Sample records for surgical intervention depending

  1. Analysis of surgical intervention populations using generic surgical process models.

    Neumuth, Thomas; Jannin, Pierre; Schlomberg, Juliane; Meixensberger, Jürgen; Wiedemann, Peter; Burgert, Oliver


    According to differences in patient characteristics, surgical performance, or used surgical technological resources, surgical interventions have high variability. No methods for the generation and comparison of statistical 'mean' surgical procedures are available. The convenience of these models is to provide increased evidence for clinical, technical, and administrative decision-making. Based on several measurements of patient individual surgical treatments, we present a method of how to calculate a statistical 'mean' intervention model, called generic Surgical Process Model (gSPM), from a number of interventions. In a proof-of-concept study, we show how statistical 'mean' procedure courses can be computed and how differences between several of these models can be quantified. Patient individual surgical treatments of 102 cataract interventions from eye surgery were allocated to an ambulatory or inpatient sample, and the gSPMs for each of the samples were computed. Both treatment strategies are exemplary compared for the interventional phase Capsulorhexis. Statistical differences between the gSPMs of ambulatory and inpatient procedures of performance times for surgical activities and activity sequences were identified. Furthermore, the work flow that corresponds to the general recommended clinical treatment was recovered out of the individual Surgical Process Models. The computation of gSPMs is a new approach in medical engineering and medical informatics. It supports increased evidence, e.g. for the application of alternative surgical strategies, investments for surgical technology, optimization protocols, or surgical education. Furthermore, this may be applicable in more technical research fields, as well, such as the development of surgical workflow management systems for the operating room of the future.

  2. Videolaparoscopic surgical interventions in emergency surgery

    Сергей Николаевич Завгородний


    Full Text Available Aim: To improve the results of treatment of patients with emergency surgical pathology by the analysis of the use of videolaparoscopic surgical interventions.Methods: in the period 2012–2014 year in MI “Zaporozhye municipal clinical hospital of emergency” in the first surgical department on the base of subdepartment “General surgery with care for patients” of Zaporozhye state medical university were carried out 791 videolaparoscopic surgical interventions.508 (64,2 % women, 283 (35,8 % men. The mean age of patients was 48±2,1.The most videolaparoscopic operations were carried out at the acute appendicitis– 359 (45,5 %. Laparoscopic cholecystectomy at the acute cholecystitis was carried out in 157 patients (19,9 %. At the acute commissural intestinal obstruction were carried out 8 videolaparoscopic operations – (1 %. Videolaparoscopic drainage of abdominal cavity at the acute pancreatitis was carried out in 79 patients (10 %. At gynecological pathology were carried out 162 videolaparoscopic surgical interventions (20,6 % and in 26 patients (3,1 % was done diagnostic videolaparoscopy.Result: At the acute appendicitis were carried out 359 (45,5 % videolaparoscopic surgical interventions. There were no complications in postsurgical period. The mean bed-day was 6,8±0,7.Videolaparoscopy at the acute cholecistitis was carried out in 157 patients (19,9 %. In 17 (10,8 % was carried out conversion and surgical intervention was continued from laparotory access.At the commissure intestinal obstruction were carried out 8 surgical interventions (1,0 %. All patients underwent surgery after the short-term pre-surgical preparation. Conversion was carried out in 2 patients (25 %. In 1 (12,5 % was injured the loop of small intestine and in 1 (12,5 % took place the total commissure disease in abdominal cavity.Diagnostic laparoscopy was carried out in 26 patients (3,1 %, in two of them – at the close blunt trauma of the stomach

  3. Pneumothorax Causing Pneumoperitoneum: Role of Surgical Intervention

    Fernanda Duarte


    Full Text Available The most common cause of a pneumoperitoneum is a perforation of a hollow viscus and the treatment is an exploratory laparotomy; nevertheless, not all pneumoperitoneums are due to a perforation and not all of them need surgical intervention. We hereby present a case of pneumoperitoneum due to a diaphragmatic defect, which allowed air from a pneumothorax to escape through the diaphragmatic hernia into the abdominal cavity.

  4. Pneumothorax Causing Pneumoperitoneum: Role of Surgical Intervention

    Wentling, Jessica; Anjum, Humayun


    The most common cause of a pneumoperitoneum is a perforation of a hollow viscus and the treatment is an exploratory laparotomy; nevertheless, not all pneumoperitoneums are due to a perforation and not all of them need surgical intervention. We hereby present a case of pneumoperitoneum due to a diaphragmatic defect, which allowed air from a pneumothorax to escape through the diaphragmatic hernia into the abdominal cavity. PMID:27656300

  5. Early surgical intervention for fulminant pseudomembranous colitis.

    Ali, Syed O; Welch, John P; Dring, Robert J


    The objective of this study of a retrospective case series was to determine factors associated with survival after surgical intervention in pseudomembranous colitis (PMC). The study was conducted at a tertiary care medical center and comprised 36 patients who underwent colectomy for fulminant PMC from 1995 to 2006. Patients including 21 females ranged from 40 to 89 years of age (mean, 70 years). Comorbidities included diabetes (39%), cardiovascular disease (77%), chronic obstructive pulmonary disease (47%), and intake of immunosuppressive medications (45%). Seventy-two per cent received antibiotics in the previous 2 months. Only patients with a confirmation of PMC on pathology specimens were included in the study. All patients underwent colectomy. Patients were stratified into two groups: survivors and nonsurvivors. Various clinical factors/ parameters used in the management of patients with PMC were studied in these two groups. Survival was correlated with mean white blood cell count (23,000 survivors versus 40,000 nonsurvivors, P < 0.01); multisystem organ failure (16 per cent survivors versus 47 per cent nonsurvivors, P < 0.05); and preoperative pressors (16 per cent survivors versus 47 per cent nonsurvivors, P < 0.05). Overall mortality for the study period was 47 per cent. Mortality rate analysis revealed a lower rate for the more recent years (32 per cent for 2000 to 2006 versus 65 per cent for 1995 to 1999, P < 0.05). In the more recent years, the time elapsing before colectomy was also lower (1.4 days versus 2.5 days, nonsignificant), and patients had less preoperative hemodynamic instability (70 per cent versus 31 per cent, P < 0.03). In one institution, survival after surgery for PMC was found to be associated with a mean white blood cell count (< 37,000), nondependence on preoperative vasopressors, and surgical intervention before the onset of hemodynamic instability.

  6. Surgical intervention in patients with necrotizing pancreatitis

    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 IN

  7. Combined surgical intervention at terminal glaucoma

    O. A. Kiseleva


    Full Text Available Purpose: to investigate hypotensive efficiency of new surgical intervention at terminal primary and neovascular glaucoma.Methods. Operation has been executed on 35 eyes of 35 patients with terminal primary (23 eyes and secondary (12 eyes neo- vascular glaucoma. A fornix based conjunctival flap was prepared in inferior part of a limbus. 1.5 mm transparent scleral incision 3 mm from limbus was performed. Goniocyclodialysis with spatula was carrying out. then 0.3 ml of viscoelastic solution was entered in cyclodialysis cleft. On sclera put cryoapplications, located in two ranks (on 6 in everyone. the period of postoperative follow-up has averaged 15.6±1.3 months.Results: In 1 month IOP did not exceed 25 mm hg and the painful syndrome has been stopped in all cases. In 1 year after operation normalization IOP took place on 27 eyes (77.2%, from them on 8 was local hypotensive therapy added. With 8 patients (22.8% IOP instillation of 2 preparations remained at level of 28-30 mm Hg, however the painful syndrome was absent.Conclusion: Long-term hypotensive effect of new operation is reached at the expense of the double mechanism: reduction of production of aqueous humor for the account cryopexy of ciliary body and improvements aqueous outflow for formations cyclodialysis cleft.

  8. Improved patient selection by stratified surgical intervention

    Wang, Miao; Bünger, Cody E; Li, Haisheng


    BACKGROUND CONTEXT: Choosing the best surgical treatment for patients with spinal metastases remains a significant challenge for spine surgeons. There is currently no gold standard for surgical treatments. The Aarhus Spinal Metastases Algorithm (ASMA) was established to help surgeons choose...... of the spinal metastases. This algorithm could help spine surgeons to discriminate the risks of surgeries. The ASMA provides a tool to guild surgeons to evaluate the spinal metastases patients, select potential optimal surgery, and avoid life-threatening risks....

  9. Equipment for surgical interventions and childbirth in weightlessness

    Mutke, H. G.

    A transparent plastic sack has been devised for surgical interventions in space. Fixed airtight on the patient, containing sterilized medical equipment and comprising long sleeves for the operations, it retains all its contents for the rest of the flight.

  10. Routine surgical intervention for childhood intussusception in a ...

    Surgery may remain our main stay of treatment until deficiencies in time to diagnosis, specialized facilities ... surgical intervention for intussusception in our ... The main presentations were abdominal pain (n = .... Improving time to diagnosis.

  11. Approach to Pediatric Patients during Surgical Interventions

    Seher Ünver


    Full Text Available A child’s surgical period usually contains unpleasant and difficult experiences, for the child and the parents. The child in this period experiences greater anxiety and distress. On the other hand, pediatric patients have complex states that directly effects their perioperative care during. Because their perioperative care includes not only the knowledge of general surgical procedure and care of a patient in the operating room. It also includes the specific understanding of a child’s airway, anatomy and physiology, the understanding of child development and care of the child and family. This review is prepared to present these differences of the pediatric surgical patients and the care during their perioperative period. (Jo­ur­nal of Cur­rent Pe­di­at­rics 2013; 11: 128-33

  12. Surgical outcome in monocular elevation deficit: A retrospective interventional study

    Bandyopadhyay Rakhi


    Full Text Available Background and Aim: Monocular elevation deficiency (MED is characterized by a unilateral defect in elevation, caused by paretic, restrictive or combined etiology. Treatment of this multifactorial entity is therefore varied. In this study, we performed different surgical procedures in patients of MED and evaluated their outcome, based on ocular alignment, improvement in elevation and binocular functions. Study Design: Retrospective interventional study. Materials and Methods: Twenty-eight patients were included in this study, from June 2003 to August 2006. Five patients underwent Knapp procedure, with or without horizontal squint surgery, 17 patients had inferior rectus recession, with or without horizontal squint surgery, three patients had combined inferior rectus recession and Knapp procedure and three patients had inferior rectus recession combined with contralateral superior rectus or inferior oblique surgery. The choice of procedure was based on the results of forced duction test (FDT. Results: Forced duction test was positive in 23 cases (82%. Twenty-four of 28 patients (86% were aligned to within 10 prism diopters. Elevation improved in 10 patients (36% from no elevation above primary position (-4 to only slight limitation of elevation (-1. Five patients had preoperative binocular vision and none gained it postoperatively. No significant postoperative complications or duction abnormalities were observed during the follow-up period. Conclusion: Management of MED depends upon selection of the correct surgical technique based on employing the results of FDT, for a satisfactory outcome.

  13. [Surgical interventions of the nail organ].

    Kirchhoff, A; Petres, J


    The nails are the largest appendage of the skin. They provide protection of the tactile regions of the fingers; moreover, well cared-for nails are an attribute of beauty. Operations of the nails should, therefore, regard both functional and cosmetic aspects. Surgical procedures are indicated in the case of nail deformities, bacterial or mycotic infections, as well as pigmentation of the nail wall or plate, and periungual or subungual tumors, which are always suspicious of malignant melanoma. All operations of the nail region can be performed in Oberst's anesthesia. We recommend the preoperative application of a tourniquet to stop the blood flow.

  14. Surgical intervention in children with multiple endocrine neoplasia type 2.

    Danko, Melissa E; Skinner, Michael A


    We provide a summary of the literature published in the past year addressing the surgical approach to multiple endocrine neoplasia type 2 in the pediatric population. The review focuses first on medullary thyroid carcinoma and performing prophylactic thyroidectomy for the prevention or cure of this disease. The timing and extent of surgery as well as additional surgical intervention for persistent or recurrent disease is discussed. Then the surgical management of hereditary pheochromocytoma is reviewed. Surgery is often the only treatment that can prevent or cure the endocrinopathies associated with multiple endocrine neoplasia type 2. Determining the proper timing and extent of surgical intervention in children affected with multiple endocrine neoplasia type 2 will lead to better outcomes and survival.

  15. Surgical Intervention for Hepatocellular Carcinoma with Bile Buct Thrombi

    PENGShuyou; LIUYingbin; WANGJianwei; CAIXiujun; MOUYiping; WUYulian; FangHeqing; LIJiangtao; WANGXinbao; XUBin; LIHaijun


    Objective: To summarize the experience of surgical intervention for hepatocellular carcinoma(HCC) with bile duct thrombi (BDT), and to evaluate the influence on prognosis. Methods: From 1994 to 2002, 15 patients with HCC and BDT who underwent surgical intervention were retrospectively analyzed.Results: The operative procedures included hepatectomy with removel of BDT (n=7), hepatectomy com-bined with extrahepatic bile duct resection (n=4), thrombectomy through choledochotomy (n=3), piggy back orthotopic liver transplantation (n=1). The 1-and 3-year survival rates were 73.3% and 40%, respec-tively. Two patients survived over 5 years. Conclusion: Surgical intervention was effective for patients with HCC and BDT. Operation for recurrent lesion can prolong survival period. Liver transplantation is a new treatment worthy of further investigation.

  16. Field Surgical Intervention of Bovine Actinomycosis

    U. Farooq*, A. Qayyum, H. A. Samad, H. R. Chaudhry and N. Ahmad1


    Full Text Available Actinomycosis, or lumpy jaw, is an important cause of economic losses in livestock because of its widespread occurrence and poor response to the routine clinical treatment. The present study describes a typical case of bovine actinomycosis in a seven-month pregnant Sahiwal heifer with a hard swelling on the middle of the maxilla bone at the level of the central molar teeth. Tentative diagnosis was made through clinical signs. After maturation of the swelling, the area was incised under local anesthesia and debridement of the wound was achieved by sharp surgical debridement and mechanical debridement. Pus, having the appearance of sulphur granules, was completely removed from the excised cavity, which was closed by applying mattress sutures. Adjunct therapy of broad-spectrum antibiotic was administered intramuscularly for five days as a post-operative measure. Catamnesis revealed that the healing was complete in 15 days with no recurrence and untoward consequences.

  17. Extrahepatic portal vein aneurysm: Two case reports of surgical intervention

    Bi Jin; Yuan Sun; Yi-Qing Li; Yu-Guo Zhao; Chuan-Shan Lai; Xian-Song Feng; Chi-Dan Wan


    We report two cases of extrahepatic portal vein aneurysm,and both of them underwent surgical intervention. The first case had a mild pain in right upper quadrant of the abdomen; the second had no obvious symptoms. Physical examination revealed nothing abnormal. Both of them were diagnosed by magnetic resonance imaging angiography (MRA). One of the aneurysms was located at the main portal vein, the other, at the confluence of the superior mesenteric vein and the splenic vein, and these two places are exactly the most common locations of the extrahepatic portal vein aneurysm reported in the literature (30.7% each site). The first case underwent aneurysmorrhaphy and the second case, aneurysm resection with splenectomy. Both of them recovered soon after the operation, and the symptom of the first case was greatly alleviated. During the follow-up of half a year, no complication and adverse effect of surgical intervention was found and the color Doppler ultrasonography revealed no recurrence of the aneurysmal dilation. We suggest that surgical intervention can alleviate the symptom of the extrahepatic portal vein aneurysm and prevent its complications effectively and safely for low risk patients.

  18. Surgical consultation and intervention during pediatric hematopoietic stem cell transplantation.

    Madenci, Arin L; Lehmann, Leslie E; Weldon, Christopher B


    Children undergoing HSCT are at risk for complications due to immune system impairment, toxicity from prior therapies and conditioning regimens, and long-term use of indwelling catheters. These problems may require assessment by the surgical team. We sought to characterize the role of surgical consultation during primary hospital stay for HSCT. We retrospectively reviewed the records of consecutive patients undergoing HSCT between September 2010 and September 2012. One hundred and seventy-three patients underwent 189 HSCTs. General surgery consultations occurred during 33% (n = 62) of primary hospitalizations for HSCT, with a total of 85 consults. Sixty-three (73%) consults resulted in an intervention in the operating room or at the bedside. The majority of consults were for CVL issues (59%, n = 50), followed by abdominal complaints (16%, n = 14). Patients requiring surgical consultation had significantly higher in-hospital mortality (16% vs. 2%, p consultation. Patients undergoing HSCT often require surgical consultation, most commonly for line-related issues. Surgical consultation heralded an increased risk of in-hospital and 100-day TRM. Issues among this high-risk cohort of children who have undergone HSCT must be familiar to the general surgeon and oncologist alike. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  19. Surgical intervention for esophageal atresia in patients with trisomy 18.

    Nishi, Eriko; Takamizawa, Shigeru; Iio, Kenji; Yamada, Yasumasa; Yoshizawa, Katsumi; Hatata, Tomoko; Hiroma, Takehiko; Mizuno, Seiji; Kawame, Hiroshi; Fukushima, Yoshimitsu; Nakamura, Tomohiko; Kosho, Tomoki


    Trisomy 18 is a common chromosomal aberration syndrome involving growth impairment, various malformations, poor prognosis, and severe developmental delay in survivors. Although esophageal atresia (EA) with tracheoesophageal fistula (TEF) is a potentially fatal complication that can only be rescued through surgical correction, no reports have addressed the efficacy of surgical intervention for EA in patients with trisomy 18. We reviewed detailed clinical information of 24 patients with trisomy 18 and EA who were admitted to two neonatal intensive care units in Japan and underwent intensive treatment including surgical interventions from 1982 to 2009. Nine patients underwent only palliative surgery, including six who underwent only gastrostomy or both gastrostomy and jejunostomy (Group 1) and three who underwent gastrostomy and TEF division (Group 2). The other 15 patients underwent radical surgery, including 10 who underwent single-stage esophago-esophagostomy with TEF division (Group 3) and five who underwent two-stage operation (gastrostomy followed by esophago-esophagostomy with TEF division) (Group 4). No intraoperative death or anesthetic complications were noted. Enteral feeding was accomplished in 17 patients, three of whom were fed orally. Three patients could be discharged home. The 1-year survival rate was 17%: 27% in those receiving radical surgery (Groups 3 and 4); 0% in those receiving palliative surgery (Groups 1 and 2). Most causes of death were related to cardiac complications. EA is not an absolute poor prognostic factor in patients with trisomy 18 undergoing radical surgery for EA and intensive cardiac management.

  20. [Surgical intervention in severe acute pancreatitis--retrospective study of 79 patients of the RWTH Aachen Surgical Clinic].

    Lohmann, A; Kasperk, R; Schumpelick, V


    This is a report on the surgical intervention in 79 patients with acute pancreatitis, who were operated in the Department of Surgery of the University Clinic RWTH Aachen in the period from 1986 to 1993. The main objective was the stratification of pancreatitis according to the Ranson-Score, the analysis of the surgical treatment and the timing of operation depending on the clinical condition. The average Ranson-score was 3.3 (median 3). 56 patients had necroses, which were removed because of the deteriorating clinical condition. In these cases the average Ranson-score was 4.2 (median 4). Seven patients (8.9% of the total number and 12.5% of the patients with necroses of the pancreas) died. This small number is the result of a severity-adapted management in a modern intensive care-unit and the good cooperation with the Department of Internal Medicine.

  1. Pneumatosis Intestinalis: Can We Avoid Surgical Intervention in Nonsurgical Patients?

    Ayman Al-Talib


    Full Text Available Pneumatosis intestinalis (PI is the presence of gas within the wall of the gastrointestinal tract and represents a tremendous spectrum of conditions and outcomes, ranging from benign diseases to abdominal sepsis and death. It is seen with increased frequency in patients who are immunocompromised because of steroids, chemotherapy, radiation therapy, or AIDS. PI may result from intraluminal bacterial gas entering the bowel wall due to increased mucosal permeability caused by defects in bowel wall lymphoid tissue. We present a case of PI who was treated conservatively and in whom PI resolved completely and we present a literature review of conservative management. It is not difficult to make a precise diagnosis of PI and to prevent unnecessary surgical intervention, especially when PI presents without clinical evidence of peritonitis. Conservative treatment is possible and safe for selected patients. Awareness of these rare causes of PI and close observation of selected patients without peritonitis may prevent unnecessary invasive surgical explorations.

  2. Surgical intervention and capsular contracture after breast augmentation

    Henriksen, Trine F; Fryzek, Jon P; Hölmich, Lisbet R


    -requiring complications and capsular contracture grades III to IV among 2277 women who underwent cosmetic breast implantation from June 1999 through April 2003. During an average follow-up period of 1.6 years after implantation, 4.3% of these women (3% of implants) required secondary surgery as a result of short......-term complications. The most frequent clinical indications for surgery were displacement of the implant (38%), capsular contracture grades III to IV (16%), ptosis (13%), and hematoma (11%). Overall, the authors found that inframammary incision and subglandular placement were associated with decreased risks...... of developing complications requiring surgical intervention, whereas implants larger than 350 mL increased the risk of such complications (relative risk [RR], 2.3; 95% confidence interval [CI], 1.3-4.0). Thirty-nine Baker III to IV capsular contractures were identified, of which 22 were treated surgically...

  3. Response of Hirayama disease to surgical intervention: case report

    Navneet Kumar


    Full Text Available Hirayama disease also known as monomelic amyotrophy, primarily involves distal upper limb extremities. It differs from the known types of motor neuron diseases because of its nonprogressive behavior and pathologic findings of focal ischemic changes in the anterior horn of the lower cervical cord. We present a young male with Hirayama disease who had a left upper extremity involvement which was progressive in nature. He didn't respond with initial treatment of cervical collar. Consequently surgical intervention improves muscle weakness and decrease the neurological deficit. [Int J Res Med Sci 2014; 2(3.000: 1232-1235

  4. The surgical management of the rheumatoid spine: Has the evolution of surgical intervention changed outcomes?

    Robin Bhatia


    Full Text Available Context: Surgery for the rheumatoid cervical spine has been shown to stabilize the unstable spine; arrest/improve the progression of neurological deficit, help neck pain, and possibly decelerate the degenerative disease process. Operative intervention for the rheumatoid spine has significantly changed over the last 30 years. Aims: The purpose of this study was to review all cases of cervical rheumatoid spine requiring surgical intervention in a single unit over the last 30 years. Materials and Methods: A prospectively-maintained spine database was retrospectively searched for all cases of rheumatoid spine, leading to a review of indications, imaging, Ranawat and Myelopathy Disability Index measures, surgical morbidity, and survival curve analysis. Results: A total of 224 cases were identified between 1981 and 2011. Dividing the data into three time-epochs, there has been a significant increase in the ratio of segment-saving Goel-Harms C1-C2: Occipitocervical fixation (OCF surgery and survival has increased between 1981 and 2011 from 30% to 51%. Patients undergoing C1-C2 fixation were comparatively less myelopathic and in a better Ranawat class preoperatively, but postoperative outcome measures were well-preserved with favorable mortality rates over mean 39.6 months of follow-up. However, 11% of cases required OCF at mean 28 months post-C1-C2 fixation, largely due to instrumentation failure (80%. Conclusion: We present the largest series of surgically managed rheumatoid spines, revealing comparative data on OCF and C1-C2 fixation. Although survival has improved over the last 30 years, there have been changes in medical, surgical and perioperative management over that period of time too confounding the interpretation; however, the analysis presented suggests that rheumatoid patients presenting early in the disease process may benefit from C1 to C2 fixation, albeit with a proportion requiring OCF at a later time.

  5. Surgical intervention for a pediatric isolated intramedullary spinal aneurysm.

    Morozumi, Masayoshi; Imagama, Shiro; Ando, Kei; Kobayashi, Kazuyoshi; Hida, Tetsuro; Ito, Kenyu; Tsushima, Mikito; Matsumoto, Akiyuki; Tanaka, Satoshi; Machino, Masaaki; Ota, Kyotaro; Nishida, Yoshihiro; Ishiguro, Naoki


    To report the case of a pediatric patient with intramedullary spinal aneurysm. A 9-year-old boy presented with low back pain and subsequent gait disturbance. He had no history of trauma. After admission, MRI revealed an intramedullary spinal cord mass lesion surrounded by hemorrhage at the cervical-thoracic junction. Initial treatment was started with intravenous methylprednisolone and bed rest. Neurological deficit disappeared under careful observation for a few months. Surgical intervention was applied for diagnosis and resection of the mass lesion to prevent recurrent hemorrhage. Intraoperative ultrasound sonography helped to diagnose the lesion as a spinal cord aneurysm, prior to midline myelotomy. Monitoring of transcranial muscle evoked potentials helped to avoid spinal cord damage during surgery. There has been no evidence of spinal aneurysm on MRI for 3 years after surgery and no neurological deterioration. To our knowledge, this is a first report of an intramedullary spinal cord aneurysm at the cervical-thoracic junction in a pediatric patient. Careful observation after initial symptoms followed by surgical intervention was favorable in this case.

  6. Surgical Intervention to Rescue Hirschsprung Disease in a Rat Model

    Stamp, Lincon A; Obermayr, Florian; Pontell, Louise; Young, Heather M; Xie, Dan; Croaker, David H; Song, Zan-Min; Furness, John B


    Background/Aims Rats with a spontaneous null mutation in endothelin receptor type B or Ednrb (sl/sl; spotting lethal) lack enteric neurons in the distal bowel and usually die within the first week after birth. This early postnatal lethality limits their use for examining the potential of cell therapy to treat Hirschsprung disease, and for studies of the influence of EDNRB on the mature CNS and vascular systems. Methods We have developed a surgical intervention to prolong the life of the spotting lethal sl/sl rat, in which we perform a colostomy on postnatal (P) day 4–6 rats to avoid the fatal obstruction caused by the lack of colonic enteric neurons. Results The stomas remained patent and functional and the rats matured normally following surgery. Weight gains were comparable between control and Hirschsprung phenotype (sl/sl) rats, which were followed until 4 weeks after surgery (5 weeks old). We confirmed the absence of enteric neurons in the distal colon of rats whose lives were saved by the surgical intervention. Conclusions This study provides a novel approach for studying EDNRB signalling in multiple organ systems in mature rats, including an animal model to study the efficacy of cell therapy to treat Hirschsprung disease. PMID:26424040

  7. Lung Cancer Survival Improvement through Surgical Intervention in PUMCH Hospital

    GUO Feng; ZHANG Zhiyong; CUI Yushang; LI Shanqing; LI Li; XU Xiaohui; GE Feng; GUO Huiqin; LI Zejian


    Objective: To investigate and evaluate improvement of lung cancer survival after surgical intervention in PUMC hospital during the last 15 years. Methods: From January 1989 to December 2003, 1574 lung cancer cases underwent surgical treatment and followed up. All cases in this series were divided into two groups according to time period: group A (1999-2003) and group B (1989-1998). The difference in the survival rate between groups A and B was compared. Results: The morbidity and mortality in group A was decreased significantly in comparison to group B (11.2% vs. 19.2%, 1.06% vs. 1.93%, respectively).However, the 3-year and 5-year survival rate was increased from 42.35% to 56.07%, and from 28.46% to38.99%, respectively. A significant improvement in survival was observed in patients with stage Ⅰ, Ⅱ and ⅢA, but not in those with stage ⅢB and Ⅳ. Also, patients with lobectomy had more satisfactory results than those receiving exploratory thoracotomy, limited resection, pneumonectomy and sleeve resection. Conclusion: Lobectomy plus systematic mediastinal lymph nodes dissection has become the standard mode for resectable lung cancer. Combination of complete resection along with lymph nodal dissection, and postoperative adjuvant chemotherapy based on platinum/3rd generation chemotherapy medicine, has preliminarily been justified, proving an important approach for effective improvement in long-term survival of non-small cell lung carcinoma.

  8. Peripheral surgical wounding and age-dependent neuroinflammation in mice.

    Zhipeng Xu

    Full Text Available Post-operative cognitive dysfunction is associated with morbidity and mortality. However, its neuropathogenesis remains largely to be determined. Neuroinflammation and accumulation of β-amyloid (Aβ have been reported to contribute to cognitive dysfunction in humans and cognitive impairment in animals. Our recent studies have established a pre-clinical model in mice, and have found that the peripheral surgical wounding without the influence of general anesthesia induces an age-dependent Aβ accumulation and cognitive impairment in mice. We therefore set out to assess the effects of peripheral surgical wounding, in the absence of general anesthesia, on neuroinflammation in mice with different ages. Abdominal surgery under local anesthesia was established in 9 and 18 month-old mice. The levels of tumor necrosis factor-α (TNF-α, interleukin-6 (IL-6, Iba1 positive cells (the marker of microglia activation, CD33, and cognitive function in mice were determined. The peripheral surgical wounding increased the levels of TNF-α, IL-6, and Iba1 positive cells in the hippocampus of both 9 and 18 month-old mice, and age potentiated these effects. The peripheral surgical wounding increased the levels of CD33 in the hippocampus of 18, but not 9, month-old mice. Finally, anti-inflammatory drug ibuprofen ameliorated the peripheral surgical wounding-induced cognitive impairment in 18 month-old mice. These data suggested that the peripheral surgical wounding could induce an age-dependent neuroinflammation and elevation of CD33 levels in the hippocampus of mice, which could lead to cognitive impairment in aged mice. Pending further studies, anti-inflammatory therapies may reduce the risk of postoperative cognitive dysfunction in elderly patients.

  9. Surgical interventions for pulmonary tuberculosis in Mumbai, India: surgical outcomes and programmatic challenges

    Shirodkar, S.; Anande, L.; Dalal, A.; Desai, C.; Corrêa, G.; Laxmeshwar, C.; Mansoor, H.; Remartinez, D.; Trelles, M.; Isaakidis, P.


    Setting: While surgery for pulmonary tuberculosis (PTB) is considered an important adjunct for specific cases, including drug-resistant tuberculosis, operational evidence on its feasibility and effectiveness is limited. Objective: To describe surgical outcomes and programmatic challenges of providing surgery for PTB in Mumbai, India. Design: A descriptive study of routinely collected data of surgical interventions for PTB from 2010 to 2014 in two Mumbai hospitals, one public, one private. Results: Of 85 patients, 5 (6%) died and 17 (20%) had complications, with wound infection being the most frequent. Repeat operation was required in 12 (14%) patients. Most procedures were performed on an emergency basis, and eligibility was established late in the course of treatment. Median time from admission to surgery was 51 days. Drug susceptibility test (DST) patterns and final treatment outcomes were not systematically collected. Conclusion: In a high-burden setting such as Mumbai, important data on surgery for PTB were surprisingly limited in both the private and public sectors. Eligibility for surgery was established late, culture and DST were not systematically offered, the interval between admission and surgery was long and TB outcomes were not known. Systematic data collection would allow for proper evaluation of surgery as adjunctive therapy for all forms of TB under programmatic conditions. PMID:27695683

  10. Palliative Interventional and Surgical Therapy for Unresectable Pancreatic Cancer

    Helmut Friess


    Full Text Available Palliative treatment concepts are considered in patients with non-curatively resectable and/or metastasized pancreatic cancer. However, patients without metastases, but presented with marginally resectable or locally non-resectable tumors should not be treated by a palliative therapeutic approach. These patients should be enrolled in neoadjuvant radiochemotherapy trials because a potentially curative resection can be achieved in approximately one-third of them after finishing treatment and restaging. Within the scope of best possible palliative care, resection of the primary cancer together with excision of metastases represents a therapeutic option to be contemplated in selected cases. Comprehensive palliative therapy is based on treatment of bile duct or duodenal obstruction for certain locally unresectable or metastasized advanced pancreatic cancer. However, endoscopic or percutaneous stenting procedures and surgical bypass provide safe and highly effective therapeutic alternatives. In case of operative drainage of the biliary tract (biliodigestive anastomosis, the prophylactic creation of a gastro-intestinal bypass (double bypass is recommended. The decision to perform a surgical versus an endoscopic procedure for palliation depends to a great extent on the tumor stage and the estimated prognosis, and should be determined by an interdisciplinary team for each patient individually.

  11. Palliative Interventional and Surgical Therapy for Unresectable Pancreatic Cancer

    Assfalg, Volker; Hüser, Norbert; Michalski, Christoph; Gillen, Sonja; Kleeff, Jorg; Friess, Helmut, E-mail: [Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, D-81675 Munich (Germany)


    Palliative treatment concepts are considered in patients with non-curatively resectable and/or metastasized pancreatic cancer. However, patients without metastases, but presented with marginally resectable or locally non-resectable tumors should not be treated by a palliative therapeutic approach. These patients should be enrolled in neoadjuvant radiochemotherapy trials because a potentially curative resection can be achieved in approximately one-third of them after finishing treatment and restaging. Within the scope of best possible palliative care, resection of the primary cancer together with excision of metastases represents a therapeutic option to be contemplated in selected cases. Comprehensive palliative therapy is based on treatment of bile duct or duodenal obstruction for certain locally unresectable or metastasized advanced pancreatic cancer. However, endoscopic or percutaneous stenting procedures and surgical bypass provide safe and highly effective therapeutic alternatives. In case of operative drainage of the biliary tract (biliodigestive anastomosis), the prophylactic creation of a gastro-intestinal bypass (double bypass) is recommended. The decision to perform a surgical versus an endoscopic procedure for palliation depends to a great extent on the tumor stage and the estimated prognosis, and should be determined by an interdisciplinary team for each patient individually.

  12. Is surgical intervention more effective than non-surgical treatment for carpal tunnel syndrome? a systematic review

    Shi Qiyun


    Full Text Available Abstract Background Carpal tunnel syndrome is a common disorder in hand surgery practice. Both surgical and conservative interventions are utilized for the carpal tunnel syndrome. Although certain indications would specifically indicate the need for surgery, there is a spectrum of patients for whom either treatment option might be selected. The purpose of this systematic review was to compare the efficacy of surgical treatment of carpal tunnel syndrome with conservative treatment Methods We included all controlled trials written in English, attempting to compare any surgical interventions with any conservative therapies. We searched Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2010, MEDLINE (1980 to June 2010, EMBASE (1980 to June 2010, PEDro (searched in June 2010, international guidelines, computer searches based on key words and reference lists of articles. Two reviewers performed study selection, assessment of methodological quality and data extraction independently of each other. Weighted mean differences and 95% confidence intervals for patient self-reported functional and symptom questionnaires were calculated. Relative risk (RR and 95% confidence intervals for electrophysiological studies and complication were also calculated. Results We assessed seven studies in this review including 5 RCTs and 2 controlled trials. The methodological quality of the trials ranged from moderate to high. The weighted mean difference demonstrated a larger treatment benefit for surgical intervention compared to non surgical intervention at six months for functional status 0.35( 95% CI 0.22, 0.47 and symptom severity 0.43 (95% CI 0.29, 0.57. There were no statistically significant difference between the intervention options at 3 months but there was a benefit in favor of surgery in terms of function and symptom relief at 12 months ( 0.35, 95% CI 0.15, 0.55 and 0.37, 95% CI 0.19 to 0.56. The RR for secondary outcomes of normal

  13. Surgical intervention for complications caused by late radiation damage of the small bowel; a retrospective analysis

    Halteren, H.K. van; Gortzak, E.; Taal, B.G.; Helmerhorst, Th.J.M.; Aleman, B.M.P.; Hart, A.A.M.; Zoetmulder, F.A.N. (Nederlands Kanker Inst. ' Antoni van Leeuwenhoekhuis' , Amsterdam (Netherlands))


    The authors studied the records of 46 patients who had been operated on between 1974 and 1990 in the Netherlands Cancer Institute because of complications due to late radiation damage of the small bowel. The following factors led to an increase in complication-risk: hypalbuminemia. more than one laparotomy prior to irradiation and a short interval (< 12 months) between irradiation and surgical intervention. The following factors related to a poorer survival: incomplete resection of the primary tumor and a short interval (< 12 months) between irradiation and surgical intervention. The type f surgical intervention did not have cumulative prognostic value in relation to complication-risk or survival. (author).

  14. 3D Rotational X-Ray guidance for surgical interventions

    Kraats, Everine Brenda van de


    The research described in this thesis is aimed at increasing the accuracy and decreasing the invasiveness of surgical procedures, with a focus on spine procedures, by using a combination of multi-modality images, computer-assisted navigation, intraoperative 3D rotational X-ray (3DRX) imaging, and mi

  15. Pharmaceutical care in surgical patients: Tools for measurement and intervention

    de Boer, M.


    Assessing and improving the quality of pharmaceutical care is a major issue in hospitals nowadays. Medication safety strategies are being developed and widely introduced in hospitals to reduce medication-related harm. Surgical patients are at risk for medication-related harm, also called adverse

  16. Surgical intervention for advanced valvular heart disease in 227 cases

    ZHANG Xi; ZHONG Fo-tian; XU Zhe; XU Ying-qi; WANG Zhi-ping; WU Zhong-kai; TANG Bai-yun; XIONG Mai; YAO Jian-ping; SUN Pei-wu


    Background Although the results of surgical treatment in cardiac valve disease continue to improve, the postoperative mortality rate and the rate of complications in patients with advanced valvular heart disease (AVHD) are still very high. We did this retrospective study to summarize the surgical experience of heart valve replacement for patients with AVHD and discuss effective ways to improve the surgical outcome.Results The operative mortality rate was 13.2% (30/227). The main causes of death included multiple organ dysfunction syndrome (MODS), low cardiac output syndrome and ventricular fibrillation. From the results of the binary noncounterpart multivariate logistic regression, the following statistically significant factors were found to influence the operative mortality rate: redo operation, age ≥55 years, preoperative NYHA cardiac function grading, extracorporeal circulation time ≥120 minutes and postoperative usage of GIK (glucose, insulin and potassium) solution. All factors were risk ones except postoperative application of GIK. The Hosmer-Lemeshow goodness of fit coefficient of this model was 0.976.Conclusions The risk factors associated with postoperative mortality rate in the patients with AVHD were redo operation, age ≥55 years, preoperative NYHA cardiac function grading and extracorporeal circulation time ≥120 minutes. Postoperative usage of GIK acted as a kind of metabolic therapy and will improve the recovery for patients with AVHD. Active perioperative management and care will play a very important role in reducing the operative risk and improving the short term outcome of surgical treatment for the patients with AVHD.

  17. Surgical double valve replacement after transcatheter aortic valve implantation and interventional mitral valve repair.

    Wendeborn, Jens; Donndorf, Peter; Westphal, Bernd; Steinhoff, Gustav


    Transcatheter aortic valve implantation, as well as interventional mitral valve repair, offer reasonable therapeutic options for high-risk surgical patients. We report a rare case of early post-interventional aortic valve prosthesis migration to the left ventricular outflow tract, with paravalvular leakage and causing severe mitral valve regurgitation. Initial successful interventional mitral valve repair using a clipped edge-to-edge technique revealed, in a subsequent procedure, the recurrence of mitral valve regurgitation leading to progressive heart failure and necessitating subsequent surgical aortic and mitral valve replacement.

  18. [Multimodal surgical intervention to improve outcome after colon cancer].

    Hohenberger, Werner; O'Connell, Ronan; Iversen, Lene Hjerrild


    Surgeons have focused their efforts towards improving outcome following surgical treatment of rectal cancer by implementation of the total mesorectal excision technique, among others. Great progress has been made, and in Denmark and Sweden survival rates for rectal cancer now exceed those for colon cancer. Recently, the significance of complete mesocolic excision in colonic cancer has been acknowledged. Treatment of colon cancer is challenging in patients with locally advanced disease, peritoneal carcinomatosis, and emergency presentation, all of which are described.

  19. Detected peritoneal fluid in small bowel obstruction is associated with the need for surgical intervention.

    O'Daly, Brendan J


    BACKGROUND: Predicting the clinical course in adhesional small bowel obstruction is difficult. There are no validated clinical or radiologic features that allow early identification of patients likely to require surgical intervention. METHODS: We conducted a retrospective review of 100 patients consecutively admitted to a tertiary level teaching hospital over a 3-year period (2002-2004) who had acute adhesional small bowel obstruction and underwent computed tomography (CT). The primary outcomes that we assessed were conservative management or the need for surgical intervention. We investigated time to physiologic gastrointestinal function recovery as a secondary outcome. We examined independent predictors of surgical intervention in a bivariate analysis using a stepwise logistic regression analysis. RESULTS: Of the 100 patients investigated, we excluded 12. Of the 88 remaining patients, 58 (66%) were managed conservatively and 30 (34%) underwent surgery. Peritoneal fluid detected on a CT scan (n = 37) was associated more frequently with surgery than conservative management (46% v. 29%, p = 0.046, chi(2)). Logistical regression identified peritoneal fluid detected on a CT scan as an independent predictor of surgical intervention (odds ratio 3.0, 95% confidence interval 1.15-7.84). CONCLUSION: The presence of peritoneal fluid on a CT scan in patients with adhesional small bowel obstruction is an independent predictor of surgical intervention and should alert the clinician that the patient is 3 times more likely to require surgery.

  20. Long-term outcomes of pediatric hypospadias and surgical intervention

    De Win G


    Full Text Available Gunter De Win,1,2 Peter Cuckow,3 Piet Hoebeke,4 Dan Wood21Adolescent and Pediatric Urology, University Hospital, Antwerp, Belgium; 2Adolescent Urology, University College London Hospitals, UK; 3Pediatric Urology, Great Ormond Street Hospital for Sick Children, London, UK; 4Pediatric Urology, University Hospital, Gent, BelgiumAbstract: Hypospadias is one of the most commonly diagnosed male congenital disorders. Many surgical techniques are described and complications often reported include fistula, wound dehiscence, and meatal stenosis. Many surgeons still believe that hypospadias should be surgically corrected before the age of 12 months. However, it is clear that the longer the follow up, the more complications are reported. Correction of a failed hypospadias repair in adult patients can be challenging. While the need for repair of proximal hypospadias during childhood is evident, distal repair during childhood is questionable. Evidence suggests that the psychosexual and functional outcomes of nonoperated distal hypospadias in the adult population are good. Therefore, the benefit of surgery and the burden of complications must be carefully evaluated. This paper highlights the difficulties inherent in decisions related to the assessment of hypospadias, the need for repair, and the paucity of good long-term data.Keywords: hypospadias, chordee, urethroplasty, fistula, stricture, hypospadias complications


    Sashi Walling


    Full Text Available OBJECTIVE: The aim of this study is to study the response of venous ulcers to compressive therapy plus surgical treatment. STUDY DESIGN : Patients presenting to our hospital from the period March’ 2014 to December’ 2014 with venous ulcers were examined and investigated. Thirty patients who had findings of venous ulcers along with varicose veins were selected for the study. Patients were initially treated with elastic compression bandages to allow ulcer healing followed by surgical intervention of varicose veins and incompetent perforators. The response to treatment was evaluated in terms of symptomatic improvement and ulcer healing. RESULTS: Venous ulcers respond well to both conservative treatment and surgical intervention. Meticulous assessment of patients is necessary for successful treatment. In our study period, elastic compres sion bandages combined with surgical treatment was successful in improving symptoms of venous ulcer as well as ulcer healing in the patients. Patient education regarding compliance to treatment is paramount to ulcer healing and preventing recurrence.

  2. Present status of surgical intervention for children with intractable seizures.

    Depositario-Cabacar, Dewi T; Riviello, James J; Takeoka, Masanori


    We present a discussion of recent relevant publications in pediatric epilepsy surgery. In 1998, the Commission on Neurosurgery of the International League Against Epilepsy formed the Subcommission for Pediatric Epilepsy Surgery. Their proposed recommendations are included here. We also discuss updates on identification and selection of children with severe refractory epilepsy. Functional imaging has advanced in recent years as an important adjunct in identifying the epileptogenic zone during the preoperative evaluation. The newer imaging modalities are summarized. Routine positron emission tomography, positron emission tomography with special tracers, and single photon emission computed tomography have proven to be beneficial. Other newer investigative techniques await validation. A number of studies on postoperative outcomes over the past few years have demonstrated the benefits of early surgical treatment for selected children.

  3. Stroke prevention-surgical and interventional approaches to carotid stenosis

    Kumar Rajamani


    Full Text Available Extra cranial carotid artery stenosis is an important cause of stroke, which often needs treatment with carotid revascularization. To prevent stroke recurrence, carotid endarterectomy (CEA has been well-established for several decades for symptomatic high and moderate grade stenosis. Carotid stenting is a less invasive alternative to CEA and several recent trials have compared the efficacy of the 2 procedures in patients with carotid stenosis. Carotid artery stenting has emerged as a potential mode of therapy for high surgical risk patients with symptomatic high-grade stenosis. This review focuses on the current data available that will enable the clinician to decide optimal treatment strategies for patients with carotid stenosis.

  4. Medical and surgical interventions to improve outcomes in obese women planning for pregnancy.

    Sharma, Anu; Bahadursingh, Sarasvati; Ramsewak, Samuel; Teelucksingh, Surujpal


    Obesity is a known risk factor for infertility in women. The exact mechanism through which obesity is linked to infertility is still not fully understood. Hyperleptinaemia, hyperinsulinaemia and resultant hyperandrogenism are all thought to play a role. Various medical and surgical interventions have been attempted to improve fertility rates in obese women. Encouraging evidence for pharmacotherapy, bariatric surgery and assisted reproduction are yet to be seen. In this chapter, we review the hormonal changes in obesity and the evidence behind medical and surgical interventions to improve fertility in obese women.

  5. Simulation-based planning of surgical interventions in pediatric cardiology

    Marsden, Alison


    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. This is particularly true in pediatric cardiology, due to the wide variation in anatomy observed in congenital heart disease patients. While medical imaging provides increasingly detailed anatomical information, clinicians currently have limited knowledge of important fluid mechanical parameters. Treatment decisions are therefore often made using anatomical information alone, despite the known links between fluid mechanics and disease progression. Patient-specific simulations now offer the means to provide this missing information, and, more importantly, to perform in-silico testing of new surgical designs at no risk to the patient. In this talk, we will outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We will then present new methodology for coupling optimization with simulation and uncertainty quantification to customize treatments for individual patients. Finally, we will present examples in pediatric cardiology that illustrate the potential impact of these tools in the clinical setting.

  6. Simulation based planning of surgical interventions in pediatric cardiology

    Marsden, Alison L.


    Hemodynamics plays an essential role in the progression and treatment of cardiovascular disease. However, while medical imaging provides increasingly detailed anatomical information, clinicians often have limited access to hemodynamic data that may be crucial to patient risk assessment and treatment planning. Computational simulations can now provide detailed hemodynamic data to augment clinical knowledge in both adult and pediatric applications. There is a particular need for simulation tools in pediatric cardiology, due to the wide variation in anatomy and physiology in congenital heart disease patients, necessitating individualized treatment plans. Despite great strides in medical imaging, enabling extraction of flow information from magnetic resonance and ultrasound imaging, simulations offer predictive capabilities that imaging alone cannot provide. Patient specific simulations can be used for in silico testing of new surgical designs, treatment planning, device testing, and patient risk stratification. Furthermore, simulations can be performed at no direct risk to the patient. In this paper, we outline the current state of the art in methods for cardiovascular blood flow simulation and virtual surgery. We then step through pressing challenges in the field, including multiscale modeling, boundary condition selection, optimization, and uncertainty quantification. Finally, we summarize simulation results of two representative examples from pediatric cardiology: single ventricle physiology, and coronary aneurysms caused by Kawasaki disease. These examples illustrate the potential impact of computational modeling tools in the clinical setting.

  7. Surgical intervention in chronic (Hashimoto's) thyroiditis

    Thomas, C.G. Jr.; Rutledge, R.G.


    Experience with 260 thyroidectomies at the North Carolina Memorial Hospital performed between 1875 and 1980 for a dominant thyroid mass was reviewed to determine the reliability of criteria for diagnosis and the indications for surgical treatment. Using the criteria of clinical findings, complemented by laboratory studies. Four patients had Hashimoto's thyroiditis coincidental to another disease for which thyroidectomy was performed. In seven patients Hashimoto's thyroiditis alone constituted the indications for operation. The indications for operation in these patients were: autonomous function with mild hyperthyroidism (2 patients); associated cold nodule (2 patients); thyromegaly unresponsive to suppressive therapy (2 patients); and rapidly enlarging mass simulating a neoplasm (1 patient). Only one of 71 patients with well differentiated carcinoma had Hashimoto's thyroiditis. One patient with Hashimoto's thyroiditis had associated lymphoma. In most patients, Hashimoto's thyroiditis can be identified using appropriate clinical and laboratory criteria without resorting to thyroidectomy to differentiate between thyroiditis and a neoplasm. Operations are indicated in patients with suspected or established chronic thyroiditis for: 1) the presence of a dominant mass with incomplete regression on suppressive therapy. 2) Progression of thyromegaly despite suppressive therapy. 3) Historic or physical findings suggest a malignancy. 4) Indeterminant findings on cutting needle biopsy.

  8. Improving surgical site infection prevention practices through a multifaceted educational intervention.

    Owens, P


    As part of the National Clinical Programme on healthcare-associated infection prevention, a Royal College of Surgeons in Ireland (RCSI) and Royal College of Physicians of Ireland (RCPI) working group developed a quality improvement tool for prevention of surgical site infection (SS). We aimed to validate the effectiveness of an educational campaign, which utilises this quality improvement tool to prevent SSI in a tertiary hospital. Prior to the SSI educational campaign, surgical patients were prospectively audited and details of antibiotic administration recorded. Prophylactic antibiotic administration recommendations were delivered via poster and educational presentations. Post-intervention, the audit was repeated. 50 patients were audited pre-intervention, 45 post-intervention. Post-intervention, prophylaxis within 60 minutes prior to incision increased from 54% to 68% (p = 0.266). Appropriate postoperative prescribing improved from 71% to 92% (p = 0.075). A multifaceted educational program may be effective in changing SSI prevention practices.

  9. Intraocular robotic interventional surgical system (IRISS): Mechanical design, evaluation, and master-slave manipulation.

    Wilson, Jason T; Gerber, Matthew J; Prince, Stephen W; Chen, Cheng-Wei; Schwartz, Steven D; Hubschman, Jean-Pierre; Tsao, Tsu-Chin


    Since the advent of robotic-assisted surgery, the value of using robotic systems to assist in surgical procedures has been repeatedly demonstrated. However, existing technologies are unable to perform complete, multi-step procedures from start to finish. Many intraocular surgical steps continue to be manually performed. An intraocular robotic interventional surgical system (IRISS) capable of performing various intraocular surgical procedures was designed, fabricated, and evaluated. Methods were developed to evaluate the performance of the remote centers of motion (RCMs) using a stereo-camera setup and to assess the accuracy and precision of positioning the tool tip using an optical coherence tomography (OCT) system. The IRISS can simultaneously manipulate multiple surgical instruments, change between mounted tools using an onboard tool-change mechanism, and visualize the otherwise invisible RCMs to facilitate alignment of the RCM to the surgical incision. The accuracy of positioning the tool tip was measured to be 0.205±0.003 mm. The IRISS was evaluated by trained surgeons in a remote surgical theatre using post-mortem pig eyes and shown to be effective in completing many key steps in a variety of intraocular surgical procedures as well as being capable of performing an entire cataract extraction from start to finish. The IRISS represents a necessary step towards fully automated intraocular surgery and demonstrated accurate and precise master-slave manipulation for cataract removal and-through visual feedback-retinal vein cannulation. Copyright © 2017 John Wiley & Sons, Ltd.

  10. [Standardization of activities in an oncology surgical center according to nursing intervention classification].

    Possari, João Francisco; Gaidzinski, Raquel Rapone; Fugulin, Fernanda Maria Togeiro; Lima, Antônio Fernandes Costa; Kurcgant, Paulina


    This study was undertaken in a surgical center specializing in oncology, and it aimed to identify nursing activities performed during the perioperative period and to classify and validate intervention activities according to the Nursing Interventions Classification (NIC). A survey of activities was conducted using records and by direct observation of nursing care across four shifts. Activities were classified as NIC nursing interventions using the cross-mapping technique. The list of interventions was validated by nursing professionals in workshops. Forty-nine interventions were identified: 34 of direct care and 15 of indirect care. Identifying nursing interventions facilitates measuring the time spent in their execution, which is a fundamental variable in the quantification and qualification of nurses' workloads.

  11. Surgical interventions for nephrolithiasis in ankylosing spondylitis and the general population

    Jakobsen, Ane Krag; Jacobsson, Lennart T H; Patschan, Oliver


    OBJECTIVE: The aim of this study was to estimate rates and type of definitive surgical interventions for nephrolithiasis in Swedish patients with ankylosing spondylitis (AS) compared to the general population. MATERIALS AND METHODS: This national prospective cohort study linked data from Swedish...

  12. [Peculiarities of surgical interventions for the treatment of inflammatory and traumatic lesions in the frontal sinus].

    Piskunov, S Z; Kuriatina, E I; Tarasov, I V


    This paper summarizes the experience with the treatment of 275 patients presenting with inflammatory diseases and traumatic lesions of the frontal sinus. Based on the results of the present study, recommendations have been developed designed to optimize surgical interventions for the enhancement of treatment efficiency and the prevention of relapses.


    Fanta, S M


    There were examined 134 patients, in whom in the clinic in 2005-2014 yrs a coronary shunting operation was performed. In patients with the angina pectoris recurrence a reoperation is indicated. The data of repeated coronaroventriculography and shuntography were analyzed. Efficacy of the surgical and interventional methods application in the patients was proved.

  14. Surgical intervention for treating an extensive internal resorption with unfavorable crown-to-root ratio

    Rezvan Ashouri


    Full Text Available Internal resorption is a rare lesion in permanent teeth. Managing perforating internal resorption is a great challenge for dentists. This report presents a successful surgical treatment of a maxillary central incisor that had extensive root perforation due to internal resorption. After unsuccessful nonsurgical approach, during surgical intervention apical part of the resorption defect was removed and the coronal part was filled with mineral trioxide aggregate. Three years later the tooth was symptom free with normal mobility and pocket depth despite unfavorable crown-to-root ratio. This case report have shown that surgical intervention and using mineral trioxide aggregate as root canal filling material in a tooth with extensive internal resorption and unfavorable crown-to-root ratio can be considered as a treatment option.

  15. Evaluation of surgical and non-surgical interventions for clavicle fractures.

    Yang, Shengping; Zhang, Rui; Zhu, Qingling; Wang, Guan; Ding, Xuanxi; Wang, Jianmin


    The aim of this study was to review all systematic reviews and meta-analyses and provide an overview of the evidence of efficacy of interventions for clavicle fractures. The Cochrane Library, PubMed, MEDLINE, Chinese Biomedicine database, China Academic Journals Full-text Database, VIP Chinese Science and Technology Periodicals Database and Wanfang Database were searched for eligible studies using keywords related to clavicle fractures. The methodological quality of included studies was assessed using the AMSTAR assessment tool. Direct evidence was analyzed narratively. Randomized controlled trials were pooled again for meta-analysis. The GRADE approach was used in summary conclusions. The result of pooled data showed that while operative treatment had lower nonunion and malunion rates and higher patient satisfaction than non-operative treatment modalities [RR=6.57, 95% CI (3.01, 14.35), RR=6.93, 95% CI (2.99, 16.09); RR=0.68, 95% CI (0.51, 0.90)], these 3 outcomes were based on low-quality evidence. There was no difference between dissimilar operative and dissimilar non-operative treatments. Operative treatment is more effective than non-operative treatment in terms of nonunion and malunion rates and patient satisfaction. As the quality of evidence comparing efficacy between intervention methods is generally low, further original studies are needed.

  16. The feasibility of surgical salvage of thrombosed arteriovenous fistula by an interventional nephrologist

    Seong Cho


    Full Text Available Background: Salvage of a thrombosed arteriovenous fistula (AVF by secondary fistula conversion may be more effective than a conventional endovascular procedure for forearm fistula thrombosis. Surgical access procedures are an undeveloped area in interventional nephrology compared to endovascular procedures. Herein, the author report the results of surgical salvage of thrombosed AVFs by interventional nephrologists. Methods: The author retrospectively analyzed 52 surgical salvage procedures for AVF thrombosis (radiocephalic fistula = 44 cases, brachiocephalic fistula = 8 cases that were performed by interventional nephrologist between March 2007 and January 2016. Results: Secondary fistula formation using the proximal vein was performed for 46 cases (88.5%; outflow rerouting was performed for two cephalic-arch stenosis cases (3.9%, simple thrombectomy was performed for two cases (3.9%, and a graft interposition was performed for two cases (3.9%. Technical success after the surgical procedures was achieved in 51 cases (98.1%, and 39 AVFs (75.0% were prepared for immediate puncturing without catheter insertion. The primary and secondary patency rates for AVF at 6, 12, 18, and 24 months were 88.5%, 83.2%, 83.2%, and 83.2% and 96.0%, 96.0%, 93.2%, and 93.2%, respectively. The re-intervention rate was 0.27 ± 0.92/patient/ year. Conclusion: Based on these results, the author conclude that surgical salvage of a thrombosed AVF, when performed under local anesthesia by a skilled interventional nephrologist, offers favorable short- and long-term success and should be the preferred treatment.

  17. Endoscopic vs. Surgical Interventions for Painful Chronic Pancreatitis: What is Needed for Future Clinical Trials

    Windsor, John A; Reddy, Nageshwar D


    The treatment of painful chronic pancreatitis remains controversial. The available evidence from two randomized controlled trials favor surgical intervention, whereas an endotherapy-first approach is widely practiced. Chronic pancreatitis is complex disease with different genetic and environmental factors, different pain mechanisms and different treatment modalities including medical, endoscopic, and surgical. The widely practiced step-up approach remains unproven. In designing future clinical trials there are some important pre-requisites including a more comprehensive pain assessment tool, the optimization of conservative medical treatment and interventional techniques. Consideration should be given to the need of a control arm and the optimal timing of intervention. Pending better designed studies, the practical way forward is to identify subgroups of patients who clearly warrant endotherapy or surgery first, and to design the future clinical trials for the remainder. PMID:28079861

  18. Teamwork, communication and safety climate: a systematic review of interventions to improve surgical culture.

    Sacks, Greg D; Shannon, Evan M; Dawes, Aaron J; Rollo, Johnathon C; Nguyen, David K; Russell, Marcia M; Ko, Clifford Y; Maggard-Gibbons, Melinda A


    To define the target domains of culture-improvement interventions, to assess the impact of these interventions on surgical culture and to determine whether culture improvements lead to better patient outcomes and improved healthcare efficiency. Healthcare systems are investing considerable resources in improving workplace culture. It remains unclear whether these interventions, when aimed at surgical care, are successful and whether they are associated with changes in patient outcomes. PubMed, Cochrane, Web of Science and Scopus databases were searched from January 1980 to January 2015. We included studies on interventions that aimed to improve surgical culture, defined as the interpersonal, social and organisational factors that affect the healthcare environment and patient care. The quality of studies was assessed using an adapted tool to focus the review on higher-quality studies. Due to study heterogeneity, findings were narratively reviewed. The 47 studies meeting inclusion criteria (4 randomised trials and 10 moderate-quality observational studies) reported on interventions that targeted three domains of culture: teamwork (n=28), communication (n=26) and safety climate (n=19); several targeted more than one domain. All moderate-quality studies showed improvements in at least one of these domains. Two studies also demonstrated improvements in patient outcomes, such as reduced postoperative complications and even reduced postoperative mortality (absolute risk reduction 1.7%). Two studies reported improvements in healthcare efficiency, including fewer operating room delays. These findings were supported by similar results from low-quality studies. The literature provides promising evidence for various strategies to improve surgical culture, although these approaches differ in terms of the interventions employed as well as the techniques used to measure culture. Nevertheless, culture improvement appears to be associated with other positive effects, including

  19. Microsurgery robots: addressing the needs of high-precision surgical interventions.

    Mattos, Leonardo S; Caldwell, Darwin G; Peretti, Giorgio; Mora, Francesco; Guastini, Luca; Cingolani, Roberto


    Robotics has a significant potential to enhance the overall capacity and efficiency of healthcare systems. Robots can help surgeons perform better quality operations, leading to reductions in the hospitalisation time of patients and in the impact of surgery on their postoperative quality of life. In particular, robotics can have a significant impact on microsurgery, which presents stringent requirements for superhuman precision and control of the surgical tools. Microsurgery is, in fact, expected to gain importance in a growing range of surgical specialties as novel technologies progressively enable the detection, diagnosis and treatment of diseases at earlier stages. Within such scenarios, robotic microsurgery emerges as one of the key components of future surgical interventions, and will be a vital technology for addressing major surgical challenges. Nonetheless, several issues have yet to be overcome in terms of mechatronics, perception and surgeon-robot interfaces before microsurgical robots can achieve their full potential in operating rooms. Research in this direction is progressing quickly and microsurgery robot prototypes are gradually demonstrating significant clinical benefits in challenging applications such as reconstructive plastic surgery, ophthalmology, otology and laryngology. These are reassuring results offering confidence in a brighter future for high-precision surgical interventions.

  20. [The Haglund exostosis--a surgical indication and a minor intervention?].

    Huber, H M; Waldis, M


    From 1946 to 1985 a total of 594 patients with Haglund's disease were treated. 165 of the 266, who had been surgically treated were questioned extensively and 32 of them clinically and radiologically examined. Besides details of indication, surgical technique and perioperative issue, the subjective result as compared with the morphological state after removal of exostoses, was noted particularly. This necessitated the introduction of new X-ray quantification techniques in addition of the procedures described in literature. 73% good, and further 20% acceptable results confirm the indication. Nevertheless the success of the method depends largely on a good surgical technique and especially on the post-operative care.

  1. Effects of surgical intervention on trochlear remodeling in pediatric patients with recurrent patella dislocation cases.

    Sugimoto, Dai; Christino, Melissa A; Micheli, Lyle J


    Patella instability is often encountered among physically active pediatric athletes, and surgical intervention is useful in cases with recurrent patella dislocations, chronic instability, and abnormal alignment. Several surgical procedures have been used for patella-realignment and stabilization, but the effects of surgical intervention on bony trochlear remodeling in skeletally immature patients have not been well studied. We thus present two cases of pediatric recurrent patella dislocations that showed trochlear remodeling following patella-realignment surgery. The first case describes an 11-year-old female treated with a Roux-Golthwait procedure and the second case highlights a 12-year-old male treated with lateral release and medial capsular reefing. The Merchant technique, a radiographic criterion that was designed to evaluate patella alignment in relation to the femoral trochlea groove, including sulcus and congruence angles was used to measure postoperative bony development. Both pediatric patients showed successful outcomes following surgical interventions for chronic patella instability. Using the Merchant technique, both patients showed improved congruence and sulcus angles postoperatively. Patella realignment in skeletally immature patients may be beneficial for promoting trochlear remodeling and deepening of the trochlear groove, which may help protect against future dislocation or subluxation events. Level IV, case report.

  2. Central venous catheterization: comparison between interventional radiological procedure and blind surgical reocedure

    Song, Won Gyu; Jin, Gong Yong; Han, Young Min; Yu, He Chul [Chonbuk National University Medical School, Chonju (Korea, Republic of)


    To determine the usefulness and safety of radiological placement of a central venous catheter by prospectively comparing the results of interventional radiology and blind surgery. For placement of a central venous catheter, the blind surgical method was used in 78 cases (77 patients), and the interventional radiological method in 56 cases (54 patients). The male to female ratio was 66:68, and the patients' mean age was 48 (range, 18-80) years. A tunneled central venous catheter was used in 74 cases, and a chemoport in 60. We evaluated the success and duration of the procedures, the number of punctures required, and ensuing complications, comparing the results of the two methods. The success rates of the interventional radiological and the blind surgical procedure were 100% and 94.8%, respectively. The duration of central catheterization was 3-395 (mean, 120) day, that of chemoport was 160.9 days, and that of tunneled central venous catheter was 95.1 days. The mean number of punctures of the subclavian vein was 1.2 of interventional radiology, and 2.1 for blind surgery. The mean duration of the interventional radiology and the blind surgical procedure was, respectively, 30 and 40 minutes. The postprocedure complication rate was 27.6% (37 cases). Early complications occurred in nine cases (6.7%): where interventional radiology was used, there was one case of hematoma, and blind surgery gave rise to hematoma (n=2), pneumothorax (n=2), and early deviation of the catheter (n=4). Late complications occurred in 32 cases (23.9%). Interventional radiology involved infection (n=4), venous thrombosis (n=1), catheter displacement (n=2) and catheter obstruction (n=5), while the blind surgical procedure gave rise to infection (n=5), venous thrombosis (n=3), catheter displacement (n=4) and catheter obstruction (n=8). The success rate of interventional radiological placement of a central venous catheter was high and the complication rate was low. In comparison with the blind

  3. Monitoring the introduction of a surgical intervention with long-term consequences

    Gorst-Rasmussen, Anders; Spiegelhalter, D.J.; Bull, C.


    Surgical innovations are often introduced for their expected long-term benefits, but the decision to abandon the existing treatment must be based on the available short-term data and rational judgment. We present a framework for monitoring the introduction of a surgical intervention with long......-term consequences and failure-time endpoints. The framework is based on Bayesian methods, and formally combines study data, clinical opinion, and external evidence to construct a posterior survival function from which intuitive summary statistics can be extracted to aid decision making. It incorporates learning...

  4. Guidelines on the facilities required for minor surgical procedures and minimal access interventions.

    Humphreys, H


    There have been many changes in healthcare provision in recent years, including the delivery of some surgical services in primary care or in day surgery centres, which were previously provided by acute hospitals. Developments in the fields of interventional radiology and cardiology have further expanded the range and complexity of procedures undertaken in these settings. In the face of these changes there is a need to define from an infection prevention and control perspective the basic physical requirements for facilities in which such surgical procedures may be carried out. Under the auspices of the Healthcare Infection Society, we have developed the following recommendations for those designing new facilities or upgrading existing facilities. These draw upon best practice, available evidence, other guidelines where appropriate, and expert consensus to provide sensible and feasible advice. An attempt is also made to define minimal access interventions and minor surgical procedures. For minimal access interventions, including interventional radiology, new facilities should be mechanically ventilated to achieve 15 air changes per hour but natural ventilation is satisfactory for minor procedures. All procedures should involve a checklist and operators should be appropriately trained. There is also a need for prospective surveillance to accurately determine the post-procedure infection rate. Finally, there is a requirement for appropriate applied research to develop the evidence base required to support subsequent iterations of this guidance.

  5. Non-Surgical Interventions for Adolescents with Idiopathic Scoliosis: An Overview of Systematic Reviews

    Płaszewski, Maciej; Bettany-Saltikov, Josette


    Background Non-surgical interventions for adolescents with idiopathic scoliosis remain highly controversial. Despite the publication of numerous reviews no explicit methodological evaluation of papers labeled as, or having a layout of, a systematic review, addressing this subject matter, is available. Objectives Analysis and comparison of the content, methodology, and evidence-base from systematic reviews regarding non-surgical interventions for adolescents with idiopathic scoliosis. Design Systematic overview of systematic reviews. Methods Articles meeting the minimal criteria for a systematic review, regarding any non-surgical intervention for adolescent idiopathic scoliosis, with any outcomes measured, were included. Multiple general and systematic review specific databases, guideline registries, reference lists and websites of institutions were searched. The AMSTAR tool was used to critically appraise the methodology, and the Oxford Centre for Evidence Based Medicine and the Joanna Briggs Institute’s hierarchies were applied to analyze the levels of evidence from included reviews. Results From 469 citations, twenty one papers were included for analysis. Five reviews assessed the effectiveness of scoliosis-specific exercise treatments, four assessed manual therapies, five evaluated bracing, four assessed different combinations of interventions, and one evaluated usual physical activity. Two reviews addressed the adverse effects of bracing. Two papers were high quality Cochrane reviews, Three were of moderate, and the remaining sixteen were of low or very low methodological quality. The level of evidence of these reviews ranged from 1 or 1+ to 4, and in some reviews, due to their low methodological quality and/or poor reporting, this could not be established. Conclusions Higher quality reviews indicate that generally there is insufficient evidence to make a judgment on whether non-surgical interventions in adolescent idiopathic scoliosis are effective. Papers

  6. "Hybrid" and combined percutaneous and surgical intervention to treat selected cardiac patients: a new strategy.

    Presbitero, P; Gallotti, R; Belli, G; Franciosi, G; Maiello, L; Nicolini, F; Manasse, E; Citterio, E; Carcagnì, A; Foresti, A


    The term "hybrid revascularization" describes the combined use of minimally-invasive surgery without cardiopulmonary bypass and percutaneous coronary revascularization in selected cases. The theoretical advantage of a less invasive surgical intervention must be weighted against the need for additional percutaneous procedures, with their own risks and limitations. We describe our initial experience with hybrid revascularization at the Istituto Clinico Humanitas in Milan. From 7/97 to 10/98, twelve patients underwent hybrid revascularization or a combined percutaneous and surgical intervention. A "classic" hybrid approach, consisting of minimally-invasive direct coronary artery bypass to the left anterior descending coronary artery and angioplasty or stenting of arteries in the right coronary artery or circumflex territories, was used in nine patients. In three patients, myocardial revascularization could be completed with percutaneous procedures after bypass surgery without cardiopulmonary bypass (in two patients because of severe aortic calcification) or valve surgery in a patient with two previous bypass operations. In-hospital complications were observed in three patients. Two required urgent median sternotomy (one for impending cardiac tamponade, one for conversion to bypass on extra-corporeal circulation). One patient developed atheroembolism after percutaneous intervention: after hospital discharge, there was a recurrence of symptoms, clinical deterioration with renal failure and eventually death. At a mean follow-up of 152 +/- 91 days (range 17 to 283) after minimally-invasive surgery and 166 +/- 122 days (range 13 to 397) after angioplasty, all surviving patients are well and free of anginal symptoms. Closer collaboration between surgical and interventional operators may offer a novel approach to effective treatment of difficult patient subsets. However, our initial experience suggests that a cautious evaluation of possible risks and benefits must carefully

  7. Is surgical intervention more effective than non-surgical treatment for acute Achilles tendon rupture? A systematic review of overlapping meta-analyses.

    Wu, Yaohong; Lin, Linghan; Li, Hao; Zhao, Yachao; Liu, Longgang; Jia, Zhiwei; Wang, Deli; He, Qing; Ruan, Dike


    There is discordance in the results from meta-analyses on surgical versus non-surgical treatment for acute Achilles tendon rupture. We systematically reviewed the overlapping meta-analyses on this topic to provide information that will be helpful to decision makers when selecting treatments based on the current best available evidence. We comprehensively searched multiple databases for systematic reviews that compared surgical and non-surgical treatments for acute Achilles tendon rupture. We only included meta-analyses that comprised randomized controlled trials (RCTs). The methodological quality and extracted data were assessed. The meta-analysis that offered the best evidence was ascertained with the Jadad decision algorithm. Nine meta-analyses were included in our study and all of them included RCTs with Level-II evidence. Assessment of Multiple Systematic Reviews (AMSTAR) scores ranged from 5 to 10 (median 7). The Jadad decision algorithm was used to select a high-quality meta-analysis with more RCTs. The results from this study showed that when functional rehabilitation was used, non-surgical intervention was similar to surgical treatment regarding the incidence of range of motion, rerupture, calf circumference and functional outcomes, and the incidence of other complications was reduced. Non-surgical intervention significantly increased the rerupture rate if functional rehabilitation was not considered. The findings of meta-analyses regarding surgical versus non-surgical treatment for acute Achilles tendon rupture are inconsistent. According to this systematic review of overlapping meta-analyses, the current best available evidence suggests that centers offering functional rehabilitation may prefer non-surgical intervention. Surgical treatment may be preferred at centers that do not have functional rehabilitation. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  8. Towards Clinically Optimized MRI-guided Surgical Manipulator for Minimally Invasive Prostate Percutaneous Interventions: Constructive Design*

    Eslami, Sohrab; Fischer, Gregory S.; Song, Sang-Eun; Tokuda, Junichi; Hata, Nobuhiko; Tempany, Clare M.; Iordachita, Iulian


    This paper undertakes the modular design and development of a minimally invasive surgical manipulator for MRI-guided transperineal prostate interventions. Severe constraints for the MRI-compatibility to hold the minimum artifact on the image quality and dimensions restraint of the bore scanner shadow the design procedure. Regarding the constructive design, the manipulator kinematics has been optimized and the effective analytical needle workspace is developed and followed by proposing the wor...

  9. Gastrointestinal complications after cardiac transplantation. Potential benefit of early diagnoses and prompt surgical intervention.

    Kirklin, J K; Holm, A; Aldrete, J S; White, C; Bourge, R C


    Acute gastrointestinal (GI) illnesses are unusual but potentially fatal complications following cardiac transplantation. A retrospective study was performed to analyze the frequency, etiology, and severity of GI complications and the potential impact of early diagnosis and prompt surgical intervention when appropriate. Between 1981 and July 1, 1988, 31 GI complications (pancreatic, 6; colonic, 6; gastroduodenal, 6; biliary, 5; esophageal, 3; appendiceal, 2; hernia, 2; and splenic, 1) occurred in 26 patients undergoing 32 cardiac transplants. Complications were most common (14 of 31 patients, 45%) within the first 30 days after transplantation. Seventeen GI complications were treated medically (2 deaths), 2 with elective surgery and 12 with emergent operations (3 deaths). The overall mortality rate was 16%. All patients who underwent emergent operations within 3 days of onset of symptoms survived; the mean interval of onset between symptoms and operation in the nonsurvivors was 10 +/- 3.8 days. We infer that among patients requiring urgent surgical intervention, successful outcome is enhanced by intense surveillance for early symptoms, prompt diagnostic evaluation, and early surgical intervention. PMID:2339915

  10. Double-balloon enteroscopy reliably directs surgical intervention for patients with small intestinal bleeding

    Mou-Bin Lin; Lu Yin; Jian-Wen Li; Wei-Guo Hu; Qian-Jian Qian


    AIM: To evaluate preoperative double-balloon enteroscopy for determining bleeding lesions of small intestine, thus directing selective surgical intervention.METHODS: We retrospectively reviewed 56 patients who underwent double-balloon enteroscopy to localize intestinal bleeding prior to surgical intervention, and compared enteroscopic findings with those of intraoperation to determine the accuracy of enteroscopy in identifying and localizing the sites of small intestinal bleeding.RESULTS: Double-balloon enteroscopy was performed in all 56 patients in a 30-mo period. A possible site of blood loss was identified in 54 (96%) patients. Enteroscopy provided accurate localization of the bleeding in 53 (95%) of 56 patients, but failed to disclose the cause of bleeding in 4 (7%). There was one case with negative intraoperative finding (2%). Resection of the affected bowel was carried out except one patient who experienced rebleeding after operation. Gastrointestinal stromal tumor (GIST) was most frequently diagnosed (55%).CONCLUSION: Double-balloon enteroscopy is a safe, reliable modality for determining bleeding lesion of small intestine. This technique can be used to direct selective surgical intervention.

  11. The effectiveness of non-surgical interventions in the treatment of Charcot foot.

    Smith, Caroline; Kumar, Saravana; Causby, Ryan


    Background  Charcot neuropathic osteoarthropathy is commonly known as 'Charcot foot'. It is a serious foot complication of diabetes mellitus that can frequently lead to foot ulceration, gangrene, hospital admission and foot amputation. A multidisciplinary approach to the management of Charcot foot is taken involving medical and allied health professionals. The management approach may also differ between different countries. To date, there is no systematic review of the literature undertaken to identify the clinical effectiveness of non-operative interventions in the treatment of acute Charcot foot. Objective  The objective of this review was to identify the effectiveness of non-surgical interventions with reducing lesions, ulceration, the rate of surgical intervention, reducing hospital admissions and improve the quality of life of subjects with Charcot foot. Search strategy  A comprehensive search strategy was undertaken on databases available from University of South Australia from their inception to November 2006. Selection criteria  Randomised controlled trials or clinical controlled trials were primarily sought. Critical appraisal of study quality and data extraction was undertaken using Joanna Briggs Institute instruments. Review Manager software was used to calculate comparative statistics. Results  This review identified 11 trials and five trials were included in the review. Three trials involved the use of bisphosphonate, a pharmacological agent. Two experimental treatments were also included, evaluating palliative radiology and magnetic fields. No trials were found using immobilisation and off-loading interventions for acute Charcot foot. The overall methodological quality score of the five studies was moderate. Owing to heterogeneous data, meta-analysis could not be performed. The trials did not report on reducing lesions, ulceration, rate of surgical intervention, hospital admissions and the quality of life of subjects with Charcot foot. The

  12. Revisiting the effectiveness of interventions to decrease surgical site infections in colorectal surgery: A Bayesian perspective.

    Phatak, Uma R; Pedroza, Claudia; Millas, Stefanos G; Chang, George J; Lally, Kevin P; Kao, Lillian S


    To evaluate the evidence for interventions to decrease surgical site infections (SSIs) in colorectal operations using Bayesian meta-analysis. Interventions other than appropriate administration of prophylactic antibiotics to prevent SSIs have not been adopted widely, in part because of lack of recommendations for these interventions based on traditional meta-analyses. Bayesian methods can provide probabilities of specific thresholds of benefit, which may be more useful in guiding clinical decision making. We hypothesized that Bayesian meta-analytic methods would complement the interpretation of traditional analyses regarding the effectiveness of interventions to decrease SSIs. We conducted a systematic search of the Cochrane database for reviews of interventions to decrease SSIs after colorectal surgery other than prophylactic antibiotics. Traditional and Bayesian meta-analyses were performed using RevMan (Nordic Cochrane Center, Copenhagen, Denmark) and WinBUGS (MRC Biostatistics Unit, Cambridge, UK). Bayesian posterior probabilities of any benefit, defined as a relative risk of Bayesian analysis, several interventions that did not result in "significant" decreases in SSIs using traditional analytic methods had a >85% probability of benefit. Also, nonuse of 2 interventions (mechanical bowel preparation and adhesive drapes) had a high probability of decreasing SSIs compared with their use. Bayesian probabilities and traditional point estimates of treatment effect yield similar information in terms of potential effectiveness. Bayesian meta-analysis, however, provides complementary information on the probability of a large magnitude of effect. The clinical impact of using Bayesian methods to inform decisions about which interventions to institute first or which interventions to combine requires further study. Copyright © 2012 Mosby, Inc. All rights reserved.

  13. Economic modeling of surgical disease: a measure of public health interventions.

    Corlew, D Scott


    The measurement of the burden of disease and the interventions that address that burden can be done in various units. Reducing these measures to the common denominator of economic units (i.e., currency) enables comparison with other health entities, interventions, and even other fields. Economic assessment is complex, however, because of the multifactorial components of what constitutes health and what constitutes health interventions, as well as the coupling of those data to economic means. To perform economic modeling in a meaningful manner, it is necessary to: (1) define the health problem to be addressed; (2) define the intervention to be assessed; (3) define a measure of the effect of the health entity with and without the intervention (which includes defining the counterfactual); and (4) determine the appropriate method of converting the health effect to economics. This paper discusses technical aspects of how economic modeling can be done both of disease entities and of interventions. Two examples of economic modeling applied to surgical problems are then given.

  14. The role of surgical intervention in lung cancer with carcinomatous pleuritis

    Yokoi, Kohei


    Patients with non-small cell lung cancer (NSCLC) associated with carcinomatous pleuritis are currently classified as having stage IV disease per the 7th edition of the tumor-node-metastasis (TNM) system, which means that the disease is deemed incurable. In fact, the 5-year survival rate of these patients was only 2% in a large global cohort collected by the International Association for the Study of Lung Cancer. However, patients with carcinomatous pleuritis have heterogeneous conditions. Some have minimal pleural effusion, which is first detected at thoracotomy; some have numerous pleural nodules without any effusion; and others have massive effusion and nodules with symptoms. Several investigators have reported the contribution of surgical intervention to favorable outcomes of patients with carcinomatous pleuritis first detected at thoracotomy. These reports show a relatively higher 5-year survival rate of 15% to 37%. The extrapleural pneumonectomy (EPP) is a radical surgical procedure that is commonly employed in the treatment of malignant pleural mesothelioma. Two authors reported that they have successfully performed EPPs for the treatment of patients with carcinomatous pleuritis. Their 5-year survival rates were estimated to be 22% and 61%, a significantly improved outcome. Although the development of chemotherapeutic agents, including molecular targeted drugs, might have the potential to prolong the survival of patients with advanced lung cancer, surgical interventions including EPP might have a role in improving the survival of patients with carcinomatous pleuritis of minimal disease and those without massive effusion or numerous pleural nodules. PMID:27942413

  15. Nosocomial transmission of sporadic Creutzfeldt-Jakob disease: results from a risk-based assessment of surgical interventions

    de Pedro-Cuesta, Jesús; Mahillo-Fernández, Ignacio; Rábano, Alberto


    Evidence of surgical transmission of sporadic Creutzfeldt-Jakob disease (sCJD) remains debatable in part due to misclassification of exposure levels. In a registry-based case-control study, the authors applied a risk-based classification of surgical interventions to determine the association betw...

  16. Adopting epidemic model to optimize medication and surgical intervention of excess weight

    Sun, Ruoyan


    We combined an epidemic model with an objective function to minimize the weighted sum of people with excess weight and the cost of a medication and surgical intervention in the population. The epidemic model is consisted of ordinary differential equations to describe three subpopulation groups based on weight. We introduced an intervention using medication and surgery to deal with excess weight. An objective function is constructed taking into consideration the cost of the intervention as well as the weight distribution of the population. Using empirical data, we show that fixed participation rate reduces the size of obese population but increases the size for overweight. An optimal participation rate exists and decreases with respect to time. Both theoretical analysis and empirical example confirm the existence of an optimal participation rate, u*. Under u*, the weighted sum of overweight (S) and obese (O) population as well as the cost of the program is minimized. This article highlights the existence of an optimal participation rate that minimizes the number of people with excess weight and the cost of the intervention. The time-varying optimal participation rate could contribute to designing future public health interventions of excess weight.

  17. Is Staphylococcal Screening and Suppression an Effective Interventional Strategy for Reduction of Surgical Site Infection?

    Edmiston, Charles E; Ledeboer, Nathan A; Buchan, Blake W; Spencer, Maureen; Seabrook, Gary R; Leaper, David


    Staphylococcus aureus has been recognized as a major microbial pathogen for over 100 y, having the capacity to produce a variety of suppurative and toxigenic disease processes. Many of these infections are life-threatening, with particularly enhanced virulence in hospitalized patients with selective risk factors. Strains of methicillin-resistant Staphylococcus aureus (MRSA) have rapidly spread throughout the healthcare environment such that approximately 20% of S. aureus isolates recovered from surgical site infections are methicillin-resistant, (although this is now reducing following national screening and suppression programs and high impact interventions). Widespread nasal screening to identify MRSA colonization in surgical patients prior to admission are controversial, but selective, evidence-based studies have documented a reduction of surgical site infection (SSI) after screening and suppression. Culture methods used to identify MRSA colonization involve selective, differential, or chromogenic media. These methods are the least expensive, but turnaround time is 24-48 h. Although real-time polymerase chain reaction (RT-PCR) technology provides rapid turnaround (1-2 h) with exceptional testing accuracy, the costs can range from three to 10 times more than conventional culture methodology. Topical mupirocin, with or without pre-operative chlorhexidine showers or skin wipes, is the current "gold-standard" for nasal decolonization, but inappropriate use of mupirocin is associated with increasing staphylococcal resistance. Selection of an effective active universal or targeted surveillance strategy should be based upon the relative risk of MSSA or MRSA surgical site infection in patients undergoing orthopedic or cardiothoracic device related surgical procedures.

  18. Effect of a "Lean" intervention to improve safety processes and outcomes on a surgical emergency unit.

    McCulloch, Peter; Kreckler, Simon; New, Steve; Sheena, Yezen; Handa, Ashok; Catchpole, Ken


    Emergency surgical patients are at high risk for harm because of errors in care. Quality improvement methods that involve process redesign, such as “Lean,” appear to improve service reliability and efficiency in healthcare. Interrupted time series. The emergency general surgery ward of a university hospital in the United Kingdom. Seven safety relevant care processes. A Lean intervention targeting five of the seven care processes relevant to patient safety. 969 patients were admitted during the four month study period before the introduction of the Lean intervention (May to August 2007), and 1114 were admitted during the four month period after completion of the intervention (May to August 2008). Compliance with the five process measures targeted for Lean intervention (but not the two that were not) improved significantly (relative improvement 28% to 149%; PLean can substantially and simultaneously improve compliance with a bundle of safety related processes. Given the interconnected nature of hospital care, this strategy might not translate into improvements in safety outcomes unless a system-wide approach is adopted to remove barriers to change.

  19. Current and emerging treatments and surgical interventions for Morquio A syndrome: a review.

    Tomatsu, Shunji; Mackenzie, William G; Theroux, Mary C; Mason, Robert W; Thacker, Mihir M; Shaffer, Thomas H; Montaño, Adriana M; Rowan, Daniel; Sly, William; Alméciga-Díaz, Carlos J; Barrera, Luis A; Chinen, Yasutsugu; Yasuda, Eriko; Ruhnke, Kristen; Suzuki, Yasuyuki; Orii, Tadao


    Patients with mucopolysaccharidosis type IVA (MPS IVA; Morquio A syndrome) have accumulation of the glycosaminoglycans, keratan sulfate, and chondroitin-6-sulfate, in bone and cartilage, causing systemic spondyloepiphyseal dysplasia. Features include lumbar gibbus, pectus carinatum, faring of the rib cage, marked short stature, cervical instability and stenosis, kyphoscoliosis, genu valgum, and laxity of joints. Generally, MPS IVA patients are wheelchair-bound as teenagers and do not survive beyond the second or third decade of life as a result of severe bone dysplasia, causing restrictive lung disease and airway narrowing, increasing potential for pneumonia and apnea; stenosis and instability of the upper cervical region; high risk during anesthesia administration due to narrowed airway as well as thoracoabdominal dysfunction; and surgical complications. Patients often need multiple surgical procedures, including cervical decompression and fusion, hip reconstruction and replacement, and femoral or tibial osteotomy, throughout their lifetime. Current measures to intervene in disease progression are largely palliative, and improved therapies are urgently needed. A clinical trial for enzyme replacement therapy (ERT) and an investigational trial for hematopoietic stem cell transplantation (HSCT) are underway. Whether sufficient enzyme will be delivered effectively to bone, especially cartilage (avascular region) to prevent the devastating skeletal dysplasias remains unclear. This review provides an overview of historical aspects of studies on MPS IVA, including clinical manifestations and pathogenesis of MPS IVA, orthopedic surgical interventions, and anesthetic care. It also describes perspectives on potential ERT, HSCT, and gene therapy.

  20. Surgical interventions in patients undergoing percutaneous balloon mitral valvotomy : a retrospective analysis of anaesthetic considerations.

    Tempe Deepak


    Full Text Available Between 1990 and 2000, 5499 balloon mitral valvotomies were performed at GB Pant Hospital. Amongst these, 45 patients required surgical intervention, which form the basis of this report. There were 18 males and 27 females with the mean age of 26.5+/-8.3 years and weight of 42.9+/-7.39 kg. Thirty-five patients underwent open-heart surgery and 10 closed-heart surgery. Twenty-five patients developed acute severe mitral regurgitation during balloon mitral valvotomy and required emergency open-heart surgery. Morphine based anaesthetic technique with careful attention to haemodynamic monitoring was used in these patients. All patients required a high inotropic support to terminate the cardiopulmonary bypass. The closed-heart surgical procedures included emergency exploration for cardiac tamponade (4, exploration + closed mitral valvotomy (4, and elective closed mitral valvotomy (2. The overall mortality was 9%, which is much higher than the reported mortality for elective mitral valve replacement. Morphine based anaesthetic technique is useful in these patients. Adequate oxygenation, vasodilators, inotropes and diuretics are required for preoperative stabilisation of patients who develop acute mitral regurgitation, while those who develop cardiac tamponade need volume replacement along with inotropes and immediate surgical decompression of the tamponade.

  1. A Systematic Review of Current Surgical Interventions for Charcot Neuroarthropathy of the Midfoot.

    Shazadeh Safavi, Pejma; Jupiter, Daniel; Panchbhavi, Vinod


    Charcot neuroarthropathy of the foot, or Charcot foot, is a pathologic entity of the foot, associated with diabetes mellitus. Owing to the increase of diabetes mellitus in developed nations worldwide, the prevalence of Charcot foot has been increasing. The initial treatment of Charcot foot is often conservative, with methods including bracing, casting, and the use of customized orthopedic shoes. However, many cases of Charcot foot eventually require surgery, because the consequent destabilization of the foot associated with bone, joint, and nerve injury due to the pathology eventually leave patients unable to walk independently. The present systematic review analyzed the published data regarding surgical interventions for midfoot Charcot deformities and estimated the rates of common complications occurring with the surgical modalities studied. The main outcomes of interest analyzed in the present study were postoperative amputation and bony fusion. The included cohort of patients with Charcot foot was very heterogeneous in terms of the demographic and comorbid characteristics. However, even with this heterogeneity, the present study should provide useful information to surgeons in terms of the outcomes after some of the common surgical procedures for midfoot Charcot. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Current and emerging treatments and surgical interventions for Morquio A syndrome: a review

    Tomatsu, Shunji; Mackenzie, William G; Theroux, Mary C; Mason, Robert W; Thacker, Mihir M; Shaffer, Thomas H; Montaño, Adriana M; Rowan, Daniel; Sly, William; Alméciga-Díaz, Carlos J; Barrera, Luis A; Chinen, Yasutsugu; Yasuda, Eriko; Ruhnke, Kristen; Suzuki, Yasuyuki; Orii, Tadao


    Patients with mucopolysaccharidosis type IVA (MPS IVA; Morquio A syndrome) have accumulation of the glycosaminoglycans, keratan sulfate, and chondroitin-6-sulfate, in bone and cartilage, causing systemic spondyloepiphyseal dysplasia. Features include lumbar gibbus, pectus carinatum, faring of the rib cage, marked short stature, cervical instability and stenosis, kyphoscoliosis, genu valgum, and laxity of joints. Generally, MPS IVA patients are wheelchair-bound as teenagers and do not survive beyond the second or third decade of life as a result of severe bone dysplasia, causing restrictive lung disease and airway narrowing, increasing potential for pneumonia and apnea; stenosis and instability of the upper cervical region; high risk during anesthesia administration due to narrowed airway as well as thoracoabdominal dysfunction; and surgical complications. Patients often need multiple surgical procedures, including cervical decompression and fusion, hip reconstruction and replacement, and femoral or tibial osteotomy, throughout their lifetime. Current measures to intervene in disease progression are largely palliative, and improved therapies are urgently needed. A clinical trial for enzyme replacement therapy (ERT) and an investigational trial for hematopoietic stem cell transplantation (HSCT) are underway. Whether sufficient enzyme will be delivered effectively to bone, especially cartilage (avascular region) to prevent the devastating skeletal dysplasias remains unclear. This review provides an overview of historical aspects of studies on MPS IVA, including clinical manifestations and pathogenesis of MPS IVA, orthopedic surgical interventions, and anesthetic care. It also describes perspectives on potential ERT, HSCT, and gene therapy. PMID:24839594

  3. Early results of surgical intervention for elbow deformity in cerebral palsy based on degree of contracture.

    Carlson, Michelle G; Hearns, Krystle A; Inkellis, Elizabeth; Leach, Michelle E


    Elbow flexion posture, caused by spasticity of the muscles on the anterior surface of the elbow, is the most common elbow deformity seen in patients with cerebral palsy. This study retrospectively evaluated early results of 2 surgical interventions for elbow flexion deformities based on degree of contracture. We hypothesized that by guiding surgical treatment to degree of preoperative contracture, elbow extension and flexion posture angle at ambulation could be improved while preserving maximum flexion. Eighty-six patients (90 elbows) were treated for elbow spasticity due to cerebral palsy. Seventy-one patients (74 elbows) were available for follow-up. Fifty-seven patients with fixed elbow contractures less than 45° were surgically treated with a partial elbow muscle lengthening, which included partial lengthening of the biceps and brachialis and proximal release of the brachioradialis. Fourteen patients (17 elbows) with fixed elbow contractures ≥ 45° had a more extensive full elbow release, with biceps z-lengthening, partial brachialis myotomy, and brachioradialis proximal release. Age at surgery averaged 10 years (range, 3-20 y) for partial lengthening and 14 years (range, 5-20 y) for full elbow release. Follow-up averaged 22 months (range, 7-144 mo) for partial lengthening and 18 months (range, 6-51 mo) for full elbow release. Both groups achieved meaningful improvement in flexion posture angle at ambulation, active and passive extension, and total range of motion. Elbow flexion posture angle at ambulation improved by 57° and active extension increased 17° in the partial lengthening group, with a 4° loss of active flexion. In the full elbow release group, elbow flexion posture angle at ambulation improved 51° and active extension improved 38°, with a loss of 19° of active flexion. Surgical treatment of spastic elbow flexion in cerebral palsy can improve deformity. We obtained excellent results by guiding the surgical intervention by the amount of

  4. Novel ways to explore surgical interventions in randomised controlled trials: applying case study methodology in the operating theatre.

    Blencowe, Natalie S; Blazeby, Jane M; Donovan, Jenny L; Mills, Nicola


    Multi-centre randomised controlled trials (RCTs) in surgery are challenging. It is particularly difficult to establish standards of surgery and ensure that interventions are delivered as intended. This study developed and tested methods for identifying the key components of surgical interventions and standardising interventions within RCTs. Qualitative case studies of surgical interventions were undertaken within the internal pilot phase of a surgical RCT for obesity (the By-Band study). Each case study involved video data capture and non-participant observation of gastric bypass surgery in the operating theatre and interviews with surgeons. Methods were developed to transcribe and synchronise data from video recordings with observational data to identify key intervention components, which were then explored in the interviews with surgeons. Eight qualitative case studies were undertaken. A novel combination of video data capture, observation and interview data identified variations in intervention delivery between surgeons and centres. Although surgeons agreed that the most critical intervention component was the size and shape of the gastric pouch, there was no consensus regarding other aspects of the procedure. They conceded that evidence about the 'best way' to perform bypass was lacking and, combined with the pragmatic nature of the By-Band study, agreed that strict standardisation of bypass might not be required. This study has developed and tested methods for understanding how surgical interventions are designed and delivered delivered in RCTs. Applying these methods more widely may help identify key components of interventions to be delivered by surgeons in trials, enabling monitoring of key components and adherence to the protocol. These methods are now being tested in the context of other surgical RCTs. Current Controlled Trials ISRCTN00786323 , 05/09/2011.

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

    Narayan H Gandedkar


    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.

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

    Gandedkar, Narayan H; Chng, Chai Kiat; Yeow, Vincent Kok Leng


    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.

  7. Use of the nursing intervention classification for identifying the workload of a nursing team in a surgical center

    João Francisco Possari; Raquel Rapone Gaidzinski; Antônio Fernandes Costa Lima; Fernanda Maria Togeiro Fugulin; Tracy Heather Herdman


    Objective: to analyze the distribution of nursing professionals' workloads, according to the Nursing Intervention Classification (NIC), during the transoperative period at a surgical center specializing in oncology. Methods: this was an observational and descriptive cross-sectional study. The sample consisted of 11 nurses, 25 nursing technicians who performed a variety of roles within the operating room, 16 nursing technicians who worked with the surgical instrumentation and two nursing techn...

  8. Interventional and surgical treatment of cardiac arrhythmias in adults with congenital heart disease.

    Koyak, Zeliha; de Groot, Joris R; Mulder, Barbara J M


    Arrhythmias are a major cause of morbidity, mortality and hospital admission in adults with congenital heart disease (CHD). The etiology of arrhythmias in this population is often multifactorial and includes electrical disturbances as part of the underlying defect, surgical intervention or hemodynamic abnormalities. Despite the numerous existing arrhythmia management tools including drug therapy, pacing and ablation, management of arrhythmias in adults with CHD remains difficult and challenging. Owing to improvement in mapping and ablation techniques, ablation and arrhythmia surgery are being performed more frequently in adults with CHD. However, there is little information on the long-term results of these treatment strategies. The purpose of this article is therefore to review the available data on nonpharmacological treatment of cardiac arrhythmias in adult patients with CHD and to give an overview of the available data on the early and late outcomes of these treatment strategies.

  9. Towards Clinically Optimized MRI-guided Surgical Manipulator for Minimally Invasive Prostate Percutaneous Interventions: Constructive Design.

    Eslami, Sohrab; Fischer, Gregory S; Song, Sang-Eun; Tokuda, Junichi; Hata, Nobuhiko; Tempany, Clare M; Iordachita, Iulian


    This paper undertakes the modular design and development of a minimally invasive surgical manipulator for MRI-guided transperineal prostate interventions. Severe constraints for the MRI-compatibility to hold the minimum artifact on the image quality and dimensions restraint of the bore scanner shadow the design procedure. Regarding the constructive design, the manipulator kinematics has been optimized and the effective analytical needle workspace is developed and followed by proposing the workflow for the manual needle insertion. A study of the finite element analysis is established and utilized to improve the mechanism weaknesses under some inevitable external forces to ensure the minimum structure deformation. The procedure for attaching a sterile plastic drape on the robot manipulator is discussed. The introduced robotic manipulator herein is aimed for the clinically prostate biopsy and brachytherapy applications.

  10. Towards Clinically Optimized MRI-guided Surgical Manipulator for Minimally Invasive Prostate Percutaneous Interventions: Constructive Design*

    Eslami, Sohrab; Fischer, Gregory S.; Song, Sang-Eun; Tokuda, Junichi; Hata, Nobuhiko; Tempany, Clare M.; Iordachita, Iulian


    This paper undertakes the modular design and development of a minimally invasive surgical manipulator for MRI-guided transperineal prostate interventions. Severe constraints for the MRI-compatibility to hold the minimum artifact on the image quality and dimensions restraint of the bore scanner shadow the design procedure. Regarding the constructive design, the manipulator kinematics has been optimized and the effective analytical needle workspace is developed and followed by proposing the workflow for the manual needle insertion. A study of the finite element analysis is established and utilized to improve the mechanism weaknesses under some inevitable external forces to ensure the minimum structure deformation. The procedure for attaching a sterile plastic drape on the robot manipulator is discussed. The introduced robotic manipulator herein is aimed for the clinically prostate biopsy and brachytherapy applications. PMID:24683502

  11. Effect of music on surgical hand disinfection: a video-based intervention study.

    Gautschi, N; Marschall, J; Candinas, D; Banz, V M


    Surgical hand disinfection (SHD) is likely to be influenced by various factors. The aim of this study was to evaluate the effect of listening to music on the duration of SHD. In total, 236 SHD procedures were recorded on video. The duration of SHD exceeded 2min in both the intervention group and the control group, with background music unable to achieve an increase in the time spent scrubbing. However, listening to music reduced the proportion of very short scrub times (<90s) from 17% to 9% (P=0.07). The following four factors increased mean scrub time significantly: female sex; lower staff seniority; scrubbing hands in groups; and use of a stopwatch. Although the improvement observed did not reach significance, it is suggested that background music may be useful for the 10% of healthcare workers who perform very short scrubs.

  12. Surgical Versus Conservative Intervention for Acute Achilles Tendon Rupture: A PRISMA-Compliant Systematic Review of Overlapping Meta-Analyses.

    Zhang, Hao; Tang, Hao; He, Qianyun; Wei, Qiang; Tong, Dake; Wang, Chuangfeng; Wu, Dajiang; Wang, Guangchao; Zhang, Xin; Ding, Wenbin; Li, Di; Ding, Chen; Liu, Kang; Ji, Fang


    Although many meta-analyses comparing surgical intervention with conservative treatment have been conducted for acute Achilles tendon rupture, discordant conclusions are shown. This study systematically reviewed the overlapping meta-analyses relating to surgical versus conservative intervention of acute Achilles tendon rupture to assist decision makers select among conflicting meta-analyses, and to offer intervention recommendations based on the currently best evidence.Multiple databases were comprehensively searched for meta-analyses comparing surgical with conservative treatment of acute Achilles tendon rupture. Meta-analyses only comprising randomized controlled trials (RCTs) were included. Two authors independently evaluated the meta-analysis quality and extracted data. The Jadad decision algorithm was applied to ascertain which meta-analysis offered the best evidence.A total of 9 meta-analyses were included. Only RCTs were determined as Level-II evidence. The scores of Assessment of Multiple Systematic Reviews (AMSTAR) ranged from 5 to 10 (median 7). A high-quality meta-analysis with more RCTs was selected according to the Jadad decision algorithm. This study found that when functional rehabilitation was used, conservative intervention was equal to surgical treatment regarding the incidence of rerupture, range of motion, calf circumference, and functional outcomes, while reducing the incidence of other complications. Where functional rehabilitation was not performed, conservative intervention could significantly increase rerupture rate.Conservative intervention may be preferred for acute Achilles tendon rupture at centers offering functional rehabilitation, because it shows a similar rerupture rate with a lower risk of other complications when compared with surgical treatment. However, surgical treatment should be considered at centers without functional rehabilitation as this can reduce the incidence of rerupture.

  13. Patient survival and surgical re-intervention predictors for intracapsular hip fractures.

    González Quevedo, David; Mariño, Iskandar Tamimi; Sánchez Siles, Juan Manuel; Escribano, Esther Romero; Granero Molina, Esther Judith; Enrique, David Bautista; Smoljanović, Tomislav; Pareja, Francisco Villanueva


    Choosing between total hip replacement (THR) and partial hip replacement (PHR) for patients with intracapsular hip fractures is often based on subjective factors. Predicting the survival of these patients and risk of surgical re-intervention is essential to select the most adequate implant. We conducted a retrospective cohort study on mortality of patients over 70 years with intracapsular hip fractures who were treated between January 2010 and December 2013, with either PHR or THR. Patients' information was withdrawn from our local computerized database. The age-adjusted Charlson comorbidity index (ACCI) and American Society of Anesthesiologists (ASA) score were calculated for all patients. The patients were followed for 2 years after surgery. Survival and surgical re-intervention rates were compared between the two groups using a Multivariate Cox proportional hazard model. A total of 356 individuals were included in this study. At 2 years of follow-up, 221 (74.4%) of the patients with ACCI score≤7 were still alive, in contrast to only 20 (29.0%) of those with ACCI score>7. In addition, 201 (76.2%) of the patients with ASA score≤3 were still alive after 2 years, compared to 30 (32.6%) of individuals with ASA >3. Patients with the ACCI score>7, and ASA score>3 had a significant increase in all-cause 2-year mortality (adjusted hazard ratio of 3.2, 95% CI 2.2-4.6; and 3.12, 95% CI 2.2-4.5, respectively). Patients with an ASA score>3 had a quasi-significant increase in the re-intervention risk (adjusted hazard ratio 2.2, 95% CI 1.0-5.1). The sensitivity, specificity, positive predictive value and negative predictive values of ACCI in predicting 2-year mortality were 39.2%, 91.1%, 71%, and 74.4%, respectively. On the other hand, the sensitivity, specificity, positive predictive value and negative predictive values of ASA score in predicting 2-year mortality were 49.6%, 79.1%, 67.4%, and 76.1%, respectively. Both ACCI and ASA scales were able to predict the 2-year

  14. The Helminths Causing Surgical or Endoscopic Abdominal Intervention: A Review Article

    Erdal UYSAL


    Full Text Available Background: Helminths sometimes require surgical or endoscopic intervention. Helminths may cause acute abdomen, mechanical intestinal obstruction, gastrointestinal hemorrhage, perforation, hepatitis, pancreatitis, and appendicitis. This study aimed to determine the surgical diseases that helminths cause and to gather, analyze the case reports, case series and original articles about this topic in literature.Methods: This study was designed as a retrospective observational study. In order to determine the studies published in literature, the search limits in PubMed database were set to 1 Jan 1957 and 31 Mar 2016 (59 yr, and the articles regarding Helminth-Surgery-Endoscopy were taken into examination. Among 521 articles scanned, 337 specific ones were involved in this study.Results: The most common surgical pathology was found to be in Ascaris lumbricoides group. Enterobius vermicularis was found to be the parasite that caused highest amount of acute appendicitis. Anisakiasis was observed to seem mainly because of abdominal pain and mechanical intestinal obstruction. Strongyloides stercoraries causes duodenal pathologies such as duodenal obstruction and duodenitis. Taenia saginata comes into prominence with appendicitis and gastrointestinal perforations. Fasciola hepatica exhibits biliary tract involvement and causes common bile duct obstruction. Hookworms were observed to arise along with gastrointestinal hemorrhage and anemia. Trichuris trichiuria draws attention with gastrointestinal hemorrhage, mechanical intestinal obstruction.Conclusion: Helminths may lead to life-threatening clinic conditions such as acute abdomen, gastrointestinal perforation, intestinal obstruction, and hemorrhages. There is a relationship between surgery and helminths. It is very important for surgeons to consider and remember helminths in differential diagnoses during their daily routines.

  15. Surgical interventions for anterior shoulder instability in rugby players: A systematic review

    Sabharwal, Sanjeeve; Patel, Nirav K; Bull, Anthony MJ; Reilly, Peter


    AIM: To systematically evaluate the evidence-based literature on surgical treatment interventions for elite rugby players with anterior shoulder instability. METHODS: We conducted a systematic review according to the PRISMA guidelines. A literature search was performed in PubMed, EMBASE and Google Scholar using the following search terms: “rugby” and “shoulder” in combination with “instability” or “dislocation”. All articles published from inception of the included data sources to January 1st 2014 that evaluated surgical treatment of elite rugby players with anterior shoulder instability were examined. RESULTS: Only five studies were found that met the eligibility criteria. A total of 379 shoulders in 376 elite rugby union and league players were included. All the studies were retrospective cohort or case series studies. The mean Coleman Methodological Score for the 5 studies was 47.4 (poor). Owing to heterogeneity amongst the studies, quantitative synthesis was not possible, however a detailed qualitative synthesis is reported. The overall recurrence rate of instability after surgery was 8.7%, and the mean return to competitive play, where reported, was 13 mo. CONCLUSION: Arthroscopic stabilization has been performed successfully in acute anterior instability and there is a preference for open Latarjet-type procedures when instability is associated with osseous defects. PMID:25992318

  16. A case of autoimmune cholangitis misdiagnosed for cholangiocarcinoma: How to avoid unnecessary surgical intervention?

    Ignjatović Igor I.


    Full Text Available Introduction. Autoimmune cholangitis or immunoglobulin G4-associated cholangitis (IAC has been recently regarded as a new clinical and histopathological entity and is a part of a complex autoimmune disorder - IgG4-related systemic disease (ISD. ISD is an autoimmune disease with multi-organic involvement, characterized with IgG4-positive plasmocytic infiltration of various tissues and organs with a consequent sclerosis, which responds well to steroid therapy. Most commonly affected organs are the pancreas (autoimmune pancreatitis, [AIP] and the common bile duct (IAC. IAC and cholangiocarcinoma (CCA share many clinical, laboratory and imaging findings. Case Outline. We present a case of a 60-year-old male with a biliary stricture of a common bile duct, which was clinically considered as a bile duct carcinoma and treated surgically. Definite histopathological findings and immunohistochemistry revealed profound chronic inflammation, showing lymphoplasmacytic IgG-positive infiltration of a resected part of a common bile duct, highly suggestive for the diagnosis of IAC. In addition, postoperative IgG4 serum levels were also increased. Conclusion. It is of primary clinical importance to make a difference between IAC and CCA, in order to avoid unnecessary surgical intervention. Therefore, IAC should be considered in differential diagnosis in similar cases.

  17. Time Trade-off Utility Analysis for Surgical Intervention in Comitant Strabismus, Glaucoma, and Cataract



    Full Text Available The utility value was compared among 3 surgical interventions, and the validity of the time trade-off (TTO method was evaluated by analyzing the correlations of the utility value with the results of the Visual Function Questionnaire-14 (VF-14 and other variables. The subjects were 127 patients aged 40-85 years who were surgically treated between January 2008 and March 2010, including 26 patients with glaucoma, 50 with cataracts, and 51 with comitant strabismus. The scores on VF-14 and utility values determined using TTO were calculated retrospectively. The mean value (SD of the utility gain was 0.096 (0.105 for glaucoma, 0.101 (0.105 for comitant strabismus, and 0.167 (0.237 for unilateral and 0.245 (0.167 for bilateral cataracts, indicating significant postoperative improvements in the utility value. A significant correlation was observed between the utility value and the postoperative VF-14 scores of the bilateral cataracts, and the postoperative visual acuity of the better eye of the unilateral cataract. The mean value of the quality-adjusted life years was 2.181 for bilateral and 1.424 for unilateral cataracts, 1.132 for strabismus, and 0.870 for glaucoma with an annual discount rate of 3%. The gain of utility value was highest in bilateral cataracts, and lowest in glaucoma, and thus the TTO analysis was considered to be highly valid for cataract surgery.

  18. Effect of a supervised exercise and physiotherapy program on surgical interventions in children with thermal injury.

    Celis, Mario M; Suman, Oscar E; Huang, Ted T; Yen, Peter; Herndon, David N


    Continuous body growth and rigidity of scars in children are significant contributors to burn scar contractures (BSCs). BSCs decrease a patient's range of motion and their ability to perform activities of daily living. A benefit of exercise is an increase the patient's ability to perform and sustain activities of daily living. Therefore, we investigated whether patients who were involved in a supervised, hospital-based exercise program, in addition to physical and occupational therapy (PTEX), would have fewer surgical interventions than a nonexercise group receiving home-delivered physical and occupational therapy (PT) alone. We examined 53 patients at 6, 9, 12, 18, and 24 months postburn. The PTEX group (n = 27) completed a 12-week supervised exercise program starting at 6 months postburn. Exercise sessions were held three times per week, with duration of 60 to 90 minutes per session. Resistance and aerobic exercises were performed at 70 to 85% of the patient's maximal effort. In contrast, the PT group (n = 26) received a home rehabilitation program with no supervised exercise. Patients were evaluated at 3-month intervals for scar formation, range of motion, and need for surgery. At 12, 18, 24 months postburn, the number of patients in the PTEX group needing release of BSC was significantly lower than the number of patients in the PT group. The results indicate that patients would receive a significant benefit if enrolled in a supervised exercise and physiotherapy program with the exercise portion consisting of an aerobic and resistance-training component. This type of program is beneficial in decreasing the number of surgical interventions and should be incorporated as part of a postburn outpatient rehabilitation.

  19. Use of the nursing intervention classification for identifying the workload of a nursing team in a surgical center

    João Francisco Possari


    Full Text Available Objective: to analyze the distribution of nursing professionals' workloads, according to the Nursing Intervention Classification (NIC, during the transoperative period at a surgical center specializing in oncology.Methods: this was an observational and descriptive cross-sectional study. The sample consisted of 11 nurses, 25 nursing technicians who performed a variety of roles within the operating room, 16 nursing technicians who worked with the surgical instrumentation and two nursing technicians from patient reception who worked in the surgical center during the transoperative period. An instrument was developed to collect data and the interventions were validated according to NIC taxonomy.Results: a total of 266 activities were identified and mapped into 49 nursing interventions, seven domains and 20 classes of the NIC. The most representative domains were Physiological-Complex (61.68% and Health System (22.12%, while the most frequent interventions were Surgical Care (30.62% and Documentation (11.47%, respectively. The productivity of the nursing team reached 95.34%.Conclusions: use of the Nursing Intervention Classification contributes towards the discussion regarding adequate, professional nursing staffing levels, because it shows the distribution of the work load.

  20. Case Report: A Non-Surgical, Non-Pharmacologic, Mind-Body Intervention for Ovarian Tumor

    Laurie Nadel


    Full Text Available A 60-year old female patient designed an experimental protocol of distant prayer, Reiki, and guided imagery to successfully treat an ovarian tumor measuring 2.5 centimeters. Background: On October 8, 2008, multiplanar imaging using T1-T2 weighted technique/MRI of patient’s lumbar spine reported “a suspected cyst within the right ovary measuring 2.5 centimeters” [1]. Patient: The patient is a psychologist who is also a Reiki master. Her decision to experiment with prayer, Reiki and guided imagery was due to the size of the tumor which was smaller than the 3 cm. required for surgical intervention. Setting: The patient’s home office was the setting for the experiment. Intervention: Due to a medical crisis in the patient’s family, she was delayed in scheduling an office visit with an obstetrician/gynecologist to follow up the findings in the MRI report of 10/8/08. On 10/10/08, she sent an email request to five Reiki masters to request distant Reiki be transmitted to the “suspected cyst.” The Reiki masters emailed their students, asking that they transmit Reiki to the patient’s right ovary.

  1. Developing a tool to measure pharmacoeconomic outcomes of post-surgical pain management interventions.

    Keller, Deborah S; Smalarz, Amy; Haas, Eric M


    Financial pressures have limited the ability of providers to use medication that may improve clinical outcomes and patient satisfaction. New interventions are often fraught with resistance from individual cost centers. A value realization tool (VRT) is essential for separate cost centers to communicate and comprehend the overall financial and clinical implications of post-surgical pain management medication interventions (PSMI). The goal was to describe development of a VRT. An evaluation of common in-patient PSMI approaches, impacts, and costs was performed. A multidisciplinary task force guided development of the VRT to ensure appropriate representation and relevance to clinical practice. The main outcome was an Excel-based tool that communicates the overall cost/benefit of PSMI for the post-operative patient encounter. The VRT aggregated input data on costs, clinical impact, and nursing burden of PSMI assessment and monitoring into two high-level outcome reports: Overall Cost Impact and Nurse & Patient Impact. Costs included PSMI specific medication, equipment, professional placement, labor, overall/opioid-related adverse events, re-admissions, and length of stay. Nursing impact included level of practice interference, job satisfaction, and patient care metrics. Patient impact included pain scores, opioid use, PACU time, and satisfaction. Reference data was provided for individual institutions that may not collect all variables included in the VRT. The VRT is a valuable way for administrators to assess PSMI cost/benefits and for individual cost centers to see the overall value of individual interventions. The user-friendly, decision-support tool allows the end-user to use built-in referenced or personalized outcome data, increasing relevance to their institutions. This broad picture could facilitate communication across cost centers and evidence-based decisions for appropriate use and impacts of PSMI.

  2. Behavioral approach with or without surgical intervention to the vulvar vestibulitis syndrome : A prospective randomized and non randomized study

    Schultz, WCMW; Gianotten, WL; vanderMeijden, WI; vandeWiel, HBM; Blindeman, L; Chadha, S; Drogendijk, AC


    This article describes the outcome of a behavioral approach with or without preceding surgical intervention in 48 women with the vulvar vestibulitis syndrome. In the first part of the study, 14 women with the vulvar vestibulitis syndrome were randomly assigned to one of two treatment programs: eithe

  3. Current and emerging treatments and surgical interventions for Morquio A syndrome: a review

    Tomatsu S


    clinical trial for enzyme replacement therapy (ERT and an investigational trial for hematopoietic stem cell transplantation (HSCT are underway. Whether sufficient enzyme will be delivered effectively to bone, especially cartilage (avascular region to prevent the devastating skeletal dysplasias remains unclear. This review provides an overview of historical aspects of studies on MPS IVA, including clinical manifestations and pathogenesis of MPS IVA, orthopedic surgical interventions, and anesthetic care. It also describes perspectives on potential ERT, HSCT, and gene therapy.Keywords: mucopolysaccharidosis IVA, keratan sulfate, GALNS, enzyme replacement therapy, gene therapy, hematopoietic stem cell transplantation

  4. Surgical nurses' attitudes towards caring for patients dying of cancer - a pilot study of an educational intervention on existential issues.

    Udo, C; Melin-Johansson, C; Henoch, I; Axelsson, B; Danielson, E


    This is a randomised controlled pilot study using a mixed methods design. The overall aim was to test an educational intervention on existential issues and to describe surgical nurses' perceived attitudes towards caring for patients dying of cancer. Specific aims were to examine whether the educational intervention consisting of lectures and reflective discussions, affects nurses' perceived confidence in communication and to explore nurses' experiences and reflections on existential issues after participating in the intervention. Forty-two nurses from three surgical wards at one hospital were randomly assigned to an intervention or control group. Nurses in both groups completed a questionnaire at equivalent time intervals: at baseline before the educational intervention, directly after the intervention, and 3 and 6 months later. Eleven face-to-face interviews were conducted with nurses directly after the intervention and 6 months later. Significant short-term and long-term changes were reported. Main results concerned the significant long-term effects regarding nurses' increased confidence and decreased powerlessness in communication, and their increased feelings of value when caring for a dying patient. In addition, nurses described enhanced awareness and increased reflection. Results indicate that an understanding of the patient's situation, derived from enhanced awareness and increased reflection, precedes changes in attitudes towards communication. © 2014 John Wiley & Sons Ltd.

  5. Data-Driven Implementation of Alarm Reduction Interventions in a Cardiovascular Surgical ICU.

    Allan, Sharon H; Doyle, Peter A; Sapirstein, Adam; Cvach, Maria


    Alarm fatigue in the ICU setting has been well documented in the literature. The ICU's high-intensity environment requires staff's vigilant attention, and distraction from false and non-actionable alarms pulls staff away from important tasks, creates dissatisfaction, and is a potential patient safety risk if alarms are missed or ignored. This project was intended to improve patient safety by optimizing alarm systems in a cardiovascular surgical intensive care unit (CVSICU). Specific aims were to examine nurses' attitudes toward clinical alarm signals, assess nurses' ability to discriminate audible alarm signals, and implement a bundled set of best practices for monitor alarm reduction without undermining patient safety. CVSICU nurses completed an alarm perception survey and participated in alarm discriminability testing. Nurse survey data and baseline monitor alarm data were used to select targeted alarm reduction interventions, which were progressively phased in. Monitor alarm data and cardiorespiratory event data were trended over one year. Five of the most frequent CVSICU monitor alarm types-pulse oximetry, heart rate, systolic and diastolic blood pressure, pulse oximetry sensor, and ventricular tachycardia > 2-were targeted. After implementation, there was a 61% reduction in average alarms per monitored bed and a downward trend in cardiorespiratory events. To reduce alarm fatigue it is important to decrease alarm burden through targeted interventions. Methods to reduce non-actionable alarms include adding short delays to allow alarm self-correction, adjusting default alarm threshold limits, providing alarm notification through a secondary device, and teaching staff to optimize alarm settings for individual patients. Copyright © 2016 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  6. Prospective clinical trial of surgical intervention for painful rib fracture nonunion.

    Fabricant, Loic; Ham, Bruce; Mullins, Richard; Mayberry, John


    We performed a prospective clinical trial of resection with or without plate fixation for symptomatic rib fracture nonunion three or more months postinjury with 6-month postoperative followup. The McGill Pain Questionnaire (MPQ) and RAND 36 Health Survey were administered and activity level (sedentary, ambulatory, moderately active, vigorous), functional status (disabled, nonphysical labor, physical labor), and work status (employed, unemployed, retired, student) were queried pre- and postoperatively. Twenty-four patients 4 to 197 months (median, 16 months) postinjury underwent surgical intervention for one to four rib fracture nonunions (median, two nonunions). Evidence of intercostal nerve entrapment was present in nine patients (38%). MPQ Present Pain Intensity and Pain Rating Index and RAND 36 Physical Functioning, Role Physical, Social Functioning, Role Social, Bodily Pain, Vitality, Mental Health, and General Health were significantly improved at six months compared with study entry (P rib fracture nonunion may improve chronic pain and disability but without change in functional or work status. Resection of adjacent nonunions with significant gaps may lead to chest wall hernia.

  7. Pharmacoeconomics of Surgical Interventions vs. Cyclooxygenase Inhibitors for the Treatment of Patent Ductus Arteriosus

    Turck, Charles J; Marsh, Wallace; Stevenson, James G.; York, John M.; Miller, Henry; Patel, Snehal


    Management of neonatal patent ductus arteriosus (PDA) often is resource-intensive and costly. Therefore, it is in hospitals' best interests to ensure the most cost-efficient use of associated resources. Clinical status, comorbidities, and response to prior therapy are considered in selecting the most appropriate intervention for PDA management. Currently, supportive measures (e.g., fluid restriction), surgical ligation, and pharmacologically based medical therapy are the primary treatment modalities for correcting PDA. Medical therapy, which comprises a small percentage (2.0%–5.0%)1 of overall PDA treatment expenses in the United States, consists of either of the 2 intravenous (IV) cyclooxygenase (COX) inhibitors: IV indomethacin and the newly available IV ibuprofen lysine. Although IV COX inhibitors represent a small portion of medical expenses, their benefits appear to be considerable. Pharmacoeconomic studies have evaluated indomethacin's beneficial impact on cost-effectiveness per quality-adjusted life year in PDA prophylaxis; however, no analysis to date prospectively assesses the effect of COX inhibitors on resource use or expenses in treating PDA. Such analysis is desirable and should consider efficacy and safety outcomes, impact on health care resource use and length of stay (LOS), and any differential effects of the agents' safety profiles; notably, IV indomethacin adversely affects renal and mesenteric blood flow and increases serum creatinine and oliguria significantly more than IV ibuprofen. These observations lay the foundation to conduct studies assessing the influence of these differences on resource use, LOS and expenses associated with PDA management. PMID:23055853

  8. Nationwide Trends and Variations in Urological Surgical Interventions and Renal Outcome in Patients with Spina Bifida.

    Wang, Hsin-Hsiao S; Lloyd, Jessica C; Wiener, John S; Routh, Jonathan C


    Bladder dysfunction in patients with spina bifida can lead to significant morbidity due to renal insufficiency. Indications for surgery vary among institutions and the impact is unclear. We examined trends and variations in urological interventions and chronic renal insufficiency in patients with spina bifida. We reviewed NIS (Nationwide Inpatient Sample) for all patients with spina bifida treated from 1998 to 2011. We used ICD-9-CM codes to identify urological surgery and chronic renal insufficiency. We calculated the Spearman correlation coefficients between rates of spina bifida related bladder surgeries and rates of chronic renal insufficiency outcomes by state. Linear regression models were fitted to investigate the associations between rates of spina bifida related surgery and chronic renal insufficiency across treatment years. We identified 427,616 spina bifida hospital admissions. Mean patient age was 26 years and 56% of patients were female. Of the admissions 35,249 (8%) were for chronic renal insufficiency and 11,078 (3%) were for surgery. During the study period chronic renal insufficiency rates doubled from 6% to 12% and surgery rates decreased from 2.0% to 1.8%. There was a moderately weak inverse association between surgery and chronic renal insufficiency rates with time (r = -0.3, p = 0.06) and by state (r = -0.3, p = 0.04). On multivariate analysis higher rates of surgery were associated with the state in which the patient was treated (p spina bifida related surgery (p = 0.67). We observed a temporal and geographic trend toward decreasing urological surgery and increasing chronic renal insufficiency rates in spina bifida and a wide variation in urological surgical rates among states. Further study is needed to determine the factors behind these trends and variations in spina bifida management. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  9. A comprehensive subaxial cervical spine injury severity assessment model using numeric scores and its predictive value for surgical intervention.

    Tsou, Paul M; Daffner, Scott D; Holly, Langston T; Shamie, A Nick; Wang, Jeffrey C


    Multiple factors contribute to the determination for surgical intervention in the setting of cervical spinal injury, yet to date no unified classification system exists that predicts this need. The goals of this study were twofold: to create a comprehensive subaxial cervical spine injury severity numeric scoring model, and to determine the predictive value of this model for the probability of surgical intervention. In a retrospective cohort study of 333 patients, neural impairment, patho-morphology, and available spinal canal sagittal diameter post-injury were selected as injury severity determinants. A common numeric scoring trend was created; smaller values indicated less favorable clinical conditions. Neural impairment was graded from 2-10, patho-morphology scoring ranged from 2-15, and post-injury available canal sagittal diameter (SD) was measured in millimeters at the narrowest point of injury. Logistic regression analysis was performed using the numeric scores to predict the probability for surgical intervention. Complete neurologic deficit was found in 39 patients, partial deficits in 108, root injuries in 19, and 167 were neurologically intact. The pre-injury mean canal SD was 14.6 mm; the post-injury measurement mean was 12.3 mm. The mean patho-morphology score for all patients was 10.9 and the mean neurologic function score was 7.6. There was a statistically significant difference in mean scores for neural impairment, canal SD, and patho-morphology for surgical compared to nonsurgical patients. At the lowest clinical score for each determinant, the probability for surgery was 0.949 for neural impairment, 0.989 for post-injury available canal SD, and 0.971 for patho-morphology. The unit odds ratio for each determinant was 1.73, 1.61, and 1.45, for neural impairment, patho-morphology, and canal SD scores, respectively. The subaxial cervical spine injury severity determinants of neural impairment, patho-morphology, and post-injury available canal SD have

  10. Application of silver sulfadiazine cream with early surgical intervention in patients suffering from combined burn-blast injury facial tattoos.

    Ebrahimi, Ali; Kalantar Motamedi, Mohammad Hosein


    Severe combined burn-blast injury is a great challenge to surgical teams due to its high mortality. It also results in unsightly traumatic tattoos. The aims of these case reports were to clarify the clinical characteristic of the dynamite explosion burn-blast facial injuries and discuss appropriate management of these patients. We report two patients suffering from facial burn-blast injury following dynamite explosion in which after primary stabilization, silver sulfadiazine cream was applied to the wounds and 12 hours later the wounds were cleaned under general anesthesia with vigorous saline solution irrigation and brushing. The foreign particles were meticulously removed from wounds and simultaneous repairing of defects was done with nylon 6-0 sutures. We conclude application of silver sulfadiazine cream on facial burn-blast injury tattoos several hours before surgical removal of particles is highly efficacious in facilitating particle removal and attaining a good result following surgical intervention, and primary repair. Treatment of combined burn-blast tattoos is different from other types of tattoos not associated with burns. Debridement and removal of foreign particles under general anesthesia from skin immediately and primary reconstruction of wounds is essential. We recommend application of the topical agent silver sulfadiazine to wounds about 12 hours before surgical intervention.

  11. Early versus late surgical intervention or medical management for infective endocarditis: a systematic review and meta-analysis.

    Anantha Narayanan, Mahesh; Mahfood Haddad, Toufik; Kalil, Andre C; Kanmanthareddy, Arun; Suri, Rakesh M; Mansour, George; Destache, Christopher J; Baskaran, Janani; Mooss, Aryan N; Wichman, Tammy; Morrow, Lee; Vivekanandan, Renuga


    Infective endocarditis is associated with high morbidity and mortality and optimal timing for surgical intervention is unclear. We performed a systematic review and meta-analysis to compare early surgical intervention with conservative therapy in patients with infective endocarditis. PubMed, Cochrane, EMBASE, CINAHL and Google-scholar databases were searched from January 1960 to April 2015. Randomised controlled trials, retrospective cohorts and prospective observational studies comparing outcomes between early surgery at 20 days or less and conservative management for infective endocarditis were analysed. A total of 21 studies were included. OR of all-cause mortality for early surgery was 0.61 (95% CI 0.50 to 0.74, pendocarditis between the overall unmatched cohorts. The results of our meta-analysis suggest that early surgical intervention is associated with significantly lower risk of mortality in patients with infective endocarditis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  12. The spatial distribution of injuries in need of surgical intervention in Nepal.

    Gupta, Shailvi; Groen, Thomas A; Stewart, Barclay T; Shrestha, Sunil; Spiegel, David A; Nwomeh, Benedict C; Groen, Reinou S; Kushner, Adam L


    Geographic information system modelling can accurately represent the geospatial distribution of disease burdens to inform health service delivery. Given the dramatic topography of Nepal and a high prevalence of unmet surgical needs, we explored the consequences of topography on the prevalence of surgical conditions. The Nepalese Surgeons OverSeas Assessment of Surgical Need (SOSAS) is a validated, countrywide, cluster randomised survey that assesses surgical need in lowand middle-income countries; it was performed in Nepal in 2014. Data on conditions potentially affected by topography (e.g. fractures, hernias, injuries, burns) were extracted from the database. A national digital elevation model was used to determine altitude, aspect, slope steepness and curvature of the SOSAS survey sites. Forward stepwise linear regression was performed with prevalence of each surgical condition as the response variable and topographic data as explanatory variables. The highest correlation coefficient was for models predicting hernias and fractures, both explaining 21% of the variance. The model fitted to death due to fall would become significant when an outlier was excluded (Pmodel to burn injury (stepwise regression) without any explanatory variables. Other models trended towards a correlation, but did not have sufficient power to detect a difference. This study identified slight correlation between elevation and the prevalence of hernias and fall injuries. Further investigation on the effects of topography and geography on surgical conditions is needed to help determine if the data would be useful for directing allocation of surgical resources.

  13. The spatial distribution of injuries in need of surgical intervention in Nepal

    Shailvi Gupta


    Full Text Available Geographic information system modelling can accurately represent the geospatial distribution of disease burdens to inform health service delivery. Given the dramatic topography of Nepal and a high prevalence of unmet surgical needs, we explored the consequences of topography on the prevalence of surgical conditions. The Nepalese Surgeons OverSeas Assessment of Surgical Need (SOSAS is a validated, countrywide, cluster randomised survey that assesses surgical need in lowand middle-income countries; it was performed in Nepal in 2014. Data on conditions potentially affected by topography (e.g. fractures, hernias, injuries, burns were extracted from the database. A national digital elevation model was used to determine altitude, aspect, slope steepness and curvature of the SOSAS survey sites. Forward stepwise linear regression was performed with prevalence of each surgical condition as the response variable and topographic data as explanatory variables. The highest correlation coefficient was for models predicting hernias and fractures, both explaining 21% of the variance. The model fitted to death due to fall would become significant when an outlier was excluded (P<0.001; R2=0.27. Excluding the outlier yielded a better-fitted model to burn injury (stepwise regression without any explanatory variables. Other models trended towards a correlation, but did not have sufficient power to detect a difference. This study identified slight correlation between elevation and the prevalence of hernias and fall injuries. Further investigation on the effects of topography and geography on surgical conditions is needed to help determine if the data would be useful for directing allocation of surgical resources.

  14. Total temporomandibular joint prosthesis as a surgical option for severe mouth opening restriction. A case report of a bilateral intervention.

    Guarda-Nardini, L; Manfredini, D; Berrone, S; Ferronato, G


    Several conservative treatment approaches to the disorders of the temporomandibular joint (TMJ) have been described in the literature. Nonetheless, in a minority of cases not respondent to reversible conservative therapies a surgical approach to the TMJ is needed. In recent years, a total temporomandibular joint replacement with alloplastic prosthesis have been introduced as a treatment option in the presence of a severely damaged or mutilated joint, mainly resulting from severe joint diseases, as in the case of complex inflammatory-degenerative diseases, or failure of previous surgeries. The present paper described a case report of a bilateral temporomandibular joint replacement intervention in a female patient with severe mouth opening restriction and pain in the TMJ area. Also, a discussion of the potential indications for TMJ replacement has been provided, along with the description of the surgical procedure.

  15. Adult aortic coarctation discovered incidentally after the rupture of sinus of Valsalva aneurysm: combined surgical and interventional approach.

    Ouali, Sana; Kortas, Chokri; Brockmeier, Konrad; Boughzela, Essia


    Combination of ruptured sinus of Valsalva aneurysm (SVA), and a coexisting asymptomatic adult aortic isthmic coarctation is extremely rare. The timing and sequence of surgical and/or interventional repair of these two pathologies are controversial. We present a case of a 37-year-old male who was admitted to our department because of severe acute congestive heart failure and signs of ruptured aneurysm of the SV into the right ventricle. Transthoracic and transoesophageal echocardiography confirmed the communication between an important right coronary SVA and right ventricle, bicuspid aortic valve, mild aortic regurgitation, and revealed severe aortic coarctation. Because of the severe dilation of right sinus of Valsalva a surgical repair of the ruptured aneurysm was performed. Aortic coarctation was treated four weeks later by a percutaneous stent-graft implantation. This case report supports the concept that hybrid approach is feasible in patients with ruptured SVA and aortic coarctation in adulthood.

  16. Changing use of surgical antibiotic prophylaxis in Thika Hospital, Kenya: a quality improvement intervention with an interrupted time series design.

    Alexander M Aiken

    Full Text Available INTRODUCTION: In low-income countries, Surgical Site Infection (SSI is a common form of hospital-acquired infection. Antibiotic prophylaxis is an effective method of preventing these infections, if given immediately before the start of surgery. Although several studies in Africa have compared pre-operative versus post-operative prophylaxis, there are no studies describing the implementation of policies to improve prescribing of surgical antibiotic prophylaxis in African hospitals. METHODS: We conducted SSI surveillance at a typical Government hospital in Kenya over a 16 month period between August 2010 and December 2011, using standard definitions of SSI and the extent of contamination of surgical wounds. As an intervention, we developed a hospital policy that advised pre-operative antibiotic prophylaxis and discouraged extended post-operative antibiotics use. We measured process, outcome and balancing effects of this intervention in using an interrupted time series design. RESULTS: From a starting point of near-exclusive post-operative antibiotic use, after policy introduction in February 2011 there was rapid adoption of the use of pre-operative antibiotic prophylaxis (60% of operations at 1 week; 98% at 6 weeks and a substantial decrease in the use of post-operative antibiotics (40% of operations at 1 week; 10% at 6 weeks in Clean and Clean-Contaminated surgery. There was no immediate step-change in risk of SSI, but overall, there appeared to be a moderate reduction in the risk of superficial SSI across all levels of wound contamination. There were marked reductions in the costs associated with antibiotic use, the number of intravenous injections performed and nursing time spent administering these. CONCLUSION: Implementation of a locally developed policy regarding surgical antibiotic prophylaxis is an achievable quality improvement target for hospitals in low-income countries, and can lead to substantial benefits for individual patients and

  17. Non-surgical interventions for pelvic organ prolapse in rural Nepal: a prospective monitoring and evaluation study

    Fitchett, Joseph R; Bhatta, Surya; Sherpa, Tenzing Y; Malla, Bishwo S; A Fitchett, Elizabeth J; Samen, Arlene


    Objectives Pelvic organ prolapse (POP) is a major cause of morbidity in Nepal, particularly affecting women in the rural communities. Women with POP in Nepal may suffer from symptoms for decades. At present, the Government of Nepal advocates surgical intervention but access to surgical care is inadequate. This report evaluated the feasibility of a non-surgical public health programme in rural Nepal, and describes risk factors associated with POP in this setting. Design Prospective monitoring and evaluation study of a new public health programme. Setting Baglung district, rural Nepal. Participants Women with gynaecological symptoms of POP. Main outcome measures Risk factors for disease progression were assessed using Fisher’s exact test, Pearson’s χ2-test and logistic regression analysis. Results Of the 74 women included in this analysis, 70.8% were diagnosed with stage 2 POP or greater. The majority of women did not have any further children following the onset of POP symptoms (63.5%). Duration of symptoms ranged from 2 months to 60 years, with 73.4% of women suffering for over 5 years and 28.4% suffering for over 20 years. Univariate analyses identified age at screening, age at onset of symptoms, the duration of symptoms and an associated rectocele as factors associated with increasing POP severity (p Kegel exercises were taught to 25 (33.8%) women with POP and ring pessaries were offered to 47 (63.5%) women with POP. Conclusions Non-surgical interventions may provide an opportunity to address the significant burden of POP in rural Nepal. PMID:26664731

  18. The utility of margin-reflex distance in determining the type of surgical intervention for congenital blepharoptosis

    Ozlem Ural


    Full Text Available Aims: To evaluate the utility of margin-reflex distance (MRD as an alternative to levator function (LF in choosing the appropriate surgical procedure for congenital blepharoptosis. Settings and Design: This was a retrospective, observational study. Subjects and Methods: Records of patients with simple (dystrophic congenital ptosis who were operated and followed for ≥6 months postoperatively and whose outcomes were deemed as successful were evaluated in the study. Success was defined as a MRD at the last postoperative visit of ≥3 mm. In all cases, levator resection was performed when LF was >4 mm and frontalis suspension when LF was ≤4 mm. Statistical Analysis Used: For statistical evaluations, LF was accepted as the gold standard parameter for deciding on the surgical intervention, and the optimum cutoff point for initial MRD was determined as the point at which sensitivity and specificity was highest at the receiving operating curve for the selection of surgical procedure. Results: Of one hundred and three eyes of ninety patients (44 female/46 male, levator resection was used in 44.7% and frontalis suspension in 55.3%. When the optimum cutoff point for MRD was determined as 0.5 mm, the sensitivity was 71%, specificity was 86%, and the area under the curve that represented the discriminative power of this parameter was found to be 0.826. Conclusion: The MRD at the cutoff point of 0.5 mm may be used as an alternative to LF to determine the type of surgical intervention in patients with congenital blepharoptosis whose LF cannot be reliably obtained in clinical evaluations.

  19. High-intensity interval training (HIT) for effective and time-efficient pre-surgical exercise interventions.

    Weston, Matthew; Weston, Kathryn L; Prentis, James M; Snowden, Chris P


    The advancement of perioperative medicine is leading to greater diversity in development of pre-surgical interventions, implemented to reduce patient surgical risk and enhance post-surgical recovery. Of these interventions, the prescription of pre-operative exercise training is gathering momentum as a realistic means for enhancing patient surgical outcome. Indeed, the general benefits of exercise training have the potential to pre-operatively optimise several pre-surgical risks factors, including cardiorespiratory function, frailty and cognitive function. Any exercise programme incorporated into the pre-operative pathway of care needs to be effective and time efficient in that any fitness gains are achievable in the limited period between the decision for surgery and operation (e.g. 4 weeks). Fortunately, there is a large volume of research describing effective and time-efficient exercise training programmes within the discipline of sports science. Accordingly, the objective of our commentary is to synthesise contemporary exercise training research, both from non-clinical and clinical populations, with the overarching aim of informing the development of effective and time-efficient pre-surgical exercise training programmes. The development of such exercise training programmes requires the careful consideration of several key principles, namely frequency, intensity, time, type and progression of exercise. Therefore, in light of more recent evidence demonstrating the effectiveness and time efficiency of high-intensity interval training-which involves brief bouts of intense exercise interspersed with longer recovery periods-the principles of exercise training programme design will be discussed mainly in the context of such high-intensity interval training programmes. Other issues pertinent to the development, implementation and evaluation of pre-operative exercise training programmes, such as individual exercise prescription, training session monitoring and potential

  20. Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review

    David Snowdon


    Full Text Available Question: Does preoperative intervention in people undergoing cardiac surgery reduce pulmonary complications, shorten length of stay in the intensive care unit (ICU or hospital, or improve physical function? Design: Systematic review with meta-analysis of (quasi randomised trials. Participants: People undergoing coronary artery bypass grafts and/or valvular surgery. Intervention: Any intervention, such as education, inspiratory muscle training, exercise training or relaxation, delivered prior to surgery to prevent/reduce postoperative pulmonary complications or to hasten recovery of function. Outcome measures: Time to extubation, length of stay in ICU and hospital (reported in days. Postoperative pulmonary complications and physical function were measured as reported in the included trials. Results: The 17 eligible trials reported data on 2689 participants. Preoperative intervention significantly reduced the time to extubation (MD -0.14 days, 95% CI -0.26 to -0.01 and the relative risk of developing postoperative pulmonary complications (RR 0.39, 95% CI 0.23 to 0.66. However, it did not significantly affect the length of stay in ICU (MD -0.15 days, 95% CI -0.37 to 0.08 or hospital (MD -0.55 days, 95% CI -1.32 to 0.23, except among older participants (MD -1.32 days, 95% CI -2.36 to -0.28. When the preoperative interventions were separately analysed, inspiratory muscle training significantly reduced postoperative pulmonary complications and the length of stay in hospital. Trial quality ranged from good to poor and considerable heterogeneity was present in the study features. Other outcomes did not significantly differ. Conclusion: For people undergoing cardiac surgery, preoperative intervention reduces the incidence of postoperative pulmonary complications and, in older patients, the length of stay in hospital. [Snowdon D, Haines TP, Skinner EH (2014 Preoperative intervention reduces postoperative pulmonary complications but not length of stay in

  1. Penile fracture and testicular rupture must be diagnosed quickly and require surgical intervention

    Kercsik, Andreas Robert Sandor; Fode, Mikkel; Joensen, Ulla Nordström;


    This article describes penile fracture and testicular rupture and offers recommendations for management. Both conditions occur most commonly after blunt trauma. Diagnosis can be supported by imaging but is usually confirmed on surgical exploration, which in both cases should be carried out prompt...

  2. Spectrum of peripheral neuropathies associated with surgical interventions; A neurophysiological assessment.

    Saidha, Shiv


    We hypothesized that a wide range of surgical procedures may be complicated by neuropathies, not just in close proximity but also remote from procedural sites. The aim of this study was to classify post-operative neuropathies and the procedures associated with them.

  3. Interventions to promote informed consent for patients undergoing surgical and other invasive healthcare procedures

    Kinnersley, P.; Phillips, K.; Savage, K.; Kelly, M.J.; Farrell, E.; Morgan, B.; Whistance, R.; Lewis, V.; Mann, M.K.; Stephens, B.L.; Blazeby, J.; Elwyn, G.; Edwards, A.G.


    BACKGROUND: Achieving informed consent is a core clinical procedure and is required before any surgical or invasive procedure is undertaken. However, it is a complex process which requires patients be provided with information which they can understand and retain, opportunity to consider their optio

  4. Long-term outcome of surgical excision of leukoplakia in a screening intervention trial, Kerala, India

    Gigi Thomas


    There were four (5 7% cases of malignant transformation during the mean follow-up period of 8-1 years. The superiority of surgical excision over other modalities of management of leukoplakia could not be established in the present study.

  5. Surgical versus conservative interventions for treating ankle fractures in adults (Review)

    Donken, C.C.M.A.; Al-Khateeb, H.; Verhofstad, M.H.J.; Laarhoven, C.J.H.M. van


    BACKGROUND: The annual incidence of ankle fractures is 122 per 100,000 people. They usually affect young men and older women. The question of whether surgery or conservative treatment should be used for ankle fractures remains controversial. OBJECTIVES: To assess the effects of surgical versus conse

  6. The imaging of maxillofacial trauma and its pertinence to surgical intervention.

    Mehta, Nisha; Butala, Parag; Bernstein, Mark P


    Maxillofacial skeletal injuries account for a large proportion of emergency department visits and often result in surgical consultation. Although many of the principles of detection and repair are basic, the evolution of technology and therapeutic strategies has led to improved patient outcomes. This article aims to provide a review of the imaging aspects involved in maxillofacial trauma and to delineate its relevance to management.

  7. The nordic aortic valve intervention (NOTION) trial comparing transcatheter versus surgical valve implantation

    Thyregod, Hans Gustav; Søndergaard, Lars; Ihlemann, Nikolaj;


    Degenerative aortic valve (AV) stenosis is the most prevalent heart valve disease in the western world. Surgical aortic valve replacement (SAVR) has until recently been the standard of treatment for patients with severe AV stenosis. Whether transcatheter aortic valve implantation (TAVI) can...

  8. Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience

    George J Hadeed


    Full Text Available Objectives: Early diagnosis and emergent surgical debridement of necrotizing soft tissue infections (NSTIs remains the cornerstone of care. We aimed to study the effect of early surgery on patients' outcomes and, in particular, on hospital length of stay (LOS and Intensive Care Unit (ICU LOS. Materials and Methods: Over a 6-year period (January 2003 through December 2008, we analyzed the records of patients with NSTIs. We divided patients into two groups based on the time of surgery (i.e., the interval from being diagnosed and surgical intervention: Early (<6 h and late (≥6 h intervention groups. For these two groups, we compared baseline demographic characteristics, symptoms, and outcomes. For our statistical analysis, we used the Student's t-test and Pearson Chi-square (χ2 test. To evaluate the clinical predictors of early diagnosis of NSTIs, we performed multivariate logistic regression analysis. Results: In the study population (n = 87; 62% males and 38% females, age, gender, wound locations, and comorbidities were comparable in the two groups. Except for higher proportion of crepitus, the clinical presentations showed no significant differences between the two groups. There were significantly shorter hospital LOS and ICU LOS in the early than late intervention group. The overall mortality rate in our study patients with NSTIs was 12.5%, but early intervention group had a mortality of 7.5%, but this did not reach statistical significance. Conclusions: Our findings show that early surgery, within the first 6 h after being diagnosed, improves in-hospital outcomes in patients with NSTIs.

  9. Assessing patient dose in interventional fluoroscopy using patient-dependent hybrid phantoms

    Johnson, Perry Barnett

    Interventional fluoroscopy uses ionizing radiation to guide small instruments through blood vessels or other body pathways to sites of clinical interest. The technique represents a tremendous advantage over invasive surgical procedures, as it requires only a small incision, thus reducing the risk of infection and providing for shorter recovery times. The growing use and increasing complexity of interventional procedures, however, has resulted in public health concerns regarding radiation exposures, particularly with respect to localized skin dose. Tracking and documenting patient-specific skin and internal organ dose has been specifically identified for interventional fluoroscopy where extended irradiation times, multiple projections, and repeat procedures can lead to some of the largest doses encountered in radiology. Furthermore, inprocedure knowledge of localized skin doses can be of significant clinical importance to managing patient risk and in training radiology residents. In this dissertation, a framework is presented for monitoring the radiation dose delivered to patients undergoing interventional procedures. The framework is built around two key points, developing better anthropomorphic models, and designing clinically relevant software systems for dose estimation. To begin, a library of 50 hybrid patient-dependent computational phantoms was developed based on the UF hybrid male and female reference phantoms. These phantoms represent a different type of anthropomorphic model whereby anthropometric parameters from an individual patient are used during phantom selection. The patient-dependent library was first validated and then used in two patient-phantom matching studies focused on cumulative organ and local skin dose. In terms of organ dose, patient-phantom matching was shown most beneficial for estimating the dose to large patients where error associated with soft tissue attenuation differences could be minimized. For small patients, inherent difference

  10. Surgical intervention may not always be required in gossypiboma with intraluminal migration


    Gossypiboma is the technical term for a retained surgical sponge. Because of legal-ethical concerns, there have not been many publications on this topic. Delays in diagnosis and treatment might increase mortality and morbidity. Radiological imaging is used in diagnosis. We present a case of gossypiboma that had fistulized to bulbous following hydatic cyst surgery. We established the diagnosis with endoscopy and followed its migration endoscopically.

  11. Heart valve surgery in hemodialysis-dependent patients: nutrition status impact on surgical outcome.

    Kawahito, Koji; Aizawa, Kei; Oki, Shinichi; Saito, Tsutomu; Misawa, Yoshio


    Valve surgery in hemodialysis-dependent patients is associated with postoperative complications and a high mortality rate, and such patients frequently suffer cachexia. This study aimed to determine pre- and intraoperative risk factors associated with in-hospital mortality and long-term survival in hemodialysis-dependent patients undergoing heart valve surgery from the viewpoint of nutrition status. Eighty-seven hemodialysis-dependent patients who underwent valve surgery between January 1998 and October 2015 were retrospectively reviewed. Thirty-seven potential perioperative risk factors were evaluated. The in-hospital mortality rate was 12.6 % (11 patients). Univariate analysis identified New York Heart Association Functional Classification III or IV, emaciation (body mass index 3000 ml as predictors of in-hospital death. Multivariate logistic regression analysis confirmed low serum albumin <3.0 mg/dl (hazard ratio 7.22; p = 0.032) and emergent/urgent operation (hazard ratio 43.57; p = 0.035) as independent predictors of in-hospital death. The 1- and 3-year actuarial survival rates were 64.9 ± 5.4 and 51.8 ± 5.8 %, respectively. Long-term survival estimated by log-rank test was negatively impacted by anemia (hemoglobin <10 mg/dl), low serum albumin, emergent/urgent operation, and infective endocarditis. Multivariate analysis using Cox proportional hazards modeling indicated low serum albumin (hazard ratio 2.12; p = 0.047) and emergent/urgent operation (hazard ratio 8.97; p = 0.0002) as independent predictors of remote death. Hypoalbuminemia and emergent/urgent operation are strong predictors of in-hospital and remote death. Malnutrition before surgery should be considered for operative risk estimation, and adequate preoperative nutrition management may improve surgical outcomes for hemodialysis-dependent patients.

  12. Proposal for evaluating the quality of reports of surgical interventions in the treatment of trigeminal neuralgia: the Surgical Trigeminal Neuralgia Score.

    Akram, Harith; Mirza, Bilal; Kitchen, Neil; Zakrzewska, Joanna M


    The aim of this study was to design a checklist with a scoring system for reporting on studies of surgical interventions for trigeminal neuralgia (TN) and to validate it by a review of the recent literature. A checklist with a scoring system, the Surgical Trigeminal Neuralgia Score (STNS), was devised partially based on the validated STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) criteria and customized for TN after a literature review and then applied to a series of articles. These articles were identified using a prespecified MEDLINE and Embase search covering the period from 2008 to 2010. Of the 584 articles found, 59 were studies of interventional procedures for TN that fulfilled the inclusion criteria and 56 could be obtained in full. The STNS was then applied independently by 3 of the authors. The maximum STNS came to 30, and was reliable and reproducible when used by the 3 authors who performed the scoring. The range of scores was 6-23.5, with a mean of 14 for all the journals. The impact factor scores of the journals in which the papers were published ranged from 0 to 4.8. Twenty-four of the studies were published in the Journal of Neurosurgery or in Neurosurgery. Studies published in neurosurgical journals ranked higher on the STNS scale than those published in nonneurosurgical journals. There was no statistically significant correlation between STNS and impact factors. Stereotactic radiosurgery (n = 25) and microvascular decompression (n = 15) were the most commonly reported procedures. The diagnostic criteria were stated in 35% of the studies, and 4 studies reported subtypes of TN. An increasing number of studies (46%) used the recommended Kaplan-Meier methodology for pain survival outcomes. The follow-up period was unclear in 8 studies, and 26 reported follow-ups of more than 5 years. Complications were reported fairly consistently but the temporal course was not always indicated. Direct interview, telephone conversation

  13. The Nordic Aortic Valve Intervention (NOTION trial comparing transcatheter versus surgical valve implantation: study protocol for a randomised controlled trial

    Thyregod Hans Gustav


    Full Text Available Abstract Background Degenerative aortic valve (AV stenosis is the most prevalent heart valve disease in the western world. Surgical aortic valve replacement (SAVR has until recently been the standard of treatment for patients with severe AV stenosis. Whether transcatheter aortic valve implantation (TAVI can be offered with improved safety and similar effectiveness in a population including low-risk patients has yet to be examined in a randomised setting. Methods/Design This randomised clinical trial will evaluate the benefits and risks of TAVI using the transarterial CoreValve System (Medtronic Inc., Minneapolis, MN, USA (intervention group compared with SAVR (control group in patients with severe degenerative AV stenosis. Randomisation ratio is 1:1, enrolling a total of 280 patients aged 70 years or older without significant coronary artery disease and with a low, moderate, or high surgical risk profile. Trial outcomes include a primary composite outcome of myocardial infarction, stroke, or all-cause mortality within the first year after intervention (expected rates 5% for TAVI, 15% for SAVR. Exploratory safety outcomes include procedure complications, valve re-intervention, and cardiovascular death, as well as cardiac, cerebral, pulmonary, renal, and vascular complications. Exploratory efficacy outcomes include New York Heart Association functional status, quality of life, and valve prosthesis and cardiac performance. Enrolment began in December 2009, and 269 patients have been enrolled up to December 2012. Discussion The trial is designed to evaluate the performance of TAVI in comparison with SAVR. The trial results may influence the choice of treatment modality for patients with severe degenerative AV stenosis. Trial registration NCT01057173

  14. Cardiac myxoma: clinical characteristics, surgical intervention, intra-operative challenges and outcome.

    Abu Abeeleh, Mahmoud; Saleh, Suhayl; Alhaddad, Emad; Alsmady, Moaath; Alshehabat, Musa; Bani Ismail, Zuhair; Massad, Islam; Bani Hani, Amjad; Abu Halaweh, Sami


    The objectives of this retrospective study were to characterize the clinical presentation, diagnostic findings, surgical approaches, intra-operative challenges and complications following the surgical treatment of cardiac myxoma in two of the largest referral hospitals in Jordan. Medical records of all patients presented to the cardiology department during the period between 1984 and 2016 were reviewed. Criteria for inclusion in the study were: (1) patients who were presented for cardiac evaluation due to symptoms suggestive of a primary cardiac problem, (2) completed medical records, including results of echocardiography suggestive of intra-cardiac occupying mass, (3) the surgical operation was undertaken and intra-operative data was available, (4) a histological diagnosis of myxoma was available and (5) the discharge status and follow-up data were available for at least 2 years after initial surgery. A total of 27 patients fulfilled the criteria for inclusion in the study. The average age was 42 years. Thirteen of the patients were females and 14 patients were males. The most common clinical presentations were dyspnea (29.6%) and murmurs (22.2%). Non-specific signs, such as weight loss, fever, fatigue, arthralgia and anemia, were reported in 10 (37%) patients. Signs related to systemic embolization were reported in 9 (33.3%) of the patients, involving the upper and lower extremities (55.6%), brain ischemia and vision loss (54.4%). Tumors in all patients were successfully resected under cardiopulmonary bypass support. The tumor was pedunculated in 17 (62.9%) of the patients and the size of the tumors varied from 1 to 7 centimeters in diameter. The tumor was located in the left atrium in 21 patients (77.7%), in the right atrium in 4 patients (14.8%), in the right ventricular side of the septum in 1 patient (3.7%) and involving the tricuspid valve in 1 patient (3.7%). The left atrial approach was used in 3 patients, a right atrial approach in 4 patients and a bi

  15. Surgical intervention for mediastinal pancreatic pseudocysts. A case series and review of the literature.

    Metaxa, Dafni; Balakrishnan, Anita; Upponi, Sara; Huguet, Emmanuel L; Praseedom, Raaj K


    Development of mediastinal pancreatic pseudocysts is a rare complication of pancreatitis. There is currently no consensus on the optimal management of this condition, options for which include conservative management with somatostatin analogues, endoscopic drainage procedures and surgery. Here we present two patients with mediastinal pancreatic pseudocysts which were initially managed endoscopically. However, in both cases, this led to complications secondary to the endoscopic procedures, recurrence or non-resolution of symptoms, requiring surgical cystogastrostomy and/or cystojejunostomy. These cases suggest that surgery may be ultimately necessary for mediastinal pancreatic pseudocysts where endoscopic procedures might have a high likelihood of failure.

  16. A Research Synthesis of Therapeutic Interventions for Whiplash-Associated Disorder (WAD: Part 5 – Surgical and Injection-Based Interventions for Chronic WAD

    Robert W Teasell


    Full Text Available Whiplash-associated disorder (WAD represents a significant public health problem, resulting in substantial social and economic costs throughout the industrialized world. While many treatments have been advocated for patients with WAD, scientific support regarding their effectiveness is often lacking. A systematic review was conducted to evaluate the strength of evidence associated with various WAD therapies. Multiple databases (including Web of Science, EMBASE and PubMed were searched to identify all studies published from January 1980 through March 2009 that evaluated the effectiveness of any well-defined treatment for acute (less than two weeks, subacute (two to 12 weeks or chronic (more than 12 weeks WAD. The present article, the fifth in a five-part series, evaluates the evidence for surgical and injection-based interventions initiated during the chronic phase of WAD. Twenty-five studies were identified that met the inclusion criteria, six of which were randomized controlled trials with ‘good’ overall methodological quality (median Physiotherapy Evidence Database score of 7.5. For the treatment of chronic WAD, there was moderate evidence supporting radiofrequency neurotomy as an effective treatment for whiplash-related pain, although relief is not permanent. Sterile water injections have been demonstrated to be superior to saline injections; however, it is not clear whether this treatment is actually beneficial. There was evidence supporting a wide range of other interventions (eg, carpal tunnel decompression with each of these evaluated by a single nonrandomized controlled trial. There is contradictory evidence regarding the effectiveness of botulinum toxin injections, and cervical discectomy and fusion. The evidence is not yet strong enough to establish the effectiveness of any of these treatments; of all the invasive interventions for chronic WAD, radiofrequency neurotomy appears to be supported by the strongest evidence. Further

  17. Surgical Versus Nonsurgical Interventions to Relieve upper Airway Obstruction in Children with Pierre Robin Sequence

    Karen Kam


    Full Text Available BACKGROUND: Newborns with Pierre Robin sequence (PRS often experience chronic intermittent hypoxemia/hypoventilation associated with airway obstruction. The heterogeneity of the severity of upper airway obstruction makes management a challenge; the optimal intervention in individual cases is not clear.

  18. Effect of non-surgical periodontal therapy on serum ferritin levels: an interventional study.

    Chakraborty, Souvik; Tewari, Shikha; Sharma, Rajinder Kumar; Narula, Satish Chander


    Ferritin, an acute-phase reactant, has been found to be elevated in many chronic inflammation-related diseases. The aim of the present study is to investigate differences in concentrations of serum ferritin in patients with and without periodontal disease before and after non-surgical periodontal therapy and correlate these values with clinical variables associated with periodontal disease. Forty-two individuals were included in this study, 20 with chronic periodontitis (CP) and 22 classified as periodontally healthy. Serum ferritin concentrations, hemoglobin levels, and periodontal parameters (probing depth [PD], clinical attachment level, gingival index, bleeding on probing, and plaque index) were recorded at baseline and 3 months after non-surgical periodontal therapy. Patients with CP showed higher concentrations of serum ferritin than periodontally healthy controls (P serum ferritin levels and the number of sites with PD ≥ 6 mm at baseline (P serum ferritin levels at baseline (R(2) = 0.823). Significant reductions in serum ferritin levels were observed at the 3-month assessment after periodontal treatment (P serum ferritin values were comparable to those of controls (P >0.05). Furthermore, the post-treatment degree of change in the serum ferritin level was positively and significantly associated with improvement in PD (R(2) = 0.213, P Serum ferritin levels are raised in patients with CP and decrease to control levels post-treatment.

  19. Clinical Value of Interventional Embolization for Sacral Chordoma before Surgical Treatment

    Zhihui CHANG; Zhaoyu LIU; Jiahe Zheng; Zaiming LU; Qiyong GUO


    Objetive:To evaluate the efficacy of preoperative transcatheter arterial embolization in the treatment of sacral chordoma,and to explore the choice of embolization timing. Methods:32 patients underwent the posterior approach after TAE of the main arteries that supplied the sacral chordoma. Intraoperative bleeding amount of each patient was recorded and compared between-group differences at different operation times. Results: After embolization, 12 patients were received resection within 24 hours (group A),that of 10 cases between 24 ~ 48h (group B), of another 10 cases between 48~ 72h (group C). All of the 32 tumors were removed intact with intraoperative bleeding about (894±199)ml, without any shock or death,nor injuries on abdominal organs such as rectum and ureter. There was no statistical significance in tumor size among group A,B and C (P>0.05). Data gave statistical significance in intraoperative blood loss between group A and B (P<0.01) ,there was no statistical differences between group B and C (P>0.05), in spite of group B slightly less than group C. Conclusion: Preoperative TAE for excising the sacral tumor can significantly decrease intraoperative blood loss, make the surgical field clear,and facilitate the maximal removal of the sacral chordoma. It would be best to select the embolization timing within 24 hours before surgical operation.

  20. [The initial trial of the clinical use of FK-1 glue in surgical interventions].

    Abzhueva, O V; Rusanov, V M; Zhidkov, I L


    The article presents results of a comparative clinical trial of the preparation "fibrinous glue" (FK-1) and "Beriplast" in operations on the lungs for hermetization of the wound and the lung as well as in reconstructive plastic gynecological operations. Intraoperative hermetization in operations on the lungs was obtained in 67% of the cases when using "FK-1" and in 64% with "Beriplast". In all the cases the lung was spread during 12 hours after operation. The visual intraoperative assessment of using "FK-1" and control laparoscopy on the 4th-5th days after operation showed its good effect in gynecological procedures. Clinical trials of the new domestic fibrinous glue "FK-1" in surgical and gynecological clinics confirmed its high medical effectiveness.

  1. Resolution of bilateral moyamoya associated collateral vessel aneurysms: Rationale for endovascular versus surgical intervention

    Sepideh Amin-Hanjani


    Full Text Available Background: Management of aneurysms associated with deep collateral vessels in moyamoya disease is challenging both from an endovascular and a surgical standpoint. Difficulties with access or localization, and compromise of the collateral circulation with subsequent ischemia are the primary concerns, making direct obliteration potentially unfeasible or risky. Alternatively, superficial temporal artery-middle cerebral artery bypass is another potential strategy for resolution of these aneurysms. Case Description: Presented are the findings and management for a patient with moyamoya disease and bilateral deep collateral vessel aneurysms, successfully treated with endovascular obliteration following a right-sided hemorrhage and subsequently with bypass for an unruptured but growing contralateral aneurysm. Conclusions: A rationale and approach to management is outlined, as derived from review of the current literature and the illustrative case with bilateral collateral vessel aneurysms.

  2. Surgical Clipping versus Endovascular Intervention for the Treatment of Subarachnoid Hemorrhage Patients in New York State.

    Kimon Bekelis

    Full Text Available Randomized trials have demonstrated a survival benefit for endovascular treatment of ruptured cerebral aneurysms. We investigated the association of surgical clipping and endovascular coiling with outcomes in subarachnoid hemorrhage (SAH patients in a real-world regional cohort.We performed a cohort study involving patients with ruptured cerebral aneurysms, who underwent surgical clipping, or endovascular coiling from 2009-2013 and were registered in the Statewide Planning and Research Cooperative System (SPARCS database. An instrumental variable analysis was used to investigate the association of treatment technique with outcomes.Of the 4,098 patients undergoing treatment, 2,585 (63.1% underwent coiling, and 1,513 (36.9% underwent clipping. Using an instrumental variable analysis, we did not identify a difference in inpatient mortality [marginal effect (ME, -0.56; 95% CI, -1.03 to 0.02], length of stay (LOS (ME, 1.72; 95% CI, -3.39 to 6.84, or the rate of 30-day readmissions (ME, -0.30; 95% CI, -0.82 to 0.22 between the two treatment techniques for patients with SAH. Clipping was associated with a higher rate of discharge to rehabilitation (ME, 0.63; 95% CI, 0.24 to 1.01. In sensitivity analysis, mixed effect regression, and propensity score adjusted regression models demonstrated identical results.Using a comprehensive all-payer cohort of patients in New York State presenting with aneurysmal SAH we did not identify an association of treatment method with mortality, LOS or 30-day readmission. Clipping was associated with a higher rate of discharge to rehabilitation.

  3. Spectrum of peripheral neuropathies associated with surgical interventions; A neurophysiological assessment

    Saidha, Shiv


    Abstract Background We hypothesized that a wide range of surgical procedures may be complicated by neuropathies, not just in close proximity but also remote from procedural sites. The aim of this study was to classify post-operative neuropathies and the procedures associated with them. Methods We retrospectively identified 66 patients diagnosed with post-procedure neuropathies between January 2005 and June 2008. We reviewed their referral cards and medical records for patient demographics, information on procedures, symptoms, as well as clinical and neurophysiological findings. Results Thirty patients (45.4%) had neuropathies remote from procedural sites and 36 patients (54.5%) had neuropathies in close proximity to procedural sites. Half of the remote neuropathies (15\\/30) developed following relatively short procedures. In 27% of cases (8\\/30) remote neuropathies were bilateral. Seven patients developed neuropathies remote from operative sites following hip arthroplasties (7\\/30: 23.3%), making hip arthroplasty the most common procedure associated with remote neuropathies. Sciatic neuropathies due to hip arthroplasty (12\\/36, 33.3%) accounted for the majority of neuropathies occurring in close proximity to operative sites. Five medial cutaneous nerve of forearm neuropathies occurred following arterio-venous fistula (AVF) formation. Conclusions An array of surgical procedures may be complicated by neuropathy. Almost half of post-procedure neuropathies occur remote from the site of procedure, emphasizing the need to try to prevent not just local, but also remote neuropathies. Mechanical factors and patient positioning should be considered in the prevention of post-operative neuropathies. There is a possible association between AVF formation and medial cutaneous nerve of forearm neuropathy, which requires further study for validation.

  4. Spectrum of peripheral neuropathies associated with surgical interventions; A neurophysiological assessment


    Background We hypothesized that a wide range of surgical procedures may be complicated by neuropathies, not just in close proximity but also remote from procedural sites. The aim of this study was to classify post-operative neuropathies and the procedures associated with them. Methods We retrospectively identified 66 patients diagnosed with post-procedure neuropathies between January 2005 and June 2008. We reviewed their referral cards and medical records for patient demographics, information on procedures, symptoms, as well as clinical and neurophysiological findings. Results Thirty patients (45.4%) had neuropathies remote from procedural sites and 36 patients (54.5%) had neuropathies in close proximity to procedural sites. Half of the remote neuropathies (15/30) developed following relatively short procedures. In 27% of cases (8/30) remote neuropathies were bilateral. Seven patients developed neuropathies remote from operative sites following hip arthroplasties (7/30: 23.3%), making hip arthroplasty the most common procedure associated with remote neuropathies. Sciatic neuropathies due to hip arthroplasty (12/36, 33.3%) accounted for the majority of neuropathies occurring in close proximity to operative sites. Five medial cutaneous nerve of forearm neuropathies occurred following arterio-venous fistula (AVF) formation. Conclusions An array of surgical procedures may be complicated by neuropathy. Almost half of post-procedure neuropathies occur remote from the site of procedure, emphasizing the need to try to prevent not just local, but also remote neuropathies. Mechanical factors and patient positioning should be considered in the prevention of post-operative neuropathies. There is a possible association between AVF formation and medial cutaneous nerve of forearm neuropathy, which requires further study for validation. PMID:20398427

  5. Spectrum of peripheral neuropathies associated with surgical interventions; A neurophysiological assessment

    Mullins Gerard


    Full Text Available Abstract Background We hypothesized that a wide range of surgical procedures may be complicated by neuropathies, not just in close proximity but also remote from procedural sites. The aim of this study was to classify post-operative neuropathies and the procedures associated with them. Methods We retrospectively identified 66 patients diagnosed with post-procedure neuropathies between January 2005 and June 2008. We reviewed their referral cards and medical records for patient demographics, information on procedures, symptoms, as well as clinical and neurophysiological findings. Results Thirty patients (45.4% had neuropathies remote from procedural sites and 36 patients (54.5% had neuropathies in close proximity to procedural sites. Half of the remote neuropathies (15/30 developed following relatively short procedures. In 27% of cases (8/30 remote neuropathies were bilateral. Seven patients developed neuropathies remote from operative sites following hip arthroplasties (7/30: 23.3%, making hip arthroplasty the most common procedure associated with remote neuropathies. Sciatic neuropathies due to hip arthroplasty (12/36, 33.3% accounted for the majority of neuropathies occurring in close proximity to operative sites. Five medial cutaneous nerve of forearm neuropathies occurred following arterio-venous fistula (AVF formation. Conclusions An array of surgical procedures may be complicated by neuropathy. Almost half of post-procedure neuropathies occur remote from the site of procedure, emphasizing the need to try to prevent not just local, but also remote neuropathies. Mechanical factors and patient positioning should be considered in the prevention of post-operative neuropathies. There is a possible association between AVF formation and medial cutaneous nerve of forearm neuropathy, which requires further study for validation.

  6. Acoustic phonetics in a clinical setting: a case study of /r/-distortion therapy with surgical intervention.

    Hagiwara, Robert; Fosnot, Susan Meyers; Alessi, David M


    Acoustic measures are used to document the speech of a 6-year-old child with persistent /r/-distortion through several treatment interventions. The child originally presented a complex of speech disorders and was treated by a speech-language pathologist using phonological process techniques. The procedures successfully corrected most of his speech problems, although /r/ remained severely distorted. The primary acoustic manifestation of this distortion was a high third formant. Surgical correction of a banded lingual frenulum, along with adenoton-sillectomy indicated for sleep apnea, is shown to have had a small effect in lowering the third formant. A dramatic change was seen on reintroduction of therapy, when an extreme drop in third formant frequencies for /r/ was observed. The acoustic data are interpreted using speaker-internal controls derived from a dialect-appropriate adult model.

  7. An observation support system with an adaptive ontology-driven user interface for the modeling of complex behaviors during surgical interventions.

    Neumuth, T; Kaschek, B; Neumuth, D; Ceschia, M; Meixensberger, J; Strauss, G; Burgert, O


    The field of surgical interventions emphasizes knowledge and experience; explicit and detailed models of surgical processes are hard to obtain by observation or measurement. However, in medical engineering and related developments, such models are highly valuable. Surgical process modeling deals with the generation of complex process descriptions by observation. This places high demands on the observers, who have to use a sizable terminology to denominate surgical actions, instruments, and patient anatomies, and to describe processes unambiguously. Here, we present a novel method, employing an ontology-based user interface that adapts to the actual situation and describe the principles of the system. A validation study showed that this method enables observers with little recording experience to reach a recording accuracy of >90%. Furthermore, this method can be used for live and video observation. We conclude that the method of ontology-supported recording for complex behaviors can be advantageously employed when surgical processes are modeled.

  8. [Effectiveness of an intervention to improve the implementation of a surgical safety check-list in a tertiary hospital].

    Vázquez-González, A; Luque-Ramírez, J M; Del Nozal-Nalda, M; Barroso-Gutierrez, C; Román-Fuentes, M; Vilaplana-Garcia, A


    To determine the percentage of verification of a Surgical Safety Checklist and improvements made. Quasi-experimental study in 28 Clinical Management Units with surgical activity in the University Hospital Virgen del Rocio (HUVR) and University Hospital Virgen Macarena (HUVM). A situation analysis was made to estimate the completing of a Surgical Safety Checklist (SSC), after which a new system of completing the SSC was introduced as an element of improvement, which included a reusable vinyl board. Subsequently, the prevalence over two periods was calculated, to assess the effectiveness of the intervention. A total 1,964 SSC were reviewed in the HUVR-HUVM in June (baseline), and in December 2013 and June 2014. A percentage completion of 65.8%, 86.2%, and 88% was obtained in the HUVR, and 70.9%, 77.2%, and 75% in the HUVM, respectively. Of these SSC, 15.1% (baseline) were completed entirely in the HUVR, increasing to 36.6% (P<.001), and 89.8% (P<.001) in the last measurement. In the HUVM, 15.6% (baseline) were fully completed, increasing to 18.3% (P=.323), and 29.4% (P=.001) in the last measurement. The percentage of completion of SSC obtained is around 80%, and is similar to that reported in the literature. The re-design of the SSC procedure, including the use of a vinyl board, the designation of SSC coordinator role, and professional staff training, is effective for improve outcomes in terms of completing the SSC, and quality of the completion. Copyright © 2016 SECA. Published by Elsevier Espana. All rights reserved.

  9. Short- and long-term racing performance of Standardbred pacers and trotters after early surgical intervention for tarsal osteochondrosis.

    McCoy, A M; Ralston, S L; McCue, M E


    Osteochondrosis (OC) is commonly diagnosed in young Standardbred racehorses but its effect on performance when surgically treated at a young age is still incompletely understood. This is especially true for Standardbred pacers, which are underrepresented in the existing literature. To characterise the short- (2-year-old) and long-term (through 5-year-old) racing performance in Standardbred pacers and trotters after early surgical intervention (horses were treated surgically prior to being sold as yearlings. Data obtained from publicly available race records for each horse included starts, wins, finishes in the top 3 (win, place or show), earnings and fastest time. Comparisons between OC-affected and unaffected horses were made for the entire population and within gaits. A smaller related population (n = 94) had these performance measures evaluated for their 2-5-year-old racing seasons. Osteochondrosis status was associated with few performance measures. Trotters were at higher risk for lesions of the medial malleolus but lower risk for lesions of the distal intermediate ridge of the tibia than were pacers. Horses with bilateral OC lesions and lateral trochlear ridge (LTR) lesions started fewer races at 2 years of age than those with unilateral lesions or without LTR lesions. Osteochondrosis seemed to have minimal effect on racing performance in this cohort, although horses with bilateral and LTR lesions started fewer races at 2 years. There was evidence for different distribution of OC lesions among pacers and trotters, which should be explored further. Standardbreds undergoing early removal of tarsal OC lesions can be expected to perform equivalently to their unaffected counterparts. © 2014 EVJ Ltd.

  10. Is lesional stability in vitiligo more important than disease stability for performing surgical interventions? results from a multicentric study

    Imran Majid


    Full Text Available Background: Ensuring stability of the disease process is essential for undertaking surgical intervention in vitiligo. However, there is no consensus regarding the minimum duration of stability or the relative importance of disease and lesional stability in selecting patients for vitiligo grafting. Aim: This multicentric study aims to assess the relative importance of lesional and disease stability on selecting patients for vitiligo grafting. Materials and Methods: One hundred seventy patients were recruited into the study and divided into two groups: Group A with lesional stability of >1 year but overall disease stability of only 6-11 months and Group B with overall disease stability of >1 year. Patients underwent either tissue or cellular vitiligo grafting on the selected lesions and the repigmentation achieved was scored from 0 (no repigmentation to 6 (100% repigmentation. Repigmentation achieved on different sites of the body was compared between the two groups. Adverse effects at both the donor and the recipient sites were also compared. Results: Of the 170 patients who were enrolled, 82 patients were placed in Group A and 88 patients in Group B. Average repigmentation achieved (on scale of 0 to 6 was 3.8 and 4.04 in Group A and Group B, respectively. In Group A, ≥90% repigmentation was achieved in 36.6% (30/82 patients, while 37.5% (33/88 achieved similar results in Group B. Additionally, 47.6% (39/82 and 53.4% (47/88 of cases achieved partial repigmentation in Group A and Group B, respectively. Perigraft halo was the commonest adverse effect observed in both groups. Statistical analysis revealed no significant differences between the two groups with respect to the repigmentation achieved or adverse effects observed. Repigmentation achieved was the best on the face and neck area, while acral areas responded the least. Conclusions: Lesional stability seems to be as relevant as the overall disease stability in selecting patients for

  11. On a definition of the appropriate timing for surgical intervention in orthognathic surgery.

    Hernández-Alfaro, F; Guijarro-Martínez, R


    Together with the introduction of new orthodontic techniques and minimally invasive surgery protocols, the emergence of modern patient prototypes has given way to novel timing schemes for the handling of dento-maxillofacial deformities. The aim of this study was to define, justify, and systematize the appropriate timing for orthognathic surgery. A retrospective analysis of orthognathic surgery procedures carried out over a 3-year period was performed. Six timing schemes were defined: 'surgery first', 'surgery early', 'surgery late', 'surgery last', 'surgery only', and 'surgery never'. Gender, age at surgery, main motivation for treatment, orthodontic treatment length, and number of orthodontic appointments were evaluated. A total of 362 orthognathic procedures were evaluated. The most common approach was 'surgery late'. While aesthetic improvement was the leading treatment motivation in 'surgery first', 'surgery early', and 'surgery last' cases, occlusal optimization was the chief aim of 'surgery late'. Sleep-disordered breathing was the main indication for treatment in 'surgery only'. Compared to 'surgery late', orthodontic treatment was substantially shorter in 'surgery early' and 'surgery first' cases, but the number of orthodontic appointments was similar. In conclusion, the skilful management of dento-maxillofacial deformities requires a comprehensive analysis of patient-, orthodontist-, and surgeon-specific variables. Each timing approach has well-defined indications, treatment planning considerations, and orthodontic and surgical peculiarities.

  12. Evolution of surgical interventions for hydrocephalus: patient preferences and the need for proper information

    Dr. P. O. Eghwrudjakpor MBBS, DMS, FICS


    Full Text Available The treatment of hydrocephalus has undergone remarkable transformation since it was first documented over two thousand years ago. Currently, the focus of hydrocephalus research is on minimally invasive techniques of treatment. This article reviews the evolution of hydrocephalus therapy, and examines current attitudes towards modern methods. We relied on journal publications, as well as literature on hydrocephalus obtained from the Internet (Google, Yahoo and PUBMED search making use of the following search terms: “hydrocephalus: history; treatment; complications”, “cerebrospinal fluid shunt”, “endoscopic third ventriculostomy: indications of; complications of; advantages; disadvantages; successes; failure”. Numerous medical and surgical approaches have been adopted in the treatment of hydrocephalus in the past. However, the breakthrough that ushered in the modern era of hydrocephalus treatment was the introduction of valve-regulated systems in the middle of the last century. Endoscopic third ventriculostomy has evolved to become an alternative to traditional shunts. Cerebrospinal fluid shunt procedures are very effective in the treatment of hydrocephalus and have radically transformed the outcome of the disorder. However, they have a number of limitations. The alternative to shunts, endoscopic third ventriculostomy, is relatively safe, effective and durable. It does not, however, succeed in every patient; and also has some potentially devastating complications. Preoperative counseling is imperative to ensure that patients are properly guided.

  13. Surgical Management of Fractures and Tendons.

    Pentecost, Rebecca; Niehaus, Andrew J; Anderson, David E


    Long bone fractures and disorders of tendons and ligaments represent a significant proportion of surgical orthopedic cases presented to ruminant veterinarians. The presentation of these patients, their diagnostic work-up, surgical treatment, and expected outcome will be discussed. The outcome of these cases depends largely on the presenting problem; however, accurate diagnosis and prompt surgical intervention can greatly improve the outcome of many of these cases.

  14. Analysis of individualized education programs to quantify long-term educational needs following surgical intervention for single-suture craniosynostosis.

    Doshier, Laura J; Muzaffar, Arshad R; Deidrick, Kathleen Km; Rice, Gale B


    Single-suture craniosynostosis (SSC) is a common craniofacial condition with potential neurocognitive sequelae. To quantify any long-term functional academic and behavioural difficulties of children with SSC as indicated by the need for individualized education programs (IEPs), despite having undergone surgical treatment. Records of all school-age patients from 1992 to 2011 who underwent operative intervention for SSC were identified. Fifty-nine patients' guardians were contacted by telephone to provide informed consent for completion of a mailed standardized questionnaire querying demographic information as well as information regarding the patient's health, family and educational history; specifically whether the patient had ever been provided educational support as delineated in an IEP. The primary outcome measure was the history of the patient being assigned educational support as delineated in an IEP. Thirty-seven consenting guardians completed and returned the standardized questionnaire (response rate 62.7%). Twenty-one patients were male and 16 were female, with an age range of five to 14 years (mean age 10.2 years). Eleven (29.7%) patients had a previous history of or currently were receiving educational support delineated in an IEP. A higher proportion of school-age patients with a history of SSC (status postsurgical intervention) in the present study received educational support delineated in an IEP than the proportion of IEPs in the general student population of the United States (11.3%).

  15. Nicotine Dependence as a Moderator of a Quitline-Based Message Framing Intervention

    Fucito, Lisa M.; Latimer, Amy E.; Carlin-Menter, Shannon; Salovey, Peter; Cummings, K. Michael; Makuch, Robert W.; Toll, Benjamin A.


    High nicotine dependence is a reliable predictor of difficulty quitting smoking and remaining smoke-free. Evidence also suggests that the effectiveness of various smoking cessation treatments may vary by nicotine dependence level. Nicotine dependence, as assessed by Heaviness of Smoking Index baseline total scores, was evaluated as a potential moderator of a message-framing intervention provided through the New York State Smokers’ Quitline (free telephone based service). Smokers were exposed ...

  16. Obesity, Type 2 Diabetes, and the Metabolic Syndrome: Pathophysiologic Relationships and Guidelines for Surgical Intervention.

    Genser, Laurent; Casella Mariolo, James Rossario; Castagneto-Gissey, Lidia; Panagiotopoulos, Spyros; Rubino, Francesco


    Several gastrointestinal (GI) operations originally developed for the treatment of severe obesity (bariatric surgery) promote sustained weight loss as well as dramatic, durable improvements of insulin-resistant states, most notably type 2 diabetes mellitus (T2DM). Experimental evidence shows that some rearrangements of GI anatomy can directly affect glucose homeostasis, insulin sensitivity, and inflammation, supporting the idea that the GI tract is a biologically rational target for interventions aimed at correcting pathophysiologic aspects of cardiometabolic disorders. This article reviews the pathophysiology of metabolic disease and the role of bariatric/metabolic surgery in current clinical guidelines for the treatment of obesity and T2DM. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Change to earlier surgical interventions: contemporary management of unilateral vocal fold paralysis.

    Costello, Declan


    The management of unilateral vocal fold paralysis has undergone significant changes in the last 2 decades. This has largely been made possible by advances in endoscope technology and new injectable materials. This article will cover the main changes in management of patients with unilateral vocal fold paralysis and summarize the recent literature in relation to early intervention in this group. Several recent studies have suggested that early vocal fold injection medialization reduces the likelihood of needing open laryngeal framework surgery in future. Early injection medialization appears to give good long-term results with few complications and minimizes the need for future laryngeal framework surgery. It should be considered in centres wherein the equipment and trained staff are available.

  18. A Continuum Robot and Control Interface for Surgical Assist in Fetoscopic Interventions

    Dwyer, George; Chadebecq, Francois; Tella Amo, Marcel; Bergeles, Christos; Maneas, Efthymios; Pawar, Vijay; Vander Poorten, Emanuel; Deprest, Jan; Ourselin, Sebastien; De Coppi, Paolo; Vercauteren, Tom; Stoyanov, Danail


    Twin–twin transfusion syndrome requires interventional treatment using a fetoscopically introduced laser to sever the shared blood supply between the fetuses. This is a delicate procedure relying on small instrumentation with limited articulation to guide the laser tip and a narrow field of view to visualize all relevant vascular connections. In this letter, we report on a mechatronic design for a comanipulated instrument that combines concentric tube actuation to a larger manipulator constrained by a remote centre of motion. A stereoscopic camera is mounted at the distal tip and used for imaging. Our mechanism provides enhanced dexterity and stability of the imaging device. We demonstrate that the imaging system can be used for computing geometry and enhancing the view at the operating site. Results using electromagnetic sensors for verification and comparison to visual odometry from the distal sensor show that our system is promising and can be developed further for multiple clinical needs in fetoscopic procedures. PMID:28680967

  19. [[Technology Surgical Intervention in Ulcerative Colitis Modeling Descending Part of the Colon in Rats Line "Wistar"].

    Kim, A D; Petuhova, S A; Chashkova, Ye Y U; Gol'dberg, O A; Shedoeva, L R


    Ulcerative colitis (UC) is a chronic immune inflammatory condition of the colon with an unknown aetiology, leading to disability and reduced quality of life of patients. UC primarily affects young adults. In most cases, inflammatory bowel disease (iBD) debuts at reproductive age. The incidence of UC and severe clinical course has increased overall across the world. The study of the mechanisms of pathogenesis and aetiology of this disease contributes to the development of new effective methods of treatment. The aim of our study was to develop technology of the surgery directed to induction of reversible ischemic damage, the erosive-ulceration of gut mucosae (descending colon) at rats of the WISTAR line. Experimental research was done using male rats (n=40), their age was more than 6 months, weight of body is 280 - 350 grams. The animals were separated into 3 groups: 1 - (n=14) Sholimov's operative method, 2 group (n=16) - model using special technology, 3 group (n=10) - Coopr's H. S. induction ulcerative colitis. Observation was been done during 10 days. We offered special surgical technique: parietal ligation on every vasa recta of colon descendens of rats the length 3 cm along colon, on the apex vesicae and then vasa recta are cut. Then during 7 days 1% solution of dextran sulfate sodium (DSN) was given for experimental animals after postoperative period. By the histolog- ical biopsy of colon mucosa the results were estimated. we have created erosive-ulceration of gut mucosae (descending colon) of rat with productive inflam- mation, vasculitis and plasmatic impregnation of the vessel walls and intimal thickening. Our model of ulcerative colitis can be used for the development and testing of new methods for the study and treatment of this pathology.

  20. Implementation of a surgical safety checklist: interventions to optimize the process and hints to increase compliance.

    Gerald Sendlhofer

    Full Text Available A surgical safety checklist (SSC was implemented and routinely evaluated within our hospital. The purpose of this study was to analyze compliance, knowledge of and satisfaction with the SSC to determine further improvements.The implementation of the SSC was observed in a pilot unit. After roll-out into each operating theater, compliance with the SSC was routinely measured. To assess subjective and objective knowledge, as well as satisfaction with the SSC implementation, an online survey (N = 891 was performed.During two test runs in a piloting unit, 305 operations were observed, 175 in test run 1 and 130 in test run 2. The SSC was used in 77.1% of all operations in test run 1 and in 99.2% in test run 2. Within used SSCs, completion rates were 36.3% in test run 1 and 1.6% in test run 2. After roll-out, three unannounced audits took place and showed that the SSC was used in 95.3%, 91.9% and 89.9%. Within used SSCs, completion rates decreased from 81.7% to 60.6% and 53.2%. In 2014, 164 (18.4% operating team members responded to the online survey, 160 of which were included in the analysis. 146 (91.3% consultants and nursing staff reported to use the SSC regularly in daily routine.These data show that the implementation of new tools such as the adapted WHO SSC needs constant supervision and instruction until it becomes self-evident and accepted. Further efforts, consisting mainly of hands-on leadership and training are necessary.

  1. The Systemic Inflammatory Response Syndrome (SIRS)--number and type of positive criteria predict interventions and outcomes in acute surgical admissions.

    Stephenson, James A; Gravante, Gianpiero; Butler, Nicholas A; Sorge, Roberto; Sayers, Rob D; Bown, Matt J


    Systemic inflammatory response syndrome (SIRS) is a syndrome that reflects the widespread activation of inflammatory pathways. The goal of this study was to find whether the presence or absence of SIRS on emergency surgical admissions is related to the subsequent clinical outcome in terms of in-hospital interventions, length of stay, and mortality. The presence of SIRS at admission, final diagnosis of the underlying disease, treatments, and clinical outcomes were prospectively recorded for 1 month. Comparisons of interventions and outcomes were performed between SIRS+ vs. SIRS- patients. In patients with SIRS, the contribution of each positive criterion was evaluated with regards to mortality. A total of 179 patients were recruited. The prevalence of SIRS at admission was 35.2%. SIRS+ patients required less diagnostic procedures compared with SIRS- (28.6% vs. 34.5%) but had more therapeutic interventions (39.7% vs. 16.4%), surgical interventions (33.3% vs. 3.4%), intensive treatments (11.1% vs. 0.9%; p SIRS+ patients with four positive criteria had more surgical interventions, intensive treatments, and fatal outcomes compared with the others. Of importance the most influent factor was the respiratory rate followed by the white cell count and the heart rate/temperature. Patients with SIRS at admission apparently receive more interventions, have longer length of stay, and increased mortality than those patients without SIRS. These findings require separate validation in a larger cohort study.

  2. Orthodontic-orthognathic interventions in orthognathic surgical cases: “Paper surgery” and “model surgery” concepts in surgical orthodontics

    Gandedkar, Narayan H.; Chng, Chai Kiat; Yeow, Vincent Kok Leng


    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. PMID:27630506

  3. Relationships among NANDA-I diagnoses, nursing outcomes classification, and nursing interventions classification by nursing students for patients in medical-surgical units in Korea.

    Noh, Hyun Kyung; Lee, Eunjoo


    The purpose of this study was to identify NANDA-I, Nursing Outcomes Classification (NOC), and Nursing Interventions Classification (NIC; NNN) linkages used by Korean nursing students during their clinical practice in medical-surgical units. A comparative descriptive research design was used to measure the effects of nursing interventions from 153 nursing students in South Korea. Nursing students selected NNN using a Web-based nursing process documentation system. Data were analyzed by paired t-test. Eighty-two NANDA-I diagnoses, 116 NOC outcomes, and 163 NIC interventions were identified. Statistically significant differences in patients' preintervention and postintervention outcome scores were observed. By determining patient outcomes linked to interventions and how the degree of outcomes change after interventions, the effectiveness of the interventions can be evaluated. © 2014 NANDA International, Inc.

  4. An application-dependent framework for the recognition of high-level surgical tasks in the OR.

    Lalys, Florent; Riffaud, Laurent; Bouget, David; Jannin, Pierre


    Surgical process analysis and modeling is a recent and important topic aiming at introducing a new generation of computer-assisted surgical systems. Among all of the techniques already in use for extracting data from the Operating Room, the use of image videos allows automating the surgeons' assistance without altering the surgical routine. We proposed in this paper an application-dependent framework able to automatically extract the phases of the surgery only by using microscope videos as input data and that can be adaptable to different surgical specialties. First, four distinct types of classifiers based on image processing were implemented to extract visual cues from video frames. Each of these classifiers was related to one kind of visual cue: visual cues recognizable through color were detected with a color histogram approach, for shape-oriented visual cues we trained a Haar classifier, for texture-oriented visual cues we used a bag-of-word approach with SIFT descriptors, and for all other visual cues we used a classical image classification approach including a feature extraction, selection, and a supervised classification. The extraction of this semantic vector for each video frame then permitted to classify time series using either Hidden Markov Model or Dynamic Time Warping algorithms. The framework was validated on cataract surgeries, obtaining accuracies of 95%.

  5. Non-surgical interventions after mild traumatic brain injury: A systematic review. Results of the International Collaboration on MTBI Prognosis (ICoMP)

    Nygren-de Boussard, Catharina; Holm, Lena W; Cancelliere, Carol


    Objective: To synthesize the best available evidence regarding the impact of non-surgical interventions on persistent symptoms after mild traumatic brain injury (MTBI). Data sources: MEDLINE and other databases were searched (2001–2012) with terms including ‘rehabilitation’. Inclusion criteria we...

  6. Number of Published Randomized Controlled Multi Center Trials Testing Pharmacological Interventions or Devices Is Increasing in Both Medical and Surgical Specialties

    Danielsen, Anne Kjaergaard; Okholm, Cecilie; Pommergaard, Hans-Christian;


    in 1995 to 1,273 in 2010, with a larger share of multicenter studies being performed in Europe and North America. The pharmacological interventions were primarily being tested in medical studies followed by the device tests predominantly in surgical studies. The number of included patients as well...

  7. Mycobacterium avium complex olecranon bursitis resolves without antimicrobials or surgical intervention: A case report and review of the literature

    Working, Selene; Tyser, Andrew; Levy, Dana


    Introduction Nontuberculous mycobacteria are an uncommon cause of septic olecranon bursitis, though cases have increasingly been described in both immunocompromised and immunocompetent hosts. Guidelines recommend a combination of surgical resection and antimicrobials for treatment. This case is the first reported case of nontuberculous mycobacterial olecranon bursitis that resolved without medical or surgical intervention. Case presentation A 67-year-old female developed a painless, fluctuant swelling of the olecranon bursa following blunt trauma to the elbow. Due to persistent bursal swelling, she underwent three separate therapeutic bursal aspirations, two involving intrabursal steroid injection. After the third aspiration, the bursa became erythematous and severely swollen, and bursal fluid grew Mycobacterium avium complex. Triple-drug antimycobacterial therapy was initiated, but discontinued abruptly due to a rash. Surgery was not performed. The patient was observed off antimicrobials, and gradually clinically improved with a compressive dressing. By 14 months after initial presentation, clinical exam revealed complete resolution of the previously erythematous bursal mass. Discussion This is the first reported case of nontuberculous mycobacterial olecranon bursitis managed successfully without surgery or antimicrobials. Musculoskeletal nontuberculous mycobacterial infections are challenging given the lack of clinical data about optimal duration and choice of antimicrobials or the role of surgery. Additionally, the potential toxicity and drug interactions of antimycobacterials are not insignificant and warrant close monitoring if treatment is pursued. Conclusion This case raises an important clinical question of whether close observation off antimicrobials is appropriate in select cases of immunocompetent patients with localized atypical mycobacterial disease of soft tissue and skeletal structures. PMID:26793457

  8. Repeat surgical interventions following "definitive" instrumentation and fusion for idiopathic scoliosis: five-year update on a previously published cohort.

    Ramo, Brandon A; Richards, B Stephens


    A retrospective case series. To identify the overall reoperation rate and factors contributing to reoperation in a recent 5-year cohort of patients (2003-2007) undergoing spinal deformity surgery. These patients were compared with a previously published 15-year cohort of consecutive patients (1988-2002) from the same institution to assess for any significant differences in reoperation rates. In a previously published report from this institution, the reoperation rate for patients with idiopathic scoliosis treated during a 15-year period (1988-2002) was 12.9%. That group was predominantly treated with first-generation TSRH (Medtronic, Memphis, TN) implants and CD implants. Lower profile, more rigid implant systems are now used along with refined techniques for correction of scoliosis deformity. We hypothesized that these factors would lead to lower rates of reoperation. METHODS.: The medical records of 452 consecutive patients (older than 9 yr) surgically treated for idiopathic scoliosis at one institution during 5 years (2003-2007) were reviewed to identify those who required reoperation. The reoperation rate for this cohort was 7.5% (34 of 452 patients). Compared with the prior cohort, significant decreases were noted with regard to total reoperation rate as well as reoperation due to infection and pseudarthrosis. Trends were noted toward decreased rates of reoperation due to prominent implants, dislodged implants, and implant proximity to vital structures. Within the newer cohort, a trend toward decreased reoperation rate was also noted for lower profile implant systems compared with first-generation TSRH implants. With the evolution of newer lower profile segmental implant systems that provide more rigid fixation and with the advancements in techniques for deformity correction, the repeat surgical intervention rate for idiopathic scoliosis has decreased.

  9. [Assessment of antibiotic use and impact of an intervention intended to modify the prescribing behavior in surgical prophylaxis in 6hospitals in the metropolitan area of Monterrey, Mexico].

    Palacios-Saucedo, Gerardo Del Carmen; de la Garza-Camargo, Mauricio; Briones-Lara, Evangelina; Carmona-González, Sandra; García-Cabello, Ricardo; Islas-Esparza, Luis Arturo; Saldaña-Flores, Gustavo; González-Cano, Juan Roberto; González-Ruvalcaba, Román; Valadez-Botello, Francisco Javier; Muñoz-Maldonado, Gerardo Enrique; Montero-Cantú, Carlos Alberto; Díaz-Ramos, Rita Delia; Solórzano-Santos, Fortino


    Improper use of antibiotics increases antimicrobial resistance. Evaluate the use of antibiotics and the impact of an intervention designed to improve antibiotic prescription for surgical prophylaxis in 6 hospitals of Monterrey, Mexico. Design: A prospective multicenter survey and a pretest-postest experimental study. Phase 1: Survey to evaluate the use of antibiotics through an especially designed guide. Phase 2: Intervention designed to improve antibiotic prescription for surgical prophylaxis by the medical staff by using printed, audiovisual and electronic messages. Phase 3: Survey to evaluate the impact of the intervention. Frequencies, percentages, medians, ranges and X(2) test. Phase 1: We evaluated 358 surgical patients, 274 prophylactic antibiotic regimens. A total of 96% of antibiotics regimens began with inappropriate timing (290/302), 82.8% were inappropriate regimens (274/331), 77.7% were in inappropriate dosage (230/296), 86% of inadequate length (241/280), and in 17.4% restricted antibiotics were used (52/299). Phase 2: 9 sessions including 189 physicians (14 department chairs, 58 general practitioners and 117 residents). Phase 3: We evaluated 303 surgical patients, 218 prophylactic antibiotics regimens. Inappropriate treatment commencement was reduced to 84.1% (180/214) (P<0.001), inappropriate regimens to 75.3% (162/215) (P=0.03), inappropriate dosages to 51.2% (110/215) (P<0.001), and use of restricted antibiotics to 8.3% (18/215) (P=0.003). Inappropriate use of prophylactic antibiotics in surgery is a frequent problem in Monterrey. The intervention improved the antibiotic prescription for surgical prophylaxis by reducing inappropriate treatment commencement, regimens, dosages, and overuse of restricted antibiotics. It is necessary to strengthen strategies to improve the prescription of antibiotics in surgical prophylaxis. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  10. Endoscopic ultrasound-guided biliary intervention inpatients with surgically altered anatomy

    Aroon Siripun; Pimsiri Sripongpun; Bancha Ovartlarnporn


    AIM To evaluate the efficacy of endoscopic ultrasoundguided biliary drainage (EUS-BD) in patients withsurgically altered anatomies.METHODS: We performed a search of the MEDLINEdatabase for studies published between 2001 to July2014 reporting on EUS-BD in patients with surgicallyaltered anatomy using the terms "EUS drainage" and"altered anatomy". All relevant articles were accessedin full text. A manual search of the reference lists ofrelevant retrieved articles was also performed. Only fulltextEnglish papers were included. Data regarding age,gender, diagnosis, method of EUS-BD and intervention,type of altered anatomy, technical success, clinicalsuccess, and complications were extracted andcollected. Anatomic alterations were categorized as:group 1, Billroth Ⅰ; group 2, Billroth Ⅱ; group 4, Rouxen-Y with gastric bypass; and group 3, all other types.RESULTS: Twenty three articles identified in theliterature search, three reports were from the samegroup with different numbers of cases. In total, 101cases of EUS-BD in patients with altered anatomy wereidentified. Twenty-seven cases had no information andwere excluded. Seventy four cases were included foranalysis. Data of EUS-BD in patients categorized asgroup 1, 2 and 4 were limited with 2, 3 and 6 caseswith EUS-BD done respectively. Thirty four cases withEUS-BD were reported in group 3. The pooled technicalsuccess, clinical success, and complication rates ofall reports with available data were 89.18%, 91.07%and 17.5%, respectively. The results are similar to thereported outcomes of EUS-BD in general, however, withlimited data of EUS-BD in patients with altered anatomyrendered it difficult to draw a firm conclusion.CONCLUSION: EUS-BD may be an option for patientswith altered anatomy after a failed endoscopic-retrogradecholangiographyin centers with expertise in EUS-BDprocedures in a research setting.

  11. Effectiveness of surgical interventions for thoracic aortic aneurysms: A systematic review and meta-analysis.

    Alsawas, Mouaz; Zaiem, Feras; Larrea-Mantilla, Laura; Almasri, Jehad; Erwin, Patricia J; Upchurch, Gilbert R; Murad, M Hassan


    cord ischemia, and pulmonary complications within 30 days of intervention. Patients undergoing TEVAR also had shorter length of hospital and ICU stay compared with patients undergoing open repair. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  12. A tailored relocation stress intervention programme for family caregivers of patients transferred from a surgical intensive care unit to a general ward.

    Lee, Seul; Oh, HyunSoo; Suh, YeonOk; Seo, WhaSook


    To develop and examine a relocation stress intervention programme tailored for the family caregivers of patients scheduled for transfer from a surgical intensive care unit to a general ward. Family relocation stress syndrome has been reported to be similar to that exhibited by patients, and investigators have emphasised that nurses should make special efforts to relieve family relocation stress to maximise positive contributions to the well-being of patients by family caregivers. A nonequivalent control group, nonsynchronised pretest-post-test design was adopted. The study subjects were 60 family caregivers of patients with neurosurgical or general surgical conditions in the surgical intensive care unit of a university hospital located in Incheon, South Korea. Relocation stress and family burden were evaluated at three times, that is before intervention, immediately after transfer and four to five days after transfer. This relocation stress intervention programme was developed for the family caregivers based on disease characteristics and relocation-related needs. In the experimental group, relocation stress levels significantly and continuously decreased after intervention, whereas in the control group, a slight nonsignificant trend was observed. Family burden levels in the control group increased significantly after transfer, whereas burden levels in the experimental group increased only marginally and nonsignificantly. No significant between-group differences in relocation stress or family burden levels were observed after intervention. Relocation stress levels of family caregivers were significantly decreased after intervention in the experimental group, which indicates that the devised family relocation stress intervention programme effectively alleviated family relocation stress. The devised intervention programme, which was tailored to disease characteristics and relocation-related needs, may enhance the practicality and efficacy of relocation stress

  13. Surgical intervention strategies for congenital tracheal stenosis associated with a tracheal bronchus based on the location of stenosis.

    Morita, Keiichi; Yokoi, Akiko; Fukuzawa, Hiroaki; Hisamatsu, Chieko; Endo, Kosuke; Okata, Yuichi; Tamaki, Akihiko; Mishima, Yasuhiko; Oshima, Yoshihiro; Maeda, Kosaku


    The aim of this study was to determine the appropriate surgical intervention strategies for congenital tracheal stenosis (CTS) associated with a tracheal bronchus based on the location of stenosis. The medical records of 13 pediatric patients with CTS associated with a tracheal bronchus at a single institution between January 2006 and December 2015 were retrospectively reviewed. Type 1: tracheal stenosis above the right upper lobe bronchus (RULB) (n = 1). One patient underwent slide tracheoplasty and was successfully extubated. Type 2: tracheal stenosis below the RULB (n = 7). Tracheal end-to-end anastomosis was performed before 2014, and one patient failed to extubate. Posterior-anterior slide tracheoplasty was performed since 2014, and all three patients were successfully extubated. Type 3: tracheal stenosis above the RULB to the carina (n = 5). One patient underwent posterior-anterior slide tracheoplasty and was successfully extubated. Two patients with left-right slide tracheoplasty and another two patients with tracheal end-to-end anastomosis for the stenosis below the RULB could not be extubated. Tracheal end-to-end anastomosis or slide tracheoplasty can be selected for tracheal stenosis above the RULB according to the length of stenosis. Posterior-anterior slide tracheoplasty appears feasible for tracheal stenosis below the RULB or above the RULB to the carina.

  14. Pre-irradiation and surgical intervention in patients with squamous cell carcinomas of the oral cavity and the oropharynx: Results of a study conducted from 1973 to 1984

    Knoebber, D.; Sack, H.; Stuetzer, H.; Rose, K.G.


    In collaboration with the Radiotherapeutic Hospital, 87 patients with squamous cell carcinomas of the oral cavity and the oropharynx were treated by combined pre-irradiation and surgical intervention at the University ORL Hospital of Cologne. The study was supposed to improve the five-year survival of patients suffering from advanced carcinomas of the head and neck area. The male and female patient's ratio was 4,5 to 1. Half of the patients had squamous cell carcinomas of the oropharynx, 21 patients had tumors of the floor of the mouth, and another 21 had tumors of the anterior two thirds of the tongue. The tumor and lymph node status was classified according to the UICC regulations (1979). In the pre-irradiation, 40 to 50 Gy were applied to the primary tumor and the regional lymph nodes. Surgery was executed generally four weeks after pre-irradiation. The tumor remission following to pre-irradiation was very good. 27% of the patients showed little or moderate post-operative disturbances in wound healing. An osteoradionecrosis was found in 4,6%. Almost 25% of the patients developed local recurrences. The cumulated five-year survival of all patients is 32%. In dependence on TNM stages, the three-year survival rates are as follows: stage I and II 80%, stage III 44%, and stage IV 40%.

  15. Concordance of expert and parental opinion about hypospadias surgical outcome is severity-dependent

    Marcos Raymond Perez-Brayfield


    Full Text Available Introduction. Hypospadias is a male congenital condition where the opening of the urethral meatus is not located in the typical anatomical position. It has been a challenge for empirical studies to ascertain the level of concordance of opinion among parents and urologists with regard to surgical outcomes according to hypospadias severity. Materials and Methods. Parents of children who had undergone hypospadias repair were recruited for this study (n=104. A set of questionnaires that included some items with Likert scale were created to evaluate postsurgical satisfaction by parents and urologists. SAHLSA-50, a validated instrument for adult Spanish-speaking adults, was used to assess health literacy. Cohen’s Kappa (k coefficient was used to assess inter-observer agreement and Chi Square Goodness of Fit Test was used to determine probability of satisfaction. Findings. Concordance on the level of satisfaction with surgical outcomes for Type cases I was slight (k=0.20; CI 95% 0-0.60, for Type II cases was moderate (k= 0.54; CI 95% 0.13-0.94, and for Type III cases was substantial (k=0.62; CI 95% 0-0.56. However, the probability of satisfaction did not change according to severity (Chi Square Goodness of Fit Test; parents, p=0.84; pediatric urologists, p=0.92. These results cannot be explained by parental health literacy according to SAHLSA-50 test scores. Conclusions. The level of concordance of opinion among parents and urologists with regard to their level of satisfaction with surgical outcomes is related to hypospadias severity, whereby the greatest level of concordance of opinion was achieved among most severe cases. This study underscores the need for longer follow-up to properly assess satisfaction with hypospadias repair, especially for the less severe forms of the condition.

  16. Insulin-dependent and insulin-independent effects after surgical alterations of the pancreas.

    Krusch, D A; Brown, K B; Cornett, G; Freedlender, A E; Kaiser, D L; Hanks, J B


    Anatomic alterations of the pancreas result in physiologic alterations that have not been completely analyzed. Insulin plays a major role in carbohydrate metabolism; nevertheless, as much as 50% of a hyperglycemic load may be metabolized independent of insulin. We analyzed the effects of surgical alterations of the pancreas on postoperative glucose metabolism, including insulin-independent effects. Mongrel female dogs underwent one of three procedures: proximal partial pancreatectomy (PPx), PPx plus diversion of pancreatic venous effluent to the systemic circulation (SC), or PPx plus segmental pancreatic autotransplantation (PAT). Intravenous glucose tolerance tests, with or without a background infusion of somatostatin (SST; 400 ng/kg/min) were performed on all animals preoperatively and postoperatively. SST completely suppressed secretion of assayable peripheral insulin. The rate of glucose disposal during SST suppression approximates the rate of insulin-independent glucose disposal (IIGD). Although there was a significant decrease in the rate of glucose disposal during SST infusion when compared with the rate without SST, no differences in IIGD were found between postoperative groups. IIGD was calculated at 50% to 55% for control, PPx, and SC groups and at 67% for PAT. Peripheral sensitivity to an exogenous insulin infusion (euglycemic clamp) was unchanged by any of the procedures. We conclude that surgical alteration of the pancreas, including pancreas transplantation, results in altered glucose handling in the face of "normal" peripheral levels of insulin. Changes in IIGD and analysis of peripheral sensitivity to insulin do not explain these alterations completely.


    Grihn, V K; Kondratenko, P G; Melekhovets, Yu V; Sinyachenko, Yu O; Sinyachenko, O V


    Physico-chemical adsorption-rheological properties of venous blood in patients, suffering varicose disease of the lower extremities, and their impact on efficacy of various methods of surgical treatment were studied. Conduction of endovasal laser coagulation in combination with crossectomy have promoted enhancement of operative treatment efficacy in patients in initial terms of observation (in 1 week), in 1 month a complete occlusion of the vein was noted more rarely. Efficacy of a small--power laser ablation with irradiation power of 10 W and less in 4 weeks postoperatively is higher, than of surgical treatment with a laser irradiation power 15 W. In a varicose disease of the lower extremities there were observed the raising of the blood volume toughness, superficial relaxation and superficial stress on background of reduction of the toughness--elasticity module, superficial toughness and superficial elasticity. Crossectomy conduction did not influence the integral dynamics of adsorption--rheological properties of venous blood, but in 1 month after endovasal laser coagulation a normalization of physicchemical parameters of blood was noted. Application of laser irradiation of the 10 W power and less promotes inhibition of the relaxation properties of venous blood; a prognostic meaning owes initial value of the blood volume toughness.

  18. Nutrition education intervention for dependent patients: protocol of a randomized controlled trial

    Arija Victoria


    Full Text Available Abstract Background Malnutrition in dependent patients has a high prevalence and can influence the prognosis associated with diverse pathologic processes, decrease quality of life, and increase morbidity-mortality and hospital admissions. The aim of the study is to assess the effect of an educational intervention for caregivers on the nutritional status of dependent patients at risk of malnutrition. Methods/Design Intervention study with control group, randomly allocated, of 200 patients of the Home Care Program carried out in 8 Primary Care Centers (Spain. These patients are dependent and at risk of malnutrition, older than 65, and have caregivers. The socioeconomic and educational characteristics of the patient and the caregiver are recorded. On a schedule of 0–6–12 months, patients are evaluated as follows: Mini Nutritional Assessment (MNA, food intake, dentures, degree of dependency (Barthel test, cognitive state (Pfeiffer test, mood status (Yesavage test, and anthropometric and serum parameters of nutritional status: albumin, prealbumin, transferrin, haemoglobin, lymphocyte count, iron, and ferritin. Prior to the intervention, the educational procedure and the design of educational material are standardized among nurses. The nurses conduct an initial session for caregivers and then monitor the education impact at home every month (4 visits up to 6 months. The North American Nursing Diagnosis Association (NANDA methodology will be used. The investigators will study the effect of the intervention with caregivers on the patient’s nutritional status using the MNA test, diet, anthropometry, and biochemical parameters. Bivariate normal test statistics and multivariate models will be created to adjust the effect of the intervention. The SPSS/PC program will be used for statistical analysis. Discussion The nutritional status of dependent patients has been little studied. This study allows us to know nutritional risk from different points of

  19. Mechanisms of Action of Surgical Interventions on Weight-Related Diseases: the Potential Role of Bile Acids.

    Mazidi, Mohsen; de Caravatto, Pedro Paulo P; Speakman, John R; Cohen, Ricardo V


    Surgical interventions for weight-related diseases (SWRD) may have substantial and sustainable effect on weight reduction, also leading to a higher remission rate of type 2 diabetes (T2D) mellitus than any other medical treatment or lifestyle intervention. The resolution of T2D after Roux-en-Y gastric bypass (RYGB) typically occurs too quickly to be accounted for by weight loss alone, suggesting that these operations have a direct impact on glucose homeostasis. The mechanisms underlying these beneficial effects however remain unclear. Recent research suggests that changes in the concentrations of plasma bile acids might contribute to these metabolic changes after surgery. In this review, we aimed to outline the potential role of bile acids in SWRD. We systematically reviewed MEDLINE, SCOPUS, and Web of Science for articles reporting the effect of SWRD on outcomes published between 1969 and 2016. We found that changes in circulating bile acids after surgery may play a major role through activation of the farnesoid X receptor A (FXRA), the fibroblast growth factor 19 (FGF19), and the G protein-coupled bile acid receptor (TGR5). Bile acid concentration increased significantly after RYGB. Some studies suggest that a transitory decrease occurs at 1 week post-surgery, followed by a gradual increase. Most studies have shown the increase to be proportionate by all bile acid subtypes. Bile acids can regulate glucose metabolism through the expression of TGR5 receptor in L cells, resulting in a release of glucagon-like peptide 1 (GLP-1). It may also induce the synthesis and secretion of FGF19 in ileal cells, thereby improving insulin sensitivity and regulating glucose metabolism. All the present SWRD are involved with changes in food stimulation to the stomach. This implies that discovering and developing the antagonists to TGR5 and FXRA may effectively control metabolic syndrome and the elucidation of the mechanisms underlying the physiological effects related to weight

  20. Infliximab dependency is related to decreased surgical rates in adult Crohn's disease patients

    Pedersen, N.; Duricova, D.; Lenicek, M.


    last intended infusion: prolonged response (maintenance of complete/partial response), infliximab dependency (relapse requiring repeated infusions to regain complete/partial response or need of infliximab > 12 months to sustain response). Results Forty-seven percent obtained prolonged response, 29...... on maintenance versus on demand regime was 33 and 31%, respectively (P = 0.63). No relevant clinical or genetic predictors were identified. Conclusion The infliximab dependency response seems to be equivalent to the prolonged response in adult CD patients when comparing surgery rates. Eur J Gastroenterol Hepatol......Background Infliximab dependency in children with Crohn's disease (CD) has recently been described and found to be associated with a decreased surgery rate. Aim To assess infliximab dependency of adult CD patients, evaluate the impact on surgery, and search for possible clinical and genetic...

  1. Combining Systems and Teamwork Approaches to Enhance the Effectiveness of Safety Improvement Interventions in Surgery: The Safer Delivery of Surgical Services (S3) Program.

    McCulloch, Peter; Morgan, Lauren; New, Steve; Catchpole, Ken; Roberston, Eleanor; Hadi, Mohammed; Pickering, Sharon; Collins, Gary; Griffin, Damian


    Patient safety improvement interventions usually address either work systems or team culture. We do not know which is more effective, or whether combining approaches is beneficial. To compare improvement in surgical team performance after interventions addressing teamwork culture, work systems, or both. Suite of 5 identical controlled before-after intervention studies, with preplanned analysis of pooled data for indirect comparisons of strategies. Operating theatres in 5 UK hospitals performing elective orthopedic, plastic, or vascular surgery PARTICIPANTS:: All operating theatres staff, including surgeons, nurses, anaesthetists, and others INTERVENTIONS:: 4-month safety improvement interventions, using teamwork training (TT), systems redesign and standardization (SOP), Lean quality improvement, SOP + TT combination, or Lean + TT combination. Team technical and nontechnical performance and World Health Organization (WHO) checklist compliance, measured for 3 months before and after intervention using validated scales. Pooled data analysis of before-after change in active and control groups, comparing combined versus single and systems versus teamwork interventions, using 2-way ANOVA. We studied 453 operations, (255 intervention, 198 control). TT improved nontechnical skills and WHO compliance (P teamwork training and systems rationalization are more effective than those adopting either approach alone. This has important implications for safety improvement strategies in hospitals.

  2. The cost-effectiveness of multi-component interventions to prevent delirium in older people undergoing surgical repair of hip fracture.

    Akunne, Anayo; Davis, Sarah; Westby, Maggie; Young, John


    This article summarizes the detailed cost-effectiveness analysis of delirium prevention interventions in people undergoing surgical repair of hip fracture. We compared a multi-component delirium prevention intervention with usual care using a model based on a decision tree analysis. The model was used to estimate the incremental net monetary benefit (INMB). The robustness of the cost-effectiveness result was explored using deterministic and probabilistic sensitivity analyses. The multi-component prevention intervention was cost-effective when compared to usual care. It was associated with an INMB of £8,180 using a cost-effectiveness threshold of £20,000 per QALY. It remained cost-effective in the majority of the deterministic sensitivity analyses and was cost-effective in 96.4 % of the simulations carried out in the probabilistic sensitivity analysis. We have demonstrated the cost-effectiveness of a multi-component delirium prevention intervention that targets modifiable risk factors for delirium in older people undergoing surgical repair of hip fracture. It is an attractive intervention for practitioners and health care policy makers as they address the double burden of hip fracture and delirium.

  3. Self-reported changes in the professional singing voice after surgical intervention treatment for breast cancer: a survey pilot study of female professional singers.

    Baroody, Margaret M; Barnes-Burroughs, Kathryn; Rodriguez, Michael C; Sataloff, Dahlia M; Sataloff, Robert Thayer


    The effects of breast cancer surgical treatment on the professional singing voice are unknown. The purpose of this study was to discover whether there are self-perceived changes in the quality and/or process of singing experienced by professional female singers who have undergone surgical intervention for the treatment of diagnosed breast cancer-including any changes perceived from the use of radiation, chemotherapy, and other drug treatments related to those surgeries. A voluntary subject pool comprised female professional singers who have undergone surgery for breast cancer was recruited from professional singing networks. Participants underwent evaluation through an anonymous online survey, psychometrically vetted for content and instrument reliability/validity before administration. Valid participants (N=56) responded to 45 questions regarding surgical procedures, related therapies, and self-perceived vocal effects. Analysis of results produced a preliminary description of types of voice change, duration of changes, and qualitative self-perceptions. This initial report reveals that there are self-perceived singing voice changes experienced by professional singers treated for breast cancer. However, additional research is needed to determine the degree of vocal impact perceived to be attributable to individual surgical interventions and related therapies. Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  4. Cumulative High-Grade Squamous Intraepithelial Lesion Rate and Need for Surgical Intervention of Atypical Squamous Cells of Undetermined Significance Cytology-Diagnosed Patients: A Prospective Study.

    Petousis, Stamatios; Kalogiannidis, Ioannis; Margioula-Siarkou, Chrysoula; Mamopoulos, Apostolos; Mavromatidis, George; Prapas, Nikolaos; Rousso, David


    Τhe study aimed to study the rate of atypical squamous cells of undetermined significance (ASCUS) that progressed to high-grade squamous intraepithelial lesions (HGSIL), as well as the number of patients who finally necessitated a surgical intervention during follow-up. A prospective study was conducted on patients admitted for colposcopy during 2007-2012. We exclusively included those who presented with newly ASCUS diagnosis, while patients with a history of cervical intraepithelial neoplasia (CIN) were excluded. Primary end points were the cumulative rate of HGSIL during follow-up and the rate of surgical procedures performed because of such lesions. There were 134 ASCUS cases included. Overall, there were 48 (35.8%) surgical excision procedures performed to treat or eliminate HGSIL during the follow-up period. According to the final histopathology of surgical specimens, the cumulative rate of CIN2 or higher cervical lesions was 28.4% (n = 38). The cumulative rate of CIN2+ during follow-up period was almost 30% for patients with ASCUS, with the necessity for interventional treatment being even higher. © 2016 S. Karger AG, Basel.

  5. Infliximab dependency is related to decreased surgical rates in adult Crohn's disease patients

    Pedersen, N.; Duricova, D.; Lenicek, M.


    Background Infliximab dependency in children with Crohn's disease (CD) has recently been described and found to be associated with a decreased surgery rate. Aim To assess infliximab dependency of adult CD patients, evaluate the impact on surgery, and search for possible clinical and genetic...... predictors. Methods Two hundred and forty-five CD patients treated with infliximab were included from Danish and Czech Crohn Colitis Database (1999-2006). Infliximab response was assessed as immediate outcome, 1 month after infliximab start: complete, partial, and no response. Three months outcome, after...

  6. Single surgical procedure combining epicardial pacemaker implantation and subsequent extraction of the infected pacing system for pacemaker-dependent patients.

    Amraoui, Sana; Barandon, Laurent; Whinnett, Zachary; Ploux, Sylvain; Labrousse, Louis; Denis, Arnaud; Oses, Pierre; Ritter, Philippe; Haissaguerre, Michel; Bordachar, Pierre


    Management of pacemaker infection in pacing-dependent patients is often challenging. Typically, temporary pacing is used while antibiotic therapy is given for a number of days before reimplantation of a new endocardial system. This results in a prolonged hospital stay and complications associated with temporary pacing. In this study, we examine the feasibility of performing a single combined procedure of epicardial pacemaker implantation followed by system extraction. One hundred consecutive infected pacemaker-dependent patients underwent implantation of 2 epicardial ventricular leads and were converted to a ventricular demand pacing system. The infected pacing system was then extracted during the same procedure. Patients were followed up for 12 months. Significant pericardial bleeding developed during the procedure in 3 patients. The presence of the pericardial drain positioned during the implantation of the epicardial pacing system meant that cardiac tamponade did not occur, allowing surgical repair with sternotomy to be carried out under stable hemodynamic conditions. Two of these 100 patients died in the 30-day postoperative period; 1 death was due to septic shock and 1 to pulmonary distress. Median 1-year epicardial pacing thresholds were stable and excellent (1.4 ± 0.9 volts). However, 1 of the 2 leads developed increased thresholds in 6 patients, which led to the exclusive use of other ventricular lead. A single combined procedure of surgical epicardial pacemaker implantation and pacemaker system extraction appears to be a safe and effective method for managing pacemaker-dependent patients with infected pacemakers. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  7. Nicotine dependence as a moderator of a quitline-based message framing intervention.

    Fucito, Lisa M; Latimer, Amy E; Carlin-Menter, Shannon; Salovey, Peter; Cummings, K Michael; Makuch, Robert W; Toll, Benjamin A


    High nicotine dependence is a reliable predictor of difficulty quitting smoking and remaining smoke-free. Evidence also suggests that the effectiveness of various smoking cessation treatments may vary by nicotine dependence level. Nicotine dependence, as assessed by Heaviness of Smoking Index baseline total scores, was evaluated as a potential moderator of a message-framing intervention provided through the New York State Smokers' Quitline (free telephone based service). Smokers were exposed to either gain-framed (n=810) or standard-care (n=1222) counseling and printed materials. Those smoking 10 or more cigarettes per day and medically eligible were also offered a free 2-week supply of nicotine patches, gum, or lozenge. Smokers were contacted for follow-up interviews at 3 months by an independent survey group. There was no interaction of nicotine dependence scores and message condition on the likelihood of achieving 7-day point prevalence smoking abstinence at the 3-month follow-up contact. Among continuing smokers at the 3-month follow-up, smokers who reported higher nicotine dependence scores were more likely to report smoking more cigarettes per day and this effect was greater in response to standard-care messages than gain-framed messages. Smokers with higher dependence scores who received standard-care messages also were less likely to report use of nicotine medications compared with less dependent smokers, while there was no difference in those who received gain-framed messages. These findings lend support to prior research demonstrating nicotine dependence heterogeneity in response to message framing interventions and suggest that gain-framed messages may result in less variable smoking outcomes than standard-care messages.

  8. Early surgical outcomes of coronary artery bypass grafting in patients with dialysis-dependent renal failure: Effects of early hemodialysis

    Chih-Yuan Lin


    Full Text Available Background: Coronary artery disease occurs frequently and is a major cause of morbidity and mortality in patients with chronic renal failure. Because the number of patients requiring dialysis for end-stage renal disease (ESRD has increased, the number of patients in this population who require coronary artery bypass grafting (CABG has increased. The aim of this study was to examine the effect of early hemodialysis (HD on the early surgical outcomes of ESRD patients undergoing CABG. Materials and Methods: Fifty-nine dialysis-dependent patients who underwent isolated CABG with cardiopulmonary bypass (CPB were enrolled in this study. These patients were divided into two groups based on the timing of the first postoperation HD session. In the early HD group, HD was performed within 6 h postoperation; in the scheduled HD group, HD was performed >6 h postoperation. The preoperative characteristics, operative variables, and postoperative outcomes were retrospectively analyzed. Results: The time to first HD after CABG was 2.43 ± 1.58 h in the early HD group and 20.68 ± 6.98 h in the scheduled HD group (P < 0.001. There were no significant differences in the operative variables, namely duration of operation, CPB time, and aortic cross-clamp time, between the two groups. The incidence of postoperative pneumonia was higher in the scheduled HD group (31.8% than in the early HD group (2.7%. There was a trend of decreased incidence of postoperative pneumonia in the early HD group with marginal significance from the univariate analysis. The intensive care unit and hospital stay duration of both groups were similar. Nine patients died in the hospital, yielding an overall 30-day mortality of 8.47%. Conclusion: In dialysis-dependent patients who underwent CABG, the short-term outcomes and surgical mortality were acceptable. Dialysis-dependent renal failure should not be considered a contraindication for CABG. Early HD in the postoperative period demonstrated

  9. Employment-based abstinence reinforcement as a maintenance intervention for the treatment of cocaine dependence: post-intervention outcomes

    DeFulio, Anthony; Silverman, Kenneth


    Aims Due to the chronicity of cocaine dependence, practical and effective maintenance interventions are needed to sustain long-term abstinence. We sought to assess the effects of long-term employment-based reinforcement of cocaine abstinence after discontinuation of the intervention. Design Participants who initiated sustained opiate and cocaine abstinence during a 6-month abstinence reinforcement and training program worked as data entry operators and were randomly assigned to a group that could work independent of drug use (Control, n = 24), or an abstinence-contingent employment (n = 27) group that was required to provide cocaine- and opiate-negative urine samples to work and maintain maximum rate of pay. Setting A nonprofit data entry business. Participants Unemployed welfare recipients who persistently used cocaine while in methadone treatment. Measurements Urine samples and self-reports were collected every six months for 30 months. Findings During the employment year, abstinence-contingent employment participants provided significantly more cocaine-negative samples than controls (82.7% and 54.2%; P = .01, OR = 4.61). During the follow-up year, the groups had similar rates of cocaine-negative samples (44.2% and 50.0%; P = .93), and HIV-risk behaviors. Participants’ social, employment, economic, and legal conditions were similar in the two groups across all phases of the study. Conclusions Employment-based reinforcement effectively maintains long-term cocaine abstinence, but many patients relapse to use when the abstinence contingency is discontinued, even after a year of abstinence-contingent employment. Relapse could be prevented in many patients by leaving employment-based abstinence reinforcement in place indefinitely, which could be facilitated by integrating it into typical workplaces. PMID:21226886

  10. Cervical necrotizing fasciitis as a complication of acute epiglottitis managed with minimally aggressive surgical intervention: Case report.

    Gollapalli, Rajesh Babu; Naiman, Ana Nusa; Merry, David


    Cervical necrotizing fasciitis secondary to epiglottitis is rare. The standard treatment of this severe condition has long been early and aggressive surgical debridement and adequate antimicrobial therapy. We report the case of an immunocompetent 59-year-old man who developed cervical necrotizing fasciitis as a complication of acute epiglottitis. We were able to successfully manage this patient with conservative surgical treatment (incision and drainage, in addition to antibiotic therapy) that did not involve aggressive debridement.

  11. [Estimation of personal dose based on the dependent calibration of personal dosimeters in interventional radiology].

    Mori, Hiroshige; Koshida, Kichiro; Ichikawa, Katsuhiro


    The purpose of present study is, in interventional radiology (IVR), to elucidate the differences between each personal dosimeter, and the dependences and calibrations of area or personal dose by measurement with electronic dosimeters in particular. We compare space dose rate distributions measured by an ionization survey meter with the value measured by personal dosimeter: an optically stimulated luminescence, two fluoroglass, and two electronic dosimeters. Furthermore, with electronic dosimeters, we first measured dose rate, energy, and directional dependences. Secondly, we calibrated the dose rate measured by electronic dosimeters with the results, and estimated these methods with coefficient of determination and Akaike's Information Criterion (AIC). The results, especially in electronic dosimeters, revealed that the dose rate measured fell by energy and directional dependences. In terms of methods of calibration, the method is sufficient for energy dependence, but not for directional dependence, because of the lack of stable calibration. This improvement poses a question for the future. The study suggested that these dependences of the personal dosimeter must be considered when area or personal dose is estimated in IVR.

  12. Improvement of recurrence-free survival after radical prostatectomy for locally advanced prostate cancer in relation to the time of surgical intervention

    E. I. Veliev


    Full Text Available Objective: to comparatively estimate the frequency of a positive surgical margin and 5-year biochemical recurrent-free survival (BRFS rates in patients with locally advanced prostate cancer in relation to the time of radical retropubic prostatectomy.Subjects and methods. The investigation enrolled 274 patients with prostate cancer (pT3-4N0-1M0 who were divided into 2 groups of 68 and 20 patients operated on in 1997 to 2006 and 2007 to 2012, respectively. Two surgeons made surgical interventions by the standardized procedure. The 5-year BRFS rates were estimated using the Kaplan-Meier method and log-rank test. A biochemical recurrence was defined as a prostatespecific antigen level of t 0.2 ng / ml in 2 consecutive measurements or as the initiation of adjuvant therapy.Results. The detection rate of a positive surgical margin decreased from 55.9 % in 1997–2006 to 37.9 % in 2007–2012 (p = 0.01; the 5-year recurrence-free survival rates were 38.8 % versus 66.2 % (p < 0.001.Conclusion. These changes would probably be a result of surgeons» better experience and improved surgical techniques in the course of time.

  13. Nursing Intervention on Surgical Patients with Enteral Nutrition%外科重症患者肠内营养的护理干预



    目的:探讨外科重症患者肠内营养的护理干预效果。方法收集我院收治的外科重症80例患者资料,将患者随机分为干预组和对照组,各40例。干预组患者给予肠内营养护理干预,对照组患者给予常规护理干预,比较两组患者胃肠功能恢复情况。结果干预组患者的肛门排便时间和排气时间均明显短于对照组,差异均有统计学意义(均P<0.05)。结论外科重症患者给予肠内营养护理有助于补充患者身体所需的营养和能量,增加患者机体的免疫力,避免患者术后因营养不良而给康复带来的影响,促进患者早日康复。%Objective To discuss the effect of surgical patients with enteral nutrition nursing intervention.Methods 80 surgical critical y il patients in our hospital were selected were randomly divided into intervention group and control group,each of 40 cases.The patients in the intervention group were given enteral nutrition nursing intervention,the control group patients were given routine nursing care,compared two groups of gastrointestinal function recovery. Results The after care,patients in the intervention group were anal defecation time and exhaust time were significantly shorter than the control group,the difference was statistical y significant(P<0.05).Conclusion Surgical patients with enteral nutrition nursing intervention is helpfulto supplement the patient body needed nutrients and energy,and increase patients immunity,prevent patients due to malnutrition and to influence rehabilitation brings,and promote an early recovery of patients.

  14. Converting Scoliosis Research Society-24 to Scoliosis Research Society-22r in a Surgical-Range, Medical/Interventional Adolescent Idiopathic Scoliosis Patient Cohort.

    Chen, Antonia F; Bi, Wenzhu; Singhabahu, Dilrukshika; Londino, Joanne; Hohl, Justin; Ward, Maeve; Ward, W Timothy


    Prospective questionnaire administration study. To assess the ability to translate total and domain scores from Scoliosis Research Society (SRS)-24 to SRS-22r in a surgical-range, medical/interventional adolescent idiopathic scoliosis (AIS) patient population. Conversion of SRS-24 to SRS-22r is demonstrated in an operative cohort of patients with AIS, but not in a medical/interventional patient population. We simultaneously administered SRS-24 and SRS-22r questionnaires to 75 surgical-range, medical/interventional AIS patients and compared them. We performed analysis by regression modeling to produce conversion equations from SRS-24 to SRS-22r. The total SRS-24 score for these medical/interventional AIS patients was 92.5 ± 9.45 (mean, 3.9 ± 0.39), and the total SRS-22r score was 93.5 ± 9.63 (mean, 4.3 ± 0.44). The correlation between these 2 groups was fair (R(2) = 0.77) and improved to good when mental health or recall questions were removed. The correlation was also fair for total pain domains (R(2) = 0.73). However, there was poor correlation for general self-image (R(2) = 0.6) and unacceptable for post-treatment self-image (R(2) = 0.01), general function (R(2) = 0.52), activity function (R(2) = 0.56), and satisfaction (R(2) = 0.53). Compared with a published population of operative AIS patients, R(2) values for total SRS-24 scores, pain, general self-image, activity function, and satisfaction were similar (p > .05). The R(2) values for general function and combined general and activity function were significantly different between the operative and medical/interventional cohorts. Scoliosis Research Society-24 can be converted to SRS-22r scores with fair accuracy in the surgical-range, medical/interventional AIS patient population for total score, and total pain domains. The SRS-24 translates unacceptably to the SRS-22r in self-image, function, and satisfaction domains. The SRS-24 to SRS-22r conversion equations are similar to operative AIS patients, except

  15. The Interventional Arm of the Flexibility In Duty-Hour Requirements for Surgical Trainees Trial: First-Year Data Show Superior Quality In-Training Initiative Outcomes.

    Mirmehdi, Issa; O'Neal, Cindy-Marie; Moon, Davis; MacNew, Heather; Senkowski, Christopher

    With the implementation of strict 80-hour work week in general surgery training, serious questions have been raised concerning the quality of surgical education and the ability of newly trained general surgeons to independently operate. Programs that were randomized to the interventional arm of the Flexibility In duty-hour Requirements for Surgical Trainees (FIRST) Trial were able to decrease transitions and allow for better continuity by virtue of less constraints on duty-hour rules. Using National Surgical Quality Improvement Program Quality In-Training Initiative data along with duty-hour violations compared with old rules, it was hypothesized that quality of care would be improved and outcomes would be equivalent or better than the traditional duty-hour rules. It was also hypothesized that resident perception of compliance with duty hour would not change with implementation of new regulations based on FIRST trial. Flexible work hours were implemented on July 1, 2014. National Surgical Quality Improvement Program Quality In-Training Initiative information was reviewed from July 2014 to January 2015. Patient risk factors and outcomes were compared between institutional resident cases and the national cohort for comparison. Residents' duty-hour logs and violations during this period were compared to the 6-month period before the implementation of the FIRST trial. The annual Accreditation Council for Graduate Medical Education resident survey was used to assess the residents' perception of compliance with duty hours. With respect to the postoperative complications, the only statistically significant measures were higher prevalence of pneumonia (3.4% vs. 1.5%, p < 0.05) and lower prevalence of sepsis (0% vs. 1.5%, p < 0.05) among cases covered by residents with flexible duty hours. All other measures of postoperative surgical complications showed no difference. The total number of duty-hour violations decreased from 54 to 16. Had the institution not been part of the

  16. Bright-light intervention induces a dose-dependent increase in striatal response to risk in healthy volunteers

    Macoveanu, Julian; Fisher, Patrick M; Madsen, Martin K


    -light intervention led to a dose-dependent increase in risk-taking in the LA/LA group relative to the non-LA/LA group. Further, bright-light intervention enhanced risk-related activity in ventral striatum and head of caudate nucleus in proportion with the individual bright-light dose. The augmentation effect...

  17. A surgical intervention for the body politic: Generation Squeeze applies the Advocacy Coalition Framework to social determinants of health knowledge translation.

    Kershaw, Paul; Swanson, Eric; Stucchi, Andrea


    The World Health Organization Commission on the Social Determinants of Health (SDoH) observes that building political will is central to all its recommendations, because governments respond to those who organize and show up. Since younger Canadians are less likely to vote or to organize in between elections, they are less effective at building political will than their older counterparts. This results in an age gap between SDoH research and government budget priorities. Whereas Global AgeWatch ranks Canada among the top countries for aging, UNICEF ranks Canada among the least generous OECD (Organisation for Economic Co-operation and Development) countries for the generations raising young children. A surgical intervention into the body politic. Guided by the "health political science" literature, the intervention builds a non-profit coalition to perform science-based, non-partisan democratic engagement to increase incentives for policy-makers to translate SDoH research about younger generations into government budget investments. All four national parties integrated policy recommendations from the intervention into their 2015 election platforms. Three referred to, or consulted with, the intervention during the election. The intervention coincided with all parties committing to the single largest annual increase in spending on families with children in over a decade. Since many population-level decisions are made in political venues, the concept of population health interventions should be broadened to include activities designed to mobilize SDoH science in the world of politics. Such interventions must engage with the power dynamics, values, interests and institutional factors that mediate the path by which science shapes government budgets.

  18. Surgical treatment of larynx T1N0M0 cancer - partial laryngectomy modified Majer-Piquet's intervention.

    Khujadze, M; Vashakidze, N; Kuliashvili, G; Khelashvili, B


    The increase of general radiation background in Georgia and some national characteristics such as spicy dishes, high level of alcohol and cigarette consumption, emotional, loud way of speaking result in a high percentage of people suffering from larynx malignant tumor. As generally known, the majority of larynx cancer cases represent surgical indications and only a small percentage submit to radio or chemotherapy. Since the beginning of the previous century, laryngologists have been intensely thinking about maintaining the larynx itself when giving surgical treatment. With this article we aim to introduce you to one of surgical techniques often applied in France. The method is Pr. B. Guerrier's modification of Majer-Piquet's cricohyoidoepiglotopexy, which is very popular in Europe. This consists in reconstructive operation maintaining cricoid cartilage and epiglottis with larynx's pexy when resecting partially. In cases of exact indications the, Majet-Piquet's modified operation provides a perfect: opportunity both to achieve the desirable outcome and maintain the main functions of larynx vocal, swallowing and breathing with a relatively less invasive surgical interference.

  19. Evaluation of diabetic foot osteomyelitis using probe to bone test and magnetic resonance imaging and their impact on surgical intervention

    Fatma Zaiton


    Conclusion: PTB test is a simple, minimally invasive, low cost test and can be done at outpatient clinic. Its sensitivity and specificity are good when compared to those of MRI, but when we need to diagnose associated soft tissue infection and planning the surgical management MRI was the image of choice.

  20. Changes in life satisfaction and self-esteem in patients with adolescent idiopathic scoliosis with and without surgical intervention.

    Zhang, Jingtao; He, Dawei; Gao, Juan; Yu, Xiuchun; Sun, Haining; Chen, Ziqiang; Li, Ming


    Pre-/poststudy comparing surgical and nonsurgical treatment. To identify whether orthopedic spinal surgery can effectively improve life satisfaction and self-esteem in patients with adolescent idiopathic scoliosis. There have been many studies about the effect of spinal deformity and its various treatments on the mental health of patients with adolescent idiopathic scoliosis. Scoliosis has been reported to have a negative effect on the life quality and mental health of patients. It has also been reported that no matter what the treatment, the existence of scoliosis is a risk factor for depression. However, there has been no report on whether orthopedic spinal surgery affects the life satisfaction and self-esteem of scoliosis patients. Forty-six patients with Cobb angles of more than 30° were recruited from a group of patients that were treated from January 2007 to August 2007. Twenty-one patients with Cobb angles of more than 40° underwent surgical correction while the remaining patients received regular observation (n = 11) or bracing (n = 14). Self-esteem and life satisfaction were assessed before and approximately 1 year after treatment using previously validated scales. There were no between-group differences in age, sex, or major curve location between the surgically and nonsurgically treated groups. The major curve Cobb angle decreased significantly following treatment in the surgically treated (52° ± 10° to 15° ± 8°, P life satisfaction (8 ± 1 vs. 7 ± 10); however, preintervention self-esteem scores were significantly higher in the nonsurgically treated group (28 ± 4 vs. 25 ± 3, P = 0.008). Postintervention, both life satisfaction (9 ± 1) and self-esteem (31 ± 2) scores improved significantly (P Self-esteem levels decreased significantly in the nonsurgically treated group (P self-esteem and life satisfaction scores were significantly higher in the surgically treated than the nonsurgically treated group (P self-esteem and life satisfaction.

  1. Biomechanical compatibility of surgical mesh and fascia being reinforced: dependence of experimental hernia defect repair results on anisotropic surgical mesh positioning.

    Anurov, M V; Titkova, S M; Oettinger, A P


    We aimed to compare the effectiveness of experimental middle hernia defect repair in regard to the transverse and longitudinal positioning of anisotropic lightweight surgical mesh. The mechanical properties of fascial layers and surgical mesh DynaMesh(®)-PP Light were determined in two perpendicular directions under uniaxial tension. In 12 male Wistar rats, middle hernia defect was repaired by the sublay technique. In six animals, the mesh was positioned across (DLH group) and in the other six along (DLV group) the midline. At 6 months after implantation, mesh deformation, structural rearrangement, and repaired abdominal wall biomechanics were evaluated. Histological sections were stained with van Giesen and Mallory's trichrome. The anisotropic mechanical properties of the mesh and fascial layers coincided in the DLH group, but did not correspond to each other in the DLV group. In the DLV group, meshes were stretched in width by 11.4% and reduced in length by 12.7%. In all animals, the lower edge of the mesh was shifted to a defect area with margin hernia formation in two rats. Constant shear stress caused disproportional connective tissue formation. Repaired abdominal wall lost its natural elasticity. In the DLH group, the mesh deformation was minimal. Formed connective tissue was tightly associated with the anterior layer and did not differ from it in composition. The mechanical properties of repaired abdominal wall were close to those of the anterior layer. In prosthetic hernia repair, the mechanical properties of surgical mesh should correspond with those of the fascia being repaired. A mismatch of mechanical properties may result in implant deformation, abdominal wall biomechanics impairment, and recurrent herniation at the edges of the meshes.

  2. A Literature Synthesis Indicates Very Low Quality, but Consistent Evidence of Improvements in Function after Surgical Interventions for Primary Osteoarthritis of the Elbow

    Joshua I. Vincent


    Full Text Available Background. Primary osteoarthritis of the elbow is a debilitating disease with an overall incidence of about 2%. Pain and reduced motion (ROM lead to disability and loss of functional independence. Purpose. To critically review the literature on patient-related important functional outcomes (pain, ROMs and functional recovery after surgery for primary OA of the elbow, utilizing the 2011 OCEBM levels of evidence. Design. A literature synthesis. Results. Twenty-six articles satisfied the inclusion and exclusion criteria; 25 of the studies were at level IV evidence, and 1 at level III. All three surgical techniques led to improvement in pain, ROM, and functional recovery in the short- and medium-term follow-up. Long-term follow-up results, available only for open joint debridement, showed recurrence of osteoarthritic signs on X-ray with minimal loss of motion. Recently, there seems to be an increased focus on arthroscopic debridement. Conclusion. The quality of research addressing surgical interventions is very low, including total elbow arthroplasty (TEA. However, the evidence concurs that open and arthroscopic joint debridement can improve function in patients with moderate-to-severe OA of the elbow. TEA is reserved for treating severe joint destruction, mostly for elderly individuals with low physical demands when other intervention options have failed.

  3. Randomized Controlled Trial of Radiation Protection With a Patient Lead Shield and a Novel, Nonlead Surgical Cap for Operators Performing Coronary Angiography or Intervention.

    Alazzoni, Ashraf; Gordon, Chris L; Syed, Jaffer; Natarajan, Madhu K; Rokoss, Michael; Schwalm, Jon-David; Mehta, Shamir R; Sheth, Tej; Valettas, Nicholas; Velianou, James; Pandie, Shaheen; Al Khdair, Darar; Tsang, Michael; Meeks, Brandi; Colbran, Kiersten; Waller, Ed; Fu Lee, Shun; Marsden, Tamara; Jolly, Sanjit S


    Interventional cardiologists receive one of the highest levels of annual occupational radiation exposure. Further measures to protect healthcare workers are needed. We evaluated the efficacy of a pelvic lead shield and a novel surgical cap in reducing operators' radiation exposure. Patients undergoing coronary angiography or percutaneous coronary intervention (n=230) were randomized to have their procedure with or without a lead shield (Ultraray Medical, Oakville, Canada) placed over the patient. During all procedures, operators wore the No Brainer surgical cap (Worldwide Innovations and Technology, Kansas City, KS) designed to protect the head from radiation exposure. The coprimary outcomes for the lead shield comparison were (1) operator dose (µSv) and (2) operator dose indexed for air kerma (µSv/mGy). For the cap comparison, the primary outcome was the difference between total radiation dose (µSv; internal and external to cap). The lead shield use resulted in a 76% reduction in operator dose (mean dose, 3.07; 95% confidence interval [CI], 2.00-4.71 µSv lead shield group versus 12.57; 95% CI, 8.14-19.40 µSv control group; Plead shield group versus 0.015; 95% CI, 0.012-0.019 µSv/mGy control group; Plead shield and the cap reduced significantly the operator radiation exposure and can be easily incorporated into clinical practice. URL: Unique identifier: NCT02128035. © 2015 American Heart Association, Inc.

  4. Micro-surgical endodontics.

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


    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.

  5. The clinical study of the optimalization of surgical treatment and the traditional Chinese medicine intervention on palmar hyperhidrosis.

    Yang, Yong; Yan, Zhikun; Fu, Xiaoqing; Dong, Liwen; Xu, Linhai; Wang, Jun; Cheng, Genmiao


    To analyze the efficacy of different surgical methods in treating palmar hyperhidrosis and the compensatory hyperhidrosis after surgery and to observe the efficacy of "Energy-boosting and Yin-nourishing anti-perspirant formula" on postsurgical hyperhidrosis patients. Two-hundred patients were randomly assigned to groups A (Chinese and Western medicine, T4 transection plus "Energy-boosting and Yin-nourishing anti-perspirant formula") and B (Western medicine, T4 transection). The surgical efficiency, recurrence rate, compensatory hyperhidrosis, and the long-term life quality were compared. Another 100 cases (group C, T2 transection) were analyzed as a control group. After surgery, the palmar hyperhidrosis and armpit sweating were relieved in all the three group patients and in 34 % of patients combined with plantar hyperhidrosis, the symptoms were relieved. Transient palmar hyperhidrosis was found in three cases at day 2 to day 5 postoperatively. One case of Horner's syndrome and one case recurrence were found in group C patients. The compensatory sweating of various degrees occurred in all the three groups. There were 25, 24, and 43 cases in groups A, B, and C, respectively. There is a significant difference between groups C, A, and B. The compensatory sweating in 13 cases of group A and four cases of group B had different degrees of improvement in the follow-up 6 months after surgery. There is a significant difference. Thoracoscopic bilateral T4 sympathetic chain and the Kuntz resection are the optimized surgical treatments for the palmar hyperhidrosis. "Energy-boosting and Yin-nourishing anti-perspirant formula" is effective in treating the postoperative compensatory sweating.

  6. Effect of Nursing Intervention on Surgical Patients with Sleep Disorders%护理干预对手术患者睡眠障碍的影响

    夏先萍; 张贵清


      Objective TO investigate methods of care to reduce the sleep disorders of surgical patients. Methods 280 cases with surgical patients in our hospital from March 2010 to July 2010 were as the control group,280 cases with surgical patients in our hos-pital from August 2010 to December 2010 were as the experimental group. The control group received normal care, the experimental group carried out the appropriate nursing intervention in addition to normal care. Sleep of two groups were surveyed. Patients with sleep disorders were surveyed the types and causes of sleep disorders with the self-questionnaire. Results The control group had 120 cases with sleep disorders, experimental group had 45 cases with sleep disorders, there was statistically significant differences be-tween the two groups(P0.05). Conclusion Nursing intervention can improve the sleep position of the surgical patients and reduce the incidence of sleep disorders, but it can not effect on the typing of of sleep disorder Significantly.%  目的探讨减轻手术患者睡眠障碍的护理方法.方法选择本院2010年3月~2010年7月的手术患者280例患者为对照组,2010年8月~2010年12月的280例手术患者为实验组.对照组采用常规护理,实验组除常规护理外,进行相应的护理干预.比较2组患者的睡眠状况,并对睡眠障碍的患者采用自拟问卷方式调查睡眠障碍类型及原因.结果对照组出现睡眠障碍120例,实验组睡眠障碍45例,2组比较差异具有统计学意义(P0.05).结论护理干预能改善手术患者的睡眠状况,减少睡眠障碍的发生,但对睡眠障碍分型无明显影响.

  7. Are the Intraday Effects of Central Bank Intervention on Exchange Rate Spreads Asymmetric and State Dependent?

    Fatum, Rasmus; Pedersen, Jesper; Sørensen, Peter Norman

    exert a significant influence on the exchange rate spread, but in opposite directions: intervention purchases of the smaller currency, on average, reduce the spread while intervention sales, on average, increase the spread. We also show that intervention only affects the exchange rate spread when...... testable hypotheses regarding how unannounced intervention purchases and intervention sales influence the market asymmetrically. To test these hypotheses we estimate weighted least squares (WLS) time-series models of the intraday bid-ask spread. Our main result is that intervention purchases and sales both...

  8. Review of six cases of maxillary ameloblastoma from the West Indies: re-entry cryosurgery as prophylactic surgical intervention.

    Ogunsalu, C; Scipio, E; Williams, N


    Maxillary ameloblastoma is a rare histopathological entity. A total of six cases of histologically confirmed maxillary ameloblastoma from the West Indies is reviewed. Three of the cases were taken from a total of 47 histologically confirmed ameloblastoma over a 15-year period (1980-1995) from two major maxillofacial units in Jamaica. Two other cases were from documentation in Jamaica between 2000 and 2002, one of which occurred in a 13-year-old girl (these two patients have been followed-up periodically to 2006). The sixth case was from the records of the maxillofacial department of the University of the West Indies in Trinidad and Tobago. This last patient, at a recent review, has inoperable recurrence. These cases were reviewed with respect to demographics (patient's age and gender), location and extent of tumour, radiological features, concurrent involvement of the mandible, treatment with special emphasis on current treatment modality and follow-up. The findings do not differ from what has been documented by other authors from other parts of the world. Because of the radiographic anatomy of the maxilla, recurrence may be detected late despite such occurring earlier following initial surgical management. It is for this reason that we suggest re-entry cryosurgery for prevention of recurrence for maxillary ameloblastoma. The only case of maxillary ameloblastoma that had re-entry cryosurgery continues to benefit from absence of recurrence at periodic follow-ups at four years post-primary surgical management (which was enucleation).

  9. Relational development in children with cleft lip and palate: influence of the waiting period prior to the first surgical intervention and parental psychological perceptions of the abnormality

    Grollemund Bruno


    Full Text Available Abstract Background The birth of a child with a cleft lip, whether or not in association with a cleft palate, is a traumatic event for parents. This prospective, multidisciplinary and multi-centre study aims to explore the perceptions and feelings of parents in the year following the birth of their child, and to analyse parent–child relationships. Four inclusion centres have been selected, differing as to the date of the first surgical intervention, between birth and six months. The aim is to compare results, also distinguishing the subgroups of parents who were given the diagnosis in utero and those who were not. Methods/Design The main hypothesis is that the longer the time-lapse before the first surgical intervention, the more likely are the psychological perceptions of the parents to affect the harmonious development of their child. Parents and children are seen twice, when the child is 4 months (T0 and when the child is one year old (T1. At these two times, the psychological state of the child and his/her relational abilities are assessed by a specially trained professional, and self-administered questionnaires measuring factors liable to affect child–parent relationships are issued to the parents. The Alarme Détresse BéBé score for the child and the Parenting Stress Index score for the parents, measured when the child reaches one year, will be used as the main criteria to compare children with early surgery to children with late surgery, and those where the diagnosis was obtained prior to birth with those receiving it at birth. Discussion The mental and psychological dimensions relating to the abnormality and its correction will be analysed for the parents (the importance of prenatal diagnosis, relational development with the child, self-image, quality of life and also, for the first time, for the child (distress, withdrawal. In an ethical perspective, the different time lapses until surgery in the different protocols and their

  10. Esophageal perforation caused by fish vertebra ingestion in a seven-month-old infant demanded surgical intervention:A case report

    Ming-Yu Chang; Ming-Ling Chang; Chang-Teng Wu


    A seven-month-old infant was admitted to our hospital with a 1-wk history of shortness of breath, dysphagia,and fever. Diagnosis of esophageal perforation following fish vertebra ingestion was made by history review,pneumomediastinum and an irregular hyperdense lesion noted in initial chest radiogram. Neck computed tomography (CT) confirmed that the foreign body located at the cricopharyngeal level and a small esophageal tracheal fistula was shown by esophagogram. The initial response to treatment of fish bone removal guided by panendoscopy and antibiotics administration was poor since pneumothorax plus empyema developed. Fortunately,the patient's condition finally improved after decortication, mediastinotomy and perforated esophagus repair.To our knowledge, this is the first case report of esophageal perforation due to fish bone ingestion in infancy.In addition to particular caution that has to be taken when feeding the innocent, young victim, it may indicate the importance of surgical intervention for complicated esophageal perforation in infancy.

  11. Are the Intraday Effects of Central Bank Intervention on Exchange Rate Spreads Asymmetric and State Dependent?

    Fatum, Rasmus; Pedersen, Jesper; Sørensen, Peter Norman

    This paper investigates the intraday effects of unannounced foreign exchange intervention on bid-ask exchange rate spreads using official intraday intervention data provided by the Danish central bank. Our starting point is a simple theoretical model of the bid-ask spread which we use to formulate...... exert a significant influence on the exchange rate spread, but in opposite directions: intervention purchases of the smaller currency, on average, reduce the spread while intervention sales, on average, increase the spread. We also show that intervention only affects the exchange rate spread when...

  12. High self-assessment of disability and the surgeon's recommendation against surgical intervention may negatively impact satisfaction scores in patients with spinal disorders.

    Mazur, Marcus D; McEvoy, Sara; Schmidt, Meic H; Bisson, Erica F


    OBJECT Patient satisfaction scores have become a common metric for health care quality. Because satisfaction scores are right-skewed, even small differences in mean scores can have a large impact. Little information, however, is available on the specific factors that play a role in satisfaction in patients with spinal disorders. The authors investigated whether disability severity and the surgeon's recommendation for or against surgical intervention were associated with patient satisfaction scores. METHODS The authors conducted a retrospective cohort study involving adult patients who were referred to a spine surgeon for an outpatient evaluation of back pain. Patients completed the Oswestry Disability Index (ODI) before their clinic appointment and a Press Ganey patient satisfaction survey after their visit. Patients were grouped by self-assessed disability severity: mild to moderate (ODI Satisfaction scores were graded from 0 (very poor) to 100 (very good). Nonparametric tests were used to evaluate the association between patient satisfaction and current disability self-assessment. The authors also investigated whether the surgeon's recommendation against surgery negatively affected patient satisfaction. RESULTS One hundred thirty patients completed the ODI questionnaire before and satisfaction surveys after seeing a spine surgeon for a new outpatient back pain consultation. Of these, 68 patients had severe disability, 62 had mild to moderate disability, 67 received a recommendation for surgery, and 63 received a recommendation against surgery. Composite satisfaction scores were lower among patients who had severe disability than among those with mild to moderate disability (median [interquartile range]: 91.7 [83.7-96.4] vs 95.8 [91.0-99.3], respectively; p = 0.0040). Patients who received a recommendation against surgery reported lower satisfaction scores than those who received a recommendation for surgery (91.7 [83.5-95.8] vs 95.8 [88.5-99.8]; p = 0

  13. Feasibility of radiofrequency ablation as an alternative to surgical intervention in patients with huge multiloculated pyogenic liver abscesses: A retrospective cohort study.

    Ke, Shan; Ding, Xue-Mei; Gao, Jun; Wang, Shao-Hong; Kong, Jian; Xu, Li; Sun, Wen-Bing


    This retrospective cohort study investigated the feasibility of radiofrequency (RF) ablation as an alternative to surgical intervention in patients with huge multiloculated pyogenic liver abscesses (PLAs).From August 2010 to April 2016, 83 patients with PLA were admitted to Beijing Chao-Yang Hospital, China. Four of these patients had huge multiloculated PLAs and underwent RF ablation plus antibiotics. The inclusion criteria for RF ablation were as follows: multiloculated PLA confirmed by computed tomography (CT) or magnetic resonance imaging (MRI), widest diameter of the PLA ≥5 cm, failure to respond to or not suitable to treatment with percutaneous drainage (PD), and patient refusal of surgery. The safety and effectiveness of RF ablation were initially assessed. All patients were commenced on antibiotics on admission to our hospital. CT-guided percutaneous catheter drainage was attempted in one patient but was unsuccessful. The main organism isolated from cultures of these patients' blood or abscess samples was Klebsiella pneumoniae (3/4). RF ablation was performed as soon as eligibility according to the above criteria was established.RF ablation was technically successful in all 4 study patients, all PLAs being completely eradicated. The median duration of fever after RF ablation was 4.5 days. No abscesses recurred; thus, this strategy for managing PLA was 100% successful (4/4). No procedure-related deaths or major complications occurred. One patient had an asymptomatic right pleural effusion that resolved with conservative treatment including albumin infusion and diuretics.Our preliminary data indicate that RF ablation is a safe, feasible, and effective treatment for huge multiloculated PLAs. It should be considered as an alternative treatment for patients who fail to respond to or not suitable for PD plus antibiotics and refuse surgical intervention.

  14. Effectiveness of a CBT Intervention for Persistent Insomnia and Hypnotic Dependency in an Outpatient Psychiatry Clinic.

    Taylor, Hannah Lund; Rybarczyk, Bruce D; Nay, William; Leszczyszyn, David


    To test cognitive-behavioral therapy for insomnia (CBT-I) in patients who not only receive psychiatric treatment in a outpatient psychiatry clinic but also continue to experience chronic insomnia despite receiving pharmacological treatment for sleep. CBT-I included an optional module for discontinuing hypnotic medications. Patients were randomized to 5 sessions of individual CBT-I (n = 13) or treatment as usual (n = 10). Sleep parameters were assessed using sleep diaries at pre- and posttreatment. Questionnaires measuring depression, anxiety, and health-related quality of life were also administered. CBT-I was associated with significant improvement in sleep, with 46% obtaining normal global sleep ratings after treatment. However, no changes in secondary outcomes (depression, anxiety, quality of life) were obtained and no patients elected to discontinue their hypnotic medications. Patients with complex, chronic psychiatric conditions can obtain sleep improvements with CBT-I beyond those obtained with pharmacotherapy alone; however, sleep interventions alone may not have the same effect on mental health outcomes in samples with more severe and chronic psychiatric symptoms and dependency on hypnotic medications. © 2015 Wiley Periodicals, Inc.

  15. Surgical innovation as sui generis surgical research.

    Lotz, Mianna


    Successful innovative 'leaps' in surgical technique have the potential to contribute exponentially to surgical advancement, and thereby to improved health outcomes for patients. Such innovative leaps often occur relatively spontaneously, without substantial forethought, planning, or preparation. This feature of surgical innovation raises special challenges for ensuring sufficient evaluation and regulatory oversight of new interventions that have not been the subject of controlled investigatory exploration and review. It is this feature in particular that makes early-stage surgical innovation especially resistant to classification as 'research', with all of the attendant methodological and ethical obligations--of planning, regulation, monitoring, reporting, and publication--associated with such a classification. This paper proposes conceptual and ethical grounds for a restricted definition according to which innovation in surgical technique is classified as a form of sui generis surgical 'research', where the explicit goal of adopting such a definition is to bring about needed improvements in knowledge transfer and thereby benefit current and future patients.

  16. Maintaining Treatment Fidelity of Mindfulness-Based Relapse Prevention Intervention for Alcohol Dependence: A Randomized Controlled Trial Experience

    Aleksandra E. Zgierska


    Full Text Available Background. Treatment fidelity is essential to methodological rigor of clinical trials evaluating behavioral interventions such as Mindfulness Meditation (MM. However, procedures for monitoring and maintenance of treatment fidelity are inconsistently applied, limiting the strength of such research. Objective. To describe the implementation and findings related to fidelity monitoring of the Mindfulness-Based Relapse Prevention for Alcohol Dependence (MBRP-A intervention in a 26-week randomized controlled trial. Methods. 123 alcohol dependent adults were randomly assigned to MM (MBRP-A and home practice, adjunctive to usual care; N=64 or control (usual care alone; N=59. Treatment fidelity assessment strategies recommended by the National Institutes of Health Behavior Change Consortium for study/intervention design, therapist training, intervention delivery, and treatment receipt and enactment were applied. Results. Ten 8-session interventions were delivered. Therapist adherence and competence, assessed using the modified MBRP Adherence and Competence Scale, were high. Among the MM group participants, 46 attended ≥4 sessions; over 90% reported at-home MM practice at 8 weeks and 72% at 26 weeks. They also reported satisfaction with and usefulness of MM for maintaining sobriety. No adverse events were reported. Conclusions. A systematic approach to assessment of treatment fidelity in behavioral clinical trials allows determination of the degree of consistency between intended and actual delivery and receipt of intervention.

  17. Surgical ethics and the challenge of surgical innovation.

    Angelos, Peter


    Surgical ethics as a specific discipline is relatively new to many. Surgical ethics focuses on the ethical issues that are particularly important to the care of surgical patients. Informed consent for surgical procedures, the level of responsibility that surgeons feel for their patients' outcomes, and the management of surgical innovation are specific issues that are important in surgical ethics and are different from other areas of medicine. The future of surgical progress is dependent on surgical innovation, yet the nature of surgical innovation raises specific concerns that challenge the professionalism of surgeons. These concerns will be considered in the following pages.

  18. The Efficacy of a Condensed "Seeking Safety" Intervention for Women in Residential Chemical Dependence Treatment at 30 Days Posttreatment

    Cash Ghee, Anna; Bolling, Lanny C.; Johnson, Candace S.


    This study examined the efficacy of a condensed version of the "Seeking Safety" intervention in the reduction of trauma-related symptoms and improved drug abstinence rates among women in residential chemical dependence treatment. One hundred and four women were randomly assigned to treatment including a condensed (six session) "Seeking Safety"…


    Croft, Mary Ann; Mcdonald, Jared P.; James, Rebecca J.; Heatley, Gregg A.; Lin, Ting-Li; Lütjen-Drecoll, Elke; Kaufman, Paul L.


    Purpose To determine how surgically altering the normal relationship between the lens and the ciliary body in rhesus monkeys affects centripetal ciliary body and lens movement. Methods In 18 rhesus monkey eyes (aged 6–27 years), accommodation was induced before and after surgery by electrical stimulation of the Edinger-Westphal (E–W) nucleus. Accommodative amplitude was measured by coincidence refractometry. Goniovideography was performed before and after intra- and extra-capsular lens extraction (ICLE, ECLE) and anterior regional zonulolysis. Centripetal lens/capsule movements, centripetal ciliary process (CP) movements, and circumlental space were measured by computerized image analysis of the goniovideography images. Results Centripetal accommodative CP and capsule movement increased in velocity and amplitude post-ECLE compared to pre-ECLE regardless of age (n=5). The presence of the lens substance retarded capsule movement by ~21% in the young eyes and by ~62% in the older eyes. Post-ICLE compared to pre-ICLE centripetal accommodative CP movement was dampened in all eyes in which the anterior vitreous was disturbed (n=7), but not in eyes in which the anterior vitreous was left intact (n=2). Following anterior regional zonulolysis (n=4), lens position shifted toward the lysed quadrant during accommodation. Conclusions The presence of the lens substance, capsule zonular attachments, and Wiegers ligament may play a role in centripetal CP movement. The capsule is still capable of centripetal movement in the older eye (although at a reduced capacity) and may have the ability to produce ~6 diopters of accommodation in the presence of a normal young crystalline lens or a similar surrogate. PMID:18552393

  20. Abortion - surgical

    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. ...

  1. Surgical Interventions and Medical Treatments in Treatment-Naïve Patients With Acromegaly: Systematic Review and Meta-Analysis

    Abu Dabrh, Abd Moain; Mohammed, Khaled; Asi, Noor; Farah, Wigdan H.; Wang, Zhen; Farah, Magdoleen H.; Prokop, Larry J.; Katznelson, Laurence


    Context: Acromegaly is usually treated with surgery as a first-line treatment, although medical therapy has also been used as an alternative primary treatment. Objective: We conducted a systematic review and meta-analysis to synthesize the existing evidence comparing these two approaches in treatment-naïve patients with acromegaly. Data Sources: This study performed a comprehensive search in multiple databases, including Medline, EMBASE, and Scopus from early inception through April 2014. Study Selection: The study used original controlled and uncontrolled studies that enrolled patients with acromegaly to receive either surgical treatment or medical treatment as their first-line treatment. Data Extraction: Reviewers extracted data independently and in duplicates. Because of the noncomparative nature of the available studies, we modified the Newcastle-Ottawa Scale to assess the quality of included studies. Outcomes evaluated were biochemical remission and change in IGF-1 or GH levels. We pooled outcomes using the random-effects model. Data Synthesis: The final search yielded 35 studies enrolling 2629 patients. Studies were noncomparative series with a follow-up range of 6–360 months. Compared with medical therapy, surgery was associated with a higher remission rate (67% vs 45%; P = .02). Surgery had higher remission rates at longer follow-up periods (≥24 mo) (66% vs 44%; P = .04) but not the shorter follow-up periods (≤6 mo) (53% vs 26%; P = .02). Surgery had higher remission rates in the follow-up levels of GH (65% vs 46%; P = .05). In one study, the IGF-1 level was reduced more with surgery compared with medical treatment (−731 μg/L vs −251 μg/L; P = .04). Studies in which surgery was performed by a single operator reported a higher remission rate than those with multiple operators (71% vs 47%; P = .002). Conclusions: Surgery may be associated with higher remission rate; however, the confidence in such evidence is very low due to the noncomparative

  2. [Surgical treatment of leiomyosarcoma of the inferior vena cava].

    Zotov, S P; Panov, I O; Tereshin, O S; Vazhenin, A V


    The presented review of the literature is generalization of the currently existing data of foreign and Russian literature concerning treatment of a rare non-organic retroperitoneal tumour from smooth-muscle tissue, i. e., leiomyosarcoma of the inferior vena cava. The authors also formulate and lay down the basic principles of surgical interventions depending on the scope and level of the lesion, as well statistical analysis of the outcomes of surgical management of the this severely ill patient cohort.

  3. Adolescents' preference for technology-based emergency department behavioral interventions: does it depend on risky behaviors?

    Ranney, Megan L; Choo, Esther K; Spirito, Anthony; Mello, Michael J


    This study aimed to (1) determine the prevalence of technology use and interest in technology-based interventions among adolescent emergency department patients and (2) examine the association between interest in an intervention and self-reported risky behaviors. Adolescents (age, 13-17 years) presenting to an urban pediatric emergency department completed a survey regarding baseline technology use, risky behaviors, and interest in and preferred format for behavioral health interventions. Questions were drawn from validated measures when possible. Descriptive statistics and χ2 tests were calculated to identify whether self-reported risky behaviors were differentially associated with intervention preference. Two hundred thirty-four patients (81.8% of eligible) consented to participate. Almost all used technology, including computers (98.7%), social networking (84.9%), and text messaging (95.1%). Adolescents reported high prevalence of risky behaviors as follows: unintentional injury (93.2%), peer violence exposure (29.3%), dating violence victimization (23.0%), depression or anxiety (30.0%), alcohol use (22.8%), drug use (36.1%), cigarette use (16.4%), and risky sexual behaviors (15.1%). Most were interested in receiving behavioral interventions (ranging from 93.6% interest in unintentional injury prevention, to 73.1% in smoking cessation); 45% to 93% preferred technology-based (vs in person, telephone call, or paper) interventions for each topic. Proportion interested in a specific topic and proportion preferring a technology-based intervention did not significantly differ by self-reported risky behaviors. Among this sample of adolescent emergency department patients, high rates of multiple risky behaviors are reported. Patients endorsed interest in receiving interventions for these behaviors, regardless of whether they reported the behavior. Most used multiple forms of technology, and approximately 50% preferred a technology-based intervention format.

  4. Early Surgical Intervention in Infective Endocarditis:Pros over Cons%早期外科干预感染性心内膜炎:利大于弊



    Albeit the morbidity of infective endocarditis is not very high,the mortality in clinical is very high. With the use of antibiotics, the recovery rate of infective endocarditis has been a significant improvement, but when vegetations or valvular dysfunction appear,the mortality rate is still high,and simple use of drugs often fails to achieve the desired result. With the deepening of understanding of the natural outcome and pathophysiology of infective endocarditis, currently, the effect of surgical treatment of infective endocarditis has been widely recognized. However,the timing of the surgery remains controversial. Through reviewing relat ed literatures,it's considered that the short and long term results of early surgical intervention of infective endocarditis is significantly better than the conventional drug treatment.%感染性心内膜炎的发病率虽然不是很高,但在临床上其病死率却很高.随着抗生素的使用,感染性心内膜炎的治愈率虽有了明显提高,但出现赘生物形成或瓣膜功能损害时,其病死率仍然居高不下,单纯使用药物往往很难达到理想的效果.随着对感染性心内膜炎自然转归、病理生理等认识的深入,目前外科手术治疗感染性心内膜炎已经得到广泛认可,但是手术时机的选择仍然存在争议.通过回顾相关文献报告,认为早期外科干预感染性心内膜炎的近远期效果明显优于传统的药物治疗.

  5. Coexisting tubular adenoma with a neuroendocrine carcinoma of colon allowing early surgical intervention and implicating a shared stem cell origin

    Soliman, Mahmoud L; Tiwari, Ashish; Zhao, Qing


    High-grade colonic neuroendocrine carcinomas (NECs) are uncommon but extremely aggressive. Their co-existence with tubular adenoma (TA) has rarely been reported. We present a 68-year-old man who was found on routine colonoscopy to have multiple colorectal TAs and an ulcerated lesion in the ascending colon. Microscopically, a poorly-differentiated invasive carcinoma juxtaposed with a TA was identified. Differential diagnosis included a poorly-differentiated adenocarcinoma, medullary carcinoma, high-grade NEC and lymphoma. The immunohistochemical profile showed positive staining for keratins, synaptophysin and chromogranin but negative for LCA, CDX2, CK7, CK20, TTF-1 and PSA, supporting the NEC diagnosis. Upon subsequent laparoscopic right hemicolectomy, the tumor was identified as a 3.0 cm umbilicated and ulcerated mass with an adjacent TA. Both TA and NEC showed positive staining for β-catenin indicating a shared colonic origin. The mitotic counts (77/10 high power fields) and a high proliferation rate (75% by Ki-67) corroborated a high-grade stratification. Mutational analysis indicated a wild-type BRAF and KRAS with mismatch repair proficiency. The AJCC (7th edition) pathologic stage is pT3, pN0, pMx. The patient received adjuvant chemotherapy with cisplatin/etoposides for three cycles and will be followed up for a year to detect recurrence. In conclusion, the co-existence of TA with high grade-NEC in our case allowed early identification and intervention of the otherwise asymptomatic but aggressive tumor. In addition, the finding of a high-grade NEC within a large TA in this case suggests a link between the two lesions and could represent a shared stem cell origin. PMID:28246485

  6. Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre.

    Koyama, Tomohide; Skattum, Jorunn; Engelsen, Peder; Eken, Torsten; Gaarder, Christine; Naess, Pål Aksel


    Although nonoperative management (NOM) has become standard care, optimal treatment of liver injuries in children is still challenging since many of these patients have multiple injuries. Moreover, the role of angiography remains poorly defined, and a high index of suspicion of complications is warranted. This study reviews treatment and outcomes in children with liver injuries at a major Scandinavian trauma centre over a 12-year period. Patients trauma registry and medical records. A total of 66 children were included. The majority was severely injured as reflected by a median injury severity score of 20.5 (mean 22.2). NOM was attempted in 60 (90.9%) patients and was successful in 57, resulting in a NOM success rate of 95.0% [95% CI 89.3 to 100]. Only one of the three NOM failures was liver related, occurred in the early part of the study period, and consisted in operative placement of drains for bile leak. Two (3.0%) patients underwent angiographic embolization (AE). Complications occurred in 18 (27.3% [95 % CI 16.2 to 38.3]) patients. Only 2 (3.0%) patients had liver related complications, in both cases bile leak. Six (9.1%) patients underwent therapeutic laparotomy for non-liver related injuries. Two (3.0%) patients died secondary to traumatic brain injury. This single institution paediatric liver injury cohort confirms high attempted NOM and NOM success rates even in patients with high grade injuries and multiple accompanying injuries. AE can be a useful NOM adjunct in the treatment of paediatric liver injuries, but is seldom indicated. Moreover, bile leak is the most common liver-related complication and the need for liver-related surgery is very infrequent. NOM is the treatment of choice in almost all liver injuries in children, with operative management and interventional radiology very infrequently indicated.

  7. Determinants for further wishes for cosmetic and reconstructive interventions in 1652 patients with surgical treated carcinomas of the oral cavity.

    Holtmann, Henrik; Spalthoff, Simon; Gellrich, Nils-Claudius; Handschel, Jörg; Lommen, Julian; Kübler, Norbert R; Krüskemper, Gertrud; Rana, Majeed; Sander, Karoline


    The impairment of the appearance is a major problem for patients with carcinomas of the oral cavity. These patients want to recover their preoperative facial appearance. Some do not realize that this is not always possible and hence develop a desire for further cosmetic and reconstructive surgery (CRS) which often causes psychological problems. The desire of patients for CRS (N = 410; 26%) has been acquired in this DÖSAK rehab study including multiple reasons such as medical, functional, aesthetic and psychosocial aspects. They relate to the parameters of diagnosis, treatment and postoperative rehabilitation. Patients without the wish for CRS (N = 1155; 74%) served as control group. For the surgeons, knowledge of the patient's views is relevant in the wish for CRS. Nevertheless, it has hardly been investigated for patients postoperatively to complete resection of oral cancer. In this retrospective cross-sectional study, questionnaires with 147 variables were completed during control appointments. Thirty-eight departments of Oral and Maxillofacial Surgery took part, and 1652 German patients at least 6 months after complete cancer resection answered the questions. Additionally, a physician's questionnaire (N = 1489) was available. Statistical analysis was performed with SPSS vers. 22. The patient's assessment of their appearance and scarring are the most important criteria resulting in wishes for CRS. Furthermore, functional limitations such as eating/swallowing, pain of the facial muscles, numb regions in the operating field, dealing with the social environment, return to work, tumour size and location, removal and reconstruction are closely related. The wish for CRS depends on diverse functional psychosocial and psychological parameters. Hence, it has to be issued during conversation to improve rehabilitation. A decision on the medical treatment can be of greater satisfaction if the surgeon knows the patients' needs and is able to compare them with the

  8. Ocular and periocular injuries associated with an isolated orbital fracture depending on a blunt cranial trauma: anatomical and surgical aspects.

    Karabekir, H Selim; Gocmen-Mas, Nuket; Emel, Erhan; Karacayli, Umit; Koymen, Ramazan; Atar, Elmas Kagnici; Ozkan, Nezih


    The anatomical location of fractures following blunt cranio-orbital trauma is important for neurosurgeons and maxillofacial surgeons. In this study, 588 cranio-orbital fractures following blunt trauma were evaluated retrospectively with regard to the anatomical site and surgical treatment. Orbital cranial nerve injuries and the outcomes of the medical and/or surgical treatment are described. Distribution of the zygomatic complex and orbital fractures were as follows: zygomatic complex fractures (n:304), isolated orbital fractures (n:58), complex comminuted fractures (n:226). In 58 cases, 69 orbit fractures were found (11 bilateral and 47 unilateral fractures). The lateral wall was the most frequent fracture (n:63). The least frequent fracture was the roof of the orbit (n:11). The accompanying lesions were as follows: 89.65% of cases were associated with periorbital haematoma (n:52), 13.79% of cases with retrobulbar haemorrhage (n:8), 96.55% cases with periorbital soft tissue oedema (n:56), 53.45% cases with pneumocephalus (n:31), 8.62% cases with intra-parenchymal contusion (n:5), 6.89% cases with enophthalmia (n:4), 5.17% of cases with rhinorrhoea (n: 3), 5.17% cases with optic bulb injury and adnexial trauma (n:3), 32.76% cases with intra-orbital emphysema (n:19), and 20.69% with vision dysfunctions (n:12), of whom 2 had no optic nerve injury. Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  9. Compared to controls, patients with ruptured aneurysm and surgical intervention show increase in symptoms of depression and lower cognitive performance, but their objective sleep is not affected.

    Brand, Serge; Zimmerer, Stefan; Kalak, Nadeem; Planta, Sandra Von; Schwenzer-Zimmerer, Katja; Müller, Andreas Albert; Zeilhofer, Hans-Florian; Holsboer-Trachsler, Edith


    Patients with aneurysmal subarachnoid haemorrhage (aSAH) have impaired sleep and cognitive performance together with more difficulties in social and everyday life. Hypocortisolism has also been reported. However, a study assessing all dimensions between aSAH severity, objective and subjective sleep, cortisol secretion, cognitive performance and social and everyday life has not so far been performed. The aim of the present study was therefore two-fold: (1) to assess, in a sample of patients with aSAH, objective and subjective sleep, cognitive functioning, social skills and cortisol secretion concurrently, and (2) to compare patients on these variables with a control group. Twenty-one patients (17 females; mean age: 58.80 years) with ruptured aneurysm and surgical intervention and 21 (14 females; mean age: 58.90 years) age- and gender-matched controls took part in the study. Assessments covered objective sleep-EGG recordings, subjective sleep, salivary cortisol analysis, and psychological functioning including memory performance, mood, and emotion recognition. Compared to healthy controls, patients had lower scores for verbal memory performance and emotion recognition; they also reported more marked depressive symptoms and complained of poor sleep. However, no differences were found for objective sleep or cortisol secretion. Subjective and objective sleep, cortisol secretion and psychological functioning were unrelated. Findings indicate that patients with aSAH face psychological rather than physiological issues.

  10. Comparative effectiveness of peripheral vascular intervention versus surgical bypass for critical limb ischemia in the Vascular Study Group of Greater New York.

    Meltzer, Andrew J; Sedrakyan, Art; Isaacs, Abby; Connolly, Peter H; Schneider, Darren B


    In this study, the effectiveness of peripheral vascular intervention (PVI) was compared with surgical bypass grafting (BPG) for critical limb ischemia (CLI) in the Vascular Study Group of Greater New York (VSGGNY). Patients undergoing BPG or PVI for CLI at VSGGNY centers (2011-2013) were included. The Society for Vascular Surgery objective performance goals for CLI were used to directly compare the safety and effectiveness of PVI and BPG. Propensity score matching was used for risk-adjusted comparisons of PVI with BPG. A total of 414 patients (268 PVI, 146 BPG) were treated for tissue loss (69%) or rest pain (31%). Patients undergoing PVI were more likely to have tissue loss (74.6% vs 57.5%; P PVI was associated with improved freedom from major adverse limb events and postoperative death at 1 year (95.6% vs 88.5%; P PVI. However, risk-adjusted comparison underscores the safety and effectiveness of PVI in the treatment of CLI. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  11. Alcohol-related brief intervention in patients treated for opiate or cocaine dependence: a randomized controlled study

    Khan Riaz


    Full Text Available Abstract Background Despite the importance of heavy drinking and alcohol dependence among patients with opiate and cocaine dependence, few studies have evaluated specific interventions within this group. The aim of the present study was to evaluate the impact of screening with the Alcohol Use Disorders Identification Test (AUDIT and of brief intervention (BI on alcohol use in a sample of patients treated for opioid or cocaine dependence in a specialized outpatient clinic. Methods Adult outpatients treated for opioid or cocaine dependence in Switzerland were screened for excessive alcohol drinking and dependence with the AUDIT. Patients with AUDIT scores that indicated excessive drinking or dependence were randomized into two groups--treatment as usual or treatment as usual together with BI--and assessed at 3 months and 9 months. Results Findings revealed a high rate (44% of problematic alcohol use (excessive drinking and dependence among patients with opiate and cocaine dependence. The number of drinks per week decreased significantly between T0 (inclusion and T3 (month 3. A decrease in average AUDIT scores was observed between T0 and T3 and between T0 and T9 (month 9. No statistically significant difference between treatment groups was observed. Conclusions In a substance abuse specialized setting, screening for alcohol use with the AUDIT, followed by feedback on the score, and use of alcohol BI are both possibly useful strategies to induce changes in problematic alcohol use. Definitive conclusions cannot, however, be drawn from the study because of limitations such as lack of a naturalistic group. An important result of the study is the excellent internal consistency of AUDIT in a population treated for opiate or cocaine dependence.

  12. Effect of surgical intervention on refractory posttraumatic epilepsy: a clinical analysis%难治性外伤性癫痫的手术治疗分析

    袁冠前; 薛洪利; 吕搏川; 史学颖; 卢乐平; 张海峰


    目的 探讨外伤性癫痫的临床特点、致痫灶位置与脑软化灶的关系和手术疗效.方法 沈阳军区总医院神经外科自2003年2月至2006年4月共手术治疗难治性外伤性癫痫患者13例,对其临床资料进行回顾性分析. 结果 8例患者致痫灶位于外伤软化灶周围(2~7 cm);5例为颞叶癫痫,其中4例为颞叶内侧型(3例受伤时年龄1.5~5岁,术后病理显示海马胶质细胞增生)、1例为颞叶外侧型.13例患者均在皮层电极监测下行手术治疗,4例同期行颅骨修补术.经2~5年随访,总手术有效率92.3%,优良率84.6%. 结论 外伤性癫痫致痫灶常位于软化灶周围;小于5岁的重型颅脑损伤易导致海马硬化;难治性外伤性癫痫的手术疗效较好,一经诊断,应积极进行手术治疗.%Objective To investigate the clinical characteristics ofposttraumatic epilepsy, the correlation between epileptogenic foci and encephalomalacia, and the therapeutic effects of surgical intervention. Methods A retrospective analysis was performed among 13 patients with refractory post-traumatic epilepsy who received surgical intervention between February, 2003 and April, 2006. Results The first seizure attack occurred 0.5-13 years (mean 5.3 years) after craniocerebral injury in these patients. The epileptogenic loci were located around the encephalomalacia (ranging from 2 to 7 cm) in 8 patients, in the temporal lobe in 5 patients, in the medial temporal lobe in 4 patients (3 of whom sustained the injuries at 1.5-5 years of age with hippocampal glial proliferation shown by postoperative pathological examination), and in the neocortex of the temporal lobe in 1 case. All the patients underwent the operations under close monitoring of the cortical electroencephalogram, and 4 also received cranioplasty. The total effective rate of the surgery was 92.3% with an excellent outcome rate of 84.6% in the follow-up for 2-5 years. Conclusion The epileptogenic loci of posttraumatic

  13. Stage movement following a 5A's intervention in tobacco dependent individuals with serious mental illness (SMI).

    DiClemente, Carlo C; Delahanty, Janine C; Kofeldt, Miranda G; Dixon, Lisa; Goldberg, Richard; Lucksted, Alicia


    Smoking among individuals with serious mental illness (SMI) creates significant health problems. This study explored stage of change transitions over time among smokers with serious mental illness (SMI) and how dose of a brief intervention and other psychosocial variables were related to stage transitions. Participants were a subsample of 110 patients who participated in a larger controlled trial (Dixon, et al., 2009) examining whether psychiatrists in mental health clinics implementing the "5A's" (Ask, Advise, Assess, Assist, and Arrange) significantly reduced smoking among persons with SMI. Participants were classified into one of the Transtheoretical Model (TTM) Stages of Change for Smoking Cessation as well as classified into groups based upon the pattern of stage status transitions over time (i.e., Regressors, Stable, Inconsistent, Progressors with and without a successful quit). Modest quit rates for this brief intervention were found at one-year (6.4%) and the dose of the intervention was meaningfully related to positive stage transitions. Cessation outcomes from the controlled trial (Dixon, et al., 2009) indicated a small effect on smoking cessation, which is confirmed in this stage transition secondary analysis with a subset of these smokers. However, these results suggest that a brief intervention delivered by psychiatrists in a mental health treatment setting does seem to make an impact on these smokers.

  14. Surgical Assisting

    ... Insert and remove Foley urinary bladder catheter Place pneumatic tourniquet Confirm procedure with surgeon Drape patient within ... Technology and Surgical Assisting (NBSTSA) offers the CertifiedSurgical First Assistant (CSFA) credential, and the National Surgical Assistant ...

  15. Psychological Evaluation of Animal-assisted Intervention (AAI) Programs Involving Visiting Dogs and Cats for Alcohol Dependents: A Pilot Study.

    Ohtani, Nobuyo; Narita, Shin; Yoshihara, Eiji; Ohta, Mitsuaki; Iwahashi, Kazuhiko


    The purpose of this study was to develop an evaluation method for animal-assisted intervention (AAI) programs involving Mood Check List-Short form.2 (MCL-S.2) and the State-Trait Anxiety Inventory (STAI) for psychiatric daycare of Japanese alcohol. dependents. A total of 36 alcohol dependents completed the study and questionnaires assessing their state. A single session of AAI reduced both subjective and physiological measures of state anxiety (A-State); and this program induced a significant reduction in the anxiety after an AAI program session with the dogs and cats involved in the intervention (p = 0.001). The Wilcoxon t-test showed that there were also significant differences in the "anxiety", "pleasantness", and "relaxation". scores for MCL-S.2 among the alcohol dependents, before and after AAI; a significantly decreased "anxiety" score (p = 0.006), and increased "pleasantness" (p = 0.002) and "relaxation" (p=0.012) scores for MCL-S.2 after AAI. The results of this study indicated that alcohol dependents who experienced a group AAI session-program exhibited significant improvements in their feeling; decreased anxiety, and increased pleasantness and relaxation.

  16. Metabolic intervention in surgical patients. An assessment of the effect of somatostatin, ranitidine, naloxone, diclophenac, dipyridamole, or salbutamol infusion on energy and protein kinetics in surgical patients using stable and radioisotopes

    Shaw, J.H.; Wolfe, R.R.


    We have assessed the effect of a variety of forms of metabolic intervention on both energy and protein metabolism in 44 severely ill surgical patients. The patients were studied either in the basal state or while receiving total parenteral nutrition (TPN), and the metabolic effects were assessed using the primed-constant infusion of a combination of stable isotopes and radioisotopes. Somatostatin infusion, either in the basal state or in the TPN, did not change glucose kinetics, but there was a significant decrease in the rate of net protein catabolism (NPC). In the basal studies the rate of NPC decreased from 3.4 +/- 0.7 g/kg/d to 2.9 +/- 0.7 g/kg/d (p less than 0.002), while in the TPN patients the corresponding values were 1.48 +/- 0.61 g/kg/d and 1.10 +/- 0.50 g/kg/d, respectively (p less than 0.005). Histamine type 2 blockade with ranitidine did not significantly alter glucose kinetics, but in both the TPN patients and in the basal state ranitidine was associated with a significant decrease in the rate of NPC. In the basal state rate of NPC was 2.44 +/- 0.53 g/kg/d and during ranitidine infusion the value was 2.08 +/- 0.42 g/kg/d (p less than 0.04). Naloxone infusion did not alter glucose kinetics, but there was a significant decrease in the rate of NPC from a basal value of 2.6 +/- 0.6 g/kg/d to 2.3 +/- 0.5 g/kg/d (p less than 0.04). The infusion of the prostaglandin antagonists diclofenac or dipyridamole resulted in increases in the plasma insulin level, and as a result glucose turnover decreased in both groups. In the diclofenac group the rate of glucose turnover decreased from 14.4 +/- 1.7 mumol/kg/min to 12.6 +/- 1.3 mumol/kg/min (p less than 0.02). Neither prostaglandin antagonist resulted in any significant change in the rate of NPC.

  17. A randomised controlled trial of extended brief intervention for alcohol dependent patients in an acute hospital setting (ADPAC

    Williamson Paula


    Full Text Available Abstract Background Alcohol dependence affects approximately 3% of the English population, and accounts for significant medical and psychiatric morbidity. Only 5.6% of alcohol-dependent individuals ever access specialist treatment and only a small percentage ever seek treatment. As people who are alcohol dependent are more likely to have experienced health problems leading to frequent attendance at acute hospitals it would seem both sensible and practical to ensure that this setting is utilised as a major access point for treatment, and to test the effectiveness of these treatments. Methods/Design This is a randomised controlled trial with a primary hypothesis that extended brief interventions (EBI delivered to alcohol-dependent patients in a hospital setting by an Alcohol Specialist Nurse (ASN will be effective when compared to usual care in reducing overall alcohol consumption and improving on the standard measures of alcohol dependence. Consecutive patients will be screened for alcohol misuse in the Emergency Department (ED of a district general hospital. On identification of an alcohol-related problem, following informed written consent, we aim to randomize 130 patients per group. The ASN will discharge to usual clinical care all control group patients, and plan a programme of EBI for treatment group patients. Follow-up interview will be undertaken by a researcher blinded to the intervention at 12 and 24 weeks. The primary outcome measure is level of alcohol dependence as determined by the Severity of Alcohol Dependence Questionnaire (SADQ score. Secondary outcome measures include; Alcohol Use Disorders Identification Test (AUDIT score, quantity and frequency of alcohol consumption, health-related quality of life measures, service utilisation, and patient experience. The trial will also allow an assessment of the cost-effectiveness of EBI in an acute hospital setting. In addition, patient experience will be assessed using qualitative methods

  18. Reduction and sustainability of cesarean section surgical site infection: An evidence-based, innovative, and multidisciplinary quality improvement intervention bundle program.

    Hsu, Chaur-Dong; Cohn, Inna; Caban, Rebeca


    We found cesarean section (C-section) surgical site infection (SSI) at our institution was significantly higher than the national benchmark. A retrospective cohort study was conducted under 4 phases from January 2008-December 2014. The hospital infection control (IC) policies and a presurgical checklist were bundled and implemented. The study was conducted with 3,334 cesarean deliveries: phase A (January 1, 2008-January 31,2010): 1,250 patients without intervention (baseline SSI rate), phase B (February 1, 2010-July 31, 2011): 682 patients were intervened with IC policies, phase C (August 1, 2011-December 31, 2012): 591 patients with an SSI reduction bundle, and phase D (January 1, 2013-December 31, 2014): 811 patients were monitored for C-section SSI sustainability. Patients not following strict protocols because of emergency C-section deliveries were excluded. The χ(2) test, Fisher exact test, and standard Z test were used for statistical analyses. C-section SSI rates were 6.2% (77/1,250) in phase A, 3.7% (25/682) in phase B, 1.7% (10/591) in phase C, and 0.1% (1/811) in phase D, respectively. By implementing the IC policies and bundle, the C-section SSI rate was reduced 40.3% (phase B vs phase A), 72.6% (phase C vs phase A), and 98.4% (phase D vs phase A). All statistics were significantly different. We conclude that implementing a C-section SSI reduction bundle was associated with reduced C-section SSI rate down toward zero. A future prospectively randomized controlled trial is warranted. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  19. Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: an improvement over the saline load test.

    Konda, Sanjit R; Davidovitch, Roy I; Egol, Kenneth A


    To report our experience with computed tomography (CT) scans to detect traumatic arthrotomies of the knee (TAK) joint based on the presence of intra-articular air. Retrospective review. Level I trauma center. Sixty-two consecutive patients (63 knees) underwent a CT scan of the knee in the emergency department and had a minimum of 14 days follow-up. Cohort of 37 patients (37 knees) from the original 62 patients who underwent a saline load test (SLT). CT scan and SLT. Positive traumatic arthrotomy of the knee (+TAK) was defined as operating room (OR) confirmation of an arthrotomy or no intra-articular air on CT scan (-iaCT) (and -SLT if performed) with follow-up revealing a septic knee. Periarticular wound equivalent to no traumatic arthrotomy (pw = (-TAK)) was defined as OR evaluation revealing no arthrotomy or -iaCT (and -SLT if performed) with follow-up revealing no septic knee. All 32 knees with intra-articular air on CT scan (+iaCT) had OR confirmation of a TAK and none of these patients had a knee infection at a mean follow-up of 140.0 ± 279.6 days. None of the 31 patients with -iaCT had a knee infection at a mean follow-up of 291.0 ± 548.1 days. Based on these results, the sensitivity and specificity of the CT scan to detect +TAK and pw = (-TAK) was 100%. In a subgroup of 37 patients that received both a CT scan and the conventional SLT, the sensitivity and specificity of the CT scan was 100% compared with 92% for the SLT (P wounds that do not require surgical intervention and should be considered a valid diagnostic test in the appropriate clinical setting. Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

  20. Changes of White Matter Diffusion Anisotropy in Response to a 6-Week iPad Application-Based Occupational Therapy Intervention in Children with Surgically Treated Hydrocephalus: A Pilot Study.

    Yuan, Weihong; Harpster, Karen; Jones, Blaise V; Shimony, Joshua S; McKinstry, Robert C; Weckherlin, Nicole; Powell, Stephanie S; Barnard, Holly; Engsberg, Jack; Kadis, Darren S; Dodd, Jonathan; Altaye, Mekibib; Limbrick, David D; Holland, Scott K; Simpson, Sarah M; Bidwell, Sarah; Mangano, Francesco T


    Objective Our aims were (1) to test whether diffusion tensor imaging (DTI) could detect underlying white matter (WM) changes after a 6-week iPad application-based occupational therapy (OT) intervention in children with surgically treated hydrocephalus (HCP); and (2) to explore the association between WM changes and performance outcomes. Methods Five children (age range: 6.05-9.10 years) with surgically treated HCP completed an intensive iPad-based OT intervention targeting common domains of long-term deficits in children with HCP. The intervention included 6 weekly sessions in an OT clinic supplementing home-based program (1 hour/day, 4 days/week). DTI and neuropsychological assessments were performed before and after the intervention. Observation After the therapy, significant increases in fractional anisotropy (FA) and/or decreases in radial diffusivity were found in extensive WM areas. All participants demonstrated an increased perceptual reasoning index (PRI, Wechsler Abbreviated Scale of Intelligence: 2nd edition, PRI gains = 14.20 ± 7.56, p = 0.014). A significant positive correlation was found between PRI increase and the increase of FA in the right posterior limb of the internal capsule and the right external capsule (both p < 0.05). Conclusion This study provides initial evidence of DTI's sensitivity to detect subtle WM changes associated with performance improvements in response to a 6-week OT intervention in children with HCP.

  1. Provision of Early Intervention and Special Education Services to Eligible DoD Dependents. Final rule.


    This rule reissues the current regulations and: Establishes policy, assigns responsibilities, and implements the non-funding and non-reporting provisions in DoD for: Provision of early intervention services (EIS) to infants and toddlers with disabilities and their families, as well as special education and related services to children with disabilities entitled under this part to receive education services from the DoD; implementation of a comprehensive, multidisciplinary program of EIS for infants and toddlers with disabilities and their families who, but for age, are eligible to be enrolled in DoD schools; provision of a free appropriate public education (FAPE), including special education and related services, for children with disabilities, as specified in their individualized education programs (IEP), who are eligible to enroll in DoD schools; and monitoring of DoD programs providing EIS, and special education and related services for compliance with this part. This rule also establishes a DoD Coordinating Committee to recommend policies and provide compliance oversight for early intervention and special education.

  2. A faith-based intervention for cocaine-dependent Black women.

    Stahler, Gerald J; Kirby, Kimberly C; Kerwin, MaryLouise E


    The purpose of the present study was to obtain preliminary data on the effectiveness of a faith-based treatment adjunct for cocaine-using homeless mothers in residential treatment. The Bridges intervention utilizes various Black church communities to provide culturally-relevant group activities and individual mentoring from volunteers. Eighteen women who were recent treatment admissions were randomly assigned to receive Standard Treatment plus Bridges or Standard Treatment with an Attention Control. Participants were assessed at intake and three and six months after intake. Bridges treatment resulted in significantly better treatment retention (75% vs. 20% at six months) than standard residential treatment alone. In addition, Bridges produced superior outcomes at the six month follow-up assessment on a secondary measure of cocaine abstinence. Creating a community of social support through Black churches appears feasible and promising, and may be a cost-effective means of providing longer-term post-treatment support for cocaine-addicted women.

  3. The Use of Gestalt Interventions in the Treatment of the Resistant Alcohol-Dependent Client.

    Ramey, Luellen


    Reviews ethical and practical dilemmas associated with clients who have hidden alcohol dependencies, and proposes an approach rooted in Gestalt counseling theory which confronts these issues and is compatible with a current emerging alcohol-treatment model. Suggests specific activities for addressing client resistance to revealing a hidden alcohol…

  4. Manual of Surgical Instruments

    Olga Lidia Sánchez Sarría


    Full Text Available Surgical instruments are the group of tools used in surgical procedures. They are very expensive and sophisticated. Consequently, a standardized and meticulous care is essential; they should go through the decontamination, cleaning and sterilization process. These instruments are designed in order to provide surgeons with tools that help them to perform a basic surgical procedure; there are multiple variations and the design depends on their function. This paper aims at showing all surgical instruments that can be used in an operating room during surgery and are not generally included in the medical literature.

  5. Formative Evaluation of a Text Messaging Intervention to Promote Varenicline Adherence Among Tobacco-Dependent Persons with HIV.

    Krebs, Paul; Tseng, Tuo-Yen; Pham, Hieu; Wong, Selena; Sherman, Scott E; Shelley, Donna; Furberg, Robert D; Wolfe, Hannah


    Few published studies describe processes in the development of mobile health interventions. This study reports data from a formative evaluation of a text messaging intervention being developed to increase adherence to smoking cessation medication (varenicline) among tobacco-dependent persons with HIV/AIDS. Four focus groups were conducted (N = 29) using a mixed-methods approach to assess: (a) beliefs and preferences regarding the use of varenicline, (b) preferences for receiving tobacco-related texts, and (c) the acceptability of draft text messages. Themes that emerged from the focus groups were that (a) participants were cautious and wanted to discuss varenicline carefully with health care providers, (b) participants preferred simple messages that were positive and encouraging, (c) messages should emphasize tobacco cessation and not varenicline adherence, and (d) texts would serve as a reminder about goals and foster support and connectedness with the health care team. Overall, 47 out of the 100 messages received a grade of C or less (rated on a 5-point grade scale: A, B, C, D, or F), the majority of which focused on medication adherence. All participants reported that they were likely to read the messages. The majority (64%) indicated that they preferred receiving 2 or more messages per day. Gathering systematic participant feedback provides critical input in intervention planning.

  6. Surgical Lasers In Gynecology

    Schellhas, Helmut F.; Barnes, Alfonso E.


    Multipurpose surgical CO2 lasers marketed in the USA have been developed to be applicable to a variety of surgical procedures in many surgical fields. They are all suited for endoscopic surgical procedures and can be fitted to all standard surgical microscopes. They all can adjust the focal length of the laser beam to the different standard focal lengths of the surgical microscope which for instance in laryngoscopy is 400 mm and in colposcopy 300 mm. One laser instrument can even change the spot size in a given focal distance which is very advantageous for some microsurgical procedures (Merrimack Laboratories 820). All multipurpose surgical CO2 laser systems provide a multi-articulated surgical arm for free-hand surgery. The surgical arms are cumbersome to use but they are adapted to the surgeons needs with ingenuity. The practicality of the multi-articulated surgical arms depends mostly on the distance of the handpiece from the surgical console which now is also overbridged by the laser tube in most surgical laser system. The spot size of the beam is variable in most handpieces by interchangeable lenses which modify the focal distance of the beam and the power density. Another common feature in all systems is a coaxial He-Ne pilot light which provides a red spot which unfortunately becomes invisible in a bleeding surgical field. Most surgical laser systems have a spacial mode of TEM 00 which is essential for incisional surgery. The continuous mode of beam delivery is used for incisional surgery and also for most endoscopic procedures.

  7. A multi-center, randomized controlled trial of a group psychological intervention for psychosis with comorbid cannabis dependence over the early course of illness.

    Madigan, Kevin


    Patients who experience the onset of psychotic illness with a comorbid diagnosis of cannabis dependence experience poor clinical outcomes. Few studies have identified interventions that reduce cannabis use and improve clinical outcome in this population.

  8. Use of a structured mirrors intervention does not reduce delirium incidence but may improve factual memory encoding in cardiac surgical ICU patients aged over 70 years: a pilot time-cluster randomised controlled trial

    Kimberly Giraud


    Full Text Available Introduction: Postoperative delirium remains a significant problem, particularly in the older surgical patient. Previous evidence suggests that the provision of supplementary visual feedback about ones environment via the use of a mirror may positively impact on mental status and attention (core delirium diagnostic domains. We aimed to explore whether use of an evidence-based mirrors intervention could be effective in reducing delirium and improving postoperative outcomes such as factual memory encoding of the Intensive Care Unit (ICU environment in older cardiac surgical patients.Methods: This was a pilot time-cluster randomised controlled trial at a 32-bed ICU, enrolling 223 patients aged 70 years and over, admitted to ICU after elective or urgent cardiac surgery from 29 October 2012 to 23 June 2013. The Mirrors Group received a structured mirrors intervention at set times (e.g., following change in mental status. The Usual Care Group received the standard care without mirrors. Primary outcome was ICU delirium incidence; secondary outcomes were ICU delirium days, ICU days with altered mental status or inattention, total length of ICU stay, physical mobilisation (balance confidence at ICU discharge, recall of factual and delusional ICU memories at 12 weeks, Health-Related Quality of Life at 12 weeks, and acceptability of the intervention.Results: The intervention was not associated with a significant reduction in ICU delirium incidence Mirrors: 20/115 (17%; Usual Care: 17/108 (16% or duration Mirrors: 1 (1-3; Usual Care: 2 (1-8. Use of the intervention on ICU was predictive of significantly higher recall of factual (but not delusional items at 12 weeks after surgery (p=0.003 and acceptability was high, with clinicians using mirrors at 86% of all recorded hourly observations. The intervention did not significantly impact on other secondary outcomes.Conclusion: Use of a structured mirrors intervention on the postoperative ICU does not reduce

  9. Randomized Controlled Trial of Radiation Protection With a Patient Lead Shield and a Novel, Nonlead Surgical Cap for Operators Performing Coronary Angiography or Intervention

    Alazzoni, Ashraf; Gordon, Chris L; Syed, Jaffer; Natarajan, Madhu K; Rokoss, Michael; Schwalm, Jon-David; Mehta, Shamir R; Sheth, Tej; Valettas, Nicholas; Velianou, James; Pandie, Shaheen; Al Khdair, Darar; Tsang, Michael; Meeks, Brandi; Colbran, Kiersten; Waller, Ed; Fu Lee, Shun; Marsden, Tamara; Jolly, Sanjit S


    .... Further measures to protect healthcare workers are needed. METHODS AND RESULTS—We evaluated the efficacy of a pelvic lead shield and a novel surgical cap in reducing operators’ radiation exposure...

  10. Prospective Developmental Subtypes of Alcohol Dependence from Age 18 to 32 Years: Implications for Nosology, Etiology, and Intervention

    Meier, Madeline H.; Caspi, Avshalom; Houts, Renate; Slutske, Wendy S.; Harrington, HonaLee; Jackson, Kristina M.; Belsky, Daniel W.; Poulton, Richie; Moffitt, Terrie E.


    The purpose of the present study was to identify child and adult correlates that differentiate (a) individuals with persistent alcohol dependence from individuals with developmentally-limited alcohol dependence and (b) individuals with adult-onset alcohol dependence from individuals who never diagnose. Participants are 1,037 members of the Dunedin longitudinal study, a birth cohort followed prospectively from birth until age 32. Past-year DSM-IV alcohol dependence diagnoses were ascertained with structured diagnostic interviews at ages 18, 21, 26, and 32. Individuals were classified as developmentally-limited, persistent, or adult-onset subtypes based on their time-ordered pattern of diagnoses. The persistent subtype generally exhibited the worst scores on all correlates, including family psychiatric history, adolescent and adult externalizing and internalizing problems, adolescent and adult substance use, adult quality of life, and coping strategies. The prospective predictors that distinguished them from the developmentally-limited subtype involved family liability, adolescent negative affectivity, daily alcohol use, and frequent marijuana use. Furthermore, young people who developed the persistent subtype of alcohol dependence were distinguished from the developmentally-limited subtype by an inability to reduce drinking and by continued use despite problems, already by age 18. The adult-onset group members were virtually indistinguishable from ordinary cohort members as children or adolescents, but, in adulthood, adult-onset cases were distinguished by problems with depression, substance use, stress, and strategies for coping with stress. Information about age-of-onset and developmental course is fundamental for identifying subtypes of alcohol dependence. Subtype-specific etiologies point to targeted prevention and intervention efforts based on characteristics of each subtype. PMID:23880392

  11. A systematic review of outcomes assessed in randomized controlled trials of surgical interventions for carpal tunnel syndrome using the International Classification of Functioning, Disability and Health (ICF as a reference tool

    Leite José


    Full Text Available Abstract Background A wide range of outcomes have been assessed in trials of interventions for carpal tunnel syndrome (CTS, however there appears to be little consensus on what constitutes the most relevant outcomes. The purpose of this systematic review was to identify the outcomes assessed in randomized clinical trials of surgical interventions for CTS and to compare these to the concepts contained in the International Classification of Functioning, Disability and Health (ICF. Methods The bibliographic databases Medline, AMED and CINAHL were searched for randomized controlled trials of surgical treatment for CTS. The outcomes assessed in these trials were identified, classified and linked to the different domains of the ICF. Results Twenty-eight studies were retrieved which met the inclusion criteria. The most frequently assessed outcomes were self-reported symptom resolution, grip or pinch strength and return to work. The majority of outcome measures employed assessed impairment of body function and body structure and a small number of studies used measures of activity and participation. Conclusion The ICF provides a useful framework for identifying the concepts contained in outcome measures employed to date in trials of surgical intervention for CTS and may help in the selection of the most appropriate domains to be assessed, especially where studies are designed to capture the impact of the intervention at individual and societal level. Comparison of results from different studies and meta-analysis would be facilitated through the use of a core set of standardised outcome measures which cross all domains of the ICF. Further work on developing consensus on such a core set is needed.

  12. Nutrition Education intervention in dyslipidemic children and adolescent with insulin-dependent diabetes mellitus (IDDM

    Asmaa m. Abdallah*, Zainab B* and Mohamed M. A. Shahat


    Full Text Available Background: Diabetes mellitus is the most common endocrine metabolic disorder of childhood and adolescence with important consequences for physical and emotional development. Aim of the study: This study was designed to detect the effect of diet therapy (through nutrition education program on lipid profile and blood glucose level in diabetic children. Subjects and Methods: The study was carried on 45 diabetic children aged between 8-15 years old at diabetic nutrition clinic of nutrition institute in Cairo from 2003-2005. Children included in the study were divided into two groups: insulin dependent dyslipidemic group (IDDM (diet control/ group and insulin dependent non dyslipidemic (control group. All were subjected to full dietetic history by the 24 hour recall for 3 days, thorough clinical examination, they were evaluated for plasma lipids, lipoproteins, fasting blood glucose (FBG and glycated hemoglobin (HbA1c levels. The dyslipidemic were measured after three months for the previously measured parameters. The nutrition education process was performed and continued on weekly intervals for three months. Results: There was significant decrease in serum cholesterol and triglyceride levels in the study group after the program, and insignificant increase in serum HDL and decrease in serum LDL. Also, there was insignificant decrease in FBG but there was statistically significant decrease in HbA1 after the program. These changes occurred in parallel with increases in intakes of protein and total calories with adequate carbohydrate and sometimes a reduction in intakes of total fat. Conclusion: Nutrition therapy for children with IDDM is essential to improve measures of glycemic control and lipoprotein mediated risk for dyslipidemia. More innovative approaches to achieve lifestyle changes are required to meet current recommendations which are likely to produce greater beneficial changes than those observed in this study

  13. Surgical treatment of acquired tracheocele.

    Porubsky, Edward A; Gourin, Christine G


    Acquired tracheoceles are rare clinical entities that can cause a variety of chronic and recurrent aerodigestive tract symptoms. The management of acquired tracheoceles is primarily conservative, but surgical intervention may be indicated for patients with refractory symptoms. We present a case of acquired tracheocele and describe a method of successful surgical management.

  14. 大动脉炎的介入及外科治疗%The surgical and interventional treatment for Takayasu's arteritis

    陈兵; 汪忠镐; 俞恒锡; 张建; 李建新; 谷涌泉; 齐立行; 齐一侠; 黄莹; 董宗俊


    Objective To evaluate vascular surgery and interventional technique applied in Takayasu's arteritis. Methods Data of 26 patients of Takayasu's arteritis admitted between January 2006 and December 2009 were retrospectively analyzed. The sex ratio(M/F) was 1: 4. 2, age averaged at (27±15)y. There were 16 cases of type Ⅰ , 7 cases of type Ⅱ and 3 cases of type Ⅲ according to Lupi-Herrera classification. 25 patients received surgery including 16 patients undergoing pecutaneous transluminal angioplasty operations, 9 patients doing traditional bypass surgery, and one patient was treated conservatively. Results 23 case-times of percutaneous transluminal angioplasty (PTA) were performed in 16 patients, including 12 cases of balloon angioplasty and 4 cases of stent angioplasty. Four significantly stenotic and occluded carotid arteries were revascularized successfully in 5 patients. Thrombosis of the carotid artery was found in one patient after balloon angioplasty. There were 4 patients in which repeated PTA treatment up to a total of 11 times were needed to guarantee vessel patency. Open surgery succeeded in 9 patients, and clinical symptoms were relieved in all cases during peri-operative period. 22 patients were followed up for 12 -46 months,one patient died of cerebral hemorrhage 3 months post-operation, one patient was found pseudoaneurysm at anastomotic stoma, and 2 patients suffered from anastomotic restenosis.Conclusions Vascular surgery played important role in the therapy of Takayasu's arteritis. PTA can be used repeatedly. Surgical bypass operation is difficult in technology, and can be used in cases that fail to response to PTA or in patients with severe cerebral ischemia.%目的 探讨介入技术和外科手术在大动脉炎治疗中的应用.方法 2006年1月至2009年12月共收治大动脉炎26例,男女比例为1:4.2,平均年龄(27±15)岁;Lupi-Herre法分型,Ⅰ型16例,Ⅱ型7例,Ⅲ型3例.16例患者实施介入治疗,9例行开放手术,1

  15. A one-day couple group intervention to enhance sexual recovery for surgically treated men with prostate cancer and their partners: a pilot study.

    Wittmann, Daniela; He, Chang; Mitchell, Staci; Wood, David P; Hola, Victor; Thelen-Perry, Steve; Montie, James E


    Researchers evaluated the acceptance and effectiveness of a group intervention that provided education about post-prostatectomy sexual recovery and peer support for couples. Couples valued the intervention and retained the information. Partners became accepting of erectile dysfunction and communicated more openly about upsetting topics.

  16. Minimum Alveolar Concentration Needed to Block Adrenergic Response of Sevoflurane with Nitrous Oxide Varies Depending on the Stimulation Sites in Adult Surgical Patients

    Tetsu Kimura


    Full Text Available Background We examined whether minimum alveolar anesthetic concentration needed to block adrenergic response (MAC-BAR of sevoflurane with nitrous oxide (N2O varies depending on body surface sites to which noxious stimuli are applied. Methods Seventy-seven ASA I adult patients, aged 18-50 years old, were anesthetized with sevoflurane and 66% N2O in O2, and their tracheas were intubated. The anesthesia was maintained with 66% N2O in O2 plus sevoflurane at predetermined end-tidal concentrations (0.8, 1.1, 1.4, 1.7, 2.0, 2.3, or 2.6%, n = 11 in each concentration for at least 15 minutes. Heart rate (HR and non-invasive blood pressure (BP was recorded at 1-minute interval automatically. As a noxious stimulus, electrical tetanic stimulation with a 15 sec burst of 50 Hz, 0.25 msec square-wave, 55 mA electric current was applied at three different sites; forehead, abdomen, or thigh. A positive cardiovascular response was defined as an increase of either mean BP or HR by more than 15% from the pre-stimulation value. Logistic regression analysis was used to determine MAC-BAR. Results MAC-BAR of sevoflurane with 66% N2O obtained by stimulating forehead, abdomen, and thigh were 2.01% (95% CI: 1.70-2.57%, 1.71% (1.13-2.74%, and 1.31% (0.77-1.66%, respectively. MAC-BAR on the forehead was significantly higher than that on the thigh. Conclusion MAC-BAR of sevoflurane with 66% N2O varied depending on the body surface sites to which noxious stimuli were applied. These findings support our clinical impression that sensitivities to pain vary among body surface sites, and that anesthetic requirement to stabilize hemodynamic variables vary among surgical sites.

  17. 外科ICU患者精神障碍危险因素分析与人性化护理干预%Analysis of the mental disorder risks of surgical ICU patients and the humanized care intervention

    张爱华; 任丽; 贾民


    目的:研究外科ICU危重患者精神障碍发生率、出现精神障碍的危险因素,采用人性化护理干预对ICU危重病人精神障碍的影响.方法:对113例外科ICU危重病人采用简明精神状态检查量表与意识障碍评估方法进行评估,获取52例出现精神障碍患者,将52例患者采用人性化护理干预,比较干预前后MMSE和CAM的评分.结果:外科ICU危重患者精神障碍发生率24.7%,且随年龄增大发病率明显增加;住院天数、环境改变、使用镇静药物等是发生精神障碍的危险因素;人性化护理干预后的MMSE和CAM的评分差别具有统计学意义(P<0.05).结论:重视外科ICU危重病人发生精神障碍的危险因素,积极采用人性化护理干预,促进患者早日康复.%Objective:To investigate the incidence, risk factors of mental disorder among surgical ICU patients, and the effect of humanized care intervention. Methods,MMSE(mini mental state examination)and CAM(confusion assessment method)were adopted to evaluate 113 surgical ICU patients and find 52 patients in mental disorder, compared the MMSE and CAM results after the nuring intervention. Results: The incidence of mental disorder of surgical ICU patients was 24.7% ,with an obvious upward trend with the increase of age. Days of hospitalization, change of environment and application of sedatives are triggering factors. Humanized care causes significant difference in incidence of mental disorder(P<0,05). Conclusion:Importance should be attached to mental disorder risks of critical patients in surgical ICU. Humanized care intervention needs to be actively applied to ensure an improved prognosis for these patients.

  18. [Artificial intelligence methods for support of medial patient education before surgical interventions in the region of the neck-nose-ear].

    Mösges, R; Kuth, G; Korves, B


    As a rule, curative operations require the patient's consent. Determined by the expansion of surgical possibilities, the kind and frequency of specific complications are subjected to constant changes. The physician is encouraged to explain therapeutic methods as well as the probability of complications within the patient's grasp. It has been investigated to what extent methods of artificial intelligence (AI) are suited for assisting the physician in this task. For this purpose, a comprehensive list of surgical complications as reported in research literature has been compiled. The list has been transferred into a hierarchical structure which can be depicted as a rule tree classified according to topographic aspects. In each otolaryngological operation, the reported complications can be classed with these rules. By employing an expert system (Fig. 1), the physician is capable of compiling an individualized document of agreement (Fig. 2) which serves as a basis for the explanatory talk with the patient.

  19. Logistic Regression Analysis and Nursing Interven-tions for High-risk Factors for Pressure Sores in Pa-tients in a Surgical Intensive Care Unit

    Xin-Ran Wang∗; Bin-Ru Han


    Objective: To investigate the risk factors related to the development of pressure sores in critically ill surgical patients and to establish a basis for the formulation of effective precautions. Methods: A questionnaire regarding the factors for pressure sores in critically ill surgical patients was created using a case control study with reference to the pertinent literature. After being exam-ined and validated by experts, the questionnaire was used to collect data about critically ill surgical patients in a grade A tertiary hospital. Among the 47 patients enrolled into the study, the 14 who developed nosocomial pressure sores were allocated to the pressure sore group, and the remaining 33 patients who met the inclusion criteria and did not exhibit pressure sores were allocated to the control group. Univariate and multivariate logistic regression analyses were employed to examine the differences in 22 indicators between the two groups in an attempt to identify the risk factors for pressure sores. Results: According to the univariate analyses, the maximum value of lactic acid in the arterial blood, the number of days of norepinephrine use, the number of days of mechanical ventilation, the number of days of blood purification, and the number of days of bowel incontinence were sta-tistically greater in the pressure sore group than in the control group ( P Conclusions: The best method for preventing and control pressure sores in surgical critically ill patients is to strongly emphasize the duration of the critical status and to give special attention to patients in a continuous state of shock. The adoption of measures specific to high-risk patient groups and risk factors, including the active control of primary diseases and the application of de-compression measures during the treatment of the patients, are helpful for improving the quality of care in the prevention and control of pressure sores in critically ill patients.

  20. How good are experienced interventional cardiologists in predicting the risk and difficulty of a coronary angioplasty procedure? A prospective study to optimize surgical standby.

    Brueren, B R; Mast, E G; Suttorp, M J; Ernst, J M; Bal, E T; Plokker, H W


    The prediction of the risk of a percutaneous transluminal coronary angioplasty has either been based on coronary lesion morphology or on clinical parameters, but a combined angiographic and clinical risk assessment system has not yet been evaluated prospectively. Five experienced interventionalists categorized 7,144 patients with 10,081 stenoses (1.4 lesion/patient) for both the risk and the difficulty of the procedure. Risk categories are as follows: 1 = low risk; 2 = intermediate risk; 3 = high risk. This division was made for percutaneous transluminal coronary angioplasty planning purposes. Category 1 patients denotes those in whom surgical standby is not required; category 2 patients, surgical standby not required but available within 1 hr; category 3 patients, surgical standby required. Difficulty categories are as follows: 1 = easy lesion; 2 = moderately difficult lesion; 3 = difficult lesion. Success was defined as a reduction of the degree of stenosis to less than 50%, without acute myocardial infarction, emergency redilatation, emergency bypass grafting, or death within 1 week. The procedure was not successful in difficulty category 1 in 1.6%, in category 2 in 3.5%, and in category 3 in 9.9%. Complications occurred in risk category 1 in 3.5%, in category 2 in 5.2%, and in category 3 in 12.4%. All differences were statistically significant (P < 0.05). Experienced cardiologists can well predict the risk and success of a coronary angioplasty procedure. This helps to optimize surgical standby, although even in the lowest-risk category complications can occur.

  1. Obstructed surgical porto-systemic shunts in the early postoperative period: interventional therapy by angioplasty (PTA) and stent placement; Obstruktion chirurgischer portosystemischer Shunts in der fruehen postoperativen Phase: interventionelle Behandlung durch Angioplastie und Stentimplantation

    Strunk, H.; Textor, J.; Koenig, R.; Wilhelm, K.; Schild, H. [Bonn Univ. (Germany). Radiologische Klinik; Wolff, M. [Bonn Univ. (Germany). Chirurgische Klinik und Poliklinik


    Recurrent variceal bleeding in patients treated with surgical porto-systemic shunting is most often due to shunt stenoses or occlusion. Radiological interventional procedures are a possible method of therapy and our experience herein is described in this report. Patients and Methods: from 1997 to 1999 54 patients with recurrent variceal bleeding were treated with a surgical porto-systemic shunt procedure. Of these early shunt occlusion occurred in 5 patients, which was treated with percutaneous transcatheter techniques. Results: in only one patient was PTA alone sufficient to reestablish shunt patency, in four patient stent placement was necessary in addition. In the follow-up period 1 patient died 26 month after intervention with (autopsy-proven) patent shunt, in one patient shunt reocclusion occurred after 11 months and in 3 patients the shunt is still patent. Conclusions: PTA, if necessary in combination with stent placement, is an attractive alternative method of therapy in case of an early surgical porto-systemic shunt occlusion. (orig.) [German] Rezidivblutungen nach chirurgischer portosystemischer Shuntanlage sind meistens durch eine Shuntstenose oder einen Shuntverschluss bedingt. Hier stellen interventionelle Eingriffe einen moeglichen therapeutischen Ansatz dar, ueber den im Folgenden berichtet werden soll. Patienten und Methode: zwischen 1997 und 1999 wurde bei insgesamt 54 Patienten wegen rezidivierender Blutungen ein operativer portosystemischer Shunt angelegt. Von diesen zeigten fuenf Patienten in der unmittelbaren postoperativen Periode einen Shuntverschluss, der radiologisch interventionell therapiert wurde. Ergebnisse: bei einem der fuenf Patienten genuegte zur Wiederherstellung des Flusses eine alleinige Ballondilatation (PTA), bei vier Patienten musste zusaetzlich eine Stentimplantation durchgefuehrt werden. In der weiteren Nachsorge ist ein Pat. nach 26 Wochen mit autoptisch offenem Shunt verstorben, bei 3 Pat. ist der Shunt offen, bei einem

  2. 泌尿外科高龄高危患者的术前护理干预措施%The study of nursing care intervention to the elder urologic patients at high surgical risk before operation

    彭红霞; 陆桂花; 梁玉霞; 邹惠梅


    目的 探讨泌尿外科高龄高危患者术前的护理干预措施.方法 对36例泌尿外科高龄高危患者术前进行的心理行为干预进行回顾性分析.结果 干预后患者术前心理稳定,完全从医行为明显提高,不完全从医行为明显降低,采纳健康行为者明显增多,具有危险行为者明显降低.结论 对泌尿外科高龄高危患者术前进行有计划的心理行为干预,有利于手术的顺利进行和术后康复.%Objective To investigate the effects of nursing care intervention on the elder urologic patients at high surgical risk before operation.Methods This study was designed as a retrospective analysis.Thirty-six cases of the elder urologie patients at high surgical risk were psyeholngical and behavior intervened before operation.Results:After being intervened,the psychology of the patients was stable,patient compliance with doctors and nurses raised and the non-compliance reduced conspicuously.Also the patients who do the healthy action increased and the patients do the dangerous action were reduced apparently.Conclusions:Being nursing care intervention to the elder urologic patients at high surgical risk before operation by plan,it can raising the patients?endurance and is beneficial for patients to get through the operation safely and postoperative rehabilitation.

  3. 婴幼儿分泌性中耳炎早期诊断及手术干预%The Early Diagnosis and Surgical Intervention for Secretory Otitis Media in Infants

    王素芳; 韩富根; 僧东杰; 王燕楠


    目的:探讨婴幼儿分泌性中耳炎的早期诊断方法及手术干预效果。方法将经226 Hz及1000 Hz声导抗、听性脑干反应、听觉稳态反应、畸变产物耳声发射和颞骨CT检查诊断为分泌性中耳炎,观察4~6个月未自愈的43例婴幼儿,分为手术干预组(22例)及继续观察组(21例)。手术干预组在全麻下行鼓膜切开置管术,继续观察组只指导家长进行家庭听觉语言康复。所有病例随访6~12个月,复查听力,并统计12个月内合并急性中耳炎的发生率。结果43例婴幼儿226 Hz及1000 Hz声导抗、听性脑干反应、听觉稳态反应、畸变产物耳声发射和颞骨CT检查均有不同程度异常;手术干预组在术后6个月及12个月时复查听阈明显低于继续观察组,12个月内并发急性中耳感染的发生率明显低于继续观察组。结论手术干预有助于减轻持续性婴幼儿分泌性中耳炎的听力损害并降低急性中耳感染的发生率。%Objective To explore the early diagnosis and surgical intervention for secretory otitis media in infants. Methods Forty-three infants were diagnosed with secretory otitis media by 226 Hz and 1000 Hz acoustic immitance, auditory brainstem response, auditory steady-state responses, distortion products OAE with temporal bone CT and did not recover in 4-6 months. These infants were divided into surgical intervention group (22 cases) and observation group (21 cases). The surgical intervention group was treated with tympanostomy tube under general anesthesia and the observation group only received family-based hearing and speech rehabilitation. All the patients were followed up for 6-12 months to examine the hearing conditions and the incidence of acute otitis media was calculated within 12 months. Results All of the 43 infants had different degrees of abnormality in 226 Hz and 1000 Hz acoustic immitance, auditory brainstem response, auditory steady-state responses

  4. Medical and surgical management of priapism

    Cherian, J; Rao, A R; Thwaini, A; Kapasi, F; Shergill, I S; Samman, R


    Priapism is a pathological condition of penile erection that persists beyond, or is unrelated to, sexual stimulation. Pathologically and clinically, two subtypes are seen—the high flow (non‐ischaemic) variety and the low flow (ischaemic) priapism. The low flow type is more dangerous, as these patients are susceptible to greater complications and the long term recovery of erectile function is dependent on prompt and urgent intervention. Many of the causes of priapism are medical, including pharmacological agents, and as such, priapism should be considered as a medical and surgical emergency. PMID:16461470

  5. Protocol for north of England and Scotland study of tonsillectomy and adeno-tonsillectomy in children (NESSTAC. A pragmatic randomised controlled trial comparing surgical intervention with conventional medical treatment in children with recurrent sore throats

    Lock Catherine


    Full Text Available Abstract Background Uncertainties surrounding the effectiveness and cost-effectiveness of childhood tonsillectomy for recurrent sore throat led the NHS Health Technology Assessment Programme to commission this research to evaluate the effectiveness and cost-effectiveness of tonsillectomy and adeno-tonsillectomy in comparison with standard non-surgical management in children aged under 16 with recurrent throat infections. The aim is to evaluate if tonsillectomy and adeno-tonsillectomy reduces the number of episodes of sore throats among children to a clinically significant extent. Methods/design A simple prospective pragmatic randomised controlled trial with economic analysis and prospective cohort study of non-trial participants comparing surgical intervention with conventional medical treatment. The treatment arm will receive tonsillectomy and adeno-tonsillectomy while in the control arm non-surgical conventional medical treatment only will be used. The primary outcome measure will be reported number of episodes of sore throat over two years with secondary outcomes measures of reported number of episodes of sore throat, otitis media and upper respiratory tract infection which invoke a GP consultation; reported number of symptom-free days; reported severity of sore throats and surgical and anaesthetic morbidity. The study will take place in five hospitals in the UK. The trial population will be 406 children aged 4–15 on their last birthday with recurrent sore throat referred by primary care to the 5 otolaryngology departments. The duration of the study is seven years (July 2001- July 2008. Discussion As with all pragmatic randomised controlled trials it is impossible to control the external environment in which the research is taking place. Since this trial began a number of factors have arisen which could affect the outcome including; a reduction in the incidence of respiratory tract infections, marked socio-economic differences in

  6. Accuracy of multi-detector computed tomography (MDCT) in staging of renal cell carcinoma (RCC): analysis of risk factors for mis-staging and its impact on surgical intervention.

    El-Hefnawy, Ahmed S; Mosbah, Ahmed; El-Diasty, Tarek; Hassan, Mohammed; Shaaban, Atallah A


    To assess the accuracy of multi-detector computed tomography (MDCT) in preoperative staging of renal cell carcinoma (RCC) and to detect the possible risk factors for mis-staging. In addition, the impact of radiological mis-staging on surgical decision and operative procedures was evaluated. Data files of 693 patients, who underwent either radical or partial nephrectomy after preoperative staging by MDCT between January 2003 and December 2010, were retrospectively reviewed. Radiological data were compared to surgical and histopathological findings. Patients were classified according to 2009 TNM staging classification. Diagnostic accuracy per stage and its impact on surgical intervention were evaluated. The overall accuracy was 64.5%, and over-stage was detected in 29.5% and under-stage in 6%. Sensitivity and specificity were highest in stage T3b (85 and 99.5%, respectively), while T4 showed the lowest sensitivity and PPV (57 and 45%). Degree of agreement with pathological staging was substantial in T1 (κ = 0.7), fair in T2 (κ = 0. 4), perfect in T3b (κ = 0.81), and slight for the other stages (κ = 7 cm represent the significant risk factors (RR: 1.6, 95% CI: 1.1-2.3, P Mis-staging was seen to have no negative impact on surgical decision. MDCT is an accepted tool for renal tumor staging. Tumor mis-staging after MDCT is of little clinical importance. Large tumor size >7 cm and conventional RCC are risk factors for tumor mis-staging.

  7. Effect of nursery intrasurgical intervention in the anxiety level of the surgical patients at Virgen de Altagracia comarcal Hospital in Manzanares (Ciudad Real

    José Maria García Mas


    Full Text Available A patient who is admitted or is going to be operated, feels himself in a reality that might be perceived as a threat, and therefore, might cause an anxiety feeling.Giving emotional support and information is essential to allow the patient to express his anxiety feelings before surgery. Several studies analyze some specific interventions effects as presurgical visit over anxiety or which interventions should be made in order to reduce the patient’s anxiety before surgery.The aim of this study is to know if some specific interventions carried out by nurses during surgery reduce the patient’s anxiety when being operated.So, a randomised controlled trial has been designed, composed by two groups of patients who are going to be operated. The experimental group will be composed by those patients who will be operated with a kind of anaesthesia that allows the established interventions developed and the control one will be composed by those patients to whom another kind of anaesthesia will be administrated and this will not allow the Nursing interventions.

  8. Surgical ethics: surgical virtue and more.

    Vercler, Christian J


    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.

  9. Surgical scar revision: An overview

    Shilpa Garg


    Full Text Available Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods.

  10. Descriptive Analysis of Spinal Neuroaxial Injections, Surgical Interventions, and Physical Therapy Utilization for Degenerative Lumbar Spondylolisthesis Within Medicare Beneficiaries from 2000 to 2011.

    Sclafani, Joseph A; Constantin, Alexandra; Ho, Pei-Shu; Akuthota, Venu; Chan, Leighton


    A retrospective, observational study. The aim of this study was to determine the utilization of various treatment modalities in the management of degenerative spondylolisthesis within Medicare beneficiaries. Degenerative lumbar spondylolisthesis is a condition often identified in symptomatic low back pain. A variety of treatment algorithms including physical therapy and interventional techniques can be used to manage clinically significant degenerative spondylolisthesis. This study utilized the 5% national sample of Medicare carrier claims from 2000 through 2011. A cohort of beneficiaries with a new International Classification of Diseases 9th edition (ICD-9) diagnosis code for degenerative lumbar spondylolisthesis was identified. Current procedural terminology codes were used to identify the number of procedures performed each year by specialty on this cohort. A total of 95,647 individuals were included in the analysis. Average age at the time of initial diagnosis was 72.8 ± 9.8 years. Within this study cohort, spondylolisthesis was more prevalent in females (69%) than males and in Caucasians (88%) than other racial demographics. Over 50% of beneficiaries underwent at least one injection, approximately one-third (37%) participated in physical therapy, one in five (21%) underwent spinal surgery, and one-third (36%) did not utilize any of these interventions. Greater than half of all procedures (124,280/216,088) occurred within 2 years of diagnosis. The ratio of focal interventions (transforaminal and facet interventions) to less selective (interlaminar) procedures was greater for the specialty of Physical Medicine and Rehabilitation than for the specialties of Anesthesiology, Interventional Radiology, Neurosurgery, and Orthopedic Surgery. The majority of physical therapy was dedicated to passive treatment modalities and range of motion exercises rather than active strengthening modalities within this cohort. Interventional techniques and physical therapy are

  11. Observation of Nursing Intervention on the Prevention of Surgical Wound Infection in Operation Room%护理干预对手术室外科伤口感染的预防效果观察



    目的:分析护理干预对手术室外科伤口感染的预防效果。方法将158例患者分为A、B两组各79例,分别给予护理干预及常规护理,分析两组护理效果。结果A组甲级愈合率高于B组,伤口感染率A组2.5%低于B组13.9%,P<0.05。结论护理干预可预防手术室外科伤口感染。%Objective To analyze the effect of nursing intervention on the prevention of surgical wound infection in operation room. Methods 158 patients were randomly divided into A,B two groups with 79 cases in each group,they were given nursing intervention and routine nursing care,the nursing effect of two groups were analyzed. Results In group A,Class-A healing rate was significantly higher than that of group B,wound infection in group A was 2.5%,lower than that in group B which was 13.9%,P<0.05. Conclusion Nursing intervention can prevent wound infection in operation room.

  12. 围术期心理护理干预对外科手术患者康复的影响%The Effect of Perioperative Psychological Nursing Intervention on Rehabilitation of Surgical Operation Patients

    何洪莉; 陈朝芝


    目的:为了进一步研究和探讨围术期心理护理干预对外科手术患者康复的临床实际影响.方法:选取2010年12月-2013年10月笔者所在医院临床收治的外科手术患者136例为研究对象,随机分为两组,常规护理组采取给予常规护理,心理护理组在此基础上采用心理护理,对两组康复效果进行比较.结果:心理护理组肠鸣音恢复时间、排便时间和住院时间明显低于常规护理组,差异有统计学意义(P<0.05);心理护理组患者的临床护理不满意率低于常规护理组,差异有统计学意义(P<0.05).结论:在临床对外科手术患者实施临床护理干预的实践过程中,在常规护理基础上采用心理护理干预后患者临床康复效果更好.%Objective:To further explore and study the clinical effect of perioperative nursing intervention on rehabilitation of surgical patients. Method:136 cases of surgical patients admitted to our hospital from December 2010 to October 2013 were chosen as the research objects.They were randomly divided into two groups,the traditional nursing group was given traditional nursing,the psychological nursing group was given psychological nursing on the basis of traditional nursing,the rehabilitation effects were compared.Result:The recovery time of bowel sounds,defecating time and hospital stay in the psychological nursing group were lower than those in the traditional nursing group,there were statistical significance(P<0.05).The dissatisfied level of the clinical nursing between the two groups,the dissatisfaction rate in the psychological care group was lower than that in the traditional nursing group,and the difference was statistical significance(P<0.05).Conclusion:In the practice of clinical nursing interventions for surgical patients,the use of psychological nursing intervention on the basis of traditional nursing is better clinical rehabilitation.

  13. Sprcial discussion: Future Roles for Tincture of Opium in Medical Intervention for Opioid Dependence Treads and Hopes


    Full Text Available Opium tincture or tincture of opium (TOP, also known as Laudanum, is an alcoholic herbal preparation of opium. It is made by combining ethanol with opium latex or powder. After works of Paracelsus, the 16th century Swiss-German alchemist, who discovered that the alkaloids in opium are far more soluble in alcohol compared to water and named Opium tincture as Laudanum, this drug has been found a broad range of applications as the drug of choice for practically every ailment through 17th to 19th centuries. The early 20th century brought increased regulation of all manner of narcotics, including laudanum, as the addictive properties of opium became more widely understood. By the late 20th century, TOP's use was almost exclusively confined to treating severe diarrhea. During these thirty years, The efficacy and cost-effectiveness of opioid substitution therapy for the treatment of opioid addiction has been well documented by methadone and buprenorphine. Based on the idea of substitution therapy, TOP and slow releasing oral morphine (SROM have been proposed as the new alternatives. TOP could be used in three different ways in interventions for opioid dependency, first, as a supportive drug to reduce withdrawal syndrome during detoxification programs, second, as a substitution drug in long term maintenance, third, as a legal form of opioid drugs for harm reduction purposes. A little but growing evidences are supporting effectiveness of TOP for detoxification programs, in Iran, some preliminary open label studies showed effectiveness of TOP as a detoxifying drug in three to six month program, Now another open label study is evaluating TOP in a specific detoxification program with monthly evaluation and providing long term follow up after reaching to abstinence. There are a strong debate among the policy makers and clinicians on implementation of TOP in Iranian National Substance Abuse Treatment Facilities. In this article, We reviewed the proposed

  14. Surgical Navigation

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


    were identified in the field of traumatology. Treatment of complex orbital fractures was considerably improved by the use of SN compared with traditionally treated control groups. Conclusions: SN seems to be a very promising addition to the surgical toolkit. Planning details of the surgical procedure...... in a 3-dimensional virtual environment and execution with real-time guidance can significantly improve precision. Among factors to be considered are the financial investments necessary and the learning curve....

  15. Brief intervention in primary care settings. A primary treatment method for at-risk, problem, and dependent drinkers.

    Fleming, M; Manwell, L B


    Primary health care providers identify and treat many patients who are at risk for or are already experiencing alcohol-related problems. Brief interventions--counseling delivered by primary care providers in the context of several standard office visits--can be a successful treatment approach for many of these patients. Numerous trials involving a variety of patient populations have indicated that brief interventions can reduce patients' drinking levels, regardless of the patients' ages and gender. In clinical practice, brief interventions can help reduce the drinking levels of nondependent drinkers who drink more than the recommended limits, facilitate therapy and abstinence in patients receiving pharmacotherapy, and enhance the effectiveness of assessment and treatment referral in patients who do not respond to brief interventions alone. Despite the evidence for their usefulness, however, brief interventions for alcohol-related problems have not yet been widely implemented in primary care settings.

  16. 胸外科手术后医院获得性肺炎的前瞻性监测与干预研究%Prospective monitoring of hospital acquired pneumonia in thoracic surgical patients and intervention measures

    仝宇红; 钱雪松; 郑颖; 刘冰慧; 张金梁; 刘维伟; 田春风; 邢江涛


    Objective To study the prevention and control measures for hospital acquired pneumonia in thoracic surgical patients.Methods Using the prospective monitoring,morbidity rate of hospital acquired pneumonia in thoracic surgical patients was monitored.The cluster intervention measures were taken,such as education training,strictly disinfecting the respirator duct,raising up the patients'bedside 30°,conducting oral cavity nursing with hlorhexidine,making assessment everyday to determine the withdrawal of the respirator,and strict hand hygiene.Results By cluster intervention measures,the implementation of hand hygienc of the medical staff was significantly improved; intervention measures including raising up the patients' bedside 30°,conducting oral cavity nursing with hlorhexidine,making assessment everyday to determine the withdrawal of the respirator were enforced well.The morbidity rate of hospital acquired pneumonia in thoracic surgical patients fell from 25.87% to 9.02% (P <0.05).Conclusions It is a positive significance for the prevention and control of the hospital acquired pneumonia in thoracic surgical patients through cluster intervention measures.%目的 探讨胸外科手术后医院获得性肺炎的预防控制措施.方法 采用前瞻性监测方法,通过集束干预包括加强培训、呼吸机管路的严格消毒、床头抬高30°、洗必泰口腔护理、每天评估是否撤机、加强手卫生等综合措施,监测胸外科手术后医院获得性肺炎发病率.结果 通过集束干预措施,手卫生依从率明显提高,床头抬高30°、洗必泰口腔护理每2~6小时1次、每天评估是否撤机干预措施执行情况优于干预前,胸外科手术后医院获得性肺炎发病率由监测前的25.87%下降至9.02%,差异有统计学意义(x2 =44.956,P<0.05).结论 开展前瞻性监测,实施集束干预措施,对控制胸外科手术后医院获得性肺炎有积极意义,降低了手术后医院获得性肺炎的发病率.

  17. Thromboprophylaxis use in medical and surgical inpatients and the impact of an electronic risk assessment tool as part of a multi-factorial intervention. A report on behalf of the elVis study investigators.

    Janus, Edward; Bassi, Anmol; Jackson, David; Nandurkar, Harshal; Yates, Mark


    Venous thromboembolism (VTE) is a major source of morbidity and mortality for both surgical and medical hospitalised patients. Despite the availability of guidelines, thromboprophylaxis continues to be underutilised. This study aims to assess the effectiveness of an electronic VTE risk assessment tool (elVis) on VTE prophylaxis in hospitalised patients. A national, multicentre, prospective clinical audit collected information on VTE prophylaxis and risk factors for VTE in 2,400 hospitalised patients (comprising of equal numbers of medical, surgical and orthopaedic patients). After auditing the standard care use of VTE prophylaxis in 1,200 consecutive patients (audit 1, A1), the elVis system was installed and a second audit (A2) of VTE prophylaxis was performed in a further 1,200 patients. The use of the electronic VTE risk assessment tool was low with 20.5% of patients assessed with elVis. The intervention, elVis plus accompanying education, improved the use VTE prophylaxis to guidelines by 5.0% amongst all patients and by 10.7% amongst high risk patients (adjusted odds ratio (AOR) 1.27 and 1.65 respectively). The use of elVis in A2 varied between hospitals and specialties and this resulted in marked heterogeneity. Despite this heterogeneity, patients assessed with elVis had 1.44 times higher AOR of being treated to guidelines compared to those who were not (P systems, such as elVis, need to be completely integrated within the treatment pathway.

  18. [da Vinci surgical system].

    Watanabe, Gou; Ishikawa, Norihiro


    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.

  19. The Need for Psychosocial Interventions to Facilitate the Transition to Extended-Release Naltrexone (XR-NTX) Treatment for Opioid Dependence: A Concise Review of the Literature

    Ramsey, Susan E.; Rounsaville, Dan; Hoskinson, Randall; Park, Tae Woo; Ames, Evan G.; Neirinckx, Victor D.; Friedmann, Peter


    Given the increase of opioid dependence and opioid-related morbidity and mortality, improving treatment options for individuals with opioid dependence warrants increased attention. This article provides a concise review of work in this area. Remission from opioid dependence can be very difficult to sustain, particularly in the absence of opioid replacement or opioid antagonist therapy. For those who wish to transition from opioid use or opioid replacement therapy to opioid antagonist therapy, a significant challenge can be the period of withdrawal symptoms that must be endured prior to the initiation of opioid antagonist therapy. Studies that have incorporated psychosocial interventions into detoxification protocols have found that they can result in improved treatment outcomes. Interventions based on Acceptance and Commitment Therapy have shown promise in the treatment of clinical disorders that present with symptoms similar to those of opioid withdrawal and have been found to positively impact outcomes among those tapering from methadone. However, the use of an Acceptance and Commitment Therapy-based intervention has yet to be studied among opioid-dependent patients transitioning to XR-NTX, and its value to those transitioning to XR-NTX is currently unknown. PMID:27512336

  20. Contemporary surgical management of rectovaginal fistula in Crohn's disease.

    Valente, Michael A; Hull, Tracy L


    Rectovaginal fistula is a disastrous complication of Crohn's disease (CD) that is exceedingly difficult to treat. It is a disabling condition that negatively impacts a women's quality of life. Successful management is possible only after accurate and complete assessment of the entire gastrointestinal tract has been performed. Current treatment algorithms range from observation to medical management to the need for surgical intervention. A wide variety of success rates have been reported for all management options. The choice of surgical repair methods depends on various fistula and patient characteristics. Before treatment is undertaken, establishing reasonable goals and expectations of therapy is essential for both the patient and surgeon. This article aims to highlight the various surgical techniques and their outcomes for repair of CD associated rectovaginal fistula.

  1. The Surgical Treatment of Mycetoma.

    Suleiman, Suleiman Hussein; Wadaella, El Sammani; Fahal, Ahmed Hassan


    Surgical intervention is an integral component in the diagnosis and management of mycetoma. Surgical treatment is indicated for small, localised lesions and massive lesions to reduce the mycetoma load and to enable better response to medical therapy. It is also a life-saving procedure in patients with massive disease and sepsis. Surgical options for mycetoma treatment range from a wide local surgical excision to repetitive debridement excisions to amputation of the affected part. Adequate anaesthesia, a bloodless field, wide local excision with adequate safety margins in a suitable surgical facility, and expert surgeons are mandatory to achieve the best surgical outcome. Surgical intervention in mycetoma is associated with considerable morbidity, deformities, and disabilities, particularly in advanced disease. These complications can be reduced by educating patients to seek medical advice earlier when the lesion is small, localised, and amenable to surgery. There is no evidence for mycetoma hospital cross infection. This communication is based on the authors' experience in managing over 7,200 mycetoma patients treated at the Mycetoma Research Centre, University of Khartoum, Sudan.

  2. The Surgical Treatment of Mycetoma.

    Suleiman Hussein Suleiman


    Full Text Available Surgical intervention is an integral component in the diagnosis and management of mycetoma. Surgical treatment is indicated for small, localised lesions and massive lesions to reduce the mycetoma load and to enable better response to medical therapy. It is also a life-saving procedure in patients with massive disease and sepsis. Surgical options for mycetoma treatment range from a wide local surgical excision to repetitive debridement excisions to amputation of the affected part. Adequate anaesthesia, a bloodless field, wide local excision with adequate safety margins in a suitable surgical facility, and expert surgeons are mandatory to achieve the best surgical outcome. Surgical intervention in mycetoma is associated with considerable morbidity, deformities, and disabilities, particularly in advanced disease. These complications can be reduced by educating patients to seek medical advice earlier when the lesion is small, localised, and amenable to surgery. There is no evidence for mycetoma hospital cross infection. This communication is based on the authors' experience in managing over 7,200 mycetoma patients treated at the Mycetoma Research Centre, University of Khartoum, Sudan.


    Shaikh MH, Singh Puneet, Kamal Tausif Syed, Shaikh Simran


    Full Text Available Background: Fournier’s gangrene is rare and rapidly spreading aggressive and progressive infection of the perineum in which fascial necrosis is more extensive than the visible gangrene.Early surgical debridement prompt antibiotic administration, are essential for a better prognosis. Delay in diagnosis or treatment increase the mortality rate. This could be because of the multi factorial and poly microbial association of the disease. Aim: We attempt to describe the importance of early radical debridement and its effect on the outcome of the disease. Methodology: We conducted an analytical study on 26 patients of Fournier gangrene admitted in the rural hospital from July 2011 to July2014. On admission their Fournier gangrene severity index was calculated. The broad spectrum antibiotics were started and radical debridement was done in all patients on the same day within 6 hours of admission. Daily dressing was done till the wound showed healthy granulation tissue. The scrotal skin was mobilized and suturing was done. Result: In our studies there was no mortality. This indicates that early aggressive resuscitation to correct the dehydration and early radical debridement improves the outcome in this rare and fatal disease.

  4. [Comparative light microscopic, scanning-electron microscopic and electron microscopic studies of the effect of experimental interventions by surgical scalpel, electrocautery and CO2-laser beam in the oral cavity].

    Gáspár, L; Sudár, F; Tóth, J; Madarász, B


    Tissue effect interventions by means of surgical scalpel, elecrtokauter and CO2-laser ray in the mouth cavity of 20 white rats has been examined. According to their light microscopical examinations both the laser and the electrokauter caused thermal injuries taking place in typical zones while by the scalpel the cut surface in rendered ragged. The band-width of the thermoinjury caused by the kauter is a multiple of that caused by the laser. It has been proved by means of scanning electronmicroscopical examinations that interventions by means of laser result in sharp wound borders, the wounds cut by means of kauter are characterised by the presence of a great number of carbonized specks while by means of the scalpel a mechanical tear of the tissues is brought about. By means of electronmicroscopical examination the characteristics of the typical thermoinjured zones are described. It has been established that in the case of laser the injury of the ultra-structure extends to 400 microns while in case of electrokauter it reaches a width of 1500 microns. The excellent haemostatic effect brought about by the thermoeffect by means of the laser, in contrast to the broad thermoinjured zone caused by the kauter, is obtained at a very mild thermoinjury.

  5. Developing Brain Injury Interventions on Both Ends of the Treatment Continuum Depends upon Early Research Partnerships and Feasibility Studies

    Sohlberg, McKay Moore; Kucheria, Priya; Fickas, Stephen; Wade, Shari L.


    Purpose: The purpose of this research article is to describe two very different lines of brain injury treatment research, both of which illuminate the benefits of implementation science. Method: The article first describes the development and pilot of a computerized cognitive intervention and highlights how adherence to implementation science…

  6. Comparative clinical study of ultrasound-guided A1 pulley release vs open surgical intervention in the treatment of trigger finger

    Nikolaou, Vasileios S; Malahias, Michael-Alexander; Kaseta, Maria-Kyriaki; Sourlas, Ioannis; Babis, George C


    AIM To investigate the effectiveness of ultrasound-guided release of the first annular pulley and compare results with the conventional open operative technique. METHODS In this prospective randomized, single-center, clinical study, 32 patients with trigger finger or trigger thumb, grade II-IV according to Green classification system, were recruited. Two groups were formed; Group A (16 patients) was treated with an ultrasound-guided percutaneous release of the affected A1 pulley under local anesthesia. Group B (16 patients) underwent an open surgical release of the A1 pulley, through a 10-15 mm incision. Patients were assessed pre- and postoperatively (follow-up: 2, 4 and 12 wk) by physicians blinded to the procedures. Treatment of triggering (primary variable of interest) was expressed as the “success rate” per digit. The time for taking postoperative pain killers, range of motion recovery, QuickDASH test scores (Greek version), return to normal activities (including work), complications and cosmetic results were assessed. RESULTS The success rate in group A was 93.75% (15/16) and in group B 100% (16/16). Mean times in group A patients were 3.5 d for taking pain killers, 4.1 d for returning to normal activities, and 7.2 and 3.9 d for complete extension and flexion recovery, respectively. Mean QuickDASH scores in group A were 45.5 preoperatively and, 7.5, 0.5 and 0 after 2, 4, and 12 wk postoperatively. Mean times in group B patients were 2.9 d for taking pain killers, 17.8 d for returning to normal activities, and 5.6 and 3 d for complete extension and flexion recovery. Mean QuickDASH scores in group B were 43.2 preoperatively and, 8.2, 1.3 and 0 after 2, 4, and 12 wk postoperatively. The cosmetic results found excellent or good in 87.5% (14/16) of group A patients, while in 56.25% (9/16) of group B patients were evaluated as fair or poor. CONCLUSION Treatment of the trigger finger using ultrasonography resulted in fewer absence of work days, and better

  7. Comparison of the Incidence of Complications and Secondary Surgical Interventions Necessary in Patients with Chronic Lower Limb Ischemia Treated by Both Open and Endovascular Surgeries

    Janczak, Dariusz; Malinowski, Maciej; Bąkowski, Wojciech; Krakowska, Katarzyna; Marschollek, Karol; Marschollek, Paweł


    Background: Peripheral arterial disease (PAD) affects 3%–10% of the population before the age of 70 years and 15%–20% after that age. The aim of the study was to compare the incidence of complications and secondary interventions in patients who underwent each type of treatment. Methods: We analyzed 734 medical records of the Department of Surgery at the 4th Military Teaching Hospital in Wroclaw, In total, 394 were operated on with open surgery; an endarterectomy (59.39%), a vascular prosthesis implantation (31.01%), or both of these techniques (6.6%), and 340 patients had angioplasty with (50.59%) or without stenting (49.41%). Results: There were no statistically significant differences in the incidence of corresponding complications. The exception was the infection of the wound; significantly fewer were reported in the case of endovascular procedures (p = 0.0087). There were 12 occasions (3.53%) during endovascular surgeries when intraoperative conversion or re-operation using the open method occurred. In the case of open surgery, the mean hospital stay was 7.77 days (median: 8, mode: 8), while for endovascular management it was equal to 4.68 days (median: 4, mode: 3), p <0.0001. Conclusion: The endovascular method results in a similar re-operation rate and number of complications as open surgery. PMID:28496017

  8. Sex-dependent behavioral effects and morphological changes in the hippocampus after prenatal invasive interventions in rats: implications for animal models of schizophrenia

    Martina von Wilmsdorff


    Full Text Available OBJECTIVES: Although schizophrenia affects both human genders, there are gender-dependent differences with respect to age of onset, clinical characteristics, course and prognosis of the disease. METHODS: To investigate sex-dependent differences in motor coordination and activity as well as in cognitive and social behavior, we repeatedly tested female (n = 14 and male (n = 12 Fisher rats (postnatal days, PD 56-174 that had received intracerebroventricular injections of kainic acid as well as female (n = 15 and male (n = 16 control animals. The hippocampus was examined histologically. RESULTS: Compared to male controls, in the alcove test both female controls and female animals with prenatal intervention spent less time in a dark box before entering an unknown illuminated area. Again, animals that received prenatal injection (particularly females made more perseveration errors in the T-maze alternation task compared to controls. Female rats exhibited a higher degree of activity than males, suggesting these effects to be sex-dependent. Finally, animals that received prenatal intervention maintained longer lasting social contacts. Histological analyses showed pyramidal cells in the hippocampal area CA3 (in both hemispheres of control animals to be longer than those found in treated animals. Sex-dependent differences were found in the left hippocampi of control animals and animals after prenatal intervention. CONCLUSION: These results demonstrate important differences between males and females in terms of weight gain, response to fear, working memory and social behavior. We also found sex-dependent differences in the lengths of hippocampal neurons. Further studies on larger sample sets with more detailed analyses of morphological changes are required to confirm our data.

  9. [NIC as a tool for assessing competences of nursing students in clinical placement at surgical units].

    Celma Vicente, Matilde; Ajuria-Imaz, Eloisa; Lopez-Morales, Manuel; Fernandez-Marín, Pilar; Menor-Castro, Alicia; Cano-Caballero Galvez, Maria Dolores


    This paper shows the utility of a NIC standardized language to assess the extent of nursing student skills at Practicum in surgical units To identify the nursing interventions classification (NIC) that students can learn to perform in surgical units. To determine the level of difficulty in learning interventions, depending on which week of rotation in clinical placement the student is. Qualitative study using Delphi consensus technique, involving nurses with teaching experience who work in hospital surgical units, where students undertake the Practicum. The results were triangulated through a questionnaire to tutors about the degree of conformity. A consensus was reached about the interventions that students can achieve in surgical units and the frequency in which they can be performed. The level of difficulty of each intervention, and the amount of weeks of practice that students need to reach the expected level of competence was also determined. The results should enable us to design better rotations matched to student needs. Knowing the frequency of each intervention that is performed in each unit determines the chances of learning it, as well as the indicators for its assessment. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  10. Bronquiectasias, estudio de 36 pacientes intervenidos en el hospital “Dr. Rafael Ángel Calderón Guardia” Bronchiectasis, Results of Surgical Intervention in 36 Patients

    José Alberto Mainieri-Hidalgo


    Full Text Available Objetivo: Analizar el resultado de la cirugía por bronquiectasias en el Servicio de Cirugía de Tórax del Hospital Calderón Guardia. Método: Se revisaron los expedientes clínicos de 36 pacientes operados, con un total de 44 intervenciones por bronquiectasias. Resultados: Se encontró una prevalencia muy significativa de la enfermedad en mujeres, con una relación de 11 a 1. La etiología fue en 10 casos el antecedente de tuberculosis, en uno el síndrome de Kartagener, y en 25 no se logró establecer. Todos los pacientes tenían antecedente de tos y expectoración mucopurulenta de larga evolución, y 29 habían sido clasificados como asmáticos, aunque 10 no tenían ningún antecedente familiar. La radiografía de tórax fue anormal en todos los casos, mostrando áreas de fibrosis, infiltrados o nódulos, pero no fue útil para establecer el diagnóstico de bronquiectasias, contrario a la TAC, que en todos mostró las lesiones bronquiales. El resultado de la cirugía, contrario a lo esperado, no logró establecer un indicador de éxito, pues pacientes con lesiones muy localizadas continuaron expectorando e infectándose, y otros con patología difusa y bilateral, mejoraron sustancialmente. Conclusiones: La cirugía por bronquiectasias está indicada cuando el tratamiento médico no logra controlar satisfactoriamente los cuadros infecciosos bronquiales. Existe franca posibilidad de mejoría, pero no un indicador de éxito para el procedimiento quirúrgico.Aim: To analyze the results of surgical interventions due to bronchiectasias at the Thoracic Surgery Department of the Dr. R. A. Calderón Guardia Hospital. Methods: In order to review the results of 44 surgical interventions due to bronchiectasias at the Thoracic Surgery Department of Calderón Guardia Hospital, the clinical files of 36 patients were examined. Results: A significant prevalence of the disease in female patients was observed, in proportion of 11 to 1. In most cases, causal

  11. Neutropenic enterocolitis: A continuing medical and surgical challenge

    Norman Oneil Machado


    Full Text Available Aim: Neutropenic enterocolitis is a life threatening complication occurring most frequently after intensive chemotherapy in acute leukemia and solid tumors. This review aims to explore the pathogenesis of the condition and appraise the option and outcome of conservative and surgical management based on the literature review. Material and Methods: A Medline search was carried out and most of the relevant papers in English literature from 1973 onwards on neutropenic enterocolitis were reviewed . Results : Twelve reports of single cases, 21 reports of 2 to 4 cases and 15 reports of 5 or more cases were identified. There were no prospective trials or case control studies on therapy of neutropenic enterocolitis. Among the total of 329 cases identified 69% were treated medically and 31% required surgical intervention . Even though a formal comparison of these 2 groups will not be appropriate, the mortality rate of 31% in the medically managed group was higher than those that required surgical intervention (23% . Conclusion: With the increasing use of multiple, new and aggressive chemotherapy for hematological and solid tumors there may be an increased frequency of neutropenic enterocolitis encountered in clinical practice. Clinicians should be acutely aware of the association of neutropenic enterocolitis with chemotherapy for the outcome would depend significantly on an early and appropriate treatment either conservative or surgical .

  12. Evolution of surgical treatment for breast cancer

    V. P. Letyagin


    Full Text Available The paper considers main surgical interventions used to treat breast cancer. It defines the role and place of conservative surgery and describes current procedures for the organ-saving treatment of cancer at this site.

  13. 胆管癌外科术后阻塞性黄疸的介入治疗%The Interventionnal Treatment for Obstructive Jaundice after Surgical Intervention in Patients with Cholangiocarcinoma



    OBJECTIVE To observe the effect of interventional in treatment of obstructive jaundice after surgical intervention in patients with cholangiocarcinoma. METHODS A retrospective analysis was conducted among patients admitted to Zhumadian Centre Hospital from December 1998 to October 2009, and these 25 cholangiocarcinoma cases showed obstructive jaundice after surgery and received interventional treatment. RESULTS The total bilirubin and direct bilirubin levels of 25 cases within 1 month were decreased from 211.1 ± 118.0μmol/L to 105.8 ± 68.6μmol/L, and from 146.5 ± 86.9u,mol/L to 80.2 ± 49.2μmol/ L, respectivley (P< 0.05). Percutaneous transhepatic cholangiobiopsy was performed in 15 patients, and the successful rate reached 100% , and no gastrointestinal bleeding and perforation occurred. CONCLUSION (1) Percutaneous transhepatic cholangiography and drainage is benefit to alleviate jaundice for patients with cholangiocarcinoma after surgical intervention, offer the advantages of simplicity and induce less complications. (2) The procedures of pathological diagnosis by PTCB in anasto-motic stenosis after cholangiojejunostomy of malignant obstuctive jaundice are simplicity and safety.%目的 观察胆管癌外科术后阻塞性黄疸的介入治疗疗效.方法 回顾性分析1998年12月~2009年10月驻马店市中心医院收治的25例胆管癌外科术后出现阻塞性黄疸并采取介入治疗的患者临床资料,观察其疗效.结果 25例患者的总胆红素和直接胆红素水平1个月内由术前的(211.1±118.0)μmol/L和(146.5±86.9) μmol/L降为术后的( 105.8±68.6) μmol/L和(80.2±49.2)μmol/L,下降显著(P<0.05).15例患者PTC术中行胆道钳夹活检,技术成功率100%,未出现消化道出血、穿孔等并发症.其中10例根治性切除患者于胆肠吻合口处行钳夹活检,3例病理提示瘢痕性狭窄,给予内外引流管置入;7例为肿瘤复发,6例给予胆道金属支架置入,1例给予

  14. Traumatic foot injuries in horses: surgical management.

    Burba, Daniel J


    Managing traumatic foot wounds in horses may require surgical intervention. These wounds include coronary-band and heel-bulb lacerations, septic pedal osteitis, septic navicular bursitis, sepsis of the collateral cartilages, and hoof-wall injuries. This article provides a practical overview of the surgical management of these types of wounds.

  15. [Optimizing surgical hand disinfection].

    Kampf, G; Kramer, A; Rotter, M; Widmer, A


    For more than 110 years hands of surgeons have been treated before a surgical procedure in order to reduce the bacterial density. The kind and duration of treatment, however, has changed significantly over time. Recent scientific evidence suggests a few changes with the aim to optimize both the efficacy and the dermal tolerance. Aim of this article is the presentation and discussion of new insights in surgical hand disinfection. A hand wash should be performed before the first disinfection of a day, ideally at least 10 min before the beginning of the disinfection as it has been shown that a 1 min hand wash significantly increases skin hydration for up to 10 min. The application time may be as short as 1.5 min depending on the type of hand rub. Hands and forearms should be kept wet with the hand rub for the recommended application time in any case. A specific rub-in procedure according to EN 12791 has been found to be suitable in order to avoid untreated skin areas. The alcohol-based hand rub should have a proven excellent dermal tolerance in order to ensure appropriate compliance. Considering these elements in clinical practice can have a significant impact to optimize the high quality of surgical hand disinfection for prevention of surgical site infections.

  16. Evaluation of surgical complications after cochlear implantation in Fars center, south of Iran


    Full Text Available Introduction: Cochlear implant, which used in patients with profound hearing loss, may followed by some major or minor complications. These complications depend on age of patient, kind of device, kind of incision, surgical technique and surgeon’s skill. Major complications mostly need surgical intervention for treatment and, may persist for long time. Minor complications need medical treatment and don’t need surgical intervention. Materials and Methods: In this descriptive study between 2004-2007, 100 patients subjected to cochlear implantation were evaluated for post operative complications. Results: Overall complication rate was 14%. We had 4 major complications, including 2 device failure, one misplaced electrode and one cases with major hematoma .These complications managed successfully by surgical intervention or reimplantation. Facial nerve damage or wound breakdown were not seen in these patients. Minor complications including small hematoma, edema, wound infection, dizziness were seen in 10 cases that managed medically. Conclusion: In the recent years complications of cochlear implantation are reduced with increasing surgeon’s skill, new surgical methods and development in device technology.  

  17. Pharmacological and genetic interventions in serotonin (5-HT)(2C) receptors to alter drug abuse and dependence processes

    Filip, Malgorzata; Spampinato, Umberto; McCreary, Andrew C.; Przegalinski, Edmund


    The present review provides an overview on serotonin (5-hydroxytryptamine; 5-HT)(2C) receptors and their relationship to drug dependence. We have focused our discussion on the impact of 5-HT2C receptors on the effects of different classes of addictive drugs, illustrated by reference to data using ph

  18. 酒依赖患者病情观察及护理干预%Observations of patient's condition and nursing intervention for patients with alcohol dependence

    黄小振; 余丹; 张爽


    通过对56例酒依赖患者进行病情观察,制定相应的护理措施并实施,可以帮助患者减轻戒断症状及并发症,安全度过戒断期,从心理及生理上缓解或消除对酒的依赖,提高患者生活质量。%Appropriate nursing interventions were made and carried out through the observation of 56 patients with alcohol dependence ,could lessen patients’ withdrawal symptoms and complications ,make them to tide over withdrawal period safely and to alleviate or eliminate psychological and physiological dependence on alcohol ,and improve patients’ quality of life .

  19. The reliability of histological grade in breast cancer core needle biopsies depends on biopsy size: a comparative study with subsequent surgical excisions.

    Focke, Cornelia M; Decker, Thomas; van Diest, Paul J


    In breast cancer patients undergoing neoadjuvant chemotherapy, histological grading needs to be performed on core needle biopsies (CNBs) that may not be representative of the whole tumour when they are small. Our aim was to study the influence of biopsy size on agreement rates for histological grade between CNBs and subsequent surgical excision biopsies (SEBs). We calculated agreement and Cohen's κ between CNBs and SEBs of 300 early-stage breast cancers. The number of cores, total core length, total tumour length and tumour/tissue ratio were assessed for each CNB set. Agreement rates for grade were calculated for different classes of core number and tumour/tissue ratio, and for total core lengths and tumour lengths per CNB set in 5-15-mm intervals. Agreement on grade between CNBs and SEBs was 73% (κ = 0.59), with underestimation of grade in CNBs in 26% of cases and overestimation in 1% of cases. There was significantly higher concordance between CNBs and SEBs at a total core length of ≥50 mm than at a total core length of cores than at fewer than three cores (75% versus 58% agreement, P = 0.048). The tumour/tissue ratio, pathological tumour size and radiological tumour size were not statistically different between concordant and discordant cases. Agreement rates for histological grade in CNBs versus SEBs improve with increasing biopsy sample size. © 2016 John Wiley & Sons Ltd.

  20. Vitiligo- A surgical approach

    Deepti Ghia


    Full Text Available Aims and objective- To describe the spectrum of surgical modalities for stable vitiligo patients Methods- Patients having stable vitiligo since past 2 years with no improvement with medical line of treatment were enrolled for surgery after informed consent. Depending upon the size and location of vitiligo patch different modalities were performed. Suction blister, mini-punch grafting, split thickness skin grafting, trypsinised melanocyte-keratinocyte transfer and non-trypsinised melanocyte- keratinocyte transfer (Jodhpur technique and follicular grafting technique have been described photographically which have been performed at a tertiary care hospital. Conclusion- Vitiligo is often difficult to treat, stable patches resistant to medical line of management do respond to surgical treatment; however it is very important to choose the modality of surgery according location of the patch, size of the lesion and available resources.

  1. Implications for Therapeutic Intervention

    A. L. Hof


    Full Text Available Patients with an upper motor neurone syndrome (CP suffer from many disabling primary symptoms: spasms, weakness, and loss of dexterity. These primary ‘neurogenic’ symptoms often lead to secondary disabilities, muscle contractures, and tertiary effects, bone deformations. A common symptom of CP is hypertonia, with. the consequence that the involved muscles remain in an excessively shortened length for most of the time. As a normal reaction of the muscle tissue, the number of sarcomeres is reduced and the muscle fibers shorten permanently: a contracture develops. A possible second type of contracture is that normal muscle lengthening along with bone growth is affected. Current treatments for the secondary effects include (1 reduction of muscle force, (2lengthening of the muscle fibers by serial plaster casts, and (3surgical lengthening of tendons or aponeurosis. The choice of treatment depends on the cause of the functional deficit. Bone tissue also adapts itself to abnormal forces, especially in the growth period. The hypertonias or contractures of CP so may give rise to bone malformations that interfere with function (e.g. femur endorotation or may reduce the action of muscles by changing the lever arm (e.g. ankle varus. Although prevention should always be preferred, a timely surgical intervention cannot always be avoided. The differences in treatment for the various groups require and justify an extensive laboratory investigation, including EMG recordings in gait, measurement of passive elastic properties, and long-term observation of the hypertonia.

  2. 经中心静脉导管介入治疗腹部外科疾病并发症%Percutaneous central venous catheter drainage for interventional treatment of complications in abdominal surgical diseases

    陈新; 宣之东; 祝志


    目的 探讨经中心静脉导管介入治疗腹部外科疾病并发症的效果.方法 回顾性分析72例腹部外科疾病患者的临床资料,其中并发腹水23例、胆漏19例、胰瘘8例、胰腺组织坏死7例、腹腔脓肿15例,均行超声或CT引导下置入中心静脉导管引流治疗.结果 72例患者均一次性置人中心静脉导管成功,导管留置时间2~37 d,5例患者带管出院,定期至门诊复查.3例腹水患者导管滑脱行重新置管;发生导管堵塞17例,经冲洗和导丝疏通后解除;胰腺组织坏死2例和胰周脓肿1例行多次穿刺并更换大口径导管后治愈.胰腺组织坏死2例、外伤性胰漏1例、阑尾炎1例患者均行开腹手术;胆囊切除术后胆漏1例行胆道内支架治疗;重症胰腺炎并发呼吸窘迫综合征1例转入ICU治疗.结论 超声或CT引导下在腹腔置人中心静脉导管治疗腹部外科疾病并发症,安全、有效,值得推广应用.%Objective To discuss the effica of central venous catheter drainage in interventional treatment of abdominal surgical complications.Methods The clinical data of 72 cases of abdominal surgical diseases were retrospectively analyzed,the complications included 23 cases of ascites,19 cases of bile leakage,8 cases of pancreatic fistula,7 cases of pancreatic necrosis and 15 cases of abdominal abscess,they all underwent percutaneous central venous catheter drainage under the guidance of ultrasound or CT.Results Central venous catheter was placed in 72 cases successfully in one time,the cathetem were kept for 2 to 37 days,5 discharged cases with catheter underwent regular reexamination in the clinic.3 cases of ascites were replaced for catheter shedding; 17 cases for occlusion recieved catheter irrigation and guidewire dredging;2 cases of pancreatic necrosis and 1 case of peripancreatic abscess were cured by repeated puncture and replacement of large-bore catheter.2 cases of pancreatic necrosis,1 case of pancreatic

  3. 小儿外科重大疾病术前贫血与干预多中心调查%Multi-center epidemiological survey of preoperative anemia and intervention status of some major pediatric surgical diseases

    林茹; 刘晋萍; 周荣华; 李鹏; 王斌; 郑珊; 舒强


    目的 了解国内部分地区小儿外科某些重大疾病术前贫血与干预状况,为进一步开展小儿围术期血液管理提供依据.方法 研究单位分别选择2012年5月至2014年3月期间住院的非紫绀先天性心脏病、先天性巨结肠和胆总管囊肿患儿做回顾性问卷调查.纳入标准:最接近手术日的术前血常规报告血红蛋白(Hb)值低于120 g/L即诊断贫血.干预措施指对术前贫血是否采用输血或补充促红细胞生成素(rHuEPO)、铁剂、维生素等等.结果 共调查北京、上海、杭州、西安、深圳和成都地区6家医院874例患儿.其中先天性心脏病组458例,男282例,女176例;年龄2个月至13.5岁,平均(28.58±29.79)个月.Hb低于120 g/L有276例,总发生率为60.3%,其中轻度贫血(Hb<120 g/L,≥90 g/L)为58.1%(266/458),中度以上贫血(Hb<90 g/L)为2.2%(10/458).福利院、小于1岁或/和肺动脉高压的患儿贫血发生率分别明显高于总发生率(P=0.008、P<0.001、P<0.001);普外组416例中,男204例,女212例,年龄2个月至16.25岁,平均(28.60±32.30)个月.Hb低于120 g/L有331例,总发生率为79.6%,其中轻度贫血为71.4%(297/416),中度以上贫血为8.2%(34/416).术前贫血发生率各个地区存在明显差异,从50%到100%不等;对术前贫血不处理直接手术的比例达到89.1%以上;除个别医院术前采用rHuEPO,较少有其他干预措施.结论 国内部分地区小儿外科某些重大疾病术前贫血发生率较高,不干预直接手术的状况十分普遍,应引起重视.%Objective To explore the incidence of preoperative anemia and intervention status of some major pediatric surgical diseases in some domestic areas so as to provide scientific rationales for perioperative blood management in children.Methods The hospitalized patients with non-cyanotic congenital heart disease,Hirschsprug's diseaseor choledochal cyst from May 2012 to March 2014 at all study units were surveyed

  4. Surgical treatment of colorectal cancer complicated with acute intestinal obstruction

    S. N. Schaeva


    percentage of multi-stage operations with removalof the tumor at the 2nd stage (33.0 and 25.2 %, respectively. DIO most often was noted in case of circular tumor growth (93.5 % of cases. To a lesser extent the severity of acute intestinal obstruction was influenced by such factors as extent of the tumor along the intestinal wall and its histological type.Conclusion. In the general surgical hospitals final decision on the choice of surgical approach depends on the general condition of patients, surgeon’s experience and hospital where the surgery is performed. It is advisable to carry out surgical interventions in the given contingent of patients in the specialized departments.

  5. The effects of surgical intervention on perineal pain after vaginal delivery%阴道分娩后产妇会阴疼痛状况调查与干预

    刘婷; 邬燕萍; 杜艳鸿; 王隽隽


    Objective: To investigate the effects of surgical intervention on the incidence of postpartum perineal pain. Methods: 866 women who had vaginal delivery in the Obstetrics and Gynecology ward, Xuanwu Hospital during January 2009 and October 2009 were surveyed. According to the degrees of tears and types of episiotomies, they were divided into four groups: group 1 with an intact perineum or first-degree tears (184); group llwith second-degree tears (266); group III with a mediolateral cut (359), and group IV with a midline cut (42). The incidence of perineal pain at 1 to 3 days postpartum was calculated for the four groups. In addition, the parturients (866) were randomized into 3 groups receiving physiotherapy, medication, and physiotherapy plus medication respectively. The incidence of perineal pain was compared among the three groups. Results: The incidence of perineal pain among the four groups at 1 day postpartum was 34% (group I), 42% (group II), 94% (group III), and 55% (Group IV); 2 days postpartum was 25% (group I), 32% (group II), 81% (group III), and 35% (Group IV); and 3 days postpartum wasll% (group I), 22% (groupll), 61% (group III), and 18% (group IV). The incidence of perineal pain for the surgical intervention groups was higher than the tears groups. Especially, the incidence of perineal pain for the mediolateral cut group was higher than the other three groups. The frequency of perineal pain was not statistically different among the three groups receiving different treatments. Conclusion: Surgical intervention is a common cause for the perineal pain after vaginal delivery. It is recommended to select the adequate type of episiotomy according to the guidelines to decrease the incidence of postpartum perineal pain.%目的:了解阴道分娩后产妇会阴疼痛状况及外科干预对阴道分娩后会阴疼痛的影响.方法:调查2009年1-10月阴道分娩产妇866例,根据会阴裂伤及侧切情况分Ⅰ~Ⅳ组,分别统计产后1-3

  6. Surgical safety checklists in developing countries.

    Vivekanantham, Sayinthen; Ravindran, Rahul Prashanth; Shanmugarajah, Kumaran; Maruthappu, Mahiben; Shalhoub, Joseph


    The World Health Organization Surgical Safety Checklist (WHO SSC) has demonstrated efficacy in developed and developing countries alike. Recent increases in awareness of surgical morbidity in developing countries has placed greater emphasis on strategies to improve surgical safety in resource-limited settings. The implementation of surgical safety checklists in low-income countries has specific barriers related to resources and culture. Adapting and amending existing surgical safety checklists, as well as considering factors unique to developing countries, may allow the potential of this simple intervention to be fully harnessed in a wider setting. This review will address the benefits and challenges of implementation of surgical safety checklists in developing countries. Moreover, inspiration for the original checklist is revisited to identify areas that will be of particular benefit in a resource-poor setting. Potential future strategies to encourage the implementation of checklists in these countries are also discussed.

  7. Should psychosocial intervention be added to pharmacological treatment for opiate abuse/dependence? An overview of systematic reviews of the literature

    Laura Amato


    Full Text Available

    Background: Opioid abuse and dependence are major health and social issues in most societies. Different interventions are available, but the majority of heroin patients relapse and these relapses are a substantial problem to their rehabilitation. Psychosocial interventions for drug addicts have been suggested as possible instruments to overcome the difficulty of maintaining a drug-free state. The aim of this paper is to provide a summary of the available evidence of effectiveness.

    Methods: We summarised the results from two systematic reviews on psychosocial interventions combined with Methadone Maintenance Treatment and Methadone or Buprenorphine Detoxification Treatment.

    Results: For detoxification treatments, the results show that benefits can be gained from adding any psychosocial treatment to any substitution detoxification treatment in terms of completion of treatment: relative risk (RR 1.68 (95% CI 1.11-2.55, and compliance (proportion of clinical absences: RR 0.48 (95% CI 0.38-0.59; for the use of heroin during treatment, the differences were not statistically significant. For maintenance treatments, there is an additional benefit to be gained in adding any psychosocial treatment to methadone maintenance treatment in relation to the use of heroin during treatment: RR 0.69(95% CI 0.53-0.91; no statistically significant additional benefit was shown in terms of treatment retention and results at follow-up.

    Conclusions: Psychosocial treatments offered in addition to pharmacological detoxification treatments are effective in terms of completion of treatment and compliance, while adding any psychosocial support to methadone maintenance significantly improves the non-use of heroin during treatment but does not improve the other outcomes considered.

  8. Surgical treatment of traumatic lower limb pseudoaneurysm

    Pan Zhongjie; Zhang Hua; Li Li; Jia Yutao; Tian Rong


    Objective:To summarize our experience in surgical treatment of traumatic lower limb pseudoaneurysm.Methods:Twenty patients with traumatic lower limb pseudoaneurysm were surgically treated in our department from January 2007 to January 2012.The treatment protocols included interventional covered-stent placement (10 cases),spring coil embolization (2 cases),and surgical operation (8 cases).Surgical operations included pseudoaneurysm repair (2 cases),autologousvein transplantation (1 case),and artificial-vessel bypass graft (5 cases).Results:All the patients were successfully treated without aggravating lower limb ischemia.Pseudoaneurysm disappeared after treatment.A surgical operation is suitable to most pseudoaneurysms,but its damage is relatively obvious and usually leads to more bleeding.It also requires a longer operating time.Compared to a surgical operation,interventional therapy is less traumatic and patients usually have a quicker recovery (P<0.05).All patients were followed up once per month for 12-36 months by color Doppler ultrasound examination.There were no cases of pseudoaneurysm recurrence.Conclusion:Both surgical operation and interventional therapy are safe and effective in the treatment of pseudoaneurysm.

  9. Do psychological variables affect early surgical recovery?

    Michael N Mavros

    Full Text Available BACKGROUND: Numerous studies have examined the effect of psychological variables on surgical recovery, but no definite conclusion has been reached yet. We sought to examine whether psychological factors influence early surgical recovery. METHODS: We performed a systematic search in PubMed, Scopus and PsycINFO databases to identify studies examining the association of preoperative psychological variables or interventions with objectively measured, early surgical outcomes. RESULTS: We identified 16 eligible studies, 15 of which reported a significant association between at least one psychological variable or intervention and an early postoperative outcome. However, most studies also reported psychological factors not influencing surgical recovery and there was significant heterogeneity across the studies. Overall, trait and state anxiety, state anger, active coping, subclinical depression, and intramarital hostility appeared to complicate recovery, while dispositional optimism, religiousness, anger control, low pain expectations, and external locus of control seemed to promote healing. Psychological interventions (guided relaxation, couple support visit, and psychiatric interview also appeared to favor recovery. Psychological factors unrelated to surgical outcomes included loneliness, perceived social support, anger expression, and trait anger. CONCLUSION: Although the heterogeneity of the available evidence precludes any safe conclusions, psychological variables appear to be associated with early surgical recovery; this association could bear important implications for clinical practice. Large clinical trials and further analyses are needed to precisely evaluate the contribution of psychology in surgical recovery.

  10. Management of refractory atrial fibrillation post surgical ablation

    Altman, Robert K.; PROIETTI, RICCARDO; Barrett, Conor D.; Paoletti Perini, Alessandro; Santangeli, Pasquale; Danik, Stephan B.; Di Biase, Luigi; Natale, Andrea


    Over the past two decades, invasive techniques to treat atrial fibrillation (AF) including catheter-based and surgical procedures have evolved along with our understanding of the pathophysiology of this arrhythmia. Surgical treatment of AF may be performed on patients undergoing cardiac surgery for other reasons (concomitant surgical ablation) or as a stand-alone procedure. Advances in technology and technique have made surgical intervention for AF more widespread. Despite improvements in out...

  11. Surgical versus non-surgical treatment of congenital hyperinsulinism.

    Mazor-Aronovitch, Kineret; Landau, Heddy; Gillis, David


    Congenital hyperinsulinism is a functional disorder of insulin secretion. In its diffuse severe form, it is traditionally treated with over 95% pancreatectomy. However, even after this procedure normoglycemia is not always achieved. Non-surgical therapy with frequent or continuous feeding, medication and close monitoring is another alternative. In this review we compare the two approaches to this condition focusing on early complications, diabetes, neurological outcome and home management issues. Early complications of pancreatectomy include mechanical, metabolic and infectious complications. Non-surgical interventions can be complicated by unwarranted effects of medications and of invasive procedures. Diabetes occurs with both approaches but much less frequently and years later with non-surgical treatment. Regarding neurodevelopmental outcome, most data come from heterogeneous groups. Nevertheless, it appears that outcome is not adversely affected by avoiding surgery. Home management is far more difficult for the non-surgical form. When the non-surgical approach is successful in achieving normoglycemia and parents are highly motivated, this mode of therapy should be considered.

  12. Metabolic control and complications over 3 years in patients with insulin dependent diabetes (IDDM): the Stockholm Diabetes Intervention Study (SDIS).

    Reichard, P; Britz, A; Carlsson, P; Cars, I; Lindblad, L; Nilsson, B Y; Rosenqvist, U


    In a planned 5-year study, 97 patients with insulin dependent diabetes mellitus (IDDM), non-proliferative retinopathy and unsatisfactory blood glucose control were monitored for 3 years. The patients were randomized to an intensified conventional treatment (ICT, n = 44) or a regular treatment (RT, n = 53) group. HbA1c (normal range 3.9-5.7%) was reduced from 9.5 +/- 0.2 (mean value +/- SEM) to 7.4 +/- 0.1% in the ICT group (P = 0.0001), and from 9.5 +/- 0.2 to 9.0 +/- 0.2% in the RT group (P = 0.004). Nerve conduction velocities in the sural and peroneal nerves (P = 0.01-0.0001) were impaired in the RT group, but not in the ICT group. Retinopathy increased in both groups. The condition of 22 ICT patients (50%, 95% confidence interval 34-66%) and 37 RT patients (73%, 61-84%) deteriorated with regard to at least one microvascular complication (retinopathy, nephropathy, neuropathy) (P = 0.024). Lower HbA1c levels during the study significantly reduced the risk of deterioration (P = 0.01). In total, 57% of the ICT patients had at least one episode of serious hypoglycaemia, compared with 23% in the RT group (P = 0.001). The patients in the ICT group also gained weight (P = 0.0001). Improved blood glucose control slowed down the progression of microangiopathy during a 3-year period in patients with non-proliferative retinopathy, but at the price of an increased frequency of serious hypoglycaemic episodes, and some gain in body weight.

  13. Surgical intervention for retrograde type A aortic dissection after endovascular repair for type B aortic dissection%胸主动脉B型夹层腔内修复术后逆向撕裂的外科治疗

    赖颢; 王春生; 洪涛; 丁文军; 陈昊; 宋凯


    Objective The technique of endovascular repair for type B aortic dissection has been widely used because of its advantage of low invasiveness and safety.But the complication of Stanford A dissection during and after this operation owing to retrograde tearing should be highly noticed because of its high mortality despite rarely happened.The present study retrospectively analyzed 11 cases of retrograde type A aortic dissection after endovascular repair for type B aortic dissection.The characteristics and surgical intervention for these cases were summarized.Methods From April 2005 to March 2008,eleven cases of retrograde type A aortic dissection after endovascular repair for type B aortic dissection were treated.Among diem,7 cases occurred within 3 months after endovascular repair,the intimal tear of the dissection all happened near ihe proximal end of the stent graft and the distal end of the vascular prosthesis was all anastomosed with the stent graft.The other 4 cases happened longer than 3 months after endovascular repair.Neither did the intimal tear of the dissection nor the distal end of the vascular prosthesis correlate with the stent graft.All the patients received median stemotomy incision.Selective cerebral perfusion through right axillary artery under deep hypothenm'c circulation arrest were used when operating on aortic arch.Results All the cases recovered and were alive after following 7 to 40 months.No serious complications such as stroke,paraplegia or renal failure were found.Conclusion Retrograde type A aortic dissection happened shortly (within 3 months) after endovascular repair may be correlated with stent insertion.The vascular prosthesis can be directly anastomosed with the stent graft.It remains to be further studied whether retrograde type A aortic dissection happened longer after endovascular repair is related with the operation.Favorable effect can be achieved for this kind of patients by surgical treatment.Satisfied cerebral protection and

  14. Surgical treatment for male prolactinoma

    Song, Yi-Jun; Chen, Mei-Ting; Lian, Wei; Xing, Bing; Yao, Yong; Feng, Ming; Wang, Ren-Zhi


    Abstract A total of 184 cases of surgically treated male prolactinoma were analyzed retrospectively to summarize the outcome of this surgical intervention. We analyzed the general characteristics, clinical manifestations, hormone levels, imaging features, preoperative treatments, surgical outcomes, pathology results, and follow-up records for all included patients. The most common clinical manifestations included sexual dysfunction (47.4%), headache (55.9%), and visual disturbance (46.7%). Serum prolactin levels ranged from 150 to 204,952 ng/mL. Tumor size varied from 6 to 70 mm. Pituitary adenomas grew in a parasellar pattern with visual deficits occurring 40.7% of the time. After surgical therapy, 88.6% of patients achieved symptom relief, and 98.4% experienced an immediate postoperative decline in prolactin level. Fifty-seven patients (31.0%) achieved initial remission, and 26 patients (45.6%) experienced recurrence. Hence, our results suggest that in male prolactinoma characterized by a large pituitary diameter and high serum prolactin level, tumor size predicts the degree of gross resection. The prognostic predictors included preoperative tumor growth pattern and Ki-67 index. Citation: Yi-jun S, Mei-ting C, Wei L, Bing X, Yong Y, Ming F, Ren-zhi W. (2016) Surgical treatment for male prolactinoma: a retrospective study of 184 cases PMID:28079813

  15. 不同心理干预方法对心脏手术围手术期应激的影响%Effect of different psychological intervention methods on stress reaction in cardiac surgical procedures



    目的 观察不同心理干预方法对心脏手术患者围手术期血桨促肾上腺皮质激素(ACTH)和皮质醇(F)的影响,以寻求科学的围术期心理干预方案.方法 将120例拟行体外循环心脏手术的患者随机分三组:A组为对照组,病房常规护理;B组围术期访谈式心理干预;C组访谈辅以多媒体进行围术期心理干预.采用放免法测定心理干预前(手术前一天)(T1)、麻醉诱导前(T2)、术后第3天(T3)血浆ACTH、F浓度,监测BP、HR及进行焦虑自评量表(SAS)评估.结果 A、B、C三组SAP、DAP、HR在T2高于T1(P<0.05),B组及C组在T2时SAP、DAP、HR均低于对照组A组(P<0.05),且C组降幅更大,HR、BP更趋于平稳;A、B、C三组ACTH、F在T2、T3高于T1(P<0.05或0.01).但B组及C组在T2、T3时低于对照组A组(P<0.05或0.01),且C组数值更低(P<0.01),ACTH、F释放更少.结论 围手术期访谈式的心理干预,一定程度上减轻了患者的应激反应;访谈辅以多媒体教材进行围术期心理干预,可增强围术期相关知识的教育效果,能进一步改善患者的不良情绪,更有效地减轻应激反应.%Objective To investigate the effect of different psychological intervention methods on stress reaction for patients with cardiac surgical during peri-operation period. Method 120 patients scheduled for heart surgery were randomly divided into group A, group B and group C, each group was 40 cases. In group A, patients received ward routine care. In group B, patients received peri-operative interview-style psychological intervention, in group C. Patients received peri-operative interviews and multimedia psychological intervention. Venous blood samples were obtained before psychological intervention the day before operation (T1), before induction of anesthesia (T2) and 3 days after operation (T3),for determining the plasma adrenocorticotropic hormone (ACTH) and cortisol (F). Blood pressure, heart rate and the self-rating anxiety

  16. 75例孤残儿童手术干预前、后体格发育主要衡量指标分析%Analysis of main measurement indexes of physique development of 75 abandoned and disabled children before and after surgical intervention

    袁仿来; 叶志宏; 任园嫚; 陈碧蕾


    目的::通过对75例孤残儿童手术前、后体格发育状况的对比调查,了解手术干预对孤残儿童体格发育的影响。方法:对75例手术干预治疗孤残儿童前、后体格发育指标回顾性分析比较。结果:75例孤残儿童术前体格发育水平落后于正常儿童;75例孤残儿童手术前、后体格发育水平存在显著性差异(P﹤0.01),手术干预效果明显。结论:孤残儿童以手术干预去除病因十分必要,有利于孤残儿童的体格发育。%Objective: To explore effects of surgical intervention on abandoned and disabled childrenˊs physique growth through comparing and investigating the physique growth indexes of 75 cases with surgical treatment before and after the surgery. Meth-ods:The physique growth indexes of 75 abandoned and disabled children before and after the surgery were retrospectively analyzed and compared. Results:The physique growth indexes before the surgery of the 75 cases were lower than those of normal children in socie-ty. The physique growth indexes before and after the surgery were significantly different (P﹤0. 01). The effect of surgical intervention was apparent. Conclusions:It is very essential for the abandoned and disabled children to remove pathogeny by surgical intervention, which is helpful to these childrenˊs physique growth.

  17. Splenic vascular surgical intervention combined wti hf ast track surgery in spleen trau ma%脾脏血管介入联合加速康复外科理念在脾脏创伤中的运用

    刘兴东; 蒋延美; 赖景奎; 杨波; 刘洪; 罗友琛


    Objective:To evaluate the feasibility of splenic vascular surgical intervention combined with fast track surgery for treatment of patients with traumatic rupture.Methods:The control group of 15 patients was diagnosed as traumatic rupture underwent conventional DAS splenic artery embolization therapy, FST group 15 cases where the concept of joint fast track surgery, postoperative observation time eating, bloating, abdominal pain time, flatus, length of stay, hospital costs.Results:30 cases were successfully retained spleen, eating earlier, relatively rapid postoperative recovery, including four cases of postoperative fever.Conclusion:DSA splenic artery embolization retention should be a simple, small damage, joint with FST patients related to the concept of eating time early, rapid recovery, pain relief, relative safety, reduce hospital costs, might have some clinical value.%目的:探讨应用血管介入联合加速康复外科理念( Fast track surgery,FST)救治外伤性脾破裂患者的可行性。方法:对照组15例诊断为外伤性脾破裂患者行常规DAS脾动脉栓塞止血治疗,FST组15例联合加速康复外科理念救治,观察患者术后进食时间,腹胀腹痛缓解时间,肛门排气时间,住院时间,住院费用。结果:30例均保留脾脏成功,进食时间早,术后恢复相对较快,其中4例出现术后发热。结论:DSA血管介入栓塞保留脾脏是一种简单,损伤小,联合加速康复外科相关理念患者术后进食时间早,康复快,疼痛减轻,相对安全,住院费用降低,具有一定临床价值。

  18. Surgical management of large scalp infantile hemangiomas

    Imad S Khan


    Full Text Available Background: Infantile Hemangiomas (IH are the most common benign tumor of infancy, occurring in over 10% of newborns. While most IHs involute and never require intervention, some scalp IHs may cause severe cosmetic deformity and threaten tissue integrity that requires surgical excision. Case Description: We present our experience with two infants who presented with large scalp IH. After vascular imaging, the patients underwent surgical resection of the IH and primary wound closure with excellent cosmetic outcome. We detail the surgical management of these cases and review the relevant literature. Conclusion: In some cases the IHs leave behind fibro-fatty residuum causing contour deformity. Surgery is often required for very large lesions causing extensive anatomical and/or functional disruption. The goal of surgical intervention is to restore normal anatomic contour and shape while minimizing the size of the permanent scar.

  19. [Some principles in surgical treatment of strabismus].

    Dinu, Doina; Grigorescu, Adina; David, Roxana; Urda, S


    Taking into consideration the age of the patient, the strabismus surgery targets different things. Thus, for infants, the goal of the surgical intervention for congenital esotropia, is to prevent the occurrence of amblyopia and binocular vision dysfunctions (ARC, suppression). In preschool children, we operate aiming the recovery of the binocular vision, while in children over ten years old, the surgery is done only for esthetic reasons. On the other hand, in adults, the strabismus surgery has two aspects: for esthetic reasons in monocular strabismus with amblyopia, or for diplopia treatment in strabismus of traumatic or neurological cause. To get the best results, the surgical intervention has to respect several rules, which differ with patient's age. This presentation will discuss several surgical procedures: for congenital esotropia (including its advantages and drawbacks), for preschool children strabismus and also for strabismus in adults. We will also review the surgical treatment for Duane syndrome, Ciancia syndrome and superior oblique muscle palsy.

  20. Bio-Psycho-Spiritual Modeling in Drug Dependents and Compiling of Intervention Program for Promotion of Resiliency Based on Cognitive Narratology and Positive Psychology

    Ezat ollah Kordmirza Nikoozadeh


    Full Text Available Introduction: Since the past few decades, the concentration of researches on drug abuse and drugs dependency have shift from risk factor to protective factors. In the past two decades, the concept of resiliency was increasingly considered by developmental psychology. The concentration shifted from risk to resiliency originates from disadvantage in emphasizing on identification of risk factors. Method: Target population was all volunteer addicts who referred to clinics in Tehran city. The group selected based on random cluster sampling. In total 319 persons (male composed of two groups, dependent to drug (150 persons and independent to drug (169 persons were participated in research and in general, 108 questionnaires of non-addicts and 126 of addicts were analyzed. In order to determine the fit model based on assumed variables in the research, by utilizing LISREL softwar99e, initially the relation between primary fundamental variables and final endogenous variables were reviewed. In continuation, the - relations between intermediary and endogenous variables were determined. Results: The results showed the fitting of predicted model of resiliency. Conclusion: In this research the program based on bio-psycho-spiritual model for instructional intervention in order to enhance of resiliency of addict people provided.


    E. V. Prozorenko


    = 4, non-seminomatous germ cell tumor (n = 5.Results. Early post-surgical lethality comprised 6 % (n = 4. Development of local relapses comprised 16 % (n = 11. Extracerebral development of the disease has become the reason of death of 59 % of patients, development of the disease in the brain has become the reason of death of 41 % of patients. The shortest survival median was found with patients suffering from melanoma and comprised 6 months, with the III class of RPA, it comprised 6 months, with the perifocal hemorrhage type, it comprised 6 months, the longest survival median was found with patients suffering from sarcoma and comprised 15.5 months, with the I class of RPA, it comprised 14 months, and with the intratumoral hemorrhage type, it comprised 14.5 months.Conclusions. Development of local relapses depended on the surgical intervention technique and did not depend on the availability of tumor elements in the hematoma. Separated resection of the metastasis and perifocal hematoma does not violate oncosurgical principles and does not cause the rate of local relapses; the common survival median of patients after surgical treatment comprised 9 months. The factors that determined survival of patients with cerebral metastases with hemorrhages were the histological form of the primary tumor, type of metastasis hemorrhage and RPA class of the patient prior to the surgery.

  2. [Surgical techniques in mitral valve diseases. Reconstruction and/or replacement].

    Noack, T; Mohr, F-W


    Mitral valve (MV) disease is one of the most common heart valve diseases. The surgical and interventional treatment for MV disease requires a multidisciplinary approach. For primary mitral valve regurgitation (MVR) surgical MV repair is the treatment of choice, which can be performed with an excellent outcome and long-term survival in reference centers. The surgical technique used for MV repair depends on the pathological mechanism, the morphological dimensions of the MV, the operative risk and the expertise of the cardiac surgeon. The surgical and interventional treatment of secondary MVVR is the subject of on-going discussions. In patients with moderate secondary MVR undergoing coronary artery bypass grafting, concomitant MV repair should be performed. In the presence of severe secondary MR with risk factors for failure of MV repair, patients should consider having MV replacement. In the rare cases of patients presenting with mitral valve stenosis (MVS) MV repair can be considered in young patients and who are most often treated with MV replacement. The choice between biological or mechanical MV replacement depends on the pathophysiology, the comorbidities, the amount of anticoagulation necessary and the age of the patient. New percutaneous techniques for MV replacement offer new treatment options for reoperation in high-risk patients.

  3. The surgical treatment of Balanitis Xerotica Obliterans


    Background: Balanitis Xerotica Obliterans (BXO) is a chronic, often progressive disease, which can lead to phimosis and urethral stenosis, affecting both urinary and sexual function. Steroid creams are usually the first-line treatment but have a limited role and surgical intervention is frequently necessary. Conservative surgical procedures (circumcision) are often preferred in the first instance with the premise that recurrence of disease will require a more definitive reconstruction. This s...

  4. 2013年外科手消毒管理成效分析及干预措施%Surgical Hand Disinfection Management Performance Analysis and Intervention Measures In 2013

    翁秀英; 朱虹; 钱吉康


    In order to further standardize and unify hospital surgical hand disinfection operation and supervision and management.From March 2013 to April 2013 surgical hand disinfection standard implementation present situation was investigated,the problems in the execution of formulate corresponding management measures were summarized and analysed,it showed that our surgical hand disinfection there was not standard.Hospital infection administration through takes surgical hand disinfection activities,and surgical hand disinfection of employee training work,to improve the quality of hospital surgical hand disinfection,ensure the patients’ medical security.%为了进一步规范、统一外科手消毒操作与监督管理,对2013年3-4月笔者所在医院外科手消毒规范执行现状进行调查,将执行过程中存在问题进行汇总、分析,制定相应管理对策,发现笔者所在医院外科手消毒存在一定不规范。医院感染管理科通过开展外科手消毒活动,外科手消毒的全员培训工作,提高手术科室外科手消毒的质量,保障了患者医疗安全。

  5. Contemporary surgical management of rectovaginal fistula in Crohn’s disease

    Michael; A; Valente; Tracy; L; Hull


    Rectovaginal fistula is a disastrous complication of Crohn’s disease(CD) that is exceedingly difficult to treat. It is a disabling condition that negatively impacts a women’s quality of life. Successful management is possible only after accurate and complete assessment of the entire gastrointestinal tract has been performed. Current treatment algorithms range from observation to medical management to the need for surgical intervention. A wide variety of success rates have been reported for all management options. The choice of surgical repair methods depends on various fistula and patient characteristics. Before treatment is undertaken, establishing reasonable goals and expectations of therapy is essential for both the patient and surgeon. This article aims to highlight the various surgical techniques and their outcomes for repair of CD associated rectovaginal fistula.

  6. SU-E-I-22: Dependence On Calibration Phantom and Field Area of the Conversion Factor Used to Calculate Skin Dose During Neuro-Interventional Fluoroscopic Procedures

    Rana, V K; Vijayan, S [Physiology and Biophysics, Toshiba Stroke and Vascular Research Center, University at Buffalo (State University of New York), Buffalo, NY (United States); Rudin, S R; Bednarek, D R [Department of Radiology, Physiology and Biophysics, Toshiba Stroke and Vascular Research Center, University at Buffalo (State University of New York), Buffalo, NY (United States)


    Purpose: To determine the appropriate calibration factor to use when calculating skin dose with our real-time dose-tracking system (DTS) during neuro-interventional fluoroscopic procedures by evaluating the difference in backscatter from different phantoms and as a function of entrance-skin field area. Methods: We developed a dose-tracking system to calculate and graphically display the cumulative skin-dose distribution in real time. To calibrate the DTS for neuro-interventional procedures, a phantom is needed that closely approximates the scattering properties of the head. We compared the x-ray backscatter from eight phantoms: 20-cm-thick solid water, 16-cm diameter water-filled container, 16-cm CTDI phantom, modified-ANSI head phantom, 20-cm-thick PMMA, Kyoto-Kagaku PBU- 50 head, Phantom-Labs SK-150 head, and RSD RS-240T head. The phantoms were placed on the patient table with the entrance surface at 15 cm tube-side from the isocenter of a Toshiba Infinix C-arm, and the entrance-skin exposure was measured with a calibrated 6-cc PTW ionization chamber. The measurement included primary radiation, backscatter from the phantom and forward scatter from the table and pad. The variation in entrance-skin exposure was also measured as a function of the skin-entrance area for a 30x30 cm by 20-cm-thick PMMA phantom and the SK-150 head phantom using four different added beam filters. Results: The entranceskin exposure values measured for eight different phantoms differed by up to 12%, while the ratio of entrance exposure of all phantoms relative to solid water showed less than 3% variation with kVp. The change in entrance-skin exposure with entrance-skin area was found to differ for the SK-150 head compared to the 20-cm PMMA phantom and the variation with field area was dependent on the added beam filtration. Conclusion: To accurately calculate skin dose for neuro-interventional procedures with the DTS, the phantom for calibration should be carefully chosen since different

  7. [Arterial and portal venous complications after HPB surgical procedures: Interdisciplinary management].

    Arend, J; Schütte, K; Peglow, S; Däberitz, T; Popp, F; Benedix, F; Pech, M; Wolff, S; Bruns, C


    The surgical treatment of hepatopancreatobiliary (HPB) diseases requires complex operative procedures. Within the last decades the morbidity (36-50 %) and mortality (surgery shows an increased rate of complications. Postoperative bleeding has a major effect on the outcome and the incidence is 6.7 % after pancreatic surgery and 3.2 % after hepatobiliary surgery. The major causes of early postoperative hemorrhage are related to technical difficulties in surgery whereas late onset postoperative hemorrhage is linked to anastomosis insufficiency, formation of fistulae or abscesses due to vascular arrosion or formation of pseudoaneurysms. In many cases, delayed hemorrhage is preceded by a self-limiting sentinel bleeding. The treatment is dependent on the point in time, location and severity of the hemorrhage. The majority of early postoperative hemorrhages require surgical treatment. Late onset hemorrhage in hemodynamically stable patients is preferably treated by radiological interventions. After interventional hemostatic therapy 8.2 % of patients require secondary procedures. In the case of hemodynamic instability or development of sepsis, a relaparotomy is necessary. The treatment concept includes surgical or interventional remediation of the underlying cause of the hemorrhage. Other causes of postoperative morbidity and mortality are arterial and portal venous stenosis and thrombosis. Following liver resection, thrombosis of the portal vein occurs in 8.5-9.1 % and in 11.6 % following pancreatic resection with vascular involvement. Interventional surgical procedures or conservative treatment are suitable therapeutic options depending on the time of diagnosis and clinical symptoms. The risk of morbidity and mortality after HPB surgery can be reduced only in close interdisciplinary cooperation, which is particularly true for vascular complications.

  8. Nutrition support in surgical oncology.

    Huhmann, Maureen B; August, David A


    This review article, the second in a series of articles to examine the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients, evaluates the evidence related to the use of nutrition support in surgical oncology patients. Cancer patients develop complex nutrition issues. Nutrition support may be indicated in malnourished cancer patients undergoing surgery, depending on individual patient characteristics. As with the first article in this series, this article provides background concerning nutrition issues in cancer patients, as well as discusses the role of nutrition support in the care of surgical cancer patients. The goal of this review is to enrich the discussion contained in the clinical guidelines as they relate to recommendations made for surgical patients, cite the primary literature more completely, and suggest updates to the guideline statements in light of subsequently published studies.

  9. The acute effects of bilateral ovariectomy or adrenalectomy on progesterone, testosterone and estradiol serum levels depend on the surgical approach and the day of the estrous cycle when they are performed

    Flores, Angélica; Gallegos, Alma I; Velasco, Jacqueline; Mendoza, Fernando D; Montiel, Cristina; Everardo, Pamela M; Cruz, María-Esther; Domínguez, Roberto


    Bilateral ovariectomy or adrenalectomy are experimental tools used to understand the mechanisms regulating the hypothalamus-pituitary-ovarian and the hypothalamus-pituitary-adrenal axis. There is evidence that acute unilateral perforation of the dorsal peritoneum in rats results in significant changes in progesterone, testosterone and estradiol serum concentrations. Because different surgical approaches for unilateral or bilateral ovariectomy or adrenalectomy, sectioning the superior ovarian nerve or the vagus nerve are used, we compare the acute effects on hormone serum concentrations resulting from the unilateral or bilateral dorsal approach to performing bilateral ovariectomy or adrenalectomy with those obtained when an unilateral incision is performed in the ventral abdomen. In general, the progesterone, testosterone and estradiol serum concentrations were higher in animals with ventral approach than in those with dorsal surgery, the effects varying depending on the day of the estrous cycle when surgery was performed. The results suggest that the neural signals arising from different zones of the peritoneum and/or the abdominal wall play different roles in the mechanisms regulating steroid hormones concentrations. PMID:18954455

  10. [Care and implications for caregivers of surgical patients at home].

    Chirveches-Pérez, Emilia; Roca-Closa, Josep; Puigoriol-Juvanteny, Emma; Ubeda-Bonet, Inmaculada; Subirana-Casacuberta, Mireia; Moreno-Casbas, María Teresa


    To identify the care given by informal caregivers to patients who underwent abdominal surgery in the Consorci Hospitalari of Vic (Barcelona). To compare the responsibility burden for those caregivers in all the different stages of the surgical process. To determine the consequences of the care itself on the caregiver's health and to identify the factors that contribute to the need of providing care and the appearance of consequences for the caregivers in the home. A longitudinal observational study with follow-up at admission, at discharge and 10 days, of 317 non-paid caregivers of patients who suffer underwent surgery. The characteristics of caregivers and surgical patients were studied. The validated questionnaire, ICUB97-R based on the model by Virginia Henderson, was used to measure the care provided by informal caregivers and its impact on patient quality of life. Most of the caregivers were women, with an average age of 52.9±13.7 years without any previous experience as caregivers. The greater intensity of care and impact was observed in the time when they arrived home after hospital discharge (p<0.05). The predictive variables of repercussions were being a dependent patient before the surgical intervention (β=2.93, p=0.007), having a cancer diagnosis (β=2.87, p<.001) and time dedicated to the care process (β=0.07, p=0.018). Caregivers involved in the surgical process provide a great amount of care at home depending on the characteristics of patients they care for, and it affects their quality of life. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  11. Hernia Surgical Mesh Implants

    ... Prosthetics Hernia Surgical Mesh Implants Hernia Surgical Mesh Implants Share Tweet Linkedin Pin it More sharing options ... majority of tissue used to produce these mesh implants are from a pig (porcine) or cow (bovine) ...

  12. Urogynecologic Surgical Mesh Implants

    ... Prosthetics Urogynecologic Surgical Mesh Implants Urogynecologic Surgical Mesh Implants Share Tweet Linkedin Pin it More sharing options ... majority of tissue used to produce these mesh implants are from a pig (porcine) or cow (bovine). ...

  13. American Pediatric Surgical Association

    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 / ...

  14. Optimizing surgical f

    Sabry Mohamed Amin


    Conclusions: In our study both dexmedetomidine and esmolol were effective in reducing MABP, and lowering the heart rate providing dry surgical field and ensured good surgical condition during cochlear implant surgery in pediatric patients.

  15. Abortion - surgical - aftercare

    ... this page: // 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 ...

  16. Surgical site infection and its associated factors following cesarean section: a cross sectional study from a public hospital in Ethiopia.

    Gelaw, Kelemu Abebe; Aweke, Amlaku Mulat; Astawesegn, Feleke Hailemichael; Demissie, Birhanu Wondimeneh; Zeleke, Liknaw Bewket


    A cesarean section is a surgical procedure in which incisions are made through a woman's abdomen and uterus to deliver her baby. Surgical site infections are a common surgical complication among patients delivered with cesarean section. Further it caused to increase maternal morbidity, stay of hospital and the cost of treatment. Hospital based cross-sectional study was conducted to assess the magnitude of surgical site infection following cesarean Site Infections and its associated factors at Lemlem Karl hospital July 1, 2013 to June 30, 2016. Retrospective card review was done on 384 women who gave birth via cesarean section at Lemlem Karl hospital from July 1, 2013 to June 30, 2016. Systematic sampling technique was used to select patient medical cards. The data were entered by Epi info version 7.2 then analyzed using Statistical Package for Social Sciences windows version 20. Both bivariate and multivariate logistic regression was done to test association between predictors and dependent variables. P value of cesarean section, the magnitude of surgical site infection following cesarean section Infection was 6.8%. The identified independent risk factors for surgical site infections were the duration of labor AOR=3.48; 95%CI (1.25, 9.68), rupture of membrane prior to cesarean section AOR=3.678; 95%CI (1.13, 11.96) and the abdominal midline incision (AOR=5.733; 95%CI (2.05, 16.00). The magnitude of surgical site infection following cesarean section is low compare to other previous studies. The independent associated factors for surgical site infection after cesarean section in this study: Membranes rupture prior to cesarean section, duration of labor and sub umbilical abdominal incision. In addition to ensuring sterile environment and aseptic surgeries, use of WHO surgical safety checklist would appear to be a very important intervention to reduce surgical site infections.

  17. Giant choledochal calculosis: Surgical treatment

    Hasan Bektas


    Full Text Available Context: Gallstone disease is one of the most common surgical pathologies. Choledocholithiasis may occur in some of these cases and require surgical intervention. Although there are relatively non-invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP, this technique is usually unsuccessful in patients with stones larger than 10 mm. In our case, we aimed to report a giant choledochal stone (15 cm × 4.5 cm, which is rare in surgical practice and our treatment with open surgery. Case Report: The patient was a 59-year-old woman. Magnetic resonance cholangiopancreatography (MRCP had showed a hydropic gallbladder with an excessively dilated CBD and a 110 mm × 41 mm stone. In the operation, an excessively dilated CBD was seen and after choledochotomy and a very large calculus that filled CBD completely. Choledochotomy incision was carried forward and a T-tube choledochostomy with choledochoduodenostomy (CD was performed. The patient was discharged without any complications on postoperative 8 th day. Conclusion: Benign gallstone disease is a multifactorial process, with risk factors such as obesity, hemolytic diseases, diabetes mellitus, and pregnancy. Risk factors for choledocholithiasis are similar to those for gallstone disease. MRCP is a non-invasive technique in detecting choledocholithiasis. The gold standard intervention for CBD stones is ERCP. Stones in CBD may reach very considerable dimensions without causing serious symptoms. The most common symptom is jaundice. During preoperative radiological examination, giant stones may be interfered with malignancies. Surgeons should obey conventional algorithms in diagnosis and open surgery must be kept in mind in earlier stages without being too insistent on endoscopic interventions.



    Background: There is little published information regarding postoperative management of patients with Chronic Exertional Compartment Syndrome (CECS). Reports of recurrence of symptoms following surgical decompression exist, and are not uncommon depending on the specific technique used. Recurrence suggests that more time and effort may need to be spent on implementing strategic post-operative rehabilitation management in order to avoid repeat surgical intervention or prolonged symptoms. Objective: To summarize relevant literature regarding CECS and propose scientifically-based guidelines for rehab following compartment release with the rationale based on tissue healing, muscle loading, and scar tissue formation and consideration of all tissues contained in the involved compartment. Literature review: A literature search was performed in PubMed, SPORTDiscus, CINAHL, PEDRO, and Google Scholar using the phrase: “chronic exertional compartment syndrome.” Results: No specific rehabilitation guidelines following surgical compartment release for lower extremity CECS were found in the literature search performed for this clinical commentary. Discussion: The development of the proposed post-operative guidelines may allow for improved long-term outcomes following anterior compartment release. Summary: Adequate description of long-term follow-up of outcomes following compartment release for CECS is lacking in current literature. The proposed guidelines for rehab following compartment release include consideration of tissue healing, muscle loading, scar tissue formation, and consideration of soft tissues contained in the involved compartment. Utilization of the proposed guidelines may allow for future research to be performed in order to assess outcomes following surgical intervention for CECS. PMID:21713230

  19. No surgical innovation without evaluation: the IDEAL recommendations.

    McCulloch, Peter; Altman, Douglas G; Campbell, W Bruce; Flum, David R; Glasziou, Paul; Marshall, John C; Nicholl, Jon; Aronson, Jeffrey K; Barkun, Jeffrey S; Blazeby, Jane M; Boutron, Isabell C; Campbell, W Bruce; Clavien, Pierre-Alain; Cook, Jonathan A; Ergina, Patrick L; Feldman, Liane S; Flum, David R; Maddern, Guy J; Nicholl, Jon; Reeves, Bournaby C; Seiler, Christoph M; Strasberg, Steven M; Meakins, Jonathan L; Ashby, Deborah; Black, Nick; Bunker, John; Burton, Martin; Campbell, Marion; Chalkidou, Kalipso; Chalmers, Iain; de Leval, Marc; Deeks, Jon; Ergina, Patrick L; Grant, Adrian; Gray, Muir; Greenhalgh, Roger; Jenicek, Milos; Kehoe, Sean; Lilford, Richard; Littlejohns, Peter; Loke, Yoon; Madhock, Rajan; McPherson, Kim; Meakins, Jonathan; Rothwell, Peter; Summerskill, Bill; Taggart, David; Tekkis, Parris; Thompson, Matthew; Treasure, Tom; Trohler, Ulrich; Vandenbroucke, Jan


    Surgery and other invasive therapies are complex interventions, the assessment of which is challenged by factors that depend on operator, team, and setting, such as learning curves, quality variations, and perception of equipoise. We propose recommendations for the assessment of surgery based on a five-stage description of the surgical development process. We also encourage the widespread use of prospective databases and registries. Reports of new techniques should be registered as a professional duty, anonymously if necessary when outcomes are adverse. Case series studies should be replaced by prospective development studies for early technical modifications and by prospective research databases for later pre-trial evaluation. Protocols for these studies should be registered publicly. Statistical process control techniques can be useful in both early and late assessment. Randomised trials should be used whenever possible to investigate efficacy, but adequate pre-trial data are essential to allow power calculations, clarify the definition and indications of the intervention, and develop quality measures. Difficulties in doing randomised clinical trials should be addressed by measures to evaluate learning curves and alleviate equipoise problems. Alternative prospective designs, such as interrupted time series studies, should be used when randomised trials are not feasible. Established procedures should be monitored with prospective databases to analyse outcome variations and to identify late and rare events. Achievement of improved design, conduct, and reporting of surgical research will need concerted action by editors, funders of health care and research, regulatory bodies, and professional societies.

  20. Global Burden of Pediatric Surgical Disease

    D. Poenaru (Dan)


    markdownabstractThe recognition of surgical care as an essential component of health care has required evidence of its potential impact in health care systems and cost-effectiveness by comparison with other standard interventions. Such evidence, essential for advocacy for resource allocation in

  1. Surgical disaster in temporomandibular joint: Case report

    Guilherme Machado De Carvalho


    Conclusion: Since there is no corrective treatment for this type of injuries, the craniomaxillofacial surgeon and other professionals who carry out interventions of this nature need perfect knowledge of the anatomy of the temporal bone and lateral skull base, taking into account the risk of surgical disasters like the one here reported.

  2. Acute surgical management in idiopathic intracranial hypertension.

    Zakaria, Zaitun


    Idiopathic intracranial hypertension is a headache syndrome with progressive symptoms of raised intracranial pressure. Most commonly, it is a slow process where surveillance and medical management are the main treatment modalities. We describe herein an acute presentation with bilateral sixth nerve palsies, papilloedema and visual deterioration, where acute surgical intervention was a vision-saving operation.

  3. Acute and chronic pancreatitis: surgical management.

    Dzakovic, Alexander; Superina, Riccardo


    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.


    徐宏光; 王以朋; 等


    Objective:To evaluate the effect of surgical treatment on metastatic spinal tumor.Methods:The results of surgical intervention for metastatic spinal tumor of 31 consecutive patients since October 1985 were reviewed.Results:The average survival time was 17.6 months (range from 3 months to 9 years),and 4 patients are still alive with an average survival time of 24.6 months(range,14-84 months).No postoperative complication was noted.The preoperative symptoms were partially relieved and neurological functions were improved after surgery.Conclusions:Surgical treatment for metastatic spinal tumor could improve the life quality,but should be adopted cautiously.The surgical procedures such as decompression and internal fixation should be involved only when neurological deficits occurred.The surgery with postoperative complementary therapy may not only improve the life quality,but also extend the patients' life span.

  5. [Surgical treatment of de-novo scoliosis].

    Putzier, M; Pumberger, M; Halm, H; Zahn, R K; Franke, J


    De-novo scoliosis is most commonly associated with chronic back pain and in 70 % of cases with neurological symptoms of the lower extremities. In recent literature, the occurrence and severity of segmental lateral listhesis has been discussed as being an important prognostic factor of sagittal and frontal deformity progression. In general, operative interventions in patients with de-novo scoliosis are associated with a high rate of complications. Therefore, conservative treatment modalities are recommended at early stages of the disease. If conservative management fails and a sufficient reduction of the patient's symptoms cannot be achieved, depending on the symptoms, a selective decompression, short-segment fusion or long-instrumented reduction and fusion are indicated. Additionally to the patient's symptoms, specific imaging diagnostics are necessary to develop an adequate surgical treatment strategy. Selective decompression without fusion is indicated in patients with a fixed deformity and primarily neurologic pain or deficits. In conditions of a focal pathology as cause of significant low back pain and/or neurologic symptoms at early stages of deformity, a short segment fusion is the treatment of choice. However, short-segment fusion as a less-invasive procedure must not be performed in biplanar unbalanced patients and/or advanced de-novo scoliosis. In advanced degenerative de-novo scoliosis a long-segment reposition and fusion following an alignment correction are needed. Standardized pre-operative planning and perioperative management are highly critical to the post-operative success. All operative treatment strategies in patients with de-novo scoliosis can be successful but they require sophisticated and individual surgical indication.

  6. The impact of the Good Behavior Game, a universal classroom-based preventive intervention in first and second grades, on high-risk sexual behaviors and drug abuse and dependence disorders into young adulthood.

    Kellam, Sheppard G; Wang, Wei; Mackenzie, Amelia C L; Brown, C Hendricks; Ompad, Danielle C; Or, Flora; Ialongo, Nicholas S; Poduska, Jeanne M; Windham, Amy


    The Good Behavior Game (GBG), a method of teacher classroom behavior management, was tested in first- and second-grade classrooms in 19 Baltimore City Public Schools beginning in the 1985-1986 school year. The intervention was directed at the classroom as a whole to socialize children to the student role and reduce aggressive, disruptive behaviors, confirmed antecedents of a profile of externalizing problem outcomes. This article reports on the GBG impact on the courses and interrelationships among aggressive, disruptive behavior through middle school, risky sexual behaviors, and drug abuse and dependence disorders through ages 19-21. In five poor to lower-middle class, mainly African American urban areas, classrooms within matched schools were assigned randomly to either the GBG intervention or the control condition. Balanced assignment of children to classrooms was made, and teachers were randomly assigned to intervention or control. Analyses involved multilevel growth mixture modeling. By young adulthood, significant GBG impact was found in terms of reduced high-risk sexual behaviors and drug abuse and dependence disorders among males who in first grade and through middle school were more aggressive, disruptive. A replication with the next cohort of first-grade children with the same teachers occurred during the following school year, but with minimal teacher mentoring and monitoring. Findings were not significant but generally in the predicted direction. A universal classroom-based prevention intervention in first- and second-grade classrooms can reduce drug abuse and dependence disorders and risky sexual behaviors.

  7. The effectiveness of a fundamental motor skill intervention in pre-schoolers with motor problems depends on gender but not environmental context.

    Bardid, Farid; Deconinck, Frederik J A; Descamps, Sofie; Verhoeven, Liesbeth; De Pooter, Greet; Lenoir, Matthieu; D'Hondt, Eva


    This study evaluated the effect of a 10-week fundamental motor skill programme in pre-schoolers with motor problems. Alongside the general effect of the intervention, we also explored possible gender differences and the role of the environmental context (living community, socio-economic status, and recreational space inside/outside the house). The intervention group (n=47; 20 ♂ and 27 ♀) received twenty 60-min motor skill sessions (2 per week) in addition to the regular physical education curriculum for pre-schoolers; the control group (n=46; 21 ♂ and 25 ♀) did not receive additional practice. General motor competence, and locomotor and object control subscales, were assessed before and after the intervention using the Test of Gross Motor Development 2nd edition (TGMD-2). Data regarding environmental factors were gathered through a questionnaire. A Group×Gender×Time ANOVA revealed that the intervention group benefited significantly from the intervention and scored better than the control group at the post-test for general motor competence and both sub-categories (locomotor and object control skill). Moreover, the intervention programme was found to be effective in helping 49% of the intervention group to achieve an average motor skill level, according to the TGMD-2 norms, while a further decline in motor competence was observed in the control group. Interestingly, the effect appeared to be gender-specific, since object control skill improved only in girls of the intervention group. Considering the environmental context, none of the above-mentioned factors was found to have an influence on the effectiveness of the intervention. The present study highlights the need for an early motor skill programme with a gender-specific approach in order to help low skilled boys and girls master a diverse set of motor skills.

  8. Surgical tools recognition and pupil segmentation for cataract surgical process modeling.

    Bouget, David; Lalys, Florent; Jannin, Pierre


    In image-guided surgery, a new generation of Computer-Assisted-Surgical (CAS) systems based on information from the Operating Room (OR) has recently been developed to improve situation awareness in the OR. Our main project is to develop an application-dependant framework able to extract high-level tasks (surgical phases) using microscope videos data only. In this paper, we present two methods: one method to segment the pupil and one to extract and recognize surgical tools. We show how both methods improve the accuracy of the framework for analysis of cataract surgery videos, to detect eight surgical phases.

  9. Surgical data science: the new knowledge domain

    Vedula S. Swaroop


    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. Surgical data science: The new knowledge domain.

    Vedula, S Swaroop; Hager, Gregory D


    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

  11. The new prognostic-therapeutic index – an easy method of establishing surgical indication in the pathology of the diabetic foot

    Bobircă, F; Catrina, E; Mihalache, O; Georgescu, D; Pătrașcu, T


    Hypothesis and aim. The large number of invalidating surgical interventions in patients suffering from lesions of the diabetic foot, the late recognition of the lesions and sometimes the wrongful interpretation of their severity, have made necessary a multi-parameter study of these types of patients and the elaboration of a therapeutic-prognostic index to guide the physician in adopting the adequate method of treatment. Starting with the therapeutic-prognostic index imagined by professor Traian Patrascu, we have elaborated a new therapeutic prognostic index, by adding new, statistically significant parameters, for the purpose of facilitating the surgical indication, depending on the lesion type. Methods. A number of 929 patients who were admitted at the Surgery Clinic of the “Dr. I. Cantacuzino” Hospital, between January 2013 and June 2014, have been analyzed, of whom 450 were evaluated retrospectively and 479 prospectively. Results. The new therapeutic prognostic index has been calculated for the retrospective lot, resulting into a concordance between the actual surgical intervention and the prognostic index of 79.4% and, for the patients evaluated prospectively, we have found a confirmation of the relation of 82.6% between the performed surgical intervention and the forecasted surgical intervention, by calculating the index. Discussion. The new therapeutic-prognostic index represents an easy method of establishing the therapeutic conduct of the patient suffering from lesions of the diabetic foot. It is of major use in preventing the execution of such surgical interventions that may be disproportionate compared to the severity of the lesions, especially in facilities where the pathology of the diabetic foot is less known. PMID:25870688

  12. 护理干预对姑息手术治疗胰腺癌患者生活质量的影响%Influence of nursing intervention on quality of life in palliative surgical treatment of pancreatic cancer

    林名云; 徐友芳; 陈少容; 郭晓君; 周羽芳


    Objective:To investigate the effect of palliative treatment of pancreatic cancer patients and their families with the implementation of nursing interventions. Methods:The 98 cases of hospitalized patients with pancreatic cancer by odd and even numbers were divided into the intervention group and the control group,with 49 cases in each. The patients and their families line in the intervention group received nursing intervention and in the control group a patient-centered ho-listic nursing intervention was adopted. Hamilton Depression Scale(HAMD)and Perceived Social Support Scale(PSSS) scores,depression and social support in the two groups of patients before and after the intervention were used to assess the patientˊs condition. Results:After the intervention,the HAMD score in the observation group was lower than that in the control group(P ﹤ 0. 05),PSSS score was higher in the observation group,and the difference was statistically significant (P ﹤ 0. 05). Conclusion:Nursing intervention can relieve depression and improve the level of social support.%目的:探讨姑息性手术方法治疗胰腺癌患者实施同期护理干预的临床效果。方法将98例胰腺癌患者按住院号单双分为干预组和对照组各49例。干预组对患者行同期护理干预,对照组采取以患者为中心的整体护理干预。比较干预前后两组患者汉密尔顿抑郁量表(HAMD)及领悟社会支持量表(PSSS)得分,评估患者的抑郁情绪及社会支持情况。结果干预后,观察组 HAMD 评分低于对照组(P ﹤0.05),PSSS 评分高于对照组( P ﹤0.05)。结论同期护理干预可促进患者缓解抑郁情绪,提高社会支持水平,从而提高患者的生活质量。

  13. The role of the surgical care practitioner within the surgical team.

    Quick, Julie

    Changes to the surgical workforce and the continued development of health policy have perpetuated the requirement for innovative perioperative roles. The surgical care practitioner is a nurse or allied health professional who works within a surgical team and has advanced perioperative skills, including the ability to undertake surgical interventions.With only limited literature evaluating this role, any benefits of their inclusion to a surgical team are largely anecdotal. This article presents the findings of an autoethnographic inquiry that explored the experiences of surgical team members who worked with the nurse researcher in her role as surgical care practitioner. Surgeons identified the provision of a knowledgeable, competent assistant and operator who enhanced patient care, helped maintain surgical services and supported the training of junior doctors. The professional, ethical and legal obligations of advanced perioperative practice were upheld. Interprofessional collaboration was improved, as was service provision. This further enhanced the patient experience. The traditional viewpoint that nurses who undertake tasks previously associated with medicine should be working to the standard of a doctor is challenged but requires further examination.

  14. Cost-effectiveness of transcatheter versus surgical management of structural heart disease

    Fanari, Zaher, E-mail: [Division of Cardiology, University of Kansas School of Medicine, Kansas City, KS (United States); Weintraub, William S. [Section of Cardiology, Christiana Care Health System, Newark, DE (United States); Value institute, Christiana Care Health System, Newark, DE (United States)


    Transcatheter management of valvular and structural heart disease is the most growing aspect of interventional cardiology. While the early experience was limited to patients who were not candidate for surgery, the continuous improvement in the efficacy and safety expanded its use to different degree depending on the procedure and the disease involved. The cost of these procedures is a major concern for health care in developed world. Cost-effectiveness of these transcatheter structural procedures varies depending on the procedure itself, the burden of the underlying disease, the feasibility and cost of both the Transcatheter and surgical procedures. In this review, we turn now to a specific discussion of the medical economics of percutaneous valvular and structural interventions.

  15. [The accreditation of professional competence: the analysis of nursinginterventions to control anxiety in surgical patients].

    Brea-Rivero, Pilar; Herrera-Usagre, Manuel; Rojas-de-Mora-Figueroa, Ana; Esposito, Thomas


    . The accreditation of professional competence: the analysis of nursing interventions to control anxiety in surgical patients. The preoperative anxiety is a state of discomfort or unpleasant tension resulting from concerns about illness, hospitalization, anesthesia, surgery or the unknown. Nurses play a vital role reducing preoperative anxiety. An accreditation program was developed in Andalusia (Spain) to measure nurses' competences in this and others fields. To analyze the accredited nurses' interventions spectrum to reduce anxiety in surgical patients and to check if their range of interventions depends upon their professional skills accreditation level. Cross-sectional study. From 20016 to 2014, 1.282 interventions performed by 303 operating room nurses accredited through the Professional Skills Accreditation Program of the Andalusian Agency for Health Care Quality (ACSA) were analyzed with the latent class analysis (LCA) and multinomial logistic regression. Two-thirds of the sample was accredited in Advanced level, about 31% in Expert level and 2.6% in Excellent level. Mean age of patients was 58.5±19.8 years. Three professional profiles were obtained from the LCA. Those nurses classified in Class I (22.4% of the sample) were more likely to be women, to can for younger patients, and to be accredited in Expert or Excellent Level and to perform the larger range of interventions, becoming therefore the most complete professional profile. Those nurses who perform a wider range of interventions and specifically two evidence based interventions such Calming Technique and Coping Enhancement are those who have a higher level of accreditation level.

  16. The STRIDE (Strategies to Increase confidence, InDependence and Energy) study: cognitive behavioural therapy-based intervention to reduce fear of falling in older fallers living in the community - study protocol for a randomised controlled trial.

    Parry, Steve W; Deary, Vincent; Finch, Tracy; Bamford, Claire; Sabin, Neil; McMeekin, Peter; O'Brien, John; Caldwell, Alma; Steen, Nick; Whitney, Susan L; Macdonald, Claire; McColl, Elaine


    Around 30% to 62% of older individuals fall each year, with adverse consequences of falls being by no means limited to physical injury and escalating levels of dependence. Many older individuals suffer from a variety of adverse psychosocial difficulties related to falling including fear, anxiety, loss of confidence and subsequent increasing activity avoidance, social isolation and frailty. Such 'fear of falling' is common and disabling, but definitive studies examining the effective management of the syndrome are lacking. Cognitive behavioural therapy has been trialed with some success in a group setting, but there is no adequately powered randomised controlled study of an individually based cognitive behavioural therapy intervention, and none using non-mental health professionals to deliver the intervention. We are conducting a two-phase study examining the role of individual cognitive behavioural therapy delivered by healthcare assistants in improving fear of falling in older adults. In Phase I, the intervention was developed and taught to healthcare assistants, while Phase II is the pragmatic randomised controlled study examining the efficacy of the intervention in improving fear of falling in community-dwelling elders attending falls services. A qualitative process evaluation study informed by Normalization Process Theory is being conducted throughout to examine the potential promoters and inhibitors of introducing such an intervention into routine clinical practice, while a health economic sub-study running alongside the trial is examining the costs and benefits of such an approach to the wider health economy. Current Controlled Trials ISRCTN78396615.

  17. Efectividad de una intervención formativa en prevención de úlceras por presión en una unidad de cuidados intensivos quirúrgica: un estudio cuasi experimental Effectiveness of an educational intervention in pressure ulcer prevention in a surgical intensive care unit: a quasi experimental study

    M.ª Jesús Wandosell Picatoste


    Full Text Available Uno de los indicadores más relevantes para evaluar la seguridad del paciente es la incidencia de eventos adversos (EA. Las úlceras por presión (UPP son un EA con una incidencia muy elevada en las unidades de cuidados intensivos. El objetivo de este estudio es valorar la efectividad de una intervención formativa en prevención de UPP a través de la valoración de la incidencia y la gravedad de las lesiones en una unidad de cuidados intensivos quirúrgicos. Se llevó a cabo un estudio cuasi experimental de controles antes-después. Los resultados muestran que la incidencia de UPP disminuye tras la intervención formativa.One of the most relevant indicators to assess patient safety is the incidence of adverse events (AE. Pressure Ulcers (PU are an AE with a high incidence in intensive care units. The aim of this study is to evaluate the effectiveness of a formative intervention on prevention of PU through the assessment of the incidence and the severity of PU in the pre and the post intervention periods, in an intensive care surgical unit. We have carried out a quasi experimental study of pre and post controls. The results show that the incidence of PU is lower after the formative intervention.

  18. Feature classification for tracking articulated surgical tools.

    Reiter, Austin; Allen, Peter K; Zhao, Tao


    Tool tracking is an accepted capability for computer-aided surgical intervention which has numerous applications, both in robotic and manual minimally-invasive procedures. In this paper, we describe a tracking system which learns visual feature descriptors as class-specific landmarks on an articulated tool. The features are localized in 3D using stereo vision and are fused with the robot kinematics to track all of the joints of the dexterous manipulator. Experiments are performed using previously-collected porcine data from a surgical robot.

  19. [Surgical treatment of type 2 diabetes mellitus].

    Carrillo-Esper, Raúl; Muciño-Bermejo, María Jimena


    Sustained remission of type 2 diabetes mellitus and significantly improved hyperlipidemia and arterial hypertension, control has been achieves in both lean and obese patient after bariatric surgery procedures or other gastrointestinal surgical procedures. It has been demonstrated that the metabolic effects of bariatric surgery in these patients derives not only in reducing weight and caloric intake, but also endocrine changes resulting from surgical manifestation gastrointestinal tract. In this article we review the clinical outcomes of such interventions (collectively called "metabolic surgery") and the perspectives on the role that these surgeries play in the treatment of patients with type 2 diabetes mellitus.


    A. A. Kardanov


    Full Text Available Objectives. The article presents the results assessment of open calcaneal excision compared to percutaneous excision of patients with Haglund’s disease. Materials and methods. Twenty-one patients (26 feet underwent the surgical treatment during the period from 2010 to 2012. The clinical diagnosis was confirmed by axial load radiography estimated with “Fowler-Philip” and “posterior pitch lines” methods. Eight feet were treated with open calcaneal excision and 18 feet - with percutaneous procedure. The mean duration of follow-up was 21,8 months. Clinical evaluation criteria were deformity and/or bursitis recurrence, tenderness, pain by wearing shoes, return to the sport training, patient satisfaction, presence/absence of major complications. Results. Good results were reported for 21 patients; fair results - for 4 patients; and poor results - for one patient. No significant differences in results depending on the method of intervention have been identified.

  1. Surgical considerations about amyloid goiter.

    García Villanueva, Augusto; García Villanueva, María Jesús; García Villanueva, Mercedes; Rojo Blanco, Roberto; Collado Guirao, María Vicenta; Cabañas Montero, Jacobo; Beni Pérez, Rafael; Moreno Montes, Irene


    Amyloidosis is an uncommon syndrome consisting of a number of disorders having in common an extracellular deposit of fibrillary proteins. This results in functional and structural changes in the affected organs, depending on deposit location and severity. Amyloid infiltration of the thyroid gland may occur in 50% and up to 80% of patients with primary and secondary amyloidosis respectively. Amyloid goiter (AG) is a true rarity, usually found associated to secondary amyloidosis. AG may require surgical excision, usually because of compressive symptoms. We report the case of a patient with a big AG occurring in the course of a secondary amyloidosis associated to polyarticular onset juvenile idiopathic arthritis who underwent total thyroidectomy. Current literature is reviewed, an attempt is made to provide action guidelines, and some surgical considerations on this rare condition are given.

  2. Realistic tool-tissue interaction models for surgical simulation and planning

    Misra, Sarthak


    Surgical simulators present a safe and potentially effective method for surgical training, and can also be used in pre- and intra-operative surgical planning. Realistic modeling of medical interventions involving tool-tissue interactions has been considered to be a key requirement in the development

  3. Recognizing surgical patterns

    Bouarfa, L.


    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

  4. Surgical medical record

    Bulow, S.


    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...

  5. Randomized Video-Feedback Intervention in Home-Based Childcare: Improvement of Children's Wellbeing Dependent on Time Spent with Trusted Caregiver

    Groeneveld, Marleen G.; Vermeer, Harriet J.; van IJzendoorn, Marinus H.; Linting, Mariëlle


    Background: The childcare environment offers a wide array of developmental opportunities for children. Providing children with a feeling of security to explore this environment is one of the most fundamental goals of childcare. Objective: In the current study the effectiveness of Video-feedback Intervention to promote Positive Parenting-Child Care…

  6. Four-factor prothrombin complex concentrate versus plasma for rapid vitamin K antagonist reversal in patients needing urgent surgical or invasive interventions: a phase 3b, open-label, non-inferiority, randomised trial.

    Goldstein, Joshua N; Refaai, Majed A; Milling, Truman J; Lewis, Brandon; Goldberg-Alberts, Robert; Hug, Bruce A; Sarode, Ravi


    Rapid reversal of vitamin K antagonist (VKA)-induced anticoagulation is often necessary for patients needing urgent surgical or invasive procedures. The optimum means of VKA reversal has not been established in comparative clinical trials. We compared the efficacy and safety of four-factor prothrombin complex concentrate (4F-PCC) with that of plasma in VKA-treated patients needing urgent surgical or invasive procedures. In a multicentre, open-label, phase 3b randomised trial we enrolled patients aged 18 years or older needing rapid VKA reversal before an urgent surgical or invasive procedure. We randomly assigned patients in a 1:1 ratio to receive vitamin K concomitant with a single dose of either 4F-PCC (Beriplex/Kcentra/Confidex; CSL Behring, Marburg, Germany) or plasma, with dosing based on international normalised ratio (INR) and weight. The primary endpoint was effective haemostasis, and the co-primary endpoint was rapid INR reduction (≤1·3 at 0·5 h after infusion end). The analyses were intended to evaluate, in a hierarchical fashion, first non-inferiority (lower limit 95% CI greater than -10% for group difference) for both endpoints, then superiority (lower limit 95% CI >0%) if non-inferiority was achieved. Adverse events and serious adverse events were reported to days 10 and 45, respectively. This trial is registered at, number NCT00803101. 181 patients were randomised (4F-PCC n=90; plasma n=91). The intention-to-treat efficacy population comprised 168 patients (4F-PCC, n=87; plasma, n=81). Effective haemostasis was achieved in 78 (90%) patients in the 4F-PCC group compared with 61 (75%) patients in the plasma group, demonstrating both non-inferiority and superiority of 4F-PCC over plasma (difference 14·3%, 95% CI 2·8-25·8). Rapid INR reduction was achieved in 48 (55%) patients in the 4F-PCC group compared with eight (10%) patients in the plasma group, demonstrating both non-inferiority and superiority of 4F-PCC over plasma

  7. Recovery of Visual Function in a Patient with an Onodi Cell Mucocele Compressive Optic Neuropathy Who Had a 5-Week Interval between Onset and Surgical Intervention: A Case Report

    Wencan Wu


    Full Text Available Purpose. To report on a patient with compressive optic neuropathy secondary to an Onodi cell mucocele, who fully recovered visual function following surgery. Method. Case report. Results. A 28-year-old male was admitted with a right visual acuity of 20/100 following treatment for an initial diagnosis of optic neuritis. Subsequent examination suggested compressive optic neuropathy, and neuroimaging confirmed the presence of an Onodi mucocele compressing the optic nerve. The patient underwent a right endonasal sphenoethmoidectomy with decompression 5 weeks after the initial onset of symptoms. Three weeks following surgery, the visual acuity was 20/20, and there was complete resolution of the visual field defect, which has remained stable at 1 year. Conclusion. Onodi cell mucocele should be included in the differential diagnosis of a young patient with compressive optic neuropathy. Surgical decompression should be considered even when symptoms have been present for over a month.

  8. [Surgical site infections: antibiotic prophylaxis in surgery].

    Asensio, Angel


    Surgical site infections (SSI) are very common, and represent more than 20% of all hospital-acquired infections. SSIs are associated with a higher mortality, as well as to an extended hospital stay and costs, depending on the surgical procedure and type of SSI. Advances in control practices for these infections include improvement in operating room ventilation, sterilization methods, barriers, and surgical techniques, as well as in surgical antimicrobial prophylaxis. For the latter, the antimicrobial agent should: be active against the most common pathogens, be administered in an appropriate dosage and in a time frame to ensure serum and tissue concentrations over the period of potential contamination, be safe, and be administered over the shortest effective time period to minimize adverse events, development of resistances, and cost. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  9. An overview of pre-surgical evaluation

    Kurupath Radhakrishnan


    Full Text Available The success of an epilepsy surgery program depends upon the early identification of potential surgical candidates and selecting from them, ideal candidates for surgery, who are destined to have a post-operative seizure-free outcome without any unacceptable neurological deficits. Since epilepsy surgery centers in resource-poor countries will lack the full range of state-of-the-art technologies usually available in resource-rich countries to perform pre-surgical evaluation, cost-effectively utilization of the locally available investigative facilities to select the surgical candidates becomes challenging. In the present era of rapid electronic communications and telemedicine, it has become possible for epilepsy surgery centers to pool their technological and human resources and to partner with centers nationally and internationally in implementing pre-surgical evaluation strategies.

  10. Simulation-based surgical education.

    Evgeniou, Evgenios; Loizou, Peter


    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.

  11. Decision making in surgical oncology.

    Lamb, B; Green, J S A; Vincent, C; Sevdalis, N


    Decisions in surgical oncology are increasingly being made by multi-disciplinary teams (MDTs). Although MDTs have been widely accepted as the preferred model for cancer service delivery, the process of decision making has not been well described and there is little evidence pointing to the ideal structure of an MDT. Performance in surgery has been shown to depend on non-technical skills, such as decision making, as well as patient factors and the technical skills of the healthcare team. Application of this systems approach to MDT working allows the identification of factors that affect the quality of decision making for cancer patients. In this article we review the literature on decision making in surgical oncology and by drawing from the systems approach to surgical performance we provide a framework for understanding the process of decision making in MDTs. Technical factors that affect decision making include the information about patients, robust ICT and video-conferencing equipment, a minimum dataset with expert review of radiological and pathological information, implementation and recording of the MDTs decision. Non-technical factors with an impact on decision making include attendance of team members at meetings, leadership, teamwork, open discussion, consensus on decisions and communication with patients and primary care. Optimising these factors will strengthen the decision making process and raise the quality of care for cancer patients.

  12. [Surgical managment of retinal detachment].

    Haritoglou, C; Wolf, A


    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.

  13. Malnutrition and obesity in pediatric oncology patients: causes, consequences, and interventions.

    Co-Reyes, Erica; Li, Rhea; Huh, Winston; Chandra, Joya


    In children with cancer, suboptimal nutrition states are common consequences of the disease and its treatment. These nutrition states have been attributed to a number of etiologies dependent on the patient's tumor type and treatment, and are associated with increased morbidity and mortality. Interventions vary from psychosocial to pharmacological and surgical management. Further research is necessary to understand the epidemiology and etiology of these nutrition states. Of great importance is the development and implementation of effective interventions to optimize nutritional status among children with cancer during and after therapy.

  14. Multiscale Surgical Telerobots

    Miles, R R; Seward, K P; Benett, W J; Tendick, F; Bentley, L; Stephan, P L


    A project was undertaken to improve robotic surgical tools for telerobotic minimally invasive surgery. The major objectives were to reduce the size of the tools to permit new surgical procedures in confined spaces such as the heart and to improve control of surgical tools by locating positional sensors and actuators at the end effector rather than external to the patient as is currently the state of the technology. A new compact end-effector with wrist-like flexibility was designed. Positional sensors based on MEMS microfabrication techniques were designed.

  15. Colorectal cancer complicated by perforation. Specific features of surgical tactics

    S. N. Shchaeva


    Full Text Available Objective: to assess the immediate results of surgical interventions for colorectal cancer complicated by perforation.Materials and methods. The immediate results of surgical treatment were retrospectively analyzed in 56 patients with colorectal cancer complicated by perforated colon cancer, who had been treated at Smolensk surgical hospitals in 2001 to 2013. Patients with diastatic perforation of the colon in the presence of decompensated obturation intestinal obstruction of tumor genesis were not included into this investigation.Results. The immediate results of uni- and multistage surgical interventions were analyzed in relation to the extent of peritonitis and the stage of colon cancer. More satisfactory immediate results were observed after multistage surgical treatment. Following these interventions, a fatal outcome of disseminated peritonitis in the presence of performed colorectal cancer was recorded in 8 (53.3 % cases whereas after symptomatic surgery there were 11 (67.8 % deaths. A fatal outcome was noted in 1 case (7.7 % after multistage surgery.Discussion. The results of surgical treatment in the patients with perforated colorectal cancer are directly related to the degree of peritonitis and the choice of surgical tactics.

  16. Coccidioidomycosis: Surgical Issues and Implications.

    Forrester, Joseph D; Guo, Haiwei Henry; Weiser, Thomas G


    Coccidioidomycosis, commonly called "valley fever," "San Joaquin fever," "desert fever," or "desert rheumatism," is a multi-system illness caused by infection with Coccidioides fungi (C. immitis or C. posadasii). This organism is endemic to the desert Southwest regions of the United States and Mexico and to parts of South America. The manifestations of infection occur along a spectrum from asymptomatic to mild self-limited fever to severe disseminated disease. Review of the English-language literature. There are five broad indications for surgical intervention in patients with coccidioidomycosis: Tissue diagnosis in patients at risk for co-existing pathology, perforation, bleeding, impingement on critical organs, and failure to resolve with medical management. As part of a multidisciplinary team, surgeons may be responsible for the care of infected patients, particularly those with severe disease. This review discusses the history, microbiology, epidemiology, pathology, diagnosis, and treatment of coccidioidomycosis, focusing on situations that may be encountered by surgeons.

  17. Pterion: An anatomical variation and surgical landmark

    Prashant E Natekar


    Full Text Available Introduction : The frontal and the parietal bones superiorly and the greater wing of the sphenoid and the squamous temporal inferiorly of one side meet at an H-shaped sutural junction termed the pterion. This is an important anatomical and anthropological landmark as it overlies both the anterior branch of middle meningeal artery and the lateral fissure of the cerebral hemisphere. The knowledge of sutural joints between frontal, parietal, sphenoid and temporal bones at pterion is clinically, radiologically and surgically important during surgical interventions involving burr hole surgeries. Materials and Methods : Study performed on 150 dry temporal bones. The pterion, and its sutural articulations with frontal, parietal, sphenoid and temporal bones and also anatomical variations, if any, were studied. Results : Four types of pterion, i.e. sphenoparietal, frontotemporal, stellate and epipteric, were observed. Conclusions : The knowledge of the variations of pterion and its surgical anatomy, in Indian population are important for surgeons operating in the fieldThe present study will also contribute additional information of skull bone fractures in infancy and early childhood, which may be associated with large intersutural bones giving false appearance of fracture radiologically and also during surgical interventions involving burr hole surgeries, as their extensions may lead to continuation of fracture lines.

  18. [Utility of the surgical treatment for severe epistaxis by endoscopic approach of sphenopalatine and ethmoidal arteries].

    Rejas Ugena, E; Trinidad Ruiz, G; Alvarez Domínguez, J; Carrasco Claver, F; Pino Rivero, V; Blasco Huelva, A


    To evaluate the efficacy and cost-effectiveness of the treatments used for controlling epistaxis, particularly compared with the surgical endoscopic ligation or cauterization of sphenopalatine (SP) and anterior ethmoid (AE) arteries, a intervention prospective-retrospective study is presented with the aim of assessing the feasibility of these surgical techniques as an alternative to conventional treatments. 184 consecutive patients admitted in the ENT ward between the years 1997 and 2005 were included in the study, and distributed into three groups depending on the last treatment applied to control their bleeding: AP group.- anterior packing (n=98); PP group.- posterior packing (n=66), and ES group.- endoscopic ligation and/or cauterization of SP or AE (n=20). Highly significant differences were found between the groups, not only regarding the efficacy (90% for surgical treatment compared with 41.3% for AP and 63.1% for PP), but also the length of postreatment hospital stay (AP.- 4.92 days; PP.- 6.3 days; ES.- 2.15 days). The lack of efficacy of conventional treatment and the increasing risk factors that condition nasal bleeding, together with the advance of endoscopic and anesthesic procedures have brought along the possibility of a surgical solution for these patients. Our results demonstrate the feasibility of these techniques as alternative for nasal packing in the treatment of posterior epistaxis, and even its ethical and economical convenience as a substitutive to posterior packing.

  19. 儿童先天性脑结构异常所致难治性癫痫的个体化外科干预及预后%Individual surgical intervention and prognosis of intractable epilepsy due to congenital brain structural abnormalities in children

    王启军; 魏祥品; 钱若兵; 牛朝诗; 傅先明; 范振


    目的:探讨儿童先天性脑结构异常所致难治性癫痫个体化外科治疗的时机、手术方式、安全性及有效性。方法回顾性分析行个体化手术治疗的先天性脑结构异常所致难治性癫痫17例患儿(年龄≤14岁)的临床资料,所有患儿术前行影像学检查及头皮长程视频脑电图(VEEG)监测,必要时行侵入性脑电图(iEEG)(皮层电极或脑深部电极置入)检查,以明确致痫灶及功能区,设计个体化外科手术干预方式。17例患儿中男10例,女7例,年龄2~14岁,8例患儿行癫痫灶切除,2例患儿行癫痫灶切除和皮层热灼术,4例行海马切除术,2例行迷走神经刺激术(VNS),1例行前颞叶皮层切除和海马切除术。术后运用Engle分级对患儿手术疗效进行评估,并对患儿手术前后的智商进行对比分析。结果术后随访13~68个月,随访期末疗效(Engle分级):Ⅰ级11例(64.7%)、Ⅱ级4例(23.5%)、Ⅲ级1例(5.9%)、Ⅳ级1例(5.9%),无长期并发症和死亡病例,通过韦氏量表和盖塞尔发展量表对手术前后进行评估,显示患儿在智商方面得到明显提高,生活质量明显好转。结论对先天性脑结构异常癫痫患儿,一旦明确,应尽早手术评估,根据影像学及脑电图监测结果,采用个体化手术治疗方案,手术微创安全,疗效确切。%Objective To investigate the individual surgical interventions and prognosis of intractable epilepsy due to the congenital structural abnormalities,to analyze the timing, operation mode, safety and effectiveness of the in-dividual surgical interventions. Methods The clinical data of 17 children( age≤14 years old) who had got intrac-table epilepsy due to the congenital structural abnormalities of the brain and accepted individual surgical interven-tion treatment were analyzed retrospectively. All patients underwent imaging examination and video eletroencepha-lography(VEEG) monitoring before operation, if necessary, intraeranial

  20. CT imaging in congenital heart disease: an approach to imaging and interpreting complex lesions after surgical intervention for tetralogy of Fallot, transposition of the great arteries, and single ventricle heart disease.

    Han, B Kelly; Lesser, John R


    Echocardiography and cardiac magnetic resonance imaging are the most commonly performed diagnostic studies in patients with congenital heart disease. A small percentage of patients with congenital heart disease will be referred to cardiac CT subsequent to echocardiography when magnetic resonance imaging is insufficient, contraindicated, or considered high risk. The most common complex lesions referred for CT at our institution are tetralogy of Fallot, transposition complexes, and single ventricle heart disease. This review discusses the most common surgical procedures performed in these patients and the technical considerations for optimal image acquisition on the basis of the prior procedure and the individual patient history. Cardiac CT can provide the functional and anatomic information required for decision making in complex congenital heart disease. Image interpretation is aided by knowledge of the common approaches to operative repair and the residual hemodynamic abnormalities. Acquisition and interpretation that is both individualized to the patient's underlying disease and the specific clinical question is likely to maintain diagnostic accuracy while decreasing the potential risk of cardiac CT.

  1. 颈椎孤立性浆细胞瘤的外科干预及放疗结果分析%Surgical intervention and radiotherapy outcome of solitary plasmacytoma of cervical spine

    黄稳定; 冯大鹏; 肖建如; 黄权; 郑伟; 吴志鹏; 周振华; 杨兴海; 谢宁


    patients received surgery. According to WBB staging system, surgical procedures were defined as total or subtotal resection (6 cases), appendix resection (4 cases), sagittal resection (3 cases) and total spondylectomy (8 cases). All surgical cases were managed using an anterior approach, posterior approach or combined anterior and posterior approach. The cervical spinal reconstruction was achieved through anterior cervical titanium plate and titanium mesh cage filled with auto iliac graft or bone cement, or anterior and posterior combined instrumented fusion. All patients received radiotherapy as adjunctive therapy. Results Follow-up of the 23 cases lasted 24. 0-143.0 months (mean: 64. 7 months). Neck pains obviously improved, and nerve compression symptoms disappeared or improved after surgery. Neurological function improved by 1-2 grades based on Frankel grading system All the internal fixations were fused well and stability of the cervical spine was fine and no spine instability could be seen in our series. The bone graft fusion rate was 100%. During the follow-up period, 6 surgical cases had local recurrence and finally progressed to multiple myeloma(MM) and 3 died. Two cases without surgical treatment progressed to MM in 1 year and 1.5 years after confirmed diagnosis. They were given systemic chemotherapy. The other 15 patients had disease-free survival and after surgery and adjunctive radiotherapy. Obvious abnormity were not found in such examinations as M protein, bone marrow aspiration and emission computed tomography or PET-CT examinations. Conclusions Solitary plasmacytoma of cervical spine is rarely seen clinically. Surgery is recommended as the primary management for patients with overt bone destruction and spinal instability or neurological dysfunction- Tumor excision with adjunctive radiotherapy can obviously reduce local recurrences and lower the possibility of progression to MM. The patients with progression to MM should receive chemotherapy according to

  2. Guide to Surgical Specialists

    ... have expertise in the following areas of responsibility: neonatal surgery (specialized knowledge in the surgical repair of ... and non-operative management of certain types of pain. Common conditions managed by neurologic surgeons include disorders ...

  3. Surgical Critical Care Initiative

    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....

  4. Ambulatory Surgical Measures - National

    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...

  5. Ambulatory Surgical Measures - Facility

    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...

  6. Surgical site infections

    and mortality as well as significant financial implications. Worldwide it has ... common nosocomial infection amongst surgical patients with up to 38% .... antibiotics as soon as the sensitivity results are available. ... Breast surgery. Staph Aureus/ ...

  7. Minimally invasive surgical therapies for benign prostatic hypertrophy: The rise in minimally invasive surgical therapies.

    Christidis, Daniel; McGrath, Shannon; Perera, Marlon; Manning, Todd; Bolton, Damien; Lawrentschuk, Nathan


    The prevalence of benign prostatic hypertrophy (BPH) causing bothersome lower urinary tract symptoms increases with our ageing population. Treatment of BPH traditionally begins with medical therapy and surgical intervention is then considered for those whose symptoms progress despite treatment. Minimally invasive surgical therapies have been developed as an intermediary in the treatment of BPH with the aim of decreasing the invasiveness of interventions. These therapies also aim to reduce morbidity and dysfunction related to invasive surgical procedures. Multiple treatment options exist in this group including mechanical and thermo-ablative strategies. Emerging therapies utilizing differing technologies range from the established to the experimental. We review the current literature related to these minimally invasive therapies and the evidence of their effectiveness in treating BPH. The role of minimally invasive surgical therapies in the treatment of BPH is still yet to be strongly defined. Given the experimental nature of many of the modalities, further study is required prior to their recommendation as alternatives to invasive surgical therapy. More mature evidence is required for the analysis of durability of effect of these therapies to make robust conclusions of their effectiveness.

  8. Surgical management of intraocular lens dislocations

    Adem Gul


    Full Text Available ABSTRACTPurpose:To report and compare the surgical, visual, and anatomical outcomes following treatment of dislocated intraocular lenses (IOLs.Methods:The medical records of 28 eyes of 28 patients were evaluated. Age, gender, pre-and postoperative best-corrected visual acuity (BCVA, surgical methods, and complications were recorded.Results:Pre-and postoperative BCVA ranged from counting fingers to 20/32 and from counting fingers to 20/25, respectively. Late-onset dislocations were the most frequently observed complication. The most frequent surgical method was IOL repositioning in 15 of 28 patients, followed by IOL exchange in 11 patients, and IOL removal in 2 patients. Only 1 patient required surgical re-intervention with IOL capture.Conclusions:Visual acuity improved following the use of either IOL repositioning or IOL exchange. No superiority of one method over the other was observed. In the present retrospective case series, management of dislocated IOLs with repositioning or exchange of the primary implant conferred comparable surgical and visual outcomes.

  9. Mindfulness Interventions.

    Creswell, J David


    Mindfulness interventions aim to foster greater attention to and awareness of present moment experience. There has been a dramatic increase in randomized controlled trials (RCTs) of mindfulness interventions over the past two decades. This article evaluates the growing evidence of mindfulness intervention RCTs by reviewing and discussing (a) the effects of mindfulness interventions on health, cognitive, affective, and interpersonal outcomes; (b) evidence-based applications of mindfulness interventions to new settings and populations (e.g., the workplace, military, schools); (c) psychological and neurobiological mechanisms of mindfulness interventions; (d) mindfulness intervention dosing considerations; and (e) potential risks of mindfulness interventions. Methodologically rigorous RCTs have demonstrated that mindfulness interventions improve outcomes in multiple domains (e.g., chronic pain, depression relapse, addiction). Discussion focuses on opportunities and challenges for mindfulness intervention research and on community applications.

  10. Paediatric musculoskeletal interventional radiology

    Paolantonio, Guglielmo; Fruhwirth, Rodolfo; Alvaro, Giuseppe; Parapatt, George K; Toma', Paolo; Rollo, Massimo


    Interventional radiology technique is now well established and widely used in the adult population. Through minimally invasive procedures, it increasingly replaces surgical interventions that involve higher percentages of invasiveness and, consequently, of morbidity and mortality. For these advantageous reasons, interventional radiology in recent years has spread to the paediatric age as well. The aim of this study was to review the literature on the development, use and perspectives of these procedures in the paediatric musculoskeletal field. Several topics are covered: osteomuscle neoplastic malignant and benign pathologies treated with invasive diagnostic and/or therapeutic procedures such as radiofrequency ablation in the osteoid osteoma; invasive and non-invasive procedures in vascular malformations; treatment of aneurysmal bone cysts; and role of interventional radiology in paediatric inflammatory and rheumatic inflammations. The positive results that have been generated with interventional radiology procedures in the paediatric field highly encourage both the development of new ad hoc materials, obviously adapted to young patients, as well as the improvement of such techniques, in consideration of the fact that childrens' pathologies do not always correspond to those of adults. In conclusion, as these interventional procedures have proven to be less invasive, with lower morbidity and mortality rates as well, they are becoming a viable and valid alternative to surgery in the paediatric population. PMID:26235144

  11. The surgical team and outcomes management: focus on postoperative ileus.

    Carter, Susan


    Postoperative ileus (POI) is defined as the impairment of bowel motility that occurs almost universally after major open abdominal procedures, as well as other abdominal and nonabdominal procedures. For the majority of affected patients, POI generally lasts approximately three to five days, but longer duration is not uncommon. The causes of POI are multifactorial, but can be broadly categorized into two groups: those related to the surgical procedure and those related to pharmacologic interventions (opioids). The fact that POI is generally transient and therefore self-limited should not deter the surgical team from seeking improved ways to mitigate its associated adverse effects, which can be substantial and immensely uncomfortable for the patient, and can have far-reaching implications regarding overall hospitalization costs for many types of surgeries. Optimization of POI management and prevention efforts is a responsibility of all members of the surgical team and can drastically affect the overall clinical outcome of major abdominal surgery. Depending on the individual team member's role, different perspectives and strategies may be used to achieve improved outcomes, including but not limited to hospitalization costs related to care and length of stay, resource utilization, and, perhaps most critically, patient quality of life not only immediately after surgery but also after discharge. The ability to reliably and significantly decrease the duration of POI should be readily recognized as an important objective in the management of this condition. Opioids will continue to be a mainstay of postoperative care regimens, but new agents such as peripherally acting mu-opioid-receptor antagonists may offer a unique clinical advantage by helping to reduce the adverse gastrointestinal effects of opioids while preserving their desired benefits for postoperative analgesia.

  12. The surgical treatment of acromegaly.

    Buchfelder, Michael; Schlaffer, Sven-Martin


    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.

  13. 地西泮合并心理干预治疗酒依赖伴抑郁35例疗效评价%Diazepam Combined with Psychological Intervention for Treating Alcohol Dependence Complicating Depression in 35 Cases

    程宇; 余成民; 李宁佳; 冯婧; 李薇


    目的:观察地西泮合并心理干预治疗酒依赖伴抑郁的疗效。方法随机将70例患者分成地西泮合并心理干预治疗组(干预组)和单用地西泮治疗组(对照组),各35例,均治疗8周。于治疗前及治疗后采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、临床总体印象量表(CGI)评定临床疗效及不良反应。结果治疗后第1,2,4,8周末的HAMD,HAMA及CGI评分,干预组和对照组均显著低于治疗前( P﹤0.05),且干预组各时间点的评分均显著低于对照组( P﹤0.05);干预组总有效率为94.29%,显著高于对照组的74.29%( P﹤0.05);干预组不良反应发生率为25.71%,显著低于对照组的60.00%( P﹤0.05)。结论地西泮合并心理干预治疗酒依赖伴抑郁的疗效优于单用地西泮,且起效更快,不良反应少。%Objective To observe the clinical efficacy of diazepam combined with psychological intervention in the treatment of alcohol dependence complicating depression. Methods 70 patients with alcohol dependence complicating depression were randomly assigned to the intervention group treated by diazepam combined with the psychological intervention ( intervention group ) and single diazepam treat-ment group ( control group ) , 35 cases in each group. The treatment lasted for 8 weeks. The curative effects and adverse reactions were assessed before treatment and at the end of 1, 2, 4, 8 weeks by adopting the Hamilton depression scale ( HAMD ) , Hamilton anxiety scale ( HAMA ) , clinical general impression ( CGI ) and treatment emergent symptom scale ( TESS ) . Results The scores of HAMD, HAMA and CGI after 1, 2, 4, 8 weeks of treatment in both groups were significantly lower than before treatment ( P ﹤ 0. 05 ) , moreover which at var-ious time points in the intervention group were significantly lower than those in the control group ( P ﹤ 0. 05 ) The effective rate in the intervention group was 94

  14. Surgical management of hepatocellular carcinoma

    Tony CY Pang; Vincent WT Lam


    Hepatocellular carcinoma (HCC) is the second mostcommon cause of death from cancer worldwide.Standard potentially curative treatments are eitherresection or transplantation. The aim of this paper isto provide an overview of the surgical managementof HCC, as well as highlight current issues in hepaticresection and transplantation. In summary, due to therelationship between HCC and chronic liver disease,the management of HCC depends both on tumourrelatedand hepatic function-related considerations. Assuch, HCC is currently managed largely through nonsurgicalmeans as the criteria, in relation to the aboveconsiderations, for surgical management is still largelyrestrictive. For early stage tumours, both resectionand transplantation offer fairly good survival outcomes(5 years overall survival of around 50%). Selectiontherefore would depend on the level of hepatic functionderangement, organ availability and local expertise.Patients with intermediate stage cancers have limitedoptions, with resection being the only potential forcure. Otherwise, locoregional therapy with transarterialchemoembolization or radiofrequency ablation are viableoptions. Current issues in resection and transplantationare also briefly discussed such as laparoscopic resection,ablation vs resection, anatomical vs non-anatomicalresection, transplantation vs resection, living donor livertransplantation and salvage liver transplantation.

  15. Instituting a Surgical Skills Competition Increases Technical Performance of Surgical Clerkship Students Over Time.

    Leraas, Harold J; Cox, Morgan L; Bendersky, Victoria A; Sprinkle, Shanna S; Gilmore, Brian F; Gunasingha, Rathnayaka M; Tracy, Elisabeth T; Sudan, Ranjan


    Surgical skills training varies greatly between institutions and is often left to students to approach independently. Although many studies have examined single interventions of skills training, no data currently exists about the implementation of surgical skills assessment as a component of the medical student surgical curriculum. We created a technical skills competition and evaluated its effect on student surgical skill development. Second-year medical students enrolled in the surgery clerkship voluntarily participated in a surgical skills competition consisting of knot tying, laparoscopic peg transfer, and laparoscopic pattern cut. Winning students were awarded dinner with the chair of surgery and a resident of their choice. Individual event times and combined times were recorded and compared for students who completed without disqualification. Disqualification included compromising cutting pattern, dropping a peg out of the field of vision, and incorrect knot tying technique. Timed performance was compared for 2 subsequent academic years using Mann-Whitney U test. Overall, 175 students competed and 71 students met qualification criteria. When compared by academic year, 2015 to 2016 students (n = 34) performed better than 2014 to 2015 students (n = 37) in pattern cut (133s vs 167s, p = 0.040), peg transfer (66s vs 101s, p skills competition improves student technical performance. Further research is needed regarding long-term benefits of surgical competitions for medical students. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  16. Implementation Science: A Neglected Opportunity to Accelerate Improvements in the Safety and Quality of Surgical Care.

    Hull, Louise; Athanasiou, Thanos; Russ, Stephanie


    The aim of this review was to emphasize the importance of implementation science in understanding why efforts to integrate evidence-based interventions into surgical practice frequently fail to replicate the improvements reported in early research studies. Over the past 2 decades, numerous patient safety initiatives have been developed to improve the quality and safety of surgical care. The surgical community is now faced with translating "promising" initiatives from the research environment into clinical practice-the World Health Organization (WHO) has described this task as one of the greatest challenges facing the global health community and has identified the importance of implementation science in scaling up evidence-based interventions. Using the WHO surgical safety checklist, a prominent example of a rapidly and widely implemented surgical safety intervention of the past decade, a review of literature, spanning surgery, and implementation science, was conducted to identify and describe a broad range of factors affecting implementation success, including contextual factors, implementation strategies, and implementation outcomes. Our current approach to conceptualizing and measuring the "effectiveness" of interventions has resulted in factors critical to implementing surgical safety interventions successfully being neglected. Improvements in the safety and quality of surgical care can be accelerated by drawing more heavily upon implementation science and that until this rapidly evolving field becomes more firmly embedded into surgical research and implementation efforts, our understanding of why interventions such as the checklist "work" in some settings and appear "not to work" in other settings will be limited.

  17. Applying the Transactional Stress and Coping Model to Sickle Cell Disorder and Insulin-Dependent Diabetes Mellitus: Identifying Psychosocial Variables Related to Adjustment and Intervention

    Hocking, Matthew C.; Lochman, John E.


    This review paper examines the literature on psychosocial factors associated with adjustment to sickle cell disease and insulin-dependent diabetes mellitus in children through the framework of the transactional stress and coping (TSC) model. The transactional stress and coping model views adaptation to a childhood chronic illness as mediated by…

  18. 3D Surgical Simulation

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


    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

  19. Patient hand hygiene practices in surgical patients.

    Ardizzone, Laura L; Smolowitz, Janice; Kline, Nancy; Thom, Bridgette; Larson, Elaine L


    Little is known about the hand hygiene practices of surgical patients. Most of the research has been directed at the health care worker, and this may discount the role that hand hygiene of the surgical patient might play in surgical site infections. A quasiexperimental, pretest/post-test study was conducted in which patients (n = 72) and nurses (n = 42) were interviewed to examine perceptions and knowledge about patient hand hygiene. Concurrently, observations were conducted to determine whether surgical patients were offered assistance by the nursing staff. Following an initial observation period, nursing staff received an educational session regarding general hand hygiene information and observation results. One month after the education session, patient/nurse dyads were observed for an additional 6 weeks to determine the impact of the educational intervention. Eighty observations, 72 patient interviews, and 42 nurse interviews were completed preintervention, and 83 observations were completed postintervention. In response to the survey, more than half of patients (n = 41, 55%) reported that they were not offered the opportunity to clean their hands, but a majority of the nursing staff reported (n = 25, 60%) that they offered patients the opportunity to clean their hands. Prior to the educational intervention, nursing staff assisted patients in 14 of 81 hand hygiene opportunities. Following the intervention, nursing staff assisted patients 37 out of 83 opportunities (17.3% vs 44.6%, respectively, [χ(2)1 = 13.008, P = .0003]). This study suggests that efforts to increase hand hygiene should be directed toward patients as well as health care workers. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  20. Development of a Cognitive Robotic System for Simple Surgical Tasks

    Riccardo Muradore


    Full Text Available The introduction of robotic surgery within the operating rooms has significantly improved the quality of many surgical procedures. Recently, the research on medical robotic systems focused on increasing the level of autonomy in order to give them the possibility to carry out simple surgical actions autonomously. This paper reports on the development of technologies for introducing automation within the surgical workflow. The results have been obtained during the ongoing FP7 European funded project Intelligent Surgical Robotics (I-SUR. The main goal of the project is to demonstrate that autonomous robotic surgical systems can carry out simple surgical tasks effectively and without major intervention by surgeons. To fulfil this goal, we have developed innovative solutions (both in terms of technologies and algorithms for the following aspects: fabrication of soft organ models starting from CT images, surgical planning and execution of movement of robot arms in contact with a deformable environment, designing a surgical interface minimizing the cognitive load of the surgeon supervising the actions, intra-operative sensing and reasoning to detect normal transitions and unexpected events. All these technologies have been integrated using a component-based software architecture to control a novel robot designed to perform the surgical actions under study. In this work we provide an overview of our system and report on preliminary results of the automatic execution of needle insertion for the cryoablation of kidney tumours.

  1. Development of a Cognitive Robotic System for Simple Surgical Tasks

    Riccardo Muradore


    Full Text Available The introduction of robotic surgery within the operating rooms has significantly improved the quality of many surgical procedures. Recently, the research on medical robotic systems focused on increasing the level of autonomy in order to give them the possibility to carry out simple surgical actions autonomously. This paper reports on the development of technologies for introducing automation within the surgical workflow. The results have been obtained during the ongoing FP7 European funded project Intelligent Surgical Robotics (I-SUR. The main goal of the project is to demonstrate that autonomous robotic surgical systems can carry out simple surgical tasks effectively and without major intervention by surgeons. To fulfil this goal, we have developed innovative solutions (both in terms of technologies and algorithms for the following aspects: fabrication of soft organ models starting from CT images, surgical planning and execution of movement of robot arms in contact with a deformable environment, designing a surgical interface minimizing the cognitive load of the surgeon supervising the actions, intra-operative sensing and reasoning to detect normal transitions and unexpected events. All these technologies have been integrated using a component-based software architecture to control a novel robot designed to perform the surgical actions under study. In this work we provide an overview of our system and report on preliminary results of the automatic execution of needle insertion for the cryoablation of kidney tumours.

  2. Self-reported barriers to pediatric surgical care in Guatemala.

    Nguyen, Karissa; Bhattacharya, Syamal D; Maloney, Megan J; Figueroa, Ligia; Taicher, Brad M; Ross, Sherry; Rice, Henry E


    Access to pediatric surgical care is limited in low- and middle-income countries. Barriers must be identified before improvements can be made. This pilot study aimed to identify self-reported barriers to pediatric surgical care in Guatemala. We surveyed 78 families of Guatemalan children with surgical conditions who were seen at a pediatric surgical clinic in Guatemala City. Spanish translators were used to complete questionnaires regarding perceived barriers to surgical care. Surgical conditions included hernias, rectal prolapse, anorectal malformations, congenital heart defects, cryptorchidism, soft tissue masses, and vestibulourethral reflux. Average patient age was 8.2 years (range, 1 month to 17 years) with male predominance (62%). Families reported an average symptom duration of 3.7 years before clinic evaluation. Families traveled a variety of distances to obtain surgical care: 36 per cent were local (less than 10 km), 17 per cent traveled 10 to 50 km, and 47 per cent traveled greater than 50 km. Other barriers to surgery included financial (58.9%), excessive wait time in the national healthcare system (10. 2%), distrust of local surgeons (37.2%), and geographic inaccessibility to surgical care (10.2%). The majority of study patients required outpatient procedures, which could improve their quality of life. Many barriers to pediatric surgical care exist in Guatemala. Interventions to remove these obstacles may enhance access to surgery and benefit children in low- and middle-income countries.

  3. Anxiety in veterinary surgical students

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


    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...

  4. Surgical bleeding in microgravity

    Campbell, M. R.; Billica, R. D.; Johnston, S. L. 3rd


    A surgical procedure performed during space flight would occur in a unique microgravity environment. Several experiments performed during weightlessness in parabolic flight were reviewed to ascertain the behavior of surgical bleeding in microgravity. Simulations of bleeding using dyed fluid and citrated bovine blood, as well as actual arterial and venous bleeding in rabbits, were examined. The high surface tension property of blood promotes the formation of large fluid domes, which have a tendency to adhere to the wound. The use of sponges and suction will be adequate to prevent cabin atmosphere contamination with all bleeding, with the exception of temporary arterial droplet streams. The control of the bleeding with standard surgical techniques should not be difficult.

  5. Surgical management of presbyopia

    Torricelli AA


    Full Text Available André AM Torricelli, Jackson B Junior, Marcony R Santhiago, Samir J BecharaDivision of Ophthalmology, University of São Paulo Medical School, São Paulo, BrazilAbstract: Presbyopia, the gradual loss of accommodation that becomes clinically significant during the fifth decade of life, is a physiologic inevitability. Different technologies are being pursued to achieve surgical correction of this disability; however, a number of limitations have prevented widespread acceptance of surgical presbyopia correction, such as optical and visual distortion, induced corneal ectasia, haze, anisometropy with monovision, regression of effect, decline in uncorrected distance vision, and the inherent risks with invasive techniques, limiting the development of an ideal solution. The correction of the presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. The purpose of this paper is to provide an update about current procedures available for presbyopia correction, their advantages, and disadvantages.Keywords: presbyopia, surgical correction, treatment

  6. Bio-Psycho-Spiritual Modeling in Drug Dependents and Compiling of Intervention Program for Promotion of Resiliency Based on Cognitive Narratology and Positive Psychology


    Introduction: Since the past few decades, the concentration of researches on drug abuse and drugs dependency have shift from risk factor to protective factors. In the past two decades, the concept of resiliency was increasingly considered by developmental psychology. The concentration shifted from risk to resiliency originates from disadvantage in emphasizing on identification of risk factors. Method: Target population was all volunteer addicts who referred to clinics in Tehran city. The grou...

  7. Recognition of surgical skills using hidden Markov models

    Speidel, Stefanie; Zentek, Tom; Sudra, Gunther; Gehrig, Tobias; Müller-Stich, Beat Peter; Gutt, Carsten; Dillmann, Rüdiger


    Minimally invasive surgery is a highly complex medical discipline and can be regarded as a major breakthrough in surgical technique. A minimally invasive intervention requires enhanced motor skills to deal with difficulties like the complex hand-eye coordination and restricted mobility. To alleviate these constraints we propose to enhance the surgeon's capabilities by providing a context-aware assistance using augmented reality techniques. To recognize and analyze the current situation for context-aware assistance, we need intraoperative sensor data and a model of the intervention. Characteristics of a situation are the performed activity, the used instruments, the surgical objects and the anatomical structures. Important information about the surgical activity can be acquired by recognizing the surgical gesture performed. Surgical gestures in minimally invasive surgery like cutting, knot-tying or suturing are here referred to as surgical skills. We use the motion data from the endoscopic instruments to classify and analyze the performed skill and even use it for skill evaluation in a training scenario. The system uses Hidden Markov Models (HMM) to model and recognize a specific surgical skill like knot-tying or suturing with an average recognition rate of 92%.

  8. The surgical treatment of a rare complication: gallstone ileus.

    Donati, Marcello; Cardì, Francesco; Brancato, Giovanna; Calò, Piergiorgio; Donati, Angelo


    The authors describe 3 cases of gallstone ileus observed in two different hospitals and evaluate the current rarity of this complication of the biliary lithiasis and/or of cholangiocarcinomas. There were two cases of stones at the ileal level and one case in the left colon. In one case a single surgical intervention was carried out while in the other a two-step strategy was adopted. Notwithstanding the fact that the correct strategy to adopt is still controversial in literature, the authors discuss the single and double step strategies and propose that the second intervention of the 2-step strategy should not be performed in high risk surgical patients.

  9. Current management of surgical oncologic emergencies.

    Marianne R F Bosscher

    Full Text Available For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC. In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed.A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days.In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%.In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy.

  10. Surgical Craniotomy for Intracerebral Haemorrhage.

    Mendelow, A David


    Craniotomy is probably indicated for patients with superficial spontaneous lobar supratentorial intracerebral haemorrhage (ICH) when the level of consciousness drops below 13 within the first 8 h of the onset of the haemorrhage. Once the level drops below 9, it is probably too late to consider craniotomy for these patients, so clinical vigilance is paramount. While this statement is only backed up by evidence that is moderately strong, meta-analysis of available data suggests that it is true in the rather limited number of patients with ICH. Meta-analyses like this can often predict the results of future prospective randomised controlled trials a decade or more before the trials are completed and published. Countless such examples exist in the literature, as is the case for thrombolysis in patients with myocardial infarction in the last millennium: meta-analysis determined the efficacy more than a decade BEFORE the last trial (ISIS-2) confirmed the benefit of thrombolysis for myocardial infarction. Careful examination of the meta-analysis' Forest plots in this chapter will demonstrate why this statement is made at the outset. Other meta-analyses of surgery for ICH have also indicated that minimal interventional techniques using topical thrombolysis or endoscopy via burrholes or even twist drill aspiration may be particularly successful for the treatment of supratentorial ICH, especially when the clot is deep seated. Ongoing clinical trials (CLEAR III and MISTIE III) should confirm this in the fullness of time. There are 2 exceptions to these generalisations. First, based on trial evidence, aneurysmal ICH is best treated with surgery. Second, cerebellar ICH represents a special case because of the development of hydrocephalus, which may require expeditious drainage as the intracranial pressure rises. The cerebellar clot will then require evacuation, usually via posterior fossa craniectomy, rather than craniotomy. Technical advances suggest that image-guided surgery

  11. The Dutch surgical colorectal audit.

    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


    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 Institute for Clinical Auditing (DICA). This article illustrates key elements of the DSCA and results of three years of auditing. Key elements include: a leading role of the professional association with integration of the audit in the national quality assurance policy; web-based registration by medical specialists; weekly updated online feedback to participants; annual external data verification with other data sources; improvement projects. In two years, all Dutch hospitals participated in the audit. Case-ascertainment was 92% in 2010 and 95% in 2011. External data verification by comparison with the Netherlands Cancer Registry (NCR) showed high concordance of data items. Within three years, guideline compliance for diagnostics, preoperative multidisciplinary meetings and standardised reporting increased; complication-, re-intervention and postoperative mortality rates decreased significantly. The success of the DSCA is the result of effective surgical collaboration. The leading role of the ASN in conducting the audit resulted in full participation of all colorectal surgeons in the Netherlands. By integrating the audit into the ASNs' quality assurance policy, it could be used to set national quality standards. Future challenges include reduction of administrative burden; expansion to a multidisciplinary registration; and addition of financial information and patient reported outcomes to the audit data. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. Dystocia in sheep and goats: outcome and fertility following surgical and non-surgical management

    Zuhair Bani Ismail


    Full Text Available Cesarean section is a life-saving surgical procedure usually undertaken in sheep and goats that fail to deliver vaginally (dystocia. Unfortunately, there are no recent review articles in literature that summarize the results of published case reports and clinical trials concerning indications, surgical approaches and procedures and outcomes following cesarean section in sheep and goats. Therefore, the aim of this article was to compile available data related to dystocia and cesarean section in small ruminants. Fortunately, the incidence of dystocia in small ruminants is considered to be low. It can be caused by either maternal or fetal factors. Maternal-related dystocia is most commonly because of failure of cervical dilation, narrow birth canal and uterine inertia. Those related to fetal causes are usually associated with fetal malposition/presentation, feto-pelvic disproportion/fetal oversize, and fetal malformation. Manual extraction of the fetus may be attempted in most cases, however, early surgical intervention by performing cesarean section ensures satisfactory outcome. Cesarean section is usually performed in lateral recumbency through left paralumbar fossa or left paralumbar fossa oblique celiotomy under local analgesia. The success rates and post-operative complications in sheep and goats are underreported; however, early surgical intervention using aseptic technique usually results in a satisfactory outcome for both the dam and newborn with acceptable prognosis for future breeding soundness.

  13. Fundamental Ethical Issues in Unnecessary Surgical Procedures.

    Tayade, Motilal Chandu; Dalvi, Shashank D


    In clinical practice performing any surgical procedure is inconsistent because all surgical procedures carry definitely some degree of risk. Worldwide every year millions of patients go under knife, but many of them are enduring great pain and shelling out thousands and dollars for surgeries they don't really need. This review work was planned with an intention to focus attention towards it with reporting cited evidences of unnecessary surgical operations and discuss ethical issues concern with it. In present review the references search included standard citations Google scholar, MEDLINE and PUBMED. We also used Google search engine for screening various news concern with highlighting this topic in community and online media. For articles we go through more than 60 articles from worldwide and 12 news media views from Google search in last one year. We used following quotes for their search-unnecessary surgeries, second opinion, ethical issues in unnecessary surgeries. Geographical variations were also kept in view. Our intension was highlighting ethical issues concern with unnecessary surgical operations. Henceforth we excluded such work that does not concern with ethical issues. Unnecessary surgery is that which is medically unjustifiable when the risks and costs are more than the likely therapeutic benefits or relief to the patient based on the patient's lifestyle requirements. To avoid or minimize such interventions basic seeding of ethics in curriculum and strict laws will definitely helpful in clinical practice. In conclusion, our aim was to highlight this major issue and underline need of competency based medical bioethics education in Indian scenario.

  14. Surgical hand hygiene: scrub or rub?

    Widmer, A F


    Surgical hand hygiene is standard care prior to any surgical procedure. Per-operative glove punctures are observed in almost 30% of all interventions, and a risk factor for postoperative infections. In the past, washing hands with antimicrobial soap and water (surgical scrub) was the norm, mainly with chlorhexidine or iodine. More recently, alcohol-based hand rub has been successfully introduced, showing greater effectiveness, less irritation to the hands, and requiring less time than washing hands. All products should have a remnant effect that delays microbial growth under the gloved hand. Some of the alcohol-based compounds are effective (as determined by the European Norm EN 12791) within 90 s whereas others require 3-5 min, similar to the scrub. The short procedure relies heavily on proper technique and timing, since lowering the exposure time to surgical hand hygiene should meet EN 12791 in Europe, or other standards, such as the US Food and Drug Administration tentative final monograph norm in the USA. It is best performed by using an alcohol-based hand rub, but a scrub with chlorhexidine-containing soap also meets these standards.

  15. Surgical Treatment of Perforation Esophageal Carcinoma

    Depu Duan; Jihua Zou; Zhigang Cai; Shengyong Wu; Haibo Xiao; Yiyong Zhou; Xiang Liang; Dekui Sun; Songchang Wu


    OBJECTIVE To determine the ideal method of surgical preoperative treatment for perforation with esophageal carcinoma.METHODS 36 cases of perforation with esophageal carcinoma were treated surgically in this series.Perforations occurred into the right lung in14 cases ,the mediastinum in 17 cases and trachea in 5 cases.Open thoracic surgery was performed in 34 cases,in which the right thoracic approach using a 3-incision method was applied in 16 cases,and operation by stages in 15 cases.Of the 34 cases,retrosternal substitution of the esophagus with stomach or colon was performed in 26 cases.RESULTS Surgery was successful in 31 cases and operative death occurred in 3 cases.The postoperative follow up study was from 3~72months.Of these cases 15 wree alive at 7~12 months, 2 at 24 months,and 1 at 72 months. The results can be considered satisfactory.CONCLUSION The therapeutic results of surgical treatment of perforation with esophageal carcinoma were markedly superior to that of conventional conservative treatment. The authors suggest that surgical intervention without delay should be undertaken for patients having a perforation with carcinoma of the esophagus. A right thoracic approach with a 3-incision method (retrosternal replacement of esophagus with stomach or colon) or operation by stages is preferable.

  16. Surgical management of OSA in adults.

    Smith, David F; Cohen, Aliza P; Ishman, Stacey L


    OSA is a common, often chronic, condition requiring long-term therapy. Given the prevalence of OSA, as well as its significant health-related sequelae, a range of medical and surgical treatments have been developed and used with varying success depending on individual anatomy and patient compliance. Although CPAP is the primary treatment, many patients cannot tolerate this treatment and require alternative therapies. In this clinical scenario, surgery is often warranted and useful. Surgical management is aimed at addressing obstruction in the nasal, retropalatal, and retroglossal/hypopharyngeal regions, and many patients have multiple levels of obstruction. This review presents a comprehensive overview of research findings on a wide spectrum of surgical approaches currently used by sleep clinicians when other therapeutic modalities fail to achieve positive outcomes.

  17. Global financial crisis and surgical practice: the Greek paradigm.

    Karidis, Nikolaos P; Dimitroulis, Dimitrios; Kouraklis, Gregory


    Apart from the significant implications of recent financial crisis in overall health indices and mortality rates, the direct effect of health resources redistribution in everyday clinical practice is barely recognized. In the case of Greece, health sector reform and health spending cuts have already had a major impact on costly interventions, particularly in surgical practice. An increase in utilization of public health resources, lack of basic and advanced surgical supplies, salary deductions, and emerging issues in patient management have contributed to serious dysfunction of a public health system unable to sustain current needs. In this context, significant implications arise for the surgeons and patients as proper perioperative management is directly affected by reduced public health funding. The surgical community has expressed concerns about the quality of surgical care and the future of surgical progress in the era of the European Union. Greek surgeons are expected to support reform while maintaining a high level of surgical care to the public. The challenge of cost control in surgical practice provides, nevertheless, an excellent opportunity to reconsider health economics while innovation through a more traditional approach to the surgical patient should not be precluded. A Greek case study on the extent of the current situation is presented with reference to health policy reform, serving as an alarming paradigm for the global community under the pressure of a profound financial recession.

  18. Surgical site infection in women undergoing surgery for gynecologic cancer.

    Mahdi, Haider; Gojayev, Anar; Buechel, Megan; Knight, Jason; SanMarco, Janice; Lockhart, David; Michener, Chad; Moslemi-Kebria, Mehdi


    The objectives of this study were to describe the rate and predictors of surgical site infection (SSI) after gynecologic cancer surgery and identify any association between SSI and postoperative outcome. Patients with endometrial, cervical, or ovarian cancers from 2005 to 2011 were identified from the American College of Surgeons National Surgical Quality Improvement Program. The extent of surgical intervention was categorized into modified surgical complexity scoring (MSCS) system. Univariate and multivariate logistic regression analyses were used. Odds ratios were adjusted for patient demographics, comorbidities, preoperative laboratory values, and operative factors. Of 6854 patients, 369 (5.4%) were diagnosed with SSI. Surgical site infection after laparotomy was 3.5 times higher compared with minimally invasive surgery (7% vs 2%; P Surgical site infection was associated with longer mean hospital stay and higher rate of reoperation, sepsis, and wound dehiscence. Surgical site infection was not associated with increased risk of acute renal failure or 30-day mortality. These findings were consistent in subset of patients with deep or organ space SSI. Seven percent of patients undergoing laparotomy for gynecologic malignancy developed SSI. Surgical site infection is associated with longer hospital stay and more than 5-fold increased risk of reoperation. In this study, we identified several risk factors for developing SSI among gynecologic cancer patients. These findings may contribute toward identification of patients at risk for SSI and the development of strategies to reduce SSI rate and potentially reduce the cost of care in gynecologic cancer surgery.

  19. Intraoperative OCT in Surgical Oncology

    South, Fredrick A.; Marjanovic, Marina; Boppart, Stephen A.

    The global incidence of cancer is rising, putting an increasingly heavy burden upon health care. The need to effectively detect and treat cancer is one of the most significant problems faced in health care today. Effective cancer treatment typically depends upon early detection and, for most solid tumors, successful removal of the cancerous tumor tissue via surgical procedures. Difficulties arise when attempting to differentiate between normal and tumor tissue during surgery. Unaided visual examination of the tissue provides only superficial, low-resolution information and often with little visual contrast. Many imaging modalities widely used for cancer screening and diagnostics are of limited use in the operating room due to low spatial resolution. OCT provides cellular resolution allowing for more precise localization of the tumor tissue. It is also relatively inexpensive and highly portable, making it well suited for intraoperative applications.

  20. [Recent surgical options for vestibular vertigo].

    Volkenstein, Stefan; Dazert, Stefan


    Vertigo is not a well defined symptom but a heterogenous entity diagnosed and treated mainly by otolaryngologists, neurologists, internal medicine and primary care physicians. Most vertigo syndroms have a good prognosis and management is predominantly conservative, whereas the need for surgical therapy is rare, but for a subset of patients often the only remaining option. In this paper, we describe the development of surgical therapy for hydropic inner ear diseases, Menière disease, dehiscence syndroms, perilymphatic fistulas, and benign paroxysmal vertigo. At the end, we shortly introduce the most recent development of vestibular implants. Surgical vestibular therapy is still indicated for selected patients nowadays when conservative options did not reduce symptoms and patients are still suffering. Success depends on the correct diagnosis and indication for the different procedures going along with an adequate patient selection. In regard to the invasiveness and the possible risks due to the surgery, in depth individual counselling is necessary. Ablative and destructive surgical procedures usually achieve a successful vertigo control, but go along with a high risk for hearing loss. Therefore, residual hearing has to be included in the decission making process for a surgical therapy. © Georg Thieme Verlag KG Stuttgart · New York.

  1. Surgical results of sacral perineural (Tarlov) cysts.

    Tanaka, Masato; Nakahara, Shinnosuke; Ito, Yasuo; Nakanishi, Kazuo; Sugimoto, Yoshihisa; Ikuma, Hisanori; Ozaki, Toshifumi


    The purpose of this study was to investigate the surgical outcomes and to determine indicators of the necessity of surgical intervention. Twelve consecutive patients harboring symptomatic sacral perineural cysts were treated between 1995 and 2003. All patients were assessed for neurological deficits and pain by neurological examination. Magnetic resonance of imaging, computerized tomography, and myelography were performed to detect signs of delayed filling of the cysts. We performed a release of the valve and imbrication of the sacral cysts with laminectomies in 8 cases or recapping laminectomies in 4 cases. After surgery, symptoms improved in 10 (83%) of 12 patients, with an average follow-up of 27 months. Ten patients had sacral perineural cysts with signs of positive filling defect. Two (17%) of 12 patients experienced no significant improvement. In one of these patients, the filling defect was negative. In conclusion, a positive filling defect may become an indicator of good treatment outcomes.

  2. Surgical results of sacral perineural (Tarlov cysts.



    Full Text Available

    The purpose of this study was to investigate the surgical outcomes and to determine indicators of the necessity of surgical intervention. Twelve consecutive patients harboring symptomatic sacral perineural cysts were treated between 1995 and 2003. All patients were assessed for neurological deficits and pain by neurological examination. Magnetic resonance of imaging, computerized tomography, and myelography were performed to detect signs of delayed filling of the cysts. We performed a release of the valve and imbrication of the sacral cysts with laminectomies in 8 cases or recapping laminectomies in 4 cases. After surgery, symptoms improved in 10 (83% of 12 patients, with an average follow-up of 27 months. Ten patients had sacral perineural cysts with signs of positive filling defect. Two (17% of 12 patients experienced no significant improvement. In one of these patients, the filling defect was negative. In conclusion, a positive filling defect may become an indicator of good treatment outcomes.

  3. Surgical management of common canine prostatic conditions.

    Freitag, Thurid; Jerram, Richard M; Walker, Alex M; Warman, Chris G A


    Prostatic diseases commonly warrant surgical intervention. Early castration may prevent the development of benign prostatic hyperplasia, prostatitis, and cavitary lesions (prostatic abscesses or cysts). In intact dogs that present with these disorders, castration should always be part of the specific surgical treatment because it enhances treatment success and may prevent recurrence. The current treatment of choice for cavitary lesions is prostatic omentalization, which results in lower postoperative mortality, faster recovery, and fewer incidences of recurrence than other prostatic drainage techniques. Prostatic neoplasia without evidence of metastasis may be managed with total prostatectomy, subtotal prostatectomy in conjunction with intraoperative radiotherapy, or postoperative chemotherapy. Understanding the neurovascular supply of the prostate and surrounding tissues is essential to decrease the risk for urinary incontinence, severe hemorrhage, and avascular necrosis. Postoperative management includes analgesia, appropriate antibiotic therapy, and in cases of subtotal or total prostatectomy, temporary urinary catheterization.

  4. Empyema thoracis: Surgical management in children

    Menon Prema


    Full Text Available Empyema thoracis can produce significant morbidity in children if inadequately treated. Correct evaluation of the stage of the disease, the clinical condition of the child and proper assessment of the response to conservative treatment is crucial in deciding the mode of further surgical intervention. This ranges from intercostal chest tube drainage and video-assisted thoracoscopic surgery to open decortication. Surgical decortication becomes mandatory in neglected cases; it gives very gratifying results ameliorating the disease rapidly and is well tolerated by young patients. This article reviews the current literature and discusses the important considerations while managing these patients. Indications for surgery are highlighted, based on our large experience at a tertiary care center.

  5. Influence of nursing intervention on relapse rate in patients with atcohol dependence%护理干预对酒精依赖患者复饮率的影响

    赖爱群; 廖风芹; 谭晓雪


    Objective: To investigate the efficacy of nursing intervention on the relapse to alcohol in patients with alcohol dependence.Methods: Analysis from 120 cases of hospitalized patients with alcohol dependence in psychiatric hospital from October 2007 to October 2009.They were randomly divided into experimental group ( n =60 ) and control group ( n =60 ).Experimental group was treated on the basis of drug treatment and nursing interventions, including psychological care, behavior guidance, whole health education and systematic health education to their families.The control group was treated only with drug substitution therapy.All cases were cured and followed up after 6 months to compare the relapse rate.Results: In addition to the cases not follow - up, the relapse rate of experimental group ( 40.68% ,24/59 ) was significantly lower than the control group ( 84.48% ,49/58 ), ( P <0.05 ).Conclusion: Nursing intervention in patients with alcohol dependence could improve their worse psychology and behavior, create a healthy lifestyle and decrease the relapse rate.%目的:探讨护理干预对酒精依赖患者复饮率的影响.方法:将120例2007年10月~2009年10月在精神科住院诊断为酒精依赖患者随机分为实验组、对照组各60例,实验组在药物治疗基础上进行护理干预,包括心理护理、行为指导、全程健康教育,并对其家属进行系统健康教育;对照组单纯药物替代疗法.两组均为治愈戒断出院.出院6个月后上门随访,比较两组复饮率.结果:实验组1例,对照组2例未获随访,按实际完成处理.实验组有59例,对照组58例纳入结果分析,实验组复饮率(40.68%,24/59)低于对照组(84.48%,49/58),差异有显著性(P<0.05).结论:对酒精依赖患者进行护理干预可改变患者不良心理状态及行为,帮助其建立健康生活方式,降低复饮率.

  6. 电话干预对酒依赖患者出院后饮酒频率的影响%Influences of telephone intervention on post-discharge drinking f requency of alcohol dependence patients



    目的:探讨电话干预对酒依赖患者出院后饮酒频率的影响。方法将69名酒依赖患者分为两组,研究组33例,对照组36例。出院后每周电话联系评定患者周饮酒次数,研究组同时予以电话干预。观察12周。比较两组出院后的饮酒频率。结果出院第8周及12周,两组饮酒频率均较出院第4周显著升高(P<0.01);同期两组间比较,出院第8周研究组显著低于对照组(P<0.05),其他时段两组比较差异无显著性(P>0.05)。结论电话干预对酒依赖者的饮酒频率仅有短期的影响。%Objective To explore the influences of telephone intervention on post-discharge drinking frequency of alcohol dependence patients .Methods Sixty-nine alcohol dependence pa-tients were assigned to research (n=33) and control group (n=36) .Drinking times were evaluated with telephone weekly after discharge ,meanwhile research group received telephone intervention .They were observed for 12 weeks .Drinking frequencies of 2 groups were compared .Results In the 8th and 12th week after discharge drinking frequencies of both groups heightened more significantly compared with the 4th week (P0 .05) .Conclusion Tele-phone intervention has only short-term influence on drinking frequency of alcohol dependence patients .

  7. Influence of midwives’surgical hand hygiene intervention in perineal inci-sional infection rate in parturients%助产人员外科手卫生干预对产妇会阴侧切切口感染率的影响

    肖夕凤; 龚秀萍


    目的:了解助产人员外科手消毒合格率与产妇会阴切口感染情况,为降低会阴侧切切口感染提供参考依据。方法收集某院2012年1月-2013年12月产科自然分娩的患者资料7148份,其中2012年1-12月未对助产人员外科手消毒进行干预的3569例病例设为对照组;2013年1-12月对助产人员外科手消毒进行干预的3579例病例设为干预组,比较两组患者会阴侧切切口感染情况及助产人员手卫生合格率。结果对照组和干预组在产妇年龄、体重指数、基础疾病、阴道产检次数、分娩季节、产程、缝合人员工作年限、预防使用抗菌药物和新生儿体重等方面比较,差异无统计学意义(均P>0.05)。助产人员外科手消毒方法合格率由干预前的19.31%(689例)上升至干预后的71.03%(2542例),两组比较,差异具有统计学意义(χ2=752.58,P0.05). The qualified rate of midwives’surgical hand disinfection method increased from 19.31%(n=689)before interven-tion to 71.03%(n=2 542)after intervention,the difference was significant between two groups(χ2=752.58,P<0.05).Perineal incisional infection rate in intervention group was significantly lower than control group ([(0.28%, 10/3 579]vs [0.81%,29/3 569]),there was significant difference between two groups (χ2=9.36,P<0.05). Conclusion The improvement of qualified rate of midwives’hand hygiene can reduce perineal incisional infection rate of parturients.

  8. A four-day Western-style dietary intervention causes reductions in hippocampal-dependent learning and memory and interoceptive sensitivity

    Attuquayefio, Tuki; Stevenson, Richard J.; Oaten, Megan J.; Francis, Heather M.


    In animals, a Western style diet–high in saturated fat and added sugar–causes impairments in hippocampal-dependent learning and memory (HDLM) and perception of internal bodily state (interoception). In humans, while there is correlational support for a link between Western-style diet, HDLM, and interoception, there is as yet no causal data. Here, healthy individuals were randomly assigned to consume either a breakfast high in saturated fat and added sugar (Experimental condition) or a healthier breakfast (Control condition), over four consecutive days. Tests of HDLM, interoception and biological measures were administered before and after breakfast on the days one and four, and participants completed food diaries before and during the study. At the end of the study, the Experimental condition showed significant reductions in HDLM and reduced interoceptive sensitivity to hunger and fullness, relative to the Control condition. The Experimental condition also showed a markedly different blood glucose and triglyceride responses to their breakfast, relative to Controls, with larger changes in blood glucose across breakfast being associated with greater reductions in HDLM. The Experimental condition compensated for their energy-dense breakfast by reducing carbohydrate intake, while saturated fat intake remained consistently higher than Controls. This is the first experimental study in humans to demonstrate that a Western-style diet impacts HDLM following a relatively short exposure–just as in animals. The link between diet-induced HDLM changes and blood glucose suggests one pathway by which diet impacts HDLM in humans. PMID:28231304

  9. Spacecraft surgical scrub system

    Abbate, M.


    Ease of handling and control in zero gravity and minimizing the quantity of water required were prime considerations. The program tasks include the selection of biocidal agent from among the variety used for surgical scrub, formulation of a dispensing system, test, and delivery of flight dispensers. The choice of an iodophore was based on effectiveness on single applications, general familiarity among surgeons, and previous qualification for space use. The delivery system was a choice between the squeeze foamer system and impregnated polyurethane foam pads. The impregnated foam pad was recommended because it is a simpler system since the squeeze foamer requires some applicator to effectively clean the skin surfaces, whereas the form pad is the applicator and agent combined. Testing demonstrated that both systems are effective for use as surgical scrubs.

  10. Interventional video tomography

    Truppe, Michael J.; Pongracz, Ferenc; Ploder, Oliver; Wagner, Arne; Ewers, Rolf


    Interventional Video Tomography (IVT) is a new imaging modality for Image Directed Surgery to visualize in real-time intraoperatively the spatial position of surgical instruments relative to the patient's anatomy. The video imaging detector is based on a special camera equipped with an optical viewing and lighting system and electronic 3D sensors. When combined with an endoscope it is used for examining the inside of cavities or hollow organs of the body from many different angles. The surface topography of objects is reconstructed from a sequence of monocular video or endoscopic images. To increase accuracy and speed of the reconstruction the relative movement between objects and endoscope is continuously tracked by electronic sensors. The IVT image sequence represents a 4D data set in stereotactic space and contains image, surface topography and motion data. In ENT surgery an IVT image sequence of the planned and so far accessible surgical path is acquired prior to surgery. To simulate the surgical procedure the cross sectional imaging data is superimposed with the digitally stored IVT image sequence. During surgery the video sequence component of the IVT simulation is substituted by the live video source. The IVT technology makes obsolete the use of 3D digitizing probes for the patient image coordinate transformation. The image fusion of medical imaging data with live video sources is the first practical use of augmented reality in medicine. During surgery a head-up display is used to overlay real-time reformatted cross sectional imaging data with the live video image.

  11. Gossypiboma—Retained Surgical Sponge

    Hung-Shun Sun


    Full Text Available Intra-abdominal retained surgical sponge is an uncommon surgical error. Herein, we report a 92-year-old woman who was brought to the emergency room for acute urinary retention. She had a history of vaginal hysterectomy for uterine prolapse 18 years previously, performed at our hospital. Retained surgical sponge in the pelvic cavity was suspected by abdominal computed tomography. The surgical gauze was removed by laparotomy excision and the final diagnosis was gossypiboma.

  12. Hepatic surgical anatomy.

    Skandalakis, John E; Skandalakis, Lee J; Skandalakis, Panajiotis N; Mirilas, Petros


    The liver, the largest organ in the body, has been misunderstood at nearly all levels of organization, and there is a tendency to ignore details that do not fit the preconception. A complete presentation of the surgical anatomy of the liver includes the study of hepatic surfaces, margins, and fissures; the various classifications of lobes and segments; and the vasculature and lymphatics. A brief overview of the intrahepatic biliary tract is also presented.

  13. Non-surgical and non-chemical attempts to treat echinococcosis: do they work?

    Tamarozzi Francesca


    Full Text Available Cystic echinococcosis (CE and alveolar echinococcosis (AE are chronic, complex and neglected diseases. Their treatment depends on a number of factors related to the lesion, setting and patient. We performed a literature review of curative or palliative non-surgical, non-chemical interventions in CE and AE. In CE, some of these techniques, like radiofrequency thermal ablation (RFA, were shelved after initial attempts, while others, such as High-Intensity Focused Ultrasound, appear promising but are still in a pre-clinical phase. In AE, RFA has never been tested, however, radiotherapy or heavy-ion therapies have been attempted in experimental models. Still, application to humans is questionable. In CE, although prospective clinical studies are still lacking, therapeutic, non-surgical drainage techniques, such as PAIR (puncture, aspiration, injection, re-aspiration and its derivatives, are now considered a useful option in selected cases. Finally, palliative, non-surgical drainage techniques such as US- or CT-guided percutaneous biliary drainage, centro-parasitic abscesses drainage, or vascular stenting were performed successfully. Recently, endoscopic retrograde cholangiopancreatography (ERCP-associated techniques have become increasingly used to manage biliary fistulas in CE and biliary obstructions in AE. Development of pre-clinical animal models would allow testing for AE techniques developed for other indications, e.g. cancer. Prospective trials are required to determine the best use of PAIR, and associated procedures, and the indications and techniques of palliative drainage.

  14. Louis Pasteur surgical revolution.

    Toledo-Pereyra, Luis H


    Louis Pasteur (1822-1895) is considered the most notable medical scientist of his time and perhaps one of the most distinguished of all times in the history of medicine. From Dole in France to Paris, from a student of crystals to "living ferments," and from chemistry to biology and medicine, Pasteur changed the world for the benefit of humanity. The genius of Pasteur dealt with the most pressing issues of his time, basing the germ theory on the effects that microorganisms had on fermentation and putrefaction of organic matter, which gave birth to the science of bacteriology. Many other difficult problems in medicine and biology were tackled by Pasteur, culminating in the spectacular results seen with the treatment of rabies. Surgery was no exception to the scientific conquests of Pasteur. The transformation of the surgical world arose from the antiseptic concepts of Lister that were based on the germ theory of the disease, which had been derived from the germ theory of fermentation and putrefaction discovered by Pasteur. The acceptance of these principles represented the surgical revolution brought on by the science of Pasteur, a revolution that is now accepted in our daily care of surgical patients.

  15. Guideline implementation: Surgical attire.

    Cowperthwaite, Liz; Holm, Rebecca L


    Surgical attire helps protect patients from microorganisms that may be shed from the hair and skin of perioperative personnel. The updated AORN "Guideline for surgical attire" provides guidance on scrub attire, shoes, head coverings, and masks worn in the semirestricted and restricted areas of the perioperative setting, as well as how to handle personal items (eg, jewelry, backpacks, cell phones) that may be taken into the perioperative suite. This article focuses on key points of the guideline to help perioperative personnel adhere to facility policies and regulatory requirements for attire. The key points address the potential benefits of wearing scrub attire made of antimicrobial fabric, covering the arms when in the restricted area of the surgical suite, removing or confining jewelry when wearing scrub attire, disinfecting personal items that will be taken into the perioperative suite, and sending reusable attire to a health care-accredited laundry facility after use. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  16. Augmented reality in surgical procedures

    Samset, E.; Schmalstieg, D.; Vander Sloten, J.; Freudenthal, A.; Declerck, J.; Casciaro, S.; Rideng, Ø.; Gersak, B.


    Minimally invasive therapy (MIT) is one of the most important trends in modern medicine. It includes a wide range of therapies in videoscopic surgery and interventional radiology and is performed through small incisions. It reduces hospital stay-time by allowing faster recovery and offers substantially improved cost-effectiveness for the hospital and the society. However, the introduction of MIT has also led to new problems. The manipulation of structures within the body through small incisions reduces dexterity and tactile feedback. It requires a different approach than conventional surgical procedures, since eye-hand co-ordination is not based on direct vision, but more predominantly on image guidance via endoscopes or radiological imaging modalities. ARIS*ER is a multidisciplinary consortium developing a new generation of decision support tools for MIT by augmenting visual and sensorial feedback. We will present tools based on novel concepts in visualization, robotics and haptics providing tailored solutions for a range of clinical applications. Examples from radio-frequency ablation of liver-tumors, laparoscopic liver surgery and minimally invasive cardiac surgery will be presented. Demonstrators were developed with the aim to provide a seamless workflow for the clinical user conducting image-guided therapy.

  17. Surgical navigation with QR codes

    Katanacho Manuel


    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.

  18. Ethical aspects of care in the newborn surgical patient

    Hazebroek, F.W.J.; Tibboel, D.; Wijnen, R.M.H.


    This article places focus on three main subjects that are all related to the ethical aspects of care of newborns undergoing major surgical interventions. The first concerns the communication between the surgeon, as a representative of the treatment team, and the parents. The second is the way to

  19. [AIDS patients--the surgical and deontological problems].

    Iarŭmov, N; Viiachki, I; Topov, Ia; Rachev, P


    A case is reported of acquired immunodeficiency, in whom operative intervention was performed. A series of problems of surgical and deontologic aspect are raised, which ought to be solved without inducing mental trauma to the patients. Paralleling this, measures should be taken, to reduce to a minimum the risk of nosocomial infection to the medical staff.

  20. Intensified conventional insulin treatment retards the microvascular complications of insulin-dependent diabetes mellitus (IDDM): the Stockholm Diabetes Intervention Study (SDIS) after 5 years.

    Reichard, P; Berglund, B; Britz, A; Cars, I; Nilsson, B Y; Rosenqvist, U


    Ninety-six patients with insulin-dependent diabetes mellitus (IDDM) and non-proliferative retinopathy were randomized to intensified conventional treatment (ICT) (n = 44) or regular treatment (RT) (n = 52), and followed up for 5 years. HbA1c decreased from 9.5 +/- 0.2% (mean value +/- SEM) to 7.2 +/- 0.1% in the ICT group, and from 9.4 +/- 0.2% to 8.7 +/- 0.1% in the RT group (difference between the groups, P less than 0.001). Retinopathy increased in both groups (P less than 0.001), but after 5 years it was worse in the RT group (P less than 0.05). The urinary albumin excretion rate was higher in the RT group than in the ICT group after 5 years (239.9 +/- 129.7 micrograms min-1 vs. 46.0 +/- 26.1 micrograms min-1, P less than 0.05). Eight RT patients developed manifest nephropathy, compared with none in the ICT group (P less than 0.01). After 5 years the conduction velocities of the sural (P less than 0.05), peroneal (P less than 0.01) and tibial (P less than 0.001) nerves were lower in the RT group. The respiratory sinus arrhythmia was 12.1 +/- 1.2 beats min-1 in the RT group and 16.7 +/- 1.4 beats min-1 in the ICT group at the end of the study (P less than 0.01). The increases in retinopathy (P less than 0.01), nephropathy (P less than 0.01) and neuropathy (P less than 0.001) were all related to the mean HbA1c value during the study. Smoking habits only influenced the progression of retinopathy (P less than 0.05). Serious hypoglycaemia occurred in 34 ICT patients and 29 RT patients (242 and 98 episodes, respectively) (P less than 0.05). Whereas weight was stable in the RT group, the body mass index increased by 5.8% in the ICT group (P less than 0.01). In conclusion, microvascular complications of diabetes were retarded by intensified conventional insulin treatment. However, such treatment increased the frequency of serious hypoglycaemia, and led to an increase in body weight.

  1. Debridement for surgical wounds.

    Dryburgh, Nancy; Smith, Fiona; Donaldson, Jayne; Mitchell, Melloney


    Surgical wounds that become infected are often debrided because clinicians believe that removal of this necrotic or infected tissue will expedite wound healing. There are numerous methods available but no consensus on which one is most effective for surgical wounds. The aim of this review is to determine the effect of different methods of debridement on the rate of debridement and healing of surgical wounds. We developed a search strategy to search the following electronic databases: Wounds Group Specialised Trials Register (searched 3/3/08) , Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2008, issue 1), MEDLINE (1950 to February Week 3 2008 ), EMBASE (1980 to 2008 Week 09) and CINHAL (1982 to February Week 4 2008). We checked the citations within obtained studies to identify additional papers and also relevant conference proceedings. We contacted manufactures of wound debridement agents to ascertain the existence of published, unpublished and ongoing trials. Our search was not limited by language or publication status. We included relevant randomised controlled trials (RCT) with outcomes including at least one of the following: time to complete debridement, or time to complete healing. Two authors independently reviewed the abstracts and titles obtained from the search, two extracted data independently using a standardised extraction sheet, and two independently assessed methodological quality. One author was involved in all stages of the data collection and extraction process, thus ensuring continuity. Five RCTs were eligible for inclusion; all compared treatments for infected surgical wounds and reported time required to achieve a clean wound bed (complete debridement). One trial compared an enzymatic agent (Streptokinase/streptodornase) with saline-soaked dressings and reported the time to complete debridement. Four of the trials compared the effectiveness of dextranomer beads or paste with other products (different comparator

  2. New Frontiers in Surgical Innovation.

    Jackson, Ryan S; Schmalbach, Cecelia E


    It is an exciting time for head and neck surgical innovation with numerous advances in the perioperative planning and intraoperative management of patients with cancer, trauma patients, and individuals with congenital defects. The broad and rapidly changing realm of head and neck surgical innovation precludes a comprehensive summary. This article highlights some of the most important innovations from surgical planning with sentinel node biopsy and three-dimensional, stereolithic modeling to intraoperative innovations, such as transoral robotic surgery and intraoperative navigation. Future surgical innovations, such as intraoperative optical imaging of surgical margins, are also highlighted. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Late surgical complications to endophthalmitis after cataract surgery in the post-EVS era

    Solborg Bjerrum, Søren; Kiilgaard, Jens Folke; Dornonville de la Cour, Morten


    BACKGROUND: To compare the risk of surgical complications after primary surgical intervention for postoperative endophthalmitis after cataract surgery (PE) in cases that underwent a pars plana vitrectomy (PPV) or a vitreous tap (VT) in Denmark in the calendar period 1 January 2000 to 30 June 2011...

  4. Statistical modeling and recognition of surgical workflow.

    Padoy, Nicolas; Blum, Tobias; Ahmadi, Seyed-Ahmad; Feussner, Hubertus; Berger, Marie-Odile; Navab, Nassir


    In this paper, we contribute to the development of context-aware operating rooms by introducing a novel approach to modeling and monitoring the workflow of surgical interventions. We first propose a new representation of interventions in terms of multidimensional time-series formed by synchronized signals acquired over time. We then introduce methods based on Dynamic Time Warping and Hidden Markov Models to analyze and process this data. This results in workflow models combining low-level signals with high-level information such as predefined phases, which can be used to detect actions and trigger an event. Two methods are presented to train these models, using either fully or partially labeled training surgeries. Results are given based on tool usage recordings from sixteen laparoscopic cholecystectomies performed by several surgeons.

  5. Module based training improves and sustains surgical skills

    Carlsen, C G; Lindorff-Larsen, K; Funch-Jensen, P


    PURPOSE: Traditional surgical training is challenged by factors such as patient safety issues, economic considerations and lack of exposure to surgical procedures due to short working hours. A module-based clinical training model promotes rapidly acquired and persistent surgical skills. METHODS......: A randomised controlled trial concerning supervised hernia repair in eight training hospitals in Denmark was performed. The participants were 18 registrars [Post graduate year (PGY) 3 or more] in their first year of surgical specialist training. The intervention consisted of different modules with a skills......-lab course followed by 20 supervised Lichtenstein hernia repairs. Operative performance was video recorded and blindly rated by two consultants using a previously validated skills rating scale (8-40 points). Outcome measures were change in the ratings of operative skills and operative time. RESULTS...

  6. Quantifying the Aesthetic Outcomes of Breast Cancer Treatment: Assessment of Surgical Scars from Clinical Photographs

    Kim, Min Soon; Rodney, William N.; Reece, Gregory P.; Beahm, Elisabeth K.; Crosby, Melissa A.; Markey, Mia K.


    Accurate assessment of the degree of scaring that results from surgical intervention for breast cancer would enable more effective pre-operative counseling. The resultant scar that accompanies an open surgical intervention may be characterized by variance in thickness, color, and contour. These factors significantly impact the overall appearance of the breast. A number of studies have addressed the mechanical and pathologic aspects of scarring. The majority of these investigations have focuse...

  7. Surgical Management of Patients with Chiari I Malformation

    John Siasios


    Full Text Available Chiari malformations (CMs constitute a variety of four mainly syndromes (I, II, III, and IV, which describe the protrusion of brain tissue into the spinal canal through the foramen magnum. These malformations frequently occur in combination with other pathological entities such as myelomeningocele, hydrocephalus, and/or hydrosyringomyelia. The recent improvement of imaging techniques has increased not only the rate of CM diagnosis but also the necessity for its early treatment. Several different surgical techniques have been employed in the treatment of patients with symptomatic CM-I. In our current study, a systematic and critical review of the pertinent literature was made for identifying the most commonly employed surgical procedures in the management of these patients. Emphasis was given in outlining the advantages and disadvantages of each surgical approach. Moreover, an attempt was made for defining those parameters that may be prognostic factors for their surgical outcome. There is a consensus that surgical treatment is reserved only for symptomatic patients with CM-I. It has also been postulated that early surgically intervention is usually associated with better outcome. Despite the large number of previously published clinical series, further clinical research with large-scale studies is necessary for defining surgical treatment guidelines in these patients.

  8. Management of refractory atrial fibrillation post surgical ablation

    Altman, Robert K.; Proietti, Riccardo; Barrett, Conor D.; Paoletti Perini, Alessandro; Santangeli, Pasquale; Danik, Stephan B.; Di Biase, Luigi


    Over the past two decades, invasive techniques to treat atrial fibrillation (AF) including catheter-based and surgical procedures have evolved along with our understanding of the pathophysiology of this arrhythmia. Surgical treatment of AF may be performed on patients undergoing cardiac surgery for other reasons (concomitant surgical ablation) or as a stand-alone procedure. Advances in technology and technique have made surgical intervention for AF more widespread. Despite improvements in outcome of both catheter-based and surgical treatment for AF, recurrence of atrial arrhythmias following initial invasive therapy may occur.Atrial arrhythmias may occur early or late in the post-operative course after surgical ablation. Early arrhythmias are generally treated with prompt electrical cardioversion with or without antiarrhythmic therapy and do not necessarily represent treatment failure. The mechanism of persistent or late occurring atrial arrhythmias is complex, and these arrhythmias may be resistant to antiarrhythmic drug therapy. The characterization and management of recurrent atrial arrhythmias following surgical ablation of AF are discussed below. PMID:24516805

  9. A Fully Sensorized Cooperative Robotic System for Surgical Interventions

    Saúl Tovar-Arriaga


    Full Text Available In this research a fully sensorized cooperative robot system for manipulation of needles is presented. The setup consists of a DLR/KUKA Light Weight Robot III especially designed for safe human/robot interaction, a FD-CT robot-driven angiographic C-arm system, and a navigation camera. Also, new control strategies for robot manipulation in the clinical environment are introduced. A method for fast calibration of the involved components and the preliminary accuracy tests of the whole possible errors chain are presented. Calibration of the robot with the navigation system has a residual error of 0.81 mm (rms with a standard deviation of ±0.41 mm. The accuracy of the robotic system while targeting fixed points at different positions within the workspace is of 1.2 mm (rms with a standard deviation of ±0.4 mm. After calibration, and due to close loop control, the absolute positioning accuracy was reduced to the navigation camera accuracy which is of 0.35 mm (rms. The implemented control allows the robot to compensate for small patient movements.

  10. Prevertebral tendinitis: how to avoid unnecessary surgical interventions.

    Hammer, Georg Philipp; Vollmann, Robert; Tomazic, Peter Valentin; Simbrunner, Josef; Friedrich, Gerhard


    Prevertebral tendinitis is an inflammatory process that affects the cervicothoracic prevertebral muscles. Because of its clinical presentation and imaging features in computed tomography scans, prevertebral tendinitis can easily be mistaken for deep cervical abscess formation. Totally different therapy regimens require clinical and diagnostic pathways for sufficient differentiation between those two pathologic entities. Case series with comparison. In 10 patients with prevertebral tendinitis, we evaluated the symptoms, laboratory reports, and radiological imaging findings. We compared these data to 65 patients with a deep cervical abscess formation. The basic radiologic imaging procedure was contrast-enhanced computed tomography. For detection of prevertebral tendinitis, we performed magnetic resonance imaging with diffusion-weighted images and calculated the apparent diffusion coefficient map. Patients with prevertebral tendinitis complained of severe neck pain, globus sensation, and neck stiffness. Diffusion-weighted images showed a typical benign prevertebral effusion. Computed tomography scans showed amorphous calcifications in the tendon of the prevertebral muscles. The C-reactive protein values were slightly increased in patients with prevertebral tendinitis, and white blood cell count remained normal. In comparison to patients with deep cervical abscess formation, the C-reactive protein and white blood cell count was significantly lower (P tendinitis cases. Prevertebral tendinitis should be considered when patients suffer from neck pain, neck stiffness, and globus sensations despite low signs of inflammation in the laboratory report. To confirm the diagnosis, the best imaging feature is magnetic resonance imaging with diffusion-weighted images and apparent diffusion coefficient map. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  11. Colo-vesical fistula: Complete healing without surgical intervention


    INTRODUCTION Colo-vesical (CV) fistulae are the most common type of fistulae associated with diverticular disease. Surgery remains the mainstay of treatment, without which, CV fistulae rarely achieve complete healing. PRESENTATION OF CASE Herein, we report the case of a 62-year-old man who developed a CV fistula after reversal of Hartmann's procedure (initially for management of diverticular abscess), which healed with conservative management alone. DISCUSSION We discuss possibilities of the ...

  12. Surgical interventions and studies of the carotid sinus

    Toorop, R.J.


    Background: The carotid baroreflex buffers acute changes in blood pressure and is triggered by baroreceptors in the carotid sinus. Baroreceptor firing results in an increased parasympathetic tone and a decreased sympathetic tone leading to reduced heart rate and blood pressure. Under normal conditio

  13. What happens after a single surgical intervention for hidradenitis suppurativa?

    Jemec, Gregor B E; Guérin, Annie; Kaminsky, Michael


    Objective Hidradenitis suppurativa (HS) is often treated by surgery. The risk of recurrence after surgery is common and the consequences are substantial, but neither has been quantified using a claims database. This study aimed to estimate the burden associated with non-curative surgery in HS...

  14. A Fully Sensorized Cooperative Robotic System for Surgical Interventions

    Tovar-Arriaga, Saúl; Vargas, José Emilio; Ramos, Juan M.; Aceves, Marco A.; Gorrostieta, Efren; Kalender, Willi A.


    In this research a fully sensorized cooperative robot system for manipulation of needles is presented. The setup consists of a DLR/KUKA Light Weight Robot III especially designed for safe human/robot interaction, a FD-CT robot-driven angiographic C-arm system, and a navigation camera. Also, new control strategies for robot manipulation in the clinical environment are introduced. A method for fast calibration of the involved components and the preliminary accuracy tests of the whole possible errors chain are presented. Calibration of the robot with the navigation system has a residual error of 0.81 mm (rms) with a standard deviation of ±0.41 mm. The accuracy of the robotic system while targeting fixed points at different positions within the workspace is of 1.2 mm (rms) with a standard deviation of ±0.4 mm. After calibration, and due to close loop control, the absolute positioning accuracy was reduced to the navigation camera accuracy which is of 0.35 mm (rms). The implemented control allows the robot to compensate for small patient movements. PMID:23012551

  15. [Duane vertical surgical treatment].

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


    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.

  16. Diverticulitis: selective surgical management.

    Rugtiv, G M


    The surgical treatment of complications of diverticulitis remains most challenging. A review of twenty years' experience with one hundred fifteen cases is presented with one proved anastomotic leak and no deaths. Interval primary resection with anastomosis for chronic recurrent disease including colovesical fistula and mesocolic abscess was proved sate with low morbidity. The three-stage procedure for perforated diverticulitis with spreading peritonitis or pericolic abscess was associated with a high rate of complications and morbidity. An aggressive approach with resection without anastomosis in two stages is indicated.

  17. Interventional treatments for hepatocellular carcinoma

    Yong-Song Guan; Yuan Liu


    BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most frequent primary malignant tumors in the world. Hepatic resection and liver transplantation are considered optimal for potential treatment of HCC. However, only 20%of HCCs can be surgically treated. And most of surgically-noneligible patients have to receive interventional managements including local ablation and transarterial chemoembolization (TACE). In this paper, we review the interventional treatments of HCC. DATA SOURCES:A literature search of PubMed database was conducted and research articles were reviewed. RESULTS: Percutaneous ethanol injection (PEI) is usually applied to small HCC for a complete necrosis. Radiofrequency ablation, an alternative to PEI, also causes tumor necrosis and needs fewer times of ablation. Other methods such as acetic acid injection, laser, microwave, etc have enriched local ablation for HCC. High intensity focus ultrasound (HIFU) is thought to be promising. TACE, another common modality, can improve the survival rate of patients with HCC. The newly developed embolic agents and adjuvant rAd-p53 gene therapy are well reported. CONCLUSIONS:Surgically-noneligible HCC can be treated with interventional procedures. Each method has its advantages and disadvantages. However, it is still pressing to develop ablative methods as well as new embolic agents for a better prognosis of HCC.

  18. Uterine artery embolization: The interventional treatment of female genital diseases

    Lee, Woong Hee [Dept. of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of); Yang, Seung Boo [Dept. of Radiology, Soonchunhyang University Gumi Hospital, Gumi (Korea, Republic of); Goo, Dong Erk; Kim, Yong Jae [Dept. of Radiology, Soonchunhyang University Seoul Hospital, Seoul (Korea, Republic of); Lee, Jae Myeong [Dept. of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Kang, Chae Hoon [Dept. of Radiology, Gangneung Asan Hospital, Gangneung (Korea, Republic of); Ohm, Joon Young [Dept. of Radiology, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon (Korea, Republic of); Kim, Young Jun [Dept. of Radiology, Presbyterian Medical Center, Jeonju (Korea, Republic of)


    The uterus is the major female sex organ and is essential for pregnancy. The organ is located in the pelvic cavity. It is usually fist-sized with its volume changing from 75 to 200 cc depending on the menstrual cycle. There are various diseases associated with the uterus, including malignancy, uterine myoma, postpartum hemorrhage, and vascular malformation. The conventional surgical treatment for these diseases is hysterectomy. However, hysterectomy has some risk, and there may be complications associated with the surgery and anesthesia. In addition, hysterectomy results in loss of fertility and loss of female characteristics, both of which may lead to emotional problems. After uterine artery embolization (UAE) was performed for post-partum bleeding in 1979 and for uterine myoma in 1995, interventional treatment of UAE replaced the existing surgical treatment of hysterectomy. UAE is performed widely as a minimally invasive treatment modality that can preserve the uterus, make pregnancy and childbirth possible and resolve emotional problems. The interventional treatment has become increasingly popular to treat various female genital diseases.

  19. Nursing intervention of incision specialist nurse on with surgical incisions of diabetic patients with gastric carcinoma%伤口专科护士对胃癌合并糖尿病患者手术切口的护理干预

    李琴; 徐亚香; 张倩


    目的:探讨伤口专科护士对胃癌合并糖尿病患者切口护理干预效果。方法:对56例胃癌合并糖尿病患者采用伤口专科护士参与管理的方式进行护理。评价患者术后切口感染率和平均住院日。结果:患者术后切口感染率5.36%,平均住院时间(9.03±3.80)d。结论:伤口专科护士的护理干预,可降低胃癌合并糖尿病患者的切口感染率,缩短平均住院日,促进患者康复。%Objective:To discuss the effect of enterostomal therapists′intervention with surgical incisions of diabetic patients with gastric carcinoma .Meth-ods:56 patients with diabetic complication gastric carcinoma cared with wound specialist nurse .To evaluate infection rate of patients′postoperative incisions and their average length of stay.Results:The infection rate of postoperative incisions was 5.36%,and average inhospital time was(9.03 ±3.80) days.Con-clusion:With the nursing of wound specialist nurse,the infection rate of incisions of diabetic patients with gastric carcinoma is effectively decreased ,reduced the average length of stay and promote the rehabilitation of patients .

  20. [Surgical treatment of patients for abdominal sepsis].

    Kryvoruchko, I A; Usenko, O Iu; Andreieshchev, S A


    Results of surgical treatment of 201 patients, suffering abdominal sepsis (AS), which have occurred after operations on abdominal organs, were analyzed. Expediency of application of modern scales for the patients state severity estimation, prognostic sign-posts and dynamic of the pathological process course in every patient was substantiated. Existing systems of prognostication (APACHE II, SOFA, MODS) are applied restrictedly for diagnosis of infection in patients, what demands relaparotomy performance in presence of clinical signs of intraabdominal infection, which persists. For prognostication of the treatment result and determination of indications for relaparotomy conduction in patients, suffering severe AS and infectious-toxic shock (ITSH), the most informative is application of the Manheim's index of peritonitis together with analysis of clinico-laboratory indices for formation of groups of patients in risk, to whom reoperation is indicated. Advantages of relaparotomy "on demand" conduction were proved in comparison with "programmed" relaparotomy during the staged surgical treatment of patients, suffering severe AS and ITSH. Complex surgical treatment with substantiation of indications and choice of adequate method of intervention secures improvement of the treatment results in these severely ill patients.


    A. V. Zaletina


    Full Text Available Objective: to develop the surgical treatment of patients with congenital metacarpal synostosis. Material and methods. 65 operations were performed in 58 children. with congenital metacarpal synostosis. Surgical intervention was determined by the localization of congenital metacarpal synostosis and the presence of concomitant deformities. Results. Excellent and good results were observed in 69,4% (33 hands cases, satisfactory - in 30,6% (15 hands, unsatisfactory results were not obtained. At the same time excellent results were obtained in patients with less severe variants of metacarpal synostosis, good treatment results were observed in children with more severe associated abnormalities, as well as in cases where the correction is not performed metacarpal shortening. Overall, the results were significantly (p <0,05 better after application of advanced methods, including correction of all components of the strain. Satisfactory results were found out in patients with severe comorbidity, a total fusion of the metacarpal bones and fingers, the total PPS. Conclusions. Surgical treatment options for all congenital metacarpal synostosis should be individualized and be concluded in the performance of bone and plastic surgery to remove metacarpal synostosis and related deformities.

  2. Preventing surgical site infection. Where now?

    Humphreys, H


    Surgical site infection (SSI) is increasingly recognised as a measure of the quality of patient care by surgeons, infection control practitioners, health planners and the public. There is increasing pressure to compare SSI rates between surgeons, institutions and countries. For this to be meaningful, data must be standardised and must include post-discharge surveillance (PDS) as many superficial SSIs do not present to the original institution. Further work is required to determine the best method of conducting PDS. In 2008 two important documents on SSI were published from the Society for Healthcare Epidemiology of America\\/The Infectious Disease Society of America and the National Institute for Health and Clincal Excellence, UK. Both emphasise key aspects during the preoperative, operative and postoperative phases of patient care. In addition to effective interventions known to be important for some time, e.g. not shaving the surgical site until the day of the procedure, there is increasing emphasis on physiological parameters, e.g. blood glucose concentrations, oxygen tensions and body temperature. Laparoscopic procedures are increasingly associated with reduced SSI rates, and the screening and decontamination of meticillin-resistant Staphylococcus aureus carriers is effective for certain surgical procedures but has to be balanced by cost and the risk of mupirocin resistance. Finally, there is a need to convert theory into practice by the rigorous application of SSI healthcare bundles. Recent studies suggest that, with a multidisciplinary approach, simple measures can be effective in reducing SSI rates.

  3. [Neuronavigation in the surgical planning of callosotomy].

    Valencia Calderón, Carlos; Castro Cevallos, Alfredo; Calderón Valdiviezo, Ana; Escobar Dávila, Roberto; Parra Rosales, Fausto; Quispe Alcocer, Julio; Vásquez Hahn, Catalina


    To describe the usefulness of 3D computer-assisted preoperative neuronavigation for stereoscopic location of the venous sinuses, arterial branches, and corpus callosum, to extrapolate anatomical landmarks on the surgical field and make decisions before the intervention. A prospective analysis was performed on patients with refractory epilepsy who underwent neuronavigation-assisted callosotomy (BRAIN LAB Dual). A total of 10 neuronavigation-assisted callosotomies were performed in the year 2014. The ages of the patients (4 males and 6 females) were between 4 and 13 years (mean 7; SD 3.02). The most common indication for callosotomy in our sample was Lennox Gastoux (5 patients). A right parasagittal craniotomy was performed in 8 patients. An anterior two-thirds callosotomy was performed in 8 patients and anterior three-quarters in 2 patients. The mean accuracy of the neuronavigation procedure was less than 2mm. In no cases were there significant intraoperative surgical complications. Callosotomy using frameless guided neuronavigation is an accurate and safe technique in patients with epilepsy refractory to surgical resection. Copyright © 2015 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  4. Interventional radiology

    Steinbrich, W. (ed.) (Basel Univ. (Switzerland). Inst. fuer Medizinische Radiologie); Gross-Fengels, W. (ed.) (Allgemeines Krankenhaus Harburg, Hamburg (Germany). Abt. fuer Klinische Radiologie)


    In interventional radiology adjunctive medical therapy can increase patient's comfort, and should further reduce the risks of the procedures. In order to fulfill the responsibility of the interventionist to the patients and to increase the success rate of the interventions, a profound knowledge of certain drugs is indispensable. This includes, for example, sedatives, analgesics, cardiovascular drugs and agents to prevent infections, thromboembolic complications or restenoses. Moreover, a good monitoring system during complex procedures will increase the safety of radiological interventions. These topics and several more are presented in this book. (orig.). 32 figs.

  5. Influence of surgical sutures on wound healing

    Mirković Siniša


    Full Text Available Historical data on closing and suturing of surgical wounds describe a wide range of various suture materials. The choice of the surgical catgut, i.e. the type and diameter, depends on the locality, characteristics and condition of the tissue to be treated. From the standpoint of oral-surgical practice the following clinical parameters are of outstanding importance with respect to the selection of suture material: accumulation of soft deposits on the sutures, score of the adjacent soft tissues and dehiscence of the operative wound. Our prospective clinical study included 150 patients distributed into three groups of 50 subjects. The surgical procedure performed on each patient involved resection (apicotomy of the tooth root end in the intercanine sector of the upper jaw. The following suture materials were applied: Black Silc 5-0, Nylon 5-0 and Vicryl 5-0. The effects of the selected sutures were evaluated according to the wound dehiscence. The effects of the applied sutures were recorded on Days 2, 5 and 7 after the surgery. The comparison of cited parameters of the investigated materials after suturing the oral mucosa revealed that none of the used material was ideal; however, a certain advantage might be given to the synthetic monofilament suture materials.

  6. Minimally invasive surgical technique for tethered surgical drains

    Shane R Hess


    Full Text Available A feared complication of temporary surgical drain placement is from the technical error of accidentally suturing the surgical drain into the wound. Postoperative discovery of a tethered drain can frequently necessitate return to the operating room if it cannot be successfully removed with nonoperative techniques. Formal wound exploration increases anesthesia and infection risk as well as cost and is best avoided if possible. We present a minimally invasive surgical technique that can avoid the morbidity associated with a full surgical wound exploration to remove a tethered drain when other nonoperative techniques fail.

  7. Arm rotated medially with supination – the ARMS variant: description of its surgical correction

    Melcher Sonya E


    Full Text Available Abstract Background Patients who have suffered obstetric brachial plexus injury (OBPI have a high incidence of musculoskeletal complications stemming from the initial nerve injury. The presence of muscle imbalances and contractures leads to typical bony changes affecting the shoulder, including the SHEAR (Scapular Hypoplasia, Elevation and Rotation deformity. The SHEAR deformity commonly occurs in conjunction with Medial Rotation Contracture (MRC of the arm. OBPI also causes muscle imbalances at the level of the forearm, that lead to a fixed supination deformity (SD in a small number of patients. Both MRC and SD will cause severe functional limitations without surgical intervention. Methods Fourteen OBPI patients were diagnosed with MRC of the shoulder and SD of the forearm along with SHEAR deformity during a 16 month study period, with eight patients available to long-term follow-up (age range 2.2 – 18 years. Surgical correction of the MRC was performed as a triangle tilt or humeral osteotomy depending on the age of the child, after which, the patients were treated with a radial osteotomy to correct the fixed supination deformity. Function was assessed using the modified Mallet scale, examination of apparent supination and appearance of the extremity at rest. Results Significant functional improvements were observed in patients with surgical reconstruction. Mallet score increased by an average of 5.2 (p Conclusion The simultaneous presence of two opposing deformities in the same limb will visually offset each other at the level of the wrist and hand, giving the false impression of neutral positioning of the limb. In reality, the neutral-appearing position of the hand indicates a fixed supination posture of the forearm in the face of a medial rotation contracture of the shoulder. Both of these deformities require surgical attention, and the presence of concurrent MRC and SD should be monitored for in OBPI patients.

  8. Diffusion tensor tractography for the surgical management of peripheral nerve sheath tumors.

    Schmidt, Manfred; Kasprian, Gregor; Amann, Gabriele; Duscher, Dominik; Aszmann, Oskar C


    OBJECT Peripheral nerve sheath tumors (PNSTs) are uncommon but bear a significant risk of malignancy. High-resolution MRI is the standard technique for characterizing PNSTs. However, planning the appropriate extent of resection and subsequent reconstructive strategies is highly dependent on the intraoperative findings because preoperative MRI evaluation can be insufficient. Diffusion tensor tractography (DTT) represents a recently developed advanced MRI technique that reveals the microstructure of tissues based on monitoring the random movement of water molecules. DTT has the potential to provide diagnostic insights beyond conventional MRI techniques due to its mapping of specific fibrillar nerve structures. Here, DTT was applied to evaluate PNSTs and to examine the usefulness of this method for the correct delineation of tumor and healthy nerve tissue and the value of this information in the preoperative planning of surgical interventions. METHODS In this prospective study, patients with the clinical symptoms of a PNST were investigated using DTT 3-Tesla MRI scans. Image data processing and tractography were performed using the FACT (fiber assessment by continuous tracking) algorithm and multiple-regions-of-interest approach. The surgical findings were then compared with the results of the DTT MRI scans. Preoperative fascicle visualization and the correlation with the intraoperative findings were graded. RESULTS In a 21-month period, 12 patients with PNSTs were investigated (7 female and 5 male patients with a mean age of 46.2 ± 19.2 years). All patients underwent surgical removal of the tumor. Schwannoma was the most common benign histopathological finding (n = 7), whereas 2 malignant lesions were detected. In 10 of 12 patients, good preoperative nerve fascicle visualization was achieved using DTT scans. In 9 of 10 patients with good preoperative fascicle visualization, good intraoperative correlation between the DTT scans and surgical anatomy was found

  9. Iatrogenic Femoral Pseudoaneurysm and Secondary Ipsilateral Deep Vein Thrombosis: An Indication for Early Surgical Exploration.

    Papadakis, Marios; Zirngibl, Hubert; Floros, Nikolaos


    Pseudoaneurysm formation often complicates transfemoral interventional procedures. Nonsurgical treatment consists of femoral compression and thrombin injection under ultrasound guidance. We report a 74-year-old man who was diagnosed with a pseudoaneurysm, following coronary angiography. Duplex ultrasound revealed deep vein thrombosis of the ipsilateral common femoral vein. Ultrasound-guided thrombin injection was unsuccessfully performed, and the patient subsequently underwent surgical exploration for repair of the pseudoaneurysm and release of the venous compression. The increased local inflammation, because of the thrombosis, added in surgical difficulties. We conclude that early surgical intervention should be considered as a primary strategy in patients with femoral pseudoaneurysms and deep vein thrombosis secondary to femoral compression.


    N. V. Merzlikin


    Full Text Available Objective: a comparative analysis of the results of the use of different surgical methods of treatment of patients with formed pancreatic cysts.Material and methods. 108 patients with formed pancreatic cysts were treated and analysis of shortand long-term results of their surgical treatment was performed. Patients were divided into three groups depending on the type of surgical intervention: I – external drainage – 44 (40.7%, II – internal drainage –33 (30.6%, III – resection operations – 31 (28.7%.Results and discussions. Marsupialization of cyst by laparotomy incision was performed in patients of I group (n = 44. 18 (40.9% complications, 9 (20.5% lethal cases were after operation. Anastomoses of cysts with the small intestine were mostly performed in II group (n = 33 – 21 (63.6%. 7 (21.2% complications, 1 (3.0% lethal case were after operation. Distal resections were performed in patients of III group (n = 31 in 16 (51.6% cases. Duodenum-preserving resections were introduced for treatment of cyst of pancreas head – 12 (38.7%. When performing this type of operations we proposed nikelid titanium stents for the prevention of anastomosis stenosis and preoperative retrograde stenting of the common bile duct for the prevention of damage. 10 (32.3% complications and no lethal cases were after operation. Immediate results were worse in patients of I group. 47 (43.5% patients were analyzed in long-term period. The number of recurrences of the disease (13.3% and long-term mortality (33.3% prevailed in the group of patients undergoing internal drainage of cysts. Quality of life, level of mental and physical health, that was assessed using SF-36, were higher in group of patients with reactionary treatment.Conclusion. The best immediate and long-term results were noted after resection operations, that enables to recommend their as the most optimal and radical method for treatment of patients with pancreatic cysts. Introducing of duodenum

  11. Analysis of exfoliated gastric carcinoma cells attached on surgical supplies

    Yu XF


    Full Text Available Xiao-Fen Yu,1 Ying-Yu Ma,2 Xian-Qin Hu,1 Qin-Fang Zhang,1 Zai-Yuan Ye3 1Operating Theatre, Zhejiang Provincial People’s Hospital, 2Key Laboratory of Gastroenterology of Zhejiang Province, Zhejiang Provincial People’s Hospital, 3Department of Gastrointestinal Surgery, Zhejiang Provincial People’s Hospital, Hangzhou, People’s Republic of China Abstract: Surgery is considered to have a leading role in the treatment of gastric carcinoma. Surgical supplies are used to cut, divide, and ligate during surgery, and are not only in close contact with normal tissues, but may also be contaminated by pathological tissues and cells. This study sought to determine the presence of exfoliated tumor cells on surgical supplies at different stages during the surgical procedure. We collected five types of surgical supplies from 90 patients who underwent D2 radical gastrectomy to find out if there was any cancer cells attached to them. Highest numbers of cancer cells were found on gauze used to clean the surgical instruments and on the gloves of scrub nurses. The likelihood of finding cancer cells increased with advancing clinical stage of disease, lower differentiation of cancer cells, increasing frequency of use of supplies and extent of contact, and was also associated with the characteristic of surgical supplies. Dissemination of tumor cells could be prevented by using a number of methods, depending on the type of surgical supply items. Keywords: exfoliated tumor cells, surgical supplies, gastric carcinoma, metastasis, prevention

  12. Surgical options for the management of visceral artery aneurysms.

    Van Petersen, A; Meerwaldt, R; Geelkerken, R; Zeebregts, C


    Visceral artery aneurysm (VAA) is a rare entity but increased use of abdominal imaging has led to an increased prevalence. Rupture is related to a high mortality rate. Open repair, endovascular treatment and laparoscopic techniques have been described as treatment options. In this systematic review we describe the surgical options for treating VAA. A literature search identified articles focussing on the key issues of visceral artery aneurysms and surgical options using the Pubmed and Cochrane databases. Case reports dominate the literature about VAA. Twenty-seven small case series and ten review articles have been published in the last 20 years concerning the surgical options for VAA. The evidence does not exceed level 3. Surgical treatment is dictated by both patient and aneurysm characteristics. Whether VAA should be treated largely depends upon age, gender, presence of hypertension (e.g. in renal aneurysm), aneurysm size and presentation. Aneurysm size and characteristics, anatomical location and presence of collateral circulation dictate the surgical option to be chosen. The mortality and morbidity rates after elective open repair are low. Literature about surgical options for treating VAA remains scarce. Only a few clinical trials have shown the possibilities and results of open surgical repair. In general, there is no consensus on the surgical treatment of VAA and the highest level of evidence is based upon expert opinions.

  13. [Clinical manifestation and surgical treatment of superior lumbar disc herniation].

    Klishin, D N; Dreval', O N; Gorozhanin, A V


    On the basis of analysis of presentation and surgical treatment of 103 patients with lumbar disc herniation the authors performed comparative assessment of symptoms and therapeutic techniques in patients with higher and lower lumbar disc disease. Short-term and long-term results were evaluated using visual analogue scale and Oswestry disability index (ODI). Statistically significant differences in dynamics of pain and ODI were not present. In spite of differences in clinical presentation, the results of surgical treatment in both groups were similar. They depended on severity of preoperative neurological deficit regardless of level of lesion. Specific features of surgical procedure in superior lumbar disk herniation are described.

  14. Extra-Pulmonary Tuberculosis and Its Surgical Treatment.

    Fry, Donald E


    Tuberculous infection has declined in the United States but remains a major infectious disease with morbidity and death for millions of people. Although the primary therapy is drugs, complications of the disease require surgical interventions. The published literature on tuberculosis was reviewed to provide a current understanding of the medical treatment of the disease and to define those areas where surgical intervention continues to be necessary. Multi-drug therapy for tuberculosis has become the standard and has reduced the complications of the disease necessitating surgical intervention. However, multi-drug resistance and extensively drug-resistant tuberculosis continue to be major problems and require effective initial therapy with surveillance to define resistant infections. The roles of surgery in tuberculosis are in establishing the diagnosis in extra-pulmonary infection and in the management of complications of disseminated disease. Tuberculosis remains an occupational risk for surgeons and surgical personnel. Tuberculosis is still a global problem, mandating recognition and treatment. Surgeons should have an understanding of the diverse presentation and complications of the disease.


    S. V. Pavlyuchenko


    Full Text Available The present review addresses a pressing orthopaedic issue of surgical treatment for patients with severe foot deformities occurring as consequence to Charcot neuroarthropathy. Described pathology is a severe threatening condition causing high risk of infections and potential limb loss. The paper describes main foot reconstructive procedures employed depending on pathology stage and localization as well as identifies ways to improve surgical treatment of affected patients.

  16. Elderly diabetic patient with surgical site mucormycosis extending to bowel

    Atul K Patel


    Full Text Available Mucormycosis is rare in clinical practice. Most infections are acquired by inhalation; other portals of entry are traumatic implantation and ingestion in immunocompromised host. Mucormycosis is life threatening infection in immunocompromised host with variable moratlity ranging from 15 -81% depending upon site of infection. General treatment principles include early diagnosis, correction of underlying immunosuppression and metabolic disturbances, adequate surgical debridement along with amphotericin therapy. We describe surgical site mucormycosis extended to involve large bowel in elderly diabetic patient.

  17. [Acute appendicitis. Surgical and non-surgical treatment].

    Souza-Gallardo, Luis Manuel; Martínez-Ordaz, José Luis


    Appendicitis represents a common disease for the surgeon with a relative risk between 7-8%. It was thought that if more time passed between diagnosis and treatment, the risk for complications, such as perforation or abscess formation, was higher; nevertheless; the evolution is variable, making necessary the development of different strategies such as antibiotic use only, interval surgery or endoscopic treatment. The purpose of this study is to make a revision in the management of appendicitis comparing conservative and surgical treatment. It is known that traditional management of appendicitis is appendectomy with a complication rate of 2.5% to 48%. Nowadays, laparoscopy is the approach of choice by many surgeons and there have proposed new invasive techniques such as endoscopic treatment with the use of prosthesis and ambulatory surgery. Antibiotic use is essential in the management of appendicitis. Its use as the only strategy to treat this disease has the purpose of lowering costs and diminishing complications related to surgery or the resection of the organ. We conclude that the ideal management of appendicitis remains controversial and it will depend of the clinical characteristics of each patient and the resources available.

  18. Surgical aspects of intestinal tuberculosis in children: Our experience

    Bilal Mirza


    Full Text Available Background: Tuberculosis (TB is a major health problem in resource-constrained countries. Intestinal TB is especially notorious as a number of cases have to be dealt surgically, which too have morbidity and mortality. This study was conducted to identify various presentations of intestinal TB necessitating surgical intervention, their management, complications, and outcome in our hospital. Materials and Methods: This was a retrospective study carried out at the Department of Paediatric Surgery, The Children′s Hospital and The Institute of Child Health Lahore, Pakistan, from December 2007 to January 2010. The information about the demography, clinical presentations, investigations, management performed, complications encountered, and outcome of patients with intestinal TB were reviewed. Results: There were a total of 18 patients with intestinal TB who were managed surgically during this period. Five were male and 13 female patients (M : F 1 : 2.6. Mean age of presentation was 8.3 years. Clinical presentations were acute peritonitis in 7 patients, pneumoperitoneum in 5 patients, complete intestinal obstruction in 4 patients, pain in right iliac fossa in 2 patients, and irreducible inguinal hernia in 1 patient. Four patients had concurrent pulmonary TB. Surgical interventions included primary repair of perforation in one, repair of perforation with diversion ileostomy in 8, and merely peritoneal drainage (haemodynamically unstable patients in 3 patients. The post-operative complications were high output ileostomy in 3, faecal fistula in 1, wound dehiscence in 3, wound infection 5, and prolonged ileus in 1 patient. In three patients stoma was reversed during the same admission. There was one expiry in our study. Conclusion: Acute peritonitis, intestinal obstruction and intestinal perforation are the main clinical presentations requiring surgical interventions. Optimal surgical strategy should be adopted to avoid such pitfalls in the management.

  19. Tophi - surgical treatment.

    Słowińska, Iwona; Słowiński, Radosław; Rutkowska-Sak, Lidia


    Gout is an inflammatory joint disease associated with deposition of monosodium urate crystals in the bones forming the joints, in periarticular tissues and in other organs. The disease is one of the most frequent causes of disability. This paper presents the case of a 57-year-old male patient treated for generalised gout. A "clinical mask" suggesting another disease was the cause of making the correct diagnosis only six years after the occurrence of the first manifestations. The patient, with high values of inflammatory markers, severe pain and advanced joint destruction, was given an aggressive anti-inflammatory treatment. The unsatisfactory effect of the conservative treatment forced the authors to perform surgical resection of the gouty nodules in the hands. After several operations the function of the hand joints operated on, appearance of the hands and the quality of the patient's life improved significantly.

  20. Tophi – surgical treatment

    Słowińska, Iwona; Słowiński, Radosław


    Gout is an inflammatory joint disease associated with deposition of monosodium urate crystals in the bones forming the joints, in periarticular tissues and in other organs. The disease is one of the most frequent causes of disability. This paper presents the case of a 57-year-old male patient treated for generalised gout. A “clinical mask” suggesting another disease was the cause of making the correct diagnosis only six years after the occurrence of the first manifestations. The patient, with high values of inflammatory markers, severe pain and advanced joint destruction, was given an aggressive anti-inflammatory treatment. The unsatisfactory effect of the conservative treatment forced the authors to perform surgical resection of the gouty nodules in the hands. After several operations the function of the hand joints operated on, appearance of the hands and the quality of the patient’s life improved significantly. PMID:27994273

  1. Neuronavigation. Principles. Surgical technique.

    Ivanov, Marcel; Ciurea, Alexandru Vlad


    Neuronavigation and stereotaxy are techniques designed to help neurosurgeons precisely localize different intracerebral pathological processes by using a set of preoperative images (CT, MRI, fMRI, PET, SPECT etc.). The development of computer assisted surgery was possible only after a significant technological progress, especially in the area of informatics and imagistics. The main indications of neuronavigation are represented by the targeting of small and deep intracerebral lesions and choosing the best way to treat them, in order to preserve the neurological function. Stereotaxis also allows lesioning or stimulation of basal ganglia for the treatment of movement disorders. These techniques can bring an important amount of confort both to the patient and to the neurosurgeon. Neuronavigation was introduced in Romania around 2003, in four neurosurgical centers. We present our five-years experience in neuronavigation and describe the main principles and surgical techniques.

  2. Surgical education in Mexico.

    Cervantes, Jorge


    Surgical education in Mexico basically follows the same model as in the United States, with a selection process resembling the matching program. There is a 4-year training period during which residents in their third year spend 4 months as the sole surgeon in a rural community. During the senior year they are entitled to an elective period in a place of their choosing. After completion of the 4 years, residents have to present a thesis and undergo an oral examination before getting a university diploma. They are then encouraged to pass the written and oral examination of the Mexican Board of Surgery before they are fully certified to enter practice in a public or private hospital.

  3. Effect of Vacuum Sealing Drainage Combined with Personalized Psychological Care Intervention on Surgical Patients with Refractory Wound%负压封闭引流技术结合个性化心理护理干预对外科创面难愈患者的影响



    Objective To investigate the effect of vacuum sealing drainage combined with personalized psychological care intervention on surgical patients with refractory wound.Methods 126 cases with refractory wound were selected as the subjects and divided into the personalized nursing group (group A,n=66) and control group (group B,n=60) in accordance with the order of admission, and given the corresponding nursing respectively after vacuum sealing drainage.The skin graft healing time, length of stay, NRS score and other wound recovery indexes were compared between the two groups.The SAS and SDS scores before and after intervention and other bad mood improvement of the two groups were analyzed. And the incidence of wound bleeding, wound infection, semipermeable membrane effusion and other complications in the two groups were recorded.Results ①The postoperative skin graft healing time and hospitalization time were much shorter and pain assessment was significantly lower in group A than that in group B, respectively(0.05).Conclusion For patients with refractory wound, vacuum sealing drainage combined with personalized psychological care intervention can effectively ameliorate the negative emotions, enhance the treatment compliance and improve the prognosis, so it is worthy of clinical promotion.%目的:探讨负压封闭引流技术结合个性化心理护理干预对外科创面难愈患者的影响。方法选取126例难愈性创面患者为研究对象,根据其入院顺序分成个性化护理组(A组,n=66)和对照组(B组,n=60)两组,均在负压封闭引流治疗后予以相应护理干预措施。比对两组患者在植皮愈合时间、住院时间、NRS评分等创面恢复指标上的差异,分析其干预前后SAS评分及SDS评分等不良情绪改善情况,记录其创面出血、创面感染、半透膜下积液等并发症发生风险。结果①A组术后植皮愈合时间、总住院时间及疼痛评估结果均明显低于B组(P0.05)。结论对难

  4. Categorization of cerebrovascular intervention methods

    Wenxin Zhao; Gelin Xu; Xinfeng Liu


    BACKGROUND: Cerebrovascular intervention is a medical strategy to diagnose and treat cerebrovascular disease by intravascular intervention techniques. With the continual developments of computer technology, imageology, and angiography, cerebrovascular intervention techniques have developed rapidly.OBJECTIVE: To summarize and to evaluate vascular imaging diagnostic techniques, vascular intra-arterial thrombolysis, vascular intra-arterial angioplasty, and vascular embolization in clinical applications.RETRIEVAL STRATEGY: An online search was conducted in PubMed for English language reports, published from January 2002 to January 2008, containing the key words: intervention therapy, cerebral vascular disease, endovascular intervention and angioplasty. A total of 57 publications were identified. Inclusion criteria: articles about cerebrovascular intervention for cerebrovascular disease; articles published either in high impact factor journals or in recent years. Exclusion criteria: duplicated articles.LITERATURE EVALUATION: 30 articles were identified concerning intravascular intervention techniques and arterial angioplasty. Of those, 7 articles were reviews and 23 were clinical or basic studies.DATA SYNTHESIS: Carotid artery and basilar artery stenosis were important etiological factors for ischemic cerebrovascular disease. The mechanism of stenosis induction included atherosclerotic plaque exfoliation and stenosis could cause hemodynamic changes to induce cerebral infarction. Therefore, the treatment of carotid artery and basilar artery stenosis played a key role in preventing ischemic cerebral infarction. The international organization for subarachnoid hemorrhage aneurysm has conclusively shown that both relative and absolute risk factors of intravascular embolotherapy were reduced compared to those of surgical occlusion, demonstrating the important role of vascular embolization for the treatment of intracranial aneurysm. Endovascular stents were placed into the

  5. Pictorial essay: Interventional radiology in the management of hemodialysis vascular access - A single-center experience

    Suraj Mammen


    Full Text Available Chronic kidney disease (CKD is a worldwide public health problem and is associated with high morbidity and mortality. The majority of patients with CKD stage 5 (CKD-5, who cannot undergo renal transplant, depend on maintenance hemodialysis by surgically created access sites. Native fistulae are preferred over grafts due to their longevity. More than half of these vital portals for dialysis access will fail over time. Screening procedures to select high-risk patients before thrombosis or stenosis appears have resulted in aggressive management. These patients are referred for angiographic evaluation and/or therapy. We present the patterns of dialysis-related interventions done in our institution.

  6. Transoral endoscopic-assisted styloidectomy: How should Eagle syndrome be managed surgically?

    Al Weteid, A S; Miloro, M


    Eagle syndrome, or calcification of the stylohyoid ligament, is a rare condition that may present a clinical diagnostic dilemma for those unfamiliar with its existence and its typical presenting signs and symptoms. Management of this disease process may involve either non-surgical or surgical treatment options. When surgery is indicated, the choice of a specific surgical modality is highly variable and is generally dependent upon individual surgeon preference and experience, since the location of the styloid process is consistent between patients, and the required surgical access is also similar depending upon the specific surgical plan. This paper reports a case of Eagle syndrome managed with a transoral endoscopic-assisted approach, explores the advantages and disadvantages of each surgical approach, and reviews the literature regarding surgical management options for Eagle syndrome.

  7. Hormonal and Surgical Treatment Options for Transgender Women and Transfeminine Spectrum Persons.

    Wesp, Linda M; Deutsch, Madeline B


    Transgender women and other transfeminine spectrum people may pursue hormonal and/or surgical gender-affirming interventions. Hormone therapy includes androgen blockade and estrogen supplementation. Approaches to hormone treatment vary widely based on patient goals and physiology. Surgical procedures are available, including genital affirmation surgery, breast augmentation, and head or neck feminization procedures. Many people are unable to obtain surgeries owing to prohibitive costs and long waiting lists. Hormonal and surgical therapies improve quality of life and mental health with minimal adverse effects. Ongoing research is needed to improve understanding about specific risks of hormone therapy and surgical outcomes.

  8. A surgical approach in the management of mucormycosis in a trauma patient.

    Zahoor, B A; Piercey, J E; Wall, D R; Tetsworth, K D


    Mucormycosis as a consequence of trauma is a devastating complication; these infections are challenging to control, with a fatality rate approaching 96% in immunocompromised patients. We present a case where a proactive approach was successfully employed to treat mucormycosis following complex polytrauma. Aggressive repeated surgical debridement, in combination with appropriate antifungal therapy, proved successful in this instance. In our opinion, mucormycosis in trauma mandates an aggressive surgical approach. This prevents ascending dissemination of mucormycosis and certainly reduces the risk of patient mortality as a direct result. Anti-fungal therapy should be used secondarily as an adjunct together with surgical debridement, or as an alternative when surgical intervention is not feasible.

  9. Emergency, anaesthetic and essential surgical capacity in the Gambia.

    Iddriss, Adam; Shivute, Nestor; Bickler, Stephen; Cole-Ceesay, Ramou; Jargo, Bakary; Abdullah, Fizan; Cherian, Meena


    To assess the resources for essential and emergency surgical care in the Gambia. The World Health Organization's Tool for Situation Analysis to Assess Emergency and Essential Surgical Care was distributed to health-care managers in facilities throughout the country. The survey was completed by 65 health facilities - one tertiary referral hospital, 7 district/general hospitals, 46 health centres and 11 private health facilities - and included 110 questions divided into four sections: (i) infrastructure, type of facility, population served and material resources; (ii) human resources; (iii) management of emergency and other surgical interventions; (iv) emergency equipment and supplies for resuscitation. Questionnaire data were complemented by interviews with health facility staff, Ministry of Health officials and representatives of nongovernmental organizations. Important deficits were identified in infrastructure, human resources, availability of essential supplies and ability to perform trauma, obstetric and general surgical procedures. Of the 18 facilities expected to perform surgical procedures, 50.0% had interruptions in water supply and 55.6% in electricity. Only 38.9% of facilities had a surgeon and only 16.7% had a physician anaesthetist. All facilities had limited ability to perform basic trauma and general surgical procedures. Of public facilities, 54.5% could not perform laparotomy and 58.3% could not repair a hernia. Only 25.0% of them could manage an open fracture and 41.7% could perform an emergency procedure for an obstructed airway. The present survey of health-care facilities in the Gambia suggests that major gaps exist in the physical and human resources needed to carry out basic life-saving surgical interventions.

  10. Surgical treatment of Perthes disease in child with hemophilia

    Anisimov D.I.


    Full Text Available Hemophilia is a genetically mediated disease caused by recessive transmission of the gene. At present etiological orientation in treatment of the given pathology has just begun to develop. Replacement therapy by the concentrate of blood factors is the principal method of treatment. With great success in the sphere of medicine life quality of children suffering from hemophilia has improved significantly. However, the given category of patients refers to the high risk group to render surgical care as before. The example of the surgical intervention is an intertrochanteric osteotomy of the femur in a child with hemophilia

  11. Surgical management of chronic otitis media: beyond tympanotomy tubes.

    Haynes, David S; Harley, David H


    Chronic ear disease encompasses a wide range of clinical entities amenable to medical and surgical intervention. The otolaryngologist must always consider the goals of surgery--first and foremost to achieve a safe ear. The least invasive procedure capable of eradicating disease is generally chosen. During surgery, a delicate balance has to exist between the careful preservation of function and the aggressive prevention of potentially recurrent disease. Postoperatively, thorough follow-up and good judgment are paramount in avoiding complications and preventing unnecessary additional surgical procedures.

  12. Changing spectrum of Budd-Chiari syndrome in India with special reference to non-surgical treatment

    Deepak N Amarapurkar; Sundeep J Punamiya; Nikhil D Patel


    AIM: To evaluate patterns of obstruction, etiological spectrum and non-surgical treatment in patients with Budd-Chiari syndrome in India.METHODS: Forty-nine consecutive cases of Budd-Chiari syndrome (BCS) were prospectively evaluated.All patients with refractory ascites or deteriorating liver function were, depending on morphology of inferior vena cava (IVC) and/or hepatic vein (HV) obstruction,triaged for radiological intervention, in addition to anticoagulation therapy. Asymptomatic patients, patients with diuretic-responsive ascites and stable liver function,and patients unwilling for surgical intervention were treated symptomatically with anticoagulation.RESULTS: Mean duration of symptoms was 41.5±11.2 (range = 1-240) mo. HV thrombosis (HVT) was present in 29 (59.1%), IVC thrombosis in eight (16.3%),membranous obstruction of IVC in two (4%) and both IVC-HV thrombosis in 10 (20.4%) cases. Of 35 cases tested for hypercoagulability, 27 (77.1%) were positive for one or more hypercoagulable states. Radiological intervention was technically successful in 37/38 (97.3%):IVC stenting in seven (18.9%), IVC balloon angioplasty in two (5.4%), combined IVC-HV stenting in two (5.4%),HV stenting in 11 (29.7%), transjugular intrahepatic portosystemic shunt (TIPS) in 13 (35.1%) and combined TIPS-IVC stenting in two (5.4%). Complications encountered in follow-up: death in five, re-stenosis of the stent in five (17.1%), hepatic encephalopathy in two and hepatocellular carcinoma in one patient. Of nine patients treated medically, two showed complete resolution of HVT.CONCLUSION: In our series, HVT was the predominant cause of BCS. In the last five years with the availability of sophisticated tests for hypercoagulability, etiologies were defined in 85.7% of cases. Non-surgical management was successful in most cases.

  13. Recent advances in the surgical management of rhinosinusitis [version 1; referees: 4 approved

    Alexandria F. Jaksha


    Full Text Available Rhinosinusitis affects a significant portion of the US population, and its management imposes a substantial burden on the healthcare system. The treatment of chronic rhinosinusitis includes initial medical management prior to consideration of surgical intervention. However, if surgery does become necessary, several factors must be considered in order to optimize outcomes. This review evaluates surgical patient selection, perioperative medical management, and the extent of operative intervention, with the goal of improving surgical results, decreasing the need for revision surgery, and enhancing the patient’s quality of life. Specific variations in patient genotypes and phenotypes will be further explored with regard to their implications on surgical outcomes. Additionally, the evidence behind pre- and post-operative antibiotic and steroid use will be evaluated. Finally, we will review evolving surgical tools and techniques that are currently being utilized for the treatment of specific subsets of rhinosinusitis.

  14. Impact of non-surgical periodontal intervention on oral health-related quality of life and periodontal clinical indices%非外科牙周干预对口腔健康相关生活质量及牙周临床指标影响

    路惠捷; 陈铁楼; 张新海; 刘进; 赵海军; 吴织芬; 周以钧


    Objective:To investigate the impact of non-surgical periodontal intervention on oral health-related quali-ty of life and periodontal clinical indices. Method:91 cases with severe periodontitis divided into group therapy (76 cases treated with non-surgical procedure) and group control (15 cases treated with 3 % hydrogen peroxide rinsed). All cases used the Chinses 14-item version of the oral health impact profile(OHIP),as well as a demographic questionnaire. This was used to assess oral health-related quality of life (OHRQoL) issues. The questionnaire and clinical inspection were done be-fore therapy(T0) and 1 month(T1) and 12 monthes(T2) after treatment. The periodontal clinical parameters including gin-gival index(GI),plaque index(PLI),probing depth(PD),attachment loss(AL) and periodontal health related symptoms of each group were measured at T0,T1 and T2. Result:Scores of OHIP were significantly associated with age,oral hygiene and smoking habits. There were significant difference of GI,PLI,PD,AL and OHIP score,and also the percentage of periodontal health related symptom between group therapy and control at T1 and T2. The median score of OHIP reduced from 26.7±3.2 at T0 to 13.1±2.1 at T1. Median OHIP scores reduced to 13.7±2.2 at T2 (P6 mm could be reduced from 65.5 % at T0 to 39.6 % at T2 (P <0.01). There were significance difference of percentage of periodontal health related symptoms and the percentage of positive response of the patients on OHIP issue between T1 and T0 or be-tween T2 and T0. The scores of GI,PLI,and PD,ALvalue decreased significantly at T1,T2 than that of T0. Conclusion:The severity of severe periodontitis are asociated with OHIP of Chinese version. Non-surgical periodontal intervention presented significantly improved effects on OHRQoL and periodontal clinical parameters,the effects maintained more than 1 year.%目的:探讨非外科牙周干预对口腔健康相关生活质量及牙周临床指标的影响。方法:91例重症慢

  15. [Organ-preserving interventions in combined therapy of children and adolescents with osteosarcoma].

    Punanov, Iu A; Gafton, G I; Gudz', Iu V; Nabokov, V V; Ivanova, T V; Safonova, S A; Levchenko, E V; Kupatadze, D D; Novik, V I; Lazareva, Iu R; Krzhivitskiĭ, P I; Petrov, V G


    An analyzed cohort consists of 50 pediatric patients with osteosarcoma receiving combined therapy in N. N. Petrov Research Institute for Oncology (1999-2010). Thirty nine of them had localized disease, 11 patients had distant metastases. The treat