Sample records for surgical margin rates

  1. Optimizing Surgical Margins in Breast Conservation

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    Preya Ananthakrishnan


    Full Text Available Adequate surgical margins in breast-conserving surgery for breast cancer have traditionally been viewed as a predictor of local recurrence rates. There is still no consensus on what constitutes an adequate surgical margin, however it is clear that there is a trade-off between widely clear margins and acceptable cosmesis. Preoperative approaches to plan extent of resection with appropriate margins (in the setting of surgery first as well as after neoadjuvant chemotherapy, include mammography, US, and MRI. Improvements have been made in preoperative lesion localization strategies for surgery, as well as intraoperative specimen assessment, in order to ensure complete removal of imaging findings and facilitate margin clearance. Intraoperative strategies to accurately assess tumor and cavity margins include cavity shave techniques, as well as novel technologies for margin probes. Ablative techniques, including radiofrequency ablation as well as intraoperative radiation, may be used to extend tumor-free margins without resecting additional tissue. Oncoplastic techniques allow for wider resections while maintaining cosmesis and have acceptable local recurrence rates, however often involve surgery on the contralateral breast. As systemic therapy for breast cancer continues to improve, it is unclear what the importance of surgical margins on local control rates will be in the future.

  2. Treatment of the positive surgical margin following radical prostatectomy

    Institute of Scientific and Technical Information of China (English)


    Objective With increased incidence of prostate cancer and an increased number of patients undergoing radical prostatectomy in China,it will be necessary to elaborate the diagnosis,clinical significance and treatment of patients whose tumors have positive surgical margins following radical prostatectomy.Data sources Positive surgical margin,prostate cancer and radical prostatectomy were used as subject words and the medical literature in recent decades was searched using the PubMed database and the results are summarized.Study selection Using positive surgical margin,prostate cancer and radical prostatectomy as subject words the PubMed medical database produced 275 papers of pertinent literature.By further screening 28 papers were selected and they represent relatively large-scale clinical randomized and controlled clinical trials.Results A pertinent literature of 275 papers was identified and 28 papers on large clinical studies were obtained.Analysis of results indicated that the positive rate of surgical margin after radical prostatectomy is 20%-40%,and although most patients with positive surgical margins are stable for a considerable period,the data available now suggested that the presence of a positive surgical margin will have an impact on the patient's prognosis.The risk factors of positive surgical margin include preoperative prostate specific antigen level,Gleason's score and pelvic lymph node metastasis.The most common site with positive surgical margin is in apical areas of the prostate;therefore surgical technique is also a factor resulting in positive surgical margins.From data available now it appears that as long as the surgical technique is skilled,different surgical modes do not affect the rate of surgical margin.Adjuvant radiotherapy is mainly used to treat patients with positive surgical margin after radical prostatectomy,but combination with androgen deprivation therapy may increase the curative effect.Conclusion The current data indicated that

  3. Molecular markers in the surgical margin of oral carcinomas

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    Bilde, A.; Buchwald, C. von; Dabelsteen, E.;


    BACKGROUND: Local or regional lymph node recurrence is the most common pattern of treatment failure in oral squamous cell carcinoma (SCC). The local recurrence rate is 30% even when the surgical resection margin is diagnosed as tumour free. Accumulation of genetic changes in histologically normal...... epithelium in the surgical resection margin may explain the local recurrence rate. The purpose of this study is to investigate the presence of senescence markers, which may represent early malignant changes in the margin that in routine pathological evaluations are classified as histologically normal....... METHODS: Formalin-fixed, paraffin-embedded surgical specimens from 16 consecutive patients with oral SCC and a clear surgical margin were obtained. The margin was analysed by immunohistochemistry for p53, p16, Chk2, Laminin-5 and glycosylated oncofetal fibronectin. RESULTS: Two patterns of p53 expression...

  4. Molecular markers in the surgical margin of oral carcinomas

    DEFF Research Database (Denmark)

    Bilde, Anders; von Buchwald, Christian; Dabelsteen, Erik


    epithelium in the surgical resection margin may explain the local recurrence rate. The purpose of this study is to investigate the presence of senescence markers, which may represent early malignant changes in the margin that in routine pathological evaluations are classified as histologically normal...

  5. Studies on correlation of positive surgical margin with clinicopathological factors and prognoses in breast conserving surgery

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    Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko [Kumamoto City Hospital (Japan)


    Out of 484 cases with breast conserving surgery between April 1989 and March 1999, surgical procedures of 34 cases were changed to total mastectomy due to positive surgical margins. In this study we evaluated a clinical significance of surgical margin in relation to clinicopathological factors and prognoses. Ninety-nine cases (20.5%) had positive margins that were judged when cancer cells existed within 5 mm from margin. In multivariate analysis of factors for surgical margin, EIC-comedo status, ly, located site, proliferative activity, and age were significant and independent factors. Regarding local recurrence, positive margin, age, ER and proliferative activity were significant factors in multivariate analysis, especially in cases not receiving postoperative radiation therapy. Radiation therapy may be beneficial for patients with positive surgical margin. And patients with breast recurrence alone had significantly higher survival rates. Therefore, it is suggested that surgical margin may not reflect survival, although it is a significant factor for local recurrence. (author)

  6. Margin requirements, margin loans, and margin rates: practice and principles


    Peter Fortune


    The Board of Governors of the Federal Reserve System establishes initial margin requirements under Regulations T, U, and X. Recent margin loan increases, both in aggregate value and relative to market capitalization, have rekindled the debate about using margin requirements as an instrument to affect the prices of common stocks. Proponents of a more active margin requirement policy see the regulations as instruments for affecting the level and volatility of stock prices by influencing investo...

  7. Intraoperative ultrasound control of surgical margins during partial nephrectomy

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    Feras M Alharbi


    Conclusions: The intraoperative US control of resection margins in PN is a simple, efficient, and effective method for ensuring negative surgical margins with a small increase in warm ischemia time and can be conducted by the operating urologist.

  8. Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: one-year experience at an ambulatory surgical center. (United States)

    Jorns, Julie M; Visscher, Daniel; Sabel, Michael; Breslin, Tara; Healy, Patrick; Daignaut, Stephanie; Myers, Jeffrey L; Wu, Angela J


    Intraoperative frozen section (FS) margin evaluation is not common practice for patients undergoing breast conservation therapy (BCT), but offers a significant reduction in reoperation. In this study, a technique to allow for more effective freezing of breast tissue was developed to perform FS evaluation of lumpectomy margins (FSM) for all patients undergoing BCT at an ambulatory surgery center. FS evaluation of sentinel lymph node biopsy specimens was performed concurrently. One hundred eighty-one study and 188 control patients, with and without FS evaluation, were compared. Reexcision was reduced 34% (from 48.9% to 14.9%) and reoperation was reduced 36% (from 55.3% to 19.3%) with FS evaluation. Most of the decrease in reoperative rate was because of a decrease in the need for margin reexcision. The number of patients requiring 1, 2, or 3 operations to complete therapy was 84, 92, and 12, respectively, in the control group, and 146, 33, and 2, respectively, in the study group. Lobular subtype, multifocal disease, and larger tumor size (≥2 cm) were significantly associated with failure of FSM to prevent reoperation, but reoperation rates were still significantly decreased in this subgroup of patients (from 75.5% to 43.8%) with FSM. This study highlights an innovative yet simple and adaptable FS approach that resulted in a nearly 3-fold reduction in reoperation for patients undergoing BCT.

  9. Whither surgical quality assurance of breast cancer surgery (surgical margins and local recurrence) after paterson. (United States)

    Bundred, N J; Thomas, J; Dixon, J M J


    The Kennedy report into the actions of the disgraced Breast Surgeon, Paterson focussed on issues of informed consent for mastectomy, management of surgical margins and raised concerns about local recurrence rates and the increasing emphasis on cosmesis after mastectomy for breast cancer. This article assesses whether Kennedy's recommendations apply to the UK as a whole and how to address these issues. New GMC advice on consent and newer nonevidenced innovations in immediate reconstruction have altered the level of informed consent required. Patients deserve a better understanding of the issues of oncological versus cosmetic outcomes on which to base their decisions. Involvement of the whole multidisciplinary team including Oncologists is necessary in surgical planning. Failure to obtain clear microscopic margins at mastectomy leads to an increased local recurrence, yet has received little attention in the UK. Whereas, other countries have used surgical quality assurance audits to reduce local recurrence; local recurrence rates are not available and the extent of variation across the UK in margin involvement after surgery, its management and relationship to local recurrence needs auditing prospectively to reduce unnecessary morbidity. To reassure public, patients and the NHS management, an accreditation system with more rigour than NHSBSP QA and peer review is now required. Resource and efforts to support its introduction will be necessary from the Royal College of Surgeons and the Association of Breast Surgeons. New innovations require careful evaluation before their backdoor introduction to the NHS. Private Hospitals need to have the same standards imposed.

  10. Intraoperative ultrasound control of surgical margins during partial nephrectomy. (United States)

    Alharbi, Feras M; Chahwan, Charles K; Le Gal, Sophie G; Guleryuz, Kerem M; Tillou, Xavier P; Doerfler, Arnaud P


    To evaluate a simple and fast technique to ensure negative surgical margins on partial nephrectomies, while correlating margin statuses with the final pathology report. This study was conducted for patients undergoing partial nephrectomy (PN) with T1-T2 renal tumors from January 2010 to the end of December 2015. Before tumor removal, intraoperative ultrasound (US) localization was performed. After tumor removal and before performing hemostasis of the kidney, the specimens were placed in a saline solution and a US was performed to evaluate if the tumor's capsule were intact, and then compared to the final pathology results. In 177 PN(s) (147 open procedures and 30 laparoscopic procedures) were performed on 147 patients. Arterial clamping was done for 32 patients and the mean warm ischemia time was 19 ± 6 min. The mean US examination time was 41 ± 7 s. The US analysis of surgical margins was negative in 172 cases, positive in four, and in only one case it was not possible to conclude. The final pathology results revealed one false positive surgical margin and one false negative surgical margin, while all other margins were in concert with US results. The mean tumor size was 3.53 ± 1.43 cm, and the mean surgical margin was 2.8 ± 1.5 mm. The intraoperative US control of resection margins in PN is a simple, efficient, and effective method for ensuring negative surgical margins with a small increase in warm ischemia time and can be conducted by the operating urologist.

  11. The tissue shrinkage phenomenon on surgical margins in oral and oropharyngeal squamous cell carcinoma

    Institute of Scientific and Technical Information of China (English)

    David González-Ballester


    Aim: One of the most important factors associated with recurrence rate and overall survival is the status of surgical margin of resection free of disease. However, sometimes, the margins measured intra-operatively at the time of surgery differ of those measured by the pathologist in the histopathologic analysis. Faced with this dilemma, a literature review of the best available evidence was conducted in an attempt to determine how the phenomenon of tissue shrinkage may influence on the surgical margin of resection in patients undergoing oral and oropharyngeal squamous cell carcinoma (SCC).Methods: An electronic and manual search was conducted by one reviewer. A combination of controlled Medical Subjects Headings and keywords were used as search strategy. Inclusion and exclusion criteria were established.Results: Finally, after an exhaustive selection process, four articles fulfilled the inclusion criteria and were analyzed. All articles reported a decrease of surgical margin after resection. The tumor site and tumor stage seem to influence in degree of margin shrinkage.Conclusion:Tissue shrinkage on surgical margins of resection in oral SCC is a tangible phenomenon. There is a significant discrepancy between margins measured intraoperatively previous to resection and margins measured by pathologist after histologic processing. The highest percentage of retraction occurs at the time of resection. Margin shrinkage based on tumor site and tumor stage should be considered by any oncologic surgeon to ensure adequate margins of resection cleared of tumor.

  12. Buccal mucosa carcinoma: surgical margin less than 3 mm, not 5 mm, predicts locoregional recurrence

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    Chiou Wen-Yen


    Full Text Available Abstract Background Most treatment failure of buccal mucosal cancer post surgery is locoregional recurrence. We tried to figure out how close the surgical margin being unsafe and needed further adjuvant treatment. Methods Between August 2000 and June 2008, a total of 110 patients with buccal mucosa carcinoma (25 with stage I, 31 with stage II, 11 with stage III, and 43 with Stage IV classified according to the American Joint Committee on Cancer 6th edition were treated with surgery alone (n = 32, surgery plus postoperative radiotherapy (n = 38 or surgery plus adjuvant concurrent chemoradiotherapy (n = 40. Main outcome measures: The primary endpoint was locoregional disease control. Results The median follow-up time at analysis was 25 months (range, 4-104 months. The 3-year locoregional control rates were significantly different when a 3-mm surgical margin (≤3 versus >3 mm, 71% versus 95%, p = 0.04 but not a 5-mm margin (75% versus 92%, p = 0.22 was used as the cut-off level. We also found a quantitative correlation between surgical margin and locoregional failure (hazard ratio, 2.16; 95% confidence interval, 1.14 - 4.11; p = 0.019. Multivariate analysis identified pN classification and surgical margin as independent factors affecting disease-free survival and locoregional control. Conclusions Narrow surgical margin ≤3 mm, but not 5 mm, is associated with high risk for locoregional recurrence of buccal mucosa carcinoma. More aggressive treatment after surgery is suggested.

  13. Negative marginal tax rates and heterogeneity


    Choné, Philippe; Laroque, Guy


    Heterogeneity is likely to be an important determinant of the shape of optimal tax schemes. This article addresses the issue in a model à la Mirrlees with a continuum of agents. The agents differ in their productivities and opportunity costs of work, but their labor supplies depend only on a unidimensional combination of their two characteristics. Conditions are given under which the standard result that marginal tax rates are everywhere non-negative holds. This is in particular the case when...

  14. Surgical margins in breast-conserving therapy: current trends and future prospects. (United States)

    Sanguinetti, Alessandro; Lucchini, Roberta; Santoprete, Stefano; Bistoni, Giovanni; Avenia, Stefano; Triola, Roberto; Avenia, Nicola


    Inadequate surgical margins represent a high risk for adverse clinical outcome in breast-conserving therapy (BCT) for early-stage breast cancer. The majority of studies report positive resection margins in 20% to 40% of the patients who underwent BCT. This may result in an increased local recurrence (LR) rate or additional surgery and, consequently, adverse effects on cosmesis, psychological distress, and health costs. In the literature, various risk factors are reported to be associated with positive margin status after lumpectomy, which may allow the surgeon to distinguish those patients with a higher “a priori” risk for re-excision. However, most risk factors are related to tumor biology and patient characteristics, which cannot be modified as such. Therefore, efforts to reduce the number of positive margins should focus on optimizing the surgical procedure itself, because the surgeon lacks real time intraoperative information on the presence of positive resection margins during breast-conserving surgery. This review presents the status of pre- and intraoperative modalities currently used in BCT. Furthermore, innovative intraoperative approaches, such as positron emission tomography, radio-guided occult lesion localization, and near-infrared fluorescence optical imaging, are addressed, which have to prove their potential value in improving surgical outcome and reducing the need for re-excision in BCT.

  15. Surgical Margins and the Risk of Local-Regional Recurrence After Mastectomy Without Radiation Therapy

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    Childs, Stephanie K. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Chen Yuhui [Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Duggan, Margaret M. [Department of Surgery, Faulkner Hospital, Boston, Massachusetts (United States); Department of Surgery, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Golshan, Mehra [Department of Surgery, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Pochebit, Stephen [Department of Pathology, Faulkner Hospital, Boston, Massachusetts (United States); Wong, Julia S. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Bellon, Jennifer R., E-mail: [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States)


    Purpose: Although positive surgical margins are generally associated with a higher risk of local-regional recurrence (LRR) for most solid tumors, their significance after mastectomy remains unclear. We sought to clarify the influence of the mastectomy margin on the risk of LRR. Methods and Materials: The retrospective cohort consisted of 397 women who underwent mastectomy and no radiation for newly diagnosed invasive breast cancer from 1998-2005. Time to isolated LRR and time to distant metastasis (DM) were evaluated by use of cumulative-incidence analysis and competing-risks regression analysis. DM was considered a competing event for analysis of isolated LRR. Results: The median follow-up was 6.7 years (range, 0.5-12.8 years). The superficial margin was positive in 41 patients (10%) and close ({<=}2 mm) in 56 (14%). The deep margin was positive in 23 patients (6%) and close in 34 (9%). The 5-year LRR and DM rates for all patients were 2.4% (95% confidence interval, 0.9-4.0) and 3.5% (95% confidence interval, 1.6-5.3) respectively. Fourteen patients had an LRR. Margin status was significantly associated with time to isolated LRR (P=.04); patients with positive margins had a 5-year LRR of 6.2%, whereas patients with close margins and negative margins had 5-year LRRs of 1.5% and 1.9%, respectively. On univariate analysis, positive margins, positive nodes, lymphovascular invasion, grade 3 histology, and triple-negative subtype were associated with significantly higher rates of LRR. When these factors were included in a multivariate analysis, only positive margins and triple-negative subtype were associated with the risk of LRR. Conclusions: Patients with positive mastectomy margins had a significantly higher rate of LRR than those with a close or negative margin. However, the absolute risk of LRR in patients with a positive surgical margin in this series was low, and therefore the benefit of postmastectomy radiation in this population with otherwise favorable

  16. Gigapixel surface imaging of radical prostatectomy specimens for comprehensive detection of cancer-positive surgical margins using structured illumination microscopy (United States)

    Wang, Mei; Tulman, David B.; Sholl, Andrew B.; Kimbrell, Hillary Z.; Mandava, Sree H.; Elfer, Katherine N.; Luethy, Samuel; Maddox, Michael M.; Lai, Weil; Lee, Benjamin R.; Brown, J. Quincy


    Achieving cancer-free surgical margins in oncologic surgery is critical to reduce the need for additional adjuvant treatments and minimize tumor recurrence; however, there is a delicate balance between completeness of tumor removal and preservation of adjacent tissues critical for normal post-operative function. We sought to establish the feasibility of video-rate structured illumination microscopy (VR-SIM) of the intact removed tumor surface as a practical and non-destructive alternative to intra-operative frozen section pathology, using prostate cancer as an initial target. We present the first images of the intact human prostate surface obtained with pathologically-relevant contrast and subcellular detail, obtained in 24 radical prostatectomy specimens immediately after excision. We demonstrate that it is feasible to routinely image the full prostate circumference, generating gigapixel panorama images of the surface that are readily interpreted by pathologists. VR-SIM confirmed detection of positive surgical margins in 3 out of 4 prostates with pathology-confirmed adenocarcinoma at the circumferential surgical margin, and furthermore detected extensive residual cancer at the circumferential margin in a case post-operatively classified by histopathology as having negative surgical margins. Our results suggest that the increased surface coverage of VR-SIM could also provide added value for detection and characterization of positive surgical margins over traditional histopathology.

  17. Characteristics of positive surgical margins in robotic-assisted radical prostatectomy, open retropubic radical prostatectomy, and laparoscopic radical prostatectomy: a comparative histopathologic study from a single academic center. (United States)

    Albadine, Roula; Hyndman, Matthew E; Chaux, Alcides; Jeong, J Y; Saab, Shahrazad; Tavora, Fabio; Epstein, Jonathan I; Gonzalgo, Mark L; Pavlovich, Christian P; Netto, George J


    Studies detailing differences in positive surgical margin among open retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robotic-assisted laparoscopic radical prostatectomy are lacking. A retrospective review of all prostatectomies with positive surgical margin performed at our center in 2007 disclosed 99 cases, 6 (5%) of which were reinterpreted cases as having negative margins. Ninety-three cases were, therefore, included, corresponding to 37 retropubic radical prostatectomies, 19 laparoscopic radical prostatectomies, and 37 robotic-assisted laparoscopic radical prostatectomies. The relationship of positive surgical margin characteristics to clinicopathologic parameters and biochemical recurrence was assessed. The most commonly found positive surgical margin site was the apex/distal third in all groups (62% retropubic prostatectomies, 79% laparoscopic prostatectomies, 60% robotic-assisted prostatectomies). Total linear length of positive surgical margin sites was significantly correlated with preoperative prostate-specific antigen, preoperative prostate-specific antigen density, pT stage, and tumor volume (P ≤ .001). We found no significant differences among the 3 groups with respect to total linear length, number of foci, laterality, or location of positive surgical margin. The rate of biochemical recurrence was also comparable in the 3 groups. On univariate analyses, biochemical recurrence was significantly associated with preoperative prostate-specific antigen values, preoperative prostate-specific antigen density, Gleason score, number of positive surgical margins, and total linear length of positive surgical margin (P ≤ .02). Only preoperative prostate-specific antigen density and number of positive surgical margin foci were statistically significant (P ≤ .03) independent predictors of biochemical recurrence. We found no significant difference in positive surgical margin characteristics or biochemical recurrence among the 3

  18. Risk factors associated with positive surgical margins following radical prostatectomy for clinically localized prostate cancer

    DEFF Research Database (Denmark)

    Røder, Martin Andreas; Thomsen, Frederik Birkebæk; Christensen, Ib Jarle


    OBJECTIVE: The aim of this study was to evaluate the impact of preoperative and surgical parameters, including nerve-sparing technique, on the risk of positive surgical margins (PSM) following radical prostatectomy for clinically localized prostate cancer. MATERIAL AND METHODS: A prospective...... consecutive single-institution Danish cohort of 1148 patients undergoing RP between 1995 and 2011 was investigated. To analyse the impact of covariates on risk of PSM, a multivariate logistic regression model was used, including cT category, biopsy Gleason score, prostate-specific antigen (PSA), percentage...... positive biopsies for cancer (PPB), surgeon and surgical technique. RESULTS: The overall rate of PSM was 31.4%. The risk of PSM depended (p value for Wald χ(2)) on PSA (p PSM...

  19. Zero positive surgical margins after radical prostatectomy: is the end in sight. (United States)

    Skarecky, Douglas W; Brenner, Mattew; Rajan, Sudhir; Rodriguez, Esequiel; Narula, Navneet; Melgoza, Frank; Ahlering, Thomas E


    Positive surgical margins represents incomplete resection by the surgeon, and the elimination of positive margins represents the only clinical feature during radical prostatectomy that can lead directly to improved cancer outcomes. The introduction of new robot-assisted technology and technical refinements has led to declines of positive surgical margins. Although margins induced by incomplete cancer resection by the surgeon have been reduced for organ-confined disease, the 'Holy Grail' of zero margins is not yet attainable in prostatectomy, and is more problematic in cancer that has penetrated beyond the prostate. Intraoperative frozen biopsies are imprecise. The union of real-time optical coherence tomography technology of the da Vinci robotic platform for identification of positive margin sites, and technical advances with wider excisions during surgery may provide promise for further reduction of surgical margins to zero.

  20. Totally laparoscopic hepatectomy exposing the vessels around the tumor intended to secure the surgical margin. (United States)

    Honda, Goro; Kurata, Masanao; Okuda, Yukihiro; Kobayashi, Shin; Sakamoto, Katsunori


    Anatomical hepatectomy (AH) is basically not required for metastatic tumors in terms of oncology, but is required for hepatocellular carcinoma [1-5]; however, the surgeon cannot secure the surgical margin by palpation via a laparoscopic approach. Therefore, AH or partial hepatectomy exposing the vessels around the tumor (PHev) is often better for deep-seated or invisible lesions [6, 7] because unexpected exposure of the tumor on the cutting plane can be avoided by creating a cutting plane on the side of exposed vessels. From August 2008 to December 2012, we performed totally laparoscopic AH or PHev for 29 patients (AH in 21 patients and PHev in 8 patients) to secure the surgical margin of metastatic tumors [8, 9]. The median operative time was 329 (range 147-519) min, with median blood loss of 141 (range 5-430) g. Conversion was performed for one patient whose stump of the Glissonean branch was positive in a frozen section. Additional hepatectomy was performed via an open approach. Postoperative morbidity rate was 20.7 % (peroneal palsy in two patients, ileus in one patient, biloma in one patient, and pulmonary embolism in one patient). Mortality was zero. The median length of hospital stay after surgery was 9 (range 4-21) days. Only one patient, who underwent extended posterior sectorectomy for a 4.2-cm tumor developing close to the right main Glissonean pedicle, had a microscopically positive margin, because the tumors were exposed on the cutting plane. The embedded video demonstrates hepatectomy of the dorsal half-segment of the right anterior sector, during which the liver was divided at the anterior fissure [10] and the border between the anterior and posterior sector. Totally laparoscopic hepatectomy exposing the vessels around the tumor can be performed safely and is useful to secure the surgical margin in patients with a metastatic tumor.

  1. Mapping biopsy with punch biopsies to determine surgical margin in extramammary Paget's disease. (United States)

    Kato, Takeshi; Fujimoto, Noriki; Fujii, Norikazu; Tanaka, Toshihiro


    It is difficult to determine the appropriate resection margin of extramammary Paget's disease (EMPD). A high recurrence rate is reported in spite of using Mohs micrographic surgery (MMS), which is performed commonly. Preoperative mapping biopsy is easier to perform than MMS. In Japan, the following method is recommended instead of MMS: well-defined border and margins histologically confirmed by mapping biopsy should be resected with 1-cm margin and ill-defined border with 3-cm margin. This study aimed to evaluate the accuracy of the Japanese guideline and to assess our mapping biopsy method compared with MMS. Preoperative mapping biopsy specimens were obtained beyond the clinical border for at least four directions in each patient. To confirm the presence of residual Paget's cells postoperatively, narrow specimens were obtained along the surgical margin. Retrospective evaluation of 17 EMPD patients was conducted concerning histological spread of Paget's cells and recurrence ratio. There were 86 directions showing a well-defined border, and in 9.3% (8/86), Paget's cells were still observed at 1-cm resection line. On the other hand, there were 21 directions showing an ill-defined border, and unnecessary radical resection was performed in 90% (19/21) of directions with 3-cm resection line. Although postoperative histological examination showed residual Paget's cells in 47% (8/17) of patients and additional resections were not performed, recurrence rate was only 5.9% (1/17). The resection line of EMPD should be based not on clinical features, but on mapping biopsy. Mapping biopsy is equivalent to MMS concerning recurrence rate and, though conventional, is useful method to treat EMPD.

  2. Recent technological developments: in situ histopathological interrogation of surgical tissues and resection margins

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    Upile Tahwinder


    Full Text Available Abstract Objectives The tumour margin is an important surgical concept significantly affecting patient morbidity and mortality. We aimed in this prospective study to apply the microendoscope on tissue margins from patients undergoing surgery for oral cancer in vivo and ex vivo and compare it to the gold standard "paraffin wax", inter-observer agreement was measured; also to present the surgical pathologist with a practical guide to the every day use of the microendoscope both in the clinical and surgical fields. Materials and methods Forty patients undergoing resection of oral squamous cell carcinoma were recruited. The surgical margin was first marked by the operator followed by microendoscopic assessment. Biopsies were taken from areas suggestive of close or positive margins after microendoscopic examination. These histological samples were later scrutinized formally and the resection margins revisited accordingly when necessary. Results Using the microendoscope we report our experience in the determination of surgical margins at operation and later comparison with frozen section and paraffin section margins "gold standard". We were able to obtain a sensitivity of 95% and a specificity of 90%. Inter-observer Kappa scores comparing the microendoscope with formal histological analysis of normal and abnormal mucosa were 0.85. Conclusion The advantage of this technique is that a large area of mucosa can be sampled and any histomorphological changes can be visualized in real time allowing the operator to make important informed decisions with regards the intra-operative resection margin at the time of the surgery.

  3. Defining the surgical margins of adenoid cystic carcinoma and their impact on outcome

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    Amit, Moran; Na'ara, Shorook; Trejo-Leider, Leonor


    Background: The mainstay of treatment in adenoid cystic carcinoma (ACC) of the head and neck is surgical resection with negative margins. The purpose of this study was to define the margin status that associates with survival outcomes of ACC of the head and neck. Methods: We conducted univariate ...

  4. Surgical margins in the genomic era: The Hayes Martin Lecture, 2012. (United States)

    Wolf, Gregory T


    One of the highest honors of one's career is to be asked to address colleagues, mentors, and students who represent the world's leading health professionals dedicated to reducing the morbidity and mortality associated with head and neck cancer. Hayes Martin would certainly share this feeling of honor and humility in having a lecture given in his name on the occasion of the Eighth International Conference on Head and Neck Cancer. I am so very pleased to share with you some thoughts on the assessment, adequacy, and application of surgical resection margins in an era in which personalized surgery and molecular medicine will have a major impact on patient outcomes. My thoughts about surgical margins have evolved over nearly 40 years of performing surgical resections for cancer. A discussion of margins may seem somewhat mundane to many of you; however, I hope to provide a futuristic and somewhat theoretical view of how surgical margin issues will relate to the personalization of modern head and neck cancer treatment and how the biology of the tumor microenvironment may be instructive in the application of our surgical approaches. This is particularly relevant because of the rapid expansion of functional surgical approaches utilizing minimally invasive endoscopic resections and robotic techniques that may not achieve the same wide oncologic margins that have been emphasized historically.(1,2) Proper selection of patients for such procedures is critical if we are to improve overall treatment results.

  5. The effect of exchange rate on marketing margin

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    Leila Torki


    Full Text Available This study presents a new structural model that incorprates price linkage and marketing marketing margin identity into a common framework. The inclusiom of exchange rate expands the framework to include goods traded in different currencies. This allows emprical estimates to be made of how changes in domestic prices exchange rates and middlemen costs are transmitted to foreign prices and the international marketing margin. The framework is emprically applied to international marketing channel using farmed apple data to investigate how Iranian export prices exchange rates and middlemen costs affect turkey wholesale prices and the marketing margin. Results suggest that the markets are via complete price and exchange rate pass through purely competitive and that the marketing margin only increase when costs of marketing service increase.

  6. Do surgical margin and local recurrence influence survival in soft tissue sarcomas? (United States)

    Novais, Eduardo N; Demiralp, Bahtiyar; Alderete, Joseph; Larson, Melissa C; Rose, Peter S; Sim, Franklin H


    Established prognostic factors influencing survival in soft tissue sarcomas include tumor stage, histopathologic grade, size, depth, and anatomic site. The presence of tumor near or at the margin of resection increases the risk of local recurrence but whether a positive surgical margin or local recurrence affect overall survival is controversial. We explored the impact of microscopic margin on local recurrence, metastasis, and overall survival in patients with intermediate- to high-grade soft tissue sarcomas of the extremities. We then determined whether local recurrence decreases overall survival. We retrospectively reviewed the medical records of 248 patients who had soft tissue sarcomas of the extremities treated surgically from 1995 to 2008. We estimated survival, local recurrence, and distant metastasis and examined factors potentially influencing these outcomes. The minimum followup was 0.4 years (median, 4.4 years; range, 0.4-13 years). The 5-year cumulative incidence of local recurrence was 4.1%. Patients who presented with positive margins or a margin of 2 mm or less had a worse survival than patients who had margins of greater than 2 mm and wide margins (5-year survival, 47% versus 70% and 72%). In addition to surgical margin, developing metastasis, tumor response of less than 90% necrosis, high histopathologic grade, high AJCC stage (Stage III), increasing age, and male gender were associated with decreased overall survival. Local recurrence independently predicted decreased overall survival. Microscopic surgical margin and local recurrence after surgical treatment should be included as risk factors predicting decreased overall survival for intermediate- to high-grade soft tissue sarcomas of the extremities.

  7. The effect of exchange rate on marketing margin


    Leila Torki; AhmadAli Rezaei; Shekofeh Nagheli


    This study presents a new structural model that incorprates price linkage and marketing marketing margin identity into a common framework. The inclusiom of exchange rate expands the framework to include goods traded in different currencies. This allows emprical estimates to be made of how changes in domestic prices exchange rates and middlemen costs are transmitted to foreign prices and the international marketing margin. The framework is emprically applied to international marketing channel ...

  8. Do Robotic Surgical Systems Improve Profit Margins? A Cross-Sectional Analysis of California Hospitals. (United States)

    Shih, Ya-Chen Tina; Shen, Chan; Hu, Jim C


    The aim of this study was to examine the association between ownership of robotic surgical systems and hospital profit margins. This study used hospital annual utilization data, annual financial data, and discharge data for year 2011 from the California Office of Statewide Health Planning and Development. We first performed bivariate analysis to compare mean profit margin by hospital and market characteristics and to examine whether these characteristics differed between hospitals that had one or more robotic surgical systems in 2011 and those that did not. We applied the t test and the F test to compare mean profit margin between two groups and among three or more groups, respectively. We then conducted multilevel logistic regression to determine the association between ownership of robotic surgical systems and having a positive profit margin after controlling for other hospital and market characteristics and accounting for possible correlation among hospitals located within the same market. The study sample included 167 California hospitals with valid financial information. Hospitals with robotic surgical systems tended to report more favorable profit margins. However, multilevel logistic regression showed that this relationship (an association, not causality) became only marginally significant (odds ratio [OR] = 6.2; P = 0.053) after controlling for other hospital characteristics, such as ownership type, teaching status, bed size, and surgical volumes, and market characteristics, such as total number of robotic surgical systems owned by other hospitals in the same market area. As robotic surgical systems become widely disseminated, hospital decision makers should carefully evaluate the financial and clinical implications before making a capital investment in this technology. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  9. Asymptotic Marginal Tax Rate of Individual Income Tax in China

    Institute of Scientific and Technical Information of China (English)



    This paper examines the asymptotic marginal rate of individual income tax which maximizes China’s social welfare through numerical simulation based on the elasticity of China’s labor supply, income distribution and the social objectives of redistribution in accordance with the optimal direct taxation theory. Taking advantage of the optimal direct taxation model with consideration of the income effect, it comes to the conclusion that combined with China’s reality, the asymptotic marginal rate of individual labor income tax in China should be between 35% and 40%.

  10. 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: a randomised, multicentre trial

    DEFF Research Database (Denmark)

    Gillgren, Peter; Drzewiecki, Krzysztof T; Niin, Marianne;


    Optimum surgical resection margins for patients with clinical stage IIA-C cutaneous melanoma thicker than 2 mm are controversial. The aim of the study was to test whether survival was different for a wide local excision margin of 2 cm compared with a 4-cm excision margin.......Optimum surgical resection margins for patients with clinical stage IIA-C cutaneous melanoma thicker than 2 mm are controversial. The aim of the study was to test whether survival was different for a wide local excision margin of 2 cm compared with a 4-cm excision margin....

  11. Risk factors for and consequences of inadequate surgical margins in oral squamous cell carcinoma

    DEFF Research Database (Denmark)

    Lawaetz, Mads; Homøe, Preben


    OBJECTIVE: The purpose of this study was to examine which factors are associated with inadequate surgical margins and to assess the postoperative consequences. STUDY DESIGN: A retrospective cohort of 110 patients with oral squamous cell carcinoma treated with surgery during a 2-year period...

  12. Prognostic relevance of number and bilaterality of positive surgical margins after radical prostatectomy.

    NARCIS (Netherlands)

    Somford, D.M.; Oort, I.M. van; Cosyns, J.P.; Witjes, J.A.; Kiemeney, L.A.L.M.; Tombal, B.


    PURPOSE: Positive surgical margin (PSM) status following radical prostatectomy (RP) is a well-established prognostic factor. The aim of the present study is to evaluate whether number of PSMs or bilaterality of PSMs might have prognostic significance for biochemical recurrence (BCR) in the populatio

  13. Recurrence rate of basal cell carcinoma with positive histopathological margins and related risk factors* (United States)

    Lara, Fernanda; Santamaría, Jesus Rodriguez; Garbers, Luiz Eduardo Fabricio de Melo


    BACKGROUND The best way to approach surgically removed basal cell carcinoma with positive histopathological margins is a controversial issue. Some authors believe that the more appropriate treatment is an immediate reoperation while others prefer a periodic follow up. The rates of recurrence are variable in literature, between 10% and 67%. OBJECTIVE To define the recurrence rate of basal cell carcinoma with positive margins after surgery. Secondarily, identify morphological aspects that can suggest a more frequent tumoral recurrence. METHODS This was a retrospective and observational study made by analysis of medical records of 487 patients between January 2003 and December 2009 in Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR). From 402 basal cell carcinomas surgically treated, 41 fulfilled inclusion criteria and were evaluated for five years or more. Recurrence rate of these tumors was analyzed in all patients and clinical characteristics such as sex, age, tumor size, tumor site, ulceration, and histological type were evaluated in order to find if they were related to more common tumoral recurrence. RESULTS The rate of positive margins after surgery was 12.18%. There were five cases of tumoral recurrence in the observation group and three cases in the re-excision group. Tumor size, site, histological type, ulceration and type of positive margin did not differ statistically between groups. It was not possible to consider if these factors were important in recurrence rates. STUDY LIMITATIONS Ideally, a prospective study with a larger sample would be more accurate. CONCLUSION The treatment of choice in basal cell carcinoma with positive margins must be individualized to reduce recurrence rates. PMID:28225958

  14. A new method of assessing the surgical margin in rectal carcinoma—using nonlinear optical microscopy (United States)

    Li, Lianhuang; Chen, Zhifen; Kang, Deyong; Deng, Tongxin; Jiang, Liwei; Zhou, Yi; Liu, Xing; Jiang, Weizhong; Zhuo, Shuangmu; Guan, Guoxian; Chi, Pan; Chen, Jianxin


    Nowadays, surgical resection is still the most effective treatment strategy for rectal carcinoma and one of the most important factors affecting whether the operation is successful or not is the surgical margin determination, especially in the distal rectal carcinoma which should take the sphincter-preserving issue into consideration. However, until recently no reliable evaluation method has been developed for this purpose. There are some shortcomings in intraoperative negative surgical margin assessment such as either lack of enough detailed information of biological tissues or the fact that it is time-consuming. Multiphoton microscopy (MPM)—nonlinear optical microscopy, which is based on the nonlinear optical process two-photon excited fluorescence (TPEF) and second harmonic generation (SHG), has the ability to label freely and noninvasively visualize tissue micro-architecture at the sub-cellular level. The advantage of providing high contrast and high resolution biomedical image in real time makes MPM have a wide range of applications in life sciences. In this study, we introduced MPM to identify the boundary between normal and abnormal rectal tissues. MPM images clearly exhibit biological tissue microstructure and its morphological changes in the regions of our interest, which enable it to determine the surgical margin in rectal carcinoma. It can be foreseen that once MPM imaging system is used in clinical examination, it will greatly improve the accuracy of surgical resection.

  15. On Homogeneous Production Functions with Proportional Marginal Rate of Substitution

    Directory of Open Access Journals (Sweden)

    Alina Daniela Vîlcu


    Full Text Available We completely classify homogeneous production functions with proportional marginal rate of substitution and with constant elasticity of labor and capital, respectively. These classifications generalize some recent results of C. A. Ioan and G. Ioan (2011 concerning the sum production function.

  16. 2-cm versus 4-cm surgical excision margins for primary cutaneous melanoma thicker than 2 mm: a randomised, multicentre trial

    DEFF Research Database (Denmark)

    Gillgren, Peter; Drzewiecki, Krzysztof T; Niin, Marianne;


    Optimum surgical resection margins for patients with clinical stage IIA-C cutaneous melanoma thicker than 2 mm are controversial. The aim of the study was to test whether survival was different for a wide local excision margin of 2 cm compared with a 4-cm excision margin....

  17. Hyperspectral Imaging for Cancer Surgical Margin Delineation: Registration of Hyperspectral and Histological Images. (United States)

    Lu, Guolan; Halig, Luma; Wang, Dongsheng; Chen, Zhuo Georgia; Fei, Baowei


    The determination of tumor margins during surgical resection remains a challenging task. A complete removal of malignant tissue and conservation of healthy tissue is important for the preservation of organ function, patient satisfaction, and quality of life. Visual inspection and palpation is not sufficient for discriminating between malignant and normal tissue types. Hyperspectral imaging (HSI) technology has the potential to noninvasively delineate surgical tumor margin and can be used as an intra-operative visual aid tool. Since histological images provide the ground truth of cancer margins, it is necessary to warp the cancer regions in ex vivo histological images back to in vivo hyperspectral images in order to validate the tumor margins detected by HSI and to optimize the imaging parameters. In this paper, principal component analysis (PCA) is utilized to extract the principle component bands of the HSI images, which is then used to register HSI images with the corresponding histological image. Affine registration is chosen to model the global transformation. A B-spline free form deformation (FFD) method is used to model the local non-rigid deformation. Registration experiment was performed on animal hyperspectral and histological images. Experimental results from animals demonstrated the feasibility of the hyperspectral imaging method for cancer margin detection.

  18. One millimetre is the safe cut-off for magnetic resonance imaging prediction of surgical margin status in rectal cancer. (United States)

    Taylor, F G M; Quirke, P; Heald, R J; Moran, B; Blomqvist, L; Swift, I; St Rose, S; Sebag-Montefiore, D J; Tekkis, P; Brown, G


    A pathologically involved margin in rectal cancer is defined as tumour within 1 mm of the surgical resection margin. There is no standard definition of a predicted safe margin on magnetic resonance imaging (MRI). The aim of this study was to assess which cut-off (1, 2 or 5 mm) was the best predictor of local recurrence based on preoperative MRI assessment of the circumferential resection margin (CRM). Data were collected prospectively on the distance between the tumour and mesorectal fascia for patients with documented radiological margin status in the MERCURY study. Positive margin and local recurrence rates were compared for MRI distances from the tumour to the mesorectal fascia of 1 mm or less, more than 1 mm up to 2 mm, more than 2 mm up to 5 mm, and more than 5 mm. The Cox proportional hazard regression method was used to determine the effect of level of margin involvement on time to local recurrence. Univariable analysis showed that, relative to a distance measured by MRI of more than 5 mm, the hazard ratio (HR) for local recurrence was 3·90 (95 per cent confidence interval 1·99 to 7·63; P < 0·001) for a margin of 1 mm or less, 0·81 (0·36 to 1·85; P = 0·620) for a margin of more than 1 mm up to 2 mm, and 0·33 (0·10 to 1·08; P = 0·067) for a margin greater than 2 mm up to 5 mm. Multivariable analysis of the effect of MRI distance to the mesorectal fascia and preoperative treatment on local recurrence showed that a margin of 1 mm or less remained significant regardless of preoperative treatment (HR 3·72, 1·43 to 9·71; P = 0·007). For preoperative staging of rectal cancer, the best cut-off distance for predicting CRM involvement using MRI is 1 mm. Using a cut-off greater than this does not appear to identify patients at higher risk of local recurrence. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  19. Utility of dermoscopy for demarcation of surgical margins in Mohs micrographic surgery* (United States)

    Suzuki, Heliane Sanae; Serafini, Sérgio Zuñeda; Sato, Maurício Shigueru


    BACKGROUND Skin cancer is the most common malignancy and can be treated in various ways. One treatment modality is Mohs micrographic surgery. Due to the increasing incidence of skin cancer in the last decades, there is a need for improvement of the Mohs technique to optimize its effectiveness. OBJECTIVE The aim of this study was to evaluate the use of dermoscopy to guide demarcation of Mohs micrographic surgery margins and ascertain whether this method can reduce operative time and, therefore, reduce surgical morbidity and cost. METHODS AND MATERIALS The sample comprised 44 patients who underwent Mohs micrographic surgery, allocated into two groups: the control group and the intervention group. In the latter, surgical margins were guided by dermoscopy. RESULTS There were no statistically significant differences between the two groups by chi-square analysis (p = 0.399). CONCLUSION Although outcomes were similar in the two groups, demonstrating that dermoscopy does not help in the demarcation of surgical margins for Mohs micrographic surgery, the study provides a practical proposal for improvement of the Mohs technique. PMID:24626646

  20. Recognition and discrimination of tissue-marking dye color by surgical pathologists: recommendations to avoid errors in margin assessment. (United States)

    Williams, Andrew S; Hache, Kelly Dakin


    A variety of tissue-marking dye (TMD) colors can be used to indicate surgical pathology specimen margins; however, the ability of pathologists to differentiate between specific microscopic margin colors has not been assessed systematically. This study aimed to evaluate pathologists' accuracy in identifying TMD color and determine the least ambiguous combinations of colors for use in surgical pathology. Seven colors of TMD were obtained from three manufacturers and applied to excess formalin-fixed uterine tissue. Study blocks contained multiple tissue pieces, each marked with a different color from the same manufacturer. Slides were assessed by eight participants for color and color distinctness of each piece of tissue. Black, green, red, and blue TMDs were accurately identified by most participants, but participants had difficulty identifying violet, orange, and yellow TMDs. Black, green, and blue TMDs were most commonly rated as "confidently discernable." Pathologists have difficulty identifying and distinguishing certain colors of TMDs. The combined use of certain colors of TMDs (yellow/orange/red, blue/violet, and red/violet) within the same specimen should be avoided to decrease the risk of inaccurately reporting specimen margins. Copyright© by the American Society for Clinical Pathology.

  1. Significance and management of positive surgical margins at the time of radical prostatectomy. (United States)

    Silberstein, Jonathan L; Eastham, James A


    Positive surgical margins (PSM) at the time of radical prostatectomy (RP) result in an increased risk of biochemical recurrence (BCR) and secondary treatment. We review current literature with a focus on stratifying the characteristics of the PSM that may define its significance, the impact of modern imaging and surgical approaches in avoidance of PSM, and management strategies when PSM do occur. We performed a review of the available literature to identify factors associated with PSM and their management. PSM have been repeatedly demonstrated to be associated with an increased risk of BCR following RP. The specific characteristics (size, number, location, Gleason score at the margin) of the PSM may influence the risk of recurrence. Novel imaging and surgical approaches are being investigated and may allow for reductions of PSM in the future. The use of adjuvant treatment for a PSM remains controversial and should be decided on an individual basis after a discussion about the risks and benefits. The goal of RP is complete resection of the tumor. PSM are associated with increased risk of BCR and secondary treatments. Of the risk factors associated with BCR after RP, a PSM is directly influenced by surgical technique.

  2. Postoperative irradiation of laryngeal carcinoma--the prognostic value of tumour-free surgical margins. (United States)

    Naudé, J; Dobrowsky, W


    Between 1972 and 1987, two hundred and five carcinoma patients were treated with surgery and postoperative radiotherapy. The histological confirmation of tumour-free margins was only predictive of significant differences in locoregional control in locally advanced disease. In addition, macroscopically assessed margins in advanced cases were predictive of survival probability. We suggest that the adjuvant radiotherapy was able to reduce the incidence of locoregional recurrence in the early stage microscopic positive group, hence the lack of a significant difference in the control rates. The effect on survival is therefore indirect. The advanced cases showed significantly reduced locoregional control rates and disease-specific survival times after macroscopic assessment of positive margins, possibly a sign of tumour extension beyond the margins of the radiation field. We compare our results with published reports of cases not receiving adjuvant therapy.

  3. Influence of pathologist experience on positive surgical margins following radical prostatectomy. (United States)

    Tallman, Jacob E; Packiam, Vignesh T; Wroblewski, Kristen E; Paner, Gladell P; Eggener, Scott E


    A positive surgical margin (PSM) following radical prostatectomy (RP) for prostate cancer is associated with increased risk of biochemical recurrence. We sought to examine whether the pathologist is an independent predictor of PSMs. We performed a retrospective review of 3,557 men who underwent RP for localized prostate cancer at our institution from 2003 to 2015. We evaluated 29 separate pathologists. Univariate and multivariable logistic regression were used to test variables previously shown to influence PSM rates. Overall rate of PSM was 18.9%. Compared with patients without PSM, patients with PSM had higher body mass index (mean: 28.8 vs. 28.3), Gleason score≥7 (84% vs. 66%), extracapsular extension (51% vs. 20%), and median prostate-specific antigen (5.9 vs. 5.1ng/ml) (all Pexperience, pathologist experience, and pathologist genitourinary fellowship training were all predictors of PSMs (all Pexperience, increased pathologist experience, higher pathologic Gleason score, higher pathologic stage, and higher prostate-specific antigen were significant predictors of PSMs. Increasing surgeon experience was associated with decreased odds of PSM (odds ratio = 0.79 per 1 standard deviation increase, 95% CI [0.70-0.89]). In contrast, increasing pathologist experience was associated with increased odds of PSM (odds ratio = 1.11 per 1 standard deviation increase, 95% CI [1.03-1.19]). The relationship between pathologist experience and PSM appeared to be nonlinear (Fig. 2). Greater pathologist experience appears to be associated with greater odds of PSMs following radical prostatectomy, even after controlling for case mix, pathologist fellowship training, and surgeon experience. Based on these findings, pathologists with less experience reviewing RP specimens may consider requesting rereview by a dedicated genitourinary pathologist. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. {sup 18}F-FDG uptake at the surgical margin after hepatic resection: Patterns of uptake and differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Peungjesada, Silanath [University New Mexico, Department of Radiology, Albuquerque, NM (United States); Aloia, Thomas A. [University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Unit 444, Houston, TX (United States); Fox, Patricia [University of Texas MD Anderson Cancer Center, Department of Biostatistics, Unit 1411, Houston, TX (United States); Chasen, Beth [University of Texas MD Anderson Cancer Center, Department of Nuclear Medicine, Unit 1483, Houston, TX (United States); Shin, Sooyoung; Loyer, Evelyne M. [University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Unit 1473, Houston, TX (United States); Baiomy, Ali [Cairo University, National Cancer Center, Cairo (Egypt)


    To evaluate the patterns of {sup 18}F-FDG uptake at the surgical margin after hepatectomy to identify features that may differentiate benign and malignant uptake. Patients who had undergone a PET/CT after hepatectomy were identified. Delay between resection and PET/CT, presence of uptake at the surgical margin, pattern of uptake, and maximal standardized value were recorded. The PET/CT findings were correlated with contrast-enhanced CT or MRI. There were 26 patients with increased 18F-FDG uptake; uptake was diffuse in seven and focal in 19. Diffuse uptake was due to inflammation in all cases. Focal uptake was due to recurrence in 12 and inflammation in seven cases. Defining a focal pattern only as a positive for malignancy yielded 100 % sensitivity, 87 % specificity, 37 % false positive rate. As expected, SUV{sub max} was significantly higher for recurrence than inflammation, but did overlap. Contrast-enhanced CT allowed differentiation between malignant and benign uptake in all cases. F-FDG uptake after hepatectomy does not equate to recurrence and yields a high false positive rate. Diffuse uptake did not require additional evaluation in our sample. Focal uptake, however, may be due to recurrence; differentiating benign and malignant nodular uptake relies on optimal contrast-enhanced CT or MRI. (orig.)

  5. 76 FR 5518 - Antidumping Proceedings: Calculation of the Weighted Average Dumping Margin and Assessment Rate... (United States)


    ... Weighted Average Dumping Margin and Assessment Rate in Certain Antidumping Duty Proceedings AGENCY: Import... regarding the calculation of the weighted average dumping margin and antidumping duty assessment rate in... regarding the calculation of the weighted average dumping margin and antidumping duty assessment rate...

  6. Faster Rates for training Max-Margin Markov Networks

    CERN Document Server

    Zhang, Xinhua; Vishwanathan, S V N


    Structured output prediction is an important machine learning problem both in theory and practice, and the max-margin Markov network (\\mcn) is an effective approach. All state-of-the-art algorithms for optimizing \\mcn\\ objectives take at least $O(1/\\epsilon)$ number of iterations to find an $\\epsilon$ accurate solution. Recent results in structured optimization suggest that faster rates are possible by exploiting the structure of the objective function. Towards this end \\citet{Nesterov05} proposed an excessive gap reduction technique based on Euclidean projections which converges in $O(1/\\sqrt{\\epsilon})$ iterations on strongly convex functions. Unfortunately when applied to \\mcn s, this approach does not admit graphical model factorization which, as in many existing algorithms, is crucial for keeping the cost per iteration tractable. In this paper, we present a new excessive gap reduction technique based on Bregman projections which admits graphical model factorization naturally, and converges in $O(1/\\sqrt{...

  7. [Positive surgical margin status after minimally invasive radical prostatectomy: a multicenter study]. (United States)

    Tafa, Ardit; Grasso, Angelica; Antonelli, Alessandro; Bove, Pierluigi; Celia, Antonio; Ceruti, Carlo; Crivellaro, Simone; Falsaperla, Mario; Minervini, Andrea; Parma, Paolo; Porreca, Angelo; Zaramella, Stefano; De Lorenzis, Elisa; Cozzi, Gabriele; Rocco, Bernardo


    UNLABELLED: The aim of our study is to evaluate the status of positive margins (PSMs) comparing their incidence between aparoscopic radical prostatectomy (LRP) and robot assisted radical prostatectomy (RARP) in centers with medium case-load (50-150 cases/year). We also analyzed the correlations between surgical technique, nerve-sparing approach (NS), and incidence of PSMs, stratifying our results by pathological stage. We analyzed 1992 patients who underwent RP in various urologic centers. We evaluated the incidence of PSMs, and then we compared the stage-related incidence of PSMs, for both the techniques. We did not find a statistically significant difference between the two surgical modalities in the study regarding the overall incidence of PSMs. In our retrospective study, we did not find any difference in terms of PSMs in RARP versus LRP. Our PSMs were not negligible, particularly in pT3 stages, compared with high-volume centers; surgical experience and patients' selection can be a possible explanation.

  8. Increased optical magnification from 2.5x to 4.3x with technical modification lowers the positive margin rate in open radical retropubic prostatectomy. (United States)

    Magera, James S; Inman, Brant A; Slezak, Jeffrey M; Bagniewski, Stephanie M; Sebo, Thomas J; Myers, Robert P


    We compared the positive surgical margin rate of 2.5x and 4.3x optical loupe magnification with associated technical improvement during open radical retropubic prostatectomy. From January 2, 2004 to September 16, 2005, 511 consecutive patients underwent open radical retropubic prostatectomy, as performed by 1 surgeon. Because 10 patients refused authorization for a retrospective chart review, 501 were evaluable. For the first 265 patients 2.5x power loupes were used and for the subsequent 236 we used 4.3x power loupes. We used the chi-square test for univariate analysis, followed by multivariate logistic regression analysis adjusted for commonly recognized predictors of positive surgical margins in the 2 successive cohorts. Focusing on the apex, which was the most commonly reported site of positive surgical margins, we include operative video segments mimicking 4.3x magnification to demonstrate the surgical precision possible at 4.3x for managing the periurethral fascial bands of Walsh and urethral transection at the prostato-urethral junction. Positive surgical margins were identified in 39 of 265 patients (14.7%) at 2.5x and in 12 of 236 (5.1%) at 4.3x. Apical positive surgical margins were identified in 25 of 265 patients (9.4%) at 2.5x and in 5 of 236 (2.1%) at 4.3x. On multivariate analysis 4.3x magnification was independently associated with a 75% decrease in the odds of a positive surgical margin overall and in the apex alone (p technical refinements that are not possible or deemed safe at 2.5x resulted in a substantial decrease in the positive surgical margin rate.

  9. Radical prostatectomy and positive surgical margins: tumor volume and Gleason score predicts cancer outcome

    Energy Technology Data Exchange (ETDEWEB)

    La Roca, Ricardo L.R. Felts de, E-mail: [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil); Fonseca, Francisco Paula da, E-mail: [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil). Divisao de Urologia. Dept. de Cirurgia Pelvica; Cunha, Isabela Werneck da; Bezerra, Stephania Martins, E-mail:, E-mail: [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil). Dept. de Patologia


    Introduction: positive surgical margins (PSMs) are common adverse factors to predict the outcome of a patient submitted to radical prostatectomy (PR). However, not all of these men will follow with biochemical (BCR) or clinical (CR) recurrence. Relationship between PSMs with these recurrent events has to be correlated with other clinicopathological findings in order to recognize more aggressive tumors in order to recommend complementary treatment to these selected patients. Materials and methods: we retrospectively reviewed the outcome of 228 patients submitted to open retropubic RP between March 1991 and June 2008, where 161 had and 67 did not have PSMs. Minimum follow-up time was considered 2 years after surgery. BCR was considered when PSA {>=} 0.2 ng/ml. CR was determined when clinical evidence of tumor appeared. Chi-square test was used to correlate clinical and pathologic variables with PSMs. The estimated 5-year risk of BCR and CR in presence of PSMs was determined using the Kaplan-Meier method and compared to log-rank tests. Results: from the total of 228 patients, 161 (71%) had PSMs, while 67 (29%) had negative surgical margins (NSMs). Prostatic circumferential margin was the most common (43.4%) site. Univariate analysis showed statistically significant (p < 0.001) associations between the presence of PSMs and BCR, but not with CR (p = 0.06). Among 161 patients with PSMs, 61 (37.8%) presented BCR, while 100 (62.8%) did not. Predicting progression-free survival for 5 years, BCR was correlated with pathological stage; Gleason score; pre-treatment PSA; tumor volume in specimen; capsular and perineural invasion; presence and number of PSMs. RC correlated only with angiolymphatic invasion and Gleason score. Considering univariate analyses the clinicopathological factors predicting BCR for 5 years, results statistically significant links with prostate weight; pre-treatment PSA; Gleason score; pathological stage; tumor volume; PSMs; capsular and perineural

  10. Influence of positive surgical margin status after radical nephroureterectomy on upper urinary tract urothelial carcinoma survival. (United States)

    Colin, Pierre; Ouzzane, Adil; Yates, David R; Audenet, François; François, Audenet; Pignot, Géraldine; Arvin-Berod, Alexis; Merigot de Treigny, Olivier; Laurent, Guy; Valeri, Antoine; Irani, Jacques; Jacques, Irani; Saint, Fabien; Gardic, Solène; Gres, Pascal; Rozet, François; Neuzillet, Yann; Ruffion, Alain; Rouprêt, Morgan


    The influence of a positive surgical margin (PSM) on survival outcome of post radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UUT-UC) is unclear. The objectives of this study were to determine the significance of PSM on cancer-specific survival (CSS), recurrence-free survival (RFS), and metastasis-free survival (MFS) post RNU. From a multicenter collaborative database, data on SM status, stage, grade, lymph node status, lymphovascular invasion (LVI), tumor location, follow-up, and survival was retrieved for 472 patients. Patients underwent open RNU with bladder cuff excision. Clinicopathological features were compared using χ(2) or Fisher exact test and unpaired t test for categorical and continuous variables, respectively. Survival was estimated using the Kaplan-Meier method, and univariate and multivariate Cox proportional hazards regression models were calculated. Median follow-up was 27.5 months (12.1-49.3 months). PSM was identified in 44 patients (9.3%) and correlated with pT stage (p = 0.002), grade (p < 0.001), LVI (p < 0.001), and location (p < 0.001). Univariate analyses revealed that PSM was a poor prognostic factor for CSS, RFS, and MFS (p = 0.003, 0.04, and <0.001, respectively). The 5-yr CSS and MFS for PSM was 59.1 and 51.6%, respectively, compared with 83.3 and 79.3% for patients with negative SM. Multivariate analyses revealed that SM status was an independent predictor of MFS [hazard ratio 2.7; p = 0.001). PSM after RNU is an important prognostic factor for developing UUT-UC metastases. The status of the surgical margin should be systematically reported on the pathological report and may be a useful variable to include in nomogram risk prediction tools.

  11. Community income and surgical rates in the Netherlands

    NARCIS (Netherlands)

    Westert, G.P.; Smits, J.P.J.M.; Polder, J.J.; Mackenbach, J.P.


    - Background: The study describes variations in use of surgical procedures by community income in the Netherlands. From the literature it is known that surgical rates have a socioeconomic gradient. Both positive and negative associations of socioeconomic factors of patients (for example, income,

  12. Reality of nerve sparing and surgical margins in surgeons' early experience with robot-assisted radical prostatectomy in Japan. (United States)

    Tatsugami, Katsunori; Yoshioka, Kunihiko; Shiroki, Ryoichi; Eto, Masatoshi; Yoshino, Yasushi; Tozawa, Keiichi; Fukasawa, Satoshi; Fujisawa, Masato; Takenaka, Atsushi; Nasu, Yasutomo; Kashiwagi, Akira; Gotoh, Momokazu; Terachi, Toshiro


    To analyze nerve sparing performance at an early stage of robot-assisted radical prostatectomy, and the correlation between the surgeons' experience and the risk of a positive surgical margin in patients treated with robot-assisted radical prostatectomy. Patients' records from January 2009 to March 2013 were retrospectively reviewed, and 3469 patients with localized prostate cancer were identified at 45 institutions. Individual surgeon's experience with nerve sparing was recorded as the number of nerve sparing cases among total robot-assisted radical prostatectomies beginning with the first case during which nerve sparing was carried out. Patients were selected by propensity score matching for nerve sparing, and predictive factors of positive surgical margins were analyzed in patients with and without positive surgical margins. A total of 152 surgeons were studied, and the median number of robot-assisted radical prostatectomy cases for all surgeons was 21 (range 1-511). In all, 54 surgeons (35.5%) undertook nerve sparing during their first robot-assisted radical prostatectomy case. For 2388 patients selected with (1194) and without (1194) nerve sparing, predictive factors for positive surgical margin were high initial prostate-specific antigen level (P 100 cases (P = 0.0058). Thus, nerve sparing was not associated with positive surgical margins. The surgeon's experience influences the occurrence of positive surgical margins, although a considerable number of surgeons carried out nerve sparing during their early robot-assisted radical prostatectomy cases. Surgeons should consider their own experience and prostate cancer characteristics before carrying out a nerve sparing robot-assisted radical prostatectomy. © 2017 The Japanese Urological Association.

  13. Magnetic resonance imaging cannot predict histological tumour involvement of a circumferential surgical margin in rectal cancer. (United States)

    Dent, O F; Chapuis, P H; Haboubi, N; Bokey, L


    Several recent studies have attempted to evaluate the accuracy of preoperative magnetic resonance imaging (MRI) in predicting the likelihood of tumour involvement of the postoperative circumferential resection margin (CRM) in rectal cancer with the intention of selecting patients who might benefit from neoadjuvant therapy and as a guide to surgery. The aim of this study was to assess whether such studies can provide a valid answer as to whether preoperative MRI can accurately predict CRM involvement by tumour. The study design and methodology of studies on this topic were critically examined. Features identified as affecting the efficacy of these studies were: representativeness of patients, definition of the margin assessed by MRI and by histology, lack of blinding of surgeons and pathologists to MRI results, effect of neoadjuvant treatment, and number of patients studied. Because of methodological inadequacies in studies completed to date, there is insufficient evidence of the ability of a positive MRI result to predict an involved CRM. Although MRI may be able to identify a tumour that has extended to the mesorectal fascia and/or intersphincteric plane, logically, it cannot indicate where the surgical boundary of the resection will ultimately lie, and therefore cannot validly predict an involved CRM and should not be relied upon for this purpose. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

  14. Incidence of positive surgical margins after robotic assisted radical prostatectomy: Does the surgeon's experience have an influence on all pathological stages? (United States)

    Villamil, A W; Costabel, J I; Billordo Peres, N; Martínez, P F; Giudice, C R; Damia, O H


    The aim of this study is to analyze the clinical and surgical features of patients who underwent robotic-assisted radical prostatectomy (RARP) at our institution, and the impact of the surgeon's experience in the oncological results related to pathological stage. An analysis of 300 RARP consecutively performed by the same urologist was conducted. Patients were divided into 3 groups of 100 patients in chronological order, according to surgery date. All patients had organ-confined clinical stage. Variables which could impact in positive margins rates were analyzed. Finally, positive surgical margins (PSM) in regard to pathological stage and surgeon's experience were compared and analyzed. No significant differences were found in variables which could impact in PSM rates. The overall PSM rate was 21%, with 28% in the first group, 20% in the second, and 16% in the third (P = .108). Significant lineal decreasing tendency was observed (P = .024). In pT2 patients, the overall PSM rate was 16.6%, with 27%, 13.8%, and 7.3% in each group respectively (P = .009). A significant difference was found between group 1 and group 3 (P = .004). In pT3 patients, the surgeon's experience was not significantly associated with margin reductions with an overall PSM rate of 27.7% (28.2%, 28.6%, and 26.7% in each group respectively). Clinical and surgical features in our patients did not vary over time. We found a significant reduction of PSM related to surgeon's experience in pT2 patients. Contrariwise, the margin status remained stable despite increasing experience in pT3 patients. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  15. Optimal Marginal Tax Rates for Low Incomes: Positive, Negative, or Zero?


    Homburg, Stefan


    Previous studies have shown that the optimal marginal tax rate at the bottom of the income distribution may be positive, negative, or even zero. This paper reexamines this problem in a unified framework and tries to evaluate the arguments. It turns out that the case for positive marginal tax rates is quite strong, whereas negative marginal tax rates seem to be based on a misconception.

  16. Clinical implications of determination of safe surgical margins by using a combination of CT and 18FDG-positron emission tomography in soft tissue sarcoma

    Directory of Open Access Journals (Sweden)

    Yoshioka Takako


    Full Text Available Abstract Background To determine safe surgical margins for soft tissue sarcoma, it is essential to perform a general evaluation of the extent of tumor, responses to auxiliary therapy, and other factors preoperatively using multiple types of diagnostic imaging. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT is a tool for diagnostic imaging that has recently spread rapidly in clinical use. At present, the roles played by FDG-PET/CT in determination of margins for surgical resection of sarcoma are unclear. The present study was undertaken to explore the roles of FDG-PET/CT in determination of surgical margins for soft tissue sarcoma and to examine whether PET can serve as a standard means for setting the margins of surgical resection during reduced surgery. Methods The study involved 7 patients with sarcoma who underwent surgery in our department and in whom evaluation with FDG-PET/CT was possible. Sarcoma was histologically rated as MFH in 6 cases and leiomyosarcoma in 1 case. In all cases, sarcoma was superficial (T1a or T2a. The tumor border was defined by contrast-enhanced MRI, and SUVs were measured at intervals of 1 cm over a 5-cm long area from the tumor border. Mapping of viable tumor cells was carried out on whole-mount sections of resected tissue, and SUVs were compared with histopathological findings. Results Preoperative maximum SUVs (SUV-max of the tumor averaged 11.7 (range: 3.8-22.1. Mean SUV-max was 2.2 (range: 0.3-3.8 at 1 cm from the tumor border, 1.1 (0.85-1.47 at 2 cm, 0.83 (0.65-1.15 at 3 cm, 0.7 (0.42-0.95 at 4 cm, and 0.64 (0.45-0.82 at 5 cm. When resected tissue was mapped, tumor cells were absent in the areas where SUV-max was below 1.0. Conclusions Our findings suggest that a safe surgical margin free of viable tumor cells can be ensured if the SUV cut-off level is set at 1.0. FDG-PET/CT is promising as a diagnostic imaging technique for setting of safe minimal margins for surgical

  17. Influence of focal and diffuse extraprostatic extension and positive surgical margins on biochemical progression following radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Athanase Billis


    Full Text Available PURPOSE: The amount of extraprostatic extension and positive surgical margin correlates in most studies with biochemical recurrence following radical prostatectomy. We studied the influence of focal and diffuse extraprostatic extension and positive surgical margins on biochemical progression using a simple method for quantification. MATERIALS AND METHODS: A total of 360 prostates were step-sectioned and totally processed from 175 patients with stage T1c and 185 patients with clinical stage T2 submitted to radical retropubic prostatectomy. Extraprostatic extension was stratified into 2 groups: present up to 1 quadrant and/or section from the bladder neck or apex (Group 1, focal and in more than 1 quadrant or section (Group 2, diffuse; and, positive surgical margin present up to 2 quadrants and/or sections (Group 1, focal and in more than 2 quadrants or sections (Group 2, diffuse. The Kaplan-Meier product-limit analysis was used for the time to biochemical recurrence, and an univariate and multivariate Cox stepwise logistic regression model to identify significant predictors. RESULTS: Extraprostatic extension was found in 129/360 (35.8% patients, 39/129 (30.2% in Group 1 and 90/129 (69.8% in Group 2. In univariate analysis but not in multivariate analysis, patients showing diffuse extraprostatic extension (Group 2 had a significant higher risk to develop biochemical recurrence in a shorter time. Positive surgical margin was present in 160/360 (44.4% patients, 81/160 (50.6% patients in Group 1 and 79/160 (49.4% patients in Group 2. Patients with diffuse positive surgical margins (Group 2 had a significant higher risk in both univariate and multivariate analyses. Diffuse positive surgical margin was the strongest predictor on both analyses and an independent predictor on multivariate analysis. CONCLUSION: Diffuse extraprostatic extension in univariate analysis and positive surgical margins on both univariate and multivariate analyses are significant

  18. A comparative analysis of primary and secondary Gleason pattern predictive ability for positive surgical margins after radical prostatectomy. (United States)

    Sfoungaristos, S; Kavouras, A; Kanatas, P; Polimeros, N; Perimenis, P


    To compare the predictive ability of primary and secondary Gleason pattern for positive surgical margins in patients with clinically localized prostate cancer and a preoperative Gleason score ≤ 6. A retrospective analysis of the medical records of patients undergone a radical prostatectomy between January 2005 and October 2010 was conducted. Patients' age, prostate volume, preoperative PSA, biopsy Gleason score, the 1st and 2nd Gleason pattern were entered a univariate and multivariate analysis. The 1st and 2nd pattern were tested for their ability to predict positive surgical margins using receiver operating characteristic curves. Positive surgical margins were noticed in 56 cases (38.1%) out of 147 studied patients. The 2nd pattern was significantly greater in those with positive surgical margins while the 1st pattern was not significantly different between the 2 groups of patients. ROC analysis revealed that area under the curve was 0.53 (p=0.538) for the 1st pattern and 0.60 (p=0.048) for the 2nd pattern. Concerning the cases with PSA <10 ng/ml, it was also found that only the 2nd pattern had a predictive ability (p=0.050). When multiple logistic regression analysis was conducted it was found that the 2nd pattern was the only independent predictor. The second Gleason pattern was found to be of higher value than the 1st one for the prediction of positive surgical margins in patients with preoperative Gleason score ≤ 6 and this should be considered especially when a neurovascular bundle sparing radical prostatectomy is planned, in order not to harm the oncological outcome.

  19. [Predictors of positive surgical margins after nephron-sparing surgery for renal cell carcinoma: retrospective analysis on 298 consecutive patients]. (United States)

    Schiavina, Riccardo; Borghesi, Marco; Chessa, Francesco; Rizzi, Simona; Martorana, Giuseppe


    Aim of our study was to evaluate the predictive factors of positive surgical margins (PSM) in a cohort of patients who underwent partial nephrectomy (PN) for renal cell carcinoma. We retrospectively evaluated our Institutional database of patients treated with open or laparoscopic PN between 200 and 2013. Categorical variables were compared using Pearson's chi-square test and linear-by-linear association. Multivariable Cox analysis was used in order to evaluate independent predictors of PSM. Surgical margins were found to be negative in 274 out of 298 patients (91.9%), and the remaining 24 (8.1%) patients had PSM at the final pathological exam. The median clinical size was significantly lower in patients with PSM than those with negative margins (2.6 vs. 3 cm, p=0.03). At univariable analysis, a shorter operative time (p=0.04), a malignant histotype (p=0.04) and higher Fuhrman grade (p=0.02) were observed in patients with positive surgical margins compared to those without PSM. At multivariable analysis, median tumor dimension (p=0.02), the malignant histotype (p=0.01) and the high Fuhrman grade (3-4) (p=0.01) were found to be independent predictive factors of PSM. The most important goal of any PN is to reach negative surgical margins. In our study, clinical tumor dimensions, malignant tumor histotype and the high Fuhrman grade demonstrated to be independent predictive factors of PSM after nephron sparing surgery for renal cell carcinoma. Other prospective, multi-institutional studies are needed in order to confirm these results.

  20. 75 FR 81533 - Antidumping Proceedings: Calculation of the Weighted Average Dumping Margin and Assessment Rate... (United States)


    ... Weighted Average Dumping Margin and Assessment Rate in Certain Antidumping Duty Proceedings AGENCY: Import... comments regarding the calculation of the weighted average dumping margin and antidumping duty assessment...-specific export prices and average normal values and does not offset any dumping that is found with...

  1. Lumpectomy cavity shaved margins do not impact re-excision rates in breast cancer patients. (United States)

    Coopey, Suzanne B; Buckley, Julliette M; Smith, Barbara L; Hughes, Kevin S; Gadd, Michele A; Specht, Michelle C


    The benefits of taking shaved cavity margins (SCM) at the time of lumpectomy are unclear. We sought to determine if taking SCM decreases re-excision rates by increasing the total breast tissue volume excised. We undertook a retrospective review of breast cancer patients who underwent lumpectomy from 2004 to 2006. Patients were divided into three groups. Group 1 had lumpectomy alone, group 2 had lumpectomy plus select (1-3) SCM, and group 3 had lumpectomy plus complete (≥4) SCM. Pathologic findings and surgical outcomes were compared between groups. 773 cancers treated by lumpectomy were included in this study; 197 were in group 1, 130 were in group 2, and 446 were in group 3. The mean total volume of breast tissue excised in group 1 (106.6 cm(3)) was significantly larger than the volume excised in groups 2 (79.3 cm(3)) and 3 (76.3 cm(3)). Rates of re-excision and successful breast-conservation therapy (BCT) were not significantly different between groups. Despite a lower total volume of breast tissue excised in groups 2 and 3, there was no significant increase in locoregional recurrence rates (LRR) at median follow-up of 54 months. Taking additional SCM during lumpectomy resulted in a significantly lower overall volume of breast tissue excised, with no increase in LRR. Contrary to prior studies, we found that SCM did not decrease re-excision rates or impact the success of BCT. Therefore, the main advantage of taking SCM appears to be that less breast tissue is excised, which could potentially improve cosmetic outcomes.

  2. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins. (United States)

    Tan, Puay Hoon; Cheng, Liang; Srigley, John R; Griffiths, David; Humphrey, Peter A; van der Kwast, Theodore H; Montironi, Rodolfo; Wheeler, Thomas M; Delahunt, Brett; Egevad, Lars; Epstein, Jonathan I


    The 2009 International Society of Urological Pathology Consensus Conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to surgical margin assessment were coordinated by working group 5. Pathologists agreed that tumor extending close to the 'capsular' margin, yet not to it, should be reported as a negative margin, and that locations of positive margins should be indicated as either posterior, posterolateral, lateral, anterior at the prostatic apex, mid-prostate or base. Other items of consensus included specifying the extent of any positive margin as millimeters of involvement; tumor in skeletal muscle at the apical perpendicular margin section, in the absence of accompanying benign glands, to be considered organ confined; and that proximal and distal margins be uniformly referred to as bladder neck and prostatic apex, respectively. Grading of tumor at positive margins was to be left to the discretion of the reporting pathologists. There was no consensus as to how the surgical margin should be regarded when tumor is present at the inked edge of the tissue, in the absence of transected benign glands at the apical margin. Pathologists also did not achieve agreement on the reporting approach to benign prostatic glands at an inked surgical margin in which no carcinoma is present.

  3. Surgical skill and complication rates after bariatric surgery. (United States)

    Birkmeyer, John D; Finks, Jonathan F; O'Reilly, Amanda; Oerline, Mary; Carlin, Arthur M; Nunn, Andre R; Dimick, Justin; Banerjee, Mousumi; Birkmeyer, Nancy J O


    Clinical outcomes after many complex surgical procedures vary widely across hospitals and surgeons. Although it has been assumed that the proficiency of the operating surgeon is an important factor underlying such variation, empirical data are lacking on the relationships between technical skill and postoperative outcomes. We conducted a study involving 20 bariatric surgeons in Michigan who participated in a statewide collaborative improvement program. Each surgeon submitted a single representative videotape of himself or herself performing a laparoscopic gastric bypass. Each videotape was rated in various domains of technical skill on a scale of 1 to 5 (with higher scores indicating more advanced skill) by at least 10 peer surgeons who were unaware of the identity of the operating surgeon. We then assessed relationships between these skill ratings and risk-adjusted complication rates, using data from a prospective, externally audited, clinical-outcomes registry involving 10,343 patients. Mean summary ratings of technical skill ranged from 2.6 to 4.8 across the 20 surgeons. The bottom quartile of surgical skill, as compared with the top quartile, was associated with higher complication rates (14.5% vs. 5.2%, Pbariatric surgeons varied widely, and greater skill was associated with fewer postoperative complications and lower rates of reoperation, readmission, and visits to the emergency department. Although these findings are preliminary, they suggest that peer rating of operative skill may be an effective strategy for assessing a surgeon's proficiency.

  4. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins.

    NARCIS (Netherlands)

    Tan, P.H.; Cheng, L.; Srigley, J.R.; Griffiths, D.; Humphrey, P.A.; Kwast, T.H. van der; Montironi, R.; Wheeler, T.M.; Delahunt, B.; Egevad, L.; Epstein, J.I.; Hulsbergen- van de Kaa, C.A.


    The 2009 International Society of Urological Pathology Consensus Conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to surgical margin assessment were coordinated by working group 5. Pathologists agreed

  5. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins.

    NARCIS (Netherlands)

    Tan, P.H.; Cheng, L.; Srigley, J.R.; Griffiths, D.; Humphrey, P.A.; Kwast, T.H. van der; Montironi, R.; Wheeler, T.M.; Delahunt, B.; Egevad, L.; Epstein, J.I.; Hulsbergen- van de Kaa, C.A.


    The 2009 International Society of Urological Pathology Consensus Conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to surgical margin assessment were coordinated by working group 5. Pathologists agreed

  6. Reduced Circumferential Resection Margin Involvement in Rectal Cancer Surgery: Results of the Dutch Surgical Colorectal Audit

    NARCIS (Netherlands)

    Gietelink, L.; Wouters, M.W.; Tanis, P.J.; Deken, M.M.; Berge, M.G. Ten; Tollenaar, R.A.; Krieken, J.H.J.M. van; Noo, M.E. de


    BACKGROUND: The circumferential resection margin (CRM) is a significant prognostic factor for local recurrence, distant metastasis, and survival after rectal cancer surgery. Therefore, availability of this parameter is essential. Although the Dutch total mesorectal excision trial raised awareness ab

  7. Comparison of marginal ulcer rates between antecolic and retrocolic laparoscopic Roux-en-Y gastric bypass. (United States)

    Ribeiro-Parenti, Lara; Arapis, Konstantinos; Chosidow, Denis; Marmuse, Jean-Pierre


    Marginal ulcer can be a serious complication after laparoscopic gastric bypass surgery. The aim of this study was to compare the rates of marginal ulcer between the antecolic and the retrocolic technique, in a large cohort of patients. Over a near 10-year period, 1,142 patients underwent laparoscopic gastric bypass surgery. The antecolic and the retrocolic technique were used in respectively 572 and 570 consecutive patients. All procedures were performed using a circular stapled gastrojejunostomy. Patients were followed for 18 to 99 months (mean 48.8 months). During follow-up, 46 patients developed a marginal ulcer (4 %), 32 in the antecolic group (5.6 %) and 14 in the retrocolic group (2.5 %). Nineteen patients (3.3 %) in the antecolic group and eight patients in the retrocolic group (1.4 %) developed early marginal ulcer (i.e., within 3 months after surgery). The mean time to onset of anastomotic ulcer symptoms after surgery was 11 months (range 0.25-72). Forty-four patients were submitted to medical treatment, and 35 patients (79.5 %) had complete resolution of their symptoms. Patients with an antecolic Roux limb develop significantly more marginal ulcers (p = 0.007) and early marginal ulcer (p = 0.033) than the patients with a retrocolic Roux limb. The antecolic technique seems to be a risk factor for appearance of marginal ulcer.

  8. Improved Surgical Site Infection (SSI) rate through accurately assessed surgical wounds. (United States)

    John, Honeymol; Nimeri, Abdelrahman; Ellahham, Samer


    Sheikh Khalifa Medical City's (SKMC) Surgery Institute was identified as a high outlier in Surgical Site Infections (SSI) based on the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) - Semi-Annual Report (SAR) in January 2012. The aim of this project was to improve SSI rates through accurate wound classification. We identified SSI rate reduction as a performance improvement and safety priority at SKMC, a tertiary referral center. We used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) best practice guidelines as a guide. ACS NSQIP is a clinical registry that provides risk-adjusted clinical outcome reports every six months. The rates of SSI are reported in an observed/expected ratio. The expected ratio is calculated based on the risk factors of the patients which include wound classification. We established a multidisciplinary SSI taskforce. The members of the SSI taskforce included the ACS NSQIP team members, quality, surgeons, nurses, infection control, IT, pharmacy, microbiology, and it was chaired by a colorectal surgeon. The taskforce focused on five areas: pre-op showering and hair removal, skin antisepsis, prophylactic antibiotics, peri-operative maintenance of glycaemia, and normothermia. We planned audits to evaluate our wound classification and our SSI rates based on the SAR. Our expected SSI rates in general surgery and the whole department were 2.52% and 1.70% respectively, while our observed SSI rates were 4.68% and 3.57% respectively, giving us a high outlier status with an odd's ratio of 1.72 and 2.03. Wound classifications were identified as an area of concern. For example, wound classifications were preoperatively selected based on the default wound classification of the booked procedure in the Electronic Medical Record (EMR) which led to under classifying wounds in many occasions. A total of 998 cases were reviewed, our rate of incorrect wound classification

  9. Extensive and intensive margins and the choice of exchange rate regimes


    Picard, Pierre M.; Hamano, Masashige


    This paper studies how the choice of fixed or flexible exchange rate regimes is affected by the existence of intensive and extensive margins. We study two models where firms enter during or before each period of production. We show how the the choice of those regimes depend on the level and the volatily of the intensive and extensive margins as well as on the congruence between consumers' preferences and the supply and diversity of products. We show that fixed exchange rate regimes are prefer...

  10. The role of molecular strategies in the evaluation of surgical margins in oropharyngeal squamous cell carcinoma

    Directory of Open Access Journals (Sweden)

    Anastasios N. Kanatas


    Full Text Available The recurrence of a tumour at the resection margins in head and neck squamous cell carcinoma (HNSCC has profound implications on the morbidity and mortality of the patient. At present HNSCC does not undergo any form of molecular analysis to aid treatment strategy and prognosticate for those individuals at higher risk of recurrence. This article aims to review current research into molecular strategies for tumour evaluation, highlighting conflicting evidence and possible novel concepts for further exploration.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Label-free reflectance hyperspectral imaging for tumor margin assessment: a pilot study on surgical specimens of cancer patients (United States)

    Fei, Baowei; Lu, Guolan; Wang, Xu; Zhang, Hongzheng; Little, James V.; Patel, Mihir R.; Griffith, Christopher C.; El-Diery, Mark W.; Chen, Amy Y.


    A label-free, hyperspectral imaging (HSI) approach has been proposed for tumor margin assessment. HSI data, i.e., hypercube (x,y,λ), consist of a series of high-resolution images of the same field of view that are acquired at different wavelengths. Every pixel on an HSI image has an optical spectrum. In this pilot clinical study, a pipeline of a machine-learning-based quantification method for HSI data was implemented and evaluated in patient specimens. Spectral features from HSI data were used for the classification of cancer and normal tissue. Surgical tissue specimens were collected from 16 human patients who underwent head and neck (H&N) cancer surgery. HSI, autofluorescence images, and fluorescence images with 2-deoxy-2-[(7-nitro-2,1,3-benzoxadiazol-4-yl)amino]-D-glucose (2-NBDG) and proflavine were acquired from each specimen. Digitized histologic slides were examined by an H&N pathologist. The HSI and classification method were able to distinguish between cancer and normal tissue from the oral cavity with an average accuracy of 90%±8%, sensitivity of 89%±9%, and specificity of 91%±6%. For tissue specimens from the thyroid, the method achieved an average accuracy of 94%±6%, sensitivity of 94%±6%, and specificity of 95%±6%. HSI outperformed autofluorescence imaging or fluorescence imaging with vital dye (2-NBDG or proflavine). This study demonstrated the feasibility of label-free, HSI for tumor margin assessment in surgical tissue specimens of H&N cancer patients. Further development of the HSI technology is warranted for its application in image-guided surgery.

  13. Risk factors of positive surgical margin and biochemical recurrence of patients treated with radical prostatectomy:a single-center 10-year report

    Institute of Scientific and Technical Information of China (English)

    LI Kin; LI Hong; YANG Yong; Ian Lap-hong; Pun Wai-hong; Ho Son-fat


    Background Many studies have shown that positive surgical margin and biochemical recurrence could impact the life of patients with prostate cancer treated with radical prostatectomy. With more and more patients with prostate cancer appeared in recent 20 years in China,it is necessary to investigate the risk of positive surgical margin and biochemical recurrence,and their possible impact on the prognosis of patients treated with radical prostatectomy. In this study,we analyzed the characteristics of patients with prostate cancer who had undergone radical prostatectomy in Macau area and tried to find any risk factor of positive surgical margin and biochemical recurrence and their relationship with the prognosis of these patients.Methods From 2000 to 2009,149 patients with prostate cancer received radical prostatectomy and were followed up.Among these patients,111 received retropubic radical prostatectomies,38 received laparoscopic radical prostatectomies.All patients were followed-up on in the 3rd month,6th month and from that point on every 6 months after operation. At each follow-up a detailed record of any complaint,serum prostate-specific antigen (PSA),full biochemical test and uroflowmetry was acquired.Results The average age was (69.0±6.1) years,preoperative average serum PSA was (10.1 ±12.1) ng/ml and average Gleason score was 6.4±1.3. The incidence of total complications was about 47.7%,the incidence of the most common complication,bladder outlet obstruction,was about 26.8%,and that of the second most common complication,urinary stress incontinence,was about 16.1% (mild 9.4% and severe 6.7%). The incidence of positive surgical margin was about 38.3%. The preoperative serum PSA ((13.4±17.6) ng/ml),average Gleason score (7.1±1.3) and pathological T stage score (7.0±1.4) were higher in patients with positive surgical margins than those with negative margins ((8.0±5.8) ng/ml,6.0±1.2 and 5.4±1.4,respectively) (P=0.004,P=0.001 and P=0.001,respectively). A

  14. Non-apical positive surgical margins after radical prostatectomy for pT2 prostate cancer is associated with the highest risk of recurrence

    DEFF Research Database (Denmark)

    Roder, Martin Andreas; Kawa, Sandra; Scheike, Thomas


    BACKGROUND AND OBJECTIVE: To investigate how location of positive surgical margins (PSM) in pT2 tumors affect the risk of biochemical recurrence (BR). METHODS: The study includes 1,133 consecutive patients from 1995 until end of 2011, who had organ-confined disease (pT2) following RP. The location...... of PSM was stratified into apical and non-apical. BR was defined as the first PSA ≥ 0.2 ng/ml after RP. Risk of BR was analyzed with Kaplan-Meier and Cox regression analysis. RESULTS: Median follow-up was 3.6 years (range: 0.5-15.5 years). The overall pT2 PSM rate was 26.3%. Overall, a pT2 with PSM had...... a 3.1-fold increased risk of BR compared to margin negative patients. Patients with pT2 apical and non-apical PSM had a 5-year biochemical recurrence-free survival of 84.9% (95% CI: 77.6-92.2%) and 78.6% (95% CI: 71.3-85.9%), respectively. In multivariate analysis, pT2 apical and non-apical PSM...

  15. The relation of gingival thickness to dynamics of gingival margin position pre- and post-surgically

    Directory of Open Access Journals (Sweden)

    Kharidhi Laxman Vandana


    Full Text Available Background: To evaluate the gingival margin position (GMP before and after open flap debridement in different gingival thickness (GT. Materials and Methods: Twenty-seven healthy patients with moderate to advanced adult periodontitis were included in a randomized control clinical trial. A calibrated UNC-15 periodontal probe, an occlusal onlay stent was used for clinical measurements recorded at baseline, 3 month, 6 month, and 16 month. The changes in the GMP were studied at midbuccal (Mi-B, mesiobuccal (MB, and distobuccal sites. GT was measured presurgically, transgingivally at Mi-B and interdental sites, divided into 2 groups: Group 1 (thin and Group 2 (thick. Results: In GT of ≤1 mm group, the statistically significant apical shift of GMP led to gingival recession at all study sites in the early postsurgical period of 1 and 3 months. During 6 and 16 months, the apical shift of GMP coincided with the Chernihiv Airport at Mi-B site (6 months, MB site (16 months. The gingival recession was obvious at Mi-B sites (16 months. In the GT of >1 mm, the statistically significant apical shift of GMP did not cause gingival recession at any sites throughout postsurgical (1, 3, 6, and 16 months period. Conclusion: Thin gingiva showed apical shift of GMP leading to gingival recession as compared to thick gingiva postsurgically.

  16. Firn thickness variations across the Northeast Greenland Ice Stream margins indicating nonlinear densification rates (United States)

    Riverman, K. L.; Anandakrishnan, S.; Alley, R. B.; Peters, L. E.; Christianson, K. A.; Muto, A.


    Northeast Greenland Ice Stream (NEGIS) is the largest ice stream in Greenland, draining approximately 8.4% of the ice sheet's area. The flow pattern and stability mechanism of this ice stream are unique to others in Greenland and Antarctica, and merit further study to ascertain the sensitivity of this ice stream to future climate change. Geophysical methods are valuable tools for this application, but their results are sensitive to the structure of the firn and any spatial variations in firn properties across a given study region. Here we present firn data from a 40-km-long seismic profile across the upper reaches of NEGIS, collected in the summer of 2012 as part of an integrated ground-based geophysical survey. We find considerable variations in firn thickness that are coincident with the ice stream shear margins, where a thinner firn layer is present within the margins, and a thicker, more uniform firn layer is present elsewhere in our study region. Higher accumulation rates in the marginal surface troughs due to drift-snow trapping can account for some of this increased densification; however, our seismic results also highlight enhanced anisotropy within the firn and upper ice column that is confined to narrow bands within the shear margins. We thus interpret these large firn thickness variations and abrupt changes in anisotropy as indicators of firn densification dependent on the effective stress state as well as the overburden pressure, suggesting that the strain rate increases nonlinearly with stress across the shear margins. A GPS strain grid maintained for three weeks across both margins observed strong side shearing, with rapid stretching and then compression along particle paths, indicating large deviatoric stresses in the margins. This work demonstrates the importance of developing a high-resolution firn densification model when conducting geophysical field work in regions possessing a complex ice flow history; it also motivates the need for a more

  17. Surgical site infection rates following laparoscopic urological procedures. (United States)

    George, Arvin K; Srinivasan, Arun K; Cho, Jane; Sadek, Mostafa A; Kavoussi, Louis R


    Surgical site infections have been categorized by the Centers for Medicare and Medicaid Services as "never events". The incidence of surgical site infection following laparoscopic urological surgery and its risk factors are poorly defined. We evaluated surgical site infection following urological laparoscopic surgery and identified possible factors that may influence occurrence. Patients who underwent transperitoneal laparoscopic procedures during a 4-year period by a single laparoscopic surgeon were retrospectively reviewed. Surgical site infections were identified postoperatively and defined using the Centers for Disease Control criteria. Clinical parameters, comorbidities, smoking history, preoperative urinalysis and culture results as well as operative data were analyzed. Nonparametric testing using the Mann-Whitney U test, multivariable logistic regression and Spearman's rank correlation coefficient were used for data analysis. In 556 patients undergoing urological laparoscopic procedures 14 surgical site infections (2.5%) were identified at mean postoperative day 21.5. Of the 14 surgical site infections 10 (71.4%) were located at a specimen extraction site. Operative time, procedure type and increasing body mass index were significantly associated with the occurrence of surgical site infections (p = 0.007, p = 0.019, p = 0.038, respectively), whereas history of diabetes mellitus (p = 0.071) and intraoperative transfusion (p = 0.053) were found to trend toward significance. Age, gender, positive urine culture, steroid use, procedure type and smoking history were not significantly associated with surgical site infection. Body mass index and operative time remained significant predictors of surgical site infection on multivariate logistic regression analysis. Surgical site infection is an infrequent complication following laparoscopic surgery with the majority occurring at the specimen extraction site. Infection is associated with prolonged operative time and

  18. A validated web-based nomogram for predicting positive surgical margins following breast-conserving surgery as a preoperative tool for clinical decision-making

    NARCIS (Netherlands)

    Pleijhuis, Rick G.; Kwast, Annemiek B. G.; Jansen, Liesbeth; de Vries, J; Lanting, Rosanne; Bart, Joost; Wiggers, Theo; van Dam, Gooitzen M.; Siesling, Sabine


    BACKGROUND: Breast-conserving therapy, consisting of lumpectomy and adjuvant radiotherapy, is considered standard treatment for early-stage breast cancer. One of the most important risk factors of local recurrence is the presence of positive surgical margins following lumpectomy. We aimed to develop

  19. Molybdenum isotope signatures from the Yangtze block continental margin and its indication to organic burial rate (United States)

    Zhou, L.; Zhou, H. B.; Huang, J. H.


    The paper presents the molybdenum isotope data, along with the trace element content, to investigate the geochemical behavior of authigenic Mo during long-term burial in sediments in continental margin settings of the Yangtze block, as well as their indication to the burial of original organic carbon. The burial rate of original organic carbon were estimated on the basis of the amount of sedimentary sulfur (TS content), whilst the carbon loss by aerobic degradation was estimated according to calculated Mn contents. On these points, the original organic carbon flux was calculated, exhibiting a large range of variation (2.54-15.82 mmol/m2/day). The strong correlation between sedimentary Mo isotope values and organic carbon burial rates previously proposed on the basis of the investigations on modern ocean sediments was also used here to estimate the organic carbon burial rate. The data gained through this model showed that organic carbon burial rates have large variations, ranging from 0.43- 2.87mmol/m2/day. Although the two sets of data gained through different geochemical records in the Yangtze block show a deviation of one order of magnitude, they do display a strong correlation. It is thus tempting to speculate that the Mo isotope signature of sediments may serve as a tracer for the accumulation rate of original organic carbon in the continental margin sediments. Keywords: Molybdenum isotopes; organic carbon burial rate; ancient continental margin setting ACKNOWLEDGMENTS We thank Professor Xie Shucheng for his constructive review comments. This research is co-supported by the Program for Changjiang Scholars and Innovative Research Team in University (grants IRT0441), the SinoPec project (grant no. G0800-06-ZS-319) and the National Nature Science Foundation of China (grants 40673020).

  20. Molybdenum isotope composition from Yangtze block continental margin and its indication to organic burial rate

    Institute of Scientific and Technical Information of China (English)

    ZHOU Lian; HUANG Junhua; Corey Archer; Chris Hawkesworth


    The paper presents the molybdenum isotope data,along with the trace element content,to investigate the geochemical behavior of authigenic Mo during long-term burial in sediments in continental margin settings of the Yangtze block,as well as their indication to the burial of original organic carbon.The burial rate of original organic carbon was estimated on the basis of the amount of sedimentary sulfur (TS content),whilst the carbon loss by aerobic degradation was estimated according to calculated Mn contents.On these points,the original organic carbon flux was calculated,exhibiting a large range of variation (0.17-0.67mmol/m2/day).The strong correlation between sedimentary Mo isotope values and organic carbon burial rates previously proposed on the basis of the investigations on modern ocean sediments,was also used here to estimate the organic carbon burial rate.The data gained through this model showed that organic carbon burial rates have large variations,ranging from 0.43-2.87 mmol/m2/day.Although the two sets of data gained through different geochemical records in the Yangtze block show a deviation of one order of magnitude,they do display a strong correlation.It is thus tempting to speculate that the Mo isotope signature of sediments may serve as a tracer for the accumulation rate of original organic carbon in the continental margin sediments.

  1. Risk of biochemical recurrence and positive surgical margins in patients with pT2 prostate cancer undergoing radical prostatectomy

    DEFF Research Database (Denmark)

    Røder, Martin Andreas; Thomsen, Frederik Birkebæk; Berg, Kasper Drimer


    BACKGROUND AND OBJECTIVE: To investigate risk factors associated with positive surgical margins (PSM) and biochemical recurrence (BR) in organ confined tumors (pT2) after radical prostatectomy (RP) for localized prostate cancer (PCa). METHODS: Between 1995 and 2011, 1,649 patients underwent RP...... at our institution. The study includes the 1,133 consecutive patients with pT2 tumors at final histopathology. Logistic regression analysis was used for risk of PSM. Risk of BR, defined as the first PSA ≥ 0.2 ng/ml, was analyzed with Kaplan-Meier and Cox regression analysis. RESULTS: Median follow......-up was 3.6 years (range: 0.5-15.5 years). In logistic regression, NS surgery was independently associated with an increased risk of pT2 PSM (OR = 1.68, 95% CI: 1.3-2.0, P = 0.01) relative to non-NS surgery. NS surgery was not independently associated with BR but the interaction of PSM and NS surgery...

  2. Risk of Local Failure in Breast Cancer Patients With Lobular Carcinoma In Situ at the Final Surgical Margins: Is Re-excision Necessary?

    Energy Technology Data Exchange (ETDEWEB)

    Sadek, Betro T.; Shenouda, Mina N.; Abi Raad, Rita F. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Niemierko, Andrzej [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Statistics Section, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Keruakous, Amany R. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Goldberg, Saveli I. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Statistics Section, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Taghian, Alphonse G., E-mail: [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States)


    Purpose: To compare the outcome of patients with invasive breast cancer both with and without lobular carcinoma in situ (LCIS)-positive/close surgical margins after breast-conserving treatment. Methods and Materials: We retrospectively studied 2358 patients with T1-T2 invasive breast cancer treated with lumpectomy and radiation therapy from January 1980 to December 2009. Median age was 57 years (range, 24-91 years). There were 82 patients (3.5%) with positive/close LCIS margins (<0.2 cm) and 2232 patients (95.7%) with negative margins. A total of 1789 patients (76%) had negative lymph nodes. Patients who received neoadjuvant chemotherapy were excluded. A total of 1783 patients (76%) received adjuvant systemic therapy. Multivariable analysis (MVA) was performed using Cox's proportional hazards model. Results: The 5-year cumulative incidence of locoregional recurrence (LRR) was 3.2% (95% confidence interval [CI] 2.5%-4.1%) for the 2232 patients with LCIS-negative surgical margins (median follow-up 104 months) and 2.8% (95% CI 0.7%-10.8%) for the 82 patients with LCIS-positive/close surgical margins (median follow-up 90 months). This was not statistically significant (P=.5). On MVA, LCIS-positive margins after the final surgery were not associated with increased risk of LRR (hazard ratio [HR] 3.4, 95% CI 0.5-24.5, P=.2). Statistically significant prognostic variables on Cox's MVA for risk of LRR included systemic therapy (HR 0.5, 95% CI 0.33-0.75, P=.001), number of positive lymph nodes (HR 1.11, 95% CI 1.05-1.18, P=.001), menopausal status (HR 0.96, 95% CI 0.95-0.98, P=.001), and histopathologic grade (grade 3 vs grade 1/2) (HR 2.6, 95% CI 1.4-4.7, P=.003). Conclusion: Our results suggest that the presence of LCIS at the surgical margin after lumpectomy does not increase the risk of LRR or the final outcome. These findings suggest that re-excision or mastectomy in patients with LCIS-positive/close final surgical margins is unnecessary.

  3. Risk Factors Analysis for Positive Surgical Margins in Laparoscopic Radical Prostatectomy%腹腔镜根治性前列腺切除术后切缘阳性的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    阎乙夫; 黄毅; 马潞林


    Objective:To analysis the risk factors for positive surgical margins in laparoscopic radical prostatectomy. Methods: We retrospectively analyzed the clinical and pathological data of 188 cases, who received laparoscopic radical prostatectomy from Jan. 2004 to Dec. 2010 in our hospital. The patients average 72 years old. All patients were dignosised by pathology before prostatectomy, and no metastasis was found before surgery. Univari-able analyse were used to estimate the relationship between the parameters and surgical margin status. Multivari-able logistic regression analyse were used to determine relative risk factors for positive surgical margins. Results; Except that two patients were converted to open surgery, laparoscopic radical prostatectomy was successfully applied in other 186 patients. The operating time was average 246 min, the blood loss during operation was average 309 ml. 76 cases (40. 5%) had positive surgical margin. Result from univariable analyse showed there were significance difference between positive and negtive surgical margins patients on biopsy Gleason score, number of positive biopsy cores, surgical Gleason score, and pathological stage. On multivariable logistic regression analyses, surgical Gleason score and pathological stage were independent factor of positive surgical margins. A surgical Gleason score more than 7 was associated with a 17. 1-fold higher chance of positive surgical margin than a surgical Gleason score not more than 6 (OR:17. 131, 95%CI:5. 237-56. 037,F<0. 001). A pathological stage of T3 was associated with a 9. 0-fold higher risk of positive surgical margin than a psthology stage of T2 (OR:8. 970, 95%CI: 4. 128-19. 493,P<0. 001). Conclusions; Surgical Gleason score and pathological stage were independent factors of positive surgical margins in laparoscopic radical prostatectomy. Patients with surgical Gleason score more than 7 and pathological stage of T3 had a higher rate of positive surgical margins.%目的:分析

  4. TM1-IR680 peptide for assessment of surgical margin and lymph node metastasis in murine orthotopic model of oral cancer (United States)

    Suganya S., Annie A.; Kochurani, K. J.; Nair, Madhumathy G.; Louis, Jiss Maria; Sankaran, Santhosh; Rajagopal, R.; Kumar, K. Santhosh; Abraham, Parvin; P. G., Balagopal; Sebastian, Paul; Somananthan, Thara; Maliekal, Tessy Thomas


    Treatment outcome after surgical removal in oral carcinoma is poor due to inadequate methodologies available for marking surgical margins. Even though some methodologies for intraoperative margin assessment are under clinical and preclinical trials for other solid tumours, a promising modality for oral cancer surgery is not developed. Fluorescent-based optical imaging using Near Infrared (NIR) dyes tagged to tumour specific target will be an optimal tool for this purpose. One such target, Gastrin Releasing Peptide Receptor (GRPR) was selected for the study, and its binding peptide, TM1-IR680, was tested for its efficacy for surgical margin prediction in murine orthotopic model of oral cancer, derived from primary samples. Here, for the first time in a preclinical analysis, we show that the size and margin of oral cancer can be predicted, as revealed by 3D-imaging. Interestingly, the peptide was sensitive enough to detect lymph nodes that harboured dispersed tumour cells before colonization, which was impossible to identify by conventional histopathology. We recommend the use of TM1-NIR dyes alone or in combination with other technologies to improve the clinical outcome of oral cancer surgery. PMID:27827443

  5. Factors affecting recurrence rate of ingrown toenail treated with marginal toenail ablation. (United States)

    Kuru, Ilhami; Sualp, Turan; Ferit, Dereboy; Gunduz, Tezeren


    This retrospective study analyzed marginal toenail ablation for ingrowing toenails and the factors affecting recurrences. Recurrence was defined as a return of the previous symptoms, regrowth of the nail edge, or patient dissatisfaction with the clinical outcome. Based on these criteria, nine patients (10.7%) were considered to have had a failed operation. There were significant differences for recurrence rate (p <.05) in the patients operated on under local anesthesia and in previously treated patients. Full exposure and excision of the germinal matrix were essential to avoid recurrence.

  6. Decreasing incidence rate for surgically treated middle ear cholesteatoma in Denmark 1977-2007

    DEFF Research Database (Denmark)

    Djurhuus, Bjarki Ditlev; Faber, Christian Emil; Skytthe, Axel


    The objective was to estimate the annual incidence rate of surgically treated middle ear cholesteatoma (STMEC) in Denmark from 1977 to 2007, taking age, gender and secular trends into consideration.......The objective was to estimate the annual incidence rate of surgically treated middle ear cholesteatoma (STMEC) in Denmark from 1977 to 2007, taking age, gender and secular trends into consideration....


    Directory of Open Access Journals (Sweden)

    Olga Gennadevna Rybakova


    Full Text Available The article deals with the problem of the flexibility of an organization as the ability to adapt effectively to the external environment. The authors have identified and investigated different approaches to estimating the flexibility of an organization on the ground of flexibility grading, calculation of the general index of flexibility as well as the calculation of flexibility’s ranking score. We have identified the advantages and disadvantages of these approaches. A new method of the estimation of an organization’s flexibility on the ground of the calculation of relative profit margin has been developed. This method is the multifunctional assessment tool of enterprise’s functionability in the current context of difficult and volatile economic environment. It allows in the early stage to identify negative trends in the production and financial figures and thus, it enables the organizational leadership to take steps in advance in order to avert a crisis in its activity. Keeping the profit margin at the same rate at the forced contraction of output, because of the negative impact of external factors, will confirm that the organization has adapted to the external environment and, therefore, it is flexible. The organization can be considered with margin rate beginning to low up to zero value as an organization with an insufficient level of flexibility that is at the “zone of crisis” and it is characterized by the depletion of reserved funds and reduction of current assets. Loss-maker is nonflexible and the presence of loss means that the organization has an evident sign of crisis and it can be bankrupt.

  8. Institution of The Steiros Algorithm(®) Outpatient Surgical Protocol reduced orthopedic surgical site infections (SSI) rates. (United States)

    Watson, Paul A; Watson, Luke; Torress-Cook, Alfonso


    Control of surgical site infections (SSI) is imperative for the safety of our patients. As orthopedic surgeons we strive to have the lowest infection rate possible for all our surgical procedures. this study evaluates the effects of a simple outpatient peri-operative patient cleaning protocol (The Steiros Algorithm(®) Outpatient Surgery Protocol) on SSI rates. We retrospectively reviewed the hospital's infection rate database for all procedures from July 2005 until February 2011 performed by one general orthopedic surgeon (PAW) within one hospital system. The Steiros Algorithm(®) Outpatient Surgery Protocol was instituted on January 1(st), 2009. We calculated and compared the deep and superficial SSI rate for orthopedic surgeries performed before and after the Outpatient Protocol was instituted. All patients had a minimum of one-year follow-up data. Lowest previously published estimated costs for SSI were used for a cost analysis ($17,708). The July 1(st), 2005 through December 31(st), 2008 SSI rate was 1.0% (13/1292). From January 1(st), 2009 through February 28(th), 2011 the SSI rate was zero (0/875). the SSI rates decreased 100%. Due to the reduction in SSI, the hospital saved a minimum of $154,059 over a two year period. In this retrospective review, the Steiros Algorithm(®) Outpatient Surgery Protocol dramatically reduced the overall SSI rate to zero and saved money. We believe this is a simple, effective protocol that can be used for all orthopedic surgical procedures.

  9. Can perineural invasion detected in prostate needle biopsy specimens predict surgical margin positivity in D’Amico low risk patients?

    Directory of Open Access Journals (Sweden)

    Ozgur Haki Yuksel


    Full Text Available Objectives: In this study, our aim was to estimate the value of perineural invasion (PNI in prostate needle biopsy (PNB specimens in the prediction of surgical margin positivity (SMP and its prognostic significance (upgrade Gleason Score in patients who had undergone radical retropubic prostatectomy (RRP with low risk prostate cancer according to D’Amico risk assessment. Materials and Methods: We retrospectively analyzed the data of 65 patients who were diagnosed as clinical stage T1c prostate cancer (PC and underwent RRP between January 2010 and June 2013. Pathological specimens of PNB and RRP were separately examined for the parameters of PNI, vascular invasion (VI, Gleason Score (GS and SMP. Results: The patients’ mean age was 63.65 ± 4.93 (range 47- 75 years. PNI in PNB specimens were identified in 12 of 65 patients and 11 of 12 patients showed SMP on RRP specimens. While 53 of 65 patients had not PNI on PNB, only 11 of them demonstrated SMP on RRP specimens. SMP was 30.64-fold more frequently encountered in PNB specimens obtained from PNI-positive patients relative to PNI-negative patients. In our study, PNI detected in PNB specimens was statistically significantly associated with SMP on RRP specimens (P = 0.0001. Conclusion: It is well known that higher PSA values and GS were independent predictors of SMP in clinically localized prostate cancer (CLPC. We think that PNI in PNB specimens may be a useful prognostic factor for predicting SMP in cases with CLPC.

  10. Risk and timing of biochemical recurrence in pT3aN0/Nx prostate cancer with positive surgical margin - A multicenter study. (United States)

    Karl, Alexander; Buchner, Alexander; Tympner, Christiane; Kirchner, Thomas; Ganswindt, Ute; Belka, Claus; Ganzer, Roman; Wieland, Wolf; Eder, Fabian; Hofstädter, Ferdinand; Schilling, David; Sievert, Karl-Dietrich; Stenzl, Arnulf; Scharpf, Marcus; Fend, Falko; Vom Dorp, Frank; Rübben, Herbert; Schmid, Kurt Werner; Porres-Knoblauch, Daniel; Heidenreich, Axel; Hangarter, Birgit; Knüchel-Clarke, Ruth; Rogenhofer, Michael; Wullich, Bernd; Hartmann, Arndt; Comploj, Evi; Pycha, Armin; Hanspeter, Esther; Pehrke, Dirk; Sauter, Guido; Graefen, Markus; Gratzke, Christian; Stief, Christian; Wiegel, Thomas; Haese, Alexander


    Positive surgical margins (PSM) after radical prostatectomy have been shown to be associated with impaired outcome. In pT3pN0 patients with PSM either immediate radiotherapy or clinical and biological monitoring followed by salvage radiotherapy is recommended by the latest guidelines of the European Association of Urology. A retrospective, multicenter study of eight urological centers was conducted on 536 prostatectomy patients with pT3aN0/NxR1 tumors and no neoadjuvant/adjuvant therapy. A pathological re-review of all prostate specimens was performed. Association of clinical and pathological features with biochemical recurrence (BCR) was analyzed using univariate and multivariate analysis. With 48months median follow-up, BCR occurred in 39.7%. Preoperative PSA value, performance of pelvic lymph node dissection and Gleason score were significantly associated with BCR. In multivariate analysis, Gleason score was the only independent prognostic factor (p<0.001) for BCR. Five-year BCR-free survival rates were 74%, 70%, 38%, and 51% with Gleason score 6, 3+4=7a, 4+3=7b, and 8-10, respectively. In pT3aN0/NxR1 patients with no adjuvant/neoadjuvant treatment, Gleason Score permits independent prediction of the risk for BCR. These findings could help to estimate and discuss the individual risk for BCR with our patients on an individual basis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Dual in vivo Photoacoustic and Fluorescence Imaging of HER2 Expression in Breast Tumors for Diagnosis, Margin Assessment, and Surgical Guidance

    Directory of Open Access Journals (Sweden)

    Azusa Maeda


    Full Text Available Biomarker-specific imaging probes offer ways to improve molecular diagnosis, intraoperative margin assessment, and tumor resection. Fluorescence and photoacoustic imaging probes are of particular interest for clinical applications because the combination enables deeper tissue penetration for tumor detection while maintaining imaging sensitivity compared to a single optical imaging modality. Here we describe the development of a human epidermal growth factor receptor 2 (HER2-targeting imaging probe to visualize differential levels of HER2 expression in a breast cancer model. Specifically, we labeled trastuzumab with Black Hole Quencher 3 (BHQ3 and fluorescein for photoacoustic and fluorescence imaging of HER2 overexpression, respectively. The dual-labeled trastuzumab was tested for its ability to detect HER2 overexpression in vitro and in vivo. We demonstrated an over twofold increase in the signal intensity for HER2-overexpressing tumors in vivo, compared to low–HER2-expressing tumors, using photoacoustic imaging. Furthermore, we demonstrated the feasibility of detecting tumors and positive surgical margins by fluorescence imaging. These results suggest that multimodal HER2-specific imaging of breast cancer using the BHQ3-fluorescein trastuzumab enables molecular-level detection and surgical margin assessment of breast tumors in vivo. This technique may have future clinical impact for primary lesion detection, as well as intraoperative molecular-level surgical guidance in breast cancer.

  12. Cataract surgical coverage rate among adults aged 40 years and older

    Directory of Open Access Journals (Sweden)

    Lusianawaty Tana


    Full Text Available Cataract is a leading cause of curable blindness. Hence, in its global declaration of ‘Vision 2020 Right to Sight’, the World Health Organization (WHO encouraged its member countries to address the problem of incident cataract. Many factors are related to the cataract surgical coverage rate, such as gender and diabetes mellitus. The objective of this study was to determine the cataract surgical coverage rate and investigate the determinants factors of cataract surgical coverage rate among adults 40 years old and above with cataract. A cross sectional study was conducted using National Basic Health Research (Riskesdas 2007 data. Cataract surgery was defined as surgery conducted within the last 12 months before the survey was performed. There were 6939 subjects (3105 male, 3834 female who fulfilled the study criteria. The cataract surgical coverage rate was 19.3%. The cataract surgical coverage rate was lower in subjects with low education, in the group of farmers/fishermen/laborers, in the 40-49 years age group, in rural areas, and in subjects of low socioeconomic status (p0.05. Determinants that were related to cataract surgical coverage rate were age, type of area of residence, socioeconomic status, and region of residence (p<0.001. The implementation of educational programs and reforms to local ophthalmic health services may improve the cataract surgical coverage rate.

  13. Expression profiles of MGMT, p16, and APC genes in tumor and matching surgical margin from patients with oral squamous cell carcinoma. (United States)

    Strzelczyk, Joanna Katarzyna; Gołąbek, Karolina; Krakowczyk, Łukasz; Owczarek, Aleksander J


    The aim of the study was to assess the expression of MGMT, p16, and APC genes in tumors and matching surgical margin samples from 56 patients with primary OSCC. We also analyzed the association of the clinical variables with the expression of the studied genes. After RNA isolation and cDNA synthesis gene expression levels were assessed by quantitative reverse transcription (qRT)-PCR. Two-sided parametrical Student's t-test for independent groups with equal/unequal variances showed no statistically significant differences in genes' expression in tumor compared to margin samples. No association was found between the genes' expression and clinical parameters, except for MGMT, whose low expression was probably associated with smoking (0.87 vs 1.34, p=0.065). 'Field cancerization' is an area with genetically or epigenetically altered cells and at the same time a risk factor for cancer. Disturbances in gene expression could also be the source of damages leading to cancerization. In conclusion, it is important to mention that the field remaining after a surgery may pose an increased risk of cancer development. It may be suggested that the diagnosis and treatment of cancers should not be concentrated only on the tumor itself, but also on the cancer field effect. Therefore, further molecular analysis on surgical margins and additional research regarding their assessment are required.

  14. Extra-Margins in ACM's Adjusted NMa ‘Mortgage-Rate-Calculation Method

    NARCIS (Netherlands)

    Dijkstra, M.; Schinkel, M.P.


    We analyse the development since 2004 of our concept of extra-margins on Dutch mortgages (Dijkstra & Schinkel, 2012), based on funding cost estimations in ACM (2013), which are an update of those in NMa (2011). Neither costs related to increased mortgage-specific risks, nor the inclusion of Basel II

  15. 77 FR 8101 - Antidumping Proceedings: Calculation of the Weighted-Average Dumping Margin and Assessment Rate... (United States)


    ... captured. To illustrate this point, some draw on the ``speeding ticket'' analogy, whereby a driver caught... issue address only certain types of comparisons in particular circumstances, such that a total... types of comparison methodologies that might be used to determine margins of dumping and antidumping...

  16. A Positive Association Between Hospice Profit Margin And The Rate At Which Patients Are Discharged Before Death. (United States)

    Dolin, Rachel; Holmes, G Mark; Stearns, Sally C; Kirk, Denise A; Hanson, Laura C; Taylor, Donald H; Silberman, Pam


    Hospice care is designed to support patients and families through the final phase of illness and death. Yet for more than a decade, hospices have steadily increased the rate at which they discharge patients before death-a practice known as "live discharge." Although certain live discharges are consistent with high-quality care, regulators have expressed concern that some hospices' desire to maximize profits drives them to inappropriately discharge patients. We used Medicare claims data for 2012-13 and cost reports for 2011-13 to explore relationships between hospice-level financial margins and live discharge rates among freestanding hospices. Adjusted analyses showed positive and significant associations between both operating and total margins and hospice-level rates of live discharge: One-unit increases in operating and total margin were associated with increases of 3 percent and 4 percent in expected hospice-level live discharge rates, respectively. These findings suggest that additional research is needed to explore links between profitability and patient-centeredness in the Medicare hospice program. Project HOPE—The People-to-People Health Foundation, Inc.

  17. A Practice Improvement Project to Reduce Cesarean Surgical Site Infection Rates. (United States)

    Holland, Cindra; Foster, Peggy; Ulrich, Deborah; Adkins, Kathryn

    We implemented an evidence-based practice improvement project at a health care facility in the Midwestern United States to address the increasing rate of cesarean surgical site infections. Women who experienced cesarean birth were cared for using a standardized evidence-based protocol including preoperative and postoperative care and education. In addition, a team-created educational video was used by both women and their families during the postoperative period and at home after discharge. This new protocol resulted in a decrease in the rate of cesarean surgical site infections from 1.35% in 2013 to 0.7% in 2014 and 0.36% in 2015. Our interdisciplinary approach to integrate best-practice strategies resulted in decreased infection rates and improved patient satisfaction scores. © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

  18. Medicaid status is associated with higher surgical site infection rates after spine surgery. (United States)

    Manoso, Mark W; Cizik, Amy M; Bransford, Richard J; Bellabarba, Carlo; Chapman, Jens; Lee, Michael J


    The Spine End Results Registry (2003-2004) is a registry of prospectively collected data of all patients undergoing spinal surgery at the University of Washington Medical Center and Harborview Medical Center. Insurance data were prospectively collected and used in multivariate analysis to determine risk of perioperative complications. Given the negative financial impact of surgical site infections (SSIs) and the higher overall complication rates of patients with a Medicaid payer status, we hypothesized that a Medicaid payer status would have a significantly higher SSI rate. The medical literature demonstrates lesser outcomes and increased complication rates in patients who have public insurance than those who have private insurance. No one has shown that patients with a Medicaid payer status compared with Medicare and privately insured patients have a significantly increased SSI rate for spine surgery. The prospectively collected Spine End Results Registry provided data for analysis. SSI was defined as treatment requiring operative debridement. Demographic, social, medical, and the surgical severity index risk factors were assessed against the exposure of payer status for the surgical procedure. The population included Medicare (N = 354), Medicaid (N = 334), the Veterans' Administration (N = 39), private insurers (N = 603), and self-pay (N = 42). Those patients whose insurer was Medicaid had a 2.06 odds (95% confidence interval: 1.19-3.58, P = 0.01) of having a SSI compared with the privately insured. The study highlights the increased cost of spine surgical procedures for patients with a Medicaid payer status with the passage of the Patient Protection and Affordable Care Act of 2010. The Patient Protection and Affordable Care Act of 2010 provisions could cause a reduction in reimbursement to the hospital for taking care of patients with Medicaid insurance due to their higher complication rates and higher costs. This very issue could inadvertently lead to access

  19. Endocervical glandular involvement, positive endocervical surgical margin and multicentricity are more often associated with high-grade than low-grade squamous intraepithelial lesion. (United States)

    Kır, Gozde; Karabulut, Murat Hakan; Topal, Cumhur Selçuk; Yılmaz, Müberra Segmen


    The aim of this study was to compare the relative frequencies of endocervical glandular involvement (EGI), multicentricity, positive endocervical surgical margins (ESM) and positive vaginal surgical margins (VSM), and adenocarcinoma in situ of the cervix (AIS) between high-grade and low-grade squamous intraepithelial lesions (HSIL and LSIL, respectively). We identified 238 patients with squamous intraepithelial lesions/cervical intraepithelial neoplasia (CIN) who were treated by loop electrocautery excision (LEEP) or conventional cold-knife conization (CKC). A total of 223 (72 [32.3%] LSIL/CIN I; 85 [38.1%] HSIL/CIN II; 66 [29.6%] HSIL/CIN III; and 151 [67.7%], HSIL/CIN II + III) LEEP/CKC slides were histologically reviewed. The frequencies of EGI, positive ESM, and multicentricity were significantly higher in the HSIL/CIN II + III group than in the LSIL/CIN I group (P = 0.001, 0.001, and 0.025, respectively). Eighteen of the 72 (25%) LSIL/CIN I patients, 44 of the 85 (51.8%) HSIL/CIN II patients, and 60 of the 66 (90.9%) HSIL/CIN III patients (P = 0.001) showed EGI. In four of the 72 (5.6%) LSIL/CIN I patients, 18 of the 85 (21.2%) HSIL/CIN II patients, and 42 of the 66 (63.6%) HSIL/CIN III patients (P = 0.001), ESM was positive. Two of the 72 (2.8%) LSIL/CIN I patients, seven of the 85 (8.2%) HSIL/CIN II patients, and 11 of the 66 (16.7%) HSIL/CIN III patients (P = 0.016) were multicentric. The current study showed that EGI, positive ESM and multicentricity were more often associated with HSIL/CIN II + III than with LSIL/CIN I. Moreover, the frequencies of EGI, multicentricity, and positive ESM increased with increasing severity of the cervical lesion. This result may influence the preference for the type of surgical procedure used for patients with cytological diagnosis of HSIL. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

  20. Reduction in Surgical Wound Infection Rates Associated with Reporting Data to Surgeons

    Directory of Open Access Journals (Sweden)

    GD Taylor


    Full Text Available Several studies have shown that wound infection (surgical site infection [ ssi ] rates fall when surgeons are provided with data on their performance. Since 1987, the authors have been performing concurrent surveillance of surgical patients and confidentially reporting surgeon-specific ssi rates to individual surgeons and their clinical directors, and providing surgeons with the mean rates of their peers. The program has been gradually refined and expanded. Data are now collected on wound infection risk and report risk adjusted rates compared with the mean for hospitals in the United States National Nosocomial Infections Surveillance (nnis data bank. Since inception through to December 1993, ssi rates have fallen 68% in clean contaminated general surgery cases (relative risk [rr] 0.36, 95% ci 0.2 to 0.6, P=0.0001, 64% in clean plastic surgery cases (rr 0.35, 95% ci 0.06 to 1.8, 72% in caesarean section cases (rr 0.23, 95% ci 0.03 to 1.96 and 42% in clean cardiovascular surgery cases (rr 0.59, 95% ci 0.34 to 1.0. In clean orthopedic surgery the ssi rate remained stable from 1987 through 1992. In 1993 a marked increase was experienced. Reasons for this are being explored. Overall there was a 32% decrease in ssi rate between the index year and 1993 or, in percentage terms, 2.8% to 1.9% (rr 0.65, 95% ci 0.51 to 0.86, P=0.002. ssi surveillance should become standard in Canadian hospitals interested in improving the quality of surgical care and reducing the clinical impact and cost associated with nosocomial infection.

  1. Value of volume measurements in evaluating abdominal aortic aneurysms growth rate and need for surgical treatment

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    Kontopodis, Nikolaos, E-mail: [Department of Vascular Surgery, University of Crete Medical School, Heraklion (Greece); Metaxa, Eleni, E-mail: [Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, Heraklion, Crete (Greece); Papaharilaou, Yannis, E-mail: [Institute of Applied and Computational Mathematics, Foundation for Research and Technology-Hellas, Heraklion, Crete (Greece); Georgakarakos, Efstratios, E-mail: [Vascular Surgery Department, “Demokritus” University of Thrace Medical School, Alexandroupolis (Greece); Tsetis, Dimitris, E-mail: [Interventional Radiology Unit, Department of Radiology, University of Crete Medical School, Heraklion, Crete (Greece); Ioannou, Christos V., E-mail: [Department of Vascular Surgery, University of Crete Medical School, Heraklion (Greece)


    Purpose: To examine whether indices other than the traditionally used abdominal aortic aneurysm (AAA) maximum diameter, such as AAA volume, intraluminal thrombus (ILT) thickness and ILT volume, may be superior to evaluate aneurismal enlargement. Materials and methods: Thirty-four small AAAs (initially presenting a maximum diameter <5.5 cm which is the threshold for surgical repair) with an initial and a follow-up CT were examined. Median increase and percentile annual change of these variables was calculated. Correlation between growth rates as determined by the new indices under evaluation and those of maximum diameter were assessed. AAAs were divided according to outcome (surveillance vs. elective repair after follow-up which is based on the maximum diameter criterion) and according to growth rate (high vs. low) based on four indices. Contingency between groups of high/low growth rate regarding each of the four indices on one hand and those regarding need for surgical repair on the other was assessed. Results: A strong correlation between growth rates of maximum diameter and those of AAA and ILT volumes could be established. Evaluation of contingency between groups of outcome and those of growth rate revealed significant associations only for AAA and ILT volumes. Subsequently AAAs with a rapid volumetric increase over time had a likelihood ratio of 10 to be operated compared to those with a slower enlargement. Regarding increase of maximum diameter, likelihood ratio between AAAs with rapid and those with slow expansion was only 3. Conclusion: Growth rate of aneurysms regarding 3Dimensional indices of AAA and ILT volumes is significantly associated with the need for surgical intervention while the same does not hold for growth rates determined by 2Dimensional indices of maximum diameter and ILT thickness.

  2. Still High: Marginal Effective Tax Rates on Low-Income Families


    Finn Poschmann


    Most federal and provincial government benefits for families with children are sharply income-tested. Reductions in these benefits, as family income rises, mean that low-income families face much higher effective tax rates than most others do, and deny such families the full benefit of the broad-based tax rate relief other Canadians have enjoyed in recent years.

  3. Preoperative hair removal with clippers does not increase infection rate in clean surgical wounds. (United States)

    Olson, M M; MacCallum, J; McQuarrie, D G


    For a one year period, hair was removed from the operative site with clippers rather than by shaving with a razor or by application of depilatories. The study involved comparison of clean (Class I) wound infection rates in 2,580 patients after clipping was instituted compared with 17,424 patients studied in seven preceding years. There was no significant change in the wound infection rate (1 per cent) when compared with the three years immediately preceding. There was no change in the identified distribution of the infecting organism. Failure to show a clear reduction in wound infection rate was probably related to the low historic base line rate. There were definite benefits achieved by avoiding cancellation of elective operations, by using operating room personnel more efficiently and by expediating the surgical schedule.

  4. Hand-rubbing with an aqueous alcoholic solution vs traditional surgical hand-scrubbing and 30-day surgical site infection rates: a randomized equivalence study. (United States)

    Parienti, Jean Jacques; Thibon, Pascal; Heller, Remy; Le Roux, Yannick; von Theobald, Peter; Bensadoun, Henri; Bouvet, Alain; Lemarchand, François; Le Coutour, Xavier; Bensadoun, Hervé


    Surgical site infections prolong hospital stays, are among the leading nosocomial causes of morbidity, and a source of excess medical costs. Clinical studies comparing the risk of nosocomial infection after different hand antisepsis protocols are scarce. To compare the effectiveness of hand-cleansing protocols in preventing surgical site infections during routine surgical practice. Randomized equivalence trial. Six surgical services from teaching and nonteaching hospitals in France. A total of 4387 consecutive patients who underwent clean and clean-contaminated surgery between January 1, 2000, and May 1, 2001. Surgical services used 2 hand-cleansing methods alternately every other month: a hand-rubbing protocol with 75% aqueous alcoholic solution containing propanol-1, propanol-2, and mecetronium etilsulfate; and a hand-scrubbing protocol with antiseptic preparation containing 4% povidone iodine or 4% chlorhexidine gluconate. Thirty-day surgical site infection rates were the primary end point; operating department teams' tolerance of and compliance with hand antisepsis were secondary end points. The 2 protocols were comparable in regard to surgical site infection risk factors. Surgical site infection rates were 55 of 2252 (2.44%) in the hand-rubbing protocol and 53 of 2135 (2.48%) in the hand-scrubbing protocol, for a difference of 0.04% (95% confidence interval, -0.88% to 0.96%). Based on subsets of personnel, compliance with the recommended duration of hand antisepsis was better in the hand-rubbing protocol of the study compared with the hand-scrubbing protocol (44% vs 28%, respectively; P =.008), as was tolerance, with less skin dryness and less skin irritation after aqueous solution use. Hand-rubbing with aqueous alcoholic solution, preceded by a 1-minute nonantiseptic hand wash before each surgeon's first procedure of the day and before any other procedure if the hands were soiled, was as effective as traditional hand-scrubbing with antiseptic soap in

  5. Success rate of anterior open-bite orthodontic-orthognathic surgical treatment. (United States)

    Jensen, Ute; Ruf, Sabine


    The aim was to evaluate the short-term success rate of combined orthodontic-orthognathic surgical correction of anterior open bite. Fifteen patients (ages, 15-28 years) with open bite treated with a combined orthodontic-surgical approach were examined. Lateral cephalograms from before treatment, after treatment, and after an average of 18 months (range, 10-26 months) of retention were evaluated. Overbite was classified as normal (2-3.5 mm), borderline (0-1.5 mm), or relapse (overjet as normal (2-3.5 mm) or relapse (≥4 and ≤1.5 mm). The average overbite was -3.2 mm before treatment, 1.8 mm after treatment, and 1.3 mm after retention. During active treatment, overbite and overjet were normalized in 53.3% and 66.7% of the subjects, respectively. After the retention period, 1 patient (6.7%) showed a negative overbite, whereas a borderline overbite was found in 53.3% of the subjects. Overjet relapsed in 40% of the subjects. Only 40% of the patients had a completely successful treatment with incisal contact and normal overjet and overbite. Orthodontic-surgical treatment of anterior open bite improves the overbite, but an excellent treatment outcome with normal overjet and overbite and proper incisal contact was achieved in only 40% of the subjects. Copyright © 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  6. Surgical wound infection rates in Spain: data summary, January 1997 through June 2012. (United States)

    Díaz-Agero Pérez, Cristina; Robustillo Rodela, Ana; Pita López, María José; López Fresneña, Nieves; Monge Jodrá, Vicente


    The Indicadores Clínicos de Mejora Continua de la Calidad (INCLIMECC) program was established in Spain in 1997. INCLIMECC is a prospective system of health care-associated infection (HAI) surveillance that collects incidence data in surgical and intensive care unit patients. The protocol is based on the National Healthcare Safety Network (NHSN) surveillance system, formerly known as the National Nosocomial Infection Surveillance (NNIS) system, and uses standard infection definitions from the US Centers for Disease Control and Prevention. Each hospital takes part voluntarily and selects the units and surgical procedures to be surveyed. This report is a summary of the data collected between January 1997 and June 2012. A total of 370,015 patients were included, and the overall incidence of surgical wound infection (SWI) was 4.51%. SWI rates are provided by NHSN operating procedure category and NNIS risk index category. More than 27% of the patients received inadequate antibiotic prophylaxis, the main reason being unsuitable duration (57.05% of cases). Today, the INCLIMECC network includes 64 Spanish hospitals. We believe that an HAI surveillance system with trained personnel external to the surveyed unit is a key component not only in infection control and prevention, but also in a quality improvement system. Copyright © 2014. Published by Mosby, Inc.

  7. Fast rates of subduction erosion along the Costa Rica Pacific margin: Implications for nonsteady rates of crustal recycling at subduction zones (United States)

    Vannucchi, P.; Ranero, C.R.; Galeotti, S.; Straub, S.M.; Scholl, D. W.; McDougall-Ried, K.


    At least since the middle Miocene (???16 Ma), subduction erosion has been the dominant process controlling the tectonic evolution of the Pacific margin of Costa Rica. Ocean Drilling Program Site 1042 recovered 16.5 Ma nearshore sediment at ???3.9 km depth, ???7 km landward of the trench axis. The overlying Miocene to Quaternary sediment contains benthic foraminifera documenting margin subsidence from upper bathyal (???200 m) to abyssal (???2000 m) depth. The rate of subsidence was low during the early to middle Miocene but increased sharply in the late Miocene-early Pliocene (5-6.5 Ma) and at the Pliocene-Pleistocene boundary (2.4 Ma). Foraminifera data, bedding dip, and the geometry of slope sediment indicate that tilting of the forearc occurred coincident with the onset of rapid late Miocene subsidence. Seismic images show that normal faulting is widespread across the continental slope; however, extension by faulting only accounts for a minor amount of the post-6.5 Ma subsidence. Basal tectonic erosion is invoked to explain the subsidence. The short-term rate of removal of rock from the forearc is about 107-123 km3 Myr-1 km-1. Mass removal is a nonsteady state process affecting the chemical balance of the arc: the ocean sediment input, with the short-term erosion rate, is a factor of 10 smaller than the eroded mass input. The low 10Be concentration in the volcanic arc of Costa Rica could be explained by dilution with eroded material. The late Miocene onset of rapid subsidence is coeval with the arrival of the Cocos Ridge at the subduction zone. The underthrusting of thick and thermally younger ocean crust decreased the subduction angle of the slab along a large segment of the margin and changed the dynamic equilibrium of the margin taper. This process may have induced the increase in the rate of subduction erosion and thus the recycling of crustal material to the mantle. Copyright 2003 by the American Geophysical Union.

  8. ExtraLevatory AbdominoPerineal Excision (ELAPE) Does Not Result in Reduced Rate of Tumor Perforation or Rate of Positive Circumferential Resection Margin

    DEFF Research Database (Denmark)

    Klein, Mads; Fischer, Anders; Rosenberg, Jacob


    OBJECTIVE: To evaluate the oncological results and possible benefits associated with extralevatory abdominoperineal excision (ELAPE) when compared with conventional abdominoperineal excision (APE). BACKGROUND: ELAPE was introduced in 2007 with the purpose of reducing the rate of positive resection...... margins after resection of low rectal cancers. Preliminary studies have shown promising results. No large-scale or nationwide data have been presented. METHODS: Database study based on data from the Danish Colorectal Cancer Group's prospective database. Data on all ELAPEs and APEs performed in Denmark...

  9. Rates and risk factors of unplanned 30-day readmission following general and thoracic pediatric surgical procedures. (United States)

    Polites, Stephanie F; Potter, Donald D; Glasgow, Amy E; Klinkner, Denise B; Moir, Christopher R; Ishitani, Michael B; Habermann, Elizabeth B


    Postoperative unplanned readmissions are costly and decrease patient satisfaction; however, little is known about this complication in pediatric surgery. The purpose of this study was to determine rates and predictors of unplanned readmission in a multi-institutional cohort of pediatric surgical patients. Unplanned 30-day readmissions following general and thoracic surgical procedures in children Pediatric. Time-dependent rates of readmission per 30 person-days were determined to account for varied postoperative length of stay (pLOS). Patients were randomly divided into 70% derivation and 30% validation cohorts which were used for creation and validation of a risk model for readmission. Readmission occurred in 1948 (3.6%) of 54,870 children for a rate of 4.3% per 30 person-days. Adjusted predictors of readmission included hepatobiliary procedures, increased wound class, operative duration, complications, and pLOS. The predictive model discriminated well in the derivation and validation cohorts (AUROC 0.710 and 0.701) with good calibration between observed and expected readmission events in both cohorts (p>.05). Unplanned readmission occurs less frequently in pediatric surgery than what is described in adults, calling into question its use as a quality indicator in this population. Factors that predict readmission including type of procedure, complications, and pLOS can be used to identify at-risk children and develop prevention strategies. III. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Cognitive Multiple-Antenna Network with Outage and Rate Margins at the Primary System

    DEFF Research Database (Denmark)

    Maham, Behrouz; Popovski, Petar


    In the common model for spectrum sharing, cognitive users can access the spectrum as long as the target performance in the legitimate primary system is not violated. In this paper, we consider a downlink primary multiple-inputsingle- output (MISO) system which operates under a controlled interfer......In the common model for spectrum sharing, cognitive users can access the spectrum as long as the target performance in the legitimate primary system is not violated. In this paper, we consider a downlink primary multiple-inputsingle- output (MISO) system which operates under a controlled...... interference from the downlink MISO cognitive radio, also called secondary system. We derive exact expressions for outage probability of the primary user under Rayleigh fading, when the primary system is exposed to interference from a secondary base station. We treat three different operating modes...... of the adaptive-rate transmit-beamforming primary system and the adaptive-rate transmit antenna-selection primary system. The analytical results are confirmed by simulations, in which we analyze the impact of different parameters, such as the number of antennas and the amount of the interference on the system...

  11. Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Moran, Meena S. [Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut (United States); Schnitt, Stuart J. [Department of Pathology, Harvard Medical School, Boston, Massachusetts (United States); Giuliano, Armando E. [Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California (United States); Harris, Jay R. [Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts (United States); Khan, Seema A. [Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois (United States); Horton, Janet [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Klimberg, Suzanne [Department of Surgery, University of Arkansas for Medical Sciences, Fayetteville, Arkansas (United States); Chavez-MacGregor, Mariana [Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Freedman, Gary [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (United States); Houssami, Nehmat [School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales (Australia); Johnson, Peggy L. [Advocate in Science, Susan G. Komen, Wichita, Kansas (United States); Morrow, Monica, E-mail: [Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)


    Purpose: To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy. Methods and Materials: A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. Results: Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. Conclusions: The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.

  12. Surgical technique, fusion rates, and planovalgus foot deformity correction with naviculocuneiform fusion. (United States)

    Ajis, Adam; Geary, Nicholas


    Arthrodesis of the naviculocuneiform (NC) joints is not a common procedure, as it is perceived by many to be less reliable or less predictable than arthrodesis of proximal or distal joints in the medial column. There is a subset of patients with planovalgus feet, cavovarus feet, and degenerative arthritis who also have an apex of deformity at the NC joints in whom fusion is indicated. The surgical technique, fusion rates, and deformity correction data for NC fusion in planovalgus feet are evaluated in this report. Twenty-eight patients (33 feet) who underwent surgery between October 2008 and November 2012 were identified who had NC fusion as their only arthrodesis procedure. Medical records and radiographs were reviewed, and time to union was calculated. Twenty patients from that group underwent NC fusion for symptomatic planovalgus feet, and their preoperative and last postoperative weight-bearing radiographs were reviewed and compared for deformity correction. All patients were operated on by the senior author or a senior foot and ankle trainee during fellowship using the same surgical technique, and all patients followed a standardized postoperative rehabilitation protocol. Mean time to union for all 33 NC fusions was 21.7 ± 2 weeks (mean ± SEM). One patient underwent revision for nonunion, resulting in an arthrodesis rate of 97%. For NC fusions in those with planovalgus feet, an improvement in mean lateral talus-first metatarsal angle (Meary's line) from 12.3 ± 1.3 degrees to 5.2 ± 1.2 degrees (P treatment for their condition. NC fusion was a safe and predictable procedure for any of its indications, with a fusion rate similar to that of other joints in the foot albeit with a longer time to union. For patients with symptomatic and flexible planovalgus feet, NC fusion resulted in deformity correction in multiple planes and good symptomatic relief. Level IV, retrospective case series.

  13. [Post-appendectomy surgical site infection: overall rate and type according to open/laparoscopic approach]. (United States)

    Aranda-Narváez, José Manuel; Prieto-Puga Arjona, Tatiana; García-Albiach, Beatriz; Montiel-Casado, María Custodia; González-Sánchez, Antonio Jesús; Sánchez-Pérez, Belinda; Titos-García, Alberto; Santoyo-Santoyo, Julio


    To compare the incidence and profile of surgical site infection (SSI) after laparoscopic (LA) or open (OA) appendicectomy. Observational and analytical study was conducted on patients older than 14years-old with suspected acute appendicitis operated on within a 4-year period (2007-2010) at a third level hospital (n=868). They were divided in two groups according to the type of appendicectomy (LA, study group, 135; OA, control group, 733). The primary endpoint was a surgical site infection (SSI), and to determine the overall rate and types (incisional/organ-space). The risk of SSI was stratified by: i)National Nosocomial Infection Surveillance (NNIS) index (low risk: 0E, 0 and 1; high risk: 2 and 3); ii)status on presentation (low risk: normal or phlegmonous; high risk: gangrenous or perforated). The statistical analysis was performed using the software SPSS. The main result and stratified analysis was determined with χ(2), and the risk parameters using OR and Mantel-Haenszel OR with 95%CI, accepting statistical significance with P<.05. Age, gender, ASA index and incidence of advanced cases were similar in both groups. The overall SSI rate was 13.4% (more than a half of them detected during follow-up after discharge). Type of SSI: OA, 13% (superficial 9%, deep 2%, organ-space 2%); AL, 14% (superficial 5%, deep 1%, organ-space 8%) (overall: not significant; distribution: P<.000). Stratified analysis showed that there is an association between incisional SSI/OA and organ-space SSI/LA, and is particularly stronger in those patients with high risk of postoperative SSI (high risk NNIS or gangrenous-perforated presentation). OA and LA are associated with a higher rate of incisional and organ-space SSI respectively. This is particularly evident in patients with high risk of SSI. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  14. Surgical Site Infections Rates in More Than 13,000 Surgical Procedures in Three Cities in Peru: Findings of the International Nosocomial Infection Control Consortium. (United States)

    Ramírez-Wong, Fernando M; Atencio-Espinoza, Teodora; Rosenthal, Victor D; Ramirez, Eliza; Torres-Zegarra, Socorro L; Díaz Tavera, Zoila Rosa; Sarmiento López, Favio; Silva Astete, Nazario; Campos Guevara, Francisco; Bazan Mendoza, Carlos; Valencia Ramírez, Augusto; Soto Pastrana, Javier


    Surgical site infections (SSIs) are a threat to patient safety. However, there are not available data on SSI rates stratified by surgical procedure (SP) in Peru. From January 2005 to December 2010, a cohort prospective surveillance study on SSIs was conducted by the International Nosocomial Infection Control Consortium (INICC) in four hospitals in three cities of Peru. Data were recorded from hospitalized patients using the U.S. Centers for Disease Control and Prevention-National Healthcare Safety Network (CDC-NHSN) methods and definitions for SSI. Surgical procedures (SPs) were classified into 4 types, according to ICD-9 criteria. We recorded 352 SSIs, associated to 13,904 SPs (2.5%; CI, 2.3-2.8) SSI rates per type of SP were the following for this study's Peruvian hospitals, compared with rates of the INICC and CDC-NHSN reports, respectively: 2.9% for appendix surgery (vs. 2.9% vs. 1.4%); 2.8% for gallbladder surgery (vs. 2.5% vs. 0.6%); 2.2% for cesarean section (vs. 0.7% vs. 1.8%); 2.8% for vaginal hysterectomy (vs. 2.0% vs. 0.9%). Our SSIs rates were higher in all of the four analyzed types of SPs compared with CDC-NHSN, whereas compared with INICC, most rates were similar. This study represents an important advance in the knowledge of SSI epidemiology in Peru that will allow us to introduce targeted interventions.

  15. Effect of Semi-quantitative Culture Results from Complex Host Surgical Wounds on Dehiscence Rates. (United States)

    Elmarsafi, Tammer; Garwood, Caitlin S; Steinberg, John S; Evans, Karen K; Attinger, Christopher E; Kim, Paul J


    The primary aim of this study was to determine the effect of positive bacterial cultures at the time of closure on dehiscence rates. Pre and post-débridement wound cultures from patients undergoing serial surgical débridement of infected wounds were compared with outcomes 30 days postoperatively. One-hundred patients were enrolled; 35 were excluded for incomplete culture data. Sixty-five patients were evaluated for species counts, including Coagulase negative Staphylococcus, and semi-quantitative culture data for each débridement. The post-débridement cultures on the date of closure had no growth in 42 patients (64.6%) of which 6 dehisced (14.3%), and 36 remained closed; with no statistically significant difference in dehiscence rates (p=0.0664). Pre-débridement cultures from the 1(st) débridement of the 65 patients showed 8 patients had no growth, 29 grew 1 species, 19 grew 2 species, and 9 had 3-5 species. There was a reduction in the number of species and improvement of semi-quantitative cultures with each subsequent débridement. The dehiscence rate for those who had 2 débridements (n=42) was 21.4% at 30 day follow-up and 21.7% in those who had 3 débridements (n=23). The number of débridements had no statistical significance on dehiscence rates. The presence of Coagulase negative Staphylococcus (CoNS) on the day of closure was a statistically significant risk for dehiscence within 30 days (p=0.0091) postoperatively. This data demonstrates: (1) positive post-débridement cultures (scant/rare, growth in enrichment broth) at the time of closure did not affect overall dehiscence rates (p=0.0664), (2) the number of species and semi-quantitiative culture results both improved with each subsequent débridement, (3) the number of surgical débridement did not influence post-closure dehiscence rates. (4) Positive cultures containing Coagulase negative Staphylococcus at the time of closure is a risk factor for dehiscence (p=0.0091). This article is protected by

  16. Assessment of Margins in Transoral Laser and Robotic Surgery

    Directory of Open Access Journals (Sweden)

    Yaniv Hamzany


    Full Text Available The growing practice of endoscopic surgery has changed the therapeutic management of selected head and neck cancers. Although a negative surgical margin in resection of neoplasm is the most important surgical principle in oncologic surgery, controversies exist regarding assessment and interpretation of the status of margin resection. The aim of this review was to summarize the literature considering the assessment and feasibility of negative margins in transoral laser microsurgery (TLM and transoral robotic surgery (TORS. Free margin status is being approached differently in vocal cord cancer (1–2 mm compared with other sites in the upper aerodigestive tract (2–5 mm. Exposure, orientation of the pathological specimen, and co-operation with the pathologist are crucial principles needed to be followed in transoral surgery. Piecemeal resection to better expose deep tumor involvement and biopsies taken from surgical margins surrounding site of resection can improve margin assessment. High rates of negative surgical margins can be achieved with TLM and TORS. Adjuvant treatment decision should take into consideration also the surgeon’s judgment with regard to the completeness of tumor resection.

  17. Using Marginal Structural Modeling to Estimate the Cumulative Impact of an Unconditional Tax Credit on Self-Rated Health. (United States)

    Pega, Frank; Blakely, Tony; Glymour, M Maria; Carter, Kristie N; Kawachi, Ichiro


    In previous studies, researchers estimated short-term relationships between financial credits and health outcomes using conventional regression analyses, but they did not account for time-varying confounders affected by prior treatment (CAPTs) or the credits' cumulative impacts over time. In this study, we examined the association between total number of years of receiving New Zealand's Family Tax Credit (FTC) and self-rated health (SRH) in 6,900 working-age parents using 7 waves of New Zealand longitudinal data (2002-2009). We conducted conventional linear regression analyses, both unadjusted and adjusted for time-invariant and time-varying confounders measured at baseline, and fitted marginal structural models (MSMs) that more fully adjusted for confounders, including CAPTs. Of all participants, 5.1%-6.8% received the FTC for 1-3 years and 1.8%-3.6% for 4-7 years. In unadjusted and adjusted conventional regression analyses, each additional year of receiving the FTC was associated with 0.033 (95% confidence interval (CI): -0.047, -0.019) and 0.026 (95% CI: -0.041, -0.010) units worse SRH (on a 5-unit scale). In the MSMs, the average causal treatment effect also reflected a small decrease in SRH (unstabilized weights: β = -0.039 unit, 95% CI: -0.058, -0.020; stabilized weights: β = -0.031 unit, 95% CI: -0.050, -0.007). Cumulatively receiving the FTC marginally reduced SRH. Conventional regression analyses and MSMs produced similar estimates, suggesting little bias from CAPTs.

  18. Laparoscopic Gastric Plication: An Emerging Bariatric Procedure with High Surgical Revision Rate. (United States)

    Albanese, Alice; Prevedello, Luca; Verdi, Daunia; Nitti, Donato; Vettor, Roberto; Foletto, Mirto


    Introduction: Laparoscopic gastric plication (LGCP) reduces gastric volume without resecting or implanting a foreign body. Although still considered investigational, it could be appropriate for young patients with a low body mass index (BMI) and for those unwilling to undergo sleeve gastrectomy, gastric banding, or bypass. Objectives: The aim of this study was to assess the mid-term results (2 years) of LGCP in terms of safety and efficacy. Methods: A total of 56 obese patients (47 female; mean age=30.5±11.7 years; mean BMI=40.31±4.7 kg/m(2)) were candidates for LGCP from January 2011 to October 2013. Early and late complications, BMI, and excess BMI loss (EBL) were prospectively recorded at 3, 6, 9, 12, 18, and 24 months follow-up. Results: Mean operative time was 72.4±15.6 minutes. No conversion was required. Mean hospital stay was 3 days. Mean %EBL was 34.3±18.40%, 40.1±24.5%, 47.4±30.2%, 46.5±34.6%, 47.8±43.2%, and 55.3±53.6% at 3, 6, 9, 12, 18, and 24 months, respectively. The overall complication rate was 32.14%. Perioperative mortality was zero. Surgical revision was needed in 30 patients: 12 for unsatisfactory weight loss and 18 for gastric prolapse (one acute within 30 days), respectively. Conclusion: LGCP showed high complication rates requiring surgical revision.

  19. Laparoscopic Gastric Plication: An Emerging Bariatric Procedure with High Surgical Revision Rate (United States)

    Albanese, Alice; Prevedello, Luca; Verdi, Daunia; Nitti, Donato; Vettor, Roberto


    Introduction: Laparoscopic gastric plication (LGCP) reduces gastric volume without resecting or implanting a foreign body. Although still considered investigational, it could be appropriate for young patients with a low body mass index (BMI) and for those unwilling to undergo sleeve gastrectomy, gastric banding, or bypass. Objectives: The aim of this study was to assess the mid-term results (2 years) of LGCP in terms of safety and efficacy. Methods: A total of 56 obese patients (47 female; mean age=30.5±11.7 years; mean BMI=40.31±4.7 kg/m2) were candidates for LGCP from January 2011 to October 2013. Early and late complications, BMI, and excess BMI loss (EBL) were prospectively recorded at 3, 6, 9, 12, 18, and 24 months follow-up. Results: Mean operative time was 72.4±15.6 minutes. No conversion was required. Mean hospital stay was 3 days. Mean %EBL was 34.3±18.40%, 40.1±24.5%, 47.4±30.2%, 46.5±34.6%, 47.8±43.2%, and 55.3±53.6% at 3, 6, 9, 12, 18, and 24 months, respectively. The overall complication rate was 32.14%. Perioperative mortality was zero. Surgical revision was needed in 30 patients: 12 for unsatisfactory weight loss and 18 for gastric prolapse (one acute within 30 days), respectively. Conclusion: LGCP showed high complication rates requiring surgical revision. PMID:26421246

  20. Developing algorithms for healthcare insurers to systematically monitor surgical site infection rates

    Directory of Open Access Journals (Sweden)

    Livingston James M


    Full Text Available Abstract Background Claims data provide rapid indicators of SSIs for coronary artery bypass surgery and have been shown to successfully rank hospitals by SSI rates. We now operationalize this method for use by payers without transfer of protected health information, or any insurer data, to external analytic centers. Results We performed a descriptive study testing the operationalization of software for payers to routinely assess surgical infection rates among hospitals where enrollees receive cardiac procedures. We developed five SAS programs and a user manual for direct use by health plans and payers. The manual and programs were refined following provision to two national insurers who applied the programs to claims databases, following instructions on data preparation, data validation, analysis, and verification and interpretation of program output. A final set of programs and user manual successfully guided health plan programmer analysts to apply SSI algorithms to claims databases. Validation steps identified common problems such as incomplete preparation of data, missing data, insufficient sample size, and other issues that might result in program failure. Several user prompts enabled health plans to select time windows, strata such as insurance type, and the threshold number of procedures performed by a hospital before inclusion in regression models assessing relative SSI rates among hospitals. No health plan data was transferred to outside entities. Programs, on default settings, provided descriptive tables of SSI indicators stratified by hospital, insurer type, SSI indicator (inpatient, outpatient, antibiotic, and six-month period. Regression models provided rankings of hospital SSI indicator rates by quartiles, adjusted for comorbidities. Programs are publicly available without charge. Conclusion We describe a free, user-friendly software package that enables payers to routinely assess and identify hospitals with potentially high SSI

  1. Stratification of surgical site infection by operative factors and comparison of infection rates after hernia repair. (United States)

    Olsen, Margaret A; Nickel, Katelin B; Wallace, Anna E; Mines, Daniel; Fraser, Victoria J; Warren, David K


    To investigate whether operative factors are associated with risk of surgical site infection (SSI) after hernia repair. Retrospective cohort study. Patients Commercially insured enrollees aged 6 months-64 years with International Classification of Diseases, Ninth Revision, Clinical Modification procedure or Current Procedural Terminology, fourth edition, codes for inguinal/femoral, umbilical, and incisional/ventral hernia repair procedures from January 1, 2004, through December 31, 2010. SSIs within 90 days after hernia repair were identified by diagnosis codes. The χ2 and Fisher exact tests were used to compare SSI incidence by operative factors. A total of 119,973 hernia repair procedures were analyzed. The incidence of SSI differed significantly by anatomic site, with rates of 0.45% (352/77,666) for inguinal/femoral, 1.16% (288/24,917) for umbilical, and 4.11% (715/17,390) for incisional/ventral hernia repair. Within anatomic sites, the incidence of SSI was significantly higher for open versus laparoscopic inguinal/femoral (0.48% [295/61,142] vs 0.34% [57/16,524], P=.020) and incisional/ventral (4.20% [701/16,699] vs 2.03% [14/691], P=.005) hernia repairs. The rate of SSI was higher following procedures with bowel obstruction/necrosis than procedures without obstruction/necrosis for open inguinal/femoral (0.89% [48/5,422] vs 0.44% [247/55,720], P<.001) and umbilical (1.57% [131/8,355] vs 0.95% [157/16,562], P<.001), but not incisional/ventral hernia repair (4.01% [224/5,585] vs 4.16% [491/11,805], P=.645). The incidence of SSI was highest after open procedures, incisional/ventral repairs, and hernia repairs with bowel obstruction/necrosis. Stratification of hernia repair SSI rates by some operative factors may facilitate accurate comparison of SSI rates between facilities.

  2. Expansion rate and geometry of floating vegetation mats on the margins of thermokarst lakes, northern Seward Peninsula, Alaska, USA (United States)

    Parsekian, A.D.; Jones, Benjamin M.; Jones, M.; Grosse, G.; Walter, Anthony K.M.; Slater, L.


    Investigations on the northern Seward Peninsula in Alaska identified zones of recent (<50years) permafrost collapse that led to the formation of floating vegetation mats along thermokarst lake margins. The occurrence of floating vegetation mat features indicates rapid degradation of near-surface permafrost and lake expansion. This paper reports on the recent expansion of these collapse features and their geometry is determined using geophysical and remote sensing measurements. The vegetation mats were observed to have an average thickness of 0.57m and petrophysical modeling indicated that gas content of 1.5-5% enabled floatation above the lake surface. Furthermore, geophysical investigation provides evidence that the mats form by thaw and subsidence of the underlying permafrost rather than terrestrialization. The temperature of the water below a vegetation mat was observed to remain above freezing late in the winter. Analysis of satellite and aerial imagery indicates that these features have expanded at maximum rates of 1-2myr-1 over a 56year period. Including the spatial coverage of floating 'thermokarst mats' increases estimates of lake area by as much as 4% in some lakes. ?? 2011 John Wiley & Sons, Ltd.

  3. Annual failure rates and marginal bone-level changes of immediate compared to conventional loading of dental implants. A systematic review of the literature and meta-analysis.

    NARCIS (Netherlands)

    Engelhardt, S.; Papacosta, P.; Rathe, F.; Ozen, J.; Jansen, J.A.; Junker, R.


    BACKGROUND: Immediate loading of dental implants appears to be a successful option. Questions still remain whether annual failure rates (AFRs) as well as annual marginal bone-level changes are comparable with conventionally loaded implants. HYPOTHESIS: Immediately loaded implants (

  4. Decreased sperm DNA fragmentation after surgical varicocelectomy is associated with increased pregnancy rate. (United States)

    Smit, Marij; Romijn, Johannes C; Wildhagen, Mark F; Veldhoven, Joke L M; Weber, Robertus F A; Dohle, Gert R


    We prospectively evaluated changes in sperm chromatin structure in infertile patients before and after surgical repair of varicocele, and the impact on the pregnancy rate. Included in the study were 49 men with at least a 1-year history of infertility, a palpable varicocele and oligospermia. World Health Organization semen analysis and sperm DNA damage expressed as the DNA fragmentation index using the sperm chromatin structure assay were assessed preoperatively and postoperatively. Pregnancy (spontaneous and after assisted reproductive technique) was recorded 2 years after surgery. Mean sperm count, sperm concentration and sperm progressive motility improved significantly after varicocelectomy from 18.3 × 10(6) to 44.4 × 10(6), 4.8 × 10(6)/ml to 14.3 × 10(6)/ml and 16.7% to 26.6%, respectively (p DNA fragmentation index decreased significantly after surgery from 35.2% to 30.2% (p = 0.019). When the definition of greater than 50% improvement in sperm concentration after varicocelectomy was applied, 31 of 49 patients (63%) responded to varicocelectomy. After varicocelectomy 37% of the couples conceived spontaneously and 24% achieved pregnancy with assisted reproductive technique. The mean postoperative DNA fragmentation index was significantly higher in couples who did not conceive spontaneously or with assisted reproductive technique (p = 0.033). After varicocelectomy sperm parameters significantly improved and sperm DNA fragmentation was significantly decreased. Low DNA fragmentation index values are associated with a higher pregnancy rate (spontaneous and with assisted reproductive technique). We suggest that varicocelectomy should be considered in infertile men with palpable varicocele, abnormal semen analysis and no major female factors. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  5. The political economy of farmers' suicides in India: indebted cash-crop farmers with marginal landholdings explain state-level variation in suicide rates. (United States)

    Kennedy, Jonathan; King, Lawrence


    A recent Lancet article reported the first reliable estimates of suicide rates in India. National-level suicide rates are among the highest in the world, but suicide rates vary sharply between states and the causes of these differences are disputed. We test whether differences in the structure of agricultural production explain inter-state variation in suicides rates. This hypothesis is supported by a large number of qualitative studies, which argue that the liberalization of the agricultural sector in the early-1990s led to an agrarian crisis and that consequently farmers with certain socioeconomic characteristics-cash crops cultivators, with marginal landholdings, and debts-are at particular risk of committing suicide. The recent Lancet study, however, contends that there is no evidence to support this hypothesis. We report scatter diagrams and linear regression models that combine the new state-level suicide rate estimates and the proportion of marginal farmers, cash crop cultivation, and indebted farmers. When we include all variables in the regression equation there is a significant positive relationship between the percentage of marginal farmers, cash crop production, and indebted farmers, and suicide rates. This model accounts for almost 75% of inter-state variation in suicide rates. If the proportion of marginal farmers, cash crops, or indebted farmers were reduced by 1%, the suicide rate--suicides per 100,000 per year--would fall by 0 · 437, 0 · 518 or 0 · 549 respectively, when all other variables are held constant. Even if the Indian state is unable to enact land reforms due to the power of local elites, interventions to stabilize the price of cash crops and relieve indebted farmers may be effective at reducing suicide rates.

  6. Evaluation of the energy component in the main grid tariff and the use of marginal loss rates; Evaluering av energileddet i sentralnettstariffen og bruk av marginaltapssatser

    Energy Technology Data Exchange (ETDEWEB)

    Bjoerndal, Endre; Bjoerndal, Mette


    In this report, we make an evaluation of the energy component of the central grid tariff and the use of marginal loss rates. We will first review the theory of optimum transmission tariffs and describes how the marginal loss rates are calculated and how these are used in combination with the system price in the current transmission costs. We describe the trend in the Swedish marginal loss schedule, and we refer the very short development in the PJM area (U.S. east coast). As the Swedish and the Norwegian system is apparently based on the same principles, we problematize the lack of harmonization, since the systems actually are now very different. There is little doubt that Statnett has refined and improved methods for calculating the marginal loss rates, while ensuring that bottlenecks are still handled fairly easy by a few large price areas on Nord Pool Spot. We discuss the relationship between loss-tariff and congestion management, and we recommend that Statnett considering using the area price as the settlement price. This will make it much easier for operators to take account of losses. (Author)

  7. Complication rate after circumcision in a paediatric surgical setting should not be neglected

    DEFF Research Database (Denmark)

    Thorup, Jørgen; Thorup, Sebastian Cortes; Ifaoui, Inge Botker Rasmussen


    As a consequence of the discussion on whether the health benefits of newborn male circumcision outweigh the risks and the discrepancies in reported figures of complications, we evaluated our results from a paediatric surgical department.......As a consequence of the discussion on whether the health benefits of newborn male circumcision outweigh the risks and the discrepancies in reported figures of complications, we evaluated our results from a paediatric surgical department....

  8. The impact of Clostridum difficile on surgical rate among ulcerative colitis patients: A systemic review and meta-analysis. (United States)

    Peng, Jiang-Chen; Shen, Jun; Zhu, Qi; Ran, Zhi-Hua


    There is growing recognition of the impact of Clostridum difficile infection (CDI) on patients with inflammatory bowel disease. Clostridium difficile infection causes greater morbidity and mortality. This study aimed to evaluate the impact of C. difficile on surgical risk among ulcerative colitis (UC) patients. We searched the following databases: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, ACP Journal Club, DARE, CMR, and HTA. Studies were included if fulfilled the following criteria: (1) Cohort or case-control studies, which involved a comparison group that lacked CDI, (2) Patients were given a primary diagnosis of UC, (3) Comorbidity of CDI was evaluated by enzyme immunoassay of stool for C. difficile toxin A and B or C. difficile stool culture, (4) Studies evaluated surgical rate, and (5) Studies reported an estimate of odds ratio, accompanied by a corresponding measure of uncertainty. Five studies with 2380 patients fulfilled the inclusion criteria. Overall, meta-analysis showed that UC with CDI patients had a significant higher surgical rate than patients with UC alone. (OR=1.76, 95% CI=1.36-2.28). C. difficile infection increased the surgical rate in UC patients. However, results should be interpreted with caution, given the limitations of this stud.

  9. The impact of Clostridum difficile on surgical rate among ulcerative colitis patients: A systemic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Jiang-Chen Peng


    Full Text Available There is growing recognition of the impact of Clostridum difficile infection (CDI on patients with inflammatory bowel disease. Clostridium difficile infection causes greater morbidity and mortality. This study aimed to evaluate the impact of C. difficile on surgical risk among ulcerative colitis (UC patients. We searched the following databases: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, ACP Journal Club, DARE, CMR, and HTA. Studies were included if fulfilled the following criteria: (1 Cohort or case–control studies, which involved a comparison group that lacked CDI, (2 Patients were given a primary diagnosis of UC, (3 Comorbidity of CDI was evaluated by enzyme immunoassay of stool for C. difficile toxin A and B or C. difficile stool culture, (4 Studies evaluated surgical rate, and (5 Studies reported an estimate of odds ratio, accompanied by a corresponding measure of uncertainty. Five studies with 2380 patients fulfilled the inclusion criteria. Overall, meta-analysis showed that UC with CDI patients had a significant higher surgical rate than patients with UC alone. (OR=1.76, 95% CI=1.36–2.28. C. difficile infection increased the surgical rate in UC patients. However, results should be interpreted with caution, given the limitations of this stud.

  10. The Impact of Clostridum Difficile on Surgical Rate Among Ulcerative Colitis Patients: A Systemic Review and Meta-analysis (United States)

    Peng, Jiang-Chen; Shen, Jun; Zhu, Qi; Ran, Zhi-Hua


    There is growing recognition of the impact of Clostridum difficile infection (CDI) on patients with inflammatory bowel disease. Clostridium difficile infection causes greater morbidity and mortality. This study aimed to evaluate the impact of C. difficile on surgical risk among ulcerative colitis (UC) patients. We searched the following databases: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, ACP Journal Club, DARE, CMR, and HTA. Studies were included if fulfilled the following criteria: (1) Cohort or case–control studies, which involved a comparison group that lacked CDI, (2) Patients were given a primary diagnosis of UC, (3) Comorbidity of CDI was evaluated by enzyme immunoassay of stool for C. difficile toxin A and B or C. difficile stool culture, (4) Studies evaluated surgical rate, and (5) Studies reported an estimate of odds ratio, accompanied by a corresponding measure of uncertainty. Five studies with 2380 patients fulfilled the inclusion criteria. Overall, meta-analysis showed that UC with CDI patients had a significant higher surgical rate than patients with UC alone. (OR=1.76, 95% CI=1.36–2.28). C. difficile infection increased the surgical rate in UC patients. However, results should be interpreted with caution, given the limitations of this stud. PMID:26228363

  11. Prognostic factors affecting disease-free survival rate following surgical resection of primary breast cancer

    Directory of Open Access Journals (Sweden)

    K Horita


    Full Text Available In order to identify the prognostic factors that significantly influence the disease-free survival rate after surgical resection of primary breast cancers, we determined tumour and lymph node grades, and immunohistochemical staining for estrogen and progesterone receptors (ER and PR, c-erbB-2, p53, bcl-2, bax and PCNA in 76 patients. Univariate analysis showed that increased grade of tumour and lymph nodes, negative immunostaining for ER, positive immunostaining for c-erbB-2, and a high PCNA index (³30% negatively influenced the disease- free survival rate, but PR, p53, bcl-2 and bax had no predictive value. Although p53 was not an independent prognostic factor by itself, the combination of p53, bcl-2, and bax proved to correlate with the disease-free survival, with the best prognosis noted in tumours negative for p53 and positive for both bcl-2 and bax, intermediate prognosis in tumours negative for p53 and positive for either bcl- 2 or bax and worst prognosis in tumors negative for p53 as well as bcl-2 and bax. Tumour grade correlated positively with PCNA index, while positive staining for ER correlated negatively with tumour grade as well as with PCNA index, although this was statistically insignificant. Immunostaining of breast cancers for Bcl-2 correlated negatively with tumour grade and PCNA index. Immunostaining for c-erbB-2 correlated positively with PCNA but not with tumour grade. Immunostaining for p53 tended to correlate positively with PCNA, but not with tumour grade. Immunostaining for PR and bax did not correlate with tumour grade and PCNA index. These results suggest that in addition to tumour size and lymph node involvement, immunostaining for ER, c-erbB-2, and a high PCNA index are important prognostic factors in human breast cancer. Wild-type p53 with preserved bcl-2 and bax gene products is also a favorable prognostic factor indicating breast cancer at an early stage of cancer progression.

  12. Impact of postdischarge surveillance on surgical site infection rates for several surgical procedures: results from the nosocomial surveillance network in The Netherlands.

    NARCIS (Netherlands)

    Manniën, Judith; Wille, Jan C; Snoeren, Ruud L M M; Hof, Susan van den


    OBJECTIVE: To compare the number of surgical site infections (SSIs) registered after hospital discharge with respect to various surgical procedures and to identify the procedures for which postdischarge surveillance (PDS) is most important. DESIGN: Prospective SSI surveillance with voluntary PDS.

  13. Use of administrative data for surgical site infection surveillance after congenital cardiac surgery results in inaccurate reporting of surgical site infection rates. (United States)

    Atchley, Krista D; Pappas, Janine M; Kennedy, Andrea T; Coffin, Susan E; Gerber, Jeffrey S; Fuller, Stephanie M; Spray, Thomas L; McCardle, Kenneth; Gaynor, J William


    The National Healthcare Safety Network (NHSN) is a safety surveillance system managed by the Centers for Disease Control and Prevention that monitors procedure specific rates of surgical site infections (SSIs). At our institution, SSI data is collected and reported by three different methods: (1) the NHSN database with reporting to the Centers for Disease Control and Prevention; (2) the hospital billing database with reporting to payers; and (3) The Society of Thoracic Surgeons Congenital Heart Surgery Database. A quality improvement initiative was undertaken to better understand issues with SSI reporting and to evaluate the effect of different data sources on annual SSI rates. Annual cardiac surgery procedure volumes for all three data sources were compared. All episodes of SSI identified in any data source were reviewed and adjudicated using NHSN SSI criteria, and the effect on SSI rates was evaluated. From January 1, 2008, to December 31, 2011, 2,474 cardiac procedures were performed and reported to The Society of Thoracic Surgeons Congenital Heart Surgery Database. Billing data identified 1,865 cardiac surgery procedures using the 63 CARD International Classification of Diseases-Ninth Revision codes from the NHSN inclusion criteria. Only 1,425 procedures were targeted for NHSN surveillance using the NHSN's CARD operative procedure group in the same period. Procedures identified for NHSN surveillance annually underestimated the number of cardiac operations performed by 17% to 71%. As a result, annual SSI rates potentially differed by 12% to 270%. The NHSN CARD surveillance guidelines for SSI fail to identify all pediatric cardiac surgical procedures. Failure to target all at-risk procedures leads to inaccurate reporting of SSI rates largely based on identifying the denominator. Inaccurate recording of SSI data has implications for public reporting, benchmarking of outcomes, and denial of payment. Use of The Society of Thoracic Surgeons Congenital Heart Surgery

  14. Incidence rates of surgically treated rhegmatogenous retinal detachment among manual workers, non-manual workers and housewives in Tuscany, Italy


    Curti, Stefania; Coggon, David; Baldasseroni, Alberto; Cooke, Robin M. T.; Fresina, Michela; Campos, Emilio C; Semeraro, Francesco; Zanardi, Francesca; Farioli, Andrea; Violante, Francesco S.; Mattioli, Stefano


    Purpose Candidate risk factors for idiopathic rhegmatogenous retinal detachment (RRD) include heavy manual handling (requiring Valsalva’s maneuver). We assessed incidence rates of surgically treated idiopathic RRD among manual workers, non-manual workers and housewives resident in Tuscany, Italy. Methods We retrieved all hospital discharge records bearing a principal diagnosis corresponding to RRD coupled with retinal surgery for any resident of Tuscany during 1997–2009. After elimination of ...

  15. Usefulness of Color Coding Resected Samples from a Pancreaticoduodenectomy with Tissue Marking Dyes for a Detailed Examination of Surgical Margin Surrounding the Uncinate Process of the Pancreas. (United States)

    Mizutani, Satoshi; Suzuki, Hideyuki; Aimoto, Takayuki; Yamagishi, Seiji; Mishima, Keisuke; Watanabe, Masanori; Kitayama, Yasuhiko; Motoda, Norio; Isshiki, Saiko; Uchida, Eiji


    Characteristics of a cancer-positive margin around a resected uncinate process of the pancreas (MUP) due to a pancreticoduodenectomy are difficult to understand by standardized evaluation because of its complex anatomy. The purposes of this study were to subclassify the MUP with tissue marking dyes of different colors and to identify the characteristics of sites that showed positivity for cancer cells in patients with pancreatic head carcinoma who underwent circumferential superior mesenteric arterial nerve plexus-preserving pancreaticoduodenectomy. Results of this evaluation were used to review operation procedures and perioperative methods. We divided the MUP into 4 sections and stained each section with a different color. These sections were the pancreatic head nerve plexus margin (Area A), portal vein groove margin (Area B), superior mesenteric artery margin (Area C), and left of the superior mesenteric artery margin (Area D). The subjects evaluated were 45 patients who had carcinoma of the pancreatic head and were treated with circumferential superior mesenteric arterial nerve plexus-preserving pancreaticoduodenectomy. Of the 45 patients, nine cases (90%) of incomplete resection showed cancer-positivity in the MUP. Among the 4 sections of the MUP, the most cases of positive results [MUP (+) ] were found in Area B, with Area A (+), 0 case; Area B (+), 6 cases; Area C (+), 2 cases; and Area D (+), 3 cases (total, 11 sites in 9 patients). Relapse occurred in 7 of the 9 patients with MUP (+). Local recurrence was observed as initial relapse in all 3 patients with Area D (+). In contrast, the most common site of recurrence other than that in patients with Area D (+) was the liver. By subclassifying the MUP with tissue marking dyes of different colors, we could confirm regional characteristics of MUP (+). As a result, circumferential superior mesenteric arterial nerve plexus-preserving pancreticoduodenectomy was able to be performed in R0 operations in selected

  16. Time matters: post-surgical recovery of gastric evacuation rate in Atlantic cod

    DEFF Research Database (Denmark)

    Behrens, Jane; Gräns, Albin; Andersen, Niels Gerner;

    GER was affected after surgically introducing dummies of a blood-flow biotelemetry system into the abdominal cavity of Atlantic cod. Two days post surgery the cod with implants were, together with a control group, force-fed a standardized meal and the stomach contents recovered 24h later....... This procedure was repeated for both groups of fish after one additional week of recovery. After two days GER was significantly lower in the group of fish with surgical implants compared to the control group, but the difference was not maintained after one additional week of recovery. We conclude that 10 days...... of postsurgical recovery will stabilize GER in cod. The results indicate that the presence of the implant per se did not affect GER but that the effects observed came from surgery and/or postsurgical stress. 10 days should consequently be a starting point for future studies even if longer recovery periods...

  17. An intensive vascular surgical skills and simulation course for vascular trainees improves procedural knowledge and self-rated procedural competence. (United States)

    Robinson, William P; Doucet, Danielle R; Simons, Jessica P; Wyman, Allison; Aiello, Francesco A; Arous, Elias; Schanzer, Andres; Messina, Louis M


    Surgical skills and simulation courses are emerging to meet the demand for vascular simulation training for vascular surgical skills, but their educational effect has not yet been described. We sought to determine the effect of an intensive vascular surgical skills and simulation course on the procedural knowledge and self-rated procedural competence of vascular trainees and to assess participant feedback regarding the course. Participants underwent a 1.5-day course covering open and endovascular procedures on high-fidelity simulators and cadavers. Before and after the course, participants completed a written test that assessed procedural knowledge concerning index open vascular and endovascular procedures. Participants also assessed their own procedural competence in open and endovascular procedures on a 5-point Likert scale (1: no ability to perform, 5: performs independently). Scores before and after the course were compared among postgraduate year (PGY) 1-2 and PGY 3-7 trainees. Participants completed a survey to rate the relevance and realism of open and endovascular simulations. Fifty-eight vascular integrated residents and vascular fellows (PGY 1-7) completed the course and all assessments. After course participation, procedural knowledge scores were significantly improved among PGY 1-2 residents (50% correct before vs 59% after; P educational effect. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  18. Higher rate of compensation after surgical treatment versus conservative treatment for acute Achilles tendon rupture

    DEFF Research Database (Denmark)

    Sveen, Thor-Magnus; Troelsen, Anders; Barfod, Kristoffer Weisskirchner


    complications. The aim of this study was to investigate: 1) the socio-economic impact of complications after ATR through the utilisation of the Danish Patient Insurance Association (DPIA) database, 2) correlations between treatment and complications. METHODS: A total of 324 patients with ATR reported...... in the period from 1992 to 2010 in the DPIA database were identified and patient records were reviewed manually. RESULTS: The compensation awarded for the 18-year period totalled 18,147,202 DKK with 41% of patient claims being recognised. Out of 180 surgically treated patients, 79 received a total compensation...

  19. Positive Surgical Margin, HPV Persistence, and Expression of Both TPX2 and PD-L1 Are Associated with Persistence/Recurrence of Cervical Intraepithelial Neoplasia after Cervical Conization.

    Directory of Open Access Journals (Sweden)

    Hui Zhang

    Full Text Available To determine the clinicopathologic and immunohistochemical predictors of the persistence/recurrence of cervical intraepithelial neoplasia (CIN after cervical conization.Medical records of 502 patients who received cervical conization treatment of CIN between 2005 and 2012 were reviewed. The clinicopathologic parameters were analyzed using Cox hazard regression. Fifty patients with CIN persistence/recurrence were matched to 50 cases without CIN persistence/recurrence. These 100 cervical specimens were assessed for expression of insulin-like growth factor II messenger RNA (mRNA-binding protein 3 (IMP3, targeting protein for xenopus kinesin-like protein 2 (TPX2, and programmed cell death-1 ligand-1 (PD-L1 using immunohistochemical staining.Multivariate analysis found that the independent predictors of CIN persistence/recurrence were positive surgical margin (hazard ratio 5.777, 95% confidence interval 2.334-14.301, p < 0.001 and human papilloma virus persistence for 6 months (hazard ratio 20.685, 95% confidence interval 7.350-57.657, p < 0.001. Co-expression of TPX2 and PD-L1 was significantly higher in CIN persistence/recurrence group than the group without CIN persistence/recurrence (p = 0.013. The depth of glandular involvement (GI was less than 3mm in about 86.8% (59/68 CIN2-3 lesions, However, No statistically significant associations between GI and persistence/recurrence were observed (P = 0.58.Positive surgical margin, HPV persistence, and expression of both TPX2 and PD-L1 are associated with persistence/recurrence of cervical intraepithelial neoplasia after cervical conization.

  20. The surgical rate and recurrence rate in right colonic diverticulitis using the CT-based modified hinchey classification

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Hwan; Kim, Hyuk Jung; Jang, Suk Ki; Yeon, Jae Woo [Dept. of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital, Seongnam (Korea, Republic of); Ko, You Sun; Lee, Kyoung Ho [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)


    The purpose of this report is to retrospectively analyze the need for surgery, and the recurrence rate, using a CT-based method in patients with right colonic diverticulitis. For the purposes of our study, we included 416 patients with a mean age of 41.9 (238 of which were men), with a diagnosis of colonic diverticulitis that was based on CT findings. These findings were reviewed by two independent radiologists, who localized diverticulitis and determined it using a modified Hinchey classification. We were able to follow-up with 384 patients over a period of 30 months. Out of the 416 patients, 396 of them had right colonic diverticulitis. In right colonic diverticulitis, the κ value in determining the modified Hinchey classification was 0.80. 98.2% (389/396) of the patients with right colonic diverticulitis had stages Ia-II. The surgery rate was 4.6% (17/366) and 28% (5/18) for right and left colonic diverticulitis, respectively (p < 0.001). In the instances of right colonic diverticulitis, the surgery rate was 2.8% (10/359) for stages Ia-II, while all seven patients with stage III or IV underwent surgery. The recurrence rate was 6.5% (23/356) and 15% (2/13) for right and left colonic diverticulitis, respectively (p = 0.224). The CT-based modified Hinchey classification of right colonic diverticulitis showed good interobserver agreement. Most patients with right colonic diverticulitis had lower stages (Ia-II) at the point of CT, rarely needed surgery, and had a low recurrence rate.

  1. Complication rate after circumcision in a paediatric surgical setting should not be neglected

    DEFF Research Database (Denmark)

    Thorup, Jørgen; Thorup, Sebastian Cortes; Ifaoui, Inge Botker Rasmussen


    INTRODUCTION: As a consequence of the discussion on whether the health benefits of newborn male circumcision outweigh the risks and the discrepancies in reported figures of complications, we evaluated our results from a paediatric surgical department. MATERIAL AND METHODS: Patient file data from...... children who had undergone ritual circumcision in the 1996-2003 period were retrieved. Complications recorded until December 2011 were noted. RESULTS: Circumcision in 315 boys aged from 3 weeks to 16 years (median five years) were evaluated. A total of 16 boys (5.1%) had significant complications......, including three incomplete circumcisions requiring re-surgery, two requiring re-surgery six months and five years postoperatively due to fibrotic phimosis and two requiring meatotomy due to meatal stenosis two and three year postoperatively. Acute complications included two superficial skin infections one...

  2. Retrospective analysis of positive LEEP surgical margin and residual lesion in 246 patients with cervical high grade squamous intraepithelial lesion and micro invasive cancer after LEEP conization%宫颈高度鳞状上皮内病变和微小浸润癌环形电切术切缘阳性与病灶残余情况的246例回顾性分析

    Institute of Scientific and Technical Information of China (English)

    高蜀君; 汪清; 郑瑞莲; 陈敏; 谢锋; 董晶; 刁雯静; 隋龙


    Objective: To evaluate the residual lesion and suitable treatment in patients with cervical high grade squamous intraepithelial lesion (HSIL) or micro invasive cancer underwent loop electrosurgical excision procedure (LEEP) conization with positive surgical margin. Methods: Two hundred and fortysix patients were included between January 2008 and December 2008 in this study for whom HSIL and micro invasive carcinoma were detected and then LEEP conizations were performed with positive surgical margin. The patients receiving conservative therapy were followed up with PAP-smear test, human papilloma virus (HPV) DNA test and cervical histological examination. The postoperative pathologic diagnosis and residual lesion were determined in patients receiving subsequent second operation.Results: Surgical margin was positive in 196 patients (16.87%, 196/1 162) of HSIL and 50 patients (43.48%, 50/115) of micro invasive cancer. The accuracy of colposcopic diagnosis and the rate of residual lesion were 90.82% (178/196) and 7.65% (15/196) for HSIL, and 8.00% (4/50) and 24.00% (12/50) for micro invasive cancer, respectively (P<0.05). The overall rate of residual lesion was 10.98% (27/246).Conclusion: Second LEEP or close monitoring are required for patients with positive surgical margin HSIL.Considered for high rates of positive surgical margin and residual disease in micro invasive cervical cancer, the active procedures should be performed on patients with positive LEEP surgical margin.%目的:探讨宫颈高度鳞状上皮内病变 (high grade squamous intraepithelial lesion,HSIL)和微小浸润癌环形电切术(loop electrosurgical excision procedure,LEEP)切缘阳性患者的病灶残留情况及其处理.方法:回顾性分析2008年1月-2008年12月因HSIL和微小浸润癌在本中心行LEEP的标本切缘阳性的246例患者的临床资料.对接受保守治疗者密切随访其宫颈细胞学、人乳头瘤病毒(human papilloma virus,HPV)感染情况

  3. A Quality Improvement Approach to Reducing the Caesarean section Surgical Site Infection Rate in a Regional Hospital

    LENUS (Irish Health Repository)

    O’ Hanlon, M


    Surgical site infection (SSI) rates are used extensively by hospitals as a basis for quality improvement. A 30-day post-discharge SSI programme for Caesarean section operations has been implemented in Our Lady of Lourdes Hospital since 2011. It has been shown that skin antisepsis and antibiotic prophylaxis are key factors in the prevention of SSI. Using quality improvement methodology, an infection prevention bundle was introduced to address these two factors. Skin antisepsis was changed from povidone-iodine to chlorhexidine-alcohol. Compliance with choice of antibiotic prophylaxis increased from 89.6% in 2014 to 98.5% in 2015. Compliance with timing also improved. The SSI rate of 7.5% was the lowest recorded to date, with the majority of SSIs (64%) diagnosed after hospital discharge. The level of variation was also reduced. However, the continued presence of variation and possibility of lower infection rates from the literature imply that further improvements are required.

  4. Predictors of circumferential resection margin involvement in surgically resected rectal cancer: A retrospective review of 23,464 patients in the US National Cancer Database (United States)

    Al-Sukhni, Eisar; Attwood, Kristopher; Gabriel, Emmanuel; Nurkin, Steven J.


    Introduction The circumferential resection margin (CRM) is a key prognostic factor after rectal cancer resection. We sought to identify factors associated with CRM involvement (CRM+). Methods A retrospective review was performed of the National Cancer Database, 2004–2011. Patients with rectal cancer who underwent radical resection and had a recorded CRM were included. Multivariable analysis of the association between clinicopathologic characteristics and CRM was performed. Tumor patients, 13.3% were CRM+. Factors associated with CRM+ were diagnosis later in the study period, lack of insurance, advanced stage, higher grade, undergoing APR, and receiving radiation. Nearly half of CRM+ patients did not receive neoadjuvant therapy. CRM+ patients who did not receive neoadjuvant therapy were more likely to be female, older, with more comorbidities, smaller tumors, earlier clinical stage, advanced pathologic stage, and CEA-negative disease compared to those who received it. Conclusions Factors associated with CRM+ include features of advanced disease, undergoing APR, and lack of health insurance. Half of CRM+ patients did not receive neoadjuvant treatment. These represent cases where CRM status may be modifiable with appropriate pre-operative selection and multidisciplinary management. PMID:26906328

  5. Marginal grafts increase early mortality in liver transplantation

    Directory of Open Access Journals (Sweden)

    Telesforo Bacchella

    Full Text Available CONTEXT AND OBJECTIVE: Expanded donor criteria (marginal grafts are an important solution for organ shortage. Nevertheless, they raise an ethical dilemma because they may increase the risk of transplant failure. This study compares the outcomes from marginal and non-marginal graft transplantation in 103 cases of liver transplantation due to chronic hepatic failure. DESIGN AND SETTING: One hundred and three consecutive liver transplantations to treat chronic liver disease performed in the Liver Transplantation Service of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo between January 2001 and March 2006 were retrospectively analyzed. METHODS: We estimated graft quality according to a validated scoring system. We assessed the pre-transplantation liver disease category using the Model for End-Stage Liver Disease (MELD, as low MELD ( 20. The parameters for marginal and non-marginal graft comparison were the one-week, one-month and one-year recipient survival rates, serum liver enzyme peak, post-transplantation hospital stay and incidence of surgical complications and retransplantation. The significance level was 0.05. RESULTS: There were no differences between the groups regarding post-transplantation hospital stay, serum liver enzyme levels and surgical complications. In contrast, marginal grafts decreased overall recipient survival one month after transplantation. Furthermore, low-MELD recipients of non-marginal grafts showed better one-week and one-month survival than did high-MELD recipients of marginal livers. After the first month, patient survival was comparable in all groups up to one year. CONCLUSION: The use of marginal graft increases early mortality in liver transplantation, particularly among high-MELD recipients.

  6. Huge pseudomyxoma peritonei: Surgical strategies and procedures to employ to optimize the rate of complete cytoreductive surgery. (United States)

    Benhaim, L; Honoré, C; Goéré, D; Delhorme, J-B; Elias, D


    Complete cytoreductive surgery (CCRS) plus Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is the best-known treatment for pseudomyxoma peritonei (PMP). In 30% of the cases, PMP realize a widespread involvement of the peritoneal cavity. In these extreme situations, we developed, devoted strategies to optimize the feasibility and safety of CCRS. This study describes the surgical resections required for CCRS and the consequent approaches that we propose to achieve CCRS. We defined "huge PMP" by a peritoneal cancer index (PCI) ≥ 28. Surgical procedures of patients operated on between 1994 and 2014 were retrospectively reviewed from a prospective database in a single institution. During this period, 311 patients were operated on and 247 (79%) underwent CCRS + HIPEC. Among them, 100 patients presented "huge" PMP and 54 patients underwent CCRS + HIPEC. In patients with "huge" PMP, the rate of CCRS + HIPEC was 25% before 2002 and reached 71% between 2011 and 2014. We identified 3 conditions for CCRS 1) to guaranty a sufficient length of residual small bowel 2) to preserve the left gastric vessels in order to preserve the superior third of the stomach 3) to ensure that the hepatic pedicle can be entirely cleared from its tumor involvement. None of the other peritonectomy procedures were decisional for CCRS. Our learning curve improved the selection and completion rate of CCRS + HIPEC for "huge PMP". Some anatomical and physiological prerequisites guarantee the feasibility and safety of such extensive surgeries. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Government Regulation, Interest Rate Liberalization and Net Interest Margin%政府管制、利率市场化和商业银行净利差

    Institute of Scientific and Technical Information of China (English)

    傅利福; 魏建


    中国的利率受管制和市场化两股力量决定,这两种力量对于不同类型的银行有着不同的影响。本文利用kumbhaka & Parmeter (2009)提出的双边随机前沿模型,实证分析了政府管制和利率市场化对我国商业银行净利差的影响。结果表明:(1)我国商业银行净利差处于低位运行状态。(2)相对于利率市场化,我国的商业银行净利差受政府管制的影响更为明显。(3)政府管制和利率市场化对地方性银行净利差的影响均要大于对全国性银行的影响。我们建议在实施利率市场化的过程中,对不同类别的银行应当差别化对待。%China's interest rate is determined by the two forces of government regulation and market liberalization , which have varied effects on different banks .Using the Two-tier Stochastic Frontier Model proposed by Kumbhaka & Parmeter (2009), the paper studies the respective influence of government regulation and interest rates liberalization on the net interest margin of commercial banks in China .The results show that:(1) interest margins in commercial banks are operating at low level;(2) government regulation has greater effect on interest margins than interest rates liberalization ;(3) compared with national banks , local banks are more vulnerable to government regulation and interest rates liberalization .The paper suggests that during the implementation of interest rates liberalization , differentiated treatments should be applied to banks of different categories .

  8. Complication rate of posterior capsule rupture with vitreous loss during phacoemulsification at a Hawaiian cataract surgical center: a clinical audit

    Directory of Open Access Journals (Sweden)

    Chen M


    Full Text Available Ming Chen,1 Kara C LaMattina,2 Thomas Patrianakos,2 Surendar Dwarakanathan2 1Department of Surgery, Division of Ophthalmology, University of Hawaii, Honolulu, HI, USA; 2Division of Ophthalmology, John H Stroger, Jr Hospital of Cook County, Chicago, IL, USA Purpose: To compare the complication rate of posterior capsule rupture (PCR with vitreous loss during phacoemulsification at an ambulatory surgical center with published results as a clinical audit for quality control. Methods: A retrospective chart review of 3,339 consecutive patients who underwent routine phacoemulsification by four experienced private practice surgeons from January 1, 2011 to June 30, 2012 at The Surgical Suites, Honolulu, HI, USA. All cases with PCR and vitreous loss were identified and selected for the study. Risk factors of this complication were further examined. Data were sent to John H Stroger Jr Hospital of Cook County, Division of Ophthalmology, for literature review, analysis, and write-up. Results: Twenty-three of the 3,339 cases incurred PCR and vitreous loss during phacoemulsification, for an incidence rate of 0.68%. Miosis, shallow chamber, restlessness, pseudoexfoliation syndrome, floppy iris syndrome, and zonulopathy were the main causes. In addition, surgeon volume (number of cases was inversely correlated with PCR. Conclusion: The rate of PCR with vitreous loss during phacoemulsification in this study may be lower than other published results done at academic centers. However, there was no compatible study available for comparison, as existing studies performed at academic centers included resident cases. This study identified risk factors for PCR/vitreous loss both preoperatively and postoperatively that may assist in application of preventive measures to decrease rates of PCR/vitreous loss. Keywords: phacoemulsification complications, posterior capsule rupture, vitreous loss, vitrectomy, miosis, pseudoexfoliation, floppy iris syndrome, zonulopathy

  9. Fault locking and slip rate deficit of the Haiyuan-Liupanshan fault zone in the northeastern margin of the Tibetan Plateau (United States)

    Li, Yanchuan; Shan, Xinjian; Qu, Chunyan; Wang, Zhenjie


    GPS-derived horizontal velocities, geologic fault slip rates and earthquake-derived fault slip vector azimuths are inverted simultaneously for fault coupling and slip rate deficit on the Haiyuan-Liupanshan fault in the northeastern margin of the Tibetan Plateau. Along the Haiyuan fault, the results show 3.2-6.2 mm/yr of left-lateral strike-slip, and the strike-slip transformed into thrusting deformation (2.8-3.5 mm/yr) along the Liupanshan fault. The results suggest full coupling down to ∼10 km along the Haiyuan fault. Significant portions from the Jinqianghe fault to the Maomaoshan fault, however, are locked to ∼23 km depth. The abrupt change in fault coupling coincides with the Tianzhu seismic gap. High slip rate deficit (3.0-4.5 mm/yr) and seismic moment accumulation rate are also interpreted along the seismic gap. The Liupanshan fault is locked to 15-20 km depth. A high seismic moment accumulation rate, low slip rate deficit (2.0-3.2 mm/yr) and scarcity of large seismic event over the last 1400 years may imply high strain accumulation on the fault. The results demonstrate that crustal deformation in the northeastern Tibetan Plateau is dominated by elastic block rotation. We also conclude that deformation due to fault coupling is limited along the near-field (less than 50 km with velocities less than 2 mm/yr) of the Haiyuan-Liupanshan fault.

  10. Recurrence Rates After Surgical or Endovascular Treatment of Spinal Dural Arteriovenous Fistulas : A Meta-analysis

    NARCIS (Netherlands)

    Bakker, Nicolaas A.; Uyttenboogaart, Maarten; Luijckx, G. J.; Eshghi, Omid S.; Mazuri, Aryan; Metzemaekers, Jan D. M.; Groen, Rob J. M.; Van Dijk, J. Marc C.


    BACKGROUND:There is an increasing tendency to treat spinal dural arteriovenous fistulas (SDAVFs) endovascularly despite the lack of clear evidence favoring embolization over surgery.OBJECTIVE:To compare the initial failure and recurrence rates of primary treatment of SDAVFs by surgery and endovascul

  11. Comparing the survival rate of juvenile Chinook salmon migrating through hydropower systems using injectable and surgical acoustic transmitters

    Energy Technology Data Exchange (ETDEWEB)

    Deng, Z. D.; Martinez, J. J.; Li, H.; Harnish, R. A.; Woodley, C. M.; Hughes, J. A.; Li, X.; Fu, T.; Lu, J.; McMichael, G. A.; Weiland, M. A.; Eppard, M. B.; Skalski, J. R.; Townsend, R. L.


    Acoustic telemetry is one of the primary technologies for studying the behavior and survival of fishes throughout the world. The size and performance of the transmitters is still the key limiting factor despite that considerable effort has been expended to understand the biological effects of implantation of acoustic transmitters in yearling and subyearling Chinook salmon. The newly developed injectable transmitter is the first active acoustic tag that can be implanted via injection instead of surgery. It also lasts more than four times longer than the commercially-available transmitters. A two-part field study was conducted to evaluate the performance of the injectable transmitter and its effect on the survival of implanted fish. The injectable transmitter performed well and similarly to the other commercially-available transmitters tested. Snake River subyearling Chinook salmon smolts implanted with the injectable tag had a higher survival probability from release to each of 11 downstream detection arrays than concurrent releases of fish surgically implanted with commercially-available tags. In addition, reach-specific survival estimates were significantly higher for the injectable group in three of the eleven reaches examined. Overall, the injectable group had a 0.263 (SE = 0.017) survival probability over the entire 500 km study area compared to 0.199 (0.012) for the surgically implanted group. The differences in survival may have been caused by warm water temperatures and higher rates of infection experienced by the surgically implanted group due to the presence of sutures acting as an attachment site for pathogens. The reduction in size and ability to implant the new transmitter via injection has further reduced the tag or tagging effect bias associated with studying small fishes. The information gathered with this new technology is helping minimize the impact of dams on fish, leading to more environmentally sustainable energy systems.

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

    DEFF Research Database (Denmark)

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


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

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

    DEFF Research Database (Denmark)

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


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

  14. Do 'Surgical Helmet Systems' or 'Body Exhaust Suits' Affect Contamination and Deep Infection Rates in Arthroplasty? A Systematic Review. (United States)

    Young, Simon W; Zhu, Mark; Shirley, Otis C; Wu, Qing; Spangehl, Mark J


    This systematic review examined whether negative-pressure Charnley-type body exhaust suits (BES) or modern positive-pressure surgical helmet systems (SHS) reduce deep infection rates and/or contamination in arthroplasty. For deep infection, four studies (3990 patients) gave adjusted relative risk for deep infection of 0.11 (P = 0.09) against SHS. Five of 7 (71%) studies found less air contamination and 2 of 4 studies (50%) less wound contamination with BES. One of 4 (25%) found less air contamination with SHS and 0 of 1 (0%) less wound contamination. In contrast to BES, modern SHS designs were not shown to reduce contamination or deep infection during arthroplasty.

  15. The Compliance Rates of Hand Hygiene in Intensive Care Unit and Surgical Services at a State Hospital in Turkey

    Directory of Open Access Journals (Sweden)

    Serap Süzük


    Full Text Available Objective: The most efficient and most cost effective method for preventing health care associated infections is hand hygiene. Although hand hygiene is the most effective and simple method, compliance rates are very low among health care workers. It was aimed to evaluate the rates of compliance of healthcare workers in a state hospital. Material and Method: In this study, totally 112 healthcare workers (31 doctors and 81 nurses were evaluated with the 5-indication observation method in a period between January and July 2013. Results: A total of 754 (65.9% out of 1.144 cases were resulted in accurate hand washing and hand-rubbing. When the intensive care unit and surgical clinics were evaluated together, it was found that hand hygiene compliance rates were 51.26% in 199 cases and 66.85% in 591 cases for doctors and nurses, respectively. Conclusion: Consequently, we think that pre-informed observations are important training instruments for hand hygiene compliance.

  16. Cosmetic Surgical Repair of Contaminated Wounds Versus Traditional Loose Approximation: Does It Increase the Rate of Wound Infections?

    Directory of Open Access Journals (Sweden)

    P. Yavari


    Full Text Available Background:The cosmetic result of the surgical scar has long been considered by surgeons as an important factor for patient satisfaction.On the other hand,there has been an old teaching that perfect closure of contaminated wounds increases the rate of infection. We decided to look into this matter and see if this is a fact or a myth. Methods: In this prospective randomized study conducted on 200 patients with suppurative or gangrenous appendicitis,we closed the wounds with a cosmetic subcuticular suture of 4/0 nylon in 100 patients and in the other 100 patients the wound was approximated loosely with a few stitches of 3/0 nylon in vertical mattress fashion during a 14-month period.Results:There was no significant difference in the rate of wound infection between these two groups.Conclusions:This study shows that perfect closure of the wound with subcuticular closure,which gives a very good cosmetic result in comparison with traditional loose closure, does not increase the rate of wound infection.

  17. Multivariate Analysis on Post-conization Positive Surgical Margin in Patients with Stage Ⅲ Cervical Intraepithelial Neoplasia%宫颈上皮内瘤变Ⅲ锥切术后病理切缘阳性的多因素分析

    Institute of Scientific and Technical Information of China (English)

    郭文萍; 郭红燕; 王静


    Objective To assess the high-risk factors associated with conization margin status and management options in patients with cervical intraepithelial neoplasia Ⅲ ( CIN Ⅲ ). Methods A retrospective analysis on 442 patients with CIN Ⅲ who underwent conization between January 2004 and April 2010 in our hospital. Postoperative pathological analysis showed positive surgical margin in 41 cases ( positive group ), and negative margin in the other 401 cases ( negative group ). Results Binary logistic analysis showed that positive margin is correlated with severe cervical erosion ( OR = 3. 438, 95% CI = 1. 323 - 8. 933 ), in situ carcinoma ( OR =3. 792, 95% CI = 1. 594 -9. 022) , involvement of the glands ( OR = 3. 940, 95% CI = 1. 724 - 9. 004 ) , and > 3 lesions (OR =5. 083, 95% CI =2. 192- 11. 787 ). In our patients, the 21 cases of positive margin received a second surgery, after which the rate of residual lesion was 38.1% (8/21), which was similar to that in the negative group ( 14.8% , 8/54; Z = 1. 898, P =0.058). A follow-up was achieved in 20 of the 21 positive patients, during the follow-up, 3 patients showed recurrence or persisitence of the lesion ( 15.0% ); the rate was significantly higher than that in the negative group ( 1.7% , 3/241, Z = 2. 799, P = 0.005 ).Conclusions More than 3 lesions, glands involvement, in situ carcinoma, and cervical erosion are high-risk factors of positive surgical margin in patients with CIN Ⅲ. The positive margin is associated with recurrence/persistence. If re-conization is technically impossible, simple hysterectomy is the treatment option for the patients with positive margins. The patients with CIN Ⅲ should be followed up closely, especially for those with positive margins.%目的 探讨影响宫颈上皮内瘤变Ⅲ(cervical intraepithelial neoplasia Ⅲ,CINⅢ)锥切病理切缘阳性的高危因素及进一步处理的选择. 方法 回顾性分析我院2004年1月~2010年4月442例因CIN Ⅲ住

  18. Transperitoneal versus extraperitoneal laparoscopic radical prostatectomy during the learning curve: does the surgical approach affect the complication rate?

    Directory of Open Access Journals (Sweden)

    Tiberio M. Siqueira Jr.


    Full Text Available Purpose: To compare the perioperative complication rate obtained with the transperitoneal laparoscopic radical prostatectomy (TLRP and with the extraperitoneal LRP (ELRP during the learning curve (LC. Materials and Methods: Data of the initial 40 TLRP (Group 1 were retrospectively compared with the initial 40 ELRP (Group 2. Each Group of patients was operated by two different surgeons. Results: The overall surgical time (175 min x 267.6 min; p < 0.001 and estimated blood loss (177.5 mL x 292.4 mL; p < 0.001 were statistically better in the Group 1. Two intraoperative complications were observed in Group 1 (5% represented by one case of bleeding and one case of rectal injury, whereas four complications (10% were observed in Group 2, represented by two cases of bleeding, one bladder and one rectal injuries (p = 0.675. Open conversion occurred once in each Group (2.5%. Overall postoperative complications were similar (52.5% x 35%; p = 0.365. Major early postoperative complications occurred in three and in one case in Group 1 and 2, respectively. Group 1 had two peritonitis (fecal and urinary, leading to one death in this group. Conclusions: No statistical differences in overall complication rates were observed. The transperitoneal approach presented more serious complications during the early postoperative time and this fact is attributed to the potential chance of intraperitoneal peritonitis not observed with the extraperitoneal route.

  19. The power of the National Surgical Quality Improvement Program--achieving a zero pneumonia rate in general surgery patients. (United States)

    Fuchshuber, Pascal R; Greif, William; Tidwell, Chantal R; Klemm, Michael S; Frydel, Cheryl; Wali, Abdul; Rosas, Efren; Clopp, Molly P


    The National Surgical Quality Improvement Program (NSQIP) of the American College of Surgeons provides risk-adjusted surgical outcome measures for participating hospitals that can be used for performance improvement of surgical mortality and morbidity. A surgical clinical nurse reviewer collects 135 clinical variables including preoperative risk factors, intraoperative variables, and 30-day postoperative mortality and morbidity outcomes for patients undergoing major surgical procedures. A report on mortality and complications is prepared twice a year. This article summarizes briefly the history of NSQIP and how its report on surgical outcomes can be used for performance improvement within a hospital system. In particular, it describes how to drive performance improvement with NSQIP data using the example of postoperative respiratory complications--a major factor of postoperative mortality. In addition, this article explains the benefit of a collaborative of several participating NSQIP hospitals and describes how to develop a "playbook" on the basis of an outcome improvement project.

  20. Surgical Site Infection Rates in Seven Cities in Vietnam: Findings of the International Nosocomial Infection Control Consortium. (United States)

    Viet Hung, Nguyen; Anh Thu, Truong; Rosenthal, Victor D; Tat Thanh, Do; Quoc Anh, Nguyen; Le Bao Tien, Nguyen; Ngo Quang, Nguyen


    Surgical site infections (SSIs) are the most common healthcare-associated infections (HAI) in lower-income countries. This is the first study to report the results of surveillance on SSI stratified by surgical procedure in seven Vietnamese cities. This was a prospective, active SSI surveillance study conducted from November 2008-December 2010 in seven hospitals using the U.S. Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC-NHSN) definitions and methods. Surgical procedures (SPs) were classified into 26 types according to the International Classification of Diseases Edition 9 criteria. We recorded 241 SSIs, associated with 4,413 SPs (relative risk [RR] 5.5%; 95% confidence interval [95% CI] 4.8-6.2). The highest SSI rates were found for limb amputation (25%), colon surgery (33%), and small bowel surgery (21%). Compared with CDC-NHSN SSI report, our SSI rates were higher for the following SPs: Limb amputation (25% vs. 1.3%; RR 20.0; p = 0.001); appendix surgery (8.8% vs. 3.5%; RR 2.54; 95% CI 1.3-5.1; p = 0.001); gallbladder surgery (13.7% vs. 1.7%; RR 7.76; 95% CI 1.9-32.1; p = 0.001); colon surgery (18.2% vs. 4.0%; RR 4.56; 95% CI 2.0-10.2; p = 0.001); open reduction of fracture (15.8% vs. 3.4%; RR 4.70, 95% CI 1.5-15.2; p = 0.004); gastric surgery (7.3% vs. 1.7%; RR 4.26; 95% CI 2.2-8.4, p = 0.001); kidney surgery (8.9% vs. 0.9%; RR 10.2; 95% CI 3.8-27.4; p = 0.001); prostate surgery (5.1% vs. 0.9%; RR 5.71; 95% CI 1.9-17.4; p = 0.001); small bowel surgery (20.8% vs. 6.7%; RR 3.07; 95% CI 1.7-5.6; p = 0.001); thyroid or parathyroid surgery (2.4% vs. 0.3%; RR 9.27; 95% CI 1.0-89.1; p = 0.019); and vaginal hysterectomy (14.3% vs. 1.2%; RR 12.3; 95% CI 1.7-88.4; p = 0.001). Our SSIs rates were significantly higher for 11 of the 26 types of SPs than for the CDC-NHSN. This study advances our knowledge of SSI epidemiology in Vietnam and will allow us to introduce targeted interventions.

  1. A new surgical technique for ingrown toenail. (United States)

    Mousavi, Seyed Reza; Khoshnevice, Jaledin


    Background. Ingrowing toenails are a common condition which, when recurrent and painful, are often treated surgically. The aim of this study is to present a new simple surgical technique for ingrown toenails with good results. Method and Patients. The selected 250 patients with affected toes were surgically treated by our technique and observed from 1998 to 2004. Marginal nail elevation combined with surgical excision of the granulation tissue was more successful. For fixing the nail margin on the toe we have done one-bite suture by Nylon 3/0 that was removed after 3 weeks. Results. All patients were operated on by our new technique and the outcome was excellent; recurrence and failure of the technique were very low. Discussion. Because with this simple technique we excise the granulation tissue and elevate margin of nail over the skin, we will have higher cure rate, shorter postoperative pain, lower risk of postoperative infection, and remarkable cosmetic result without deformity; hence this technique should be considered as an alternative method of treatment.

  2. Moderate rates of late Quaternary slip along the northwestern margin of the Basin and Range Province, Surprise Valley fault, northeastern California (United States)

    Personius, Stephen F.; Crone, Anthony J.; Machette, Michael N.; Mahan, Shannon; Lidke, David J.


    The 86-km-long Surprise Valley normal fault forms part of the active northwestern margin of the Basin and Range province in northeastern California. We use trench mapping and radiocarbon, luminescence, and tephra dating to estimate displacements and timing of the past five surface-rupturing earthquakes on the central part of the fault near Cedarville. A Bayesian OxCal analysis of timing constraints indicates earthquake times of 18.2 ± 2.6, 10.9 ± 3.2, 8.5 ± 0.5, 5.8 ± 1.5, and 1.2 ± 0.1 ka. These data yield recurrence intervals of 7.3 ± 4.1, 2.5 ± 3.2, 2.7 ± 1.6, and 4.5 ± 1.5 ka and an elapsed time of 1.2 ± 0.1 ka since the latest surface-rupturing earthquake. Our best estimate of latest Quaternary vertical slip rate is 0.6 ?? 0.1 mm/a. This late Quaternary rate is remarkably similar to long-term (8-14 Ma) minimum vertical slip rates (>0.4-0.5 ± 0.3 mm/a) calculated from recently acquired seismic reflection and chronologic and structural data in Surprise Valley and the adjacent Warner Mountains. However, our slip rate yields estimates of extension that are lower than recent campaign GPS determinations by factors of 1.5-4 unless the fault has an unusually shallow (30°-35°) dip as suggested by recently acquired seismic reflection data. Coseismic displacements of 2-4.5 ± 1 m documented in the trench and probable rupture lengths of 53-65 km indicate a history of latest Quaternary earthquakes of M 6.8-7.3 on the central part of the. Surprise Valley fault.

  3. Superior quality of life and improved surgical margins are achievable with robotic radical prostatectomy after a long learning curve: a prospective single-surgeon study of 1552 consecutive cases. (United States)

    Thompson, James E; Egger, Sam; Böhm, Maret; Haynes, Anne-Maree; Matthews, Jayne; Rasiah, Krishan; Stricker, Phillip D


    Comparative studies suggest functional and perioperative superiority of robot-assisted radical prostatectomy (RARP) over open radical prostatectomy (ORP). To determine whether high-volume experienced open surgeons can improve their functional and oncologic outcomes with RARP and, if so, how many cases are required to surpass ORP outcomes and reach the learning curve plateau. A prospective observational study compared two surgical techniques: 1552 consecutive men underwent RARP (866) or ORP (686) at a single Australian hospital from 2006 to 2012, by one surgeon with 3000 prior ORPs. Demographic and clinicopathologic data were collected prospectively. The Expanded Prostate Cancer Index Composite quality of life (QoL) questionnaire was administered at baseline, 1.5, 3, 6, 12, and 24 mo. Multivariate linear and logistic regression modelled the difference in QoL domains and positive surgical margin (PSM) odds ratio (OR), respectively, against case number. A total of 1511 men were included in the PSM and 609 in the QoL analysis. RARP sexual function scores surpassed ORP scores after 99 RARPs and increased to a mean difference at 861st case of 11.0 points (95% confidence interval [CI], 5.9-16.1), plateauing around 600-700 RARPs. Early urinary incontinence scores for RARP surpassed ORP after 182 RARPs and increased to a mean difference of 8.4 points (95% CI, 2.1-14.7), plateauing around 700-800 RARPs. The odds of a pT2 PSM were initially higher for RARP but became lower after 108 RARPs and were 55% lower (OR: 0.45; 95% CI, 0.22-0.92) by the 866th RARP. The odds of a pT3/4 PSM were initially higher for RARP but decreased, plateauing around 200-300 RARPs with an OR of 1.15 (0.68-1.95) at the 866th RARP. Limitations include single-surgeon data and residual confounding. RARP had a long learning curve with inferior outcomes initially, and then showed progressively superior sexual, early urinary, and pT2 PSM outcomes and similar pT3 PSM and late urinary outcomes. Learning RARP

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

  5. Postoperative Ambulatory Performance Status Significantly Affects Implant Failure Rate Among Surgical Treatment Strategies in Patients With Proximal Femur Metastasis. (United States)

    Tsai, Shang-Wen; Wu, Po-Kuei; Chen, Cheng-Fong; Chang, Ming-Chau; Chen, Wei-Ming


    Surgical treatment strategies for proximal femur metastasis have been reported with mixed results. Little is known about risk factor for implant failure except for longer patient survival. Therefore, we determined whether implant survivorship differed among treatment strategies, as well as risk factors for implant failure. We retrospectively reviewed a consecutive 106 patients with proximal femur metastasis treated with prosthesis replacement (n = 38), intramedullary nail (n = 32), and dynamic hip screw (DHS) (n = 36). Eastern Cooperative Oncology Group (ECOG) scale and Karnofsky index were used to evaluate functional outcome. Patient characteristics and postoperative ambulatory performance status were assessed for their values in determining implant failure. Overall implant failure rate was 11.3% (12 of 106). Prosthesis replacement was related to better implant survivorship (P = 0.041), without mechanical failures. On the contrary, 7 of the 10 implant failures in the fixation group were considered mechanical failures. Better postoperative ambulatory status (ECOG ≤ 2) was a risk factor for implant failure (P = 0.03). Notably, for patients with poor ambulatory status (ECOG ≥ 3), implant survivorship was not different among choice of implants. In conclusion, prosthesis replacement would be a more durable option in the treatment of proximal femur metastasis. Postoperative ambulatory status could be an additional consideration. For patients with poor expected ambulatory performance status, fixation with intramedullary nail or DHS might be considered for a less technical demanding procedure.

  6. Impact of Gleason score on biochemical recurrence in patients with pT3aN0/Nx prostate cancer with positive surgical margins: a multicenter study from the Prostate Cancer Research Committee. (United States)

    Song, Wan; Lee, Dong Hyeon; Jeon, Hwang Gyun; Jeong, Byong Chang; Seo, Seong Il; Lee, Hyun Moo; Choi, Han Yong; Kim, Jong Wook; Lee, SangChul; Byun, Seok-Soo; Jeong, Chang Wook; Kwak, Cheol; Cho, Jin Seon; Ahn, Hanjong; Jeon, Seong Soo


    Oncologic outcomes of patients with pT3aN0/Nx prostate cancer (PCa) with positive surgical margins (PSM) after radical prostatectomy (RP) are heterogeneous. We investigated the impact of Gleason score (GS) on biochemical recurrence (BCR) in these patients. A retrospective, multicenter study was performed on 795 patients with pT3aN0/Nx PCa with PSM after RP between January 2006 and December 2014. Clinicopathologic characteristics of patients were examined and onset of BCR was identified. Kaplan-Meier survival analysis was used to illustrate BCR-free survival (BFS) and Cox proportional hazard models were applied to identify factors predicting BCR. During the mean follow-up period of 63.9 months, BCR was identified in 274 (34.5%) patients. The 5-year BFS was 56.6% in all patients. In multivariate analysis, pathologic GS was the only significant prognostic factor for BCR in patients with pT3aN0/Nx PCa with PSM (GS 6 vs. GS 7 (3 + 4), P = 0.047; vs. GS 7 (4 + 3), P = 0.007, and vs. GS 8-10, P Nx with PSM after RP, pathologic GS is the sole independent predictor for risk stratification of BCR. These findings might be used to determine the risk and timing of BCR and to help counsel patients regarding treatment strategy and prognosis of disease on an individual basis.

  7. Radiographic failure and rates of re-operation after acromioclavicular joint reconstruction: a comparison of surgical techniques. (United States)

    Spencer, H T; Hsu, L; Sodl, J; Arianjam, A; Yian, E H


    To compare radiographic failure and re-operation rates of anatomical coracoclavicular (CC) ligament reconstructional techniques with non-anatomical techniques after chronic high grade acromioclavicular (AC) joint injuries. We reviewed chronic AC joint reconstructions within a region-wide healthcare system to identify surgical technique, complications, radiographic failure and re-operations. Procedures fell into four categories: (1) modified Weaver-Dunn, (2) allograft fixed through coracoid and clavicular tunnels, (3) allograft loop coracoclavicular fixation, and (4) combined allograft loop and synthetic cortical button fixation. Among 167 patients (mean age 38.1 years, (standard deviation (sd) 14.7) treated at least a four week interval after injury, 154 had post-operative radiographs available for analysis. Radiographic failure occurred in 33/154 cases (21.4%), with the lowest rate in Technique 4 (2/42 4.8%, p = 0.001). Half the failures occurred by six weeks, and the Kaplan-Meier survivorship at 24 months was 94.4% (95% confidence interval (CI) 79.6 to 98.6) for Technique 4 and 69.9% (95% CI 59.4 to 78.3) for the other techniques when combined. In multivariable survival analysis, Technique 4 had better survival than other techniques (Hazard Ratio 0.162, 95% CI 0.039 to 0.068, p = 0.013). Among 155 patients with a minimum of six months post-operative insurance coverage, re-operation occurred in 9.7% (15 patients). However, in multivariable logistic regression, Technique 4 did not reach a statistically significant lower risk for re-operation (odds ratio 0.254, 95% CI 0.05 to 1.3, p = 0.11). In this retrospective series, anatomical CC ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure. Anatomical coracoclavicular ligament reconstruction using combined synthetic cortical button and allograft loop fixation had the lowest rate of radiographic failure. ©2016 The British Editorial

  8. Transformation rates and fate of dissolved, colloidal and particulate forms of organic carbon in ocean margins. Final report, May 1, 1992--April 30, 1995

    Energy Technology Data Exchange (ETDEWEB)

    Buesseler, K.O. [Wood Hole Oceanographic Institution, MA (United States). Dept. of Marine Chemistry and Geochemistry; Moran, S.B. [Univ. of Rhode Island, Narragansett, RI (United States). Graduate School of Oceanography; Bauer, J.E. [College of William and Mary, Gloucester Point, VA (United States). Virginia Institute of Marine Sciences] [and others


    The goal of our proposal was to develop new sampling and analytical techniques which could be used to understand the transformation rates and mechanisms of exchange between dissolved, colloidal, small particle and large particle size classes of organic carbon in ocean margins. To meet this goal, we focused on the development of cross-flow filtration (CFF) for the isolation of colloidal material from the dissolved phase in seawater. In addition, we tested and optimized high sensitivity techniques for the measurement of thorium isotopes using thermal ionization mass spectrometry (TIMS) and carbon isotopes using accelerator mass spectrometry (AMS) and stable C mass spectrometric techniques. Many of these techniques were pioneered by the PI`s assembled for original DOE study. In this final report, we highlight some of these new sampling and analytical developments as well as preliminary results from our first DOE cruise this past April. The report is broken down into 4 sections, namely (1) colloidal sampling strategies, (2) TIMS analytical developments, (3) carbon isotopic measurements and (4) results from the R/V Columbus Iselin cruise. For more detailed discussion of our findings, we have included as an appendix to final report manuscripts which have been published or will be submitted during this funding cycle.

  9. Transformation rates and fate of dissolved, colloidal and particulate forms of organic carbon in ocean margins. Final report, May 1, 1992--April 3, 1995

    Energy Technology Data Exchange (ETDEWEB)

    Buesseler, K.O. [Woods Hole Oceanographic Inst., MA (United States). Dept. of Marine Chemistry and Geochemistry; Moran, S.B. [Univ. of Rhode Island, Narragansett, RI (United States). Graduate School of Oceanography; Bauer, J.E. [Coll. of William and Mary, Gloucester Point, VA (United States). Virginia Inst. of Marine Sciences; Druffel, E.R.M. [Univ. of California, Irvine, CA (United States). Dept. of Geosciences


    The goal of this proposal was to develop new sampling and analytical techniques which could be used to understand the transformation rates and mechanisms of exchange between dissolved, colloidal, small particle and large particle size classes of organic carbon in ocean margins. To meet this goal, the authors focused on the development of cross-flow filtration (CFF) for the isolation of colloidal material from the dissolved phase in seawater. In addition, they tested and optimized high sensitivity techniques for the measurement of thorium isotopes using thermal ionization mass spectrometry (TIMS) and carbon isotopes using accelerator mass spectrometry (AMS) and stable C mass spectrometric techniques. In this final report, they highlight some of these new sampling and analytical developments as well as preliminary results from the first DOE cruise this past April. The report is broken down into 4 sections, namely (1) colloidal sampling strategies, (2) TIMS analytical developments, (3) carbon isotopic measurements and (4) results from the R/V Columbus Iselin cruise. For more detailed discussion of the findings, they have included as an appendix to this final report manuscripts which have been published or will be submitted during this funding cycle.

  10. Body mass index is not associated with reoperation rates in patients with a surgically treated perforated peptic ulcer

    DEFF Research Database (Denmark)

    Duch, Patricia; Møller, Morten Hylander


    INTRODUCTION: The aim of the present nationwide Danish cohort study was to examine the association between body mass index (BMI) and reoperation in patients who are sur-gically treated for perforated peptic ulcer (PPU). METHODS: This was a nationwide cohort study of all Danish patients who were...... surgically treated for benign gastric or duodenal PPU between 2011 and 2013. OUTCOME MEASURES: reoperation within 30 days of the primary surgical procedure and 90-day survival. The association between BMI and reoperation are presented as crude and adjusted odds ratios (OR) with 95% confidence intervals (CIs...

  11. 2013~2014年清洁手术抗菌药物使用率与切口感染率相关性分析%Correlation analysis of the utilization rate of antibacterials and surgical site infection rates in clean surgical incision from 2013 to 2014

    Institute of Scientific and Technical Information of China (English)

    曹栋; 孙福生; 范春


    ObjectiveTo study the correlation between the utilization rate of antibacterials and surgical site infection rates in clean surgical incision.Methods All the clean surgical incisions in our hospital from January in 2013 to December in 2014 were enrolled in this study. The utilization rate of antibacterials and surgical site infection rates were retrospectively investigated according to each month. On the condition that the utilization rate of antibacterials and surgical site infection rates were independent variable and dependent variable alternately, with Pearson Correlation Analysis and scatter diagram, we studied the relationship of the utilization rate of antibacterials and surgical site infection rates in clean surgical incision. Results Before logarithmic transformation of the utilization rate of antibacterials and surgical site infection rates, Pearson coeffi cient of correlation was 0.196,P=0.36>0.05.After logarithmic transformation of the utilization rate of antibacterials and surgical site infection rates, Pearson coeffi cient of correlation was 0.069, P=0.75>0.05. The results showed that there was no correlation between the utilization rate of antibacterials and surgical site infection rates, wether logarithmic transformation or not. The scatter diagram of the utilization rate of antibacterials and surgical site infection rates also demonstrated the same results. Conclusion To decrease the utilization rate of antibacterials in clean surgical incision not lead to increase of surgical site infection rates.%目的:探讨清洁手术抗菌药物使用率与切口感染率之间的相关性。方法对本院2013年1月至2014年12月清洁手术进行回顾性调查,按月份分别统计抗菌药物使用率和切口感染率。以抗菌药物使用率与切口感染率互为自变量与因变量,进行Pearson相关性分析和散点图评价。结果抗菌药物使用率与切口感染率对数转换前Pearson相关性分析,相关系数r=0.196, P

  12. Are Staple Foods Becoming More Expensive For Urban Consumers In Eastern And Southern Africa? Trends in Food Prices, Marketing Margins, and Wage Rates in Kenya, Malawi, Mozambique, and Zambia


    Mason, Nicole M.; Jayne, Thomas S.; Donovan, Cynthia; Chapoto, Antony


    The world food and financial crises threaten to undermine the real incomes of urban consumers in eastern and southern Africa. This study investigates patterns in staple food prices, wage rates, and marketing margins for urban consumers in Kenya, Malawi, Mozambique, and Zambia between 1993 and 2009. There is high correlation among wage rate series for various government and private sector categories. We find that average formal sector wages rose at a faster rate than retail maize meal and brea...

  13. A New Surgical Technique for Ingrown Toenail


    Seyed Reza Mousavi; Jaledin Khoshnevice


    Background. Ingrowing toenails are a common condition which, when recurrent and painful, are often treated surgically. The aim of this study is to present a new simple surgical technique for ingrown toenails with good results. Method and Patients. The selected 250 patients with affected toes were surgically treated by our technique and observed from 1998 to 2004. Marginal nail elevation combined with surgical excision of the granulation tissue was more successful. For fixing the nail margin o...

  14. Surveillance for surgical site infection (SSI) after neurosurgery: influence of the US or Brest (France) National Nosocomial Infection Surveillance risk index on SSI rates. (United States)

    Lietard, Claire; Thébaud, Véronique; Besson, Gérard; Lejeune, Benoist


    A total of 5,628 neurosurgical patients were observed in France to assess the occurrence of surgical site infection (SSI). Their risk of SSI was defined by calculating both the US National Nosocomial Infection Surveillance and the Brest National Nosocomial Infection Surveillance risk indexes. This study compares SSI rates stratified according to either the US or Brest (France) National Nosocomial Infection Surveillance risk index. The SSI rates were correlated with National Nosocomial Infection Surveillance data involving only local operation durations.

  15. 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.

  16. Rates of clinically apparent heparin-induced thrombocytopenia for unfractionated heparin vs. low molecular weight heparin in non-surgical patients are low and similar

    Directory of Open Access Journals (Sweden)

    Gerber Jonathan


    Full Text Available Abstract With the growing use of low-molecular-weight heparins (LMWH for the treatment and prevention of venous thromboembolism (VTE, it is important to provide an evidence-based comparison with unfractionated heparin (UFH concerning rates of heparin-induced thrombocytopenia (HIT. Such comparisons are essential in clinical decision-making and cost-modeling. In this paper we review data regarding non-surgical (medical patients. We conclude that the lack of uniform evaluation and standardized testing for HIT in the current literature precludes making a reliable estimate of the relative risk of HIT in UFH vs. LMWH in either the treatment or prevention of VTE in non-surgical patients. However, current data suggest that the risk of thrombocytopenia and HIT is low and similar for non-surgical patients who receive either LMWH or UFH.

  17. Daily skin cleansing with chlorhexidine did not reduce the rate of central-line associated bloodstream infection in a surgical intensive care unit. (United States)

    Popovich, Kyle J; Hota, Bala; Hayes, Robert; Weinstein, Robert A; Hayden, Mary K


    Cleansing the skin of intensive care unit (ICU) patients daily with chlorhexidine gluconate (CHG) has been associated with beneficial effects, including a reduction in central-line-associated bacteremias (CLABSIs). Most studies have been done in medical ICUs. In this study, we evaluated the effectiveness of daily chlorhexidine skin cleansing on CLABSI rates in a surgical ICU. In Fall 2005, the 30-bed surgical ICU at Rush University Medical Center discontinued daily soap-and-water bathing of patients and substituted skin cleansing with no-rinse, 2% CHG-impregnated cloths. This change was made without research investigator input or oversight. Using administrative, microbiological and infection control practitioner databases, we compared rates of CLABSIs and blood culture contamination during soap-and-water bathing (September 2004-October 2005) and CHG cleansing (November 2005-October 2006) periods. Rates of other nosocomial infections that were not expected to be affected by CHG bathing (secondary bacteremia, Clostridium difficile-associated diarrhea, ventilator-associated pneumonia, urinary tract infection) were included as control variables. There was no significant difference in the CLABSI rate between soap-and-water and CHG bathing periods (3.81/1,000 central line days vs. 4.6/1,000 central line days; p = 0.57). Blood culture contamination declined during CHG bathing (5.97/1,000 to 2.41/1,000 patient days; p = 0.003). Rates of other nosocomial infections did not change significantly. In this real-world effectiveness trial, daily cleansing of surgical ICU patients' skin with CHG had no effect on CLABSI rates, but was associated with half the rate of blood culture contamination. Controlled trials in surgical ICUs are needed to determine whether CHG bathing can prevent infections in this setting.

  18. [Resection margins in conservative breast cancer surgery]. (United States)

    Medina Fernández, Francisco Javier; Ayllón Terán, María Dolores; Lombardo Galera, María Sagrario; Rioja Torres, Pilar; Bascuñana Estudillo, Guillermo; Rufián Peña, Sebastián


    Conservative breast cancer surgery is facing a new problem: the potential tumour involvement of resection margins. This eventuality has been closely and negatively associated with disease-free survival. Various factors may influence the likelihood of margins being affected, mostly related to the characteristics of the tumour, patient or surgical technique. In the last decade, many studies have attempted to find predictive factors for margin involvement. However, it is currently the new techniques used in the study of margins and tumour localisation that are significantly reducing reoperations in conservative breast cancer surgery. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  19. Trends and variations in the rates of hospital complications, failure-to-rescue and 30-day mortality in surgical patients in New South Wales, Australia, 2002-2009.

    Directory of Open Access Journals (Sweden)

    Lixin Ou

    Full Text Available BACKGROUND: Despite the increased acceptance of failure-to-rescue (FTR as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications, there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator. METHODS: We conducted a population-based study on elective surgical patients from 82 public acute hospitals in New South Wales, Australia between 2002 and 2009, exploring the trends and variations in rates of hospital complications, FTR and 30-day mortality. We used Poisson regression models to derive relative risk ratios (RRs after adjusting for a range of patient and hospital characteristics. RESULTS: The average rates of complications, FTR and 30-day mortality were 13.8 per 1000 admissions, 14.1% and 6.1 per 1000 admission, respectively. The rates of complications and 30-day mortality were stable throughout the study period however there was a significant decrease in FTR rate after 2006, coinciding with the establishment of national and state-level peak patient safety agencies. There were marked variations in the three rates within the top 20% of hospitals (best and bottom 20% of hospitals (worst for each of the four peer-hospital groups. The group comprising the largest volume hospitals (principal referral/teaching hospitals had a significantly higher rate of FTR in comparison to the other three groups of smaller-sized peer hospital groups (RR = 0.78, 0.57, and 0.61, respectively. Adjusted rates of complications, FTR and 30-day mortality varied widely for individual surgical procedures between the best and worst quintile hospitals within the principal referral hospital group. CONCLUSIONS: The decrease in FTR rate over the study period appears to be associated with a wide range of patient safety programs. The marked variations in the three rates between- and within- peer hospital groups

  20. The Effect of Participating in a Surgical Site Infection (SSI) Surveillance Network on the Time Trend of SSI Rates: A Systematic Review. (United States)

    Abbas, Mohamed; Tartari, Ermira; Allegranzi, Benedetta; Pittet, Didier; Harbarth, Stephan


    This systematic literature review reveals that participating in a surgical site infection (SSI) surveillance network is associated with short-term reductions in SSI rates: relative risk [RR] for year 2, 0.80 (95% confidence interval [CI], 0.79-0.82); year 3 RR, 0.92 (95% CI, 0.90-0.94); year 4 RR, 0.98 (95% CI, 0.96-1.00). Infect Control Hosp Epidemiol 2017;1-3.

  1. Preoperative breast MRI can reduce the rate of tumor-positive resection margins and reoperations in patients undergoing breast-conserving surgery

    NARCIS (Netherlands)

    A.I.M. Obdeijn (Inge-Marie); M.M.A. Tilanus-Linthorst (Madeleine); S. Spronk (Sandra); C.H.M. van Deurzen (Carolien); C. de Monyé (Cécile); M.G.M. Hunink (Myriam); M.B. Menke (Marian )


    textabstractOBJECTIVE. In breast cancer patients eligible for breast-conserving surgery, we evaluated whether the information provided by preoperative MRI of the breast would result in fewer tumor-positive resection margins and fewer reoperations. SUBJECTS AND METHODS. The study group consisted of 1

  2. 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. ...

  3. New Frontiers in Surgical Innovation. (United States)

    Jackson, Ryan S; Schmalbach, Cecelia E


    It is an exciting time for head and neck surgical innovation with numerous advances in the perioperative planning and intraoperative management of patients with cancer, trauma patients, and individuals with congenital defects. The broad and rapidly changing realm of head and neck surgical innovation precludes a comprehensive summary. This article highlights some of the most important innovations from surgical planning with sentinel node biopsy and three-dimensional, stereolithic modeling to intraoperative innovations, such as transoral robotic surgery and intraoperative navigation. Future surgical innovations, such as intraoperative optical imaging of surgical margins, are also highlighted. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. The Impact of Clostridum Difficile on Surgical Rate Among Ulcerative Colitis Patients: A Systemic Review and Meta-analysis


    Jiang-Chen Peng; Jun Shen; Qi Zhu; Zhi-Hua Ran


    There is growing recognition of the impact of Clostridum difficile infection (CDI) on patients with inflammatory bowel disease. Clostridium difficile infection causes greater morbidity and mortality. This study aimed to evaluate the impact of C. difficile on surgical risk among ulcerative colitis (UC) patients. We searched the following databases: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, ACP Journal Club, DARE, CMR, and HTA. Studies were included if fulfilled the f...

  5. Effect of preoperative administration of erythromycin or flunixin meglumine on postoperative abomasal emptying rate in dairy cows undergoing surgical correction of left displacement of the abomasum. (United States)

    Wittek, Thomas; Tischer, Katja; Gieseler, Tobias; Fürll, Manfred; Constable, Peter D


    To determine whether preoperative administration of erythromycin or flunixin meglumine altered postoperative abomasal emptying rate, rumen contraction rate, or milk production in dairy cattle undergoing surgical correction of left displacement of the abomasum (LDA). Nonrandomized, controlled clinical trial. 45 lactating Holstein-Friesian cows with LDA. Cows were alternately assigned to an erythromycin (10 mg/kg [4.5 mg/lb], IM), flunixin (2.2 mg/kg [1.0 mg/lb], IV), or control group (n = 15/group). Treatments were administered once 1 hour before surgical correction of LDA. D-Xylose solution (50%; 0.5 g/kg [0.23 g/lb]) was injected into the abomasal lumen during surgery, and venous blood samples were periodically obtained to determine time to maximum serum D-xylose concentration. Abomasal emptying rate was significantly faster in cows treated with erythromycin (mean +/- SD time to maximum serum D-xylose concentration, 149 +/- 48 minutes) than in control cows (277 +/- 95 minutes) but was not significantly different between cows treated with flunixin (230 +/- 49 minutes) and control cows. Cows treated with erythromycin had significantly greater milk production, relative to production before surgery, on postoperative days 1 and 2 than did control cows. Cows in the erythromycin and flunixin groups had a significantly higher rumen contraction rate on the first postoperative day than did control cows. Results suggested that preoperative administration of a single dose of erythromycin increased abomasal emptying rate, rumen contraction rate, and milk production in the immediate postoperative period in cows undergoing surgical correction of LDA.

  6. Foaling rates and risk factors for abortion in pregnant mares presented for medical or surgical treatment of colic: 153 cases (1993–2005) (United States)

    Chenier, Tracey S.; Whitehead, Ashley E.


    The purpose of this study was to determine foaling rates in mares presented for medical or surgical treatment of colic, and to examine risk factors associated with abortion following colic. A retrospective analysis of 153 medical records found that mares treated surgically for colic (P = 0.0007) were 3.5 times more likely to have a negative pregnancy outcome than were mares treated medically for colic. Anesthetic time (P = 0.01) and intra-operative hypotension (P = 0.03) were significantly associated with negative pregnancy outcome. Mares with an anesthetic time ≥ 3 h were 6 times more likely to abort. Signs of endotoxemia (P = 0.30), hypoxia (P = 0.89), flunixin meglumine administration (P = 0.13), mucous membrane color at the time of presentation (P = 0.82) and capillary refill time (P = 0.76) were not associated with pregnancy outcome. There was no difference in the foaling rate for mares that had received progestin supplementation versus those that had not (P = 0.42). In this study, the significant risk factors for abortion were surgically treated colic, long anesthetic time, and intraoperative hypotension. PMID:19436632

  7. Effect of preoperative biliary drainage on surgical results after pancreaticoduodenectomy in patients with distal common bile duct cancer:Focused on the rate of decrease in serum bilirubin

    Institute of Scientific and Technical Information of China (English)

    Yun Mee Choi; Seok-Hwan Shin; Kyung Rae Kim; Ze-Hong Woo; Eung-Ho Cho; Keon-Young Lee; Seung-Ik Ahn; Sun Keun Choi; Sei Joong Kim; Yoon Seok Hut; Young Up Cho; Kee-Chun Hang


    AIM:To examine if the rate of decrease in serum bilirubin after preoperative biliary drainagecan be used as a predicting factor for surgical complications and postoperative recovery after pancreaticoduodenectomy in patients with distal common bile duct cancer.METHODS:A retrospective study was performed in 49 consecutive patients who underwent pancreaticoduodenectomy for distal common bile duct cancer.Potential risk factors were compared between the complicated and uncomplicated groups.Also,the rates of decrease in serum bilirubin were compared pre-and postoperatively.RESULTS:Preoperative biliary drainage (PBD) was performed in 40 patients (81.6%).Postoperative morbidity and mortality rates were 46.9% (23/49) and 6.1% (3/49),respectively.The presence or absence of PBD was not different between the complicated and uncomplicated groups.In patients with PBD,neither the absolute level nor the rate of decrease in serum bilirubin was significantly different.Patients with rapid decrease preoperatively showed faster decrease during the first postoperative week (5.5±4.4 μmol/L vs-1.7±9.9μmol/L,P=0.004).CONCLUSION:PBD does not affect the surgical outcome of pancreaticoduodenectomy in patients with distal common bile duct cancer.There is a certain group of patients with a compromised hepatic excretory function,which is represented by the slow rate of decrease in serum bilirubin after PBD.

  8. Effects of resection margins on local recurrence of osteosarcoma in extremity and pelvis: Systematic review and meta-analysis. (United States)

    He, Fangzhou; Zhang, Weibin; Shen, Yuhui; Yu, Pei; Bao, Qiyuan; Wen, Junxiang; Hu, Chuanzhen; Qiu, Shijing


    There are conflicting findings about the effect of resection margins on local recurrence in osteosarcoma after surgery. In this meta-analysis, we examined the association between local recurrence and resection margins for osteosarcoma in extremity and pelvis. EMBASE, PubMed and Cochrane CENTRAL were searched from January 1980 to July 2016. The quality of included studies was evaluated using the Newcastle-Ottawa Quality Assessment Scale. The odds ratio and 95% confidence interval of local recurrence were estimated, respectively, for inadequate vs adequate margins and marginal vs wide margins using a random-effect model. Chi-square test was performed to comparing the local recurrence rate between extremity and pelvic osteosarcomas with an identical surgical margin. Thirteen articles involving 1559 patients (175 with and 1384 without local recurrence) were included in this study. The meta-analysis showed that the osteosarcoma resected with inadequate and marginal margins, whether in extremity or in pelvis, were associated with a significantly higher local recurrence rate than the osteosarcoma resected with adequate and wide margins, respectively. Chi-square test showed that, when pelvic and extremity osteosarcomas were removed with an identical resection margin, the local recurrence was significantly more frequent in pelvis osteosarcoma than in extremity osteosarcoma. This study provides level IIa evidence to support that the surgery with adequate or wide resection margin has positive effect on reducing the risk of local recurrence in osteosarcoma. In addition, the factors independent of resection margin are more likely to increase the risk of local recurrence in pelvic osteosarcoma. Level IIa, Therapeutic study. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  9. Crown lengthening: a surgical flap approach. (United States)

    Lundergan, W; Hughes, W R


    In many instances it is not possible to place a restoration margin without encroaching on the periodontal attachment apparatus. A surgical crown-lengthening procedure can provide a good solution to this common clinical problem. This article discusses indication and contraindication for surgical crown-lengthening procedures and presents an appropriate surgical technique.

  10. Breast Conservation Therapy: The Influence of Molecular Subtype and Margins

    Energy Technology Data Exchange (ETDEWEB)

    Demirci, Senem, E-mail: [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Department of Radiation Oncology, Ege University Faculty of Medicine, Izmir (Turkey); Broadwater, Gloria [Department of Biostatistics and Bioinformatics, Duke Cancer Institute, Durham, NC (United States); Cancer and Leukemia Group B Statistical Center, Duke Cancer Institute, Durham, NC (United States); Marks, Lawrence B. [Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC (United States); Clough, Robert; Prosnitz, Leonard R. [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States)


    Purpose: To evaluate treatment results and prognostic factors, especially margin status and molecular subtype, in early-stage breast cancer patients treated with breast conservation therapy (BCT). Methods and Materials: The records of 1,058 Stage I or II breast cancer patients treated with BCT (surgical excision plus radiotherapy) at Duke University Medical Center, Durham, North Carolina, from 1985-2005 were retrospectively reviewed. Conventional receptor analyses were used as surrogate markers for molecular subtype classification (luminal A, luminal B, Her2 positive, and basal like). Actuarial estimates of overall survival (OS), cause-specific survival (CSS), failure-free survival, and locoregional control (LRC) were computed by use of Kaplan-Meier plots. We analyzed prognostic variables for significance using Cox proportional hazards univariate and multivariate analysis. The study was approved by the Duke University Medical Center Institutional Review Board. Results: The median age of the patients was 56 years (range, 18-89 years). Of the patients, 80% had T1 disease and 66% N0 disease pathologically. With a median follow-up of 9.8 years, an in-breast recurrence developed in 53 patients and 10 patients had nodal failure. For all patients, the 10-year CSS rate was 94%; LRC rate, 94%; and failure-free survival rate, 88%. Luminal A patients had a CSS rate of 95% and LRC rate of 99%. Basal-type patients appeared to do worse, with regard to both CSS rate (74%) and LRC rate (76%), but the numbers were small and the difference was not statistically significant. LRC rates of patients with negative margins (widely negative, close, and extent of margin not known) were virtually identical (93%, 96%, and 94%, respectively). Those with positive margins appeared to fare slightly worse based on LRC rate (88%), but again, the numbers were small and the difference was not statistically significant. Conclusions: BCT remains the treatment of choice for early-stage breast cancer

  11. 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 ...

  12. Study Suggests Smaller Melanoma Excision Margins May Be Option for Some Patients (United States)

    A randomized controlled trial of patients with stage IIA–C cutaneous melanoma thicker than 2-mm found that a 2-cm surgical resection margin is sufficient and is as safe for patients as a 4-cm margin.

  13. Liposarcoma of the Spermatic Cord: Impact of Final Surgical Intervention—An Institutional Experience (United States)

    Bachmann, R.; Rolinger, J.; Girotti, P.; Kopp, H. G.; Heissner, K.; Amend, B.; Königsrainer, A.; Ladurner, R.


    Background. Paratesticular liposarcomas are almost always mistakenly diagnosed as inguinal hernias subsequently followed by inadequate operation. Methods. 14 consecutive patients with paratesticular liposarcoma were retrospectively reviewed. Preoperative management was evaluated. Disease-free and overall survival were determined. Results. In 11 patients primary and in 3 patients recurrent liposarcoma of the spermatic cord were diagnosed. Regarding primary treatment in primary surgical intervention resection was radical (R0) in 7 of 14 (50%) patients, marginal (R1) in 6 (43%) patients, and incomplete with macroscopic residual tumour (R2) in 1 (7%) patient. Primary treatment secondary surgical intervention was performed in 4 patients: resection was radical (R0) in 3 (75%) patients and marginal (R1) in 1 (25%) patient. Regarding secondary treatment in recurrent disease resection was marginal (R1) in 3 patients (100%). Final histologic margins were negative in 10 patients with primary disease (71%) and positive in 4 patients with subsequent recurrent disease. After radical resection disease-free survival rates at 3 years were 100%. Overall survival at 4.5 years (54 (18–180) months) was 64%. Conclusion. An incomplete first surgical step increases the number of positive margins leading to local recurrences and adverse prognoses. Aggressive surgery should be attempted to attain 3-dimensional negative margins. PMID:27190644

  14. Differential impact of infection control strategies on rates of resistant hospital-acquired pathogens in critically ill surgical patients. (United States)

    Jayaraman, Sudha P; Askari, Reza; Bascom, Molli; Liu, Xiaoxia; Rogers, Selwyn O; Klompas, Michael


    There were two major outbreaks of multi-drug resistant Acinetobacter baumannii (MDRA) in our general surgery and trauma intensive care units (ICUs) in 2004 and 2011. Both required aggressive multi-faceted interventions to control. We hypothesized that the infection control response may have had a secondary benefit of reducing rates of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Clostridium difficile (C. diff). We analyzed data retrospectively from a prospective infection control database at a major university hospital and calculated the incidence rates of nosocomial MRSA, VRE, and C. diff before and after the two MDRA outbreaks (2004 and 2011) in the general surgery and trauma ICUs, and two unaffected control ICUs: thoracic surgery ICU and medical ICU. We tracked incidence rates in 6 mos segments for 24 mos per outbreak and created a composite variable of "any resistant pathogen" for comparison. The incidence rates of "any resistant pathogen" were significantly lower in the general surgery ICU after both outbreaks (24 to 11 cases per 1000 patient days in 2004, p=0.045 and 7.7 ->4.0 cases per 1000 patient days in 2011, p=0.04). This did not persist after 6 mos. The trauma ICU's rate of "any resistant pathogen" did not change after either outbreak (16 ->16.5 cases per 1000 patient days in 2004, p=0.44 and 4.6 ->1.9 cases per 1000 patient days in 2011, p=0.41). The rates in the control ICUs were unchanged during the study periods. Rates of resistant pathogens were lower in the general surgery ICU after response to MDRA outbreaks in both 2004 and 2011 although the rates increased again with time. There were no changes in rates of resistant pathogens in the trauma ICU after MDRA outbreaks in 2004 and 2011. Outbreak responses may have a differential impact in general surgery ICU versus trauma ICUs.

  15. Comparing the survival rate of juvenile Chinook salmon migrating through hydropower systems using injectable and surgical acoustic transmitters (United States)

    Deng, Z. D.; Martinez, J. J.; Li, H.; Harnish, R. A.; Woodley, C. M.; Hughes, J. A.; Li, X.; Fu, T.; Lu, J.; McMichael, G. A.; Weiland, M. A.; Eppard, M. B.; Skalski, J. R.; Townsend, R. L.


    Acoustic telemetry is one of the primary technologies for studying the behavior and survival of fishes throughout the world. The size and performance of the transmitter are key limiting factors. The newly developed injectable transmitter is the first acoustic transmitter that can be implanted via injection instead of surgery. A two-part field study was conducted to evaluate the performance of the injectable transmitter and its effect on the survival of implanted fish. The injectable transmitter performed well and similarly to the proceeding generation of commercially-available JSATS transmitters tested concurrently. Snake River subyearling Chinook salmon smolts implanted with the injectable transmitter had a higher survival probability from release to each of eleven downstream detection arrays, because reach-specific survival estimates were significantly higher for the injectable group in three of the eleven reaches examined. Overall, the injectable group had a 0.263 (SE = 0.017) survival probability over the entire 500 km study area compared to 0.199 (0.012) for the surgically implanted group. The reduction in size and ability to implant the new transmitter via injection has reduced the tag or tagging effect bias associated with studying small fishes. The information gathered with this new technology is helping to evaluate the impacts of dams on fishes. PMID:28220850

  16. Comparing the survival rate of juvenile Chinook salmon migrating through hydropower systems using injectable and surgical acoustic transmitters. (United States)

    Deng, Z D; Martinez, J J; Li, H; Harnish, R A; Woodley, C M; Hughes, J A; Li, X; Fu, T; Lu, J; McMichael, G A; Weiland, M A; Eppard, M B; Skalski, J R; Townsend, R L


    Acoustic telemetry is one of the primary technologies for studying the behavior and survival of fishes throughout the world. The size and performance of the transmitter are key limiting factors. The newly developed injectable transmitter is the first acoustic transmitter that can be implanted via injection instead of surgery. A two-part field study was conducted to evaluate the performance of the injectable transmitter and its effect on the survival of implanted fish. The injectable transmitter performed well and similarly to the proceeding generation of commercially-available JSATS transmitters tested concurrently. Snake River subyearling Chinook salmon smolts implanted with the injectable transmitter had a higher survival probability from release to each of eleven downstream detection arrays, because reach-specific survival estimates were significantly higher for the injectable group in three of the eleven reaches examined. Overall, the injectable group had a 0.263 (SE = 0.017) survival probability over the entire 500 km study area compared to 0.199 (0.012) for the surgically implanted group. The reduction in size and ability to implant the new transmitter via injection has reduced the tag or tagging effect bias associated with studying small fishes. The information gathered with this new technology is helping to evaluate the impacts of dams on fishes.

  17. Comparing the survival rate of juvenile Chinook salmon migrating through hydropower systems using injectable and surgical acoustic transmitters (United States)

    Deng, Z. D.; Martinez, J. J.; Li, H.; Harnish, R. A.; Woodley, C. M.; Hughes, J. A.; Li, X.; Fu, T.; Lu, J.; McMichael, G. A.; Weiland, M. A.; Eppard, M. B.; Skalski, J. R.; Townsend, R. L.


    Acoustic telemetry is one of the primary technologies for studying the behavior and survival of fishes throughout the world. The size and performance of the transmitter are key limiting factors. The newly developed injectable transmitter is the first acoustic transmitter that can be implanted via injection instead of surgery. A two-part field study was conducted to evaluate the performance of the injectable transmitter and its effect on the survival of implanted fish. The injectable transmitter performed well and similarly to the proceeding generation of commercially-available JSATS transmitters tested concurrently. Snake River subyearling Chinook salmon smolts implanted with the injectable transmitter had a higher survival probability from release to each of eleven downstream detection arrays, because reach-specific survival estimates were significantly higher for the injectable group in three of the eleven reaches examined. Overall, the injectable group had a 0.263 (SE = 0.017) survival probability over the entire 500 km study area compared to 0.199 (0.012) for the surgically implanted group. The reduction in size and ability to implant the new transmitter via injection has reduced the tag or tagging effect bias associated with studying small fishes. The information gathered with this new technology is helping to evaluate the impacts of dams on fishes.

  18. In North Ecuador - South Colombia margin (0-4°N), the sedimentation rate in the trench and the tectonic deformation co-control the location of the seismogenic zone. (United States)

    Marcaillou, Boris; Jean-Yves, Collot; Allessandra, Ribodetti; Elia, D'acremont


    related to the sedimentation rate over the oceanic plate: thick sediment loading in the trench results in low heat flow values inducing a cooling effect along the interplate contact that can shift landward the updip of the seismogenic zone by tens of km. 2/ The tectonic regime by controlling the depth of the decollement also impact its thermal regime. The decollement is much deeper and hotter in accretionnary margins than in non-accretionnary or/and erosional margins. As a consequence, In Ecuador-Colombia, the thermally-defined seismogenic zone extends closer to the trench in accretionnary segments, consistently with the aftershock zone and the rupture zone of great subduction earthquakes.

  19. Can the Misinterpretation Amendment Rate Be Used as a Measure of Interpretive Error in Anatomic Pathology?: Implications of a Survey of the Directors of Anatomic and Surgical Pathology. (United States)

    Parkash, Vinita; Fadare, Oluwole; Dewar, Rajan; Nakhleh, Raouf; Cooper, Kumarasen


    A repeat survey of the Association of the Directors of Anatomic and Surgical Pathology, done 10 years after the original was used to assess trends and variability in classifying scenarios as errors, and the preferred post signout report modification for correcting error by the membership of the Association of the Directors of Anatomic and Surgical Pathology. The results were analyzed to inform on whether interpretive amendment rates might act as surrogate measures of interpretive error in pathology. An analyses of the responses indicated that primary level misinterpretations (benign to malignant and vice versa) were universally qualified as error; secondary-level misinterpretations or misclassifications were inconsistently labeled error. There was added variability in the preferred post signout report modification used to correct report alterations. The classification of a scenario as error appeared to correlate with severity of potential harm of the missed call, the perceived subjectivity of the diagnosis, and ambiguity of reporting terminology. Substantial differences in policies for error detection and optimal reporting format were documented between departments. In conclusion, the inconsistency in labeling scenarios as error, disagreement about the optimal post signout report modification for the correction of the error, and variability in error detection policies preclude the use of the misinterpretation amendment rate as a surrogate measure for error in anatomic pathology. There is little change in uniformity of definition, attitudes and perception of interpretive error in anatomic pathology in the last 10 years.

  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. Lower rates of symptom recurrence and surgical revision after primary compared with secondary endoscopic third ventriculostomy for obstructive hydrocephalus secondary to aqueductal stenosis in adults. (United States)

    Sankey, Eric W; Goodwin, C Rory; Jusué-Torres, Ignacio; Elder, Benjamin D; Hoffberger, Jamie; Lu, Jennifer; Blitz, Ari M; Rigamonti, Daniele


    OBJECT Endoscopic third ventriculostomy (ETV) is the treatment of choice for obstructive hydrocephalus; however, the success of ETV in patients who have previously undergone shunt placement remains unclear. The present study analyzed 103 adult patients with aqueductal stenosis who underwent ETV for obstructive hydrocephalus and evaluated the effect of previous shunt placement on post-ETV outcomes. METHODS This study was a retrospective review of 151 consecutive patients who were treated between 2007 and 2013 with ETV for hydrocephalus. One hundred three (68.2%) patients with aqueductal stenosis causing obstructive hydrocephalus were included in the analysis. Postoperative ETV patency and aqueductal and cisternal flow were assessed by high-resolution, gradient-echo MRI. Post-ETV Mini-Mental State Examination, Timed Up and Go, and Tinetti scores were compared with preoperative values. Univariate and multivariate analyses were performed comparing the post-ETV outcomes in patients who underwent a primary (no previous shunt) ETV (n = 64) versus secondary (previous shunt) ETV (n = 39). RESULTS The majority of patients showed significant improvement in symptoms after ETV; however, no significant differences were seen in any of the quantitative tests performed during follow-up. Symptom recurrence occurred in 29 (28.2%) patients after ETV, after a median of 3.0 (interquartile range 0.8-8.0) months post-ETV failure. Twenty-seven (26.2%) patients required surgical revision after their initial ETV. Patients who received a secondary ETV had higher rates of symptom recurrence (p = 0.003) and surgical revision (p = 0.003), particularly in regard to additional shunt placement/revision post-ETV (p = 0.005). These differences remained significant after multivariate analysis for both symptom recurrence (p = 0.030) and surgical revision (p = 0.043). CONCLUSIONS Patients with obstructive hydrocephalus due to aqueductal stenosis exhibit symptomatic improvement after ETV, with a

  2. Surgical Management of Benign and Borderline Phyllodes Tumors of the Breast. (United States)

    Moutte, Amandine; Chopin, Nicolas; Faure, Christelle; Beurrier, Frédéric; Ho Quoc, Christophe; Guinaudeau, Florence; Treilleux, Isabelle; Carrabin, Nicolas


    Phyllodes tumors (PT) are uncommon fibroepithelial breast neoplasms and there is currently no clear consensual treatment for these tumors. The aim of our study was to evaluate the surgical management and outcome of benign and borderline PT. We retrospectively assessed 76 cases of benign or borderline PT managed at the Leon Berard comprehensive cancer center in Lyon, France between July 2003 and December 2013. The mean age at diagnosis was 37.9 years and the median follow-up was 58 months. Seventy-five patients (99%), with a mean tumor size of 27 mm, underwent a breast-conserving procedure. The tumor margins were considered positive (when the tumor was present at the inked surgical section) in seven of 76 cases (9%) and negative in 65 out of 76 cases (86%). We observed the presence of small negative surgical margins <10 mm in 89% and <1 mm in 71% of the patients. Although no re-excision was performed to increase these margins, we did not see any increase in the local recurrence rate (4%) when compared to recurrence rates reported in the literature. We thus suggest that systematic revision surgery for close or positive surgical margins for benign PT should not be systematically performed. However, as recurrences occur within 2 years of initial excision, we recommend a regular clinical and imaging follow-up especially during this period for which patient's compliance is essential.

  3. Hospitalisation, surgical and medical recurrence rates in inflammatory bowel disease 2003-2011-A Danish population-based cohort study

    DEFF Research Database (Denmark)

    Vester-Andersen, Marianne K.; Vind, Ida; Prosberg, Michelle V.;


    OBJECTIVE: The aim of this study is to evaluate the cumulative probability of recurrence and admission rates in an inflammatory bowel disease (IBD) inception cohort diagnosed in 2003-2004. METHODS: Data on medications, phenotypes and surgery for 513 individuals with ulcerative colitis (UC, n=300...... (47%) had at least one IBD-related hospitalisation. The hospitalisation rate decreased from 7.0 days/person-year in year one to 0.9 day at year 5 in CD, and from 4.7 days to 0.4 days for UC patients. Age above 40, current smoking, stricturing behaviour, and disease localisation (colonic, ileocolonic......, but not the surgery or hospitalisation rates, have decreased for CD but not for UC. The phenotypic characteristics at diagnosis predict the risk of recurrence and hospitalisation....


    Directory of Open Access Journals (Sweden)

    Josephine Pudumai Selvi


    Full Text Available BACKGROUND Surgical site infection (SSI is an immense burden on healthcare resources even in the modern era of immaculate sterilization approaches and highly effective antibiotics. An estimated 234 million various surgical procedures, involving skin incisions requiring various types of wound closure techniques, are performed in the world, with the majority resulting in a wound healing by primary intention. Triclosan (5-chloro-2-(2, 4-dichlorophenoxy phenol is a broad-spectrum bactericidal agent that has been used for more than 40 years in various products, such as toothpaste and soaps. Higher concentrations of Triclosan work as a bactericide by attacking different structures in the bacterial cytoplasm and cell membrane. Use of Triclosan-coated sutures should theoretically result in the reduction of SSI. The aim of the study is to assess the abdominal closure with antibacterial coated suture materials and its relation to the incidence of post-operative superficial surgical site infection rates. MATERIALS AND METHODS The data will be collected from hospital records of surgery performed, post-operative daily progress notes and outpatient folders and telephonic conversations with patients after discharge. All patients undergoing laparotomy procedure for any cause. 100 patients divided as 50 in each group. RESULTS The positive outcome of infection (21.5% in patients using ordinary sutures was significantly differed with the positive outcome of infection (11.4% of Triclosan coated sutures. CONCLUSION In conclusion since there was a definite advantage inferred to the patients by using Triclosan coated polyglactin 910, it is the opinion of the researcher that Triclosan coated sutures has a role to play in reducing SSI in clean wounds and its use should be confined to areas where its application has proven benefits. However more studies should be done to clearly define its role and indications in surgery.

  5. Tension-free Polypropylene Mesh-related Surgical Repair for Pelvic Organ Prolapse has a Good Anatomic Success Rate but a High Risk of Complications

    Institute of Scientific and Technical Information of China (English)

    Lei Zhang; Lan Zhu; Juan Chen; Tao Xu; Jing-He Lang


    Background:Food and Drug Administration announcements have highlighted the standard rate of mesh-related complications.We aimed to report the short-term results and complications of tension-free polypropylene mesh (PROSIMATM) surgical repair of pelvic organ prolapse (POP) using the standard category (C),timing (T),and site (S) classification system.Methods:A prospective cohort study of 48 patients who underwent PROSIMATM mesh kit-related surgical repairs were followed for two years at Peking Union Medical College Hospital.Recurrence was defined as symptomatic POP quantification (POP-Q) Stage Ⅱ or higher (leading edge ≥-1 cm).The Patient Global Impression of Change Questionnaire,the Chinese version of the Pelvic Floor Impact Questionnaire short-form-7 and POP/Urinary Incontinence Sexual Questionnaire short-form-12 were used to evaluate the self-perception and sexual function of each patient.Mesh-related complications conformed to the International Urogynecological Association/International Continence Society joint terminology.The paired-sample t-test,one-way analysis of variance,Fisher's exact test,Kaplan-Meier survival analysis and log-rank test were used to analyze data.Results:All patients were followed up for≥1 2 months; 30 (62.5%) patients completed the 24 months study.We observed a 93.8% (45/48) positive anatomical outcome rate at 12 months and 90.0% (27/30) at 24 months.Recurrence most frequently involved the anterior compartment (P < 0.05).Pelvic symptoms improved significantly from baseline (P < 0.05),although the patients' impressions of change and sexual function were not satisfying.Vaginal complication was the main complication observed (35.4%,17/48).The survival analysis did not identify any relationship between vaginal complication and anatomical recurrent prolapse (POP-Q ≥ Stage Ⅱ) (P =0.653).Conclusions:Tension-free polypropylene mesh (PROSIMATM)-related surgical repair of POP has better short-term anatomical outcomes at the

  6. Surgical Site Infection (SSI) Rates in the United States, 1992-1998: The National Nosocomial Infections Surveillance System Basic SSI Risk Index

    National Research Council Canada - National Science Library

    Robert P. Gaynes; David H. Culver; Teresa C. Horan; Jonathan R. Edwards; Chesley Richards; James S. Tolson; The National Nosocomial Infections Surveillance System


    By use of the National Nosocomial Infections Surveillance (NNIS) System's surgical patient surveillance component protocol, the NNIS basic risk index was examined to predict the risk of a surgical site infection (SSI...

  7. Evaluating the impacts of landscape positions and nitrogen fertilizer rates on dissolved organic carbon on switchgrass land seeded on marginally yielding cropland. (United States)

    Lai, Liming; Kumar, Sandeep; Mbonimpa, Eric G; Hong, Chang Oh; Owens, Vance N; Neupane, Ram P


    Dissolved organic carbon (DOC) through leaching into the soils is another mechanism of net C loss. It plays an important role in impacting the environment and impacted by soil and crop management practices. However, little is known about the impacts of landscape positions and nitrogen (N) fertilizer rates on DOC leaching in switchgrass (Panicum virgatum L.). This experimental design included three N fertilizer rates [0 (low); 56 (medium); 112 (high) kg N ha(-1)] and three landscape positions (shoulder, backslope and footslope). Daily average DOC contents at backslope were significantly lower than that at shoulder and footslope. The DOC contents from the plots that received medium N rate were also significantly lower than the plots that received low N rates. The interactions of landscape and N rates on DOC contents were different in every year from 2009 to 2014, however, no significant consistent trend of DOC contents was observed over time. Annual average DOC contents from the plots managed with low N rate were higher than those with high N rate. These contents at the footslope were higher than that at the shoulder position. Data show that there is a moderate positive relationship between the total average DOC contents and the total average switchgrass biomass yields. Overall, the DOC contents from leachate in the switchgrass land were significantly influenced by landscape positions and N rates. The N fertilization reduced DOC leaching contents in switchgrass field. The switchgrass could retain soil and environment sustainability to some extent. These findings will assist in understanding the mechanism of changes in DOC contents with various parameters in the natural environment and crop management systems. However, use of long-term data might help to better assess the effects of above factors on DOC leaching contents and loss in the switchgrass field in the future.

  8. Determining the Oncologic Safety of Autologous Fat Grafting as a Reconstructive Modality: An Institutional Review of Breast Cancer Recurrence Rates and Surgical Outcomes. (United States)

    Cohen, Oriana; Lam, Gretl; Karp, Nolan; Choi, Mihye


    The increasing use of autologous fat grafting in breast cancer patients has raised concerns regarding its oncologic safety. This study evaluated patient outcomes and tumor recurrence following mastectomy reconstruction and autologous fat grafting. Retrospective chart review identified patients who underwent mastectomy followed by breast reconstruction from 2010 to 2015. Eight hundred twenty-nine breasts met inclusion criteria: 248 (30.0 percent) underwent autologous fat grafting, whereas 581 (70.0 percent) breasts did not. Patient demographics, cancer characteristics, oncologic treatment, surgical treatment, surgical complications, local recurrence, and distant metastases were analyzed. Autologous fat grafting patients and control patients were of similar body mass index, smoking status, and BRCA status. Patients who underwent fat grafting were significantly younger than control patients and were less likely to have diabetes, hypertension, or hyperlipidemia. The two groups represented similar distributions of BRCA status, Oncotype scores, and hormone receptor status. Patients underwent one to four grafting procedures: one procedure in 83.1 percent, two procedures in 13.7 percent, three in 2.8 percent, and four in 0.4 percent. Mean follow-up time from initial surgery was 45.6 months in the fat grafting group and 38.8 months in controls. The overall complication rate following fat grafting was 9.4 percent. Among breasts undergoing surgery for therapeutic indications, there were similar rates of local recurrence (fat grafting group, 2.5 percent; controls, 1.9 percent; p = 0.747). Interestingly, mean time to recurrence was significantly longer in the fat grafting group (52.3 months versus 22.8 months from initial surgery; p = 0.016). Autologous fat grafting is a powerful tool in breast reconstruction. This large, single-institution study provides valuable evidence-based support for its oncologic safety. Therapeutic, III.

  9. Surgical Responses of Medial Rectus Muscle Recession in Thyroid Eye Disease-Related Esotropia.

    Directory of Open Access Journals (Sweden)

    In Jeong Lyu

    Full Text Available We evaluate the surgical outcomes and surgical responses of medial rectus muscle (MR recession patients with thyroid eye disease (TED-related esotropia (ET. The surgical dose-response curves 1 week postoperatively and at the final visit were analyzed. Univariable and multivariable linear regression analyses were applied to investigate factors influencing surgical dose-response. A total of 43 patients with TED-related ET that underwent MR recession were included. The final success rate was 86.0% and the rate of undercorrection was 14.0%. The surgical dose-response curves of TED-related ET showed a gentle slope compared with those of standard surgical tables. In the univariable model, simultaneous vertical rectus muscle recession was the only significant factor influencing surgical dose-response of MR recession in TED-related ET (β = -0.397, P = 0.044. In a model adjusted for age, sex, type of surgery, and preoperative horizontal angle of deviation, simultaneous vertical rectus muscle recession showed marginal significance (β = -0.389, P = 0.064. The surgical dose-response curve of TED-related ET was unique. Simultaneous vertical rectus muscle recession was associated with increased surgical dose-response in TED-related ET.

  10. Does the Type of Surgical Approach and the Use of Uterine Manipulators Influence the Disease-Free Survival and Recurrence Rates in Early-Stage Endometrial Cancer? (United States)

    Marcos-Sanmartín, Josefa; López Fernández, José Antonio; Sánchez-Payá, José; Piñero-Sánchez, Óscar Cruz; Román-Sánchez, María José; Quijada-Cazorla, María Asunción; Candela-Hidalgo, María Amparo; Martínez-Escoriza, Juan Carlos


    Objective The purpose of this study was to compare the long-term safety, disease-free survival, and recurrence rate of total laparoscopic hysterectomy using uterine manipulator and abdominal hysterectomy in the surgical treatment in early-stage endometrial cancer. Study Design This was a cohort study of 147 patients with clinical endometrial cancer (laparoscopic surgery group, 77 women; laparotomy group, 70 women). Data were evaluated and analyzed by intention-to-treat principle, and survival data of stage I endometrial cancer (129 patients; 66 from laparoscopic surgery group and 60 from laparotomy group) were estimated by using the Kaplan-Meier curves. Results After a follow-up period of 60 months for both laparoscopic surgery and laparotomy groups, no significant difference in the cumulative recurrence rates (7.4% and 13.1%, P = 0.091) and overall survival (97.1% and 95.1%, P = 0.592) was detected between both groups of stage I endometrial cancer. Conversion to laparotomy occurred in 10.4% (8/77) of the laparoscopic procedures. Laparoscopic hysterectomy was associated with less use of pain medication (P = 0.001) and a shorter hospital stay (P manipulators did not have increased recurrence rate in patients treated with laparoscopic approach. Conclusions The laparoscopic surgery approach to early-stage endometrial cancer using uterine manipulators is as safe and effective as the laparotomic approach. PMID:27518143

  11. Analysis the factors related to the cone marginal status of the patients with cervical intraepithelial neoplasia Ⅲ

    Institute of Scientific and Technical Information of China (English)

    Dai Zhi-qin; Pan Ling-ya; Huang Hui-fang; Lang Jing-he


    Objective:To assess the factors related to the cone marginal status of patients with cervical intraepithelial neo-plasia Ⅲ(CINⅢ)after conization.Method:A retrospective analysis of consecutive patients with CIN Ⅲ accepted conization between Jan.1st 1999 and Dec 31th 2004 was performed.To assess the relationships between the positive margin of conization of the pa-tients with cervical intraepithelial neoplasia Ⅲ and the patient's age,size of lesion and the operator.To assess the management of the positive cone margin and follow-up of the patient with CIN Ⅲ.Results:361 patients first accepted conization.Among them were 58 patients(16.1%)with positive cone mar-gin.There was no difference in the positive margin of conization in the different age groups,size of lesions and oper-ators.The rate of positive margin of conization was 14.3% with the surgeon of the gynecological oncologist,and the 20.4 % with the non-gynecological oncologist.The rate of the follow-up was 70%.According to the rate of the ab-normal cytology of follow-up,the positive margin of conization was 21.4%,and the negative margin of conization was 10.6%,there was no significant difference.Conclusion:The status of the resection margin of the conization may be related to the surgical skill.The patients with CINⅢ should be accepted a regular postoperative follow up,especially the patients with positive margin.

  12. Rapid diagnostic imaging and pathologic evaluation of surgical tissue using video rate structured illumination microscopy (VR-SIM) (Conference Presentation) (United States)

    Wang, Mei; Tulman, David; Elfer, Kate; Sholl, Andrew; Brown, J. Quincy


    Currently available pathology techniques for obtaining a rapid tissue diagnosis, or for determining the adequacy of specimens intended for downstream analysis, are too slow, labor-intensive, and destructive for point-of-care (POC) applications. We previously demonstrated video-rate structured illumination microscopy (VR-SIM) for accurate, high-throughput, non-destructive diagnostic imaging of fluorescently-stained prostate biopsies in seconds per biopsy, with an area under the ROC curve of 0.82-0.88 after pathologist review. In addition, we have demonstrated that it is feasible to use VR-SIM to routinely image very large gross pathology specimens, such as entire prostate resection surfaces, in relatively short timeframes at subcellular resolution. However, our prior work has focused on applications in prostate cancer; the utility in other organ sites has not been explored. Here we extended our technology to varying size kidney, liver, and lung biopsies. We conducted a validation study of VR-SIM against histopathology on a variety of human tissues, including both small biopsies and large slices of tissue. We conducted a blinded study in which the study pathologist accurately identified the organs based on VR-SIM images alone. The results were then used to create a clinical atlas between VR-SIM and H and E images for the different tissues of interest. This clinical atlas will be used to aid in pathologist interpretation in future POC clinical applications of VR-SIM in kidney, liver, and lung. Such applications could include on-site identification of the presence of kidney glomeruli for to ensure successful downstream IHC analysis, or determination of the adequacy of lung cancer biopsies for genomic analysis.

  13. Intraoperative Assessment of Breast Cancer Margins ex vivo using Aqueous Quantum Dot-Functionalized Molecular Probes (United States)

    Au, Giang Hoang Thuy

    Breast cancer is increasingly diagnosed at an early stage, allowing the diseased breast to be removed only partially or breast conserving surgery (BCS). Current BCS procedures have no rapid methods during surgery to assess if the surgical margin is clear of cancer, often resulting in re-excision. The current breast cancer re-excision rate is estimated to be 15% to as high as 60%. It would be desirable if there is a rapid and reliable breast cancer margin assessment tool in the operating room to help assess if the surgical margin is clean to minimize unnecessary re-excisions. In this research, we seek to develop an intraoperative, molecular probe-based breast cancer surgical margin assessment tool using aqueous quantum dots (AQDs) coupled with cancer specific biomarkers. Quantum dots (QDs) are photoluminescent semiconductor nanoparticles that do not photobleach and are brighter than organic fluorescent dyes. Aqueous quantum dots (AQDs) such as CdSe and near infrared (NIR) CdPbS developed in Shih's lab emit light longer than 600 nm. We have examined conjugating AQDs with antibodies to cancer specific biomarkers such as Tn antigen, a cancer-associated glycan antigen for epithelial cancers. We showed that AQDs could achieve ~80% antibody conjugation efficiency, i.e., 100 times less antibodies than required by commercial, making such AQD molecular probe surgical margin evaluation economically feasible. By conjugating AQDs with anti-Tn-antigen antibody, the AQDs molecular probe exhibited 94% sensitivity and 92% specificity in identifying breast cancer against normal breast tissues as well as benign breast tumors in 480 tissue blocks from 126 patients. Furthermore, mice model and clinical human studies indicated that AQDs imaging did not interfere with the following pathological staining. More interestingly, we showed that it it possible to directly conjugate one antibody to multiple AQDs, further reduces the required amount of antibodies needed, a feat that could not be

  14. Comparison of healing rate in diabetes-related foot ulcers with low frequency ultrasonic debridement versus non-surgical sharps debridement: a randomised trial protocol (United States)


    Background Foot ulceration has been reported as the leading cause of hospital admission and amputation in individuals with diabetes. Diabetes-related foot ulcers require multidisciplinary management and best practice care, including debridement, offloading, dressings, management of infection, modified footwear and management of extrinsic factors. Ulcer debridement is a commonly applied management approach involving removal of non-viable tissue from the ulcer bed. Different methods of debridement have been reported in the literature including autolytic debridement via moist wound healing, mechanical debridement utilising wet to dry dressings, theatre based sharps debridement, biological debridement, non-surgical sharps debridement and newer technology such as low frequency ultrasonic debridement. Methods People with diabetes and a foot ulcer, referred to and treated by the Podiatry Department at Monash Health and who meet the inclusion criteria will be invited to participate in this randomised controlled trial. Participants will be randomly and equally allocated to either the non-surgical sharps debridement (control) or low frequency ultrasonic debridement (intervention) group (n = 322 ulcers/n = 108 participants). Where participants have more than one ulcer, only the participant will be randomised, not the ulcer. An investigator not involved in participant recruitment or assessment will be responsible for preparing the random allocation sequence and envelopes. Each participant will receive weekly treatment for six months including best practice podiatric management. Each ulcer will be measured on a weekly basis by calculating total area in centimetres squared. Measurement will be undertaken by a trained research assistant to ensure outcomes are blinded from the treating podiatrist. Another member of the research team will assess the final primary outcome. Discussion The primary aim of this study is to compare healing rates for diabetes-related foot ulcers

  15. Correlation between the survival rate of the patients with synchronous hepatic metastases from gastric carcinoma after surgical resection and patient's index

    Institute of Scientific and Technical Information of China (English)

    YANG Xin-wei; LI Zhe; LIU Kai; FU Xiao-hui; YANG Jia-he; WU Meng-chao


    Background Many studies have reported the benefit of hepatic resection for solitary and metachronous metastases from gastric cancer.However,indications and surgical results for synchronous hepatic metastases from gastric carcinoma have not been clearly defined.This study was performed to assess the benefits and limits of simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases,as well as to identify prognostic factors affecting the survival.Methods Between January 2005 and June 2008,13 patients with synchronous hepatic metastases underwent simultaneous combined resection.The clinicopathologic features and the surgical results of the 13 patients were retrospectively analyzed.Patient,tumor (primary and metastatic carcinoma),and operative parameters were analyzed for their influence on survival.Results No patient died and two patients (15.4%) developed complications during peri-operative course.The actuarial 6-month,1-year,and 2-year survival rates after hepatic resection were 76.9%,38.5%,and 30.8%,respectively,and two patients survived for more than 2 years after surgery without any signs of recurrences until latest follow-up.In univariate analysis,hepatic tumor distribution (P=0.01) and number of hepatic metastases (P=0.003) were significant prognostic factors that influenced survival.Factors associated with the primary lesion were not significant prognostic factors.Conclusions Satisfactory survival may be achieved by simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases in strictly selected patients.The number of hepatic metastases and hepatic tumor distribution are significant prognostic determinants of survival.

  16. Marginalization of the Youth

    DEFF Research Database (Denmark)

    Jensen, Niels Rosendal


    The article is based on a key note speach in Bielefeld on the subject "welfare state and marginalized youth", focusing upon the high ambition of expanding schooling in Denmark from 9 to 12 years. The unintended effect may be a new kind of marginalization.......The article is based on a key note speach in Bielefeld on the subject "welfare state and marginalized youth", focusing upon the high ambition of expanding schooling in Denmark from 9 to 12 years. The unintended effect may be a new kind of marginalization....

  17. Biotic and a-biotic Mn and Fe cycling in deep sediments across a gradient of sulfate reduction rates along the California margin (United States)

    Schneider-Mor, A.; Steefel, C.; Maher, K.


    The coupling between the biological and a-biotic processes controlling trace metals in deep marine sediments are not well understood, although the fluxes of elements and trace metals across the sediment-water interface can be a major contribution to ocean water. Four marine sediment profiles (ODP leg 167 sites 1011, 1017, 1018 and 1020)were examined to evaluate and quantify the biotic and abiotic reaction networks and fluxes that occur in deep marine sediments. We compared biogeochemical processes across a gradient of sulfate reduction (SR) rates with the objective of studying the processes that control these rates and how they affect major elements as well as trace metal redistribution. The rates of sulfate reduction, methanogenesis and anaerobic methane oxidation (AMO) were constrained using a multicomponent reactive transport model (CrunchFlow). Constraints for the model include: sediment and pore water concentrations, as well as %CaCO3, %biogenic silica, wt% carbon and δ13C of total organic carbon (TOC), particulate organic matter (POC) and mineral associated carbon (MAC). The sites are distinguished by the depth of AMO: a shallow zone is observed at sites 1018 (9 to 19 meters composite depth (mcd)) and 1017 (19 to 30 mcd), while deeper zones occur at sites 1011 (56 to 76 mcd) and 1020 (101 to 116 mcd). Sulfate reduction rates at the shallow AMO sites are on the order 1x10-16 mol/L/yr, much faster than rates in the deeper zone sulfate reduction (1-3x10-17 mol/L/yr), as expected. The dissolved metal ion concentrations varied between the sites, with Fe (0.01-7 μM) and Mn (0.01-57 μM) concentrations highest at Site 1020 and lowest at site 1017. The highest Fe and Mn concentrations occurred at various depths, and were not directly correlated with the rates of sulfate reduction and the maximum alkalinity values. The main processes that control cycling of Fe are the production of sulfide from sulfate reduction and the distribution of Fe-oxides. The Mn distribution

  18. Utility of frozen section analysis for fungal organisms in soft tissue wound debridement margin determination. (United States)

    Zimmermann, Nives; Hagen, Matthew C; Schrager, Jason J; Hebbeler-Clark, Renee S; Masineni, Sreeharsha


    Zygomycetes cause different patterns of infection in immunosuppressed individuals, including sino-orbito-cerebral, pulmonary, skin/soft tissue infection and disseminated disease. Infections with Zygomycetes have a high mortality rate, even with prompt treatment, which includes anti-fungal agents and surgical debridement. In some centers, clear margins are monitored by serial frozen sections, but there are no specific guidelines for the use of frozen sections during surgical debridement. Studies in fungal rhinosinusitis found 62.5-85 % sensitivity of frozen section analysis in margin assessment. However, the utility of frozen section analysis for margin evaluation in debridement of skin/soft tissue infection has not been published. We present a case of zygomycosis of decubitus ulcers in which we assessed statistical measures of performance of frozen section analysis for presence of fungal organisms on the margin, compared with formalin-fixed paraffin embedded (FFPE) sections as gold standard. A total of 33 specimens (94 blocks) were sectioned, stained with H&E and evaluated by both frozen and FFPE analysis. Negative interpretations were confirmed by Gomori methenamine silver stain on FFPE sections. H&E staining of frozen sections had 68.4 % sensitivity and 100 % specificity for assessing margins clear of fungal organisms. The negative and positive predictive values were 70.0 % and 100 %, respectively. Using presence of acute inflammation and necrosis as markers of fungal infection improved sensitivity (100 %) at the expense of specificity (42.9 %). Use of intraoperative assessment of skin and soft tissue margins for fungal infection is a valuable tool in the management of skin and soft tissue fungal infection treatment.

  19. Practical Marginalized Multilevel Models. (United States)

    Griswold, Michael E; Swihart, Bruce J; Caffo, Brian S; Zeger, Scott L


    Clustered data analysis is characterized by the need to describe both systematic variation in a mean model and cluster-dependent random variation in an association model. Marginalized multilevel models embrace the robustness and interpretations of a marginal mean model, while retaining the likelihood inference capabilities and flexible dependence structures of a conditional association model. Although there has been increasing recognition of the attractiveness of marginalized multilevel models, there has been a gap in their practical application arising from a lack of readily available estimation procedures. We extend the marginalized multilevel model to allow for nonlinear functions in both the mean and association aspects. We then formulate marginal models through conditional specifications to facilitate estimation with mixed model computational solutions already in place. We illustrate the MMM and approximate MMM approaches on a cerebrovascular deficiency crossover trial using SAS and an epidemiological study on race and visual impairment using R. Datasets, SAS and R code are included as supplemental materials.

  20. Respiration in ocean margin sediments


    Andersson, J.H.


    The aim of this thesis was the study of respiration in ocean margin sediments and the assessments of tools needed for this purpose. The first study was on the biological pump and global respiration patterns in the deep ocean using an empirical model based on sediment oxygen consumption data. In this thesis the depth dependence of respiration patterns was modelled using a compiled data set of sediment oxygen consumption rates. We showed that the depth relationship can best be described by a do...

  1. Surgical Management of Local Recurrences of Renal Cell Carcinoma

    Directory of Open Access Journals (Sweden)

    Ömer Acar


    Full Text Available Surgical resection either in the form of radical nephrectomy or in the form of partial nephrectomy represents the mainstay options in the treatment of kidney cancer. In most instances, resecting the tumor bearing kidney or the tumor itself provides durable cancer specific survival rates. However, recurrences may rarely develop in the renal fossa or remnant kidney. Despite its rarity, locally recurrent RCC is a challenging condition in terms of the possible management options and relatively poor prognosis. If technically feasible, wide surgical excision and ensuring negative surgical margins are the most effective treatment options. Repeat surgeries (completion nephrectomy, excision of locally recurrent tumor, or repeat partial nephrectomy may often be complicated, and perioperative morbidity is a major concern. Open approach has been extensively applied in this context and 5-year cancer specific survival rates have been reported to be around 50%. The roles of minimally invasive surgical options (laparoscopic and robotic approach and nonsurgical alternatives (cryoablation, radiofrequency ablation have yet to be described. In selected patients, surgical resection may have to be complemented with (neoadjuvant radiotherapy or medical treatment.

  2. Skin cancer margin analysis within minutes with full-field OCT (Conference Presentation) (United States)

    Dalimier, Eugénie; Ogrich, Lauren; Morales, Diego; Cusack, Carrie Ann; Abdelmalek, Mark; Boccara, Claude; Durkin, John


    Non-melanoma skin cancer (NMSC) is the most common cancer. Treatment consists of surgical removal of the skin cancer. Traditional excision involves the removal of the visible skin cancer with a significant margin of normal skin. On cosmetically sensitive areas, Mohs micrographic tissue is the standard of care. Mohs uses intraoperative microscopic margin assessment which minimizes the surgical defect and can help reduce the recurrence rate by a factor of 3. The current Mohs technique relies on frozen section tissue slide preparation which significantly lengthens operative time and requires on-site trained histotechnicians. Full-Field Optical Coherence Tomography (FFOCT) is a novel optical imaging technique which provides a quick and efficient method to visualize cancerous areas in minutes, without any preparation or destruction of the tissue. This study aimed to evaluate the potential of FFOCT for the analysis of skin cancer margins during Mohs surgery. Over 150 images of Mohs specimens were acquired intraoperatively with FFOCT before frozen section analysis. The imaging procedure took less than 5 minutes for each specimen. No artifacts on histological preparation were found arising from FFOCT manipulation; however frozen section artifact was readily seen on FFOCT. An atlas was established with FFOCT images and corresponding histological slides to reveal FFOCT reading criteria of normal and cancerous structures. Blind analysis showed high concordance between FFOCT and histology. FFOCT can potentially reduce recurrence rates while maintaining short surgery times, optimize clinical workflow, and decrease healthcare costs. For the patient, this translates into smaller infection risk, decreased stress, and better comfort.

  3. Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies

    Directory of Open Access Journals (Sweden)

    Edvin Prifti, MD, PhD


    Conclusion: In conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients.

  4. An Auto-Fluorescence guided surgical approach performed with Er:YAG laser and Nd:YAG Low Level Laser Therapy for Medication-Related Osteonecrosis of the Jaw

    Directory of Open Access Journals (Sweden)

    Ilaria Giovannacci


    Full Text Available Medication-Related Osteonecrosis of the Jaw (MRONJ therapy remains an unresolved problem. The proposed conservative and surgical treatment regimens are associated to contradictory success rates. Surgical approach with Er:YAG laser is associated to significant better results compared to medical treatment and traditional surgical approaches. Objective: To describe a new surgical approach that couples the advantages of the Er:YAG laser and the usefulness of the AF in highlighting surgical margins. One of the difficulties encountered during surgical removal of a MRONJ is the precise individuation of necrotic bone margins. Case Report: A case of Stage III mandibular osteonecrosis treated with a new surgical approach is presented. The aim is to describe an auto-fluorescence (AF guided surgical approach performed with Er:YAG laser and Nd:YAG Low Level Laser Therapy (LLLT. After one month of follow-up, the complete mucosal healing was evident and symptoms was unobserved. Such a technique allowed a highly accurate and minimally invasive approach through the selective ablation of the non-/hypofluorescent areas. Conclusion: Taking into account the advantages of laser therapy and the possible effectiveness of the AF in highlighting surgical margins, this approach would probably achieve excellent outcomes.DOI: 10.14693/jdi.v22i2.486

  5. Pre-operative antiseptic shower and bath policy decreases the rate of S. aureus and methicillin-resistant S. aureus surgical site infections in patients undergoing joint arthroplasty. (United States)

    Colling, Kristin; Statz, Catherine; Glover, James; Banton, Kaysie; Beilman, Greg


    Surgical site infection (SSI) following joint arthroplasty increases length of stay, hospital cost, and leads to patient and healthcare provider dissatisfaction. Due to the presence of non-biologic implants (the prosthetic joint) in these procedures, infection is often devastating and treatment of the infection is more difficult. For this reason, prevention of SSI is of crucial importance in this population. Staphylococcus aureus colonizes the nares of approximately 30-40% of the population, is the most common pathogen causing SSI, and is associated with high morbidity and mortality rate. A pre-operative shower or bath with an antiseptic is an inexpensive and effective method of removal of these transient skin pathogens prior to the procedure and may be used to decrease SSI. We hypothesize that a preoperative antiseptic shower or bath will decrease the rate of SSI. A retrospective review was performed at two affiliated hospitals within the same system, one with a hospital-wide policy enforcing pre-operative antiseptic shower or bath and the other with no policy, with cases included from January 2010 to June 2012. International Classification of Disease-Ninth Revision-Clinical Modification (ICD-9-CM) codes and chart review were used to identify patients undergoing joint arthroplasty and to identify those with SSI. Two thousand three-hundred forty-nine arthroplasties were performed at the University of Minnesota Medical Center, a tertiary-care hospital with a pre-operative antiseptic shower or bath policy in place. An additional 1,693 procedures were performed at Fairview Ridges Hospital, a community hospital with no pre-operative policy. There was no difference in the rate of SSI between the two hospitals (1.96% vs. 1.95%; p=1.0). However, the rate of SSI caused by S. aureus was significantly decreased by pre-operative antiseptic shower/bath (17% vs. 61%; p=0.03), as was the rate of methicillin-resistant S. aureus (MRSA) infections (2% vs. 24% p=0.002). A pre

  6. Comparison of periprocedural and mid-term stroke rates and outcomes between surgical aortic valve replacement and transcatheter aortic valve replacement patients. (United States)

    Aalaei-Andabili, Seyed Hossein; Anderson, R David; Petersen, John W; Beaver, Thomas M; Bavry, Anthony A; Klodell, Charles T


    We compared stroke occurrence and outcomes between Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR), both periprocedural and at follow-up. From March 2012 to December 2014, 391 consecutive patients underwent TAVR (N.=290) or isolated SAVR (N.=101), concomitantly. Patients' data were prospectively collected. TAVR patients had more comorbidities. One (0.34%) TIA and 9 (3.11%) strokes occurred in-hospital following TAVR, but no cerebrovascular event occurred after SAVR (P=0.11). One stroke (0.99%) and one TIA (0.99%) were detected in SAVR group within 30 days. Among TAVR patients, one (0.75%) stroke at 6 months, 2 (1.9%) strokes and 2 (1.9%) TIAs at 12 months were diagnosed. Kaplan-Meier analysis revealed that 96% and 99% 12-month CVA free survival following TAVR and SAVR, respectively (P=0.67). Preoperative mean trans-aortic valve systolic pressure gradient higher than 40 mmHg remained as risk factor for stroke in TAVR patients only, OR: 4.48 (CI: 1.2-16.54, P=0.02). One intraoperative death, and 5 (4 with CVA) in-hospital deaths occurred after TAVR; whereas only one patient died in SAVR group (P=0.49). Thirty-day mortality was 3.8% (11/290) for TAVR and 0.99% (1/101) for SAVR patients. SAVR patients' survival was 99% at 6 months, 97.9% at 12, and 96.4% at 24 months, whereas survival in TAVR was 97.5% at 6, 92% at 12, and 73.6% at 24 months (HR: 8.43 (CI: 2.47-28.73), P<0.001). Even with significant differences in patients' baseline characteristics; in-hospital and mid-term stroke rates are not significantly higher following TAVR than SAVR. Although periprocedural stroke is not uncommon in TAVR, mid-term stroke rate is low.

  7. Clinical assessment of human breast cancer margins with wide-field optical coherence micro-elastography (Conference Presentation) (United States)

    Allen, Wes M.; Chin, Lixin; Wijesinghe, Philip; Kirk, Rodney W.; Latham, Bruce; Sampson, David D.; Saunders, Christobel M.; Kennedy, Brendan F.


    Breast cancer has the second highest mortality rate of all cancers in females. Surgical excision of malignant tissue forms a central component of breast-conserving surgery (BCS) procedures. Incomplete excision of malignant tissue is a major issue in BCS with typically 20 - 30% cases requiring a second surgical procedure due to postoperative detection of tumor in the margin. A major challenge for surgeons during BCS is the lack of effective tools to assess the surgical margin intraoperatively. Such tools would enable the surgeon to more effectively remove all tumor during the initial surgery, hence reducing re-excision rates. We report advances in the development of a new tool, optical coherence micro-elastography, which forms images, known as elastograms, based on mechanical contrast within the tissue. We demonstrate the potential of this technique to increase contrast between malignant tumor and healthy stroma in elastograms over OCT images. We demonstrate a key advance toward clinical translation by conducting wide-field imaging in intraoperative time frames with a wide-field scanning system, acquiring mosaicked elastograms with overall dimensions of 50 × 50 mm, large enough to image an entire face of most lumpectomy specimens. We describe this wide-field imaging system, and demonstrate its operation by presenting wide-field optical coherence tomography images and elastograms of a tissue mimicking silicone phantom and a number of representative freshly excised human breast specimens. Our results demonstrate the feasibility of scanning large areas of lumpectomies, which is an important step towards practical intraoperative margin assessment.

  8. Prostate Cancer Biochemical Recurrence Rates After Robotic-Assisted Laparoscopic Radical Prostatectomy (United States)

    Ginzburg, Serge; Nevers, Thomas; Staff, Ilene; Tortora, Joseph; Champagne, Alison; Kesler, Stuart S.; Laudone, Vincent P.


    Background and Objectives: To determine prostate cancer biochemical recurrence rates with respect to surgical margin (SM) status for patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP). Methods: IRB-approved radical prostatectomy database was queried. Patients were stratified as low, intermediate, and high risk according to D’Amico's risk classification. Postoperative prostate-specific antigen (PSA) values were obtained every 3 mo for the first year, then biannually and annually thereafter. Biochemical recurrence was defined as ≥0.2ng/mL. Patients receiving adjuvant or salvage treatment were included. Positive surgical margin was defined as presence of cancer cells at inked resection margin in the final specimen. Margin presence (negative/positive), margin multiplicity (single/multiple), and margin length (≤3mm focal and >3mm extensive) were noted. Kaplan-Meier curves of biochemical recurrence-free survival (BRFS) as a function of SM were generated. Forward stepwise multivariate Cox regression was performed, with preoperative PSA, Gleason score, pathologic stage, prostate gland weight, and SM as covariates. Results: At our institution, 1437 patients underwent RALP (2003-2009). Of these, 1159 had sufficient data and were included in our analysis. Mean follow-up was 16 mo. Kaplan-Meier curves demonstrated significant increase in BRFS in low-risk and intermediate-risk groups with negative SM. Overall BRFS at 5 y was 72%. Gleason score, pathologic stage, and SM status were significant prognostic factors in multivariate analysis. Conclusions: Negative surgical margins resulted in lower biochemical recurrence rates for low-risk and intermediate-risk groups. Multifocal and longer positive margins were associated with higher biochemical recurrence rates compared with unifocal and shorter positive margins. Documenting biochemical recurrence rates for RALP is important, because this treatment for localized prostate cancer is validated. PMID

  9. Ocean margins workshop

    Energy Technology Data Exchange (ETDEWEB)



    The Department of Energy (DOE) is announcing the refocusing of its marine research program to emphasize the study of ocean margins and their role in modulating, controlling, and driving Global Change phenomena. This is a proposal to conduct a workshop that will establish priorities and an implementation plan for a new research initiative by the Department of Energy on the ocean margins. The workshop will be attended by about 70 scientists who specialize in ocean margin research. The workshop will be held in the Norfolk, Virginia area in late June 1990.

  10. "We call ourselves marginalized"

    DEFF Research Database (Denmark)

    Jørgensen, Nanna Jordt


    In recent decades, indigenous knowledge has been added to the environmental education agenda in an attempt to address the marginalization of non-western perspectives. While these efforts are necessary, the debate is often framed in terms of a discourse of victimization that overlooks the agency o...... argue that researchers not only need to pay attention to how certain voices are marginalized in Environmental Education research and practice, but also to how learners as agents respond to, use and negotiate the marginalization of their perspectives....

  11. Ex vivo ultrasound control of resection margins during partial nephrectomy. (United States)

    Doerfler, Arnaud; Cerantola, Yannick; Meuwly, Jean-Yves; Lhermitte, Benoît; Bensadoun, Henri; Jichlinski, Patrice


    Surgery remains the treatment of choice for localized renal neoplasms. While radical nephrectomy was long considered the gold standard, partial nephrectomy has equivalent oncological results for small tumors. The role of negative surgical margins continues to be debated. Intraoperative frozen section analysis is expensive and time-consuming. We assessed the feasibility of intraoperative ex vivo ultrasound of resection margins in patients undergoing partial nephrectomy and its correlation with margin status on definitive pathological evaluation. A study was done at 2 institutions from February 2008 to March 2011. Patients undergoing partial nephrectomy for T1-T2 renal tumors were included in analysis. Partial nephrectomy was done by a standardized minimal healthy tissue margin technique. After resection the specimen was kept in saline and tumor margin status was immediately determined by ex vivo ultrasound. Sequential images were obtained to evaluate the whole tumor pseudocapsule. Results were compared with margin status on definitive pathological evaluation. A total of 19 men and 14 women with a mean ± SD age of 62 ± 11 years were included in analysis. Intraoperative ex vivo ultrasound revealed negative surgical margins in 30 cases and positive margins in 2 while it could not be done in 1. Final pathological results revealed negative margins in all except 1 case. Ultrasound sensitivity and specificity were 100% and 97%, respectively. Median ultrasound duration was 1 minute. Mean tumor and margin size was 3.6 ± 2.2 cm and 1.5 ± 0.7 mm, respectively. Intraoperative ex vivo ultrasound of resection margins in patients undergoing partial nephrectomy is feasible and efficient. Large sample studies are needed to confirm its promising accuracy to determine margin status. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  12. The Value of Intraoperative Frozen Section Analysis for Margin Status in Breast Conservation Surgery in a Nontertiary Institution

    Directory of Open Access Journals (Sweden)

    Mona P. Tan


    Full Text Available Introduction. Breast conservation treatment (BCT for early-stage breast malignancies requires negative margins and good cosmesis. Reoperations may be needed to achieve negative margins, which can have an adverse impact on outcomes. This study was performed to evaluate the efficacy of intraoperative frozen section analysis (IFSA for margin assessment to reduce excision rates. Methods. All patients treated at the authors’ private healthcare facility between 2009 and 2011 for breast cancer were included in the study. Those for whom BCT was intended underwent wide excision with IFSA. Six margins of the excised tissue, and the sentinel lymph node (SLN, where appropriate, were submitted for IFSA. Patient demographics, tumour characteristics, number of operations performed, and outcomes were analysed. Results. Of the 161 patients analysed, 138 (85.7% had successful breast conservation. Four patients required a reoperation for incomplete surgical extirpation. One had a false negative SLN assessment on IFSA, and was returned to the operating room for an axillary dissection. Three patients required reoperations for inadvertently missed multicentric disease. None had false negative margin evaluation with IFSA necessitating reexcision. Conclusion. The use of IFSA allows low rates of reoperation with BCT. Further research is needed to establish consistency in low reexcision rates for cost-effectiveness and optimum resource allocation.

  13. Indian Ocean margins

    Digital Repository Service at National Institute of Oceanography (India)

    Naqvi, S.W.A.

    The most important biogeochemical transformations and boundary exchanges in the Indian Ocean seem to occur in the northern region, where the processes originating at the land-ocean boundary extend far beyond the continental margins. Exchanges across...

  14. Learning unbelievable marginal probabilities

    CERN Document Server

    Pitkow, Xaq; Miller, Ken D


    Loopy belief propagation performs approximate inference on graphical models with loops. One might hope to compensate for the approximation by adjusting model parameters. Learning algorithms for this purpose have been explored previously, and the claim has been made that every set of locally consistent marginals can arise from belief propagation run on a graphical model. On the contrary, here we show that many probability distributions have marginals that cannot be reached by belief propagation using any set of model parameters or any learning algorithm. We call such marginals `unbelievable.' This problem occurs whenever the Hessian of the Bethe free energy is not positive-definite at the target marginals. All learning algorithms for belief propagation necessarily fail in these cases, producing beliefs or sets of beliefs that may even be worse than the pre-learning approximation. We then show that averaging inaccurate beliefs, each obtained from belief propagation using model parameters perturbed about some le...



    Josephine Pudumai Selvi; Celine Foustina Mary; Karthikeyan Rajashekar


    BACKGROUND Surgical site infection (SSI) is an immense burden on healthcare resources even in the modern era of immaculate sterilization approaches and highly effective antibiotics. An estimated 234 million various surgical procedures, involving skin incisions requiring various types of wound closure techniques, are performed in the world, with the majority resulting in a wound healing by primary intention. Triclosan (5-chloro-2-(2, 4-dichlorophenoxy) phenol) is a broad-spectrum b...

  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. Intraoperative radiological margin assessment in breast-conserving surgery. (United States)

    Ihrai, T; Quaranta, D; Fouche, Y; Machiavello, J-C; Raoust, I; Chapellier, C; Maestro, C; Marcy, M; Ferrero, J-M; Flipo, B


    A prospective study was lead in order to analyze the accuracy of an X-ray device settled in the operating room for margin assessment, when performing breast-conserving surgery. One hundred and seventy patients were included. All lesions were visible on the preoperative mammograms. An intraoperative X-ray of the lumpectomy specimen was systematically performed for margins assessment. Final histological data were collected and the accuracy of intraoperative specimen radiography (IOSR) for margin assessment was analyzed. IOSR allowed an evaluation of margins status in 155 cases (91.2%). After final histological examination, the positive margins rate would have been 6.5% if margin assessment had relied only on IOSR. Margin assessment with a two-dimensional X-ray device would have allowed the achievement of negative margins in 93.5% of the cases. Moreover, this procedure allows important time-saving and could have a substantial economical impact. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Evaluation of marginal circumference and marginal thickness changes in precrimped stainless steel crowns, after recrimping

    Directory of Open Access Journals (Sweden)

    Afshar H


    Full Text Available Background and Aim: The need for recrimping precrimped stainless steel crowns by the dentist in clinic is controversial. This study aimed to evaluate the rate of marginal circumference and marginal thickness change of precrimped stainless steel crowns after recrimping. Materials and Methods: In this experimental study, 30 primary photos were taken from margins of 30 S.S.Cs (3M, Ni-Cr related to tooth 85 with a digital camera fixed at a determined distance. Margins of crowns were crimped by 114 and 137 pliers with a controlled force (0.2 N and then 30 secondary photos were taken in the same conditions. The circumference of crown margins in primary (group A and secondary (group B photos were assessed by a digitizer system. Comparing the circumferences of crown margins in primary and secondary photos showed a significant decrease after crimping. Thickness of 30 random points on the crown margins of a crown similar to mentioned cases was measured by SEM (×150. Then similar procedures including taking a primary photo, crimping and taking a secondary photo was done for the sample crown. After significant reduction in margin circumference, thickness of 30 other random points on the crown margin were measured by SEM. Data were analyzed by paired sample t-test with p<0.05 as the limit of significance. Results: The mean marginal circumference of precrimped stainless steel crowns was reduced by 7.3% which was significant (P<0.001. On the other hand the mean marginal thickness of sample stainless steel crown showed 18µ increase. Conclusion: According to the results of this study, marginal circumference of precrimped stainless steel crowns (3M, Ni-Cr showed a significant decrease after crimping. It is concluded that crimping the stainless steel crowns even for precrimped ones seems necessary.

  19. Tumor-related markers in histologically normal margins correlate with locally recurrent oral squamous cell carcinoma: a retrospective study. (United States)

    Wang, Xinhong; Chen, Si; Chen, Xinming; Zhang, Cuicui; Liang, Xueyi


    Oral squamous cell carcinoma (OSCC) is characterized by a high rate of local recurrence (LR) even when the surgical margins are considered histopathologically 'normal'. The aim of our study was to determine the relationship between early tumor-related markers detected in histologically normal margins (HNM) and LR as well as disease-free survival in OSCC. The loss of heterozygosity (LOH) of markers on 9p21 (D9s1747, RPS6, D9s162) and 17p13 (TP53) and the immunostaining results of the corresponding mutant P53, P14, P15, and P16 proteins were assessed and correlated with LR and disease-free survival in 71 OSCC patients who had HNM. Fifteen of 71 patients with HNM developed LR. The presence of the following molecular markers in surgical margins was significantly correlated with the development of LR: LOH on chromosome 9p21 (D9s1747 + RPS6 + D9s162), any LOH, P16, and P53 (chi-square test, P tumor-related markers in histologically 'normal' resection margins may be a useful method for assessing LR in OSCC patients. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. 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.

  1. 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.


    Institute of Scientific and Technical Information of China (English)



    Objective To study the relative factors which influence the positive rate of bacterial culture from surgical incision, and to improve the accuracy of detection. Methods Retrospectively investigation was used to analysis 1 000 cases of surgical incisions bacterial culture results in our hospital, and find out the related factors which influence the positive rate. Results Several factors were found affecting the bacterial species and positive rate of surgical incision bacterial culture, including the disinfection of patient's skin and doctor's arm, the type of surgical incision, the time of operation, and so on. Conclusion When collecting and culturing the bacteria from surgical incision, we should pay attention to the disinfection of patient's skin and doctor's arm and other influencing factors, and take actions to obtain the accurate culture results.%目的 研究影响手术切口细菌培养阳性率的相关因素,提高检测的准确性.方法 通过回顾性调查方法,对某医院1000例手术患者切口细菌培养结果进行分析,找出相关因素.结果 切口细菌培养的细菌种类及阳性率与病人的皮肤和医生手臂的消毒、手术切口类型、手术时间、手术接台情况等相关因素呈正相关.结论 患者手术切口细菌学标本采集和培养应考虑到手术皮肤和术者手消毒及其他因素,采取控制措施,获得准确的培养结果.

  3. Intraoperative targeted optical imaging: a guide towards tumor-free margins in cancer surgery. (United States)

    Orbay, Hakan; Bean, Jero; Zhang, Yin; Cai, Weibo


    Over the last several decades, development of various imaging techniques such as computed tomography, magnetic resonance imaging, and positron emission tomography greatly facilitated the early detection of cancer. Another important aspect that is closely related to the survival of cancer patients is complete tumor removal during surgical resection. The major obstacle in achieving this goal is to distinguish between tumor tissue and normal tissue during surgery. Currently, tumor margins are typically assessed by visual assessment and palpation of the tumor intraoperatively. However, the possibility of microinvasion to the surrounding tissues makes it difficult to determine an adequate tumor-free excision margin, often forcing the surgeons to perform wide excisions including the healthy tissue that may contain vital structures. It would be ideal to remove the tumor completely, with minimal safety margins, if surgeons could see precise tumor margins during the operation. Molecular imaging with optical techniques can visualize the tumors via fluorophore conjugated probes targeting tumor markers such as proteins and enzymes that are upregulated during malignant transformation. Intraoperative use of this technique may facilitate complete excision of the tumor and tumor micromasses located beyond the visual capacity of the naked eye, ultimately improving the clinical outcome and survival rates of cancer patients.

  4. Masculinity at the margins

    DEFF Research Database (Denmark)

    Jensen, Sune Qvotrup


    This article analyses how young marginalized ethnic minority men in Denmark react to the othering they are subject to in the media as well as in the social arenas of every day life. The article is based on theoretically informed ethnographic fieldwork among such young men as well as interviews an...

  5. From Borders to Margins

    DEFF Research Database (Denmark)

    Parker, Noel


    upon Deleuze's philosophy to set out an ontology in which the continual reformulation of entities in play in ‘post-international' society can be grasped.  This entails a strategic shift from speaking about the ‘borders' between sovereign states to referring instead to the ‘margins' between a plethora...

  6. Marginally Deformed Starobinsky Gravity

    DEFF Research Database (Denmark)

    Codello, A.; Joergensen, J.; Sannino, Francesco


    We show that quantum-induced marginal deformations of the Starobinsky gravitational action of the form $R^{2(1 -\\alpha)}$, with $R$ the Ricci scalar and $\\alpha$ a positive parameter, smaller than one half, can account for the recent experimental observations by BICEP2 of primordial tensor modes....

  7. "We call ourselves marginalized"

    DEFF Research Database (Denmark)

    Jørgensen, Nanna Jordt


    In recent decades, indigenous knowledge has been added to the environmental education agenda in an attempt to address the marginalization of non-western perspectives. While these efforts are necessary, the debate is often framed in terms of a discourse of victimization that overlooks the agency o...

  8. Oncoplastic Breast Reduction: Maximizing Aesthetics and Surgical Margins

    Directory of Open Access Journals (Sweden)

    Michelle Milee Chang


    Full Text Available Oncoplastic breast reduction combines oncologically sound concepts of cancer removal with aesthetically maximized approaches for breast reduction. Numerous incision patterns and types of pedicles can be used for purposes of oncoplastic reduction, each tailored for size and location of tumor. A team approach between reconstructive and breast surgeons produces positive long-term oncologic results as well as satisfactory cosmetic and functional outcomes, rendering oncoplastic breast reduction a favorable treatment option for certain patients with breast cancer.

  9. Epithelial and Stromal Spectral Imaging for Rapid Surgical Margin Analysis (United States)


    column two. Hematoxylin has a deep blue-purple color and stains nucleic acids , which are primarily located in the cell nuclei. Eosin is pink and stains...Pietsch, H. Lanfermann, U. Pichlmeier, M. Mehdorn and -. A. R. Glioma, "Five-Aminolevulinic Acid for Fluorescence-Guided Resection of Recurrent...ed. (CRC Press, 2008). 27. C. Goutte , "Note on free lunches and cross-validation," Neural Comput 9 (6), 1245-1249 (1997). 28. H. Y. Zhu and R

  10. Epithelial and Stromal Spectral Imaging for Rapid Surgical Margin Analysis (United States)


    cancer (orange). (f) Corresponding immunohistochemical measures of percent stroma, epithelium and fat, and CD31- positive, CD105-positive vascular...density and area. A b [HbT] % O2 % H2O % Epithelium -0.06 -0.37 0.27 -0.11 -0.21 % Stroma 0.06 0.33 -0.28 0.09 0.25 % Fat -0.02 -0.01 0.21 0.02...scattering slope was observed to better localize suspicious fibro- glandular lesions. The scattering slope was likely under-valued by the limitations

  11. Margin Distance Does Not Influence Recurrence and Survival After Wedge Resection for Lung Cancer. (United States)

    Maurizi, Giulio; D'Andrilli, Antonio; Ciccone, Anna Maria; Ibrahim, Mohsen; Andreetti, Claudio; Tierno, Simone; Poggi, Camilla; Menna, Cecilia; Venuta, Federico; Rendina, Erino Angelo


    The relationship between the free margin distance and the recurrence rate and overall survival after R0 wedge resection for non-small cell lung cancer (NSCLC) is still not clear. We retrospectively evaluated the long-term oncologic outcome of patients who had undergone wedge resection for NSCLC to assess the prognostic effect of margin distance in this setting. Between 2003 and 2013, 243 consecutive patients with a functional contraindication to major lung resection underwent wedge resection with systematic lymph node dissection for clinical stage I NSCLC. The study enrolled 182 patients with pathologic stage I and R0 resection and divided them into three subgroups according to margin distance of less than 1 cm (n = 30), 1 to 2 cm (n = 80), and more than 2 cm (n = 72). The histologic assessment was adenocarcinoma in 112 patients, squamous cell in 30, and other in 40. Postoperative morbidity was 18.7%, and postoperative mortality was 1.1%. The median follow-up was 31 months (range, 2 to 133 months). The locoregional (lung parenchyma, hilum, mediastinum) recurrence rate was 26.4% (n = 48). The distant recurrence rate was 11% (n = 20). Overall 5-year survival was 70.4%. Disease-free 5-year survival was 51.7%. There was no statistical difference in locoregional (p = 0.9) and distant (p = 0.3) recurrence rate and no difference in overall survival (p = 0.07) when the three groups were compared. Wedge resection is a viable option for the surgical treatment of stage I NSCLC when lobectomy is contraindicated. The distance between the tumor and the parenchymal suture margin does not influence recurrence or the survival rate when an R0 resection is achieved. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Empirical Study of Corporate Marginal Tax Rates of Chinese Listed Companies%中国上市公司企业所得税边际税率的实证研究

    Institute of Scientific and Technical Information of China (English)



    The study is based on Chinese financial and tax regulations with capital market situation consideration .By adopting five different marginal tax rate ( MTR ) estimation methods , the MTRs of 1859 listed companies are estimated from 2007 to 2014 .According to annual MTR and industrial MTR analysis , the most influential factors on MTR are found ,which also helps the government to formulate enterprise income tax preferential policies with more scientific prospective .Evidence is found that trichotomous and uniform MTR estimation methods are reasonable alternative methods to the theoretical sound simulation MTR estimation method ,which is important to further research on MTR in China .%基于中国财税法规与资本市场现状,采用5种不同边际税率估算方法对中国1859家上市公司2007—2014年边际税率进行估算。针对不同年度、行业的边际税率分布及变化情况进行分析,得出影响中国企业边际税率的主要因素,为国家企业所得税税收优惠政策的制定提供更科学的视角。同时通过对比分析,找出理论最佳模拟边际税率估值法的简易替代估值计算方法,结论对中国边际税率估值、计算和研究有着重要意义。

  13. Tips and tricks in surgical management of maxillary sinus tumors

    Directory of Open Access Journals (Sweden)

    Ahmed Mostafa Mahmoud


    Conclusion: Fine intraoperative surgical maneuvers can obtain secured resection margin (with special attention to adenoid cystic carcinoma; avoid postoperative functional complications like trismus, nasal regurgitation of food, epiphora or double vision finally enhance esthetic results

  14. Masculinity at the margins

    DEFF Research Database (Denmark)

    Jensen, Sune Qvotrup


    of critique although in a masculinist way. These reactions to othering represent a challenge to researchers interested in intersectionality and gender, because gender is reproduced as a hierarchical form of social differentiation at the same time as racism is both reproduced and resisted.......This article analyses how young marginalized ethnic minority men in Denmark react to the othering they are subject to in the media as well as in the social arenas of every day life. The article is based on theoretically informed ethnographic fieldwork among such young men as well as interviews...... and other types of material. Taking the concepts of othering, intersectionality and marginality as point of departure the article analyses how these young men experience othering and how they react to it. One type of reaction, described as stylization, relies on accentuating the latently positive symbolic...

  15. Actively stressed marginal networks

    CERN Document Server

    Sheinman, M; MacKintosh, F C


    We study the effects of motor-generated stresses in disordered three dimensional fiber networks using a combination of a mean-field, effective medium theory, scaling analysis and a computational model. We find that motor activity controls the elasticity in an anomalous fashion close to the point of marginal stability by coupling to critical network fluctuations. We also show that motor stresses can stabilize initially floppy networks, extending the range of critical behavior to a broad regime of network connectivities below the marginal point. Away from this regime, or at high stress, motors give rise to a linear increase in stiffness with stress. Finally, we demonstrate that our results are captured by a simple, constitutive scaling relation highlighting the important role of non-affine strain fluctuations as a susceptibility to motor stress.

  16. Actively stressed marginal networks. (United States)

    Sheinman, M; Broedersz, C P; MacKintosh, F C


    We study the effects of motor-generated stresses in disordered three-dimensional fiber networks using a combination of a mean-field theory, scaling analysis, and a computational model. We find that motor activity controls the elasticity in an anomalous fashion close to the point of marginal stability by coupling to critical network fluctuations. We also show that motor stresses can stabilize initially floppy networks, extending the range of critical behavior to a broad regime of network connectivities below the marginal point. Away from this regime, or at high stress, motors give rise to a linear increase in stiffness with stress. Finally, we demonstrate that our results are captured by a simple, constitutive scaling relation highlighting the important role of nonaffine strain fluctuations as a susceptibility to motor stress.

  17. The Role of Weight Shrinking in Large Margin Perceptron Learning

    CERN Document Server

    Panagiotakopoulos, Constantinos


    We introduce into the classical perceptron algorithm with margin a mechanism that shrinks the current weight vector as a first step of the update. If the shrinking factor is constant the resulting algorithm may be regarded as a margin-error-driven version of NORMA with constant learning rate. In this case we show that the allowed strength of shrinking depends on the value of the maximum margin. We also consider variable shrinking factors for which there is no such dependence. In both cases we obtain new generalizations of the perceptron with margin able to provably attain in a finite number of steps any desirable approximation of the maximal margin hyperplane. The new approximate maximum margin classifiers appear experimentally to be very competitive in 2-norm soft margin tasks involving linear kernels.

  18. Abrupt plate accelerations shape rifted continental margins (United States)

    Brune, Sascha; Williams, Simon E.; Butterworth, Nathaniel P.; Müller, R. Dietmar


    Rifted margins are formed by persistent stretching of continental lithosphere until breakup is achieved. It is well known that strain-rate-dependent processes control rift evolution, yet quantified extension histories of Earth’s major passive margins have become available only recently. Here we investigate rift kinematics globally by applying a new geotectonic analysis technique to revised global plate reconstructions. We find that rifted margins feature an initial, slow rift phase (less than ten millimetres per year, full rate) and that an abrupt increase of plate divergence introduces a fast rift phase. Plate acceleration takes place before continental rupture and considerable margin area is created during each phase. We reproduce the rapid transition from slow to fast extension using analytical and numerical modelling with constant force boundary conditions. The extension models suggest that the two-phase velocity behaviour is caused by a rift-intrinsic strength-velocity feedback, which can be robustly inferred for diverse lithosphere configurations and rheologies. Our results explain differences between proximal and distal margin areas and demonstrate that abrupt plate acceleration during continental rifting is controlled by the nonlinear decay of the resistive rift strength force. This mechanism provides an explanation for several previously unexplained rapid absolute plate motion changes, offering new insights into the balance of plate driving forces through time.

  19. Abrupt plate accelerations shape rifted continental margins. (United States)

    Brune, Sascha; Williams, Simon E; Butterworth, Nathaniel P; Müller, R Dietmar


    Rifted margins are formed by persistent stretching of continental lithosphere until breakup is achieved. It is well known that strain-rate-dependent processes control rift evolution, yet quantified extension histories of Earth's major passive margins have become available only recently. Here we investigate rift kinematics globally by applying a new geotectonic analysis technique to revised global plate reconstructions. We find that rifted margins feature an initial, slow rift phase (less than ten millimetres per year, full rate) and that an abrupt increase of plate divergence introduces a fast rift phase. Plate acceleration takes place before continental rupture and considerable margin area is created during each phase. We reproduce the rapid transition from slow to fast extension using analytical and numerical modelling with constant force boundary conditions. The extension models suggest that the two-phase velocity behaviour is caused by a rift-intrinsic strength--velocity feedback, which can be robustly inferred for diverse lithosphere configurations and rheologies. Our results explain differences between proximal and distal margin areas and demonstrate that abrupt plate acceleration during continental rifting is controlled by the nonlinear decay of the resistive rift strength force. This mechanism provides an explanation for several previously unexplained rapid absolute plate motion changes, offering new insights into the balance of plate driving forces through time.

  20. Is the Longitudinal Margin of Carcinoma-Bearing Colon Resections a Neglected Parameter?

    DEFF Research Database (Denmark)

    Rørvig, Sara; Schlesinger, Nis; Mårtensson, Nina Løth;


    BACKGROUND: Resection of colon cancer with curative intent implies clear margins. An arbitrary requirement of 2 cm DtLM generally ensures surgical and pathological clearance. However, harvest of tumor-draining lymph nodes is related to DtLM. For this reason, an extended longitudinal margin become...

  1. [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.

  2. Rare Posterior Pharyngeal Mass: Atypical Marginal Zone Hyperplasia. (United States)

    Eliçora, Sultan Şevik; Güven, Mehmet; Varli, Ali F; Yilmaz, Mahmut S; Alponat, Selin


    Cases of posterior pharyngeal masses are quite rare, and are typically derived from schwannoma or encephalocele, or are of vascular or infectious origin. They are clinically significant due to their tendency to cause airway obstruction. The aim of this study was to present a rare atypical marginal hyperplasia case of a posterior pharyngeal wall mass. A 10-year-old male was admitted to our clinic with dyspnea. A plane-surfaced 4 × 3 × 3 cm mass was observed on the posterior pharyngeal wall upon physical examination. The patient underwent magnetic resonance imaging and surgical treatment. Following excision of material from the patient's mass, a pathologic diagnosis of atypical marginal zone hyperplasia was made. Atypical marginal zone hyperplasia of the posterior pharyngeal wall has not yet been reported in the literature. Marginal zone hyperplasia associated with a lymphoproliferative disease should be considered when making differential diagnoses of posterior pharyngeal wall masses.

  3. Iberian Atlantic Margins Group investigates deep structure of ocean margins (United States)

    The Iberian Atlantic Margins Group; Banda, Enric; Torne, Montserrat

    With recent seismic reflection data in hand, investigators for the Iberian Atlantic Margins project are preparing images of the deep continental and oceanic margins of Iberia. In 1993, the IAM group collected near vertical incidence seismic reflection data over a total distance of 3500 km along the North and Western Iberian Margins, Gorringe Bank Region and Gulf of Cadiz (Figure 1). When combined with data on the conjugate margin off Canada, details of the Iberian margin's deep structure should aid in distinguishing rift models and improve understanding of the processes governing the formation of margins.The North Iberian passive continental margin was formed during a Permian to Triassic phase of extension and matured during the early Cretaceous by rotation of the Iberian Peninsula with respect to Eurasia. From the late Cretaceous to the early Oligocene period, Iberia rotated in a counterclockwise direction around an axis located west of Lisbon. The plate boundary between Iberia and Eurasia, which lies along the Pyrenees, follows the north Spanish marginal trough, trends obliquely in the direction of the fossil Bay of Biscay triple junction, and continues along the Azores-Biscay Rise [Sibuet et al., 1994]. Following the NE-SW convergence of Iberia and Eurasia, the reactivation of the North Iberian continental margin resulted in the formation of a marginal trough and accretionary prism [Boillot et al., 1971].

  4. Surgical Treatment of Skin Tumors

    Directory of Open Access Journals (Sweden)



    Full Text Available When we mention about surgical treatment of any tumor residing on the skin independent of its benign or malignant nature, the first method we recall is excision. Elliptical excision is the mainstay of the dermatologic surgery. Each excision ends with a defect for which we are responsible to repair functionally and cosmetically. The diameter of the tumor we excised and the safety margin used for excision determine the diameter of the final defect. After achieving tumor free lateral and deep margins with the appropriate surgical method, we decide between the repair options of second intention healing, primary repair, flaps, full or split thickness grafts, considering the diameter and the anatomic localization of the defect, for the best functional and cosmetic result for that specific defect. This review overviews not only the most common dermatologic surgical methods, but also Mohs surgery which is a method rarely used in our country, although it is the treatment of choice for the treatment of high risk basal cell carcinoma (BCC and squamous cell carcinoma (SCC.

  5. Collapse of modern carbonate platform margins

    Energy Technology Data Exchange (ETDEWEB)

    Mullins, H.T.; Hine, A.C.; Gardulski, A.


    Modern carbonate platform margins in the Florida-Bahama region have been viewed as depositional or constructional features. However, recent studies have shown that carbonate escarpments, such as the Blake-Bahama and West Florida Escarpments, are erosional in origin where the platform margins have a scalloped or horse-shoe shape. Seismic reflection data from one of these crescentic features along the west Florida platform margin indicate that it originated by large scale gravity collapse (slump). This collapse structure extends for at least 120 km along the margin and has removed about 350 m of strata as young as early Neogene. Although at least three generations of slope failure are recognized, catastrophic collapse appears to have occurred in the mid-Miocene. Gravitational instability due to high rates of sediment accumulation may have been the triggering mechanism. These data suggest that submarine slumping is an important process in the retreat of limestone escarpments and in the generation of carbonate megabreccia debris flows. Scalloped platform margins occur on satellite images of northern Exuma Sound and Columbus Basin in the Bahamas. The authors suggest that large-scale submarine slumping can cause elongation of structurally controlled intraplatform basins (Exuma South), and produce anomalous horse-shoe shaped basins (Columbus Basin) by mega-collapse processes.

  6. Carbonate mound development in contrasting settings on the Irish margin

    NARCIS (Netherlands)

    van der Land, C.; Eisele, M.; Mienis, F; de Haas, H.; Hebbeln, D.; Reijmer, J.J.G.; van Weering, T.C.E.


    Cold-water coral carbonate mounds, formed by framework building cold-water corals, are found in several mound provinces on the Irish margin. Differences in cold-water coral mound development rates and sediment composition between mounds at the southwest Rockall Trough margin and the Galway Mound in

  7. Carbonate mound development in contrasting settings on the Irish margin

    NARCIS (Netherlands)

    van der Land, C.; Eisele, M.; Mienis, F; de Haas, H.; Hebbeln, D.; Reijmer, J.J.G.; van Weering, T.C.E.


    Cold-water coral carbonate mounds, formed by framework building cold-water corals, are found in several mound provinces on the Irish margin. Differences in cold-water coral mound development rates and sediment composition between mounds at the southwest Rockall Trough margin and the Galway Mound in

  8. Marginally Stable Nuclear Burning (United States)

    Strohmayer, Tod E.; Altamirano, D.


    Thermonuclear X-ray bursts result from unstable nuclear burning of the material accreted on neutron stars in some low mass X-ray binaries (LMXBs). Theory predicts that close to the boundary of stability oscillatory burning can occur. This marginally stable regime has so far been identified in only a small number of sources. We present Rossi X-ray Timing Explorer (RXTE) observations of the bursting, high-inclination LMXB 4U 1323-619 that reveal for the first time in this source the signature of marginally stable burning. The source was observed during two successive RXTE orbits for approximately 5 ksec beginning at 10:14:01 UTC on March 28, 2011. Significant mHz quasi-periodic oscillations (QPO) at a frequency of 8.1 mHz are detected for approximately 1600 s from the beginning of the observation until the occurrence of a thermonuclear X-ray burst at 10:42:22 UTC. The mHz oscillations are not detected following the X-ray burst. The average fractional rms amplitude of the mHz QPOs is 6.4% (3 - 20 keV), and the amplitude increases to about 8% below 10 keV.This phenomenology is strikingly similar to that seen in the LMXB 4U 1636-53. Indeed, the frequency of the mHz QPOs in 4U 1323-619 prior to the X-ray burst is very similar to the transition frequency between mHz QPO and bursts found in 4U 1636-53 by Altamirano et al. (2008). These results strongly suggest that the observed QPOs in 4U 1323-619 are, like those in 4U 1636-53, due to marginally stable nuclear burning. We also explore the dependence of the energy spectrum on the oscillation phase, and we place the present observations within the context of the spectral evolution of the accretion-powered flux from the source.

  9. Gaussian quantum marginal problem

    CERN Document Server

    Eisert, J; Sanders, B C; Tyc, T


    The quantum marginal problem asks what local spectra are consistent with a given state of a composite quantum system. This setting, also referred to as the question of the compatibility of local spectra, has several applications in quantum information theory. Here, we introduce the analogue of this statement for Gaussian states for any number of modes, and solve it in generality, for pure and mixed states, both concerning necessary and sufficient conditions. Formally, our result can be viewed as an analogue of the Sing-Thompson Theorem (respectively Horn's Lemma), characterizing the relationship between main diagonal elements and singular values of a complex matrix: We find necessary and sufficient conditions for vectors (d1, ..., dn) and (c1, ..., cn) to be the symplectic eigenvalues and symplectic main diagonal elements of a strictly positive real matrix, respectively. More physically speaking, this result determines what local temperatures or entropies are consistent with a pure or mixed Gaussian state of ...

  10. Triage for management of cervical high-grade squamous intraepithelial lesion patients with positive margin by conization:a retrospective analysis

    Institute of Scientific and Technical Information of China (English)

    Yuya Dou; Xiaodan Zhang; Yang Li; Fenfen Wang; Xing Xie; Xinyu Wang


    The objective of this study is to guide a triage for the management of cervical high-grade squamous intraepithelial lesion (HSIL) patients with positive margin by conization.Clinico-pathological data of HSIL patients with positive margin by conization were retrospectively collected from January 2009 to December 2014.All patients underwent secondary conization or hysterectomy within 6 months.The rate of residual lesion was calculated,and the factors associated with residual lesion were analyzed by univariate and multivariate analyses.Among a total of 119 patients,56 (47.06%) patients presented residual HSIL in their subsequent surgical specimens,including 4 cases of invasive cervical carcinoma (3 stage IA1 and 1 stage IA2 patients).Univariate analysis showed that patient age > 35 years (P =0.005),menopausal period > 5 years (P =0.0035),and multiplequadrant involvement (P=0.001) were significantly correlated with residual disease;however,multivariate analysis revealed that multiple-quadrant involvement (P=0.001;OR,3.701;95%CI,1.496-9.154) was an independent risk factor for residual disease.Nearly half of HSIL patients with positive margin by conization were disease-free in subsequent surgical specimens,and those with multiple positive margins may consider reconization or re-assessment.

  11. 品管圈活动在提高手术器械包装合格率中的应用%Application of Quality Control Circle activity to improve the qualiifed rate in surgical instruments packaging

    Institute of Scientific and Technical Information of China (English)

    向艺; 郑宣冬


    目的:探索通过品管圈活动提高手术器械包装合格率的方法。方法:成立品管圈小组,针对消毒供应中心出现的手术器械包装合格率低的情况,运用品管圈手法进行现状把握、目标设定、要因分析、对策拟定并实施。结果:通过开展品管圈活动,手术器械包装合格率由活动前97.2%提高到99.8%,差异有统计学意义(P<0.01)。结论:开展品管圈活动对提高手术器械包装质量、加强科室间的协作、提升团队精神、快速适应消毒供应中心管理模式变化起到了积极的推动作用。%Objective:To explore the method of improving the rate of qualiifed surgical instruments packaging with the application of Quality Control Circle (QCC) activity. Methods:QCC group was established to grasp the current status, set goals, analyze major factors, form and implement countermeasures with QCC method for the low rate of qualiifed surgical instruments packaging in the disinfection supply center. Result:The rates of qualiifed surgical instruments packaging increased from 97.2%to 99.8%after conducting QCC activities. The difference was statistically significant (P<0.01). Conclusion:QCC activities played a positive role in improving packaging quality of surgical instruments, strengthening collaboration between departments, promoting team spirit, and timely adapting to changes in the management mode of disinfection supply center.

  12. Surgical Innovation in Sarcoma Surgery. (United States)

    Jeys, L; Morris, G; Evans, S; Stevenson, J; Parry, M; Gregory, J


    The field of orthopaedic oncology relies on innovative techniques to resect and reconstruct a bone or soft tissue tumour. This article reviews some of the most recent and important innovations in the field, including biological and implant reconstructions, together with computer-assisted surgery. It also looks at innovations in other fields of oncology to assess the impact and change that has been required by surgeons; topics including surgical margins, preoperative radiotherapy and future advances are discussed. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  13. The Effect of Evolving Strategies in the Surgical Management of Organ-Confined Prostate Cancer: Comparison of Data from 2005 to 2014 in a Multicenter Setting. (United States)

    Pohle, Margit; Magheli, Ahmed; Fischer, Tom; Kempkensteffen, Carsten; Busch, Jonas; Cash, Hannes; Miller, Kurt; Hinz, Stefan


    The objective of this study was to evaluate changes of patient characteristics and surgical techniques in radical prostatectomy in Germany within the last decade. Data from 44 German prostate cancer centers were included in the study. Patients' characteristics (age, initial PSA value), surgical techniques (open vs. minimally invasive approaches), perioperative parameters (operating time, rate of nerve-sparing (NS) radical prostatectomies (RPs), hospitalization time, catheter indwelling time, surgical margin status, number of dissected lymph nodes (LN)), and pathological findings (tumor stage, Gleason score) were analyzed. Data from 11,675 patients who underwent RP between 2005 and 2014 were analyzed. The rate of open RP approaches decreased by 1.7% (p = 0.0164), the rate of minimally invasive approaches increased by 1.8% (p = 0.0164). Robot-assisted RPs (RARP) increased by 4.6% (p rate of positive surgical margins (p = 0.5061) and the ratio of positive lymph nodes removed (p = 0.4628) was observed. The number of Gleason ≤6 tumors decreased significantly (p rate of nerve-sparing procedures has significantly increased.

  14. Investigating Clinical and Radiographical Success Rate of Dental Procedures Performed On Children under General Anesthesia in a Surgical Clinic in Yazd between 2006- 2011

    Directory of Open Access Journals (Sweden)

    Z bahrololoomi


    Conclusion: Regarding failure rate of amalgam and composite restorations, a definitive treatment plan consisting of SSC, pulp therapy and / or extraction may be preferred for oral rehabilitation of the children under GA.

  15. Influence of Crack Morphology on Leak Before Break Margins

    Energy Technology Data Exchange (ETDEWEB)

    Weilin Zang (Inspecta Technology AB, Stockholm (SE))


    The purpose of the project is to evaluate the deterministic LBB-margins for different pipe systems in a Swedish PWR-plant and using different crack morphology parameters. Results: - The influence of crack morphology on Leak Before Break (LBB) margins is studied. The subject of the report is a number of LBB-submittals to SKI where deterministic LBB-margins are reported. These submittals typically uses a surface roughness of 0.0762 mm (300 microinch) and number of turns equal to zero and an in-house code for the leak rate evaluations. The present report has shown that these conditions give the largest LBB-margins both in terms of the quotient between the critical crack length and the leakage crack size and for the leak rate margin. - Crack morphology parameters have a strong influence on the leak rate evaluations. Using the SQUIRT code and more recent recommendations for crack morphology parameters, it is shown that in many cases the evaluated margins, using 1 gpm as the reference leak rate detection limit, are below the safety factor of 2 on crack size and 10 on leak rate, which is generally required for LBB approval. - The effect of including weld residual stresses on the LBB margins is also investigated. It is shown that for the two examples studied, weld residual stresses were important for the small diameter thin wall pipe whereas it was negligible for the large diameter thick wall pipe which had a self-balanced weld residual stress distribution

  16. Reliability of Margin Assessment after Surgery for Extremity Soft Tissue Sarcoma: The SSG Experience

    Directory of Open Access Journals (Sweden)

    Clement S. Trovik


    Full Text Available Surgery remains the mainstay of soft tissue sarcoma (STS treatment and has been the primary treatment for the majority of patients in Scandinavia during the last 30 years although the use of adjuvant radiotherapy has increased. Patient and treatment characteristics have been recorded in the Scandinavian Sarcoma Group (SSG Register since 1987. When the effect of new radiotherapy guidelines from 1998 was evaluated, the reliability of surgical margin assessments among different Scandinavian institutions was investigated. Margins were reevaluated by a panel of sarcoma surgeons, studying pathology and surgical reports from 117 patients, randomly selected among 470 recorded patients treated between 1998–2003. In 80% of cases, the panel agreed with the original classification. Disagreement was most frequent when addressing the distinction between marginal and wide margins. Considered the element of judgment inherent in all margin assessment, we find this reliability acceptable for using the Register for studies of local control of STS.

  17. Margins and outcome of screen-detected breast cancer with extensive in situ component. (United States)

    Kitchen, Paul R B; Cawson, Jennifer N; Moore, Suzanne E; Hill, Prue A; Barbetti, Toni M; Wilkins, Pamela A; Power, Ann-Marie; Henderson, Michael A


    In situ disease surrounding invasive tumours is an important consideration in the management of patients with early breast cancer. This study of screen-detected breast cancers assessed the influence of in situ disease including an extensive in situ component (defined as ductal carcinoma in situ involving more than 25% of the area within the invasive tumour) on surgical management, local recurrence and survival of a group of patients. A total of 595 cases of invasive breast cancer detected at St Vincent's BreastScreen were retrospectively reviewed to determine presence and extent of in situ disease, the surgical procedure and adequacy of excision. Outcome was examined in a cohort of 126 cases. A total of 438 (74%) patients had in situ foci in or around the invasive tumour and 107 (18%) were defined as extensive in situ component (EIC)-positive. The initial procedure was mastectomy in 20% of the cases and breast-conserving surgery in 80% including 18% who underwent further surgery. Re-excision (P = 0.02) or mastectomy (P = 0.01) was more often required in patients with EIC. After definitive local excision, margins were close or involved with invasive disease in 3% but the patients with EIC were more likely to have margins close or involved with in situ disease (16 vs 2%; P = 0.001). There were seven deaths and one local invasive recurrence in the follow-up group and none of the deaths were in patients who were EIC-positive. EIC predicts for a higher rate of re-excision and/or mastectomy. For patients with EIC, there is an acceptably low risk of local recurrence if margins are clear.

  18. Geophysical constraints on geodynamical processes at convergent margins

    DEFF Research Database (Denmark)

    Artemieva, Irina; Thybo, Hans; Shulgin, Alexey


    Convergent margins, being the boundaries between colliding lithospheric plates, form the most disastrous areas in the world due to intensive, strong seismicity and volcanism. We review global geophysical data in order to illustrate the effects of the plate tectonic processes at convergent margins...... on the crustal and upper mantle structure, seismicity, and geometry of subducting slab. We present global maps of free-air and Bouguer gravity anomalies, heat flow, seismicity, seismic Vs anomalies in the upper mantle, and plate convergence rate, as well as 20 profiles across different convergent margins....... A global analysis of these data for three types of convergent margins, formed by ocean-ocean, ocean-continent, and continent-continent collisions, allows us to recognize the following patterns. (1) Plate convergence rate depends on the type of convergent margins and it is significantly larger when...

  19. Evidence-based surgical wound care on surgical wound infection. (United States)

    Reilly, Jaqueline


    Surgical wound infection is an important outcome indicator in the postoperative period. A 3-year prospective cohort epidemiological study of 2202 surgical patients from seven surgical wards across two hospitals was carried out using gold standard surveillance methodology. This involved following patients up as inpatients and postdischarge surveillance to 30 days by an independent observer. The results led to the development of a mathematical model for risk of clean, elective surgical wound infection. Risk of surgical wound infection was increased by smoking, higher body mass index, presence of malignancy, haematoma formation, increasing numbers of people in theatre, adherent dressing usage, and higher times to suture removal (P<0.05). The results show that this type of surveillance is an effective way of collecting accurate data on wound infection rates. It was noted that patient care practices affected the surgical wound infection rate and the surveillance was used to facilitate the adoption of evidence-based practice, through recommendations for clean surgery, to reduce the risk from extrinsic risk factors for wound infection. As a result of the implementation of this evidence-based practice there was a significant reduction (P<0.05) in the clean wound infection rate.

  20. Cosmetic outcome and surgical site infection rates of antibacterial absorbable (Polyglactin 910) suture compared to Chinese silk suture in breast cancer surgery: a randomized pilot research

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zhong-tao; Jessica Shen; Martin Weisberg; ZHANG Hong-wei; FANG Xue-dong; WANG Li-ming; LI Xiao-xi; LI Ya-fen; SUN Xiao-wei; Judith Carver; Dorella Simpkins


    Background The primary objective of this multicenter post-market study was to compare the cosmetic outcome of triclosan-coated VICRYL* Plus sutures with Chinese silk sutures for skin closure of modified radical mastectomy. A secondary objective was to assess the incidence of surgical site infection (SSI).Methods Patients undergoing modified radical mastectomy were randomly assigned to coated VICRYL* Plus antibacterial (Polyglactin 910) suture or Chinese silk suture. Cosmetic outcomes were evaluated postoperatively at days 12 (±2) and 30 (±5), and the evidence of SSI was assessed at days 3, 5, 7, 12 (±2), 30 (±5), and 90 (±7). Cosmetic outcomes were independently assessed via visual analogue scale (VAS) score evaluations of blinded incision photographs (primary endpoint) and surgeon-assessed modified Hollander Scale (mHCS) scores (secondary endpoint).SSI assessments used both CDC criteria and ASEPSIS scores.Results Six Chinese hospitals randomized 101 women undergoing modified radical mastectomy to closure with coated VICRYL* Plus suture (n=51) or Chinese silk suture (n=50). Mean VAS cosmetic outcome scores for antibacterial suture (67.2) were better than for Chinese silk (45.4) at day 30 (P<0.0001)). Mean mHCS cosmetic outcome total scores, were also higher for antibacterial suture (5.7) than for Chinese silk (5.0) at day 30 (P=0.002).Conclusions Patients using coated VICRYL* Plus suture had significantly better cosmetic outcomes than those with Chinese silk sutures. Patients using coated VICRYL* Plus suture had a lower SSI incidence compared to the Chinese silk sutures, although the difference did not reach statistical significance. ( NCT 00768222)

  1. The influence of circumferential resection margins on survival following rectal cancer surgery. (United States)

    Mois, Emil; Graur, Florin; Hajjar, Nadim Al; Puia, Cosmin; Cote, Adrian; Zaharie, Florin; Bartos, Adrian; Momani, Noemi Al; Pop, Flaviu; Neagos, Horatiu; Ciorogar, George; Iancu, Cornel


    A negative (R0) circumferential resection margin (CRM) is described as one of the most important factor that decrease the rate of local recurrence in rectal cancer. The primary outcome of the study was the status of the CRM, while the secondary outcomes were local recurrence and overall survival. Study includes 192 patients with rectal cancer operated between January 2012 and December 2013 in our Institute. The incidence of positive CRM and its impact on the survival rates after oncologic surgical resection were investigated along with factors that determine positive CRM. R1 was defined as a distance of ≤ 1 mm between the tumor and the resection margin. The R1 rate was 3.6 % (7 cases). Nine patients (4.68%) developed local recurrence during a median followup period of 720 days. A positive CRM was found to be a risk factor of local recurrence (p-value = 0.031) and it decreased the overall survival (p-value=0.001). pT4 stage (p-value=0.008) and vascular invasion (p-value=0.005) are factors that play significant roles in determining CRM positivity. In case of inferior rectal tumours abdomino-perineal resection (APR) determines significantly higher (p-value=0.048) rates of positive CRM than anterior resection (AR) of the rectum. Positive CRM affects overall survival and local recurrence in rectal cancer. pT4 stage and vascular invasion play determinant roles in determine CRM status. APR is a risk factor for positive CRM in inferior rectal tumors. Abdomino-perineal resection, Circumferential resection margins, Local recurrence, Rectal cancer, Overall survival.

  2. Locational marginal prices with SVC in Indian electricity market

    African Journals Online (AJOL)


    real and reactive power has become central issue for better and economic operation of system. .... bilateral contract model used in this paper is basically a subset of the full ...... Wheeling rates of reactive flow under marginal cost theory.

  3. Leukocyte margination in a model microvessel (United States)

    Freund, Jonathan B.


    The physiological inflammation response depends upon the multibody interactions of blood cells in the microcirculation that bring leukocytes (white blood cells) to the vessel walls. We investigate the fluid mechanics of this using numerical simulations of 29 red blood cells and one leukocyte flowing in a two-dimensional microvessel, with the cells modeled as linearly elastic shell membranes. Despite its obvious simplifications, this model successfully reproduces the increasingly blunted velocity profiles and increased leukocyte margination observed at lower shear rates in actual microvessels. Red cell aggregation is shown to be unnecessary for margination. The relative stiffness of the red cells in our simulations is varied by over a factor of 10, but the margination is found to be much less correlated with this than it is to changes associated with the blunting of the mean velocity profile at lower shear rates. While velocity around the leukocyte when it is near the wall depends upon the red cell properties, it changes little for strongly versus weakly marginating cases. In the more strongly marginating cases, however, a red cell is frequently observed to be leaning on the upstream side of the leukocyte and appears to stabilize it, preventing other red cells from coming between it and the wall. A well-known feature of the microcirculation is a near-wall cell-free layer. In our simulations, it is observed that the leukocyte's most probable position is at the edge of this layer. This wall stand-off distance increases with velocity following a scaling that would be expected for a lubrication mechanism, assuming that there were a nearly constant force pushing the cells toward the wall. The leukocyte's near-wall position is observed to be less stable with increasing mean stand-off distance, but this distance would have potentially greater effect on adhesion since the range of the molecular binding is so short.

  4. Workers' marginal costs of commuting

    DEFF Research Database (Denmark)

    van Ommeren, Jos; Fosgerau, Mogens


    This paper applies a dynamic search model to estimate workers' marginal costs of commuting, including monetary and time costs. Using data on workers' job search activity as well as moving behaviour, for the Netherlands, we provide evidence that, on average, workers' marginal costs of one hour...

  5. 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.

  6. Sustainable biomass production on Marginal Lands (SEEMLA) (United States)

    Barbera, Federica; Baumgarten, Wibke; Pelikan, Vincent


    Sustainable biomass production on Marginal Lands (SEEMLA) The main objective of the H2020 funded EU project SEEMLA (acronym for Sustainable Exploitation of Biomass for Bioenergy from Marginal Lands in Europe) is the establishment of suitable innovative land-use strategies for a sustainable production of plant-based energy on marginal lands while improving general ecosystem services. The use of marginal lands (MagL) could contribute to the mitigation of the fast growing competition between traditional food production and production of renewable bio-resources on arable lands. SEEMLA focuses on the promotion of re-conversion of MagLs for the production of bioenergy through the direct involvement of farmers and forester, the strengthening of local small-scale supply chains, and the promotion of plantations of bioenergy plants on MagLs. Life cycle assessment is performed in order to analyse possible impacts on the environment. A soil quality rating tool is applied to define and classify MagL. Suitable perennial and woody bioenergy crops are selected to be grown in pilot areas in the partner countries Ukraine, Greece and Germany. SEEMLA is expected to contribute to an increasing demand of biomass for bioenergy production in order to meet the 2020 targets and beyond.

  7. Achieving Adequate Margins in Ameloblastoma Resection: The Role for Intra-Operative Specimen Imaging. Clinical Report and Systematic Review (United States)

    Ramakrishnan, Anand; Mirkazemi, Mansoor; Baillieu, Charles; Ptasznik, Ronnie; Leong, James


    Background Ameloblastoma is a locally aggressive odontogenic neoplasm. With local recurrence rates reaching 90%, only completeness of excision can facilitate cure. Surgical clearance has widely been based on pre-operative imaging to guide operative excision margins, however use of intra-operative specimen x-ray or frozen-section has been sought to improve clearance rates, and advanced imaging technologies in this role have been proposed. This manuscript aims to quantify the evidence for evaluating intra-operative resection margins and present the current standard in this role. Method The current study comprises the first reported comparison of imaging modalities for assessing ameloblastoma margins. A case is presented in which margins are assessed with each of clinical assessment based on preoperative imaging, intra-operative specimen x-ray, intra-operative specimen computed tomography (CT) and definitive histology. Each modality is compared quantitatively. These results are compared to the literature through means of systematic review of current evidence. Results A comparative study highlights the role for CT imaging over plain radiography. With no other comparative studies and a paucity of high level evidence establishing a role for intra-operative margin assessment in ameloblastoma in the literature, only level 4 evidence supporting the use of frozen section and specimen x-ray, and only one level 4 study assesses intra-operative CT. Conclusion The current study suggests that intra-operative specimen CT offers an improvement over existing techniques in this role. While establishing a gold-standard will require higher level comparative studies, the use of intra-operative CT can facilitate accurate single-stage resection. PMID:23094099

  8. Achieving adequate margins in ameloblastoma resection: the role for intra-operative specimen imaging. Clinical report and systematic review.

    Directory of Open Access Journals (Sweden)

    Inoka De Silva

    Full Text Available BACKGROUND: Ameloblastoma is a locally aggressive odontogenic neoplasm. With local recurrence rates reaching 90%, only completeness of excision can facilitate cure. Surgical clearance has widely been based on pre-operative imaging to guide operative excision margins, however use of intra-operative specimen x-ray or frozen-section has been sought to improve clearance rates, and advanced imaging technologies in this role have been proposed. This manuscript aims to quantify the evidence for evaluating intra-operative resection margins and present the current standard in this role. METHOD: The current study comprises the first reported comparison of imaging modalities for assessing ameloblastoma margins. A case is presented in which margins are assessed with each of clinical assessment based on preoperative imaging, intra-operative specimen x-ray, intra-operative specimen computed tomography (CT and definitive histology. Each modality is compared quantitatively. These results are compared to the literature through means of systematic review of current evidence. RESULTS: A comparative study highlights the role for CT imaging over plain radiography. With no other comparative studies and a paucity of high level evidence establishing a role for intra-operative margin assessment in ameloblastoma in the literature, only level 4 evidence supporting the use of frozen section and specimen x-ray, and only one level 4 study assesses intra-operative CT. CONCLUSION: The current study suggests that intra-operative specimen CT offers an improvement over existing techniques in this role. While establishing a gold-standard will require higher level comparative studies, the use of intra-operative CT can facilitate accurate single-stage resection.

  9. Recommendations for use of marginal donors in heart transplantation: Brazilian Association of Organs Transplantation guideline. (United States)

    Fiorelli, A I; Stolf, N A G; Pego-Fernandes, P M; Oliveira Junior, J L; Santos, R H B; Contreras, C A M; Filho, D D L; Dinkhuysen, J J; Moreira, M C V; Mejia, J A C; Castro, M C R


    The high prevalence of heart failure has increased the candidate list for heart transplantation; however, there is a shortage of viable donated organs, which is responsible for the high mortality of patients awaiting a transplantation. Because the marginal donor presents additional risk factors, it is not considered to be an ideal donor. The use of a marginal donor is only justified in situations when the risk of patient death due to heart disease is greater than that offered by the donor. These recommendations sought to expand the supply of donors, consequently increasing the transplant rate. We selected articles based on robust evidence to provide a substratum to develop recommendations for donors who exceed the traditional acceptance criteria. Recipient survival in the immediate postoperative period is intimately linked to allograft quality. Primary allograft failure is responsible for 38% to 40% of immediate deaths after heart transplantation: therefore; marginal donor selection must be more rigorous to not increase the surgical risk. The main donor risk factors with the respective evidence levels are: cancer in the donor (B), female donor (B), donor death due to hemorrhagic stroke (B), donor age above 50 years (relative risk [RR] = 1.5) (B), weight mismatch between donor and recipient 240 minutes (RR = 1.2) (B), left ventricular dysfunction with ejection fraction below 45% (B), and use of high doses of vasoactive drugs (dopamine > 15 mg/kg·min) (B). Factors that impact recipient mortality are: age over 50 years (RR = 1.5); allograft harvest at a distance; adult recipient weighing more than 20% of the donor; high doses of vasoactive drugs (dopamine greater than 15 mg/kg·min) and ischemic time >4 hours. The use of a marginal donor is only justified when it is able to increase life expectancy compared with clinical treatment, albeit the outcomes are interior to those using an ideal donor.

  10. Klatskin tumor: Diagnosis, preoperative evaluation and surgical considerations. (United States)

    Molina, Víctor; Sampson, Jaime; Ferrer, Joana; Sanchez-Cabus, Santiago; Calatayud, David; Pavel, Mihai Calin; Fondevila, Constantino; Fuster, Jose; García-Valdecasas, Juan Carlos


    Hiliar cholangiocarcinoma is the most common type of cholangiocarcinoma, an represent around 10% of all hepatobiliary tumors. It is an aggressive malignancy, resectable in around 47% of the patients at diagnosis. Complete resection is the most effective and only potentially curative therapy, with a survival rate of less than 12 months in unresectable cases. Axial computerized tomography and magnetic resonance are the most useful image techniques to determine the surgical resectability. Clinically, jaundice and pruritus are the most common symptoms at diagnosis;preoperative biliary drainage is recommended using endoscopic retrograde cholangiography or percutaneous transhepatic cholangiography. Surgery using extended liver resections with an en bloc resection of the liver with vascular reconstruction is the technique with the highest survival. Complete resection with histologically negative resection margins (R0), nodal involvement and metastases are the most important prognostic factors.

  11. A Novel Approach to the Management of Margin-positive DCIS in Nipple-sparing Mastectomy

    Directory of Open Access Journals (Sweden)

    Hilton Becker, MD


    Full Text Available Summary: Nipple-sparing mastectomy (NSM is gaining acceptance as an oncologically sound and cosmetically superior mastectomy technique. Debate exists over the management of positive margins near the nipple-areola complex. This case report presents a novel approach to the management of margin-positive ductal carcinoma in situ in NSM. A 50-year-old white female with invasive ductal carcinoma underwent NSM. Intraoperative pathology indicated the presence of DCIS-positive retroareolar margins. Revision through a direct vertical nipple incision allowed for adequate surgical revision and pathologic evaluation of the retroareolar breast tissue while maintaining the nipple-areola skin and primary mastectomy incision. This novel approach ensures negative margins, allows superior cosmetic outcome, and improves patient autonomy in decision making. The technique may translate to NSM patients with positive retroareolar margins or false-negative margins.

  12. Estimating Marginal Returns to Education (United States)

    Carneiro, Pedro; Heckman, James J.; Vytlacil, Edward


    This paper estimates marginal returns to college for individuals induced to enroll in college by different marginal policy changes. The recent instrumental variables literature seeks to estimate this parameter, but in general it does so only under strong assumptions that are tested and found wanting. We show how to utilize economic theory and local instrumental variables estimators to estimate the effect of marginal policy changes. Our empirical analysis shows that returns are higher for individuals with values of unobservables that make them more likely to attend college. We contrast our estimates with IV estimates of the return to schooling. PMID:25110355

  13. Marginal Solutions for the Superstring

    CERN Document Server

    Erler, Theodore


    We construct a class of analytic solutions of WZW-type open superstring field theory describing marginal deformations of a reference D-brane background. The deformations we consider are generated by on-shell vertex operators with vanishing operator products. The superstring solution exhibits an intriguing duality with the corresponding marginal solution of the {\\it bosonic} string. In particular, the superstring problem is ``dual'' to the problem of re-expressing the bosonic marginal solution in pure gauge form. This represents the first nonsingular analytic solution of open superstring field theory.

  14. 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.

  15. MRI Evaluation of Resection Margins in Bone Tumour Surgery

    Directory of Open Access Journals (Sweden)

    Simon Vandergugten


    Full Text Available In 12 patients operated on for bone sarcoma resection, a postoperative magnetic resonance imaging of the resection specimens was obtained in order to assess the surgical margins. Margins were classified according to MRI in R0, R1, and R2 by three independent observers: a radiologist and two orthopaedic surgeons. Final margin evaluation (R0, R1, and R2 was assessed by a confirmed pathologist. Agreement for margin evaluation between the pathologist and the radiologist was perfect (κ=1. Agreement between the pathologist and an experienced orthopaedic surgeon was very good while it was fair between the pathologist and a junior orthopaedic surgeon. MRI should be considered as a tool to give quick information about the adequacy of margins and to help the pathologist to focus on doubtful areas and to spare time in specimen analysis. But it may not replace the pathological evaluation that gives additional information about tumor necrosis. This study shows that MRI extemporaneous analysis of a resection specimen may be efficient in bone tumor oncologic surgery, if made by an experienced radiologist with perfect agreement with the pathologist.

  16. Marginal revenue and length of stay in inpatient psychiatry. (United States)

    Pletscher, Mark


    This study examines the changes in marginal revenue during psychiatric inpatient stays in a large Swiss psychiatric hospital after the introduction of a mixed reimbursement system with tariff rates that vary over length of stay. A discrete time duration model with a difference-in-difference specification and time-varying coefficients is estimated to assess variations in policy effects over length of stay. Among patients whose costs are fully reimbursed by the mixed scheme, the model demonstrates a significant effect of marginal revenue on length of stay. No significant policy effects are found among patients for whom only health insurance rates are delivered as mixed tariffs and government contributions are made retrospectively. The results indicate that marginal revenue can affect length of stay in inpatient psychiatry facilities, but that the reduction in marginal revenue must be sufficiently large.

  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. SUrgical versus PERcutaneous Bypass: SUPERB-trial; Heparin-bonded endoluminal versus surgical femoro-popliteal bypass: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Wallis de Vries Bas M


    Full Text Available Abstract Background Endovascular treatment options for the superficial femoral artery are evolving rapidly. For long lesions, the venous femoropopliteal bypass considered to be superior above the prosthetic bypass. An endoluminal bypass, however, may provide equal patency rates compared to the prosthetic above knee bypass. The introduction of heparin-bonded endografts may further improve patency rates. The SUrgical versus PERcutaneous Bypass (SuperB study is designed to assess whether a heparin-bonded endoluminal bypass provides equal patency rates compared to the venous bypass and to prove that it is associated with improved quality of life, related to a decreased complication rate, or not. Methods/design Two-hundred-twenty-two patients with peripheral arterial occlusive disease, category 3-6 according to Rutherford, will be randomized in two treatment arms; 1. the surgical femoro-popliteal bypass, venous whenever possible, and 2. the heparin-bonded endoluminal bypass. The power analysis was based on a non-inferiority principle, with an effect size of 90% and 10% margins (alpha 5%, power 80%. Patients will be recruited from 5 teaching hospitals in the Netherlands during a 2-year period. The primary endpoint is primary patency and quality of life evaluated by the RAND-36 questionnaire and the Walking Impairment Questionnaire. Secondary endpoints include secondary patency, freedom-from-TLR and complications. Discussion The SuperB trial is a multicentre randomized controlled trial designed to show non-inferiority in patency rates of the heparin-bonded endograft compared to the surgical bypass for treatment of long SFA lesions, and to prove a better quality of life using the heparin bonded-endograft compared to surgically treatment, related to a reduction in complications. Trial Registration Clinicaltrials: NCT01220245

  19. 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.

  20. 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.

  1. [Sinaloa: the geography of marginalization]. (United States)

    Aguayo Hernandez, J R


    Sinaloa's State Population Program for 1993-98 contains the objective of promoting integration of demographic criteria into the planning process. The action program calls for establishing indicators of economic and social inequality so that conditions of poverty and margination can be identified. To further these goals, the State Population Council used data from the National Population Council project on regional inequality and municipal margination in Mexico to analyze margination at the state level. Nine indicators of educational status, housing conditions, spatial distribution, and income provide information that allows the definition of municipios and regions that should receive priority in economic and social development programs. The index of municipal margination (IMM) is a statistical summary of the nine indicators, which are based on information in the 1990 census. As of March 1990, 9.9% of Sinaloa's population over age 15 was illiterate and 37.4% had incomplete primary education. 91.0% had electricity, but 18.7% lacked indoor toilet facilities and 19.4% had no piped water. 23.7% of houses had dirt floors. 60% of households were crowded, defined as having more than two persons per bedroom. 43.5% of the state population lived in localities with fewer than 5000 inhabitants, where service delivery is difficult and costly. 55.6% of the economically active population was judged to earn less than the amount needed to satisfy essential needs. All except one municipio bordering the Pacific ocean had low or very low indicators of margination, while all those in the sierra had a medium or high degree of margination. Sinaloa's statewide IMM was eighteenth among Mexico's 32 federal entities, with Chiapas showing the highest degree of margination and the Federal District the lowest.

  2. Marginal Effects of a Gross Income Increase for a Single Parent Family in Six European Countries

    DEFF Research Database (Denmark)

    Willumsen, Marie

    High marginal tax rates constitute an issue in several countries because they are supposed to create barriers for increased labour supply. It is, however, often the case that relatively low income families with children face substantially higher combined marginal rates than even the highest...... the contributions to the combined marginal rate, the marginal effective tax rate, METR, using the OECD term, from taxation, payment for childcare, tapering of housing benefits and sometimes child benefits, when the income varies from a low level to a high level for a single parent family. Six countries are included...

  3. Avaliação dos resultados do tratamento cirúrgico artroscópico da instabilidade anterior traumática do ombro com sutura da lesão na margem cruentizada da cavidade glenoidal Evaluation of the results from arthroscopic surgical treatment for traumatic anterior shoulder instability using suturing of the lesion at the opened margin of the glenoid cavity

    Directory of Open Access Journals (Sweden)

    Alberto Naoki Miyazaki


    Full Text Available OBJETIVO: Avaliar os resultados clínicos dos pacientes portadores de instabilidade anterior traumática do ombro tratados cirurgicamente por visualização artroscópica, utilizando âncoras bioabsorvíveis e com o uso da técnica de cruentização da margem anterior da cavidade glenoidal para a reparação da lesão de Bankart. MÉTODO: Entre março de 2006 e outubro de 2008 foram operados 27 ombros de 27 pacientes com diagnóstico de instabilidade anterior traumática do ombro, com média de idade de 28 anos e número de luxações prévias variando entre dois e 25 episódios. O sexo masculino predominou com 24 (89% pacientes. O tempo mínimo de seguimento foi de 24 meses, com uma média de 36 meses, e nenhum paciente tinha cirurgia prévia no ombro acometido ou lesão óssea significativa na margem glenoidal. A avaliação clínica pós-operatória foi realizada por meio da escala de Rowe. Para medirmos o grau de amplitude articular pré-operatória e pós-operatória, utilizamos o método descrito pela Academia Americana de Cirurgiões Ortopédicos (AAOS. RESULTADO: Pelos critérios de Rowe, 25 pacientes (93% obtiveram resultados excelentes e dois (7% resultados ruins, nenhum paciente apresentou resultado bom ou regular. Vinte e três pacientes estavam satisfeitos com o resultado obtido (85%, retornando às suas atividades sem limitações, e quatro pacientes (15% tinham algum grau de limitação. Houve recidiva da instabilidade em dois pacientes (7%. CONCLUSÃO: O tratamento da instabilidade traumática anterior do ombro por visualização artroscópica com a técnica de cruentização da margem articular anterior da cavidade glenoidal, para reparação da lesão de Bankart, proporcionou excelentes resultados em 93% dos pacientes operados.OBJECTIVE: To evaluate the clinical results from patients with traumatic anterior shoulder instability that was treated surgically through arthroscopic viewing, using bioabsorbable anchors and a technique

  4. Retroperitoneal margin involvement by adenocarcinoma of the caecum and ascending colon: what does it mean? (United States)

    Scott, N; Jamali, A; Verbeke, C; Ambrose, N S; Botterill, I D; Jayne, D G


    Circumferential margin involvement (CRM) is a powerful predictor of local recurrence, distant metastasis and patient survival in rectal cancer. In this study, we aimed to determine the frequency of retroperitoneal margin involvement in right colon cancer and describe its relationship to tumour stage and outcome of surgical treatment. Two hundred and twenty-eight consecutive resections for adenocarcinoma of the ascending colon and caecum were identified between 1998 and 2006. Tumour involvement of the posterior retroperitoneal surgical resection margin (RSRM) was recorded and correlated with tumour stage, grade and clinical outcome. RSRM positive patients were compared with CRM positive rectal tumours resected in the same surgical unit. Nineteen of 228 right hemicolectomies (8.4%) showed tumour involvement of the RSRM (defined as CRM positive rectal cancers. Retroperitoneal surgical resection margin involvement by caecal and ascending colon carcinoma is a marker of advanced tumour stage and associated with a high incidence of synchronous and metachronous distant metastasis. More aggressive surgery to obtain a clear margin or postoperative radiotherapy to the tumour bed is likely to benefit only a minority of patients.

  5. 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....

  6. Maximum margin Bayesian network classifiers. (United States)

    Pernkopf, Franz; Wohlmayr, Michael; Tschiatschek, Sebastian


    We present a maximum margin parameter learning algorithm for Bayesian network classifiers using a conjugate gradient (CG) method for optimization. In contrast to previous approaches, we maintain the normalization constraints on the parameters of the Bayesian network during optimization, i.e., the probabilistic interpretation of the model is not lost. This enables us to handle missing features in discriminatively optimized Bayesian networks. In experiments, we compare the classification performance of maximum margin parameter learning to conditional likelihood and maximum likelihood learning approaches. Discriminative parameter learning significantly outperforms generative maximum likelihood estimation for naive Bayes and tree augmented naive Bayes structures on all considered data sets. Furthermore, maximizing the margin dominates the conditional likelihood approach in terms of classification performance in most cases. We provide results for a recently proposed maximum margin optimization approach based on convex relaxation. While the classification results are highly similar, our CG-based optimization is computationally up to orders of magnitude faster. Margin-optimized Bayesian network classifiers achieve classification performance comparable to support vector machines (SVMs) using fewer parameters. Moreover, we show that unanticipated missing feature values during classification can be easily processed by discriminatively optimized Bayesian network classifiers, a case where discriminative classifiers usually require mechanisms to complete unknown feature values in the data first.

  7. Practice patterns and perceptions of margin status for breast conserving surgery for breast carcinoma: National Survey of Canadian General Surgeons. (United States)

    Lovrics, Peter J; Gordon, Maggie; Cornacchi, Sylvie D; Farrokhyar, Forough; Ramsaroop, Amanda; Hodgson, Nicole; Quan, May Lynn; Wright, Francis; Porter, Geoffrey


    We surveyed Canadian General Surgeons to examine decision-making in early stage breast cancer. A modified Dillman Method was used for this mail survey of 1443 surgeons. Practice patterns and factors that influence management choices for: preoperative assessment, definition of margin status, surgical techniques and recommendations for re-excision were assessed. The response rate was 51% with 41% treating breast cancer. Most (80%) were community surgeons, with equal distribution of low/medium/high volume and years of practice categories. Approximately 25% of surgeons "sometimes or frequently" performed diagnostic excisional biopsies while 90% report "frequently" or "always" performing preoperative core biopsies. There was marked variation in defining negative and close margins, in the use of intra-operative margin assessment techniques and recommendations for re-excision. Responses revealed significant variation in attitudes and practices. These findings likely reflect an absence of consensus in the literature and potential gaps between best evidence and practice. Copyright © 2012 Elsevier Ltd. All rights reserved.

  8. Surgical site infection in posterior spine surgery

    African Journals Online (AJOL)


    Mar 20, 2016 ... Background: Surgical site infections (SSIs) in spine surgery remain a significant cause of ... before postoperative day 5 were associated with an increase in the rate of SSI. .... Table 1: Patient characteristics and associated wound .... patients with superficial or deep surgical site infection after spinal surgery.

  9. 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

  10. Ambulatory Surgical Center Payment Rates Archive Page (United States)

    U.S. Department of Health & Human Services — These files contain the procedure codes which may be performed in an ASC under the Medicare program as well as the ASC payment group assigned to each of the...

  11. Surgical Difficulties, Success, and Complication Rates of ...

    African Journals Online (AJOL)


    May 22, 2017 ... force in all three spatial planes transverse, vertical, and sagittal. There is a ... kinds of miniplates are inserted between the lateral and .... The root and tooth germs were .... on the mobile gingiva, sufficient bone exposure was.

  12. A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy (United States)

    Klatte, Tobias; Ficarra, Vincenzo; Gratzke, Christian; Kaouk, Jihad; Kutikov, Alexander; Macchi, Veronica; Mottrie, Alexandre; Porpiglia, Francesco; Porter, James; Rogers, Craig G.; Russo, Paul; Thompson, R. Houston; Uzzo, Robert G.; Wood, Christopher G.; Gill, Inderbir S.


    Context A detailed understanding of renal surgical anatomy is necessary to optimize preoperative planning and operative technique and provide a basis for improved outcomes. Objective To evaluate the literature regarding pertinent surgical anatomy of the kidney and related structures, nephrometry scoring systems, and current surgical strategies for partial nephrectomy (PN). Evidence acquisition A literature review was conducted. Evidence synthesis Surgical renal anatomy fundamentally impacts PN surgery. The renal artery divides into anterior and posterior divisions, from which approximately five segmental terminal arteries originate. The renal veins are not terminal. Variations in the vascular and lymphatic channels are common; thus, concurrent lymphadenectomy is not routinely indicated during PN for cT1 renal masses in the setting of clinically negative lymph nodes. Renal-protocol contrast-enhanced computed tomography or magnetic resonance imaging is used for standard imaging. Anatomy-based nephrometry scoring systems allow standardized academic reporting of tumor characteristics and predict PN outcomes (complications, remnant function, possibly histology). Anatomy-based novel surgical approaches may reduce ischemic time during PN; these include early unclamping, segmental clamping, tumor-specific clamping (zero ischemia), and unclamped PN. Cancer cure after PN relies on complete resection, which can be achieved by thin margins. Post-PN renal function is impacted by kidney quality, remnant quantity, and ischemia type and duration. Conclusions Surgical renal anatomy underpins imaging, nephrometry scoring systems, and vascular control techniques that reduce global renal ischemia and may impact post-PN function. A contemporary ideal PN excises the tumor with a thin negative margin, delicately secures the tumor bed to maximize vascularized remnant parenchyma, and minimizes global ischemia to the renal remnant with minimal complications. Patient summary In this report

  13. Effect of laminar flow clean operating room on surgical wound infection rate%层流洁净手术室对手术切口感染的影响研究

    Institute of Scientific and Technical Information of China (English)



    目的 探讨层流洁净手术室对手术切口感染的影响,为不同类型手术的手术室安排及手术切口感染控制提供参考依据.方法 采用回顾性方法对医院2010年1月-2011年6月普通手术室1652台手术以及2011年7月-2012年6月层流洁净手术室842台手术资料分析,比较各类切口在普通手术室和层流洁净手术室施行的手术切口感染率.结果 洁净手术室手术切口总感染率为1.31%,普通手术室切口总感染率为2.66%,洁净手术室切口总感染率低于普通手术室(P<0.05);洁净层流手术室Ⅰ、Ⅱ、Ⅲ类手术切口感染率分别为0、0.40%、5.10%,普通手术室Ⅰ、Ⅱ、Ⅲ类手术切口感染率分别为1.14%、2.48%、5.77%,洁净层流手术室Ⅰ、Ⅱ类切口感染率低于普通手术室(P<0.05);Ⅲ类手术切口感染率同普通手术室差异无统计学意义.结论 层流洁净手术室能够降低Ⅰ、Ⅱ类手术切口感染率,有利于医院感染控制.%OBJECTIVE To investigate the effect of laminar flow clean operating room on the incidence of surgical incision infections so as to provide basis for the arrangement of operating room as well as for the control of surgical incision infections.METHODS Totally 1652 cases of operations in the ordinary operating rooms from Jan 2010 to Jun 2011 and 842 cases of operations in laminar flow clean operating rooms from Jul 2011 to Jun 2012 were enrolled in the study,then the clinical data of the cases were retrospectively analyzed,and the incidence of surgical incision infections was compared between the ordinary operating rooms and the laminar flow clean operating rooms.RESULTS The total incidence rate of surgical incision infections in the ordinary operating rooms was 2.66%,significantly higher than 1.31% in the laminar flow clean operating rooms (P<0.05).In the laminar flow clean operating rooms,the incidence rate of type Ⅰ incision infection was 0%,the type Ⅱ incision

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

    Directory of Open Access Journals (Sweden)

    Heidecke Claus-Dieter


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

  15. 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.

  16. [Surgical adrenal approaches: learned experiences]. (United States)

    Bravo-Lázaro, Santos; Hernandis-Villalba, Juan; Meroño-Carbajosa, Emilio; Navío-Perales, Juan; Marzal-Felici, Vicente


    Laparoscopic surgery is the standard approach for surgical adrenal gland pathology. However, the open procedure still has its role. Our intention is to report our results and experience using different techniques. A retrospective study of 40 patients was carried out. Demographic and surgical data were analyzed. Thirty two patients had benign pathology and eight had malignant tumors. Laparotomy was performed in 18 patients: seven patients with malignant tumors and 11 with benign pathology. Young's approach was indicated in four patients. Laparoscopic aproach was indicated in 25 patients with seven patients requiring conversion to laparotomy. The conversion rate was 28% In most cases, the laparoscopic approach is the standard technique. Appropriate case selection is of primary importance. Other surgical techniques should be considered if necessary.

  17. 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) ...

  18. 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). ...

  19. 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 / ...

  20. 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 ...

  1. Alterations of the marginal soft tissue (gingival margin following periodontal therapy: A clinical study

    Directory of Open Access Journals (Sweden)

    Gupta Ira


    Full Text Available Background and Objectives: The evaluation of gingival margin position (GMP plays a vital role in periodontal therapy and is critical in esthetic/plastic surgical procedures revolving around restorative dentistry. Comparative evaluations of GMP measurements in various periodontal therapies are scarce. Thus, the objectives of this study are to measure the alteration in the gingival margin position following various therapies, and to compare GMP alterations among different treatment modalities from the baseline to six months after therapy. Materials and Methods: The changes in GMP were studied for MB, B, DB, ML, and L sites for SRP, curettage, and flap surgery, and for MB, B, and DB sites for crown lengthening cases at the end of one, three, and six months after therapy. The results were interpreted from baseline to one, three, and six months posttreatment. Statistical Analysis : The results were subjected to statistical analysis. Paired ′t′-test was used for intra-group comparisons and intergroup comparisons were done by one-way ANOVA. Results: The GMP changed from baseline in all the sites at different time periods following various therapies. The net results after six months were an apical shift of GMP in SRP, curettage, and flap surgery, and a coronal shift of GMP in crown lengthening. Conclusion: GMP shows various patterns of alteration after various periodontal therapies. One should wait for the GMP to become stable before attempting any restorative procedure.

  2. Toward real-time tumor margin identification in image-guided robotic brain tumor resection (United States)

    Hu, Danying; Jiang, Yang; Belykh, Evgenii; Gong, Yuanzheng; Preul, Mark C.; Hannaford, Blake; Seibel, Eric J.


    For patients with malignant brain tumors (glioblastomas), a safe maximal resection of tumor is critical for an increased survival rate. However, complete resection of the cancer is hard to achieve due to the invasive nature of these tumors, where the margins of the tumors become blurred from frank tumor to more normal brain tissue, but in which single cells or clusters of malignant cells may have invaded. Recent developments in fluorescence imaging techniques have shown great potential for improved surgical outcomes by providing surgeons intraoperative contrast-enhanced visual information of tumor in neurosurgery. The current near-infrared (NIR) fluorophores, such as indocyanine green (ICG), cyanine5.5 (Cy5.5), 5-aminolevulinic acid (5-ALA)-induced protoporphyrin IX (PpIX), are showing clinical potential to be useful in targeting and guiding resections of such tumors. Real-time tumor margin identification in NIR imaging could be helpful to both surgeons and patients by reducing the operation time and space required by other imaging modalities such as intraoperative MRI, and has the potential to integrate with robotically assisted surgery. In this paper, a segmentation method based on the Chan-Vese model was developed for identifying the tumor boundaries in an ex-vivo mouse brain from relatively noisy fluorescence images acquired by a multimodal scanning fiber endoscope (mmSFE). Tumor contours were achieved iteratively by minimizing an energy function formed by a level set function and the segmentation model. Quantitative segmentation metrics based on tumor-to-background (T/B) ratio were evaluated. Results demonstrated feasibility in detecting the brain tumor margins at quasi-real-time and has the potential to yield improved precision brain tumor resection techniques or even robotic interventions in the future.

  3. Retrospective analysis of prognostic factors in 205 patients with laryngeal squamous cell carcinoma who underwent surgical treatment.

    Directory of Open Access Journals (Sweden)

    Si-Yi Zhang

    Full Text Available OBJECTIVES: To investigate the most important factors affecting the prognosis of the patients with squamous cell carcinoma (SCC of the larynx. METHODS: Based on the clinical and follow-up data, 205 patients with SCC of the larynx receiving total laryngectomy, partial laryngectomy, or CO2 laser surgery in GuangDong General Hospital were retrospectively analyzed. A survival analysis was performed by the Kaplan-Meier method and a multivariable analysis of prognostic factors was carried out using the Cox proportional hazard model. RESULTS: Subtypes of carcinoma included 69.8% glottic and 30.2% supraglottic. Most patients were in N0 stage (77.6%, and 22.4% patients were in N1∼N3 stage. Over half of the patients were in T1∼T2 stage (55.1%, 20.0% in T3, and 24.9% in T4. Mean follow-up duration was 49.2 months. The survival rates 1, 2, and 3 years after the surgery were 99.0%, 91.7%, and 81.5%, respectively. The survival rate for those patients with clinical stage IV was significantly lower than for those with clinical stage I and II (p<0.001 and p = 0.013, respectively. The disease-free progression rates 1, 2, and 3 years after the surgery were 83.9%, 74.6%, and 71.2%, respectively. Futhermore, those patients with a Charlson score of 1 to 2 and ≥3 had higher risk of mortality than those with a Charlson score of 0 (hazard ratios of 1.8 and 2.41 p = 0.042 and p = 0.008. Multivariable analysis revealed that clinical stage, surgical margin, and comorbidity were significantly associated with both mortality and disease-free progression. CONCLUSION: The surgical resection margin, clinical stage, and comorbidity were independent factors affecting the laryngeal cancer prognosis. The survival rates were lower for patients with advanced laryngeal cancer, positive surgical margins, or severe comorbidity, suggesting the importance of early diagnosis, early treatment, negative surgical margins, and conditions of comorbidity.

  4. Profit margins in Japanese retailing

    NARCIS (Netherlands)

    J.C.A. Potjes; A.R. Thurik (Roy)


    textabstractUsing a rich data source, we explain differences and developments in profit margins of medium-sized stores in Japan. We conclude that the protected environment enables the retailer to pass on all operating costs to the customers and to obtain a relatively high basic income. High service

  5. Profit margins in Japanese retailing

    NARCIS (Netherlands)

    J.C.A. Potjes; A.R. Thurik (Roy)


    textabstractUsing a rich data source, we explain differences and developments in profit margins of medium-sized stores in Japan. We conclude that the protected environment enables the retailer to pass on all operating costs to the customers and to obtain a relatively high basic income. High service

  6. Respiration in ocean margin sediments

    NARCIS (Netherlands)

    Andersson, J.H.


    The aim of this thesis was the study of respiration in ocean margin sediments and the assessments of tools needed for this purpose. The first study was on the biological pump and global respiration patterns in the deep ocean using an empirical model based on sediment oxygen consumption data. In this

  7. Respiration in ocean margin sediments

    NARCIS (Netherlands)

    Andersson, J.H.


    The aim of this thesis was the study of respiration in ocean margin sediments and the assessments of tools needed for this purpose. The first study was on the biological pump and global respiration patterns in the deep ocean using an empirical model based on sediment oxygen consumption data.

  8. Surgical planning for resection of an ameloblastoma and reconstruction of the mandible using a selective laser sintering 3D biomodel. (United States)

    Sannomiya, Eduardo Kazuo; Silva, Jorge Vicente L; Brito, Antonio Albuquerque; Saez, Daniel Martinez; Angelieri, Fernanda; Dalben, Gisele da Silva


    Ameloblastoma is a benign locally aggressive infiltrative odontogenic lesion. It is characterized by slow growth and painless swelling. The treatment for ameloblastoma varies from curettage to en bloc resection, and the reported recurrence rates after treatment are high; the safety margin of resection is important to avoid recurrence. Advances in technology brought about great benefits in dentistry; a new generation of computed tomography scanners and 3-dimensional images enhance the surgical planning and management of maxillofacial tumors. The development of new prototyping systems provides accurate 3D biomodels on which surgery can be simulated, especially in cases of ameloblastoma, in which the safety margin is important for treatment success. A case of mandibular follicular ameloblastoma is reported where a 3D biomodel was used before and during surgery.

  9. Robotic-assisted laparoscopic radical cystectomy: surgical and oncological outcomes

    Directory of Open Access Journals (Sweden)

    Adrian Treiyer


    Full Text Available PURPOSE:Our first 91 consecutive cases undergoing a robotic assisted cystectomy were analyzed regarding perioperative outcomes, pathological stages and surgical complications. MATERIALS AND METHODS: Between 2007 and 2010 a total of 91 patients (76 male and 15 female, 86 with clinically localized bladder cancer and 5 with non-urothelial tumors underwent a radical robotic assisted cystectomy. We analyzed the perioperative factors, length of hospital stay, pathological outcomes and complication rates. RESULTS: Mean age was 65.6 years (range 28 to 82. Among the 91 patients, 68 were submitted to an ileal conduit and 23 to a neobladder procedure for urinary diversion. Mean operating time was 412 min (range: 243-618 min. and mean blood loss was 294 mL (range: 50-2000 mL. In 29% of the cases with urothelial carcinoma the T-stage was pT1 or less, 38% were pT2; 26% and 7% were classified as pT3 and pT4, respectively. 14% of cases had lymph node positive disease. Mean number of lymph nodes removed was 15 (range 4 to 33. Positive surgical margins occurred in 2 cases (2.1%. Mean days to flatus were 2.13, bowel movement 2.88 and inpatient stay 18.8 (range: 10-33. There were 45 postoperative complications with 11% major (Clavien grade 3 or higher. At a mean follow-up of 15 months 10 patients had disease recurrence and 6 died of the disease. CONCLUSIONS: Our experience demonstrates that robotic assisted radical cystectomies for the treatment of bladder cancers seems to be very promising regarding surgical and oncological outcomes.

  10. Carbonate mound development in contrasting settings on the Irish margin (United States)

    van der Land, Cees; Eisele, Markus; Mienis, Furu; de Haas, Henk; Hebbeln, Dierk; Reijmer, John J. G.; van Weering, Tjeerd C. E.


    Cold-water coral carbonate mounds, formed by framework building cold-water corals, are found in several mound provinces on the Irish margin. Differences in cold-water coral mound development rates and sediment composition between mounds at the southwest Rockall Trough margin and the Galway Mound in the Porcupine Seabight are investigated. Variations in sediment composition in the two mound provinces are related to the local environmental conditions and sediment sources. Mound accumulation rates are possibly higher at the Galway Mound probably due to a higher influx of hemipelagic fine grained non-carbonate sediments. In both cold-water coral mound areas, mound growth has been continuous for the last ca 11,000 years, before this period several hiatuses and unconformities exist in the mound record. The most recent unconformity can be correlated across multiple mounds and mound provinces at the Irish margin on the basis of apparent age. On the southwest Rockall Trough margin these hiatuses/unconformities are associated with post-depositional aragonite dissolution in, and lithification of, certain intervals, while at Galway Mound no lithification occurs. This study revealed that the influx and types of material transported to cold-water coral mounds may have a direct impact on the carbonate mound accumulation rate and on post-depositional processes. Significantly, the Logachev Mounds on the SW Rockall Trough margin accumulate slower but, because they contain lithified layers, are less susceptible to erosion. This net effect may account for their larger size compared to the Belgica Mounds.

  11. Comparison of margin status and lesional size between radioactive seed localized vs conventional wire localized breast lumpectomy specimens. (United States)

    Rarick, Jason; Kimler, Bruce F; Tawfik, Ossama


    Despite the known benefits of the use of radioactive seed localization (RSL), few studies have looked at the resultant pathologic marginal status of these lumpectomy specimens, especially in regard to different definitions of close/positive margins. We compared the marginal status of lumpectomy specimens removed by either RSL or conventional wire localization (CWL) techniques. A total of 106 lumpectomy specimens including 62 by CWL and 44 by RSL for invasive ductal and lobular carcinomas were compared. Data on gross and microscopic surgical margin status, tumor type and grade, and demographic information were retrospectively collected. There was no difference between the techniques in terms of tumor characteristics including size, histologic grade, lymph node positivity, or age. Although the distributions are very similar between CWL and RSL specimens for final marginal assessments (P=.69), there is a (modest) statistically significant difference in the distribution for margin classifications based on gross assessments (P=.040), specifically more RSL specimens exhibiting tumor within 1mm of the closest margin. Concordance between gross and microscopic lesion measurements is highest for invasive ductal carcinoma grade 3 for both CWL and RSL lumpectomies (78.6% and 80.0%). This study shows that there were no significant marginal status differences between RSL and CWL lumpectomy specimens with invasive carcinoma. Rather, what was relevant is whether the entire specimen could be classified as having negative/close margins. Significant workflow challenges in surgical pathology laboratories are expected with the adoption of the RSL process.

  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. [Financing and control of surgical training]. (United States)

    Schröder, W; Welcker, K


    The present analyses of different surgical training systems show that training of surgical residents significantly contributes to hospital costs. These are predominantly caused by prolonged operation times of residents with increased work load for other staff members in the operating room. In addition, the productivity of surgical residents is less compared to experienced surgeons. On the other hand, hospital managements save money by the lower standard wages paid to the residents. The amount of educational costs is difficult to determine because surgical training takes place as on the job training. Therefore, from an economic point of view, the two products patient care and surgical training are difficult to separate. There are no reliable cost analyses available for the German training system. At present surgical training is indirectly financed by the DRG (diagnosis-related groups) flat rates of the health insurance. Possible options of financing the surgical training are additional funding from the health department or redistribution with supplemental payment for those surgical departments which contribute significantly more to the residents' training. Statements of medical associations, health departments and health insurances demonstrate the difficulty to come to an agreement concerning the finances of the training system. Despite this controversial discussion it should be taken into consideration that there is no alternative to a high quality surgical training as this is the basis for an effective health system.

  14. Tendencia de la mortalidad por cáncer en niños y adolescentes según grado de marginación en México (1990-2009 Trends of cancer mortality rates in children and adolescents by level of marginalization in Mexico (1990-2009

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    Ricardo Antonio Escamilla-Santiago


    Full Text Available OBJETIVO: Determinar la tendencia de mortalidad por cáncer en niños y adolescentes por nivel de marginación en México. MATERIAL Y MÉTODOS: La información se obtuvo de certificados de defunción (1990-2009; se calcularon tasas estandarizadas por edad. Se obtuvo el porcentaje promedio anual de cambio (AAPC calculados con Joinpoint Regression del National Cancer Institute para evaluar la tendencia. RESULTADOS: La mortalidad por cáncer en niños y adolescentes incrementó: en niños fue de 0.87% hombres y 0.96% mujeres y 1.22% hombres y 0.63% mujeres en adolescentes. El patrón de neoplasias en niños fue leucemias -sistema nervioso- linfomas, y en adolescentes leucemias -huesos y articulaciones- linfomas. Los incrementos de la mortalidad correspondieron a alta y muy alta marginalidad. CONCLUSIÓN: El incremento de mortalidad correspondiente a los estados de alta y muy alta marginalidad puede explicarse en parte por un mejor registro. Se requieren estudios de sobrevida para evaluar mejor la efectividad de los tratamientos en el país.OBJECTIVE: To determine childhood and adolescent cancer mortality by the level of marginalization in Mexico. MATERIALS AND METHODS: We used 1990-2009 death certificates estimating age-standardized rates. We calculated the Average Annual Percent Change (AAPC using the Joinpoint Regression program available at the National Cancer Institute to assess tendency. RESULTS: Cancer mortality rates increased. AAPC were 0.87% male and 0.96% female children, and for adolescents were: males 1.22% and females 0.63%. The neoplasm pattern in infants was leukemia -central nervous system- lymphomas; and in adolescents it was leukemia -bone and articulation- lymphomas. The increase in cancer mortality corresponded to the high and highest marginated areas of each state. CONCLUSION: The increase in highly marginated areas may be partly explained by well-documented local registration of deaths. Further studies focusing on survival are

  15. Max-margin based Bayesian classifier

    Institute of Scientific and Technical Information of China (English)

    Tao-cheng HU‡; Jin-hui YU


    There is a tradeoff between generalization capability and computational overhead in multi-class learning. We propose a generative probabilistic multi-class classifi er, considering both the generalization capability and the learning/prediction rate. We show that the classifi er has a max-margin property. Thus, prediction on future unseen data can nearly achieve the same performance as in the training stage. In addition, local variables are eliminated, which greatly simplifi es the optimization problem. By convex and probabilistic analysis, an efficient online learning algorithm is developed. The algorithm aggregates rather than averages dualities, which is different from the classical situations. Empirical results indicate that our method has a good generalization capability and coverage rate.

  16. Surgical Space Conditions During Low-Pressure Laparoscopic Cholecystectomy with Deep Versus Moderate Neuromuscular Blockade

    DEFF Research Database (Denmark)

    Staehr-Rye, Anne K; Rasmussen, Lars S.; Rosenberg, Jacob;


    described, but deep neuromuscular blockade may be beneficial. We investigated if deep muscle relaxation would be associated with a higher proportion of procedures with "optimal" surgical space conditions compared with moderate relaxation during low-pressure (8 mm Hg) laparoscopic cholecystectomy. METHODS...... with surgical space conditions that were marginally better than with moderate muscle relaxation during low-pressure laparoscopic cholecystectomy....

  17. The Margins of Medieval Manuscripts

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    Nataša Kavčič


    Full Text Available Shortly after the mid-thirteenth century, various images began to fill the margins in both religious and secular texts. Many factors influenced the emergence of this type of manuscript decoration, but it has generally been attributed to the revived interest in nature and the Gothic inclination for humorous and anecdotic detail. After highlighting other possible reasons for the occurrence of marginal illumination, this paper introduces two manuscripts from the Archiepiscopal Archives in Ljubljana. The manuscripts show numerous facial drawings affixed to some of the letters. This article addresses how to interpret such drawings and stresses that they do not necessarily function as symbolic images or images with any specific didactic value. Quite the opposite, these drawings seem not to have any meaning and are oft en merely indications of an illuminator’s sense of humor. Because of their exaggerated facial expressions, these drawings could be perceived as the true predecessors of modern caricature.

  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. A cross-sectional survey of clinicians performing periodontal surgical crown lengthening. (United States)

    Wyatt, Gillian; Grey, Nick; Deery, Chris


    The aim of this study was to conduct a survey of surgical crown lengthening practice performed by dental specialists and general dental practitioners using a cross-sectional questionnaire. One hundred general dental practitioners and 100 specialists from each of the following specialties: prosthodontics, periodontics, restorative dentistry and surgical dentistry. There were fewer surgical dentists performing surgical crown lengthening than the other specialists. The specialists in periodontics were significantly more likely to perform surgical crown lengthening than not. The respondents predominantly considered that periodontal surgical crown lengthening is within the remit of periodontics. 33% of the respondents performing more than 50 PSCL procedures in one year thought that the gingival margin was stable after three months. 33% thought that it was stable after six months and 33% declined to state a post-operative marginal stability time period.

  20. Surgical attire, practices and their perception in the prevention of surgical site infection. (United States)

    McHugh, S M; Corrigan, M A; Hill, A D K; Humphreys, H


    Clean surgical scrubs, surgical gowns and headgear are worn by operative teams to decrease bacterial contamination and lower surgical site infection (SSI) rates. A detailed review was undertaken of peer-reviewed publications and other sources of material in the English language over the last 50 years included. Surgical scrubs should be clean and made of tightly woven material. Studies investigating single-use gowns and drapes versus reusable gowns report conflicting evidence. Double gloving may reduce SSI rates in procedures where no antibiotic prophylaxis was administered. Bacterial contamination of the operative field has been shown to be decreased by the wearing of surgical headgear by the operating team. Further consideration and better trials are required to determine the impact of different theatre clothing on SSI rates. Copyright © 2013 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  1. Chances, risks and limitations of neoadjuvant therapy in surgical oncology

    Directory of Open Access Journals (Sweden)

    Lordick Florian


    Full Text Available Over the last decades, neoadjuvant treatment has been established as a standard of care for a variety of tumor types in visceral oncology. Neoadjuvant treatment is recommended in locally advanced esophageal and gastric cancer as well as in rectal cancer. In borderline resectable pancreatic cancer, neoadjuvant therapy is an emerging treatment concept, whereas in resectable colorectal liver metastases, neoadjuvant treatment is often used, although the evidence for improvement of survival outcomes is rather weak. What makes neoadjuvant treatment attractive from a surgical oncology viewpoint is its ability to shrink tumors to a smaller size and to increase the chances for complete resection with clear surgical margins, which is a prerequisite for cure. Studies suggest that local tumor control is increased in some visceral tumor types, especially with neoadjuvant chemoradiotherapy. In some other studies, a better control of systemic disease has contributed to significantly improved survival rates. Additionally, delaying surgery offers the chance to bring the patient into a better general condition for major surgery, but it also confers the risk of progression. Although it is a relatively rare event, cancers may progress locally during neoadjuvant treatment or distant metastases may occur, jeopardizing a curative surgical treatment approach. Although this is seen as risk of neoadjuvant treatment, it can also be seen as a chance to select only those patients for surgery who have a better control of systemic disease. Some studies showed increased perioperative morbidity in patients who underwent neoadjuvant treatment, which is another potential disadvantage. Optimal multidisciplinary teamwork is key to controlling that risk. Meanwhile, the neoadjuvant treatment period is also used as a “window of opportunity” for studying the activity of novel drugs and for investigating predictive and prognostic biomarkers of chemoradiotherapy and radiochemotherapy

  2. Changes in ice-margin processes and sediment routing during ice-sheet advance across a marginal moraine (United States)

    Knight, P.G.; Jennings, C.E.; Waller, R.I.; Robinson, Z.P.


    Advance of part of the margin of the Greenland ice sheet across a proglacial moraine ridge between 1968 and 2002 caused progressive changes in moraine morphology, basal ice formation, debris release, ice-marginal sediment storage, and sediment transfer to the distal proglacial zone. When the ice margin is behind the moraine, most of the sediment released from the glacier is stored close to the ice margin. As the margin advances across the moraine the potential for ice-proximal sediment storage decreases and distal sediment flux is augmented by reactivation of moraine sediment. For six stages of advance associated with distinctive glacial and sedimentary processes we describe the ice margin, the debris-rich basal ice, debris release from the glacier, sediment routing into the proglacial zone, and geomorphic processes on the moraine. The overtopping of a moraine ridge is a significant glaciological, geomorphological and sedimentological threshold in glacier advance, likely to cause a distinctive pulse in distal sediment accumulation rates that should be taken into account when glacial sediments are interpreted to reconstruct glacier fluctuations. ?? 2007 Swedish Society for Anthropology and Geography.

  3. Appositional bone formation in marginal defects at implants. (United States)

    Botticelli, Daniele; Berglundh, Tord; Buser, Daniel; Lindhe, Jan


    In a previous experiment, it was demonstrated that a wide marginal defect around an implant can heal with a high degree of osseointegration. The present experiment was performed to evaluate the degree and quality of de novo bone formation and osseointegration in marginal defects adjacent to submerged titanium implants. All mandibular premolars and 1st molars were extracted in four Labrador dogs. Four experimental sites were identified in the right side of the mandible. In two sites, custom-made implants with a sandblasted, large grit, acid-etched (SLA) surface were installed without further ostectomy (control sites). In the two remaining sites (test sites), a specially designed step drill was used to widen the marginal 5 mm of the canal. A barrier membrane was used to cover the implants in the defect sites. All implants were submerged. One month later, an identical procedure, including site preparation and implant installation, was performed in the left side of the mandible. Two months following the first implant installation procedure, biopsies were collected and prepared for sectioning. Ostectomy and implant installation in the control location resulted in a series of bone tissue alterations which eventually allowed newly formed bone to establish contact with the SLA surface. The marginal defect lateral to the implant in the test locations gradually became filled with newly formed bone. De novo bone formation started within the walls of the surgically prepared defect. Bone-to-implant contact was first established in the apical portion of the gap. This new bone tissue was in the coronal direction continuous with a dense, non-mineralized 'implant attached' soft tissue which, over time, also became mineralized to increase the height of the zone of bone-to-implant contact. The results suggest that healing of a wide marginal defect around an implant is characterized by appositional bone growth from the lateral and apical bone walls of the defect.

  4. Length of Distal Resection Margin after Partial Mesorectal Excision for Upper Rectal Cancer Estimated by Magnetic Resonance Imaging

    DEFF Research Database (Denmark)

    Bondeven, Peter; Hagemann-Madsen, Rikke Hjarnø; Bro, Lise;

    BACKGROUND: Rectal cancer requires surgery for cure. Partial mesorectal excision (PME) is suggested for tumours in the upper rectum and implies transection of the mesorectum perpendicular to the bowel a minimum of 5 cm below the tumour. Reports have shown distal mesorectal tumour spread of up to 5...... cm from the primary tumour; therefore, guidelines for cancer of the upper rectum recommend PME with a distal resection margin (DRM) of at least 5 cm or total mesorectal excision (TME). PME exerts a hazard of removing less than 5 cm - leaving microscopic tumour cells that have spread in the mesorectum....... Studies at our department have shown inadequate DRM in 75 % of the patients estimated by post-operative MRI of the pelvis and by measurements of the histopathological specimen. Correspondingly, a higher rate of local recurrence in patients surgically treated with PME for rectal cancer - compared to TME...

  5. The Incidence of Complex Regional Pain Syndrome in Simultaneous Surgical Treatment of Carpal Tunnel Syndrome and Dupuytren Contracture. (United States)

    Buller, Mitchell; Schulz, Steven; Kasdan, Morton; Wilhelmi, Bradon J


    To determine the incidence of complex regional pain syndrome (CRPS) in the concurrent surgical treatment of Dupuytren contracture (DC) and carpal tunnel syndrome (CTS) through a thorough review of evidence available in the literature. The indices of 260 hand surgery books and PubMed were searched for concomitant references to DC and CTS. Studies were eligible for inclusion if they evaluated the outcome of patients treated with simultaneous fasciectomy or fasciotomy for DC and carpal tunnel release using CRPS as a complication of treatment. Of the literature reviewed, only 4 studies met the defined criteria for use in the study. Data from the 4 studies were pooled, and the incidence of recurrence and complications, specifically CRPS, was noted. The rate of CRPS was found to be 10.4% in the simultaneous treatment group versus 4.1% in the fasciectomy-only group. This rate is nearly half the 8.3% rate of CRPS found in a randomized trial of patients undergoing carpal tunnel release. Our analysis demonstrates a marginal increase in the occurrence of CRPS by adding the carpal tunnel release to patients in need of fasciectomy, contradicting the original reports demonstrating a much higher rate of CRPS. This indicates that no clear clinical risk is associated with simultaneous surgical treatment of DC and CTS. In some patients, simultaneous surgical management of DC and CTS can be accomplished safely with minimal increased risk of CRPS type 1.

  6. [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.

  7. Análise de 33 peças cirúrgicas de colectomias laparoscópicas para câncer, durante a curva de aprendizado inicial: margens oncológicas e número de linfonodos não diferem de colectomias abertas Analysis of 33 surgical specimens of laparoscopic resections for colorectal cancer in the early learning curve: margins and nodes harvest do not differ from open resections

    Directory of Open Access Journals (Sweden)

    Augusto Motta Neiva


    no início da experiência com colectomia laparoscópica, os critérios para ressecção oncológica podem ser preservados quando os procedimentos são realizados por cirurgiões especialistas trabalhando com equipe especializada em patologia gastrointestinal.INTRODUCTION: Colorectal laparoscopic surgery is considered a procedure with long learning curve. Despite surgeons with experience in laparoscopic surgery are able to achieve the same oncological results obtained in open procedures, it is important to evaluate if these good results are sustained during the learning curve. The aim of this study was to evaluate the adequacy of the margins and the lymph nodes harvest in early learning curve of laparoscopic colectomies performed by specialized surgeons compared to open colectomies. METHODS: Thirty-three surgical specimens of laparoscopic resections for colorectal cancer performed during the early learning curve were evaluated. The following data were analyzed: age, sex, tumor location, pathologic classification, lymph node harvest and proximal and distal margins. Data were compared to a control group of 45 open resections for colorectal cancer. RESULTS: Age, tumor location and Dukes classification of laparoscopic and open groups were similar. Laparoscopic group had more female patients. Distal margins were similar between the groups [mean of 7,15 cm (SD ± 9,98 for open and 8,26 cm (SD ± 11,5 for laparoscopic group, p=NS]. There was no difference in the lymph nodes harvest between the groups. The mean of lymph nodes harvest of open and laparoscopic groups were 19 (SD ± 19,41 and 21 (SD ± 14,73, respectively, (p=NS. CONCLUSION: Oncologic margins and lymph nodes harvest obtained during early learning curve of laparoscopic resections were similar to open procedures. Despite the natural difficulties faced during early learning curve, oncologic criteria can be achieved when laparoscopic colorectal resections are performed by specialized surgeons working with

  8. Manual of Surgical Instruments

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    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.

  9. Margin Requirements and Equity Option Returns

    DEFF Research Database (Denmark)

    Hitzemann, Steffen; Hofmann, Michael; Uhrig-Homburg, Marliese

    In equity option markets, traders face margin requirements both for the options themselves and for hedging-related positions in the underlying stock market. We show that these requirements carry a significant margin premium in the cross-section of equity option returns. The sign of the margin pre...

  10. Securing aesthetic outcomes for composite grafts to alar margin and columellar defects: A long term experience. (United States)

    Ahuja, Rajeev B; Gupta, Rajat; Chatterjee, Pallab; Shrivastava, Prabhat


    Composite grafts for nasal reconstruction have been around for over a century but the opinion on its virtues and failings keeps vacillating with a huge difference on the safe size of the graft for transfer. Alar margin and columellar defects are more distinct than dorsal nasal defects in greater difficulty in ensuring a good aesthetic outcome. We report our series of 19 consecutive patients in whom a composite graft was used to reconstruct a defect of alar margin (8 patients), alar base (7 patients) or columella (4 patients). Patient ages ranged from 3-35 years with 5 males and 14 females. The grafts to alar margin and base ranged 0.6-1 cm in width, while grafts to columella were 0.7-1.2 cm. The maximum dimension of the graft in this series was 0.9 mm x 10 mm. Composite grafts were sculpted to be two layered (skin + cartilage), three layered wedges (skin + cartilage + skin) or their combination (two layered in a portion and three layered in another portion). All grafts were cooled in postoperative period for three days by applying an indigenous ice pack of surgical glove. The follow up ranged from 3-9 months with an average of 4.5 months. All of our 19 composite grafts survived completely but they all shrank by a small percentage of their bulk. Eleven patients rated the outcome between 90-95% improvement. We noticed that composite grafts tended to show varied pigmentation in our patients, akin to split skin grafts. In our opinion, most critical to graft survival is its size and the ratio of the marginal raw area to the graft bulk. We recommend that graft width should not exceed 1 cm to ensure complete survival even though larger sized grafts have been reported to survive. We recommend cooling of the graft and justify it on the analogy of 'warm ischemia time' for a replantation, especially in warmer climes like ours in India. We have outlined several considerations in the technique, with an analysis of differing opinions that should facilitate a surgeon in making an

  11. The impact of surgical and pathological findings on radiotherapy of early breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Borger, J.H. (Nederlands Kanker Inst. ' Antoni van Leeuwenhoekhuis' , Amsterdam (Netherlands))


    Treatment results in breast conserving therapy show considerable variation with local breast control rates from 1-13% at 5 yrs. of follow-up. This wide variation and reports on prognostic factors (age, extensive ductal carcinoma in situ component and margin involvement) having adverse effects on local control raise questions about the safety of this treatment. An attempt is made to identify surgical and pathological factors which make modifications in radio-therapeutic treatment necessary in order to reach perfect balance between good local control and optimal cosmic results. For this purpose literature is reviewed including 3 randomized trials on this subject and studies providing sufficient data on most of mentioned prognostic factors. Looking at treatment characteristics of above mentioned studies, considerable variation is observed with regard to surgical margins, boost dose and application of adjuvant systemic treatment. Microscopic margin evaluation and identification of extensive in situ component (EIC) is performed in half of these studies and the implications of the findings are very different. Although some authors perform multivariate analyses, this is rarely done on a complete set of variables. This results in different treatment results and conflicting data on prognostic factors. There is no agreement on even 1 prognostic factor and best results in terms of local control are seen in centres combining very wide excision with a moderate boost or a less wide excision with a high boost. These approaches are likely to result in less acceptable cosmesis and are unnecessarily aggressive in the majority of the patients. The incidence and volume of residual breast tumor can be estimated after careful pathologic evaluation of the tumor specimen and information provided by the surgeon with special attention to preoperative mammography. Treatment can be tailored for each individual patient providing consultation between surgeon, pathologist and radiotherapist.

  12. Biomass energy and marginal areas

    Energy Technology Data Exchange (ETDEWEB)

    Chassany, J.P.


    The aim of this study was to analyze the conditions and effects of a possible development of the biomass energy upgrading in uneconomical or not rentable areas. The physical, social and economical characteristics of these regions (in France) are described; then the different types of biomass are presented (agricultural wastes, energetic cultures, forest and land products and residues, food processing effluents, municipal wastes) as well as the various energy process (production of alcohol, methane, thermochemical processes, vegetable oils). The development and the feasability of these processes in marginal areas are finally analyzed taking into account the accessibility of the biomass and the technical and commercial impacts.

  13. Bronchial resection margin and long-term survival in non-small-cell lung cancer. (United States)

    Poullis, Michael; McShane, James; Shaw, Mathew; Page, Richard; Woolley, Steve; Shackcloth, Michael; Mediratta, Neeraj


    Clear resection margins are necessary for long-term survival of patients undergoing surgical resection. We aimed to determine whether bronchial resection margin is a factor determining long-term survival in patients undergoing R0 resections for non-small-cell lung cancer. There were 2695 consecutive pulmonary resections performed between October 2001 and September 2011 in our institution; 1795 were R0 resections for non-small-cell lung cancer and bronchial margin length data were available. Benchmarking against the 7th International Association for the Study of Lung Cancer dataset was performed. Cox multivariate and neuronal network analysis was undertaken. Benchmarking failed to reveal any significant differences between our data and the 7th International Association for the Study of Lung Cancer dataset. Cox regression demonstrated that age (pNeuronal network analysis confirmed these findings. Bronchial resection margin length has no impact on long-term survival.

  14. Margin Analysis: Malignant Salivary Gland Neoplasms of the Head and Neck. (United States)

    Ord, Robert A; Ghazali, Naseem


    There are no established protocols for the optimum surgical margin required for salivary gland malignancies. Factors including histologic diagnosis and TNM stage have been shown to be important in prognosis and survival outcome and mandate special consideration of margin size. Salivary cancers are treated differently at different anatomic sites, and different histologic types show a propensity for major or minor glands. Low-grade malignancies are treated with soft tissue margins of 1 cm or less. The facial nerve is preserved unless infiltrated and encased. Adenoid cystic carcinoma and carcinoma ex pleomorphic adenoma require more complex planning to obtain negative margins. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

  15. Three different surgical techniques of crown lengthening: A comparative study

    Directory of Open Access Journals (Sweden)

    Ramya Nethravathy


    Full Text Available Introduction: A short clinical crown may lead to poor retention form thereby leading to improper tooth preparation. Surgical crown lengthening procedure is done to increase the clinical crown length without violating the biologic width. Several techniques have been proposed for clinical crown lengthening which includes gingivectomy, apically displaced flap with or without resective osseous surgery, and surgical extrusion using periotome. Objective: The aim of this paper is to compare clinically the three different surgical techniques of crown lengthening procedures. Materials and Methods: Fifteen patients who reported to the department of Periodontology, were included in the study. Patients were randomly divided into three groups, which include patients who underwent gingivectomy (Group A, apically repositioned flap (Group B and surgical extrusion using periotome (Group C. Clinical measurements such as clinical crown length, gingival zenith, interdental papilla height were taken at baseline and at 3 rd month post-operatively. Results: Clinical and radiographic evaluation at 3 rd month suggest that surgical extrusion technique offers several advantages over the other conventional surgical techniques such as preservation of the interproximal papilla, gingival margin position and no marginal bone loss. Conclusions: This technique can be used to successfully treat a grossly damaged crown structure as a result of tooth fracture, dental caries and iatrogenic factors especially in the anterior region, where esthetics is of great concern.

  16. 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.

  17. The “excluding” suture technique for surgical closure of ventricular septal defects: A retrospective study comparing the standard technique

    Directory of Open Access Journals (Sweden)

    Roy Varghese


    Conclusion: Surgical closure of VSDs can be accomplished by placing sutures along the margins or away with comparable results. The incidence of CHB, however, seems to be less when the “excluding” technique is employed.

  18. 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

  19. 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...

  20. Clinical experience in the use of marginal donor hearts

    Institute of Scientific and Technical Information of China (English)

    XIE Ai-ni; DONG Nian-guo; ZHANG Kai-lun; XIA Jia-hong; XIAO Shi-liang; SUN Zong-quan


    Background Although heart transplantation has become a standard therapy for end-stage heart disease, there are few published studies regarding the use of transplant organs from marginal donors. Here we describe the clinical outcome we have obtained using marginal donor hearts.Methods We analyzed 21 cases of orthotropic heart transplantation for end-stage heart disease performed in our department between September 2008 and July 2010. Of these patients, six received hearts from marginal donors and the remainder received standard-donor hearts. The two groups were compared in terms of both mortality and the incidence of perioperative complications such as infection, acute rejection, and right heart insufficiency.Results The 1-year survival rate of both groups was 100%. Only one death was recorded in standard-donor group during follow-up. Patients who received marginal donor hearts (83%) experienced more early complications than did the standard-donor-heart group (13%), but the mortality of the two groups was the same. The duration of post-ICU stay was greater in the marginal donor group than in the standard-donor group, (35.5±17.4) days and (21.7±2.6) days, respectively (P <0.05).Conclusions The use of marginal donor hearts increases the number of patients who can receive and benefit from transplants. However, it may introduce an increased risk of early complications, thus care should be taken both in the choice of patients who will receive marginal donor hearts and in the perioperative treatment of those for whom the procedure is performed.

  1. Investigation of platelet margination phenomena at elevated shear stress. (United States)

    Zhao, Rui; Kameneva, Marina V; Antaki, James F


    Thrombosis is a common complication following the surgical implantation of blood contacting artificial organs. Platelet transport, which is an important process of thrombosis and strongly modulated by flow dynamics, has not been investigated under the shear stress level associated with these devices, which may range from tens to several hundred Pascal.The current research investigated platelet transport within blood under supra-physiological shear stress conditions through a micro flow visualization approach. Images of platelet-sized fluorescent particles in the blood flow were recorded within microchannels (2 cm x 100 microm x 100 microm). The results successfully demonstrated the occurrence of platelet-sized particle margination under shear stresses up to 193 Pa, revealing a platelet near-wall excess up to 8.7 near the wall (within 15 microm) at the highest shear stress. The concentration of red blood cells was found to influence the stream-wise development of platelet margination which was clearly observed in the 20% Ht sample but not the 40% Ht sample. Shear stress had a less dramatic effect on the margination phenomenon than did hematocrit. The results imply that cell-cell collision is an important factor for platelet transport under supra-physiologic shear stress conditions. It is anticipated that these results will contribute to the future design and optimization of artificial organs.

  2. Dynamics of the continental margins

    Energy Technology Data Exchange (ETDEWEB)


    On 18--20 June 1990, over 70 oceanographers conducting research in the ocean margins of North America attended a workshop in Virginia Beach, Virginia. The purpose of the workshop was to provide the Department of Energy with recommendations for future research on the exchange of energy-related materials between the coastal and interior ocean and the relationship between the ocean margins and global change. The workshop was designed to optimize the interaction of scientists from specific research disciplines (biology, chemistry, physics and geology) as they developed hypotheses, research questions and topics and implementation plans. The participants were given few restraints on the research they proposed other than realistic time and monetary limits. The interdisciplinary structure of the meeting promoted lively discussion and creative research plans. The meeting was divided into four working groups based on lateral, vertical, air/sea and sediment/water processes. Working papers were prepared and distributed before the meeting. During the meeting the groups revised the papers and added recommendations that appear in this report, which was reviewed by an Executive Committee.

  3. Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients

    DEFF Research Database (Denmark)

    Shabanzadeh, Daniel M; Sørensen, Lars T


    : To compare surgical site infections rate in obese patients after laparoscopic surgery with open general abdominal surgery.......: To compare surgical site infections rate in obese patients after laparoscopic surgery with open general abdominal surgery....

  4. Utilization and Outcomes of Nephroureterectomy for Upper Tract Urothelial Carcinoma by Surgical Approach. (United States)

    Rodriguez, Joseph F; Packiam, Vignesh T; Boysen, William R; Johnson, Scott C; Smith, Zachary L; Smith, Norm D; Shalhav, Arieh L; Steinberg, Gary D


    To compare outcomes and survival of open-, robotic-, and laparoscopic nephroureterectomy (ONU, RNU, LNU) using population-based data. Using the National Cancer Database, we identified patients who underwent nephroureterectomy for localized upper tract urothelial carcinoma between 2010 and 2013. Demographic and clinicopathologic characteristics were compared among the three operative approaches. Multivariate regression analyses were used to determine the impact of approach on performance of lymphadenectomy (LND), positive surgical margins (PSM), and overall survival (OS). In total, there were 9401 cases identified for analysis, including 3199 ONU (34%), 2098 RNU (22%), and 4104 LNU (44%). From 2010 to 2013, utilization of RNU increased from 14% to 30%. On multivariate analysis, LND was more likely in RNU (odds ratio [OR] 1.52; p ONU. RNU was associated with decreased PSM compared with ONU (OR = 0.73; p = 0.04). After adjusting for other factors, OS was not significantly associated with surgical approach. RNU utilization doubled over the study period. While RNU was associated with greater likelihood of LND performance as well as lower PSM rates when compared with ONU and LNU, surgical approach did not independently affect OS.

  5. Reconstructing marginality: a new model of cultural diversity in nursing. (United States)

    Southwick, Margaret; Polaschek, Nick


    This article presents a new model of cultural diversity in nursing that critically reconstructs the concept of marginality that underpins other models. Rather than viewing the marginal as "other," marginality is redefined as the space in between the dominant cultural reality and the cultural realities of minority groups located within a society. Members of a minority cultural group who become skilled in the difficult process of negotiating this in-between space open the possibility of transformation within nursing education and practice. This model has been applied in a study of the experience of nursing students of Pacific ethnicity in New Zealand. Subsequently, an undergraduate Pacific nursing program was developed, with greatly increased success rates in registration of Pacific nurses. This model of cultural diversity can also be used to understand nursing practice involving people from minority cultures or other socially excluded categories.

  6. Natural Gas Venting on the Northern Cascadia Margin (United States)

    Scherwath, M.; Riedel, M.; Roemer, M.; Paull, C. K.; Spence, G.; Veloso, M.


    Over the past decades, hundreds of natural gas vents have been observed along the Northern Cascadia Margin in the Northeast Pacific, and we present a summary of these observations from offshore Vancouver Island, BC, Canada. We have gathered observed locations and analyzed original data from published literature as well as research cruises and fishing sonar from various archives. By far the highest accumulation of gas vent locations appear both shallow (100-200 m) and concentrated towards the mouth of the Juan de Fuca Strait, however these observations are naturally biased toward the distribution of the observation footprints. Normalized observations confirm the shallow high concentrations of gas vents but also establish some deeper sections of focused venting activity. We will speculate about the reasons behind the distribution, focus on specific examples, extrapolate for rough margin flux rate ranges and comment on short-comings and future directions for margin-wide gas vent studies.

  7. Prediction of margin involvement and local recurrence after skin-sparing and simple mastectomy. (United States)

    Al-Himdani, S; Timbrell, S; Tan, K T; Morris, J; Bundred, N J


    Skin-sparing mastectomy (SSM) facilitates immediate breast reconstruction. We investigated locoregional recurrence rates after SSM compared with simple mastectomy and the factors predicting oncological failure. Patients with early breast cancer that underwent mastectomy between 2000 and 2005 at a single institution were studied to ascertain local and systemic recurrence rates between groups. Kaplan-Meier curves and log-rank test were used to evaluate disease-free survival. Patients (n = 577) underwent simple mastectomy (80%) or SSM (20%). Median follow up was 80 months. Patients undergoing SSM were of younger average age, less often had involved lymph nodes (22% vs 44%, p mastectomy respectively (p = 0.35). Predictors of locoregional recurrence were lymph node involvement (HR 8.0, for >4 nodes, p mastectomy radiotherapy. Re-excision of involved margins is essential to prevent local recurrence after mastectomy. Copyright © 2016 Elsevier Ltd, BASO ~ the Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  8. Risk factors for positive margins in conservative surgery for breast cancer after neoadjuvant chemotherapy. (United States)

    Bouzón, Alberto; Acea, Benigno; García, Alejandra; Iglesias, Ángela; Mosquera, Joaquín; Santiago, Paz; Seoane, Teresa


    Breast conservative surgery after neoadjuvant chemotherapy intends to remove any residual tumor with negative margins. The purpose of this study was to analyze the preoperative clinical-pathological factors influencing the margin status after conservative surgery in breast cancer patients receiving neoadjuvant chemotherapy. A retrospective study of 91 breast cancer patients undergoing neoadjuvant chemotherapy (92 breast lesions) during the period 2006 to 2013. A Cox regression analysis to identify baseline tumor characteristics associated with positive margins after breast conservative surgery was performed. Of all cases, 71 tumors were initially treated with conservative surgery after neoadjuvant chemotherapy. Pathologic exam revealed positive margins in 16 of the 71 cases (22.5%). The incidence of positive margins was significantly higher in cancers with initial size >5cm (P=.021), in cancers with low tumor grade (P=.031), and in patients with hormone receptor-positive cancer (P=.006). After a median follow-up of 45.2 months, 7 patients of the 71 treated with conservative surgery had disease recurrence (9.8%). There was no significant difference in terms of disease-free survival according to the margin status (P=.596). A baseline tumor size >5cm, low tumor grade and hormone receptor-positive status increase the risk for surgical margin involvement in breast conservative surgery after neoadjuvant chemotherapy. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Clinical Outcomes of Endoscopic Hemostasis in Marginal Ulcer Bleeding. (United States)

    Yamasaki, Yasushi; Takenaka, Ryuta; Hori, Keisuke; Takemoto, Koji; Kawano, Seiji; Kawahara, Yoshiro; Fujiki, Shigeatsu; Okada, Hiroyuki


    The usefulness of endoscopy in marginal ulcer bleeding has rarely been studied, and the optimal method for preventing rebleeding is unclear. Here we assessed the efficacy of endoscopy in marginal ulcer bleeding and examined the efficacy of proton pump inhibitors (PPIs) in the prevention of rebleeding. A total of 28 patients with marginal ulcer bleeding (21 men, 7 women; median age 58.5 years) were treated by endoscopy. We analyzed the clinical characteristics, results of endoscopic therapy, characteristics of rebleeding patients, and relation between the use of PPIs and the duration of rebleeding. Sixteen patients had active bleeding. Initial hemostasis was achieved in all patients. There were no procedure-related adverse events. Rebleeding occurred in one patient within the first month and in 7 patients thereafter. There was a significant difference in the rebleeding rate between the patients who received a PPI and those who did not. In a multivariate analysis, the non-use of PPIs was a risk factor for rebleeding (hazard ratio, 6.22). Therapeutic endoscopy is effective in achieving hemostasis from marginal ulcer bleeding. PPIs may prevent rebleeding from marginal ulcers.

  10. A simple method for ensuring resection margins during laparoscopic partial nephrectomy: the intracorporeal ultrasonography. (United States)

    Doerfler, Arnaud; Oitchayomi, Abeni; Tillou, Xavier


    To describe a simple method for ensuring surgical margins during laparoscopic partial nephrectomy (PN). A study was done at our institution from October 2013 to March 2014 for all patients undergoing laparoscopic PN for T1 renal tumors. Before tumor removal, intraoperative ultrasonography (US) localization was performed. The tumor was then removed with a standardized minimal healthy tissue margin technique. Immediately after removal and before performing hemostasis of the kidney, the specimen was placed into a laparoscopic endobag filled with saline solution. The laparoscopic probe was then placed into the endobag and a sequential ultrasonographic scan was performed to evaluate if the tumor's pseudocapsule was respected. Twelve patients were included in our study. Mean warm ischemia time was 19 ± 3 minutes. Mean US examination was 42 ± 9 seconds. US analysis of surgical margins was negative in all except 1 patient. The final histologic examination of all specimens confirmed US results with a 100% correlation. We describe an original, simple, and cost-effective method for ensuring surgical margins during laparoscopic PN with a moderate increase in warm time ischemia. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Using the Sampling Margin of Error to Assess the Interpretative Validity of Student Evaluations of Teaching (United States)

    James, David E.; Schraw, Gregory; Kuch, Fred


    We present an equation, derived from standard statistical theory, that can be used to estimate sampling margin of error for student evaluations of teaching (SETs). We use the equation to examine the effect of sample size, response rates and sample variability on the estimated sampling margin of error, and present results in four tables that allow…

  12. [Tubulo-villous rectal tumours. Results of surgical resection in relation to histotype (30 years' experience)]. (United States)

    Carditello, Antonio; Milone, Antonino; Paparo, Domenica; Anastasi, Giuliana; Mollo, Francesco; Stilo, Francesco


    Adenomas of the rectum are frequently found during endoscopic examination. We report on our 30 years of experience with the treatment of tubulo-villous adenomas based on histotype. Between 1971 and 2001, 104 villous tumours of the rectum were treated surgically. The patients' average age was 65 years. These were sessile tumours in 69% of cases, pedunculated in 17.5% and flowing tumours in 13.5%. The mean tumour size was 3 cm. They were associated with colon cancer in 15% of cases and with polyadenoma in 10%. They were located in the rectum within 0 to 6 cm of the anal margin in half the cases. These tumours were treated by local excision in 74 cases and by wide excision in 30 cases. The malignant potential of the tumours was 30%, including 10% invasive malignancy. There were no surgical fatalities, but a 6% medical fatality rate was registered. There was a 20% complication rate related to the surgical technique. Twenty patients were lost to follow-up. Out of 84 villous tumours, monitored over a mean survival period of 6.5 years, there were 24 recurrences: 18 underwent endoscopic excision and in 6 cases a wide resection. The various tumour resection techniques and the operative indications of variable difficulty are presented. It would seem, at present, that total resection of the rectum with a colo-anal anastomosis is the best treatment for large flowing villous tumours occupying almost the entire rectum. Thorough preoperative examination and the mastering of various surgical procedures should allow the most suitable choice of treatment for each individual case.

  13. Impact of Margin Status on Local Recurrence After Mastectomy for Ductal Carcinoma In Situ

    Energy Technology Data Exchange (ETDEWEB)

    Childs, Stephanie K. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Chen, Yu-Hui [Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Duggan, Margaret M. [Department of Surgery, Faulkner Hospital, Boston, Massachusetts (United States); Department of Surgery, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Golshan, Mehra [Department of Surgery, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Pochebit, Stephen [Department of Pathology, Faulkner Hospital, Boston, Massachusetts (United States); Punglia, Rinaa S.; Wong, Julia S. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Bellon, Jennifer R., E-mail: [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States)


    Purpose: To examine the rate of local recurrence according to the margin status for patients with pure ductal carcinoma in situ (DCIS) treated by mastectomy. Methods and Materials: One hundred forty-five consecutive women who underwent mastectomy with or without radiation therapy for DCIS from 1998 to 2005 were included in this retrospective analysis. Only patients with pure DCIS were eligible; patients with microinvasion were excluded. The primary endpoint was local recurrence, defined as recurrence on the chest wall; regional and distant recurrences were secondary endpoints. Outcomes were analyzed according to margin status (positive, close (≤2 mm), or negative), location of the closest margin (superficial, deep, or both), nuclear grade, necrosis, receptor status, type of mastectomy, and receipt of hormonal therapy. Results: The primary cohort consisted of 142 patients who did not receive postmastectomy radiation therapy (PMRT). For those patients, the median follow-up time was 7.6 years (range, 0.6-13.0 years). Twenty-one patients (15%) had a positive margin, and 23 patients (16%) had a close (≤2 mm) margin. The deep margin was close in 14 patients and positive in 6 patients. The superficial margin was close in 13 patients and positive in 19 patients. One patient experienced an isolated invasive chest wall recurrence, and 1 patient had simultaneous chest wall, regional nodal, and distant metastases. The crude rates of chest wall recurrence were 2/142 (1.4%) for all patients, 1/21 (4.8%) for those with positive margins, 1/23 (4.3%) for those with close margins, and 0/98 for patients with negative margins. PMRT was given as part of the initial treatment to 3 patients, 1 of whom had an isolated chest wall recurrence. Conclusions: Mastectomy for pure DCIS resulted in a low rate of local or distant recurrences. Even with positive or close mastectomy margins, the rates of chest wall recurrences were so low that PMRT is likely not warranted.

  14. Vertical tectonics at an active continental margin (United States)

    Houlié, N.; Stern, T. A.


    Direct observations of vertical movements of the earth's surface are now possible with space-based GPS networks, and have applications to resources, hazards and tectonics. Here we present data on vertical movements of the Earth's surface in New Zealand, computed from the processing of GPS data collected between 2000 and 2015 by 189 permanent GPS stations. We map the geographical variation in vertical rates and show how these variations are explicable within a tectonic framework of subduction, volcanic activity and slow slip earthquakes. Subsidence of >3 mm/yr is observed along southeastern North Island and is interpreted to be due to the locked segment of the Hikurangi subduction zone. Uplift of 1-3 mm/yr further north along the margin of the eastern North Island is interpreted as being due to the plate interface being unlocked and underplating of sediment on the subduction thrust. The Volcanic Plateau of the central North Island is being uplifted at about 1 mm/yr, which can be explained by basaltic melts being injected in the active mantle-wedge at a rate of ∼6 mm/yr. Within the Central Volcanic Region there is a 250 km2 area that subsided between 2005 and 2012 at a rate of up to 14 mm/yr. Time series from the stations located within and near the zone of subsidence show a strong link between subsidence, adjacent uplift and local earthquake swarms.

  15. 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.

  16. 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.

  17. South Atlantic continental margins of Africa: a comparison of the tectonic vs climate interplay on the evolution of equatorial west Africa and SW Africa margins

    CERN Document Server

    Seranne, M; Seranne, Michel; Anka, Zahie


    The comparative review of 2 representative segments of Africa continental margin: the equatorial western Africa and the SW Africa margins, helps in analysing the main controlling factors on their development. Early Cretaceous active rifting S of the Walvis Ridge resulted in the formation of the SW Africa volcanic margin. The non-volcanic rifting N of the Walvis ridge, led to the formation of the equatorial western Africa margin, with thick and extensive, synrift basins. Regressive erosion of SW Africa prominent shoulder uplift accounts for high clastic sedimentation rate in Late Cretaceous - Eocene, while dominant carbonate production on equatorial western Africa shelf suggests little erosion of a low hinterland. The early Oligocene climate change had contrasted response in both margins. Emplacement of the Congo deep-sea fan reflects increased erosion in equatorial Africa, under the influence of wet climate, whereas establishment of an arid climate over SW Africa induced a drastic decrease of denudation, and ...

  18. 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 ...

  19. Surgical Critical Care Initiative (United States)

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

  20. Ambulatory Surgical Measures - National (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...

  1. 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...

  2. Surgical site infections

    African Journals Online (AJOL)

    and mortality as well as significant financial implications. Worldwide it has ... common nosocomial infection amongst surgical patients with up to 38% .... antibiotics as soon as the sensitivity results are available. ... Breast surgery. Staph Aureus/ ...

  3. Performance Evaluation of Portfolios with Margin Requirements


    Hui Ding; Zhongbao Zhou; Helu Xiao; Chaoqun Ma; Wenbin Liu


    In financial markets, short sellers will be required to post margin to cover possible losses in case the prices of the risky assets go up. Only a few studies focus on the optimization and performance evaluation of portfolios in the presence of margin requirements. In this paper, we investigate the theoretical foundation of DEA (data envelopment analysis) approach to evaluate the performance of portfolios with margin requirements from a different perspective. Under the mean-variance framework,...

  4. [Surgical managment of retinal detachment]. (United States)

    Haritoglou, C; Wolf, A


    The detachment of the neurosensory retina from the underlying retinal pigment epithelium can be related to breaks of the retina allowing vitreous fluid to gain access to the subretinal space, to exudative changes of the choroid such as tumours or inflammatory diseases or to excessive tractional forces exerted by interactions of the collagenous vitreous and the retina. Tractional retinal detachment is usually treated by vitrectomy and exudative detachment can be addressed by treatment of the underlying condition in many cases. In rhegmatogenous retinal detachment two different surgical procedures, vitrectomy and scleral buckling, can be applied for functional and anatomic rehabilitation of our patients. The choice of the surgical procedure is not really standardised and often depends on the experience of the surgeon and other more ocular factors including lens status, the number of retinal breaks, the extent of the detachment and the amount of preexisting PVR. Using both techniques, anatomic success rates of over 90 % can be achieved. Especially in young phakic patients scleral buckling offers the true advantage to prevent the progression of cataract formation requiring cataract extraction and intraocular lens implantation. Therefore, scleral buckling should be considered in selected cases as an alternative surgical option in spite of the very important technical refinements in modern vitrectomy techniques. Georg Thieme Verlag KG Stuttgart · New York.

  5. Is surgical workforce diversity increasing? (United States)

    Andriole, Dorothy A; Jeffe, Donna B; Schechtman, Kenneth B


    We sought to determine the extent to which recent increases in levels of gender and racial diversity in the overall resident-physician workforce were evident among core-surgical specialty resident workforces. Chi-square tests for trend assessed the importance of changes from 1996 to 2004 in proportions of women and African Americans in the surgery-resident workforce. Surgery-resident trends were compared with overall resident workforce trends using two-tailed t-tests to compare regression slopes that quantified rates of change over time. Chi-square tests assessed differences between proportions of women and African Americans in the current overall board-certified workforce and their proportions in the surgery board-certified workforce. From 1996 to 2004, proportions of women increased in all seven surgical specialties studied. Compared with the overall trend toward increasing proportions of women in the resident workforce, the trend in one surgical specialty was larger (obstetrics/gynecology, p 0.05), and two were smaller (each p 0.05). Proportions of African Americans decreased in three specialties (each p workforce, except obstetrics/gynecology, remained lower than in the overall board-certified workforce (each p workforces have persisted since 1996 and will likely perpetuate ongoing surgery board-certified workforce disparities.

  6. Faster Algorithms for Privately Releasing Marginals


    Thaler, Justin R; Ullman, Jonathan Robert; Vadhan, Salil P.


    We study the problem of releasing $k$-way marginals of a database $D \\in (\\{0,1\\}^d)^n$, while preserving differential privacy. The answer to a $k$-way marginal query is the fraction of $D$'s records $x \\in \\{0,1\\}^d$ with a given value in each of a given set of up to $k$ columns. Marginal queries enable a rich class of statistical analyses of a dataset, and designing efficient algorithms for privately releasing marginal queries has been identified as an important open problem in private data...

  7. Assessment of seismic margin calculation methods

    Energy Technology Data Exchange (ETDEWEB)

    Kennedy, R.P.; Murray, R.C.; Ravindra, M.K.; Reed, J.W.; Stevenson, J.D.


    Seismic margin review of nuclear power plants requires that the High Confidence of Low Probability of Failure (HCLPF) capacity be calculated for certain components. The candidate methods for calculating the HCLPF capacity as recommended by the Expert Panel on Quantification of Seismic Margins are the Conservative Deterministic Failure Margin (CDFM) method and the Fragility Analysis (FA) method. The present study evaluated these two methods using some representative components in order to provide further guidance in conducting seismic margin reviews. It is concluded that either of the two methods could be used for calculating HCLPF capacities. 21 refs., 9 figs., 6 tabs.

  8. On the evaluation of marginal expected shortfall

    DEFF Research Database (Denmark)

    Caporin, Massimiliano; Santucci de Magistris, Paolo


    In the analysis of systemic risk, Marginal Expected Shortfall may be considered to evaluate the marginal impact of a single stock on the market Expected Shortfall. These quantities are generally computed using log-returns, in particular when there is also a focus on returns conditional distribution....... In this case, the market log-return is only approximately equal to the weighed sum of equities log-returns. We show that the approximation error is large during turbulent market phases, with a subsequent impact on Marginal Expected Shortfall. We then suggest how to improve the evaluation of Marginal Expected...

  9. On the Marginal Stability of Glassy Systems (United States)

    Yan, Le; Baity-Jesi, Marco; Müller, Markus; Wyart, Matthieu


    In various glassy systems that are out of equilibrium, like spin glasses and granular packings, the dynamics appears to be critical: avalanches involving almost the whole system could happen. A recent conceptual breakthrough argues that such glassy systems sample the ensemble of marginal stable states, which inevitably results into critical dynamics. However, it is unclear how the marginal stability is dynamically guaranteed. We investigate this marginal stability assumption by studying specifically the critical athermal dynamics of the Sherrington-Kirkpatrick model. We discuss how a pseudo-gap in the density distribution of local fields characterizing the marginal stability arises dynamically.

  10. Spectrally Encoded Confocal Microscopy (SECM) for Diagnosing of Breast Cancer in Excision and Margin Specimens (United States)

    Brachtel, Elena F.; Johnson, Nicole B.; Huck, Amelia E.; Rice-Stitt, Travis L.; Vangel, Mark G.; Smith, Barbara L.; Tearney, Guillermo J.; Kang, Dongkyun


    A large percentage of breast cancer patients treated with breast conserving surgery need to undergo multiple surgeries due to positive margins found during post-operative margin assessment. Carcinomas could be removed completely during the initial surgery and additional surgery avoided if positive margins can be determined intra-operatively. Spectrally-encoded confocal microscopy (SECM) is a high-speed reflectance confocal microscopy technology that has a potential to rapidly image the entire surgical margin at sub-cellular resolution and accurately determine margin status intra-operatively. In this paper, in order to test feasibility of using SECM for intra-operative margin assessment, we have evaluated the diagnostic accuracy of SECM for detecting various types of breast cancers. Forty-six surgically-removed breast specimens were imaged with a SECM system. Side-by-side comparison between SECM and histologic images showed that SECM images can visualize key histomorphologic patterns of normal/benign and malignant breast tissues. Small (500 µm × 500 µm) spatially-registered SECM and histologic images (n=124 for each) were diagnosed independently by three pathologists with expertise in breast pathology. Diagnostic accuracy of SECM for determining malignant tissues was high, average sensitivity of 0.91, specificity of 0.93, positive predictive value of 0.95, and negative predictive value of 0.87. Intra-observer agreement and inter-observer agreement for SECM were also high, 0.87 and 0.84, respectively. Results from this study suggest that SECM may be developed into an intra-operative margin assessment tool for guiding breast cancer excisions. PMID:26779830

  11. Wide-field optical coherence elastography for intraoperative assessment of tumour margins in breast cancer (Conference Presentation) (United States)

    Allen, Wes M.; Chin, Lixin; Sampson, David D.; Kennedy, Brendan F.


    Incomplete excision of tumour margins is a major issue in breast-conserving surgery. Currently 20 - 60% of cases require a second surgical procedure required as a result of cancer recurrence. A number of techniques have been proposed to assess margin status, including frozen section analysis and imprint cytology. However, the recurrence rate after using these techniques remains very high. Over the last several years, our group has been developing optical coherence elastography (OCE) as a tool for the intraoperative assessment of tumour margins in breast cancer. We have reported a feasibility study on 65 ex vivo samples from patients undergoing mastectomy or wide local excision demonstrates the potential of OCE in differentiating benign from malignant tissue. In this study, malignant tissue was readily distinguished from surrounding relative tissue by a distinctive heterogeneous pattern in micro-elastograms. To date the largest field of view for a micro-elastogram is 20 x 20mm, however, lumpectomy samples are typically ~50 x 50 x 30mm. For OCE to progress as a useful clinical tool, elastograms must be acquired over larger areas to allow a greater portion of the surface area of lumpectomies to be assessed. Here, we propose a wide-field OCE scanner that utilizes a piezoelectric transducer with an internal diameter of 65mm. In this approach partially overlapped elastograms are stitched together forming a mosaic with overall dimensions of 50 x 50mm in a total acquisition time of 15 - 30 minutes. We present results using this approach on both tissue-mimicking phantoms and tissue, and discuss prospects for shorter acquisitions times.

  12. Surgical checklists: the human factor.

    LENUS (Irish Health Repository)

    O Connor, Paul


    BACKGROUND: Surgical checklists has been shown to improve patient safety and teamwork in the operating theatre. However, despite the known benefits of the use of checklists in surgery, in some cases the practical implementation has been found to be less than universal. A questionnaire methodology was used to quantitatively evaluate the attitudes of theatre staff towards a modified version of the World Health Organisation (WHO) surgical checklist with relation to: beliefs about levels of compliance and support, impact on patient safety and teamwork, and barriers to the use of the checklist. METHODS: Using the theory of planned behaviour as a framework, 14 semi-structured interviews were conducted with theatre personnel regarding their attitudes towards, and levels of compliance with, a checklist. Based upon the interviews, a 27-item questionnaire was developed and distribute to all theatre personnel in an Irish hospital. RESULTS: Responses were obtained from 107 theatre staff (42.6% response rate). Particularly for nurses, the overall attitudes towards the effect of the checklist on safety and teamworking were positive. However, there was a lack of rigour with which the checklist was being applied. Nurses were significantly more sensitive to the barriers to the use of the checklist than anaesthetists or surgeons. Moreover, anaesthetists were not as positively disposed to the surgical checklist as surgeons and nurse. This finding was attributed to the tendency for the checklist to be completed during a period of high workload for the anaesthetists, resulting in a lack of engagement with the process. CONCLUSION: In order to improve the rigour with which the surgical checklist is applied, there is a need for: the involvement of all members of the theatre team in the checklist process, demonstrated support for the checklist from senior personnel, on-going education and training, and barriers to the implementation of the checklist to be addressed.

  13. Surgical outcome of pancreatic cancer using radical antegrade modular pancreatosplenectomy procedure

    Institute of Scientific and Technical Information of China (English)

    Ye Rim Chang; Sung-Sik Han; Sang-Jae Park; Seung Duk Lee; Tae Suk Yoo; Young-Kyu Kim; Tae Hyun Kim


    To evaluate the surgical outcomes following radical antegrade modular pancreatosplenectomy (RAMPS)for pancreatic cancer.METHODS:Twenty-four patients underwent RAMPS with curative intent between January 2005 and June 2009 at the National Cancer Center,South Korea.Clinicopathologic data,including age,sex,operative findings,pathologic results,adjuvant therapy,postoperative clinical course and follow-up data were retrospectively collected and analyzed for this study.RESULTS:Twenty-one patients (87.5%) underwent distal pancreatectomy and 3 patients (12.5%) underwent total pancreatectomy using RAMPS.Nine patients (37.5%) underwent combined vessel resection,including 8 superior mesenteric-portal vein resections and 1 celiac axis resection.Two patients (8.3%) underwent combined resection of other organs,including the colon,stomach or duodenum.Negative tangential margins were achieved in 22 patients (91.7%).The mean tumor diameter for all patients was 4.09 ± 2.15 cm.The 2 patients with positive margins had a mean diameter of 7.25 cm.The mean number of retrieved lymph nodes was 20.92 ± 11.24 and the node positivity rate was 70.8%.The median survival of the 24 patients was 18.23 ± 6.02 mo.Patients with negative margins had a median survival of 21.80 ± 5.30 mo and those with positive margins had a median survival of 6.47 mo (P =0.021).Nine patients (37.5%) had postoperative complications,but there were no postoperative mortalities.Pancreatic fistula occurred in 4 patients (16.7%):2 patients had a grade A fistula and 2 had a grade B fistula.On univariate analysis,histologic grade,positive tangential margin,pancreatic fistula and adjuvant therapy were significant prognostic factors for survival.CONCLUSION:RAMPS is a feasible procedure for achieving negative tangential margins in patients with carcinoma of the body and tail of the pancreas.

  14. Disposable surgical face masks for preventing surgical wound infection in clean surgery

    Directory of Open Access Journals (Sweden)

    Allyson Lipp

    Full Text Available BACKGROUND: Surgical face masks were originally developed to contain and filter droplets containing microorganisms expelled from the mouth and nasopharynx of healthcare workers during surgery, thereby providing protection for the patient. However, there are several ways in which surgical face masks could potentially contribute to contamination of the surgical wound, e.g. by incorrect wear or by leaking air from the side of the mask due to poor string tension. OBJECTIVES: To determine whether disposable surgical face masks worn by the surgical team during clean surgery prevent postoperative surgical wound infection. SEARCH METHODS: We searched The Cochrane Wounds Group Specialised Register (searched 14 September 2011; The Cochrane Central Register of Controlled Trials (CENTRAL (The Cochrane Library 2011, Issue 3; Ovid MEDLINE (2008 to August Week 5 2011; Ovid MEDLINE (In-Process &Other Non-Indexed Citations September 13, 2011; Ovid EMBASE (2008 to 2011 Week 35; and EBSCO CINAHL (2008 to 9 September 2011. SELECTION CRITERIA: Randomized controlled trials (RCTs and quasi-randomized controlled trials comparing the use of disposable surgical masks with the use of no mask. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently. MAIN RESULTS: Three trials were included, involving a total of 2113 participants. There was no statistically significant difference in infection rates between the masked and unmasked group in any of the trials. AUTHORS' CONCLUSIONS: From the limited results it is unclear whether the wearing of surgical face masks by members of the surgical team has any impact on surgical wound infection rates for patients undergoing clean surgery.

  15. [Update on surgical treatment of primary and metastatic cutaneous melanoma]. (United States)

    Zuluaga-Sepúlveda, María Alejandra; Arellano-Mendoza, Ivonne; Ocampo-Candiani, Jorge


    Melanoma is a common cutaneous tumour. It is of great importance due to its increasing incidence and aggressive behaviour, with metastasis to lymph nodes and internal organs. When suspecting melanoma, excisional biopsy should be performed to obtain complete histological information in order to determine the adverse factors such as ulceration, mitosis rate, and Breslow depth, which influence preoperative staging and provide data for sentinel lymph biopsy decision making. The indicated management for melanoma is wide local excision, observing recommended and well-established excision margins, depending on Breslow depth and anatomical location of the tumour. Therapeutic lymphadenectomy is recommended for patients with clinically or radiologically positive lymph nodes. This article reviews surgical treatment of melanoma, adverse histological factors, sentinel lymph node biopsy, and radical lymphadenectomy. Details are presented on special situations in which management of melanoma is different due to the anatomical location (plantar, subungual, lentigo maligna), or pregnancy. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  16. Sparing Sphincters and Laparoscopic Resection Improve Survival by Optimizing the Circumferential Resection Margin in Rectal Cancer Patients. (United States)

    Keskin, Metin; Bayraktar, Adem; Sivirikoz, Emre; Yegen, Gülcin; Karip, Bora; Saglam, Esra; Bulut, Mehmet Türker; Balik, Emre


    The goal of rectal cancer treatment is to minimize the local recurrence rate and extend the disease-free survival period and survival. For this aim, obtainment of negative circumferential radial margin (CRM) plays an important role. This study evaluated predictive factors for positive CRM status and its effect on patient survival in mid- and distal rectal tumors.Patients who underwent curative resection for rectal cancer were included. The main factors were demographic data, tumor location, surgical technique, neoadjuvant therapy, tumor diameter, tumor depth, lymph node metastasis, mesorectal integrity, CRM, the rate of local recurrence, distant metastasis, and overall and disease-free survival. Statistical analyses were performed by using the Chi-squared test, Fisher exact test, Student t test, Mann-Whitney U test and the Mantel-Cox log-rank sum test.A total of 420 patients were included, 232 (55%) of whom were male. We observed no significant differences in patient characteristics or surgical treatment between the patients who had positive CRM and who had negative CRM, but a higher positive CRM rate was observed in patients undergone abdominoperineal resection (APR) (P CRM status. Logistic regression analysis revealed that APR (P CRM status. Moreover, positive CRM was associated with decreased 5-year overall and disease-free survival (P = 0.002 and P = 0.004, respectively).This large single-institution series demonstrated that APR and open resection were independent predictive factors for positive CRM status in rectal cancer. Positive CRM independently decreased the 5-year overall and disease-free survival rates.

  17. Instrumentation of the da Vinci Robotic Surgical System

    DEFF Research Database (Denmark)

    Hansen, Karl Damkjær; Jensen, Simon; Sloth, Christoffer


    This paper details the AAU surgical robot, its hardware and software setup. The aim of the paper is to explain how a surgical robot has been rebuild as an open source platform for research in surgical robotics. As a result, the robot has full actuation and sensing capabilities at high sampling ra....... We aim at exploiting the developed surgical robot for research in semi-autonomous control, and safety mechanisms in the context of robotic surgery.......This paper details the AAU surgical robot, its hardware and software setup. The aim of the paper is to explain how a surgical robot has been rebuild as an open source platform for research in surgical robotics. As a result, the robot has full actuation and sensing capabilities at high sampling rate...

  18. Instrumentation of the da Vinci Robotic Surgical System

    DEFF Research Database (Denmark)

    Hansen, Karl Damkjær; Jensen, Simon; Sloth, Christoffer


    This paper details the AAU surgical robot, its hardware and software setup. The aim of the paper is to explain how a surgical robot has been rebuild as an open source platform for research in surgical robotics. As a result, the robot has full actuation and sensing capabilities at high sampling ra....... We aim at exploiting the developed surgical robot for research in semi-autonomous control, and safety mechanisms in the context of robotic surgery.......This paper details the AAU surgical robot, its hardware and software setup. The aim of the paper is to explain how a surgical robot has been rebuild as an open source platform for research in surgical robotics. As a result, the robot has full actuation and sensing capabilities at high sampling rate...

  19. Fibroadenomas of the breast showing an ill-defined margin on ultrasonogram: Correlation with histopathologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Ji Young; Choi, Hye Young; Shim, Sung Shine; Rhee, Chung Sik; Sung, Soon Hee [Ewha Womans University College of Medicine, Seoul (Korea, Republic of)


    To correlate the sonographic finding of ill-defined fibroadenoma with the histopathologic findings. Sonographic finding of forty nine surgically proven fibroadenomas were retrospectively correlated with histopathologic findings. We evaluated sonographic findings including the margin, shape, size and the echotexture of fibroadenoma. The histopathologic glandular structure, stromal type of fibroadenoma, type of the surrounding breast tissue and presence of interdigitation between fibroadenoma and the surrounding breast tissue were pathologically reviewed and analyzed statistically. Breast sonography of fibroadenomas demonstrated well-defined margin in 28 (57%) and ill-defined margin in 21 (43%) among 49 lesions. Histopathologically, the glandular structure and type of the surrounding breast tissue were not significantly different between well-defined and ill-defined fibroadenomas. The stromal type of fibroadenoma was sclerotic in 8 (29%) well-defined fibroadenomas while sclerotic in 15 (72%) of 21 ill-defined fibroadenomas,showing difference with a statistical significance between well-defined and ill-defined fibroadenomas (p<0.05). Twenty (71%) of 28 fibroadenomas with well-defined sonographic margins showed well-defined border between mass and the surrounding breast tissue, pathologically. Meanwhile, twenty (95%) of 21 fibroadenomas with ill-defined sonographic margins demonstrated interdigitation of the surrounding breast tissue and mass, exhibiting a statistical significance (p<0.005). Ill-defined margins of fibroadenomas on sonography represent the interdigitation of the surrounding breast tissue with a mass and is seen in the sclerotic stromal type of fibroadenomas.

  20. Values and marginal preferences in international business

    NARCIS (Netherlands)

    Maseland, Robbert; van Hoorn, Andre


    In a recent paper in this journal, Maseland and van Hoorn argued that values surveys tend to conflate values and marginal preferences. This assertion has been challenged by Brewer and Venaik, who claim that the wording of most survey items does not suggest that these elicit marginal preferences. Thi

  1. Marginal Utility and Convex Indifference Curves. (United States)

    Jackson, A.A.


    Reviews discussion of the relationship between marginal utility and indifference curves which has been presented in recent issues of "Economics." Concludes that indifference analysis does not embody the assumptions of marginal utility theory and that there is no simple relationship between these concepts that does not entail unacceptable…

  2. The homogeneous marginal utility of income assumption

    NARCIS (Netherlands)

    Demuynck, T.


    We develop a test to verify if every agent from a population of heterogeneous consumers has the same marginal utility of income function. This homogeneous marginal utility of income assumption is often (implicitly) used in applied demand studies because it has nice aggregation properties and facilit

  3. Tumor margin detection using optical biopsy techniques (United States)

    Zhou, Yan; Liu, Cheng-hui; Li, Jiyou; Li, Zhongwu; Zhou, Lixin; Chen, Ke; Pu, Yang; He, Yong; Zhu, Ke; Li, Qingbo; Alfano, Robert R.


    The aim of this study is to use the Resonance Raman (RR) and fluorescence spectroscopic technique for tumor margin detection with high accuracy based on native molecular fingerprints of breast and gastrointestinal (GI) tissues. This tumor margins detection method utilizes advantages of RR spectroscopic technique in situ and in real-time to diagnose tumor changes providing powerful tools for clinical guiding intraoperative margin assessments and postoperative treatments. The tumor margin detection procedures by RR spectroscopy were taken by scanning lesion from center or around tumor region in ex-vivo to find the changes in cancerous tissues with the rim of normal tissues using the native molecular fingerprints. The specimens used to analyze tumor margins include breast and GI carcinoma and normal tissues. The sharp margin of the tumor was found by the changes of RR spectral peaks within 2 mm distance. The result was verified using fluorescence spectra with 300 nm, 320 nm and 340 nm excitation, in a typical specimen of gastric cancerous tissue within a positive margin in comparison with normal gastric tissues. This study demonstrates the potential of RR and fluorescence spectroscopy as new approaches with labeling free to determine the intraoperative margin assessment.

  4. 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

  5. The surgical treatment of acromegaly. (United States)

    Buchfelder, Michael; Schlaffer, Sven-Martin


    Surgical extraction of as much tumour mass as possible is considered the first step of treatment in acromegaly in many centers. In this article the potential benefits, disadvantages and limitations of operative acromegaly treatment are reviewed. Pertinent literature was selected to provide a review covering current indications, techniques and results of operations for acromegaly. The rapid reduction of tumour volume is an asset of surgery. To date, in almost all patients, minimally invasive, transsphenoidal microscopic or endoscopic approaches are employed. Whether a curative approach is feasible or a debulking procedure is planned, can be anticipated on the basis of preoperative magnetic resonance imaging. The radicality of adenoma resection essentially depends on localization, size and invasive character of the tumour. The normalization rates of growth hormone and IGF-1 secretion, respectively, depend on tumour-related factors such as size, extension, the presence or absence of invasion and the magnitude of IGF-1 and growth hormone oversecretion. However, also surgeon-related factors such as experience and patient load of the centers have been shown to strongly affect surgical results and the rate of complications. As compared to most medical treatments, surgery is relatively cheap since the costs occur only once and not repeatedly. There are several new technical gadgets which aid in the surgical procedure: navigation and variants of intraoperative imaging. For the mentioned reasons, current algorithms of acromegaly management suggest an initial operation, unless the patients are unfit for surgery, refuse an operation or only an unsatisfactory resection is anticipated. A few suggestions are made when a re-operation could be considered.

  6. Anxiety in veterinary surgical students

    DEFF Research Database (Denmark)

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


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

  7. Air-sea interactions in the marginal ice zone

    Directory of Open Access Journals (Sweden)

    Seth Zippel


    Full Text Available Abstract The importance of waves in the Arctic Ocean has increased with the significant retreat of the seasonal sea-ice extent. Here, we use wind, wave, turbulence, and ice measurements to evaluate the response of the ocean surface to a given wind stress within the marginal ice zone, with a focus on the local wind input to waves and subsequent ocean surface turbulence. Observations are from the Beaufort Sea in the summer and early fall of 2014, with fractional ice cover of up to 50%. Observations showed strong damping and scattering of short waves, which, in turn, decreased the wind energy input to waves. Near-surface turbulent dissipation rates were also greatly reduced in partial ice cover. The reductions in waves and turbulence were balanced, suggesting that a wind-wave equilibrium is maintained in the marginal ice zone, though at levels much less than in open water. These results suggest that air-sea interactions are suppressed in the marginal ice zone relative to open ocean conditions at a given wind forcing, and this suppression may act as a feedback mechanism in expanding a persistent marginal ice zone throughout the Arctic.

  8. Coral reef evolution on rapidly subsiding margins (United States)

    Webster, J.M.; Braga, J.C.; Clague, D.A.; Gallup, C.; Hein, J.R.; Potts, D.C.; Renema, W.; Riding, R.; Riker-Coleman, K.; Silver, E.; Wallace, L.M.


    A series of well-developed submerged coral reefs are preserved in the Huon Gulf (Papua New Guinea) and around Hawaii. Despite different tectonics settings, both regions have experienced rapid subsidence (2-6??m/ka) over the last 500??ka. Rapid subsidence, combined with eustatic sea-level changes, is responsible for repeated drowning and backstepping of coral reefs over this period. Because we can place quantitative constraints on these systems (i.e., reef drowning age, eustatic sea-level changes, subsidence rates, accretion rates, basement substrates, and paleobathymetry), these areas represent unique natural laboratories for exploring the roles of tectonics, reef accretion, and eustatic sea-level changes in controlling the evolution of individual reefs, as well as backstepping of the entire system. A review of new and existing bathymetric, radiometric, sedimentary facies and numerical modeling data indicate that these reefs have had long, complex growth histories and that they are highly sensitive, recording drowning not only during major deglaciations, but also during high-frequency, small-amplitude interstadial and deglacial meltwater pulse events. Analysis of five generalized sedimentary facies shows that reef drowning is characterized by a distinct biological and sedimentary sequence. Observational and numerical modeling data indicate that on precessional (20??ka) and sub-orbital timescales, the rate and amplitude of eustatic sea-level changes are critical in controlling initiation, growth, drowning or sub-aerial exposure, subsequent re-initiation, and final drowning. However, over longer timescales (> 100-500??ka) continued tectonic subsidence and basement substrate morphology influence broad scale reef morphology and backstepping geometries. Drilling of these reefs will yield greatly expanded stratigraphic sections compared with similar reefs on slowly subsiding, stable and uplifting margins, and thus they represent a unique archive of sea-level and climate

  9. Surgical bleeding in microgravity (United States)

    Campbell, M. R.; Billica, R. D.; Johnston, S. L. 3rd


    A surgical procedure performed during space flight would occur in a unique microgravity environment. Several experiments performed during weightlessness in parabolic flight were reviewed to ascertain the behavior of surgical bleeding in microgravity. Simulations of bleeding using dyed fluid and citrated bovine blood, as well as actual arterial and venous bleeding in rabbits, were examined. The high surface tension property of blood promotes the formation of large fluid domes, which have a tendency to adhere to the wound. The use of sponges and suction will be adequate to prevent cabin atmosphere contamination with all bleeding, with the exception of temporary arterial droplet streams. The control of the bleeding with standard surgical techniques should not be difficult.

  10. Surgical management of presbyopia

    Directory of Open Access Journals (Sweden)

    Torricelli AA


    Full Text Available André AM Torricelli, Jackson B Junior, Marcony R Santhiago, Samir J BecharaDivision of Ophthalmology, University of São Paulo Medical School, São Paulo, BrazilAbstract: Presbyopia, the gradual loss of accommodation that becomes clinically significant during the fifth decade of life, is a physiologic inevitability. Different technologies are being pursued to achieve surgical correction of this disability; however, a number of limitations have prevented widespread acceptance of surgical presbyopia correction, such as optical and visual distortion, induced corneal ectasia, haze, anisometropy with monovision, regression of effect, decline in uncorrected distance vision, and the inherent risks with invasive techniques, limiting the development of an ideal solution. The correction of the presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. The purpose of this paper is to provide an update about current procedures available for presbyopia correction, their advantages, and disadvantages.Keywords: presbyopia, surgical correction, treatment

  11. Small peripheral lung carcinomas with five-year post-surgical follow-up: assessment by semi-automated volumetric measurement of tumour size, CT value and growth rate on TSCT

    Energy Technology Data Exchange (ETDEWEB)

    Sone, Shusuke [JA Nagano Azumi General Hospital, Ikeda, Nagano (Japan); Nagano Health Promotion Corporation, Inasato, Nagano (Japan); Hanaoka, Takaomi [JA Nagano Azumi General Hospital, Department of Chest Surgery, Ikeda, Nagano (Japan); Ogata, Hiroyuki [JA Nagano Azumi General Hospital, Division of Clinical Laboratory and Pathology, Ikeda, Nagano (Japan); Takayama, Fumiyoshi [JA Nagano Azumi General Hospital, Department of Radiology, Ikeda, Nagano (Japan); Ichinose Neurosurgery Hospital, Matsumoto, Nagano (Japan); Watanabe, Tomofumi [Iida Municipal Hospital, Iida, Nagano (Japan); Haniuda, Masayuki [Aichi Medical University, Division of Chest Surgery, Aichi (Japan); Kaneko, Kazuhiko [Shinshu University School of Medicine, Department of Surgery, Matsumoto (Japan); Okaya-Enrei Hospital, Okaya, Nagano (Japan); Kondo, Ryoichi [National Chushin Matsumoto Hospital, Matsumoto (Japan); Yoshida, Kazuo [Shinshu University School of Medicine, Department of Surgery, Matsumoto (Japan); Honda, Takayuki [Shinshu University School of Medicine, Department of Laboratory Medicine, Matsumoto (Japan)


    To retrospectively assess the utility of semi-automated measurements by stratification of CT values of tumour size, CT value and doubling time (DT) using thin-section computed tomography (CT) images. The post-surgical outcomes of favourable and problematic tumours (more advanced p stage than IA, post-surgical recurrence or mortality from lung cancer) were compared using the measured values. The computed DTs were compared with manually measured values. The study subjects comprised 85 patients (aged 33-80 years, 48 women, 37 men), followed-up for more than 5 years postoperatively, with 89 lung lesions, including 17 atypical adenomatous hyperplasias and 72 lung cancers. DTs were determined in 45 lesions. For problematic lesions, whole tumour diameter and density were >18 mm and >-400 HU, respectively. The respective values for the tumour core (with CT values of -350 to 150 HU) were >15 mm and >-70 HU. Analysis of tumour core DTs showed interval tumour progression even if little progress was seen by standard tumour volume DT (TVDT). Software-based volumetric measurements by stratification of CT values provide valuable information on tumour core and help estimate tumour aggressiveness and interval tumour progression better than standard manually measured 2D-VDTs. (orig.)

  12. Margin Proximity Correlates with Local Recurrence After Mastectomy for Patients Not Receiving Adjuvant Radiotherapy. (United States)

    Glorioso, Jaime M; Gonzalez Juarrero, Alexandra B; Rodysill, Brian R; Harmsen, William S; Habermann, Elizabeth B; Carter, Jodi M; Mutter, Robert W; Degnim, Amy C; Jakub, James W


    Although considerable evidence exists regarding margin status and reexcision for patients undergoing breast conservation therapy, few data address the impact of a close margin for patients undergoing mastectomy without postmastectomy radiotherapy. This retrospective review identified 1147 patients who underwent 1206 mastectomies with negative final margins for breast cancer from 2006 to 2010. Margin distance was analyzed as a continuous variable and dichotomized variable ((≤2 vs >2 mm). Patients undergoing adjuvant radiation therapy were excluded from the study. Uni- and multivariable analyses were used to assess the association of reexcision, proximity of the final margin, adjuvant therapy, and other clinical and pathologic factors with local recurrence (LR). In 158 mastectomies (13.1%), a reexcision was performed for a close (n = 90) or positive (n = 68) margin. All but one were identified intraoperatively using frozen section analysis. The reexcision rates for skin- and nipple-sparing mastectomy (SSM/NSM) were higher than for simple mastectomy (SM) (19.8 vs 9.3%; p mastectomy for breast cancer, a wider final margin correlated with a reduced risk for LR. The rates for LR were similar between SSM/NSM and SM despite higher rates of intraoperative reexcision for SSM/NSM.

  13. Fluid and Solute Fluxes from the Deformation Front to the Upper Slope at the Cascadia Margin (United States)

    Berg, R. D.; Solomon, E. A.; Johnson, H. P.; Culling, D. P.; Harris, R. N.


    Fluid expulsion from accretionary convergent margins may be an important factor in global geochemical cycling and biogeochemical processes. However, the rates and distribution of fluid flow at these margins are not well known. To better understand these processes at the Cascadia margin, we collected 35 short (Mosquito fluid flow meter measurements along a transect from the deformation front to the upper slope offshore of the Washington coast as part of a coupled heat and fluid flow survey. We identified two active seep areas, one emergent at 1990 mbsl, and one long-lived at 1050 mbsl. At both sites we observed carbonate deposits several meters thick and hundreds of meters in horizontal dimension. Thermogenic hydrocarbons measured in pore waters at the long-lived seep site indicate deeply-sourced fluids originating at >80oC, likely migrating along faults. In addition, pore water solute profiles from the emergent seep site suggest active shallow circulation in the upper sediment column, with implications for the seep biological community and fluid budget of the margin. Pore fluid advection rates along the transect are used to characterize the geographic distribution and geologic controls on active fluid pathways. Pore water solute profiles from the sediment cores are integrated with the measured fluid advection rates to calculate solute fluxes out of the margin. Our transect of fluid flow and pore water chemistry measurements from the Cascadia margin will help to better understand fluid and geochemical cycling at accretionary convergent margins.

  14. Performance Evaluation of Portfolios with Margin Requirements

    Directory of Open Access Journals (Sweden)

    Hui Ding


    Full Text Available In financial markets, short sellers will be required to post margin to cover possible losses in case the prices of the risky assets go up. Only a few studies focus on the optimization and performance evaluation of portfolios in the presence of margin requirements. In this paper, we investigate the theoretical foundation of DEA (data envelopment analysis approach to evaluate the performance of portfolios with margin requirements from a different perspective. Under the mean-variance framework, we construct the optimization model and portfolio possibility set on considering margin requirements. The convexity of the portfolio possibility set is proved and the concept of efficiency in classical economics is extended to the portfolio case. The DEA models are then developed to evaluate the performance of portfolios with margin requirements. Through the simulations carried out in the end, we show that, with adequate portfolios, DEA can be used as an effective tool in computing the efficiencies of portfolios with margin requirements for the performance evaluation purpose. This study can be viewed as a justification of DEA into performance evaluation of portfolios with margin requirements.

  15. Surgical treatment for giant incisional hernia

    DEFF Research Database (Denmark)

    Eriksson, A; Rosenberg, J; Bisgaard, T


    INTRODUCTION: Repair for giant incisional hernias is a challenge due to unacceptable high morbidity and recurrence rates. Several surgical techniques are available, but all are poorly documented. This systematic review was undertaken to evaluate the existing literature on repair for giant incisio...... procedure and severely lack evidence-based research from high-quality, large-scaled randomised studies....

  16. Surgical Treatment of Facial Basal Cell Carcinoma: Patient-Based Assessment of Clinical Outcome in a Prospective Cohort Study. (United States)

    Ofaiche, Joséphine; Lopez, Raphael; Bérard, Emilie; André, Aymeric; Bulai-Livideanu, Cristina; Méresse, Thomas; Vairel, Benjamin B; Grolleau, Jean-Louis; Paul, Carle; Meyer, Nicolas


    There are limited data on the esthetic, functional, and morphological outcomes of surgical treatment of facial basal cell carcinoma (BCC). The aim of our study was to assess the determinants of the evaluation of both the patients and the investigator of the esthetic, functional, and morphological impact of the surgical treatment of facial BCC. A prospective observational study evaluated 111 patients treated surgically for facial BCCs (n = 135 BCCs), using the Patient and Observer Scar Assessment Scale (POSAS), a validated and reliable scale designed for the evaluation of all types of scars by professionals and patients. Scar assessment rated by the patients was very good. Skin aging was associated with a better surgical outcome as evaluated by POSAS (OR = 0.30, 95% CI: 0.09-0.98; p = 0.04). Conversely, histologically infiltrative or sclerosing BCC (OR = 2.33, 95% CI: 0.95-5.71; p = 0.06) was independently associated with poorer POSAS. In terms of the investigator's evaluation, aging signs (protective factor: OR = 0.17, 95% CI: 0.04-0.73; p = 0.01), location on the H-zone of the face (risk factor: OR = 2.95, 95% CI: 1.07-8.15; p = 0.03), and histologically infiltrative or sclerosing BCC (risk factor: OR = 2.89, 95% CI: 1.01-8.29; p = 0.04) were independently associated with POSAS. Esthetic, functional, and morphological outcomes of facial BCC surgery provide high patient satisfaction overall. Taking wider margins requires specific measures to improve the surgical outcome. © 2016 S. Karger AG, Basel.

  17. The economics of marginal offshore oil discoveries in China

    Energy Technology Data Exchange (ETDEWEB)

    Jones, G.C.L.; Jacobs, F.A.; Toh, C.M.


    In any area a given set of conditions exists which will define the profitability of development of a hydrocarbon discovery. Many factors will help decide whether development will proceed. Reserves of 25 million bbl may be viable in shallow water but in a deep-water environment would show minimal return. The technology exists to exploit discoveries in water depths to over 200 m. It is the cost of development and the fiscal framework that establishes the limits of acceptable economic production. It can be concluded that, for a marginal field in the physical and cost environment considered here, recoverable reserves of 15 million bbl needs to be identified before development is undertaken. To obtain such a commitment requires confidence in the level of reserves and the productivity of the reservoir. Where confidence is low, government assistance may be justified in order to encourage the operator to commit to development. Particular consideration should therefore be given to: A careful logging, coring, and testing program to evaluate not only major finds, but also marginal discoveries. The use of a rig or single well production system to carry out extended production testing. Single well production systems are currently being conceived that would allow such tests to pay for themselves and thus provide an economic method of testing the validity of a marginal field. Reducing the royalty rate or relaxing the production sharing terms to allow operators to recover delineation drilling costs. Such reductions should be allowed on fields with uncertain deliverability and marginal reserves. It is certain that the limits on marginal field development will continue to recede. With a clear understanding of reserve uncertainties and available technology, such progress can be made within a minimal risk of failure.

  18. [Optimizing surgical hand disinfection]. (United States)

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


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

  19. On the relationship between sequential faulting, margin asymmetry and highly thinned continental crust (United States)

    Brune, Sascha; Heine, Christian; Pérez-Gussinyé, Marta; Sobolev, Stephan


    The architecture of magma-poor continental margins is remarkably variable. The width of highly thinned continental crust (with a thickness material; (2) Formation of a low viscosity exhumation channel adjacent to the rift centre that is generated by heat transfer from the upwelling mantle and enhanced by viscous strain softening. Rift migration takes place in a steady-state manner and is accomplished by oceanward-younging sequential faults within the upper crust and balanced through lower crustal flow. We demonstrate that the rate of extension has paramount control on margin width. Since higher velocities lead to elevated heat flow within the rift and hence to hot and weak lower crust, a larger low-viscosity exhumation channel is generated that facilitates rift migration leading to wider margins. The South Atlantic is an ideal test bed for the hypothesis of velocity-dependent margin width since rifting was fast in the south, but slow in the northern part. As predicted by our numerical models, the maximum present-day margin width increases almost linearly from the conjugate Equatorial margin segments to the Florianopolis/Walvis ridge. Even though the polarity of the magma-poor South Atlantic margins alternates, the asymmetry and the width of the wider margin are in very good agreement with our simulations. The described rift evolution has three fundamental implications: (1) It implies sustained transfer of material across the extensional plate boundary thereby predicting that large portions of a wide margin originate from its conjugate side. (2) Migration of the deformation locus causes faulting in the distal parts of the margin to postdate that of the proximal parts by as much as 10 million years. This means that syn-rift and post-rift phase are location-dependent. (3) Lateral movement of the rift centre generates drastically different peak heat flow and subsidence histories at the proximal and the distal margin.

  20. Life at the margin: the mating system of Mediterranean conifers

    Directory of Open Access Journals (Sweden)

    G. Restoux


    Full Text Available Mixed mating, where a single tree progeny results from a mixture of selfing and outcrossing, is widespread in conifers and could be an evolutionary advantage at ecological margins when mating partners become scarce. This study analyzes how the mating system responds to bioclimate and density variations. We surveyed published data on the mating system of Abies, Picea and Pinus species when information on bioclimate and stand density was available. Our survey revealed that Mediterranean species demonstrate a lower selfing rate than other species and that the proportion of selfed versus outcrossed progeny is not fixed within species. The highest variability in mating types within populations was found when stand density was the most variable.

    To show how density affects the proportion of selfed versus outcrossed progeny, we used isozymes to genotype single tree seeds from a marginal Abies alba forest in Mediterranean France (Mont Ventoux where low-to high-density stands are found. We then tested the adaptive potential of the different high and low density progenies by sowing them under controlled nursery conditions and measuring germination rate and seedling survival after 4 yr under 3 different water regimes. Although the mean value of outcrossing rate was typical for mixed mating conifers (tm = 0.85, individual outcrossing rates varied from 0.05 to 0.99 and were strongly correlated with stand type and density (tm from 0.87 in high-density to 0.43 in low-density marginal stands. Significantly fewer seeds from the low density marginal stand germinated (32% vs. 53% in the high density mature stand, although seedlings from the marginal stand had a better 4-yr survival (81% than seedlings from the high-density mature stand (63% when the three water regimes (from least to most stressful were averaged.

    Trees from low density stands may be at a selective disadvantage because they produce

  1. Three-year and five-year outcomes of surgical resection for pancreatic ductal adenocarcinoma: Long-term experiences in one medical center. (United States)

    Hsu, Chih-Po; Hsu, Jun-Te; Liao, Chien-Hung; Kang, Shih-Ching; Lin, Being-Chuan; Hsu, Yu-Pao; Yeh, Chun-Nan; Yeh, Ta-Sen; Hwang, Tsann-Long


    Pancreatic ductal adenocarcinoma is one of the most malignant types of cancer. This study evaluated the 3-year and 5-year surgical outcomes associated with the cancer and determined whether statistically identified factors can be used to predict survival. This retrospective review was conducted from 1995 to 2010. Patients who had resectable pancreatic ductal adenocarcinoma and received surgical treatment were included. Cases of hospital mortality were excluded. The relationships between several clinicopathological factors and the survival rate were analyzed. A total of 223 patients were included in this study. The 3-year and 5-year survival rates were 21.4% and 10.1%, respectively, and the median survival was 16.1 months. Tumor size, N status, and resection margins were independent predictive factors for 3-year survival. Tumor size independently predicted 5-year survival. Tumor size is the most important independent prognostic factor for 3-year and 5-year survival. Lymph node status and the resection margins also independently affected the 3-year survival. These patient outcomes might be improved by early diagnosis and radical resection. Future studies should focus on the tumor biology of this aggressive cancer. Copyright © 2016. Published by Elsevier Taiwan.

  2. Risk factors for surgical site infection of pilon fractures

    Directory of Open Access Journals (Sweden)

    Tingting Ren


    Full Text Available OBJECTIVES: Pilon fracture is a complex injury that is often associated with severe soft tissue damage and high rates of surgical site infection. The goal of this study was to analyze and identify independent risk factors for surgical site infection among patients undergoing surgical fixation of a pilon fracture. METHODS: The medical records of all pilon fracture patients who underwent surgical fixation from January 2010 to October 2012 were reviewed to identify those who developed a surgical site infection. Then, we constructed univariate and multivariate logistic regressions to evaluate the independent associations of potential risk factors with surgical site infection in patients undergoing surgical fixation of a pilon fracture. RESULTS: A total of 519 patients were enrolled in the study from January 2010 to October 2012. A total of 12 of the 519 patients developed a surgical site infection, for an incidence of 2.3%. These patients were followed for 12 to 29 months, with an average follow-up period of 19.1 months. In the final regression model, open fracture, elevated postoperative glucose levels (≥125 mg/dL, and a surgery duration of more than 150 minutes were significant risk factors for surgical site infection following surgical fixation of a pilon fracture. CONCLUSIONS: Open fractures, elevated postoperative glucose levels (≥125 mg/dL, and a surgery duration of more than 150 minutes were related to an increased risk for surgical site infection following surgical fixation of a pilon fracture. Patients exhibiting the risk factors identified in this study should be counseled regarding the possible surgical site infection that may develop after surgical fixation.

  3. Evaluation of the Effect of Surgical Crown Lengthening on Periodontal Parameters



    Background: Surgical crown lengthening is needed for teeth with subgingival caries, fractured teeth, insufficient crown length, and deep subgingival margin of failed restorations. Since there is no agreement on the effects of crown lengthening surgery on gingival parameters, the purpose of this study was to evaluate periodontal parameters in patients who needed crown lengthening surgery. Methods: Twenty patients who had healthy periodontium and needed surgical crown lengthening were included ...

  4. [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.

  5. Percutaneous vascular plug for incomplete surgical left atrial appendage closure. (United States)

    Levisay, Justin P; Sangodkar, Sandeep; Salinger, Michael H; Lampert, Mark; Feldman, Ted


    Surgical left atrial appendage (LAA) exclusion has a failure rate as high as 60% due to persistent residual flow in the LAA or large LAA remnants. We describe a novel technique for treatment of incomplete surgical LAA ligation, and define the mechanism that led to persistence of the remnant LAA without any thrombus formation.

  6. Using laser irradiation for the surgical treatment of periodontal disease (United States)

    Vieru, Rozana D.; Lefter, Agafita; Herman, Sonia


    In the marginal pr ogressive profound periodontities, we associated low level laser therapy (LLLT) to the classical surgical treatment with implant of biovitroceramics. From a total of 50 patients, 37 where irradiated with the laser. We used a diode laser, =830 nm, energy density up to 2 J cm2, in Nogier pulsed mode. The laser treatment is used in a complex of therapeutic procedures: odontal, local anti-inflammatory -- as well as in the cabinet and at home --, prosthetic, and for the morphologic and functional rebalancing. The immediate effects where: an evolution without bleeding and without post-surgical complications, as can appear at the patients who didn't benefit of laser irradiation (hematom, pain, functional alteration in the first post-surgical week). Operated tissue is recovering faster. The percentage of recurrences decreases and the success depends less on the biological potential and the immunity of each individual.

  7. Evaluation of the margins of differentiated early gastric cancer by using conventional endoscopy (United States)

    Yoshinaga, Shigetaka; Oda, Ichiro; Abe, Seiichiro; Nonaka, Satoru; Suzuki, Haruhisa; Takisawa, Hajime; Taniguchi, Hirokazu; Saito, Yutaka


    AIM: To evaluate the determination of the margin of differentiated-type early gastric cancers by using conventional endoscopy. METHODS: We retrospectively evaluated 364 differentiated early gastric cancers that were endoscopically resected as en-bloc specimens and diagnosed pathologically in detail between November 2007 and October 2008. All procedures were done with conventional endoscopes and all endoscopic samples, before and after indigo carmine dye, were re-evaluated using a digital filing system by one endoscopist. We analyzed the incidence of lesions with unclear margins and the relationship between unclear margins and relevant clinicopathological findings. RESULTS: The rate of lesions with unclear margins was 20.6% (75/364). Multivariate regression analysis suggested that the factors that make the determination of the margin difficult were normal color, presence of components of flat area (0-IIb), a diameter ≥ 21 mm, ulceration, and components of poorly differentiated adenocarcinoma in the mucosal surface. CONCLUSION: As many as 20% of differentiated early gastric cancers show unclear margins. Consideration of the factors associated with unclear margins may help endoscopists to accurately determine the margins of the lesion. PMID:26078834

  8. Surgical versus non-surgical management for pleural empyema. (United States)

    Redden, Mark D; Chin, Tze Yang; van Driel, Mieke L


    non-surgical management of pleural empyema for all age groups. Video-assisted thoracoscopic surgery may reduce length of hospital stay compared to thoracostomy drainage alone.There was insufficient evidence to assess the impact of fibrinolytic therapy.A number of common outcomes were reported in the included studies that were not directly examined in our primary and secondary outcomes. These included duration of chest tube drainage, duration of fever, analgesia requirement, and total cost of treatment. Future studies focusing on patient-centred outcomes, such as patient functional scores, and other clinically relevant outcomes, such as radiographic improvement, treatment failure rates, and amount of fluid drainage, are needed to inform clinical decisions.

  9. On the dynamics of turbulent transport near marginal stability

    Energy Technology Data Exchange (ETDEWEB)

    Diamond, P.H. [California Univ., San Diego, La Jolla, CA (United States). Dept. of Physics]|[General Atomics, San Diego, CA (United States); Hahm, T.S. [Princeton Univ., NJ (United States). Plasma Physics Lab.


    A general methodology for describing the dynamics of transport near marginal stability is formulated. Marginal stability is a special case of the more general phenomenon of self-organized criticality. Simple, one field models of the dynamics of tokamak plasma self-organized criticality have been constructed, and include relevant features such as sheared mean flow and transport bifurcations. In such models, slow mode (i.e. large scale, low frequency transport events) correlation times determine the behavior of transport dynamics near marginal stability. To illustrate this, impulse response scaling exponents (z) and turbulent diffusivities (D) have been calculated for the minimal (Burgers) and sheared flow models. For the minimal model, z = 1 (indicating ballastic propagation) and D {approximately}(S{sub 0}{sup 2}){sup 1/3}, where S{sub 0}{sup 2} is the noise strength. With an identically structured noise spectrum and flow with shearing rate exceeding the ambient decorrelation rate for the largest scale transport events, diffusion is recovered with z = 2 and D {approximately} (S{sub 0}{sup 2}){sup 3/5}. This indicates a qualitative change in the dynamics, as well as a reduction in losses. These results are consistent with recent findings from {rho} scaling scans. Several tokamak transport experiments are suggested.

  10. Exploration of the continental margins of India

    Digital Repository Service at National Institute of Oceanography (India)

    Siddiquie, H.N.; Hashimi, N.H.; Vora, K.H.; Pathak, M.C.

    In mid 1970's the National Institute of Oceanography, Goa, India prepared a plan for systematic regional, geological and geophysical surveys of the continental margins of India. This involved over 75,000 km of underway (bathymetric, side scan sonar...

  11. Mental Depreciation and Marginal Decision Making (United States)

    Heath; Fennema


    We propose that individuals practice "mental depreciation," that is, they implicitly spread the fixed costs of their expenses over time or use. Two studies explore how people spread fixed costs on durable goods. A third study shows that depreciation can lead to two distinct errors in marginal decisions: First, people sometimes invest too much effort to get their money's worth from an expense (e.g., they may use a product a lot to spread the fixed expense across more uses). Second, people sometimes invest too little effort to get their money's worth: When people add a portion of the fixed cost to the current costs, their perceived marginal (i.e., incremental) costs exceed their true marginal costs. In response, they may stop investing because their perceived costs surpass the marginal benefits they are receiving. The latter effect is supported by two field studies that explore real board plan decisions by university students.

  12. Time Safety Margin: Theory and Practice (United States)


    safety plan as the test event approaches. Did the planners miss anything? What doesn’t make sense ? Is it too conservative or not conservative enough? The...seconds of TSM for a 10-degree dive at 150 KTAS, producing inefficiency with excessive margin. Somewhere in the middle, the restriction makes sense , but...412TW-TIH-16-01 TIME SAFETY MARGIN: THEORY AND PRACTICE WILLIAM R. GRAY, III Chief Test Pilot USAF Test Pilot School SEPTEMBER 2016

  13. Marketing margins and agricultural technology in Mozambique

    DEFF Research Database (Denmark)

    Arndt, Channing; Jensen, Henning Tarp; Robinson, Sherman


    Improvements in agricultural productivity and reductions in marketing costs in Mozambique are analysed using a computable general equilibrium (CGE) model. The model incorporates detailed marketing margins and separates household demand for marketed and home-produced goods. Individual simulations...... of improved agricultural technology and lower marketing margins yield welfare gains across the economy. In addition, a combined scenario reveals significant synergy effects, as gains exceed the sum of gains from the individual scenarios. Relative welfare improvements are higher for poor rural households...

  14. Statistical Analysis of Thermal Analysis Margin (United States)

    Garrison, Matthew B.


    NASA Goddard Space Flight Center requires that each project demonstrate a minimum of 5 C margin between temperature predictions and hot and cold flight operational limits. The bounding temperature predictions include worst-case environment and thermal optical properties. The purpose of this work is to: assess how current missions are performing against their pre-launch bounding temperature predictions and suggest any possible changes to the thermal analysis margin rules

  15. Investigating Mechanisms of Marginal Settlement Life Improvement

    Directory of Open Access Journals (Sweden)

    Hamid M. Mohammadi


    Full Text Available The main purpose of this research was to investigate mechanisms to improve marginal settlement life in Koohdasht County in Lorestan province. This research was a sort of the survey studies and a questionnaire was compiled for collection of data. Statistical population of this study was included 1560 households; also sampling method was a sort of random sampling. Number of sample size was estimated 85 households. Questionnaire's reliability was confirmed through computing Cronbach's alpha coefficient which was 0.85. Face validity of questionnaire was confirmed by some Tehran university agricultural extension and education department scientific board members. Also data analyzed by WINspss 11.5. The results of research revealed that marginal area residents had not good financial situation but they undertook great supporting burden and in point of view access to services and life conditions had not good situation. Therefore improvement of life conditions of marginal settlement life such as fundamental infrastructure include communication systems and sanitation offloading system recognized as the most important mechanisms of marginal settlement improvement according to results of priority setting of marginal settlement situation mechanisms. Also the results of factor analysis showed that 7 main mechanisms were be effective in term of marginal settlement life improvement that in order to importance were included servicing and life condition improvement, credit-economic, civil and legal, control and prevention, population and migration control, infrastructures improvement and hygiene situation.

  16. Review article: surgical, neo-adjuvant and adjuvant management strategies in biliary tract cancer. (United States)

    Skipworth, J R A; Olde Damink, S W M; Imber, C; Bridgewater, J; Pereira, S P; Malagó, M


    The majority of patients with cholangiocarcinoma present with advanced, irresectable tumours associated with poor prognosis. The incidence and mortality rates associated with cholangiocarcinoma continue to rise, mandating the development of novel strategies for early detection, improved resection and treatment of residual lesions. To review the current evidence base for surgical, adjuvant and neo-adjuvant techniques in the management of cholangiocarcinoma. A search strategy incorporating PubMed/Medline search engines and utilising the key words biliary tract carcinoma; cholangiocarcinoma; management; surgery; chemotherapy; radiotherapy; photodynamic therapy; and radiofrequency ablation, in various combinations, was employed. Data on neo-adjuvant and adjuvant techniques remain limited, and much of the literature concerns palliation of inoperable disease. The only opportunity for long-term survival remains surgical resection with negative pathological margins or liver transplantation, both of which remain possible in only a minority of selected patients. Neo-adjuvant and adjuvant techniques currently provide only limited success in improving survival. The development of novel strategies and treatment techniques is crucial. However, the shortage of randomised controlled trials is compounded by the low feasibility of conducting adequately powered trials in liver surgery, due to the large sample sizes that are required. © 2011 Blackwell Publishing Ltd.

  17. Role of tumour-free margin distance for loco-regional control in vulvar cancer-a subset analysis of the Arbeitsgemeinschaft Gynäkologische Onkologie CaRE-1 multicenter study. (United States)

    Woelber, Linn; Griebel, Lis-Femke; Eulenburg, Christine; Sehouli, Jalid; Jueckstock, Julia; Hilpert, Felix; de Gregorio, Nikolaus; Hasenburg, Annette; Ignatov, Atanas; Hillemanns, Peter; Fuerst, Sophie; Strauss, Hans-Georg; Baumann, Klaus H; Thiel, Falk C; Mustea, Alexander; Meier, Werner; Harter, Philipp; Wimberger, Pauline; Hanker, Lars Christian; Schmalfeldt, Barbara; Canzler, Ulrich; Fehm, Tanja; Luyten, Alexander; Hellriegel, Martin; Kosse, Jens; Heiss, Christoph; Hantschmann, Peer; Mallmann, Peter; Tanner, Berno; Pfisterer, Jacobus; Richter, Barbara; Neuser, Petra; Mahner, Sven


    A tumour-free pathological resection margin of ≥8 mm is considered state-of-the-art. Available evidence is based on heterogeneous cohorts. This study was designed to clarify the relevance of the resection margin for loco-regional control in vulvar cancer. AGO-CaRE-1 is a large retrospective study. Patients (n = 1618) with vulvar cancer ≥ FIGO stage IB treated at 29 German gynecologic-cancer-centres 1998-2008 were included. This subgroup analysis focuses on solely surgically treated node-negative patients with complete tumour resection (n = 289). Of the 289 analysed patients, 141 (48.8%) had pT1b, 140 (48.4%) pT2 and 8 (2.8%) pT3 tumours. One hundred twenty-five (43.3%) underwent complete vulvectomy, 127 (43.9%) partial vulvectomy and 37 (12.8%) radical local excision. The median minimal resection margin was 5 mm (1 mm-33 mm); all patients received groin staging, in 86.5% with full dissection. Median follow-up was 35.1 months. 46 (15.9%) patients developed recurrence, thereof 34 (11.8%) at the vulva, after a median of 18.3 months. Vulvar recurrence rates were 12.6% in patients with a margin <8 mm and 10.2% in patients with a margin ≥8 mm. When analysed as a continuous variable, the margin distance had no statistically significant impact on local recurrence (HR per mm increase: 0.930, 95% CI: 0.849-1.020; p = 0.125). Multivariate analyses did also not reveal a significant association between the margin and local recurrence neither when analysed as continuous variable nor categorically based on the 8 mm cutoff. Results were consistent when looking at disease-free-survival and time-to-recurrence at any site (HR per mm increase: 0.949, 95% CI: 0.864-1.041; p = 0.267). The need for a minimal margin of 8 mm could not be confirmed in the large and homogeneous node-negative cohort of the AGO-CaRE database. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Characterization of aerosols produced by surgical procedures

    Energy Technology Data Exchange (ETDEWEB)

    Yeh, H.C.; Muggenburg, B.A.; Lundgren, D.L.; Guilmette, R.A.; Snipes, M.B.; Jones, R.K. [Inhalation Toxicology Research Institute, Albuquerque, NM (United States); Turner, R.S. [Lovelace Health Systems, Albuquerque, NM (United States)


    In many surgeries, especially orthopedic procedures, power tools such as saws and drills are used. These tools may produce aerosolized blood and other biological material from bone and soft tissues. Surgical lasers and electrocautery tools can also produce aerosols when tissues are vaporized and condensed. Studies have been reported in the literature concerning production of aerosols during surgery, and some of these aerosols may contain infectious material. Garden et al. (1988) reported the presence of papilloma virus DNA in the fumes produced from laser surgery, but the infectivity of the aerosol was not assessed. Moon and Nininger (1989) measured the size distribution and production rate of emissions from laser surgery and found that particles were generally less than 0.5 {mu}m diameter. More recently there has been concern expressed over the production of aerosolized blood during surgical procedures that require power tools. In an in vitro study, the production of an aerosol containing the human immunodeficiency virus (HIV) was reported when power tools were used to cut tissues with blood infected with HIV. Another study measured the size distribution of blood aerosols produced by surgical power tools and found blood-containing particles in a number of size ranges. Health care workers are anxious and concerned about whether surgically produced aerosols are inspirable and can contain viable pathogens such as HIV. Other pathogens such as hepatitis B virus (HBV) are also of concern. The Occupational Safety and Health funded a project at the National Institute for Inhalation Toxicology Research Institute to assess the extent of aerosolization of blood and other tissues during surgical procedures. This document reports details of the experimental and sampling approach, methods, analyses, and results on potential production of blood-associated aerosols from surgical procedures in the laboratory and in the hospital surgical suite.

  19. Vitiligo- A surgical approach

    Directory of Open Access Journals (Sweden)

    Deepti Ghia


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

  20. 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.

  1. Gossypiboma—Retained Surgical Sponge

    Directory of Open Access Journals (Sweden)

    Hung-Shun Sun


    Full Text Available Intra-abdominal retained surgical sponge is an uncommon surgical error. Herein, we report a 92-year-old woman who was brought to the emergency room for acute urinary retention. She had a history of vaginal hysterectomy for uterine prolapse 18 years previously, performed at our hospital. Retained surgical sponge in the pelvic cavity was suspected by abdominal computed tomography. The surgical gauze was removed by laparotomy excision and the final diagnosis was gossypiboma.

  2. Surgical treatment for complex acetabular fractures

    Institute of Scientific and Technical Information of China (English)

    LIU Qiang; WU Dou; LI Ping; HAN Shu-feng


    Objective: To explore the effect of surgical treatment on complex acetabular fractures.Methods: The data of 46 patients (38 males and 8 females, aged 16-75 years, mean = 38. 5 years ) with complex acetabular fractures, who were admitted to our hospital from January 1998 to December 2005, were analyzed retrospectively in this study. According to Letournel rules, posterior wall and posterior column fractures were found in 11 patients, transverse and posterior wall fractures in 13, T-type fracture in 4, both columns fracture in 10, and anterior column and posterior transverse fracture in 8. The choice of surgical approach was based on the individual fractures, which included ilioinguinal approach in 5 patients, Kocher-Langenbech approach in 7, combined approach in 26, and extended iliofemoral approach in 8.Results: All the patients were followed up for 3.5 years averagely. The clinical outcomes were analyzed with Harris hip score and radiography. In 36 patients (78.3%), the surgical procedure was successful (Harris hip score > 80 points). The rate of excellent and good was about 86 %.Conclusions: The keys to increase the effectiveness of surgical treatment on acetabular fractures are correct preoperative classification of factures and choices of appropriate surgical approach and time.

  3. Surgical site infection in women undergoing surgery for gynecologic cancer. (United States)

    Mahdi, Haider; Gojayev, Anar; Buechel, Megan; Knight, Jason; SanMarco, Janice; Lockhart, David; Michener, Chad; Moslemi-Kebria, Mehdi


    The objectives of this study were to describe the rate and predictors of surgical site infection (SSI) after gynecologic cancer surgery and identify any association between SSI and postoperative outcome. Patients with endometrial, cervical, or ovarian cancers from 2005 to 2011 were identified from the American College of Surgeons National Surgical Quality Improvement Program. The extent of surgical intervention was categorized into modified surgical complexity scoring (MSCS) system. Univariate and multivariate logistic regression analyses were used. Odds ratios were adjusted for patient demographics, comorbidities, preoperative laboratory values, and operative factors. Of 6854 patients, 369 (5.4%) were diagnosed with SSI. Surgical site infection after laparotomy was 3.5 times higher compared with minimally invasive surgery (7% vs 2%; P Surgical site infection was associated with longer mean hospital stay and higher rate of reoperation, sepsis, and wound dehiscence. Surgical site infection was not associated with increased risk of acute renal failure or 30-day mortality. These findings were consistent in subset of patients with deep or organ space SSI. Seven percent of patients undergoing laparotomy for gynecologic malignancy developed SSI. Surgical site infection is associated with longer hospital stay and more than 5-fold increased risk of reoperation. In this study, we identified several risk factors for developing SSI among gynecologic cancer patients. These findings may contribute toward identification of patients at risk for SSI and the development of strategies to reduce SSI rate and potentially reduce the cost of care in gynecologic cancer surgery.

  4. Louis Pasteur surgical revolution. (United States)

    Toledo-Pereyra, Luis H


    Louis Pasteur (1822-1895) is considered the most notable medical scientist of his time and perhaps one of the most distinguished of all times in the history of medicine. From Dole in France to Paris, from a student of crystals to "living ferments," and from chemistry to biology and medicine, Pasteur changed the world for the benefit of humanity. The genius of Pasteur dealt with the most pressing issues of his time, basing the germ theory on the effects that microorganisms had on fermentation and putrefaction of organic matter, which gave birth to the science of bacteriology. Many other difficult problems in medicine and biology were tackled by Pasteur, culminating in the spectacular results seen with the treatment of rabies. Surgery was no exception to the scientific conquests of Pasteur. The transformation of the surgical world arose from the antiseptic concepts of Lister that were based on the germ theory of the disease, which had been derived from the germ theory of fermentation and putrefaction discovered by Pasteur. The acceptance of these principles represented the surgical revolution brought on by the science of Pasteur, a revolution that is now accepted in our daily care of surgical patients.

  5. Guideline implementation: Surgical attire. (United States)

    Cowperthwaite, Liz; Holm, Rebecca L


    Surgical attire helps protect patients from microorganisms that may be shed from the hair and skin of perioperative personnel. The updated AORN "Guideline for surgical attire" provides guidance on scrub attire, shoes, head coverings, and masks worn in the semirestricted and restricted areas of the perioperative setting, as well as how to handle personal items (eg, jewelry, backpacks, cell phones) that may be taken into the perioperative suite. This article focuses on key points of the guideline to help perioperative personnel adhere to facility policies and regulatory requirements for attire. The key points address the potential benefits of wearing scrub attire made of antimicrobial fabric, covering the arms when in the restricted area of the surgical suite, removing or confining jewelry when wearing scrub attire, disinfecting personal items that will be taken into the perioperative suite, and sending reusable attire to a health care-accredited laundry facility after use. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  6. Surgical navigation with QR codes

    Directory of Open Access Journals (Sweden)

    Katanacho Manuel


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

  7. Evaluating Surgical Margins with Optical Spectroscopy and Spectral Imaging Following Breast Cancer Resection (United States)


    parathyroid glands to prevent their accidental removal. G. Several undergraduate student s had summ er internships in m y lab, and I provided...Med (in review). Paras C, Keller MD, White L, Phay J, Mahadevan-Jansen A. “Seeing” the Parathyroid During Surgery. Nature Med (in review), 2009

  8. Surgical Team Stability and Risk of Sharps-Related Blood and Body Fluid Exposures During Surgical Procedures. (United States)

    Myers, Douglas J; Lipscomb, Hester J; Epling, Carol; Hunt, Debra; Richardson, William; Smith-Lovin, Lynn; Dement, John M


    To explore whether surgical teams with greater stability among their members (ie, members have worked together more in the past) experience lower rates of sharps-related percutaneous blood and body fluid exposures (BBFE) during surgical procedures. A 10-year retrospective cohort study. A single large academic teaching hospital. Surgical teams participating in surgical procedures (n=333,073) performed during 2001-2010 and 2,113 reported percutaneous BBFE were analyzed. A social network measure (referred to as the team stability index) was used to quantify the extent to which surgical team members worked together in the previous 6 months. Poisson regression was used to examine the effect of team stability on the risk of BBFE while controlling for procedure characteristics and accounting for procedure duration. Separate regression models were generated for percutaneous BBFE involving suture needles and those involving other surgical devices. RESULTS The team stability index was associated with the risk of percutaneous BBFE (adjusted rate ratio, 0.93 [95% CI, 0.88-0.97]). However, the association was stronger for percutaneous BBFE involving devices other than suture needles (adjusted rate ratio, 0.92 [95% CI, 0.85-0.99]) than for exposures involving suture needles (0.96 [0.88-1.04]). Greater team stability may reduce the risk of percutaneous BBFE during surgical procedures, particularly for exposures involving devices other than suture needles. Additional research should be conducted on the basis of primary data gathered specifically to measure qualities of relationships among surgical team personnel.

  9. Reconstructing Rodinia by Fitting Neoproterozoic Continental Margins (United States)

    Stewart, John H.


    Reconstructions of Phanerozoic tectonic plates can be closely constrained by lithologic correlations across conjugate margins by paleontologic information, by correlation of orogenic belts, by paleomagnetic location of continents, and by ocean floor magmatic stripes. In contrast, Proterozoic reconstructions are hindered by the lack of some of these tools or the lack of their precision. To overcome some of these difficulties, this report focuses on a different method of reconstruction, namely the use of the shape of continents to assemble the supercontinent of Rodinia, much like a jigsaw puzzle. Compared to the vast amount of information available for Phanerozoic systems, such a limited approach for Proterozoic rocks, may seem suspect. However, using the assembly of the southern continents (South America, Africa, India, Arabia, Antarctica, and Australia) as an example, a very tight fit of the continents is apparent and illustrates the power of the jigsaw puzzle method. This report focuses on Neoproterozoic rocks, which are shown on two new detailed geologic maps that constitute the backbone of the study. The report also describes the Neoproterozoic, but younger or older rocks are not discussed or not discussed in detail. The Neoproterozoic continents and continental margins are identified based on the distribution of continental-margin sedimentary and magmatic rocks that define the break-up margins of Rodinia. These Neoproterozoic continental exposures, as well as critical Neo- and Meso-Neoproterozoic tectonic features shown on the two new map compilations, are used to reconstruct the Mesoproterozoic supercontinent of Rodinia. This approach differs from the common approach of using fold belts to define structural features deemed important in the Rodinian reconstruction. Fold belts are difficult to date, and many are significantly younger than the time frame considered here (1,200 to 850 Ma). Identifying Neoproterozoic continental margins, which are primarily

  10. Higher Inpatient Medical Surgical Bed Occupancy Extends Admitted Patients’ Stay


    Krall, Scott P.; O'Connor, Robert E.; Maercks, Lisa


    Objective: Determine the effect that increased medical surgical (med/surg) bed occupancy has on the time interval from admission order to arrival in the bed for the patients admitted from the emergency department (ED). Methods: This retrospective observational study compares the total hospital bed occupancy rate and the medical surgical inpatient bed occupancy rate to daily averages for the time interval from admission order (patient posting for admission) to the patient’s arrival in...

  11. Theory of margination in confined multicomponent suspensions (United States)

    Henriquez Rivera, Rafael; Sinha, Kushal; Graham, Michael


    In blood flow, leukocytes and platelets tend to segregate near the vessel walls; this is known as margination. Margination of leukocytes and platelets is important in physiological processes, medical diagnostics and drug delivery. A mechanistic theory is developed to describe flow-induced segregation in confined multicomponent suspensions of deformable particles such as blood. The theory captures the essential features of margination by describing it in terms of two key competing processes in these systems at low Reynolds number: wall-induced migration and hydrodynamic pair collisions. The theory also includes the effect of physical properties of the deformable particles and molecular diffusion. Several regimes of segregation are identified, depending on the value of a ``margination parameter'' M. Moreover, there is a critical value of M below which a sharp ``drainage transition'' occurs: one component is completely depleted from the bulk flow to the vicinity of the walls. Direct hydrodynamic simulations also display this transition in suspensions where the components differ in size or flexibility. The developed mechanistic theory leads to substantial insight into the origins of margination and will help in guiding development of new technologies involving multicomponent suspensions. This work was supported by NSF grant CBET-1436082.

  12. Surface smoothness and marginal fit with phosphate-bonded investments. (United States)

    Cooney, J P; Doyle, T M; Caputo, A A


    Two phosphate-bonded investments and one calcium sulfate investment were evaluated for the surface smoothness and marginal fit they impart to gold castings. A modified technique was also evaluated for each phosphate-bonded investment, where the silica sol was not diluted and the spatulation time was reduced. The results of this study lead to the following conclusions: 1. The marginal fits obtained with all four phosphate-bonded methods were comparable to each other and superior to that obtained with the calcium sulfate investment. 2. The presence of nodules on the surface of the castings was more prevalent with the phosphate-bonded investments. However, this effect was not statistically significant. 3. Clinical assessment of the roughness of the castings revealed that all the methods tested produced clinically acceptable castings. 4. Visual observation by five dentists revealed that both the recommended and modified techniques for one of the phosphate-bonded investments (Ceramigold) produced a smoother surface than any other investment tested. Rating of scanning electron microscope photographs (X600) revealed no difference in the surface roughness between any of the castings. Consequently, no definitive relation between investment type or technique and surface roughness was established. 5. No correlation was demonstrated between surface roughness, as evaluated by either clinical observation or scanning electron microscope photography, and marginal fit of the castings.

  13. Complexity, Diminishing Marginal Returns, and Serial Mesopotamian Fragmentation

    Directory of Open Access Journals (Sweden)

    William R. Thompson


    Full Text Available Following up on an earlier paper demonstrating statistically significant relationships between measures of recurring political-economic crises (hinterland incursions, trade collapses, economic contractions, and regime transitions and a measure of climate deterioration (the interaction of falling Tigris-Euphrates river levels and years of warming/ drying, the inter-relationships among these variables are examined more closely for the 3400–1000 bce period. Theoretically focused on a test of Tainter’s diminishing marginal return theory of societal collapse, additional indicators are introduced encompassing population (urban population size, urban popula-tion growth rate as a proxy for diminishing marginal returns, two measures of centralization/ fragmentation (including imperial size, and the indicators used for the climate interaction term in the earlier paper. The multivariate logit outcome for interactions among and between the 11 variables reinforces the earlier findings linking climate deterioration to political-economic crises, extends the climate deterioration linkage to fragmentation and population decline, and finds relatively strong support for the Tainter derived expectation that diminishing marginal returns and fragmentation are closely linked but that both are less closely linked to recurring political-economic crises than might otherwise have been anticipated.

  14. Clinical review: surgical management of locally advanced and recurrent colorectal cancer.

    LENUS (Irish Health Repository)

    Courtney, D


    Recurrent and locally advanced colorectal cancers frequently require en bloc resection of involved organs to achieve negative margins. The aim of this review is to evaluate the most current literature related to the surgical management of locally advanced and recurrent colorectal cancer.

  15. Computer assisted surgery in orthopaedic oncology : Indications, applications and surgical workflow

    NARCIS (Netherlands)

    Gerbers, Jasper Gerhard


    In the treatment of bone tumors surgical accuracy and precision are of vital importance to achieve an efficient but oncologically safe result. Most procedures in bone tumour surgery require intraop-erative imaging (fluoroscopy) and/or measurements for anatomical orientation and margin control. Compu

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

    NARCIS (Netherlands)

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


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

  17. Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies. (United States)

    Prifti, Edvin; Bonacchi, Massimo; Baboci, Arben; Giunti, Gabriele; Veshti, Altin; Demiraj, Aurel; Zeka, Merita; Rruci, Edlira; Bejko, Ervin


    The left ventricular pseudoaneurysm (LVP) is rare, the surgical experience is limited and its surgical treatment remains still a challenge with an elevated mortality. Herein, it is presented a retrospective analysis of our experience with acquired post infarct LVP over a10-year period. Between January 2006 through August 2016, a total of 13 patients underwent operation for post infarct pseudoaneurysm of the left ventricle. There were 10 men and 3 women and the mean age was 61 ± 7.6 years. 4 patients presented acute LVP. Two patients had preoperative intraortic balloon pump implantation. Various surgical techniques were used to obliterate the pseudoaneurysm such as direct pledgeted sutures buttressed by polytetrafluoroethylene felt, a Gore-Tex or Dacron patch, transatrial closure of LVP neck in submitral pseudoaneurysm, or linear closure in cases presenting associated postinfarct ventricular septal defect. Concomitant coronary artery bypasses were performed for significant stenoses in 12 patients, ventricular septal defect closure in 4 patients, mitral valve replacement in 3 and aortic valve replacement in 1 patient. Operative mortality was 30.8% (4 patients). Three of them were acute LVP. Three patients required the continuous hemodyalisis and 8 patients required intra-aortic balloon pump. At follow-up two deaths occurred at 1 and 3 years after surgery. In conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients.

  18. 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.

  19. Digital Margins : How spatially and socially marginalized communities deal with digital exclusion

    NARCIS (Netherlands)

    Salemink, Koen


    The increasing importance of the Internet as a means of communication has transformed economies and societies. For spatially and socially marginalized communities, this transformation has resulted in digital exclusion and further marginalization. This book presents a study of two kinds of marginaliz

  20. Marginalization revisited: critical, postmodern, and liberation perspectives. (United States)

    Hall, J M


    Marginalization was advocated by Hall, Stevens, and Meleis in 1994 as a guiding concept for valuing diversity in knowledge development. Properties, risks, and resilience associated with the concept were detailed. This conceptualization of marginalization is reexamined here for its sociopolitical usefulness to nursing, from (1) critical theory, (2) postmodern, and (3) liberation philosophy perspectives. Additional properties are proposed to update the original conceptualization. These include: exteriority, Eurocentrism, constraint, economics, seduction, testimony, and hope. Effects of Eurocentric capitalism on all marginalized people are explored. Nursing implications include the need for interdisciplinary dialogue about the ethics of promoting and exporting Eurocentrism in nursing education and practice, and the need for integrated economic analyses of all aspects of life and health.

  1. A Novel System for the Surgical Staging of Primary High-grade Osteosarcoma: The Birmingham Classification. (United States)

    Jeys, Lee M; Thorne, Chris J; Parry, Michael; Gaston, Czar Louie L; Sumathi, Vaiyapuri P; Grimer, J Robert


    Chemotherapy response and surgical margins have been shown to be associated with the risk of local recurrence in patients with osteosarcoma. However, existing surgical staging systems fail to reflect the response to chemotherapy or define an appropriate safe metric distance from the tumor that will allow complete excision and closely predict the chance of disease recurrence. We therefore sought to review a group of patients with primary high-grade osteosarcoma treated with neoadjuvant chemotherapy and surgical resection and analyzed margins and chemotherapy response in terms of local recurrence. (1) What predictor or combination of predictors available to the clinician can be assessed that more reliably predict the likelihood of local recurrence? (2) Can we determine a better predictor of local recurrence-free survival than the currently applied system of surgical margins? (3) Can we determine a better predictor of overall survival than the currently applied system of surgical margins? This retrospective study included all patients with high-grade conventional osteosarcomas without metastasis at diagnosis treated at one center between 1997 and 2012 with preoperative chemotherapy followed by resection or amputation of the primary tumor who were younger than age 50 years with minimum 24-month followup for those still alive. A total of 389 participants matched the inclusion criteria. Univariate log-rank test and multivariate Cox analyses were undertaken to identify predictors of local recurrence-free survival (LRFS). The Birmingham classification was devised on the basis of two stems: the response to chemotherapy (good response = ≥ 90% necrosis; poor response = HR], 9.9; 95% CI, 1.2-82; p = 0.03 versus radical margin HR, 1) and a poor response to neoadjuvant chemotherapy (HR, 3.8; 95% CI, 1.7-8.4; p = 0.001 versus good response HR, 1) were independent risk factors for local recurrence (LR). The best predictor of LR, however, was a combination of margins ≤ 2 mm and

  2. [Duane vertical surgical treatment]. (United States)

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


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

  3. Surgical options for the management of visceral artery aneurysms. (United States)

    Van Petersen, A; Meerwaldt, R; Geelkerken, R; Zeebregts, C


    Visceral artery aneurysm (VAA) is a rare entity but increased use of abdominal imaging has led to an increased prevalence. Rupture is related to a high mortality rate. Open repair, endovascular treatment and laparoscopic techniques have been described as treatment options. In this systematic review we describe the surgical options for treating VAA. A literature search identified articles focussing on the key issues of visceral artery aneurysms and surgical options using the Pubmed and Cochrane databases. Case reports dominate the literature about VAA. Twenty-seven small case series and ten review articles have been published in the last 20 years concerning the surgical options for VAA. The evidence does not exceed level 3. Surgical treatment is dictated by both patient and aneurysm characteristics. Whether VAA should be treated largely depends upon age, gender, presence of hypertension (e.g. in renal aneurysm), aneurysm size and presentation. Aneurysm size and characteristics, anatomical location and presence of collateral circulation dictate the surgical option to be chosen. The mortality and morbidity rates after elective open repair are low. Literature about surgical options for treating VAA remains scarce. Only a few clinical trials have shown the possibilities and results of open surgical repair. In general, there is no consensus on the surgical treatment of VAA and the highest level of evidence is based upon expert opinions.

  4. Organic carbon production, mineralization and preservation on the Peruvian margin

    Directory of Open Access Journals (Sweden)

    A. W. Dale


    Full Text Available Carbon cycling in Peruvian margin sediments (11° S and 12° S was examined at 16 stations from 74 m on the inner shelf down to 1024 m water depth by means of in situ flux measurements, sedimentary geochemistry and modeling. Bottom water oxygen was below detection limit down to ca. 400 m and increased to 53 μM at the deepest station. Sediment accumulation rates and benthic dissolved inorganic carbon fluxes decreased rapidly with water depth. Particulate organic carbon (POC content was lowest on the inner shelf and at the deep oxygenated stations (< 5% and highest between 200 and 400 m in the oxygen minimum zone (OMZ, 15–20%. The organic carbon burial efficiency (CBE was unexpectedly low on the inner shelf (< 20% when compared to a global database, for reasons which may be linked to the frequent ventilation of the shelf by oceanographic anomalies. CBE at the deeper oxygenated sites was much higher than expected (max. 81%. Elsewhere, CBEs were mostly above the range expected for sediments underlying normal oxic bottom waters, with an average of 51 and 58% for the 11° S and 12° S transects, respectively. Organic carbon rain rates calculated from the benthic fluxes alluded to a very efficient mineralization of organic matter in the water column, with a Martin curve exponent typical of normal oxic waters (0.88 ± 0.09. Yet, mean POC burial rates were 2–5 times higher than the global average for continental margins. The observations at the Peruvian margin suggest that a lack of oxygen does not affect the degradation of organic matter in the water column but promotes the preservation of organic matter in marine sediments.

  5. Pathogenesis of splenic marginal zone lymphoma

    Directory of Open Access Journals (Sweden)

    Ming-Qing Du


    Full Text Available Splenic marginal zone lymphoma (SMZL is a distinct low grade B-cell lymphoma with an immunophenotype similar to that of splenic marginal zone B-cells. Like the normal splenic marginal zone B-cells, SMZLs also show variable features in somatic mutations of their rearranged immunoglobulin genes, with ∼90% of cases harbouring somatic mutations but at remarkably variable degrees, suggesting that SMZL may have multiple cell of origins, deriving from the heterogeneous B-cells of the splenic marginal zone. Notably, ∼30% of SMZLs show biased usage of IGHV1-2*04, with the expressed BCR being potentially polyreactive to autoantigens. Recent exome and targeted sequencing studies have identified a wide spectrum of somatic mutations in SMZL with the recurrent mutations targeting multiple signalling pathways that govern the development of splenic marginal zone B-cells. These recurrent mutations occur in KLF2 (20–42%, NOTCH2 (6.5–25%, NF-κB (CARD11 ∼7%, IKBKB ∼7%, TNFAIP3 7–13%, TRAF3 5%, BIRC3 6.3% and TLR (MYD88 5–13% signalling pathways. Interestingly, the majority of SMZL with KLF2 mutation have both 7q32 deletion and IGHV1-2 rearrangement, and these cases also have additional mutations in NOTCH2, or TNFAIP3, or TRAF3. There is a potential oncogenic cooperation among concurrent genetic changes, for example between the IGHV1-2 expressing BCR and KLF2 mutation in activation of the canonical NF-κB pathway, and between KLF2 and TRAF3 mutations in activation of the non-canonical NF-κB pathway. These novel genetic findings have provided considerable insights into the pathogenesis of SMZL and will stimulate the research in both normal and malignant marginal zone B-cells.

  6. Time-gated optical imaging to detect positive prostate cancer margins (United States)

    Lin, Zi-Jing; Alexandrakis, George; Patel, Nimit; Shen, Jinhui; Tang, Liping; Liu, Hanli


    Laparoscopic radical prostatectomy (LRP) has revolutionized the surgical treatment of prostate cancer. This procedure permits complete removal of the prostate and seminal vesicles while minimizing pain and recovery time. However, the laparoscopic approach greatly limits the surgeon's tactile sensation during the procedure. This is particularly true with robot-assisted LRP where no tactile feedback is available forcing the surgeon to rely solely on visual cues. The surgeon and pathologist perform intraoperative frozen section pathologic analysis of a few select tissue fragments, but this is time consuming and costly. Concrete conclusions based on such samples are unreliable as they do not reflect the entire surgical margin status. In this case a conservative approach might dictate removal of more marginal material than necessary, thereby compromising the important nerve-sparing aspects of the procedure. In this study, we demonstrate the feasibility of using multi-modal time-gated optical imaging, i.e. time-resolved light reflectance and auto-fluorescence life-time imaging performed by an ICCD (Intensified Charge-Coupled Device) imaging system to enable clinicians to detect positive tumor margins with high sensitivity and specificity over the prostate. Results from animal experiments present the potential of identifying differences in optical signals between prostate cancer and control tissues. Results also show that the use of classification algorithms can identify cancerous regions with high sensitivity and specificity.

  7. 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.

  8. Surgical site infection prevention: time to move beyond the surgical care improvement program. (United States)

    Hawn, Mary T; Vick, Catherine C; Richman, Joshua; Holman, William; Deierhoi, Rhiannon J; Graham, Laura A; Henderson, William G; Itani, Kamal M F


    The objective of this study was to evaluate whether the Surgical Care Improvement Project (SCIP) improved surgical site infection (SSI) rates using national data at the patient level for both SCIP adherence and SSI occurrence. The SCIP was established in 2006 with the goal of reducing surgical complications by 25% in 2010. National Veterans' Affairs (VA) data from 2005 to 2009 on adherence to 5 SCIP SSI prevention measures were linked to Veterans' Affairs Surgical Quality Improvement Program SSI outcome data. Effect of SCIP adherence and year of surgery on SSI outcome were assessed with logistic regression using generalized estimating equations, adjusting for procedure type and variables known to predict SSI. Correlation between hospital SCIP adherence and SSI rate was assessed using linear regression. There were 60,853 surgeries at 112 VA hospitals analyzed. SCIP adherence ranged from 75% for normothermia to 99% for hair removal and all significantly improved over the study period (P Surgical site infection occurred after 6.2% of surgeries (1.6% for orthopedic surgeries to 11.3% for colorectal surgeries). None of the 5 SCIP measures were significantly associated with lower odds of SSI after adjusting for variables known to predict SSI and procedure type. Year was not associated with SSI (P = 0.71). Hospital SCIP performance was not correlated with hospital SSI rates (r = -0.06, P = 0.54). Adherence to SCIP measures improved whereas risk-adjusted SSI rates remained stable. SCIP adherence was neither associated with a lower SSI rate at the patient level, nor associated with hospital SSI rates. Policies regarding continued SCIP measurement and reporting should be reassessed.

  9. Working marginal reserves using Auger technology

    Energy Technology Data Exchange (ETDEWEB)

    Celada Tamames, B.


    Following up an idea put forward at a meeting of the PEN (National Energy Plan) R and D working party held in Ponferrada in the province of Leon, Ocicarbon contracted Geocontrol SA to carry out a study on the possible use of Auger technology for working marginal coal reserves. This article summarises the most important points in the final report on this project: current state of Auger technology, inventory of marginal coal reserves in Spain and the use of Auger technology in Spain. 6 figs., 2 tabs.

  10. Algorithms for computing the multivariable stability margin (United States)

    Tekawy, Jonathan A.; Safonov, Michael G.; Chiang, Richard Y.


    Stability margin for multiloop flight control systems has become a critical issue, especially in highly maneuverable aircraft designs where there are inherent strong cross-couplings between the various feedback control loops. To cope with this issue, we have developed computer algorithms based on non-differentiable optimization theory. These algorithms have been developed for computing the Multivariable Stability Margin (MSM). The MSM of a dynamical system is the size of the smallest structured perturbation in component dynamics that will destabilize the system. These algorithms have been coded and appear to be reliable. As illustrated by examples, they provide the basis for evaluating the robustness and performance of flight control systems.

  11. Jatropha potential on marginal land in Ethiopia

    DEFF Research Database (Denmark)

    Wendimu, Mengistu Assefa

    narrative. But both the availability and suitability of “marginal” land for commercial level jatropha production is not well understood/examined, especially in Africa. Using a case study of large-scale jatropha plantation in Ethiopia, this paper examines the process of land identification for jatropha...... investments, and the agronomic performance of large-scale jatropha plantation on so-called marginal land. Although it has been argued that jatropha can be grown well on marginal land without irrigation, and thus does not compete for land and water or displace food production from agricultural land, this study...

  12. Use of marginal organs in kidney transplantation for marginal recipients: too close to the margins of safety?

    Directory of Open Access Journals (Sweden)

    Heuer M


    Full Text Available Abstract Objective Due to organ shortage, average waiting time for a kidney in Germany is about 4 years after start of dialysis. Number of kidney grafts recovered can only be maintained by accepting older and expanded criteria donors. The aim of this study was to analyse the impact of donor and recipient risk on kidney long-term function. Methods All deceased kidney transplantations were considered. We retrospectively studied 332 patients between 2002 and 2006; divided in 4 groups reflecting donor and recipient risk. Results Non-marginal recipients were less likely to receive a marginal organ (69 of 207, 33% as compared to marginal recipients, of whom two-thirds received a marginal organ (p Conclusions As we were able to show expanded criteria donor has a far bigger effect on long-term graft function than the "extra risk" recipient. Although there have been attempts to define groups of recipients who should be offered ECD kidneys primarily the discussion is still ongoing.

  13. Normalized fluorescence lifetime imaging for tumor identification and margin delineation (United States)

    Sherman, Adria J.; Papour, Asael; Bhargava, Siddharth; Taylor, Zach; Grundfest, Warren S.; Stafsudd, Oscar M.


    Fluorescence lifetime imaging microscopy (FLIM) is a technique that has been proven to produce quantitative and qualitative differentiation and identification of substances with good specificity and sensitivity based on lifetime extracted information. This technique has shown the ability to also differentiate between a wide range of tissue types to identify malignant from benign tissue in vivo and ex vivo. However, the complexity, long duration and effort required to generate this information has limited the adoption of these techniques in a clinical setting. Our group has developed a time-resolved imaging system (patent pending) that does not require the extraction of lifetimes or use of complex curve fitting algorithms to display the needed information. The technique, entitled Lifetime Fluorescence Imaging (LFI, or NoFYI), converts fluorescence lifetime decay information directly into visual contrast. Initial studies using Fluorescein and Rhodamine-B demonstrated the feasibility of this approach. Subsequent studies demonstrated the ability to separate collagen and elastin powders. The technique uses nanosecond pulsed UV LEDs at 375 nm for average illumination intensities of ~4.5 μW on the tissue surface with detection by a gated CCD camera. To date, we have imaged 11 surgical head and neck squamous cell carcinoma and brain cancer biopsy specimens including 5 normal and 6 malignant samples. Images at multiple wavelengths clearly demonstrate differentiation between benign and malignant tissue, which was later confirmed by histology. Contrast was obtained between fluorophores with 35 μm spatial resolution and an SNR of ~30 dB allowing us to clearly define tumor margins in these highly invasive cancers. This method is capable of providing both anatomical and chemical information for the pathologist and the surgeon. These results suggest that this technology has a possible role in identifying tumors in tissue specimens and detecting tumor margins during procedures.

  14. Margins in high temperature leak-before-break assessments

    Energy Technology Data Exchange (ETDEWEB)

    Budden, P.J.; Hooton, D.G.


    Developments in the defect assessment procedure R6 to include high-temperature mechanisms in Leak-before-Break arguments are described. In particular, the effect of creep on the time available to detect a leak and on the crack opening area, and hence leak rate, is discussed. The competing influence of these two effects is emphasized by an example. The application to Leak-before-Break of the time-dependent failure assessment diagram approach for high temperature defect assessment is then outlined. The approach is shown to be of use in assessing the erosion of margins by creep.

  15. 17 CFR 242.405 - Withdrawal of margin. (United States)


    ...) REGULATIONS M, SHO, ATS, AC, AND NMS AND CUSTOMER MARGIN REQUIREMENTS FOR SECURITY FUTURES Customer Margin Requirements for Security Futures § 242.405 Withdrawal of margin. (a) By the customer. Except as otherwise... account after such withdrawal is sufficient to satisfy the required margin for the security futures...

  16. Atrial septal defects: Pattern, clinical profile, surgical techniques and outcome at Innova heart hospital: A 4-year review

    Directory of Open Access Journals (Sweden)

    Daberechi K Adiele


    Full Text Available Background: Atrial septal defect (ASD is a congenital heart defect that leads to shunting of blood between left and right atria. It may be asymptomatic and sometimes may present with heart failure. Surgical repair is definitive, but currently non-surgical procedure is used to close the defect. Materials and Methods: It is a retrospective study of patients who underwent transcatheter closure of ASD at Innova Heart Hospital, Hyderabad, India. Echocardiography was repeated at intervals of 24 hours, then at 1, 3 and 6 months after the procedure to assess complications. The morphological characteristics of the ASD, including its diameter, location, shape and the width of surrounding septal margins, were also evaluated. Results: From April 2007 to June 2011, 69 consecutive children (29 males, 40 females with a median age of 9.0 years (range = 3.2-19 years registered with diagnosis of ASD. The median weight was 31.5 kg (range = 7.5-39.0 kg. Five patients (7.2% were young children aged 3-5 years. Forty-four (63.8% of these children presented with symptoms of heart failure, whereas 47 (68.1% of the cases repaired with device were large-sized ASD. The most common interventional procedures done were Searcare Heart® and Amplatzer® technique with a highest success rate obtained in 2010. Conclusions: ASD is a common congenital heart disease with a high success rate for those who undergo intervention.

  17. Module based training improves and sustains surgical skills

    DEFF Research Database (Denmark)

    Carlsen, C G; Lindorff-Larsen, K; Funch-Jensen, P


    PURPOSE: Traditional surgical training is challenged by factors such as patient safety issues, economic considerations and lack of exposure to surgical procedures due to short working hours. A module-based clinical training model promotes rapidly acquired and persistent surgical skills. METHODS......: A randomised controlled trial concerning supervised hernia repair in eight training hospitals in Denmark was performed. The participants were 18 registrars [Post graduate year (PGY) 3 or more] in their first year of surgical specialist training. The intervention consisted of different modules with a skills......-lab course followed by 20 supervised Lichtenstein hernia repairs. Operative performance was video recorded and blindly rated by two consultants using a previously validated skills rating scale (8-40 points). Outcome measures were change in the ratings of operative skills and operative time. RESULTS...

  18. On the Evolution of Glaciated Continental Margins (United States)

    Sverre Laberg, Jan; Rydningen, Tom Arne; Safronova, Polina A.; Forwick, Matthias


    Glaciated continental margins, continental margins where a grounded ice sheet repeatedly has been at or near the shelf break, are found at both northern and southern high-latitudes. Their evolution are in several aspects different from their low-latitude counterparts where eustatic sea-level variations possess a fundamental control on their evolution and where fluvial systems provide the main sediment input. From studies of the Norwegian - Barents Sea - Svalbard and NE Greenland continental margins we propose the following factors as the main control on the evolution of glaciated continental margins: 1) Pre-glacial relief controlling the accommodation space, 2) Ice sheet glaciology including the location of fast-flowing ice streams where source area morphology exerts a fundamental control, 3) Composition of the glacigenic sediments where the clay content in previous studies have been found to be important, and 4) Sea-level controlled both by eustacy and isostacy. From three case studies, 1) the western Barents Sea, 2) part of the North Norwegian (Troms), and 3) the Mid-Norwegian margin, the influence on these factors for the sea-floor morphology, sedimentary processes of the continental slope - deep sea and continental margin architecture are discussed. The pre-glacial relief of the mid-Norwegian and Troms margins relates to the onset of rifting and plate break-up from the early Cenozoic while for the SW Barents Sea, plate shear was followed by rifting. A wide zone of extended continental crust occurs offshore mid-Norway while this zone is much narrower offshore Troms leading to a more pronounced pre-glacial relief. Regarding sediment delivery and ice sheet glaciology the western Barents Sea exemplifies very high sediment input corresponding to an estimated average erosion of the source area of ~0.4 mm/yr (SW Barents Sea), much of which is related to subglacial erosion of Mesozoic - Cenozoic sedimentary rocks from large paleo-ice streams. The mid-Norwegian margin

  19. 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.

  20. Persistence of the embryonic lateral marginal vein: report of two cases

    Directory of Open Access Journals (Sweden)

    Rojas Martinez Raúl


    Full Text Available PURPOSE: Congenital venous malformations of the lower limbs represent a particular challenge for the vascular surgeon. Persistence of fetal veins is a rare malformation, and the most common is the persistence of the lateral marginal vein usually observed in patients with Klippel-Trenaunnay Syndrome. The persistence of this embryonic vein as an isolated venous malformation without the other characteristics of the Klippel-Trenaunnay Syndrome has not yet been reported. This paper describes two cases. METHODS: Two patients, a 17-year-old male patient and a 16-year-old female, have had since their birth a large venous trunk in the lateral aspect of the right leg and thigh. The limbs underwent duplex scanning and phlebography. The surgical removal of the lateral marginal vein was performed. RESULTS: Surgical treatment resulted in very good functional and aesthetic results. Follow-up at 26 months showed no evidence of varicose vein recurrence. CONCLUSIONS: To achieve good results, surgical intervention may be indicated in cases of orthopedic deformity, hemorrhage, symptomatic, and unaesthetic lesions.

  1. Variance Analysis on the Impact of High Savings Rate on the Urban and Rural Population Structure--Based on Time-varying Analysis of the Marginal Propensity to Consume%储蓄率居高的城乡人口结构影响的差异分析--基于边际消费倾向的时变性分析

    Institute of Scientific and Technical Information of China (English)



    A prominent feature of China’s economic imbalance is the high savings rate. Enhancing theconsumption power helps China’s economyshift to a new normal state on a stable and sustainable basis. Based on the theory of life cycle,the marginal propensity to consume is dynamically solved in this article. And this paper analyzes how it is affect-ed by the income fluctuations and changes in population age structure of the urban and rural areas respectively. The re-search result indicates that the consumption action of the urban residents has a stronger propensity,while the consump-tion level of rural residents has a higher elasticity as the income fluctuates. The impact of the changes in thepopulation age structure is different on the consumption of the rural and urban residents. Rural residents tend to reduce the current consumption to increase savings to cope with old age as the fertility ratio falls continuously. As the social security sys-tem for the urban residents is rather perfect,their motivation to save is small. Meanwhile, as there is a substitution ef-fect of the quantity by the quality of the children, the motivation of the urban residents shows stronger propensity for the education savings and gift savings.%我国经济不平衡的一个突出特点是高储蓄率。提升消费动力有助于我国经济在稳定和可持续的基础上转入新常态。本文以生命周期理论为研究基础,动态求解居民边际消费倾向,分城乡研究了居民收入的波动和人口年龄结构转变对其的影响特点。研究结论表明:城镇居民的消费行为具有较强的惯性,而农村居民消费水平则依据收入波动而呈现较高弹性。人口结构的变化对农村和城镇居民消费的影响也是不一样的,农村居民满足理论规律。在生育率不断下降情况下,农民倾向于降低当期消费而提高储蓄以应付养老。较完善的社保体制导致城镇居民养老储蓄动机较小;由于子

  2. Preparing and Restoring Composite Resin Restorations. The Advantage of High Magnification Loupes or the Dental Surgical Operating Microscope. (United States)

    Mamoun, John


    Use of magnification, such as 6x to 8x binocular surgical loupes or the surgical operating microscope, combined with co-axial illumination, may facilitate the creation of stable composite resin restorations that are less likely to develop caries, cracks or margin stains over years of service. Microscopes facilitate observation of clinically relevant microscopic visual details, such as microscopic amounts of demineralization or caries at preparation margins; microscopic areas of soft, decayed tooth structure; microscopic amounts of moisture contamination of the preparation during bonding; or microscopic marginal gaps in the composite. Preventing microscope-level errors in composite fabrication can result in a composite restoration that, at initial placement, appears perfect when viewed under 6x to 8x magnification and which also is free of secondary caries, marginal staining or cracks at multi-year follow-up visits.

  3. Minimally invasive surgical technique for tethered surgical drains

    Directory of Open Access Journals (Sweden)

    Shane R Hess


    Full Text Available A feared complication of temporary surgical drain placement is from the technical error of accidentally suturing the surgical drain into the wound. Postoperative discovery of a tethered drain can frequently necessitate return to the operating room if it cannot be successfully removed with nonoperative techniques. Formal wound exploration increases anesthesia and infection risk as well as cost and is best avoided if possible. We present a minimally invasive surgical technique that can avoid the morbidity associated with a full surgical wound exploration to remove a tethered drain when other nonoperative techniques fail.

  4. Marginal integrity of two zirconia-based crowns before and after porcelain veneering

    Directory of Open Access Journals (Sweden)

    Sakineh Nikzad


    Full Text Available Background and Aims: The marginal integrity of fixed restorations always is a major matter of concern for dental clinicians. Any cause of distortion, including veneering processes, in the marginal integrity is supposed to be detrimental for long-term success of fixed dental prostheses. The aim of this in vitro study was to compare the marginal adaptation of two different full ceramic restoration systems (Zirkouzahu&Cercon and possible changes in marginal integrity following the multiple veneering process. Materials and Methods: Twelve all-ceramic crowns in the form of coping were fabricated on a pre-made standard metal die with finish line of shoulder preparation from two commercial systems: Cercon® and Zirkonzahn®. The specimens were not cemented. The Crown/Die discrepancy were measured by means of a precise stereo microscope (accuracy±0.1 μm, at various points (n=12 selected along circumferential margin of the restorations. Same procedure was accomplished after applying the veneering porcelain. The mean gap dimensions were calculated and data were analyzed by multivariate (b test. Results: Mean marginal gap dimensions before and after veneering porcelain firing cycles, for Cercon® were (59.67±13.46 µm and (63.75±14.16 µm and for Zirkonzahn® were (65.81±24.37 µm and (64.74±21.94 µm, respectively. Hotelling trace Multivariate(b test method showed that the rate of mismatching marginal integrity in two groups (Cercon® and Zirkonzahn® had no significant difference before and after porcelain firing (P>0.05. Conclusion: Within the limitation of this study, the marginal integrity of both systems were seems to be within the clinically acceptable standard dimension, i.e. 120μm.The marginal gap of both all-ceramic systems were not affected by veneering porcelain firing cycles.

  5. Upper lid crease approach for margin rotation in trachomatous cicatricial entropion without external sutures

    Directory of Open Access Journals (Sweden)

    Antonio Augusto Velasco e Cruz


    Full Text Available ABSTRACT Purpose: To describe the use of a lid crease incision for upper eyelid margin rotation in cicatricial entropion combining internal traction on the anterior lamella, tarsotomy, and tarsal overlap without external sutures. Methods: Surgical description: The main steps of the procedure consisted of exposure of the entire tarsal plate up to the eyelashes followed by tarsotomy through the conjunctiva. A double-armed 6.0 polyglactin suture was then passed through the distal tarsal fragment to the marginal section of the orbicularis oculi muscle. As the sutures were tied, the distal tarsus advanced over the marginal section, and traction was exerted on the marginal strip of the orbicularis muscle. There were no bolsters or external knots. The pretarsal skin-muscle flap was closed with a 6.0 plain gut suture. Results: We used this procedure at a tertiary hospital in Saudi Arabia from 2013 to 2014. Sixty upper lids of 40 patients (23 women and 17 men were operated on, with an age range of 44-99 years [mean ± standard deviation (SD = 70.9 ± 13.01 years]. Bilateral surgery was performed on 21 patients. Follow-up ranged from 1 to 12 months (mean 3.0 ± 2.71 months. Forty percent of the patients (24 lids had more than 3 months' follow-up. The postoperative lid margin position was good in all cases. Trichiasis (two lashes was observed in only one patient with unilateral entropion on the medial aspect of the operated lid. Conclusions: The upper lid margin can be effectively rotated through a lid crease incision with internal sutures. The technique combines the main mechanisms of the Wies and Trabut approaches and avoids the use of bolsters or external sutures, which require a second consultation to be removed. Some other lid problems, such as ptosis, retraction, or dermatochalasis, can be concomitantly addressed during the procedure.

  6. Geological features and geophysical signatures of continental margins of India

    Digital Repository Service at National Institute of Oceanography (India)

    Krishna, K.S.

    and classification of continental margins are in general dependent on style of continental splitting, rifting, subsidence and their proximity to the tectonic plate boundaries, at times the margins undergo for modifications by sediment deposition and volcanic... by Deccan-Reunion hotspot volcanism and Bengal Fan sedimentation respectively. Volcanism has dominated on the western continental margin of India, thereby the margin had been turned into a volcanic passive continental margin, while eastern continental...


    Energy Technology Data Exchange (ETDEWEB)



    BI-OMP supports DOE's mission in Climate Change Research. The program provides the fundamental understanding of the linkages between carbon and nitrogen cycles in ocean margins. Researchers are providing a mechanistic understanding of these cycles, using the tools of modern molecular biology. The models that will allow policy makers to determine safe levels of greenhouse gases for the Earth System.

  8. Recidiva tardia de linfoma da zona marginal


    Rocha,Talita M. B.S.; Bortolheiro,Tereza C.; Costa, Eduardo; Haardt,Daniela; Roberto P. Paes; Chiattone, Carlos S.


    O linfoma de zona marginal é um linfoma de baixo grau com curso clínico indolente e potencial de recidiva.1,2 Apresentamos um caso de recidiva tardia após 25 anos de aparente remissão completa, levantando a possibilidade de recidiva de doença preexistente ou desenvolvimento de novo clone neoplásico.

  9. Large margin image set representation and classification