting Thyroid Cytopathology classifications with clinical, laboratory, and radiological results. This algorithm was created to formalize the decision-making process selected herein in managing patients with thyroid nodules. Between April 1, 2014, and March 31, 2015, a prospective study of patients who had undergone diagnostic molecular testing of a thyroid nodule before being seen for surgical consultation was performed. The recommended management undertaken by the surgeon was then prospectively compared with the corresponding one in the algorithm. Patients with thyroid nodules who did not undergo molecular testing and were seen for surgical consultation during the same period served as a control group. All pertinent treatment options were presented to each patient, and any deviation from the algorithm was recorded prospectively. To evaluate the appropriateness of any change (deviation) in management, the surgical histopathology diagnosis was correlated with the surgery performed. The study cohort comprised 140 patients who underwent molecular testing. Their mean (SD) age was 50.3 (14.6) years, and 75.0% (105 of 140) were female. Over a 1-year period, 20.3% (140 of 688) had undergone diagnostic molecular testing before surgical consultation, and 79.7% (548 of 688) had not undergone molecular testing. The surgical management deviated from the treatment algorithm in 12.9% (18 of 140) with molecular testing and in 10.2% (56 of 548) without molecular testing (P = .37). In the group with

  13. Diagnostic evaluation and aggressive surgical approach in bleeding pseudoaneurysms associated with pancreatic pseudocysts

    International Nuclear Information System (INIS)

    Pitkaeranta, P.; Haapiainen, R.; Kivisaari, L.; Schroeder, T.

    1991-01-01

    Hemorrhage is an uncommon but serious complication of pancreatic pseudocysts. When gastrointestinal bleeding or intra-abdominal hemorrhage is associated with a pancreatic pseudocysts and the usual sources of bleeding are not detected by endoscopy, the rupture of a pseudoaneurysm inside the pseudocyst should be suspected. The article present 13 cases, 11 associated with chronic and 2 with late complications after acute necrotizing pancreatitis. On the basis of sonographic findings, bleeding site was suspected in 8 of 11 patients. Computed tomography (CT) was performed on 10, and bleeding was suspected in 8. The pseudoaneurysm itself was detected by CT in one and by ultrasonography in none. Visceral angiography was performed on five patients, and the pseudoaneurysm was evident in all. External drainage with arterial ligation was done as a primary operation in five patients; four of them later underwent pancreatic resection because of rebleeding. In eight cases pancreatic resection was the initial operation; none of these patients continued to bleed or needed reoperation because of the same pseudoaneurysm. There were no intraoperative deaths, but one patient died postoperatively. Aggressive diagnostic evaluation and surgical approach are associated with a reduction in mortality and morbidity in this serious complication of pancreatic pseudocysts. 28 refs., 2 figs., 1 tab

  14. Tertiary work-up of apparent treatment-resistant hypertension.

    Science.gov (United States)

    Heimark, Sondre; Eskås, Per Anders; Mariampillai, Julian Eek; Larstorp, Anne Cecilie K; Høieggen, Aud; Fadl Elmula, Fadl Elmula M

    2016-10-01

    Treatment-resistant hypertension (TRH) has regained attention with development of new methods for treatment. However, the prevalence of TRH varies considerably from primary to secondary and tertiary care. We aimed to assess the prevalence of true TRH in a population of patients with apparent TRH in a university hospital setting of tertiary work-up and also investigate reasons for poor BP control and evaluate how work-up can be performed in general practice and secondary care. In this cohort study, we characterize a study population from Oslo Renal Denervation (RDN) Study. Patients (n = 83) were referred for RDN from secondary care. All patients underwent thorough medical investigation and 24-h ambulatory blood pressure measurements (24ABPM) after directly observed therapy (DOT). We then assessed reasons for lack of BP control. Fifty-three of 83 patients did not have true TRH. Main reasons for non-TRH were poor drug adherence (32%), secondary hypertension (30%) and white coat hypertension (15%). Forty-seven percent achieved blood pressure control after DOT with subsequent 24ABPM. There were otherwise no statistically significant differences in patient characteristics between the true TRH and the non-TRH group. Despite being a highly selected cohort referred for tertiary work-up of apparent TRH, BP control was achieved or secondary causes were identified in almost two thirds of the patients. Thorough investigation according to guidelines and DOT with subsequent 24ABPM is needed in work-up of apparent TRH.

  15. [Treatment of Hallux Valgus: Current Diagnostic Testing and Surgical Treatment Performed by German Foot and Ankle Surgeons].

    Science.gov (United States)

    Arbab, Dariusch; Schneider, Lisa-Maria; Schnurr, Christoph; Bouillon, Bertil; Eysel, Peer; König, Dietmar Pierre

    2018-04-01

    Hallux valgus is one of the most prevalent foot deformities, and surgical treatment of Hallux valgus is one of the most common procedures in foot and ankle surgery. Diagnostic and treatment standards show large variation despite medical guidelines and national foot and ankle societies. The aim of this nationwide survey is a description of the current status of diagnostics and therapy of Hallux valgus in Germany. A nationwide online questionnaire survey was sent to two German foot and ankle societies. The participants were asked to answer a questionnaire of 53 questions with four subgroups (general, diagnostics, operation, preoperative management). Surgical treatment for three clinical cases demonstrating a mild, moderate and severe Hallux valgus deformity was inquired. 427 foot and ankle surgeons answered the questionnaire. 388 participants were certified foot and ankle surgeons from one or both foot and ankle societies. Medical history (78%), preoperative radiographs (100%) and preoperative radiographic management (78%) are of high or very high importance for surgical decision pathway. Outcome scores are used by less than 20% regularly. Open surgery is still the gold standard, whereas minimally invasive surgery is performed by only 7%. Our survey showed that diagnostic standards are met regularly. There is a wide variation in the type of procedures used to treat Hallux valgus deformity. TMT I arthrodesis is preferred in severe Hallux valgus, but also used to treat moderate and mild deformities. Minimally invasive surgery is still used by a minority of surgeons. It remains to be seen, to what extent minimally invasive surgery will be performed in the future. Georg Thieme Verlag KG Stuttgart · New York.

  16. Fluidized bed reactor for working up carbon coated particles

    International Nuclear Information System (INIS)

    Marschollek, M.; Simon, W.; Walter, C.

    1981-01-01

    A fluidized bed reactor is described for working up carbon coated particles, particularly nuclear fuel particles or fertile material particles consisting essentially of a cylindrical portion connected to a conical portion. Gas supply pipes, gas distribution space and gas distribution heads are provided within the conical reactor lower portion, the gas distribution members being arranged in at least two superimposed planes and distributed symmetrically over the cross-section of the reactor

  17. Diagnostic Efficiency in Digital Pathology: A Comparison of Optical Versus Digital Assessment in 510 Surgical Pathology Cases.

    Science.gov (United States)

    Mills, Anne M; Gradecki, Sarah E; Horton, Bethany J; Blackwell, Rebecca; Moskaluk, Christopher A; Mandell, James W; Mills, Stacey E; Cathro, Helen P

    2018-01-01

    Prior work has shown that digital images and microscopic slides can be interpreted with comparable diagnostic accuracy. Although accuracy has been well-validated, the interpretative time for digital images has scarcely been studied and concerns about efficiency remain a major barrier to adoption. We investigated the efficiency of digital pathology when compared with glass slide interpretation in the diagnosis of surgical pathology biopsy and resection specimens. Slides were pulled from 510 surgical pathology cases from 5 organ systems (gastrointestinal, gynecologic, liver, bladder, and brain). Original diagnoses were independently confirmed by 2 validating pathologists. Diagnostic slides were scanned using the Philips IntelliSite Pathology Solution. Each case was assessed independently on digital and optical by 3 reading pathologists, with a ≥6 week washout period between modalities. Reading pathologists recorded assessment times for each modality; digital times included time to load the case. Diagnostic accuracy was determined based on whether a rendered diagnosis differed significantly from the original diagnosis. Statistical analysis was performed to assess for differences in interpretative times across modalities. All 3 reading pathologists showed comparable diagnostic accuracy across optical and digital modalities (mean major discordance rates with original diagnosis: 4.8% vs. 4.4%, respectively). Mean assessment times ranged from 1.2 to 9.1 seconds slower on digital versus optical. The slowest reader showed a significant learning effect during the course of the study so that digital assessment times decreased over time and were comparable with optical times by the end of the series. Organ site and specimen type did not significantly influence differences in interpretative times. In summary, digital image reading times compare favorably relative to glass slides across a variety of organ systems and specimen types. Mean increase in assessment time is 4

  18. New diagnostic techniques in staging in the surgical treatment of cutaneous malignant melanoma

    NARCIS (Netherlands)

    Cobben, DCP; Koopal, S; Tiebosch, ATMG; Jager, PL; Elsinga, PH; Wobbes, T; Hoekstra, HJ

    2002-01-01

    The emphasis of the research on the surgical treatment of melanoma has been on the resection margins, the role of elective lymph node dissection. in high risk patients and the value of adjuvant regional treatment with hyperthermic isolated lymph perfusion with melphalan. Parallel to this research,

  19. Diagnostic p53 immunostaining of endobiliary brush cytology: preoperative cytology compared with the surgical specimen

    NARCIS (Netherlands)

    Tascilar, M.; Sturm, P. D.; Caspers, E.; Smit, M.; Polak, M. M.; Huibregtse, K.; Noorduyn, L. A.; Offerhaus, G. J.

    1999-01-01

    Endobiliary brush cytology is important in the distinction of malignant and benign causes of extrahepatic bile duct obstruction. The additional diagnostic value of p53 immunostaining on these cytology specimens was assessed. All patients with extrahepatic bile duct obstruction who underwent

  20. Diagnostic performance of magnetic resonance imaging and pre-surgical evaluation in the assessment of traumatic intra-articular knee disorders in children and adolescents: what conditions still pose diagnostic challenges?

    Energy Technology Data Exchange (ETDEWEB)

    Gans, Itai; Ganley, Theodore J. [The Children' s Hospital of Philadelphia, Division of Orthopaedics, 34th and Civic Center Boulevard, Philadelphia, PA (United States); Bedoya, Maria A.; Ho-Fung, Victor [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States)

    2014-08-31

    Diagnosis of intra-articular lesions in children based on clinical examination and MRI is particularly challenging. To evaluate the diagnostic performance of MRI and pre-surgical evaluation of the knee in pediatric patients relative to arthroscopic evaluation as the gold standard. We report diagnoses frequently missed or inaccurately diagnosed pre-operatively. We conducted a retrospective review of MRI and pre-surgical evaluation in children and adolescents ages 1-17 years who were treated by knee arthroscopy during a 21/2-year period. All MRIs were reviewed by a pediatric radiologist blinded to clinical findings. Pediatric orthopedic clinic notes were reviewed for pre-surgical evaluation (based on physical exam, radiograph, MR images and radiologist's MRI report). Arthroscopic findings were used as the gold standard. We calculated the percentages of diagnoses at arthroscopy missed on both MRI and pre-surgical evaluation. Diagnostic accuracy between children and adolescents and in patients with one pathological lesion vs. those with >1 lesion was analyzed. We performed a second review of MR images of the missed or over-called MRI diagnoses with knowledge of arthroscopic findings. We included 178 children and adolescents. The most common diagnoses missed on MRI or pre-surgical evaluation but found at arthroscopy were: discoid meniscus (8/30, or 26.7% of cases); lateral meniscal tears (15/80, or 18.8% of cases); intra-articular loose bodies (5/36, or 13.9% of cases), and osteochondral injuries (9/73, or 12.3% of cases). Overall diagnostic accuracy of MRI and pre-surgical evaluation was 92.7% and 95.3%, respectively. No significant difference in diagnostic accuracy between children and adolescents was observed. When multiple intra-articular lesions were present, lateral meniscal tears were more likely to be inaccurately diagnosed (missed or over-called) on both MRI (P = 0.009) and pre-surgical evaluation (P < 0.001). Overall diagnostic accuracy of MRI and pre-surgical

  1. Diagnostic performance of magnetic resonance imaging and pre-surgical evaluation in the assessment of traumatic intra-articular knee disorders in children and adolescents: what conditions still pose diagnostic challenges?

    International Nuclear Information System (INIS)

    Gans, Itai; Ganley, Theodore J.; Bedoya, Maria A.; Ho-Fung, Victor

    2015-01-01

    Diagnosis of intra-articular lesions in children based on clinical examination and MRI is particularly challenging. To evaluate the diagnostic performance of MRI and pre-surgical evaluation of the knee in pediatric patients relative to arthroscopic evaluation as the gold standard. We report diagnoses frequently missed or inaccurately diagnosed pre-operatively. We conducted a retrospective review of MRI and pre-surgical evaluation in children and adolescents ages 1-17 years who were treated by knee arthroscopy during a 21/2-year period. All MRIs were reviewed by a pediatric radiologist blinded to clinical findings. Pediatric orthopedic clinic notes were reviewed for pre-surgical evaluation (based on physical exam, radiograph, MR images and radiologist's MRI report). Arthroscopic findings were used as the gold standard. We calculated the percentages of diagnoses at arthroscopy missed on both MRI and pre-surgical evaluation. Diagnostic accuracy between children and adolescents and in patients with one pathological lesion vs. those with >1 lesion was analyzed. We performed a second review of MR images of the missed or over-called MRI diagnoses with knowledge of arthroscopic findings. We included 178 children and adolescents. The most common diagnoses missed on MRI or pre-surgical evaluation but found at arthroscopy were: discoid meniscus (8/30, or 26.7% of cases); lateral meniscal tears (15/80, or 18.8% of cases); intra-articular loose bodies (5/36, or 13.9% of cases), and osteochondral injuries (9/73, or 12.3% of cases). Overall diagnostic accuracy of MRI and pre-surgical evaluation was 92.7% and 95.3%, respectively. No significant difference in diagnostic accuracy between children and adolescents was observed. When multiple intra-articular lesions were present, lateral meniscal tears were more likely to be inaccurately diagnosed (missed or over-called) on both MRI (P = 0.009) and pre-surgical evaluation (P < 0.001). Overall diagnostic accuracy of MRI and pre-surgical

  2. Diagnostics

    DEFF Research Database (Denmark)

    Donné, A.J.H.; Costley, A.E.; Barnsley, R.

    2007-01-01

    of the measurements—time and spatial resolutions, etc—will in some cases be more stringent. Many of the measurements will be used in the real time control of the plasma driving a requirement for very high reliability in the systems (diagnostics) that provide the measurements. The implementation of diagnostic systems...... on ITER is a substantial challenge. Because of the harsh environment (high levels of neutron and gamma fluxes, neutron heating, particle bombardment) diagnostic system selection and design has to cope with a range of phenomena not previously encountered in diagnostic design. Extensive design and R......&D is needed to prepare the systems. In some cases the environmental difficulties are so severe that new diagnostic techniques are required. The starting point in the development of diagnostics for ITER is to define the measurement requirements and develop their justification. It is necessary to include all...

  3. Studies of diagnostic imaging and surgical treatment on patients with pancreatic cysts

    International Nuclear Information System (INIS)

    Koh, Koichi; Yamamoto, Masahiro; Okumura, Shuichi

    1987-01-01

    A retrospective study of 36 cases of pancreatic cyst treated during the recent 13 years was performed from the aspects of imaging and treatment. Visualization of the internal structure by abdominal echography and CT was rare in inflammatory cysts, but frequent in neoplastic cysts. Differentiation between mucous and serous cystadenoma on the basis of properties was possible. Retrograde pancreatography, which disclosed the entire pancreatic ductal system, was important in determining surgical procedure. Angiography was effective for differentiating between benign and malignant cysts, even though some of the inflammatory cysts suggested malignant findings. The most frequent therapy in cases of inflammatory cyst was internal fistulization, with additional side-to-side pancreaticojejunostomy as a procedure for underlying chronic pancreatitis. Neoplastic cysts were resected in all cases, and the procedure for pancreatic cancer was modified for use in the cases of cystic adenocarcinoma. The remote postoperative results in the cases of inflammatory cyst were satisfactory: symptomatic improvement was found in 83.1 % of patients and occupational rehabilitation in 70.6 %. All of the three patients with cystic adenocarcinoma are well, including the one surviving a maximum period of 4 years and 10 months. (author)

  4. Studies of diagnostic imaging and surgical treatment on patients with pancreatic cysts

    Energy Technology Data Exchange (ETDEWEB)

    Koh, K.; Yamamoto, M.; Okumura, S.

    1987-04-01

    A retrospective study of 36 cases of pancreatic cyst treated during the recent 13 years was performed from the aspects of imaging and treatment. Visualization of the internal structure by abdominal echography and CT was rare in inflammatory cysts, but frequent in neoplastic cysts. Differentiation between mucous and serous cystadenoma on the basis of properties was possible. Retrograde pancreatography, which disclosed the entire pancreatic ductal system, was important in determining surgical procedure. Angiography was effective for differentiating between benign and malignant cysts, even though some of the inflammatory cysts suggested malignant findings. The most frequent therapy in cases of inflammatory cyst was internal fistulization, with additional side-to-side pancreaticojejunostomy as a procedure for underlying chronic pancreatitis. Neoplastic cysts were resected in all cases, and the procedure for pancreatic cancer was modified for use in the cases of cystic adenocarcinoma. The remote postoperative results in the cases of inflammatory cyst were satisfactory: symptomatic improvement was found in 83.1 % of patients and occupational rehabilitation in 70.6 %. All of the three patients with cystic adenocarcinoma are well, including the one surviving a maximum period of 4 years and 10 months.

  5. Local audit of diagnostic surgical pathology as a tool for quality assurance.

    Science.gov (United States)

    Malami, Sani Abubakar; Iliyasu, Yawale

    2008-01-01

    Internal audit has been rarely done for quality assurance of histology laboratories in Nigeria. We reviewed the steps involved in the production of reports with a view to assessing the performance of the histopathology laboratory of Aminu Kano Teaching Hospital, Nigeria. A randomly selected 2 per cent sample of the total histology workload of the center for the year ending December 2005 amounting to 2877 cases was systematically reviewed. Analysis of the accumulated data showed a concordance rate of 94.8% between the original and review histological diagnoses, comparable to other published studies. Significant defects were observed to be due to missing demographic information on request forms (22.8%), poor technical quality of slide sections (18.4%) and typographical errors by typists (12.3%) In a minority of cases microscopic description was inadequate or inappropriate (7.0%) and some were inaccurate (2.7%). The turnaround time ranged from 2 to 16 days (mean 6.2 days) with results of 75.8 per cent of the specimens completed within 7 days. From the study we have shown that local audit is feasible in Nigerian laboratories and is an excellent method for detecting errors and improving performance in Surgical Pathology to optimize the scarce resources available to patient care in our country.

  6. Undesended testis: How extensive should the work up be?

    Directory of Open Access Journals (Sweden)

    Shera Altaf

    2010-01-01

    Full Text Available Aim: The aim of this study was to highlight various anomalies associated with undescended testis and to determine how much work up is necessary for this condition. Material and Methods: The study was conducted in the department of Pediatric Surgery SKIMS Srinagar, Kashmir. All patients between 0-14 years of age who attended out patient department (OPD from January 2002 to December 2003 with maldescent of testes were included in the study. Detailed relevant history and physical examination findings were recorded in all the cases. Baseline investigations were performed along with ultrasonography of the abdomen. In relevant cases other investigations like intravenous urography, micturating cystourethrography, CT scan and laparoscopy were performed as and when indicated. Results: A total of 250 cases of undescended testis were registered during this period. Maximum number of cases were in the age group of 5-10 years. In 130 (52% cases the right testis was undescended while 75 (30% had left sided undescended testis and 45 (18% had bilateral undescended testis. Maldescended testis comprised 11% of the admissions. The majority of cases were having gestational age of 37 weeks or more. The associated anomalies picked up on investigations included duplication of upper urinary tract (3.2%, hydronephrosis and polycystic kidney (0.8% each, horseshoe kidney, ectopic kidney, crossed renal ectopia (0.4% each Posterior urethral valves, Prune belly syndrome (0.4% and spina bifida (0.4%. On detailed clinical examination of genitalia several abnormalities were picked which included hydrocele, hypospadias, hernia, chordee, micropenis and ambiguous genitalia. Conclusion: We recommend ultrasonography to be done in all cases of undescended testis in addition to a thorough history and physical examination. Intravenous pyelography, micturating cystourethrogram, CT scan and other investigations should be performed selectively based on history, physical examination or

  7. Pocket pathologist: A mobile application for rapid diagnostic surgical pathology consultation

    Directory of Open Access Journals (Sweden)

    Douglas J Hartman

    2014-01-01

    Full Text Available Introduction: Telepathology allows the digital transmission of images for rapid access to pathology experts. Recent technologic advances in smartphones have allowed them to be used to acquire and transmit digital images of the glass slide, representing cost savings and efficiency gains over traditional forms of telepathology. We report our experience with developing an iPhone application (App - Pocket Pathologist to facilitate rapid diagnostic pathology teleconsultation utilizing a smartphone. Materials and Methods: A secure, web-based portal (http://pathconsult.upmc.com/ was created to facilitate remote transmission of digital images for teleconsultation. The App augments functionality of the web-based portal and allows the user to quickly and easily upload digital images for teleconsultation. Image quality of smartphone cameras was evaluated by capturing images using different adapters that directly attach phones to a microscope ocular lens. Results: The App was launched in August 2013. The App facilitated easy submission of cases for teleconsultation by limiting the number of data entry fields for users and enabling uploading of images from their smartphone′s gallery wirelessly. Smartphone cameras properly attached to a microscope create static digital images of similar quality to a commercial digital microscope camera. Conclusion: Smartphones have great potential to support telepathology because they are portable, provide ubiquitous internet connectivity, contain excellent digital cameras, and can be easily attached to a microscope. The Pocket Pathologist App represents a significant reduction in the cost of creating digital images and submitting them for teleconsultation. The iPhone App provides an easy solution for global users to submit digital pathology images to pathology experts for consultation.

  8. Cardiac myxoma: diagnostic approach, surgical treatment and follow-up. A twenty years experience.

    Science.gov (United States)

    Jelic, J; Milicić, D; Alfirević, I; Anić, D; Baudoin, Z; Bulat, C; Corić, V; Dadić, D; Husar, J; Ivanćan, V; Korda, Z; Letica, D; Predrijevac, M; Ugljen, R; Vućemilo, I

    1996-12-01

    years after the operation. Among them there was no evidence of the tumour recurrence, 15 pts were asymptomatic and 7 had NYHA II class symptoms. For 17 pts with a left atrial myxoma preoperative and postoperative echocardiographic data were available for comparison, showing a significant reduction of the left atrial diameter (p<0.001) during the postoperative follow-up. Our data, presenting one of the biggest reports concerning cardiac myxomas, showed a broad spectrum of their clinical presentation, importance of echocardiography in diagnosing and postoperative follow-up and efficacy of a proper surgical intervention as a definite, curative therapy since there were no deaths and no significant cardiac dysfunction neither tumour reccurrence as well.

  9. The Utility of the Laboratory Work Up at the Time of Diagnosis of Amyotrophic Lateral Sclerosis.

    Science.gov (United States)

    Mirian, Ario; Korngut, Lawrence

    2018-01-01

    Serological testing is routinely performed in the work up for a diagnosis of Amyotrophic Lateral Sclerosis (ALS) to exclude pathologies with similar clinical phenotypes. To determine the proportion of serological workup that changes the primary diagnosis and/or clinical management for patients presenting with signs of ALS. A retrospective chart review was conducted on patients from the Calgary Neuromuscular Intake Clinic in which the neurologist working diagnosis post-assessment is ALS. Charts from 2012 to 2016 with completed standard serological workup were reviewed. The proportion of abnormal results per investigation was determined and whether it resulted in a change in diagnosis and/or clinical management. A total of 276 charts were reviewed and 85 met full inclusion criteria. Serum creatine kinase (35%), vitamin B12 (18%), complete blood count with differential (11%), and parathyroid hormone (10%) were the among the investigations that had a proportion of abnormal results greater than 5%. Only 6% of patients had an abnormal result that qualified for a change in their clinical management none of which changed the primary diagnosis of ALS. Standard serological investigations in the work-up for a patient with ALS may have low utility from a diagnostic and management perspective.

  10. How to work up a patient with polyneuropathy?

    LENUS (Irish Health Repository)

    Renganathan, R

    2009-01-01

    Undiagnosed and untreated neuropathy may lead to disability and poor quality of life. Ordering every possible test to find the cause of polyneuropathy can waste time and resources. In this study, we investigated what could be used as a routine neuropathy screen. A retrospective audit of all charts of patients diagnosed to have polyneuropathy by nerve conduction studies from November 2001 to November 2002 were carried out. Demographics, background history, type of neuropathy and investigations done were documented. The charts of 61 patients were audited. 12 patients had a background history of diabetes mellitus. 2 patients had history of alcohol abuse. 23 patients presented with paraesthesia and 33 with weakness of limbs. We found a cause of polyneuropathy in 79% of cases. In most patients with polyneuropathy where a cause can be identified, this can be achieved by the medical history, neurological examination, nerve conduction studies and the baseline blood tests. We suggest a 3-step approach to the diagnostic workup of polyneuropathy.

  11. Volumetric capnography: In the diagnostic work-up of chronic thromboembolic disease

    Directory of Open Access Journals (Sweden)

    Marcos Mello Moreira

    2010-05-01

    Full Text Available Marcos Mello Moreira1, Renato Giuseppe Giovanni Terzi1, Laura Cortellazzi2, Antonio Luis Eiras Falcão1, Heitor Moreno Junior2, Luiz Cláudio Martins2, Otavio Rizzi Coelho21Department of Surgery, 2Department of Internal Medicine, State University of Campinas, School of Medical Sciences, Campinas, Sao Paulo, BrazilAbstract: The morbidity and mortality of pulmonary embolism (PE have been found to be related to early diagnosis and appropriate treatment. The examinations used to diagnose PE are expensive and not always easily accessible. These options include noninvasive examinations, such as clinical pretests, ELISA D-dimer (DD tests, and volumetric capnography (VCap. We report the case of a patient whose diagnosis of PE was made via pulmonary arteriography. The clinical pretest revealed a moderate probability of the patient having PE, and the DD result was negative; however, the VCap associated with arterial blood gases result was positive. The patient underwent all noninvasive exams following admission to hospital and again eight months after discharge. Results gained from invasive tests were similar to those produced by image exams, highlighting the importance of VCap as an important noninvasive tool.Keywords: pulmonary embolism, pulmonary hypertension, volumetric capnography, d-dimers, pretest probability

  12. Anemia in children: prevalence, causes, diagnostic work-up, and long-term consequences.

    Science.gov (United States)

    Allali, Slimane; Brousse, Valentine; Sacri, Anne-Sylvia; Chalumeau, Martin; de Montalembert, Mariane

    2017-11-01

    Anemia in children is a major public health problem throughout the world. It is often multifactorial, iron deficiency being the most frequent etiology. Consequences are diverse and largely under evaluated. Areas covered: This paper briefly reviews the main causes and focus on the potential consequences of acute and chronic anemia in children. Expert commentary: Anemia in children should never be trivialized. Even if iron deficiency is frequently involved, other potentially life-threatening causes are possible and should be looked for. The exact contribution of anemia to child mortality and morbidity is difficult to assess because of overlapping comorbidities. Chronic anemia may impair growth, cardiac function and cognitive development in infants but other consequences are rather poorly described and should be explored more thoroughly.

  13. Diagnostic Work-up and Treatment of Severe and/or Refractory Atopic Dermatitis

    NARCIS (Netherlands)

    A.C.A. Devillers (Arjan)

    2009-01-01

    textabstractAtopic dermatitis (AD) or atopic eczema , is a chronic inflammatory skin disease characterized by dry skin, itching and recurrent red and scaly skin lesions. It is a relatively common skin disease with an estimated prevalence of 10-20%. The majority of patients show their first clinical

  14. Assessment of short stature in children : auxological screening and diagnostic work-up

    NARCIS (Netherlands)

    Grote, Floor Katelijn

    2007-01-01

    Growth impairment is considered a relatively early sign of poor health in children. Depending on its setting and the age of the child the impairment is expressed in several ways. In industrialized countries, where malnutrition is rare, the major purpose of growth monitoring, implying regular

  15. Para-aortic lymphadenectomy in advanced stage cervical cancer, a protocol for comparing safety, feasibility and diagnostic accuracy of surgical staging versus PET-CT; PALDISC trial.

    Science.gov (United States)

    Tax, Casper; Abbink, Karin; Rovers, Maroeska M; Bekkers, Ruud L M; Zusterzeel, Petra L M

    2018-01-01

    Currently, a PET-CT is used to assess the need for extended field radiotherapy of para-aortic lymph nodes (PALN) in International Federation of Gynaecology and Obstetrics (FIGO) stage IB2, IIA2-IVA (locally advanced stage) cervical cancer. A small study established a sensitivity and specificity estimate for PALN metastases of 50% (95% CI; 7-93%) and 83% (95% CI; 52-98%), respectively. Surgical staging of PALN may lead to a higher diagnostic accuracy. However, surgical staging of para-aortic lymph nodes in locally advanced stage cervical cancer is not common practice. Therefore, a phase 2 randomised controlled trial is needed to assess its safety and feasibility. In addition to standard imaging (MRI or CT scan) with PET-CT, 30 adult women with FIGO stage IB2, IIA2-IVA cervical cancer will be randomised to receive either surgical staging or usual PET-CT staging. Administering extended field radiotherapy will be based on lymphadenectomy results for the intervention group and on the PET-CT results for the control group. Follow-up visits at 0, 3, 6, 9 and 12 months will assess health-related quality of life and progression-free survival.Primary safety and feasibility outcomes of surgical staging will be assessed by calculating means with 95% confidence intervals for duration of surgery, number of complications, blood loss, nodal yield after para-aortic lymphadenectomy and treatment delay due to surgical staging. Secondary patient-centred outcomes on quality of life and first year survival will be documented and compared between the two groups. Estimates of sensitivity, specificity and negative and positive predictive values of MRI, PET-CT and surgical staging will be presented with 95% CI.. All analysis will be performed according to the intention to treat principle. This study will assess safety and feasibility, expressed as the number and severity of complications, effect on quality of life and the treatment delay due to surgically staging para-aortic lymph nodes in

  16. Staging of untreated nasopharyngeal carcinoma with PET/CT: comparison with conventional imaging work-up

    International Nuclear Information System (INIS)

    Ng, Shu-Hang; Chan, Sheng-Chieh; Yen, Tzu-Chen; Liu, Feng-Yuan; Chang, Joseph Tung-Chieh; Fan, Kang-Hsing; Liao, Chun-Ta; Ko, Sheung-Fat; Chin, Shu-Chyn; Hsu, Cheng-Lung

    2009-01-01

    We prospectively compared PET/CT and conventional imaging for initial staging of nasopharyngeal carcinoma (NPC). A total of 111 patients with histologically proven NPC were investigated with PET/CT and conventional imaging (head-and-neck MRI, chest X-ray, abdominal ultrasound, and bone scan) before treatment. The respective findings were reviewed independently and then compared with each other. With regard to T staging, PET/CT showed a discrepancy with head-and-neck MRI in 36 (32.4%) of the study subjects. With regard to N staging, PET/CT showed a discrepancy with head-and-neck MRI in 15 (13.5%) patients. Among the discordant cases, MRI was superior in demonstrating tumor involvement in the parapharyngeal space, skull base, intracranial area, sphenoid sinus, and retropharyngeal nodes while PET/CT was superior in demonstrating neck nodal metastasis. PET/CT disclosed 13 of 16 patients with distant malignancy compared with four patients disclosed by conventional imaging work-up. The false-positive rate of PET/CT was 18.8%. PET/CT correctly modified M staging in eight patients (7.2%) and disclosed a second primary lung malignancy in one patient (0.9%). In NPC patients, MRI appears to be superior to PET/CT for the assessment of locoregional invasion and retropharyngeal nodal metastasis. PET/CT is more accurate than MRI for determining cervical nodal metastasis and should be the better reference for the neck status. PET/CT has an acceptable diagnostic yield and a low false-positive rate for the detection of distant malignancy and can replace conventional work-up to this aim. PET/CT and head-and-neck MRI are suggested for the initial staging of NPC patients. (orig.)

  17. Delayed post-surgical sepsis from Teflon felt: The diagnostic value of CT scanning, and a reminder for theatre staff

    Directory of Open Access Journals (Sweden)

    D Emby

    2011-05-01

    Full Text Available We report on 2 patients with surgical site infections following the inadvertent use of Teflon felt for haemostasis in elective and emergency surgery. CT scanning was superior to plain radiography in demonstrating the foreign bodies to enable planning of further surgical treatment.

  18. Improving work-up of the abnormal mammogram through organized assessment: results from the ontario breast screening program.

    Science.gov (United States)

    Quan, May Lynn; Shumak, Rene S; Majpruz, Vicky; Holloway, Claire M D; O'Malley, Frances P; Chiarelli, Anna M

    2012-03-01

    Women with an abnormal screening mammogram should ideally undergo an organized assessment to attain a timely diagnosis. This study evaluated outcomes of women undergoing work-up after abnormal mammogram through a formal breast assessment affiliate (BAA) program with explicit care pathways compared with usual care (UC) using developed quality indicators for screening mammography programs. Between January 1 and December 31, 2007, a total of 320,635 women underwent a screening mammogram through the Ontario Breast Screening Program (OBSP), of whom 25,543 had an abnormal result requiring further assessment. Established indicators assessing timeliness, appropriateness of follow-up, and biopsy rates were compared between women who were assessed through either a BAA or UC using χ(2) analysis. Work-up of the abnormal mammogram for patients screened through a BAA resulted in a greater proportion of women attaining a definitive diagnosis within the recommended time interval when a histologic diagnosis was required. In addition, use of other quality measures including specimen radiography for both core biopsies and surgical specimens and preoperative core needle biopsy was greater in BAA facilities. These findings support future efforts to increase the number of BAAs within the OBSP, because the pathways and reporting methods associated with them result in improvements in our ability to provide timely and appropriate care for women requiring work-up of an abnormal mammogram.

  19. Spontaneous perforation of bile duct, clinical presentation, laboratory work up, treatment and outcome

    International Nuclear Information System (INIS)

    Malik, H.S.; Cheema, H.A.; Fayyaz, Z.; Hashmi, M.A.

    2016-01-01

    Spontaneous perforation of bile duct (SPBD) is a rare and often misdiagnosed entity. Though rare, it is the second most common surgical cause of jaundice in infants, after biliary atresia. This study was planned to determine the clinical presentation, study different diagnostic modalities, treatment and outcome of patients with spontaneous perforation of bile duct. Methods: This descriptive case series, comprising 22 patients with spontaneous perforation of bile duct over a period of 24 months. Clinical presentation, biochemical abnormalities, imaging details, treatment options and outcome were studied. Results: Total 22 patients (12 Males and 10 Females) between ages of 1.5-36 months were studied. Associated anatomical defects included choledochal cyst in 7 (31.8%) while acquired biliary atresia in 1 (4.5%). Elevated liver enzymes (ALT and AST) were present in 16 patients (72.7%) and 5 (22.7%) had bilirubin above 3 mg/dl. Coagulopathy was seen in 8 (36.6%) patients. Abdominal USG showed presence of ascites in all 22 (100%), hydrocele in 2 (9.0%), inguinal hernia in 1 (4.5%), choledochal cyst in 7 (31.8%) and atretic gall bladder suggestive of acquired biliary atresia in one (4.5%) patient. HIDA scan was diagnostic in all 17 (77.27%) in which it was performed. MRCP was done in 3 (13.6%) patients. Mortality frequency was 3/22 (13.6%); one died of post-surgical sepsis second one was cirrhotic at time of presentation and didnot make It. Two were lost to follow up one which died at home while we lost contact with fourth patient. Conclusion: Spontaneous perforation of bile duct can present and should be suspected as an important cause of neonatal biliary ascites or peritonitis. Most patients can be managed with intravenous antibiotics, percutaneous drainage and t-tube insertion while patients with choledochal cysts required cholecystectomy with roux en y choledochjejunostomy. Timely recognition and intervention is associated with favourable outcome. (author)

  20. Advanced radiological work-up as an adjunct to decision in early reconstructive surgery in brachial plexus injuries

    Directory of Open Access Journals (Sweden)

    Björkman Anders

    2010-07-01

    Full Text Available Abstract Background As neurophysiologic tests may not reveal the extent of brachial plexus injury at the early stage, the role of early radiological work-up has become increasingly important. The aim of the study was to evaluate the concordance between the radiological and clinical findings with the intraoperative findings in adult patients with brachial plexus injuries. Methods Seven consecutive male patients (median age 33; range 15-61 with brachial plexus injuries, caused by motor cycle accidents in 5/7 patients, who underwent extensive radiological work-up with magnetic resonance imaging (MRI, computed tomography myelography (CT-M or both were included in this retrospective study. A total of 34 spinal nerve roots were evaluated by neuroradiologists at two different occasions. The degree of agreement between the radiological findings of every individual nerve root and the intraoperative findings was estimated by calculation of kappa coefficient (К-value. Using the operative findings as a gold standard, the accuracy, sensitivity, specificity, positive predictive value (PPV and negative predictive value (NPV of the clinical findings and the radiological findings were estimated. Results The diagnostic accuracy of radiological findings was 88% compared with 65% for the clinical findings. The concordance between the radiological findings and the intraoperative findings was substantial (К = 0.76 compared with only fair (К = 0.34 for the clinical findings. There were two false positive and two false negative radiological findings (sensitivity and PPV of 0.90; specificity and NPV of 0.87. Conclusions The advanced optimized radiological work-up used showed high reliability and substantial agreement with the intraoperative findings in adult patients with brachial plexus injury.

  1. Diagnostic confidence analysis in the magnetic resonance imaging of ovarian and deep endometriosis: comparison with surgical results

    Energy Technology Data Exchange (ETDEWEB)

    Saba, Luca; Sulcis, Rosa; Ibba, Giannina; Piga, Mario [Azienda Ospedaliero Universitaria, Department of Radiology, Monserrato (Italy); Melis, Gian Benedetto; Guerriero, Stefano [Azienda Ospedaliero Universitaria, Department of Gynecology, Monserrato (Italy); Alcazar, Juan Luis [University of Navarra, Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, Pamplona (Spain)

    2014-02-15

    To assess the diagnostic confidence of multiple readers in the magnetic resonance imaging (MRI) diagnosis of endometriosis. Sixty-five patients (mean age 33; range 19-45 years) who had undergone MRI were retrospectively evaluated. Five regions were analysed and the presence of endometriosis was scored on a five-point scale in order to assess the diagnostic confidence. Statistical analysis included receiver operating characteristic (ROC) curve analysis, the Cohen weighted test and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, positive likelihood ratio (LR+) and negative likelihood ratio (LR-). The areas under the curve (AUC) in the detection of ovarian endometrioma were 0.942, 0.893 and 0.883 for readers 1, 2 and 3, respectively; in the uterosacral ligament (USL) AUCs were 0.907, 0.804 and 0.842; in the vaginal fornix (VF) 0.819, 0.733 and 0.69; in the anterior compartment 0.916, 0.833 and 0.873; and in the rectum/sigma/pouch of Douglas (RSD) 0.936, 0.856 and 0.834. Diagnostic confidence of the observers is different according to the region of the nodules of endometriosis and it can be challenging in the VF and for the less experience readers also in the AC and RSD. Moreover the degree of uncertain diagnosis for the less expert readers may reach up to one third of the examinations. (orig.)

  2. Diagnostic confidence analysis in the magnetic resonance imaging of ovarian and deep endometriosis: comparison with surgical results

    International Nuclear Information System (INIS)

    Saba, Luca; Sulcis, Rosa; Ibba, Giannina; Piga, Mario; Melis, Gian Benedetto; Guerriero, Stefano; Alcazar, Juan Luis

    2014-01-01

    To assess the diagnostic confidence of multiple readers in the magnetic resonance imaging (MRI) diagnosis of endometriosis. Sixty-five patients (mean age 33; range 19-45 years) who had undergone MRI were retrospectively evaluated. Five regions were analysed and the presence of endometriosis was scored on a five-point scale in order to assess the diagnostic confidence. Statistical analysis included receiver operating characteristic (ROC) curve analysis, the Cohen weighted test and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, positive likelihood ratio (LR+) and negative likelihood ratio (LR-). The areas under the curve (AUC) in the detection of ovarian endometrioma were 0.942, 0.893 and 0.883 for readers 1, 2 and 3, respectively; in the uterosacral ligament (USL) AUCs were 0.907, 0.804 and 0.842; in the vaginal fornix (VF) 0.819, 0.733 and 0.69; in the anterior compartment 0.916, 0.833 and 0.873; and in the rectum/sigma/pouch of Douglas (RSD) 0.936, 0.856 and 0.834. Diagnostic confidence of the observers is different according to the region of the nodules of endometriosis and it can be challenging in the VF and for the less experience readers also in the AC and RSD. Moreover the degree of uncertain diagnosis for the less expert readers may reach up to one third of the examinations. (orig.)

  3. The role of PET in initial work-up and evaluation after therapy in patients with carcinoma of unknown primary

    Energy Technology Data Exchange (ETDEWEB)

    Ryoo, Baek Yeol; Kang, Yoon Koo

    1998-12-01

    The carcinoma of unknown primary occupied 5 - 10 % of all malignancies. It is heterogenous in origin and has poor prognosis. The indentification of primary site and definition of involved area are more helpful in the management. The efficacy of positron emission tomography (PET) with fluorine-18- fluorodeoxyglucose (F18-FDG) positron emission tomography (PET) with fluorine-18-fluorodeoxyglucose (F18-FDG) was evaluated in several tumors such as breast, pancreas and head and neck cancers. In carcinoma of unknown primary, it was reported that the concentration of FDG was increased in tumor tissues, and that PET with F18-FDG may be much helpful in identifying primary site and defining involved area. The authors evaluated the usefulness of PET with F18-FDG in initial work-up and in evaluation after radical therapy for the patients with carcinoma of unknown primary. The visual analysis of FDG-PET would be helpful in identifying primary site and defining involved area. In detecting recurrent of residual lesions, FDG-PET seemed to be less helpful than conventional diagnostic work-up. But more studies with larger number of cases and longer follow-up were required. The results of this study can be bases for the direction of future studies for the usefulness of PET in carcinoma of unknown primary.

  4. The role of PET in initial work-up and evaluation after therapy in patients with carcinoma of unknown primary

    International Nuclear Information System (INIS)

    Ryoo, Baek Yeol; Kang, Yoon Koo

    1998-12-01

    The carcinoma of unknown primary occupied 5 - 10 % of all malignancies. It is heterogenous in origin and has poor prognosis. The indentification of primary site and definition of involved area are more helpful in the management. The efficacy of positron emission tomography (PET) with fluorine-18- fluorodeoxyglucose (F18-FDG) positron emission tomography (PET) with fluorine-18-fluorodeoxyglucose (F18-FDG) was evaluated in several tumors such as breast, pancreas and head and neck cancers. In carcinoma of unknown primary, it was reported that the concentration of FDG was increased in tumor tissues, and that PET with F18-FDG may be much helpful in identifying primary site and defining involved area. The authors evaluated the usefulness of PET with F18-FDG in initial work-up and in evaluation after radical therapy for the patients with carcinoma of unknown primary. The visual analysis of FDG-PET would be helpful in identifying primary site and defining involved area. In detecting recurrent of residual lesions, FDG-PET seemed to be less helpful than conventional diagnostic work-up. But more studies with larger number of cases and longer follow-up were required. The results of this study can be bases for the direction of future studies for the usefulness of PET in carcinoma of unknown primary

  5. Diagnostic Value of Serial Measurement of C-Reactive Protein in the Detection of a Surgical Complication after Laparoscopic Bowel Resection for Endometriosis

    DEFF Research Database (Denmark)

    Riiskjær, Mads; Forman, Axel; Kesmodel, Ulrik Schiøler

    2016-01-01

    AIMS: The study aimed to assess the diagnostic value of serial monitoring of biochemical inflammatory markers (C-reactive protein (CRP) and white blood cell (WBC) count) in the postoperative diagnosis of anastomotic leakage or ureteral injury after bowel resection for deep infiltrating endometrio......AIMS: The study aimed to assess the diagnostic value of serial monitoring of biochemical inflammatory markers (C-reactive protein (CRP) and white blood cell (WBC) count) in the postoperative diagnosis of anastomotic leakage or ureteral injury after bowel resection for deep infiltrating...... endometriosis. METHODS: This is a review of prospectively collected data from 217 patients who underwent laparoscopic bowel resection for endometriosis from January 2009 to April 2015. Patients with an anastomotic leakage or ureteral injury were identified and classified. RESULTS: The frequency of anastomotic...... leakage requiring reoperation was 8.3%. The frequency of ureteral injury was 4.6%. Median time to diagnosis was 6 days for anastomotic leakage and 8 days for ureteral injury. The daily mean values of serum CRP were significantly higher in patients with a surgical complication starting at the second...

  6. Diagnostic application of Ga-67 scintigraphy in primary lung cancer, hepatoma and abdominal abscess. On surgical operation

    Energy Technology Data Exchange (ETDEWEB)

    Oshiumi, Yoshihiko (National Central Hospital of Fukuoka (Japan))

    1983-05-01

    It is difficult to detect tumor lesions by /sup 67/Ga-scintigraphy, though it is named as a tumor scintigraphy. Recently, /sup 67/Ga-scintigraphy is well used in the detection of inflammatic lesions. This paper is to discuss the detectability of lesions and diagnostic limitation on operability by /sup 67/Ga-scintigraphy to primary lung cancer, minute hepatoma and abdominal abscess. Primary lung cancer: In detecting metastatic hilar lymph nodes, the sensitivity is 54%, and the specificity is 78%. In detecting metastatic mediastinal lymph nodes, the sensitivity is 32% and the specificity is 89%. Minute hepatoma : The detectability depended on the size of the lesion. It is hard to detect lesions with under 2 cm by /sup 67/Ga-scintigraphy. Abdominal abscess : The sensitivity is 88%, and the specificity is 92%.

  7. Evaluation of the menisci of the knee joint using three-dimensional isotropic resolution fast spin-echo imaging: diagnostic performance in 250 patients with surgical correlation

    Energy Technology Data Exchange (ETDEWEB)

    Kijowski, Richard; Davis, Kirkland W.; Blankenbaker, Donna G.; Woods, Michael A.; De Smet, Arthur A. [University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI (United States); Munoz del Rio, Alejandro [University of Wisconsin School of Medicine and Public Health, Department of Radiology, Madison, WI (United States); University of Wisconsin School of Medicine and Public Health, Department of Statistics, Madison, WI (United States)

    2012-02-15

    To compare the diagnostic performance of FSE-Cube, a three-dimensional isotropic resolution intermediate-weighted fast spin-echo sequence, with a routine magnetic resonance (MR) protocol at 3.0 T for detecting surgically confirmed meniscal tears of the knee joint in a large patient population. FSE-Cube was added to a routine MR protocol performed at 3.0 T on 250 patients who underwent subsequent knee arthroscopy. Three radiologists independently used FSE-Cube during one review and the routine MR protocol during a second review to detect medial and lateral meniscal tears. Using arthroscopy as the reference standard, the sensitivity and specificity of FSE-Cube and the routine MR protocol for detecting meniscal tears were determined for all readers combined. McNemar's tests were used to compare diagnostic performance between FSE-Cube and the routine MR protocol. FSE-cube and the routine MR protocol had similar sensitivity (95.5%/95.3% respectively, P=0.94) and similar specificity (69.8%/74.0% respectively, P=0.10) for detecting 156 medial meniscal tears. FSE-Cube had significantly lower sensitivity than the routine MR protocol (79.4%/85.0% respectively, P < 0.05) but similar specificity (83.9%/82.2% respectively, P=0.37) for detecting 89 lateral mensical tears. For lateral meniscal tears, FSE-Cube had significantly lower sensitivity (P < 0.05) than the routine MR protocol for detecting 19 root tears but similar sensitivity (P=0.17-1.00) for detecting all other tear locations and types. FSE-Cube had diagnostic performance similar to a routine MR protocol for detecting meniscal tears except for a significantly lower sensitivity for detecting lateral meniscal tears, which was mainly attributed to decreased ability to identify lateral meniscus root tears. (orig.)

  8. Evaluation of the menisci of the knee joint using three-dimensional isotropic resolution fast spin-echo imaging: diagnostic performance in 250 patients with surgical correlation

    International Nuclear Information System (INIS)

    Kijowski, Richard; Davis, Kirkland W.; Blankenbaker, Donna G.; Woods, Michael A.; De Smet, Arthur A.; Munoz del Rio, Alejandro

    2012-01-01

    To compare the diagnostic performance of FSE-Cube, a three-dimensional isotropic resolution intermediate-weighted fast spin-echo sequence, with a routine magnetic resonance (MR) protocol at 3.0 T for detecting surgically confirmed meniscal tears of the knee joint in a large patient population. FSE-Cube was added to a routine MR protocol performed at 3.0 T on 250 patients who underwent subsequent knee arthroscopy. Three radiologists independently used FSE-Cube during one review and the routine MR protocol during a second review to detect medial and lateral meniscal tears. Using arthroscopy as the reference standard, the sensitivity and specificity of FSE-Cube and the routine MR protocol for detecting meniscal tears were determined for all readers combined. McNemar's tests were used to compare diagnostic performance between FSE-Cube and the routine MR protocol. FSE-cube and the routine MR protocol had similar sensitivity (95.5%/95.3% respectively, P=0.94) and similar specificity (69.8%/74.0% respectively, P=0.10) for detecting 156 medial meniscal tears. FSE-Cube had significantly lower sensitivity than the routine MR protocol (79.4%/85.0% respectively, P < 0.05) but similar specificity (83.9%/82.2% respectively, P=0.37) for detecting 89 lateral mensical tears. For lateral meniscal tears, FSE-Cube had significantly lower sensitivity (P < 0.05) than the routine MR protocol for detecting 19 root tears but similar sensitivity (P=0.17-1.00) for detecting all other tear locations and types. FSE-Cube had diagnostic performance similar to a routine MR protocol for detecting meniscal tears except for a significantly lower sensitivity for detecting lateral meniscal tears, which was mainly attributed to decreased ability to identify lateral meniscus root tears. (orig.)

  9. Diagnostic and Prognostic Significance of Lipid Profiles in Holstein Dairy Cattle with Displaced Abomasum: Before and After Surgical Operation

    Directory of Open Access Journals (Sweden)

    Arafat Khalphallah

    2016-01-01

    Full Text Available The study aimed to describe the pattern of changes in clinical findings and lipid metabolism profiles in dairy cattle with displacement of the abomasum (DA from day 0 until day 30 after operation. The study was conducted on DA cattle (n= 25 belonged to dairy farms in Hokkaido area, Japan. Cows were examined and sampled at days 0 (operation, 7 and 30. They were clinically and biochemically examined to estimate BCS and many serum biochemical constituents such as lecithin:cholesterol acyltransferase (LCAT and apolipoprotein B-100 (apoB-100, β-hydroxybutyric acid (BHBA, non-esterified fatty acids (NEFAs and aspartate amino transferase (AST. Based on blood BHBA at day 0, DA cows were classified into three categories; DA only (<1.2 mmol/l, DA with subclinical ketosis (DA SCK (1.2-2.4 mmol/l and DA with clinical ketosis (DA CK (≥2.5 mmol/l. The changes in the pattern of serum biochemical constituents throughout this study indicated recovery of diseased cows and significant effect of surgical operation. Serum biochemical constituents returned to their physiological values indicating that these cows were restoring their normal physiological status. This was reflected through a significant (P<0.05 elevation of LCAT, apoB-100, and cholesterol and a significant (P<0.05 reduction in AST, NEFAs and BHBA (Not in DA group, in all DA groups particularly at day 30 when their values compared with those at day 0. The current study also recorded no remarkable changes (P>0.05 between the diseased groups except for NEFA and BHBA (at day 0 between DA group and the other two groups at any of the three sampling days.

  10. Determination of hemispheric language dominance in the surgical epilepsy patient: diagnostic properties of functional magnetic resonance imaging.

    Science.gov (United States)

    Spritzer, Scott D; Hoerth, Matthew T; Zimmerman, Richard S; Shmookler, Aaron; Hoffman-Snyder, Charlene R; Wellik, Kay E; Demaerschalk, Bart M; Wingerchuk, Dean M

    2012-09-01

    Presurgical evaluation for refractory epilepsy typically includes assessment of cognitive and language functions. The reference standard for determination of hemispheric language dominance has been the intracarotid amobarbital test (IAT) but functional magnetic resonance imaging (fMRI) is increasingly used. To critically assess current evidence regarding the diagnostic properties of fMRI in comparison with the IAT for determination of hemispheric language dominance. The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario, structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and content experts in the fields of epilepsy and neurosurgery. A systematic review and meta-analysis that compared the sensitivity and specificity of fMRI to IAT-determined language lateralization was selected for critical appraisal. The review included data from 23 articles (n=442); study methodology varied widely. fMRI was 83.5% sensitive and 88.1% specific for detection of hemispheric language dominance. There are insufficient data to support routine use of fMRI for the purpose of determining hemispheric language dominance in patients with intractable epilepsy. Larger, well-designed studies of fMRI for language and other cognitive outcomes as part of the presurgical and postsurgical evaluation of epilepsy patients are necessary.

  11. Efficiency of Staging Work-Ups in the Evaluation of Carcinoma of the Uterine Cervix

    International Nuclear Information System (INIS)

    Kim, Jae Sung; Ha, Sung Whan

    1991-01-01

    A series of 510 patients with carcinoma of the uterine cervix given the curative radiation therapy from March 1979 through December 1986 was evaluated to determine the value of intravenous pyelography(IVP), cystoscopy, sigmoidoscopy, and abdomino-pelvic CT as staging work-up prior to treatment. On IVP and cystoscopy, 10.7%(49/456) and 5/3%(24/452) showed abnormality, respectively, but only 0.7% (3/413) did on signoidoscopy. As a result of these work-ups prerequisite to FIGO staging, twenty six (5.1%) out of 510 patients were upstaged from the stage determined by the findings of physical examination alone. The proportions of upstaging in each stage were as follows none in stage IB(35), IIA (89) and IIIA(8), 7.9%(20/252) in stage IIB(14 patients to FIGO Stage IIIB, 6 patients to FIGO stage IVA), and 4.8% (6/126) in stage IIIB (all to FIGO stage IVA). Positive findings of staging work-ups were found only in patients with advanced stages of stage IIB or over determined by physical examination alone but not in those with earlier stages. CT was performed in 337 patients. CT detected pelvic lymph node (LN) enlargement in 25.2% (85/337) and paraaortic LN enlargement in 7.4% (25/337). Pelvic LN positivity was well correlated with increasing stage but paraaortic LN positivity was not. In the evaluation of parametrial involvement, CT findings were in accordance with those of physical examination only in 65.6%(442/674). When compared with endoscopic studies, CT had much lower positive predictive value than negative predictive value in the evaluation of adjacent organ invasion. The staging work-ups should be individualized by the disease extent of each patient, and then the efficiency of work-ups may be increased without compromising the appropriate FIGO staging and treatment

  12. Diagnostic imaging of compression neuropathy

    International Nuclear Information System (INIS)

    Weishaupt, D.; Andreisek, G.

    2007-01-01

    Compression-induced neuropathy of peripheral nerves can cause severe pain of the foot and ankle. Early diagnosis is important to institute prompt treatment and to minimize potential injury. Although clinical examination combined with electrophysiological studies remain the cornerstone of the diagnostic work-up, in certain cases, imaging may provide key information with regard to the exact anatomic location of the lesion or aid in narrowing the differential diagnosis. In other patients with peripheral neuropathies of the foot and ankle, imaging may establish the etiology of the condition and provide information crucial for management and/or surgical planning. MR imaging and ultrasound provide direct visualization of the nerve and surrounding abnormalities. Bony abnormalities contributing to nerve compression are best assessed by radiographs and CT. Knowledge of the anatomy, the etiology, typical clinical findings, and imaging features of peripheral neuropathies affecting the peripheral nerves of the foot and ankle will allow for a more confident diagnosis. (orig.) [de

  13. Diagnostic work-up of 449 consecutive girls who were referred to be evaluated for precocious puberty

    DEFF Research Database (Denmark)

    Mogensen, Signe Sloth; Aksglaede, Lise; Mouritsen, Annette

    2011-01-01

    A decrease in age at pubertal onset has been observed internationally. The aim of this study was to describe a large cohort of Caucasian girls referred with signs of early puberty according to etiology and compare biochemical characteristics.......A decrease in age at pubertal onset has been observed internationally. The aim of this study was to describe a large cohort of Caucasian girls referred with signs of early puberty according to etiology and compare biochemical characteristics....

  14. Idiopathic interstitial pneumonias. From classification to diagnostic work-up; Idiopathische interstitielle Pneumonien. Von der Klassifikation zur Diagnostik

    Energy Technology Data Exchange (ETDEWEB)

    Mueller-Mang, C.; Bankier, A. [Medizinische Universitaet, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Stiebellehner, L. [Medizinische Universitaet, Klinische Abteilung fuer Pulmologie, Universitaetsklinik fuer Innere Medizin, Wien (Austria); Schmid, K. [Medizinische Universitaet, Klinisches Institut fuer Pathologie, Wien (Austria)

    2007-05-15

    Idiopathic interstitial pneumonias (IIP) comprise seven entities with distinct histologic patterns. In their idiopathic form IIP are rare diseases. They are, nevertheless, considered prototypes of the much more common secondary interstitial pneumonias. The advent of high-resolution computed tomography (HRCT) has had a profound impact on the imaging of IIP, because the detailed delineation of the lung anatomy allows a close correlation between the histologic patterns of IIP and the CT features. On the basis of CT morphology and in the correct clinical context, the radiologist can achieve an accurate diagnosis in many cases. However, due to overlap between the various entities, complementary lung biopsy is recommended in virtually all cases. This article reviews the CT pattern of IIP and offers relevant clinical and histological information for the purpose of enabling the radiologist to understand and participate in the multidisciplinary concept of IIP. (orig.) [German] Die Bezeichnung idiopathische interstitielle Pneumonien (IIP) umfasst 7 Entitaeten mit definierten histologischen Mustern. In ihrer idiopathischen Form sind die interstitiellen Pneumonien selten, allerdings werden die einzelnen Muster als Prototypen fuer die haeufigeren sekundaeren interstitiellen Pneumonien betrachtet. Mit der Einfuehrung der hochaufloesenden Computertomographie (HRCT) hat die Bildgebung der IIP einen deutlichen Aufschwung erfahren, da durch die detaillierte Darstellung der Lungenanatomie eine sehr gute Korrelation zwischen den histologischen Mustern der IIP und den CT-Veraenderungen gegeben ist. Der Radiologe kann anhand der CT-Morphologie und unter Beruecksichtigung der Klinik des Patienten in vielen Faellen eine korrekte Diagnose erstellen. Dennoch wird aufgrund von Ueberlappungen zwischen den verschiedenen Entitaeten bei nahezu allen Formen der IIP eine ergaenzende Lungenbiopsie empfohlen. Dieser Uebersichtsartikel veranschaulicht die verschiedenen CT-Merkmale der IIP und beinhaltet relevante klinische und histologische Informationen, mit dem Ziel, dem Radiologen das interdisziplinaere Konzept der IIP naeher zu bringen und ihm dadurch ein Instrument zur verbesserten Kommunikation mit den zuweisenden Klinikern in die Hand zu geben. (orig.)

  15. An Evaluation of the Diagnostic Accuracy of the Grade of Preoperative Biopsy Compared to Surgical Excision in Chondrosarcoma of the Long Bones

    Directory of Open Access Journals (Sweden)

    Robert Jennings

    2010-01-01

    Full Text Available Chondrosarcoma is the second most common primary malignant bone tumour. Distinguishing between grades is not necessarily straightforward and may alter the disease management. We evaluated the correlation between histological grading of the preoperative image-guided needle biopsy and the resection specimen of 78 consecutive cases of chondrosarcoma of the femur, humerus, and tibia. In 11 instances, there was a discrepancy in histological grade between the biopsy and surgical specimen. Therefore, there was an 85.9% (67/78 accuracy rate for pre-operative histological grading of chondrosarcoma, based on needle biopsy. However, the accuracy of the diagnostic biopsy to distinguish low-grade from high-grade chondrosarcoma was 93.6% (73/78. We conclude that accurate image-guided biopsy is a very useful adjunct in determining histological grade of chondrosarcoma and the subsequent treatment plan. At present, a multidisciplinary approach, comprising experienced orthopaedic surgeons, radiologists, and pathologists, offers the most reliable means of accurately diagnosing and grading of chondrosarcoma of long bones.

  16. Cerebrospinal fluid (CSF) shunting and ventriculocisternostomy (ETV) in 400 pediatric patients. Shifts in understanding, diagnostics, case-mix, and surgical management during half a century.

    Science.gov (United States)

    Paulsen, A Henriette; Due-Tønnessen, Bernt J; Lundar, Tryggve; Lindegaard, Karl-Fredrik

    2017-02-01

    To characterize shifts from the 1960s to the first decade in the 21st century as to diagnostics, case-mix, and surgical management of pediatric patients undergoing permanent CSF diversion procedures. One hundred and thirty-four patients below 15 years of age were the first time treated with CSF shunt or ETV for hydrocephalus or idiopathic intracranial hypertension (IIH) in 2009-2013. This represents our current practice. Our previously reported cohorts of shunted children 1967-1970 (n = 128) and 1985-1988 (n = 138) served as backgrounds for comparison. In the 1960s, ventriculography and head circumference measurements were the main diagnostic tools; ventriculoatrial shunt was the preferred procedure (94 %), neural tube defect (NTD) was the leading etiology (33 %), and overall 2-year survival rate was 76 % (non-tumor survival 84 %). In the 1980s, computerized tomography (CT) was the preferred diagnostic imaging tool; ventriculoperitoneal shunt (VPS) had become standard (91 %), the proportion of NTD children declined to 17 %, and the 2-year survival rate was 91 % (non-tumor survival 95 %). Hydrocephalus caused by intracranial hemorrhage had, on the other hand, increased from 7 to 19 %. In the years 2009-2013, when MRI and endoscopic third ventriculocisternostomy (ETV) were matured technologies, 73 % underwent VPS, and 23 % ETV as their initial surgical procedure. The most prevalent etiology was CNS tumor (31 %). The proportion of NTD patients was yet again halved to 8 %, while intracranial hemorrhage was also reduced to 12 %. In this last period, six children were treated with VPS for Idiopathic Intracranial Hypertension (IIH) due to unsatisfactory response to medical treatment. They all had headache, papilledema, and visual disturbances and responded favorably to treatment. The 2 years of survival was 92 % (non-tumor survival 99 %). In contrast to the previous periods, there was no early shunt related mortality (2 years). Aqueductal stenosis

  17. Role of Fluorine-18-Fluorodeoxyglucose in the Work-up of Febrile AIDS Patients. Experience with Dual Head Coincidence Imaging.

    Science.gov (United States)

    Santiago, Jonas F.; Jana, Suman; Gilbert, Holly M.; Salem, Shahenda; Bellman, Paul Curtis; Hsu, Ricky K.S.; Naddaf, Sleiman; Abdel-Dayem, Hussein M.

    1999-11-01

    OBJECTIVE AND METHODS: This study was undertaken to find the role of fluorine-18-fluorodeoxyglucose (F18-FDG) in the diagnostic work-up of febrile Acquired Immune Deficiency Syndrome (AIDS) patients. Forty-seven (42 male and 5 female; mean age = 40.3 years) febrile patients with AIDS underwent imaging with F18-FDG by Dual Head Coincidence Imaging (DHCI). Findings were correlated with other imaging modalities.RESULTS: Our data show good sensitivity for scanning with F18-FDG by DHCI in determining the extent of Castleman's disease, lymphoma, Kaposi's sarcoma (KS), adenocarcinoma, and germ cell carcinoma. Various opportunistic infections also manifest with increased F18-FDG uptake.CONCLUSION: Total-body imaging can be done with F18-FDG with better resolution and a shorter procedure time compared to imaging with Gallium-67 (Ga-67). Furthermore, F18-FDG is more sensitive than Ga-67 for evaluating extent of involvement in various pathologies affecting AIDS patients. The new technology of DHCI is a good alternative for hospitals with no dedicated positron emission tomography (PET) scanner.

  18. Pragmatic approach to the clinical work-up of patients with putative allergic disease to metallic orthopaedic implants before and after surgery.

    Science.gov (United States)

    Thyssen, J P; Menné, T; Schalock, P C; Taylor, J S; Maibach, H I

    2011-03-01

    Allergic complications following insertion of metallic orthopaedic implants include allergic dermatitis reactions but also extracutaneous complications. As metal-allergic patients and/or surgeons may ask dermatologists and allergologists for advice prior to planned orthopaedic implant surgery, and as surgeons may refer patients with complications following total joint arthroplasty for diagnostic work-up, there is a continuous need for updated guidelines. This review presents published evidence for patch testing prior to surgery and proposes tentative diagnostic criteria which clinicians can rely on in the work-up of patients with putative allergic complications following surgery. Few studies have investigated whether subjects with metal contact allergy have increased risk of developing complications following orthopaedic implant insertion. Metal allergy might in a minority increase the risk of complications caused by a delayed-type hypersensitivity reaction. At present, we do not know how to identify the subgroups of metal contact allergic patients with a potentially increased risk of complications following insertion of a metal implant. We recommend that clinicians should refrain from routine patch testing prior to surgery unless the patient has already had implant surgery with complications suspected to be allergic or has a history of clinical metal intolerance of sufficient magnitude to be of concern to the patient or a health provider. The clinical work-up of a patient suspected of having an allergic reaction to a metal implant should include patch testing and possibly in vitro testing. We propose diagnostic criteria for allergic dermatitis reactions as well as noneczematous complications caused by metal implants. © 2011 The Authors. BJD © 2011 British Association of Dermatologists.

  19. Geriatric work-up in the Nordic countries. The Nordic approach to comprehensive geriatric assessment

    DEFF Research Database (Denmark)

    Sletvold, O; Tilvis, R; Jonsson, A

    1996-01-01

    A group established by the Nordic professors of geriatrics has developed a position document presenting a shared and updated review of geriatric work-up as a way of comprehensive geriatric assessment in the Nordic countries. The main intention is that the document will serve as support and help f...... languages, and the translated versions should ideally have been subjected to validity and reliability testing. However, so far no scale meets these demands regarding all the five Nordic languages.......A group established by the Nordic professors of geriatrics has developed a position document presenting a shared and updated review of geriatric work-up as a way of comprehensive geriatric assessment in the Nordic countries. The main intention is that the document will serve as support and help...... for the clinician concerned with hospital based geriatric medicine. It may also be useful for quality control and teaching. Not least, it may be useful for health professionals other than geriatricians. To some extent, the position of geriatric medicine in the Nordic countries varies between the countries. However...

  20. Diagnostic nerve ultrasonography

    International Nuclear Information System (INIS)

    Baeumer, T.; Grimm, A.; Schelle, T.

    2017-01-01

    For the diagnostics of nerve lesions an imaging method is necessary to visualize peripheral nerves and their surrounding structures for an etiological classification. Clinical neurological and electrophysiological investigations provide functional information about nerve lesions. The information provided by a standard magnetic resonance imaging (MRI) examination is inadequate for peripheral nerve diagnostics; however, MRI neurography is suitable but on the other hand a resource and time-consuming method. Using ultrasonography for peripheral nerve diagnostics. With ultrasonography reliable diagnostics of entrapment neuropathies and traumatic nerve lesions are possible. The use of ultrasonography for neuropathies shows that a differentiation between different forms is possible. Nerve ultrasonography is an established diagnostic tool. In addition to the clinical examination and clinical electrophysiology, structural information can be obtained, which results in a clear improvement in the diagnostics. Ultrasonography has become an integral part of the diagnostic work-up of peripheral nerve lesions in neurophysiological departments. Nerve ultrasonography is recommended for the diagnostic work-up of peripheral nerve lesions in addition to clinical and electrophysiological investigations. It should be used in the clinical work-up of entrapment neuropathies, traumatic nerve lesions and spacy-occupying lesions of nerves. (orig.) [de

  1. How should we work up a patient with chronic diarrhea and are ...

    African Journals Online (AJOL)

    This review addresses two clinical situations medical practitioners see frequently; in the first scenario an appropriate cost-efficient diagnostic approach is described and in the second situation the uncertainty regarding a therapeutic choice is elucidated.

  2. Surgical Assisting

    Science.gov (United States)

    ... instruction, including: Microbiology Pathophysiology Pharmacology Anatomy and physiology Medical terminology Curriculum . Course content includes: Advanced surgical anatomy Surgical microbiology Surgical pharmacology Anesthesia methods and agents Bioscience Ethical ...

  3. No Value for Routine Chest Radiography in the Work-Up of Early Stage Cervical Cancer Patients

    Science.gov (United States)

    Hoogendam, Jacob P.; Zweemer, Ronald P.; Verkooijen, Helena M.; de Jong, Pim A.; van den Bosch, Maurice A. A. J.; Verheijen, René H. M.; Veldhuis, Wouter B.

    2015-01-01

    Aim Evidence supporting the recommendation to include chest radiography in the work-up of all cervical cancer patients is limited. We investigated the diagnostic value of routine chest radiography in cervical cancer staging. Methods All consecutive cervical cancer patients who presented at our tertiary referral center in the Netherlands (January 2006 – September 2013), and for whom ≥6 months follow-up was available, were included. As part of the staging procedure, patients underwent a routine two-directional digital chest radiograph. Findings were compared to a composite reference standard consisting of all imaging studies and histology obtained during the 6 months following radiography. Results Of the 402 women who presented with cervical cancer, 288 (71.6%) underwent chest radiography and had ≥6 months follow-up. Early clinical stage (I/II) cervical cancer was present in 244/288 (84.7%) women, while 44 (15.3%) presented with advanced disease (stage III/IV). The chest radiograph of 1 woman – with advanced pre-radiograph stage (IVA) disease – showed findings consistent with pulmonary metastases. Radiographs of 7 other women – 4 early, 3 advanced stage disease – were suspicious for pulmonary metastases which was confirmed by additional imaging in only 1 woman (with pre-radiograph advanced stage (IIIB) disease) and excluded in 6 cases, including all women with early stage disease. In none of the 288 women were thoracic skeletal metastases identified on imaging or during 6 months follow up. Radiography was unremarkable in 76.4% of the study population, and showed findings unrelated to the cervical carcinoma in 21.2%. Conclusion Routine chest radiography was of no value for any of the early stage cervical cancer patients presenting at our tertiary center over a period of 7.7 years. PMID:26135733

  4. Abortion - surgical

    Science.gov (United States)

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  5. Histologic work-up of non-palpable breast lesions classified as probably benign at initial mammography and/or ultrasound (BI-RADS category 3).

    Science.gov (United States)

    Gruber, R; Jaromi, S; Rudas, M; Pfarl, G; Riedl, C C; Flöry, D; Graf, O; Sickles, E A; Helbich, T H

    2013-03-01

    To determine the accuracy of a probably benign assessment of non-palpable breast lesions (BI-RADS category 3) at mammography and/or ultrasound with immediate histological work-up. Stereotactic or ultrasound guided core needle breast biopsy (NBB) was performed to evaluate 288 lesions, which were prospectively assessed as BI-RADS category 3. Imaging findings included 195 masses, 73 calcification cases, 16 focal asymmetries, and four architectural distortion cases. After NBB, patients underwent either open surgical biopsy (OSB) (n=204) or mammographic follow-up (n=84) for at least 24 months. Histological results of NBB were compared with those of OSB. Three of the 288 lesions (1.0%) proved to be malignant at histological work-up, two of them were ductal carcinoma in situ (DCIS) and one of them was an invasive carcinoma. NBB revealed invasive carcinoma in 1/288 (0.35%) and atypical ductal hyperplasia (ADH) in 13/288 (4.5%) lesions. OSB revealed DCIS in 2/204 (1%) and invasive carcinoma in 1/204 (0.5%) lesions. The two DCIS were underestimated as ADH by NBB. The remaining 285 (99%) lesions proved to be benign at OSB or remained stable during follow-up. Confirmed by tissue diagnosis, the low likelihood of malignancy of prospectively assessed probably benign lesions is below the 2% threshold established for BI-RADS category 3. Imaging follow-up is a safe and effective alternative to immediate histological work-up for such lesions. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  6. Symptomatology, Clinical Presentation and Basic Work up in Patients with Suspected Pulmonary Embolism

    DEFF Research Database (Denmark)

    Madsen, Poul Henning; Hess, Søren

    2017-01-01

    Basic knowledge of pulmonary embolism is relevant to most practicing physicians. Many medical specialties care for patients with increased risk of pulmonary embolism, why recognition of relevant symptoms, a thorough medical history, assessment of the clinical condition of the patient and possibly......-ray and biochemical analyses are appropriate. In addition, lung ultrasound and echocardiography are indicated in many of these patients. The information available from the medical history, clinical assessment and basic investigation form the basis on which the decision about further diagnostic imaging and intensity...... of treatment and monitoring can be made. These decisions can be guided by clinical scoring systems like the Wells score, revised Geneva score and the PESI....

  7. [Diagnostic validity of the intraoperative analysis in frozen section of the sentinel lymph node in the surgical management of breast cancer].

    Science.gov (United States)

    Bañuelos-Andrío, Luis; Rodríguez-Caravaca, Gil; Argüelles-Pintos, Miguel; Mitjavilla-Casanovas, Mercedes

    2014-01-01

    The method for intraoperative sentinel lymph node (SLN) evaluation has still not been established in breast cancer staging. This study has evaluated the diagnostic validity and impact of intraoperative analysis using the frozen section (FS) of SLN. We performed a descriptive study of the diagnostic validity of the FS of the SLN in patients with breast cancer and selective sentinel node biopsy (SSNB) from October-2006 to October-2012. The diagnostic validity indexes were evaluated using sensitivity, specificity, positive and negative predictive values and global value. Gold standard was considered as the final histopathological results of the biopsies. A total of 370 patients were studied. Sensitivity and specificity for detection of metastasis by FS in the SLN were 67% and 100%, respectively. Global diagnostic validity was 95%. There was a correlation between detection of metastasis and tumor size (pcancer. FS reduces the need for second interventions, at least for most patients who have breast cancer with identifiable positive SLN and unequivocal evidence of positive lymph node disease. Copyright © 2013 Elsevier España, S.L. and SEMNIM. All rights reserved.

  8. Surgical lighting

    NARCIS (Netherlands)

    Knulst, A.J.

    2017-01-01

    The surgical light is an important tool for surgeons to create and maintain good visibility on the surgical task. Chapter 1 gives background to the field of (surgical) lighting and related terminology. Although the surgical light has been developed strongly since its introduction a long time ago,

  9. Optimization of diagnostic imaging use in patients with acute abdominal pain (OPTIMA): Design and rationale

    NARCIS (Netherlands)

    Laméris, Wytze; van Randen, Adrienne; Dijkgraaf, Marcel G. W.; Bossuyt, Patrick M. M.; Stoker, Jaap; Boermeester, Marja A.

    2007-01-01

    ABSTRACT: BACKGROUND: The acute abdomen is a frequent entity at the Emergency Department (ED), which usually needs rapid and accurate diagnostic work-up. Diagnostic work-up with imaging can consist of plain X-ray, ultrasonography (US), computed tomography (CT) and even diagnostic laparoscopy.

  10. Surgical Removal of a Canine Aortic Thromboembolism Secondary to Pancreatitis

    Directory of Open Access Journals (Sweden)

    Jill Narak

    2015-01-01

    Full Text Available A 7-year-old castrated male Pomeranian was evaluated on emergency for diagnostic work-up and treatment for acute nonpainful paraparesis. The neurologic examination suggested a L4-S3 myelopathy, but physical examination revealed lack of femoral pulses and rectal hypothermia, as well as a grade II/VI systolic heart murmur, so ischemic neuromyopathy was suspected. Clinicopathologic analysis revealed increased muscle enzymes and proteinuria. Abdominal ultrasonography confirmed aortic thromboembolism (ATE, and surgical histopathology diagnosed necrotizing pancreatitis. Surgical aortic thrombectomy was performed, and antithrombotic therapy was instituted. Pancreatitis was treated supportively. The dog was discharged to the owners after 10 days of hospitalization. Recheck examination 6 weeks after initial presentation revealed a normal neurologic examination and normal femoral pulses. The patient has had no further bouts of pancreatitis and remains neurologically normal 5 years after initial presentation. Canine ATE is relatively rare compared to the feline counterpart. Directed therapy for feline ATE is often not recommended, as underlying conditions are oftentimes ultimately fatal. Underlying etiologies for canine ATE include cardiovascular disease and endocrinopathies, but canine ATE secondary to pancreatitis has not yet been reported. Surgical removal of aortic thromboembolus should be considered as curative for pelvic limb dysfunction in the canine patient without a terminal underlying disease.

  11. Is Whole-Body Computed Tomography the Standard Work-up for Severely-Injured Children? Results of a Survey among German Trauma Centers.

    Science.gov (United States)

    Bayer, J; Reising, K; Kuminack, K; Südkamp, N P; Strohm, P C

    2015-01-01

    Whole-body computed tomography is accepted as the standard procedure in the primary diagnostic of polytraumatised adults in the emergency room. Up to now there is still controversial discussion about the same algorithm in the primary diagnostic of children. The aim of this study was to survey the participation of German trauma-centres in the care of polytraumatised children and the hospital dependant use of whole-body computed tomography for initial patient work-up. A questionnaire was mailed to every Department of Traumatology registered in the DGU (German Trauma Society) databank. We received 60,32% of the initially sent questionnaires and after applying exclusion criteria 269 (53,91%) were applicable to statistical analysis. In the three-tiered German hospital system no statistical difference was seen in the general participation of children polytrauma care between hospitals of different tiers (p = 0.315). Even at the lowest hospital level 69,47% of hospitals stated to participate in polytrauma care for children, at the intermediate and highest level hospitals 91,89% and 95,24% stated to be involved in children polytrauma care, respectively. Children suspicious of multiple injuries or polytrauma received significantly fewer primary whole-body CTs in lowest level compared to intermediate level hospitals (36,07% vs. 56,57%; p = 0.015) and lowest level compared to highest level hospitals (36,07% vs. 68,42%; p = 0.001). Comparing the use of whole-body CT in intermediate to highest level hospitals a not significant increase in its use could be seen in highest level hospitals (56,57% vs. 68,42%; p = 0.174). According to our survey, taking care of polytraumatised children in Germany is not limited to specialised hospitals or a defined hospital level-of-care. Additionally, there is no established radiologic standard in work-up of the polytraumatised child. However, in higher hospital care -levels a higher percentage of hospitals employs whole-body CTs for primary

  12. The diagnostic utility of 3D-ESI rotating and moving dipole methodology in the pre-surgical evaluation of MRI-negative childhood epilepsy due to focal cortical dysplasia.

    Science.gov (United States)

    Russo, Angelo; Lallas, Matt; Jayakar, Prasanna; Miller, Ian; Hyslop, Ann; Dunoyer, Catalina; Resnick, Trevor; Duchowny, Michael

    2016-09-01

    This study investigates whether a combined rotating dipole (RD) and moving dipole (MD) solution enhances three-dimensional electroencephalography (EEG) source imaging (3D-ESI) localization in magnetic resonance imaging (MRI)-negative pediatric patients with focal cortical dysplasia (FCD). We retrospectively selected 14 MRI-negative patients with FCD from a cohort of 60 pediatric patients previously used to evaluate the diagnostic utility of 3D-ESI in epilepsy surgery. Patients were younger than 18 years at time of surgery and had at least 1 year of outcome data. RD and MD models were constructed for each interictal spike or sharp wave, and it was determined whether each inverse algorithm localized within the surgical resection cavity (SRC). We also compared the 3D-ESI findings and surgical outcome with positron emission tomography (PET) and ictal single photon emission computed tomography (iSPECT). RD analyses revealed a high concordance with the SRC (78.6%), particularly for temporal lobe resection (100.0%), and showed superior localization compared to PET and iSPECT, with the highest correlation in FCD type I and temporal lobe resection. Furthermore, the RD method was superior to iSPECT in FCD type II cases and to PET in extratemporal resections. RD and MD results were comparable, but in 18.2% of patients with FCD type I with localizing RDs, the MD solution was only partially within the SRC; in all of these patients 3D-ESI also correlated with superior surgical outcome compared to PET and iSPECT, especially when RD and MD solutions were analyzed together. 3D-ESI in MRI-negative cases showed superior localization compared to iSPECT or PET, especially in FCD type I and temporal lobe epilepsy, and correlated with superior surgical outcome compared to iSPECT and PET at 1 year and 2 years postoperatively, especially when RD and MD solutions were analyzed together. These findings suggest that 3D-ESI based on a combined RD-MD solution improves surgical accuracy in

  13. Is a Double Contrast Barium Enema Necessary in Patients who Undergo a CT Colonography as a Preoperative Work-up?

    International Nuclear Information System (INIS)

    Lee, Ji Won; Lee, Soon Jin; Choi, Dong Il; Kim, Hee Jung; Chun, Ho Kyung; Yun, Seong Hyeon; Jeon, Yong Hwan; Park, Seung Bae; Kim, Min Ju

    2009-01-01

    To determine the efficiency of CT colonography (CTC), as compared with the double contrast barium enema (DCBE) for the preoperative work-up of colorectal neoplasms. A total of 39 patients underwent both a CTC and DCBE before surgery. Three abdominal radiologists and three colorectal surgeons retrospectively reviewed virtual double contrast (VDC) and DCBE images, regarding each examination for localization, conspicuity, extent and morphology of neoplasms. We reviewed the radiological reports of the CTC and DCBE for the polyps. In the case of both VDC and DCBE, 40 cancers were detected in 39 patients. According to abdominal radiologists, VDC showed the same ability to identify DCBE for localization of neoplasms (p 0.05). The performance of the CTC is comparable to the DCBE for the localization of main mass and polyps in patients with colorectal neoplasm. Barium enema don't seem to be necessary for patients who undergo a CTC as preoperative work-up

  14. Surgical evaluation of acute abdomen in pregnancy

    International Nuclear Information System (INIS)

    Kovarova, P.

    2013-01-01

    Acute abdomen in pregnancy is a disease with a low incidence. The purpose of this work was therefore to create a review of current recommended practice in diagnostics and surgical solution. I also mention surgically relevant physiological and pathological changes specific to pregnancy, differential diagnostics of acute abdomen in pregnancy and impact of the disease and its treatment on the fetus. (author)

  15. Surgical smoke.

    Science.gov (United States)

    Fan, Joe King-Man; Chan, Fion Siu-Yin; Chu, Kent-Man

    2009-10-01

    Surgical smoke is the gaseous by-product formed during surgical procedures. Most surgeons, operating theatre staff and administrators are unaware of its potential health risks. Surgical smoke is produced by various surgical instruments including those used in electrocautery, lasers, ultrasonic scalpels, high speed drills, burrs and saws. The potential risks include carbon monoxide toxicity to the patient undergoing a laparoscopic operation, pulmonary fibrosis induced by non-viable particles, and transmission of infectious diseases like human papilloma virus. Cytotoxicity and mutagenicity are other concerns. Minimisation of the production of surgical smoke and modification of any evacuation systems are possible solutions. In general, a surgical mask can provide more than 90% protection to exposure to surgical smoke; however, in most circumstances it cannot provide air-tight protection to the user. An at least N95 grade or equivalent respirator offers the best protection against surgical smoke, but whether such protection is necessary is currently unknown.

  16. [Surgical treatment of lower digestive tract hemorrhage. Experience at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán].

    Science.gov (United States)

    García-Osogobio, Sandra; Remes-Troche, José María; Takahashi, Takeshi; Barreto Camilo, Juan; Uscanga, Luis

    2002-01-01

    Lower gastrointestinal bleeding is usually self-limiting in about 80% of cases; however, surgical treatment may be required in selected cases. Preoperative precise identification of the bleeding source is crucial for a successful outcome. To determine the most frequent diagnoses, as well as short and long-term results in a series of patients who underwent a surgical procedure for lower gastrointestinal bleeding. Retrospective analysis of 39 patients operated upon for lower gastrointestinal bleeding from 1979 through 1997 in a referral center. Demographic data, history, physical examination, laboratory tests, resuscitative measures, preoperative work-up for identification of bleeding source, definitive cause of bleeding, surgical procedure, operative morbidity and mortality, as well as long-term status and recurrence of bleeding were recorded. There were 54% women and 46% men. Mean age was 56 years (range, 15-92). Most patients presented hematochezia (69%). Colonoscopy was the most used diagnostic procedure (69%). The bleeding source was located in 90% of patients. Diverticular disease was the most frequent cause of bleeding. A segmental bowel resection was the treatment in 97% of cases. Morbidity was 23% with 18% of mortality. Recurrence occurred in 9% of survivors. Morbidity and mortality were high. Patients who require a surgical operation should be carefully selected and evaluated with a complete work-up to determine the site and cause of bleeding.

  17. English language version of the S3-consensus guidelines on chronic pancreatitis: Definition, aetiology, diagnostic examinations, medical, endoscopic and surgical management of chronic pancreatitis.

    Science.gov (United States)

    Hoffmeister, A; Mayerle, J; Beglinger, C; Büchler, M W; Bufler, P; Dathe, K; Fölsch, U R; Friess, H; Izbicki, J; Kahl, S; Klar, E; Keller, J; Knoefel, W T; Layer, P; Loehr, M; Meier, R; Riemann, J F; Rünzi, M; Schmid, R M; Schreyer, A; Tribl, B; Werner, J; Witt, H; Mössner, J; Lerch, M M

    2015-12-01

    Chronic pancreatitis is a disease of the pancreas in which recurrent inflammatory episodes result in replacement of pancreatic parenchyma by fibrous connective tissue. This fibrotic reorganization of the pancreas leads to a progressive exocrine and endocrine pancreatic insufficiency. In addition, characteristic complications arise, such as pseudocysts, pancreatic duct obstructions, duodenal obstruction, vascular complications, obstruction of the bile ducts, malnutrition and pain syndrome. Pain presents as the main symptom of patients with chronic pancreatitis. Chronic pancreatitis is a risk factor for pancreatic carcinoma. Chronic pancreatitis significantly reduces the quality of life and the life expectancy of affected patients. These guidelines were researched and compiled by 74 representatives from 11 learned societies and their intention is to serve evidence-based professional training as well as continuing education. On this basis they shall improve the medical care of affected patients in both the inpatient and outpatient sector. Chronic pancreatitis requires an adequate diagnostic workup and systematic management, given its severity, frequency, chronicity, and negative impact on the quality of life and life expectancy. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Patterns of anaphylaxis after diagnostic workup

    DEFF Research Database (Denmark)

    Oropeza, Athamaica Ruiz; Bindslev-Jensen, Carsten; Broesby-Olsen, Sigurd

    2017-01-01

    BACKGROUND: Most published studies on anaphylaxis are retrospective or register based. Data on subsequent diagnostic work-up are sparse. We aimed to characterize patients seen with suspected anaphylaxis at the emergency care setting (ECS), after subsequent diagnostic work-up at our Allergy Center...... (AC). METHODS: Prospective study including patients from the ECS, Odense University Hospital, during May 2013-April 2014. Possible anaphylaxis cases were daily identified based on a broad search profile including history and symptoms in patient records, diagnostic codes and pharmacological treatments....... At the AC, all patients were evaluated according to international guidelines. RESULTS: Among 226 patients with suspected anaphylaxis, the diagnosis was confirmed in 124 (54.9%) after diagnostic work-up; 118 of the 124 fulfilled WAO/EAACI criteria of anaphylaxis at the ECS, while 6 were found among 46...

  19. Screening vs. non-screening detected colorectal cancer: Differences in pre-therapeutic work up and treatment.

    Science.gov (United States)

    Saraste, D; Martling, A; Nilsson, P J; Blom, J; Törnberg, S; Janson, M

    2017-06-01

    Objectives To compare preoperative staging, multidisciplinary team-assessment, and treatment in patients with screening detected and non-screening detected colorectal cancer. Methods Data on patient and tumour characteristics, staging, multidisciplinary team-assessment and treatment in patients with screening and non-screening detected colorectal cancer from 2008 to 2012 were collected from the Stockholm-Gotland screening register and the Swedish Colorectal Cancer Registry. Results The screening group had a higher proportion of stage I disease (41 vs. 15%; p team-assessed than the non-screening group ( p team-assessed than patients with surgically resected cancers ( p team assessed more extensively than patients with non-screening detected cancers. Staging and multidisciplinary team assessment prior to endoscopic resection was less complete compared with surgical resection. Extensive surgical and (neo)adjuvant treatment was given in stage I disease. Participation in screening reduced the risk of emergency surgery for colorectal cancer.

  20. A single-centre experience of the implementation of adrenal vein sampling procedure: the impact on the diagnostic work-up in primary aldosteronism

    NARCIS (Netherlands)

    Kadziela, J.; Prejbisz, A.; Michalowska, I.; Kolodziejczyk-Kruk, S.; Schultze Kool, L.J.; Kabat, M.; Janaszek-Sitkowska, H.; Toutounchi, S.; Galazka, Z.; Ambroziak, U.; Bednarczuk, T.; Ptasinska-Wnuk, D.; Hoffmann, M.; Januszewicz, M.; Januszewicz, A.; Witkowski, A.

    2017-01-01

    BACKGROUND: Primary aldosteronism is one of the most common causes of secondary hypertension. Adrenal vein sampling (AVS) remains a "gold standard" procedure in differentiation between unilateral (adenoma) and bilateral (hyperplasia) disease. AIM: The aim of this study was to present our

  1. The value of FDG-PET/CT in the diagnostic work-up of extra cardiac infectious manifestations in infectious endocarditis

    DEFF Research Database (Denmark)

    Ozcan, C; Asmar, A; Gill, S

    2013-01-01

    Infectious endocarditis (IE) is a serious condition with a high morbidity and mortality. The optimal management of IE depends not only on correct antibiotic therapy and surgery when needed, but involves identification of the portal of entry and detection of extracardiac infectious manifestations...

  2. Clinical value of measurement of pulmonary radioaerosol mucociliary clearance in the work up of primary ciliary dyskinesia

    DEFF Research Database (Denmark)

    Munkholm, Mathias; Nielsen, Kim Gjerum; Mortensen, Jann

    2015-01-01

    BACKGROUND: We aimed to evaluate and define the general clinical applicability and impact of pulmonary radioaerosol mucociliary clearance (PRMC) on the work up of patients suspected of having primary ciliary dyskinesia (PCD). In addition, we wanted to evaluate the accuracy of the reference values...... primarily to results from nasal ciliary function testing, to electron microscopic (EM) examination of the ultrastructure of the cilia, and to the final clinical diagnosis. RESULTS: Of the 239 patients, 27 ended up with a final clinical diagnosis of definitive PCD. No patients with a PRMC test...... of the entire lung. Its greatest strength is its ability to reject a suspected PCD diagnosis with great certainty. In our material, this accounted for 2/3 of referred patients. In addition, the test has a high rate of conclusive results. According to our analyses, reference equations on children would benefit...

  3. Doenças pulmonares intersticiais: Acuidade diagnóstica e riscos da biópsia pulmonar cirúrgica Interstitial lung disease: Diagnostic accuracy and safety of surgical lung biopsy

    Directory of Open Access Journals (Sweden)

    Miguel Guerra

    2009-05-01

    Full Text Available Os autores descrevem a sua casuística de biópsias pulmonares cirúrgicas em doentes com doença pulmonar intersticial, de forma a determinar a acuidade diagnóstica, os riscos e a morbimortalidade associados ao procedimento. Entre Janeiro de 1998 e Dezembro de 2007, 53 doentes (idade média de 47,2±13 anos foram referenciados para a realização de biópsia pulmonar cirúrgica, dos quais 22 eram mulheres (41,5%. As biópsias pulmonares foram realizadas quer por videotoracoscopia (37 doentes, 69,8%, quer por minitoracotomia (16 doentes, 30,2%. Foi escolhido o pulmão direito para biopsar em 88,7% dos casos. Registaram-se complicações pós-operatórias em 5 doentes (9,4%: fuga aérea prolongada em 3 doentes (5,7%, persistência de loca de pneumotórax num doente (1,9% e hemorragia com necessidade de revisão de hemostase noutro doente (1,9%. Ocorreu um óbito de causa desconhecida num doente sem risco acrescido. A duração média da drenagem foi de 4,4±3 dias e o tempo de internamento médio de 5,5±4 dias. O diagnóstico histológico definitivo foi conseguido em 50 doentes, registando-se uma acuidade diagnóstica de 94,3%. Em conclusão, o potencial benefício de um diagnóstico histopatológico conclusivo através de uma biópsia pulmonar cirúrgica deve ser balanceado com os riscos associados ao procedimento cirúrgico, especialmente para aqueles doentes com disfunção cardiopulmonar severa.This study reports our experience, diagnostic accuracy and safety of surgical lung biopsy in patients with interstitial lung diseases. From January 1998 – December 2007 surgical lung biopsy was performed in 53 patients (22 female [41.5%]; age 47.2±13 years. A total of 37 patients (69.8% underwent videothoracoscopic lung biopsy and minithoracotomy was performed in 16 patients (30.2%. Right lung was the choice in 47 patients (88.7%. Postoperative complications were rare (9.4% and included three prolonged air leaks (5.7%, one pneumothorax requiring a

  4. Surgical orthodontics.

    Science.gov (United States)

    Strohl, Alexis M; Vitkus, Lauren

    2017-08-01

    The article reviews some commonly used orthodontic treatments as well as new strategies to assist in the correction of malocclusion. Many techniques are used in conjunction with surgical intervention and are a necessary compliment to orthognathic surgery. Basic knowledge of these practices will aid in the surgeon's ability to adequately treat the patient. Many orthodontists and surgeons are eliminating presurgical orthodontics to adopt a strategy of 'surgery first' orthodontics in orthognathic surgery. This has the benefit of immediate improvement in facial aesthetics and shorter treatment times. The advent of virtual surgical planning has helped facilitate the development of this new paradigm by making surgical planning faster and easier. Furthermore, using intraoperative surgical navigation is improving overall precision and outcomes. A variety of surgical and nonsurgical treatments may be employed in the treatment of malocclusion. It is important to be familiar with all options available and tailor the patient's treatment plan accordingly. Surgery-first orthodontics, intraoperative surgical navigation, virtual surgical planning, and 3D printing are evolving new techniques that are producing shorter treatment times and subsequently improving patient satisfaction without sacrificing long-term stability.

  5. Diagnostic imaging of craniopharyngioma

    International Nuclear Information System (INIS)

    Gradzki, J.; Nowak, S.; Paprzycki, W.

    1993-01-01

    40 patients have been examined with operational and histological confirmation of craniopharyngioma. CT image and X-ray plane of skull were performed in case all of these patients. TMR was conformed to examine 4 patients. X-ray planes was compared to CT. CT permits tumor cyst detection. The efficacy of mentioned above diagnostic techniques was compared with surgical findings. (author)

  6. A "package solution" fast track program can reduce the diagnostic waiting time in head and neck cancer

    DEFF Research Database (Denmark)

    Sørensen, Jesper Roed; Johansen, Jørgen; Gano, Lars

    2014-01-01

    and Neck Surgery during three comparable time intervals 2006-2007, 2007-2008, and 2011-2012 (groups 1-3) were investigated. We recorded the time from patient referral, to first consultation and final diagnosis. The first interval was before initiation of the "package solution", the second just after......In 2007, a fast track program for patients with suspicion of head and neck cancer (HNC) was introduced in Denmark to reduce unnecessary waiting time. The program was based on so called "package solutions" including pre-booked slots for outpatient evaluation, imaging, and diagnostic surgical...... procedures. The purpose of this study is to present a model for fast track handling of patients suspicious of cancer in the head and neck region and to evaluate the effect of implementation on the diagnostic work up time. Patients with suspicion of HNC referred to the same university department of ENT Head...

  7. The role of PET in staging work-up and evaluation after therapy in patients with malignant lymphoma

    International Nuclear Information System (INIS)

    Kang, Yoon Koo; Ryoo, Baek Yeol

    1998-12-01

    The stage of disease in patients with malignant lymphoma in important in decision of treatment modality and in prediction of prognosis. The authors evaluated the usefulness of PET with F18-FDG in initial staging, in reevaluation after radical therapy and in diagnosis of recurrence or disease progression of malignant lymphoma, compared with conventional imaging studies. The efficacy of positron emission tomography (PET) with fluorine-18-fluorodeoxyglucose (F18-FDG) was evaluated in several tumors. In malignant lymphoma. It was reported that the concentration of FDG was increased in tumor tissues, and that PET with F18-FDG was more sensitive and specific in staging evaluation compared with CT scan. The visual analysis of FDG-PET would be helpful in initial staging work-up, in reevaluation of residual disease after radical therapy and in suspicious recurrence or disease progression, determining the residual disease of lymphoma after radical therapy. But more studies with larger number of cases and longer follow-up were required. The results of this study can be bases for the direction of future studies for the usefulness of PET in malignant lymphoma

  8. Clinical value of Tl per rectum scintigraphy in the work-up of patients with alcoholic liver disease

    Energy Technology Data Exchange (ETDEWEB)

    Urbain, D.; Reding, P.; Georges, B.; Thys, O.; Ham, H.R.

    1986-09-01

    The clinical value of thallium 201 per rectum scintigraphy in the work-up of patients with alcoholic liver disease was evaluated using data obtained in 104 patients. The 25th min ratio of heart to liver activities was used as an index of portal systemic shunting. This ratio was found to be normal in alcoholic patients with normal liver biopsy and also in those presenting only steatosis. It was slightly higher in patients with liver fibrosis and significantly higher values were observed in patients with liver cirrhosis. High values of the ratio were associated with a higher risk of portal systemic encephalopathy and/or gastrointestinal bleeding. The prognostic value of the test was supported by the fact that good correlations were observed between the ratio and widely accepted prognostic scores such as the Child score or the Orrego index. Moreover, high ratios were associated with an increased mortality risk at one year. We conclude that this simple test is interesting in the screening of cirrhotics at risk of encephalopathy, gastrointestinal hemorrhage, or early death.

  9. The clinical value of 201Tl per rectum scintigraphy in the work-up of patients with alcoholic liver disease

    International Nuclear Information System (INIS)

    Urbain, D.; Reding, P.; Georges, B.; Thys, O.; Ham, H.R.; Vrije Univ., Brussels

    1986-01-01

    The clinical value of thallium 201 per rectum scintigraphy in the work-up of patients with alcoholic liver disease was evaluated using data obtained in 104 patients. The 25th min ratio of heart to liver activities was used as an index of portal systemic shunting. This ratio was found to be normal in alcoholic patients with normal liver biopsy and also in those presenting only steatosis. It was slightly higher in patients with liver fibrosis and significantly higher values were observed in patients with liver cirrhosis. High values of the ratio were associated with a higher risk of portal systemic encephalopathy and/or gastrointestinal bleeding. The prognostic value of the test was supported by the fact that good correlations were observed between the ratio and widely accepted prognostic scores such as the Child score or the Orrego index. Moreover, high ratios were associated with an increased mortality risk at one year. We conclude that this simple test is interesting in the screening of cirrhotics at risk of encephalopathy, gastrointestinal hemorrhage, or early death. (orig.)

  10. Surgical competence.

    Science.gov (United States)

    Patil, Nivritti G; Cheng, Stephen W K; Wong, John

    2003-08-01

    Recent high-profile cases have heightened the need for a formal structure to monitor achievement and maintenance of surgical competence. Logbooks, morbidity and mortality meetings, videos and direct observation of operations using a checklist, motion analysis devices, and virtual reality simulators are effective tools for teaching and evaluating surgical skills. As the operating theater is also a place for training, there must be protocols and guidelines, including mandatory standards for supervision, to ensure that patient care is not compromised. Patients appreciate frank communication and honesty from surgeons regarding their expertise and level of competence. To ensure that surgical competence is maintained and keeps pace with technologic advances, professional registration bodies have been promoting programs for recertification. They evaluate performance in practice, professional standing, and commitment to ongoing education.

  11. Is thyroid hormones evaluation of clinical value in the work-up of males of infertile couples?

    Science.gov (United States)

    Lotti, F; Maseroli, E; Fralassi, N; Degl'Innocenti, S; Boni, L; Baldi, E; Maggi, M

    2016-03-01

    Is thyroid hormones (TH) evaluation of clinical value in the work-up of males of infertile couples? Our results suggest that TH evaluation is not mandatory in the work-up of male infertility. A few previous studies performed on a limited series of subjects reported a negative impact of hyper- and hypo-thyroidism on semen volume, sperm concentration, progressive motility and normal morphology. No previous study has systematically evaluated associations between TH variation, semen parameters and ultrasound characteristics of the male genital tract. Cross-sectional analysis of a consecutive series of 172 subjects seeking medical care for couple infertility from September 2010 to November 2014. Of the entire cohort, 163 men (age 38.9 ± 8.0 years) free of genetic abnormalities were studied. All subjects underwent a complete andrological and physical examination, biochemical and hormonal assessment, scrotal and transrectal colour-Doppler ultrasound (CDUS) and semen analysis (including seminal interleukin 8 levels, sIL-8) evaluation within the same day. Among the patients studied, 145 (88.9%) showed euthyroidism, 6 (3.7%) subclinical hyper- and 12 (7.4%) subclinical hypo-thyroidism. No subjects showed overt hyper- or hypo-thyroidism. At univariate analysis, no associations among thyroid-stimulating hormone (TSH) or TH levels and sperm parameters were observed. Conversely, we observed positive associations among free triiodothyronine (fT3) and free thyroxine (fT4) levels, ejaculate volume and seminal fructose levels. In a multivariate model, after adjusting for confounders such as age, body mass index, smoking habit, sexual abstinence, calculated free testosterone, prolactin and sIL-8 levels, only the associations found for fT3 levels were confirmed. When CDUS features were investigated, using the same multivariate model, we found positive associations between fT3 levels and seminal vesicles (SV) volume, both before and after ejaculation (adj. r = 0.354 and adj. r = 0

  12. Validating the Modified Drug Adherence Work-Up (M-DRAW) Tool to Identify and Address Barriers to Medication Adherence.

    Science.gov (United States)

    Lee, Sun; Bae, Yuna H; Worley, Marcia; Law, Anandi

    2017-09-08

    Barriers to medication adherence stem from multiple factors. An effective and convenient tool is needed to identify these barriers so that clinicians can provide a tailored, patient-centered consultation with patients. The Modified Drug Adherence Work-up Tool (M-DRAW) was developed as a 13-item checklist questionnaire to identify barriers to medication adherence. The response scale was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often). The checklist was accompanied by a GUIDE that provided corresponding motivational interview-based intervention strategies for each identified barrier. The current pilot study examined the psychometric properties of the M-DRAW checklist (reliability, responsiveness and discriminant validity) in patients taking one or more prescription medication(s) for chronic conditions. A cross-sectional sample of 26 patients was recruited between December 2015 and March 2016 at an academic medical center pharmacy in Southern California. A priming question that assessed self-reported adherence was used to separate participants into the control group of 17 "adherers" (65.4%), and into the intervention group of nine "unintentional and intentional non-adherers" (34.6%). Comparable baseline characteristics were observed between the two groups. The M-DRAW checklist showed acceptable reliability (13 item; alpha = 0.74) for identifying factors and barriers leading to medication non-adherence. Discriminant validity of the tool and the priming question was established by the four-fold number of barriers to adherence identified within the self-selected intervention group compared to the control group (4.4 versus 1.2 barriers, p tool will include construct validation.

  13. Validating the Modified Drug Adherence Work-Up (M-DRAW Tool to Identify and Address Barriers to Medication Adherence

    Directory of Open Access Journals (Sweden)

    Sun Lee

    2017-09-01

    Full Text Available Barriers to medication adherence stem from multiple factors. An effective and convenient tool is needed to identify these barriers so that clinicians can provide a tailored, patient-centered consultation with patients. The Modified Drug Adherence Work-up Tool (M-DRAW was developed as a 13-item checklist questionnaire to identify barriers to medication adherence. The response scale was a 4-point Likert scale of frequency of occurrence (1 = never to 4 = often. The checklist was accompanied by a GUIDE that provided corresponding motivational interview-based intervention strategies for each identified barrier. The current pilot study examined the psychometric properties of the M-DRAW checklist (reliability, responsiveness and discriminant validity in patients taking one or more prescription medication(s for chronic conditions. A cross-sectional sample of 26 patients was recruited between December 2015 and March 2016 at an academic medical center pharmacy in Southern California. A priming question that assessed self-reported adherence was used to separate participants into the control group of 17 “adherers” (65.4%, and into the intervention group of nine “unintentional and intentional non-adherers” (34.6%. Comparable baseline characteristics were observed between the two groups. The M-DRAW checklist showed acceptable reliability (13 item; alpha = 0.74 for identifying factors and barriers leading to medication non-adherence. Discriminant validity of the tool and the priming question was established by the four-fold number of barriers to adherence identified within the self-selected intervention group compared to the control group (4.4 versus 1.2 barriers, p < 0.05. The current study did not investigate construct validity due to small sample size and challenges on follow-up with patients. Future testing of the tool will include construct validation.

  14. Surgical Navigation

    DEFF Research Database (Denmark)

    Azarmehr, Iman; Stokbro, Kasper; Bell, R. Bryan

    2017-01-01

    Purpose: This systematic review investigates the most common indications, treatments, and outcomes of surgical navigation (SN) published from 2010 to 2015. The evolution of SN and its application in oral and maxillofacial surgery have rapidly developed over recent years, and therapeutic indicatio...

  15. Surgical Instrument

    NARCIS (Netherlands)

    Dankelman, J.; Horeman, T.

    2009-01-01

    The present invention relates to a surgical instrument for minimall-invasive surgery, comprising a handle, a shaft and an actuating part, characterised by a gastight cover surrounding the shaft, wherein the cover is provided with a coupler that has a feed- through opening with a loskable seal,

  16. Diagnostic nerve ultrasonography; Diagnostische Nervensonographie

    Energy Technology Data Exchange (ETDEWEB)

    Baeumer, T. [Universitaet zu Luebeck CBBM, Haus 66, Institut fuer Neurogenetik, Luebeck (Germany); Grimm, A. [Universitaetsklinikum Tuebingen, Klinik und Poliklinik fuer Neurologie, Tuebingen (Germany); Schelle, T. [Staedtisches Klinikum Dessau, Neurologische Klinik, Dessau (Germany)

    2017-03-15

    For the diagnostics of nerve lesions an imaging method is necessary to visualize peripheral nerves and their surrounding structures for an etiological classification. Clinical neurological and electrophysiological investigations provide functional information about nerve lesions. The information provided by a standard magnetic resonance imaging (MRI) examination is inadequate for peripheral nerve diagnostics; however, MRI neurography is suitable but on the other hand a resource and time-consuming method. Using ultrasonography for peripheral nerve diagnostics. With ultrasonography reliable diagnostics of entrapment neuropathies and traumatic nerve lesions are possible. The use of ultrasonography for neuropathies shows that a differentiation between different forms is possible. Nerve ultrasonography is an established diagnostic tool. In addition to the clinical examination and clinical electrophysiology, structural information can be obtained, which results in a clear improvement in the diagnostics. Ultrasonography has become an integral part of the diagnostic work-up of peripheral nerve lesions in neurophysiological departments. Nerve ultrasonography is recommended for the diagnostic work-up of peripheral nerve lesions in addition to clinical and electrophysiological investigations. It should be used in the clinical work-up of entrapment neuropathies, traumatic nerve lesions and spacy-occupying lesions of nerves. (orig.) [German] Fuer die Diagnostik von Nervenlaesionen ist ein bildgebendes Verfahren zur Darstellung des peripheren Nervs und seiner ihn umgebenden Strukturen fuer eine aetiologische Einordnung erforderlich. Mit der klinisch-neurologischen Untersuchung und Elektrophysiologie ist eine funktionelle Aussage ueber die Nervenlaesion moeglich. In der Standard-MRT-Untersuchung wird der periphere Nerv nur unzureichend gut dargestellt. Die MRT-Neurographie ist ein sehr gutes, aber auch zeit- und ressourcenintensives Verfahren. Nutzung des Ultraschalls fuer die

  17. NON-INVASIVE METHODS OF THE WORK-UP FOR ASSESSMENT OF MORPHOLOGIC AND FUNCTIONAL STATE OF THE SIGMOID WALL

    Directory of Open Access Journals (Sweden)

    A. E. Mashkov

    2015-01-01

    Full Text Available Background: Prolonged colonic congestion in children with chronic constipation and dolichosigma are characterized  by a permanent imbalance of gut microflora, secondary inflammation and degeneration of the sigmoid wall. There is plenty of research papers on the optic non-invasive diagnostics in medicine, based on spectrophotometry and laser spectral analysis. Aim: To study morphologic and functional state  of the sigmoid wall for detection of inflammation  and  degeneration in the  sigmoid  wall and  optimization  of treatment of children with dolichosigma  and long-standing constipation. Materials and methods: From 2009 to 2014, 30 children with dolichosigma  were seen in the Department of Pediatric surgery of MONIKI. All patients  were  hospitalized  after unsuccessful conservative  treatment in in-patient  clinics of the Moscow Region. The children underwent a set of investigations  for objective assessment of degree of the secondary  inflammatory and degenerative abnormalities  in the sigmoid wall, such as microbiological assessment, cytological assessment and fluorescent  diagnostics.  Results:  There  was  no   caused  by dolichosigma. It maintains  chronic inflammation  and  may play an indirect  role in abnormalities  of gut  motor  function. Inflammatory and  degenerative abnormalities  were  confirmed by a cytological investigation  of wall-adjacent biopsy of the  sigma. The results of the  complex assessment showed  moderate inflammation  and degeneration in the  sigmoid wall in 20 children; subsequent conservative treatment of chronic colostasis was effective. Ten children had advanced secondary inflammatory and degenerative abnormalities of the  sigmoid  wall, with high  levels of elastin and collagen in the colon wall. Surgery was performed in 6 children with the highest degree of fibrous transformation of the sigma. Conclusion: Complex assessment of the sigmoid wall, including

  18. Additive value of amyloid-PET in routine cases of clinical dementia work-up after FDG-PET

    International Nuclear Information System (INIS)

    Brendel, Matthias; Schnabel, Jonas; Wagner, Leonie; Brendel, Eva; Meyer-Wilmes, Johanna; Unterrainer, Marcus; Schoenecker, Sonja; Prix, Catharina; Ackl, Nibal; Schildan, Andreas; Patt, Marianne; Barthel, Henryk; Sabri, Osama; Catak, Cihan; Pogarell, Oliver; Levin, Johannes; Danek, Adrian; Buerger, Katharina; Bartenstein, Peter; Rominger, Axel

    2017-01-01

    In recent years, several [ 18 F]-labeled amyloid-PET tracers have been developed and have obtained clinical approval. Despite their widespread scientific use, studies in routine clinical settings are limited. We therefore investigated the impact of [ 18 F]-florbetaben (FBB)-PET on the diagnostic management of patients with suspected dementia that was still unclarified after [ 18 F]-fluordeoxyglucose (FDG)-PET. All subjects were referred in-house with a suspected dementia syndrome due to neurodegenerative disease. After undergoing an FDG-PET exam, the cases were discussed by the interdisciplinary dementia board, where the most likely diagnosis as well as potential differential diagnoses were documented. Because of persistent diagnostic uncertainty, the patients received an additional FBB-PET exam. Results were interpreted visually and classified as amyloid-positive or amyloid-negative, and we then compared the individual clinical diagnoses before and after additional FBB-PET. A total of 107 patients (mean age 69.4 ± 9.7y) were included in the study. The FBB-PET was rated as amyloid-positive in 65/107. In 83% of the formerly unclear cases, a final diagnosis was reached through FBB-PET, and the most likely prior diagnosis was changed in 28% of cases. The highest impact was observed for distinguishing Alzheimer's dementia (AD) from fronto-temporal dementia (FTLD), where FBB-PET altered the most likely diagnosis in 41% of cases. FBB-PET has a high additive value in establishing a final diagnosis in suspected dementia cases when prior investigations such as FDG-PET are inconclusive. The differentiation between AD and FTLD was particularly facilitated by amyloid-PET, predicting a considerable impact on patient management, especially in the light of upcoming disease-modifying therapies. (orig.)

  19. Additive value of amyloid-PET in routine cases of clinical dementia work-up after FDG-PET

    Energy Technology Data Exchange (ETDEWEB)

    Brendel, Matthias; Schnabel, Jonas; Wagner, Leonie; Brendel, Eva; Meyer-Wilmes, Johanna; Unterrainer, Marcus [University Hospital, LMU Munich, Department of Nuclear Medicine, Munich (Germany); Schoenecker, Sonja; Prix, Catharina; Ackl, Nibal [University Hospital, LMU Munich, Department of Neurology, Munich (Germany); Schildan, Andreas; Patt, Marianne; Barthel, Henryk; Sabri, Osama [University of Leipzig, Department of Nuclear Medicine, Leipzig (Germany); Catak, Cihan [Klinikum der Universitaet Muenchen, Institute for Stroke and Dementia Research, Munich (Germany); Pogarell, Oliver [University Hospital, LMU Munich, Department of Psychiatry, Munich (Germany); Levin, Johannes; Danek, Adrian [University Hospital, LMU Munich, Department of Neurology, Munich (Germany); DZNE - German Center for Neurodegenerative Diseases, Munich (Germany); Buerger, Katharina [Klinikum der Universitaet Muenchen, Institute for Stroke and Dementia Research, Munich (Germany); DZNE - German Center for Neurodegenerative Diseases, Munich (Germany); Bartenstein, Peter; Rominger, Axel [University Hospital, LMU Munich, Department of Nuclear Medicine, Munich (Germany); Munich Cluster for Systems Neurology (SyNergy), Munich (Germany)

    2017-12-15

    In recent years, several [{sup 18}F]-labeled amyloid-PET tracers have been developed and have obtained clinical approval. Despite their widespread scientific use, studies in routine clinical settings are limited. We therefore investigated the impact of [{sup 18}F]-florbetaben (FBB)-PET on the diagnostic management of patients with suspected dementia that was still unclarified after [{sup 18}F]-fluordeoxyglucose (FDG)-PET. All subjects were referred in-house with a suspected dementia syndrome due to neurodegenerative disease. After undergoing an FDG-PET exam, the cases were discussed by the interdisciplinary dementia board, where the most likely diagnosis as well as potential differential diagnoses were documented. Because of persistent diagnostic uncertainty, the patients received an additional FBB-PET exam. Results were interpreted visually and classified as amyloid-positive or amyloid-negative, and we then compared the individual clinical diagnoses before and after additional FBB-PET. A total of 107 patients (mean age 69.4 ± 9.7y) were included in the study. The FBB-PET was rated as amyloid-positive in 65/107. In 83% of the formerly unclear cases, a final diagnosis was reached through FBB-PET, and the most likely prior diagnosis was changed in 28% of cases. The highest impact was observed for distinguishing Alzheimer's dementia (AD) from fronto-temporal dementia (FTLD), where FBB-PET altered the most likely diagnosis in 41% of cases. FBB-PET has a high additive value in establishing a final diagnosis in suspected dementia cases when prior investigations such as FDG-PET are inconclusive. The differentiation between AD and FTLD was particularly facilitated by amyloid-PET, predicting a considerable impact on patient management, especially in the light of upcoming disease-modifying therapies. (orig.)

  20. The level of diagnostic assessment in severe asthma

    DEFF Research Database (Denmark)

    von Bulow, Anna; Backer, Vibeke; Bodtger, Uffe

    2017-01-01

    INTRODUCTION: Systematic assessment of patients with severe asthma is pivotal to decide which patients are eligible to new biological therapies. However, the level of diagnostic work-up in patients with severe asthma is only poorly investigated. AIMS & OBJECTIVES: To describe the diagnostic work-...

  1. Clinical impact of 18F-FDG-PET/CT in the extra cardiac work-up of patients with infective endocarditis

    DEFF Research Database (Denmark)

    Asmar, Ali; Ozcan, Cengiz; Diederichsen, Axel C P

    2014-01-01

    OBJECTIVE: The purpose of this study was to assess the clinical importance of (18)F-FDG-PET/CT used in the extra cardiac work-up of patients with infective endocarditis (IE). BACKGROUND: IE is a serious condition with a significant mortality. Besides the degree of valvular involvement, the progno......OBJECTIVE: The purpose of this study was to assess the clinical importance of (18)F-FDG-PET/CT used in the extra cardiac work-up of patients with infective endocarditis (IE). BACKGROUND: IE is a serious condition with a significant mortality. Besides the degree of valvular involvement...

  2. Radiological diagnostics in hyperparathyroidism

    International Nuclear Information System (INIS)

    Moedder, U.; Kuhn, F.P.; Gruetzner, G.

    1991-01-01

    The most important radiologically detectable effects of the primary and secondary hyperparathyroidism of the skeletal system and the periarticular soft tissue structures are presented. In the following sensitivity and specificity of radiological imaging - sonography, scintigraphy, computed tomography, magnetic resonance imaging, arteriography and selective venous sampling - in the preoperative diagnostic of the parathyroid adenomas are discussed. Therefore, radiological imaging can be omitted before primary surgery. It was only in secondary surgery that radiological process proved useful and a guide during surgical intervention. (orig.) [de

  3. Comparison of a gene expression profiling strategy to standard clinical work-up for determination of tumour origin in cancer of unknown primary (CUP)

    DEFF Research Database (Denmark)

    Ades, Felipe; de Azambuja, Evandro; Daugaard, Gedske

    2013-01-01

    CupPrint® is a genomic signature able to identify 47 different cancer types. The aim of our study was to compare the accuracy of this genomic signature to that of a full clinical work-up in diagnosing the primary tumour site. Patients with newly diagnosed, untreated metastatic tumours were eligible...

  4. Surgical management of Gerhardt syndrome.

    Science.gov (United States)

    Chirilă, M; Mureşan, R; Cosgarea, M; Tomescu, E

    2010-01-01

    Adduction bilateral vocal fold immobility syndrome may be due by both recurrent laryngeal nerves paralysis--Gerhardt syndrome--and all intrinsic laryngeal muscles paralysis--Riegel syndrome. Etiology of Gerhardt syndrome is thyroid surgery, intubation's maneuver, trauma, neurological disorders, extrala-ryngeal malignancies. The manifestations of Gerhardt syndrome are inspiratory dyspnea and slightly influenced voicing by paramedian vocal folds paralysis with an important narrowing of the airway at the glottic level. The surgical procedures for enlargement of the glottic space can be classified in many ways and their major characteristics are: changes at the glottic level; surgical approach: open neck or endoscopic, with or without opening of the mucosal lining; the need for tracheostomy; the equipment used. The aim of this review is to expound the variety of interventions through the last century marked by the development of the diagnostic methods, the anesthesia and the surgical armament with sophisticated instruments and technologies.

  5. Investigação da trombose venosa na gravidez Deep vein thrombosis during pregnancy work up

    Directory of Open Access Journals (Sweden)

    Jorge Agle Kalil

    2008-03-01

    the disease developed in the third trimester of pregnancy (64.3%. Of the 42 patients diagnosed with DVT, 18 (42.8% occurred in infrapatellar veins. There was a case of pulmonary thromboembolism in a 37-year-old patient, who had been submitted to in vitro fecundation, with twin pregnancy and a diagnostic of DVT (no thrombophilia after a cesarean section. Of the 42 patients, 16 (38.1% had the cause of their DVT determined, with a prevalence of heterozygous mutation of factor V Leiden in six patients (14.2%, followed by phospholipid syndrome and other causes. Most patients were treated with low-molecular-weight heparin. CONCLUSION: DVT during pregnancy, despite having low frequency, is a major cause of increased maternal-fetal morbidity. Investigation of thrombophilia should be conducted in selected cases, such as personal or family history of thrombotic phenomena and/or thrombophilia. Twin pregnancy, cesarean birth and artificial insemination were also found as factors leading to DVT.

  6. Residual manifestations of hypercortisolemia following surgical treatment in a patient with Cushing syndrome.

    Science.gov (United States)

    Bartz, Sara K; Karaviti, Lefkothea P; Brandt, Mary L; Lopez, Monica E; Masand, Prakash; Devaraj, Sridevi; Hicks, John; Anderson, Lauren; Lodish, Maya; Keil, Meg; Stratakis, Constantine A

    2015-01-01

    Cushing Syndrome is difficult to diagnose, and the comorbidities and persistent late effects of hypercortisolemia after treatment of the primary disease are challenging for the patient and the endocrinologist. To report the case of a girl with obesity and hypertension, ultimately diagnosed with Cushing syndrome due to primary pigmented nodular adrenocortical disease. In this case, the complications of hypercortisolism persisted short term despite surgical intervention. A 4 year old morbidly obese African-American girl with developmental delay presented with hypertensive emergency in the ER and 18-month history of progressive weight gain. Her previous history included premature adrenarche, hypertension, seizures and a random high cortisol with suppressed ACTH. She was subsequently stabilized, and a diagnostic work-up persistently demonstrated elevated cortisol and suppressed ACTH. An abdominal MRI showed bilateral adrenal multinodular disease, consistent with multinodular hyperplasia of the adrenal glands. Based on these findings the patient underwent a bilateral adrenalectomy, which confirmed primary pigmented nodular adrenocortical disease. The patient had a complicated, protracted post-operative course requiring adjustment of therapy for persistent hypertension. Two months after surgery, she was readmitted to the Emergency Department with hyperpyrexia and hypertension and succumbed to the complications of sepsis. This case highlights the significant diagnostic and therapeutic challenges in treating children with Cushing syndrome. Resolution of the source of hypercortisolemia does not imply regression of hypertension or recovery of the immune system. Although the child underwent bilateral adrenalectomy, persistent consequences of prolonged severe hypercortisolism contributed to her death two months later.

  7. Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association For European Cardiovascular Pathology: II. Noninflammatory degenerative diseases - nomenclature and diagnostic criteria

    NARCIS (Netherlands)

    Halushka, Marc K.; Angelini, Annalisa; Bartoloni, Giovanni; Basso, Cristina; Batoroeva, Lubov; Bruneval, Patrick; Buja, L. Maximilian; Butany, Jagdish; d'Amati, Giulia; Fallon, John T.; Gallagher, Patrick J.; Gittenberger-de Groot, Adriana C.; Gouveia, Rosa H.; Kholova, Ivana; Kelly, Karen L.; Leone, Ornella; Litovsky, Silvio H.; Maleszewski, Joseph J.; Miller, Dylan V.; Mitchell, Richard N.; Preston, Stephen D.; Pucci, Angela; Radio, Stanley J.; Rodriguez, E. Rene; Sheppard, Mary N.; Stone, James R.; Suvarna, S. Kim; Tan, Carmela D.; Thiene, Gaetano; Veinot, John P.; van der Wal, Allard C.

    2016-01-01

    Surgical aortic specimens are usually examined in Pathology Departments as a result of treatment of aneurysms or dissections. A number of diseases, genetic syndromes (Marfan syndrome, Loeys-Dietz syndrome, etc.), and vasculopathic aging processes involved in vascular injury can cause both distinct

  8. Pragmatic approach to the clinical work-up of patients with putative allergic disease to metallic orthopaedic implants before and after surgery

    DEFF Research Database (Denmark)

    Thyssen, J P; Menné, T; Schalock, P C

    2011-01-01

    on in the work-up of patients with putative allergic complications following surgery. Few studies have investigated whether subjects with metal contact allergy have increased risk of developing complications following orthopaedic implant insertion. Metal allergy might in a minority increase the risk...... testing prior to surgery unless the patient has already had implant surgery with complications suspected to be allergic or has a history of clinical metal intolerance of sufficient magnitude to be of concern to the patient or a health provider. The clinical work-up of a patient suspected of having......Allergic complications following insertion of metallic orthopaedic implants include allergic dermatitis reactions but also extracutaneous complications. As metal-allergic patients and/or surgeons may ask dermatologists and allergologists for advice prior to planned orthopaedic implant surgery...

  9. Can value for money be improved by changing the sequence of our donor work-up in the living kidney donor programme?

    DEFF Research Database (Denmark)

    Larsen, J.; Sorensen, S.S.; Feldt-Rasmussen, B.

    2009-01-01

    and December 2006 at our department. The cost in euro (euro) for the programme was estimated using the Danish diagnosis-related group-system (DRG). The donor work-up programme was described. One hundred and thirty-three potential donors were identified; 66 male- and 67 female subjects, median age of 52 years......The aim of the study was to identify procedures of maximum importance for acceptance or rejection of kidney donation from a living donor as well as making the process more cost-effective. We identified all potential living related donors who were examined during the period between January 2002...... was the procedure identifying most subjects who were unsuited for kidney donation. A rearrangement of the present donor work-up programme could potentially reduce the costs from euro6911 to euro5292 per donor--saving 23% of the costs. By changing the sequence of examinations, it might be possible to cut down...

  10. [Diagnostic laparoscopy in acute abdomen].

    Science.gov (United States)

    Keller, R; Kleemann, M; Hildebrand, P; Roblick, U J; Bruch, H-P

    2006-11-01

    Acute abdomen is not a disease in itself but a description of a complex of symptoms combined with severe abdominal pain developed within a time frame of less than 24 h. All strategies for the management of acute abdomen underline the need for an interdisciplinary approach to diagnosis and therapy. This requires focused and intelligent use of efficient diagnostic procedures. Diagnostic laparoscopy may be a key to solving the diagnostic dilemma of unspecific acute abdomen. Furthermore, it allows not only direct inspection of the abdominal cavity but also surgical intervention, if needed. In particular the rate of negative laparotomies can be reduced.

  11. [Surgical managment of colorectal liver metastasis].

    Science.gov (United States)

    Prot, Thomas; Halkic, Nermin; Demartines, Nicolas

    2007-06-27

    Surgery offer the only curative treatment for colorectal hepatic metastasis. Nowadays, five-year survival increases up to 58% in selected cases, due to the improvement and combination of chemotherapy, surgery and ablative treatment like embolisation, radio-frequency or cryoablation. Surgery should be integrated in a multi disciplinary approach and initial work-up must take in account patient general conditions, tumor location, and possible extra hepatic extension. Thus, a surgical resection may be performed immediately or after preparation with chemotherapy or selective portal embolization. Management of liver metastasis should be carried out in oncological hepato-biliary centre.

  12. Primary Lymphoma of the Thyroid: Diagnostic and Therapeutic Considerations

    Directory of Open Access Journals (Sweden)

    Basro Sarinah

    2010-01-01

    Conclusion: The diagnosis of primary thyroid lymphoma should be considered when dealing with rapidly growing goitres. The role of FNAC in diagnosing thyroid lymphoma is limited but it is still useful in the initial work-up. Nevertheless, surgical intervention is often required to establish the diagnosis and relieve critical airway compression. A combination of chemotherapy and irradiation is the mainstay of management.

  13. Clinical and surgical management of unilateral prepubertal gynecomastia

    Directory of Open Access Journals (Sweden)

    Giuseppe Andrea Ferraro

    2014-01-01

    CONCLUSION: The exact mechanism of unilateral gynecomastia formation in our case is unclear. The evaluation of unilateral gynecomastia can therefore be complex. In conclusion, the surgical treatment of unilateral gynecomastia requires an individual approach, based on an appropriate diagnostic algorithm.

  14. Congenital diarrheal disorders: an updated diagnostic approach.

    Science.gov (United States)

    Terrin, Gianluca; Tomaiuolo, Rossella; Passariello, Annalisa; Elce, Ausilia; Amato, Felice; Di Costanzo, Margherita; Castaldo, Giuseppe; Canani, Roberto Berni

    2012-01-01

    Congenital diarrheal disorders (CDDs) are a group of inherited enteropathies with a typical onset early in the life. Infants with these disorders have frequently chronic diarrhea of sufficient severity to require parenteral nutrition. For most CDDs the disease-gene is known and molecular analysis may contribute to an unequivocal diagnosis. We review CDDs on the basis of the genetic defect, focusing on the significant contribution of molecular analysis in the complex, multistep diagnostic work-up.

  15. Congenital Diarrheal Disorders: An Updated Diagnostic Approach

    Directory of Open Access Journals (Sweden)

    Giuseppe Castaldo

    2012-03-01

    Full Text Available Congenital diarrheal disorders (CDDs are a group of inherited enteropathies with a typical onset early in the life. Infants with these disorders have frequently chronic diarrhea of sufficient severity to require parenteral nutrition. For most CDDs the disease-gene is known and molecular analysis may contribute to an unequivocal diagnosis. We review CDDs on the basis of the genetic defect, focusing on the significant contribution of molecular analysis in the complex, multistep diagnostic work-up.

  16. [Diagnostic workup of fragrance allergy].

    Science.gov (United States)

    Geier, J; Uter, W

    2015-09-01

    The diagnostic workup of contact allergy to fragrances must not be limited to patch testing with the two well-established fragrance mixes. False-positive reactions to these mixes occur in up to 50 % of the patch tested patients. For the diagnostic work-up of positive reactions, and in cases of suspected fragrance allergy, patch testing with the single mix components and additional fragrances is mandatory. Frequently sensitizing fragrance materials are the 14 components of the two fragrance mixes and tree moss (Evernia furfuracea), ylang ylang oil (I + II; Cananga odorata), lemongrass oil (Cymbopogon schoenanthus), sandalwood oil (Santalum album), jasmine absolute (Jasminum spp.), and, less frequently, clove oil (Eugenia caryophyllus), cedarwood oil (Cedrus atlantica/deodara, Juniperus virginiana), Neroli oil (Citrus aurantium amara flower oil), salicylaldehyde, narcissus absolute (Narcissus spp.), and patchouli oil (Pogostemon cablin).

  17. Molecular Diagnostics

    OpenAIRE

    Choe, Hyonmin; Deirmengian, Carl A.; Hickok, Noreen J.; Morrison, Tiffany N.; Tuan, Rocky S.

    2015-01-01

    Orthopaedic infections are complex conditions that require immediate diagnosis and accurate identification of the causative organisms to facilitate appropriate management. Conventional methodologies for diagnosis of these infections sometimes lack accuracy or sufficient rapidity. Current molecular diagnostics are an emerging area of bench-to-bedside research in orthopaedic infections. Examples of promising molecular diagnostics include measurement of a specific biomarker in the synovial fluid...

  18. Surgical approach to pineal tumours.

    Science.gov (United States)

    Pluchino, F; Broggi, G; Fornari, M; Franzini, A; Solero, C L; Allegranza, A

    1989-01-01

    During a period of 10 years (1977-1986) 40 cases of tumour of the pineal region have been treated at the Istituto Neurologico "C. Besta"-of Milan. Out of these 40 cases, 27 (67.5%) were in the paediatric (10-15 years) or juvenile (15-20 years) age at the time of operation. Since 1983 a specific diagnostic and therapeutic protocol has been adopted and thereafter direct surgical removal of the tumour was performed only when the neuroradiological investigations were highly suggestive of a benign extrinsic lesion. Sixteen cases in this series underwent direct surgical removal; in the remaining 24 cases stereotactic biopsy of the tumour was performed in the first instance. On the basis of the histological diagnosis obtained by this procedure surgical excision of the tumour (9 cases) or radiotherapy (15 cases) was then performed. 25 cases underwent surgical removal of the lesion. In all the cases the infratentorial supracerebellar approach as introduced by Krause and then modified by Stein was adopted. On analysis of the data of this series it was observed that in 25% of the cases completely benign resectable tumours were found; in 25% of the cases astrocytoma (grade I-II) which could be treated at least by partial removal were present; in 30% of the cases radiosensitive lesions were encountered. In the remaining 20% of the cases highly malignant tumours were found which should be treated only by radiotherapy and/or chemotherapy.

  19. Pediatric surgical diseases. A radiological surgical case study approach

    International Nuclear Information System (INIS)

    Esposito, Ciro; Esposito, Giovanni

    2009-01-01

    Radiologic evaluation of an infant or child suspected of having a surgical disease can be a complex problem. With this volume, the editors have created a book focused on pediatric imaging written by pediatricians, pediatric surgeons and pediatric radiologists. This book is a collection of over 200 case reports. The concept is a case study approach: The reader is given radiologic images (plain radiography, computed tomography, magnetic resonance imaging, ultrasonography, etc.) and the clinical history of the patient. On the basis of this information, the reader is asked to identify a diagnostic and therapeutic strategy. Each case is complemented by information on the disease affecting the patient and the management of the case shown, including therapy and follow-up. This educational text is targeted at all medical professionals faced with a variety of diagnostic and therapeutic problems affecting infants and children. (orig.)

  20. Pediatric surgical diseases. A radiological surgical case study approach

    Energy Technology Data Exchange (ETDEWEB)

    Esposito, Ciro [Federico II Univ. of Naples (Italy). Chair of Pediatric Surgery; Esposito, Giovanni (eds.) [Federico II Univ. of Naples (Italy). School of Medicine

    2009-07-01

    Radiologic evaluation of an infant or child suspected of having a surgical disease can be a complex problem. With this volume, the editors have created a book focused on pediatric imaging written by pediatricians, pediatric surgeons and pediatric radiologists. This book is a collection of over 200 case reports. The concept is a case study approach: The reader is given radiologic images (plain radiography, computed tomography, magnetic resonance imaging, ultrasonography, etc.) and the clinical history of the patient. On the basis of this information, the reader is asked to identify a diagnostic and therapeutic strategy. Each case is complemented by information on the disease affecting the patient and the management of the case shown, including therapy and follow-up. This educational text is targeted at all medical professionals faced with a variety of diagnostic and therapeutic problems affecting infants and children. (orig.)

  1. Micro-surgical endodontics.

    Science.gov (United States)

    Eliyas, S; Vere, J; Ali, Z; Harris, I

    2014-02-01

    Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.

  2. Can value for money be improved by changing the sequence of our donor work-up in the living kidney donor programme?

    Science.gov (United States)

    Larsen, Jesper; Sørensen, Søren Schwartz; Feldt-Rasmussen, Bo

    2009-08-01

    The aim of the study was to identify procedures of maximum importance for acceptance or rejection of kidney donation from a living donor as well as making the process more cost-effective. We identified all potential living related donors who were examined during the period between January 2002 and December 2006 at our department. The cost in euro (euro) for the programme was estimated using the Danish diagnosis-related group-system (DRG). The donor work-up programme was described. One hundred and thirty-three potential donors were identified; 66 male- and 67 female subjects, median age of 52 years (range 22-69). Sixty-four participants were rejected as donors. Abdominal CT-scan with angiography and urography ruled out 22 of the above 64 potential organ donors; thus, 48% of the volunteers for living kidney donation were unsuited for donation. Abdominal CT-scan with angiography and urography was the procedure identifying most subjects who were unsuited for kidney donation. A rearrangement of the present donor work-up programme could potentially reduce the costs from euro6911 to euro5292 per donor--saving 23% of the costs. By changing the sequence of examinations, it might be possible to cut down on time spent and number of tests needed for approving or rejecting subjects for living kidney donation.

  3. In-vitro diagnostics of Hymenoptera venom allergy

    NARCIS (Netherlands)

    Rueff, F.; Vos, B.; Przybilla, B.

    In-vitro diagnostics of Hymenoptera venom allergy Patients with a history of anaphylactic sting reactions require an allergological work-up (history, in-vitro tests, and skin tests) to clarify indications on venom immunotherapy and on the type of venom to be used. To demonstrate a venom

  4. Companion diagnostics

    DEFF Research Database (Denmark)

    Jørgensen, Jan Trøst; Hersom, Maria

    2016-01-01

    of disease mechanisms, things are slowly changing. Within the last few years, we have seen an increasing number of predictive biomarker assays being developed to guide the use of targeted cancer drugs. This type of assay is called companion diagnostics and is developed in parallel to the drug using the drug-diagnostic...... co-development model. The development of companion diagnostics is a relatively new discipline and in this review, different aspects will be discussed including clinical and regulatory issues. Furthermore, examples of drugs, such as the ALK and PD-1/PD-L1 inhibitors, that have been approved recently....... Despite having discussed personalized medicine for more than a decade, we still see that most drug prescriptions for severe chronic diseases are largely based on 'trial and error' and not on solid biomarker data. However, with the advance of molecular diagnostics and a subsequent increased understanding...

  5. Value of computed tomography arthrography with delayed acquisitions in the work-up of ganglion cysts of the tarsal tunnel: report of three cases

    International Nuclear Information System (INIS)

    Omoumi, Patrick; Gheldere, Antoine de; Leemrijse, Thibaut; Galant, Christine; Van den Bergh, Peter; Malghem, Jacques; Simoni, Paolo; Berg, Bruno C.V.; Lecouvet, Frederic E.

    2010-01-01

    Ganglion cysts are a common cause of tarsal tunnel syndrome. As in other locations, these cysts are believed to communicate with neighboring joints. The positive diagnosis and preoperative work-up of these cysts require identification and location of the cyst pedicles so that they may be excised and the risk of recurrence decreased. This can be challenging with ultrasonography and magnetic resonance (MR) imaging. We present three cases of symptomatic ganglion cysts of the tarsal tunnel, diagnosed by MR imaging, where computed tomography (CT) arthrography with delayed acquisitions helped to confirm the diagnosis and identify precisely the topography of the communication with the subtalar joint. These cases provide new evidence of the articular origin of ganglion cysts developing in the tarsal tunnel. (orig.)

  6. Can value for money be improved by changing the sequence of our donor work-up in the living kidney donor programme?

    DEFF Research Database (Denmark)

    Larsen, Jesper; Sørensen, Søren Schwartz; Feldt-Rasmussen, Bo

    2009-01-01

    (range 22-69). Sixty-four participants were rejected as donors. Abdominal CT-scan with angiography and urography ruled out 22 of the above 64 potential organ donors; thus, 48% of the volunteers for living kidney donation were unsuited for donation. Abdominal CT-scan with angiography and urography......The aim of the study was to identify procedures of maximum importance for acceptance or rejection of kidney donation from a living donor as well as making the process more cost-effective. We identified all potential living related donors who were examined during the period between January 2002...... was the procedure identifying most subjects who were unsuited for kidney donation. A rearrangement of the present donor work-up programme could potentially reduce the costs from euro6911 to euro5292 per donor--saving 23% of the costs. By changing the sequence of examinations, it might be possible to cut down...

  7. The role of whole body spiral CT in the primary work-up of polytrauma patients - comparison with conventional radiography and abdominal sonography

    International Nuclear Information System (INIS)

    Albrecht, T.; Schlippenbach, J. von; Wolf, K.J.; Stahel, P.F.; Ertel, W.

    2004-01-01

    Purpose: To evaluate the role of routine 'whole body spiral CT' in the primary work-up of polytrauma patients for injuries of the thorax, abdomen and spine, and to compare the results with those of conventional radiography of the chest and spine and abdominal ultrasound. Materials and Methods: Fifty consecutive polytrauma patients underwent contrast-enhanced single slice spiral CT (5 mm collimation) from the vertex to the floor of the pelvis as part of the primary work-up after emergency room admission. Overlapping high resolution sections and sagittal reformations of the spine were obtained. Reports of additional chest radiographs (n=43), abdominal ultrasound examinations (n=47) and spine radiographs (n=36) performed in the emergency room were available for retrospective comparison. The 'final diagnoses', which served as the standard of reference, were taken from the patients' records using all information that became available until discharge or death, such as findings from further imaging, surgery and autopsy. Results: CT showed 109 (97%) of 112 thoracic and abdominal soft-tissue injuries. Relevant injuries missed were an early splenic laceration and an early pelvic hematoma, both of which became clinically apparent several hours later. There were 4 false positive CT findings. Conventional chest radiography demonstrated only 20% of thoracic and sonography 22% of abdominal injuries. Chest radiography and sonography produced 2 false-positive findings each. CT showed 66 (87%) of 76 vertebral fractures including all 19 unstable ones. CT missed 5 anterior vertebral body and 5 spinous/transverse process fractures. Conventional radiography found 71% of vertebral fractures including only 50% of the unstable one. (orig.)

  8. Contrast-enhanced spectral mammography as work-up tool in patients recalled from breast cancer screening has low risks and might hold clinical benefits.

    Science.gov (United States)

    Houben, I P L; Van de Voorde, P; Jeukens, C R L P N; Wildberger, J E; Kooreman, L F; Smidt, M L; Lobbes, M B I

    2017-09-01

    Contrast-enhanced spectral mammography (CESM) is a reliable problem solving tool in the work-up of women recalled from breast cancer screening. We evaluated additional findings caused by CESM alone and outweighed them against the disadvantages of this technique. From December 2012 to December 2015, all women recalled from screening who underwent CESM were considered for this study. Radiation exposure and number of adverse contrast reactions were analysed. An experienced breast radiologist reviewed all exams and identified cases with lesions detected by CESM alone and scored their conspicuity. From these cases, data on breast density and final diagnosis were collected. For malignant cases, tumour grade and receptor characteristics were also collected. During this study, 839 women underwent CESM after a screening recall, in which five minor adverse contrast reactions were observed. Median radiation dose per exam was 6.0mGy (0.9-23.4mGy). Seventy CESM-only lesions were detected in 65 patients. Of these 70 lesions, 54.3% proved to be malignant, most commonly invasive ductal carcinomas. The remaining CESM-only lesions were benign, predominantly fibroadenomas. No complications were observed during biopsy of these lesions. Retrospectively, the majority of the lesions were either occult or a 'minimal sign' on low-energy CESM images or the screening mammogram. Using CESM as a work-up tool for women recalled from screening carries low risk for the patient, while additionally detected tumour foci might hold important clinical implications which need to be further studied in large, randomized controlled trials. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Inadequate Diagnostic Evaluation in Young Patients Registered with a Diagnosis of Dementia

    DEFF Research Database (Denmark)

    Salem, Lise Cronberg; Andersen, Birgitte Bo; Nielsen, T Rune

    2014-01-01

    BACKGROUND: Establishing a diagnosis of dementia in young patients may be complex and have significant implications for the patient. The aim of this study was to evaluate the quality of the diagnostic work-up in young patients diagnosed with dementia in the clinical routine. METHODS: Two hundred...... patients were randomly selected from 891 patients aged ≤65 years registered with a diagnosis of dementia for the first time in 2008 in Danish hospitals, and 159 medical records were available for review. Three raters evaluated their medical records for the completeness of the diagnostic work-up on which...... the diagnosis of dementia had been based, using evidence-based guidelines for the diagnostic evaluation of dementia as reference standards. RESULTS: According to the rater review, only 111 (70%) patients met the clinical criteria for dementia. An acceptable diagnostic work-up including all items of recommended...

  10. Surgical versus non-surgical management of abdominal injury.

    Science.gov (United States)

    Oyo-Ita, Angela; Chinnock, Paul; Ikpeme, Ikpeme A

    2015-11-13

    Injury to the abdomen can be blunt or penetrating. Abdominal injury can damage internal organs such as the liver, spleen, kidneys, intestine, and large blood vessels. There are controversies about the best approach to manage abdominal injuries. To assess the effects of surgical and non-surgical interventions in the management of abdominal trauma in a haemodynamically stable and non-peritonitic abdomen. We searched the Cochrane Injuries Group's Specialised Register, The Cochrane Library, Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), EMBASE Classic+EMBASE (Ovid), ISI WOS (SCI-EXPANDED, SSCI, CPCI-S & CPSI-SSH), CINAHL Plus (EBSCO), and clinical trials registers, and screened reference lists. We ran the most recent search on 17 September 2015. Randomised controlled trials of surgical interventions and non-surgical interventions involving people with abdominal injury who were haemodynamically stable with no signs of peritonitis. The abdominal injury could be blunt or penetrating. Two review authors independently applied the selection criteria. Data were extracted by two authors using a standard data extraction form, and are reported narratively. Two studies are included, which involved a total of 114 people with penetrating abdominal injuries. Both studies are at moderate risk of bias because the randomisation methods are not fully described, and the original study protocols are no longer available. The studies were undertaken in Finland between 1992 and 2002, by the same two researchers.In one study, 51 people were randomised to surgery or an observation protocol. None of the participants in the study died. Seven people had complications: 5 (18.5%) in the surgical group and 2 (8.3%) in the observation group; the difference was not statistically significant (P = 0.42; Fischer's exact). Among the 27 people who had surgery, 6 (22.2%) surgeries were negative laparotomies, and 15 (55.6%) were non

  11. Plasma Diagnostics

    Energy Technology Data Exchange (ETDEWEB)

    Zaveryaev, V [Kurchatov Institute, Moscow (Russian Federation); others, and

    2012-09-15

    The success in achieving peaceful fusion power depends on the ability to control a high temperature plasma, which is an object with unique properties, possibly the most complicated object created by humans. Over years of fusion research a new branch of science has been created, namely plasma diagnostics, which involves knowledge of almost all fields of physics, from electromagnetism to nuclear physics, and up-to-date progress in engineering and technology (materials, electronics, mathematical methods of data treatment). Historically, work on controlled fusion started with pulsed systems and accordingly the methods of plasma parameter measurement were first developed for short lived and dense plasmas. Magnetically confined hot plasmas require the creation of special experimental techniques for diagnostics. The diagnostic set is the most scientifically intensive part of a plasma device. During many years of research operation some scientific tasks have been solved while new ones arose. New tasks often require significant changes in the diagnostic system, which is thus a very flexible part of plasma machines. Diagnostic systems are designed to solve several tasks. As an example here are the diagnostic tasks for the International Thermonuclear Experimental Reactor - ITER: (1) Measurements for machine protection and basic control; (2) Measurements for advanced control; (3) Additional measurements for performance evaluation and physics. Every new plasma machine is a further step along the path to the main goal - controlled fusion - and nobody knows in advance what new phenomena will be met on the way. So in the planning of diagnostic construction we should keep in mind further system upgrading to meet possible new scientific and technical challenges. (author)

  12. American Pediatric Surgical Association

    Science.gov (United States)

    American Pediatric Surgical Association Search for: Login Resources + For Members For Professionals For Training Program Directors For Media For ... Surgical Outcomes Surveys & Results Publications Continuing Education + ExPERT Pediatric Surgery NaT Annual Meeting CME MOC Requirements Residents / ...

  13. Abortion - surgical - aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000658.htm Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  14. Urogynecologic Surgical Mesh Implants

    Science.gov (United States)

    ... procedures performed to treat pelvic floor disorders with surgical mesh: Transvaginal mesh to treat POP Transabdominal mesh to treat ... address safety risks Final Order for Reclassification of Surgical Mesh for Transvaginal Pelvic Organ Prolapse Repair Final Order for Effective ...

  15. [Surgical tactics in duodenal trauma].

    Science.gov (United States)

    Ivanov, P A; Grishin, A V

    2004-01-01

    Results of surgical treatment of 61 patients with injuries of the duodenum are analyzed. The causes of injuries were stab-incised wounds in 24 patients, missile wound -- in 7, closed abdominal trauma -- in 26, trauma of the duodenum during endoscopic papillosphincterotomy -- in 4. All the patients underwent surgery. Complications were seen in 32 (52.5%) patients, 21 patients died, lethality was 34.4%. Within the first 24 hours since the trauma 7 patients died due to severe combined trauma, blood loss, 54 patients survived acute period of trauma, including 28 patients after open trauma, 26 -- after closed and 4 -- after trauma of the duodenum during endoscopic papillosphincterotomy. Diagnostic and surgical policies are discussed. Results of treatment depending on kind and time of surgery are regarded. It is demonstrated that purulent complications due to retroperitoneal phlegmona, traumatic pancreatitis, pneumonia are the causes of significant number of unfavorable outcomes. Therefore, it is important to adequately incise and drainage infected parts of retroperitoneal fat tissue with two-lumen drainages. Decompression through duodenal tube is the effective procedure for prophylaxis of suture insufficiency and traumatic pancreatitis. Suppression of pancreatic and duodenal secretion with octreotid improves significantly surgical treatment results.

  16. Surgical Management of Chronic Pancreatitis.

    Science.gov (United States)

    Parekh, Dilip; Natarajan, Sathima

    2015-10-01

    Advances over the past decade have indicated that a complex interplay between environmental factors, genetic predisposition, alcohol abuse, and smoking lead towards the development of chronic pancreatitis. Chronic pancreatitis is a complex disorder that causes significant and chronic incapacity in patients and a substantial burden on the society. Major advances have been made in the etiology and pathogenesis of this disease and the role of genetic predisposition is increasingly coming to the fore. Advances in noninvasive diagnostic modalities now allow for better diagnosis of chronic pancreatitis at an early stage of the disease. The impact of these advances on surgical treatment is beginning to emerge, for example, patients with certain genetic predispositions may be better treated with total pancreatectomy versus lesser procedures. Considerable controversy remains with respect to the surgical management of chronic pancreatitis. Modern understanding of the neurobiology of pain in chronic pancreatitis suggests that a window of opportunity exists for effective treatment of the intractable pain after which central sensitization can lead to an irreversible pain syndrome in patients with chronic pancreatitis. Effective surgical procedures exist for chronic pancreatitis; however, the timing of surgery is unclear. For optimal treatment of patients with chronic pancreatitis, close collaboration between a multidisciplinary team including gastroenterologists, surgeons, and pain management physicians is needed.

  17. Diagnostic development

    International Nuclear Information System (INIS)

    Barnett, C.F.; Brisson, D.A.; Greco, S.E.

    1978-01-01

    During the past year the far-infrared or submillimeter diagnostic research program resulted in three major developments: (1) an optically pumped 0.385-μm D 2 O-laser oscillator-amplifier system was operated at a power level of 1 MW with a line width of less than 50 MHz; (2) a conical Pyrex submillimeter laser beam dump with a retention efficiency greater than 10 4 was developed for the ion temperature Thompson scattering experiment; and (3) a new diagnostic technique was developed that makes use of the Faraday rotation of a modulated submillimeter laser beam to determine plasma current profile. Measurements of the asymmetric distortion of the H/sub α/ (6563 A) spectral line profile show that the effective toroidal drift velocity, dv/sub two vertical bars i/dT/sub i/, may be used as an indicator of plasma quality and as a complement to other ion temperature diagnostics

  18. Radiologic diagnostics of dementia

    International Nuclear Information System (INIS)

    Essig, M.; Schoenberg, S.O.

    2003-01-01

    Dementia is one of the most common diseases in the elderly population and is getting more and more important with the ageing of the population. A radiologic structural examination with CT or MRI is meanwhile a standard procedure in the diagnostic work up of patients with dementia syndrome. Radiology enables an early diagnosis and a differential diagnosis between different causes of dementia. Because structural changes occur only late in the disease process, a more detailed structural analysis using volumetric techniques or the use of functional imaging techniques is mandatory. These days, structural imaging uses MRI which enables to detect early atrophic changes at the medial temporal lobe with focus on the amygdala hippocampal complex. These changes are also present in the normal ageing process. In patients with Alzheimer's disease, however, they are more rapid and more pronounced. The use of functional imaging methods such as perfusion MRI, diffusion MRI or fMRI allow new insights into the pathophysiologic changes of dementia. The article gives an overview of the current status of structural imaging and an outlook into the potential of functional imaging methods. Detailed results of structural and functional imaging are presented in other articles of this issue. (orig.) [de

  19. The value of indicated computed tomography scan of the chest and abdomen in addition to the conventional radiologic work-up for blunt trauma patients.

    NARCIS (Netherlands)

    Deunk, J.; Dekker, H.M.; Brink, M.; Vugt, R. van; Edwards, M.J.R.; Vugt, A.B. van

    2007-01-01

    BACKGROUND: Multidetector computed tomography (CT) is more sensitive and specific in detecting traumatic injuries than conventional radiology is. However, still little is known about the diagnostic value and the therapeutic impact of indicated thoraco-abdominal CT scan when it is performed in

  20. Should PET/CT be implemented in the routine imaging work-up of locally advanced head and neck squamous cell carcinoma? A prospective analysis

    Energy Technology Data Exchange (ETDEWEB)

    Cacicedo, Jon; Bilbao, Pedro [Cruces University Hospital, Radiation Oncology Department, Barakaldo, Bizkaia (Basque Country) (Spain); BioCruces Health Research Institute, Bizkaia, Basque Country (Spain); Fernandez, Iratxe [Cruces University Hospital, Nuclear Medicine Department, Barakaldo (Spain); Hoyo, Olga del; Hortelano, Eduardo [Cruces University Hospital, Radiation Oncology Department, Barakaldo, Bizkaia (Basque Country) (Spain); Dolado, Ainara [Cruces University Hospital, Radiodiagnostic and Medical Imaging Department, Barakaldo (Spain); Gomez-Suarez, Javier [Cruces University Hospital, Otolaryngology Department, Barakaldo (Spain); Sancho, Aintzane [Cruces University Hospital, Medical Oncology Department, Barakaldo (Spain); Pijoan, Jose I. [BioCruces Health Research Institute, Bizkaia, Basque Country (Spain); Cruces University Hospital, Clinical Epidemiology Unit, Barakaldo (Spain); CIBER de Epidemiologia y Salud Publica (CIBERESP), Madrid (Spain); Alvarez, Julio [Cruces University Hospital, Oral and Maxillofacial Surgery Department, Barakaldo (Spain); Espinosa, Jose M. [Cruces University Hospital, Medical Physics Department, Barakaldo (Spain); Gaafar, Ayman [Cruces University Hospital, Department of Pathology, Barakaldo (Spain)

    2015-08-15

    The objective of this study was to determine the incremental staging information provided by positron emission tomography/computed tomography (PET/CT) and its impact on management plans in patients with untreated stage III-IV head and neck squamous cell carcinoma (HNSCC). We prospectively studied, between September 2011 and February 2013, 84 consecutive patients [median age 63.5 years (39-84); 73 men] with histologically confirmed HNSCC. First, based on a conventional work-up (physical examination, CT imaging of the head, neck and chest), the multidisciplinary Head and Neck Tumour Board documented the TNM stage and a management plan for each patient, outlining the modalities to be used, including surgery, radiation therapy (RT), chemotherapy or a combination. After release of the PET/CT results, new TNM staging and management plans were agreed on by the multidisciplinary Tumour Board. Any changes in stage or intended management due to the PET/CT findings were then analysed. The impact on patient management was classified as: low (treatment modality, delivery and intent unchanged), moderate (change within the same treatment modality: type of surgery, radiation technique/dose) or high (change in treatment intent and/or treatment modality → curative to palliative, or surgery to chemoradiation or detection of unknown primary tumour or a synchronous second primary tumour). TNM stage was validated by histopathological analysis, additional imaging or follow-up. Accuracy of the conventional and PET/CT-based staging was compared using McNemar's test. Conventional and PET/CT stages were discordant in 32/84 (38 %) cases: the T stage in 2/32 (6.2 %), the N stage in 21/32 (65.7 %) and the M stage 9/32 (28.1 %). Patient management was altered in 22/84 (26 %) patients, with a moderate impact in 8 (9.5 %) patients and high impact in 14 (16.6 %) patients. PET/CT TNM classification was significantly more accurate (92.5 vs 73.7 %) than conventional staging with a p value < 0

  1. Should PET/CT be implemented in the routine imaging work-up of locally advanced head and neck squamous cell carcinoma? A prospective analysis

    International Nuclear Information System (INIS)

    Cacicedo, Jon; Bilbao, Pedro; Fernandez, Iratxe; Hoyo, Olga del; Hortelano, Eduardo; Dolado, Ainara; Gomez-Suarez, Javier; Sancho, Aintzane; Pijoan, Jose I.; Alvarez, Julio; Espinosa, Jose M.; Gaafar, Ayman

    2015-01-01

    The objective of this study was to determine the incremental staging information provided by positron emission tomography/computed tomography (PET/CT) and its impact on management plans in patients with untreated stage III-IV head and neck squamous cell carcinoma (HNSCC). We prospectively studied, between September 2011 and February 2013, 84 consecutive patients [median age 63.5 years (39-84); 73 men] with histologically confirmed HNSCC. First, based on a conventional work-up (physical examination, CT imaging of the head, neck and chest), the multidisciplinary Head and Neck Tumour Board documented the TNM stage and a management plan for each patient, outlining the modalities to be used, including surgery, radiation therapy (RT), chemotherapy or a combination. After release of the PET/CT results, new TNM staging and management plans were agreed on by the multidisciplinary Tumour Board. Any changes in stage or intended management due to the PET/CT findings were then analysed. The impact on patient management was classified as: low (treatment modality, delivery and intent unchanged), moderate (change within the same treatment modality: type of surgery, radiation technique/dose) or high (change in treatment intent and/or treatment modality → curative to palliative, or surgery to chemoradiation or detection of unknown primary tumour or a synchronous second primary tumour). TNM stage was validated by histopathological analysis, additional imaging or follow-up. Accuracy of the conventional and PET/CT-based staging was compared using McNemar's test. Conventional and PET/CT stages were discordant in 32/84 (38 %) cases: the T stage in 2/32 (6.2 %), the N stage in 21/32 (65.7 %) and the M stage 9/32 (28.1 %). Patient management was altered in 22/84 (26 %) patients, with a moderate impact in 8 (9.5 %) patients and high impact in 14 (16.6 %) patients. PET/CT TNM classification was significantly more accurate (92.5 vs 73.7 %) than conventional staging with a p value < 0

  2. Diagnostic dilemma

    DEFF Research Database (Denmark)

    Feldt-Rasmussen, Ulla; Dobrovolny, Robert; Nazarenko, Irina

    2011-01-01

    Fabry disease, an X-linked lysosomal storage disorder, results from the deficient activity of a-galactosidase A (a-Gal A). In affected males, the clinical diagnosis is confirmed by the markedly decreased a-Gal A activity. However, in female heterozygotes, the a-Gal A activity can range from low t...... on enzyme replacement therapy. Thus, gene dosage analyses can detect large deletions (>50bp) in suspect heterozygotes for X-linked and autosomal dominant diseases that are "sequencing cryptic," resolving molecular diagnostic dilemmas....... to normal due to random X-chromosomal inactivation, and diagnostic confirmation requires identification of the family's a-Gal A gene mutation. In a young female who had occasional acroparesthesias, corneal opacities, and 15 to 50% of the lower limit of normal leukocyte a-Gal A activity, a-Gal A sequencing...... in two expert laboratories did not identify a confirmatory mutation, presenting a diagnostic dilemma. A renal biopsy proved diagnostic and renewed efforts to detect an a-Gal A mutation. Subsequent gene dosage analyses identified a large a-Gal A deletion confirming her heterozygosity, and she was started...

  3. Pediatric abdominal non-Hodgkin's lymphoma: diagnosis through surgical and non-surgical procedures.

    Science.gov (United States)

    Aguiar, Arthur Almeida; Lima, Luciana Cavalvanti; Araújo, Cláudia Corrêa de; Gallindo, Rodrigo Melo

    2017-12-29

    To describe the success rate and the complications after procedures to diagnose abdominal non-Hodgkin's lymphoma in children and adolescents. A retrospective cross-sectional study was conducted with a population consisting of children and adolescents with abdominal non-Hodgkin's lymphoma diagnosed between September 1994 and December 2012. The sample comprised of 100 patients who underwent 113 diagnostic procedures, including urgent surgery (n=21), elective surgery (n=36), and non-surgical diagnosis (n=56). The most frequent procedures were laparotomy (46.9%) and ultrasound-guided core biopsy (25.6%). The rate of diagnostic success was 95.2% for urgent surgeries; 100% for elective surgeries and 82.1% for non-surgical procedures (p<0.05). The rates of complication during the three diagnosis procedures considered were significant (p<0.001; 95.2% of the urgent surgeries, 83.8% of the elective surgeries, and 10.7% of the non-surgical procedures). The length of time before resuming a full diet and starting chemotherapy was significantly reduced for patients who underwent non-surgical procedures when compared with the other procedures (p<0.001). Non-surgical procedures for the diagnosis of pediatric abdominal non-Hodgkin's lymphoma are an effective option with low morbidity rate, allowing an earlier resumption of a full diet and chemotherapy initiation. Furthermore, non-surgical procedures should also be considered for obtaining tumor samples from patients with extensive disease. Copyright © 2017. Published by Elsevier Editora Ltda.

  4. Is stereotactic large-core needle biopsy beneficial prior to surgical treatment in BI-RADS 5 lesions?

    NARCIS (Netherlands)

    Hoorntje, LE; Peeters, PHM; Mali, WPTM; Rinkes, IHMB

    Introduction. Due to screening mammography, more nonpalpable mammographic lesions warrant histological evaluation. Stereotactic large-core needle biopsy (SLCNB) has been shown to be as effective in diagnosing these lesions as diagnostic surgical excision, and has become the preferred diagnostic

  5. Time-efficient and convenient synthesis of [18F]altanserin for human PET imaging by a new work-up procedure

    International Nuclear Information System (INIS)

    Massarweh, G.; Kovacevic, M.; Rosa-Neto, P.; Evans, A.C.; Diksic, M.; Schirrmacher, R.

    2009-01-01

    [ 18 F]Altanserin, an important PET radioligand for the in vivo imaging of the 5-HT 2A receptor, was synthesized from its precursor nitro-altanserin in DMF or DMSO at high temperatures of 150 deg. C in an overall radiochemical yield (EOB) of 23-25% after 75 min. A new solid phase work-up procedure involving the acidification of the crude reaction mixture and a C18-SepPak-solid phase separation preceded the final HPLC purification. This led to a significantly reduced synthesis time as a result of a stable and early elution from the HPLC column using improved HPLC conditions (MeOH/THF/NaOAc 0.05 N pH 5: 27/18/55, flow: 5 mL/min, Symetry Prep 7 μm C18 (Waters)). The synthesis was performed semi-automatically in a modified GE TracerLab synthesis module using an in-house-developed program. The synthesized [ 18 F]altanserin was used in our ongoing human and animal PET imaging studies.

  6. Time-efficient and convenient synthesis of [{sup 18}F]altanserin for human PET imaging by a new work-up procedure

    Energy Technology Data Exchange (ETDEWEB)

    Massarweh, G. [McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, Quebec (Canada)], E-mail: gassan.wassarweh@mcgill.ca; Kovacevic, M.; Rosa-Neto, P.; Evans, A.C.; Diksic, M. [McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, Quebec (Canada); Schirrmacher, R. [McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, Quebec (Canada)], E-mail: ralf.schirrmacher@mcgill.ca

    2009-11-15

    [{sup 18}F]Altanserin, an important PET radioligand for the in vivo imaging of the 5-HT{sub 2A} receptor, was synthesized from its precursor nitro-altanserin in DMF or DMSO at high temperatures of 150 deg. C in an overall radiochemical yield (EOB) of 23-25% after 75 min. A new solid phase work-up procedure involving the acidification of the crude reaction mixture and a C18-SepPak-solid phase separation preceded the final HPLC purification. This led to a significantly reduced synthesis time as a result of a stable and early elution from the HPLC column using improved HPLC conditions (MeOH/THF/NaOAc 0.05 N pH 5: 27/18/55, flow: 5 mL/min, Symetry Prep 7 {mu}m C18 (Waters)). The synthesis was performed semi-automatically in a modified GE TracerLab synthesis module using an in-house-developed program. The synthesized [{sup 18}F]altanserin was used in our ongoing human and animal PET imaging studies.

  7. High resolution MRI for preoperative work-up of neonates with an anorectal malformation: a direct comparison with distal pressure colostography/fistulography

    Energy Technology Data Exchange (ETDEWEB)

    Thomeer, Maarten G. [Erasmus MC, Department of Radiology, Rotterdam (Netherlands); Devos, Annick; Lequin, Maarten; Graaf, Nanko de; Meradji, Morteza [Erasmus MC, Department of Pediatric Radiology, Rotterdam (Netherlands); Meeussen, Conny J.H.M.; Blaauw, Ivo de; Sloots, Cornelius E.J. [Erasmus MC, Department of Pediatric Surgery, Rotterdam (Netherlands)

    2015-12-15

    To compare MRI and colostography/fistulography in neonates with anorectal malformations (ARM), using surgery as reference standard. Thirty-three neonates (22 boys) with ARM were included. All patients underwent both preoperative high-resolution MRI (without sedation or contrast instillation) and colostography/fistulography. The Krickenbeck classification was used to classify anorectal malformations, and the level of the rectal ending in relation to the levator muscle was evaluated. Subjects included nine patients with a bulbar recto-urethral fistula, six with a prostatic recto-urethral fistula, five with a vestibular fistula, five with a cloacal malformation, four without fistula, one with a H-type fistula, one with anal stenosis, one with a rectoperineal fistula and one with a bladderneck fistula. MRI and colostography/fistulography predicted anatomy in 88 % (29/33) and 61 % (20/33) of cases, respectively (p = 0.012). The distal end of the rectal pouch was correctly predicted in 88 % (29/33) and 67 % (22/33) of cases, respectively (p = 0.065). The length of the common channel in cloacal malformation was predicted with MRI in all (100 %, 5/5) and in 80 % of cases (4/5) with colostography/fistulography. Two bowel perforations occurred during colostography/fistulography. MRI provides the most accurate evaluation of ARM and should be considered a serious alternative to colostography/fistulography during preoperative work-up. (orig.)

  8. Catarata congênita: aspectos diagnósticos, clínicos e cirúrgicos em pacientes submetidos a lensectomia Congenital cataract: diagnostic, clinic and surgical features in patients submitted to lensectomy

    Directory of Open Access Journals (Sweden)

    Márcia Lima Santos Oliveira

    2004-12-01

    children who underwent surgery at the Congenital Cataract Sector - Department of Ophthalmology - Federal University of São Paulo, Brazil. RESULTS: Among the 62 children, 30.64% showed infectious causes, 19.36% genetic causes and 50% idiopathic causes. Strabismus was found in 54.83% of the patients and 27.42% had systemic diseases. Concerning pregnancy conditions, 22.58% of the mothers had no adequate prenatal care. Consanguinity was observed in 17.74% of the cases and congenital cataracts in 6 (9.68% relatives. The diagnostic suspicion was of the mothers in 72.58% of children. Leukocoria was the main feature. The suspicion age varied from immediately after birth to 15 months (mean = 1.34 months. Age on diagnosis in the department varied from 8 days to 20 months (mean = 5.84 months. Secondary opacification in the visual axis was the most frequent postoperative complication; it occurred in 19.11% of 89 eyes. It was observed that 45.16% of the patients had difficulties in following postoperative treatment. They did not use eyeglasses, eye drops or correct eye patching for amblyopia. CONCLUSION: Rubeola is still one of the most important causes of congenital cataract in our country. This condition shows the necessity of better prevention. The first diagnostic suspicion is mainly by the mothers and within the three first months of age in most children, but there is a considerable delay between suspicion and the patient's presence in a specialized service center. Despite satisfactory surgery results, delay of surgery and difficulties in postoperative treatment impair final visual results.

  9. A revolution in diagnostic imaging.

    Science.gov (United States)

    Mamula, Paul W

    2003-03-01

    In November 1966, Sandy Koufax, the star left-handed pitcher of the Los Angeles Dodgers, retired after spending his final season coping with traumatic arthritis in his elbow, the compounded effects of a sliding injury to his pitching arm the previous season and 12 years of hard throwing.1 Had his career begun a few years later, he might have been able to benefit from the advances in diagnostic imaging and treatment that were introduced at that time. Modern arthroscopy and computed tomography (CT) did not become available until the mid 1970s,2 and the first elbow reconstruction was done by Frank Jobe, MD, about 10 years after Koufax retired.1 Arthroscopy was first used as a diagnostic tool, but it later became a surgical tool, affecting treatment of knees, then, later, shoulders. Since 1973, when The Physician and Sportsmedicine was launched, we have witnessed a revolution in diagnostic imaging and are continuing to see an evolution of modalities.

  10. Prevalence of sacral dysmorphia in a prospective trauma population: Implications for a "safe" surgical corridor for sacro-iliac screw placement.

    Science.gov (United States)

    Hasenboehler, Erik A; Stahel, Philip F; Williams, Allison; Smith, Wade R; Newman, Justin T; Symonds, David L; Morgan, Steven J

    2011-05-10

    Percutaneous sacro-iliac (SI) screw fixation represents a widely used technique in the management of unstable posterior pelvic ring injuries and sacral fractures. The misplacement of SI-screws under fluoroscopic guidance represents a critical complication for these patients. This study was designed to determine the prevalence of sacral dysmorphia and the radiographic anatomy of surgical S1 and S2 corridors in a representative trauma population. Prospective observational cohort study on a consecutive series of 344 skeletally mature trauma patients of both genders enrolled between January 1, 2007, to September 30, 2007, at a single academic level 1 trauma center. Inclusion criteria included a pelvic CT scan as part of the initial diagnostic trauma work-up. The prevalence of sacral dysmorphia was determined by plain radiographic pelvic films and CT scan analysis. The anatomy of sacral corridors was analyzed on 3 mm reconstruction sections derived from multislice CT scan, in the axial, coronal, and sagittal plane. "Safe" potential surgical corridors at S1 and S2 were calculated based on these measurements. Radiographic evidence of sacral dysmorphia was detected in 49 patients (14.5%). The prevalence of sacral dysmorphia was not significantly different between male and female patients (12.2% vs. 19.2%; P = 0.069). In contrast, significant gender-related differences were detected with regard to radiographic analysis of surgical corridors for SI-screw placement, with female trauma patients (n = 99) having significantly narrower corridors at S1 and S2 in all evaluated planes (axial, coronal, sagittal), compared to male counterparts (n = 245; P dysmorphia. These findings emphasize a high prevalence of sacral dysmorphia in a representative trauma population and imply a higher risk of SI-screw misplacement in female patients. Preoperative planning for percutaneous SI-screw fixation for unstable pelvic and sacral fractures must include a detailed CT scan analysis to determine

  11. Most common surgical mistakes with treatment of prosthetic joint infections

    Directory of Open Access Journals (Sweden)

    Boštjan Kocjančič

    2014-08-01

    Full Text Available The treatment of infections of orthopedic implants is often difficult and complex, although the chances of successful treatment with properly selected diagnostics, surgical and antibiotic treatment protocol have recently increased significantly. Surgical treatment is a key stone factor in the treatment of infections of orthopedic implants and any errors in it often lead to worse clinical outcomes. The most important and frequent surgical errors include: conservative treatment of periprothetic infections with antibiotics only, to-late surgical revision, insufficient debridement during surgical revision, inadequate intraoperative samples for bacteriological and histological analysis. It is important to have and to follow proper treatment algorithm for periprosthetic joint infection. In this work we present the listed surgical and most illustrative key errors.

  12. Acute and chronic pancreatitis: surgical management.

    Science.gov (United States)

    Dzakovic, Alexander; Superina, Riccardo

    2012-08-01

    Pancreatitis is becoming increasingly prevalent in children, posing new challenges to pediatric health care providers. Although some general adult treatment paradigms are applicable in the pediatric population, diagnostic workup and surgical management of acute and chronic pancreatitis have to be tailored to anatomic and pathophysiological entities peculiar to children. Nonbiliary causes of acute pancreatitis in children are generally managed nonoperatively with hydration, close biochemical and clinical observation, and early initiation of enteral feeds. Surgical intervention including cholecystectomy or endoscopic retrograde cholangiopancreatography is often required in acute biliary pancreatitis, whereas infected pancreatic necrosis remains a rare absolute indication for pancreatic debridement and drainage via open, laparoscopic, or interventional radiologic procedure. Chronic pancreatitis is characterized by painful irreversible changes of the parenchyma and ducts, which may result in or be caused by inadequate ductal drainage. A variety of surgical procedures providing drainage, denervation, resection, or a combination thereof are well established to relieve pain and preserve pancreatic function. Copyright © 2012. Published by Elsevier Inc.

  13. Diagnostic evaluation of dementia in the secondary health care sector

    DEFF Research Database (Denmark)

    Phung, Thien Kieu Thi; Andersen, Birgitte Bo; Kessing, Lars Vedel

    2009-01-01

    BACKGROUND: We conducted a nationwide registry-based study of the quality of diagnostic evaluation for dementia in the secondary health care sector. METHOD: Two hundred patients were randomly selected from the patient population (4,682 patients) registered for the first time with a dementia...... diagnosis in the nationwide hospital registries during the last 6 months of 2003. Through medical record review, we evaluated the completeness of the work-up on which the dementia diagnosis was based, using evidence-based dementia guidelines as reference standards. RESULTS: Satisfactory or acceptable...... completion of the basic dementia work-up was documented in 51.3% of the patients. Only 11.5% of those with unsatisfactory work-up were referred to follow-up investigations. Dementia syndrome was confirmed in 88.5% of the cases, but correct subtypes were diagnosed in only 35.1%. CONCLUSION: The adherence...

  14. Head and neck imaging: An atlas and diagnostic guide

    International Nuclear Information System (INIS)

    Noyek, A.; Wortzman, G.

    1987-01-01

    This book presents an illustrated guide to the radiologic diagnosis of specific clinical problems. It combines the atlas format with a focus on making the diagnosis with the help of decision trees, strategies, and work-up protocols that include CT, ultrasound, and other modalities. It emphasizes communication between radiologists and otolaryngologists. It reviews radiologic evaluation of such clinical problems as the congenital ear, traumatic lesions, osteomyelitis, facial paralysis, local manifestations of systemic disease and post-surgical disorders

  15. Diagnostic imaging of compression neuropathy; Bildgebende Diagnostik von Nervenkompressionssyndromen

    Energy Technology Data Exchange (ETDEWEB)

    Weishaupt, D.; Andreisek, G. [Universitaetsspital, Institut fuer Diagnostische Radiologie, Zuerich (Switzerland)

    2007-03-15

    Compression-induced neuropathy of peripheral nerves can cause severe pain of the foot and ankle. Early diagnosis is important to institute prompt treatment and to minimize potential injury. Although clinical examination combined with electrophysiological studies remain the cornerstone of the diagnostic work-up, in certain cases, imaging may provide key information with regard to the exact anatomic location of the lesion or aid in narrowing the differential diagnosis. In other patients with peripheral neuropathies of the foot and ankle, imaging may establish the etiology of the condition and provide information crucial for management and/or surgical planning. MR imaging and ultrasound provide direct visualization of the nerve and surrounding abnormalities. Bony abnormalities contributing to nerve compression are best assessed by radiographs and CT. Knowledge of the anatomy, the etiology, typical clinical findings, and imaging features of peripheral neuropathies affecting the peripheral nerves of the foot and ankle will allow for a more confident diagnosis. (orig.) [German] Kompressionsbedingte Schaedigungen peripherer Nerven koennen die Ursache hartnaeckiger Schmerzen im Bereich des Sprunggelenks und Fusses sein. Eine fruehzeitige Diagnose ist entscheidend, um den Patienten der richtigen Therapie zuzufuehren und potenzielle Schaedigungen zu vermeiden oder zu verringern. Obschon die klinische Untersuchung und die elektrophysiologische Abklaerungen die wichtigsten Elemente der Diagnostik peripherer Nervenkompressionssyndrome sind, kann die Bildgebung entscheidend sein, wenn es darum geht, die Hoehe des Nervenschadens festzulegen oder die Differenzialdiagnose einzugrenzen. In gewissen Faellen kann durch Bildgebung sogar die Ursache der Nervenkompression gefunden werden. In anderen Faellen ist die Bildgebung wichtig bei der Therapieplanung, insbesondere dann, wenn die Laesion chirurgisch angegangen wird. Magnetresonanztomographie (MRT) und Sonographie ermoeglichen eine

  16. Deriving DICOM surgical extensions from surgical workflows

    Science.gov (United States)

    Burgert, O.; Neumuth, T.; Gessat, M.; Jacobs, S.; Lemke, H. U.

    2007-03-01

    The generation, storage, transfer, and representation of image data in radiology are standardized by DICOM. To cover the needs of image guided surgery or computer assisted surgery in general one needs to handle patient information besides image data. A large number of objects must be defined in DICOM to address the needs of surgery. We propose an analysis process based on Surgical Workflows that helps to identify these objects together with use cases and requirements motivating for their specification. As the first result we confirmed the need for the specification of representation and transfer of geometric models. The analysis of Surgical Workflows has shown that geometric models are widely used to represent planned procedure steps, surgical tools, anatomical structures, or prosthesis in the context of surgical planning, image guided surgery, augmented reality, and simulation. By now, the models are stored and transferred in several file formats bare of contextual information. The standardization of data types including contextual information and specifications for handling of geometric models allows a broader usage of such models. This paper explains the specification process leading to Geometry Mesh Service Object Pair classes. This process can be a template for the definition of further DICOM classes.

  17. Recognizing surgical patterns

    NARCIS (Netherlands)

    Bouarfa, L.

    2012-01-01

    In the Netherlands, each year over 1700 patients die from preventable surgical errors. Numerous initiatives to improve surgical practice have had some impact, but problems persist. Despite the introduction of checklists and protocols, patient safety in surgery remains a continuing challenge. This is

  18. Surgical medical record

    DEFF Research Database (Denmark)

    Bulow, S.

    2008-01-01

    A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15......A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15...

  19. Whole-body-MR imaging including DWIBS in the work-up of patients with head and neck squamous cell carcinoma: A feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Noij, Daniel P., E-mail: d.noij@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands); Boerhout, Els J., E-mail: e.boerhout@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands); Pieters-van den Bos, Indra C., E-mail: i.pieters@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands); Comans, Emile F., E-mail: efi.comans@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands); Oprea-Lager, Daniela, E-mail: d.oprea-lager@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands); Reinhard, Rinze, E-mail: r.reinhard@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands); Hoekstra, Otto S., E-mail: os.hoekstra@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands); Bree, Remco de, E-mail: r.debree@vumc.nl [Department Otolaryngology/Head and Neck Surgery, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands); Graaf, Pim de, E-mail: p.degraaf@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands); Castelijns, Jonas A., E-mail: j.castelijns@vumc.nl [Department of Radiology and Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, PO Box 7057, 1007 MB Amsterdam (Netherlands)

    2014-07-15

    Objectives: To assess the feasibility of whole-body magnetic resonance imaging (WB-MRI) including diffusion-weighted whole-body imaging with background-body-signal-suppression (DWIBS) for the evaluation of distant malignancies in head and neck squamous cell carcinoma (HNSCC); and to compare WB-MRI findings with {sup 18}F-fluorodeoxyglucose positron emission tomography/computed tomography ({sup 18}F-FDG-PET/CT) and chest-CT. Methods: Thirty-three patients with high risk for metastatic spread (26 males; range 48–79 years, mean age 63 ± 7.9 years (mean ± standard deviation) years) were prospectively included with a follow-up of six months. WB-MRI protocol included short-TI inversion recovery and T1-weighted sequences in the coronal plane and half-fourier acquisition single-shot turbo spin-echo T2 and contrast-enhanced-T1-weighted sequences in the axial plane. Axial DWIBS was reformatted in the coronal plane. Interobserver variability was assessed using weighted kappa and the proportion specific agreement (PA). Results: Two second primary tumors and one metastasis were detected on WB-MRI. WB-MRI yielded seven clinically indeterminate lesions which did not progress at follow-up. The metastasis and one second primary tumor were found when combining {sup 18}F-FDG-PET/CT and chest-CT findings. Interobserver variability for WB-MRI was κ = 0.91 with PA ranging from 0.82 to 1.00. For {sup 18}F-FDG-PET/CT κ could not be calculated due to a constant variable in the table and PA ranged from 0.40 to 0.99. Conclusions: Our WB-MRI protocol with DWIBS is feasible in the work-up of HNSCC patients for detection and characterization of distant pathology. WB-MRI can be complementary to {sup 18}F-FDG-PET/CT, especially in the detection of non {sup 18}F-FDG avid second primary tumors.

  20. Comparing diagnostic tests on benefit-risk.

    Science.gov (United States)

    Pennello, Gene; Pantoja-Galicia, Norberto; Evans, Scott

    2016-01-01

    Comparing diagnostic tests on accuracy alone can be inconclusive. For example, a test may have better sensitivity than another test yet worse specificity. Comparing tests on benefit risk may be more conclusive because clinical consequences of diagnostic error are considered. For benefit-risk evaluation, we propose diagnostic yield, the expected distribution of subjects with true positive, false positive, true negative, and false negative test results in a hypothetical population. We construct a table of diagnostic yield that includes the number of false positive subjects experiencing adverse consequences from unnecessary work-up. We then develop a decision theory for evaluating tests. The theory provides additional interpretation to quantities in the diagnostic yield table. It also indicates that the expected utility of a test relative to a perfect test is a weighted accuracy measure, the average of sensitivity and specificity weighted for prevalence and relative importance of false positive and false negative testing errors, also interpretable as the cost-benefit ratio of treating non-diseased and diseased subjects. We propose plots of diagnostic yield, weighted accuracy, and relative net benefit of tests as functions of prevalence or cost-benefit ratio. Concepts are illustrated with hypothetical screening tests for colorectal cancer with test positive subjects being referred to colonoscopy.

  1. Thyroid diagnostics

    Energy Technology Data Exchange (ETDEWEB)

    Scriba, P C; Boerner, W; Emrich, S; Gutekunst, R; Herrmann, J; Horn, K; Klett, M; Krueskemper, H L; Pfannenstiel, P; Pickardt, C R

    1985-03-01

    None of the in-vitro and in-vivo methods listed permits on unambiguous diagnosis when applied alone, owing to the fact that similar or even identical findings are obtained for various individual parameters in different thyroid diseases. Further, especially the in-vitro tests are also subject to extrathyroidal effects which may mask the typical findings. The limited and varying specificity and sensitivity of the tests applied, as well as the falsification of results caused by the patients' idiosyncracies and the methodology, make it necessary to interpret and evaluate the in-vivo and in-vitro findings only if the clinical situation (anamnesis and physical examination) is known. For maximum diagnostic quality of the tests, the initial probability of the assumed type of thyroid disease must be increased (formulation of the clinical problem). The concepts of exclusion diagnosis and identification must be distinguished as well as the diagnosis of functional disturbances on the one hand and of thyroid diseases on the other. Both of this requires a qualified, specific and detailed anamnesis and examination procedure, and the clinical examination remains the obligatory basis of clinical diagnostics. In case of inexplicable discrepancies between the clinical manifestations and the findings obtained with specific methods, or between the findings obtained with a specific method, the patient should be referred to an expert institution, or the expert institution should be consulted.

  2. Thyroid diagnostics

    International Nuclear Information System (INIS)

    Scriba, P.C.; Boerner, W.; Emrich, S.; Gutekunst, R.; Herrmann, J.; Horn, K.; Klett, M.; Krueskemper, H.L.; Pfannenstiel, P.; Pickardt, C.R.; Reiners, C.; Reinwein, D.; Schleusener, H.

    1985-01-01

    None of the in-vitro and in-vivo methods listed permits on unambiguous diagnosis when applied alone, owing to the fact that similar or even identical findings are obtained for various individual parameters in different thyroid diseases. Further, especially the in-vitro tests are also subject to extrathyroidal effects which may mask the typical findings. The limited and varying specificity and sensitivity of the tests applied, as well as the falsification of results caused by the patients' idiosyncracies and the methodology, make it necessary to interpret and evaluate the in-vivo and in-vitro findings only if the clinical situation (anamnesis and physical examination) is known. For maximum diagnostic quality of the tests, the initial probability of the assumed type of thyroid disease must be increased (formulation of the clinical problem). The concepts of exclusion diagnosis and identification must be distinguished as well as the diagnosis of functional disturbances on the one hand and of thyroid diseases on the other. Both of this requires a qualified, specific and detailed anamnesis and examination procedure, and the clinical examination remains the obligatory basis of clinical diagnostics. In case of inexplicable discrepancies between the clinical manifestations and the findings obtained with specific methods, or between the findings obtained with a specific method, the patient should be referred to an expert institution, or the expert institution should be consulted. (orig./MG) [de

  3. Ambient diagnostics

    CERN Document Server

    Cai, Yang

    2014-01-01

    Part I. FundamentalsIntroductionWhat is Ambient Diagnostics?Diagnostic ModelsMultimedia IntelligenceCrowd SourcingSoft SensorsScience of SimplicityPersonal DiagnosesBasic AlgorithmsBasic ToolsSummaryProblemsTransformationEarly Discoveries of Heartbeat PatternsTransforms, Features, and AttributesSequential FeaturesSpatiotemporal FeaturesShape FeaturesImagery FeaturesFrequency Domain FeaturesMulti-Resolution FeaturesSummaryProblemsPattern RecognitionSimilarities and DistancesClustering MethodsClassification MethodsClassifier Accuracy MeasuresSummaryProblemsPart II. Multimedia IntelligenceSound RecognitionMicrophone AppsModern Acoustic Transducers (Microphones)Frequency Response CharacteristicsDigital Audio File FormatsHeart Sound SensingLung Sound SensingSnore MeterSpectrogram (STFT)Ambient Sound AnalysisSound RecognitionRecognizing Asthma SoundPeak ShiftFeature CompressionRegroupingNoise IssuesFuture ApplicationsSummaryProblemsColor SensorsColor SensingHuman Color VisionColor SensorsColor Matching ExperimentsC...

  4. Detection surgical treatment and its results in children's thyroid gland

    International Nuclear Information System (INIS)

    Polyakov, V.G.; Lebedev, V.I.; Belkina, B.M.; Shishkov, R.V.; Makarova, I.S.; Durnov, L.A.

    1995-01-01

    208 patients with thyroid gland cancer were observed in 1975-1993 . The morphological investigations point to an absolute prevalence of highly differentiated forms of thyroid gland cancer in children. The radiation diagnostic techniques included ultrasound investigations of neck organs, chest roentgenography, thyroid gland scintigraphy. It is shown that the surgical method is the basic technique of treating thyroid gland cancer in children. 5-year survival rate of patients depending on the stage of disease development and scope of surgical treatment is analysed

  5. The emerging age of endovascular treatment of acute ischaemic stroke and the role of CT angiography in patient work-up: a guide for the radiologist

    International Nuclear Information System (INIS)

    Loughborough, W.; Mahady, K.; Bradley, M.D.; Renowden, S.A.; Mortimer, A.M.

    2016-01-01

    Recent trial evidence suggests that for patients suffering large-vessel occlusive stroke, endovascular therapy based on the stent-retriever technique is associated with superior clinical outcomes when compared to intravenous thrombolysis alone. The challenge now is how this service is to be delivered. This may involve both centralisation of services around large cities and development of robust networks to receive patients from district general hospitals situated further afield. Both diagnostic and interventional neuroradiology will need to expand. Furthermore, we suggest that it would be advantageous for radiology departments in those hospitals receiving hyperacute stroke patients to perform computed tomography (CT) angiography in addition to non-contrast CT, which also has implications for service delivery in these units. This could swiftly aid identification of patients who might benefit from thrombectomy and improve decision-making through demonstration of occlusive thrombus and of collateral status.

  6. Clinical Applications of Contrast-Enhanced Ultrasound in the Pediatric Work-Up of Focal Liver Lesions and Blunt Abdominal Trauma

    DEFF Research Database (Denmark)

    Laugesen, Nicolaj Grønbæk; Nolsoe, Christian Pallson; Rosenberg, Jacob

    2017-01-01

    of CEUS is indeed promising. However, no ultrasound contrast agent manufactured today is registered for pediatric use in Europe. The contrast agent SonoVue(®) has recently been approved by the FDA under the name of Lumason(®) to be used in hepatic investigations in adults and children. This article...... help reduce radiation exposure and use of iodinated contrast agents in pediatrics, thereby potentially reducing complications in routine imaging.......In pediatrics ultrasound has long been viewed more favorably than imaging that exposes patients to radiation and iodinated contrast or requires sedation. It is child-friendly and diagnostic capabilities have been improved with the advent of contrast-enhanced ultrasound (CEUS). The application...

  7. Unproven diagnostic procedures in IgE-mediated allergic diseases.

    Science.gov (United States)

    Niggemann, B; Grüber, C

    2004-08-01

    A considerable body of literature on therapeutic aspects of complementary and alternative medicine has been published in recent years, but little is known on diagnostic procedures. This short review lists complementary and alternative diagnostic procedures for the diagnosis of allergic diseases and presents an assessment of their usefulness for the daily practice. The review of the literature revealed that neither the determination of specific immunoglobulin G-antibodies in serum, the hair-analysis, the cytotoxic test, kinesiology, iridology, or electrodermal testing represent useful tests for the daily practice. To date, no complementary or alternative diagnostic procedure can be recommended as a meaningful element in the diagnostic work-up of allergic diseases. This is especially true for food allergy: properly performed oral food challenges still represent the gold standard for implementing specific diets in food allergic individuals. Ineffective diagnostic approaches may be costly for the consumer and delay appropriate therapy.

  8. Diagnostic accuracy of organ electrodermal diagnostics | Szopinski ...

    African Journals Online (AJOL)

    Objective. To estimate the diagnostic accuracy as well as the scope of utilisation of a new bio-electronic method of organ diagnostics. Design. Double-blind comparative study of the diagnostic results obtained by means of organ electrodermal diagnostics (OED) and clinical diagnoses, as a criterion standard. Setting.

  9. SNS Diagnostics

    International Nuclear Information System (INIS)

    Shea, T.J.; Cameron, P.; Doolittle, L.; Power, J.

    2000-01-01

    The Spallation Neutron Source (SNS) Project is a collaborative effort to build the next generation neutron science facility at Oak Ridge, TN. The facility will deliver a 2 MW proton beam to a liquid mercury target. Neutrons from this target will be moderated and sent to several state-of-the-art instruments. Six national laboratories are involved in SNS construction. Berkeley (LBNL) will build the front end that produces a 2.5 MeV, 52 mA H-beam. Los Alamos (LANL) is responsible for the 1 GeV linac with a superconducting section provided by Thomas Jefferson (JLab). Brookhaven (BNL) is building the transfer lines and accumulator ring. Oak Ridge (ORNL) and Argonne (ANL) have responsibility for the target and instruments. All activities are coordinated by the SNS project office at Oak Ridge. The high beam power, a desired availability of 95%, and an aggressive commissioning schedule lead to some interesting challenges in beam diagnostics

  10. Surgical ethics: surgical virtue and more.

    Science.gov (United States)

    Vercler, Christian J

    2015-01-01

    The encounter between a patient and her surgeon is unique for several reasons. The surgeon inflicts pain upon a patient for the patient's own good. An operative intervention is irreducibly personal, such that the decisions about and performance of operations are inseparable from the idiosyncrasies of the individual surgeon. Furthermore, there is a chasm of knowledge between the patient and surgeon that is difficult to cross. Hence, training in the discipline of surgery includes the inculcation of certain virtues and practices to safeguard against abuses of this relationship and to make sure that the best interests of the patient are prioritized. The stories in this issue are evidence that in contemporary practice this is not quite enough, as surgeons reflect on instances they felt were ethically challenging. Common themes include the difficulty in communicating surgical uncertainty, patient-surgeon relationships, ethical issues in surgical training, and the impact of the technological imperative on caring for dying patients.

  11. The management of esophageal achalasia: from diagnosis to surgical treatment.

    Science.gov (United States)

    Dobrowolsky, Adrian; Fisichella, P Marco

    2014-03-01

    The goal of this review is to illustrate our approach to patients with achalasia in terms of preoperative evaluation and surgical technique. Indications, patient selection and management are herein discussed. Specifically, we illustrate the pathogenetic theories and diagnostic algorithm with current up-to-date techniques to diagnose achalasia and its manometric variants. Finally, we focus on the therapeutic approaches available today: medical and surgical. A special emphasis is given on the surgical treatment of achalasia and we provide the reader with a detailed description of our pre and postoperative management.

  12. Giant prostatic utricle (utriculus masculinis): diagnostic imaging and surgical implications

    International Nuclear Information System (INIS)

    Lopatina, O.A.; Berry, T.T.; Spottswood, S.E.

    2004-01-01

    The prostatic utricle is an embryological remnant of the Mullerian duct system. It is often revealed incidentally on voiding cystourethrography in young males undergoing evaluation for possible vesicoureteral reflux. We present the case of a very large prostatic utricle found incidentally on ultrasound evaluation in a 4-year-old boy with a history of recurrent urinary tract infections. (orig.)

  13. Diagnostic value of high strength MRCP in the obstructive jaundice

    International Nuclear Information System (INIS)

    Yang Yang; Dong Yuhai; Yin Jie; Lv Guoyi

    2007-01-01

    Objective: To evaluate the diagnostic value of high strength MRCP in patients with obstructive jaundice. Methods: Routine MRI and MRCP examination on 161 patients with obstructive jaundice were carded out with 1.5T Siemens super-conductive magnetic resonance machine. Of them, 103 cases were benign lesions and 58 were malignant after surgical and ERCP pathological confirmation. Results: The diagnostic accuracy of MRCP was 100%, with the qualitative diagnostic accuracy at 90.2%. Conclusion: MRCP was the best method in diagnosing patients with obstructive jaundice, the concerned performances of MRCP could provide the dependable basis for surgical operation project. (authors)

  14. Surgical site infections

    African Journals Online (AJOL)

    Decrease the inflammatory response Vasodilatation leads to better perfusion and ... Must NOT be allowed to come in contact with brain, meninges, eyes or .... project (SCIP): Evolution of National Quality Measure. Surgical. Infection 2008 ...

  15. Surgical Critical Care Initiative

    Data.gov (United States)

    Federal Laboratory Consortium — The Surgical Critical Care Initiative (SC2i) is a USU research program established in October 2013 to develop, translate, and validate biology-driven critical care....

  16. Ambulatory Surgical Measures - Facility

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  17. Surgical Management of Hemorrhoids

    Science.gov (United States)

    Agbo, S. P.

    2011-01-01

    Hemorrhoids are common human afflictions known since the dawn of history. Surgical management of this condition has made tremendous progress from complex ligation and excision procedures in the past to simpler techniques that allow the patient to return to normal life within a short period. Newer techniques try to improve on the post-operative complications of older ones. The surgical options for the management of hemorrhoids today are many. Capturing all in a single article may be difficult if not impossible. The aim of this study therefore is to present in a concise form some of the common surgical options in current literature, highlighting some important post operative complications. Current literature is searched using MEDLINE, EMBASE and the Cochrane library. The conclusion is that even though there are many surgical options in the management of hemorrhoids today, most employ the ligature and excision technique with newer ones having reduced post operative pain and bleeding. PMID:22413048

  18. Surgical site infections

    African Journals Online (AJOL)

    Surgical site infections (SSIs) are a worldwide problem that has ... deep tissue is found on clinical examination, re-opening, histopathological or radiological investigation ..... Esposito S, Immune system and SSI, Journal of Chemotherapy, 2001.

  19. Surgical management of pain

    African Journals Online (AJOL)

    If these therapies fail, and with a thorough multidisciplinary approach involving carefully ... Generally, surgical pain management is divided into neuro- modulative .... 9 suggested. It is important to be sure that the underlying instability or.

  20. [Simulation in surgical training].

    Science.gov (United States)

    Nabavi, A; Schipper, J

    2017-01-01

    Patient safety during operations hinges on the surgeon's skills and abilities. However, surgical training has come under a variety of restrictions. To acquire dexterity with decreasingly "simple" cases, within the legislative time constraints and increasing expectations for surgical results is the future challenge. Are there alternatives to traditional master-apprentice learning? A literature review and analysis of the development, implementation, and evaluation of surgical simulation are presented. Simulation, using a variety of methods, most important physical and virtual (computer-generated) models, provides a safe environment to practice basic and advanced skills without endangering patients. These environments have specific strengths and weaknesses. Simulations can only serve to decrease the slope of learning curves, but cannot be a substitute for the real situation. Thus, they have to be an integral part of a comprehensive training curriculum. Our surgical societies have to take up that challenge to ensure the training of future generations.

  1. Diagnostic Approach to a Patient With Paraneoplastic Neurological Syndrome.

    Science.gov (United States)

    Mahta, Ali; Vijayvergia, Namrata; Bhavsar, Tapan M; Ward, Lawrence D

    2012-10-01

    Herein, we discussed a case of an otherwise healthy man who presented with progressive gait imbalance and ataxia, found to have small cell lung cancer. Based upon our clinical findings and laboratory data, a diagnosis of paraneoplastic cerebellar degeneration was made. Paraneoplastic neurological syndromes (PNS) are relatively rare but diverse and always should be considered in differentials. A diagnostic algorithm along with appropriate work up is discussed here.

  2. Diagnostic thoracoscopy

    Directory of Open Access Journals (Sweden)

    Plavec Goran

    2002-01-01

    Full Text Available Diagnostic thoracoscopy in patients with pleural effusion of unclear origin mostly provides the correct diagnosis. Results from published reports of previous researches are not uniform. In 47 male and 20 female patients with pleural effusion of unknown etiology, after receiving negative results obtained from cytological finding of pleural effusion and percutaneous needle biopsy, thoracoscopy with biopsy of one or both pleurae was performed. Procedure was done in local anesthesia using Stortz rigid thoracoscope. In 37 patients with malignant disease (primary or metastatic diagnosis was confirmed histopathologically in 31 patient (81.12%. In 27 patients with inflammatory pleural disease diagnosis was confirmed histopathologically in 22 patients (81.4%. Among 11 patients with specific pleural effusions, tuberculosis was confirmed in 10 (90.91%. Normal finding in cases of spontaneous pneumothorax and pulmonary embolism was taken as a positive result. Total number of positive findings was 55 (82.10%. In one patient, the third spontaneous pneumothorax was the indication for thoracoscopy, and after numerous bullae were seen during the procedure, talcum powder pleurodesis was done. In four patients low intensity subcutaneous emphysema occurred one day after thoracoscopy. It can be concluded that thoracoscopy in local anesthesia out of the operating room is good and practical method for solving the unclear pleural effusions, with neglectable rate of complications.

  3. Mitigation diagnostics

    International Nuclear Information System (INIS)

    Hall, S.T.

    1990-01-01

    This paper reports that experience in the remediation of schools and other large buildings has shown the importance of the effects of both the location of geologic sources and HVAC-induced distribution of indoor radon. In general, elevated radon in areas of schools with evenly distributed HVAC pressures are correlated with maximum soil radon emanations. However, strong or unequal HVAC effects can redistribute indoor radon to areas away from the direct source. Effective remediation required a complete understanding of both contributions. In some schools, highest indoor radon levels were located near large return ducts and were attributed to proximity to negative HVAC pressure. Successful sub-slab depressurization systems were installed, however, in rooms with lower indoor but greatest sub-slab radon levels, closest to the source. This shows the inadequacy of using indoor radon levels alone as a basis for remediation. Wings of two other schools with radon problems have equivalent window fan coil units in rooms of equal size and no central HVAC system. Highest indoor radon levels correlated well with highest sub-slab radon levels due to the equivalent effects of the window units. Diagnostic tests in other schools have revealed: blockwall radon transport to upper floors; high blockwall radon adjacent to sub-slab sources; and elevated indoor radon over crawlspace being drawn upward by HVAC-induced negative pressure, determined from indoor to outdoor micromanometer measurements

  4. Orthodontic-orthognathic interventions in orthognathic surgical cases: "Paper surgery" and "model surgery" concepts in surgical orthodontics

    Directory of Open Access Journals (Sweden)

    Narayan H Gandedkar

    2016-01-01

    Full Text Available Thorough planning and execution is the key for successful treatment of dentofacial deformity involving surgical orthodontics. Presurgical planning (paper surgery and model surgery are the most essential prerequisites of orthognathic surgery, and orthodontist is the one who carries out this procedure by evaluating diagnostic aids such as crucial clinical findings and radiographic assessments. However, literature pertaining to step-by-step orthognathic surgical guidelines is limited. Hence, this article makes an attempt to provide an insight and nuances involved in the planning and execution. The diagnostic information revealed from clinical findings and radiographic assessments is integrated in the "paper surgery" to establish "surgical-plan." Furthermore, the "paper surgery" is emulated in "model surgery" such that surgical bite-wafers are created, which aid surgeon to preview the final outcome and make surgical movements that are deemed essential for the desired skeletal and dental outcomes. Skeletal complexities are corrected by performing "paper surgery" and an occlusion is set up during "model surgery" for the fabrication of surgical bite-wafers. Further, orthodontics is carried out for the proper settling and finishing of occlusion. Article describes the nuances involved in the treatment of Class III skeletal deformity individuals treated with orthognathic surgical approach and illustrates orthodontic-orthognathic step-by-step procedures from "treatment planning" to "execution" for successful management of aforementioned dentofacial deformity.

  5. Post surgical complications from students' large animal surgical ...

    African Journals Online (AJOL)

    A retrospective study of post surgical complications was conducted on records of students' Large Animal Surgical Laboratories in the Faculty of Veterinary Medicine (F.V.M.), Ahmadu Bello University (A.B.U), Zaria from 1989 to 1993. Three hundred and eleven surgical complications were recorded from five surgical ...

  6. Prospective validation of an automated chemiluminescence-based assay of renin and aldosterone for the work-up of arterial hypertension.

    Science.gov (United States)

    Rossi, Gian Paolo; Ceolotto, Giulio; Rossitto, Giacomo; Seccia, Teresa Maria; Maiolino, Giuseppe; Berton, Chiara; Basso, Daniela; Plebani, Mario

    2016-09-01

    The availability of simple and accurate assays of plasma active renin (DRC) and aldosterone concentration (PAC) can improve the detection of secondary forms of arterial hypertension. Thus, we investigated the performance of an automated chemiluminescent assay for DRC and PAC in referred hypertensive patients. We prospectively recruited 260 consecutive hypertensive patients referred to an ESH Center for Hypertension. After exclusion of six protocol violations, 254 patients were analyzed: 67.3% had primary hypertension, 17.3% an aldosterone producing adenoma (APA), 11.4% idiopathic hyperaldosteronism (IHA), 2.4% renovascular hypertension (RVH), 0.8% familial hyperaldosteronism type 1 (FH-1), 0.4% apparent mineralocorticoid excess (AME), 0.4% a renin-producing tumor, and 3.9% were adrenalectomized APA patients. Bland-Altman plots and Deming regression were used to analyze results. The diagnostic accuracy (area under the curve, AUC of the ROC) of the DRC-based aldosterone-renin ratio (ARRCL) was compared with that of the PRA-based ARR (ARRRIA) using as reference the conclusive diagnosis of APA. At Bland-Altman plot, the DRC and PAC assay showed no bias as compared to the PRA and PAC assay. A tight relation was found between the DRC and the PRA values (concordance correlation coefficient=0.92, pAPA identification the AUC of the ARRCL was higher than that of the ARRRIA [0.974 (95% CI 0.940-0.991) vs. 0.894 (95% CI 0.841-0.933), p=0.02]. This rapid automated chemiluminescent DRC/PAC assay performed better than validated PRA/PAC radioimmunoassays for the identification of APA in referred hypertensive patients.

  7. Surgical data science: The new knowledge domain.

    Science.gov (United States)

    Vedula, S Swaroop; Hager, Gregory D

    2017-04-01

    Healthcare in general, and surgery/interventional care in particular, is evolving through rapid advances in technology and increasing complexity of care with the goal of maximizing quality and value of care. While innovations in diagnostic and therapeutic technologies have driven past improvements in quality of surgical care, future transformation in care will be enabled by data. Conventional methodologies, such as registry studies, are limited in their scope for discovery and research, extent and complexity of data, breadth of analytic techniques, and translation or integration of research findings into patient care. We foresee the emergence of Surgical/Interventional Data Science (SDS) as a key element to addressing these limitations and creating a sustainable path toward evidence-based improvement of interventional healthcare pathways. SDS will create tools to measure, model and quantify the pathways or processes within the context of patient health states or outcomes, and use information gained to inform healthcare decisions, guidelines, best practices, policy, and training, thereby improving the safety and quality of healthcare and its value. Data is pervasive throughout the surgical care pathway; thus, SDS can impact various aspects of care including prevention, diagnosis, intervention, or post-operative recovery. Existing literature already provides preliminary results suggesting how a data science approach to surgical decision-making could more accurately predict severe complications using complex data from pre-, intra-, and post-operative contexts, how it could support intra-operative decision-making using both existing knowledge and continuous data streams throughout the surgical care pathway, and how it could enable effective collaboration between human care providers and intelligent technologies. In addition, SDS is poised to play a central role in surgical education, for example, through objective assessments, automated virtual coaching, and robot

  8. Surgical data science: The new knowledge domain

    Science.gov (United States)

    Vedula, S. Swaroop; Hager, Gregory D.

    2017-01-01

    Healthcare in general, and surgery/interventional care in particular, is evolving through rapid advances in technology and increasing complexity of care with the goal of maximizing quality and value of care. While innovations in diagnostic and therapeutic technologies have driven past improvements in quality of surgical care, future transformation in care will be enabled by data. Conventional methodologies, such as registry studies, are limited in their scope for discovery and research, extent and complexity of data, breadth of analytic techniques, and translation or integration of research findings into patient care. We foresee the emergence of Surgical/Interventional Data Science (SDS) as a key element to addressing these limitations and creating a sustainable path toward evidence-based improvement of interventional healthcare pathways. SDS will create tools to measure, model and quantify the pathways or processes within the context of patient health states or outcomes, and use information gained to inform healthcare decisions, guidelines, best practices, policy, and training, thereby improving the safety and quality of healthcare and its value. Data is pervasive throughout the surgical care pathway; thus, SDS can impact various aspects of care including prevention, diagnosis, intervention, or post-operative recovery. Existing literature already provides preliminary results suggesting how a data science approach to surgical decision-making could more accurately predict severe complications using complex data from pre-, intra-, and post-operative contexts, how it could support intra-operative decision-making using both existing knowledge and continuous data streams throughout the surgical care pathway, and how it could enable effective collaboration between human care providers and intelligent technologies. In addition, SDS is poised to play a central role in surgical education, for example, through objective assessments, automated virtual coaching, and robot

  9. Surgical data science: the new knowledge domain

    Directory of Open Access Journals (Sweden)

    Vedula S. Swaroop

    2017-04-01

    Full Text Available Healthcare in general, and surgery/interventional care in particular, is evolving through rapid advances in technology and increasing complexity of care, with the goal of maximizing the quality and value of care. Whereas innovations in diagnostic and therapeutic technologies have driven past improvements in the quality of surgical care, future transformation in care will be enabled by data. Conventional methodologies, such as registry studies, are limited in their scope for discovery and research, extent and complexity of data, breadth of analytical techniques, and translation or integration of research findings into patient care. We foresee the emergence of surgical/interventional data science (SDS as a key element to addressing these limitations and creating a sustainable path toward evidence-based improvement of interventional healthcare pathways. SDS will create tools to measure, model, and quantify the pathways or processes within the context of patient health states or outcomes and use information gained to inform healthcare decisions, guidelines, best practices, policy, and training, thereby improving the safety and quality of healthcare and its value. Data are pervasive throughout the surgical care pathway; thus, SDS can impact various aspects of care, including prevention, diagnosis, intervention, or postoperative recovery. The existing literature already provides preliminary results, suggesting how a data science approach to surgical decision-making could more accurately predict severe complications using complex data from preoperative, intraoperative, and postoperative contexts, how it could support intraoperative decision-making using both existing knowledge and continuous data streams throughout the surgical care pathway, and how it could enable effective collaboration between human care providers and intelligent technologies. In addition, SDS is poised to play a central role in surgical education, for example, through objective

  10. Clinical utility of (18)F-FDG positron emission tomography/computed tomography scan vs. (99m)Tc-HMPAO white blood cell single-photon emission computed tomography in extra-cardiac work-up of infective endocarditis

    DEFF Research Database (Denmark)

    Lauridsen, Trine K; Iversen, Kasper K; Ihlemann, Nikolaj

    2017-01-01

    The extra-cardiac work-up in infective endocarditis (IE) comprises a search for primary and secondary infective foci. Whether18FDG-PET/CT or WBC-SPECT/CT is superior in detection of clinically relevant extra-cardiac manifestations in IE is unexplored. The objectives of this study were to identify...

  11. 3D Surgical Simulation

    Science.gov (United States)

    Cevidanes, Lucia; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael

    2009-01-01

    This paper discusses the development of methods for computer-aided jaw surgery. Computer-aided jaw surgery allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery (CAS) system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3D surface models from Cone-beam CT (CBCT), dynamic cephalometry, semi-automatic mirroring, interactive cutting of bone and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intra-operative guidance. The system provides further intra-operative assistance with the help of a computer display showing jaw positions and 3D positioning guides updated in real-time during the surgical procedure. The CAS system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training and assessing the difficulties of the surgical procedures prior to the surgery. CAS has the potential to make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. Supported by NIDCR DE017727, and DE018962 PMID:20816308

  12. 18F-FDG PET-CT after Neoadjuvant Chemoradiotherapy in Esophageal Cancer Patients to Optimize Surgical Decision Making.

    Directory of Open Access Journals (Sweden)

    Maarten C J Anderegg

    Full Text Available Prognosis of esophageal cancer patients can be significantly improved by neoadjuvant chemoradiotherapy (nCRT. Given the aggressive nature of esophageal tumors, it is conceivable that in a significant portion of patients treated with nCRT, dissemination already becomes manifest during the period of nCRT. The aim of this retrospective study was to determine the value and diagnostic accuracy of PET-CT after neoadjuvant chemoradiotherapy to identify patients with metastases preoperatively in order to prevent non-curative surgery.From January 2011 until February 2013 esophageal cancer patients deemed eligible for a curative approach with nCRT and surgical resection underwent a PET-CT after completion of nCRT. If abnormalities on PET-CT were suspected metastases, histological proof was acquired. A clinical decision model was designed to assess the cost-effectiveness of this diagnostic strategy.156 patients underwent a PET-CT after nCRT. In 31 patients (19.9% PET-CT showed abnormalities suspicious for dissemination, resulting in 17 cases of proven metastases (10.9%. Of the patients without proven metastases 133 patients were operated. In 6 of these 133 cases distant metastases were detected intraoperatively, corresponding to 4.5% false-negative results. The standard introduction of a post-neoadjuvant therapy PET-CT led to a reduction of overall health care costs per patient compared to a scenario without restaging with PET-CT ($34,088 vs. $36,490.In 10.9% of esophageal cancer patients distant metastases were detected by standard PET-CT after neoadjuvant chemoradiotherapy. To avoid non-curative resections we advocate post-neoadjuvant therapy PET-CT as a cost-effective step in the standard work-up of candidates for surgery.

  13. 18F-FDG PET-CT after Neoadjuvant Chemoradiotherapy in Esophageal Cancer Patients to Optimize Surgical Decision Making

    Science.gov (United States)

    Anderegg, Maarten C. J.; de Groof, Elisabeth J.; Gisbertz, Suzanne S.; Bennink, Roel J.; Lagarde, Sjoerd M.; Klinkenbijl, Jean H. G.; Dijkgraaf, Marcel G. W.; Bergman, Jacques J. G. H. M.; Hulshof, Maarten C. C. M.; van Laarhoven, Hanneke W. M.; van Berge Henegouwen, Mark I.

    2015-01-01

    Background Prognosis of esophageal cancer patients can be significantly improved by neoadjuvant chemoradiotherapy (nCRT). Given the aggressive nature of esophageal tumors, it is conceivable that in a significant portion of patients treated with nCRT, dissemination already becomes manifest during the period of nCRT. The aim of this retrospective study was to determine the value and diagnostic accuracy of PET-CT after neoadjuvant chemoradiotherapy to identify patients with metastases preoperatively in order to prevent non-curative surgery. Methods From January 2011 until February 2013 esophageal cancer patients deemed eligible for a curative approach with nCRT and surgical resection underwent a PET-CT after completion of nCRT. If abnormalities on PET-CT were suspected metastases, histological proof was acquired. A clinical decision model was designed to assess the cost-effectiveness of this diagnostic strategy. Results 156 patients underwent a PET-CT after nCRT. In 31 patients (19.9%) PET-CT showed abnormalities suspicious for dissemination, resulting in 17 cases of proven metastases (10.9%). Of the patients without proven metastases 133 patients were operated. In 6 of these 133 cases distant metastases were detected intraoperatively, corresponding to 4.5% false-negative results. The standard introduction of a post-neoadjuvant therapy PET-CT led to a reduction of overall health care costs per patient compared to a scenario without restaging with PET-CT ($34,088 vs. $36,490). Conclusion In 10.9% of esophageal cancer patients distant metastases were detected by standard PET-CT after neoadjuvant chemoradiotherapy. To avoid non-curative resections we advocate post-neoadjuvant therapy PET-CT as a cost-effective step in the standard work-up of candidates for surgery. PMID:26529313

  14. Anxiety in veterinary surgical students

    DEFF Research Database (Denmark)

    Langebæk, Rikke; Eika, Berit; Jensen, Asger Lundorff

    2012-01-01

    The surgical educational environment is potentially stressful and this can negatively affect students' learning. The aim of this study was to investigate whether veterinary students' level of anxiety is higher in a surgical course than in a non-surgical course and if pre-surgical training...... in a Surgical Skills Lab (SSL) has an anxiety reducing effect. Investigations were carried out as a comparative study and a parallel group study. Potential participants were fourth-year veterinary students who attended a surgical course (Basic Surgical Skills) and a non-surgical course (Clinical Examination...... and 28 students from 2010). Our results show that anxiety levels in veterinary students are significantly higher in a surgical course than in a non-surgical course (p...

  15. Surgical management of necrotizing sialometaplasia of palate

    Directory of Open Access Journals (Sweden)

    S M Balaji

    2015-01-01

    Full Text Available Necrotizing sialometaplasia (NSM is a rare benign, inflammatory disease of both major and minor salivary glands, although more commonly reported in the minor glands of the palate. The characteristic clinical presentation can perplex the clinician and may be mistaken for a malignant neoplasm, such as mucoepidermoid carcinoma, as well as invasive squamous cell carcinoma. The clinical and histological similarity between this entity and a malignant lesion may result in unnecessary or mis-treatment. Though clinically mimics malignancy, NSM is considered to be a self-limiting disease, and takes about 3-12 weeks to resolve. Majority of the case resolves itself or by supportive and symptomatic treatment. Surgical intervention is rarely required in NSM except the diagnostic biopsy. Herein we report the clinical, histopathological feature and surgical management of a case of NSM of hard palate in a young adult male.

  16. Surgical management of necrotizing sialometaplasia of palate.

    Science.gov (United States)

    Balaji, S M; Balaji, Preetha

    2015-01-01

    Necrotizing sialometaplasia (NSM) is a rare benign, inflammatory disease of both major and minor salivary glands, although more commonly reported in the minor glands of the palate. The characteristic clinical presentation can perplex the clinician and may be mistaken for a malignant neoplasm, such as mucoepidermoid carcinoma, as well as invasive squamous cell carcinoma. The clinical and histological similarity between this entity and a malignant lesion may result in unnecessary or mis-treatment. Though clinically mimics malignancy, NSM is considered to be a self-limiting disease, and takes about 3-12 weeks to resolve. Majority of the case resolves itself or by supportive and symptomatic treatment. Surgical intervention is rarely required in NSM except the diagnostic biopsy. Herein we report the clinical, histopathological feature and surgical management of a case of NSM of hard palate in a young adult male.

  17. Measuring the cortical silent period can increase diagnostic confidence for amyotrophic lateral sclerosis.

    NARCIS (Netherlands)

    Schelhaas, H.J.; Arts, I.M.P.; Overeem, S.; Houtman, C.J.; Janssen, H.; Kleine, B.U.; Munneke, M.; Zwarts, M.J.

    2007-01-01

    We evaluated a modified measurement of the cortical silent period (CSP) as a simple procedure to add further confidence in the diagnostic work-up for ALS. Thirty-seven consecutive patients with a suspicion of having ALS were included together with 25 healthy volunteers, and followed until a final

  18. Moyamoya disease: Diagnostic imaging

    International Nuclear Information System (INIS)

    Tarasów, Eugeniusz; Kułakowska, Alina; Łukasiewicz, Adam; Kapica-Topczewska, Katarzyna; Korneluk-Sadzyńska, Alicja; Brzozowska, Joanna; Drozdowski, Wiesław

    2011-01-01

    Moyamoya disease is a progressive vasculopathy leading to stenosis of the main intracranial arteries. The incidence of moyamoya disease is high in Asian countries; in Europe and North America, the prevalence of the disease is considerably lower. Clinically, the disease may be of ischaemic, haemorrhagic and epileptic type. Cognitive dysfunction and behavioral disturbance are atypical symptoms of moyamoya disease. Characteristic angiographic features of the disease include stenosis or occlusion of the arteries of the circle of Willis, as well as the development of collateral vasculature. Currently, magnetic resonance angiography and CT angiography with multi-row systems are the main imaging methods of diagnostics of the entire range of vascular changes in moyamoya disease. The most common surgical treatment combines the direct arterial anastomosis between the superficial temporal artery and middle cerebral, and the indirect synangiosis involving placement of vascularised tissue in the brain cortex, in order to promote neoangiogenesis. Due to progressive changes, correct and early diagnosis is of basic significance in selecting patients for surgery, which is the only effective treatment of the disease. An appropriate qualification to surgery should be based on a comprehensive angiographic and imaging evaluation of brain structures. Despite the rare occurrence of moyamoya disease in European population, it should be considered as one of causes of ischaemic or haemorrhagic strokes, especially in young patients

  19. SURGICAL SITE INFECTION: REVIEW

    Directory of Open Access Journals (Sweden)

    P. H. M. Bonai

    2016-07-01

    Full Text Available Nosocomial infection or nosocomial infection (NI is one of the factors that increase the cost of maintaining patients in the health system, even in processes that should safely occur, such as hospital patients and performing simple and routine surgical procedures surgical centers and clinics leading to complications resulting from these infections that prolong hospital stay and promote pain and suffering to the patient, resulting in the defense of the quality of services and influencing negatively the hospitals. Therefore, the aim of this study was to review the factors that result in surgical site infection, with the purpose of better understanding of the subject and the possibility of preventive actions to better treatment outcome of the patient.

  20. Retained surgical sponge

    International Nuclear Information System (INIS)

    Koyama, Masashi; Kurono, Kenji; Iida, Akihiko; Suzuki, Hirochika; Hara, Masaki; Mizutani, Hirokazu; Ohba, Satoru; Mizutani, Masaru; Nakajima, Yoichiro.

    1993-01-01

    The CT, US, and MRI findings of confirmed retained surgical sponges were reviewed. The CT examinations in eight lesions demonstrated round or oval masses with heterogeneous internal structures. The US examinations in 5 lesions demonstrated low echogenic masses with high echogenic internal structures, which suggested retained surgical sponges. MR imagings in three lesions showed slightly high intensity comparable to that of muscles on T1-weighted images and high signal intensity on T2-weighted images, suggesting fluid collections of high protein concentration. (author)

  1. Lectures in plasma diagnostics

    International Nuclear Information System (INIS)

    Hutchinson, I.H.

    1990-06-01

    This paper discusses the following topics on plasma diagnostics: Electric probes in flowing and magnetized plasmas; Electron cyclotron emission absorption; Magnetic diagnostics; Spectroscopy; and Thomson Scattering

  2. Tissue preservation with mass spectroscopic analysis: Implications for cancer diagnostics.

    Science.gov (United States)

    Hall, O Morgan; Peer, Cody J; Figg, William D

    2018-05-17

    Surgical intervention is a common treatment modality for localized cancer. Post-operative analysis involves evaluation of surgical margins to assess whether all malignant tissue has been resected because positive surgical margins lead to a greater likelihood of recurrence. Secondary treatments are utilized to minimize the negative effects of positive surgical margins. Recently, in Science Translational Medicine, Zhang et al describe a new mass spectroscopic technique that could potentially decrease the likelihood of positive surgical margins. Their nondestructive in vivo tissue sampling leads to a highly accurate and rapid cancer diagnosis with great precision between healthy and malignant tissue. This new tool has the potential to improve surgical margins and accelerate cancer diagnostics by analyzing biomolecular signatures of various tissues and diseases.

  3. Surgical infections with Mycoplasma

    DEFF Research Database (Denmark)

    Levi-Mazloum, Niels Donald; Prag, Jørgen Brorson; Jensen, J S

    1997-01-01

    Mycoplasma hominis and Ureaplasma urealyticum are common inhabitants of the human genital tract. Evidence for an aetiological role in pyelonephritis, pelvic inflammatory disease, post-abortion and post-partum fever has been presented. There are sporadic reports of Mycoplasma causing serious...... extragenital infection such as septicemia, septic arthritis, neonatal meningitis and encephalitis. We review 38 cases of surgical infections with Mycoplasma....

  4. [Surgical therapy of gynecomastia].

    Science.gov (United States)

    Heckmann, A; Leclère, F M; Vogt, P M; Steiert, A

    2011-09-01

    Nowadays surgical intervention is an essential part of the treatment of idiopathic gynecomastia. Choosing the right method is crucial and is based on the current status in the clinical and histological evaluation. Before finalizing the process of choosing a specific method a prior interdisciplinary evaluation of the patient is necessary to ascertain clear indications for a surgical intervention. Liposuction is one of the methods which have become popular in recent years. The advantages are the possible combination with traditional techniques, such as subcutaneous mastectomy or periareolar mastopexy. The main indication is for gynecomastia stage IIa/b and is justifiable due to the reduction in surgical complications and scarring. Furthermore this technique provides an excellent aesthetical outcome for the patient. A total of 162 patients suffering from gynecomastia stages I-III (according to Simon) were surgically treated between 2000 and 2010 and these cases were retrospectively evaluated. The results showed a decline in the use of a T-shaped incision in combination with subcutaneous mastectomy with periareolar tightening compared to an increase in the use of subcutaneous mastectomy in combination with liposuction. The excised tissue should always be sent for histological examination to make sure no malignant cells were present.

  5. Surgical manifestations of filariasis

    Directory of Open Access Journals (Sweden)

    Subrahmanyam M

    1978-01-01

    Full Text Available Surgical manifestations of filariasis as seen in 150 cases over a period of three years in the department of Surgery, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha are reviewed. The genital manifestations are more common than the elephantiasis in this endemic zone.

  6. Improving surgical weekend handover.

    Science.gov (United States)

    Culwick, Caroline; Devine, Chris; Coombs, Catherine

    2014-01-01

    Effective handovers are vital to patient safety and continuity of care, and this is recognised by several national bodies including the GMC. The existing model at Great Western Hospital (GWH) involved three general surgical teams and a urology team placing their printed patient lists, complete with weekend jobs, in a folder for the on-call team to collect at the weekend. We recognised a need to reduce time searching for patients, jobs and reviews, and to streamline weekend ward rounds. A unified weekend list ordering all surgical patients by ward and bed number was introduced. Discrepancies in the layout of each team's weekday list necessitated the design of a new weekday list to match the weekend list to facilitate the easy transfer of information between the two lists. A colour coding system was also used to highlight specific jobs. Prior to this improvement project only 7.1% of those polled were satisfied with the existing system, after a series of interventions satisfaction increased to 85.7%. The significant increase in overall satisfaction with surgical handover following the introduction of the unified weekend list is promising. Locating patients and identifying jobs is easier and weekend ward rounds can conducted in a more logical and timely fashion. It has also helped facilitate the transition to consultant ward rounds of all surgical inpatients at the weekends with promising feedback from a recent consultants meeting.

  7. [Surgical complications of colostomies].

    Science.gov (United States)

    Ben Ameur, Hazem; Affes, Nejmeddine; Rejab, Haitham; Abid, Bassem; Boujelbene, Salah; Mzali, Rafik; Beyrouti, Mohamed Issam

    2014-07-01

    The colostomy may be terminal or lateral, temporary or permanent. It may have psychological, medical or surgical complications. reporting the incidence of surgical complications of colostomies, their therapeutic management and trying to identify risk factors for their occurrence. A retrospective study for a period of 5 years in general surgery department, Habib Bourguiba hospital, Sfax, including all patients operated with confection of a colostomy. Were then studied patients reoperated for stoma complication. Among the 268 patients who have had a colostomy, 19 patients (7%) developed surgical stoma complications. They had a mean age of 59 years, a sex ratio of 5.3 and a 1-ASA score in 42% of cases. It was a prolapse in 9 cases (reconfection of the colostomy: 6 cases, restoration of digestive continuity: 3 cases), a necrosis in 5 cases (reconfection of the colostomy), a plicature in 2 cases (reconfection of the colostomy) a peristomal abscess in 2 cases (reconfection of the colostomy: 1 case, restoration of digestive continuity: 1 case) and a strangulated parastomal hernia in 1 case (herniorrhaphy). The elective incision and the perineal disease were risk factors for the occurrence of prolapse stomial. Surgical complications of colostomies remain a rare event. Prolapse is the most common complication, and it is mainly related to elective approach. Reoperation is often required especially in cases of early complications, with usually uneventful postoperative course.

  8. [Diagnostic imaging and acute abdominal pain].

    Science.gov (United States)

    Liljekvist, Mads Svane; Pommergaard, Hans-Christian; Burcharth, Jakob; Rosenberg, Jacob

    2015-01-19

    Acute abdominal pain is a common clinical condition. Clinical signs and symptoms can be difficult to interpret, and diagnostic imaging may help to identify intra-abdominal disease. Conventional X-ray, ultrasound (US) and computed tomography (CT) of the abdomen vary in usability between common surgical causes of acute abdominal pain. Overall, conventional X-ray cannot confidently diagnose or rule out disease. US and CT are equally trustworthy for most diseases. US with subsequent CT may enhance diagnostic precision. Magnetic resonance seems promising for future use in acute abdominal imaging.

  9. Surgical Treatment for Pulmonary Hamartomas

    Directory of Open Access Journals (Sweden)

    Funda Ižncekara

    2015-11-01

    Full Text Available Aim: In this study, we evaluated the patients operated for hamartoma and treated endobronchially and the diagnostic value of this approach has been examined. Material and Method: 59 patients (24 females, 35 males; mean age 53 years, range 28-78 years which were operated and endobronchial treated for hamartoma in our clinic between January 2003 - January 2013 were analyzed retrospectively. Patient age, sex, symptoms, histopathological, surgical procedures and treatment outcomes were evaluated. Results: The most common complaint was shortness of breath, while 25 patients were asymptomatic. Thoracotomy and mass enucleation in 29 patients (%49,15, thoracotomy and wedge resection in 18 patients (%30.5, VATS and wedge resection in 4 patients (%6.77, thoracotomy and upper lobectomy in 4 patients (%6.77, thoracotomy and lower lobectomy in 2 patients (%3.38 and left upper lobe segmentectomy in 1 patient (%1.69 and right upper bronchial sleeve resection in 1 patient were performed. The postoperative pathology of lesions examined and diagnosis were chondroid hamartoma in 28 , pulmonary hamartoma in 20 , hamartoma chondrolypomatous in 11 and the bronchial hamartoma in 2 . No mortality was observed intraoperatively. Discussion: Although hamartomas are benign , diagnosis should be made because it can be confused with lung cancer. Definitive diagnosis and treatment can be performed successfully through VATS in primarily appropriate cases with minimal morbidity or thoracotomy or endobronchial treatment.

  10. [da Vinci surgical system].

    Science.gov (United States)

    Watanabe, Gou; Ishikawa, Norihiro

    2014-07-01

    The da Vinci surgical system was developed by Intuitive Surgical Inc. in the United States as an endoscopic surgical device to assist remote control surgeries. In 1998, the Da Vinci system was first used for cardiothoracic procedures. Currently a combination of robot-assisted internal thoracic artery harvest together with coronary artery bypass grafting (CABG) through a mini-incision (ThoraCAB) or totally endoscopic procedures including anastomoses under robotic assistance (TECAB) are being conducted for the treatment of coronary artery diseases. With the recent advances in catheter interventions, hybrid procedures combining catheter intervention with ThoraCAB or TECAB are anticipated in the future.On the other hand, with the decrease in number of coronary artery bypass surgeries, the share of valvular surgeries is expected to increase in the future. Among them, mitral valvuloplasty for mitral regurgitation is anticipated to be conducted mainly by low-invasive procedures, represented by minimally invasive cardiac surgery( MICS) and robot-assisted surgery. Apart from the intrinsic good surgical view, robotic-assisted systems offer additional advantages of the availability of an amplified view and the easy to observe the mitral valve in the physiological position. Thus, robotic surgical surgeries that make complicated procedures easier are expected to accomplish further developments in the future. Furthermore, while the number of surgeries for atrial septal defects has decreased dramatically following the widespread use of Amplatzer septal occluder, robotic surgery may become a good indication for cases in which the Amplatzer device is not indicated. In Japan, clinical trial of the da Vinci robotic system for heart surgeries has been completed. Statutory approval of the da Vinci system for mitral regurgitation and atrial septal defects is anticipated in the next few years.

  11. Prevalence of sacral dysmorphia in a prospective trauma population: Implications for a "safe" surgical corridor for sacro-iliac screw placement

    Directory of Open Access Journals (Sweden)

    Newman Justin T

    2011-05-01

    Full Text Available Abstract Background Percutaneous sacro-iliac (SI screw fixation represents a widely used technique in the management of unstable posterior pelvic ring injuries and sacral fractures. The misplacement of SI-screws under fluoroscopic guidance represents a critical complication for these patients. This study was designed to determine the prevalence of sacral dysmorphia and the radiographic anatomy of surgical S1 and S2 corridors in a representative trauma population. Methods Prospective observational cohort study on a consecutive series of 344 skeletally mature trauma patients of both genders enrolled between January 1, 2007, to September 30, 2007, at a single academic level 1 trauma center. Inclusion criteria included a pelvic CT scan as part of the initial diagnostic trauma work-up. The prevalence of sacral dysmorphia was determined by plain radiographic pelvic films and CT scan analysis. The anatomy of sacral corridors was analyzed on 3 mm reconstruction sections derived from multislice CT scan, in the axial, coronal, and sagittal plane. "Safe" potential surgical corridors at S1 and S2 were calculated based on these measurements. Results Radiographic evidence of sacral dysmorphia was detected in 49 patients (14.5%. The prevalence of sacral dysmorphia was not significantly different between male and female patients (12.2% vs. 19.2%; P = 0.069. In contrast, significant gender-related differences were detected with regard to radiographic analysis of surgical corridors for SI-screw placement, with female trauma patients (n = 99 having significantly narrower corridors at S1 and S2 in all evaluated planes (axial, coronal, sagittal, compared to male counterparts (n = 245; P P = 0.06, implying S2 as a safe surgical corridor of choice in patients with sacral dysmorphia. Conclusions These findings emphasize a high prevalence of sacral dysmorphia in a representative trauma population and imply a higher risk of SI-screw misplacement in female patients

  12. Diagnostic imaging of craniopharyngioma; Diagnostyka obrazowa czaszkogardlakow

    Energy Technology Data Exchange (ETDEWEB)

    Gradzki, J.; Nowak, S.; Paprzycki, W. [Akademia Medyczna, Poznan (Poland)

    1993-12-31

    40 patients have been examined with operational and histological confirmation of craniopharyngioma. CT image and X-ray plane of skull were performed in case all of these patients. TMR was conformed to examine 4 patients. X-ray planes was compared to CT. CT permits tumor cyst detection. The efficacy of mentioned above diagnostic techniques was compared with surgical findings. (author). 7 refs, 5 figs, 2 tabs.

  13. Paediatric Abdominal Surgical Emergencies in a General Surgical ...

    African Journals Online (AJOL)

    ... organized for general surgeons undertaking paediatric surgical emergencies. More paediatric surgeons should be trained and more paediatric surgical units should established in the country. Key Words: Paediatric Abdominal Surgical Emergencies; Paediatric Surgeons, General Surgeons. Journal of College of Medicine ...

  14. Diagnostic reasoning strategies and diagnostic success.

    Science.gov (United States)

    Coderre, S; Mandin, H; Harasym, P H; Fick, G H

    2003-08-01

    Cognitive psychology research supports the notion that experts use mental frameworks or "schemes", both to organize knowledge in memory and to solve clinical problems. The central purpose of this study was to determine the relationship between problem-solving strategies and the likelihood of diagnostic success. Think-aloud protocols were collected to determine the diagnostic reasoning used by experts and non-experts when attempting to diagnose clinical presentations in gastroenterology. Using logistic regression analysis, the study found that there is a relationship between diagnostic reasoning strategy and the likelihood of diagnostic success. Compared to hypothetico-deductive reasoning, the odds of diagnostic success were significantly greater when subjects used the diagnostic strategies of pattern recognition and scheme-inductive reasoning. Two other factors emerged as independent determinants of diagnostic success: expertise and clinical presentation. Not surprisingly, experts outperformed novices, while the content area of the clinical cases in each of the four clinical presentations demonstrated varying degrees of difficulty and thus diagnostic success. These findings have significant implications for medical educators. It supports the introduction of "schemes" as a means of enhancing memory organization and improving diagnostic success.

  15. Surgical camps: the Ugandan experience

    African Journals Online (AJOL)

    . The planned visits were advertised locally and in the national media. Screening of the patients was done first by the local medical teams and later by the visiting surgical teams. The surgical teams were comprised of the following personnel:.

  16. Improving surgical weekend handover

    OpenAIRE

    Culwick, Caroline; Devine, Chris; Coombs, Catherine

    2014-01-01

    Effective handovers are vital to patient safety and continuity of care, and this is recognised by several national bodies including the GMC. The existing model at Great Western Hospital (GWH) involved three general surgical teams and a urology team placing their printed patient lists, complete with weekend jobs, in a folder for the on-call team to collect at the weekend. We recognised a need to reduce time searching for patients, jobs and reviews, and to streamline weekend ward rounds. A unif...

  17. Acquiring minimally invasive surgical skills

    OpenAIRE

    Hiemstra, Ellen

    2012-01-01

    Many topics in surgical skills education have been implemented without a solid scientific basis. For that reason we have tried to find this scientific basis. We have focused on training and evaluation of minimally invasive surgical skills in a training setting and in practice in the operating room. This thesis has led to an enlarged insight in the organization of surgical skills training during residency training of surgical medical specialists.

  18. Robotic surgical training.

    Science.gov (United States)

    Ben-Or, Sharon; Nifong, L Wiley; Chitwood, W Randolph

    2013-01-01

    In July 2000, the da Vinci Surgical System (Intuitive Surgical, Inc) received Food and Drug Administration approval for intracardiac applications, and the first mitral valve repair was done at the East Carolina Heart Institute in May 2000. The system is now approved and used in many surgical specialties. With this disruptive technology and accepted use, surgeons and hospitals are seeking the most efficacious training pathway leading to safe use and responsible credentialing.One of the most important issues related to safe use is assembling the appropriate team of professionals involved with patient care. Moreover, proper patient selection and setting obtainable goals are also important.Creation and maintenance of a successful program are discussed in the article focusing on realistic goals. This begins with a partnership between surgeon leaders, hospital administrators, and industry support. Through this partnership, an appropriate training pathway and clinical pathway for success can be outlined. A timeline can then be created with periods of data analysis and adjustments as necessary. A successful program is attainable by following this pathway and attending to every detail along the journey.

  19. Surgical experts: born or made?

    Science.gov (United States)

    Sadideen, Hazim; Alvand, Abtin; Saadeddin, Munir; Kneebone, Roger

    2013-01-01

    The concept of surgical expertise and the processes involved in its development are topical, and there is a constant drive to identify reliable measures of expert performance in surgery. This review explores the notion of whether surgical experts are "born" or "made", with reference to educational theory and pertinent literature. Peer-reviewed publications, books, and online resources on surgical education, expertise and training were reviewed. Important themes and aspects of expertise acquisition were identified in order to better understand the concept of a surgical expert. The definition of surgical expertise and several important aspects of its development are highlighted. Innate talent plays an important role, but is insufficient on its own to produce a surgical expert. Multiple theories that explore motor skill acquisition and memory are relevant, and Ericsson's theory of the development of competence followed by deliberate self-practice has been especially influential. Psychomotor and non-technical skills are necessary for progression in the current climate in light of our training curricula; surgical experts are adaptive experts who excel in these. The literature suggests that surgical expertise is reached through practice; surgical experts are made, not born. A deeper understanding of the nature of expert performance and its development will ensure that surgical education training programmes are of the highest possible quality. Surgical educators should aim to develop an expertise-based approach, with expert performance as the benchmark. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  20. Surgical navigation with QR codes

    Directory of Open Access Journals (Sweden)

    Katanacho Manuel

    2016-09-01

    Full Text Available The presented work is an alternative to established measurement systems in surgical navigation. The system is based on camera based tracking of QR code markers. The application uses a single video camera, integrated in a surgical lamp, that captures the QR markers attached to surgical instruments and to the patient.

  1. Nigerian Journal of Surgical Research

    African Journals Online (AJOL)

    The Nigerian Journal of Surgical Research is a publication of the Surgical Research Society with main office in Zaria, Nigeria. Zaria is home to Ahmadu Bello University (ABU), a premier university in Nigeria. The aim of The Nigerian Journal of Surgical Research is to cover developments and advances in the broad field of ...

  2. Work up of Pediatric Urinary Tract Infection

    Science.gov (United States)

    Copp, Hillary L.; Schmidt, Bogdana

    2016-01-01

    Pediatric UTI costs the healthcare system upwards of 180 million dollars annually, and accounts for over 1.5 million clinician visits per year. Accurate and timely diagnosis of these infections is important for determining appropriate treatment and preventing long-term complications such as renal scarring, hypertension, and end-stage renal disease. Outside of the first 12 months, girls are more likely to be diagnosed with a UTI. About half of boys with UTI will be diagnosed within the first 12 months of life. The prevalence and incidence of pediatric UTI varies by age, race/ethnicity, sex and circumcision status. Diagnosis of UTI is made based on history and exam findings and confirmed with appropriately collected urine. If a bag specimen is negative, this can be used to rule out UTI without the need for confirmatory culture; however positive urinalysis tests from bag specimen warrant further investigation with a catheterized specimen or suprapubic aspiration. Urine culture is the gold standard for diagnosing UTI: Greater than 50,000 CFU on a catheterized specimen or suprapubic aspiration indicate presence of a UTI. Greater than 100,000 CFU on a voided specimen is considered a positive culture. There is no consensus on the need and optimal strategy for imaging in the setting of urinary tract infection in the pediatric population. Prompt recognition of UTI and antibiogram-based, empiric treatment or culture-based, targeted treatment should be initiated within 72 of presentation. PMID:26475948

  3. Working up a lactofermented vegetable product

    NARCIS (Netherlands)

    Nagy-Gasztonyi, M.; Biekman, E.S.A.; Krebbers, B.

    2002-01-01

    The combination of lactofermentation and enzyme-treatment (Rohament-PL as endo-polygalacturonase and the mixture of Rohament-PL and Rohalase 7069 as cellulase) of sliced carrot and orange juice resulted in a homogeneous product, with pleasant organoleptic features, after 18 h fermentation period.

  4. Patterns of diagnostic marker assessment in adult diffuse glioma

    DEFF Research Database (Denmark)

    Woehrer, Adelheid; Kristensen, Bjarne W.; Vital, Anne

    2017-01-01

    The 2016 update of the WHO classification has introduced an integrated diagnostic approach that incorporates both tumor morphology and molecular information. This conceptual change has far-reaching implications, especially for neuropathologists who are in the forefront of translating molecular...... markers to routine diagnostic use. Adult diffuse glioma is a prototypic example for a group of tumors that underwent substantial regrouping, and it represents a major workload for surgical neuropathologists. Hence, we conducted a survey among members of the European Confederation of Neuropathological...

  5. Diagnostic Ultrasound in Colorectal Cancer

    DEFF Research Database (Denmark)

    Rafaelsen, Søren Rafael

    2014-01-01

    SUMMARYBackground and purpose Colorectal cancer is a common disease in Denmark with considerable morbidity and mortality. Although survival in recent years has improved, Denmark still has the lowest 5-year survival compared to the other Nordic countries. The treatment of patients depends on local...... the potential to contribute to the staging of colorectal cancer. The purpose of these studies was to determine the usefulness of ultrasound diagnostics in patients with colorectal cancer.The purpose of the TRUS studies was to compare staging of rectal carcinomas using digital rectal exploration...... of 295 patients with primary colorectal cancer we found a sensitivity of preoperative ultrasound, surgical exploration, and intraoperative ultrasound of 70%, 84%, and 97%, respectively, based on a patient-by-patient comparison (p

  6. Diagnostic significance of CT discography

    International Nuclear Information System (INIS)

    Nishiyama, Toru; Tomita, Yu; Maeda, Katsuhisa; Takayama, Atsuya; Takada, Shunichi; Murakami, Masazumi; Saito, Yasufumi.

    1986-01-01

    In a total of 179 patients, comprising 161 with intervertebral disorder and 18 with spondylolysis or spondylolisthesis, CT discographic findings of 456 intervertebral discs were reviewed. Computed tomographic discography showed the direction of herniation, the size of hernial masses, and the deformity of the intervertebral disc and joint, being helpful in deciding indications for surgery and selecting surgical procedures. Computed tomographic discographic patterns of disk deformity were classified as types A, B, and C. This classification almost concurred with the findings of conventional discography. Discography or CT discography is recommended to be used when deformity at the L5-S1 level may be missed on myelography and there is extraforaminal lateral disc herniation. Combined use of myelography, discography, and CT discography would increase the diagnostic accuracy for lumbar diseases. (Namekawa, K.)

  7. Surgical management of hyperthyroidism.

    Science.gov (United States)

    Quérat, C; Germain, N; Dumollard, J-M; Estour, B; Peoc'h, M; Prades, J-M

    2015-04-01

    Hyperthyroidism includes several clinical and histopathological situations. Surgery is commonly indicated after failure of medical treatment. The aim of this study was to analyze the indications and complications of surgery as well as endocrine results. Patients operated on for hyperthyroidism between 2004 and 2012 were included in a retrospective study. Total thyroidectomy was performed for Graves' disease, toxic multinodular goiter and amiodarone-associated thyrotoxicosis; patients with toxic nodule underwent hemithyroidectomy. Pathologic analysis assessed surgical specimens; postoperative complications and resolution of hyperthyroidism were noted. Two hundred patients from 15 to 83 years old were included. One hundred and eighty-eight underwent primary surgery and 12 were re-operated for recurrent goiter (6 with subtotal thyroidectomy for multinodular goiter 25 years previously; 6 with hemithyroidectomy for solitary nodule 15 years previously). Eighty-two patients suffered from toxic multinodular goiter, 78 from Graves' disease, 35 from solitary toxic nodules and 5 from amiodarone-associated thyrotoxicosis. Fourteen papillary carcinomas (including 11 papillary microcarcinomas) and 34 healthy parathyroid glands (17%) were identified in the pathological specimens. Postoperative complications comprised 4% permanent recurrent laryngeal nerve palsy (1 year follow-up), 9% hematoma requiring surgical revision, and 3% definitive hypocalcemia. Normalization of thyroid hormone levels was observed in 198 patients. Two recurrences occurred due to incomplete resection (1 case of Graves' disease and 1 intrathoracic toxic goiter that occurred respectively 18 and 5 months after resection). Postoperative complications were more frequent in multinodular goiter (23%) than in Graves' disease (13%) (ns: P>0.05). Surgical management of hyperthyroidism enables good endocrinal control if surgery is complete. Patients need to be fully informed of all possible postoperative complications

  8. [Duane vertical surgical treatment].

    Science.gov (United States)

    Merino, M L; Gómez de Liaño, P; Merino, P; Franco, G

    2014-04-01

    We report 3 cases with a vertical incomitance in upgaze, narrowing of palpebral fissure, and pseudo-overaction of both inferior oblique muscles. Surgery consisted of an elevation of both lateral rectus muscles with an asymmetrical weakening. A satisfactory result was achieved in 2 cases, whereas a Lambda syndrome appeared in the other case. The surgical technique of upper-insertion with a recession of both lateral rectus muscles improved vertical incomitance in 2 of the 3 patients; however, a residual deviation remains in the majority of cases. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  9. Procedures in diagnostic radiology

    International Nuclear Information System (INIS)

    Doyle, T.; Hare, W.S.C.; Thomson, K.; Tess, B.

    1989-01-01

    This book outlines the various procedures necessary for the successful practice of diagnostic radiology. Topics covered are: general principles, imaging of the urinary and gastrointestinal tracts, vascular radiology, arthrography, and miscellaneous diagnostic radiologic procedures

  10. Diagnostic Algorithm Benchmarking

    Science.gov (United States)

    Poll, Scott

    2011-01-01

    A poster for the NASA Aviation Safety Program Annual Technical Meeting. It describes empirical benchmarking on diagnostic algorithms using data from the ADAPT Electrical Power System testbed and a diagnostic software framework.

  11. Radiogenomics: Creating a link between molecular diagnostics and diagnostic imaging

    Energy Technology Data Exchange (ETDEWEB)

    Rutman, Aaron M. [Department of Radiology, University of California San Diego Medical Center, San Diego, CA 92103 (United States); Kuo, Michael D. [Department of Radiology, University of California San Diego Medical Center, San Diego, CA 92103 (United States); Center for Translational Medical Systems, University of California San Diego Medical Center, San Diego, CA 92103 (United States)], E-mail: mkuo@ucsd.edu

    2009-05-15

    Studies employing high-throughput biological techniques have recently contributed to an improved characterization of human cancers, allowing for novel sub-classification, better diagnostic accuracy, and more precise prognostication. However, requirement of surgical procurement of tissue among other things limits the clinical application of such methods in everyday patient care. Radiographic imaging is routine in clinical practice but is currently histopathology based. The use of routine radiographic imaging provides a potential platform for linking specific imaging traits with specific gene expression patterns that inform the underlying cellular pathophysiology; imaging features could then serve as molecular surrogates that contribute to the diagnosis, prognosis, and likely gene-expression-associated treatment response of various forms of human cancer. This review focuses on high-throughput methods such as microarray analysis of gene expression, their role in cancer research, and in particular, on novel methods of associating gene expression patterns with radiographic imaging phenotypes, known as 'radiogenomics.' These findings underline a potential future role of both diagnostic and interventional radiologists in genetic assessment of cancer patients with radiographic imaging studies.

  12. Radiogenomics: Creating a link between molecular diagnostics and diagnostic imaging

    International Nuclear Information System (INIS)

    Rutman, Aaron M.; Kuo, Michael D.

    2009-01-01

    Studies employing high-throughput biological techniques have recently contributed to an improved characterization of human cancers, allowing for novel sub-classification, better diagnostic accuracy, and more precise prognostication. However, requirement of surgical procurement of tissue among other things limits the clinical application of such methods in everyday patient care. Radiographic imaging is routine in clinical practice but is currently histopathology based. The use of routine radiographic imaging provides a potential platform for linking specific imaging traits with specific gene expression patterns that inform the underlying cellular pathophysiology; imaging features could then serve as molecular surrogates that contribute to the diagnosis, prognosis, and likely gene-expression-associated treatment response of various forms of human cancer. This review focuses on high-throughput methods such as microarray analysis of gene expression, their role in cancer research, and in particular, on novel methods of associating gene expression patterns with radiographic imaging phenotypes, known as 'radiogenomics.' These findings underline a potential future role of both diagnostic and interventional radiologists in genetic assessment of cancer patients with radiographic imaging studies.

  13. Veterinary Molecular Diagnostics

    NARCIS (Netherlands)

    Roest, H.I.J.; Engelsma, M.Y.; Weesendorp, E.; Bossers, A.; Elbers, A.R.W.

    2017-01-01

    In veterinary molecular diagnostics, samples originating from animals are tested. Developments in the farm animals sector and in our societal attitude towards pet animals have resulted in an increased demand for fast and reliable diagnostic techniques. Molecular diagnostics perfectly matches this

  14. [Surgical treatment of gynecomastia].

    Science.gov (United States)

    Târcoveanu, E; Lupaşcu, C; Vasilescu, A; Moldovanu, R; Ichim, Mihaela; Georgescu, St; Niculescu, D; Dănilă, N; Dimofte, G; Anton, Raluca; Crumpei, Felicia; Florea, Niculina; Ungureanu, Cristina

    2008-01-01

    Gynecomastia describes a benign increase of the mammary gland in men. When medical treatment fails, the surgical procedure is the treatment of choice. There are two main surgical procedures: subdermal mastectomy and liposuction. To evaluate the results after surgical treatment (mastectomy) performed in a general surgery unit. We performed a retrospective study; all the patients operated for gynecomastia were reviewed. The clinical, imaging, biological, intraoperative and histological data were included into a MS Access database and statistical analyzed. From 1990-2007, 114 patients were admitted in the First Surgical Clinic Iaşi for gynecomastia. Only 12.6% from the patients were with bilateral gynecomastia. The mean age was 40.54 +/- 1.83 years old (range 12-84). Mean body mass was 26.72 +/- 0.46 kg/m2 (range 18.5-41), and about 20% from the patients had a BMI of over 30 kg/m2. We also noted that 46.5% were smokers. Simon classification was used for preoperative staging: 2.6% from the cases (N = 3) were included in stage I, 16.7% (N = 19) in stage IIa, 50% (N = 57) in stage IIb and 30.7% in stage III. The patients included in stages IIa and I are younger then the patients included in stage III (p = 0.024). Mastodynia was noted in 46 cases (40.4%). Ultrasound exam was performed in all the cases, and the larger diameter of the nodule measured was 3.75 +/- 0.18 cm (range 0.5-9.7). Only three cases were preoperatively treated with tamoxifen. Most of the cases were operated using general anesthesia (53.5%). Mastectomy was performed by peri-areolar (70.2%), elliptical (28.9%) or radial (0.9%) incisions. The subdermal mastectomy using peri-areolar approach was performed especially for the cases included in stages I, IIa and IIb--p gynecomastia in 6 cases; the other cases presented dilated ducts. We also noted intraductal papillary hyperplasia in 87 cases and chronic inflammation in 35 cases. The histological exam also revealed intraductal papilloma--9 cases, fibro

  15. [Stress-ECG is adequate to detect myocardial ischemia: when are additional diagnostic tests needed?].

    Science.gov (United States)

    Baer, F M

    2007-09-01

    The stress-ECG is the most often adopted and most cost effective initial diagnostic test for the assessment of myocardial ischemia in patients with suspected coronary artery disease (CAD). Prerequisites for the diagnostic usefullness of stress-ECG are a clearly interpretable ST-segment, ability to reach the predicted work load, an intermediate pretest probability for CAD ranging between 10% and 90% and the absence of any contraindications for dynamic exercise. Because of the limited diagnostic sensitivity of about 70%, and a high percentage of patients, who are unable to exercise, a negative stress ECG can definitely not exclude hemodynamically significant CAD. Therefore, stress imaging techniques like myocardial scintigraphy, stress-echocardiography and stress magnetic resonance imaging play a major role in the stepwise diagnostic work-up of patients with suspected CAD. These stress imaging techniques are basically interchangeable since no method is definitely superior to one of the others. However, each method has its specific pros and cons and inherent contraindications. Therefore the choice of the stress imaging method and the form of stress applied should be based on the individual patients characteristics to gain optimal image quality and diagnostic accuracy. Moreover, the decision for one method should take the local availability and institutional expertise of diagnostic centers into account. Although partly substituted by stress imaging techniques the stress-ECG still remains the workhorse for a stepwise diagnostic work-up of patients with suspected CAD.

  16. Surgical Instrument Sets for Special Operations Expeditionary Surgical Teams.

    Science.gov (United States)

    Hale, Diane F; Sexton, Justin C; Benavides, Linda C; Benavides, Jerry M; Lundy, Jonathan B

    The deployment of surgical assets has been driven by mission demands throughout years of military operations in Iraq and Afghanistan. The transition to the highly expeditious Golden Hour Offset Surgical Transport Team (GHOST- T) now offers highly mobile surgical assets in nontraditional operating rooms; the content of the surgical instrument sets has also transformed to accommodate this change. The 102nd Forward Surgical Team (FST) was attached to Special Operations assigned to southern Afghanistan from June 2015 to March 2016. The focus was to decrease overall size and weight of FST instrument sets without decreasing surgical capability of the GHOST-T. Each instrument set was evaluated and modified to include essential instruments to perform damage control surgery. The overall number of main instrument sets was decreased from eight to four; simplified augmentation sets have been added, which expand the capabilities of any main set. The overall size was decreased by 40% and overall weight decreased by 58%. The cardiothoracic, thoracotomy, and emergency thoracotomy trays were condensed to thoracic set. The orthopedic and amputation sets were replaced with an augmentation set of a prepackaged orthopedic external fixator set). An augmentation set to the major or minor basic sets, specifically for vascular injuries, was created. Through the reorganization of conventional FST surgical instrument sets to maintain damage control capabilities and mobility, the 102nd GHOST-T reduced surgical equipment volume and weight, providing a lesson learned for future surgical teams operating in austere environments. 2017.

  17. The complex treatment of acute pancreatitis using miniinvasive surgical treatment

    Directory of Open Access Journals (Sweden)

    G. I. Ohrimenko

    2015-06-01

    Full Text Available Nowadays methods used in acute pancreatitis diagnostic do not allow to find the most optimal indications, terms of surgical drainage approaches in surgical treatment of acute pancreatitis. Aim. In order to develop optimal diagnostic and treatment algorithm 316 patients took part in the study. Methods and results. Surgery outcomes were assessed by the next methods: ultrasound, computed tomography. We determined that destructive changes in pancreas in group of sterile pancreatic necrosis were limited. In cases of infected pancreatic necrosis the damage was spread and the disease course was septic. That’s why the operative treatment in cases of sterile pancreatitis has to be used with strict indications such as fermentative peritonitis, acute liquid formations, acute pseudocysts. Conclusion. In such cases miniinvasive surgery is mainly used while in the cases of infected pancreatic necrosis we ought to choose open surgery treatment.

  18. Imaging mammary diagnostics. Diagnostic techniques, archetypical findings, differential diagnostcs and interventions. 2. rev. and enl. ed.

    International Nuclear Information System (INIS)

    Heywang-Koebrunner, S.; Schreer, I.

    2008-01-01

    The book includes the following chapters: I. Methodology: anamnesis and interview; clinical evidence, mammography, sonography, magnetic resonance tomography, new imaging techniques (scintigraphy, PET), transcutaneous biopsy, pre-operative marking; II. phenotypes: normal mammary glands, mastopathics, cysts, benign tumors, inflammatory diseases, in-situ carcinomas, invasive carcinomas, lymphomas, other semi-malign and malign tumors, post-traumatic, post-surgical and post-therapeutic changes, skin changes, male mamma, screening, continuative diagnostics of screening evidence and problem solving for symptomatic patients

  19. Global curriculum in surgical oncology.

    Science.gov (United States)

    Are, C; Berman, R S; Wyld, L; Cummings, C; Lecoq, C; Audisio, R A

    2016-06-01

    The significant global variations in surgical oncology training paradigms can have a detrimental effect on tackling the rising global cancer burden. While some variations in training are essential to account for the differences in types of cancer and biology, the fundamental principles of providing care to a cancer patient remain the same. The development of a global curriculum in surgical oncology with incorporated essential standards could be very useful in building an adequately trained surgical oncology workforce, which in turn could help in tackling the rising global cancer burden. The leaders of the Society of Surgical Oncology and European Society of Surgical Oncology convened a global curriculum committee to develop a global curriculum in surgical oncology. A global curriculum in surgical oncology was developed to incorporate the required domains considered to be essential in training a surgical oncologist. The curriculum was constructed in a modular fashion to permit flexibility to suit the needs of the different regions of the world. Similarly, recognizing the various sociocultural, financial and cultural influences across the world, the proposed curriculum is aspirational and not mandatory in intent. A global curriculum was developed which may be considered as a foundational scaffolding for training surgical oncologists worldwide. It is envisioned that this initial global curriculum will provide a flexible and modular scaffolding that can be tailored by individual countries or regions to train surgical oncologists in a way that is appropriate for practice in their local environment. Copyright © 2016 Society of Surgical Oncology, European Society of Surgical Oncology. Published by Elsevier Ltd.. All rights reserved.

  20. Surgical criteria for femoroacetabular impingement syndrome: a scoping review.

    Science.gov (United States)

    Peters, Scott; Laing, Alisha; Emerson, Courtney; Mutchler, Kelsey; Joyce, Thomas; Thorborg, Kristian; Hölmich, Per; Reiman, Michael

    2017-11-01

    The purpose of this review was to analyse and report criteria used for open and arthroscopic surgical treatment of femoroacetabular impingement syndrome (FAIS). A librarian-assisted computer search of Medline, CINAHL and Embase for studies related to criterion for FAIS surgery was used in this study. Inclusion criteria included studies with the primary purpose of surgery or surgical outcomes for treatment of FAIS with and without labral tear, and reporting criteria for FAIS surgery. Diagnostic imaging was a criterion for surgery in 92% of the included studies, with alpha angle the most frequently reported (68% of studies) criterion. Reporting of symptoms was a criterion for surgery in 75%, and special tests a criterion in 70% of studies. Range-of-motion limitations were only a required criterion in 30%, only 12% of studies required intra-articular injection and 44% of studies described previously failed treatment (non-surgical or physiotherapist-led rehabilitation) as a criterion for surgery. Only 56% of included studies utilised the combination of symptoms, clinical signs and diagnostic imaging combined for diagnosis of FAIS as suggested by the Warwick Agreement on FAIS meeting. Diagnostic imaging evidence of FAIS was the most commonly reported criterion for surgery. Only 56% of included studies utilised the combination of symptoms, clinical signs and diagnostic imaging for diagnosis of FAIS as suggested by the Warwick Agreement on FAIS meeting, and only 44% of studies had failed non-surgical treatment (and 18% a failed trial of physiotherapy) as a criterion for surgery. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. VEIL Surgical Steps.

    Science.gov (United States)

    Raghunath, S K; Nagaraja, H; Srivatsa, N

    2017-03-01

    Inguinal lymphadenectomy remains the standard of care for metastatic nodal disease in cases of penile, urethral, vulval and vaginal cancers. Outcomes, including cure rates and overall and progression-free survivals, have progressively improved in these diseases with extending criteria to offer inguinal lymph node dissection for patients 'at-risk' for metastasis or loco-regional recurrence. Hence, despite declining incidence of advanced stages of these cancers, many patients will still need to undergo lymphadenectomy for optimal oncological outcomes. Inguinal node dissection is a morbid procedure with operative morbidity noted in almost two third of the patients. Video endoscopic inguinal lymphadenectomy (VEIL) was described and currently practiced with proven equivalent oncological outcomes. We describe our technique of VEIL using laparoscopic and robotic access as well as various new surgical strategies.

  2. Outcomes After Diagnostic Hip Injection.

    Science.gov (United States)

    Lynch, T Sean; Steinhaus, Michael E; Popkin, Charles A; Ahmad, Christopher S; Rosneck, James

    2016-08-01

    To provide a comprehensive review of outcomes associated with local anesthetic (LA) or LA and corticosteroid (CS) diagnostic hip injections, and how well response predicts subsequent operative success. A systematic review from database (PubMed, Medline, Scopus, Embase) inception to January 2015 for English-language articles reporting primary patient outcomes data was performed, excluding studies with >50% underlying osteoarthritis. Studies were assessed by 2 reviewers who collected pertinent data. Seven studies were included, reporting on a total 337 patients undergoing diagnostic hip injection. The mean age was 34.4 years, with 5 studies reporting 94 (35.2%) males and 173 (64.8%) females. One study examined the rate of pain relief with LA (92.5%); 2 CS studies reported relief on a scale from 0% to 100% (no to complete relief), ranging from 61% to 82.3%; and 3 studies used 10-point pain scales, with a CS study noting a pain score of 1.0, an LA study with a score of 3.03, and 1 study using either CS or LA scores of 3 to 5.6. Duration of pain relief was 9.8 (CS) and 2.35 days (LA). By pathology, greatest relief was achieved in acetabular chondral injury (93.3%) and least in cam impingement (81.6%), with clinical and imaging findings being unreliable predictors of relief. One study showed nonresponse to be a strong predictor of negative surgical outcome for femoroacetabular impingement. Diagnostic hip injections provide substantial pain relief for patients with various hip pathologies, with limited data to suggest greatest relief for those with chondral injury. Clinical and imaging findings are unreliable predictors of injection response, and nonresponse to injection is a strong negative predictor of surgical outcome. Future research should focus on elucidating differences by underlying pathology and predicting future operative success. Level IV, systematic review. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights

  3. Aggressive surgical management of craniopharyngiomas

    Directory of Open Access Journals (Sweden)

    Manmohan Singh

    2013-01-01

    Full Text Available Surgical treatment of craniopharyngiomas is challenging and despite advancements it continues to pose a challenge. Proponents of subtotal resection in conjunction with radiotherapy argue that this less aggressive approach can yield appropriate results with the lower morbidity. On the contrary, other argument is that gross total resection is superior. Though surgical management of craniopharyngioma is challenging due to its location and important surrounding neurovascular structures, optimal surgical results can be expected following radical surgical excision. Radical excision of craniopharyngiomas is associated with excellent long-term recurrence free survival. Radiation induced long-term complications can be altogether avoided by excising these tumors completely.

  4. Surgical treatment of parastomal hernia

    International Nuclear Information System (INIS)

    Basti, Z.; Mayer, A.

    2013-01-01

    Stoma construction is among standard surgical skills and is performed for many indications. Every stoma means huge impact on quality of life for patients even with great improvement in surgical technique and ostomy devices. All patients are very sensitive to complication of stoma and the most frequent complication is parastomal hernia. Incidence reported in literature is very high and unacceptable, it is 30-70%. Surgical approach is very demanding on technical equipment and experiences of surgeon. Authors focus on each surgical approach for treating this complication weather it´s using mesh or laparoscopic or open approach. (author)

  5. Timing of surgical site infection and pulmonary complications after laparotomy

    DEFF Research Database (Denmark)

    Gundel, Ossian; Gundersen, Sofie Kirchhoff; Dahl, Rikke Maria

    2018-01-01

    BACKGROUND: Surgical site infection (SSI) and other postoperative complications are associated with high costs, morbidity, secondary surgery, and mortality. Many studies have identified factors that may prevent SSI and pulmonary complications, but it is important to know when they in fact occur....... The aim of this study was to investigate the diagnostic timing of surgical site infections and pulmonary complications after laparotomy. MATERIAL AND METHODS: This is a secondary analysis of the PROXI trial which was a randomized clinical trial conducted in 1400 patients undergoing elective or emergent...... laparotomy. Patients were randomly allocated to either 80% or 30% perioperative inspiratory oxygen fraction. RESULTS: SSI or pulmonary complications were diagnosed in 24.2% (95% CI: 22.0%-26.5%) of the patients at a median of 9 days [IQR: 5-15] after surgery. Most common was surgical site infection (19...

  6. Pictorial Review of Surgical Anatomy in Adult Congenital Heart Disease.

    Science.gov (United States)

    De Cecco, Carlo N; Muscogiuri, Giuseppe; Madrid Pérez, José M; Eid, Marwen; Suranyi, Pal; Lesslie, Virginia W; Bastarrika, Gorka

    2017-07-01

    The survival rate of patients with congenital heart disease (CHD) has dramatically improved over the last 2 decades because of technological and surgical advances in diagnosis and treatment, respectively. The vast majority of CHD patients are, in fact, amenable to treatment by either device closure or surgery. Considering the wide spectrum of surgical procedures and complex native and derived anatomy, continuous and detailed follow-up is of paramount importance. Cardiac magnetic resonance and cardiac computed tomography angiography are the cornerstones of diagnosis and follow-up of CHD, allowing for comprehensive noninvasive assessment of the heart, coronary tree, and intrathoracic great vessels, along with both morphological and functional evaluation. The aim of this pictorial review is to provide an overview of the most common CHDs and their related surgical procedures as familiarity with the radiological findings of grown-up congenital heart disease patients is crucial for proper diagnostic and follow-up pathways.

  7. Usefulness of CT-scan in the diagnosis and therapeutic approach of gallstone ileus: report of two surgically treated cases

    OpenAIRE

    Michele, Danzi; Luciano, Grimaldi; Massimiliano, Fabozzi; Stefano, Reggio; Roberta, Danzi; Ernesto, Soscia; Bruno, Amato

    2013-01-01

    Background Gallstone ileus is a rare cause of gastrointestinal obstruction, more frequent in elderly patients, whose treatment is essentially surgical, although some para-surgical and mini-invasive possibilities exist, allowing the solution of such obstructive condition in a completely non-invasive way. Description In our study, after reporting two cases of biliary ileus managed by our surgical division, we will analyze the most suitable diagnostic procedures and the therapeutic approaches to...

  8. Surgical treatment of hepatic Echinococcus granulosus

    Directory of Open Access Journals (Sweden)

    Waldemar Patkowski

    2017-09-01

    Full Text Available Introduction : Infections caused by metacestode stage of the Echinococcus granulosus in humans result in disease named cystic echinococcosis. Aim: To present the outcomes of patients treated surgically for cystic echinococcosis of the liver. Material and methods : One hundred and nineteen patients treated in the period between 1989 and 2014 due to E. granulosus infection in the Department of General, Transplant, and Liver Surgery, Medical University of Warsaw were selected for this retrospective study. Diagnostic protocol included imaging examinations, i.e. ultrasonography and computed tomography of the abdomen. Blood samples where used to proceed sequential enzyme-linked immunosorbent assay (ELISA using Em2plus antigen as well as polymerase chain reaction (PCR to detect E. granulosus . Results : Surgery was the choice for treatment for almost all of the patients (98.3%. In 40 (34.2% patients right hemihepatectomy, in 19 (16.2% patients left hemihepatectomy, and in 21 (17.9% patients bisegementectomy were performed. Postoperative complications occurred in 4 (3.4% patients. In 3 patients biliary fistula requiring endoscopic treatment was observed, and 1 patient had subdiaphragmatic abscess successfully treated with drainage under ultrasound guidance. None of the patients died in the postoperative period, and the 1-, 5-, and 10-year survival rates were 100.0%, 90.9%, and 87.9%, respectively. Conclusions : Surgical treatment of the symptomatic cystic echinococcosis is the modality of choice for E. granulosus infection of the liver. Despite substantial development of diagnostic methods and new management opportunities, echinococcal infection still presents a challenge for epidemiologists, pharmacologists, and clinicists.

  9. Access to Specialized Surgical Care

    African Journals Online (AJOL)

    The ANNALS of AFRICAN SURGERY. January 2016 Volume 13 Issue 1 1. EDITORIAL. Access to Specialized Surgical Care. Saidi H. University of Nairobi. Correspondence to: Prof Hassan Saidi, P.O Box 30196-00100, Nairobi. Email: hsaid2ke@yahoo.com. Ann Afr Surg. 2016;13(1):1-2. The narrative of surgical disease in ...

  10. Surgical residency: A tenant's view

    African Journals Online (AJOL)

    'To sleep: perchance to dream', is the frequent mantra of the surgical resident. However, unlike. Hamlet, there is no ensuing speculation as to what dreams may come as there are seldom any!! Surgical residency has been both vilified and immortalized, but the fact remains that it is one of the most challenging, provocative ...

  11. Surgical innovations in canine gonadectomy

    NARCIS (Netherlands)

    Van Goethem, Bart

    2016-01-01

    In this thesis some recent technological developments in human surgery are evaluated for their potential use in veterinary medicine by introducing them as surgical innovations for canine gonadectomy. Barbed sutures achieve wound apposition without surgical knot tying and thus avoid knot-associated

  12. Acquiring minimally invasive surgical skills

    NARCIS (Netherlands)

    Hiemstra, Ellen

    2012-01-01

    Many topics in surgical skills education have been implemented without a solid scientific basis. For that reason we have tried to find this scientific basis. We have focused on training and evaluation of minimally invasive surgical skills in a training setting and in practice in the operating room.

  13. Diagnostic Development on NSTX

    International Nuclear Information System (INIS)

    A.L. Roquemore; D. Johnson; R. Kaita; et al

    1999-01-01

    Diagnostics are described which are currently installed or under active development for the newly commissioned NSTX device. The low aspect ratio (R/a less than or equal to 1.3) and low toroidal field (0.1-0.3T) used in this device dictate adaptations in many standard diagnostic techniques. Technical summaries of each diagnostic are given, and adaptations, where significant, are highlighted

  14. TFTR diagnostic vacuum controller

    International Nuclear Information System (INIS)

    Olsen, D.; Persons, R.

    1981-01-01

    The TFTR diagnostic vacuum controller (DVC) provides in conjunction with the Central Instrumentation Control and Data Acquisition System (CICADA), control and monitoring for the pumps, valves and gauges associated with each individual diagnostic vacuum system. There will be approximately 50 systems on TFTR. Two standard versions of the controller (A and B) wil be provided in order to meet the requirements of two diagnostic manifold arrangements. All pump and valve sequencing, as well as protection features, will be implemented by the controller

  15. Essential fatty acid deficiency in surgical patients.

    Science.gov (United States)

    O'Neill, J A; Caldwell, M D; Meng, H C

    1977-01-01

    Parenteral nutrition may protect patients unable to eat from malnutrition almost indefinitely. If fat is not also given EFAD will occur. This outlines a prospective study of 28 surgical patients on total intravenous fat-free nutrition to determine the developmental course of EFAD and the response to therapy. Twenty-eight patients ranging from newborn to 66 years receiving parenteral nutrition without fat had regular determinations of the composition of total plasma fatty acids and the triene/tetraene ratio using gas liquid chromatography. Physical signs of EFAD were looked for also. Patients found to have evidence of EFAD were treated with 10% Intralipid. Topical safflower oil was used in three infants. Total plasma fatty acid composition was restudied following therapy. In general, infants on fat-free intravenous nutrition developed biochemical EFAD within two weeks, but dermatitis took longer to become evident. Older individuals took over four weeks to develop a diagnostic triene/tetraene ratio (greater than 0.4; range 0.4 to 3.75). Therapeutic correction of biochemical EFAD took 7 to 10 days but dermatitis took longer to correct. Cutaneous application of safflower oil alleviated the cutaneous manifestations but did not correct the triene/tetraene ratio of total plasma fatty acids. These studies indicate that surgical patients who are unable to eat for two to four weeks, depending upon age and expected fat stores, should receive fat as a part of their intravenous regimen. Images Fig. 7. PMID:404973

  16. Marfan Syndrome: Clinical, Surgical, and Anesthetic Considerations.

    Science.gov (United States)

    Castellano, José M; Silvay, George; Castillo, Javier G

    2014-09-01

    Marfan syndrome is a multisystem connective tissue disorder, with primary involvement of the cardiovascular, ocular, and skeletal systems. This autosomal heritable disease is mainly attributable to a defect in the FBN1 gene. Clinical diagnosis of Marfan syndrome has been based on the Ghent criteria since 1996. In 2010, these criteria were updated, and the revised guidelines place more emphasis on aortic root dilation, ectopia lentis, and FBN1 mutation testing in the diagnostic assessment of Marfan syndrome. Among its many different clinical manifestations, cardiovascular involvement deserves special consideration, owing to its impact on prognosis. Recent molecular, surgical, and clinical research has yielded profound new insights into the pathological mechanisms that ultimately lead to tissue degradation and weakening of the aortic wall, which has led to exciting new treatment strategies. Furthermore, with the increasing life expectancy of patients with Marfan syndrome, there has been a subtle shift in the spectrum of medical problems. Consequently, this article focuses on recent advances to highlight their potential impact on future concepts of patient care from a clinical, surgical, and anesthetic perspective. © The Author(s) 2013.

  17. Assessing Old and New Diagnostic Tests for Gastroesophageal Reflux Disease.

    Science.gov (United States)

    Vaezi, Michael F; Sifrim, Daniel

    2018-01-01

    A detailed critique of objective measurements of gastroesophageal reflux disease (GERD) would improve management of patients suspecting of having reflux, leading to rational selection of treatment and better outcomes. Many diagnostic tests for GERD have been developed over the past decades. We analyze their development, positive- and negative-predictive values, and ability to predict response to treatment. These features are important for development of medical, surgical, and endoscopic therapies for GERD. We discuss the value of available diagnostic tests and review their role in management of patients with persistent reflux symptoms despite adequate medical or surgical treatment. This is becoming a significant health economic problem, due to the widespread use of proton pump inhibitors. GERD is believed to cause nonesophageal symptoms, such as those provoked by ear, nose, throat, or respiratory disorders. We analyze the value of GERD diagnostic tests in evaluation of these troublesome, nonesophageal symptoms. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

  18. Combined Surgical Treatment of Gynecomastia

    Directory of Open Access Journals (Sweden)

    Yordanov Y.

    2015-05-01

    Full Text Available Surgical treatment of gynecomastia could present unique challenges for the plastic surgeon. Achieving a good balance between effectiveness of the selected approach and the satisfactory aesthetic outcome often is a difficult endeavor. Optimal surgical treatment involves a combination of liposuction and direct excision. In the present study the charts of 11 patients treated with suction-assisted liposuction and direct surgical excision were retrospectively reviewed; a special emphasis is placed on the surgical technique. The mean follow-up period of the patients was 11.6 months. No infection, hematoma, nipple-areola complex necrosis and nipple retraction was encountered in this series. The combined surgical treatment of gynecomastia has shown to be a reliable technique in both small and moderate breast enlargement including those with skin excess.

  19. Diagnostic Procedures to Detect Chlamydia trachomatis Infections

    Directory of Open Access Journals (Sweden)

    Thomas Meyer

    2016-08-01

    Full Text Available The intracellular life style of chlamydia and the ability to cause persistent infections with low-grade replication requires tests with high analytical sensitivity to directly detect C. trachomatis (CT in medical samples. Nucleic acid amplification tests (NAATs are the most sensitive assays with a specificity similar to cell culture and are considered the method of choice for CT detection. In addition, NAATs can be performed on various clinical specimens that do not depend on specific transport and storage conditions, since NAATs do not require infectious bacteria. In the case of lower genital tract infections, first void urine and vaginal swabs are the recommended specimens for testing males and females, respectively. Infections of anorectal, oropharyngeal and ocular epithelia should also be tested by NAAT analysis of corresponding mucosal swabs. In particular, anorectal infections of men who have sex with men (MSM should include evaluation of lymphogranuloma venereum (LGV by identification of genotypes L1, L2 or L3. Detection of CT antigens by enzyme immunoassay (EIAs or rapid diagnostic tests (RDTs are unsuitable due to insufficient sensitivity and specificity. Recent PCR-based RDTs, however, are non-inferior to standard NAATs, and might be used at the point-of-care. Serology finds application in the diagnostic work-up of suspected chronic CT infection but is inappropriate to diagnose acute infections.

  20. Diagnostic imaging of the diabetic foot

    International Nuclear Information System (INIS)

    Ranachowska, C.; Lass, P.; Korzon-Burakowska, A.; Dobosz, M.

    2010-01-01

    Diabetic foot syndrome is a significant complication of diabetes. Diagnostic imaging is a crucial factor determining surgical decision and extent of surgical intervention. At present the gold standard is MRI scanning, whilst the role of bone scanning is decreasing, although in some cases it brings valuable information. In particular, in early stages of osteitis and Charcot neuro-osteoarthropathy, radionuclide imaging may be superior to MRI. Additionally, a significant contribution of inflammation-targeted scintigraphy should be noted. Probably the role of PET scanning will grow, although its high cost and low availability may be a limiting factor. In every case, vascular status should be determined, at least with Doppler ultrasound, with following conventional angiography or MR angiography. (authors)

  1. Output control of da Vinci surgical system's surgical graspers.

    Science.gov (United States)

    Johnson, Paul J; Schmidt, David E; Duvvuri, Umamaheswar

    2014-01-01

    The number of robot-assisted surgeries performed with the da Vinci surgical system has increased significantly over the past decade. The articulating movements of the robotic surgical grasper are controlled by grip controls at the master console. The user interface has been implicated as one contributing factor in surgical grasping errors. The goal of our study was to characterize and evaluate the user interface of the da Vinci surgical system in controlling surgical graspers. An angular manipulator with force sensors was used to increment the grip control angle as grasper output angles were measured. Input force at the grip control was simultaneously measured throughout the range of motion. Pressure film was used to assess the maximum grasping force achievable with the endoscopic grasping tool. The da Vinci robot's grip control angular input has a nonproportional relationship with the grasper instrument output. The grip control mechanism presents an intrinsic resistant force to the surgeon's fingertips and provides no haptic feedback. The da Vinci Maryland graspers are capable of applying up to 5.1 MPa of local pressure. The angular and force input at the grip control of the da Vinci robot's surgical graspers is nonproportional to the grasper instrument's output. Understanding the true relationship of the grip control input to grasper instrument output may help surgeons understand how to better control the surgical graspers and promote fewer grasping errors. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Comparative effectiveness of coronary CT angiography vs stress cardiac imaging in patients following hospital admission for chest pain work-up: The Prospective First Evaluation in Chest Pain (PERFECT) Trial.

    Science.gov (United States)

    Uretsky, Seth; Argulian, Edgar; Supariwala, Azhar; Agarwal, Shiv K; El-Hayek, Georges; Chavez, Patricia; Awan, Hira; Jagarlamudi, Ashadevi; Puppala, Siva P; Cohen, Randy; Rozanski, Alan

    2017-08-01

    Because the frequency of cardiac event rates is low among chest pain patients following either performance of coronary CT angiography (CCTA) or stress testing, there is a need to better assess how these tests influence the central management decisions that follow from cardiac testing. The present study was performed to assess the relative impact of CCTA vs stress testing on medical therapies and downstream resource utilization among patients admitted for the work-up of chest pain. The admitted patients were randomized in a 1:1 ratio to either cardiac imaging stress test or CCTA. Primary outcomes were time to discharge, change in medication usage, and frequency of downstream testing, cardiac interventions, and cardiovascular re-hospitalizations. We randomized 411 patients, 205 to stress testing, and 206 to CCTA. There were no differences in time to discharge or initiation of new cardiac medications at discharge. At 1 year follow-up, there was no difference in the number of patients who underwent cardiovascular downstream tests in the CCTA vs stress test patients (21% vs 15%, P = .1) or cardiovascular hospitalizations (14% vs 16%, P = .5). However, there was a higher frequency of invasive angiography in the CCTA group (11% vs 2%, P = .001) and percutaneous coronary interventions (6% vs 0%, P work-up to either CCTA or to stress testing resulted in similar discharge times, change in medical therapies at discharge, frequency of downstream noninvasive testing, and repeat hospitalizations. However, a higher frequency of invasive coronary angiography and revascularization procedures were performed in the CCTA arm. (ClinicalTrials.gov number, NCT01604655.).

  3. Reliability of implant surgical guides based on soft-tissue models.

    Science.gov (United States)

    Maney, Pooja; Simmons, David E; Palaiologou, Archontia; Kee, Edwin

    2012-12-01

    The purpose of this study was to determine the accuracy of implant surgical guides fabricated on diagnostic casts. Guides were fabricated with radiopaque rods representing implant positions. Cone beam computerized tomograms were taken with guides in place. Accuracy was evaluated using software to simulate implant placement. Twenty-two sites (47%) were considered accurate (13 of 24 maxillary and 9 of 23 mandibular sites). Soft-tissue models do not always provide sufficient accuracy for fabricating implant surgical guides.

  4. Solitary rectal ulcer syndrome: clinical findings, surgical treatment, and outcomes.

    Science.gov (United States)

    Torres, Carlos; Khaikin, Marat; Bracho, Jorge; Luo, Cheng Hua; Weiss, Eric G; Sands, Dana R; Cera, Susan; Nogueras, Juan J; Wexner, Steven D

    2007-11-01

    Solitary rectal ulcer syndrome (SRUS) is a rare disorder often misdiagnosed as a malignant ulcer. Histopathological features of SRUS are characteristic and pathognomonic; nevertheless, the endoscopic and clinical presentations may be confusing. The aim of the present study was to assess the clinical findings, surgical treatment, and outcomes in patients who suffer from SRUS. A retrospective chart review was undertaken, from January 1989 to May 2005 for all patients who were diagnosed with SRUS. Data recorded included: patient's age, gender, clinical presentation, past surgical history, diagnostic and preoperative workup, operative procedure, complications, and outcomes. During the study period, 23 patients were diagnosed with SRUS. Seven patients received only medical treatment, and in three patients, the ulcer healed after medical treatment. Sixteen patients underwent surgical treatment. In four patients, the symptoms persisted after surgery. Two patients presented with postoperative rectal bleeding requiring surgical intervention. Three patients developed late postoperative sexual dysfunction. One patient continued suffering from rectal pain after a colostomy was constructed. Median follow-up was 14 (range 2-84) months. The results of this study show clearly that every patient with SRUS must be assessed individually. Initial treatment should include conservative measures. In patients with refractory symptoms, surgical treatment should be considered. Results of anterior resection and protocolectomy are satisfactory for solitary rectal ulcer.

  5. Psychologists' diagnostic processes during a diagnostic interview

    NARCIS (Netherlands)

    Groenier, Marleen; Beerthuis, Vos R.J.; Pieters, Julius Marie; Witteman, C.L.M.; Witteman, Cilia L.M.; Swinkels, Jan A.

    2011-01-01

    In mental health care, psychologists assess clients’ complaints, analyze underlying problems, and identify causes for these problems, to make treatment decisions. We present a study on psychologists’ diagnostic processes, in which a mixed-method approach was employed. We aimed to identify a common

  6. Diagnostic radiology on multiple injured patients: interdisciplinary management

    International Nuclear Information System (INIS)

    Linsenmaier, U.; Pfeifer, K.J.; Kanz, K.G.; Mutschler, W.

    2001-01-01

    The presence of a radiologist within the admitting area of an emergency department and his capability as a member of the trauma team have a major impact on the role of diagnostic radiology in trauma care. The knowledge of clinical decision criteria, algorithms, and standards of patient care are essential for the acceptance within a trauma team. We present an interdisciplinary management concept of diagnostic radiology for trauma patients, which comprises basic diagnosis, organ diagnosis, radiological ABC, and algorithms of early clinical care. It is the result of a prospective study comprising over 2000 documented multiple injured patients. The radiologist on a trauma team should support trauma surgery and anesthesia in diagnostic and clinical work-up. The radiological ABC provides a structured approach for diagnostic imaging in all steps of the early clinical care of the multiple injured patient. Radiological ABC requires a reevaluation in cases of equivocal findings or difficulties in the clinical course. Direct communication of radiological findings with the trauma team enables quick clinical decisions. In addition, the radiologist can priority-oriented influence the therapy by using interventional procedures. The clinical radiologist is an active member of the interdisciplinary trauma team, not only providing diagnostic imaging but also participating in clinical decisions. (orig.) [de

  7. Diagnostic value of imaging in infective endocarditis: a systematic review.

    Science.gov (United States)

    Gomes, Anna; Glaudemans, Andor W J M; Touw, Daan J; van Melle, Joost P; Willems, Tineke P; Maass, Alexander H; Natour, Ehsan; Prakken, Niek H J; Borra, Ronald J H; van Geel, Peter Paul; Slart, Riemer H J A; van Assen, Sander; Sinha, Bhanu

    2017-01-01

    Sensitivity and specificity of the modified Duke criteria for native valve endocarditis are both suboptimal, at approximately 80%. Diagnostic accuracy for intracardiac prosthetic material-related infection is even lower. Non-invasive imaging modalities could potentially improve diagnosis of infective endocarditis; however, their diagnostic value is unclear. We did a systematic literature review to critically appraise the evidence for the diagnostic performance of these imaging modalities, according to PRISMA and GRADE criteria. We searched PubMed, Embase, and Cochrane databases. 31 studies were included that presented original data on the performance of electrocardiogram (ECG)-gated multidetector CT angiography (MDCTA), ECG-gated MRI, 18 F-fluorodeoxyglucose ( 18 F-FDG) PET/CT, and leucocyte scintigraphy in diagnosis of native valve endocarditis, intracardiac prosthetic material-related infection, and extracardiac foci in adults. We consistently found positive albeit weak evidence for the diagnostic benefit of 18 F-FDG PET/CT and MDCTA. We conclude that additional imaging techniques should be considered if infective endocarditis is suspected. We propose an evidence-based diagnostic work-up for infective endocarditis including these non-invasive techniques. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Ongoing experiments: diagnostics requirements

    International Nuclear Information System (INIS)

    Dickerman, C.E.

    1976-01-01

    The paper reviews the fuel motion diagnostics needs for ongoing LMFBR safety experiments over approximately the next five years, with the discussion centered on TREAT. Brief comments on the direction in which clad motion diagnostics requirements are expected to develop are also presented

  9. Clinical diagnostic ultrasound

    International Nuclear Information System (INIS)

    Barnett, E.; Morley, P.

    1986-01-01

    This textbook on diagnostic ultrasound covers the main systems, with emphasis being placed on the clinical application of diagnostic ultrasound in everyday practice. It provides not only a textbook for postgraduates (particularly FRCR candidates), but also a reference work for practitioners of clinical ultrasound and clinicians generally

  10. Gearbox vibration diagnostic analyzer

    Science.gov (United States)

    1992-01-01

    This report describes the Gearbox Vibration Diagnostic Analyzer installed in the NASA Lewis Research Center's 500 HP Helicopter Transmission Test Stand to monitor gearbox testing. The vibration of the gearbox is analyzed using diagnostic algorithms to calculate a parameter indicating damaged components.

  11. SURGICAL TREATMENT OF ENDOMETRIOSIS IN INFERTILE PATIENTS

    Directory of Open Access Journals (Sweden)

    Andrej Vogler

    2003-12-01

    Full Text Available Background. Endometriosis is nowadays probably the most frequent cause of infertility or subfertility and is revealed in approximately 30–40% of infertile women. The association between fertility and minimal or mild endometriosis remains unclear and controversial. Moderate and severe forms of the disease distort anatomical relations in the minor pelvis, resulting in infertility. The goals of endometriosis treatment are relief of pain symptoms, prevention of the disease progression and fertility improvement. Treatment of stages I and II endometriosis (according to the R-AFS classification may be expectative, medical or surgical. In severely forms of the disease (stage III and IV the method of choice is surgical treatment. Combined medical and surgical treatment is justified only in cases, in which the complete endometriotic tissue removal is not possible or recurrence of pain symptoms occur. Nowadays, laparoscopic surgical treatment is the golden standard being the diagnostic and therapeutic tool during the same procedure. The aim of this study was to evaluate the fertility rate after surgical treatment of different stages of endometriosis.Patients and methods. In prospectively designed study 100 infertile women were included. The only known cause of infertility was endometriosis. In group A there were 51 patients with stage I and II endometriosis, whereas in group B there were 49 patients with stage III and IV of the disease. Endometriosis was diagnosed and treated laparoscopically. Endometriotic implants were removed either with bipolar coagulation or CO2 laser vaporisation, whereas adhesions were sharp or blunt dissected, and endometriomas stripped out of ovaries. Pregnancy rates were calculated for both groups of patients, and statistically compared between the groups.Results. Mean age of patients was 29.25 (SD ± 4.08 years and did not significantly differ between the groups of patients (29.5 years in group A and 29 years in group B. In

  12. Surgical therapy in chronic pancreatitis.

    Science.gov (United States)

    Neal, C P; Dennison, A R; Garcea, G

    2012-12-01

    Chronic pancreatitis (CP) is an inflammatory disease of the pancreas which causes chronic pain, as well as exocrine and endocrine failure in the majority of patients, together producing social and domestic upheaval and a very poor quality of life. At least half of patients will require surgical intervention at some stage in their disease, primarily for the treatment of persistent pain. Available data have now confirmed that surgical intervention may produce superior results to conservative and endoscopic treatment. Comprehensive individual patient assessment is crucial to optimal surgical management, however, in order to determine which morphological disease variant (large duct disease, distal stricture with focal disease, expanded head or small duct/minimal change disease) is present in the individual patient, as a wide and differing range of surgical approaches are possible depending upon the specific abnormality within the gland. This review comprehensively assesses the evidence for these differing approaches to surgical intervention in chronic pancreatitis. Surgical drainage procedures should be limited to a small number of patients with a dilated duct and no pancreatic head mass. Similarly, a small population presenting with a focal stricture and tail only disease may be successfully treated by distal pancreatectomy. Long-term results of both of these procedure types are poor, however. More impressive results have been yielded for the surgical treatment of the expanded head, for which a range of surgical options now exist. Evidence from level I studies and a recent meta-analysis suggests that duodenum-preserving resections offer benefits compared to pancreaticoduodenectomy, though the results of the ongoing, multicentre ChroPac trial are awaited to confirm this. Further data are also needed to determine which of the duodenum-preserving procedures provides optimal results. In relation to small duct/minimal change disease total pancreatectomy represents the only

  13. Surgical Skills Beyond Scientific Management.

    Science.gov (United States)

    Whitfield, Nicholas

    2015-07-01

    During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel's attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel-Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice.

  14. DIAGNOSTIC METHODS IN BREAST CANCER DETECTION

    Directory of Open Access Journals (Sweden)

    Kristijana Hertl

    2018-02-01

    Full Text Available Background. In the world as well as in Slovenia, breast cancer is the most frequent female cancer. Due to its high incidence, it appears to be a serious health and economic problem. Content. Among other, tumour size at diagnosis, is an important prognostic factors of the course of the disease. The probability of axillary lymph node involvement as well as distant metastases is greater in larger tumours. This is the reason that encouraged the development of various diagnostic methods for early detection of small, clinically non-palpable breast tumours. Mammography, however, remains the »golden standard« of early breast cancer detection. It is the basic diagnostic method applied in all symptomatic women over 35 years of age and in asymptomatic women over 40 years of age. Ultrasonography (US, additional projections, magnetic resonance imaging (MRI and ductography are regarded as complementary diagnostic breast imaging techniques in addition to mammography. The detected changes in the breast can be further confirmed by US-, MR-guided or stereotactic biopsy. If necessary, surgical biopsy and the excision of a tissue sample, after wire or isotope localisation of the nonpalpable lesion, can be performed. Conclusions. Any of the above mentioned diagnostic methods has advantages as well as drawbacks and only detailed knowledge and understanding of each of them may assure the best option.

  15. Decisions to withhold diagnostic investigations in nursing home patients with a clinical suspicion of venous thromboembolism.

    Directory of Open Access Journals (Sweden)

    Henrike J Schouten

    Full Text Available This study aimed to gather insights in physicians' considerations for decisions to either refer for- or to withhold additional diagnostic investigations in nursing home patients with a suspicion of venous thromboembolism.Our study was nested in an observational study on diagnostic strategies for suspected venous thromboembolism in nursing home patients. Patient characteristics, bleeding-complications and mortality were related to the decision to withhold investigations. For a better understanding of the physicians' decisions, 21 individual face-to-face in-depth interviews were performed and analysed using the grounded theory approach.Referal for additional diagnostic investigations was forgone in 126/322 (39.1% patients with an indication for diagnostic work-up. 'Blind' anticoagulant treatment was initiated in 95 (75.4% of these patients. The 3 month mortality rates were higher for patients in whom investigations were withheld than in the referred patients, irrespective of anticoagulant treatment (odds ratio 2.45; 95% confidence interval 1.40 to 4.29 but when adjusted for the probability of being referred (i.e. the propensity score, there was no relation of non-diagnosis decisions to mortality (odds ratio 1.75; 0.98 to 3.11. In their decisions to forgo diagnostic investigations, physicians incorporated the estimated relative impact of the potential disease; the potential net-benefits of diagnostic investigations and whether performing investigations agreed with established management goals in advance care planning.Referral for additional diagnostic investigations is withheld in almost 40% of Dutch nursing home patients with suspected venous thromboembolism and an indication for diagnostic work-up. We propose that, given the complexity of these decisions and the uncertainty regarding their indirect effects on patient outcome, more attention should be focused on the decision to either use or withhold additional diagnostic tests.

  16. Radioisotope monitoring of gastro-esophageal reflux in patients with achalasia cardiae after surgical treatment

    International Nuclear Information System (INIS)

    Tran Dinh Ha; Szilvasi, J.

    1994-01-01

    Results of a radioisotope method of the gastro-esophageal reflux are presented in patients with achalasia cardiae after different types of surgical treatment. Both Belsey-Mark and modified Nissen techniques are effective in preventing spontaneous gastroesophageal reflux, however 2 patients after Nissen fundoplication demonstrated gastro-esophageal reflux provoked by abdominal compression. This simple, noninvasive and physiologic method is an appropriate diagnostic tool for evaluating the efficiency of different anti reflux surgical techniques and is recommended for follow-up studies of patients after gastro-esophageal surgical intervention. (N.T.). 8 refs., 1 fig

  17. ANAESTHESIA FOR OPHTHALMIC SURGICAL PROCEDURES

    African Journals Online (AJOL)

    Objective: To review factors influencing the choice of anaesthesia for ophthalmic surgical procedures. ... as risk associated with general anaesthesia (8) they are more .... Wilson ME, Pandey SK, Thakur J. Paediatric cataract blindness in the ...

  18. uniportal vats for surgical repair

    African Journals Online (AJOL)

    2017-03-23

    Mar 23, 2017 ... aDepartamet of Pediatric Surgery, Hospital Teresa Herrera, Complejo Hospitalario. Universitario de A ... Advances in anesthesia, neonatal intensive, surgical, and cardiac care have ... First, these patients are at risk of airway ...

  19. Spinal surgery: non surgical complications

    African Journals Online (AJOL)

    Adele

    surgical procedure). Arterial cannulation ... Acute retinal necrosis syndrome after epidural corticos- teroid injections ... prevented, or respond to early recognition and treatment. ..... drugs should only be administered if there are no alternatives.

  20. Patient-specific surgical simulation.

    Science.gov (United States)

    Soler, Luc; Marescaux, Jacques

    2008-02-01

    Technological innovations of the twentieth century have provided medicine and surgery with new tools for education and therapy definition. Thus, by combining Medical Imaging and Virtual Reality, patient-specific applications providing preoperative surgical simulation have become possible.

  1. Diagnostics on Z (invited)

    International Nuclear Information System (INIS)

    Nash, T. J.; Derzon, M. S.; Chandler, G. A.; Fehl, D. L.; Leeper, R. J.; Porter, J. L.; Spielman, R. B.; Ruiz, C.; Cooper, G.; McGurn, J.

    2001-01-01

    The 100 ns, 20 MA pinch-driver Z is surrounded by an extensive set of diagnostics. There are nine radial lines of sight set at 12 o above horizontal and each of these may be equipped with up to five diagnostic ports. Instruments routinely fielded viewing the pinch from the side with these ports include x-ray diode arrays, photoconducting detector arrays, bolometers, transmission grating spectrometers, time-resolved x-ray pinhole cameras, x-ray crystal spectrometers, calorimeters, silicon photodiodes, and neutron detectors. A diagnostic package fielded on axis for viewing internal pinch radiation consists of nine lines of sight. This package accommodates virtually the same diagnostics as the radial ports. Other diagnostics not fielded on the axial or radial ports include current B-dot monitors, filtered x-ray scintillators coupled by fiber optics to streak cameras, streaked visible spectroscopy, velocity interferometric system for any reflector, bremsstrahlung cameras, and active shock breakout measurement of hohlraum temperature. The data acquisition system is capable of recording up to 500 channels and the data from each shot is available on the Internet. A major new diagnostic presently under construction is the BEAMLET backlighter. We will briefly describe each of these diagnostics and present some of the highest-quality data from them

  2. Classical Hodgkin's lymphoma in adults: guidelines of the Italian Society of Hematology, the Italian Society of Experimental Hematology, and the Italian Group for Bone Marrow Transplantation on initial work-up, management, and follow-up.

    Science.gov (United States)

    Brusamolino, Ercole; Bacigalupo, Andrea; Barosi, Giovanni; Biti, Giampaolo; Gobbi, Paolo G; Levis, Alessandro; Marchetti, Monia; Santoro, Armando; Zinzani, Pier Luigi; Tura, Sante

    2009-04-01

    The Italian Society of Hematology (SIE), the Italian Society of Experimental Haematology (SIES) and the Italian Group for Bone Marrow Transplantation (GITMO) commissioned a project to develop practice guidelines for the initial work-up, therapy and follow-up of classical Hodgkin's lymphoma. Key questions to the clinical evaluation and treatment of this disease were formulated by an Advisory Committee, discussed and approved by an Expert Panel (EP) composed of senior hematologists and one radiotherapist. After a comprehensive and systematic literature review, the EP recommendations were graded according to their supporting evidence. An explicit approach to consensus methodologies was used for evidence interpretation and for producing recommendations in the absence of a strong evidence. The EP decided that the target domain of the guidelines should include only classical Hodgkin's lymphoma, as defined by the WHO classification, and exclude lymphocyte predominant histology. Distinct recommendations were produced for initial work-up, first-line therapy of early and advanced stage disease, monitoring procedures and salvage therapy, including hemopoietic stem cell transplant. Separate recommendations were formulated for elderly patients. Pre-treatment volumetric CT scan of the neck, thorax, abdomen, and pelvis is mandatory, while FDG-PET is recommended. As to the therapy of early stage disease, a combined modality approach is still recommended with ABVD followed by involved-field radiotherapy; the number of courses of ABVD will depend on the patient risk category (favorable or unfavorable). Full-term chemotherapy with ABVD is recommended in advanced stage disease; adjuvant radiotherapy in patients without initial bulk who achieved a complete remission is not recommended. In the elderly, chemotherapy regimens more intensive than ABVD are not recommended. Early evaluation of response with FDG-PET scan is suggested. Relapsed or refractory patients should receive high

  3. Surgical management of Crohn's disease.

    Science.gov (United States)

    Lu, Kim C; Hunt, Steven R

    2013-02-01

    Although medical management can control symptoms in a recurring incurable disease, such as Crohn's disease, surgical management is reserved for disease complications or those problems refractory to medical management. In this article, we cover general principles for the surgical management of Crohn's disease, ranging from skin tags, abscesses, fistulae, and stenoses to small bowel and extraintestinal disease. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Surgical innovations in canine gonadectomy

    OpenAIRE

    Van Goethem, Bart

    2016-01-01

    In this thesis some recent technological developments in human surgery are evaluated for their potential use in veterinary medicine by introducing them as surgical innovations for canine gonadectomy. Barbed sutures achieve wound apposition without surgical knot tying and thus avoid knot-associated negative consequences (lengthy placement, impaired wound healing around bulky knots, and the effect of unsightly knots on cosmetics). A study in 9 dogs found that celiotomy closure was easily achiev...

  5. Cable Diagnostic Focused Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Hartlein, R.A.; Hampton, R.N.

    2010-12-30

    This report summarizes an extensive effort made to understand how to effectively use the various diagnostic technologies to establish the condition of medium voltage underground cable circuits. These circuits make up an extensive portion of the electric delivery infrastructure in the United States. Much of this infrastructure is old and experiencing unacceptable failure rates. By deploying efficient diagnostic testing programs, electric utilities can replace or repair circuits that are about to fail, providing an optimal approach to improving electric system reliability. This is an intrinsically complex topic. Underground cable systems are not homogeneous. Cable circuits often contain multiple branches with different cable designs and a range of insulation materials. In addition, each insulation material ages differently as a function of time, temperature and operating environment. To complicate matters further, there are a wide variety of diagnostic technologies available for assessing the condition of cable circuits with a diversity of claims about the effectiveness of each approach. As a result, the benefits of deploying cable diagnostic testing programs have been difficult to establish, leading many utilities to avoid the their use altogether. This project was designed to help address these issues. The information provided is the result of a collaborative effort between Georgia Tech NEETRAC staff, Georgia Tech academic faculty, electric utility industry participants, as well as cable system diagnostic testing service providers and test equipment providers. Report topics include: •How cable systems age and fail, •The various technologies available for detecting potential failure sites, •The advantages and disadvantages of different diagnostic technologies, •Different approaches for utilities to employ cable system diagnostics. The primary deliverables of this project are this report, a Cable Diagnostic Handbook (a subset of this report) and an online

  6. Evolution of surgical skills training

    Science.gov (United States)

    Roberts, Kurt E; Bell, Robert L; Duffy, Andrew J

    2006-01-01

    Surgical training is changing: one hundred years of tradition is being challenged by legal and ethical concerns for patient safety, work hours restrictions, the cost of operating room time, and complications. Surgical simulation and skills training offers an opportunity to teach and practice advanced skills outside of the operating room environment before attempting them on living patients. Simulation training can be as straight forward as using real instruments and video equipment to manipulate simulated “tissue” in a box trainer. More advanced, virtual reality simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations. The Accreditation Council of Graduate Medical Education’s (ACGME) has mandated the development of novel methods of training and evaluation. Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and to credential surgeons as technically competent. Simulators in their current form have been demonstrated to improve the operating room performance of surgical residents. Development of standardized training curricula remains an urgent and important agenda, particularly for minimal invasive surgery. An innovative and progressive approach, borrowing experiences from the field of aviation, can provide the foundation for the next century of surgical training, ensuring the quality of the product. As the technology develops, the way we practice will continue to evolve, to the benefit of physicians and patients. PMID:16718842

  7. Plasma diagnostic reflectometry

    International Nuclear Information System (INIS)

    Cohen, B.I.; Afeyan, B.B.; Garrison, J.C.; Kaiser, T.B.; Luhmann, N.C. Jr.; Domier, C.W.; Chou, A.E.; Baang, S.

    1996-01-01

    Theoretical and experimental studies of plasma diagnostic reflectometry have been undertaken as a collaborative research project between the Lawrence Livermore National Laboratory (LLNL) and the University of California Department of Applied Science Plasma Diagnostics Group under the auspices of the Laboratory Directed Research and Development Program at LLNL. Theoretical analyses have explored the basic principles of reflectometry to understand its limitations, to address specific gaps in the understanding of reflectometry measurements in laboratory experiments, and to explore extensions of reflectometry such as ultra-short-pulse reflectometry. The theory has supported basic laboratory reflectometry experiments where reflectometry measurements can be corroborated by independent diagnostic measurements

  8. Minimizing surgical skin incision scars with a latex surgical glove.

    Science.gov (United States)

    Han, So-Eun; Ryoo, Suk-Tae; Lim, So Young; Pyon, Jai-Kyung; Bang, Sa-Ik; Oh, Kap-Sung; Mun, Goo-Hyun

    2013-04-01

    The current trend in minimally invasive surgery is to make a small surgical incision. However, the excessive tensile stress applied by the retractors to the skin surrounding the incision often results in a long wound healing time and extensive scarring. To minimize these types of wound problems, the authors evaluated a simple and cost-effective method to minimize surgical incision scars based on the use of a latex surgical glove. The tunnel-shaped part of a powder-free latex surgical glove was applied to the incision and the dissection plane. It was fixed to the full layer of the dissection plane with sutures. The glove on the skin surface then was sealed with Ioban (3 M Health Care, St. Paul, MN, USA) to prevent movement. The operation proceeded as usual, with the retractor running through the tunnel of the latex glove. It was possible to complete the operation without any disturbance of the visual field by the surgical glove, and the glove was neither torn nor separated by the retractors. The retractors caused traction and friction during the operation, but the extent of damage to the postoperative skin incision margin was remarkably less than when the operation was performed without a glove. This simple and cost-effective method is based on the use of a latex surgical glove to protect the surgical skin incision site and improve the appearance of the postoperative scar. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  9. Bacterial migration through punctured surgical gloves under real surgical conditions

    Directory of Open Access Journals (Sweden)

    Heidecke Claus-Dieter

    2010-07-01

    Full Text Available Abstract Background The aim of this study was to confirm recent results from a previous study focussing on the development of a method to measure the bacterial translocation through puncture holes in surgical gloves under real surgical conditions. Methods An established method was applied to detect bacterial migration from the operating site through the punctured glove. Biogel™ double-gloving surgical gloves were used during visceral surgeries over a 6-month period. A modified Gaschen-bag method was used to retrieve organisms from the inner glove, and thus-obtained bacteria were compared with micro-organisms detected by an intra-operative swab. Results In 20 consecutive procedures, 194 gloves (98 outer gloves, 96 inner gloves were examined. The rate of micro-perforations of the outer surgical glove was 10% with a median wearing time of 100 minutes (range: 20-175 minutes. Perforations occurred in 81% on the non-dominant hand, with the index finger most frequently (25% punctured. In six cases, bacterial migration could be demonstrated microbiologically. In 5% (5/98 of outer gloves and in 1% (1/96 of the inner gloves, bacterial migration through micro-perforations was observed. For gloves with detected micro-perforations (n = 10 outer layers, the calculated migration was 50% (n = 5. The minimum wearing time was 62 minutes, with a calculated median wearing time of 71 minutes. Conclusions This study confirms previous results that bacterial migration through unnoticed micro-perforations in surgical gloves does occur under real practical surgical conditions. Undetected perforation of surgical gloves occurs frequently. Bacterial migration from the patient through micro-perforations on the hand of surgeons was confirmed, limiting the protective barrier function of gloves if worn over longer periods.

  10. Muscle diseases with prominent joint contractures: Main entities and diagnostic strategy.

    Science.gov (United States)

    Eymard, B; Ferreiro, A; Ben Yaou, R; Stojkovic, T

    2013-01-01

    Muscle diseases may have various clinical manifestations including muscle weakness, atrophy or hypertrophy and joint contractures. A spectrum of non-muscular manifestations (cardiac, respiratory, cutaneous, central and peripheral nervous system) may be associated. Few of these features are specific. Limb joint contractures or spine rigidity, when prevailing over muscle weakness in ambulant patients, are of high diagnostic value for diagnosis orientation. Within this context, among several disorders, four groups of diseases should systematically come to mind including the collagen VI-related myopathies, the Emery-Dreifuss muscular dystrophies, the SEPN1 and FHL1 related myopathies. More rarely other genetic or acquired myopathies may present with marked contractures. Diagnostic work-up should include a comprehensive assessment including family history, neurological, cardiologic and respiratory evaluations. Paraclinical investigations should minimally include muscle imaging and electromyography. Muscle and skin biopsies as well as protein and molecular analyses usually help to reach a precise diagnosis. We will first describe the main muscle and neuromuscular junction diseases where contractures are typically a prominent symptom of high diagnostic value for diagnosis orientation. In the following chapters, we will present clues for the diagnostic strategy and the main measures to be taken when, at the end of the diagnostic work-up, no definite muscular disease has been identified. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  11. BRIEF REPORT: Beyond Clinical Experience: Features of Data Collection and Interpretation That Contribute to Diagnostic Accuracy

    Science.gov (United States)

    Nendaz, Mathieu R; Gut, Anne M; Perrier, Arnaud; Louis-Simonet, Martine; Blondon-Choa, Katherine; Herrmann, François R; Junod, Alain F; Vu, Nu V

    2006-01-01

    BACKGROUND Clinical experience, features of data collection process, or both, affect diagnostic accuracy, but their respective role is unclear. OBJECTIVE, DESIGN Prospective, observational study, to determine the respective contribution of clinical experience and data collection features to diagnostic accuracy. METHODS Six Internists, 6 second year internal medicine residents, and 6 senior medical students worked up the same 7 cases with a standardized patient. Each encounter was audiotaped and immediately assessed by the subjects who indicated the reasons underlying their data collection. We analyzed the encounters according to diagnostic accuracy, information collected, organ systems explored, diagnoses evaluated, and final decisions made, and we determined predictors of diagnostic accuracy by logistic regression models. RESULTS Several features significantly predicted diagnostic accuracy after correction for clinical experience: early exploration of correct diagnosis (odds ratio [OR] 24.35) or of relevant diagnostic hypotheses (OR 2.22) to frame clinical data collection, larger number of diagnostic hypotheses evaluated (OR 1.08), and collection of relevant clinical data (OR 1.19). CONCLUSION Some features of data collection and interpretation are related to diagnostic accuracy beyond clinical experience and should be explicitly included in clinical training and modeled by clinical teachers. Thoroughness in data collection should not be considered a privileged way to diagnostic success. PMID:17105525

  12. DIAGNOSTIC VALUE OF SEROLOGICAL MARKERS OF RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    Aleksei Leonidovich Maslaynski

    2012-01-01

    Full Text Available Rheumatoid arthritis (RA is a classic autoimmune disease associated with the production of wide range of autoantibodies, and their detection has diagnostic and prognostic implication. The objective of this study was to estimate the diagnostic value of antibodies against modified citrullinated vimentin (AMCV and nuclear antigen RA33 of the IgA rheumatoid factor (RF versus the value of routinely used profile of autoantibodies in diagnostic work-up of RA. Material and methods. 253 patients with RA prehistory of varying duration were included into the study group. The control group was comprised of 92 patients, including patients with seronegative spondyloarthropathies and diffuse connective tissue diseases, as well as sex and age matched healthy controls. Serum levels of IgM and IgA RF, antibodies against cyclic citrullinated peptide (ACCP, ACMV, anti-keratin antibodies (AKA, antibodies against RA33 antigen (ARA33 and antinuclear factor (ANF were measured in all patients and controls. Results and discussion. Diagnostic sensitivity of AMCV equaled 78%, ACCP — 77%, IgM RF — 71%, IgA RF — 43%, AKA — 43%, ARA33 — 31% and ANF — 31%. All anti-citrullinic antibodies (AKA, ACCP, ACMV were significantly more commonly associated with IgM RF. Among RF and ACCP seronegative patients ACMV were found in 24% cases with 20 IU/Ml detection threshold, and in 21% — with 30 IU/Ml, allowing to increase diagnostic specificity of the test up to 91% with the increment of diagnostic threshold. Incidence of ARA33 was not significantly different among the RF and ACCP positive or negative subgroups, thus making ARA33 an independent RA marker. Specificity of this marker was 87,9%, thus making it inferior to RF and ACCP by a composite of diagnostic characteristics. Conclusions. Integrated measurement of ACMV and ARA33 is a rational approach at the second stage of serologic testing work-up in suspected cases of RA onset, when initial RF and ACCP tests were negative.

  13. Update on the management of menometrorrhagia: new surgical approaches.

    Science.gov (United States)

    Fernandez, Hervé

    2011-12-01

    Hysterectomy has traditionally been the definitive surgical approach for heavy menstrual bleeding. However, the more modern concept of 'save the uterus' has led to new surgical approaches for the treatment of heavy menstrual bleeding, based on second-generation endometrial destruction (ablation/resection) techniques, including microwave endometrial ablation, thermal balloon endometrial ablation, radiofrequency electrosurgery, hydrothermal ablation and cryoablation. As pregnancy following endometrial ablation is still possible, we proposed to combine endometrial ablation and sterilization with Essure(®) micro-inserts in women with confirmed menometrorrhagia and the desire, or medical need, for permanent tubal sterilization. Although large diameter resectoscopy provides excellent results in the surgical treatment of myomas, the technique requires dilation of the cervical canal (difficult in nulliparous or menopausal patients), and requires general or epidural anaesthesia and, therefore, must be performed in an operating theatre. A major advance in terms of hysteroscopic procedures is the 'see and treat' approach (i.e. when performing an initial diagnostic hysteroscopy, it is now possible to treat the pathology concurrently). Newer hysteroscopic techniques, often not requiring anaesthesia or analgesia, include OPPIuM (Office Preparation of Partially Intramural Myomas) and use of a mini-resectoscope, allowing office diagnostic-operative hysteroscopic procedures.

  14. [Results from a general training hospital for the implementation of a diagnostic workup for pulmonary embolism according to the Dutch Institute for Health Care Improvement

    NARCIS (Netherlands)

    Kamphuisen, P.W.; Jacobs, E.M.G.; Mol, J.J.; Rijnders, A.J.; Ullmann, E.F.

    2002-01-01

    OBJECTIVE: To evaluate the active implementation of the Dutch Institute for Healthcare Improvement's guideline for the diagnostic work-up for pulmonary embolism in a general training hospital, and to analyse reasons for not following the guideline strategy. DESIGN: Partly retrospective and partly

  15. Equipment for radiation diagnostics

    International Nuclear Information System (INIS)

    Tschunt, E.; Platz, W.

    1976-01-01

    The invention relates to an improvement of the line type of the plotter in an X-ray diagnostics apparatus enabling the production of distinguishable recordings by means of a single plot type. The construction is described explicitly. (UWI) [de

  16. National Convective Weather Diagnostic

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Current convective hazards identified by the National Convective Weather Detection algorithm. The National Convective Weather Diagnostic (NCWD) is an automatically...

  17. Diagnostic radiology: I

    International Nuclear Information System (INIS)

    Anon.

    1993-01-01

    This chapter describes the historic development of diagnostic equipment for radiology. The problems associated with fluoroscope design are detailed and the current uses of updated technology, particularly digitization, are considered. Numerous historical photographs are included. 13 refs

  18. Prenatal Genetic Diagnostic Tests

    Science.gov (United States)

    ... are available for many inherited disorders. The main disadvantage is that diagnostic testing carries a very small ... chromosomes, arranged in order of size. Microarray: A technology that examines all of a person’s genes to ...

  19. Non-invasive diagnostic methods in dentistry

    Science.gov (United States)

    Todea, Carmen

    2016-03-01

    The paper, will present the most important non-invasive methods for diagnostic, in different fields of dentistry. Moreover, the laser-based methods will be emphasis. In orthodontics, 3D laser scanners are increasingly being used to establish database for normative population and cross-sectional growth changes but also to asses clinical outcomes in orthognatic surgical and non-surgical treatments. In prevention the main methods for diagnostic of demineralization and caries detection in early stages are represented by laser fluorescence - Quantitative Light Florescence (QLF); DiagnoDent-system-655nm; FOTI-Fiberoptic transillumination; DIFOTI-Digital Imaging Fiberoptic transillumination; and Optical Coherence Tomography (OCT). In odontology, Laser Doppler Flowmetry (LDF) is a noninvasive real time method used for determining the tooth vitality by monitoring the pulp microcirculation in traumatized teeth, fractured teeth, and teeth undergoing different conservative treatments. In periodontology, recently study shows the ability of LDF to evaluate the health of gingival tissue in periodontal tissue diseases but also after different periodontal treatments.

  20. Molecular diagnostics of periodontitis

    OpenAIRE

    Izabela Korona-Głowniak; Radosław Siwiec; Marcin Berger; Anna Malm; Jolanta Szymańska

    2017-01-01

    The microorganisms that form dental plaque are the main cause of periodontitis. Their identification and the understanding of the complex relationships and interactions that involve these microorganisms, environmental factors and the host’s health status enable improvement in diagnostics and targeted therapy in patients with periodontitis. To this end, molecular diagnostics techniques (both techniques based on the polymerase chain reaction and those involving nucleic acid analysis via hybridi...

  1. Optics/Optical Diagnostics Laboratory

    Data.gov (United States)

    Federal Laboratory Consortium — The Optics/Optical Diagnostics Laboratory supports graduate instruction in optics, optical and laser diagnostics and electro-optics. The optics laboratory provides...

  2. Primary breast tuberculosis: diagnostic and therapeutic dilemmas.

    Science.gov (United States)

    Hiremath, Bharati V; Subramaniam, Narayana

    2015-01-01

    To review the diagnostic and therapeutic challenges associated with treating isolated primary breast tuberculosis through discussion of our series of seven cases. Although breast is an uncommon site of occurrence of tuberculosis and isolated primary breast tuberculosis is an even rarer entity, its importance lies in distinguishing it from more common pathologies like abscesses or malignancy and avoiding unnecessary erroneous surgical intervention. The spectrum and presentation is wide and varied and we present our experience in managing seven such cases. A retrospective analysis of all the cases of histopathologically proven primary breast tuberculosis in the last three years at M.S. Ramaiah Hospital (2012-2014) was done. Analysis was in terms of mode of presentation, clinical features, diagnostic modalities used for evaluation and confirmation of the diagnosis, medical treatment and surgical intervention, if any. Special emphasis was placed on dilemmas in diagnosis and difficulties encountered during treatment. All cases were followed up till cure. Patients most commonly presented with a breast abscess, painful breast lumps and recurrent abscesses. Other foci of tuberculosis were ruled out in all of these patients. Majority were treated exclusively with anti-tubercular therapy (although regimens varied), but those with abscesses underwent incision and drainage. All cases were treated and followed up till cure. The challenges associated with primary breast tuberculosis are multiple, including which anti-tubercular therapy regimen to use, when to surgically intervene (as the breast is a cosmetically important area) and treating atypical mycobacteria. We provide a detailed discussion of the challenges we faced and review of literature.

  3. Surgical strategies in childhood craniopharyngioma

    Directory of Open Access Journals (Sweden)

    Jörg eFlitsch

    2011-12-01

    Full Text Available Craniopharyngiomas are biologically benign lesions (WHO Grade 1 of the sellar and suprasellar region, associated with a serious morbidity. About 50% of these tumors become clinically apparent during childhood. Clinical symptoms include headaches, chiasm syndrome, hydrocephalus, pituitary insufficiencies, and obesity. Growth arrest is a typical symptom in children. The treatment of craniopharyngiomas includes surgery as well as radiotherapy. The goal of surgery varies according to the tumor location and extension and may range from complete resection to biopsy. Surgical complications are well known and cause constant evaluation of surgical strategies. Diencephalic obesity is related to surgical manipulation of hypothalamic tissue. Therefore, a classification system for craniopharyngiomas based on preoperative MRI is suggested by the authors, which may help assess the surgical risk. Recurrences are frequent in craniopharyngiomas, even after complete or gross-total resection. Radiotherapy is therefore recommended to patients with incomplete resections. However, the ideal time for radiotherapy after surgery is under discussion.The treatment of craniopharyngiomas requires an interdisciplinary and multimodal approach. Each patient should receive an individually tailored treatment. Surgically, different approaches as well as different degrees of resection can be considered, depending on tumor location and tumor extension.

  4. Surgical Management of Localized Scleroderma.

    Science.gov (United States)

    Lee, Jae Hyun; Lim, Soo Yeon; Lee, Jang Hyun; Ahn, Hee Chang

    2017-09-01

    Localized scleroderma is characterized by a thickening of the skin from excessive collagen deposits. It is not a fatal disease, but quality of life can be adversely affected due to changes in skin appearance, joint contractures, and, rarely, serious deformities of the face and extremities. We present six cases of localized scleroderma in face from our surgical practice. We reviewed six localized scleroderma cases that were initially treated with medication and then received follow-up surgery between April 2003 and February 2015. Six patients had facial lesions. These cases presented with linear dermal sclerosis on the forehead, oval subcutaneous and dermal depression in the cheek. En coup de sabre (n=4), and oval-shaped lesion of the face (n=2) were successfully treated. Surgical methods included resection with or without Z-plasty (n=3), fat graft (n=1), dermofat graft (n=1), and adipofascial free flap (n=1). Deformities of the affected parts were surgically corrected without reoccurrence. We retrospectively reviewed six cases of localized scleroderma that were successfully treated with surgery. And we propose an algorithm for selecting the best surgical approach for individual localized scleroderma cases. Although our cases were limited in number and long-term follow-up will be necessary, we suggest that surgical management should be considered as an option for treating scleroderma patients.

  5. Three-dimensional surgical simulation.

    Science.gov (United States)

    Cevidanes, Lucia H C; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael

    2010-09-01

    In this article, we discuss the development of methods for computer-aided jaw surgery, which allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3-dimensional surface models from cone-beam computed tomography, dynamic cephalometry, semiautomatic mirroring, interactive cutting of bone, and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intraoperative guidance. The system provides further intraoperative assistance with a computer display showing jaw positions and 3-dimensional positioning guides updated in real time during the surgical procedure. The computer-aided surgery system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training, and assessing the difficulties of the surgical procedures before the surgery. Computer-aided surgery can make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  6. Evidence-Based Surgical Treatments for Chronic Pancreatitis.

    Science.gov (United States)

    Kleeff, Jörg; Stöß, Christian; Mayerle, Julia; Stecher, Lynne; Maak, Matthias; Simon, Peter; Nitsche, Ulrich; Friess, Helmut

    2016-07-25

    If conservative treatment of chronic pancreatitis is unsuccessful, surgery is an option. The choice of the most suitable surgical method can be difficult, as the indications, advantages, and disadvantages of the available methods have not yet been fully documented with scientific evidence. In April 2015, we carried out a temporally unlimited systematic search for publications on surgery for chronic pancreatitis. The target parameters were morbidity, mortality, pain, endocrine and exocrine insuffi - ciency, weight gain, quality of life, length of hospital stay, and duration of urgery. Differences between surgical methods were studied with network meta-analysis, and duodenum-preserving operations were compared with partial duodenopancreatectomy with standard meta-analysis. Among the 326 articles initially identified, 8 randomized controlled trials on a total of 423 patients were included in the meta-analysis. The trials were markedly heterogeneous in some respects. There was no significant difference among surgical methods with respect to perioperative morbidity, pain, endocrine and exocrine insufficiency, or quality of life. Duodenumpreserving procedures, compared to duodenopancreatectomy, were associated with a long-term weight gain that was 3 kg higher (p chronic pancreatitis is superior to partial duodenopancreatectomy in multiple respects. Only limited recommendations can be given, however, on the basis of present data. The question of the best surgical method for the individual patient, in view of the clinical manifestations, anatomy, and diagnostic criteria, remains open.

  7. Frequency of nursing diagnoses in a surgical clinic

    Directory of Open Access Journals (Sweden)

    Andreza Cavalcanti Vasconcelos

    2015-12-01

    Full Text Available Objective: to identify the frequency of Nursing Diagnoses of patients in a surgical clinic. Methods: cross-sectional study, performed with 99 patients in the postoperative of general surgery. Data were collected through a questionnaire validated according to domains of NANDA International, including physical and laboratory examination. Results: 17 nursing diagnoses were found; eight had a frequency higher than 50.0% (infection risk, impaired tissue integrity, constipation risk, anxiety, bleeding risk, acute pain, delayed surgical recovery, dysfunctional gastrointestinal motility. It was observed in all patients the Nursing Diagnostics: risk of infection, impaired tissue integrity and risk of constipation. Conclusion: the frequency of the most prevalent diagnosis is inserted in the domains safety/protection and nutrition, which determines the need to redirect nursing care, prioritizing the patient's clinic.

  8. Vaginoscopy in Ewes Utilizing a Laparoscopic Surgical Port Device

    Directory of Open Access Journals (Sweden)

    Jeremiah Easley

    2017-01-01

    Full Text Available Vaginoscopy allows for diagnostic evaluation and treatment of the vaginal vault. A laparoscopic surgical port device and rigid telescope were utilized for serial vaginoscopy in 8 healthy anesthetized ewes. Vaginoscopy examinations were performed in each ewe at days 1, 14, and 28. This technique was well-tolerated and facilitated carbon dioxide vaginal inflation, complete vaginal examination, identification of the cervix, and targeted biopsy collection. No complications were encountered during or following the vaginoscopy procedures. The laparoscopic port device was well-suited to the ewe vulvar size. This technique could be applied to clinical evaluation in ewes for the purposes of examination, biopsy, culture, foreign body removal, and minor surgical procedures.

  9. Surgical-prosthetic treatment of large mandibular cysts

    Directory of Open Access Journals (Sweden)

    Džambas Ljubiša D.

    2003-01-01

    Full Text Available This paper presents a combined surgical-prosthetic procedure of reconstructing mandibular bone defect in a 53 year old patient, following enucleation of a mandibular cyst (Cystectomy Partsch II. After a thorough diagnostic evaluation, a surgical procedure was planned with the particular attention to the nature of the disease, patient’s condition, size and extension of the cyst, tissue loss, and the possibilities of prosthetic management of a mandibular bone defect with partial postresection dental prosthesis. It is of great importance to point to the significance of teamwork of a maxillofacial surgeon and a specialist in prosthodontics. This kind of cooperation provided very effective and less risky soft tissue, as well as bone tissue regeneration (osteogenesis. The patient’s recovery was fast, and he could return to his daily activities and work without significant changes regarding quality of life after surgery and prosthetic treatment.

  10. Drug sensitivity testing platforms for gastric cancer diagnostics.

    Science.gov (United States)

    Lau, Vianne; Wong, Andrea Li-Ann; Ng, Christopher; Mok, Yingting; Lakshmanan, Manikandan; Yan, Benedict

    2016-02-01

    Gastric cancer diagnostics has traditionally been histomorphological and primarily the domain of surgical pathologists. Although there is an increasing usage of molecular and genomic techniques for clinical diagnostics, there is an emerging field of personalised drug sensitivity testing. In this review, we describe the various personalised drug sensitivity testing platforms and discuss the challenges facing clinical adoption of these assays for gastric cancer. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Surgical Approaches to Chronic Pancreatitis

    Directory of Open Access Journals (Sweden)

    Daniel Hartmann

    2015-01-01

    Full Text Available Chronic pancreatitis is a progressive inflammatory disease resulting in permanent structural damage of the pancreas. It is mainly characterized by recurring epigastric pain and pancreatic insufficiency. In addition, progression of the disease might lead to additional complications, such as pseudocyst formation or development of pancreatic cancer. The medical and surgical treatment of chronic pancreatitis has changed significantly in the past decades. With regard to surgical management, pancreatic head resection has been shown to be a mainstay in the treatment of severe chronic pancreatitis because the pancreatic head mass is known to trigger the chronic inflammatory process. Over the years, organ-preserving procedures, such as the duodenum-preserving pancreatic head resection and the pylorus-preserving Whipple, have become the surgical standard and have led to major improvements in pain relief, preservation of pancreatic function, and quality of life of patients.

  12. Surgical ethics: today and tomorrow.

    Science.gov (United States)

    Sade, Robert M; Kavarana, Minoo N

    2017-11-01

    Ethical behavior has always been deeply ingrained in surgical culture, but ethical deliberation has only recently become an important component of cardiac surgical practice. In our earlier review, we covered a range of issues including several related to informed consent, conflict of interest, professional self-regulation and innovation, among many others. This update covers several topics of interest to cardiac surgeons and cardiologists, focusing on controversial issues specific to the practice of cardiothoracic surgery: informed consent, relations with hospitals and euthanasia and physician-assisted suicide. The future holds much uncertainty for cardiac surgical practice, research and culture, and we provide an update on ethical issues to serve as a platform for envisioning what is to come.

  13. Epilepsy with dual pathology: surgical treatment of cortical dysplasia accompanied by hippocampal sclerosis.

    Science.gov (United States)

    Kim, Dong W; Lee, Sang K; Nam, Hyunwoo; Chu, Kon; Chung, Chun K; Lee, Seo-Young; Choe, Geeyoung; Kim, Hyun K

    2010-08-01

    The presence of two or more epileptogenic pathologies in patients with epilepsy is often observed, and the coexistence of focal cortical dysplasia (FCD) with hippocampal sclerosis (HS) is one of the most frequent clinical presentations. Although surgical resection has been an important treatment for patients with refractory epilepsy associated with FCD, there are few studies on the surgical treatment of FCD accompanied by HS, and treatment by resection of both neocortical dysplastic tissue and hippocampus is still controversial. We retrospectively recruited epilepsy patients who had undergone surgical treatment for refractory epilepsy with the pathologic diagnosis of FCD and the radiologic evidence of HS. We evaluated the prognostic roles of clinical factors, various diagnostic modalities, surgical procedures, and the severity of pathology. A total of 40 patients were included, and only 35.0% of patients became seizure free. Complete resection of the epileptogenic area (p = 0.02), and the presence of dysmorphic neurons or balloon cells on histopathology (p = 0.01) were associated with favorable surgical outcomes. Patients who underwent hippocampal resection were more likely to have a favorable surgical outcome (p = 0.02). We show that patients with complete resection of epileptogenic area, the presence of dysmorphic neurons or balloon cells on histopathology, or resection of hippocampus have a higher chance of a favorable surgical outcome. We believe that this observation is useful in planning of surgical procedures and predicting the prognoses of individual patients with FCD patients accompanied by HS. Wiley Periodicals, Inc. © 2009 International League Against Epilepsy.

  14. LHD neutron diagnostics

    International Nuclear Information System (INIS)

    Isobe, M.; Ogawa, K.; Kobuchi, T.

    2015-01-01

    The Large Helical Device (LHD) project will step into a next stage, i.e. experiment by using deuterium gases after two years of preparation. A comprehensive set of neutron and γ-ray diagnostics is going to be installed on the LHD towards extension of energetic-particle (EP) physics research in heliotron plasmas. Conceptual design of fusion products diagnostics for the LHD was made in late 1990s. After conclusion of agreements for the LHD deuterium experiment with local government bodies, development of FPs diagnostics has begun lately. Because there are a lot of tasks to do, all Japan fusion neutron and γ-ray diagnostics team has been organized in the collaboration framework of National Institute for Fusion Science. FPs diagnostics system on the LHD will consist of 1) wide dynamic range neutron flux monitor (NFM), 2) neutron activation system (NAS), 3) vertical neutron camera (VNC). In addition to these, we are developing a directional scintillating fiber detector, an artificial diamond detector and a γ-ray scintillation detector for confinement study of MeV ions. A neutron energy spectrometer prototype is also being developed and tested in KSTAR. In this paper, roles of NFM, NAS and VNC and current status of implementation onto the LHD are briefly described. (author)

  15. Pitfalls in diagnostic radiology

    Energy Technology Data Exchange (ETDEWEB)

    Peh, Wilfred C.G. (ed.) [Khoo Teck Puat Hospital (Singapore). Dept. of Diagnostic Radiology

    2015-04-01

    Only textbook to focus primarily on the topic of pitfalls in diagnostic radiology. Highlights the pitfalls in a comprehensive and systematic manner. Written by experts in different imaging modalities and subspecialties from reputable centers across the world. The practice of diagnostic radiology has become increasingly complex, with the use of numerous imaging modalities and division into many subspecialty areas. It is becoming ever more difficult for subspecialist radiologists, general radiologists, and residents to keep up with the advances that are occurring year on year, and this is particularly true for less familiar topics. Failure to appreciate imaging pitfalls often leads to diagnostic error and misinterpretation, and potential medicolegal problems. Diagnostic errors may be due to various factors such as inadequate imaging technique, imaging artifacts, failure to recognize normal structures or variants, lack of correlation with clinical and other imaging findings, and poor training or inexperience. Many, if not most, of these factors are potentially recognizable, preventable, or correctable. This textbook, written by experts from reputable centers across the world, systematically and comprehensively highlights the pitfalls that may occur in diagnostic radiology. Both pitfalls specific to different modalities and techniques and those specific to particular organ systems are described with the help of numerous high-quality illustrations. Recognition of these pitfalls is crucial in helping the practicing radiologist to achieve a more accurate diagnosis.

  16. Pitfalls in diagnostic radiology

    International Nuclear Information System (INIS)

    Peh, Wilfred C.G.

    2015-01-01

    Only textbook to focus primarily on the topic of pitfalls in diagnostic radiology. Highlights the pitfalls in a comprehensive and systematic manner. Written by experts in different imaging modalities and subspecialties from reputable centers across the world. The practice of diagnostic radiology has become increasingly complex, with the use of numerous imaging modalities and division into many subspecialty areas. It is becoming ever more difficult for subspecialist radiologists, general radiologists, and residents to keep up with the advances that are occurring year on year, and this is particularly true for less familiar topics. Failure to appreciate imaging pitfalls often leads to diagnostic error and misinterpretation, and potential medicolegal problems. Diagnostic errors may be due to various factors such as inadequate imaging technique, imaging artifacts, failure to recognize normal structures or variants, lack of correlation with clinical and other imaging findings, and poor training or inexperience. Many, if not most, of these factors are potentially recognizable, preventable, or correctable. This textbook, written by experts from reputable centers across the world, systematically and comprehensively highlights the pitfalls that may occur in diagnostic radiology. Both pitfalls specific to different modalities and techniques and those specific to particular organ systems are described with the help of numerous high-quality illustrations. Recognition of these pitfalls is crucial in helping the practicing radiologist to achieve a more accurate diagnosis.

  17. Surgically Assisted Rapid Maxillary Expansion: surgical and orthodontic aspects

    NARCIS (Netherlands)

    M.J. Koudstaal (Maarten)

    2008-01-01

    textabstractThe scope of this thesis is to shed more light, from a number of perspectives, on surgically assisted rapid maxillary expansion (SARME). The primary questions this thesis set out to answer were; ‘is there a difference in stability between bone-borne and tooth-borne distraction?’ and ‘can

  18. Emotions in veterinary surgical students

    DEFF Research Database (Denmark)

    Langebæk, Rikke; Eika, Berit; Pedersen, Lene Tanggaard

    2012-01-01

    A surgical educational environment is potentially stressful and can negatively affect students' learning. The aim of the present study was to investigate the emotions experienced by veterinary students in relation to their first encounter with live-animal surgery and to identify possible sources...... of positive and negative emotions, respectively. During a Basic Surgical Skills course, 155 veterinary fourth-year students completed a survey. Of these, 26 students additionally participated in individual semi-structured interviews. The results of the study show that students often experienced a combination...

  19. Non-vascular surgical mediastinum

    International Nuclear Information System (INIS)

    Schiavon, S.; Trenaghi, P.; Nardini, S.; Pagan, V.

    1989-01-01

    A review was made of the chest X-ray features of 120 patients who underwent surgical treatment for mediastinal non-vascular pathologies over the past 12 years in the Mestre Hospital. A method of analysis is proposed which takes into account not only the differences between the immediate post-operative period and the follow-up, but also the anatomotopographic partition and the surgical practice. Normal and pathological patterns for both of the above periods are described. The ''dimness'' of the arial tracheogram is emphasized as a usefull and early sign of mediastinal recurrence

  20. Surgical options after Fontan failure

    DEFF Research Database (Denmark)

    van Melle, Joost P; Wolff, Djoeke; Hörer, Jürgen

    2016-01-01

    by the European Congenital Heart Surgeons Association among 22 member centres. Outcome of surgery to address failing Fontan was collected in 225 patients among which were patients with Fontan takedown (n=38; 17%), Fontan conversion (n=137; 61%) or HTX (n=50; 22%). RESULTS: The most prevalent indication...... for failing Fontan surgery was arrhythmia (43.6%), but indications differed across the surgical groups (p...OBJECTIVE: The objective of this European multicenter study was to report surgical outcomes of Fontan takedown, Fontan conversion and heart transplantation (HTX) for failing Fontan patients in terms of all-cause mortality and (re-)HTX. METHODS: A retrospective international study was conducted...

  1. Innovation in pediatric surgical education.

    Science.gov (United States)

    Clifton, Matthew S; Wulkan, Mark L

    2015-06-01

    Pediatric surgical training in the United States remained basically unchanged from the model developed by Ladd and Gross in the 1930s until recently. Standardized curriculum and novel evaluation methods are now being implemented. Pediatric Surgical education is currently undergoing a transition to competency-based evaluation and promotion. Unfortunately, there is little data on the efficacy of these changes. This presents an opportunity for further study of how we conduct training, and how we evaluate and promote our trainees. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Mechanical valve obstruction: Review of diagnostic and treatment strategies

    Science.gov (United States)

    Salamon, Jason; Munoz-Mendoza, Jerson; Liebelt, Jared J; Taub, Cynthia C

    2015-01-01

    Prosthetic valve obstruction (PVO) is a rare but feared complication of mechanical valve replacement. Diagnostic evaluation should focus on differentiating prosthetic valve thrombosis (PVT) from pannus formation, as their treatment options differ. History of sub-optimal anti-coagulation and post-op time course to development of PVO are useful clinical characteristics in differentiating thrombus from pannus formation. Treatment of PVT is influenced by the patient’s symptoms, valve location, degree of obstruction and thrombus size and may include thrombolysis or surgical intervention. Alternatively, pannus formation requires surgical intervention. The purpose of this article is to review the pathophysiology, epidemiology, diagnostic approach and treatment options for aortic and mitral valve PVO. PMID:26730292

  3. ACL Surgical Technique — Staying Out of Trouble

    Directory of Open Access Journals (Sweden)

    Predescu Vlad

    2016-11-01

    Full Text Available The incidence of ACL tear and reconstruction has increased over time, and failure of ACL reconstruction is not perfectly defined among surgeons. Atraumatic failure of ACL surgery represents approximately 70% of causes, and occurs in diagnostic errors, technical errors and problems of ACL graft integrations. Regarding surgical technique, we should answer certain questions about our choice of surgery, tunnel position, graft type, graft suture, tensioning the graft, and how we deal with certain incidents or intraoperative accidents. The purpose of this article is to review the current information and trends of ACL reconstruction, and presents some tips and tricks we use in our current practice.

  4. Improved patient specific seizure detection during pre-surgical evaluation.

    LENUS (Irish Health Repository)

    Chua, Eric C-P

    2011-04-01

    There is considerable interest in improved off-line automated seizure detection methods that will decrease the workload of EEG monitoring units. Subject-specific approaches have been demonstrated to perform better than subject-independent ones. However, for pre-surgical diagnostics, the traditional method of obtaining a priori data to train subject-specific classifiers is not practical. We present an alternative method that works by adapting the threshold of a subject-independent to a specific subject based on feedback from the user.

  5. Economic evaluation of diagnostic localization following biochemical prostate cancer recurrence.

    Science.gov (United States)

    Barocas, Daniel A; Bensink, Mark E; Berry, Kristin; Musa, Zahra; Bodnar, Carolyn; Dann, Robert; Ramsey, Scott D

    2014-10-01

    The aim of this study was to assess potential cost-effectiveness of using a prostate cancer specific functional imaging technology capable of identifying residual localized disease versus small volume metastatic disease for asymptomatic men with low but detectable prostate specific antigen (PSA) elevation following radical prostatectomy. Markov modeling was used to estimate the incremental impact on healthcare system costs (2012 USD) and quality-adjusted life-years (QALYs) of two alternative strategies: (i) using the new diagnostic to guide therapy versus (ii) current usual care-using a combination of computed tomography, magnetic resonance imaging, and bone scan to guide therapy. Costs were based on estimates from literature and Medicare reimbursement. Prostate cancer progression, survival, utilities, and background risk of all-cause mortality were obtained from literature. Base-case diagnostic sensitivity (75 percent), specificity (90 percent), and cost (USD 2,500) were provided by our industry partner GE Healthcare. The new diagnostic strategy provided an average gain of 1.83 (95 percent uncertainty interval [UI]: 1.24-2.64) QALYs with added costs of USD 15,595 (95 percent UI: USD -6,330-44,402) over 35 years. The resulting incremental cost-effectiveness ratio was USD 8,516/QALY (95 percent UI: USD -2,947-22,372). RESULTS were most influenced by the utility discounting rate and test performance characteristics; however, the new diagnostic provided clinical benefits over a wide range of sensitivity and specificity. This analysis suggests a diagnostic technology capable of identifying whether men with biochemical recurrence after radical prostatectomy have localized versus metastatic disease would be a cost-effective alternative to current standard work-up. The results support additional investment in development and validation of such a diagnostic.

  6. Polychromatic holographic plasma diagnostics

    International Nuclear Information System (INIS)

    Zhiglinskij, A.G.; Morozov, A.O.

    1992-01-01

    Review of holographic interferometry properties is performed and advantages of this method by plasma diagnostics are indicated. Main results obtained by the method of holographic interferometry in studies of various-type plasmas are considered. Special attention is paid to multiwave plasma diagnostics, the necessity of which is related as a rule to multicomponent composition of plasma. The eight laser and gas-discharge sources and holographic schemes, which make it possible to realize plasma polychromatic and holographic interferometry, are considered. The advantages of the method are demonstrated by examples of polychromatic holographic diagnostics of arc discharge and discharge in a hollow cathode. Review of theoretical works determining the applicability area of resonance polychromatic interferometry is carried out

  7. Reversed field pinch diagnostics

    International Nuclear Information System (INIS)

    Weber, P.G.

    1986-01-01

    The Reversed Field Pinch (RFP) is a toroidal, axisymmetric magnetic confinement configuration characterized by a magnetic field configuration in which the toroidal magnetic field is of similar strength to the poloidal field, and is reversed at the edge compared to the center. The RFP routinely operates at high beta, and is a strong candidate for a compact fusion device. Relevant attributes of the configuration will be presented, together with an overview of present and planned experiments and their diagnostics. RFP diagnostics are in many ways similar to those of other magnetic confinement devices (such as tokamaks); these lectures will point out pertinent differences, and will present some diagnostics which provide special insights into unique attributes of the RFP

  8. Metabolomics for laboratory diagnostics.

    Science.gov (United States)

    Bujak, Renata; Struck-Lewicka, Wiktoria; Markuszewski, Michał J; Kaliszan, Roman

    2015-09-10

    Metabolomics is an emerging approach in a systems biology field. Due to continuous development in advanced analytical techniques and in bioinformatics, metabolomics has been extensively applied as a novel, holistic diagnostic tool in clinical and biomedical studies. Metabolome's measurement, as a chemical reflection of a current phenotype of a particular biological system, is nowadays frequently implemented to understand pathophysiological processes involved in disease progression as well as to search for new diagnostic or prognostic biomarkers of various organism's disorders. In this review, we discussed the research strategies and analytical platforms commonly applied in the metabolomics studies. The applications of the metabolomics in laboratory diagnostics in the last 5 years were also reviewed according to the type of biological sample used in the metabolome's analysis. We also discussed some limitations and further improvements which should be considered taking in mind potential applications of metabolomic research and practice. Copyright © 2014 Elsevier B.V. All rights reserved.

  9. Corpuscular plasma diagnostics

    International Nuclear Information System (INIS)

    Afrosimov, V.; Petrov, M.

    1984-01-01

    An elementary explanation is presented of the physical principles and important methods of corpuscular plasma diagnostics. The invaluable role of corpuscular methods for measuring the hot plasma ion component in thermonuclear facilities, especially hydrogen ions in tokamaks, is emphasized. All corpuscular methods employ analysis of fast neutral atoms and therefore the mechanism of their creation inside a hot plasma is explained first. The ammount of information obtainable from spectra of fast neutrals is discussed. Multichannel analyzers developed at the FTI A.F. Ioffe in Leningrad are described in detail. Classical passive corpuscular diagnostics are examined as are active methods using artifitial beams of hydrogen atoms. The method used for obtaining local values of ion temperature and density is explained. Corpuscular spectroscopic diagnostics and its application for measuring impurities is mentioned. (J.U.)

  10. [Cytology in uropathological diagnostics].

    Science.gov (United States)

    Gaisa, N T; Lindemann-Docter, K

    2015-11-01

    Cytology in uropathological diagnostics is mainly performed for oncological purposes. The assessment of malignancy by urothelial cell morphology is therefore decisive; however, cytology is only sensitive enough to detect high-grade tumor cells and the different low-grade tumors cannot be reliably diagnosed. Thus, the four-tier classification system of cytological findings (i.e. negative, atypical cells but significance uncertain, suspicious and positive) refers to high-grade tumor cells only. Furthermore, for valid cytological diagnostics not only the cytological specimen but also clinical information on cystoscopy findings and, if applicable, a biopsy should be evaluated together. In difficult differential diagnostic settings, e.g. differentiation between reactive versus neoplastic atypia or difficult to access lesions in the upper urinary tract, additional fluorescence in situ hybridization of cytological preparations might be helpful. At the moment there are no indications for further immunocytology or additional biomarker tests.

  11. ORION laser target diagnostics

    International Nuclear Information System (INIS)

    Bentley, C. D.; Edwards, R. D.; Andrew, J. E.; James, S. F.; Gardner, M. D.; Comley, A. J.; Vaughan, K.; Horsfield, C. J.; Rubery, M. S.; Rothman, S. D.; Daykin, S.; Masoero, S. J.; Palmer, J. B.; Meadowcroft, A. L.; Williams, B. M.; Gumbrell, E. T.; Fyrth, J. D.; Brown, C. R. D.; Hill, M. P.; Oades, K.

    2012-01-01

    The ORION laser facility is one of the UK's premier laser facilities which became operational at AWE in 2010. Its primary mission is one of stockpile stewardship, ORION will extend the UK's experimental plasma physics capability to the high temperature, high density regime relevant to Atomic Weapons Establishment's (AWE) program. The ORION laser combines ten laser beams operating in the ns regime with two sub ps short pulse chirped pulse amplification beams. This gives the UK a unique combined long pulse/short pulse laser capability which is not only available to AWE personnel but also gives access to our international partners and visiting UK academia. The ORION laser facility is equipped with a comprehensive suite of some 45 diagnostics covering optical, particle, and x-ray diagnostics all able to image the laser target interaction point. This paper focuses on a small selection of these diagnostics.

  12. ORION laser target diagnostics.

    Science.gov (United States)

    Bentley, C D; Edwards, R D; Andrew, J E; James, S F; Gardner, M D; Comley, A J; Vaughan, K; Horsfield, C J; Rubery, M S; Rothman, S D; Daykin, S; Masoero, S J; Palmer, J B; Meadowcroft, A L; Williams, B M; Gumbrell, E T; Fyrth, J D; Brown, C R D; Hill, M P; Oades, K; Wright, M J; Hood, B A; Kemshall, P

    2012-10-01

    The ORION laser facility is one of the UK's premier laser facilities which became operational at AWE in 2010. Its primary mission is one of stockpile stewardship, ORION will extend the UK's experimental plasma physics capability to the high temperature, high density regime relevant to Atomic Weapons Establishment's (AWE) program. The ORION laser combines ten laser beams operating in the ns regime with two sub ps short pulse chirped pulse amplification beams. This gives the UK a unique combined long pulse/short pulse laser capability which is not only available to AWE personnel but also gives access to our international partners and visiting UK academia. The ORION laser facility is equipped with a comprehensive suite of some 45 diagnostics covering optical, particle, and x-ray diagnostics all able to image the laser target interaction point. This paper focuses on a small selection of these diagnostics.

  13. Nova diagnostics summary

    International Nuclear Information System (INIS)

    Slivinsky, V.W.; Drake, R.P.

    1985-01-01

    The authors intend that Nova be the best diagnosed ICF research facility in operation today. The authors experience in providing advanced diagnostics for previous laser systems will be extended at Nova, and will be challenged by the development of new instrumentation to diagnose the more advanced targets made possible by this powerful laser. Previous experience has shown that to understand target performance, the authors must have as complete a set of diagnostics as possible. The Nova diagnostics are divided into two sets: the basic set required for the initial Nova experiments and the more advanced set for later, generally more complex, experiments. The basic set will be operational for the first Nova shots; it was a Nova line item funded with Nova construction money. This basic set is presented in a table

  14. Angiography - interventional diagnostic applications

    International Nuclear Information System (INIS)

    Schild, H.

    1994-01-01

    The angiography system is very different from the other systems used in diagnostic radiology. The invasivity of angiography requires special, high standards in theoretical and practical training and experience both of beginners and experienced personnel. This textbook fully meets the demand for in-depth and exhaustive information, as it presents: - The fundamentals and techniques of angiography, the vascular anatomy, and many hints and tips of great help in practice. - A comprehensive survey of diagnostic problems and examination approaches, including neuro-angiography, with 221 reproductions of original angiographs, and additional schematic representations. - A special chapter devoted to indication and relevant techniques for the major vascular interventional examinations. - A great number of tables explain at a glance standard examination techniques, indications and diagnostic criteria. (orig./CB) [de

  15. [CONE BEAM COMPUTED TOMOGRAPHY IN DIAGNOSTICS OF ODONTOGENIC MAXILLARY SINUSITIS (CASE REPORTS)].

    Science.gov (United States)

    Demidova, E; Khurdzidze, G

    2017-06-01

    Diagnostic studies performed by cone beam computed tomography Morita 3D made possible to obtain high resolution images of hard tissues of upper jawbone and maxillary sinus, to detect bony tissue defects, such as odontogenic cysts, cystogranulomas and granulomas. High-resolution and three dimensional tomographic image reconstructions allowed for optimal and prompt determination of the scope of surgical treatment and planning of effective conservative treatment regimen. Interactive diagnostics helped to estimate cosmetic and functional results of surgical treatment, to prevent the occurrence of surgical complications, and to evaluate the efficacy of conservative treatment. The obtained data contributed to determination of particular applications of cone beam computed tomography in the diagnosis of odontogenic maxillary sinusitis, detection of specific defects with cone beam tomography as the most informative method of diagnosis; as well as to determination of weak and strong sides, and helped to offer mechanisms of x-ray diagnostics to dental surgeons and ENT specialists.

  16. Beam Instrumentation and Diagnostics

    CERN Document Server

    Strehl, Peter

    2006-01-01

    This treatise covers all aspects of the design and the daily operations of a beam diagnostic system for a large particle accelerator. A very interdisciplinary field, it involves contributions from physicists, electrical and mechanical engineers and computer experts alike so as to satisfy the ever-increasing demands for beam parameter variability for a vast range of operation modi and particles. The author draws upon 40 years of research and work, most of them spent as the head of the beam diagnostics group at GSI. He has illustrated the more theoretical aspects with many real-life examples that will provide beam instrumentation designers with ideas and tools for their work.

  17. Diagnostic Imaging Workshop

    International Nuclear Information System (INIS)

    Sociedad Argentina de Fisica Medica

    2012-01-01

    The American Association of Physicist in Medicine (AAPM), the International Organization for Medical Physics (IOMP) and the Argentina Society of Medical Physics (SAFIM) was organized the Diagnostic Imaging Workshop 2012, in the city of Buenos Aires, Argentina. This workshop was an oriented training and scientific exchange between professionals and technicians who work in medical physics, especially in the areas of diagnostic imaging, nuclear medicine and radiotherapy, with special emphasis on the use of multimodal imaging for radiation treatment, planning as well of quality assurance associates.

  18. The dutch surgical colorectal audit

    NARCIS (Netherlands)

    Leersum, N.J. van; Snijders, H.S.; Henneman, D.; Kolfschoten, N.E.; Gooiker, G.A.; Berge, M.G. Ten; Eddes, E.H.; Wouters, M.W.; Tollenaar, R.A.E.M.; Bemelman, W.A.; Dam, R.M. van; Elferink, M.A.; Karsten, T.M.; Krieken, J.H. van; Lemmens, V.E.; Rutten, H.J.; Manusama, E.R.; Velde, C.J. van de; Meijerink, W.J.H.J.; Wiggers, T.; Harst, E. van der; Dekker, J.W.T.; Boerma, D.

    2013-01-01

    INTRODUCTION: In 2009, the nationwide Dutch Surgical Colorectal Audit (DSCA) was initiated by the Association of Surgeons of the Netherlands (ASN) to monitor, evaluate and improve colorectal cancer care. The DSCA is currently widely used as a blueprint for the initiation of other audits, coordinated

  19. Surgical treatment of buried penis.

    Science.gov (United States)

    Lipszyc, E; Pfister, C; Liard, A; Mitrofanoff, P

    1997-10-01

    The buried penis is a rare congenital entity, whose treatment is surgical. There are few publications concerning this matter. The authors report on their experience in 10 cases (1990-1995). In this abnormality, the tip of the glans does not project from the pubic or scrotal skin. It is due to: 1) an excessive development of the penile fascia which retracts the penis; 2) insufficient attachment of the penile skin at the base of the penis; 3) often excessive prepubic fat worsens the appearance of the abnormality but does not by itself totally explain it; 4) a tight phimosis is often present. Surgical treatment is necessary because this aspect tends to persist even after puberty. One cannot indeed count on the development at the age of puberty, neither on the diminution of the fat, nor on the simple cure of the phimosis. One must above all ban circumcision which causes the risk of eliminating the skin necessary for reconstruction. The surgical procedure will comprise: 1) a longitudinal dorsal incision extended circumferentially; 2) resection of the thickened fascia penis; 3) anchoring of the deep face of the dermis to the proximal part of the fascia penis at the base of the penis. This surgical procedure has always brought a significant improvement to the appearance of the penis.

  20. Surgical management of tubal pregnancy

    NARCIS (Netherlands)

    Mol, F.

    2013-01-01

    The work presented in this thesis first addresses the magnitude of the clinical problem of surgically treated tubal pregnancy in The Netherlands. Next, we studied the adherence to recommendations from the Dutch guideline on diagnosis and management of ectopic pregnancy. A systematic review and

  1. The Dutch surgical colorectal audit

    NARCIS (Netherlands)

    van Leersum, N. J.; Snijders, H. S.; Henneman, D.; Kolfschoten, N. E.; Gooiker, G. A.; ten Berge, M. G.; Eddes, E. H.; Wouters, M. W. J. M.; Tollenaar, R. A. E. M.; Bemelman, W. A.; van Dam, R. M.; Elferink, M. A.; Karsten, Th M.; van Krieken, J. H. J. M.; Lemmens, V. E. P. P.; Rutten, H. J. T.; Manusama, E. R.; van de Velde, C. J. H.; Meijerink, W. J. H. J.; Wiggers, Th; van der Harst, E.; Dekker, J. W. T.; Boerma, D.

    2013-01-01

    In 2009, the nationwide Dutch Surgical Colorectal Audit (DSCA) was initiated by the Association of Surgeons of the Netherlands (ASN) to monitor, evaluate and improve colorectal cancer care. The DSCA is currently widely used as a blueprint for the initiation of other audits, coordinated by the Dutch

  2. Surgical smoke and infection control.

    NARCIS (Netherlands)

    Alp, E.; Bijl, D.; Bleichrodt, R.P.; Hansson, B.M.; Voss, A.

    2006-01-01

    Gaseous byproducts produced during electrocautery, laser surgery or the use of ultrasonic scalpels are usually referred to as 'surgical smoke'. This smoke, produced with or without a heating process, contains bio-aerosols with viable and non-viable cellular material that subsequently poses a risk of

  3. Surgical training in the Netherlands

    NARCIS (Netherlands)

    Borel-Rinkes, Inne H. M.; Gouma, Dirk J.; Hamming, Jaap F.

    2008-01-01

    Surgical training in the Netherlands has traditionally been characterized by learning on the job under the classic master-trainee doctrine. Over the past decades, it has become regionally organized with intensive structural training courses, and a peer-based quality control system. Recently, the

  4. Tc-99m leucoscintigraphy in surgical patients

    International Nuclear Information System (INIS)

    Durre-e-Sabih

    1990-01-01

    Leucoscintigraphy with Tc-99m-HMPAO is an important diagnostic modality for localizing of the site of infection. It has distinct advantages over gallium 67 and indium-111 labelled leukocytes, in terms of better image quality, less cell activation and the choice of using Technetium instead of In-111. This study was designed to set up the technique in AEMC, Multan Pakistan, to assess the practicality of using the procedure, and to see if the results offered additional clinical information that could affect patient management in our clinical environment. 27 patients were studied using the technique. There were 17 post-surgical patients, 4 post-partal patients and 6 patients who did no fit into the above categories. An accuracy of 81%, sensitivity of 75% and a specificity of 100 % were achieved. The spectrum of clinical presentation was broad and included post-operative infections, intra-abdominal haematoms, brain abscesses, localized peritonitis, sterile and infected intraperitoneal collections, infected pleural effusions and pyrexia of unknown origin. It was concluded that this technique is practicable in our conditions and gives important clinical information. (author)

  5. Surgical travellers: tapestry to Bayeux.

    Science.gov (United States)

    Hedley-Whyte, John; Milamed, Debra R

    2014-09-01

    The planning for surgery in war was revisited in 1937 when Ian Fraser was elected a member of the Surgical Travellers. At their 1938 Surgical Travellers meeting in Vienna, Ian and Eleanor Fraser were evicted from their hotel room by the Nazis. The 1939 meeting in Belfast discussed the organization of surgery and the conduct of Emergency Medical Service Hospitals in the United Kingdom; the vast majority were to be under civilian government and military control. From 1943 lengthy and informative organizational meetings were held at least monthly under the chairmanship of Sir Alexander Hood, KBE, Head of the RAMC. Surgical Consultants, now Major Generals, Brigadiers or Full Colonels in the British and U.S. Armies stationed in the UK, prepared for the invasion of Europe. The allocation of medical, surgical, nursing and auxiliary responsibilities was delineated. Liaison with the RAF and US Army Air Force was close as it was with the proposed leaders, Ulstermen Brooke and Montgomery. Montgomery chose Arthur Porritt as Surgeon in Chief to Supreme Headquarters Allied Expeditionary Force (SHAEF), and Eisenhower, General Albert W. Kenner. Just after D-Day, Porritt met Ian Fraser, who had waded in on Arromanches Beach. The triage and evacuation plans for Allied casualties had been controversial, particularly as regards Landing Ship Tanks (LSTs). The dispute with the Hood-selected surgeons on one side, against medical and surgical deployment of LSTs, and Admiral Ernest King and Winston Churchill on the other, favouring LST use for surgery and evacuation. King and Churchill were correct but total Allied air superiority allowed wide use of many of the Allies' Dakotas; 10,000 DC-3s were eventually in service. Supported by forty Allied combat planes to each Luftwaffe, the dispute about Landing Ship Tank use in about a fortnight became moot. The multifaceted role of the Princess Royal in the Emergency Medical Services of the United Kingdom and her close liaison with the Consultant

  6. Virtual reality in surgical education.

    Science.gov (United States)

    Ota, D; Loftin, B; Saito, T; Lea, R; Keller, J

    1995-03-01

    Virtual reality (VR) is an emerging technology that can teach surgeons new procedures and can determine their level of competence before they operate on patients. Also VR allows the trainee to return to the same procedure or task several times later as a refresher course. Laparoscopic surgery is a new operative technique which requires the surgeon to observe the operation on a video-monitor and requires the acquisition of new skills. VR simulation could duplicate the operative field and thereby enhance training and reduce the need for expensive animal training models. Our preliminary experience has shown that we have the technology to model tissues and laparoscopic instruments and to develop in real time a VR learning environment for surgeons. Another basic need is to measure competence. Surgical training is an apprenticeship requiring close supervision and 5-7 years of training. Technical competence is judged by the mentor and has always been subjective. If VR surgical simulators are to play an important role in the future, quantitative measurement of competence would have to be part of the system. Because surgical competence is "vague" and is characterized by such terms as "too long, too short" or "too close, too far," it is possible that the principles of fuzzy logic could be used to measure competence in a VR surgical simulator. Because a surgical procedure consists of a series of tasks and each task is a series of steps, we will plan to create two important tasks in a VR simulator and validate their use. These tasks consist of laparoscopic knot tying and laparoscopic suturing. Our hypothesis is that VR in combination with fuzzy logic can educate surgeons and determine when they are competent to perform these procedures on patients.

  7. Electron beam diagnostics study

    International Nuclear Information System (INIS)

    Garganne, P.

    1989-08-01

    This paper summarizes the results of a study on beam diagnostics, using carbon wire scanners and optical transition radiation (DTR) monitors. The main consideration consists in the material selection, taking their thermal properties and their effect on the beam into account [fr

  8. Molecular Beacons in Diagnostics

    OpenAIRE

    Tyagi, Sanjay; Kramer, Fred Russell

    2012-01-01

    Recent technical advances have begun to realize the potential of molecular beacons to test for diverse infections in clinical diagnostic laboratories. These include the ability to test for, and quantify, multiple pathogens in the same clinical sample, and to detect antibiotic resistant strains within hours. The design principles of molecular beacons have also spawned a variety of allied technologies.

  9. Diagnostic radiation and pregnancy

    International Nuclear Information System (INIS)

    Collins, L.; Fitzgerald, P.

    1983-01-01

    Accidental irradiation of the embryo or fetus in the first trimester is a problem which will occasionally occur. The value of a proper estimation of the radiation dose is emphasised. Very rarely does a single diagnostic procedure result in a uterine dose as high as 50 mGy. An accidental irradiation should rarely be cause for termination of a pregnancy

  10. Diagnostics for induction accelerators

    International Nuclear Information System (INIS)

    Fessenden, T.J.

    1996-04-01

    The induction accelerator was conceived by N. C. Christofilos and first realized as the Astron accelerator that operated at LLNL from the early 1960's to the end of 1975. This accelerator generated electron beams at energies near 6 MeV with typical currents of 600 Amperes in 400 ns pulses. The Advanced Test Accelerator (ATA) built at Livermore's Site 300 produced 10,000 Ampere beams with pulse widths of 70 ns at energies approaching 50 MeV. Several other electron and ion induction accelerators have been fabricated at LLNL and LBNL. This paper reviews the principal diagnostics developed through efforts by scientists at both laboratories for measuring the current, position, energy, and emittance of beams generated by these high current, short pulse accelerators. Many of these diagnostics are closely related to those developed for other accelerators. However, the very fast and intense current pulses often require special diagnostic techniques and considerations. The physics and design of the more unique diagnostics developed for electron induction accelerators are presented and discussed in detail

  11. Diagnostic studies in amyloidosis

    NARCIS (Netherlands)

    Hazenberg, Bouke Pier Cornelis

    2007-01-01

    In this thesis two diagnostic techniques are studied in amyloidosis. Systemic amyloidosis is characterized by deposition of amyloid fibrils (tiny fibres) throughout the body resulting in damage of vital organs. Amyloid can be detected in a tissue specimen stained with Congo red: red-stained amyloid

  12. 1968 Prototype Diagnostic Test.

    Science.gov (United States)

    Veterans Administration Hospital, Bedford, MA.

    This true-false diagnostic test was used for pretesting of employees at a Veterans Administration Hospital. The test is comprised of 20 items. An alternate test--Classification Questionnaire--was used for testing after remedial training. (For related document, see TM 002 334.) (DB)

  13. Diagnostics for induction accelerators

    International Nuclear Information System (INIS)

    Fessenden, T.J.

    1997-01-01

    The induction accelerator was conceived by N. C. Christofilos and first realized as the Astron accelerator that operated at Lawrence Livermore National Laboratory (LLNL) from the early 1960s to the end of 1975. This accelerator generated electron beams at energies near 6 MeV with typical currents of 600 Amperes in 400-ns pulses. The Advanced Test Accelerator (ATA) built at Livermore close-quote s Site 300 produced 10,000-Ampere beams with pulse widths of 70 ns at energies approaching 50 MeV. Several other electron and ion induction accelerators have been fabricated at LLNL and Lawrence Berkeley National Laboratory (LBNL). This paper reviews the principal diagnostics developed through efforts by scientists at both laboratories for measuring the current, position, energy, and emittance of beams generated by these high-current, short-pulse accelerators. Many of these diagnostics are closely related to those developed for other accelerators. However, the very fast and intense current pulses often require special diagnostic techniques and considerations. The physics and design of the more unique diagnostics developed for electron induction accelerators are presented and discussed in detail. copyright 1997 American Institute of Physics

  14. It's diagnostics, stupid.

    Science.gov (United States)

    Bernards, René

    2010-04-02

    To stem the spiraling cost of cancer treatment, a concerted effort is urgently needed to develop molecular diagnostics to better identify the patients that respond to expensive targeted therapies. Opportunities and obstacles in the development of such drug response biomarkers are discussed here. Copyright 2010 Elsevier Inc. All rights reserved.

  15. Diagnostics for pellet experiments

    International Nuclear Information System (INIS)

    Johnson, R.R.

    1978-01-01

    The target diagnostics which are being used and planned in current laser driven ICF Experiments are described. Most of these diagnostics can be easily applied to future ion-beam fusion experiments. The status of laser fusion diagnostics has been much improved in the last 5 years and further improvements can be expected and should be available when the first ICF experiments using ion beams are performed. As an example, x-ray temporal and spatial resolutions are now approximately 5 psec and 3 μm, which is approximately a factor of 4 better than the resolution reported in the first implosion experiments. As one plans ahead for ion-beam fusion experiments it should be emphasized that high yield experiments are easier to diagnose provided adequate shielding is employed. However, in the event that the first high yield experiments fail it will be necessary to have diagnostics available to determine where the problems lie. In laser fusion it is interesting to note that higher laser powers are required now for breakeven experiments than first anticipated, mainly because some aspects of the laser-interaction physics were not recognized until the experiments were carefully diagnosed. Thus as has been pointed out, it may be necessary to increase the energy of the ion-beam driver to enable us to do breakeven experiments with high confidence

  16. Flowfield modeling and diagnostics

    International Nuclear Information System (INIS)

    Gupta, A.K.; Lilley, D.G.

    1985-01-01

    This textbook is devoted solely to flowfield modeling and diagnostics; their practical use, recent and current research, and projected developments and trends. It provides an account of the use of a broad range of techniques in industrial and research practice, both with and without combustion. Application ideas are complemented by details about experimental and modeling techniques

  17. Serbia : Systematic Country Diagnostic

    OpenAIRE

    World Bank Group

    2015-01-01

    This Systematic Country Diagnostic (SCD) aims to identify the major constraints on and opportunities for sustaining poverty reduction and shared prosperity in Serbia. The SCD serves as the analytic foundation on which the World Bank Group and the Government of Serbia will define a new Country Partnership Framework for FY2016 to FY2020. It is based on the best possible analysis, drawing on ...

  18. Diagnostic and interventional radiology

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, Thomas J. [Klinikum der Johann Wolfgang Goethe-Universitaet, Frankfurt am Main (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Reith, Wolfgang [Universitaetsklinikum des Saarlandes, Homburg/Saar (Germany). Klinik fuer Diagnostische und Interventionelle Neuroradiologie; Rummeny, Ernst J. (ed.) [Technische Univ. Muenchen Klinikum rechts der Isar, Muenchen (Germany). Inst. fuer Radiologie

    2016-08-01

    This exceptional book covers all aspects of diagnostic and interventional radiology within one volume, at a level appropriate for the specialist. From the basics through diagnosis to intervention: the reader will find a complete overview of all areas of radiology. The clear, uniform structure, with chapters organized according to organ system, facilitates the rapid retrieval of information. Features include: Presentation of the normal radiological anatomy Classification of the different imaging procedures according to their diagnostic relevance Imaging diagnosis with many reference images Precise description of the interventional options The inclusion of many instructive aids will be of particular value to novices in decision making: Important take home messages and summaries of key radiological findings smooth the path through the jungle of facts Numerous tables on differential diagnosis and typical findings in the most common diseases offer a rapid overview and orientation Diagnostic flow charts outline the sequence of diagnostic evaluation All standard procedures within the field of interventional radiology are presented in a clinically relevant and readily understandable way, with an abundance of illustrations. This is a textbook, atlas, and reference in one: with more than 2500 images for comparison with the reader's own findings. This comprehensive and totally up-to-date book provides a superb overview of everything that the radiology specialist of today needs to know.

  19. Surgical Treatment of Traumatic Myositis Ossificans of the Extensor Carpi Radialis Muscle in a Dog.

    Science.gov (United States)

    Morton, Bridget A; Hettlich, Bianca F; Pool, Roy R

    2015-07-01

    To report clinical signs, diagnostic imaging findings, and outcome in a dog with traumatic myositis ossificans of the origin of the extensor carpi radialis muscle. Clinical report. An 8-month-old intact female Irish Setter Dog. After radiographic and computed tomographic evaluation of an osseous proliferation arising from the cranial cortex of the right distal humeral diaphysis, the protruding bone was surgically removed and evaluated by histopathology. Traumatic myositis ossificans was successfully treated with surgical removal of the osseous proliferation resulting in improved postoperative range of motion of the right elbow joint. There was no evidence of lameness or abnormal bone regrowth associated with the surgical site radiographically at follow up. Surgical removal of a traumatic myositis ossificans lesion resulted in full return to function in a young, competitive show dog. © Copyright 2014 by The American College of Veterinary Surgeons.

  20. Imaging of chest trauma: radiological patterns of injury and diagnostic algorithms

    International Nuclear Information System (INIS)

    Lomoschitz, Fritz M.; Eisenhuber, Edith; Linnau, Ken F.; Peloschek, Philipp; Schoder, Maria; Bankier, Alexander A.

    2003-01-01

    In patients after chest trauma, imaging plays a key role for both, the primary diagnostic work-up, and the secondary assessment of potential treatment. Despite its well-known limitations, the anteroposterior chest radiograph remains the starting point of the imaging work-up. Adjunctive imaging with computed tomography, that recently is increasingly often performed on multidetector computed tomography units, adds essential information not readily available on the conventional radiograph. This allows better definition of trauma-associated thoracic injuries not only in acute traumatic aortic injury, but also in pulmonary, tracheobronchial, cardiac, diaphragmal, and thoracic skeletal injuries. This article reviews common radiographic findings in patients after chest trauma, shows typical imaging features resulting from thoracic injury, presents imaging algorithms, and recalls to the reader less common but clinically relevant entities encountered in patients after thoracic trauma

  1. Tune-Based Halo Diagnostics

    International Nuclear Information System (INIS)

    Cameron, Peter

    2003-01-01

    Tune-based halo diagnostics can be divided into two categories -- diagnostics for halo prevention, and diagnostics for halo measurement. Diagnostics for halo prevention are standard fare in accumulators, synchrotrons, and storage rings, and again can be divided into two categories -- diagnostics to measure the tune distribution (primarily to avoid resonances), and diagnostics to identify instabilities (which will not be discussed here). These diagnostic systems include kicked (coherent) tune measurement, phase-locked loop (PLL) tune measurement, Schottky tune measurement, beam transfer function (BTF) measurements, and measurement of transverse quadrupole mode envelope oscillations. We refer briefly to tune diagnostics used at RHIC and intended for the SNS, and then present experimental results. Tune-based diagnostics for halo measurement (as opposed to prevention) are considerably more difficult. We present one brief example of tune-based halo measurement

  2. Surgical Masculinization of the Breast: Clinical Classification and Surgical Procedures.

    Science.gov (United States)

    Cardenas-Camarena, Lazaro; Dorado, Carlos; Guerrero, Maria Teresa; Nava, Rosa

    2017-06-01

    Aesthetic breast area improvements for gynecomastia and gender dysphoria patients who seek a more masculine appearance have increased recently. We present our clinical experience in breast masculinization and a classification for these patients. From July 2003 to May 2014, 68 patients seeking a more masculine thorax underwent surgery. They were divided into five groups depending on three factors: excess fatty tissue, breast tissue, and skin. A specific surgical treatment was assigned according to each group. The surgical treatments included thoracic liposuction, subcutaneous mastectomy, periareolar skin resection in one or two stages, and mastectomy with a nipple areola complex graft. The evaluation was performed 6 months after surgery to determine the degree of satisfaction and presence of complications. Surgery was performed on a total of 68 patients, 45 male and 22 female, with ages ranging from 18 to 49 years, and an average age of 33 years. Liposuction alone was performed on five patients; subcutaneous mastectomy was performed on eight patients; subcutaneous mastectomy combined with liposuction was performed on 27 patients; periareolar skin resection was performed on 11 patients; and mastectomy with NAC free grafts was performed on 16 patients. The surgical procedure satisfied 94% of the patients, with very few complications. All patients who wish to obtain a masculine breast shape should be treated with only one objective regardless patient's gender: to obtain a masculine thorax. We recommend a simple mammary gland classification for determining the best surgical treatment for these patients LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  3. The pregnant female surgical resident

    Directory of Open Access Journals (Sweden)

    Shifflette V

    2018-05-01

    Full Text Available Vanessa Shifflette,1 Susannah Hambright,2 Joseph Darryl Amos,1 Ernest Dunn,3 Maria Allo4 1Associates in Surgical Acute Care, Methodist Dallas Medical Center, Dallas, TX, USA; 2Methodist Surgical Associates, Methodist Dallas Medical Center, Dallas, TX, USA; 3Graduate Medical Education - General Surgery, Methodist Dallas Medical Center, Dallas, TX, USA; 4Santa Clara Valley Medical Center, San Jose, CA, USA Background: Surgery continues to be an intense, time-consuming residency. Many medical students decide against surgery as a profession due to the long work hours and family strain. The pregnant female surgical resident has an added stress factor compared to her male counterpart. Methods: We distributed an electronic, online 26-question survey to 32 general surgery programs in the southwestern region of the United States. Each program distributed our survey to the female surgical residents who had been pregnant during residency in the last 5 years. Each program was re-contacted 6 weeks after the initial contact. Most questions were in a 5-point Likert scale format. The responses were collected and analyzed using the Survey Monkey website. Results: An unvalidated survey was sent to 32 general surgery programs and 26 programs responded (81%. Each program was asked for the total number of possible responses from female residents that met our criteria (60 female residents. Seven of the programs (27% stated that they have had zero residents pregnant. We had 22 residents respond (37%. Over half of the residents (55% were pregnant during their 2nd or 3rd year of residency, with only 18% pregnant during a research year. Thirty-one percent had a lower American Board of Surgery In-Training Exam (ABSITE score. Ninety percent of the residents were able to take 4 weeks or more for maternity leave. Most of the residents (95% stated that they would do this again during residency given the opportunity, but many of the residents felt that returning back to work

  4. Radiological and surgical management of nonpalpable breast lesions

    International Nuclear Information System (INIS)

    Leinung, S.; Wuerl, P.; Preusse, C.; Boerner, P.; Schoenfelder, M.; Schneider, J.P.; Schmidt, F.; Guetz, U.

    2000-01-01

    In this retrospective study the results of surgical biopsy of suspected breast cancer in 319 outpatients are reported. In 113 cases (35.4%) the lesion was palpable, in 206 cases (64.6%) it was not. Concerning the nonpalpable lesions, mammography was performed in 98 patients (47.6%) for work-up of fibrocystic changes, in 41 patients (19.9%) for initial participation in a breast cancer prevention program, and in 33 patients (16.0%) for surveillance after breast conservation therapy. Prior to operation, 84.0% (n=173) of the nonpalpable lesions were detected by mammography, 11.2% (n=23) by sonography, and 4.8% (n=10) by magnetic resonance imaging. Intra-operative specimen mammography was carried out in every case detected by mammography. In 19.4% (n=40) of 206 nonpalpable lesions a malignant tumor was found. Twenty-five percent (n=10) of all marked tumors were diagnosed and treated as in-situ stage tumors, while 65% (n=26) were diagnosed and treated as tumors in the pT1 stage. As regards the nodal stage, 85% (n=34) of the tumors were diagnosed and treated as pN0 tumors, and 100% (n=40) were found to be free from any distant metastases. Consequently, for improving prognosis and, at the same time, for reducing the rate of breast amputations as a means of curative therapy of breast cancer, regular screening in defined risk groups is necessary. Surgical treatment of patients with small and nonpalpable findings should be reserved for departments with marking and quick-freezing facilities. (orig.) [de

  5. Beyond Diagnostic Accuracy: The Clinical Utility of Diagnostic Tests

    NARCIS (Netherlands)

    Bossuyt, Patrick M. M.; Reitsma, Johannes B.; Linnet, Kristian; Moons, Karel G. M.

    2012-01-01

    Like any other medical technology or intervention, diagnostic tests should be thoroughly evaluated before their introduction into daily practice. Increasingly, decision makers, physicians, and other users of diagnostic tests request more than simple measures of a test's analytical or technical

  6. Surgical intervention in patients with necrotizing pancreatitis

    NARCIS (Netherlands)

    Besselink, MG; de Bruijn, MT; Rutten, JP; Boermeester, MA; Hofker, HS; Gooszen, HG

    Background: This study evaluated the various surgical strategies for treatment of (suspected) infected necrotizing pancreatitis (INP) and patient referrals for this condition in the Netherlands. Methods: This retrospective study included all 106 consecutive patients who had surgical treatment for

  7. Deep Neuromuscular Blockade Improves Laparoscopic Surgical Conditions

    DEFF Research Database (Denmark)

    Rosenberg, Jacob; Herring, W Joseph; Blobner, Manfred

    2017-01-01

    INTRODUCTION: Sustained deep neuromuscular blockade (NMB) during laparoscopic surgery may facilitate optimal surgical conditions. This exploratory study assessed whether deep NMB improves surgical conditions and, in doing so, allows use of lower insufflation pressures during laparoscopic cholecys...

  8. Diagnostic Evaluation of Nontraumatic Chest Pain in Athletes.

    Science.gov (United States)

    Moran, Byron; Bryan, Sean; Farrar, Ted; Salud, Chris; Visser, Gary; Decuba, Raymond; Renelus, Deborah; Buckley, Tyler; Dressing, Michael; Peterkin, Nicholas; Coris, Eric

    This article is a clinically relevant review of the existing medical literature relating to the assessment and diagnostic evaluation for athletes complaining of nontraumatic chest pain. The literature was searched using the following databases for the years 1975 forward: Cochrane Database of Systematic Reviews; CINAHL; PubMed (MEDLINE); and SportDiscus. The general search used the keywords chest pain and athletes. The search was revised to include subject headings and subheadings, including chest pain and prevalence and athletes. Cross-referencing published articles from the databases searched discovered additional articles. No dissertations, theses, or meeting proceedings were reviewed. The authors discuss the scope of this complex problem and the diagnostic dilemma chest pain in athletes can provide. Next, the authors delve into the vast differential and attempt to simplify this process for the sports medicine physician by dividing potential etiologies into cardiac and noncardiac conditions. Life-threatening causes of chest pain in athletes may be cardiac or noncardiac in origin, which highlights the need for the sports medicine physician to consider pathology in multiple organ systems simultaneously. This article emphasizes the importance of ruling out immediately life threatening diagnoses, while acknowledging the most common causes of noncardiac chest pain in young athletes are benign. The authors propose a practical algorithm the sports medicine physician can use as a guide for the assessment and diagnostic work-up of the athlete with chest pain designed to help the physician arrive at the correct diagnosis in a clinically efficient and cost-effective manner.

  9. Risk factors for autism: translating genomic discoveries into diagnostics.

    Science.gov (United States)

    Scherer, Stephen W; Dawson, Geraldine

    2011-07-01

    Autism spectrum disorders (ASDs) are a group of conditions characterized by impairments in communication and reciprocal social interaction, and the presence of restricted and repetitive behaviors. The spectrum of autistic features is variable, with severity of symptoms ranging from mild to severe, sometimes with poor clinical outcomes. Twin and family studies indicate a strong genetic basis for ASD susceptibility. Recent progress in defining rare highly penetrant mutations and copy number variations as ASD risk factors has prompted early uptake of these research findings into clinical diagnostics, with microarrays becoming a 'standard of care' test for any ASD diagnostic work-up. The ever-changing landscape of the generation of genomic data coupled with the vast heterogeneity in cause and expression of ASDs (further influenced by issues of penetrance, variable expressivity, multigenic inheritance and ascertainment) creates complexity that demands careful consideration of how to apply this knowledge. Here, we discuss the scientific, ethical, policy and communication aspects of translating the new discoveries into clinical and diagnostic tools for promoting the well-being of individuals and families with ASDs.

  10. Surgical Treatment of Tattoo Complications.

    Science.gov (United States)

    Sepehri, Mitra; Jørgensen, Bo

    2017-01-01

    With a continuing increase in the number of tattoos performed worldwide, the need to treat tattoo complications is growing. Earlier treatments of chronic inflammatory tattoo reactions were dominated by a medical approach, or with no active intervention. In this chapter, we will address modern surgical approaches applied to situations when medical treatment is inefficient and lasers are not applicable. Dermatome shaving is positioned as first-line treatment of allergic tattoo reactions and also indicated in a number of other tattoo reactions, supplemented with excision in selected cases. The methods allow fundamental treatment with removal of the culprit pigment from the dermis. The different instruments, surgical methods, and treatment schedules are reviewed, and a guide to surgeons is presented. Postoperative treatments and the long-term outcomes are described in detail. An algorithm on specialist treatment and follow-up of tattoo reactions, which can be practiced in other countries, is presented. © 2017 S. Karger AG, Basel.

  11. Surgical tools and medical devices

    CERN Document Server

    Jackson, Mark

    2016-01-01

    This new edition presents information and knowledge on the field of biomedical devices and surgical tools. The authors look at the interactions between nanotechnology, nanomaterials, design, modeling, and tools for surgical and dental applications, as well as how nanostructured surfaces can be created for the purposes of improving cell adhesion between medical devices and the human body. Each original chapter is revised in this second edition and describes developments in coatings for heart valves, stents, hip and knee joints, cardiovascular devices, orthodontic applications, and regenerative materials such as bone substitutes. There are also 8 new chapters that address: Microvascular anastomoses Inhaler devices used for pulmonary delivery of medical aerosols Surface modification of interference screws Biomechanics of the mandible (a detailed case study) Safety and medical devices The synthesis of nanostructured material Delivery of anticancer molecules using carbon nanotubes Nano and micro coatings for medic...

  12. Surgical treatment of pathological obesity

    International Nuclear Information System (INIS)

    Portie Felix, Antonio; Navarro Sanchez, Gustavo; Hernandez Solar, Abel; Grass Baldoquin, Jorge Alberto; Domloge Fernandez, Joana

    2011-01-01

    The obesity is the chronic non-communicable disease with a higher rate of growth in past 20 years. It is a risk factor for type 2 diabetes mellitus, high blood pressure, cardiovascular and respiratory affections, infertility, sexual and functional impotence, metabolic syndrome, load joint disorders and some types of cancer (breast, colon, prostate). The metabolic bariatric surgery is the surgical treatment more effective for the morbid obesity at long -and medium- term and not the pharmacologic treatment and the isolated diets. The aim of present historical review of the international literature on the evolution of surgical techniques of the bariatric surgery (malabsorption techniques, gastric restrictive techniques and mixed techniques), is to make available to those interested in this subject, a valuable therapeutic tool to be rationally used. (author)

  13. [Surgical correction of cleft palate].

    Science.gov (United States)

    Kimura, F T; Pavia Noble, A; Soriano Padilla, F; Soto Miranda, A; Medellín Rodríguez, A

    1990-04-01

    This study presents a statistical review of corrective surgery for cleft palate, based on cases treated at the maxillo-facial surgery units of the Pediatrics Hospital of the Centro Médico Nacional and at Centro Médico La Raza of the National Institute of Social Security of Mexico, over a five-year period. Interdisciplinary management as performed at the Cleft-Palate Clinic, in an integrated approach involving specialists in maxillo-facial surgery, maxillar orthopedics, genetics, social work and mental hygiene, pursuing to reestablish the stomatological and psychological functions of children afflicted by cleft palate, is amply described. The frequency and classification of the various techniques practiced in that service are described, as well as surgical statistics for 188 patients, which include a total of 256 palate surgeries performed from March 1984 to March 1989, applying three different techniques and proposing a combination of them in a single surgical time, in order to avoid complementary surgery.

  14. Open surgical simulation--a review.

    Science.gov (United States)

    Davies, Jennifer; Khatib, Manaf; Bello, Fernando

    2013-01-01

    Surgical simulation has benefited from a surge in interest over the last decade as a result of the increasing need for a change in the traditional apprentice model of teaching surgery. However, despite the recent interest in surgical simulation as an adjunct to surgical training, most of the literature focuses on laparoscopic, endovascular, and endoscopic surgical simulation with very few studies scrutinizing open surgical simulation and its benefit to surgical trainees. The aim of this review is to summarize the current standard of available open surgical simulators and to review the literature on the benefits of open surgical simulation. Open surgical simulators currently used include live animals, cadavers, bench models, virtual reality, and software-based computer simulators. In the current literature, there are 18 different studies (including 6 randomized controlled trials and 12 cohort studies) investigating the efficacy of open surgical simulation using live animal, bench, and cadaveric models in many surgical specialties including general, cardiac, trauma, vascular, urologic, and gynecologic surgery. The current open surgical simulation studies show, in general, a significant benefit of open surgical simulation in developing the surgical skills of surgical trainees. However, these studies have their limitations including a low number of participants, variable assessment standards, and a focus on short-term results often with no follow-up assessment. The skills needed for open surgical procedures are the essential basis that a surgical trainee needs to grasp before attempting more technical procedures such as laparoscopic procedures. In this current climate of medical practice with reduced hours of surgical exposure for trainees and where the patient's safety and outcome is key, open surgical simulation is a promising adjunct to modern surgical training, filling the void between surgeons being trained in a technique and a surgeon achieving fluency in that

  15. The dilemma of diagnostic testing for Prader-Willi syndrome

    Science.gov (United States)

    Hung, Dorothy

    2017-01-01

    Although Prader-Willi syndrome (PWS) is a well-described clinical dysmorphic syndrome, DNA testing is required for a definitive diagnosis. A definitive diagnosis can be made in approximately 99% of cases using DNA testing; there are a number of DNA tests that can be used for this purpose, although there is no set standard algorithm of testing. The dilemma arises because of the complex genetic mechanisms at the basis of PWS, which need to be elucidated. To establish the molecular mechanism with a complete work up, involves at least 2 tests. Here we discuss the commonly used tests currently available and suggest a cost—effective approach to diagnostic testing. PMID:28164030

  16. Surgical Treatment of Hepatocellular Carcinoma

    Science.gov (United States)

    Zamora-Valdes, Daniel; Taner, Timucin; Nagorney, David M.

    2017-01-01

    Hepatocellular carcinoma (HCC) is a major cause of cancer-related death worldwide. In select patients, surgical treatment in the form of either resection or transplantation offers a curative option. The aims of this review are to (1) review the current American Association for the Study of Liver Diseases/European Association for the Study of the Liver guidelines on the surgical management of HCC and (2) review the proposed changes to these guidelines and analyze the strength of evidence underlying these proposals. Three authors identified the most relevant publications in the literature on liver resection and transplantation for HCC and analyzed the strength of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification. In the United States, the liver allocation system provides priority for liver transplantation to patients with HCC within the Milan criteria. Current evidence suggests that liver transplantation may also be indicated in certain patient groups beyond Milan criteria, such as pediatric patients with large tumor burden or adult patients who are successfully downstaged. Patients with no underlying liver disease may also benefit from liver transplantation if the HCC is unresectable. In patients with no or minimal (compensated) liver disease and solitary HCC ≥2 cm, liver resection is warranted. If liver transplantation is not available or contraindicated, liver resection can be offered to patients with multinodular HCC, provided that the underlying liver disease is not decompensated. Many patients may benefit from surgical strategies adapted to local resources and policies (hepatitis B prevalence, organ availability, etc). Although current low-quality evidence shows better overall survival with aggressive surgical strategies, this approach is limited to select patients. Larger and well-designed prospective studies are needed to better define the benefits and limits of such approach. PMID:28975836

  17. Towards Safe Robotic Surgical Systems

    DEFF Research Database (Denmark)

    Sloth, Christoffer; Wisniewski, Rafael

    2015-01-01

    a controller for motion compensation in beating-heart surgery, and prove that it is safe, i.e., the surgical tool is kept within an allowable distance and orientation of the heart. We solve the problem by simultaneously finding a control law and a barrier function. The motion compensation system is simulated...... from several initial conditions to demonstrate that the designed control system is safe for every admissible initial condition....

  18. Surgical treatment of chest instability

    International Nuclear Information System (INIS)

    Kitka, M.; Masek, M.

    2015-01-01

    Fractures of the ribs is the most common thoracic injury after blunt trauma. Chest wall instability (flail chest) is a common occurrence in the presence of multiple ribs fracture. Unilateral or bilateral fractures more ribs anteriorly or posteriorly will produce enough instability that paradoxical respiratory motion results in hypoventilation of an unacceptable degree. Open approach and surgical stabilisation of the chest preserved pulmonary function, improved pain control, minimized posttraumatic deformities and shorter back to work time. (author)

  19. Surgical management of venous malformations.

    Science.gov (United States)

    Loose, D A

    2007-01-01

    Among vascular malformations, the predominantly venous malformations represent the majority of cases. They form a clinical entity and therefore need clear concepts concerning diagnosis and treatment. This paper presents an overview of contemporary classification as well as tactics and techniques of treatment. According to the Hamburg Classification, predominantly venous malformations are categorized into truncular and extratruncular forms, with truncular forms distinguished as obstructions and dilations, and extratruncular forms as limited or infiltrating. The tactics of treatment represent surgical and non-surgical methods or combined techniques. Surgical approaches utilize different tactics and techniques that are adopted based on the pathologic form and type of the malformation: (I) operation to reduce the haemodynamic activity of the malformation; (II) operation to eliminate the malformation; and (III) reconstructive operation. As for (I), a type of a tactic is the operation to derive the venous flow. In (II), the total or partial removal of the venous malformation is demonstrated subdivided into three different techniques. In this way, the infiltrating as well as the limited forms can be treated. An additional technique is dedicated to the treatment of a marginal vein. Approach (III) involves the treatment of venous aneurysms, where a variety of techniques have been successful. Long-term follow-up demonstrates positive results in 91% of the cases. Congenital predominantly venous malformations should be treated according to the principles developed during the past decades in vascular surgery, interventional treatment and multidisciplinary treatment. The days of predominantly conservative treatment should be relegated to the past. Special skills and experiences are necessary to carry out appropriate surgical strategy, and the required operative techniques should be dictated by the location and type of malformation and associated findings.

  20. Frugal Design and Surgical Robotics

    OpenAIRE

    McKinley, Stephen Alan

    2016-01-01

    A new era of robotic surgery is poised to begin when critical patents held by Intuitive Surgical (IS) expire in 2016. IS market dominance for decades has led to an effective monopoly that will be challenged by several commercial enterprises working on next generation general robotic surgery systems. Robotic surgery has the potential to alleviate the skill-gap between experienced and inexperienced surgeons through the automation of sub-tasks within surgicalprocedures.The primary objective of...

  1. Surgical treatment of radiation proctitis

    Energy Technology Data Exchange (ETDEWEB)

    Maruyama, Izumi; Sato, Gohei; Okaue, Toyotake; Isobe, Yoshinari; Ohtsu, Akira; Sugimoto, Yuzo (Kansai Electric Power Co., Inc., Osaka (Japan))

    1982-08-01

    Severe radiation proctitis was surgically treated in 8 cases. Colostomy was performed in 2 cases, total resection of the rectum in 2 and proctectomy with colostomy in 4. Perineal abscess developed in the 2 cases with total resection of the rectum. Rather than completely resection of the lesion, a procedure leaving no dead space i.e. proctectomy with colostomy, is desirable for radiation proctitis. Complete preoperative examination of the condition of the underlying disease and possible urinary tract complications is important.

  2. Surgical checklists: the human factor.

    LENUS (Irish Health Repository)

    O Connor, Paul

    2013-05-14

    BACKGROUND: Surgical checklists has been shown to improve patient safety and teamwork in the operating theatre. However, despite the known benefits of the use of checklists in surgery, in some cases the practical implementation has been found to be less than universal. A questionnaire methodology was used to quantitatively evaluate the attitudes of theatre staff towards a modified version of the World Health Organisation (WHO) surgical checklist with relation to: beliefs about levels of compliance and support, impact on patient safety and teamwork, and barriers to the use of the checklist. METHODS: Using the theory of planned behaviour as a framework, 14 semi-structured interviews were conducted with theatre personnel regarding their attitudes towards, and levels of compliance with, a checklist. Based upon the interviews, a 27-item questionnaire was developed and distribute to all theatre personnel in an Irish hospital. RESULTS: Responses were obtained from 107 theatre staff (42.6% response rate). Particularly for nurses, the overall attitudes towards the effect of the checklist on safety and teamworking were positive. However, there was a lack of rigour with which the checklist was being applied. Nurses were significantly more sensitive to the barriers to the use of the checklist than anaesthetists or surgeons. Moreover, anaesthetists were not as positively disposed to the surgical checklist as surgeons and nurse. This finding was attributed to the tendency for the checklist to be completed during a period of high workload for the anaesthetists, resulting in a lack of engagement with the process. CONCLUSION: In order to improve the rigour with which the surgical checklist is applied, there is a need for: the involvement of all members of the theatre team in the checklist process, demonstrated support for the checklist from senior personnel, on-going education and training, and barriers to the implementation of the checklist to be addressed.

  3. [Surgical treatment of supraventricular tachycardia].

    Science.gov (United States)

    Vigano, A N; Minzioni, G; Graffigna, A; Paganini, F; Salerno, J A

    1991-10-01

    The article deals with the modern approaches to the treatment of supraventricular tachycardia . The authors analyse the results of operations in ectopic atrial tachycardias, the Wolff-Parkinson-White syndrome, modal re-entry tachycardias, and atrial fibrillation . The last-named is of most interest because the authors possess experience in a new operation for isolation of the internodal tracts. In all conditions the authors obtained convincing evidence on the efficacy of modern surgical treatment in supraventricular tachycardias.

  4. Quantification of surgical blood loss.

    Science.gov (United States)

    Lee, Marcel H; Ingvertsen, Britt T; Kirpensteijn, Jolle; Jensen, Asger L; Kristensen, Annemarie T

    2006-06-01

    To compare gravimetric and colorimetric methods of quantifying surgical blood loss, and to determine if there is a correlation between preoperative hemostatic tests (buccal mucosa bleeding time [BMBT] and intraoperative blood loss). Prospective clinical study. Dogs (n=15) admitted for cutaneous tumor excision, orthopedic procedure, or exploratory laparotomy. Intraoperative blood loss was quantified by measuring irrigation fluid and weighing surgical sponges used for blood and fluid collection during surgery. Results of gravimetric measurements were then correlated to blood loss quantified using spectrophotometric analysis of hemoglobin (Hb) content. Hemostatic variables including BMBT were measured before surgery and compared with the calculated amount of blood loss. Blood loss quantified by gravimetric measurement showed a significant correlation with colorimetric determination of Hb content in surgical sponges and collected irrigation fluid (r=0.93, P<.0001). BMBT correlated weakly but significantly with intraoperative blood loss (r=0.56, P<.05). Quantifying intraoperative blood loss using spectrophotometric Hb analysis accurately assessed the amount of blood loss; however, it is a time-consuming procedure, primarily applicable as a research tool. Gravimetric evaluation of intraoperative blood loss was found to be an accurate method, which can be recommended for use in a clinical setting. Estimation of blood loss using a gravimetric method is accurate and applicable in the clinical setting and provides surgeons with a simple and objective tool to evaluate intraoperative blood loss.

  5. Is surgical workforce diversity increasing?

    Science.gov (United States)

    Andriole, Dorothy A; Jeffe, Donna B; Schechtman, Kenneth B

    2007-03-01

    We sought to determine the extent to which recent increases in levels of gender and racial diversity in the overall resident-physician workforce were evident among core-surgical specialty resident workforces. Chi-square tests for trend assessed the importance of changes from 1996 to 2004 in proportions of women and African Americans in the surgery-resident workforce. Surgery-resident trends were compared with overall resident workforce trends using two-tailed t-tests to compare regression slopes that quantified rates of change over time. Chi-square tests assessed differences between proportions of women and African Americans in the current overall board-certified workforce and their proportions in the surgery board-certified workforce. From 1996 to 2004, proportions of women increased in all seven surgical specialties studied. Compared with the overall trend toward increasing proportions of women in the resident workforce, the trend in one surgical specialty was larger (obstetrics/gynecology, p 0.05), and two were smaller (each p 0.05). Proportions of African Americans decreased in three specialties (each p workforce, except obstetrics/gynecology, remained lower than in the overall board-certified workforce (each p workforces have persisted since 1996 and will likely perpetuate ongoing surgery board-certified workforce disparities.

  6. [Surgical managment of retinal detachment].

    Science.gov (United States)

    Haritoglou, C; Wolf, A

    2015-05-01

    The detachment of the neurosensory retina from the underlying retinal pigment epithelium can be related to breaks of the retina allowing vitreous fluid to gain access to the subretinal space, to exudative changes of the choroid such as tumours or inflammatory diseases or to excessive tractional forces exerted by interactions of the collagenous vitreous and the retina. Tractional retinal detachment is usually treated by vitrectomy and exudative detachment can be addressed by treatment of the underlying condition in many cases. In rhegmatogenous retinal detachment two different surgical procedures, vitrectomy and scleral buckling, can be applied for functional and anatomic rehabilitation of our patients. The choice of the surgical procedure is not really standardised and often depends on the experience of the surgeon and other more ocular factors including lens status, the number of retinal breaks, the extent of the detachment and the amount of preexisting PVR. Using both techniques, anatomic success rates of over 90 % can be achieved. Especially in young phakic patients scleral buckling offers the true advantage to prevent the progression of cataract formation requiring cataract extraction and intraocular lens implantation. Therefore, scleral buckling should be considered in selected cases as an alternative surgical option in spite of the very important technical refinements in modern vitrectomy techniques. Georg Thieme Verlag KG Stuttgart · New York.

  7. Surgical smoke and ultrafine particles

    Directory of Open Access Journals (Sweden)

    Nowak Dennis

    2008-12-01

    Full Text Available Abstract Background Electrocautery, laser tissue ablation, and ultrasonic scalpel tissue dissection all generate a 'surgical smoke' containing ultrafine ( Methods To measure the amount of generated particulates in 'surgical smoke' during different surgical procedures and to quantify the particle number concentration for operation room personnel a condensation particle counter (CPC, model 3007, TSI Inc. was applied. Results Electro-cauterization and argon plasma tissue coagulation induced the production of very high number concentration (> 100000 cm-3 of particles in the diameter range of 10 nm to 1 μm. The peak concentration was confined to the immediate local surrounding of the production side. In the presence of a very efficient air conditioning system the increment and decrement of ultrafine particle occurrence was a matter of seconds, with accumulation of lower particle number concentrations in the operation room for only a few minutes. Conclusion Our investigation showed a short term very high exposure to ultrafine particles for surgeons and close assisting operating personnel – alternating with longer periods of low exposure.

  8. Uncommon surgical emergencies in neonatology

    Directory of Open Access Journals (Sweden)

    R. Angotti

    2014-12-01

    Full Text Available Objective. Over the past decade, multiple factors have changed the pattern of neonatal surgical emergencies. An increase in prenatal screenings and the development of neonatal tertiary care centres have changed the clinical approach to these kids. Materials and methods. Between 1995 to 2011 were retrospectively reviewed 34 patients with diagnosis of uncommon rare neonatal surgical emergencies at our institute. We analyzed: sex, gestational age, weight at birth, primary pathology, prenatal diagnosis, associated anomalies, age and weight at surgery, clinical presentation, start of oral feeding and hospitalization. The follow-up was performed at 6,12, 24 and 36 months. Results. There were 21 male and 13 female. The gestational age ranged between 28 and 36 weeks. The weight at birth ranged between 700 and 1400 grams. Oral feeding was started between 4th and 10th postoperative day. The average hospitalization was about 70.47 days. To date, all patients have finished the followup. They are healthy. Conclusion. The outcome of the patients with uncommon surgical emergencies is different based on the etiology. Overall survival is generally good but is influenced by the associated anomalies.

  9. Surgical management of radiation enterocolitis

    International Nuclear Information System (INIS)

    Sakaguchi, Masahiro; Katsumi, Masaharu; Ishimoto, Kiwao; Yamamoto, Shinji; Yukawa, Hirofumi; Koh, Kenzo; Yamaguchi, Kazuya; Ohta, Masataka; Hayashido, Motonori

    1986-01-01

    Radiotherapy for malignant tumors is effective and established. However, there are many complications in radiotherapy. A typical complication is radiation enterocolitis. It is difficult to treat severe histological damage to the irradiated tissues. This paper reports our experience with 26 patients with radiation enterocolitis for whom surgical treatment was given during a period of 16 years in our surgical department. The most frequent original disease requiring irradiation was cancer of the cervix uteri (15 cases) which was followed by cancer of the urinary bladder (7 cases). All of these patients had received external 60 Co irradiation. The ileum was the most frequent site of the lesion, followed by the rectum, sigmoid and descending colon. The period between the end of irradiation and the onset of enterocolitis ranged from 2 months to 10 years, with an average of 28 months. The main symptoms were intestinal obstruction in the ileum, and melena and fistula in the rectum and sigmoid colon. Intestinal resection was performed in 10 patients, a bypass operation in 4, and colostomy in 12. As to types of intestinal suture in these cases, Gambee's single layer method was thought useful from our experience. Colostomy as surgical management of melena and fistula did not yield satisfactory results. (author)

  10. Simulation-based surgical education.

    Science.gov (United States)

    Evgeniou, Evgenios; Loizou, Peter

    2013-09-01

    The reduction in time for training at the workplace has created a challenge for the traditional apprenticeship model of training. Simulation offers the opportunity for repeated practice in a safe and controlled environment, focusing on trainees and tailored to their needs. Recent technological advances have led to the development of various simulators, which have already been introduced in surgical training. The complexity and fidelity of the available simulators vary, therefore depending on our recourses we should select the appropriate simulator for the task or skill we want to teach. Educational theory informs us about the importance of context in professional learning. Simulation should therefore recreate the clinical environment and its complexity. Contemporary approaches to simulation have introduced novel ideas for teaching teamwork, communication skills and professionalism. In order for simulation-based training to be successful, simulators have to be validated appropriately and integrated in a training curriculum. Within a surgical curriculum, trainees should have protected time for simulation-based training, under appropriate supervision. Simulation-based surgical education should allow the appropriate practice of technical skills without ignoring the clinical context and must strike an adequate balance between the simulation environment and simulators. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

  11. Surgical correction of postoperative astigmatism

    Directory of Open Access Journals (Sweden)

    Lindstrom Richard

    1990-01-01

    Full Text Available The photokeratoscope has increased the understanding of the aspheric nature of the cornea as well as a better understanding of normal corneal topography. This has significantly affected the development of newer and more predictable models of surgical astigmatic correction. Relaxing incisions effectively flatten the steeper meridian an equivalent amount as they steepen the flatter meridian. The net change in spherical equivalent is, therefore, negligible. Poor predictability is the major limitation of relaxing incisions. Wedge resection can correct large degrees of postkeratoplasty astigmatism, Resection of 0.10 mm of tissue results in approximately 2 diopters of astigmatic correction. Prolonged postoperative rehabilitation and induced irregular astigmatism are limitations of the procedure. Transverse incisions flatten the steeper meridian an equivalent amount as they steepen the flatter meridian. Semiradial incisions result in two times the amount of flattening in the meridian of the incision compared to the meridian 90 degrees away. Combination of transverse incisions with semiradial incisions describes the trapezoidal astigmatic keratotomy. This procedure may correct from 5.5 to 11.0 diopters dependent upon the age of the patient. The use of the surgical keratometer is helpful in assessing a proper endpoint during surgical correction of astigmatism.

  12. An evaluation of the diagnostic accuracy of the 1991 American College of Chest Physicians/Society of Critical Care Medicine and the 2001 Society of Critical Care Medicine/European Society of Intensive Care Medicine/American College of Chest Physicians/American Thoracic Society/Surgical Infection Society sepsis definition.

    Science.gov (United States)

    Zhao, Huifang; Heard, Stephen O; Mullen, Marie T; Crawford, Sybil; Goldberg, Robert J; Frendl, Gyorgy; Lilly, Craig M

    2012-06-01

    Limited research has been conducted to compare the test characteristics of the 1991 and 2001 sepsis consensus definitions. This study assessed the accuracy of the two sepsis consensus definitions among adult critically ill patients compared to sepsis case adjudication by three senior clinicians. Observational study of patients admitted to intensive care units. Seven intensive care units of an academic medical center. A random sample of 960 patients from all adult intensive care unit patients between October 2007 and December 2008. None. Sensitivity, specificity, and the area under the receiver operating characteristic curve for the two consensus definitions were calculated by comparing the number of patients who met or did not meet consensus definitions vs. the number of patients who were or were not diagnosed with sepsis by adjudication. The 1991 sepsis definition had a high sensitivity of 94.6%, but a low specificity of 61.0%. The 2001 sepsis definition had a slightly increased sensitivity but a decreased specificity, which were 96.9% and 58.3%, respectively. The areas under the receiver operating characteristic curve for the two definitions were not statistically different (0.778 and 0.776, respectively). The sensitivities and areas under the receiver operating characteristic curve of both definitions were lower at the 24-hr time window level than those of the intensive care unit stay level, though their specificities increased slightly. Fever, high white blood cell count or immature forms, low Glasgow coma score, edema, positive fluid balance, high cardiac index, low PaO2/FIO2 ratio, and high levels of creatinine and lactate were significantly associated with sepsis by both definitions and adjudication. Both the 1991 and the 2001 sepsis definition have a high sensitivity but low specificity; the 2001 definition has a slightly increased sensitivity but a decreased specificity compared to the 1991 definition. The diagnostic performances of both definitions were

  13. Cancer pancreatis, diagnostic procedures

    International Nuclear Information System (INIS)

    Graadal, Oe.; Schlichting, E.; Aasen, A.O.; Stadaas, J.O.

    1990-01-01

    151 patients treated for carcinoma of the pancreas at Ullevaal Hospital (Oslo University) during the period 1980-89 were studied. The most common initial symptom was abdominal pain. Other frequent debut symptoms were loss of weight and jaundice. ERCP and PTC were found to be the best diagnostic procedures. CT or ultrasonography were normal in 10-20% of the patients. Nearly all tumors of the pancreas were found by the ERCP procedure. Also angiography was used to evaluate operability of the pancreas tumor, but was found to be a very uncertain diagnostic method. This method will not be used in the future evaluation of patients with cancer of the pancreas. 13 refs., 1 fig., 2 tabs

  14. Inertial confinement fusion diagnostics

    International Nuclear Information System (INIS)

    Coleman, L.W.

    1986-10-01

    The concept and goals of ICF will be briefly reviewed and the new 100 kJ class Nova laser facility will be described. Experimental results obtained to date with Nova will be summarized, and the discussions of diagnostics will use examples on the present capabilities of Nova and new developments that are underway. The classes of diagnostic systems to be discussed fall into three basic categories: optical, x-ray, and particle. Examples of highly space resolved, time resolved, and spectrally resolved techniques as well as schemes involving combinations of these capabilities will be presented. A brief summary of the sophisticated acquisition and analysis system in use for Nova data will be provided

  15. Nanodevices in diagnostics

    Science.gov (United States)

    Hu, Ye; Fine, Daniel H.; Tasciotti, Ennio; Bouamrani, Ali; Ferrari, Mauro

    2010-01-01

    The real-time, personalized and highly sensitive early-stage diagnosis of disease remains an important challenge in modern medicine. With the ability to interact with matter at the nanoscale, the development of nanotechnology architectures and materials could potentially extend subcellular and molecular detection beyond the limits of conventional diagnostic modalities. At the very least, nanotechnology should be able to dramatically accelerate biomarker discovery, as well as facilitate disease monitoring, especially of maladies presenting a high degree of molecular and compositional heterogeneity. This article gives an overview of several of the most promising nanodevices and nanomaterials along with their applications in clinical practice. Significant work to adapt nanoscale materials and devices to clinical applications involving large interdisciplinary collaborations is already underway with the potential for nanotechnology to become an important enabling diagnostic technology. PMID:20229595

  16. Nanobiosensors in diagnostics

    Directory of Open Access Journals (Sweden)

    Alejandro Chamorro-Garcia

    2016-11-01

    Full Text Available Medical diagnosis has been greatly improved thanks to the development of new techniques capable of performing very sensitive detection and quantifying certain parameters. These parameters can be correlated with the presence of specific molecules and their quantity. Unfortunately, these techniques are demanding, expensive, and often complicated. On the other side, progress in other fields of science and technology has contributed to the rapid growth of nanotechnology. Although being an emerging discipline, nanotechnology has raised huge interest and expectations. Most of the enthusiasm comes from new possibilities and properties of nanomaterials. Biosensors (simple, robust, sensitive, cost-effective combined with nanomaterials, also called nanobiosensors, are serving as bridge between advanced detection/diagnostics and daily/routine tests. Here we review some of the latest applications of nanobiosensors in diagnostics field.

  17. Diagnostic radiation risks

    Energy Technology Data Exchange (ETDEWEB)

    Sherwood, T [Addenbrooke' s Hospital, Cambridge (UK)

    1980-04-01

    A brief discussion on diagnostic radiation risks is given. First some fundamental facts on the concepts and units of radiation measurement are clarified. Medical diagnostic radiation doses are also compared to the radiation doses received annually by man from natural background radiation. The controversy concerning the '10-day rule' in X-raying women of child-bearing age is discussed; it would appear that the risk of malformation in an unborn child due to X-radiation is very much less than the natural level of risk of malformation. The differences in the radiographic techniques and thus the different X-ray doses needed to make adequate X-ray images of different parts of the body are considered. The radiation burden of nuclear medicine investigations compared to X-ray procedures is also discussed. Finally, the problems of using volunteers in radiation research are aired.

  18. Diagnostics and structure

    International Nuclear Information System (INIS)

    Vial, J.C.

    1986-01-01

    The structure of prominences and the diagnostic techniques used to evaluate their physical parameters are discussed. These include electron temperature, various densities (n sub p, n sub e, n sub l), ionization degree, velocities, and magnetic field vector. UV and radio measurements have already evidenced the existence of different temperature regions, corresponding to different geometrical locations, e.g., the so called Prominence-Corona (P-C) interface. Velocity measurements are important for considering formation and mass balance of prominences but there are conflicting velocity measurements which have led to the basic question: what structure is actually observed at a given wavelength; what averaging is performed within the projected slit area during the exposure time? In optically thick lines, the question of the formation region of the radiation along the line of sight is also not a trivial one. The same is true for low resolution measurements of the magnetic field. Coupling diagnostics with structure is now a general preoccupation

  19. FEL components and diagnostics

    International Nuclear Information System (INIS)

    Carr, R.

    1997-01-01

    FEL hardware includes undulators, alignment systems, electron beam diagnostics, and mechanical and vacuum systems. While most FEL close-quote s employ conventional undulators, there is some interest in novel types, particularly where conventional designs cannot be used, as at very short periods and high fields. For these areas, superconducting technology is indicated. The most serious issue facing long FEL undulators is that of alignment; mechanical techniques may not be accurate enough, and beam-based strategies must be considered. To maintain alignment and control the electron trajectory, beam position monitors with micron precision are required. Beam size monitors are also required to assure control of emittance. The talks given in the working group sessions touch on undulators, alignment, and electron beam diagnostics, and they are summarized here. copyright 1997 American Institute of Physics

  20. Litigations in diagnostic radiology

    International Nuclear Information System (INIS)

    Patil, Ranjit

    2014-01-01

    There are various regulatory bodies at the international and national level, which lay down norms for radiation protection. These are the International Commission for Radiation Protection (ICRP) the National Commission for Radiation Protection (NCRP) in America, and the Atomic Energy Regulatory Board (AERB) in India. These bodies recommend norms on various radiation issues. Radiography and radiology are two key tools for diagnosing and treating diseases. Recently there are concerns about the effect of ionizing radiation on man and the frequent use of diagnostic radiographs. The professionals are expected to conduct their actions according to guidelines which reflect new information and changing technology in diagnostic radiography. Failure to do so may have severe legal consequences. Patient protection is a matter of normal course but knowledge and awareness of the legal issues is important to avoid legal hassles. Implications of the radiation protection guidelines are discussed. (author)

  1. Fighting surgical site infections in small animals

    DEFF Research Database (Denmark)

    Verwilghen, Denis; Singh, Ameet

    2015-01-01

    A diverse array of pathogen-related, patient-related, and caretaker-related issues influence risk and prevention of surgical site infections (SSIs). The entire surgical team involved in health care settings in which surgical procedures are performed play a pivotal role in the prevention of SSIs. ...

  2. Journal of Surgical Technique and Case Report

    African Journals Online (AJOL)

    The aim of Journal of Surgical Technique and Case Report is to advance surgical knowledge and practice by promoting the reporting of innovative and reproducible surgical techniques ... Anterior palatal island advancement flap for bone graft coverage: technical note · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT

  3. Surgical versus non-surgical management for pleural empyema.

    Science.gov (United States)

    Redden, Mark D; Chin, Tze Yang; van Driel, Mieke L

    2017-03-17

    Empyema refers to pus in the pleural space, commonly due to adjacent pneumonia, chest wall injury, or a complication of thoracic surgery. A range of therapeutic options are available for its management, ranging from percutaneous aspiration and intercostal drainage to video-assisted thoracoscopic surgery (VATS) or thoracotomy drainage. Intrapleural fibrinolytics may also be administered following intercostal drain insertion to facilitate pleural drainage. There is currently a lack of consensus regarding optimal treatment. To assess the effectiveness and safety of surgical versus non-surgical treatments for complicated parapneumonic effusion or pleural empyema. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 9), MEDLINE (Ebscohost) (1946 to July week 3 2013, July 2015 to October 2016) and MEDLINE (Ovid) (1 May 2013 to July week 1 2015), Embase (2010 to October 2016), CINAHL (1981 to October 2016) and LILACS (1982 to October 2016) on 20 October 2016. We searched ClinicalTrials.gov and WHO International Clinical Trials Registry Platform for ongoing studies (December 2016). Randomised controlled trials that compared a surgical with a non-surgical method of management for all age groups with pleural empyema. Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked the data for accuracy. We contacted trial authors for additional information. We assessed the quality of the evidence using the GRADE approach. We included eight randomised controlled trials with a total of 391 participants. Six trials focused on children and two on adults. Trials compared tube thoracostomy drainage (non-surgical), with or without intrapleural fibrinolytics, to either VATS or thoracotomy (surgical) for the management of pleural empyema. Assessment of risk of bias for the included studies was generally unclear for selection and blinding but low for attrition and reporting bias. Data analyses compared

  4. STELLA Experiment - Microbunch Diagnostic

    Energy Technology Data Exchange (ETDEWEB)

    He, P.; Liu, Y.; Cline, D. B.; Babzien, M.; Gallardo, J. C.; Kusche, K. P.; Pogorelsky, I. V.; Skaritka, J.; van Steenbergen, A.; Yakimenko, V.; Kimura, W. D.

    1998-07-01

    A microbunch diagnostic system is built at the Accelerator Test Facility (ATF) of Brookhaven National Laboratory for monitoring microbunches (10-fs bunch length) produced by the Inverse Free Electron Laser accelerator in Staged Electron Laser Acceleration experiment. It is similar to one already demonstrated at the ATF. With greatly improved beam optics conditions higher order harmonic coherent transition radiation will be measurable to determine the microbunch length and shape.

  5. Advanced diagnostic graphics

    International Nuclear Information System (INIS)

    Bray, M.A.; Petersen, R.J.; Clark, M.T.; Gertman, D.I.

    1981-01-01

    This paper reports US NRC-sponsored research at the Idaho National Engineering Laboratory (INEL) involving evaluation of computer-based diagnostic graphics. The specific targets of current evaluations are multivariate data display formats which may be used in Safety Parameter Display Systems (SPDS) being developed for nuclear power plant control rooms. The purpose of the work is to provide a basis for NRC action in regulating licensee SPDSs or later computer/cathode ray tube (CRT) applications in nuclear control rooms

  6. Molecular diagnostics in endodontics

    OpenAIRE

    Rechenberg, Dan-Krister; Zehnder, Matthias

    2014-01-01

    Recent systematic reviews have substantiated the fact that current testing methods to assess the inflammatory state of the pulp and the periapical tissues are of limited value. Consequently, it may be time to search for alternative routes in endodontic diagnostics. Molecular assessment methods could be the future. However, in the field of endodontics, the research in that direction is only about to evolve. Because pulpal and periradicular diseases are related to opportunistic infections, diag...

  7. Molecular Diagnostics of ?-Thalassemia

    OpenAIRE

    Atanasovska, B; Bozhinovski, G; Chakalova, L; Kocheva, S; Karanfilski, O; Plaseska-Karanfiska, D

    2012-01-01

    A high-quality hemoglobinopathy diagnosis is based on the results of a number of tests including assays for molecular identification of causative mutations. We describe the current diagnostic strategy for the identification of ?-thalassemias and hemoglobin (Hb) variants at the International Reference Laboratory for Haemoglobinopathies, Research Centre for Genetic Engineering and Biotechnology (RCGEB) ?Georgi D. Efremov,? Skopje, Republic of Macedonia. Our overall approach and most of the meth...

  8. Equipment for isotope diagnostics

    International Nuclear Information System (INIS)

    Platz, W.

    1976-01-01

    The invention concerns an improvement of equipment for isotope diagnostics allowing to mark special intensity ranges of the recorded measurements by means of different colors. For undisturbed operation it is of advantage to avoid electric circuits between movable and unmovable parts of the color recorder. According to the invention, long gear wheels of glass fiber-reinforced polyamide are used for these connections. (ORU) [de

  9. RFQ1 diagnostic devices

    International Nuclear Information System (INIS)

    Chidley, B.G.; Arbique, G.M.; de Jong, M.S.; McMichael, G.E.; Michel, W.L.; Smith, B.H.

    1991-01-01

    The diagnostic devices in use on RFQ1 will be described. They consist of a double-slit emittance-measuring unit, a 45 degree deflection energy-analysis magnet, parametric current transformers, optical beam sensors, beam-stop current monitors, and an x-ray end-point analyzer. All of these devices are able to operate up to the full output current of RFQ1 (75 mA cw at 0.6 MeV)

  10. Idiopathic chondrolysis - diagnostic difficulties

    International Nuclear Information System (INIS)

    Kozlowski, K.; Scougall, J.; Royal Alexandra Hospital for Children, Sydney

    1984-01-01

    Four cases of idiopathic chondrolysis of the hip in three white girls and one Maori girl are reported. The authors stress the causes why a disease with characteristic clinical and radiographic appearances and normal biochemical findings presents diagnostic difficulties. It is suspected that idiopathic chondrolysis is a metabolic disorder of chondrocytes, triggered by environment circumstances in susceptible individuals. Idiopathic chondrolysis is probably one of the most common causes of coxarthrosis in women. (orig.)

  11. Thioaptamer Diagnostic System, Phase I

    Data.gov (United States)

    National Aeronautics and Space Administration — AM Biotechnologies (AM) will develop a diagnostic system in response to SBIR Topic X10.01 Reusable Diagnostic Lab Technology that will simultaneously detect and...

  12. Molecular diagnostics of periodontitis.

    Science.gov (United States)

    Korona-Głowniak, Izabela; Siwiec, Radosław; Berger, Marcin; Malm, Anna; Szymańska, Jolanta

    2017-01-28

    The microorganisms that form dental plaque are the main cause of periodontitis. Their identification and the understanding of the complex relationships and interactions that involve these microorganisms, environmental factors and the host's health status enable improvement in diagnostics and targeted therapy in patients with periodontitis. To this end, molecular diagnostics techniques (both techniques based on the polymerase chain reaction and those involving nucleic acid analysis via hybridization) come increasingly into use. On the basis of a literature review, the following methods are presented: polymerase chain reaction (PCR), real-time polymerase chain reaction (real-time PCR), 16S rRNA-encoding gene sequencing, checkerboard and reverse-capture checkerboard hybridization, microarrays, denaturing gradient gel electrophoresis (DGGE), temperature gradient gel electrophoresis (TGGE), as well as terminal restriction fragment length polymorphism (TRFLP) and next generation sequencing (NGS). The advantages and drawbacks of each method in the examination of periopathogens are indicated. The techniques listed above allow fast detection of even small quantities of pathogen present in diagnostic material and prove particularly useful to detect microorganisms that are difficult or impossible to grow in a laboratory.

  13. Molecular diagnostics of periodontitis

    Directory of Open Access Journals (Sweden)

    Izabela Korona-Głowniak

    2017-01-01

    Full Text Available The microorganisms that form dental plaque are the main cause of periodontitis. Their identification and the understanding of the complex relationships and interactions that involve these microorganisms, environmental factors and the host’s health status enable improvement in diagnostics and targeted therapy in patients with periodontitis. To this end, molecular diagnostics techniques (both techniques based on the polymerase chain reaction and those involving nucleic acid analysis via hybridization come increasingly into use. On the basis of a literature review, the following methods are presented: polymerase chain reaction (PCR, real-time polymerase chain reaction (real-time PCR, 16S rRNA-encoding gene sequencing, checkerboard and reverse-capture checkerboard hybridization, microarrays, denaturing gradient gel electrophoresis (DGGE, temperature gradient gel electrophoresis (TGGE, as well as terminal restriction fragment length polymorphism (TRFLP and next generation sequencing (NGS. The advantages and drawbacks of each method in the examination of periopathogens are indicated. The techniques listed above allow fast detection of even small quantities of pathogen present in diagnostic material and prove particularly useful to detect microorganisms that are difficult or impossible to grow in a laboratory.

  14. XML Diagnostics Description Standard

    International Nuclear Information System (INIS)

    Neto, A.; Fernandes, H.; Varandas, C.; Lister, J.; Yonekawa, I.

    2006-01-01

    A standard for the self-description of fusion plasma diagnostics will be presented, based on the Extensible Markup Language (XML). The motivation is to maintain and organise the information on all the components of a laboratory experiment, from the hardware to the access security, to save time and money when problems arises. Since there is no existing standard to organise this kind of information, every Association stores and organises each experiment in different ways. This can lead to severe problems when the organisation schema is poorly documented or written in national languages. The exchange of scientists, researchers and engineers between laboratories is a common practice nowadays. Sometimes they have to install new diagnostics or to update existing ones and frequently they lose a great deal of time trying to understand the currently installed system. The most common problems are: no documentation available; the person who understands it has left; documentation written in the national language. Standardisation is the key to solving all the problems mentioned. From the commercial information on the diagnostic (component supplier; component price) to the hardware description (component specifications; drawings) to the operation of the equipment (finite state machines) through change control (who changed what and when) and internationalisation (information at least in the native language and in English), a common XML schema will be proposed. This paper will also discuss an extension of these ideas to the self-description of ITER plant systems, since the problems will be identical. (author)

  15. SNS Diagnostics Timing Integration

    CERN Document Server

    Long, Cary D; Murphy, Darryl J; Pogge, James; Purcell, John D; Sundaram, Madhan

    2005-01-01

    The Spallation Neutron Source (SNS) accelerator systems will deliver a 1.0 GeV, 1.4 MW proton beam to a liquid mercury target for neutron scattering research. The accelerator complex consists of a 1 GeV linear accelerator, an accumulator ring and associated transport lines. The SNS diagnostics platform is PC-based running Windows XP Embedded for its OS and LabVIEW as its programming language. Coordinating timing among the various diagnostics instruments with the generation of the beam pulse is a challenging task that we have chosen to divide into three phases. First, timing was derived from VME based systems. In the second phase, described in this paper, timing pulses are generated by an in house designed PCI timing card installed in ten diagnostics PCs. Using fan-out modules, enough triggers were generated for all instruments. This paper describes how the Timing NAD (Network Attached Device) was rapidly developed using our NAD template, LabVIEW's PCI driver wizard, and LabVIEW Channel Access library. The NAD...

  16. Surgical management of generalized gingival enlargement - a case series

    International Nuclear Information System (INIS)

    Akhtar, M.U.; Nazir, A.; Montmorency College of Dentistry, Lahore; Kiran, S.; Montmorency College of Dentistry, Lahore

    2014-01-01

    Generalized gingival enlargement is characterized by massive and exuberant gingival overgrowth that poses social, aesthetic, phonetic and functional problems for the patient. Therefore, it requires meticulous management. Objective: To describe the surgical management of generalized gingival enlargement by electrosurgical excision of patients presenting to a tertiary care centre. Study Design: Case series. Materials and Methods: The study was conducted at the Department of Oral and Maxillofacial Surgery, de'Montmorency College of Dentistry, Lahore, from January 2010 to December 2012. A total of sixteen patients were operated by using electrosurgical approach under general anaesthesia for surgical excision of generalized gingival enlargement. Results: All of the sixteen patients, 11 males and 5 females, showed excellent healing postoperatively without any recurrent gingival overgrowth. Discussion: To the best of our knowledge, the current study presents the largest case series of generalized gingival enlargement. Most of these cases were with massive disease due to lack of information of the study population about their disease, delay in referral by the general dental practitioners, painless and innocent nature of the problem. Early referral of such patients to tertiary care centers can prevent the patients from social and psychological embarrassment. Conclusion: Electrosurgical excision is an excellent surgical technique for management of generalized gingival enlargement. Moreover, cross comparative studies are required to establish some diagnostic and therapeutic standards for such patients. (author)

  17. Diagnostic imaging in COPD

    International Nuclear Information System (INIS)

    Owsijewitsch, Michael; Ley-Zaporozhan, Julia; Eichinger, Monika

    2011-01-01

    COPD is a heterogeneous disease defined by expiratory airflow limitation. Airflow limitation is caused by a variable combination of emphysematous destruction of lung parenchyma and small airway obstruction. Only advanced emphysema can be diagnosed by chest X-ray. Less severe emphysema and changes in small airways are commonly diagnosed by computed tomography. Typical visual appearance of pathologic changes in lung parenchyma and airways of COPD patients are presented, furthermore methods for quantitative assessment of these changes and the crucial role of imaging for surgical and bronchoscopic treatment in COPD are discussed. (orig.)

  18. Evaluation of the International Consensus Guidelines for the Surgical Resection of Intraductal Papillary Mucinous Neoplasms.

    Science.gov (United States)

    Tsukagoshi, Mariko; Araki, Kenichiro; Saito, Fumiyoshi; Kubo, Norio; Watanabe, Akira; Igarashi, Takamichi; Ishii, Norihiro; Yamanaka, Takahiro; Shirabe, Ken; Kuwano, Hiroyuki

    2018-04-01

    International consensus guidelines for intraductal papillary mucinous neoplasms (IPMNs) were revised in 2012. We aimed to evaluate the clinical utility of each predictor in the 2006 and 2012 guidelines and validate the diagnostic value and surgical indications. Forty-two patients with surgically resected IPMNs were included. Each predictor was applied to evaluate its diagnostic value. The 2012 guidelines had greater accuracy for invasive carcinoma than the 2006 guidelines (64.3 vs. 31.0%). Moreover, the accuracy for high-grade dysplasia was also increased (48.6 vs. 77.1%). When the main pancreatic duct (MPD) size ≥8 mm was substituted for MPD size ≥10 mm in the 2012 guidelines, the accuracy for high-grade dysplasia was 80.0%. The 2012 guidelines exhibited increased diagnostic accuracy for invasive IPMN. It is important to consider surgical resection prior to invasive carcinoma, and high-risk stigmata might be a useful diagnostic criterion. Furthermore, MPD size ≥8 mm may be predictive of high-grade dysplasia.

  19. Radiological diagnostics of skeletal tumors

    International Nuclear Information System (INIS)

    Uhl, M.; Herget, G.W.

    2008-01-01

    The book contains contributions concerning the following topics: 1. introduction and fundamentals: WHO classification of bone tumors, imaging diagnostics and their function; localization, typical clinical and radiological criteria, TNM classification and status classification, invasive tumor diagnostics; 2. specific tumor diagnostics: chondrogenic bone tumors, osseous tumors, connective tissue bony tumors, osteoclastoma, osteomyelogenic bone tumors, vascular bone tumors, neurogenic bone tumors, chordoma; adamantinoma of the long tubular bone; tumor-like lesions, bony metastases, bone granulomas, differential diagnostics: tumor-like lesions

  20. Endoscopic ultrasound-guided pancreaticobiliary intervention in patients with surgically altered anatomy and inaccessible papillae: A review of current literature

    Science.gov (United States)

    Martin, Aaron; Kistler, Charles Andrew; Wrobel, Piotr; Yang, Juliana F.; Siddiqui, Ali A.

    2016-01-01

    The management of pancreaticobiliary disease in patients with surgically altered anatomy is a growing problem for gastroenterologists today. Over the years, endoscopic ultrasound (EUS) has emerged as an important diagnostic and therapeutic modality in the treatment of pancreaticobiliary disease. Patient anatomy has become increasingly complex due to advances in surgical resection of pancreaticobiliary disease and EUS has emerged as the therapy of choice when endoscopic retrograde cholangiopancreatography failed cannulation or when the papilla is inaccessible such as in gastric obstruction or duodenal obstruction. The current article gives a comprehensive review of the current literature for EUS-guided intervention of the pancreaticobiliary tract in patients with altered surgical anatomy. PMID:27386471

  1. Diagnostic imaging of lymphoma of the kidney

    International Nuclear Information System (INIS)

    Grzesiakowska, U.; Smorczewska, M.; Huczynska-Szubert, E.

    2010-01-01

    Purpose. The aim of this paper is to discuss both the clinical and radiological signs and the diagnostic principles of lymphomatous infiltrations of the kidney. Materials and methods. The studied group consisted of 20 patients (9 women, 11 men) aged 18-79 years. The follows-up varied from 2 to 156 months. All patients underwent CT and ultrasound investigations, while only 1 patient had an MRI examination. In 7 cases surgical treatment was performed, while the remaining 13 patients received chemotherapy. One patient died, 12 are in remission and seven are under observation and considered cured. Results. The radiological signs of kidney lymphoma may be divided into groups: a) kidney enlargement, obliteration of the cortex-core differentiation and obliteration of the outline; b) heterogenous kidney structure with undefined hypodense fociand lack of enhancement after the administration of contrasting material; c) presence of a well-defined tumor within the renal pelvis and external infiltration of the kidney, d) infiltration of the kidney originating from the retroperitoneal space encompassing the organ from the outside. Conclusions. The radiological signs of lymphoma differ in the kidney and exhibit a characteristic set of features. Radiology results combined with clinical symptoms may suggest lymphoma in the kidney and thus advocate the necessity of pathological evaluation prior to surgical treatment. (authors)

  2. Usefulness of diagnostic imaging in primary hyperparathyroidism

    International Nuclear Information System (INIS)

    Sekiyama, Kazuya; Akakura, Koichiro; Mikami, Kazuo; Mizoguchi, Ken-ichi; Tobe, Toyofusa; Nakano, Koichi; Numata, Tsutomu; Konno, Akiyoshi; Ito, Haruo

    2003-01-01

    In patients with primary hyperparathyroidism, prevention of urinary stone recurrence can be achieved by surgical removal of the enlarged parathyroid gland. To ensure the efficacy of surgery for primary hyperparathyroidism, preoperative localization of the enlarged gland is important. In the present study, usefulness of diagnostic imaging for localization of the enlarged gland was investigated in primary hyperparathyroidism. We retrospectively examined the findings of imaging studies and clinical records in 79 patients (97 glands) who underwent surgical treatment for primary hyperparathyroidism at Chiba University Hospital between 1976 and 2000. The detection rates of accurate localization were investigated for imaging techniques, such as ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI) thallium-201 and technetium-99m pertechnetate (Tl-Tc) subtraction scintigraphy and 99m Tc-methoxyisobutylisonitrile (MIBI) scintigraphy, and analysed in relation to the size and weight of the gland and pathological diagnosis. The detection rates by US, CT, MRI, Tl-Tc subtraction scintigraphy and MIBI scintigraphy were 70%, 67%, 73%, 38% and 78%, respectively. The overall detection rate changed from 50% to 88% before and after 1987. The detection rate of MIBI scintigraphy was superior to Tl-Tc subtraction scintigraphy. In primary hyperparathyroidism, improvement of accurate localization of an enlarged parathyroid gland was demonstrated along with recent advances in imaging techniques including MIBI scintigraphy. (author)

  3. The architecture of diagnostic research

    DEFF Research Database (Denmark)

    Colli, Agostino; Fraquelli, Mirella; Casazza, Giovanni

    2014-01-01

    The diagnostic research process can be divided into five phases, designed to establish the clinical utility of a new diagnostic test - the index test. The aim of the present review is to illustrate the study designs that are appropriate for each diagnostic phase, using clinical examples regarding...

  4. 2012 HIV Diagnostics Conference: the molecular diagnostics perspective.

    Science.gov (United States)

    Branson, Bernard M; Pandori, Mark

    2013-04-01

    2012 HIV Diagnostic Conference Atlanta, GA, USA, 12-14 December 2012. This report highlights the presentations and discussions from the 2012 National HIV Diagnostic Conference held in Atlanta (GA, USA), on 12-14 December 2012. Reflecting changes in the evolving field of HIV diagnostics, the conference provided a forum for evaluating developments in molecular diagnostics and their role in HIV diagnosis. In 2010, the HIV Diagnostics Conference concluded with the proposal of a new diagnostic algorithm which included nucleic acid testing to resolve discordant screening and supplemental antibody test results. The 2012 meeting, picking up where the 2010 meeting left off, focused on scientific presentations that assessed this new algorithm and the role played by RNA testing and new developments in molecular diagnostics, including detection of total and integrated HIV-1 DNA, detection and quantification of HIV-2 RNA, and rapid formats for detection of HIV-1 RNA.

  5. [Assessment of surgical teleconsultations in a developing country: two years of experience in Djibouti].

    Science.gov (United States)

    Bertani, A; Menguy, P; Delmas, J M; Launay, F; Mathieu, L; Candoni, P; Dulou, R; Rongiéras, F

    2012-01-01

    Our objective was to assess the influence of teleconsultations on patient management and clinical outcomes in a developing country. All the surgical teleconsultations by a single surgeon (orthopedist) between November 2009 and November 2011 were recorded. Neurosurgery and pediatric orthopedics were the two most important specialities most often concerned, accounting for 67% of the 157 teleconsultations for 138 patients. The teleconsultations resolved the diagnostic uncertainties in 29 of 37 cases (78%). Advice from the expert modified management in 69% cases. Clinical outcomes were good or very good in 86% of the treated patients. This study establishes the feasibility and usefulness of surgical teleconsultations in Djibouti.

  6. Recurrent Pneumonia in Children: A Reasoned Diagnostic Approach and a Single Centre Experience.

    Science.gov (United States)

    Montella, Silvia; Corcione, Adele; Santamaria, Francesca

    2017-01-29

    Recurrent pneumonia (RP), i.e., at least two episodes of pneumonia in one year or three episodes ever with intercritical radiographic clearing of densities, occurs in 7.7%-9% of children with community-acquired pneumonia. In RP, the challenge is to discriminate between children with self-limiting or minor problems, that do not require a diagnostic work-up, and those with an underlying disease. The aim of the current review is to discuss a reasoned diagnostic approach to RP in childhood. Particular emphasis has been placed on which children should undergo a diagnostic work-up and which tests should be performed. A pediatric case series is also presented, in order to document a single centre experience of RP. A management algorithm for the approach to children with RP, based on the evidence from a literature review, is proposed. Like all algorithms, it is not meant to replace clinical judgment, but it should drive physicians to adopt a systematic approach to pediatric RP and provide a useful guide to the clinician.

  7. Alcohol skin preparation causes surgical fires.

    Science.gov (United States)

    Rocos, B; Donaldson, L J

    2012-03-01

    Surgical fires are a rare but serious preventable safety risk in modern hospitals. Data from the US show that up to 650 surgical fires occur each year, with up to 5% causing death or serious harm. This study used the National Reporting and Learning Service (NRLS) database at the National Patient Safety Agency to explore whether spirit-based surgical skin preparation fluid contributes to the cause of surgical fires. The NRLS database was interrogated for all incidents of surgical fires reported between 1 March 2004 and 1 March 2011. Each report was scrutinised manually to discover the cause of the fire. Thirteen surgical fires were reported during the study period. Of these, 11 were found to be directly related to spirit-based surgical skin preparation or preparation soaked swabs and drapes. Despite manufacturer's instructions and warnings, surgical fires continue to occur. Guidance published in the UK and US states that spirit-based skin preparation solutions should continue to be used but sets out some precautions. It may be that fire risk should be included in pre-surgical World Health Organization checklists or in the surgical training curriculum. Surgical staff should be aware of the risk that spirit-based skin preparation fluids pose and should take action to minimise the chance of fire occurring.

  8. Accomplishments and challenges of surgical simulation.

    Science.gov (United States)

    Satava, R M

    2001-03-01

    For nearly a decade, advanced computer technologies have created extraordinary educational tools using three-dimensional (3D) visualization and virtual reality. Pioneering efforts in surgical simulation with these tools have resulted in a first generation of simulators for surgical technical skills. Accomplishments include simulations with 3D models of anatomy for practice of surgical tasks, initial assessment of student performance in technical skills, and awareness by professional societies of potential in surgical education and certification. However, enormous challenges remain, which include improvement of technical fidelity, standardization of accurate metrics for performance evaluation, integration of simulators into a robust educational curriculum, stringent evaluation of simulators for effectiveness and value added to surgical training, determination of simulation application to certification of surgical technical skills, and a business model to implement and disseminate simulation successfully throughout the medical education community. This review looks at the historical progress of surgical simulators, their accomplishments, and the challenges that remain.

  9. Using dummies for surgical skills training

    DEFF Research Database (Denmark)

    Langebæk, Rikke

    2011-01-01

    Effective acquisition of a skill requires practise. Therefore it is of great importance to provide veterinary students with opportunities to practice their surgical skills before carrying out surgical procedures on live patients. Some veterinary schools let students perform entire surgical...... procedures on research animals, in order to learn the basic skills along the way. From an ethical point of view it is questionable however to use live research animals for the sole purpose of practising surgery, and also, research animals are very costly. It is therefore necessary to identify alternative...... teaching methods for veterinary surgical training. At the Department of Small Animal Clinical Sciences, Faculty of Life Sciences, a number of low fidelity, stuffed toy animal dummies was developed for the Surgical Skills Lab in order to teach 4th year students the basic surgical skills. In the Surgical...

  10. Update on diagnostic strategies of pulmonary embolism

    International Nuclear Information System (INIS)

    Kauczor, H.U.; Heussel, C.P.; Thelen, M.

    1999-01-01

    Acute pulmonary embolism is a frequent disease with non-specific findings, high mortality, and multiple therapeutic options. A definitive diagnosis must be established by accurate, non-invasive, easily performed, cost-effective, and widely available imaging modalities. Conventional diagnostic strategies have relied on ventilation-perfusion scintigraphy complemented by venous imaging. If the results are inconclusive, pulmonary angiography, which is regarded as the gold standard, is to be performed. Recently, marked improvements in CT and MRI and shortcomings of scintigraphy led to an update of the diagnostic strategy. Spiral CT is successfully employed as a second-line procedure to clarify indeterminate scintigraphic results avoiding pulmonary angiography. It can also be used as a first-line screening tool if service and expertise is provided. Venous imaging is indicated if CT is inconclusive. The MRI technique can be applied as an alternative second-line test if spiral CT is not available or is contraindicated. It has the greatest potential for further developments and refinements. Echocardiography should be used as a first-line bedside examination in critical patients. If inconclusive stabilized patients undergo spiral CT, unstable patients should be referred for pulmonary angiography. Chronic thromboembolic pulmonary hypertension is a rare sequela of acute pulmonary embolism which can be cured surgically. Morphology, complications, and differential diagnoses are better illustrated by spiral CT and MRA, whereas invasive acquisition of hemodynamic data is the sole advantage of angiography. (orig.)

  11. Diagnostic and therapeutic management of hepatocellular carcinoma

    Science.gov (United States)

    Bellissimo, Francesco; Pinzone, Marilia Rita; Cacopardo, Bruno; Nunnari, Giuseppe

    2015-01-01

    Hepatocellular carcinoma (HCC) is an increasing health problem, representing the second cause of cancer-related mortality worldwide. The major risk factor for HCC is cirrhosis. In developing countries, viral hepatitis represent the major risk factor, whereas in developed countries, the epidemic of obesity, diabetes and nonalcoholic steatohepatitis contribute to the observed increase in HCC incidence. Cirrhotic patients are recommended to undergo HCC surveillance by abdominal ultrasounds at 6-mo intervals. The current diagnostic algorithms for HCC rely on typical radiological hallmarks in dynamic contrast-enhanced imaging, while the use of α-fetoprotein as an independent tool for HCC surveillance is not recommended by current guidelines due to its low sensitivity and specificity. Early diagnosis is crucial for curative treatments. Surgical resection, radiofrequency ablation and liver transplantation are considered the cornerstones of curative therapy, while for patients with more advanced HCC recommended options include sorafenib and trans-arterial chemo-embolization. A multidisciplinary team, consisting of hepatologists, surgeons, radiologists, oncologists and pathologists, is fundamental for a correct management. In this paper, we review the diagnostic and therapeutic management of HCC, with a focus on the most recent evidences and recommendations from guidelines. PMID:26576088

  12. Surgical management of intracerebral hematomas

    International Nuclear Information System (INIS)

    Tsementzis, S.A.

    1985-01-01

    Traditional and recent developments in the management of spontaneous intracranial hematomas are reviewed. A comprehensive account of the epidemiological characteristics worldwide with an etiological analysis including prevention and prophylaxis introduce the size and clinical significance of this neurological problem. The usefulness and limitations of the available diagnostic methods are described. Most of the emphasis, however, is placed on the management and medicosurgical treatment of intracranial hematomas in correlation with their clinical presentation and localization. 80 references

  13. The role of student surgical interest groups and surgical Olympiads in anatomical and surgical undergraduate training in Russia.

    Science.gov (United States)

    Dydykin, Sergey; Kapitonova, Marina

    2015-01-01

    Traditional department-based surgical interest groups in Russian medical schools are useful tools for student-based selection of specialty training. They also form a nucleus for initiating research activities among undergraduate students. In Russia, the Departments of Topographical Anatomy and Operative Surgery play an important role in initiating student-led research and providing learners with advanced, practical surgical skills. In tandem with department-led activities, student surgical interest groups prepare learners through surgical competitions, known as "Surgical Olympiads," which have been conducted in many Russian centers on a regular basis since 1988. Surgical Olympiads stimulate student interest in the development of surgical skills before graduation and encourage students to choose surgery as their postgraduate specialty. Many of the participants in these surgical Olympiads have become highly qualified specialists in general surgery, orthopedic surgery, neurosurgery, urology, gynecology, and emergency medicine. The present article emphasizes the role of student interest groups and surgical Olympiads in clinical anatomical and surgical undergraduate training in Russia. © 2015 American Association of Anatomists.

  14. Surgical management of spasmodic torticollis

    Directory of Open Access Journals (Sweden)

    Wael Fouad

    2011-12-01

    Full Text Available Introduction: Spasmodic torticollis (ST is a neuromuscular disorder characterized by uncontrolled clonic and intermittently tonic spasm of the neck muscles. Objective: This retrospective study was done to study clinical picture and to evaluate the surgical results of different surgical procedures in 11 patients who had spasmodic torticollis. Methods: The male to female ratio was 1–2 (4 males and 7 females and their ages ranged from 18 to 65 years. The X-ray of the cervical spine was performed before the operation to exclude cervical disorders that can cause symptoms similar to spasmodic torticollis. MRI of the head and neck was performed in all patients, without finding significant brain lesions. Electromyography of the cervical muscles was performed preoperatively and postoperatively. All cases underwent surgery in the form of variable combinations of ventral rhizotomy of C1, C2+ selective peripheral denervation of neck muscles involved according to the type of torticollis. Mean postoperative follow up period was 24 months. Results: There was no operative mortality. As regards the morbidity, one patient had deficiency of shoulder elevation that was transient and improved after 3 months; one patient had wound infection that responded well to antibiotics after culture and sensitivity. Postoperative dysphagia was found in two cases that improved in one of them after two months. At the last follow up examination period, excellent results were obtained in 55% of patients, good results in 18% of patients, fair results in 18% of patients, and poor results in 9% of cases. Conclusion: There is no standard surgical procedure for treatment of ST; this is adapted to each patient according to type of torticollis. Better results were obtained in simple torticollis (excellent results in 100%, than in complex type (excellent and good results in 33.3%. Keywords: Focal dystonia, Spasmodic torticollis, Anterior rhizotomy, Selective denervation

  15. The surgical treatment of acromegaly.

    Science.gov (United States)

    Buchfelder, Michael; Schlaffer, Sven-Martin

    2017-02-01

    Surgical extraction of as much tumour mass as possible is considered the first step of treatment in acromegaly in many centers. In this article the potential benefits, disadvantages and limitations of operative acromegaly treatment are reviewed. Pertinent literature was selected to provide a review covering current indications, techniques and results of operations for acromegaly. The rapid reduction of tumour volume is an asset of surgery. To date, in almost all patients, minimally invasive, transsphenoidal microscopic or endoscopic approaches are employed. Whether a curative approach is feasible or a debulking procedure is planned, can be anticipated on the basis of preoperative magnetic resonance imaging. The radicality of adenoma resection essentially depends on localization, size and invasive character of the tumour. The normalization rates of growth hormone and IGF-1 secretion, respectively, depend on tumour-related factors such as size, extension, the presence or absence of invasion and the magnitude of IGF-1 and growth hormone oversecretion. However, also surgeon-related factors such as experience and patient load of the centers have been shown to strongly affect surgical results and the rate of complications. As compared to most medical treatments, surgery is relatively cheap since the costs occur only once and not repeatedly. There are several new technical gadgets which aid in the surgical procedure: navigation and variants of intraoperative imaging. For the mentioned reasons, current algorithms of acromegaly management suggest an initial operation, unless the patients are unfit for surgery, refuse an operation or only an unsatisfactory resection is anticipated. A few suggestions are made when a re-operation could be considered.

  16. Disc degeneration: current surgical options

    Directory of Open Access Journals (Sweden)

    C Schizas

    2010-10-01

    Full Text Available Chronic low back pain attributed to lumbar disc degeneration poses a serious challenge to physicians. Surgery may be indicated in selected cases following failure of appropriate conservative treatment. For decades, the only surgical option has been spinal fusion, but its results have been inconsistent. Some prospective trials show superiority over usual conservative measures while others fail to demonstrate its advantages. In an effort to improve results of fusion and to decrease the incidence of adjacent segment degeneration, total disc replacement techniques have been introduced and studied extensively. Short-term results have shown superiority over some fusion techniques. Mid-term results however tend to show that this approach yields results equivalent to those of spinal fusion. Nucleus replacement has gained some popularity initially, but evidence on its efficacy is scarce. Dynamic stabilisation, a technique involving less rigid implants than in spinal fusion and performed without the need for bone grafting, represents another surgical option. Evidence again is lacking on its superiority over other surgical strategies and conservative measures. Insertion of interspinous devices posteriorly, aiming at redistributing loads and relieving pain, has been used as an adjunct to disc removal surgery for disc herniation. To date however, there is no clear evidence on their efficacy. Minimally invasive intradiscal thermocoagulation techniques have also been tried, but evidence of their effectiveness is questioned. Surgery using novel biological solutions may be the future of discogenic pain treatment. Collaboration between clinicians and basic scientists in this multidisciplinary field will undoubtedly shape the future of treating symptomatic disc degeneration.

  17. Surgical management of calcaneal unicameral bone cysts.

    Science.gov (United States)

    Glaser, D L; Dormans, J P; Stanton, R P; Davidson, R S

    1999-03-01

    Unicameral bone cysts are not seen commonly in the calcaneus. Little is known about the etiology and natural history of these lesions. Calcaneal cysts often are symptomatic, although some of these lesions are detected as incidental findings. Treatment has been advocated based on the fear of pathologic fracture and collapse. Several published series have been divided in their favor for either open treatment or injection management. These series are small, and the optimal treatment is still in question. The current study compared the efficacy of methylprednisolone acetate injection treatment with curettage and bone grafting in the treatment of unicameral bone cysts of the calcaneus. All patients treated for unicameral bone cysts of the calcaneus during the past 7 years at two institutions were reviewed. Eleven patients met inclusion criteria. All diagnoses were confirmed radiographically or histologically. Demographic information, presenting complaints, diagnostic imaging, treatment modalities, and outcome were analyzed. Long term radiographic and subjective followup was obtained. Eighteen surgical procedures were performed on 11 patients with 12 cysts. Nine injections performed on six patients failed to show healing of the cyst. Nine cysts treated with curettage and bone grafting showed cyst healing. At mean followup of 28 months (range, 12-77 months), all 11 patients had no symptoms; there were no recurrences of the cyst in the nine patients who underwent bone grafting and persistence of the cyst in the two patients who underwent injection therapy. This review reports one of the largest series of cysts in this location. The results indicate that steroid injection treatment, although useful in other locations, may not be the best option for the management of unicameral bone cysts in the calcaneus. Curettage and bone grafting yielded uniformly good results.

  18. Disposable Fluidic Actuators for Miniature In-Vivo Surgical Robotics.

    Science.gov (United States)

    Pourghodrat, Abolfazl; Nelson, Carl A

    2017-03-01

    Fusion of robotics and minimally invasive surgery (MIS) has created new opportunities to develop diagnostic and therapeutic tools. Surgical robotics is advancing from externally actuated systems to miniature in-vivo robotics. However, with miniaturization of electric-motor-driven surgical robots, there comes a trade-off between the size of the robot and its capability. Slow actuation, low load capacity, sterilization difficulties, leaking electricity and transferring produced heat to tissues, and high cost are among the key limitations of the use of electric motors in in-vivo applications. Fluid power in the form of hydraulics or pneumatics has a long history in driving many industrial devices and could be exploited to circumvent these limitations. High power density and good compatibility with the in-vivo environment are the key advantages of fluid power over electric motors when it comes to in-vivo applications. However, fabrication of hydraulic/pneumatic actuators within the desired size and pressure range required for in-vivo surgical robotic applications poses new challenges. Sealing these types of miniature actuators at operating pressures requires obtaining very fine surface finishes which is difficult and costly. The research described here presents design, fabrication, and testing of a hydraulic/pneumatic double-acting cylinder, a limited-motion vane motor, and a balloon-actuated laparoscopic grasper. These actuators are small, seal-less, easy to fabricate, disposable, and inexpensive, thus ideal for single-use in-vivo applications. To demonstrate the ability of these actuators to drive robotic joints, they were modified and integrated in a robotic arm. The design and testing of this surgical robotic arm are presented to validate the concept of fluid-power actuators for in-vivo applications.

  19. MAST magnetic diagnostics

    Science.gov (United States)

    Edlington, T.; Martin, R.; Pinfold, T.

    2001-01-01

    The mega-ampere spherical tokamak (MAST) experiment is a new, large, low aspect ratio device (R=0.7-0.8 m, a=0.5-0.65 m, maximum BT˜0.63 T at R=0.7 m) operating its first experimental physics campaign. Designed to study a wide variety of plasma shapes with up to 2 MA of plasma current with an aspect ratio down to 1.3, the poloidal field (PF) coils used for plasma formation, equilibrium and shaping are inside the main vacuum vessel. For plasma control and to investigate a wide range of plasma phenomena, an extensive set of magnetic diagnostics have been installed inside the vacuum vessel. More than 600 vacuum compatible, bakeable diagnostic coils are configured in a number of discrete arrays close to the plasma edge with about half the coils installed behind the graphite armour tiles covering the center column. The coil arrays measure the toroidal and poloidal variation in the equilibrium field and its high frequency fluctuating components. Internal coils also measure currents in the PF coils, plasma current, stored energy and induced currents in the mechanical support structures of the coils and graphite armour tiles. The latter measurements are particularly important when halo currents are induced following a plasma termination, for example, when the plasma becomes vertically unstable. The article describes the MAST magnetic diagnostic coil set and their calibration. The way in which coil signals are used to control the plasma equilibrium is described and data from the first MAST experimental campaign presented. These coil data are used as input to the code EFIT [L. Lao et al., Nucl. Fusion 25, 1611 (1985)], for measurement of halo currents in the vacuum vessel structure and for measurements of the structure of magnetic field fluctuations near the plasma edge.

  20. Planetary Transmission Diagnostics

    Science.gov (United States)

    Lewicki, David G. (Technical Monitor); Samuel, Paul D.; Conroy, Joseph K.; Pines, Darryll J.

    2004-01-01

    This report presents a methodology for detecting and diagnosing gear faults in the planetary stage of a helicopter transmission. This diagnostic technique is based on the constrained adaptive lifting algorithm. The lifting scheme, developed by Wim Sweldens of Bell Labs, is a time domain, prediction-error realization of the wavelet transform that allows for greater flexibility in the construction of wavelet bases. Classic lifting analyzes a given signal using wavelets derived from a single fundamental basis function. A number of researchers have proposed techniques for adding adaptivity to the lifting scheme, allowing the transform to choose from a set of fundamental bases the basis that best fits the signal. This characteristic is desirable for gear diagnostics as it allows the technique to tailor itself to a specific transmission by selecting a set of wavelets that best represent vibration signals obtained while the gearbox is operating under healthy-state conditions. However, constraints on certain basis characteristics are necessary to enhance the detection of local wave-form changes caused by certain types of gear damage. The proposed methodology analyzes individual tooth-mesh waveforms from a healthy-state gearbox vibration signal that was generated using the vibration separation (synchronous signal-averaging) algorithm. Each waveform is separated into analysis domains using zeros of its slope and curvature. The bases selected in each analysis domain are chosen to minimize the prediction error, and constrained to have the same-sign local slope and curvature as the original signal. The resulting set of bases is used to analyze future-state vibration signals and the lifting prediction error is inspected. The constraints allow the transform to effectively adapt to global amplitude changes, yielding small prediction errors. However, local wave-form changes associated with certain types of gear damage are poorly adapted, causing a significant change in the