Sample records for surgical intervention including

  1. Analysis of surgical intervention populations using generic surgical process models. (United States)

    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. Surgical options in ICH including decompressive craniectomy. (United States)

    Mitchell, Patrick; Gregson, Barbara A; Vindlacheruvu, Raghu R; Mendelow, A David


    Intracerebral haemorrhage (ICH) accounts for 15 to 20% of strokes. The condition carries a higher morbidity and mortality than occlusive stroke. Despite considerable research effort, no therapeutic modality either medical or surgical has emerged with clear evidence of benefit other than in rare aneurysmal cases. Intracerebral haemorrhages can be divided into those that arise from pre-existing macroscopic vascular lesions - so called "ictohaemorrhagic lesions", and those that do not; the latter being the commoner. Most of the research that has been done on the benefits of surgery has been in this latter group. Trial data available to date precludes a major benefit from surgical evacuation in a large proportion of cases however there are hypotheses of benefit still under investigation, specifically superficial lobar ICH treated by open surgical evacuation, deeper ICH treated with minimally invasive surgical techniques, and decompressive craniectomy. When an ICH arises from an ictohaemorrhagic lesion, therapy has two goals: to treat the effects of the acute haemorrhage and to prevent a recurrence. Three modalities are available for treating lesions to prevent recurrence: stereotactic radiosurgery, endovascular embolisation, and open surgical resection. As with ICH without an underlying lesion there is no evidence to support surgical removal of the haemorrhage in most cases. An important exception is ICHs arising from intracranial aneurysms where there is good evidence to support evacuation of the haematoma as well as repair of the aneurysm.

  3. Videolaparoscopic surgical interventions in emergency surgery

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    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

  4. Surgical intervention in patients with necrotizing pancreatitis

    NARCIS (Netherlands)

    Besselink, MG; de Bruijn, MT; Rutten, JP; Boermeester, MA; Hofker, HS; Gooszen, HG


    Background: This study evaluated the various surgical strategies for treatment of (suspected) infected necrotizing pancreatitis (INP) and patient referrals for this condition in the Netherlands. Methods: This retrospective study included all 106 consecutive patients who had surgical treatment for IN

  5. Early surgical intervention for fulminant pseudomembranous colitis. (United States)

    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 for Hepatocellular Carcinoma with Bile Buct Thrombi

    Institute of Scientific and Technical Information of China (English)

    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.

  7. Pneumothorax Causing Pneumoperitoneum: Role of Surgical Intervention

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    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.

  8. Pneumothorax Causing Pneumoperitoneum: Role of Surgical Intervention (United States)

    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

  9. Approach to Pediatric Patients during Surgical Interventions

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    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

  10. Surgical intervention for esophageal atresia in patients with trisomy 18. (United States)

    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.

  11. Combined surgical intervention at terminal glaucoma

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    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.

  12. Improved patient selection by stratified surgical intervention

    DEFF Research Database (Denmark)

    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....

  13. Equipment for surgical interventions and childbirth in weightlessness (United States)

    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.

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

    African Journals Online (AJOL)

    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.

  15. Surgical Intervention to Rescue Hirschsprung Disease in a Rat Model (United States)

    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

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

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    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

  17. [Surgical interventions of the nail organ]. (United States)

    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.

  18. Surgical intervention in children with multiple endocrine neoplasia type 2. (United States)

    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.

  19. Field Surgical Intervention of Bovine Actinomycosis

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    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.

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

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    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.

  1. Surgical interventions for pulmonary tuberculosis in Mumbai, India: surgical outcomes and programmatic challenges (United States)

    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

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

    Institute of Scientific and Technical Information of China (English)

    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.

  3. Surgical consultation and intervention during pediatric hematopoietic stem cell transplantation. (United States)

    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.

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

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    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.

  5. Surgical intervention and capsular contracture after breast augmentation

    DEFF Research Database (Denmark)

    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...

  6. Endoscopic vs. Surgical Interventions for Painful Chronic Pancreatitis: What is Needed for Future Clinical Trials (United States)

    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

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

    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. Response of Hirayama disease to surgical intervention: case report

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    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

  9. Teamwork, communication and safety climate: a systematic review of interventions to improve surgical culture. (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Surgical intervention for a pediatric isolated intramedullary spinal aneurysm. (United States)

    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.

  12. Non-Surgical Interventions for Adolescents with Idiopathic Scoliosis: An Overview of Systematic Reviews (United States)

    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

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

    LENUS (Irish Health Repository)

    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.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  15. Effects of surgical intervention on trochlear remodeling in pediatric patients with recurrent patella dislocation cases. (United States)

    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.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  17. Internet interventions for chronic pain including headache: A systematic review

    Directory of Open Access Journals (Sweden)

    Monica Buhrman


    Full Text Available Chronic pain is a major health problem and behavioral based treatments have been shown to be effective. However, the availability of these kinds of treatments is scarce and internet-based treatments have been shown to be promising in this area. The objective of the present systematic review is to evaluate internet-based interventions for persons with chronic pain. The specific aims are to do an updated review with a broad inclusion of different chronic pain diagnoses and to assess disability and pain and also measures of catastrophizing, depression and anxiety. A systematic search identified 891 studies and 22 trials were selected as eligible for review. Two of the selected trials included children/youth and five included individuals with chronic headache and/or migraine. The most frequently measured domain reflected in the primary outcomes was interference/disability, followed by catastrophizing. Result across the studies showed a number of beneficial effects. Twelve trials reported significant effects on disability/interference outcomes and pain intensity. Positive effects were also found on psychological variable such as catastrophizing, depression and anxiety. Several studies (n = 12 were assessed to have an unclear level of risk bias. The attrition levels ranged from 4% to 54% where the headache trials had the highest drop-out levels. However, findings suggest that internet-based treatments based on cognitive behavioural therapy (CBT are efficacious measured with different outcome variables. Results are in line with trials in clinical settings. Meta-analytic statistics were calculated for interference/disability, pain intensity, catastrophizing and mood ratings. Results showed that the effect size for interference/disability was Hedge's g = −0.39, for pain intensity Hedge's g = −0.33, for catastrophizing Hedge's g = −0.49 and for mood variables (depression Hedge's g = −0.26.

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

    Directory of Open Access Journals (Sweden)

    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

  19. The role of surgical intervention in lung cancer with carcinomatous pleuritis (United States)

    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

  20. Present status of surgical intervention for children with intractable seizures. (United States)

    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.

  1. The effectiveness of non-surgical interventions in the treatment of Charcot foot. (United States)

    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

  2. Economic modeling of surgical disease: a measure of public health interventions. (United States)

    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.

  3. Surgical Versus Conservative Intervention for Acute Achilles Tendon Rupture: A PRISMA-Compliant Systematic Review of Overlapping Meta-Analyses. (United States)

    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.

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

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    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).

  5. Current and emerging treatments and surgical interventions for Morquio A syndrome: a review. (United States)

    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.

  6. Current and emerging treatments and surgical interventions for Morquio A syndrome: a review (United States)

    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

  7. Simulation based planning of surgical interventions in pediatric cardiology (United States)

    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.

  8. Efficacy of a surgical scrub including 2% chlorhexidine acetate for canine superficial pyoderma. (United States)

    Murayama, Nobuo; Nagata, Masahiko; Terada, Yuri; Shibata, Sanae; Fukata, Tsuneo


    The clinical efficacy of a surgical scrub containing 2% chlorhexidine acetate (2CA; Nolvasan® Surgical Scrub; Fort Dodge Animal Health, USA) was evaluated for the topical management of canine superficial pyoderma. The first study was a randomized, double-blind, controlled trial. The control was a shampoo containing 4% chlorhexidine gluconate (4CG; Skin Clinic Shampoo; CHD MEDICS, Goyang, Korea). Ten dogs with symmetrical lesions of canine superficial pyoderma were allocated to receive either 2CA or the control shampoo applied to either side of the body twice weekly for 1 week. Both the owners and the investigators subjectively scored skin lesions including pruritus, erythema, crusted papules and scales on a scale of 0-3. The 2CA and 4CG resulted in almost the same degree of improvement of skin lesions, and there were no significant differences between the two groups. The second study was an open trial of 2CA monotherapy in eight dogs with cefalexin-resistant Staphylococcus intermedius group-associated superficial pyoderma. The 2CA monotherapy was applied every 2 days for 2 weeks. Five dogs improved with 2CA monotherapy, one partially improved and two did not. No adverse reactions were seen in either trial. This suggests that a 2CA surgical scrub could be a useful and safe topical adjunct therapy for dogs with superficial pyoderma involving cefalexin-resistant Staphylococcus intermedius group.

  9. A Systematic Review of Current Surgical Interventions for Charcot Neuroarthropathy of the Midfoot. (United States)

    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.

  10. Evaluation of surgical and non-surgical interventions for clavicle fractures. (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. 3D Rotational X-Ray guidance for surgical interventions

    NARCIS (Netherlands)

    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

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

    NARCIS (Netherlands)

    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

  14. Surgical double valve replacement after transcatheter aortic valve implantation and interventional mitral valve repair. (United States)

    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.

  15. Early results of surgical intervention for elbow deformity in cerebral palsy based on degree of contracture. (United States)

    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

  16. [Multimodal surgical intervention to improve outcome after colon cancer]. (United States)

    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.

  17. Interventional and surgical treatment of cardiac arrhythmias in adults with congenital heart disease. (United States)

    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.

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

    LENUS (Irish Health Repository)

    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.

  19. Palliative Interventional and Surgical Therapy for Unresectable Pancreatic Cancer

    Directory of Open Access Journals (Sweden)

    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.

  20. Palliative Interventional and Surgical Therapy for Unresectable Pancreatic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    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.

  1. Surgical interventions for anterior shoulder instability in rugby players: A systematic review (United States)

    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


    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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. Developing a tool to measure pharmacoeconomic outcomes of post-surgical pain management interventions. (United States)

    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.

  5. Medical and surgical interventions to improve outcomes in obese women planning for pregnancy. (United States)

    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.

  6. [Surgical intervention in severe acute pancreatitis--retrospective study of 79 patients of the RWTH Aachen Surgical Clinic]. (United States)

    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.

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

    Directory of Open Access Journals (Sweden)



    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.

  8. Simulation-based planning of surgical interventions in pediatric cardiology (United States)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    LENUS (Irish Health Repository)

    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.

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

    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.

  12. Patient survival and surgical re-intervention predictors for intracapsular hip fractures. (United States)

    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

  13. [Standardization of activities in an oncology surgical center according to nursing intervention classification]. (United States)

    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.

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

    DEFF Research Database (Denmark)

    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...

  15. [Peculiarities of surgical interventions for the treatment of inflammatory and traumatic lesions in the frontal sinus]. (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  18. Distribution of Familial Mediterranean Fever mutations in surgical emergencies including nonspecific abdominal pain: Surgical point of view

    Directory of Open Access Journals (Sweden)

    Pinar Yazici


    Full Text Available Purpose : Familial Mediterranean fever (FMF is characterized by recurrent episodes of fever and serositis, resulting in pain in the abdomen, chest, joints and muscles. While patients diagnosed with FMF are under follow-up of the internal medicine doctors, surgeons are rarely responsible the initial diagnosis of FMF. We aimed to investigate the frequency of the FMF in the surgical emergency in those with acute nonspecific abdominal pain. Material and Methods: All patients admitted to emergency service due to acute abdominal pain were evaluated and those resulted with nonspecific pain were enrolled. During six months period, patients consistent with above criteria were examined with abdominal x-ray and ultrasound(US, hematological and biochemical test, and physical examinations. Nine type of FMF mutations were investigated in the patients. All results were comparatively evaluated considering MEFV (+ or MEFV(-. Results: There were 68 patients (35, 51.4% male and 33, 48.5% female with a mean age of 29.5+/-10.1 (range: 17-49 years. All patients displayed mild or severe abdominal pain. Genetic analysis revealed that 19 [MEFV(+] out of 68 patients (27,9% carry mutation either homozygote or heterozygote. The most frequent mutation seen in seven patients was M694V (36.8%. In MEFV(+ patients, fibrinogen, CRP and lactate dehydrogenase levels(LDH were significantly higher (p<0.05. On computed tomography, in six patients in whom US showed decompressed appendix, appendicitis was confirmed and appendectomy was performed. Conclusions: The patients with nonspecific abdominal pain should also be considered for FMF before decision of surgery. High levels of fibrinogen, CRP and LDH in addition to clinical history of similar attacks that arise strong clinical suspicion can help diagnose FMF with genetic analysis. Our results need confirmation in larger prospective studies to confirm these preliminary results. [Cukurova Med J 2014; 39(4.000: 814-821

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

    Directory of Open Access Journals (Sweden)

    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.

  20. Early versus late surgical intervention or medical management for infective endocarditis: a systematic review and meta-analysis. (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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

  2. Microsurgery robots: addressing the needs of high-precision surgical interventions. (United States)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

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

    DEFF Research Database (Denmark)

    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...

  5. "Hybrid" and combined percutaneous and surgical intervention to treat selected cardiac patients: a new strategy. (United States)

    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

  6. 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...

  7. Data-Driven Implementation of Alarm Reduction Interventions in a Cardiovascular Surgical ICU. (United States)

    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.

  8. Gastrointestinal complications after cardiac transplantation. Potential benefit of early diagnoses and prompt surgical intervention. (United States)

    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

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

    Institute of Scientific and Technical Information of China (English)

    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.

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

    DEFF Research Database (Denmark)

    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...

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

    DEFF Research Database (Denmark)

    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...

  12. Delayed peripheral nerve repair: methods, including surgical ′cross-bridging′ to promote nerve regeneration

    Directory of Open Access Journals (Sweden)

    Tessa Gordon


    Full Text Available Despite the capacity of Schwann cells to support peripheral nerve regeneration, functional recovery after nerve injuries is frequently poor, especially for proximal injuries that require regenerating axons to grow over long distances to reinnervate distal targets. Nerve transfers, where small fascicles from an adjacent intact nerve are coapted to the nerve stump of a nearby denervated muscle, allow for functional return but at the expense of reduced numbers of innervating nerves. A 1-hour period of 20 Hz electrical nerve stimulation via electrodes proximal to an injury site accelerates axon outgrowth to hasten target reinnervation in rats and humans, even after delayed surgery. A novel strategy of enticing donor axons from an otherwise intact nerve to grow through small nerve grafts (cross-bridges into a denervated nerve stump, promotes improved axon regeneration after delayed nerve repair. The efficacy of this technique has been demonstrated in a rat model and is now in clinical use in patients undergoing cross-face nerve grafting for facial paralysis. In conclusion, brief electrical stimulation, combined with the surgical technique of promoting the regeneration of some donor axons to ′protect′ chronically denervated Schwann cells, improves nerve regeneration and, in turn, functional outcomes in the management of peripheral nerve injuries.

  13. Revisiting the effectiveness of interventions to decrease surgical site infections in colorectal surgery: A Bayesian perspective. (United States)

    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.

  14. Non-surgical interventions for pelvic organ prolapse in rural Nepal: a prospective monitoring and evaluation study (United States)

    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

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

    DEFF Research Database (Denmark)

    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. An Intervention Including an Online Game to Improve Grade 6 Students' Performance in Early Algebra (United States)

    Kolovou, Angeliki; van den Heuvel-Panhuizen, Marja; Koller, Olaf


    This study investigated whether an intervention including an online game contributed to 236 Grade 6 students' performance in early algebra, that is, solving problems with covarying quantities. An exploratory quasi-experimental study was conducted with a pretest-posttest-control-group design. Students in the experimental group were asked to solve…

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

    Directory of Open Access Journals (Sweden)

    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

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

    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

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

    Directory of Open Access Journals (Sweden)

    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

  20. Adopting epidemic model to optimize medication and surgical intervention of excess weight (United States)

    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.

  1. A systematic review of income generation interventions, including microfinance and vocational skills training, for HIV prevention. (United States)

    Kennedy, Caitlin E; Fonner, Virginia A; O'Reilly, Kevin R; Sweat, Michael D


    Income generation interventions, such as microfinance or vocational skills training, address structural factors associated with HIV risk. However, the effectiveness of these interventions on HIV-related outcomes in low- and middle-income countries has not been synthesized. The authors conducted a systematic review by searching electronic databases from 1990 to 2012, examining secondary references, and hand-searching key journals. Peer-reviewed studies were included in the analysis if they evaluated income generation interventions in low- or middle-income countries and provided pre-post or multi-arm measures on behavioral, psychological, social, care, or biological outcomes related to HIV prevention. Standardized forms were used to abstract study data in duplicate and study rigor was assessed. Of the 5218 unique citations identified, 12 studies met criteria for inclusion. Studies were geographically diverse, with six conducted in sub-Saharan Africa, three in South or Southeast Asia, and three in Latin America and the Caribbean. Target populations included adult women (N = 6), female sex workers/bar workers (N = 3), and youth/orphans (N = 3). All studies targeted females except two among youth/orphans. Study rigor was moderate, with two group-randomized trials and two individual-randomized trials. All interventions except three included some form of microfinance. Only a minority of studies found significant intervention effects on condom use, number of sexual partners, or other HIV-related behavioral outcomes; most studies showed no significant change, although some may have had inadequate statistical power. One trial showed a 55% reduction in intimate partner violence (adjusted risk ratio 0.45, 95% confidence interval 0.23-0.91). No studies measured incidence/prevalence of HIV or sexually transmitted infections among intervention recipients. The evidence that income generation interventions influence HIV-related behaviors and outcomes is inconclusive. However, these

  2. Is Staphylococcal Screening and Suppression an Effective Interventional Strategy for Reduction of Surgical Site Infection? (United States)

    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.

  3. Meta-analyses including non-randomized studies of therapeutic interventions: a methodological review

    Directory of Open Access Journals (Sweden)

    Timor Faber


    Full Text Available Abstract Background There is an increasing number of meta-analyses including data from non-randomized studies for therapeutic evaluation. We aimed to systematically assess the methods used in meta-analyses including non-randomized studies evaluating therapeutic interventions. Methods For this methodological review, we searched MEDLINE via PubMed, from January 1, 2013 to December 31, 2013 for meta-analyses including at least one non-randomized study evaluating therapeutic interventions. Etiological assessments and meta-analyses with no comparison group were excluded. Two reviewers independently assessed the general characteristics and key methodological components of the systematic review process and meta-analysis methods. Results One hundred eighty eight meta-analyses were selected: 119 included both randomized controlled trials (RCTs and non-randomized studies of interventions (NRSI and 69 only NRSI. Half of the meta-analyses (n = 92, 49 % evaluated non-pharmacological interventions. “Grey literature” was searched for 72 meta-analyses (38 %. An assessment of methodological quality or risk of bias was reported in 135 meta-analyses (72 % but this assessment considered the risk of confounding bias in only 33 meta-analyses (18 %. In 130 meta-analyses (69 %, the design of each NRSI was not clearly specified. In 131 (70 %, whether crude or adjusted estimates of treatment effect for NRSI were combined was unclear or not reported. Heterogeneity across studies was assessed in 182 meta-analyses (97 % and further explored in 157 (84 %. Reporting bias was assessed in 127 (68 %. Conclusions Some key methodological components of the systematic review process—search for grey literature, description of the type of NRSI included, assessment of risk of confounding bias and reporting of whether crude or adjusted estimates were combined—are not adequately carried out or reported in meta-analyses including NRSI.

  4. Effect of a "Lean" intervention to improve safety processes and outcomes on a surgical emergency unit. (United States)

    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.

  5. Text messaging interventions for individuals with mental health disorders including substance use: A systematic review. (United States)

    Watson, Tyler; Simpson, Scot; Hughes, Christine


    We completed a systematic review of the literature to characterize the impact of text messaging interventions on medication adherence or mental health related outcomes in people with mental health disorders including substance use. Four electronic databases were searched from January 1999 to October 2015. Seven studies met our inclusion criteria: three studies evaluated text messaging in patients with schizophrenia or schizoaffective disorder diagnosis, two studies evaluated text messaging in patients with chronic alcohol dependence, and two studies reviewed text messaging in patients with mood disorders. Six studies were randomized controlled trials and one was a prospective pilot study with pre-post intervention design. Text messaging frequency ranged from once weekly to twelve per day. The effect of text messaging on medication adherence was measured in five studies; one study reporting significant improvements in the text messaging intervention group. The effect of text messaging on mental health related outcomes was measured in all seven studies, with five studies showing significant improvements in a variety of psychiatric and social functioning assessments. Collectively, these studies suggest text messaging is a promising tool to support management of patients with mental illness. Further research examining theory-based text messaging interventions in larger samples of patients is required.

  6. [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]. (United States)

    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.

  7. Novel ways to explore surgical interventions in randomised controlled trials: applying case study methodology in the operating theatre. (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    Narayan H Gandedkar


    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.

  9. Orthodontic-orthognathic interventions in orthognathic surgical cases: "Paper surgery" and "model surgery" concepts in surgical orthodontics. (United States)

    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.

  10. 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...

  11. [Effectiveness of an intervention to improve the implementation of a surgical safety check-list in a tertiary hospital]. (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  13. Towards Clinically Optimized MRI-guided Surgical Manipulator for Minimally Invasive Prostate Percutaneous Interventions: Constructive Design. (United States)

    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.

  14. Towards Clinically Optimized MRI-guided Surgical Manipulator for Minimally Invasive Prostate Percutaneous Interventions: Constructive Design* (United States)

    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

  15. Effect of music on surgical hand disinfection: a video-based intervention study. (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    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

    Directory of Open Access Journals (Sweden)

    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. Short- and long-term racing performance of Standardbred pacers and trotters after early surgical intervention for tarsal osteochondrosis. (United States)

    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.

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

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    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.

  2. 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. (United States)

    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.

  3. Proposal for evaluating the quality of reports of surgical interventions in the treatment of trigeminal neuralgia: the Surgical Trigeminal Neuralgia Score. (United States)

    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

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

    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.

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

    NARCIS (Netherlands)

    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

  6. Systematic review of interventions to prevent the spread of sexually transmitted infections, including HIV, among young people in Europe

    DEFF Research Database (Denmark)

    Lazarus, Jeff; Sihvonen-Riemenschneider, Henna; Laukamm-Josten, Ulrich


    To examine the effectiveness of interventions seeking to prevent the spread of sexually transmitted infections (STIs), including HIV, among young people in the European Union.......To examine the effectiveness of interventions seeking to prevent the spread of sexually transmitted infections (STIs), including HIV, among young people in the European Union....

  7. Surgical intervention for mediastinal pancreatic pseudocysts. A case series and review of the literature. (United States)

    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.

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

    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.

  9. Surgical nurses' attitudes towards caring for patients dying of cancer - a pilot study of an educational intervention on existential issues. (United States)

    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.

  10. Interventions for rosacea: abridged updated Cochrane systematic review including GRADE assessments. (United States)

    van Zuuren, E J; Fedorowicz, Z


    Rosacea is a common chronic facial dermatosis. This update of our Cochrane review on interventions for rosacea summarizes the evidence, including Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group assessments, of the effects of the currently available treatments. Searches included the following: Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, MEDLINE, EMBASE, LILACS and the Science Citation Index, and ongoing trials registries (July 2014). We included 106 randomized controlled trials (RCTs) with 13 631 participants, a more than 80% increase since the last update in 2011. Pooling of data was feasible for a few outcomes, for topical metronidazole and azelaic acid and both appeared to be more effective than placebo (moderate and high-quality evidence, respectively). Topical ivermectin was more effective than placebo based on two studies (high-quality evidence), and slightly more effective than metronidazole in one study. Brimonidine was more effective than vehicle in reducing erythema in rosacea (high-quality evidence). Ciclosporin ophthalmic emulsion was effective for ocular rosacea (low-quality evidence). For oral treatments there was moderate-quality evidence for the effectiveness of tetracycline based on two old studies, and high-quality evidence for doxycycline 40 mg compared with placebo according to physician assessments. One study at high risk of bias demonstrated equivalent effectiveness for azithromycin and doxycycline 100 mg. Minocycline 45 mg may be effective for papulopustular rosacea (low-quality evidence). Low-dose isotretinoin appeared to be slightly more effective than doxycycline 50-100 mg (high-quality evidence). Laser and light-based therapies for erythema in rosacea were effective (low-quality evidence). Further RCTs are required for ocular rosacea.

  11. Prospective clinical trial of surgical intervention for painful rib fracture nonunion. (United States)

    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.

  12. Pharmacoeconomics of Surgical Interventions vs. Cyclooxygenase Inhibitors for the Treatment of Patent Ductus Arteriosus (United States)

    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

  13. Evaluating the prevalence of canceling surgical operations,including its influencing factors at Imam Khomeini hospital in Sari during 2006-2007

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    A. Zamani kiasari


    Full Text Available AbstractBackground and Purpose: Hospital admission for surgery is an important event for patients. Canceling surgical procedures produce several unpleasant results for patients such as waste of time, including payment. The aim of this study is to identify the prevalence and causes of canceling surgical procedures, in order to achieve problem solving methods.Materials and Methods: This is a descriptive cross-sectional study. Statistical data regarding all surgical procedures (without sampling performed during 2006 to 2007, were recorded in a checklist. Study variables were identified based on surgical procedures that were canceled during this study. Data was analyzed using SPSS software and statistical analysis tests.Results: Of 4,711 scheduled patients, 510 (10/9% surgical operations were canceled. The highest number of patient candidates for surgical operation was related to gynecology, orthopedic, urology, while the least were related to reconstructive and vascular surgery groups respectively. The most canceled surgical procedures were related to neurosurgical operation 32/4% (68 from 207 cases while the least canceled cases belonged to gynecology 4/4% (48 from 1094 cases.Conclusion: The results of our study showed that 54/2% of canceled cases were preventable. The results of this study and similar studies demonstrate that traditional pre-operative preparation for surgical scheduling, day before surgery is in need of serious consideration. We recommend a fundamental change by discarding traditional methods and creating a new committee including specialized bed or resource groups, monthly management meetings to discuss causes of canceling surgical procedures, in order to reduce its occurrence. Thus, decreasing the rate of canceling surgical wasted, while reducing anxiety in patients and their family. J Mazand Univ Med Sci 2008; 18(65:52-62 (Persian

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

    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. Effect of non-surgical periodontal therapy on serum ferritin levels: an interventional study. (United States)

    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.

  16. Nationwide Trends and Variations in Urological Surgical Interventions and Renal Outcome in Patients with Spina Bifida. (United States)

    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.

  17. A comprehensive subaxial cervical spine injury severity assessment model using numeric scores and its predictive value for surgical intervention. (United States)

    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

  18. Application of silver sulfadiazine cream with early surgical intervention in patients suffering from combined burn-blast injury facial tattoos. (United States)

    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.

  19. Participatory modeling to support gender equality : The importance of including stakeholders in interventions

    NARCIS (Netherlands)

    Bleijenbergh, I.L.; van Engen, Marloes


    Purpose Interventions to support gender equality in organisations are often unsuccessful. Stakeholders disagree about the causes and problem definition of gender equality or pay lip service to the principle of gender equality, but fail to implement gender equality in practice. The purpose of this

  20. Effect of a Multiyear Intervention on Science Achievement of All Students Including English Language Learners (United States)

    Maerten-Rivera, Jaime; Ahn, Soyeon; Lanier, Kimberly; Diaz, Jennifer; Lee, Okhee


    This study was part of the Promoting Science among English Language Learners (P-SELL) efficacy study, a research and development project that implemented a curricular and professional development intervention to improve science achievement of English Language Learners (ELLs) in urban elementary schools. The study used a cluster randomized control…

  1. The spatial distribution of injuries in need of surgical intervention in Nepal. (United States)

    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.

  2. [The Haglund exostosis--a surgical indication and a minor intervention?]. (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  4. Total temporomandibular joint prosthesis as a surgical option for severe mouth opening restriction. A case report of a bilateral intervention. (United States)

    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.

  5. Adult aortic coarctation discovered incidentally after the rupture of sinus of Valsalva aneurysm: combined surgical and interventional approach. (United States)

    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.

  6. A surgical intervention for the body politic: Generation Squeeze applies the Advocacy Coalition Framework to social determinants of health knowledge translation. (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

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    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

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

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    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.

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

    DEFF Research Database (Denmark)

    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...

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

    LENUS (Irish Health Repository)

    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.

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

    NARCIS (Netherlands)

    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

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

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    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.

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

    NARCIS (Netherlands)

    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

  15. The imaging of maxillofacial trauma and its pertinence to surgical intervention. (United States)

    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.

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

    DEFF Research Database (Denmark)

    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...

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

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    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.

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

    Institute of Scientific and Technical Information of China (English)

    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.

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

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    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.

  20. Increasing resource allocation and research into tobacco control activities: a comprehensive approach including primary prevention, treatment and brief intervention. (United States)

    Richmond, R


    The range of tobacco control activities should be viewed as essential parts of a complex multi-component puzzle. Intervention strategies designed to address tobacco control should be comprehensive and include both primary and secondary prevention activities and be multi-faceted and capable of bringing about change at both the individual and broader social and cultural levels. In this paper I argue for a mutually inclusive framework in which the various components contribute in important and different ways. I examine the prevalence of smoking and identify the high risk groups, then I examine the range of available strategies and present the evidence for their success. I discuss the primary prevention approaches such as warning labels, taxes, price increases, workplace bans, education in schools, mass media and self-help materials, as well as brief interventions and treatment strategies which are conducted at the worksite, general practice and specialized cessation clinics. The areas for future research are delineated for increased resource allocation and include: the best ways to disseminate brief interventions to smokers, methods to motivate smokers; training of health professionals to deliver brief interventions; enhancing quitting and access to existing treatment resources among specific disadvantaged minority groups, e.g. migrants, unemployed youth, the effect on smoking prevalence of warning labels on cigarette packets and price rises on cigarettes.

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

    Institute of Scientific and Technical Information of China (English)


    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.

  2. Effectiveness of surgical interventions for thoracic aortic aneurysms: A systematic review and meta-analysis. (United States)

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


    A systematic review and meta-analysis was conducted to evaluate the effectiveness of thoracic endovascular aortic repair (TEVAR) and open repair in patients with descending thoracic aortic aneurysms (TAAs). PubMed, Ovid MEDLINE, Ovid Embase, EBSCO Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched from each database's inception to January 29, 2016. We selected studies that compared the two approaches in adults with TAAs and reported 30-day mortality or procedure complications. Two reviewers independently extracted data, and conflicts were resolved by consensus. Random-effects meta-analysis was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). The main outcomes and measures were all-cause 30-day mortality, 30-day paraplegia or spinal cord ischemia, stroke, pulmonary complications, and length of hospital and intensive care unit (ICU) stay. Twenty-seven studies of moderate methodologic quality were included. TEVAR was associated with lower 30-day mortality in ruptured (OR, 0.58; 95% CI, 0.38-0.88) and intact (OR, 0.6; 95% CI, 0.36-0.99) aneurysms. Paraplegia or spinal cord ischemia (OR, 0.35; 95% CI, 0.2-0.61) and pulmonary complications (OR, 0.41; 95% CI, 0.37-0.46) were reduced in patients undergoing TEVAR, whereas a reduction in stroke risk was not statistically significant (OR, 0.89; 95% CI, 0.76-1.03). Pooled mean difference in length of hospital and ICU stay was lower for TEVAR by -5.17 days (95% CI, -7.77 to -2.57) and -5.89 days (95% CI, -9.65 to -2.12), respectively. Three studies showed that compared with open repair, a hybrid approach reduced hospital stay (pooled mean difference, -8.83 days; 95% CI, -14.37 to -3.29) and ICU stay (pooled mean difference, -3.17 days (95% CI, -5.54 to -0.97), with minimal evidence on other outcomes studied. Observational evidence at high risk of confounding suggests that compared with open repair for TAA, TEVAR reduced risk of mortality, paraplegia, spinal

  3. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease. (United States)

    Lenferink, Anke; Brusse-Keizer, Marjolein; van der Valk, Paul Dlpm; Frith, Peter A; Zwerink, Marlies; Monninkhof, Evelyn M; van der Palen, Job; Effing, Tanja W


    Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease. Exacerbation action plans are considered to be a key component of COPD self-management interventions. Studies assessing these interventions show contradictory results. In this Cochrane Review, we compared the effectiveness of COPD self-management interventions that include action plans for acute exacerbations of COPD (AECOPD) with usual care. To evaluate the efficacy of COPD-specific self-management interventions that include an action plan for exacerbations of COPD compared with usual care in terms of health-related quality of life, respiratory-related hospital admissions and other health outcomes. We searched the Cochrane Airways Group Specialised Register of trials, trials registries, and the reference lists of included studies to May 2016. We included randomised controlled trials evaluating a self-management intervention for people with COPD published since 1995. To be eligible for inclusion, the self-management intervention included a written action plan for AECOPD and an iterative process between participant and healthcare provider(s) in which feedback was provided. We excluded disease management programmes classified as pulmonary rehabilitation or exercise classes offered in a hospital, at a rehabilitation centre, or in a community-based setting to avoid overlap with pulmonary rehabilitation as much as possible. Two review authors independently assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. Study authors were contacted to obtain additional information and missing outcome data where possible. When appropriate, study results were pooled using a random-effects modelling meta-analysis. The primary

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

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    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.

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

    Institute of Scientific and Technical Information of China (English)

    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.

  6. Parents' Adoption of Social Communication Intervention Strategies: Families Including Children with Autism Spectrum Disorder Who are Minimally Verbal. (United States)

    Shire, Stephanie Y; Goods, Kelly; Shih, Wendy; Distefano, Charlotte; Kaiser, Ann; Wright, Courtney; Mathy, Pamela; Landa, Rebecca; Kasari, Connie


    Notably absent from the intervention literature are parent training programs targeting school-aged children with autism who have limited communication skills (Tager-Flusberg and Kasari in Autism Res 6:468-478, 2013). Sixty-one children with autism age 5-8 with minimal spontaneous communication received a 6-month social communication intervention including parent training. Parent-child play interactions were coded for parents' strategy implementation and children's time jointly engaged (Adamson et al. in J Autism Dev Disord 39:84-96, 2009). Parents mastered an average of 70% of the strategies. Further analyses indicated some gains in implementation occurred from mere observation of sessions, while the greatest gains occurred in the first month of active coaching and workshops. Children's joint engagement was associated with parents' implementation success across time demonstrating parents' implementation was relevant to children's social engagement.

  7. [The initial trial of the clinical use of FK-1 glue in surgical interventions]. (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    LENUS (Irish Health Repository)

    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.

  11. Spectrum of peripheral neuropathies associated with surgical interventions; A neurophysiological assessment (United States)


    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

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

    Directory of Open Access Journals (Sweden)

    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.

  13. Acoustic phonetics in a clinical setting: a case study of /r/-distortion therapy with surgical intervention. (United States)

    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.

  14. Nonrandomized studies are not always found even when selection criteria for health systems intervention reviews include them: a methodological study. (United States)

    Glenton, Claire; Lewin, Simon; Mayhew, Alain; Scheel, Inger; Odgaard-Jensen, Jan


    Systematic reviews within the Cochrane Effective Practice and Organisation of Care Group (EPOC) can include both randomized and nonrandomized study designs. We explored how many EPOC reviews consider and identify nonrandomized studies, and whether the proportion of nonrandomized studies identified is linked to the review topic. We recorded the study designs considered in 65 EPOC reviews. For reviews that considered nonrandomized studies, we calculated the proportion of identified studies that were nonrandomized and explored whether there were differences in the proportion of nonrandomized studies according to the review topic. Fifty-one (78.5%) reviews considered nonrandomized studies. Forty-six of these reviews found nonrandomized studies, but the proportion varied a great deal (median, 33%; interquartile range, 25--50%). Reviews of health care delivery interventions had lower proportions of nonrandomized studies than those of financial and governance interventions. Most EPOC reviews consider nonrandomized studies, but the degree to which they find them varies. As nonrandomized studies are believed to be at higher risk of bias and their inclusion entails a considerable effort, review authors should consider whether the benefits justify the inclusion of these designs. Research should explore whether it is more useful to consider nonrandomized studies in reviews of some intervention types than others. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. An observation support system with an adaptive ontology-driven user interface for the modeling of complex behaviors during surgical interventions. (United States)

    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.

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

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    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

  17. On a definition of the appropriate timing for surgical intervention in orthognathic surgery. (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  19. Systematic review of interventions in the management of overweight and obese children which include a dietary component. (United States)

    Collins, Clare E; Warren, Janet M; Neve, Melinda; McCoy, Penelope; Stokes, Barrie


    Background  The prevalence of overweight and obesity in children and adolescents is increasing at an alarming rate around the world and prevention has become a key public health objective. Treatment and management of those already overweight and obese must be aligned with the best available evidence on effectiveness, if the risk of obesity-related morbidity and mortality is yet be reduced. Diet plays a pivotal role in successful treatment of obesity but to date, there is limited evidence on which to base practice. Objectives  To identify and present the best available evidence on the optimal dietetic treatment and management of children and adolescent who are overweight or obese. Search strategy  Published English language literature was searched using the electronic databases CINAHL, MEDLINE, PRE-MEDLINE, DARE, COCHRANE, EMBASE, AUSTROM, Current Concepts and Dissertation Abstracts. The databases were limited to English Language from 1975 until 2003. Government reports from the UK, USA and Australian were also searched and a hand search performed for the Journal of the Dietitians Association of Australia, International Journal of Obesity and the Journal of Human Nutrition and Dietetics and the bibliographies of retrieved articles. Selection criteria  (i) Interventions that evaluated the effectiveness of nutrition or dietary interventions to treat or manage overweight and obesity; (ii) Children aged less than 18 years; and (iii) Participants were defined as overweight or obese by relative weight or a measure of body weight status, studies that reported body weight per se were excluded. Data collection and analysis  An experienced professional librarian searched the databases, and two trained research assistants independently identified studies for retrieval and assessed each article for inclusion. The included studies were critically appraised for methodological quality by two people independently. Data were extracted from the appropriate articles and

  20. Analysis of individualized education programs to quantify long-term educational needs following surgical intervention for single-suture craniosynostosis. (United States)

    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%).

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

    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.

  2. Obesity, Type 2 Diabetes, and the Metabolic Syndrome: Pathophysiologic Relationships and Guidelines for Surgical Intervention. (United States)

    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.

  3. Change to earlier surgical interventions: contemporary management of unilateral vocal fold paralysis. (United States)

    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.

  4. A Continuum Robot and Control Interface for Surgical Assist in Fetoscopic Interventions (United States)

    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

  5. [[Technology Surgical Intervention in Ulcerative Colitis Modeling Descending Part of the Colon in Rats Line "Wistar"]. (United States)

    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.

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

    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.

  7. Orthodontic-orthognathic interventions in orthognathic surgical cases: “Paper surgery” and “model surgery” concepts in surgical orthodontics (United States)

    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

  8. Relationships among NANDA-I diagnoses, nursing outcomes classification, and nursing interventions classification by nursing students for patients in medical-surgical units in Korea. (United States)

    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.

  9. 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. (United States)

    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.

  10. Mycobacterium avium complex olecranon bursitis resolves without antimicrobials or surgical intervention: A case report and review of the literature (United States)

    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

  11. Repeat surgical interventions following "definitive" instrumentation and fusion for idiopathic scoliosis: five-year update on a previously published cohort. (United States)

    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.

  12. Intensive lifestyle intervention including high-intensity interval training program improves insulin resistance and fasting plasma glucose in obese patients. (United States)

    Marquis-Gravel, Guillaume; Hayami, Douglas; Juneau, Martin; Nigam, Anil; Guilbeault, Valérie; Latour, Élise; Gayda, Mathieu


    To analyze the effects of a long-term intensive lifestyle intervention including high-intensity interval training (HIIT) and Mediterranean diet (MedD) counseling on glycemic control parameters, insulin resistance and β-cell function in obese subjects. The glycemic control parameters (fasting plasma glucose, glycated hemoglobin), insulin resistance, and β-cell function of 72 obese subjects (54 women; mean age = 53 ± 9 years) were assessed at baseline and upon completion of a 9-month intensive lifestyle intervention program conducted at the cardiovascular prevention and rehabilitation center of the Montreal Heart Institute, from 2009 to 2012. The program included 2-3 weekly supervised exercise training sessions (HIIT and resistance exercise), combined to MedD counseling. Fasting plasma glucose (FPG) (mmol/L) (before: 5.5 ± 0.9; after: 5.2 ± 0.6; P fasting insulin (pmol/L) (before: 98 ± 57; after: 82 ± 43; P = 0.003), and insulin resistance, as assessed by the HOMA-IR score (before: 3.6 ± 2.5; after: 2.8 ± 1.6; P = 0.0008) significantly improved, but not HbA1c (%) (before: 5.72 ± 0.55; after: 5.69 ± 0.39; P = 0.448), nor β-cell function (HOMA-β, %) (before: 149 ± 78; after: 144 ± 75; P = 0.58). Following a 9-month intensive lifestyle intervention combining HIIT and MedD counseling, obese subjects experienced significant improvements of FPG and insulin resistance. This is the first study to expose the effects of a long-term program combining HIIT and MedD on glycemic control parameters among obese subjects.

  13. A tailored relocation stress intervention programme for family caregivers of patients transferred from a surgical intensive care unit to a general ward. (United States)

    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


    Directory of Open Access Journals (Sweden)

    Mitrička Stardelova


    Full Text Available This paper includes an experiment that was performed on a hundred patients by using our self-developed methods during a two year period. The treatment of discus hernia was carried out by using our self-developed methods combined with a completely new technology, as well as clinical biomechanics, chiropractics, massotherapy, thermotherapy, cryotherapy and various other specific exercises practiced in esthetic and orthopedic kinesiology - kinesitherapy.50 females and 50 males aged 35 to 55 underwent our therapy and the results we obtained display very high curative effects.

  15. An analysis of cardiac defects and surgical interventions in 84 cases with full trisomy 18. (United States)

    Bruns, Deborah A; Martinez, Alyssa


    Trisomy 18 (Edwards syndrome) is the second most common autosomal trisomy after trisomy 21. Medical issues commonly include cardiac defects, such as ventricular septal defect (VSD) and atrial septal defect (ASD). If untreated, these conditions can contribute to the associated infant mortality. The objective of the study was review parent-reported information on 84 cases with full trisomy 18 focusing on prenatal and postnatal assessment and confirmation of cardiac defects and on subsequent treatment with cardiac surgery and post-surgery outcomes. At birth, 65 parent responses indicated the presence of VSD (77.4%), 38 ASD (45.2%), and 50 patent ductus arteriosus (PDA) (59.5%). The presence of multiple cardiac defects was also analyzed including 25 cases with VSD, ASD, and PDA at birth. The total reduced to 18 at survey completion. Twenty-four cases had one or more cardiac defects repaired for a total of 34 corrective surgeries. Age at surgery varied from 2 weeks to 41 months of age with most performed under 1 year of age. Twenty-one cases were still living at the time of survey completion (87.5%). From these date we provide recommendations and implications.

  16. Surgical intervention strategies for congenital tracheal stenosis associated with a tracheal bronchus based on the location of stenosis. (United States)

    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.

  17. Paliperidone Palmitate Associated with Necrotizing Deep Tissue Infection and Sepsis Requiring Surgical Intervention

    Directory of Open Access Journals (Sweden)

    Jonathan G. Leung


    Full Text Available Long-acting injectable antipsychotics provide the delivery of medication over an extended period of time requiring administration typically only every 2 to 4 weeks. The side effect profile of a long-acting injectable antipsychotic is predictable and similar to the oral formulation. However, injection site reactions may occur with this novel delivery system. The risk of an injection site reaction may be greater with the repeated administration of a lipophilic decanoate formulation and include pain, development of indurations, and fibrosis. Severe complications from injection site reactions have rarely been described in the literature with newer agents. We report the first case of a patient prescribed paliperidone palmitate every 3 weeks that developed severe sepsis requiring vasopressors and intubation due to delayed relayed recognition of a necrotizing infection at an injection site. Clinicians should be alerted to screen for injection site reactions when there is an unknown source infection in a patient receiving a long-acting injectable antipsychotic.

  18. [Unavoidable surgical intervention in two women with severe actinomycosis during IUD use]. (United States)

    Bergenhenegouwen, L A; de Haan, H H; Sijbrandij, E S; Groeneveld, P H


    Extensive abdominal infections with Actinomyces were diagnosed in two women aged 35 and 33 years respectively, who suffered from the nonspecific symptoms fever and abdominal pain. These infections occur more often in women with an intrauterine device. Development of an abdominal mass with ureter or bowel obstruction may cause hydronephrosis and mechanical ileus. The patients underwent a laparotomy and a double-J catheter was inserted, which could be removed later on (temporary stoma). Treatment included high-dose penicillin i.v. followed by oral amoxicillin. Both patients recovered. It may be difficult to establish this diagnosis: the first patient was diagnosed by histopathological examination, in the second Actinomyces had been found in a routine cervical smear a few years earlier.

  19. Primary gastric Hodgkin's lymphoma: favourable outcome following multi-agent chemotherapy without surgical intervention.

    LENUS (Irish Health Repository)

    Quintyne, K I


    The authors report the case of a 51-year-old man who presented with left-sided abdominal pain and weight loss associated with drenching night sweats. Preliminary blood tests yielded no specific cause for his symptoms, but abdominal ultrasound revealed multiple hepatic lesions and peripancreatic lymphadenopathy. Further imaging, including positron emission tomography (PET)\\/CT, revealed fludeoxyglucose 18F (FDG) avid uptake within lymphadenopathy above and below the diaphragm and also noted gastric thickening. Diagnosis was established with gastric biopsy and revealed gastric Hodgkin\\'s lymphoma. He was started on and tolerated multi-agent chemotherapy. Repeated PET\\/CT and gastric biopsy showed complete metabolic and pathologic response to treatment.

  20. HEPS Inventory Tool: An Inventory Tool Including Quality Assessment of School Interventions on Healthy Eating and Physical Activity (United States)

    Dadaczynski, Kevin; Paulus, Peter; de Vries, Nanne; de Ruiter, Silvia; Buijs, Goof


    The HEPS Inventory Tool aims to support stakeholders working in school health promotion to promote high quality interventions on healthy eating and physical activity. As a tool it provides a step-by-step approach on how to develop a national or regional inventory of existing school based interventions on healthy eating and physical activity. It…

  1. A Cochrane review of the evidence for non-surgical interventions for flexible pediatric flat feet. (United States)

    Evans, A M; Rome, K


    The pediatric flat foot is a frequent presentation in clinical practice, a common concern to parents and continues to be debated within professional ranks. As an entity, it is confused by varied classifications, the notion of well-intended prevention and unsubstantiated, if common, treatment. The available prevalence estimates are all limited by variable sampling, assessment measures and age groups and hence result in disparate findings (0.6-77.9%). Consistently, flat foot has been found to normally reduce with age. The normal findings of flat foot versus children's age estimates that approximately 45% of preschool children, and 15% of older children (average age 10 years) have flat feet. Few flexible flat feet have been found to be symptomatic. Joint hypermobility and increased weight or obesity may increase flat foot prevalence, independently of age. Most attempts at classification of flat foot morphology include the arch, heel position and foot flexibility. Usual assessment methods are footprint measures, X-rays and visual (scaled) observations. There is no standardized framework from which to evaluate the pediatric flat foot. The pediatric flat foot is often unnecessarily treated, being ill-defined and of uncertain prognosis. Contemporary management of the pediatric flat foot is directed algorithmically within this review, according to pain, age, flexibility; considering gender, weight, and joint hypermobility. When foot orthoses are indicated, inexpensive generic appliances will usually suffice. Customised foot orthoses should be reserved for children with foot pain and arthritis, for unusual morphology, or unresponsive cases. Surgery is rarely indicated for pediatric flat foot (unless rigid) and only at the failure of thorough conservative management. The assessment of the pediatric flatfoot needs to be considered with reference to the epidemiological findings, where there is consensus that pediatric flexible flat foot reduces with age and that most children

  2. Traumatic foot injuries in horses: surgical management. (United States)

    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.

  3. Bleeding after initiation of multiple antithrombotic drugs, including triple therapy, in atrial fibrillation patients following myocardial infarction and coronary intervention

    DEFF Research Database (Denmark)

    Lamberts, Morten; Olesen, Jonas Bjerring; Ruwald, Martin Huth;


    Uncertainty remains over optimal antithrombotic treatment of patients with atrial fibrillation presenting with myocardial infarction and/or undergoing percutaneous coronary intervention. We investigated the risk and time frame for bleeding following myocardial infarction/percutaneous coronary int...

  4. Mechanisms of Action of Surgical Interventions on Weight-Related Diseases: the Potential Role of Bile Acids. (United States)

    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

  5. The cost-effectiveness of multi-component interventions to prevent delirium in older people undergoing surgical repair of hip fracture. (United States)

    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.

  6. The impact of a multifaceted intervention including sepsis electronic alert system and sepsis response team on the outcomes of patients with sepsis and septic shock. (United States)

    Arabi, Yaseen M; Al-Dorzi, Hasan M; Alamry, Ahmed; Hijazi, Ra'ed; Alsolamy, Sami; Al Salamah, Majid; Tamim, Hani M; Al-Qahtani, Saad; Al-Dawood, Abdulaziz; Marini, Abdellatif M; Al Ehnidi, Fatimah H; Mundekkadan, Shihab; Matroud, Amal; Mohamed, Mohamed S; Taher, Saadi


    Compliance with the clinical practice guidelines of sepsis management has been low. The objective of our study was to describe the results of implementing a multifaceted intervention including an electronic alert (e-alert) with a sepsis response team (SRT) on the outcome of patients with sepsis and septic shock presenting to the emergency department. This was a pre-post two-phased implementation study that consisted of a pre-intervention phase (January 01, 2011-September 24, 2012), intervention phase I (multifaceted intervention including e-alert, from September 25, 2012-March 03, 2013) and intervention phase II when SRT was added (March 04, 2013-October 30, 2013) in a 900-bed tertiary-care academic hospital. We recorded baseline characteristics and processes of care in adult patients presenting with sepsis or septic shock. The primary outcome measures were hospital mortality. Secondary outcomes were the need for mechanical ventilation and length of stay in the intensive unit and in the hospital. After implementing the multifaceted intervention including e-alert and SRT, cases were identified with less severe clinical and laboratory abnormalities and the processes of care improved. When adjusted to propensity score, the interventions were associated with reduction in hospital mortality [for intervention phase II compared to pre-intervention: adjusted odds ratio (aOR) 0.71, 95% CI 0.58-0.85, p = 0.003], reduction in the need for mechanical ventilation (aOR 0.45, 95% CI 0.37-0.55, p < 0.0001) and reduction in ICU LOS and hospital LOS for all patients as well as ICU LOS for survivors. Implementing a multifaceted intervention including sepsis e-alert with SRT was associated with earlier identification of sepsis, increase in compliance with sepsis resuscitation bundle and reduction in the need for mechanical ventilation and reduction in hospital mortality and LOS.

  7. 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. (United States)

    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.

  8. Comparative effectiveness of peripheral vascular intervention versus surgical bypass for critical limb ischemia in the Vascular Study Group of Greater New York. (United States)

    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.

  9. 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...

  10. Impact of a multifaceted educational intervention including serious games to improve the management of invasive candidiasis in critically ill patients. (United States)

    Ferrer, R; Zaragoza, R; Llinares, P; Maseda, E; Rodríguez, A; Quindós, G

    Infections caused by Candida species are common in critically ill patients and contribute to significant morbidity and mortality. The EPICO Project (Epico 1 and Epico 2.0 studies) recently used a Delphi approach to elaborate guidelines for the diagnosis and treatment of this condition in critically ill adult patients. We aimed to evaluate the impact of a multifaceted educational intervention based on the Epico 1 and Epico 2.0 recommendations. Specialists anonymously responded to two online surveys before and after a multifaceted educational intervention consisting of 60-min educational sessions, the distribution of slide kits and pocket guides with the recommendations, and an interactive virtual case presented at a teleconference and available for online consultation. A total of 74 Spanish hospitals. Specialists of the Intensive Care Units in the participating hospitals. Specialist knowledge and reported practices evaluated using a survey. The McNemar test was used to compare the responses in the pre- and post-intervention surveys. A total of 255 and 248 specialists completed both surveys, in both periods, respectively. The pre-intervention surveys showed many specialists to be unaware of the best approach for managing invasive candidiasis. After both educational interventions, specialist knowledge and reported practices were found to be more in line with nearly all the recommendations of the Epico 1 and Epico 2.0 guidelines, except as regards de-escalation from echinocandins to fluconazole in Candida glabrata infections (p=0.055), and the duration of antifungal treatment in both candidemia and peritoneal candidiasis. This multifaceted educational intervention based on the Epico Project recommendations improved specialist knowledge of the management of invasive candidiasis in critically ill patients. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

  11. Identifying relevant components to include in a parenting intervention for homeless families in transitional housing: Using parent input to inform adaptation efforts. (United States)

    Holtrop, Kendal; Chaviano, Casey L; Scott, Jenna C; McNeil Smith, Shardé


    Homeless families in transitional housing face a number of distinct challenges, yet there is little research seeking to guide prevention and intervention work with homeless parents. Informed by the tenets of community-based participatory research, the purpose of this study was to identify relevant components to include in a parenting intervention for this population. Data were gathered from 40 homeless parents through semistructured individual interviews and were analyzed using qualitative content analysis. The resulting 15 categories suggest several topics, approach considerations, and activities that can inform parenting intervention work with homeless families in transitional housing. Study findings are discussed within the context of intervention fidelity versus adaptation, and implications for practice, research, and policy are suggested. This study provides important insights for informing parenting intervention adaptation and implementation efforts with homeless families in transitional housing. (PsycINFO Database Record

  12. Intensive lifestyle intervention including high-intensity interval training program improves insulin resistance and fasting plasma glucose in obese patients

    Directory of Open Access Journals (Sweden)

    Guillaume Marquis-Gravel


    Conclusion: Following a 9-month intensive lifestyle intervention combining HIIT and MedD counseling, obese subjects experienced significant improvements of FPG and insulin resistance. This is the first study to expose the effects of a long-term program combining HIIT and MedD on glycemic control parameters among obese subjects.

  13. Unrelated medical costs in life-years gained : should they be included in economic evaluations of healthcare interventions?

    NARCIS (Netherlands)

    Rappange, David R; van Baal, Pieter H M; van Exel, N Job A; Feenstra, Talitha L; Rutten, Frans F H; Brouwer, Werner B F


    Which costs and benefits to consider in economic evaluations of healthcare interventions remains an area of much controversy. Unrelated medical costs in life-years gained is an important cost category that is normally ignored in economic evaluations, irrespective of the perspective chosen for the an

  14. Parents' Adoption of Social Communication Intervention Strategies: Families Including Children with Autism Spectrum Disorder Who Are Minimally Verbal (United States)

    Shire, Stephanie Y.; Goods, Kelly; Shih, Wendy; Distefano, Charlotte; Kaiser, Ann; Wright, Courtney; Mathy, Pamela; Landa, Rebecca; Kasari, Connie


    Notably absent from the intervention literature are parent training programs targeting school-aged children with autism who have limited communication skills (Tager-Flusberg and Kasari in "Autism Res" 6:468-478, 2013). Sixty-one children with autism age 5-8 with minimal spontaneous communication received a 6-month social communication…

  15. Economic evaluation of angiographic interventions including a whole-radiology in- and outpatient care; Wirtschaftliche Evaluation angiographischer Interventionen einschliesslich einer radiologischen stationaeren und ambulanten Patientenbetreuung

    Energy Technology Data Exchange (ETDEWEB)

    Nolte-Ernsting, C.; Abel, K.; Krupski, G.; Lorenzen, J.; Adam, G. [Klinik und Poliklinik fuer Diagnostische und Interventionelle Radiologie, Universitaetsklinikum Hamburg-Eppendorf (Germany)


    Purpose: To determine the economic efficiency of a whole-radiology in- and outpatient treatment with angiographic interventions performed as the main or sole therapy. Materials and Methods: The calculations represent the data of a university radiology department, including the following angiographic interventions (neuroradiology not considered): Vascular intervention (PTA, stent implantation) of kidneys and extremities, recanalization of hemodialysis access, chemoembolization, diagnostic arterioportal liver CT, port implantation, varicocele embolization, PTCD, percutaneous implantation of biliary stent. First, the different angiographic interventions are categorized with reference to the German DRG system 2005. Considering the example of a university hospital, the individual cost of each intervention is calculated and correlated with reimbursements by G-DRG2005 and so-called ''ambulant operation'' (EBM200plus). With these data, profits and losses are calculated for both in- and outpatient care. Results: Radiologic interventions of inpatients yield a profit in the majority of cases. With a base rate of 2900 Euro, the profits in our university hospital range between -872 Euro and +3411 Euro (mean: +1348 Euro). On the other hand, those angiographic interventions suitable for ''ambulant operation'' generate average profits of +372 Euro, if only direct costs are considered. The data of outpatient radiological interventions average between 381 Euro up to 1612 Euro lower than compared with profits obtained from in patient care. (orig.)

  16. Surgical ethics: surgical virtue and more. (United States)

    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.

  17. [Relationship between CD4(+) T lymphocyte cell count and the prognosis (including the healing of the incision wound) of HIV/AIDS patients who had undergone surgical operation]. (United States)

    Yang, Di; Zhao, Hongxin; Gao, Guiju; Wei, Kai; Zhang, Li; Han, Ning; Xiao, Jiang; Li, Xin; Wang, Fang; Liang, Hongyuan; Zhang, Wei; Wu, Liang


    To explore the relationship between CD4(+) T lymphocyte cell count and prognosis as well as healing of the surgical incision in HIV/AIDS patients who had received operation. Data were collected and analysed retrospectively from 234 HIV/AIDS patients hospitalized at the Beijing Ditan hospital who underwent operation between January 2008 and December 2012. Following factors were taken into consideration that including:age, gender, time and where that anti-HIV(+) was diagnosed, CD4(+)T lymphocyte cell count at the time of operation, part of the body that being operated, typology of incision, different levels of healing on the surgical incision, infection at the incision site, post-operative complications and the prognosis, etc. Wilcoxon rank sum test, χ(2) test, Kruskal-Wallis H test and Spearman rank correlation were used for statistical analysis to compare the different levels on healing of the incision in relation to the different CD4(+)T lymphocyte cell counts. Rates of level A healing under different CD4(+)T cell counts were also compared. 1) Among the 234 patients including 125 males and 109 females, the average age was 36.17±11.56 years old. Time after discovery of anti-HIV(+)was between 0 and 204 months. The medium CD4(+)T cell count was 388.5 cell/µl; 23.93% of the patients having CD4(+)T lymphocyte cell counts as different organs affected at the time of operation, due to 48 different kinds of illness. 21.37% of the operations belonged to class I incision, 49.57% was class II incision and 29.06% was class III incision. 86.32% of the incisions resulted in level A healing, 12.51% resulted in level B and 1.71% in level C. 4.27% of the patients developed post-operative complications. Differences between level A healing and level B or C healing in terms of CD4(+)T lymphocyte cell count were not significant (P > 0.05). There was no statistically significant difference on the CD4(+) T lymphocyte count in patients with or without postoperative complications

  18. Cervical necrotizing fasciitis as a complication of acute epiglottitis managed with minimally aggressive surgical intervention: Case report. (United States)

    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.

  19. The effect of weight management interventions that include a diet component on weight-related outcomes in pregnant and postpartum women: a systematic review protocol. (United States)

    Spencer, Lisa; Rollo, Megan; Hauck, Yvonne; MacDonald-Wicks, Lesley; Wood, Lisa; Hutchesson, Melinda; Giglia, Roslyn; Smith, Roger; Collins, Clare


    What are the effects of weight management interventions that include a diet component on weight-related outcomes in pregnant and postpartum women?The primary objective of this systematic review is to evaluate the effectiveness of weight management interventions which include a diet component and are aimed at limiting gestational weight gain and postpartum weight retention in women.The second objective of this systematic review is to investigate included intervention components with respect to effect on weight-related outcomes. This may include, but is not limited to: length of intervention, use of face-to-face counselling, group or individual consultations, use of other interventions components including exercise, use of goals and use of support tools like food diaries, coaching, including email or text message support. Around half of all women of reproductive age are either overweight or obese, with women aged 25-34 years having a greater risk of substantial weight gain compared with men of all ages. Excessive gestational weight gain (GWG) and postpartum weight retention (PPWR) may play a significant role in long term obesity. Having one child doubles the five- and 10-year obesity incidence for women, with many women who gain excessive weight during pregnancy remaining obese permanently. Excessive GWG and/or PPWR can also significantly contribute to short- and long-term adverse health outcomes for mother, baby and future pregnancies.Maternal obesity increases the risk of pregnancy related complications such as pre-eclampsia, gestational diabetes mellitus, stillbirth and the rate of caesarean section. Childhood obesity is a further long term complication of maternal obesity for offspring, which may persist in to adulthood. Excess GWG is also a risk factor for PPWR both in the short and long-term. Nehring et al. conducted a meta-analysis with over 65,000 women showing that, compared to women who gained weight within recommendations during pregnancy, women with GWG

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

    Directory of Open Access Journals (Sweden)

    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.

  1. An exploratory randomised controlled trial of a premises-level intervention to reduce alcohol-related harm including violence in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Moore Simon C


    Full Text Available Abstract Background To assess the feasibility of a randomised controlled trial of a licensed premises intervention to reduce severe intoxication and disorder; to establish effect sizes and identify appropriate approaches to the development and maintenance of a rigorous research design and intervention implementation. Methods An exploratory two-armed parallel randomised controlled trial with a nested process evaluation. An audit of risk factors and a tailored action plan for high risk premises, with three month follow up audit and feedback. Thirty-two premises that had experienced at least one assault in the year prior to the intervention were recruited, match paired and randomly allocated to control or intervention group. Police violence data and data from a street survey of study premises’ customers, including measures of breath alcohol concentration and surveyor rated customer intoxication, were used to assess effect sizes for a future definitive trial. A nested process evaluation explored implementation barriers and the fidelity of the intervention with key stakeholders and senior staff in intervention premises using semi-structured interviews. Results The process evaluation indicated implementation barriers and low fidelity, with a reluctance to implement the intervention and to submit to a formal risk audit. Power calculations suggest the intervention effect on violence and subjective intoxication would be raised to significance with a study size of 517 premises. Conclusions It is methodologically feasible to conduct randomised controlled trials where licensed premises are the unit of allocation. However, lack of enthusiasm in senior premises staff indicates the need for intervention enforcement, rather than voluntary agreements, and on-going strategies to promote sustainability. Trial registration UKCRN 7090; ISRCTN: 80875696

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

    Institute of Scientific and Technical Information of China (English)



    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.

  3. Converting Scoliosis Research Society-24 to Scoliosis Research Society-22r in a Surgical-Range, Medical/Interventional Adolescent Idiopathic Scoliosis Patient Cohort. (United States)

    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

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

    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

  5. Outcomes of cardiopulmonary resuscitation and predictors of survival in patients undergoing coronary angiography including percutaneous coronary interventions. (United States)

    Sprung, Juraj; Ritter, Matthew J; Rihal, Charanjit S; Warner, Mary E; Wilson, Gregory A; Williams, Brent A; Stevens, Susanna R; Schroeder, Darrell R; Bourke, Denis L; Warner, David O


    We studied the outcome of cardiopulmonary resuscitation (CPR) in patients undergoing coronary angiography (CA) and/or percutaneous coronary interventions (PCI). Of 51,985 CA and PCI patients treated between January 1, 1990, and December 31, 2000, 114 required CPR. Records were reviewed for relationships between patient characteristics and various procedures and short-term survival. Long-term survival was compared with that of a matched cohort of patients who did not have an arrest during catheterization and a matched cohort from the general Minnesota population. Over the 11-year period, the overall incidence of CPR was 21.9 per 10,000 procedures. This rate decreased from 33.9 per 10,000 before 1995 to 13.1 per 10,000 after 1995. Overall survival to hospital discharge after CPR was 56.1%. Survival to discharge was less frequent with a history of congestive heart failure, previous coronary artery bypass graft surgery, hemodynamic instability during the procedure, and with prolonged or emergent catheterizations. Pulseless electrical activity (versus asystole or ventricular fibrillation) indicated very poor short-term survival. Interestingly, short-term survival was not related to the extent of coronary artery disease. Long-term survival of patients who survived cardiac arrest was comparable to that of those who did not have arrest during catheterization. In conclusion, the incidence of periprocedural CPR during diagnostic or interventional coronary procedures decreased after 1995. Patients who received CPR in the cardiac catheterization lab have a remarkably frequent survival to hospital discharge rate. Long-term survival of these patients is only minimally reduced.

  6. Surgical Interventions and Medical Treatments in Treatment-Naïve Patients With Acromegaly: Systematic Review and Meta-Analysis (United States)

    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

  7. Surgical treatment of larynx T1N0M0 cancer - partial laryngectomy modified Majer-Piquet's intervention. (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  9. Changes in life satisfaction and self-esteem in patients with adolescent idiopathic scoliosis with and without surgical intervention. (United States)

    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.

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

    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.

  11. Modifying the Sleep Treatment Education Program for Students to include technology use (STEPS-TECH): Intervention effects on objective and subjective sleep outcomes. (United States)

    Barber, Larissa K; Cucalon, Maria S


    University students often have sleep issues that arise from poor sleep hygiene practices and technology use patterns. Yet, technology-related behaviors are often neglected in sleep hygiene education. This study examined whether the Sleep Treatment Education Program for Students-modified to include information regarding managing technology use (STEPS-TECH)-helps improve both subjective and objective sleep outcomes among university students. Results of an experimental study among 78 university students showed improvements in objective indicators of sleep quantity (total sleep time) and sleep quality (less awakenings) during the subsequent week for students in the STEPS-TECH intervention group compared to a control group. Exploratory analyses indicated that effects were driven by improvements in weekend days immediately following the intervention. There were also no intervention effects on subjective sleep quality or quantity outcomes. In terms of self-reported behavioral responses to educational content in the intervention, there were no group differences in sleep hygiene practices or technology use before bedtime. However, the intervention group reported less technology use during sleep periods than the control group. These preliminary findings suggest that STEPS-TECH may be a useful educational tool to help improve objective sleep and reduce technology use during sleep periods among university students. Copyright © 2017 John Wiley & Sons, Ltd.

  12. Prevention of diabetes in overweight/obese children through a family based intervention program including supervised exercise (PREDIKID project): study protocol for a randomized controlled trial. (United States)

    Arenaza, Lide; Medrano, María; Amasene, María; Rodríguez-Vigil, Beatriz; Díez, Ignacio; Graña, Manuel; Tobalina, Ignacio; Maiz, Edurne; Arteche, Edurne; Larrarte, Eider; Huybrechts, Inge; Davis, Catherine L; Ruiz, Jonatan R; Ortega, Francisco B; Margareto, Javier; Labayen, Idoia


    The global pandemic of obesity has led to an increased risk for prediabetes and type-2 diabetes (T2D). The aims of the current project are: (1) to evaluate the effect of a 22-week family based intervention program, including supervised exercise, on insulin resistance syndrome (IRS) risk in children with a high risk of developing T2D and (2) to identify the profile of microRNA in circulating exosomes and in peripheral blood mononuclear cells in children with a high risk of developing T2D and its response to a multidisciplinary intervention program including exercise. A total of 84 children, aged 8-12 years, with a high risk of T2D will be included and randomly assigned to control (N = 42) or intervention (N = 42) groups. The control group will receive a family based lifestyle education and psycho-educational program (2 days/month), while the intervention group will attend the same lifestyle education and psycho-educational program plus the exercise program (3 days/week, 90 min per session including warm-up, moderate to vigorous aerobic activities, and strength exercises). The following measurements will be evaluated at baseline prior to randomization and after the intervention: fasting insulin, glucose and hemoglobin A1c; body composition (dual-energy X-ray absorptiometry); ectopic fat (magnetic resonance imaging); microRNA expression in circulating exosomes and in peripheral blood mononuclear cells (MiSeq; Illumina); cardiorespiratory fitness (cardiopulmonary exercise testing); dietary habits and physical activity (accelerometry). Prevention and identification of children with a high risk of developing T2D could help to improve their cardiovascular health and to reduce the comorbidities associated with obesity., ID: NCT03027726 . Registered on 16 January 2017.

  13. Coexisting tubular adenoma with a neuroendocrine carcinoma of colon allowing early surgical intervention and implicating a shared stem cell origin (United States)

    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

  14. Surgical intervention for paediatric liver injuries is almost history - a 12-year cohort from a major Scandinavian trauma centre. (United States)

    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.

  15. Botulinum toxin assessment, intervention and aftercare for paediatric and adult niche indications including pain: international consensus statement. (United States)

    Rawicki, B; Sheean, G; Fung, V S C; Goldsmith, S; Morgan, C; Novak, I


    Evidence is emerging for the use of botulinum neurotoxin type-A (BoNT-A) for niche indications including pain independent of spasticity. Pain indications such as chronic nociceptive back pain, piriformis syndrome, chronic myofascial pain, pelvic pain, complex regional pain syndrome, facial pain and neuropathic pain are outlined in this paper. Of these, class I evidence is available for the treatment of chronic nociceptive low back pain, piriformis syndrome, myofascial pain, facial pain, neuropathic pain and plantar fasciitis. Peri-operative use of BoNT-A is emerging, with indications including planning for surgery and facilitating surgery, as well as healing and improving analgesia post-operatively. Evidence is limited, although there are some reports that clinicians are successfully using BoNT-A peri-operatively. There is class I evidence showing pre-operative use of BoNT-A has a beneficial effect on outcomes following adductor-release surgery. The use of BoNT for treatment of tremor, other than neck tremor in the setting of cervical dystonia, including evidence for upper limb tremor, cranial tremor and non-dystonic neck tremor is reviewed. The evidence is variable at this stage, and further study is required to develop definitive recommendations for the clinical utility of BoNT-A for these indications.

  16. Surgical treatment of traumatic lower limb pseudoaneurysm

    Institute of Scientific and Technical Information of China (English)

    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.

  17. 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

    Directory of Open Access Journals (Sweden)

    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

  18. [da Vinci surgical system]. (United States)

    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 clinical study of the optimalization of surgical treatment and the traditional Chinese medicine intervention on palmar hyperhidrosis. (United States)

    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.

  20. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  1. Development and Field-Testing of a Study Protocol, including a Web-Based Occupant Survey Tool, for Use in Intervention Studies of Indoor Environmental Quality

    Energy Technology Data Exchange (ETDEWEB)

    Mendell, Mark; Eliseeva, Ekaterina; Spears, Michael; Fisk, William J.


    We developed and pilot-tested an overall protocol for intervention studies to evaluate the effects of indoor environmental changes in office buildings on the health symptoms and comfort of occupants. The protocol includes a web-based survey to assess the occupant's responses, as well as specific features of study design and analysis. The pilot study, carried out on two similar floors in a single building, compared two types of ventilation system filter media. With support from the building's Facilities staff, the implementation of the filter change intervention went well. While the web-based survey tool worked well also, low overall response rates (21-34percent among the three work groups included) limited our ability to evaluate the filter intervention., The total number of questionnaires returned was low even though we extended the study from eight to ten weeks. Because another simultaneous study we conducted elsewhere using the same survey had a high response rate (>70percent), we conclude that the low response here resulted from issues specific to this pilot, including unexpected restrictions by some employing agencies on communication with occupants.

  2. Development and Field-Testing of a Study Protocol, including a Web-Based Occupant Survey Tool, for Use in Intervention Studies of Indoor Environmental Quality

    Energy Technology Data Exchange (ETDEWEB)

    Mendell, Mark; Eliseeva, Ekaterina; Spears, Michael; Fisk, William J.


    We developed and pilot-tested an overall protocol for intervention studies to evaluate the effects of indoor environmental changes in office buildings on the health symptoms and comfort of occupants. The protocol includes a web-based survey to assess the occupant's responses, as well as specific features of study design and analysis. The pilot study, carried out on two similar floors in a single building, compared two types of ventilation system filter media. With support from the building's Facilities staff, the implementation of the filter change intervention went well. While the web-based survey tool worked well also, low overall response rates (21-34percent among the three work groups included) limited our ability to evaluate the filter intervention., The total number of questionnaires returned was low even though we extended the study from eight to ten weeks. Because another simultaneous study we conducted elsewhere using the same survey had a high response rate (>70percent), we conclude that the low response here resulted from issues specific to this pilot, including unexpected restrictions by some employing agencies on communication with occupants.

  3. Review of six cases of maxillary ameloblastoma from the West Indies: re-entry cryosurgery as prophylactic surgical intervention. (United States)

    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).

  4. 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

    Directory of Open Access Journals (Sweden)

    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

  5. Do psychological variables affect early surgical recovery?

    Directory of Open Access Journals (Sweden)

    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.

  6. Effects of Lifestyle Interventions That Include a Physical Activity Component in Class II and III Obese Individuals: A Systematic Review and Meta-Analysis (United States)

    Baillot, Aurélie; Romain, Ahmed J.; Boisvert-Vigneault, Katherine; Audet, Mélisa; Baillargeon, Jean Patrice; Dionne, Isabelle J.; Valiquette, Louis; Chakra, Claire Nour Abou; Avignon, Antoine; Langlois, Marie-France


    Background In class II and III obese individuals, lifestyle intervention is the first step to achieve weight loss and treat obesity-related comorbidities before considering bariatric surgery. A systematic review, meta-analysis, and meta-regression were performed to assess the impact of lifestyle interventions incorporating a physical activity (PA) component on health outcomes of class II and III obese individuals. Methods An electronic search was conducted in 4 databases (Medline, Scopus, CINAHL and Sportdiscus). Two independent investigators selected original studies assessing the impact of lifestyle interventions with PA components on anthropometric parameters, cardiometabolic risk factors (fat mass, blood pressure, lipid and glucose metabolism), behaviour modification (PA and nutritional changes), and quality of life in adults with body mass index (BMI) ≥ 35 kg/m2. Estimates were pooled using a random-effect model (DerSimonian and Laird method). Heterogeneity between studies was assessed by the Cochran’s chi-square test and quantified through an estimation of the I². Results Of the 3,170 identified articles, 56 met our eligibility criteria, with a large majority of uncontrolled studies (80%). The meta-analysis based on uncontrolled studies showed significant heterogeneity among all included studies. The pooled mean difference in weight loss was 8.9 kg (95% CI, 10.2–7.7; p lifestyle intervention on fat mass, waist circumference, blood pressure, total cholesterol, LDL-C, triglycerides and fasting insulin was found (pfasting blood glucose. Conclusions Lifestyle interventions incorporating a PA component can improve weight and various cardiometabolic risk factors in class II and III obese individuals. However, further high quality trials are needed to confirm this evidence, especially beyond weight loss. PMID:25830342

  7. Effects of lifestyle interventions that include a physical activity component in class II and III obese individuals: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Aurélie Baillot

    Full Text Available In class II and III obese individuals, lifestyle intervention is the first step to achieve weight loss and treat obesity-related comorbidities before considering bariatric surgery. A systematic review, meta-analysis, and meta-regression were performed to assess the impact of lifestyle interventions incorporating a physical activity (PA component on health outcomes of class II and III obese individuals.An electronic search was conducted in 4 databases (Medline, Scopus, CINAHL and Sportdiscus. Two independent investigators selected original studies assessing the impact of lifestyle interventions with PA components on anthropometric parameters, cardiometabolic risk factors (fat mass, blood pressure, lipid and glucose metabolism, behaviour modification (PA and nutritional changes, and quality of life in adults with body mass index (BMI ≥ 35 kg/m2. Estimates were pooled using a random-effect model (DerSimonian and Laird method. Heterogeneity between studies was assessed by the Cochran's chi-square test and quantified through an estimation of the I².Of the 3,170 identified articles, 56 met our eligibility criteria, with a large majority of uncontrolled studies (80%. The meta-analysis based on uncontrolled studies showed significant heterogeneity among all included studies. The pooled mean difference in weight loss was 8.9 kg (95% CI, 10.2-7.7; p < 0.01 and 2.8 kg/m² in BMI loss (95% CI, 3.4-2.2; p < 0.01. Long-term interventions produced superior weight loss (11.3 kg compared to short-term (7.2 kg and intermediate-term (8.0 kg interventions. A significant global effect of lifestyle intervention on fat mass, waist circumference, blood pressure, total cholesterol, LDL-C, triglycerides and fasting insulin was found (p<0.01, without significant effect on HDL-C and fasting blood glucose.Lifestyle interventions incorporating a PA component can improve weight and various cardiometabolic risk factors in class II and III obese individuals. However, further

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

    Institute of Scientific and Technical Information of China (English)

    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.

  9. How Are Gender Equality and Human Rights Interventions Included in Sexual and Reproductive Health Programmes and Policies: A Systematic Review of Existing Research Foci and Gaps. (United States)

    Hartmann, Miriam; Khosla, Rajat; Krishnan, Suneeta; George, Asha; Gruskin, Sofia; Amin, Avni


    The importance of promoting gender equality and human rights in sexual and reproductive health (SRH) programmes and policies has been affirmed in numerous international and regional agreements, most recently the 2030 Agenda for Sustainable Development. Given the critical role of research to determine what works, we aimed to identify research gaps as part of a broader priority setting exercise on integrating gender equality and human rights approaches in SRH programmes and policies. A systematic literature review of reviews was conducted to examine the question: what do we know about how research in the context of SRH programmes and policies has addressed gender equality and human rights and what are the current gaps in research. We searched three databases for reviews that addressed the research question, were published between 1994-2014, and met methodological standards for systematic reviews, qualitative meta-syntheses and other reviews of relevance to the research question. Additional grey literature was identified based on expert input. Articles were appraised by the primary author and examined by an expert panel. An abstraction and thematic analysis process was used to synthesize findings. Of the 3,073 abstracts identified, 56 articles were reviewed in full and 23 were included along with 10 from the grey literature. The majority focused on interventions addressing gender inequalities; very few reviews explicitly included human rights based interventions. Across both topics, weak study designs and use of intermediate outcome measures limited evidence quality. Further, there was limited evidence on interventions that addressed marginalized groups. Better quality studies, longer-term indicators, and measurement of unintended consequences are needed to better understand the impact of these types of interventions on SRH outcomes. Further efforts are needed to cover research on gender equality and human rights issues as they pertain to a broader set of SRH topics

  10. How Are Gender Equality and Human Rights Interventions Included in Sexual and Reproductive Health Programmes and Policies: A Systematic Review of Existing Research Foci and Gaps (United States)

    Khosla, Rajat; Krishnan, Suneeta; George, Asha; Gruskin, Sofia; Amin, Avni


    The importance of promoting gender equality and human rights in sexual and reproductive health (SRH) programmes and policies has been affirmed in numerous international and regional agreements, most recently the 2030 Agenda for Sustainable Development. Given the critical role of research to determine what works, we aimed to identify research gaps as part of a broader priority setting exercise on integrating gender equality and human rights approaches in SRH programmes and policies. A systematic literature review of reviews was conducted to examine the question: what do we know about how research in the context of SRH programmes and policies has addressed gender equality and human rights and what are the current gaps in research. We searched three databases for reviews that addressed the research question, were published between 1994–2014, and met methodological standards for systematic reviews, qualitative meta-syntheses and other reviews of relevance to the research question. Additional grey literature was identified based on expert input. Articles were appraised by the primary author and examined by an expert panel. An abstraction and thematic analysis process was used to synthesize findings. Of the 3,073 abstracts identified, 56 articles were reviewed in full and 23 were included along with 10 from the grey literature. The majority focused on interventions addressing gender inequalities; very few reviews explicitly included human rights based interventions. Across both topics, weak study designs and use of intermediate outcome measures limited evidence quality. Further, there was limited evidence on interventions that addressed marginalized groups. Better quality studies, longer-term indicators, and measurement of unintended consequences are needed to better understand the impact of these types of interventions on SRH outcomes. Further efforts are needed to cover research on gender equality and human rights issues as they pertain to a broader set of SRH topics

  11. [Some principles in surgical treatment of strabismus]. (United States)

    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.

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

    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. 小儿肾血管性高血压的外科治疗(包括6例自体肾移植术)%Surgical Treatment of Renovascular Hypertension in Children: Including 6 Cases of Renal Autotransplantation

    Institute of Scientific and Technical Information of China (English)

    李衷初; 余亚雄


    @@ 近十余年来,对肾血管性高血压的外科治疗有较大的进展,国内外文献报导亦渐见增多,但有关小儿病例的报告尚少.我院自1976~1981年间共收治9例,均作了腹主动脉、肾动脉造影术,诊断明确.本文重点介绍与讨论自体肾移植术的疗效与评价.%From 1976 to 1981,9 cases of renovas,cular hypertension in children were treated surgically.The etiology of renal artery steno sis in this series consisted of congenital abhor real renal artery(2 cases),fibromuscular dyspla sin(1 case)and Takayasu's arteritis(6 cases).The diagnosis was made by the aorto-reno gram in each case and was proved by the intervention and the pathological examination.Except those 3 cases,the others were treated by nephrectomy,of which one case died from unknown cause one year after operation,6 cases had undergone the renal autotransplan tation.The authors reviewed 13 pediatric cases(including this series)reported in Chinese literature(<12 years old),who were treated by renal autotransplantation with cure rate 84.6%(normotension on no medication).The authors indicated that the results of the renal autotrancplantation were much better than that of the revascularization techni ques with the following advantages:(1)the success rate was higher;(2)it provided excellent exposure for the vascular anastomosis in the iliac fossa;(3)the blood pressure in internal itiac artery was generally higher than that of the renal artery so that the blood pressure in transplanted kidney could be elevated after operation,and(4)it seemed more profitable in cases with renal artery stenosis by Takayasu's arteritis,because of no apparent stenosis:in the internal iliac arteries,which was observed from the arteriograms in the papers reported by others and us.

  14. Surgical innovation as sui generis surgical research. (United States)

    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.

  15. HPTN 071 (PopART: a cluster-randomized trial of the population impact of an HIV combination prevention intervention including universal testing and treatment: mathematical model.

    Directory of Open Access Journals (Sweden)

    Anne Cori

    Full Text Available BACKGROUND: The HPTN 052 trial confirmed that antiretroviral therapy (ART can nearly eliminate HIV transmission from successfully treated HIV-infected individuals within couples. Here, we present the mathematical modeling used to inform the design and monitoring of a new trial aiming to test whether widespread provision of ART is feasible and can substantially reduce population-level HIV incidence. METHODS AND FINDINGS: The HPTN 071 (PopART trial is a three-arm cluster-randomized trial of 21 large population clusters in Zambia and South Africa, starting in 2013. A combination prevention package including home-based voluntary testing and counseling, and ART for HIV positive individuals, will be delivered in arms A and B, with ART offered universally in arm A and according to national guidelines in arm B. Arm C will be the control arm. The primary endpoint is the cumulative three-year HIV incidence. We developed a mathematical model of heterosexual HIV transmission, informed by recent data on HIV-1 natural history. We focused on realistically modeling the intervention package. Parameters were calibrated to data previously collected in these communities and national surveillance data. We predict that, if targets are reached, HIV incidence over three years will drop by >60% in arm A and >25% in arm B, relative to arm C. The considerable uncertainty in the predicted reduction in incidence justifies the need for a trial. The main drivers of this uncertainty are possible community-level behavioral changes associated with the intervention, uptake of testing and treatment, as well as ART retention and adherence. CONCLUSIONS: The HPTN 071 (PopART trial intervention could reduce HIV population-level incidence by >60% over three years. This intervention could serve as a paradigm for national or supra-national implementation. Our analysis highlights the role mathematical modeling can play in trial development and monitoring, and more widely in evaluating the

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

    Institute of Scientific and Technical Information of China (English)

    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.


    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

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

    Institute of Scientific and Technical Information of China (English)

    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

  19. Surgical treatment for male prolactinoma (United States)

    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

  20. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  1. Abortion - surgical (United States)

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

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

    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

  3. Predictors for anterior pelvic tilt following surgical correction of flexed knee gait including patellar tendon shortening in children with cerebral palsy. (United States)

    Böhm, Harald; Hösl, Matthias; Döderlein, Leonhard


    Patellar tendon shortening procedure within single event multilevel surgeries was shown to improve crouch gait in Cerebral Palsy (CP) patients. However, one of the drawbacks associated to the correction of flexed knee gait may be increased pelvic anterior tilt with compensatory lumbar lordosis. Which CP patients are at risk for excessive anterior pelvic tilt following correction of flexed knee gait including patellar tendon shortening? 32 patients with CP between 8 and 18 years GMFCS I&II were included. They received patellar tendon shortenings within multilevel surgery. Patients with concomitant knee flexor lengthening were excluded. Gait analysis and clinical testing was performed pre- and 24.1 (SD=1.9) months postoperatively. Patients were subdivided into more/less than 5° increase in anterior pelvic tilt. Preoperative measures indicating m. rectus and m. psoas shortness, knee flexor over-length, hip extensor and abdominal muscle weakness and equinus gait were compared between groups. Stepwise multilinear regression of the response value increase in pelvic tilt during stance phase was performed from parameters that were significantly different between groups. 34% of patients showed more than 5° increased pelvic anterior tilt postoperatively. Best predictors for anterior pelvic tilt from preoperative measures were increased m. rectus tone and reduced hip extension during walking that explained together 39% of the variance in increase of anterior pelvic tilt. Every third patient showed considerable increased pelvic tilt following surgery of flexed knee gait. In particular patients with preoperative higher muscle tone in m. rectus and lower hip extension during walking were at risk and both features need to be addressed in the therapy. Copyright © 2017 Elsevier B.V. All rights reserved.

  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

    Institute of Scientific and Technical Information of China (English)



    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. Long-term pain relief with optimized medical treatment including antioxidants and step-up interventional therapy in patients with chronic pancreatitis. (United States)

    Shalimar; Midha, Shallu; Hasan, Ajmal; Dhingra, Rajan; Garg, Pramod Kumar


    Abdominal pain is difficult to treat in patients with chronic pancreatitis (CP). Medical therapy including antioxidants has been shown to relieve pain of CP in the short-term. Our aim was to study the long-term results of optimized medical and interventional therapy for pain relief in patients with CP with a step-up approach. All consecutive patients with CP were included prospectively in the study. They were treated medically with a well-balanced diet, pancreatic enzymes, and antioxidants (9000 IU beta-carotene, 0.54 g vitamin C, 270 IU vitamin E, 600 µg organic selenium, and 2 g methionine). Endoscopic therapy and/or surgery were offered if medical therapy failed. Pain relief was the primary outcome measure. A total of 313 patients (mean age 26.16 ± 12.17; 244 males) with CP were included; 288 (92%) patients had abdominal pain. The etiology of CP was idiopathic in 224 (71.6%) and alcohol in 82 (26.2%). At 1-year follow-up, significant pain relief was achieved in 84.7% of patients: 52.1% with medical therapy, 16.7% with endoscopic therapy, 7.6% with surgery, and 8.3% spontaneously. The mean pain score decreased from 6.36 ± 1.92 to 1.62 ± 2.10 (P < 0.001). Of the 288 patients, 261, 218, 112, and 51 patients were followed up for 3, 5, 10, and 15 years, respectively; 54.0%, 57.3%, 60.7%, and 68.8% of them became pain free at those follow-up periods. Significant pain relief is achieved in the majority of patients with optimized medical and interventional treatment. © 2016 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  6. Issues Relating to Study Design and Risk of Bias When Including Non-Randomized Studies in Systematic Reviews on the Effects of Interventions (United States)

    Higgins, Julian P. T.; Ramsay, Craig; Reeves, Barnaby C.; Deeks, Jonathan J.; Shea, Beverley; Valentine, Jeffrey C.; Tugwell, Peter; Wells, George


    Non-randomized studies may provide valuable evidence on the effects of interventions. They are the main source of evidence on the intended effects of some types of interventions and often provide the only evidence about the effects of interventions on long-term outcomes, rare events or adverse effects. Therefore, systematic reviews on the effects…

  7. Is a Picture Worth a Thousand Words? Few Evidence-Based Features of Dietary Interventions Included in Photo Diet Tracking Mobile Apps for Weight Loss. (United States)

    Hales, Sarah; Dunn, Caroline; Wilcox, Sara; Turner-McGrievy, Gabrielle M


    Apps using digital photos to track dietary intake and provide feedback are common, but currently there has been no research examining what evidence-based strategies are included in these apps. A content analysis of mobile apps for photo diet tracking was conducted, including whether effective techniques for interventions promoting behavior change, including self-regulation, for healthy eating (HE) are targeted. An initial search of app stores yielded 34 apps (n = 8 Android and Apple; n = 11 Android; n = 15 Apple). One app was removed (unable to download), and other apps (n = 4) were unable to be rated (no longer available). Remaining apps (n = 29) were downloaded, reviewed, and coded by 2 independent reviewers to determine the number of known effective self-regulation and other behavior change techniques included. The raters met to compare their coding of the apps, calculate interrater agreement, resolve any discrepancies, and come to a consensus. Six apps (21%) did not utilize any of the behavior change techniques examined. Three apps (10%) provided feedback to users via crowdsourcing or collective feedback from other users and professionals, 7 apps (24%) used crowdsourcing or collective feedback, 1 app (3%) used professionals, and 18 apps (62%) did not provide any dietary feedback to users. Few photo diet-tracking apps include evidence-based strategies to improve dietary intake. Use of photos to self-monitor dietary intake and receive feedback has the potential to reduce user burden for self-monitoring, yet photo diet tracking apps need to incorporate known effective behavior strategies for HE, including self-regulation. © 2016 Diabetes Technology Society.

  8. Effectiveness of interventions on physical activity in overweight or obese children: a systematic review and meta-analysis including studies with objectively measured outcomes. (United States)

    Nooijen, C F J; Galanti, M R; Engström, K; Möller, J; Forsell, Y


    There is no consensus on interventions to be recommended in order to promote physical activity among overweight or obese children. The objective of this review was to assess the effects on objectively measured physical activity, of interventions promoting physical activity among overweight or obese children or adolescents, compared to no intervention or to interventions without a physical activity component. Publications up to December 2015 were located through electronic searches for randomized controlled trials resulting in inclusion of 33 studies. Standardized mean differences from baseline to post-intervention and to long-term follow-up were determined for intervention and control groups and meta-analysed using random effects models. The meta-analysis showed that interventions had no effect on total physical activity of overweight and obese children, neither directly post-intervention (-0.02 [-0.15, 0.11]) nor at long-term follow-up (0.07 [-0.27, 0.40]). Separate analyses by typology of intervention (with or without physical fitness, behavioural or environmental components) showed similar results (no effect). In conclusion, there is no evidence that currently available interventions are able to increase physical activity among overweight or obese children. This questions the contribution of physical activity to the treatment of overweight and obesity in children in the studied interventions and calls for other treatment strategies. © 2017 World Obesity Federation.

  9. Surgical versus non-surgical treatment of congenital hyperinsulinism. (United States)

    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.

  10. 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

    Energy Technology Data Exchange (ETDEWEB)

    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%.

  11. 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

    Institute of Scientific and Technical Information of China (English)

    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

  12. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs (United States)

    Steuri, Ruedi; Sattelmayer, Martin; Elsig, Simone; Kolly, Chloé; Tal, Amir; Taeymans, Jan


    Objective To investigate the effectiveness of conservative interventions for pain, function and range of motion in adults with shoulder impingement. Design Systematic review and meta-analysis of randomised trials. Data sources Medline, CENTRAL, CINAHL, Embase and PEDro were searched from inception to January 2017. Study selection criteria Randomised controlled trials including participants with shoulder impingement and evaluating at least one conservative intervention against sham or other treatments. Results For pain, exercise was superior to non-exercise control interventions (standardised mean difference (SMD) −0.94, 95% CI −1.69 to −0.19). Specific exercises were superior to generic exercises (SMD −0.65, 95% CI −0.99 to −0.32). Corticosteroid injections were superior to no treatment (SMD −0.65, 95% CI −1.04 to −0.26), and ultrasound guided injections were superior to non-guided injections (SMD −0.51, 95% CI −0.89 to −0.13). Nonsteroidal anti-inflammatory drugs (NSAIDS) had a small to moderate SMD of −0.29 (95% CI −0.53 to −0.05) compared with placebo. Manual therapy was superior to placebo (SMD −0.35, 95% CI −0.69 to −0.01). When combined with exercise, manual therapy was superior to exercise alone, but only at the shortest follow-up (SMD −0.32, 95% CI −0.62 to −0.01). Laser was superior to sham laser (SMD −0.88, 95% CI −1.48 to −0.27). Extracorporeal shockwave therapy (ECSWT) was superior to sham (−0.39, 95% CI −0.78 to –0.01) and tape was superior to sham (−0.64, 95% CI −1.16 to −0.12), with small to moderate SMDs. Conclusion Although there was only very low quality evidence, exercise should be considered for patients with shoulder impingement symptoms and tape, ECSWT, laser or manual therapy might be added. NSAIDS and corticosteroids are superior to placebo, but it is unclear how these treatments compare to exercise. PMID:28630217

  13. Determinants for further wishes for cosmetic and reconstructive interventions in 1652 patients with surgical treated carcinomas of the oral cavity. (United States)

    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

  14. Acute and chronic pancreatitis: surgical management. (United States)

    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.

  15. Surgical Assisting (United States)

    ... 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 ...

  16. Issues Relating to Confounding and Meta-analysis When Including Non-Randomized Studies in Systematic Reviews on the Effects of Interventions (United States)

    Valentine, Jeffrey C.; Thompson, Simon G.


    Background: Confounding caused by selection bias is often a key difference between non-randomized studies (NRS) and randomized controlled trials (RCTs) of interventions. Key methodological issues: In this third paper of the series, we consider issues relating to the inclusion of NRS in systematic reviews on the effects of interventions. We discuss…

  17. 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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  18. Implementation Science: A Neglected Opportunity to Accelerate Improvements in the Safety and Quality of Surgical Care. (United States)

    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.

  19. Reduction and sustainability of cesarean section surgical site infection: An evidence-based, innovative, and multidisciplinary quality improvement intervention bundle program. (United States)

    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.

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

    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.

  1. Outcome of Triple Antiplatelet Therapy Including Cilostazol in Elderly Patients with ST-Elevation Myocardial Infarction who Underwent Primary Percutaneous Coronary Intervention: Results from the INTERSTELLAR Registry. (United States)

    Jang, Ho-Jun; Park, Sang-Don; Park, Hyun Woo; Suh, Jon; Oh, Pyung Chun; Moon, Jeonggeun; Lee, Kyounghoon; Kang, Woong Chol; Kwon, Sung Woo; Kim, Tae-Hoon


    Compared with dual antiplatelet therapy including aspirin and clopidogrel, triple antiplatelet therapy including cilostazol has a mortality benefit in patients with ST-segment elevation myocardial infarction. However, whether the mortality benefit persists in elderly patients is not clear. From 2007 to 2014, 1278 patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention were retrospectively analyzed. The patients were divided into four groups by age (antiplatelet strategy (triple or dual antiplatelet therapy). We compared the mortality rates between the triple and dual antiplatelet therapy groups. There were 1052 (male, 85%; mean age, 56.3 ± 10.4 years) patients in the young group and 241 (male, 52.7%; mean age, 80.3 ± 4.5 years) patients in the elderly group. In the young and elderly groups, 220 (20.9%) and 28 (12.3%) patients were treated with triple antiplatelet therapy. During a 1-year follow-up period, 80 patients died (4.2% in the young group vs. 15.5% in the elderly group). Kaplan-Meier survival analysis revealed that triple antiplatelet therapy was associated with a lower mortality rate in the young group (log-rank, p = 0.005). Although there were more angiographic high-risk patients in the elderly group, similar mortality rates were reported (log-rank, p = 0.803) without increased bleeding rates (1 vs. 3.6% in the elderly group, p = 0.217). Triple antiplatelet therapy might be a better antiplatelet regimen than dual antiplatelet therapy for patients with ST-segment elevation myocardial infarction. Although this benefit was strong in patients aged <75 years, no definite increase in major bleeding was seen for elderly patients (aged ≥75 years).

  2. Planned development and evaluation protocol of two versions of a web-based computer-tailored nutrition education intervention aimed at adults, including cognitive and environmental feedback


    Springvloet, Linda; Lechner, Lilian; Oenema, Anke


    Background Despite decades of nutrition education, the prevalence of unhealthy dietary patterns is still high and inequalities in intake between high and low socioeconomic groups still exist. Therefore, it is important to innovate and improve existing nutrition education interventions. This paper describes the development, design and evaluation protocol of a web-based computer-tailored nutrition education intervention for adults targeting fruit, vegetable, high-energy snack and fat intake. Th...

  3. The role of the surgical care practitioner within the surgical team. (United States)

    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.

  4. Colorectal cancer complicated by perforation. Specific features of surgical tactics

    Directory of Open Access Journals (Sweden)

    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.

  5. 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

    Directory of Open Access Journals (Sweden)

    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

  6. Surgical data science: the new knowledge domain

    Directory of Open Access Journals (Sweden)

    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

  7. Surgical data science: The new knowledge domain. (United States)

    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

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

    National Research Council Canada - National Science Library

    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...

  9. 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

    Directory of Open Access Journals (Sweden)

    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.

  10. Self-reported barriers to pediatric surgical care in Guatemala. (United States)

    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.

  11. Hormonal and Surgical Treatment Options for Transgender Women and Transfeminine Spectrum Persons. (United States)

    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.

  12. Surgical treatment of acquired tracheocele. (United States)

    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.

  13. Manual of Surgical Instruments

    Directory of Open Access Journals (Sweden)

    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.

  14. Effects of lifestyle changes including specific dietary intervention and physical activity in the management of patients with chronic hepatitis C--a randomized trial. (United States)

    Rusu, Emilia; Jinga, Mariana; Enache, Georgiana; Rusu, Florin; Dragomir, Andreea Diana; Ancuta, Ioan; Draguţ, Ramona; Parpala, Cristina; Nan, Raluca; Sima, Irina; Ateia, Simona; Stoica, Victor; Cheţa, Dan Mircea; Radulian, Gabriela


    In patients with chronic hepatitis C (CHC), obesity is involved in the pathogenesis of insulin resistance, fatty liver disease and progression of fibrosis. The objective of this study was to compare a normoglucidic low-calorie diet (NGLCD) with a low-fat diet (LFD) among participants with CHC. Aimed to measure the impact of dietary changes in reduction of insulin resistance, obesity but also in steatosis and fibrosis. Randomized, controlled trial in three medical centers with assessments at baseline, 6 months and 12 months. Participants were patients over 35 years with chronic hepatitis C (n = 120) with BMI over 25 kg/m². We evaluated the effects of NGLCD vs. LFD in weight management and metabolic improvement. The primary endpoint was to measure the impact of dietary changes through nutritional intervention in reversibility of insulin resistance, obesity, steatosis, and fibrosis. We performed anthropometric measurements, fasting glucose profile, serum lipids, liver profile, blood count at baseline, 6 and 12 months. Steatosis was evaluated using ultrasonographic criteria. Liver fibrosis was non-invasively assessed. After 6 and 12 months of intervention, both groups had a significant decrease in caloric consumption. At 6 months, weight loss was greater in the NGLCD group (-5.02 ± 3.43 kg vs. -4.1 ± 2.6 kg; p = 0.002) compared to the LFD group. At 1-year, however, weight loss was similar in both groups (-3.9 ± 3.3 kg vs. -3.1 ± 2.6 kg; p = 0.139). At 12 months, fasting plasma glucose, fasting plasma insulin, and HOMA-IR had significant improvements in both groups. With both diets aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT) decreased with significant differences; also there were significant improvements in AST/ALT ratio, Forns fibrosis index. The two diets were associated with reduction of both the prevalence and the severity of steatosis (all p lifestyle intervention (specific

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

    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. 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

    Institute of Scientific and Technical Information of China (English)

    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

  17. Implications of Public Reporting of Risk-Adjusted Mortality Following Percutaneous Coronary Intervention: Misperceptions and Potential Consequences for High-Risk Patients Including Nonsurgical Patients. (United States)

    Gupta, Anuj; Yeh, Robert W; Tamis-Holland, Jacqueline E; Patel, Shalin H; Guyton, Robert A; Klein, Lloyd W; Rab, Tanveer; Kirtane, Ajay J


    Assessment of clinical outcomes such as 30-day mortality following coronary revascularization procedures has historically been used to spur quality improvement programs. Public reporting of risk-adjusted outcomes is already mandated in several states, and proposals to further expand public reporting have been put forward as a means of increasing transparency and potentially incentivizing high quality care. However, for public reporting of outcomes to be considered a useful surrogate of procedural quality of care, several prerequisites must be met. First, the reporting measure must be truly representative of the quality of the procedure itself, rather than be dominated by other underlying factors, such as the overall level of illness of a patient. Second, to foster comparisons among physicians and institutions, the metric requires accurate ascertainment of and adjustment for differences in patient risk profiles. This is particularly relevant for high-risk clinical patient scenarios. Finally, the potential deleterious consequences of public reporting of a quality metric should be considered prior to expanding the use of public reporting more broadly. In this viewpoint, the authors review in particular the characterization of high-risk patients currently treated by percutaneous coronary interventional procedures, assessing the adequacy of clinical risk models used in this population. They then expand upon the limitations of 30-day mortality as a quality metric for percutaneous coronary intervention, addressing the strengths and limitations of this metric, as well as offering suggestions to enhance its future use in public reporting. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  18. Minimally invasive surgical therapies for benign prostatic hypertrophy: The rise in minimally invasive surgical therapies. (United States)

    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.

  19. Comparative clinical study of ultrasound-guided A1 pulley release vs open surgical intervention in the treatment of trigger finger (United States)

    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

  20. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  1. [Artificial intelligence methods for support of medial patient education before surgical interventions in the region of the neck-nose-ear]. (United States)

    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.

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

    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.

  3. Guide to Surgical Specialists (United States)

    ... 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 ...

  4. 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

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    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

  5. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  6. 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

    Institute of Scientific and Technical Information of China (English)

    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

  7. Recent advances in the surgical management of rhinosinusitis [version 1; referees: 4 approved

    Directory of Open Access Journals (Sweden)

    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.

  8. 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. (United States)

    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.

  9. Instituting a Surgical Skills Competition Increases Technical Performance of Surgical Clerkship Students Over Time. (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    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.

  11. Surgical care for the direct and indirect victims of violence in the eastern Democratic Republic of Congo

    Directory of Open Access Journals (Sweden)

    Ford Nathan


    Full Text Available Abstract Background The provision of surgical assistance in conflict is often associated with care for victims of violence. However, there is an increasing appreciation that surgical care is needed for non-traumatic morbidities. In this paper we report on surgical interventions carried out by Médecins sans Frontières in Masisi, North Kivu, Democratic Republic of Congo to contribute to the scarce evidence base on surgical needs in conflict. Methods We analysed data on all surgical interventions done at Masisi district hospital between September 2007 and December 2009. Types of interventions are described, and logistic regression used to model associations with violence-related injury. Results 2869 operations were performed on 2441 patients. Obstetric emergencies accounted for over half (675, 57% of all surgical pathology and infections for another quarter (160, 14%. Trauma-related injuries accounted for only one quarter (681, 24% of all interventions; among these, 363 (13% were violence-related. Male gender (adjusted odds ratio (AOR = 20.0, p Conclusions In this study, most surgical interventions were unrelated to violent trauma and rather reflected the general surgical needs of a low-income tropical country. Programs in conflict zones in low-income countries need to be prepared to treat both the war-wounded and non-trauma related life-threatening surgical needs of the general population. Given the limited surgical workforce in these areas, training of local staff and task shifting is recommended to support broad availability of essential surgical care. Further studies into the surgical needs of the population are warranted, including population-based surveys, to improve program planning and resource allocation and the effectiveness of the humanitarian response.

  12. Surgical scar revision: An overview

    Directory of Open Access Journals (Sweden)

    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.

  13. 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

    Institute of Scientific and Technical Information of China (English)



    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.

  14. 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

    Institute of Scientific and Technical Information of China (English)

    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。

  15. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  16. Surgical Navigation

    DEFF Research Database (Denmark)

    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....

  17. Significance of including field non-uniformities such as the heel effect and beam scatter in the determination of the skin dose distribution during interventional fluoroscopic procedures (United States)

    Rana, Vijay; Gill, Kamaljit; Rudin, Stephen; Bednarek, Daniel R.


    The current version of the real-time skin-dose-tracking system (DTS) we have developed assumes the exposure is contained within the collimated beam and is uniform except for inverse-square variation. This study investigates the significance of factors that contribute to beam non-uniformity such as the heel effect and backscatter from the patient to areas of the skin inside and outside the collimated beam. Dose-calibrated Gafchromic film (XR-RV3, ISP) was placed in the beam in the plane of the patient table at a position 15 cm tube-side of isocenter on a Toshiba Infinix C-Arm system. Separate exposures were made with the film in contact with a block of 20-cm solid water providing backscatter and with the film suspended in air without backscatter, both with and without the table in the beam. The film was scanned to obtain dose profiles and comparison of the profiles for the various conditions allowed a determination of field non-uniformity and backscatter contribution. With the solid-water phantom and with the collimator opened completely for the 20-cm mode, the dose profile decreased by about 40% on the anode side of the field. Backscatter falloff at the beam edge was about 10% from the center and extra-beam backscatter decreased slowly with distance from the field, being about 3% of the beam maximum at 6 cm from the edge. Determination of the magnitude of these factors will allow them to be included in the skin-dose-distribution calculation and should provide a more accurate determination of peak-skin dose for the DTS.

  18. 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. (United States)

    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.

  19. Clinical research in surgical oncology: an analysis of (United States)

    Menezes, Amber S; Barnes, Alison; Scheer, Adena S; Martel, Guillaume; Moloo, Husein; Boushey, Robin P; Sabri, Elham; Auer, Rebecca C


    The objective of this study was to provide a descriptive analysis of registered clinical trials in surgical oncology at Data was extracted from using the following search engine criteria: "Cancer" as Condition, "Surgery OR Operation OR Resection" as Intervention, and Non-Industry sponsored. The search was limited to Canada and the United States and included trials registered from January 1, 2001 to January 1, 2011. Of 9,961 oncology trials, 1,049 (10.5%) included any type of surgical intervention. Of these trials, 125 (11.9%, 1.3% of all oncology trials) assessed a surgical variable, 773 (73.7%) assessed adjuvant/neoadjuvant therapies, and 151 (14.4%) were observational studies. Of the trials assessing adjuvant therapies, systemic treatment (362 trials, 46.8%) and multimodal therapy (129 trials, 16.7%) comprised a large focus. Of the 125 trials where surgery was the intervention, 59 trials (47.2%) focused on surgical techniques or devices, 45 trials (36.0%) studied invasive diagnostic methods, and 21 trials (16.8%) evaluated surgery versus no surgery. The majority of the 125 trials were nonrandomized (72, 57.6%). The number of registered surgical oncology trials is small in comparison to oncology trials as a whole. Clinical trials specifically designed to assess surgical interventions are vastly outnumbered by trials focusing on adjuvant therapies. Randomized surgical oncology trials account for <1% of all registered cancer trials. Barriers to the design and implementation of randomized trials in surgical oncology need to be clarified in order to facilitate higher-level evidence in surgical decision-making.

  20. Management of refractory atrial fibrillation post surgical ablation (United States)

    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

  1. The Surgical Treatment of Mycetoma. (United States)

    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.

    Directory of Open Access Journals (Sweden)

    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.


    Directory of Open Access Journals (Sweden)

    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]. (United States)

    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. Surgical management of common canine prostatic conditions. (United States)

    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.

  6. Current management of surgical oncologic emergencies.

    Directory of Open Access Journals (Sweden)

    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.

  7. Medical and surgical management of priapism (United States)

    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

  8. Fundamental Ethical Issues in Unnecessary Surgical Procedures. (United States)

    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.

  9. 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 (United States)

    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

  10. Computer-enhanced thoracoscopic thymectomy with the Zeus telemanipulation surgical system. (United States)

    Berman, Marius; Stamler, Alon; Vidne, Bernardo A; Saute, Milton


    Recent years have witnessed important progress in the use of minimally invasive robotic-enhanced surgical systems in cardiac and general thoracic interventions. We report the first-ever successful use of the Zeus robotic surgical system (Computer Motion, Inc, Goleta, CA) for the excision of an anterior mediastinal mass. Proper positioning of the thoracic ports for the robotic arms to permit a wide range of movement, is the key to the application of the system for intrathoracic cage operations. Other advantages of the system include three-dimensional voice controlled imaging, low-heat surgical field, and good exposure of the structures.

  11. Interventional treatments for hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    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.

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

    Directory of Open Access Journals (Sweden)

    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

  13. Surgical aspects of intestinal tuberculosis in children: Our experience

    Directory of Open Access Journals (Sweden)

    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.

  14. Evolution of surgical treatment for breast cancer

    Directory of Open Access Journals (Sweden)

    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.

  15. [Surgical wound infection in patients undergoing extra-anatomical arterial surgery. A retrospective study]. (United States)

    Monreal, M; Callejas, J M; Lisbona, C; Martorell, A; Lerma, R; Boabaid, R; Mejía, S


    We present a retrospective review of a series of patients from our Service submitted to surgical extra-anatomical grafts. Correlation between diverse variants and ulterior obliteration by thrombosis or infection of the surgical wounds is analyzed. The series included 133 patients surgically treated between 1986 and 1991. The studied variants were: sex, age, type of graft, the material used, length and type of anesthesia, presentation of hypotension during the surgical intervention, diabetes, platelet recount. Fourteen patients (11%) presented early graft obliteration and 15 (11%) presented an infection of their surgical wound. Only the platelet variant showed statistical differences in patients presenting infection. A high recount of platelets could be a factor risk of infection.

  16. Impact of surgical complications on length of stay after hip fracture surgery

    DEFF Research Database (Denmark)

    Foss, Nicolai Bang; Palm, Henrik; Krasheninnikoff, Michael;


    BACKGROUND: Rehabilitation after hip fracture may be lengthy, with bed-day consumption accounting for up to 85% of the total cost of admission to hospital. Data suggest that surgical complications requiring reoperation may lead to an excessively long in-patient stays. However, the overall impact...... of surgical complications has not been examined in detail. METHODS: All 600 consecutive patients included were admitted with primary hip fracture and received primary surgical intervention with multimodal rehabilitation. Surgical complications were audited and classified as being due to a patient fall......, infection or suboptimal surgery, stratified into either requiring reoperation or not allowing mobilisation because of instability. RESULTS: Of the 600, 116 (19.3, 95% CI 16-22%) patients underwent reoperation or immobilisation; 27.1% of bed-day consumption resulted from surgical complications. The audit...

  17. Emergency, anaesthetic and essential surgical capacity in the Gambia. (United States)

    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.

  18. Surgical Management of Fractures and Tendons. (United States)

    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.

  19. 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

    Institute of Scientific and Technical Information of China (English)



    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

  20. What is the impact of obtaining medical clearance to participate in a randomised controlled trial examining a physical activity intervention on the socio-demographic and risk factor profiles of included participants? (United States)

    Duncan, Mitch J; Rosenkranz, Richard R; Vandelanotte, Corneel; Caperchione, Cristina M; Rebar, Amanda L; Maeder, Anthony J; Tague, Rhys; Savage, Trevor N; van Itallie, Anetta; Mummery, W Kerry; Kolt, Gregory S


    Requiring individuals to obtain medical clearance to exercise prior to participation in physical activity interventions is common. The impact this has on the socio-demographic characteristic profiles of participants who end up participating in the intervention is not clear. As part of the multi-component eligibility screening for inclusion in a three-arm randomised controlled trial examining the efficacy of a web-based physical activity intervention, individuals interested in participating were required to complete the Physical Activity Readiness Questionnaire (PAR-Q). The PAR-Q identified individuals as having lower or higher risk. Higher-risk individuals were required to obtain medical exercise clearance prior to enrolment. Comparisons of the socio-demographic characteristics of the lower- and higher-risk individuals were performed using t tests and chi-square tests (p = 0.05). A total of 1244 individuals expressed interest in participating, and 432 were enrolled without needing to undergo further screening. Of the 251 individuals required to obtain medical clearance, 148 received clearance, 15 did not receive clearance and 88 did not return any form of clearance. A total of 105 individuals were enrolled after obtaining clearance, and the most frequent reason for being required to seek clearance was for using blood pressure/heart condition medication. Higher-risk individuals were significantly older, had a higher body mass index and engaged in more sedentary behaviour than lower-risk individuals. Use of more inclusive participant screening protocols that maintain high levels of participant safety are encouraged. Allowing individuals to obtain medical clearance to participate can result in including a more diverse population likely to benefit most from participation. Australian New Zealand Clinical Trials Registry ( ACTRN12611000157976 ). Registered on 9 February 2011.

  1. Teamwork and Collaboration for Prevention of Surgical Site Infections. (United States)

    Dellinger, E Patchen


    The surgeon has been regarded as the "captain of the ship" in the operating room (OR) for many years, but cannot accomplish successful operative intervention without the rest of the team. Review of the pertinent English-language literature. Many reports demonstrate very different impressions of teamwork and communication in the OR held by different members of the surgical team. Objective measures of teamwork and communication demonstrate a reduction in complications including surgical site infections with improved teamwork and communication, with fewer distractions such as noise, and with effective use of checklists. Efforts to improve teamwork and communication and promote the effective use of checklists promote patient safety and improved outcomes for patients with reduction in surgical site infections.

  2. [Choice of surgical method of treatment of cholelithiasis]. (United States)

    Timerbulatov, V M; Mekhdiev, D I; Timerbulatov, M V; Sagitov, R B; Iamalov, R A


    This article presents results of surgical treatment of 2963 patients with cholelithiasis. The majority of them (71.8%) had an elective surgery, though 28.2% of patients underwent an emergency operation. A comparative assessment of obligate treatment criteria was made in 2 groups. A first group consisted of 803 patients and it was before introduction of Roman selection criteria used for surgical treatment of patients. A second group included 2963 patients in the period after introduction of selection criteria. Preoperative planning of surgery with evaluation of technical complexity of all stages of intervention with prognosis for possible complications should be the base of reasonable choice of surgical method of treatment of cholelithiasis and safety protection of surgery. The study completed and results obtained allowed decrease of the rate of postoperative complications to 1.4% and lethality--to 0.3%, respectively.

  3. 3D Surgical Simulation (United States)

    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

  4. The Dutch surgical colorectal audit. (United States)

    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.

  5. Operating theatre quality and prevention of surgical site infections. (United States)

    Spagnolo, A M; Ottria, G; Amicizia, D; Perdelli, F; Cristina, M L


    Surgical site infections (SSI) account for 14% to 17% of all hospital-acquired infections and 38% of nosocomial infections in surgical patients. SSI remain a substantial cause of morbidity and death, possibly because of the larger numbers of elderly surgical patients or those with a variety of chronic and immunocompromising conditions, and emergence of antibiotic-resistant microorganisms. Factors causing surgical site infection are multifarious. Several studies have identified the main patient-related (endogenous risk factors) and procedure-related (external risk factors) factors that influence the risk of SSI. The rate of surgical wound infections is strongly influenced by operating theatre quality, too. A safe and salubrious operating theatre is an environment in which all sources of pollution and any micro-environmental alterations are kept strictly under control. This can be achieved only through careful planning, maintenance and periodic checks, as well as proper ongoing training for staff Many international scientific societies have produced guidelines regarding the environmental features of operating theatres (positive pressure, exchanges of filtered air per hour, air-conditioning systems with HEPA filters, etc.) and issued recommendations on healthcare-associated infection, including SSI, concerning surveillance methods, intervention to actively prevent SSI and approaches to monitoring the implementation of such strategies. Therefore, the prevention of SSI requires a multidisciplinary approach and the commitment of all concerned, including that of those who are responsible for the design, layout and functioning of operating theatres.

  6. Benign Strictures of the Esophagus and Gastric Outlet: Interventional Management

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Hyoung; Shin, Ji Hoon; Song, Ho Young [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)


    Benign strictures of the esophagus and gastric outlet are difficult to manage conservatively and they usually require intervention to relieve dysphagia or to treat the stricture-related complications. In this article, authors review the non-surgical options that are used to treat benign strictures of the esophagus and gastric outlet, including balloon dilation, temporary stent placement, intralesional steroid injection and incisional therapy

  7. Categorization of cerebrovascular intervention methods

    Institute of Scientific and Technical Information of China (English)

    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


    Directory of Open Access Journals (Sweden)

    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.

  9. Preventing surgical site infection. Where now?

    LENUS (Irish Health Repository)

    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.

  10. Surgical management of tricuspid valve endocarditis in the current era: A review. (United States)

    Yong, Matthew S; Coffey, Sean; Prendergast, Bernard D; Marasco, Silvana F; Zimmet, Adam D; McGiffin, David C; Saxena, Pankaj


    The incidence of isolated tricuspid valve infective endocarditis is increasing. Medical management is the mainstay of treatment but surgical intervention is required in a subset of patients. Surgical treatment options include valve excision and replacement or valve reconstruction. We searched PubMed and the Cochrane library to identify articles to be included in this review of surgical outcomes. References of selected articles were crosschecked for other relevant studies. Surgical management of tricuspid valve endocarditis can be achieved with satisfactory outcomes. However, the optimal indication and timing of surgery remain unclear, and the frequent association with intravenous drug use complicates management. Repair techniques are preferable though there is no clear evidence supporting one method over another.

  11. 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

    Directory of Open Access Journals (Sweden)

    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.

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

    Directory of Open Access Journals (Sweden)


    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.  

  13. Trauma remains a surgical disease from cradle to grave. (United States)

    Acker, Shannon N; Stovall, Robert T; Moore, Ernest E; Partrick, David A; Burlew, Clay Cothren; Bensard, Denis D


    A dramatic rise in nonoperative management of many blunt and some penetrating traumatic injuries has occurred during the past four decades. This trend has lead some to suggest that trauma is no longer a surgical disease. We questioned what role the trauma surgeon plays in the care of the injured patient. We hypothesized that surgical intervention and judgment are still often required in both injured children and adults. We queried the trauma databases at two academic Level I trauma centers (adult and pediatric) for all patients admitted for trauma who underwent an inpatient operation between July 1, 2009, and June, 31, 2013, as well as those patients with "potentially operative injury." Potentially operative injury was defined as the presence of liver or splenic laceration of any grade or hemothorax in patients who did not undergo an inpatient operation. For analysis, we divided patients into groups based on age. We differentiated infants (0-1 years), toddlers (2-5 years), school-aged children (6-12 years), adolescents (13-15 years), young adults (16-21 years), adults (22-40 years), middle-aged adults (41-50 years), late middle-aged adults (51-64 years), and elderly (>65 years). Data collected included demographic information and number of operations performed in each patient based on surgical service (neurosurgery, trauma surgery, orthopedic surgery, and other surgical services). During this 4-year study period, 11,611 patients were admitted to the trauma service, 6,334 (54.6%) of whom underwent an inpatient operation and another 492 (4.2%) of whom had potentially operative injury. Across all age groups, orthopedic procedures accounted for the greatest percentage of inpatient procedures (>70% of inpatient operations performed). Neurosurgical intervention accounted for less than 10% of inpatient surgical interventions, and general surgical procedures performed by trauma surgeons accounted for 17.1%. More than half of all general surgical procedures were performed

  14. Essential Tremor (ET): Surgical Options (United States)

    ... t respond to propranolol, primidone, or other common ET medications and whose tremor has become debilitating, there ... treatments were first introduced. Current surgical options for ET include Deep Brain Stimulation (DBS) , Focused Ultrasound Thalamotomy , ...

  15. 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

    Institute of Scientific and Technical Information of China (English)

    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

  16. Effects of Art on Surgical Patients: A Systematic Review and Meta-analysis. (United States)

    Vetter, Diana; Barth, Jürgen; Uyulmaz, Sema; Uyulmaz, Semra; Vonlanthen, René; Belli, Giulio; Montorsi, Marco; Bismuth, Henri; Witt, Claudia M; Clavien, Pierre-Alain


    The aim of the study was to assess the effect of art including ambient features such as music, interior design including visual art, and architectural features on health outcomes in surgical patients. Healing environments can have a positive influence on many patients, but data focusing on art in surgical patients remain scarce. We conducted a systematic search following the PRISMA guidelines from January 2000 to October 2014 on art in surgical patients. For music interventions, we pooled controlled studies measuring health outcomes (eg, pain, anxiety, blood pressure, and heart rate) in a meta-analysis. For other art forms (ambient and architectural features and interior design), we did a narrative review, also including nonsurgical patients, and looked for examples covering 3 countries. Our search identified 1101 hits with 48 studies focusing on art in surgical patients: 47 studies on musical intervention and 1 on sunlight. The meta-analysis of these studies disclosed significant effects for music on pain after surgery, anxiety, systolic blood pressure, and heart rate, when compared with control groups without music. Effects of music were larger with self-selected music, and lower in surgical interventions performed under general anesthesia. Interior design features such as nature images and more spacious rooms, and architectural features providing more sunlight had positive effects on anxiety and postoperative pain. Self-selected music for surgical patients is an effective and low-cost intervention to enhance well being and possibly faster recovery. Although potentially very important, the impact of environmental features and spacious architecture with wide access to sunlight remains poorly explored in surgery. Further experimental research is needed to better assess the magnitude of the impact and cost effectiveness.

  17. 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

    Institute of Scientific and Technical Information of China (English)

    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

  18. Systematic review comparing endoscopic, percutaneous and surgical pancreatic pseudocyst drainage

    Institute of Scientific and Technical Information of China (English)

    Anthony Yuen Bun Teoh; Vinay Dhir; Zhen-Dong Jin; Mitsuhiro Kida; Dong Wan Seo; Khek Yu Ho


    AIM: To perform a systematic review comparing the outcomes of endoscopic, percutaneous and surgical pancreatic pseudocyst drainage.METHODS: Comparative studies published between January 1980 and May 2014 were identified on Pub Med, Embase and the Cochrane controlled trials register and assessed for suitability of inclusion. The primary outcome was the treatment success rate. Secondary outcomes included were the recurrence rates, re-interventions, length of hospital stay, adverse events and mortalities.RESULTS: Ten comparative studies were identified and 3 were randomized controlled trials. Four studies reported on the outcomes of percutaneous and surgical drainage. Based on a large-scale national study, surgical drainage appeared to reduce mortality and adverse events rate as compared to the percutaneous approach. Three studies reported on the outcomes of endoscopic ultrasound(EUS) and surgical drainage. Clinical success and adverse events rates appeared to be comparable but the EUS approach reduced hospital stay, cost and improved quality of life. Three other studies comparedEUS and esophagogastroduodenoscopy-guided drainage. Both approaches were feasible for pseudocyst drainage but the success rate of the EUS approach was better for non-bulging cyst and the approach conferred additional safety benefits.CONCLUSION: In patients with unfavorable anatomy, surgical cystojejunostomy or percutaneous drainage could be considered. Large randomized studies with current definitions of pseudocysts and longer-term follow-up are needed to assess the efficacy of the various modalities.

  19. Surgical safety checklists in developing countries. (United States)

    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.

  20. Hepatic surgical anatomy. (United States)

    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.

  1. Surgical Treatment for Refractory Epilepsy: Review of Patient Evaluation and Surgical Options

    Directory of Open Access Journals (Sweden)

    Kristen M. Kelly


    Full Text Available Treatment of epilepsy often imposes an exposure to various antiepileptic drugs and requires long-term commitment and compliance from the patient. Although many new medications are now available for the treatment of epilepsy, approximately 30% of epilepsy patients still experience recurrent seizures and many experience undesirable side effects. Treatment of epilepsy requires a multidisciplinary approach. For those patients with medically refractory seizures, surgical treatment has increased in prevalence as techniques and devices improve. With increased utilization, proper patient selection has become crucial in evaluating appropriateness of surgical intervention. Epilepsy syndromes in which surgery has shown to be effective include mesial temporal sclerosis, cortical dysplasia, many pediatric epilepsy syndromes, and vascular malformations. Monitoring in an epilepsy monitoring unit with continuous scalp or intracranial EEG is an important step in localization of seizure focus. MRI is the standard imaging technique for evaluation of anatomy. However, other imaging studies including SPECT and PET have become more widespread, often offering increased diagnostic value in select situations. In addition, as an alternative or adjunct to surgical resection, implantable devices such as vagus nerve stimulators, deep brain stimulators, and direct brain stimulators could be useful in seizure treatment.

  2. Implications for Therapeutic Intervention

    Directory of Open Access Journals (Sweden)

    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.

  3. Surgical management of vesicoureteral reflux in children. (United States)

    Sung, Jennifer; Skoog, Steven


    Vesicoureteral reflux (VUR) is the most common uropathy affecting children. Compared to children without VUR, those with VUR have a higher rate of pyelonephritis and renal scarring following urinary tract infection (UTI). Options for treatment include observation with or without antibiotic prophylaxis and surgical repair. Surgical intervention may be necessary in patients with persistent reflux, renal scarring, and recurrent or breakthrough febrile UTI. Both open and endoscopic approaches to reflux correction are successful and reduce the occurrence of febrile UTI. Estimated success rates of open and endoscopic reflux correction are 98.1% (95% CI 95.1, 99.1) and 83.0% (95% CI 69.1, 91.4), respectively. Factors that affect the success of endoscopic injection include pre-operative reflux grade and presence of functional or anatomic bladder abnormalities including voiding dysfunction and duplicated collecting systems. Few studies have evaluated the long-term outcomes of endoscopic injection, and with variable results. In patients treated endoscopically, recurrent febrile UTI occurred in 0-21%, new renal damage in 9-12%, and recurrent reflux in 17-47.6% of treated ureters with at least 1 year follow-up. These studies highlight the need for standardized outcome reporting and longer follow-up after endoscopic treatment.

  4. Augmented reality in surgical procedures (United States)

    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.

  5. Surgical treatment of pediatric rhinosinusitis. (United States)

    Isaacson, G


    Pediatric rhinosinusitis is a common sequela of upper respiratory infections in children. It is usually a self-limited disease, sometimes requiring antibiotic therapy. Surgery may be indicated in children who suffer complication of acute rhinosinusitis, severe recurrent acute rhinosinusitis, rhinosinusitis in cystic fibrosis with or without polyposis, chronic rhinosinusitis refractory to maximal medical management, allergic fungal sinusitis, and paranasal sinus mucoceles. Surgical options include, adenoidectomy, sinus puncture and lavage, open surgical approaches, endoscopic sinus surgery, balloon sinuplasty, and turbinectomy or turbinate reduction. This paper reviews the anatomy and physiology of rhinosinusitis in children and current knowledge of the indications and best methods of surgical treatment.

  6. Spacecraft surgical scrub system (United States)

    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.

  7. 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

    Institute of Scientific and Technical Information of China (English)

    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

  8. Impact of a multi-faceted training intervention on the improvement of hand hygiene and gloving practices in four healthcare settings including nursing homes, acute-care geriatric wards and physical rehabilitation units. (United States)

    Eveillard, Matthieu; Raymond, Françoise; Guilloteau, Véronique; Pradelle, Marie-Thérèse; Kempf, Marie; Zilli-Dewaele, Marina; Joly-Guillou, Marie-Laure; Brunel, Patrick


    To assess the impact of a multi-faceted training program on the compliance with hand hygiene and gloving practices. Hand hygiene is considered as the cornerstone of the prevention of hospital-acquired infections. Several studies have enhanced the poor effectiveness of training programs in improving hand hygiene compliance. A before-after evaluation study. The study was conducted in four healthcare settings before and after an intervention program which included the performance feedback of the first evaluation phase, three six-h training sessions, the assessment of hand hygiene performance with teaching boxes and the organisation of one full-day session devoted to institutional communication around hand hygiene in each setting. Hand hygiene compliance and quality of hand rubbing were evaluated. Hand hygiene opportunities were differentiated into extra-series opportunities (before or after a single contact and before the first contact or after the last contact of a series of consecutive contacts) and intra-series opportunities (from the opportunity following the first contact to the opportunity preceding the last in the same series). Overall, 969 contacts corresponding to 1,470 hand hygiene opportunities (760 during the first phase and 710 during the second) were observed. A significant improvement of observed practices was recorded for the hand hygiene compliance in intra-series opportunities (39·0% vs. 19·0%; p hand rubbing (85·0% vs. 71·9%; p hand hygiene and gloving practices were improved. We plan to extend this investigation by performing a qualitative study with experts in behavioural sciences to try improving practices for which adherence was still weak after the training program such as hand hygiene in intra-series opportunities. This study underscored the usefulness of implementing contextualised training programs, while more traditional courses have shown little impact. © 2011 Blackwell Publishing Ltd.

  9. 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

    Institute of Scientific and Technical Information of China (English)



    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

  10. Interventional radiology

    Energy Technology Data Exchange (ETDEWEB)

    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.

  11. 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

    Institute of Scientific and Technical Information of China (English)

    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.

  12. Surgical management of large scalp infantile hemangiomas

    Directory of Open Access Journals (Sweden)

    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.

  13. Surgical correction of cleft lip and palate. (United States)

    Jayaram, Rahul; Huppa, Christoph


    Surgical cleft repair aims to restore function of the oro-nasal sphincter and oro-nasal soft tissues and re-establish the complex relationship between perioral and perinasal muscle rings without compromising subsequent mid-facial growth and development. Here we review the surgical anatomy of this region, optimal timing for surgical repair and current thinking on the use of surgical adjuncts. In addition, an overview of current surgical techniques available for the repair of cleft lip, cleft palate and velopharyngeal insufficiency is presented. Finally, we briefly discuss nasal revision surgery and the use of osteotomy, including distraction osteogenesis in the cleft patient.

  14. 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...

  15. Definition and scope of the surgical treatment in patients with pulmonary metastases from colorectal cancer

    Directory of Open Access Journals (Sweden)

    B. B. Ahmedov


    Full Text Available Surgical treatment of metastatic colorectal cancer in lungs is a relatively new trend of modern oncology. In this connection, still there are no clearly formulated criteria for patient selection for this type of intervention, approaches to repeated resections and scope of the surgical operation in case of multiple lesions. Established key prognostic factors include lesion of intrathoracic lymph nodes, timing of the development of metastatic disease, baseline level of carcinoembryonic antigen, number of foci and the volume of metastatic lesion, stage of the disease. Options for surgical access include lateral thoracotomy, sternotomy, thoracoscopy and thoracoscopy combined with additional minithoracotomy.If a patient has a single peripheral metastatic lesions, physician should prefer thoracoscopic operations. One of their advantages include minimum development of adhesions and possibility of subsequent re-thoracoscopy. Resection of pulmonary metastases from colorectal cancer (R0 resection rate allows to achieve persistent healing of the tumor process in a significant number of patients.

  16. 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

    Institute of Scientific and Technical Information of China (English)

    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。

  17. Debridement for surgical wounds. (United States)

    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

  18. Micro-surgical endodontics. (United States)

    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.

  19. Effects of art on surgical patients


    Vetter, Diana; Barth, Jürgen; Uyulmaz, Sema; Uyulmaz, Semra; Vonlanthen, René; Belli, Giulio; Montorsi, Marco; Bismuth, Henri; Claudia M. Witt; Clavien, Pierre-Alain


    Objectives: The aim of the study was to assess the effect of art including ambient features such as music, interior design including visual art, and architectural features on health outcomes in surgical patients. Background: Healing environments can have a positive influence on many patients, but data focusing on art in surgical patients remain scarce. Methods: We conducted a systematic search following the PRISMA guidelines from January 2000 to October 2014 on art in surgical patients....

  20. Complications in the surgical management of children with malignant solid tumors. (United States)

    Davidoff, Andrew M; Fernandez-Pineda, Israel


    With improvement in the outcomes for children with cancer has come an increasing focus on minimizing the morbidity from therapeutic interventions, including surgical procedures, while continuing to have a high likelihood of cure. Thus, an appreciation for the potential complications of surgery, both acute and long term, is critical when considering the risks and benefits of any procedure performed on a child with cancer. Although not meant to be an exhaustive review, here we discuss the most common and significant surgical complications that may occur when performing diagnostic, therapeutic, or supportive procedures in children with the most common malignant solid tumors. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Diverticulitis: selective surgical management. (United States)

    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.

  2. Justice and Surgical Innovation: The Case of Robotic Prostatectomy. (United States)

    Hutchison, Katrina; Johnson, Jane; Carter, Drew


    Surgical innovation promises improvements in healthcare, but it also raises ethical issues including risks of harm to patients, conflicts of interest and increased injustice in access to health care. In this article, we focus on risks of injustice, and use a case study of robotic prostatectomy to identify features of surgical innovation that risk introducing or exacerbating injustices. Interpreting justice as encompassing matters of both efficiency and equity, we first examine questions relating to government decisions about whether to publicly fund access to innovative treatments. Here the case of robotic prostatectomy exemplifies the difficulty of accommodating healthcare priorities such as improving the health of marginalized groups. It also illustrates challenges with estimating the likely long-term costs and benefits of a new intervention, the difficulty of comparing outcomes of an innovative treatment to those of established treatments, and the further complexity associated with patient and surgeon preferences. Once the decision has been made to fund a new procedure, separate issues of justice arise at the level of providing care to individual patients. Here, the case of robotic prostatectomy exemplifies how features of surgical innovation, such as surgeon learning curves and the need for an adequate volume of cases at a treatment centre, can exacerbate injustices associated with treatment cost and the logistics of travelling for treatment. Drawing on our analysis, we conclude by making a number of recommendations for the just introduction of surgical innovations.

  3. Role of Computational Modelling in Planning and Executing Interventional Procedures for Congenital Heart Disease. (United States)

    Slesnick, Timothy C


    Increasingly, computational modelling and numerical simulations are used to help plan complex surgical and interventional cardiovascular procedures in children and young adults with congenital heart disease. From its origins more than 30 years ago, surgical planning with analysis of flow hemodynamics and energy loss/efficiency has helped design and implement many modifications to existing techniques. On the basis of patient-specific medical imaging, surgical planning allows accurate model production that can then be manipulated in a virtual surgical environment, with the proposed solutions finally tested with advanced computational fluid dynamics to evaluate the results. Applications include a broad range of congenital heart disease, including patients with single-ventricle anatomy undergoing staged palliation, those with arch obstruction, with double outlet right ventricle, or with tetralogy of Fallot. In the present work, we focus on clinical applications of this exciting field. We describe the framework for these techniques, including brief descriptions of the engineering principles applied and the interaction between "benchtop" data with medical decision-making. We highlight some early insights learned from pioneers over the past few decades, including refinements in Fontan baffle geometries and configurations. Finally, we offer a glimpse into exciting advances that are presently being explored, including use of modelling for transcatheter interventions. In this era of personalized medicine, computational modelling and surgical planning allows patient-specific tailoring of interventions to optimize clinical outcomes. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  4. Palliative surgical bypass for unresectable periampullar y carcinoma

    Institute of Scientific and Technical Information of China (English)

    Shivendra Singh; Ajay Kumar Sachdev; Adarsh Chaudhary; Anil Kumar Agarwal


    BACKGROUND:Around 60% to 80% of patients with periampullary carcinoma are unresectable either due to distant metastasis or local vascular invasion. With the advancement of endoscopic interventional procedures, the role of surgical bypass has diminished. However, surgical bypass is still appropriate in patients with unresectable disease discovered at the time of surgery. This study was conducted to assess the results of palliative surgical bypass for patients with unresectable periampullary carcinoma at our hospital, a tertiary referral center of Northern India. METHOD:The study group comprised 204 patients who had undergone surgical bypass for advanced periampullary carcinoma over the last 15 years. RESULTS:Between January 1990 and December 2004, 204 patients (128 males, 76 females) consisting of 179 patients with carcinoma of head of the pancreas, 14 patients with ampullary carcinoma, 8 patients with lower end cholangiocarcinoma and 3 patients with duodenal carcinoma underwent surgical bypass. Their average age was 51 years (range 20-78 years). Both biliary and gastric bypasses were done in 158 (77.45%), biliary bypass alone in 37 (18.13%), and gastric bypass alone in 9 (4.32%). Biliary bypass was done by Roux-en-Y hepaticojejunostomy, and gastric bypass by retrocolic gastrojejunostomy. The overall postoperative mortality and morbidity were 0.98%and 26.9%, respectively. The patients who died had undergone previously endoscopic intervention. Complications included wound infection in 12.25% of the patients, bile leak in 5.12%, delayed gastric emptying in 5.38%, ascitic leak from drains in 8.8%, and upper gastrointestinal bleeding in 1.96%. The incidences of wound infection and bile leak both were signiifcantly higher in patients who had had preoperative biliary stenting. None of the patients who had undergone Roux-en-Y hepati-cojejunostomy+retrocolic gastrojejunostomy required any intervention later in their life. CONCLUSIONS:Surgical bypass is a safe procedure with

  5. Intraoperative monitoring technician: a new member of the surgical team. (United States)

    Brown, Molly S; Brown, Debra S


    As surgery needs have increased, the traditional surgical team has expanded to include personnel from radiology and perfusion services. A new surgical team member, the intraoperative monitoring technician, is needed to perform intraoperative monitoring during procedures that carry a higher risk of central and peripheral nerve injury. Including the intraoperative monitoring technician on the surgical team can create challenges, including surgical delays and anesthesia care considerations. When the surgical team members, including the surgeon, anesthesia care provider, and circulating nurse, understand and facilitate this new staff member's responsibilities, the technician is able to perform monitoring functions that promote the smooth flow of the surgical procedure and positive patient outcomes.

  6. Combined interventional therapies of hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Jun Qian; Gan-Sheng Feng; Thomas Vogl


    Hepatocellular carcinoma (HCC) is one of the most commonmalignancies in the world, responsible for an estimated one million deaths annually. It has a poor prognosis due to its rapid infiltrating growth and complicating liver cirrhosis.Surgical resection, liver transplantation and cryosurgery are considered the best curative options, achieving a high rate of complete response, especially in patients with small HCC and good residual liver function. In nonsurgery, regional interventional therapies have led to a major breakthrough in the management of unresectable HCC, which include transarterial chemoembolization (TACE), percutaneous ethanol injection (PEI), radiofrequency ablation (RFA), microwave coagulation therapy (MCT), laser-induced thermotherapy (LITT), etc. As a result of the technical development of locoregional approaches for HCC during the recent decades,the range of combined interventional therapies has been continuously extended. Most combined multimodal interventional therapies reveal their enormous advantages as compared with any single therapeutic regimen alone,and play more important roles in treating unresectable HCC.

  7. The effects of psychological interventions on wound healing: A systematic review of randomized trials. (United States)

    Robinson, Hayley; Norton, Sam; Jarrett, Paul; Broadbent, Elizabeth


    Psychological stress has been shown to delay wound healing. Several trials have investigated whether psychological interventions can improve wound healing, but to date, this evidence base has not been systematically synthesized. The objective was to conduct a systematic review of randomized controlled trials in humans investigating whether psychological interventions can enhance wound healing. A systematic review was performed using PsychINFO, CINAHL, Web of Science, and MEDLINE. The searches included all papers published in English up until September 2016. The reference lists of relevant papers were screened manually to identify further review articles or relevant studies. Nineteen studies met inclusion criteria and were included in the review. Fifteen of nineteen studies were of high methodological quality. Six studies were conducted with acute experimentally created wounds, five studies with surgical patients, two studies with burn wounds, two studies with fracture wounds, and four studies were conducted with ulcer wounds. Post-intervention standardized mean differences (SMD) between groups across all intervention types ranged from 0.13 to 3.21, favouring improved healing, particularly for surgical patients and for relaxation interventions. However, there was some evidence for publication bias suggesting negative studies may not have been reported. Due to the heterogeneity of wound types, population types, and intervention types, it is difficult to pool effect sizes across studies. Current evidence suggests that psychological interventions may aid wound healing. Although promising, more research is needed to assess the efficacy of each intervention on different wound types. Statement of contribution What is already known on this subject? Psychological stress negatively affects wound healing. A number of studies have investigated whether psychological interventions can improve healing. However, no systematic reviews have been conducted. What does this study add

  8. Comparison of the outcome of early and delayed surgical treatment of complete acromioclavicular joint dislocation. (United States)

    Song, Tengfei; Yan, Xu; Ye, Tianwen


    The aim of this study is to compare the clinical and radiographic results and the complication rate between early and delayed surgical treatment of acromioclavicular joint (ACJ) dislocation. Publications in the management of ACJ dislocation are identified from the PubMed database between January 1993 and December 2013 using "acromioclavicular joint" and "dislocation" as keywords. The eligibility criteria included are as follows: (1) ACJ dislocation; (2) intervention, early compared with delayed surgical treatment or the surgical treatment for acute compared with chronic ACJ dislocation; (3) human; and (4) English articles. Exclusion criteria consist of the following: (1) type I and type II ACJ dislocation, (2) no definition of the time of early and delayed surgery in studies, (3) no comparison between the clinical result of early and delayed surgery in studies, (4) laboratory studies, radiographic studies, biomechanical studies, (5) the cases including fractures or revisions in studies, and (6) systematic analyses. Eight studies comparing early and delayed surgical treatment of ACJ dislocation are included in this systematic review. According to Constant scores and shoulder subjective value, early surgery has better functional outcomes than delayed surgery in the treatment of ACJ dislocation (P < 0.05). Partial-dislocation/re-dislocation is found at 26.0 % in early and 38.1 % in delayed surgical treatment (P < 0.05). The rate of CC ossification in early surgical treatment is found as the same as the delayed. The complication rates are found at 12.5 % in early surgical treatment and 17.7 % in the delayed, which is not significantly different. Early surgical treatment may have superiority to the delayed procedure in the management of ACJ dislocation with better functional outcomes and more satisfied reduction. However, high-quality evidence studies are required to provide stronger support for this opinion in the future. IV.

  9. Surgical Complications of Cochlear Implantation

    Directory of Open Access Journals (Sweden)

    Basir Hashemi


    Full Text Available Cochlear implantation is a method used for the treatment ofpatients with profound hearing loss. This procedure may theaccompanied by some major or minor complications. Weevaluated the surgical complications of cochlear implantationin Fars province (south of Iran. A total of 150 patients withcochlear implantation were enrolled in the present study. Mostof the patients were pre-lingual children and most of our deviceswere nucleus prosthesis. We had three device failuresand four major complications, including one misplaced electrode,one case of meningitis, one case of foreign body reactionto suture and one case with extensive hematoma. Thesecomplications were managed successfully by surgical interventionor re-implantation. Facial nerve damage or woundbreakdown was not seen. Minor complications including smallhematoma, edema, stitch infection and dizziness were found in15 cases, which were managed medically. In our center, therate of minor complications was comparable to other centersin the world. But the rate of major surgical complications waslower than other centers.

  10. Hernia Surgical Mesh Implants (United States)

    ... 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) ...

  11. Urogynecologic Surgical Mesh Implants (United States)

    ... 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). ...

  12. American Pediatric Surgical Association (United States)

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

  13. Optimizing surgical f

    Directory of Open Access Journals (Sweden)

    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.

  14. Abortion - surgical - aftercare (United States)

    ... 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 ...

  15. Surgical Aspects of Ovarian Tissue Removal and Ovarian Tissue Transplantation for Fertility Preservation (United States)

    Beckmann, M. W.; Dittrich, R.; Findeklee, S.; Lotz, L.


    Introduction: The removal of ovarian tissue prior to starting oncologic treatment and the subsequent transplantation of this tissue after completing therapy have become increasingly important surgical fertility-preserving techniques. The aim of this review was to investigate the different surgical techniques used for this method reported in the literature to date and to discuss the advantages and disadvantages of the respective techniques. Review: A search was done in MEDLINE using a defined algorithm to find studies published between January 2004 and December 2015. All study designs were included in our review if they contained statements on the surgical technique used. We found 16 publications (8 retrospective cohort studies, 6 case reports and 2 systematic reviews) with a total of 1898 female patients which reported on the surgical technique used for ovarian biopsy and 15 publications (7 retrospective cohort studies, 6 case reports and 2 systematic reviews) with a total of 455 women which mentioned the surgical technique used for ovarian transplantation. Different surgical techniques can be used both for ovarian biopsy and for the transplantation of ovarian tissue. A number of different surgical routes have been used, and the amount of tissue extracted, the instruments used, the treatment of the ovary, the transplantation site, the blood supply to the transplanted ovarian tissue and the procedure used for simultaneous surgical interventions vary. Conclusion: In future, one of the tasks will be to establish a standard surgical method for ovarian extraction and transplantation which will have a low rate of complications and a high pregnancy and birth rate while ensuring that the transplanted tissue is fully functional. PMID:27761026

  16. Peripheral interventions and antiplatelet therapy: Role in current practice. (United States)

    Singh, Pahul; Harper, Yenal; Oliphant, Carrie S; Morsy, Mohamed; Skelton, Michelle; Askari, Raza; Khouzam, Rami N


    Peripheral arterial disease (PAD) is a common disorder associated with a high risk of cardiovascular mortality and continues to be under-recognized. The major risk factors for PAD are similar to those for coronary and cerebrovascular disease. Management includes exercise program, pharmacologic therapy and revascularization including endovascular and surgical approach. The optimal revascularization strategy, endovascular or surgical intervention, is often debated due to the paucity of head to head randomized controlled studies. Despite significant advances in endovascular interventions resulting in increased utilization over surgical bypass, significant challenges still remain. Platelet activation and aggregation after percutaneous transluminal angioplasty of atherosclerotic arteries are important risk factors for re-occlusion/restenosis and life-threatening thrombosis following endovascular procedures. Antiplatelet agents are commonly prescribed to reduce the risk of myocardial infarction, stroke and death from cardiovascular causes in patients with PAD. Despite an abundance of data demonstrating efficacy of antiplatelet therapy in coronary artery disease and cerebrovascular disease, there is a paucity of clinical information, clinical guidelines and randomized controlled studies in the PAD population. Hence, data on antiplatelet therapy in coronary interventions is frequently extrapolated to peripheral interventions. The aim of this review article is to elucidate the current data on revascularization and the role and duration of antiplatelet and anticoagulant therapy in re-vascularized lower limb PAD patients.

  17. Giant choledochal calculosis: Surgical treatment

    Directory of Open Access Journals (Sweden)

    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.

  18. U.S. survey of surgical capabilities and experience with surgical procedures in patients with congenital haemophilia with inhibitors. (United States)

    Shapiro, A; Cooper, D L


    General guidelines exist for the use of recombinant activated factor VII (rFVIIa) to maintain haemostasis during surgery in congenital haemophilia A and B patients with high responding inhibitors (CHwI). Individual surgical plans are required and based upon historical therapy response, adverse events and anticipated procedure. Surgical interventions are feasible, yet it remains unclear how many US hemophilia treatment centres (HTCs) perform procedures in this fragile population. To better understand the US HTC surgical experience in CHwI patients and the number/types of procedures performed, a 21-question survey was sent to 133 US HTCs, with follow-up for response clarification and to non-responders. 98/133 HTCs (74%) responded, with 87 currently treating CHwI patients. In the last decade, 76/85 HTCs performed 994 surgeries on CHwI patients. Sites were experienced in the following procedures: central line insertion/removal (73 HTCs), dental (58), orthopaedic (52), abdominal (23), cardiovascular (14) and otolaryngologic (11). Experience with orthopaedic surgeries included synovectomies - arthroscopic (23 HTCs), radioisotopic (22), and open (7); joint replacement (18); fracture repair (14); and arthrodesis (8). Treatment modalities included rFVIIa bolus (83 HTCs) or continuous infusions (9), plasma-derived activated prothrombin complex concentrate (pd-aPCC) (55), antifibrinolytics (51), topical haemostatic agents (29), factor VIII (16) and fibrin sealants (14). Protocols for bypassing agents were used by 31/92 (33%) HTCs. Most US HTCs surveyed care for CHwI patients (74%) and have experience in minor surgery; fewer HTCs reported complex orthopaedic surgical experience. Identification of best practices and surgical barriers is required to guide future initiatives to support these patients.

  19. Sublingual misoprostol versus standard surgical care for treatment of incomplete abortion in five sub-Saharan African countries

    Directory of Open Access Journals (Sweden)

    Shochet Tara


    Full Text Available Abstract Background In low-resource settings, where abortion is highly restricted and self-induced abortions are common, access to post-abortion care (PAC services, especially treatment of incomplete terminations, is a priority. Standard post-abortion care has involved surgical intervention but can be hard to access in these areas. Misoprostol provides an alternative to surgical intervention that could increase access to abortion care. We sought to gather additional evidence regarding the efficacy of 400 mcg of sublingual misoprostol vs. standard surgical care for treatment of incomplete abortion in the environments where need for economical non-surgical treatments may be most useful. Methods A total of 860 women received either sublingual misoprostol or standard surgical care for treatment of incomplete abortion in a multi-site randomized trial. Women with confirmed incomplete abortion, defined as past or present history of vaginal bleeding during pregnancy and an open cervical os, were eligible to participate. Participants returned for follow-up one week later to confirm clinical status. If abortion was incomplete at that time, women were offered an additional follow-up visit or immediate surgical evacuation. Results Both misoprostol and surgical evacuation are highly effective treatments for incomplete abortion (misoprostol: 94.4%, surgical: 100.0%. Misoprostol treatment resulted in a somewhat lower chance of success than standard surgical practice (RR = 0.90; 95% CI: 0.89-0.92. Both tolerability of side effects and women’s satisfaction were similar in the two study arms. Conclusion Misoprostol, much easier to provide than surgery in low-resource environments, can be used safely, successfully, and satisfactorily for treatment of incomplete abortion. Focus should shift to program implementation, including task-shifting the provision of post-abortion care to mid- and low- level providers, training and assurance of drug availability. Trial

  20. Global Burden of Pediatric Surgical Disease

    NARCIS (Netherlands)

    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

    Directory of Open Access Journals (Sweden)

    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.

    LENUS (Irish Health Repository)

    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. Emergency coronary artery bypass surgery after failed percutaneous coronary intervention. (United States)

    Darwazah, A K; Islim, I; Hanbali, B; Shama, R A; Aloul, J


    The incidence of patients subjected to emergency coronary artery bypass graft (CABG) after percutaneous coronary intervention (PCI) is decreasing due to improvement of PCI technique and device technology. The aim of our study is to evaluate cases subjected to emergency CABG after complicated PCI to determine incidence, indications and results of surgery and to compare them with other emergency cases which are not related to angioplasty or stenting. From April 1999 to December 2005, 1 200 patients who underwent PCI were analysed. Those patients who developed complications related to PCI and required surgical intervention were included (PCI group N.=31). These patients were compared with other emergency cases not related to PCI (non-PCI group N.=48). The selection of these patients was based on the criteria of the Society of Thoracic Surgeons. The incidence of PCI complications which necessitated emergency surgical intervention was 2.6%. The main indication was due to unsatisfactory angioplasty with ongoing myocardial ischemia (68%), stent thrombosis (13%), dissection (10%) retained angioplasty wire (6.5%), and perforation (3%). The incidence of cardiogenic shock, ongoing ischemia, acute infarction Emergency coronary artery bypass grafting among patients with PCI complications and those patients not related to PCI is associated with high mortality and morbidity. Although, the percentage of mortality and morbidity was more among PCI patients the difference between both groups was not significant. Surgical backup and collaboration between cardiologist and surgeons is needed to reduce delay in management and patients transfer to obtain the best surgical outcome.

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

    Directory of Open Access Journals (Sweden)

    S. N. Schaeva


    Full Text Available Background. The main reason for urgent complications of colon cancer is an acute intestinal obstruction (AIO. This is complex pathological condition in 90 % of cases caused by colorectal cancer (CRC.Objective – to evaluate radicality of the performed operations in complicated colorectal cancer in general surgical hospitals. Dependence of the severity of intestinal obstruction by tumor localization, its morphological characteristics, determine dependence of the type of the surgical operation performed on the severity of intestinal obstruction.Materials and methods. We have studied the data on 667 patients with colorectal cancer complicated by acute intestinal obstruction. These patients were treated in the period from 2001 to 2013 in general surgical hospital in the territory of Smolensk and Smolensk region. For the processing of the obtained results we have used software Statistica 6.1. Differences were considered statistically at p ≤ 0.05.Results. All the patients were divided into 3 groups by the expression of intestinal obstruction. Group 1 (n = 279 consisted of patients with the presence of decompensated intestinal obstruction (DIO, group 2 (n = 313 consisted of patients with subcompensated intestinal obstruction (SIO, group 3 (n = 75 included patients with compensated intestinal obstruction (CIO. In case of tumor localization in right halfof the colon we most commonly observed clinical picture of acute development of decompensated intestinal obstruction (p = 0.041. Subcompensated intestinal obstruction prevailed in case of tumor localization in left half of the colon and rectal localization. In general surgical hospitals it is not always possible to speak about radicality of surgical treatment, as in a large number of cases (62.5 % the number of examined lymph nodes was less than 4. When DIO patients are admitted in the clinic, the percentage of singlestage operations is equal to 7.5 % (n = 21. In case of DIO and SIO there was a high

  5. Surgical management of pelvic organ prolapse and uterine descent in the Netherlands. (United States)

    Detollenaere, R J; den Boon, J; Kluivers, K B; Vierhout, M E; van Eijndhoven, H W F


    To evaluate current practice in the surgical treatment of uterine descent among members of the Dutch Urogynecological Society and to analyze possible trends in the surgical treatment of pelvic organ prolapse in the Netherlands during the last decade. A questionnaire, including case scenarios, was sent to the members of the Dutch Urogynecological Society. Using a nationwide registry from the Netherlands, we assessed the number and type of surgical procedures performed for pelvic organ prolapse between 1997 and 2009. The response rate was 73%, with 161 questionnaires completed. Vaginal hysterectomy, sacrospinous hysteropexy, and the Manchester Fothergill procedure were the most frequently performed surgical interventions for uterine descent. In the case of lower stage uterine descent, uterus preservation was preferred, but in the case of higher stage there was wide variation. Two thirds of the respondents stated that in recent years they tended to save the uterus more often. The registered number of hospital admissions for uterine descent increased by 30% between 1997 and 2009 and the number of surgical procedures almost doubled. The number of vaginal hysterectomies performed because of uterine descent increased by only 15% in this period. In the Netherlands, surgical policy in the case of uterine descent is very variable, with no clear preference for either hysterectomy or uterus preservation. There was a high increase in hospital admissions and pelvic organ prolapse procedures in the last decade. The number of vaginal hysterectomies performed because of uterine descent did not follow this change, which reflects a trend toward preserving the uterus.

  6. Surgical treatment of primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Brasso, K; Karstrup, S; Lundby, C M


    One hundred and two patients with primary hyperparathyroidism underwent a total of 108 bilateral neck explorations with attempted identification and biopsy of all four glands. Hypercalcaemia was surgically eliminated in 97 of 102 patients (95%). Of the remaining hypercalcaemic patients one was cu......--including bilateral neck exploration and attempted biopsies of all parathyroid glands--is safe with a high cure rate....

  7. Posterior fossa meningioma (surgical experiences)

    African Journals Online (AJOL)

    Wael M. Moussa


    Aug 27, 2012 ... Morbidity included decreased level of consciousness, cranial nerve palsy and wound infection. ..... (10 cases), trigeminal nerve compression (6 cases), facial nerve .... and magnetic resonance imaging for surgical planning for menin- ... anatomy scanning in the operation of intracranial parasagittal.


    Institute of Scientific and Technical Information of China (English)

    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.

  9. The use of a surgical incision management system on vascular surgery incisions: a pilot study. (United States)

    Weir, Gregory


    Health care-associated infections in hospitals, including surgical site infections, contribute significantly to morbidity as well as mortality. Surgical incision management (SIM) using negative pressure wound therapy (Prevena™ Incision Management System, Kinetic Concepts, Inc., San Antonio, TX, USA) is designed to cover and protect closed surgical incisions from external factors including infectious sources and local trauma, while negative pressure removes fluid and infectious material from the surgical incision. A prospective case-control study assessed wound complications in patients undergoing vascular bypass procedures, where both femoral areas were incised to gain access to the femoral arteries. SIM was placed on one femoral area while a standard postoperative wound dressing was placed on the contralateral femoral area. Eight patients were included in this pilot study. All of them required bilateral femoral artery access. During the follow-up period patients were monitored for wound complications. All wound complications requiring surgical intervention were considered significant. No significant wound complications occurred in wounds treated with SIM, compared with three significant complications in control wounds. These preliminary data would suggest a potential reduction in wound complications and no observed increase in haemorrhage in high-risk patients with severe co-morbidities undergoing vascular surgery.

  10. Surgical treatment for male prolactinoma: A retrospective study of 184 cases. (United States)

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


    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.

  11. Angiography suite concept for an interdisciplinary centre for cardiovascular interventions


    Teichgräber, Ulf K. M.; Wintzer, Christian; Hamm, Bernd


    A permanently mounted angiography suite in an operating room (OR) is considered to be a hybrid OR. However, regular use for angiographic interventions is restricted with this setup. We introduce an alternative use of space for the efficient utilisation of an angiographic suite outside the surgical unit. This concept includes three scenarios that describe a modification of the catheter suite according to the specific clinical demands by adapting the workflow.

  12. Surgical Lasers In Gynecology (United States)

    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.

  13. Oral and maxillofacial surgical considerations for a case of Hutchinson-Gilford progeria. (United States)

    Batstone, M D; Macleod, A W G


    Hutchinson-Guilford progeria is a rare genetic condition showing the stigmata of accelerated ageing combined with severe growth retardation. Patients with this condition show a classical facies and clinical features with an average age of death of 13, usually due to atherosclerotic changes. Craniofacial and dental manifestations include mandibular and maxillary hypoplasia, both vertically and horizontally. Delayed and abnormal tooth eruption and morphology are commonly present. The long-term medical prognosis and eruption potential of individual teeth is important when considering treatment. In addition to this, surgical planning and surgical technique must be modified by the abnormal facial morphology, dermal inelasticity, potential anaesthetic difficulties, and ongoing deterioration in the medical condition. These factors mandate early and definitive intervention for oral surgical conditions. We report the case of a 13-year-old male treated for pericoronitis and oral pain relating to delayed eruption of first permanent molars.

  14. Can we measure surgical resilience? (United States)

    Graham, David; Becerril-Martinez, Guillermo; Quinto, Lena; Zhao, Dong Fang


    Surgical resilience describes psychological resilience within a surgical setting. Within a surgical setting, psychologically resilient patients have improved recovery and wound-healing. The search for biological correlates in resilient patients has led to the hypothesis that certain endogenous biomarkers (namely neuropeptide Y (NPY), testosterone, and dehydroepiandrosterone (DHEA)) are altered in resilient patients. The concept of surgical resilience raises the question of whether enhanced recovery following surgery can be demonstrated in patients with high titres of resilience biomarkers as compared to patients with low titres of resilience biomarkers. To determine the prognostic value of resilience biomarkers in surgical recovery, a cohort of patients undergoing major surgery should initially be psychometrically tested for their resilience levels before and after surgery so that biomarker levels of NPY, testosterone and DHEA can be compared to a validated psychometric test of resilience. The primary outcome would be length of hospital stay with and without an enhanced recovery program. Secondary outcome measures such as complications, time in rehabilitation and readmission could also be included. If the hypothesis is upheld, resilience biomarkers could be used to support more individualised perioperative management and lead to more efficient and effective allocation of healthcare resources.

  15. Evaluation of teleoperated surgical robots in an enclosed undersea environment. (United States)

    Doarn, Charles R; Anvari, Mehran; Low, Thomas; Broderick, Timothy J


    The ability to support surgical care in an extreme environment is a significant issue for both military medicine and space medicine. Telemanipulation systems, those that can be remotely operated from a distant site, have been used extensively by the National Aeronautics and Space Administration (NASA) for a number of years. These systems, often called telerobots, have successfully been applied to surgical interventions. A further extension is to operate these robotic systems over data communication networks where robotic slave and master are separated by a great distance. NASA utilizes the National Oceanographic and Atmospheric Administration (NOAA) Aquarius underwater habitat as an analog environment for research and technology evaluation missions, known as NASA Extreme Environment Mission Operations (NEEMO). Three NEEMO missions have provided an opportunity to evaluate teleoperated surgical robotics by astronauts and surgeons. Three robotic systems were deployed to the habitat for evaluation during NEEMO 7, 9, and 12. These systems were linked via a telecommunications link to various sites for remote manipulation. Researchers in the habitat conducted a variety of tests to evaluate performance and applicability in extreme environments. Over three different NEEMO missions, components of the Automated Endoscopic System for Optimal Positioning (AESOP), the M7 Surgical System, and the RAVEN were deployed and evaluated. A number of factors were evaluated, including communication latency and semiautonomous functions. The M7 was modified to permit a remote surgeon the ability to insert a needle into simulated tissue with ultrasound guidance, resulting in the world's first semi-autonomous supervisory-controlled medical task. The deployment and operation of teleoperated surgical systems and semi-autonomous, supervisory-controlled tasks were successfully conducted.

  16. Evaluation of characteristics and surgical outcomes in cervical spondylotic amyotrophy

    Directory of Open Access Journals (Sweden)

    Hong-Li Wang


    Full Text Available Background: Cervical spondylotic amyotrophy (CSA is a rare clinical syndrome resulting from cervical spondylosis. Surgical treatment includes anterior cervical decompression and fusion (ACDF, and laminoplasty with or without foraminotomy. Some studies indicate that ACDF is an effective method for treating CSA because anterior decompression with or without medial foraminotomy can completely eliminate anterior and/or anterolateral lesions. We retrospectively evaluated outcome of surgical outcome by anterior cervical decompression and fusion (ACDF. Materials and Methods: 28 CSA patients, among whom 12 had proximal type CSA and 16 had distal type CSA, treated by ACDF, were evaluated clinicoradiologically. The improvement in atrophic muscle power was assessed by manual muscle testing (MMT and the recovery rate of the patients was determined on the basis of the Japanese Orthopedic Association (JOA scores. Patient satisfaction was also examined. Results: The percentage of patients, who gained 1 or more grades of muscle power improvement, as determined by MMT, was 91.7% for those with proximal type CSA and 37.5% for those with distal type CSA (P < 0.01. The JOA score-based recovery rates of patients with proximal type and distal type CSA were 60.8% and 41.8%, respectively (P < 0.05. Patient satisfaction was 8.2 for those with proximal type CSA and 6.9 for those with distal type CSA (P < 0.01. A correlation was observed among the levels of improvement in muscle power, JOA score based recovery rate, patient satisfaction and course of disease (P < 0.05. Conclusion: ACDF can effectively improve the clinical function of patients with CSA and result in good patient satisfaction despite the surgical outcomes for distal type CSA being inferior to those for proximal type CSA. Course of disease is the fundamental factor that affects the surgical outcomes for CSA. We recommend that patients with CSA undergo surgical intervention as early as possible.




    Orthognathic surgery is a surgical procedure largely practiced throughout the world for the correction of various maxillofacial deformities. The procedure for correcting a particular deformity will be done after proper evaluation, which includes cephalometric, dental model analysis and photographs. The patient undergoes pre-surgical orthodontic correction for dental compensation, after which surgery is planned. During the last few decades, the profession has witnessed ...

  18. Surgical management of pancreatic neuroendocrine tumors

    NARCIS (Netherlands)

    Jilesen, A.P.J.


    This thesis gives an overview of the surgical management and prognosis of patients with pancreatic neuroendocrine tumors (pNET). A systematic review including 2600 studies, was performed on complications and survival after different surgical procedures for pNETs. The overall pancreatic fistula rate

  19. Medical and Surgical Management of Postpartum Hemorrhage in a Woman with Factor XIII Deficiency

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    Michael Cheng


    Full Text Available Factor XIII deficiency is a rare inherited coagulopathy. Factor XIII is the last clotting factor in the coagulation cascade to insure strength and stability to fibrin clots. Without this enzyme, the fibrous clot is unstable and nonresistant to fibrinolysis. Gravid women with this congenital disease are especially at risk for complications including miscarriages and hemorrhage without appropriate interventions. We present a case of a woman in her 20s with Factor XIII deficiency who was treated with cryoprecipitate and had a successful normal spontaneous vaginal delivery; subsequently, patient suffered from postpartum hemorrhage and consumptive coagulopathy due to consumption of Factor XIII, requiring emergency surgical intervention. Intraoperative management was challenged by an ethical dilemma involving the patient’s religious beliefs about not receiving blood. This paper will discuss the mechanism of Factor XIII and the medical and surgical management involved with this patient.

  20. Surgical management of cesarean scar pregnancies – A single tertiary experience

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    Xiaohui Ong


    Full Text Available Cesarean scar pregnancies (CSPs are a rare complication of previous cesarean deliveries. As cesarean section rates continue to increase worldwide, the incidence of CSPs is likely to rise as well. The diagnosis and management of CSPs pose challenging problems to clinicians. Early accurate diagnosis is crucial, as CSP is a life-threatening emergency that can lead to potentially catastrophic consequences such as uterine rupture, hemorrhage, loss of fertility and maternal death. There is no general consensus, however, regarding the best means of management. Various case reports and case series have reported successful outcomes with medical treatment, surgical intervention, interventional radiology, as well as a combination of methods. We present a case series of CSPs managed in our center, a tertiary obstetrics and gynecology hospital. All were treated primarily by conservative and fertility-sparing surgical methods. We have also included a short review of the current literature on this rare but important condition.

  1. Interventional Radiology of Male Varicocele: Current Status

    Energy Technology Data Exchange (ETDEWEB)

    Iaccarino, Vittorio, E-mail:; Venetucci, Pietro [University of Naples ' Federico II' , Diagnostic Imaging Department-Cardiovascular and Interventional Radiology, School of Medicine (Italy)


    Varicocele is a fairly common condition in male individuals. Although a minor disease, it may cause infertility and testicular pain. Consequently, it has high health and social impact. Here we review the current status of interventional radiology of male varicocele. We describe the radiological anatomy of gonadal veins and the clinical aspects of male varicocele, particularly the physical examination, which includes a new clinical and ultrasound Doppler maneuver. The surgical and radiological treatment options are also described with the focus on retrograde and antegrade sclerotherapy, together with our long experience with these procedures. Last, we compare the outcomes, recurrence and persistence rates, complications, procedure time and cost-effectiveness of each method. It clearly emerges from this analysis that there is a need for randomized multicentre trials designed to compare the various surgical and percutaneous techniques, all of which are aimed at occlusion of the anterior pampiniform plexus.

  2. 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

    Institute of Scientific and Technical Information of China (English)

    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。

  3. 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

    Institute of Scientific and Technical Information of China (English)

    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

  4. 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

    Directory of Open Access Journals (Sweden)

    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.

  5. Feature classification for tracking articulated surgical tools. (United States)

    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.

  6. [Surgical treatment of type 2 diabetes mellitus]. (United States)

    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.

  7. Scaphotrapeziotrapezoidal Joint Osteoarthritis: A Systematic Review of Surgical Treatment. (United States)

    Deans, Victoria M; Naqui, Zafar; Muir, Lindsay T S W


    The management of scaphotrapeziotrapezoidal (STT) joint osteoarthritis (OA) remains controversial. This systematic review aims to review the evidence for surgical interventions specific to STT OA. Medline and Embase libraries were searched using a pre-defined search strategy in October 2014. All study designs and languages were included and evaluated by two reviewers (VMD and LM) against the inclusion/exclusion criteria. The study eligibility criteria included papers discussing surgical treatment of STT OA, and the review was conducted using the PRISMA guidelines. 295 unique results were identified from the search strategy after duplicates were filtered. 21 articles met the eligibility criteria. Trapezial excision and partial trapezoidal excision is an effective treatment with low morbidity and complications, although can lead to weakness of the thumb. Distal scaphoid excision remains an effective pain relief treatment with improved grip and pinch strengths post-operatively. The procedure is technically less demanding than arthrodesis, does not carry the risks of non-union and complication rate of STT joint arthrodesis, and has a shorter immobilisation requirement. It produces reliable results, but is contraindicated if there is either scapholunocapitate pathology or midcarpal instability. STT joint fusion has a place, typically producing 75% range of movement of the non-operated wrist. However it has a higher associated complication rate, and simultaneous radial styloidectomy is recommended to reduce ongoing pain from impingement. Implant arthroplasty using a graphite-coated pyrocarbon implant has been used more recently. The patients gained significant pain relief, although there have been reports of implant dislocation secondary to surgical errors. A reduction in post-operative wrist extension and radial deviation has been noted. From this systematic review, we have composed a treatment algorithm for the surgical management of STT joint OA.

  8. Mandatory palliative care education for surgical residents: initial focus on teaching pain management. (United States)

    Oya, Hisaharu; Matoba, Motohiro; Murakami, Satoshi; Ohshiro, Taihei; Kishino, Takayoshi; Satoh, Yuya; Tsukahara, Tetsuo; Hori, Syutarou; Maeda, Masahiro; Makino, Takashi; Maeda, Takashi


    Knowledge concerning palliative care and the associated skills, including effective pain control, is essential for surgeons who treat cancer patients in daily practice. This study focuses on a palliative care training course that has been mandatorily conducted for all surgical residents of our hospital since 2009. We evaluated the effectiveness of our mandatory palliative care training course by conducting a retrospective study of the patients' medical records and participants' questionnaire results and discussed the importance of palliative care education for surgical residents. All 12 surgical residents who participated in the course in 2009 had graduated 4-9 years back. They were assigned to look after a total of 92 cases (average, 7.66 cases per resident) during the course. The purpose of care in most cases (92.3%) was to mitigate pain. Introducing analgesic adjuvants such as gabapentin or amitriptyline accounted for the largest part of initial interventions (23.9%) aimed at controlling cancer pain, followed by changes in route of administration or doses of prior opioid analgesics (21.7%). Interventions with opioid analgesics were conducted most frequently (47.7%). The overall pain improvement rate was 89.1%. We used a questionnaire after the course to evaluate its effectiveness. The surgical residents stated that it was a meaningful course through which they gained practical knowledge on palliative care and that the experience would change their approach to home care.



    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

  10. Surgical Management of Severe Colitis in the Intensive Care Unit. (United States)

    Halaweish, Ihab; Alam, Hasan B


    Severe colitis, an umbrella encompassing several entities, is one of the most common acute gastrointestinal disorders resulting in critical illness. Clostridium difficile infection is responsible for the majority of nosocomial diarrhea with fulminant C difficile colitis (CDC) carrying a high mortality. Optimal outcomes can be achieved by early identification and treatment of fulminant CDC, with appropriate surgical intervention when indicated. Ischemic colitis, on the other hand, is uncommon with a range of etiological factors including abdominal aortic surgery, inotropic drugs, rheumatoid diseases, or often no obvious triggering factor. Most cases resolve with nonsurgical management; however, prompt recognition of full-thickness necrosis and gangrene is crucial for good patient outcomes. Fulminant colitis is a severe disease secondary to progressive ulcerative colitis with systemic deterioration. Surgical intervention is indicated for hemorrhage, perforation, or peritonitis and failure of medical therapy to control the disease. Although, failure of medical management is the most common indication, it can be difficult to define objectively and requires a collaborative multidisciplinary approach. This article proposes some simple management algorithms for these clinical entities, with a focus on critically ill patients.

  11. Comparison of endovascular coiling and surgical clipping for the treatment of intracranial aneurysms: A prospective study.

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    Zeinab Taheri


    Full Text Available Management of intracranial aneurysms has made debates about the best treatment modality in recent years. The aim of this study was to compare the interventional outcomes between two groups of patients, one treated with endovascular coiling and the other treated with surgical clipping.This prospective study included 48 patients with intracranial aneurysms who underwent endovascular coiling (27 patients or surgical clipping (21 patients from July 2011 to August 2013. A neurologist examined patients in admission and followed them by phone call 1-year after intervention.Mean modified Rankin Scale (MRS score at the time of admission in endovascular group was 2.86 ± 0.974 whereas it was 3.81 ± 1.078 in surgical clipping group (P = 0.0040. Focal neurologic signs were higher in clipping during procedures (P = 0.0310. Of 37 patients who followed up for a year, 19 were in endovascular group and 18 in surgical clipping group. At 1 year follow-up, MRS improvement was statistically significant in coiling group (P = 0.0090, but not in clipping group (P = 0.8750. Mean difference of MRS score at the time of admission and at one year later, was 0.947 ± 1.224 in endovascular group and 0.111 ± 2.083 in surgical group (P = 0.3000.There was no statistically significant difference at 1 year outcome between two groups. We recommend further interventional studies with larger sample sizes for better evaluation of the modalities.

  12. Surgical ethics and the challenge of surgical innovation. (United States)

    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.

  13. Realistic tool-tissue interaction models for surgical simulation and planning

    NARCIS (Netherlands)

    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

  14. Recognizing surgical patterns

    NARCIS (Netherlands)

    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

  15. Surgical medical record

    DEFF Research Database (Denmark)

    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...

  16. Functional outcome of the surgical management of acute acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    Naseem Munshi; Asad Abbas; Mohamed Amirali Gulamhussein; Ghulam Mehboob; Rija Aitzaz Qureshi


    Objective:To assess the functional outcome of early surgical management of displaced acetabular fractures and the complications associated with the procedure. Methods: This is a case series study and data was collected using specialized performance. The study included 75 patients and the sampling technique was a non-probability purposive type. Patients presenting with close displaced acetabular fractures of more than 2 mm within 10 days of injury were included. However, elderly patients presenting after 10 days of injury, with evidence of local infection, severe osteoporotic bone and co-morbid such as chronic obstructive pulmonary disease were not included in the study. New acetabular scoring system was used for assessing outcome of patients. Results:A total of 75 patients were operated on. Union was achieved in anatomical position in 66 (88%) patients and in malposition in 9 (12%) patients. Excellent results were obtained in 18 (24%) patients, good results in 41 (54.6%), fair results in 12 (16%), and poor results in 4 (5.4%) patients. Postoperative complications included infection [5 (6.7%)], heterotropic ossification [3 (4%)], sciatic nerve injury [10 (13.3%)], avascular necrosis [3 (4%)] patients. Conclusions: Patients with displaced acetabular fractures should be referred to specialised centres. Early surgical intervention and experienced management is a prime factor in achieving good results.

  17. Patient participation in pulmonary interventions to reduce postoperative pulmonary complications following cardiac surgery. (United States)

    McTier, Lauren; Botti, Mari; Duke, Maxine


    Clinical interventions aimed at reducing the incidence of postoperative pulmonary complications necessitate patient engagement and participation in care. Patients' ability and willingness to participate in care to reduce postoperative complications is unclear. Further, nurses' facilitation of patient participation in pulmonary interventions has not been explored. To explore patients' ability and willingness to participate in pulmonary interventions and nurses' facilitation of pulmonary interventions. Single institution, case study design. Multiple methods of data collection were used including preadmission (n=130) and pre-discharge (n=98) patient interviews, naturalistic observations (n=48) and nursing focus group interviews (n=2). A cardiac surgical ward of a major metropolitan, tertiary referral hospital in Melbourne, Australia. One hundred and thirty patients admitted for cardiac surgery via the preadmission clinic during a 1-year period and 40 registered nurses who were part of the permanent workforce on the cardiac surgical ward. Patients' understanding of their role in pulmonary interventions and patients' preference for and reported involvement in pulmonary management. Nurses' facilitation of patients to participate in pulmonary interventions. Patients displayed a greater understanding of their role in pulmonary interventions after their surgical admission than they did at preadmission. While 55% of patients preferred to make decisions about deep breathing and coughing exercises, three-quarters of patients (75%) reported they made decisions about deep breathing and coughing during their surgical admission. Nurses missed opportunities to engage patients in this aspect of pulmonary management. Patients appear willing to take responsibility for pulmonary management in the postoperative period. Nurses could enhance patient participation in pulmonary interventions by ensuring adequate information and education is provided. Facilitation of patients' participation

  18. [Arterial and portal venous complications after HPB surgical procedures: Interdisciplinary management]. (United States)

    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.

  19. Efficacy, safety, and cost of surgical versus nonsurgical treatment for carpal tunnel syndrome (United States)

    Ren, Yi-Ming; Wang, Xi-Shan; Wei, Zhi-Jian; Fan, Bao-You; Lin, Wei; Zhou, Xian-Hu; Feng, Shi-Qing


    Abstract Background: Carpal tunnel syndrome (CTS) is a common peripheral nerve entrapment disease. Either surgical or conservative intervention for CTS patients is needed to choose. We conducted this systematic review and meta-analysis to compare the clinical efficacy, safety, and cost of surgical versus nonsurgical intervention. Methods: The eligible studies were acquired from PubMed, Medline, Embase, Web of Science, Google, and Cochrane Library. The data were extracted by 2 of the coauthors independently and were analyzed by RevMan5.3. Standardized mean differences (SMDs), odds ratios (ORs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration Risk of Bias Tool and Newcastle–Ottawa Scale were used to assess risk of bias. Results: Thirteen studies including 9 randomized controlled trials (RCTs) and 4 observational studies were assessed. The methodological quality of the trials ranged from moderate to high. The difference of clinical efficacy was statistically significant between surgical and nonsurgical intervention, and nonsurgical treatment was more effective (OR = 2.35, 95%CI = 1.18–4.67, P = 0.01). Meanwhile, different results were discovered by subgroup analysis. The pooled results of function improvement, symptom improvement, neurophysiological parameters improvement, and cost of care at different follow-up times showed that the differences were not statistically significant between the 2 interventions. The difference of complications and side-effects was statistically significant and conservative treatment achieved better result than surgery (OR = 2.03, 95%CI = 1.28–3.22, P = 0.003). Sensitivity analysis proved the stability of the pooled results. Conclusion: Both surgical and conservative interventions had benefits in CTS. Nonsurgical treatment was more effective and safety than surgical treatment, but there were no significant differences in function improvement, symptom improvement, neurophysiological

  20. [Surgical education has its price]. (United States)

    Schröder, W; Krones, C J


    The radical economisation of the German health-care system has caused an increasing cost awareness. Following this trend, medical education has been identified as a possible expense factor. The theoretical and practical training of young doctors needs time and costs money. However, a detailed cost analysis is still not available, since the complex daily work schedule of young professionals only allows the calculation of single cost factors. Investigations in the USA estimate the costs of surgical training at US$ 80 000 per year and per resident. At present in Germany, surgical training is indirectly financed by the DRG flat rates of the health insurance companies. Possible alternatives include the implementation of a "training fond" which is financed by a percentage fee of the DRG's as well as an on-top funding by the federal government. This "training fond" would support only those surgical units that offer a structured and certified training to surgical residents. However, a systematic cost analysis of such a structured curriculum is necessary for any further discussion.

  1. Disparities between industrial and surgical ergonomics. (United States)

    Seagull, F Jacob


    A surgeon's work environment and working conditions are often harsher than those of an industrial worker. Accepted principles and regulations of ergonomics in manufacturing are largely ignored or absent in the medical/surgical domain. Examples include poor surgical tool handle design, awkward and stressful surgical postures, and prolonged standing without breaks and without a foot mat. In these and other areas, there are documented "best practices" for industrial hygiene and ergonomics that are not yet widely accepted for surgery. There is support in the literature for innovations in surgical ergonomics, yet adoption is not widespread. In the absence of these ergonomic principles, surgical repetitive strain injuries in minimally invasive surgery are reaching epidemic levels. As ergonomists, it falls upon us to understand why current solutions have not been widely adopted within this domain, and to derive solutions to the unique challenges of surgery.

  2. 21 CFR 878.4370 - Surgical drape and drape accessories. (United States)


    ... (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4370 Surgical drape... site of surgical incision from microbial and other contamination. The device includes a plastic wound... insertion of the surgeon's finger into the rectum during performance of a transurethral prostatectomy....

  3. 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. (United States)

    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

  4. Debriefing decreases mental workload in surgical crisis: A randomized controlled trial. (United States)

    Boet, Sylvain; Sharma, Bharat; Pigford, Ashlee-Ann; Hladkowicz, Emily; Rittenhouse, Neil; Grantcharov, Teodor


    Mental workload is the amount of mental effort involved in performing a particular task. Crisis situations may increase mental workload, which can subsequently negatively impact operative performance and patient safety. This study aims to measure the impact of learning through debriefing and a systematic approach to crisis on trainees' mental workload in a simulated surgical crisis. Twenty junior surgical residents participated in a high-fidelity, simulated, postoperative crisis in a surgical ward environment (pretest). Participants were randomized to either an instructor-led debriefing, including performance feedback (intervention; n = 10) or no debriefing (control; n = 10). Subjects then immediately managed a second simulated crisis (post-test). Mental workload was assessed in real time during the scenarios using a previously validated, wireless, vibrotactile device. Mental workload was represented by subject response times to the vibrations, which were recorded and analyzed using the Mann-Whitney U test. Participants in the debriefing arm had a significantly reduced median response time in milliseconds (post-test minus pretest -695, quartile range -2,136 to -297) compared to participants in the control arm (42, -1,191 to 763), (between-arm difference P = .049). Debriefing after simulated surgical crisis situations may improve performance by decreasing trainee's mental workload during a subsequent simulated surgical crisis. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. [Rethinking clinical research in surgical oncology. From comic opera to quality control]. (United States)

    Evrard, Serge


    The evidence base for the effectiveness of surgical interventions is relatively poor and data from large, randomized prospective studies are rare with often a poor quality. Many efforts have been made to increase the number of high quality randomized trials in surgery and theoretical proposals have been put forward to improve the situation, but practical implementation of these proposals is seriously lacking. The consequences of this policy are not trivial; with very few patients included in surgical oncology trials, this represents wasted opportunity for advances in cancer treatment. In this review, we cover the difficulties inherent to clinical research in surgical oncology, such as quality control, equipoise, accrual, and funding and promote alternative designs to the randomized controlled trial. Although the classic randomized controlled trial has a valid but limited place in surgical oncology, other prospective designs need to be promoted as a new deal. This new deal not only implicates surgeons but also journal editors, tender jury, as well as regulatory bodies to cover legal gaps currently surrounding surgical innovation.

  6. Surgical management of liver hydatidosis: a multicentre series of 1412 patients. (United States)

    Secchi, Mario A; Pettinari, Ricardo; Mercapide, Carlos; Bracco, Ricardo; Castilla, Carlos; Cassone, Eduardo; Sisco, Pablo; Andriani, Oscar; Rossi, Leonardo; Grondona, Jorge; Quadrelli, Lisandro; Cabral, Raúl; Rodríguez León, Nicolás; Ledesma, Carlos


    The management of hydatid liver disease (HLD) includes various nonsurgical and surgical treatment options. The purpose of the present longitudinal study was to report the changes in surgical management and the consequent outcome of HLD patients in 10 referral surgical centres in Argentina from 1975 to 2007. The study result analysis was divided into two study periods (1975-1990 and 1991-2007). A total of 1412 patients underwent radical (Group 1: 396 patients), conservative (Group 2: 748 patients) or combined (Group 3: 536 interventions in 268 patients) surgical procedures. The overall mortality and complication rate (Clavien I-IV) was 1.8 and 39% respectively. The complication rate was significantly lower in Group 1 (26%) compared with Group 2 (45%) and Group 3 (42%) There was a significant decrease in mortality (2.3 vs. 1%), complication (42 vs. 34%) and early reoperation (12 vs. 6%) rates between the first study part (918 patients) and the second study part (494 patients). During a median follow-up of 7 years, there was a significant decrease in the first part of this study in the late reoperation rate (8.4-3%) and in disease recurrence (9-1.6%). This large national observational multicentre series shows a significant improvement in surgical management of HLD in Argentina, with a decrease in mortality, morbidity, early and late reoperation and recurrence rates. A recent trend was observed in favour of an earlier diagnosis, less complicated clinical presentation and recent use of minimally invasive approaches.

  7. [Surgical approaches in surgery for cicatrical tracheal stenosis]. (United States)

    Parshin, V D; Rusakov, M A; Parshin, V V; Mirzoian, O S; Khoruzhenko, A I


    At present time several surgical approaches are being used for cicatrical tracheal stenosis including cervicotomy, longitudinal- circumferential sternotomy and thoracotomy. Besides location of stenosis an approach is being determined by constitutional and anatomical features of patient, surgeon's and anesthesiologist's experience, well-coordinated work of operating team. If pathological process is placed in cervico-laryngeal, cervical and upper thoracic segment cervicotomy is preferable. Partial longitudinal-circumferential sternotomy is believed to be adequate in case of lesion of thoracic trachea and its bifurcation. This approach provides all types of tracheal reconstructions. Technical difficulties appear if process is localized in membranous wall of suprabifurcational part, bifurcation and primary bronchus. In these cases we recommend thoracotomy through the bed of resected the 3rd or the 4th ribs and patient's position on his front. Interventions including pulmonary tissue resection and tracheal edges convergence are possible through thoracotomy.


    Directory of Open Access Journals (Sweden)

    I. Y. Klychkova


    Full Text Available Purpose - a complex assessment of the neuromuscular apparatus in different age groups of children with congenital clubfoot before and after surgery. Material and methods. The study included 80 patients (23 girls and 57 boys with moderate and severe congenital clubfoot between the ages of 0 to 18 years. In 46% of patients a bilateral lesion was noted, in 54% - unilateral. All patients who received surgical treatment tendon-muscle plasty by the Sturm-Zatsepin method, modified in the Turner Institute, were carried out. Long-term results of surgical treatment were investigated in terms of 1 to 5 years. Neurophysiological studies were carried out on a multi-channel computer complex "Neuro-MEP-4" (Russia. Contractive ability of the tibial, peroneal, and gastrocnemius muscles of lower leg was assessed by global electromyography (EMG for the affected and healthy sides. In order to receive the normal age indexes of electrogenesis the identical study was conducted in 30 subjects in each age group without pathology of the lower extremities. Results. Significant abnormalities of the functional state of the neuro-muscular system in shin were revealed in patients with congenital clubfoot. The analysis of the EMG results in patients admitted for conservative treatment (group 1 showed that in unilateral disease there is a decrease of electrical activity of leg muscles on the affected side. If bilateral symmetrical lesions observed decreasing of muscle electrogenesis were noted compared with the age norm. There are quantitative and qualitative changes in electrogenesis, which are characterized by secondary changes in the muscles on the background of segmental abnormalities. After surgical intervention in patients 0-3 years the positive dynamics of the neuro-muscular functional state of the shin was achieved, which allows to recommend surgical treatment of congenital clubfoot in children in age till three years. Revealed violations of the conductivity on the

  9. Intraoperative Hypothermia During Surgical Fixation of Hip Fractures. (United States)

    Frisch, Nicholas B; Pepper, Andrew M; Jildeh, Toufic R; Shaw, Jonathan; Guthrie, Trent; Silverton, Craig


    Hip fractures are common orthopedic injuries and are associated with significant morbidity/mortality. Intraoperative normothermia is recommended by national guidelines to minimize additional morbidity/mortality, but limited evidence exists regarding hypothermia's effect on orthopedic patients. The purpose of this study was to determine the incidence of intraoperative hypothermia in patients with operatively treated hip fractures and evaluate its effect on complications and outcomes. Retrospective chart review was performed on clinical records from 1541 consecutive patients who sustained a hip fracture and underwent operative fixation at the authors' institution between January 2005 and October 2013. A total of 1525 patients were included for analysis, excluding those with injuries requiring additional surgical intervention. Patient demographic data, surgery-specific data, postoperative complications, length of stay, and 30-day readmission were recorded. Patients with a mean intraoperative temperature less than 36°C were identified as hypothermic. Statistical analysis with univariate and multivariate logistic regression modeling evaluated associations with hypothermia and effect on complications/outcomes. The incidence of intraoperative hypothermia in operatively treated hip fractures was 17.0%. Hypothermia was associated with an increase in the rate of deep surgical-site infection (odds ratio, 3.30; 95% confidence interval, 1.19-9.14; P=.022). Lower body mass index and increasing age demonstrated increased association with hypothermia (P=.004 and P=.005, respectively). To the authors' knowledge, this is the first and largest study analyzing the effect of intraoperative hypothermia in orthopedic patients. In patients with hip fractures, the study's findings confirm evidence found in other surgical specialties that hypothermia may be associated with an increased risk of deep surgical-site infection and that lower body mass index and increasing age are risk factors

  10. Surgical management of chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Stavros Gourgiotis; Stylianos Germanos; Marco Pericoli Ridolifni


    BACKGROUND:Treatment of chronic pancreatitis (CP) is a challenging condition for surgeons. During the last decades, increasing knowledge about pathophysiology of CP, improved results of major pancreatic resections, and integration of sophisticated diagnostic methods in clinical practice have resulted in signiifcant changes in surgery for CP. DATA SOURCES:To detail the indications for CP surgery, the surgical procedures, and outcome, a Pubmed database search was performed. The abstracts of searched articles about surgical management of CP were reviewed. The articles could be identiifed and further scrutinized. Further references were extracted by cross-referencing. RESULTS: Main indications of CP for surgery are intractable pain, suspicion of malignancy, and involvement of adjacent organs. The goal of surgical treatment is to improve the quality of life of patients. The surgical approach to CP should be individualized according to pancreatic anatomy, pain characteristics, baseline exocrine and endocrine function, and medical co-morbidity. The approach usually involves pancreatic duct drainage and resection including longitudinal pancreatojejunostomy, pancreatoduodenectomy (Whipple's procedure), pylorus-preserving pancreatoduodenectomy, distal pancreatectomy, total pancreatectomy, duodenum-preserving pancreatic head resection (Beger's procedure), and local resection of the pancreatic head with longitudinal pancreatojejunostomy (Frey's procedure). Non-pancreatic and endoscopic management of pain has also been advocated. CONCLUSIONS:Surgical procedures provide long-term pain relief, a good postoperative quality of life with preservation of endocrine and exocrine pancreatic function, and are associated with low early and late mortality and morbidity. In addition to available results from randomized controlled trials, new studies are needed to determine which procedure is the most effective for the management of patients with CP.

  11. Multiscale Surgical Telerobots

    Energy Technology Data Exchange (ETDEWEB)

    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.

  12. Coccidioidomycosis: Surgical Issues and Implications. (United States)

    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.

  13. Pterion: An anatomical variation and surgical landmark

    Directory of Open Access Journals (Sweden)

    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.

  14. Effects of surgical and chemical sterilization on the behavior of free-roaming male dogs in Puerto Natales, Chile. (United States)

    Garde, E; Pérez, G E; Vanderstichel, R; Dalla Villa, P F; Serpell, J A


    Population management of free-roaming domestic dogs (Canis lupus familiaris) is of interest due to the threat these animals pose to people, other animals and the environment. Current sterilization procedures for male dogs include surgical and chemical methods. However, little is known about how these procedures affect their behavior. The primary objective of this study was to investigate changes in selected behaviors following chemical and surgical sterilization in a male free-roaming dog (FRD) population in southern Chile. We also examined the association between serum testosterone levels and behaviors thought to be influenced by circulating androgens. A total of 174 dogs were randomly assigned to either a surgical or chemical sterilization group, or a control group. At the onset of the intervention period, 119 dogs remained and 102 dogs successfully completed the study. Each dog was monitored pre- and post-intervention using video recordings, GPS collars, and blood samples for the measurement of testosterone. Analysis of behavior revealed that surgically castrated dogs showed no reduction of sexual activity or aggression when compared to their pre-intervention behavior. Chemically sterilized dogs showed a statistically significant increase in dog-directed aggression, but no change in sexual activity. There was no change in home range size in any groups between the pre- and post-intervention measurement. We found no consistent association between levels of serum testosterone concentration and behavioral changes in any of the groups. This study presents the first detailed behavioral observations following surgical and chemical sterilization in male FRDs. The information generated is highly relevant to communities struggling with the control of FRDs. Complementary studies to further our understanding of the effects of male sterilization on the behavioral and reproductive dynamics of FRD populations are needed.

  15. 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

    Institute of Scientific and Technical Information of China (English)

    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

  16. [Surgical tactics by various ameloblastic tumors]. (United States)

    Semkin, V A; Grigor'ian, A S; Babichenko, I I; Usachev, E S; Zaretskaia, A S


    Ameloblastoma and ameloblastic fibroma are benign odontogenous tumors of the jaws with local destructive growth, prone to recurrence. They have various typical radiological and histological features. Surgical tactic generally includes partial resection of the affected jaw. Immunohistochemical study of the tumor tissues allows assessing the expression of tumor progression markers and forecasting tumor growth thus providing individual choice of surgical tactics. Our experience in treatment of ameloblastic tumors showed total biopsy with osseous surgical margins resection to be sufficient for normal bone structure remodeling in some patients.

  17. Dermato-Surgical Approach In Vitiliogo

    Directory of Open Access Journals (Sweden)

    Malakar Subrata


    Full Text Available Vitiligo is a hypomelanotic disorder often difficult to treat. Different medicinal treatments such as PUNA, steroids and adjunct theraples give partial or complete repigmentation in about 60-90% cases. Moreover, vitiligo patches which are refractory to most medical therapies are acrofacial, mucosal and segmental. At the backdrop of these medicinal shortcomings, various surgical procedures and their modifications have gradually evolved. To decide why, where and when surgical interference is required, is of utmost importance. In this review different surgical modes, including some of the latest, and their future prospects are discussed.

  18. Quality of pharmaceutical care in surgical patients.

    Directory of Open Access Journals (Sweden)

    Monica de Boer

    Full Text Available BACKGROUND: Surgical patients are at risk for preventable adverse drug events (ADEs during hospitalization. Usually, preventable ADEs are measured as an outcome parameter of quality of pharmaceutical care. However, process measures such as QIs are more efficient to assess the quality of care and provide more information about potential quality improvements. OBJECTIVE: To assess the quality of pharmaceutical care of medication-related processes in surgical wards with quality indicators, in order to detect targets for quality improvements. METHODS: For this observational cohort study, quality indicators were composed, validated, tested, and applied on a surgical cohort. Three surgical wards of an academic hospital in the Netherlands (Academic Medical Centre, Amsterdam participated. Consecutive elective surgical patients with a hospital stay longer than 48 hours were included from April until June 2009. To assess the quality of pharmaceutical care, the set of quality indicators was applied to 252 medical records of surgical patients. RESULTS: Thirty-four quality indicators were composed and tested on acceptability and content- and face-validity. The selected 28 candidate quality indicators were tested for feasibility and 'sensitivity to change'. This resulted in a final set of 27 quality indicators, of which inter-rater agreements were calculated (kappa 0.92 for eligibility, 0.74 for pass-rate. The quality of pharmaceutical care was assessed in 252 surgical patients. Nearly half of the surgical patients passed the quality indicators for pharmaceutical care (overall pass rate 49.8%. Improvements should be predominantly targeted to medication care related processes in surgical patients with gastro-intestinal problems (domain pass rate 29.4%. CONCLUSIONS: This quality indicator set can be used to measure quality of pharmaceutical care and detect targets for quality improvements. With these results medication safety in surgical patients can be enhanced.

  19. 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. (United States)

    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.

  20. 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

    Institute of Scientific and Technical Information of China (English)

    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

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    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...

  3. Ambulatory Surgical Measures - Facility (United States)

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

  4. Surgical site infections

    African Journals Online (AJOL)

    and mortality as well as significant financial implications. Worldwide it has ... common nosocomial infection amongst surgical