WorldWideScience

Sample records for surgical margin status

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

    International Nuclear Information System (INIS)

    Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko

    1999-01-01

    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)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1999-09-01

    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)

  3. Radical prostatectomy: positive surgical margins matter.

    Science.gov (United States)

    Meeks, Joshua J; Eastham, James A

    2013-10-01

    A positive surgical margin (PSM) in the radical prostatectomy (RP) specimen is associated with biochemical recurrence (BCR) and the need for adjuvant radiation therapy, and is a surrogate for surgical quality. We review the available data describing the identification, anatomy, and management of PSM after RP. A PubMed search (using English language as a filter) was performed to identify factors affecting PSMs and their management. PSMs are associated with an increased likelihood of BCR after RP. The most common location for a PSM is the apex, followed by the posterolateral edge of the prostate. The risk of recurrence in a patient with a PSM is associated with the location, length, and Gleason score of the PSM. The management of a patient with a PSM remains controversial, with some recommending adjuvant radiation therapy for all PSMs and others suggesting only salvage radiation therapy for men who experience BCR. PSMs are associated with an increased likelihood of BCR and often result in initiation of adjuvant treatment. Therefore, the goal of surgery should be to minimize the likelihood of a PSM. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Influence of radiation dose on positive surgical margins in women undergoing breast conservation therapy

    International Nuclear Information System (INIS)

    DiBiase, Steven J.; Komarnicky, Lydia T.; Heron, Dwight E.; Schwartz, Gordon F.; Mansfield, Carl M.

    2002-01-01

    Purpose: Positive surgical margins adversely influence local tumor control in breast conservation therapy (BCT). However, reports have conflicted regarding whether an increased radiation dose can overcome this poor prognostic factor. In this study, we evaluated the influence of an increased radiation dose on tumor control in women with positive surgical margins undergoing BCT. Methods and Materials: Between 1978 and 1994, 733 women with pathologic Stage I-II breast cancer and known surgical margin status were treated at Thomas Jefferson University Hospital with BCT. Of these 733 patients, 641 women had a minimal tumor bed dose of 60 Gy and had documentation of their margin status; 509 had negative surgical margins, and 132 had positive surgical margins before definitive radiotherapy. Complete gross excision of the tumor and axillary lymph node sampling was obtained in all patients. The median radiation dose to the primary site was 65.0 Gy (range 60-76). Of the women with positive margins (n=132), the influence of higher doses of radiotherapy was evaluated. The median follow-up time was 52 months. Results: The local tumor control rate for patients with negative margins at 5 and 10 years was 94% and 88%, respectively, compared with 85% and 67%, respectively, for those women with positive margins (p=0.001). The disease-free survival rate for the negative margin group at 5 and 10 years was 91% and 82%, respectively, compared with 76% and 71%, respectively, for the positive margin group (p = 0.001). The overall survival rate of women with negative margins at 5 and 10 years was 95% and 90%, respectively. By comparison, for women with positive surgical margins, the overall survival rate at 5 and 10 years was 86% and 79%, respectively (p=0.008). A comparison of the positive and negative margin groups revealed that an increased radiation dose (whether entered as a dichotomous or a continuous variable) >65.0 Gy did not improve local tumor control (p=0.776). On Cox

  5. Preoperative imaging and surgical margins in maxillectomy patients

    NARCIS (Netherlands)

    Kreeft, Anne Marijn; Smeele, Ludwig E.; Rasch, Coen R. N.; Hauptmann, Michael; Rietveld, Derk H. F.; Leemans, C. René; Balm, Alfons J. M.

    2012-01-01

    Background High rates of positive surgical margins are reported after a maxillectomy. A large part of tumors that are preoperatively considered operable can thus not be resected with tumor-free margins. Methods This was a retrospective study on medical files of 69 patients that underwent

  6. Molecular markers in the surgical margin of oral carcinomas

    DEFF Research Database (Denmark)

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

    2009-01-01

    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...

  7. Positive Surgical Margins in Favorable-Stage Differentiated Thyroid Cancer.

    Science.gov (United States)

    Mercado, Catherine E; Drew, Peter A; Morris, Christopher G; Dziegielewski, Peter T; Mendenhall, William M; Amdur, Robert J

    2018-04-16

    The significance of positive margin in favorable-stage well-differentiated thyroid cancer is controversial. We report outcomes of positive-margin patients with a matched-pair comparison to a negative-margin group. A total of 25 patients with classic-histology papillary or follicular carcinoma, total thyroidectomy +/- node dissection, stage T1-3N0-1bM0, positive surgical margin at primary site, adjuvant radioactive iodine (I-131), and age older than 18 years were treated between 2003 and 2013. Endpoints were clinical and biochemical (thyroglobulin-only) recurrence-free survival. Matched-pair analysis involved a 1:1 match with negative-margin cases matched for overall stage and I-131 dose. Recurrence-free survival in positive-margin patients was 71% at 10 years. No patient was successfully salvaged with additional treatment. Only 1 patient died of thyroid cancer. Recurrence-free survival at 10 years was worse with a positive (71%) versus negative (90%) margin (P=0.140). Cure with a microscopically positive margin was suboptimal (71%) despite patients having classic-histology papillary and follicular carcinoma, favorable stage, and moderate-dose I-131 therapy.

  8. Role of specimen US for predicting resection margin status in breast conserving therapy.

    Science.gov (United States)

    Moschetta, M; Telegrafo, M; Introna, T; Coi, L; Rella, L; Ranieri, V; Cirili, A; Stabile Ianora, A A; Angelelli, G

    2015-01-01

    To assess the diagnostic accuracy of specimen ultrasound (US) for predicting resection margin status in women undergoing breast conserving therapy for US-detected cancer, having the histological findings as the reference standard. A total of 132 consecutive patients (age range, 34-87 years; mean, 51 years) underwent breast-conserving surgery for US-detected invasive breast cancer. All surgical specimens underwent US examination. The presence of lesion within the specimen and its distance from the specimen margins were assessed considering a threshold distance between the lesion and specimen margins of 10 mm. US findings were then compared with the pathological ones and specimen US. Sensitivity, specificity, diagnostic accuracy, positive (PPV) and negative predictive values (NPV) for predicting histological margin status were evaluated, having the histological findings as the reference standard. The histological examination detected invasive ductal carcinoma in 96/132 (73%) cases, invasive lobular carcinoma in 32/132 (24%), mucinous carcinoma in 4/132 (3%). The pathological margin analysis revealed 96/132 (73%) negative margins and 36 (27%) close/positive margins. US examination detected all 132 breast lesions within the surgical specimens. 110 (83%) negative margins and 22 (17%) positive margins were found on US. Sensitivity, specificity, diagnostic accuracy, PPV and NPV of 44%, 94%, 80%, 73% and 82%, respectively, were found for specimen US. Specimen US represents a time and cost saving imaging tool for evaluating the presence of US detected-breast lesion within surgical specimen and for predicting the histological margin status.

  9. Do Robotic Surgical Systems Improve Profit Margins? A Cross-Sectional Analysis of California Hospitals.

    Science.gov (United States)

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

    2017-09-01

    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.

  10. [A new technique for ensuring negative surgical margins during partial nephrectomy: the ex vivo ultrasound control].

    Science.gov (United States)

    Desmonts, A; Tillou, X; Le Gal, S; Secco, M; Orczyk, C; Bensadoun, H; Doerfler, A

    2013-10-01

    To evaluate the feasibility and the efficiency of intraoperative ex vivo ultrasound of resection margins in patients undergoing partial nephrectomy by urologist. Patients undergoing partial nephrectomy from July 2010 to November 2012 for T1-T2 renal tumors were included in analysis. Tumor margin status was immediately determined by ex vivo ultrasound done by the surgeon himself. Results were compared with margin status on definitive pathological evaluation. A total of 26 men and 15 women with a median age of 61 (30-82) years old were included in analysis. Intraoperative ex vivo ultrasound revealed negative surgical margins in 38 cases and positive margins in two. Final pathological results revealed negative margins in all except one case. Ultrasound sensitivity and specificity were 100% and 97%, respectively. Mean ultrasound duration was 1minute±1. Mean tumor and margin sizes were 3.4±1.8cm and 2.38±1.76mm, respectively. Intraoperative ex vivo ultrasound of resection margins in patients undergoing partial nephrectomy by a urologist seemed to be feasible, efficient and easy. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  11. Factors That Influence Surgical Margin State in Patients Undergoing Cold Knife Conization - A Single Center Experience.

    Science.gov (United States)

    Aluloski, Igor; Tanturovski, Mile; Petrusevska, Gordana; Jovanovic, Rubens; Kostadinova-Kunovska, Slavica

    2017-12-01

    To evaluate the factors that influence the surgical margin state in patients undergoing cold knife conization at the University Clinic of Gynecology and Obstetrics in Skopje, Republic of Macedonia Materials and methods: We have retrospectively analyzed the medical records of all patients that underwent a cold knife conization at our Clinic in 2015. We cross-referenced the surgical margin state with the histopathological diagnosis (LSIL, HSIL or micro-invasive/invasive cancer), menopausal status of the patients, number of pregnancies, surgeon experience, operating time and cone depth. The data was analyzed with the Chi square test, Fisher's exact test for categorical data and Student's T test for continuous data and univariate and multivariate logistical regressions were performed. A total of 246 medical records have neen analyzed, out of which 29 (11.79%) patients had LSIL, 194 (78.86%) had HSIL and 23 (9.34%) patients suffered micro-invasive/invasive cervical cancer. The surgical margins were positive in 78 (31.7%) of the patients. The average age of the patients was 41.13 and 35 (14.23%) of the patients were menopausal. The multivariate logistic regression identified preoperative forceps biopsy of micro-invasive SCC, HSIL or higher cone specimen histology and shorter cone depth as independent predictors of surgical margin involvement in patients undergoing cold knife conization. In the current study, we have found no association between the inherent characteristics of the patient and the surgeon and the surgical margin state after a CKC. The most important predictors for positive margins were the severity of the lesion and the cone depth.

  12. A gene signature in histologically normal surgical margins is predictive of oral carcinoma recurrence

    International Nuclear Information System (INIS)

    Reis, Patricia P; Simpson, Colleen; Goldstein, David; Brown, Dale; Gilbert, Ralph; Gullane, Patrick; Irish, Jonathan; Jurisica, Igor; Kamel-Reid, Suzanne; Waldron, Levi; Perez-Ordonez, Bayardo; Pintilie, Melania; Galloni, Natalie Naranjo; Xuan, Yali; Cervigne, Nilva K; Warner, Giles C; Makitie, Antti A

    2011-01-01

    Oral Squamous Cell Carcinoma (OSCC) is a major cause of cancer death worldwide, which is mainly due to recurrence leading to treatment failure and patient death. Histological status of surgical margins is a currently available assessment for recurrence risk in OSCC; however histological status does not predict recurrence, even in patients with histologically negative margins. Therefore, molecular analysis of histologically normal resection margins and the corresponding OSCC may aid in identifying a gene signature predictive of recurrence. We used a meta-analysis of 199 samples (OSCCs and normal oral tissues) from five public microarray datasets, in addition to our microarray analysis of 96 OSCCs and histologically normal margins from 24 patients, to train a gene signature for recurrence. Validation was performed by quantitative real-time PCR using 136 samples from an independent cohort of 30 patients. We identified 138 significantly over-expressed genes (> 2-fold, false discovery rate of 0.01) in OSCC. By penalized likelihood Cox regression, we identified a 4-gene signature with prognostic value for recurrence in our training set. This signature comprised the invasion-related genes MMP1, COL4A1, P4HA2, and THBS2. Over-expression of this 4-gene signature in histologically normal margins was associated with recurrence in our training cohort (p = 0.0003, logrank test) and in our independent validation cohort (p = 0.04, HR = 6.8, logrank test). Gene expression alterations occur in histologically normal margins in OSCC. Over-expression of the 4-gene signature in histologically normal surgical margins was validated and highly predictive of recurrence in an independent patient cohort. Our findings may be applied to develop a molecular test, which would be clinically useful to help predict which patients are at a higher risk of local recurrence

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

    International Nuclear Information System (INIS)

    Childs, Stephanie K.; Chen Yuhui; Duggan, Margaret M.; Golshan, Mehra; Pochebit, Stephen; Wong, Julia S.; Bellon, Jennifer R.

    2012-01-01

    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 features

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

    Science.gov (United States)

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

    2017-10-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Chiou Wen-Yen

    2010-09-01

    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.

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

    International Nuclear Information System (INIS)

    Chiou, Wen-Yen; Hung, Shih-Kai; Lin, Hon-Yi; Hsu, Feng-Chun; Lee, Moon-Sing; Ho, Hsu-Chueh; Su, Yu-Chieh; Lee, Ching-Chih; Hsieh, Chen-Hsi; Wang, Yao-Ching

    2010-01-01

    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. 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 6 th 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. 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. 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

  17. Light Reflectance Spectroscopy to Detect Positive Surgical Margins on Prostate Cancer Specimens.

    Science.gov (United States)

    Morgan, Monica S C; Lay, Aaron H; Wang, Xinlong; Kapur, Payal; Ozayar, Asim; Sayah, Maryam; Zeng, Li; Liu, Hanli; Roehrborn, Claus G; Cadeddu, Jeffrey A

    2016-02-01

    Intraoperative frozen section analysis is not routinely performed to determine positive surgical margins at radical prostatectomy due to time requirements and unproven clinical usefulness. Light reflectance spectroscopy, which measures light intensity reflected or backscattered from tissues, can be applied to differentiate malignant from benign tissue. We used a novel light reflectance spectroscopy probe to evaluate positive surgical margins on ex vivo radical prostatectomy specimens and correlate its findings with pathological examination. Patients with intermediate to high risk disease undergoing radical prostatectomy were enrolled. Light reflectance spectroscopy was performed on suspected malignant and benign prostate capsule immediately following organ extraction. Each light reflectance spectroscopy at 530 to 830 nm was analyzed and correlated with pathological results. A regression model and forward sequential selection algorithm were developed for optimal feature selection. Eighty percent of light reflectance spectroscopy data were selected to train a logistic regression model, which was evaluated by the remaining 20% data. This was repeated 5 times to calculate averaged sensitivity, specificity and accuracy. Light reflectance spectroscopy analysis was performed on 17 ex vivo prostate specimens, on which a total of 11 histologically positive and 22 negative surgical margins were measured. Two select features from 700 to 830 nm were identified as unique to malignant tissue. Cross-validation when performing the predictive model showed that the optical probe predicted positive surgical margins with 85% sensitivity, 86% specificity, 86% accuracy and an AUC of 0.95. Light reflectance spectroscopy can identify positive surgical margins accurately in fresh ex vivo radical prostatectomy specimens. Further study is required to determine whether such analysis may be used in real time to improve surgical decision making and decrease positive surgical margin rates

  18. Raman spectroscopy reveals biophysical markers in skin cancer surgical margins

    Science.gov (United States)

    Feng, Xu; Moy, Austin J.; Nguyen, Hieu T. M.; Zhang, Yao; Fox, Matthew C.; Sebastian, Katherine R.; Reichenberg, Jason S.; Markey, Mia K.; Tunnell, James W.

    2018-02-01

    The recurrence rate of nonmelanoma skin cancer is highly related to the residual tumor after surgery. Although tissueconserving surgery, such as Mohs surgery, is a standard method for the treatment of nonmelanoma skin cancer, they are limited by lengthy and costly frozen-section histopathology. Raman spectroscopy (RS) is proving to be an objective, sensitive, and non-destructive tool for detecting skin cancer. Previous studies demonstrated the high sensitivity of RS in detecting tumor margins of basal cell carcinoma (BCC). However, those studies rely on statistical classification models and do not elucidate the skin biophysical composition. As a result, we aim to discover the biophysical differences between BCC and primary normal skin structures (including epidermis, dermis, hair follicle, sebaceous gland and fat). We obtained freshly resected ex vivo skin samples from fresh resection specimens from 14 patients undergoing Mohs surgery. Raman images were acquired from regions containing one or more structures using a custom built 830nm confocal Raman microscope. The spectra were grouped using K-means clustering analysis and annotated as either BCC or each of the five normal structures by comparing with the histopathology image of the serial section. The spectral data were then fit by a previously established biophysical model with eight primary skin constituents. Our results show that BCC has significant differences in the fit coefficients of nucleus, collagen, triolein, keratin and elastin compared with normal structures. Our study reveals RS has the potential to detect biophysical changes in resection margins, and supports the development of diagnostic algorithms for future intraoperative implementation of RS during Mohs surgery.

  19. Whipple Resection: Concordance Between Frozen Section And Permanent Section Diagnosis Of Surgical Margins.

    Science.gov (United States)

    Bilal, Muhammad; Tariq, Hina; Mamoon, Nadira

    2018-01-01

    Margin assessment is done in Whipple procedures which are usually performed to resect tumours of head of pancreas and ampullary/periampullary region. Aims and objective of the study are to determine the concordance between frozen sections (FS) and permanent sections (PS) of surgical margins in Whipple resections. It is a retrospective study, from January 2008 to January 2015 (07 years). It includes the specimen with malignancy in final report and for which FS of pancreatic and/or CBD margin(s) were requested. Data was retrieved from Laboratory information system (LIS) database. Of the 41 bile duct margins in cases of ampullary tumours, 03 were positive on FS as well as PS, 35 were negative on FS as well as on PS. Results showed 100% sensitivity, 92.1% specificity, 50% PPV and 100% NPV. Results of 36 pancreatic margins in cases of ampullary showed 100% sensitivity, 97.1% specificity, 50% PPV and 100% NPV. In pancreatic carcinoma cases, none of CBD margins were reported as positive on FS, 02 margins reported as negative were found positive on PS, while 17 were negative on FS as well as PS. Results showed 100% specificity and 89.5% NPV. Of the 27 pancreatic margins tested in pancreatic tumours 100% sensitivity, 94.1% specificity, 88.9% PPV and 100% NPV was found. Factors such as absent prior tissue diagnosis and/or inflammatory processes make margin diagnosis difficult. However, a high concordance was observed between our FS and PS diagnosis.

  20. Systematic Review of Studies Reporting Positive Surgical Margins After Bladder Neck Sparing Radical Prostatectomy.

    Science.gov (United States)

    Bellangino, Mariangela; Verrill, Clare; Leslie, Tom; Bell, Richard W; Hamdy, Freddie C; Lamb, Alastair D

    2017-11-07

    Bladder neck preservation (BNP) during radical prostatectomy (RP) has been proposed as a method to improve early recovery of urinary continence after radical prostatectomy. However, there is concern over a possible increase in the risk of positive surgical margins and prostate cancer recurrence rate. A recent systematic review and meta-analysis reported improved early recovery and overall long-term urinary continence without compromising oncologic control. The aim of our study was to perform a critical review of the literature to assess the impact on bladder neck and base margins after bladder neck sparing radical prostatectomy. We carried out a systematic review of the literature using Pubmed, Scopus and Cochrane library databases in May 2017 using medical subject headings and free-text protocol according to PRISMA guidelines. We used the following search terms: bladder neck preservation, prostate cancer, radical prostatectomy and surgical margins. Studies focusing on positive surgical margins (PSM) in bladder neck sparing RP pertinent to the objective of this review were included. Overall, we found 15 relevant studies reporting overall and site-specific positive surgical margins rate after bladder neck sparing radical prostatectomy. This included two RCTs, seven prospective comparative studies, two retrospective comparative studies and four case series. All studies were published between 1993 and 2015 with sample sizes ranging between 50 and 1067. Surgical approaches included open, laparoscopic and robot-assisted radical prostatectomy. The overall and base-specific PSM rates ranged between 7-36% and 0-16.3%, respectively. Mean base PSM was 4.9% in those patients where bladder neck sparing was performed, but only 1.85% in those without sparing. Bladder neck preservation during radical prostatectomy may increase base-positive margins. Further studies are needed to better investigate the impact of this technique on oncological outcomes. A future paradigm could

  1. 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

    2011-01-01

    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....

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

    DEFF Research Database (Denmark)

    Lawaetz, Mads; Homøe, Preben

    2014-01-01

    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...

  3. 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

    2011-01-01

    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....

  4. Original Article Surgical Margin Status after Breast Conservation ...

    African Journals Online (AJOL)

    KIGZ

    analysis of breast surgery for breast cancer patients was done from 2008 to 2011 at Aga Khan. University ... early breast cancer, thus breast conservation therapy is becoming more available. Excision of the ... palpable nodes. Histology was ...

  5. Clinical implication of negative conversion of predicted circumferential resection margin status after preoperative chemoradiotherapy for locally advanced rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Nam Kwon [Department of Radiation Oncology, Korea University Medical Center, Korea University College of Medicine, Seoul (Korea, Republic of); Kim, Chul Yong, E-mail: kcyro@korea.ac.kr [Department of Radiation Oncology, Korea University Medical Center, Korea University College of Medicine, Seoul (Korea, Republic of); Park, Young Je; Yang, Dae Sik; Yoon, Won Sup [Department of Radiation Oncology, Korea University Medical Center, Korea University College of Medicine, Seoul (Korea, Republic of); Kim, Seon Hahn; Kim, Jin [Division of Colorectal Surgery, Department of Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul (Korea, Republic of)

    2014-02-15

    Objective: To evaluate the prognostic implication of the negative conversion of predicted circumferential resection margin status before surgery in patients with locally advanced rectal cancer with predicted circumferential resection margin involvement. Methods: Thirty-eight patients (28 men, 10 women; median age, 61 years; age range, 39–80 years) with locally advanced rectal cancer with predicted circumferential resection margin involvement who underwent preoperative chemoradiotherapy followed by radical surgery were analyzed. Involvement of the circumferential resection margin was predicted on the basis of pre- and post-chemoradiotherapy magnetic resonance imaging. The primary endpoints were 3-year local recurrence-free survival and overall survival. Results: The median follow-up time was 41.1 months (range, 13.9–85.2 months). The negative conversion rate of predicted circumferential resection margin status after preoperative chemoradiotherapy was 65.8%. Patients who experienced negative conversion of predicted circumferential resection margin status had a significantly higher 3-year local recurrence-free survival rate (100.0% vs. 76.9%; P = 0.013), disease-free survival rate (91.7% vs. 59.3%; P = 0.023), and overall survival rate (96.0% vs. 73.8%; P = 0.016) than those who had persistent circumferential resection margin involvement. Conclusions: The negative conversion of the predicted circumferential resection margin status as predicted by magnetic resonance imaging will assist in individual risk stratification as a predictive factor for treatment response and survival before surgery. These findings may help physicians determine whether to administer more intense adjuvant chemotherapy or change the surgical plan for patients displaying resistance to preoperative chemoradiotherapy.

  6. Non-tumor enhancement at the surgical margin on CT after the removal of brain tumors

    International Nuclear Information System (INIS)

    Adachi, Michito; Hosoya, Takaaki; Yamaguchi, Kohichi; Yamada, Kiyotada

    1992-01-01

    Marginal enhancement is occasionally seen at the surgical margin on CT after the total removal of brain tumors. This enhancement disappears in due time, and therefore we call it non-tumor enhancement. It is often difficult, however, to differentiate non-tumor enhancement from tumor recurrence. In this study, we attempted to determine the characteristics of non-tumor enhancement. The subjects of the study consisted of 15 patients with astrocytoma and one with metastatic tumor in whom sequential CT scans had been performed after total removal of the tumor. Based on the observation of these sequential CT scans, the characteristics of non-tumor enhancement were presumed to be as follows: (1) In four cases, enhancement at the surgical margin persisted more than four months after surgery and then disappeared. Therefore, these cases were considered non-tumor enhancement. Prolonged duration of enhancement such as that in these cases is not necessarily due to recurrence. Marginal enhancement within 3 mm in thickness and with a well-demarcated border like that of a flax is likely to be non-tumor enhancement. (author)

  7. Significance and management of positive surgical margins at the time of radical prostatectomy.

    Science.gov (United States)

    Silberstein, Jonathan L; Eastham, James A

    2014-10-01

    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.

  8. Significance and management of positive surgical margins at the time of radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Jonathan L. Silberstein

    2014-01-01

    Full Text Available 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.

  9. Positive surgical margins in nephron-sparing surgery; the great unknown

    Directory of Open Access Journals (Sweden)

    Dan Spinu

    2018-04-01

    Full Text Available There is a currently a general trend towards organ-preserving surgery, and urology is no exception. Specifically, nephron-sparing surgery (NSS has gained general acceptance for T1a renal cell carcinoma (guidelines recommendations. Moreover T1b, T2 and even T3 stage tumors have been included on the nephron sparing list at some centers. An unresolved issue is that of positive surgical margins (PSM, not only their detection but also the implications for follow up and treatment. This paper highlights data available on risk factors for PSM, their clinical relevance, and possible therapeutic consequences. From the surgeon’s viewpoint, NSS is a daring and risky surgical procedure. Urological guidelines stress the importance of NSS, and thus the trend is moving in that direction. Unresolved, however, is the problem of PSM. Trifecta, MIC, and pentafecta are applicable concepts which attempt to define the optimal endpoint of NSS, but further elaboration is necessary. Specifically, research needs to focus less on the concept of definitive margins and more on their identification and avoidance. Although some studies suggest that PSMs do not influence overall survival rate, the basic idea of preserving tissue that is not cancerous leads to further medical, social, and psychological considerations.

  10. Ex vivo MRI evaluation of prostate cancer: Localization and margin status prediction of prostate cancer in fresh radical prostatectomy specimens.

    Science.gov (United States)

    Heidkamp, Jan; Hoogenboom, Martijn; Kovacs, Iringo E; Veltien, Andor; Maat, Arie; Sedelaar, J P Michiel; Hulsbergen-van de Kaa, Christina A; Fütterer, Jurgen J

    2018-02-01

    To investigate the ability of high field ex vivo magnetic resonance imaging (MRI) to localize prostate cancer (PCa) and to predict the margin status in fresh radical prostatectomy (RP) specimens using histology as the reference standard. This Institutional Review Board (IRB)-approved study had written informed consent. Patients with biopsy-proved PCa and a diagnostic multiparametric 3T MRI examination of the prostate prior to undergoing RP were prospectively included. A custom-made container provided reference between the 7T ex vivo MRI obtained from fresh RP specimens and histological slicing. On ex vivo MRI, PCa was localized and the presence of positive surgical margins was determined in a double-reading session. These findings were compared with histological findings obtained from completely cut, whole-mount embedded, prostate specimens. In 12 RP specimens, histopathology revealed 36 PCa lesions, of which 17 (47%) and 20 (56%) were correlated with the ex vivo MRI in the first and second reading session, respectively. Nine of 12 (75%) index lesions were localized in the first session, in the second 10 of 12 (83%). Seven and 8 lesions of 11 lesions with Gleason score >6 and >0.5 cc were localized in the first and second session, respectively. In the first session none of the four histologically positive surgical margins (sensitivity 0%) and 9 of 13 negative margins (specificity 69%) were detected. In second session the sensitivity and specificity were 25% and 88%, respectively. Ex vivo MRI enabled accurate localization of PCa in fresh RP specimens, and the technique provided information on the margin status with high specificity. 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:439-448. © 2017 International Society for Magnetic Resonance in Medicine.

  11. 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: ataghian@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States)

    2013-11-15

    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.

  12. Prospective Analysis of Surgical Bone Margins After Partial Foot Amputation in Diabetic Patients Admitted With Moderate to Severe Foot Infections.

    Science.gov (United States)

    Schmidt, Brian M; McHugh, Jonathan B; Patel, Rajiv M; Wrobel, James S

    2018-04-01

    Osteomyelitis is common in diabetic foot infections and medical management can lead to poor outcomes. Surgical management involves sending histopathologic and microbiologic specimens which guides future intervention. We examined the effect of obtainment of surgical margins in patients undergoing forefoot amputations to identify patient characteristics associated with outcomes. Secondary aims included evaluating interobserver reliability of histopathologic data at both the distal-to and proximal-to surgical bone margin. Data were prospectively collected on 72 individuals and was pooled for analysis. Standardized method to retrieve intraoperative bone margins was established. A univariate analysis was performed. Negative outcomes, including major lower extremity amputation, wound dehiscence, reulceration, reamputation, or death were recorded. Viable proximal margins were obtained in 63 out of 72 cases (87.5%). Strong interobserver reliability of histopathology was recorded. Univariate analysis demonstrated preoperative platelets, albumin, probe-to-bone testing, absolute toe pressures, smaller wound surface area were associated with obtaining viable margins. Residual osteomyelitis resulted in readmission 2.6 times more often and more postoperative complications. Certain patients were significantly different in the viable margin group versus dirty margin group. High interobserver reliability was demonstrated. Obtainment of viable margins resulted in reduced rates of readmission and negative outcomes. Prognostic, Level I: Prospective.

  13. The Influence of Hospital Volume on Circumferential Resection Margin Involvement: Results of the Dutch Surgical Colorectal Audit.

    Science.gov (United States)

    Gietelink, Lieke; Henneman, Daniel; van Leersum, Nicoline J; de Noo, Mirre; Manusama, Eric; Tanis, Pieter J; Tollenaar, Rob A E M; Wouters, Michel W J M

    2016-04-01

    This population-based study evaluates the association between hospital volume and CRM (circumferential resection margin) involvement, adjusted for other confounders, in rectal cancer surgery. A low hospital volume (risk of CRM involvement (odds ratio=1.54; 95% CI: 1.12-2.11). To evaluate the association between hospital volume and CRM (circumferential resection margin) involvement in rectal cancer surgery. To guarantee the quality of surgical treatment of rectal cancer, the Association of Surgeons of the Netherlands has stated a minimal annual volume standard of 20 procedures per hospital. The influence of hospital volume has been examined for different outcome variables in rectal cancer surgery. Its influence on the pathological outcome (CRM) however remains unclear. As long-term outcomes are best predicted by the CRM status, this parameter is of essential importance in the debate on the justification of minimal volume standards in rectal cancer surgery. Data from the Dutch Surgical Colorectal Audit (2011-2012) were used. Hospital volume was divided into 3 groups, and baseline characteristics were described. The influence of hospital volume on CRM involvement was analyzed, in a multivariate model, between low- and high-volume hospitals, according to the minimal volume standards. This study included 5161 patients. CRM was recorded in 86% of patients. CRM involvement was 11% in low-volume group versus 7.7% and 7.9% in the medium- and high-volume group (P≤0.001). After adjustment for relevant confounders, the influence of hospital volume on CRM involvement was still significant odds ratio (OR) = 1.54; 95% CI: 1.12-2.11). The outcomes of this pooled analysis support minimal volume standards in rectal cancer surgery. Low hospital volume was independently associated with a higher risk of CRM involvement (OR = 1.54; 95% CI: 1.12-2.11).

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

    International Nuclear Information System (INIS)

    La Roca, Ricardo L.R. Felts de; Fonseca, Francisco Paula da; Cunha, Isabela Werneck da; Bezerra, Stephania Martins

    2013-01-01

    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

  15. 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: Ricardo@delarocaurologia.com.br [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil); Fonseca, Francisco Paula da, E-mail: fpf@uol.com.br [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: iwerneck@gmail.com, E-mail: stephaniab@gmail.com [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil). Dept. de Patologia

    2013-07-01

    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

  16. Impact of Margin Status on Local Recurrence After Mastectomy for Ductal Carcinoma In Situ

    International Nuclear Information System (INIS)

    Childs, Stephanie K.; Chen, Yu-Hui; Duggan, Margaret M.; Golshan, Mehra; Pochebit, Stephen; Punglia, Rinaa S.; Wong, Julia S.; Bellon, Jennifer R.

    2013-01-01

    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

  17. Expression profiles of selected genes in tumors and matched surgical margins in oral cavity cancer: Do we have to pay attention to the molecular analysis of the surgical margins?

    Science.gov (United States)

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

    2018-04-24

    Head and neck squamous cell carcinomas (HNSCCs) are associated with an interplay between genetics and the environment; they account for 3% of all diagnosed malignant tumors in men and 2% of those in women. The aim of the study was to analyze the significance of TIMP3, SFRP1, SFRP2, CDH1, RASSF1, RORA, and DAPK1 gene expression in head and neck squamous cell carcinoma tumors, and in matching surgical margin samples. We also analyzed the association between clinical parameters and the expression of the selected genes. Following surgical resection, 56 primary HNSCC tumors and matching surgical margin samples were collected from patients at the Clinic of Oncological and Reconstructive Surgery of Maria Skłodowska-Curie Memorial Cancer Center and the Institute of Oncology in Gliwice, Poland. The gene expression levels were analyzed by quantitative reverse transcription (qRT)-PCR. SFRP1 gene expression was statistically significantly lower in the tumor samples than in the surgical margins (0.30 ±0.36 vs 0.62 ±0.36; p < 0.01). No correlation was found between gene expression and clinical parameters, except DAPK1, where low expression correlated with alcohol abuse (0.85 ±1.19 vs 1.97 ±3.22; p = 0.074). Moreover, patients with G3 grade tumors, i.e., poorly differentiated tumors, had significantly higher values of DAPK1 gene expression than the G1 (well-differentiated tumors) and G2 (moderately differentiated) groups. There are many different reasons and concepts for altered gene expression in tumors and surgical margin tissue. Tumor heterogeneity and its microenvironment are undoubtedly linked to the biology of HNSCC. In order to understand specific tumor behavior and the microenvironment, further studies are needed. To find markers connected with cancer development and to provide insight into the earliest stages of cancer development, attention should also be focused on molecular analysis of the surgical margins.

  18. In vitro histological evaluation of the surgical margins made by different laser wavelengths in tongue tissues

    Science.gov (United States)

    Azevedo, Ana-Salvaterra; Ferreira, Fernando; Delgado, Maria-Leonor; Garcês, Fernanda; Carreira, Sofia; Martins, Marco; Suarez-Quintanilla, Juan

    2016-01-01

    Background Lasers have become standard tools for the surgical treatment of oral lesions. The purpose of this study is to determine the surgical margins and histologically evaluate the tissue thermal effects induced by different types of surgical instruments. Material and Methods Cuts were made in pork tongues’ mucosa with different lasers (Er:YAG at 2W with and without air / water spray and at 4W with and without air / water spray; CO2 at 3.5W and 7W in pulsed mode and at 7W in continuous mode; the diode laser at 3.5W and boost 3.5W in pulsed mode; Nd:YAG at 6W, 40Hz and electroscalpel at 5W and conventional scalpel as control. Macroscopic and microscopic morphological changes were evaluated. Results The results of this study showed that the surgical instruments that caused greater tissue damage extension were: the Nd:YAG laser (670.68μm), the diode 3.5W and boost PW (626.82μm), the CO2 7W CW (571.18μm), the CO2 at 7W PW (485.45μm), the diode 3.5W PW (456.15μm), the electroscalpel (409.57μm) and lastly the CO2 laser 3.5W PW (306.19μm) and Er:YAG (74.66μm) laser, regardless of power, mode or air / water spray used. An association between the Tissue Damage Extension and the Degree of Carbonization (r = 0.789; P = 0.01), and an association between the Tissue Damage Extension and Regularity of the Incision were found (r = -, 299; P = 0.01). Conclusions The results of this study suggest that lasers can be used in soft tissues biopsies of the oral cavity, enabling a correct histopathological analysis, as long as the biological effects of each laser type are considered. The Er:YAG laser revealed its potential for biopsies of the oral mucosa ensuring a successful histological evaluation and the CO2 laser at 3,5W in pulsed mode presented itself as the best choice for surgeries with hemostasis. Key words:CO2 laser, diode laser, Er:YAG laser, laser surgery, Nd:YAG laser, oral mucosa, thermal effect. PMID:27703606

  19. 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

    2014-01-01

    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...

  20. Influence of margin status and radiation on recurrence after radical hysterectomy in Stage IB cervical cancer

    International Nuclear Information System (INIS)

    Viswanathan, Akila N.; Lee, Hang; Hanson, Emily; Berkowitz, Ross S.; Crum, Christopher P.

    2006-01-01

    Purpose: To examine the relationship between margin status and local recurrence (LR) or any recurrence after radical hysterectomy (RH) in women treated with or without radiotherapy (RT) for Stage IB cervical carcinoma. Methods and Materials: This study included 284 patients after RH with assessable margins between 1980 and 2000. Each margin was scored as negative (≥1 cm), close (>0 and <1 cm), or positive. The outcomes measured were any recurrence, LR, and relapse-free survival. Results: The crude rate for any recurrence was 11%, 20%, and 38% for patients with negative, close, and positive margins, respectively. The crude rate for LR was 10%, 11%, and 38%, respectively. Postoperative RT decreased the rate of LR from 10% to 0% for negative, 17% to 0% for close, and 50% to 25% for positive margins. The significant predictors of decreased relapse-free survival on univariate analysis were the depth of tumor invasion (hazard ratio [HR] 2.14/cm increase, p = 0.007), positive margins (HR 3.92, p = 0.02), tumor size (HR 1.3/cm increase, p = 0.02), lymphovascular invasion (HR 2.19, p = 0.03), and margin status (HR 0.002/increasing millimeter from cancer for those with close margins, p = 0.03). Long-term side effects occurred in 8% after RH and 19% after RH and RT. Conclusion: The use of postoperative RT may decrease the risk of LR in patients with close paracervical margins. Patients with other adverse prognostic factors and close margins may also benefit from the use of postoperative RT. However, RT after RH may increase the risk of long-term side effects

  1. Radical prostatectomy and positive surgical margins: relationship with prostate cancer outcome

    Directory of Open Access Journals (Sweden)

    Ricardo L. R. Felts de La Roca

    2014-06-01

    Full Text Available Introduction Positive surgical margins (PSMs are an adverse factor that may predict a worse outcome in patients submitted to radical prostatectomy (RP. However, not all of these cases will evolve to biochemical (BCR or clinical (CR recurrence, therefore relationship between PSMs and these recurrent events has to be correlated with other clinical and pathologic findings to indicate complementary treatment for selected patients. Materials and Methods Of 1250 patients submitted to open retropubic radical prostatectomy (RRP, between March 1991 and June 2008, the outcome of 161 patients with PSMs and of 67 without PSMs as a control group, comprising a total of 228 cases were retrospectively reviewed. A minimum follow-up time of 2 years after surgery was considered. BCR was determined when PSA ≥ 0.2ng/mL. CR was determined whenever there was clinical evidence of tumor. Chi-square test was used to correlate clinical and pathologic variables with PSMs. Time interval to biochemical recurrence was analyzed by the Kaplan-Meier product limit analysis using the log-rank test for comparison between groups. Univariate and multivariate Cox stepwise logistic regression models were used to identify significant predictors of risk of shorter intervals to BCR. Results Prostate circumference margin was the most common site with 78 cases (48.44%. Regarding the outcome of 228 cases from both groups, BCR occurred in 68 patients (29.82%, and CR in 10 (4.38%. Univariate analysis showed statistically significant associations (p < 0.001 between presence of PSMs with BCR, but not with CR (p = 0.05. At follow-up of the 161 patients with PSMs, only 61(37.8% presented BCR, while 100 (62.8% did not. BCR correlated with pathologic stage; Gleason score; preoperative PSA; tumor volume in the specimen; capsular and perineural invasion; presence and number of PSMs. CR correlated only with angiolymphatic invasion and Gleason score. Considering univariate analysis of clinical and

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

    Science.gov (United States)

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

    2014-03-01

    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.

  3. Pancreatic Neuroendocrine Tumors With Involved Surgical Margins: Prognostic Factors and the Role of Adjuvant Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Arvold, Nils D. [Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA (United States); Willett, Christopher G. [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Fernandez-del Castillo, Carlos [Department of Surgery, Massachusetts General Hospital, Boston, MA (United States); Ryan, David P. [Department of Medicine, Massachusetts General Hospital, Boston, MA (United States); Ferrone, Cristina R. [Department of Surgery, Massachusetts General Hospital, Boston, MA (United States); Clark, Jeffrey W.; Blaszkowsky, Lawrence S. [Department of Medicine, Massachusetts General Hospital, Boston, MA (United States); Deshpande, Vikram [Department of Pathology, Massachusetts General Hospital, Boston, MA (United States); Niemierko, Andrzej [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Allen, Jill N.; Kwak, Eunice L.; Wadlow, Raymond C.; Zhu, Andrew X. [Department of Medicine, Massachusetts General Hospital, Boston, MA (United States); Warshaw, Andrew L. [Department of Surgery, Massachusetts General Hospital, Boston, MA (United States); Hong, Theodore S., E-mail: Tshong1@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)

    2012-07-01

    Purpose: Pancreatic neuroendocrine tumors (pNET) are rare neoplasms associated with poor outcomes without resection, and involved surgical margins are associated with a worse prognosis. The role of adjuvant radiotherapy (RT) in these patients has not been characterized. Methods and Materials: We retrospectively evaluated 46 consecutive patients with positive or close (<1 mm) margins after pNET resection, treated from 1983 to 2010, 16 of whom received adjuvant RT. Median RT dose was 50.4 Gy in 1.8-Gy fractions; half the patients received concurrent chemotherapy with 5-fluorouracil or capecitabine. No patients received adjuvant chemotherapy. Cox multivariate analysis (MVA) was used to analyze factors associated with overall survival (OS). Results: Median age at diagnosis was 56 years, and 52% of patients were female. Median tumor size was 38 mm, 57% of patients were node-positive, and 11% had a resected solitary liver metastasis. Patients who received RT were more likely to have larger tumors (median, 54 mm vs. 30 mm, respectively, p = 0.002) and node positivity (81% vs. 33%, respectively, p = 0.002) than those not receiving RT. Median follow-up was 39 months. Actuarial 5-year OS was 62% (95% confidence interval [CI], 41%-77%). In the group that did not receive RT, 3 patients (10%) experienced local recurrence (LR) and 5 patients (18%) developed new distant metastases, while in the RT group, 1 patient (6%) experienced LR and 5 patients (38%) developed distant metastases. Of all recurrences, 29% were LR. On MVA, male gender (adjusted hazard ratio [AHR] = 3.81; 95% CI, 1.21-11.92; p = 0.02) and increasing tumor size (AHR = 1.02; 95% CI, 1.01-1.04; p = 0.007) were associated with decreased OS. Conclusions: Long-term survival is common among patients with involved-margin pNET. Despite significantly worse pathologic features among patients receiving adjuvant RT, rates of LR between groups were similar, suggesting that RT might aid local control, and merits further

  4. A comparative analysis of primary and secondary Gleason pattern predictive ability for positive surgical margins after radical prostatectomy.

    Science.gov (United States)

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

    2011-01-01

    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.

  5. Excision margin status: does it impact on local control of breast cancer?

    International Nuclear Information System (INIS)

    Lamoury, G.; Morgan, G.; Ward, R.

    2003-01-01

    Whilst many patients treated with breast conservation undergo re-excision(s) to obtain clear margins, the relationship between clear margins and local recurrence remains unclear. We aimed to determine the impact of final pathological margin status on local recurrence and other breast cancer outcomes. Our study cohort consisted of 755 consecutive patients treated with breast conservation between January 1984 and December 1995. Pathology reports were available for review in 681subjects (90%). Patients were stratified into 8 groups based on final pathological margin status: 1) negative (>3mm, n = 307), close [further divided into two groups 2) >0 1< 2mm, (n = 67)], 4) positive (n= 79), 5) indeterminate (n= 144), 6) low grade DCIS at the margin (n= 3), 7) high grade DCIS at the margin (n= 23) and 8) LCIS at the margin (n= 4). There were no differences between the groups based on histology, T size, grade, LN positivity or total radiation dose. At a median follow-up of 71 months, the breast relapse free survival (BRFS) was 97%, the distant metastasis free survival (DMFS) 78% and the overall survival (OS) 86%, for the entire cohort. There were no statistically significant differences between the negative, close, and positive groups in terms of BRFS: 96% vs. 94% vs. 93% (p=0.59), MFS: 98% vs. 97% vs. 98% (p=0.87) or OS: 84%vs. 85% vs. 86% (p=0.78). Although not statistically significant, the presence of EIC, in the context of close or positive margins, impacted adversely upon local and overall disease free survival. Patients undergoing breast conservation carry a lifelong risk of local recurrence. It is still not clear whether obtaining a radical margin decreases this risk. Tissue microarray analysis will be performed to further elucidate the causes of ipsilateral recurrence at a molecular and genetic level

  6. Does nerve-sparing radical prostatectomy increase the risk of positive surgical margins and biochemical progression?

    Directory of Open Access Journals (Sweden)

    Alkhateeb Sultan

    2010-01-01

    Full Text Available Background: Since the introduction of nerve-sparing radical prostatectomy (NSRP, there have been concerns about the increased risks of positive surgical margins (PSM and biochemical progression (BP. We examined the relationship of NSRP with PSM and BP using a large, mature dataset. Materials and Methods: Patients who underwent RP for clinically localized prostate cancer at our center between 1997 and 2008 were identified. Patients who received neoadjuvant therapy were excluded. We examined the relation of NSRP to the rate of PSM and BP in univariate and multivariate analyses adjusting for clinical and pathological variables including age, pretreatment prostate-specific antigen (PSA levels and doubling time, and pathological stage and grade. Results: In total, 856 patients were included, 70.9% underwent NSRP and 29.1% had non-NSRP. PSM rates were 13.5% in the NSRP group compared to 17.7% in non-NSRP (P=0.11. In a multivariate analysis, non-NSRP was preformed in patients with a higher pathological stage (HR 1.95, 95% CI 1.25-3.04, P=0.003 and a higher baseline PSA level (HR 1.04, 95% CI 1.01-1.08, P=0.005. With a median follow-up of 41 months, BP-free survival was 88% for non-NSRP compared to 92% for the NSRP group (log rank P=0.018; this difference was not significant in a multivariate Cox regression analysis (HR 0.54, 95% CI 0.28-1.06, P=0.09. Conclusion: When used in properly selected patients, NSRP does not seem to increase the risk of PSM and disease progression. The most effective way of resolving this issue is through a randomized clinical trial; however, such a trial is not feasible.

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

    Science.gov (United States)

    Gietelink, Lieke; Wouters, Michel W J M; Tanis, Pieter J; Deken, Marion M; Ten Berge, Martijn G; Tollenaar, Rob A E M; van Krieken, J Han; de Noo, Mirre E

    2015-09-01

    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 about CRM in the late 1990s, quality assurance on pathologic reporting was not available until the Dutch Surgical Colorectal Audit (DSCA) started in 2009. The present study describes the rates of CRM reporting and involvement since the start of the DSCA and analyzes whether improvement of these parameters can be attributed to the audit. Data from the DSCA (2009-2013) were analyzed. Reporting of CRM and CRM involvement was plotted for successive years, and variations of these parameters were analyzed in a funnelplot. Predictors of CRM involvement were determined in univariable analysis and the independent influence of year of registration on CRM involvement was analyzed in multivariable analysis. A total of 12,669 patients were included for analysis. The mean percentage of patients with a reported CRM increased from 52.7% to 94.2% (2009-2013) and interhospital variation decreased. The percentage of patients with CRM involvement decreased from 14.2% to 5.6%. In multivariable analysis, the year of DSCA registration remained a significant predictor of CRM involvement. After the introduction of the DSCA, a dramatic improvement in CRM reporting and a major decrease of CRM involvement after rectal cancer surgery have occurred. This study suggests that a national quality assurance program has been the driving force behind these achievements. Copyright © 2015 by the National Comprehensive Cancer Network.

  8. Significance of post-resection tissue shrinkage on surgical margins of oral squamous cell carcinoma.

    Science.gov (United States)

    El-Fol, Hossam Abdelkader; Noman, Samer Abduljabar; Beheiri, Mohamed Galal; Khalil, Abdalla M; Kamel, Mahmoud Mohamed

    2015-05-01

    Resecting oral squamous cell carcinoma (SCC) with an appropriate margin of uninvolved tissue is critical in preventing local recurrence and in making decisions regarding postoperative radiation therapy. This task can be difficult due to the discrepancy between margins measured intraoperatively and those measured microscopically by the pathologist after specimen processing. A total of 61 patients underwent resective surgery with curative intent for primary oral SCC were included in this study. All patients underwent resection of the tumor with a measured 1-cm margin. Specimens were then submitted for processing and reviewing, and histopathologic margins were measured. The closest histopathologic margin was compared with the in situ margin (1 cm) to determine the percentage discrepancy. The mean discrepancy between the in situ margins and the histopathological margins of all close and positive margins were 47.6% for the buccal mucosa (with a P value corresponding to 0.05 equaling 2.1), which is statistically significant, 4.8% for the floor of mouth, 9.5% for the mandibular alveolus, 4.8% for the retromolar trigon, and 33.3% for the tongue. There is a significant difference among resection margins based on tumor anatomical location. Margins shrinkage after resection and processing should be considered at the time of the initial resection. Tumors located in the buccal mucosa show significantly greater discrepancies than tumors at other sites. These findings suggest that it is critical to consider the oral site when outlining margins to ensure adequacy of resection. Buccal SCC is an aggressive disease, and should be considered as an aggressive subsite within the oral cavity, requiring a radical and aggressive resective approach. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  9. Interaction of 2-Gy Equivalent Dose and Margin Status in Perioperative High-Dose-Rate Brachytherapy

    International Nuclear Information System (INIS)

    Martinez-Monge, Rafael; Cambeiro, Mauricio; Moreno, Marta; Gaztanaga, Miren; San Julian, Mikel; Alcalde, Juan; Jurado, Matias

    2011-01-01

    Purpose: To determine patient, tumor, and treatment factors predictive of local control (LC) in a series of patients treated with either perioperative high-dose-rate brachytherapy (PHDRB) alone (Group 1) or with PHDRB combined with external-beam radiotherapy (EBRT) (Group 2). Patient and Methods: Patients (n = 312) enrolled in several PHDRB prospective Phase I-II studies conducted at the Clinica Universidad de Navarra were analyzed. Treatment with PHDRB alone, mainly because of prior irradiation, was used in 126 patients to total doses of 32 Gy/8 b.i.d. or 40 Gy/10 b.i.d. treatments after R0 or R1 resections. Treatment with PHDRB plus EBRT was used in 186 patients to total doses of 16 Gy/4 b.i.d. or 24 Gy/6 b.i.d. treatments after R0 or R1 resections along with 45 Gy of EBRT with or without concomitant chemotherapy. Results: No dose-margin interaction was observed in Group 1 patients. In Group 2 patients there was a significant interaction between margin status and 2-Gy equivalent (Eq2Gy) dose (p = 0.002): (1) patients with negative margins had 9-year LC of 95.7% at Eq2Gy = 62.9Gy; (2) patients with close margins of >1 mm had 9-year LC of 92.4% at Eq2Gy = 72.2Gy, and (3) patients with positive/close <1-mm margins had 9-year LC of 68.0% at Eq2Gy = 72.2Gy. Conclusions: Two-gray equivalent doses ≥70 Gy may compensate the effect of close margins ≥1 mm but do not counterbalance the detrimental effect of unfavorable (positive/close <1 mm) resection margins. No dose-margin interaction is observed in patients treated at lower Eq2Gy doses ≤50 Gy with PHDRB alone.

  10. Impact of complete bladder neck preservation on urinary continence, quality of life and surgical margins after radical prostatectomy: a randomized, controlled, single blind trial.

    Science.gov (United States)

    Nyarangi-Dix, Joanne N; Radtke, Jan Philipp; Hadaschik, Boris; Pahernik, Sascha; Hohenfellner, Markus

    2013-03-01

    We investigated the influence of bladder neck preservation on urinary continence, quality of life and surgical margins after radical prostatectomy. A total of 208 men who presented for radical prostatectomy were randomized to complete bladder neck preservation with subsequent urethro-urethral anastomosis or to no preservation as controls. Patients with failed bladder neck preservation were not included in study. We documented objective continence by the 24-hour pad test, social continence by the number of pads per day and quality of life outcomes by the validated Incontinence Quality of Life questionnaire in a single blind setting. Cancer resection was assessed by surgical margin status. At 0, 3, 6 and 12 months mean urine loss in the control vs the bladder neck preservation group was 713.3 vs 237.0, 49.6 vs 15.6, 44.4 vs 5.5 and 25.4 vs 3.1 gm, respectively (each p <0.001). At 3, 6 and 12 months in the control vs the preservation group the social continence rate was 55.3% vs 84.2% (p <0.001), 74.8% vs 89.5% (p = 0.05) and 81.4% vs 94.7% (p = 0.027), and the quality of life score was 80.4 vs 90.3 (p <0.001), 85.4 vs 91.7 (p = 0.016) and 86.0 vs 93.8 (p = 0.001), respectively. We noted significantly less urine loss, higher objective and social continence rates, and higher quality of life scores after complete bladder neck preservation at all followup points. On multiple logistic regression analysis complete bladder neck preservation was an independent positive predictor of continence. No significant difference was found in surgical margin status between the control and bladder neck preservation groups (12.5% vs 14.7%, p = 0.65). In what is to our knowledge the first prospective, randomized, controlled, single blind trial complete bladder neck preservation during radical prostatectomy was associated with a significantly higher urinary continence rate and increased patient satisfaction without compromising resection margins. Copyright © 2013 American Urological

  11. Surgical margin reporting in breast conserving surgery: Does compliance with guidelines affect re-excision and mastectomy rates?

    Science.gov (United States)

    Persing, Sarah; Jerome, Mairin A; James, Ted A; Callas, Peter; Mace, John; Sowden, Michelle; Goodwin, Andrew; Weaver, Donald L; Sprague, Brian L

    2015-10-01

    Margin status is important in guiding decisions to re-excise following breast-conserving surgery (BCS) for breast cancer. The College of American Pathologists (CAP) developed guidelines to standardize pathology reporting; however, compliance with margin documentation guidelines has been shown to vary. The aim of this retrospective study was to determine whether compliance with CAP guidelines affects re-excision and mastectomy rates. We identified 1423 patients diagnosed with breast cancer between 1998 and 2006 who underwent BCS with negative margins. CAP compliance was categorized as maximal, minimal, or non-compliant. Statistical analyses were performed comparing the frequency of re-excision and mastectomy after initial BCS according to CAP margin reporting guideline compliance. Data were adjusted for provider facility by including a clustering variable within the regression model. Patients with non-compliant margin reporting were 1.7 times more likely to undergo re-excision and/or mastectomy than those with maximally compliant reporting. Level of compliance was most strongly associated with the frequency of mastectomy; non-compliant margin reporting was associated with a 2.5-fold increase in mastectomy rates compared to maximally compliant reporting. The results did not substantially change when the analyses accounted for clustering at the provider facility level. Our findings suggest that compliance with CAP guidelines in pathology reporting may be associated with variation in re-excision and mastectomy rates following BCS. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Socio-economic status and health in a marginalized group: the role of subjective social status among prison inmates.

    Science.gov (United States)

    Friestad, Christine

    2010-12-01

    One problem in studies of social inequality in health is that traditional socio-economic indicators are unsuitable for groups finding themselves on the outside of those societal arenas from which measures of education, income and occupation are generated. A measure of subjective social position has accordingly been proposed as an addition to the traditional objective socio-economic measures. The present study investigates this concepts' usefulness as an addition to objective SES markers in a sample of prison inmates, known for their marginalized position in society as well as their poor health. Analyses are based on the male part (n = 225) of a nationally representative sample of prison inmates in Norway. Outcome measures are self-rated health, long-standing illness or disability, mental health problems, perceived change in health status and drug use. Analyses of correlation as well as multivariate logistic regression analyses were performed. Subjective social status was bivariately related to all of the health outcomes, except long-standing illness. Multivariate analyses indicated that subjective social status influenced the odds of experiencing mental health problems, but not any of the other health outcomes when controlling for the other independent variables. Subjective social status may add important information to our understanding of the relationship between social disadvantage and mental health in a marginalized social group such as prison inmates.

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

    NARCIS (Netherlands)

    Gietelink, Lieke; Wouters, Michel W. J. M.; Tanis, Pieter J.; Deken, Marion M.; ten Berge, Martijn G.; Tollenaar, Rob A. E. M.; van Krieken, J. Han; de Noo, Mirre E.

    2015-01-01

    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

  14. 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

    2015-01-01

    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

  15. Comparison of Selected Protein Levels in Tumour and Surgical Margin in a Group of Patients with Oral Cavity Cancer.

    Science.gov (United States)

    Strzelczyk, Joanna Katarzyna; Gołąbek, Karolina; Cuber, Piotr; Krakowczyk, Łukasz; Owczarek, Aleksander Jerzy; Fronczek, Martyna; Choręża, Piotr; Hudziec, Edyta; Ostrowska, Zofia

    2017-08-01

    Oral cavity cancer belongs to head-and-neck squamous cell carcinoma group. The purpose of the study was to assess the levels of certain proteins in a tumour and surgical margin in a group of patients with oral cavity cancer. The levels of DAPK1, MGMT, CDH1, SFRP1, SFRP2, RORA, TIMP3, p16, APC and RASSF1 proteins were measured by ELISA in tissue homogenates. The protein levels of DAPK1, MGMT, CDH1, SFRP2 and RASSF1 were significantly higher in tumour tissue than in the margin, contrary to TIMP3 which was lower in the tumour itself. DAPK1 level in the tumour was significantly higher in females than in males, the MGMT and p16 levels were lower in the tumours with lymph node metastasis (N1 + N2) than in N0 samples. The CDH1 expression was higher in a group with smoking habits, whereas TIMP3 was lower in this group. Changes in the levels of proteins in tumour and surgical margin may be either reflective of tumour occurrence and development, or they might be also responsible for the progress and reoccurrence of the disease. Levels of the studied proteins might be good prognostic factors; however, further studies are required.

  16. Circumferential scouting punch biopsies to delineate surgical margin for dermatofibrosarcoma protuberans

    Directory of Open Access Journals (Sweden)

    Tsung-Mao Huang

    2012-03-01

    Full Text Available Dermatofibrosarcoma protuberans (DFSP is an uncommon soft-tissue tumor involving the dermis and subcutaneous tissue with a high local recurrence rate after standard excision. Mohs micrographic surgery offers a lower recurrence rate. However, the procedure requires multiple stages of excision with intraoperative histopathological mapping, which is time consuming and expensive. We report our experience of using circumferential scouting punch biopsy technique in five patients to determine in advance the resection margins for DFSP prior to wide excision. Multiple 4 mm punches, usually eight in number, were performed 1–2.5 cm around the palpable borders of DFSP to delineate the resection margins in five consecutive patients. Tumors were excised at a later date along the margin defined by these biopsies and the wounds were repaired with skin graft. The operation was completed in 2 hours in all cases excluding one that required frozen sections for deep margin. No recurrence was noted 2–10 years after the operations. The results suggest that circumferential scouting punch biopsies before wide excision may be an alternative method to define the resection margins for DFSP when Mohs surgery is not available.

  17. Mandibular marginal contouring in oriental aesthetic surgery: refined surgical concept and operative procedure.

    Science.gov (United States)

    Satoh, Kaneshige; Mitsukawa, Nobuyuki

    2014-05-01

    In aesthetic mandibular contouring surgery, which is often conducted in Asians, the operative procedure is thought to deliver a more aesthetic mandibular shape by means of contouring conducted as a whole from the ramus to the symphysis. The authors describe the refined concept and operative procedures of mandibular marginal contouring. For the 7-year period from 2004 to 2011, mandibular marginal contouring has been used in 57 consecutive series of Japanese subjects. Patient ages ranged from 18 to 33 years, and the subjects included 15 men and 42 women. The surgery was carried out by cutting off the protruding deformed mandibular margin from the ramus to the symphysis. In 53 of 57 cases, the focus was on angle contouring. Concomitant genioplasty by horizontal osteotomy of the chin was conducted in 42 of 57 cases (recession, advancement, shortening, elongation, and correction of the shift variously). In 22 materials exhibiting bulk around the mandibular, the ramus to the body was excised sagittally and thinned. In all the patients, mandibular marginal contouring from the ramus to the symphysis was completed. Partial masseter muscle resection was conducted in 11 of 57 cases. Mandibular contouring effectively achieved a highly satisfactory result in all cases. The upper portion of the peripheral branch of the trunk of the mental nerve was dissected by an electric scalpel in 1 case but sutured immediately using an 8-0 nylon stitch. Transient palsy of the mental nerve was noticed in a few cases but subsided in 1 to 2 months. No particular complications were encountered. No secondary revision was required in this series. In mandibular angle plasty, mandibular marginal contouring from the ramus to the symphysis should be carried out by cutting off the angle keeping in mind the entire mandibular shape. This concept and the procedure can deliver greater patient satisfaction.

  18. {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)

    2015-08-15

    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.)

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    .2–6.2; p =.04) and 2.63 (95% CI, 1.1–6.3; p =.03) for overall survival (OS) and disease-specific survival (DSS), respectively. Close margins had no significant impact on outcome, with HRs of 1.1 (95% CI, 0.4–3.0; p =.12) and 1.07 (95% CI, 0.3–3.4; p =.23) for OS and DSS, respectively, relative...

  20. Robot-assisted radical prostatectomy: Multiparametric MR imaging-directed intraoperative frozen-section analysis to reduce the rate of positive surgical margins.

    Science.gov (United States)

    Petralia, Giuseppe; Musi, Gennaro; Padhani, Anwar R; Summers, Paul; Renne, Giuseppe; Alessi, Sarah; Raimondi, Sara; Matei, Deliu V; Renne, Salvatore L; Jereczek-Fossa, Barbara A; De Cobelli, Ottavio; Bellomi, Massimo

    2015-02-01

    To investigate whether use of multiparametric magnetic resonance (MR) imaging-directed intraoperative frozen-section (IFS) analysis during nerve-sparing robot-assisted radical prostatectomy reduces the rate of positive surgical margins. This retrospective analysis of prospectively acquired data was approved by an institutional ethics committee, and the requirement for informed consent was waived. Data were reviewed for 134 patients who underwent preoperative multiparametric MR imaging (T2 weighted, diffusion weighted, and dynamic contrast-material enhanced) and nerve-sparing robot-assisted radical prostatectomy, during which IFS analysis was used, and secondary resections were performed when IFS results were positive for cancer. Control patients (n = 134) matched for age, prostate-specific antigen level, and stage were selected from a pool of 322 patients who underwent nerve-sparing robot-assisted radical prostatectomy without multiparametric MR imaging and IFS analysis. Rates of positive surgical margins were compared by means of the McNemar test, and a multivariate conditional logistic regression model was used to estimate the odds ratio of positive surgical margins for patients who underwent MR imaging and IFS analysis compared with control subjects. Eighteen patients who underwent MR imaging and IFS analysis underwent secondary resections, and 13 of these patients were found to have negative surgical margins at final pathologic examination. Positive surgical margins were found less frequently in the patients who underwent MR imaging and IFS analysis than in control patients (7.5% vs 18.7%, P = .01). When the differences in risk factors are taken into account, patients who underwent MR imaging and IFS had one-seventh the risk of having positive surgical margins relative to control patients (adjusted odds ratio: 0.15; 95% confidence interval: 0.04, 0.61). The significantly lower rate of positive surgical margins compared with that in control patients provides

  1. Label-free optical imaging technologies for rapid translation and use during intraoperative surgical and tumor margin assessment

    Science.gov (United States)

    Boppart, Stephen A.; Brown, J. Quincy; Farah, Camile S.; Kho, Esther; Marcu, Laura; Saunders, Christobel M.; Sterenborg, Henricus J. C. M.

    2018-02-01

    The biannual International Conference on Biophotonics was recently held on April 30 to May 1, 2017, in Fremantle, Western Australia. This continuing conference series brought together key opinion leaders in biophotonics to present their latest results and, importantly, to participate in discussions on the future of the field and what opportunities exist when we collectively work together for using biophotonics for biological discovery and medical applications. One session in this conference, entitled "Tumor Margin Identification: Critiquing Technologies," challenged invited speakers and attendees to review and critique representative label-free optical imaging technologies and their application for intraoperative assessment and guidance in surgical oncology. We are pleased to share a summary in this outlook paper, with the intent to motivate more research inquiry and investigations, to challenge these and other optical imaging modalities to evaluate and improve performance, to spur translation and adoption, and ultimately, to improve the care and outcomes of patients.

  2. Label-free reflectance hyperspectral imaging for tumor margin assessment: a pilot study on surgical specimens of cancer patients

    Science.gov (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.

    2017-08-01

    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.

  3. Ductal carcinoma in situ: USC/Van Nuys Prognostic Index and the impact of margin status.

    Science.gov (United States)

    Silverstein, Melvin J; Buchanan, Claire

    2003-12-01

    As our knowledge of ductal carcinoma in situ (DCIS) continues to evolve, treatment decision-making has become increasingly complex and controversial for both patients and physicians. Treatment options include mastectomy, and breast conservation with or without radiation therapy. Data produced from the randomized clinical trials for DCIS has provided the basis for important treatment recommendations, but are not without limitations. In this article, we review our prospectively collected database consisting of 1036 patients with DCIS treated at the Van Nuys Breast Center and the USC/Norris Comprehensive Cancer Center. We review the use of the USC/Van Nuys Prognostic Index, a clinical algorithm designed to assist physicians in selection of appropriate treatments, and examine the impact of margin status as a sole predictor of local recurrence.

  4. Current Status of Surgical Planning for Orthognathic Surgery: Traditional Methods versus 3D Surgical Planning

    Directory of Open Access Journals (Sweden)

    Jeffrey A. Hammoudeh, MD, DDS

    2015-02-01

    Conclusions: It is our opinion that virtual model surgery will displace and replace traditional model surgery as it will become cost and time effective in both the private and academic setting for practitioners providing orthognathic surgical care in cleft and noncleft patients.

  5. Pilot study of intraoperative digital imaging with the use of a mammograph for assessment of bone surgical margins in the head and neck region

    International Nuclear Information System (INIS)

    Ntomouchtsis, A.; Xinou, K.; Patrikidou, A.; Paraskevopoulos, K.; Kechagias, N.; Tsekos, A.; Balis, G.C.; Gerasimidou, D.; Thuau, H.; Mangoudi, D.; Vahtsevanos, K.

    2013-01-01

    Aim: To investigate alternative possibilities for the intraoperative evaluation of surgical margins after bone resection utilizing more conventional hospital infrastructure technologies. Materials and methods: A small pilot study was performed using digital mammograph imaging intraoperatively on 16 surgical specimens of bone tumours or malignancies with bone infiltration of the head and neck area, with the aim of evaluating the resection margins. Results: In thirteen cases the intraoperative specimen images indicated clinically complete excision. In two cases incomplete resection or close proximity of margins was detected, which required additional resection. Conclusions: The results indicated that intraoperative specimen radiography can prove useful in evaluating completeness of excision. The significance of intraoperative assessment of surgical margin is of paramount importance when immediate reconstruction is performed. This proposed method is cheap, easy to perform and fast. Its cost–benefit ratio is superior than that of any other available technique. Intraoperative analysis of specimens with digital mammography imaging can potentially become a useful tool for immediate evaluation of osseous margins after resection

  6. Does circumferential tumor location affect the circumferential resection margin status in mid and low rectal cancer?

    Directory of Open Access Journals (Sweden)

    Byung Mo Kang

    2018-05-01

    Full Text Available Summary: Background/Objective: The purpose of this study was to assess the impact of circumferential tumor location on circumferential resection margin (CRM status and the depth of tumor invasion in mid and low rectal cancer. Methods: We retrospectively analyzed whole-mount slides of 58 patients who underwent total mesorectal excision for mid and low rectal cancer. The rate of tumor-positive CRM was compared according to the circumferential tumor location. In 31 patients, morphometric analyses of whole-mount specimens were performed to measure the depth of tumor invasion according to circumferential tumor location. Results: Among 58 patients, 50% of tumors were anterior tumor and 50% were nonanterior. A tumor-positive CRM was more observed frequently in anterior tumors than in nonanterior tumors (41.1% vs. 10.3%, p = 0.007. In a multivariate analysis, anterior tumor was the only independent risk factor for a positive CRM (odds ratio 4.725, 95% confidence interval 1.102–20.261, p = 0.037. In a morphometric analysis of 31 patients, the depth of tumor invasion from the muscularis mucosa was greater (11.9 mm vs. 6.6 mm, p = 0.028 in those with anterior tumors. Conclusion: Anterior tumors are associated with a higher risk of tumor-positive CRM and tend to exhibit deeper invasion in mid and low rectal cancer. Keywords: circumferential resection margin, depth of invasion, rectal cancer, tumor location

  7. Discordance between location of positive cores in biopsy and location of positive surgical margin following radical prostatectomy.

    Science.gov (United States)

    Kim, Ji Won; Park, Hyoung Keun; Kim, Hyeong Gon; Ham, Dong Yeub; Paick, Sung Hyun; Lho, Yong Soo; Choi, Woo Suk

    2015-10-01

    We compared location of positive cores in biopsy and location of positive surgical margin (PSM) following radical prostatectomy. This retrospective analysis included patients who were diagnosed as prostate cancer by standard 12-core transrectal ultrasonography guided prostate biopsy, and who have PSM after radical prostatectomy. After exclusion of number of biopsy cores location data, 46 patients with PSM were identified. Locations of PSM in pathologic specimen were reported as 6 difference sites (apex, base and lateral in both sides). Discordance of biopsy result and PSM was defined when no positive cores in biopsy was identified at the location of PSM. Most common location of PSM were right apex (n=21) and left apex (n=15). Multiple PSM was reported in 21 specimens (45.7%). In 32 specimens (69.6%) with PSM, one or more concordant positive biopsy cores were identified, but 14 specimens (28%) had no concordant biopsy cores at PSM location. When discordant rate was separated by locations of PSM, right apex PSM had highest rate of discordant (38%). The discordant group had significantly lower prostate volume and lower number of positive cores in biopsy than concordant group. This study showed that one fourth of PSM occurred at location where tumor was not detected at biopsy and that apex PSM had highest rate of discordant. Careful dissection to avoid PSM should be performed in every location, including where tumor was not identified in biopsy.

  8. Assessment of Periodontal Status of Surgically Exposed and Orthodontically Aligned Impacted Maxillary Canines

    Directory of Open Access Journals (Sweden)

    Adina Coșarcă

    2014-02-01

    Full Text Available Aim: The aim of this study was to compare the periodontal status of impacted canines after 5 years following completion of the combined surgical and orthodontic treatment. Materials and methods: We examined 20 labially impacted canines and 20 palatally impacted canines at 5 years after the end of treatment. We assessed the periodontal status of these teeth. Results: Different outcomes were found regarding the probing depth and the amount of keratinized gingiva in the two mentioned groups of teeth. Conclusions: The assessed periodontal indices may signal the appearance of a periodontal disease around the teeth that were surgically and orthodontically treated

  9. Close or positive margins after surgical resection for the head and neck cancer patient: the addition of brachytherapy improves local control

    International Nuclear Information System (INIS)

    Beitler, Jonathan J.; Smith, Richard V.; Silver, Carl E.; Quish, Astrid; Deore, Shivaji M.; Mullokandov, Eduard; Fontenla, Doracy P.; Wadler, Scott; Hayes, Mary Katherine; Vikram, Bhadrasain

    1998-01-01

    Purpose: Microscopically positive or close margins after surgical resection results in an approximately 21-26% local failure rate despite excellent postoperative external radiation therapy. We sought to demonstrate improved local control in head and neck cancer patients who had a resection with curative intent, and had unexpected, microscopically positive or close surgical margins. Methods and Materials: Twenty-nine patients with microscopically close or positive margins after curative surgery were given definitive, adjuvant external radiation therapy and 125 I brachytherapy. All 29 patients had squamous cell cancer and tonsil was the most common subsite within the head and neck region. After external radiation therapy and thorough discussions with the attending surgeon and pathologists, the slides, gross specimens, and appropriate radiographs were reviewed and a target volume was determined. The target volume was the region of the margin in question and varied in size based on the surgery and pathologic results. Once the target volume was identified the patient was taken back to the operating room for insertion of 125 I seeds. Activity implanted (range 2.9-21.5 millicuries) was designed to administer a cumulative lifetime dose of 120-160 Gy. Results: Twenty-nine patients were followed for a median of 26 months (range 5-86 months). Two-year actuarial local control was 92%. Conclusion: 125 I, after external radiation therapy, is an excellent method to improve local control in the subset of patients with unexpectedly unsatisfactory margins

  10. Assessment of Periodontal Status of Surgically Exposed and Orthodontically Aligned Impacted Maxillary Canines

    OpenAIRE

    Adina Coșarcă; Mariana Păcurar; Cecilia Petrovan; Alina Ormenișan

    2014-01-01

    Aim: The aim of this study was to compare the periodontal status of impacted canines after 5 years following completion of the combined surgical and orthodontic treatment. Materials and methods: We examined 20 labially impacted canines and 20 palatally impacted canines at 5 years after the end of treatment. We assessed the periodontal status of these teeth. Results: Different outcomes were found regarding the probing depth and the amount of keratinized gingiva in the two mentioned groups of t...

  11. 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

    2011-07-01

    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

  12. Association between socioeconomic status, surgical treatment and mortality in patients with colorectal cancer.

    Science.gov (United States)

    Dik, V K; Aarts, M J; Van Grevenstein, W M U; Koopman, M; Van Oijen, M G H; Lemmens, V E; Siersema, P D

    2014-08-01

    High socioeconomic status is associated with better survival in colorectal cancer (CRC). This study investigated whether socioeconomic status is associated with differences in surgical treatment and mortality in patients with CRC. Patients diagnosed with stage I-III CRC between 2005 and 2010 in the Eindhoven Cancer Registry area in the Netherlands were included. Socioeconomic status was determined at a neighbourhood level by combining the mean household income and the mean value of the housing. Some 4422 patients with colonic cancer and 2314 with rectal cancer were included. Patients with colonic cancer and high socioeconomic status were operated on with laparotomy (70·7 versus 77·6 per cent; P = 0·017), had laparoscopy converted to laparotomy (15·7 versus 29·5 per cent; P = 0·008) and developed anastomotic leakage or abscess (9·6 versus 12·6 per cent; P = 0·049) less frequently than patients with low socioeconomic status. These differences remained significant after adjustment for patient and tumour characteristics. In rectal cancer, patients with high socioeconomic status were more likely to undergo resection (96·3 versus 93·7 per cent; P = 0·083), but this was not significant in multivariable analysis (odds ratio (OR) 1·44, 95 per cent confidence interval 0·84 to 2·46). The difference in 30-day postoperative mortality in patients with colonic cancer and high and low socioeconomic status (3·6 versus 6·8 per cent; P socioeconomic status have more favourable surgical treatment characteristics than patients with low socioeconomic status. The lower 30-day postoperative mortality found in patients with colonic cancer and high socioeconomic status is largely explained by patient and surgical factors. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

  13. Surgical pathology to describe the clinical margin of debridement of chronic wounds using a wound electronic medical record.

    Science.gov (United States)

    Golinko, Michael S; Joffe, Renata; de Vinck, David; Chandrasekaran, Eashwar; Stojadinovic, Olivera; Barrientos, Stephan; Vukelic, Sasa; Tomic-Canic, Marjana; Brem, Harold

    2009-08-01

    Chronic wounds, including diabetic foot ulcers (DFU), pressure ulcers (PU), and venous ulcers (VU) result from multiple physiologic impairments. Operative debridement is a mainstay of treatment to remove nonviable tissue and to stimulate wound healing. Unlike tumor resection, however, operative wound specimens are not routinely sent for pathology. The objective of this study was to describe the pathology present in chronic wounds. Pathology reports of the skin edge and wound base from 397 initial debridements in 336 consecutive patients with chronic wounds were retrospectively reviewed. All data were entered and stored in a Wound Electronic Medical Record. Pathology data were extracted from the Wound Electronic Medical Record, coded, and quantified. Up to 15 distinct histopathologic findings across 7 tissue types were observed after review of pathology reports from chronic wounds. Specifically, the pathology of epidermis revealed hyperkeratosis: 66% in DFUs, 31% in PUs, and 29% in VUs. Dermal pathology revealed fibrosis in 49% of DFUs, 30% of PUs, and 15% of VUs. Wound bed pathology revealed necrosis in the subcutaneous tissue in 67% of DFUs, 55% of PUs, and 19% of VUs. Fibrosis was reported in between 19% and 52% of all wound types. Acute osteomyelitis was present in 39% of DFUs, 33% of PUs, and 29% of VUs. This observational study of the histopathology of initial surgical debridement of chronic wounds revealed a wide range of findings across multiple tissue levels. Although certain findings such as osteomyelitis and gangrene have been shown to directly relate to impaired wound healing and amputation, other findings require additional investigation. To rigorously define a margin of debridement, a prospective study relating histopathology and clinical outcomes such as healing rates and amputation is needed.

  14. A uniform residual tumor (R) classification: integration of the R classification and the circumferential margin status.

    NARCIS (Netherlands)

    Wittekind, C.; Compton, C.; Quirke, P.; Nagtegaal, I.D.; Merkel, S.; Hermanek, P.; Sobin, L.H.

    2009-01-01

    BACKGROUND: Since the introduction of the TNM residual tumor (R) classification, the involvement of resection margins has been defined either as a microscopic (R1) or a macroscopic (R2) demonstration of tumor directly at the resection margin ("tumor transected"). METHODS: The recognition of the

  15. Number of fragments, margin status and thermal artifacts of conized specimens from LLETZ surgery to treat cervical intraepithelial neoplasia.

    Science.gov (United States)

    Bittencourt, Dulcimary Dias; Zanine, Rita Maira; Sebastião, Ana Martins; Taha, Nabiha Saadi; Speck, Neila Góis; Ribalta, Julisa Chamorro Lascasas

    2012-01-01

    Large loop excision of the transformation zone (LLETZ) is a nontraumatic cut and coagulation method with several advantages, but it induces thermal artifacts in the cut region. The aim here was to assess the correlations of age, number of fragments, lesion grade and degree of thermal artifacts with margin quality in conized specimens from LLETZ for cervical intraepithelial neoplasia (CIN). Cross-sectional study at Universidade Federal de São Paulo (Unifesp). The records and histopathology findings of 118 women who underwent LLETZ between 1999 and 2007 were reviewed. Age, number of fragments, lesion grade, degree of thermal artifacts and margin quality were assessed. The patients' mean age was 27.14 years; 63.6% had been diagnosed with CIN II and 36.4% with CIN III. The lesion was removed as a single fragment in 79.6% of the cases. The margins were free from intraepithelial neoplasia in 85.6% and compromised in the endocervical margin in 6.8%. Fragment damage due to artifacts occurred in 2.5%. Severe artifacts occurred in 22.8%. Women aged 30 years or over presented more cases of CIN III (P < 0.0004). Neoplastic compromising of surgical margins and severe artifacts occurred more often in cases in which two or more fragments were removed, and in patients aged 30 years or over. CIN III in women aged 30 or over, when removed in two or more fragments during LLETZ, presented a greater number of compromised margins and greater severity of thermal artifacts.

  16. 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

    2015-01-01

    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.

  17. Comparison of histologic margin status in low-grade cutaneous and subcutaneous canine mast cell tumours examined by radial and tangential sections.

    Science.gov (United States)

    Dores, C B; Milovancev, M; Russell, D S

    2018-03-01

    Radial sections are widely used to estimate adequacy of excision in canine cutaneous mast cell tumours (MCTs); however, this sectioning technique estimates only a small fraction of total margin circumference. This study aimed to compare histologic margin status in grade II/low grade MCTs sectioned using both radial and tangential sectioning techniques. A total of 43 circumferential margins were evaluated from 21 different tumours. Margins were first sectioned radially, followed by tangential sections. Tissues were examined by routine histopathology. Tangential margin status differed in 10 of 43 (23.3%) margins compared with their initial status on radial section. Of 39 margins, 9 (23.1%) categorized as histologic tumour-free margin (HTFM) >0 mm were positive on tangential sectioning. Tangential sections detected a significantly higher proportion of positive margins relative to radial sections (exact 2-tailed P-value = .0215). The HTFM was significantly longer in negative tangential margins than positive tangential margins (mean 10.1 vs 3.2 mm; P = .0008). A receiver operating characteristic curve comparing HTFM and tangentially negative margins found an area under the curve of 0.83 (95% confidence interval: 0.71-0.96). Although correct classification peaked at the sixth cut-point of HTFM ≥1 mm, radial sections still incorrectly classified 50% of margins as lacking tumour cells. Radial sections had 100% specificity for predicting negative tangential margins at a cut-point of 10.9 mm. These data indicate that for low grade MCTs, HTFMs >0 mm should not be considered completely excised, particularly when HTFM is <10.9 mm. This will inform future studies that use HTFM and overall excisional status as dependent variables in multivariable prognostic models. © 2017 John Wiley & Sons Ltd.

  18. Influence of surgical and prosthetic techniques on marginal bone loss around titanium implants. Part I: immediate loading in fresh extraction sockets.

    Science.gov (United States)

    Berberi, Antoine N; Tehini, Georges E; Noujeim, Ziad F; Khairallah, Alexandre A; Abousehlib, Moustafa N; Salameh, Ziad A

    2014-10-01

    Delayed placement of implant abutments has been associated with peri-implant marginal bone loss; however, long-term results obtained by modifying surgical and prosthetic techniques after implant placement are still lacking. This study aimed to evaluate the marginal bone loss around titanium implants placed in fresh extraction sockets using two loading protocols after a 5-year follow-up period. A total of 36 patients received 40 titanium implants (Astra Tech) intended for single-tooth replacement. Implants were immediately placed into fresh extraction sockets using either a one-stage (immediate loading by placing an interim prosthesis into functional occlusion) or a two-stage prosthetic loading protocol (insertion of abutments after 8 weeks of healing time). Marginal bone levels relative to the implant reference point were evaluated at four time intervals using intraoral radiographs: at time of implant placement, and 1, 3, and 5 years after implant placement. Measurements were obtained from mesial and distal surfaces of each implant (α = 0.05). One-stage immediate implant placement into fresh extraction sockets resulted in a significant reduction in marginal bone loss (p sockets reduced marginal bone loss and did not compromise the success rate of the restorations. © 2014 by the American College of Prosthodontists.

  19. [Current status and expectations in the surgical treatment of recurrent lateral patellar dislocation].

    Science.gov (United States)

    Zhao, Zhi-Dong; Li, Peng-Cui; Wei, Xiao-Chun

    2017-11-25

    Up to now, surgical treatment of recurrent lateral patellar dislocation mainly includes: medial patellofemoral ligament reconstruction, tibial tubercle osteotomy, trochleoplasty, lateral retinacular release, derotation osteotomy and so on . Clinical reports show that: the use of a single or combined with several methods have achieved ideal short to mid-term clinical outcomes. However, there is no consolidate criterion concerning the choices of different kinds of surgical ways for the treatment of individual recurrent lateral patellar dislocation. Meanwhile, with the wide use of MPFL reconstruction and other surgical options, there are more and more complications and failures that are worthy and necessary for us to pay attention to, even though its high success rate. The aim of this article is to make a systematic review of the application status of different surgical methods, collecting the positive results we have achieved, illuminating application keys of surgical techniques, guiding patient-specific therapy more precisely. Copyright© 2017 by the China Journal of Orthopaedics and Traumatology Press.

  20. The role of discourse practices in the emergence of marginal status of Messianic Jewish communities

    Directory of Open Access Journals (Sweden)

    Anna Panteleeva

    2015-06-01

    Full Text Available The author attempts to analyze the most significant stages of the developing of the Messianic conception within Judaism as well as the cultural and historical conditions and mechanisms which contributed to the marginalizing of Messianic Jewish communities within Judaism. The main research instrument used by the author is the discourse analysis method proposed by M. Foucault as well as the method of problematization developed and systematized later by Castel. Given methodology presupposes a reconstruction of historical events as refracted by their modern perception; the aims are, fi rstly, to discover invariant models or continuity that are instrumental in preserving the identity of problematization in its constant transformations and, secondly, to single out the principles of varying, that is the variant models of the phenomenon under study. In our case, the problematization emerges at the moment when abruption or marginalization of Messianic Jewish communities takes place. At the end the author arrives at the following conclusions: with respect to Messianic Judaism it is obvious that in the course of its historical development the term «Messianic» has acquired and appropriated negative connotations which was preconditioned mainly by the fact that Messianic communities and groups which shared and actively propagated the Messianic ideas in the society were perceived and declared by the dominant religious tradition as unacceptable, heretical or marginal phenomena destabilizing the established order.

  1. The Influence of Hospital Volume on Circumferential Resection Margin Involvement: Results of the Dutch Surgical Colorectal Audit

    NARCIS (Netherlands)

    Gietelink, Lieke; Henneman, Daniel; van Leersum, Nicoline J.; de Noo, Mirre; Manusama, Eric; Tanis, Pieter J.; Tollenaar, Rob A. E. M.; Wouters, Michel W. J. M.

    2016-01-01

    This population-based study evaluates the association between hospital volume and CRM (circumferential resection margin) involvement, adjusted for other confounders, in rectal cancer surgery. A low hospital volume ( <20 cases/year) was independently associated with a higher risk of CRM involvement

  2. 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

    2014-01-01

    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...... 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...... was individually associated with a 2.2- and 3.8-fold increased risk of BR compared to margin negative patients. CONCLUSION: In our cohort the location of pT2 PSM was associated with time to BR, that is, patients with non-apical pT2 PSM endured the highest risk of BR compared to apical PSM. This may indicate...

  3. Effects of different abutment material and surgical insertion torque on the marginal adaptation of an internal conical interface: an in vitro study.

    Science.gov (United States)

    Farronato, Davide; Pieroni, Stefano; Mangano, Francesco Guido; Briguglio, Francesco; Re, Dino

    2014-10-01

    To evaluate the marginal adaptation at implant-abutment connection of an implant featuring a conical (45° taper) internal hexagonal abutment with a connection depth of 2.5mm, comparing the performance of two identical abutments of different material (titanium grade-4 and Co-Cr-alloy). Twenty implants (3.75 mm×15 mm) were connected to non-matching abutments (5.5 mm×10 mm) of two different materials (titanium grade-4: n=10; Co-Cr-alloy: n=10). The specimens were separately embedded in epoxylite resin, inside copper cylinders, and submerged without covering the most coronal portion (5 mm) of the fixture. Five specimens per group were stressed simulating a surgical 100 Ncm insertion torque, while the others had no torque simulation. All specimens were subjected to a non-axial static load (100 N) in a universal testing machine, under an angle of 30° with respect to the implant axis. Once 100 N load was reached, low shrinkage self-curing resin was injected inside the cylinders, and load was maintained until complete resin polymerization. Specimens were cut and analyzed with optical and scanning-electron-microscope (SEM) to evaluate the marginal adaptation at the implant-abutment connection. Statistical analysis was performed using one-way ANOVA (p=0.02). None of the 20 samples failed. The implant-abutment connection was able to guarantee a good optical seal; SEM analysis confirmed the absence of microgaps. Within the limits of this study (small sample size, limited time) the marginal adaptation of the implant-abutment connection was not affected by the abutment material nor by the application of surgical insertion torque. Copyright © 2014 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

  4. Marginal/peripheral populations of forest tree species and their conservation status: report for Atlantic region

    Directory of Open Access Journals (Sweden)

    Colin T. Kelleher

    2018-04-01

    Full Text Available This report is a synthesis of information from the national reports, prepared as part of the COST Action FP1202 Strengthening conservation: a key issue for adaptation of marginal/peripheral populations of forest trees to climate change in Europe (MaPFGR. The individual national reports can be found as part of the supplemental data to the COST action. The data compiled in this report indicate that the Atlantic area has sufficient resources in terms of knowledge and capacity to assess the potential impact of climate change on marginal and peripheral (MaP sites within the area. Maps of vegetation, soil, climate and climatic predictions are publicly available for most countries and often are of high quality and resolution. These can be utilized to help identify MaP sites and populations in the Atlantic area. In addition, some species have been characterized genetically and the genetic data can also be utilized to identify and characterize sites. However, genetic data is not universally available and in particular may be absent for peripheral sites. There are many data sources for phenotypic traits, such as data from provenance trials but these have not been assessed for MaP populations. There may not be sufficient legislative capacity for the conservation of MaP populations in comparison to, for example, annex habitats of the EU Habitats Directive. Although some of the MaP sites lie within Natura 2000 boundaries, many are not in protected areas. If MaP populations are not characterized and conserved there is a risk of losing traits that may be of potential in adaptation to climate change. A detailed spatial analysis incorporating all of the data is needed to give a comprehensive assessment of the potential threats to MaP populations in this area.

  5. The influence of circumferential resection margin status on loco-regional recurrence in esophageal squamous cell carcinoma.

    Science.gov (United States)

    Park, Hae Jin; Kim, Hak Jae; Chie, Eui Kyu; Kang, Chang Hyun; Kim, Young Tae

    2013-06-01

    To analyze treatment outcomes and patterns of recurrence, and to examine the impact of adjuvant postoperative radiotherapy (PORT) after esophagectomy in esophageal squamous cell carcinoma (SqCC) regarding the status of circumferential resection margin (CRM). We performed a retrospective review of esophageal cancer patients operated in Seoul National University Hospital between 2003 and 2010. Pathologically proven T3 SqCC patients with written reports mentioning the status of CRM were selected. Fifty-nine out of 71 patients (83.1%) had CRM+. Twenty-eight patients had radiotherapy in CRM+ and CRM-, respectively. The median follow-up period was 17.1 months (range: 5.2-63.1). Median survival and 2-year overall survival were 13.8 months and 41.9% in CRM+, and 27.3 months and 74.1% in CRM-, respectively. Loco-regional relapse-free survival (LRRFS) rate at 2 years was 33.6% and 74.1% in each groups (P = 0.029). Loco-regional recurrence was the major pattern of failure in CRM+. PORT did not improve LRRFS. The esophageal SqCC patients with CRM+ after resection showed worse LRRFS. This finding validated the prognostic value of CRM status. Nevertheless, we failed to demonstrate the benefits of adjuvant PORT in CRM+. This might suggest the necessity of neoadjuvant therapy to decrease the CRM+ rate after esophagectomy. Copyright © 2012 Wiley Periodicals, Inc.

  6. Postresection CA19-9 and margin status as predictors of recurrence after adjuvant treatment for pancreatic carcinoma: Analysis of NRG oncology RTOG trial 9704

    Directory of Open Access Journals (Sweden)

    William F. Regine, MD

    2018-04-01

    Full Text Available Purpose: NRG Oncology RTOG 9704 was the first adjuvant trial to validate the prognostic value of postresection CA19-9 levels for survival in patients with pancreatic carcinoma. The data resulting from this study also provide information about predictors of recurrence that may be used to tailor individualized management in this disease setting. This secondary analysis assessed the prognostic value of postresection CA19-9 and surgical margin status (SMS in predicting patterns of disease recurrence. Methods and materials: This multicenter cooperative trial included participants who were enrolled as patients at oncology treatment sites in the United States and Canada. The study included 451 patients analyzable for SMS, of whom 385 were eligible for postresection CA19-9 analysis. Postresection CA19-9 was analyzed at cut points of 90, 180, and continuously. Patterns of disease recurrence included local/regional recurrence (LRR and distant failure (DF. Multivariable analyses included treatment, tumor size, and nodal status. To adjust for multiple comparisons, a P value of ≤ .01 was considered statistically significant and > .01 to ≤ .05 to be a trend. Results: For CA19-9, 132 (34% patients were Lewis antigen–negative (no CA19-9 expression, 200 (52% had levels <90, and 220 (57% had levels <180. A total of 188 patients (42% had negative margins, 152 (34% positive, and 111 (25% unknown. On univariate analysis, CA19-9 cut at 90 was associated with increases in LRR (trend and DF. Results were similar at the 180 cut point. SMS was not associated with an increase in LRR on univariate or multivariate analyses. On multivariable analysis, CA19-9 ≥ 90 was associated with increased LRR and DF. Results were similar at the 180 cut point. Conclusions: In this prospective evaluation, postresection CA19-9 was a significant predictor of both LRR and DF, whereas SMS was not. These findings support consideration of adjuvant radiation therapy dose

  7. Outcomes in breast cancer patients relative to margin status after treatment with breast-conserving surgery and radiation therapy: the University of Pennsylvania experience

    International Nuclear Information System (INIS)

    Peterson, Michael E.; Schultz, Delray J.; Reynolds, Carol; Solin, Lawrence J.

    1999-01-01

    Purpose: To evaluate the significance of final microscopic resection margin status on treatment outcomes in women with early breast cancer who are treated with breast-conserving surgery and definitive breast irradiation. Methods and Materials: An analysis was performed of 1021 consecutive women with clinical Stage I or II invasive carcinoma of the breast treated with breast-conserving surgery and definitive breast irradiation. Complete gross excision of tumor was performed in all cases, and an axillary staging procedure was performed to determine pathologic axillary lymph node status. The 1021 patients were divided into four groups based on the final microscopic margin from the tumor excision or from the re-excision if performed. These four groups were: (a) 518 patients with negative margins; (b) 124 patients with focally positive margins; (c) 96 patients with focally close margins (≤ 2 mm); and (d) 283 patients with unknown margins. Results: Local failure was not significantly different in patients with negative, focally positive, focally close or unknown final pathologic margins of resection at 8 years (8% vs. 10% vs. 17% vs. 16%, respectively, p = 0.21). The 8-year outcome also was not different among the four groups for overall survival (86% vs. 83% vs. 88% vs. 81%, respectively, p = 0.13), cause-specific survival (89% vs. 86% vs. 88% vs. 83%, respectively, p 0.14), no evidence of disease survival (81% vs. 73% vs. 86% vs. 77%, respectively, p = 0.09), and freedom from distant metastases (85% vs. 75% vs. 86% vs. 79%, respectively, p = 0.08). Conclusion: These results demonstrate that selected patients with focally positive or focally close microscopic resection margins can be treated with breast-conserving surgery and definitive breast irradiation with 8-year local control rates and survival rates that are similar to those seen in breast-conservation patients with negative or unknown final resection margins

  8. The status of oral hygiene in cleft lip, palate patients after surgical correction

    Directory of Open Access Journals (Sweden)

    Pandey S

    2005-01-01

    Full Text Available The cleft lip and palate patients usually present a number of problems viz. altered oral anatomy leading to changes in oral physiology diminishing the self-cleansing ability of individual. The handicapped children are unable to maintain their oral hygiene properly. The present study was formulated with the aim that does normalization of oral anatomy have its effect on improvement of oral hygiene? An assessment of oral hygiene index-simplified was performed between preoperative and postoperative values in the same patient at KGMU and KGDU. A total of 50 cases were recorded in two groups of 25 each: (i < 6 years old and (ii > 6 years. The observations are statistically analyzed by paired ′t′ test to get the significance of results. Results: The data analyzed showed the significant decrease in oral hygiene indices observed in both groups. A relative significance in oral hygiene status following surgery was observed. Both groups expressed greater significance when compared pre and postoperatively which is indicative of considerable improvement of oral hygiene after surgical correction. The study concludes that oral hygiene improves more in older cleft lip-palate cases following reconstruction of palatal vault, premaxilla and anterior lip seal by secondary bone grafting method when compared with oral hygiene indices results in primary periosteoplasty cases. The surgical correction of cleft lip palate enhances self-cleaning ability and better compliance to maintain oral hygiene in children as the age advances.

  9. Clinical and nutritional status of surgical patients with and without malignant diseases: cross-sectional study

    Directory of Open Access Journals (Sweden)

    Vânia Aparecida Leandro-Merhi

    2011-03-01

    Full Text Available CONTEXT: Malnutrition is frequently observed in inpatients with malignant diseases and may contribute to longer hospital stays. OBJECTIVE: To compare the nutritional status, lymphocyte count, hemoglobin values and length of hospital stay of patients with and without malignant diseases. METHODS: This comparative study assessed indicators of nutritional status, namely body mass index, recent weight loss, lymphocyte count, hemoglobin and length of hospital stay, of 928 surgical patients with and without malignant diseases (50.2% females and 49.8% males. The chi-square test was used to compare proportions and the Mann-Whitney test was used to compare continuous measurements between two groups. The significance level was set at 5%. RESULTS: Patients with malignant diseases had longer hospital stays (P<0.0001, furthermore, a higher percentage of patients with malignant diseases had body mass index <18.5 (P<0.0001 and experienced recent weight changes (P<0.0002. Lymphocyte count also differed statistically between the groups (P = 0.0131, which lower levels were identified among patients with malignant diseases. CONCLUSION: The lymphocyte count, hemoglobin values and weight loss are important findings of nutritional depletion in patients with malignant diseases.

  10. The differentiation of malignant and benign human breast tissue at surgical margins and biopsy using x-ray interaction data and Bayesian classification

    International Nuclear Information System (INIS)

    Mersov, A.; Mersov, G.; Al-Ebraheem, A.; Cornacchi, S.; Gohla, G.; Lovrics, P.; Farquharson, M.J.

    2014-01-01

    Worldwide, about 1.3 million women are diagnosed with breast cancer annually with an estimated 465,000 deaths. Accordingly, there is a need for high accuracy and speed in diagnosis of lesions suspected of being cancerous. This study assesses the interaction data collected from low energy x-rays within breast tissue samples. Trace element concentrations are assessed using x-ray fluorescence, as well as electron density, and molecular structure which are examined using incoherent and coherent scatter, respectively. Our work to date has shown that such data can provide a quantitative measure of certain tissue characterising parameters and hence, through appropriate modelling, could be used to classify samples for uses such as surgical margin detection and biopsy examination. The parameters used in this study for comparing the normal and tumour tissue sample populations are: levels of elements Ca, Cu, Fe, Br, Zn, Rb, K; the area, FWHM and amplitude from peaks fitted to the coherent scatter profile that are associated with fat, fibre and water content; the ratio of the Compton and coherent scatter peak area, FWHM and amplitude from the incoherent scatter profile. The novelty of the approach to this work lies in the fact that the classification process does not rely on one source of data but combines several measurements, the data from which in this application are modelled using a method based on Bayesian classification. The reliability of the classifications was assessed by its application to diagnostically known data that was not itself included in the thresholds determination. The results of the classification of over 70 breast tissue samples will be presented in this study. Bayesian modelling was carried out using selected significant parameters for classification resulting in 71% of normal tissue samples (n=35) and 66% of tumour tissue samples (n=35) being correctly classified when using all the samples. Bayesian classification using the same variables on all

  11. Evaluation of Resection Margins in Breast Conservation Therapy: The Pathology Perspective—Past, Present, and Future

    Directory of Open Access Journals (Sweden)

    Rajyasree Emmadi

    2012-01-01

    Full Text Available Tumor surgical resection margin status is important for any malignant lesion. When this occurs in conjunction with efforts to preserve or conserve the afflicted organ, these margins become extremely important. With the demonstration of no difference in overall survival between mastectomy versus lumpectomy and radiation for breast carcinoma, there is a definite trend toward smaller resections combined with radiation, constituting “breast-conserving therapy.” Tumor-free margins are therefore key to the success of this treatment protocol. We discuss the various aspects of margin status in this setting, from a pathology perspective, incorporating the past and current practices with a brief glimpse of emerging future techniques.

  12. Motion tracking to enable pre-surgical margin mapping in basal cell carcinoma using optical imaging modalities: initial feasibility study using optical coherence tomography

    Science.gov (United States)

    Duffy, M.; Richardson, T. J.; Craythorne, E.; Mallipeddi, R.; Coleman, A. J.

    2014-02-01

    A system has been developed to assess the feasibility of using motion tracking to enable pre-surgical margin mapping of basal cell carcinoma (BCC) in the clinic using optical coherence tomography (OCT). This system consists of a commercial OCT imaging system (the VivoSight 1500, MDL Ltd., Orpington, UK), which has been adapted to incorporate a webcam and a single-sensor electromagnetic positional tracking module (the Flock of Birds, Ascension Technology Corp, Vermont, USA). A supporting software interface has also been developed which allows positional data to be captured and projected onto a 2D dermoscopic image in real-time. Initial results using a stationary test phantom are encouraging, with maximum errors in the projected map in the order of 1-2mm. Initial clinical results were poor due to motion artefact, despite attempts to stabilise the patient. However, the authors present several suggested modifications that are expected to reduce the effects of motion artefact and improve the overall accuracy and clinical usability of the system.

  13. Fluctuations in Blood Marginal Zone B-Cell Frequencies May Reflect Migratory Patterns Associated with HIV-1 Disease Progression Status.

    Science.gov (United States)

    Gauvin, Julie; Chagnon-Choquet, Josiane; Poudrier, Johanne; Roger, Michel

    2016-01-01

    We have previously shown that overexpression of BLyS/BAFF was associated with increased relative frequencies of innate "precursor" marginal zone (MZ)-like B-cells in the blood of HIV-1-infected rapid and classic progressors. However, along with relatively normal BLyS/BAFF expression levels, these cells remain unaltered in elite-controllers (EC), rather, percentages of more mature MZ-like B-cells are decreased in the blood of these individuals. Fluctuations in frequencies of blood MZ-like B-cell populations may reflect migratory patterns associated with disease progression status, suggesting an important role for these cells in HIV-1 pathogenesis. We have therefore longitudinally measured plasma levels of B-tropic chemokines by ELISA-based technology as well as their ligands by flow-cytometry on blood B-cell populations of HIV-1-infected individuals with different rates of disease progression and uninfected controls. Migration potential of B-cell populations from these individuals were determined by chemotaxis assays. We found important modulations of CXCL13-CXCR5, CXCL12-CXCR4/CXCR7, CCL20-CCR6 and CCL25-CCR9 chemokine-axes and increased cell migration patterns in HIV progressors. Interestingly, frequencies of CCR6 expressing cells were significantly elevated within the precursor MZ-like population, consistent with increased migration in response to CCL20. Although we found little modulation of chemokine-axes in EC, cell migration was greater than that observed for uninfected controls, especially for MZ-like B-cells. Overall the immune response against HIV-1 may involve recruitment of MZ-like B-cells to peripheral sites. Moreover, our findings suggest that "regulated" attraction of these cells in a preserved BLyS/BAFF non-inflammatory environment, such as encountered in EC could be beneficial to the battle and even control of HIV.

  14. Long-term survival outcomes in patients with surgically treated oropharyngeal cancer and defined human papilloma virus status.

    Science.gov (United States)

    Dale, O T; Sood, S; Shah, K A; Han, C; Rapozo, D; Mehanna, H; Winter, S C

    2016-11-01

    This study investigated long-term survival outcomes in surgically treated oropharyngeal cancer patients with known human papilloma virus status. A case note review was performed of all patients undergoing primary surgery for oropharyngeal cancer in a single centre over a 10-year period. Human papilloma virus status was determined via dual modality testing. Associations between clinicopathological variables and survival were identified using a log-rank test. Of the 107 cases in the study, 40 per cent (n = 41) were human papilloma virus positive. The positive and negative predictive values of p16 immunohistochemistry for human papilloma virus status were 57 per cent and 100 per cent, respectively. At a mean follow up of 59.5 months, 5-year overall and disease-specific survival estimates were 78 per cent and 69 per cent, respectively. Human papilloma virus status (p = 0.014), smoking status (p = 0.021) and tumour stage (p = 0.03) were significant prognostic indicators. The long-term survival rates in surgically treated oropharyngeal cancer patients were comparable to other studies. Variables including human papilloma virus status and tumour stage were associated with survival in patients treated with primary surgery; however, nodal stage and presence of extracapsular spread were non-prognostic.

  15. A therapy for oral cancer. The present status and prospects of surgical therapy

    International Nuclear Information System (INIS)

    Fukutake, Kimio; Ohtsuru, Hiroshi

    1995-01-01

    Surgery for carcinoma of the oral cavity has developed rapidly with recent advances in reconstruction. Particularly, in radical surgery for progressive and recurrent disease, safe and adequate resection has been made possible and postoperative cosmetic and functional recovery has been achieved. We reviewed 64 patients with progressive and recurrent cancer who had undergone reconstruction using microvascular techniques during the 12 years from 1983 to 1994. There were 19 patients with T3 disease, 25 with T4 disease, and 20 with recurrence. The free grafts used were radial forearm flaps, the jejunum, rectus abdominis musculocutaneous flaps, and scapular flaps. The survival of free flap grafts was 95.3%. The primary tumor control rate was 85.9%, and the 5-year cumulative survival rate was 61.1%, 60.1%, and 62.9% for patients with T3, T4, and recurrent disease, respectively. Twelve patients with T4 disease of the tongue and the floor of the mouth were treated with combined preoperative brachytherapy and surgery to alleviate postoperative dysfunction, and this treatment was found to be exceedingly effective for improving the postoperative quality of life. There are still many problems with mandibular reconstruction. Since cancer patients commonly undergo preoperative radiotherapy, transplantation of living vascularized bone grafts is frequently performed and is believed to be effective. Since it is important to reconstruct masticatory function as well as to achieve cosmetic improvement, various techniques have recently been used to fit the reconstructed mandible with dental prostheses in order to restore masticatory function. This paper describes the present status and the prospects of surgical therapy for oral cancer. (author)

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

    Science.gov (United States)

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

    2016-04-01

    The circumferential resection margin (CRM) is a key prognostic factor after rectal cancer resection. We sought to identify factors associated with CRM involvement (CRM+). 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 CRM+. Of 23,464 eligible 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. 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. Copyright © 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  17. Randomized comparison of surgical stress and the nutritional status between laparoscopy-assisted and open distal gastrectomy for gastric cancer.

    Science.gov (United States)

    Aoyama, Toru; Yoshikawa, Takaki; Hayashi, Tsutomu; Hasegawa, Shinichi; Tsuchida, Kazuhito; Yamada, Takanobu; Cho, Haruhiko; Ogata, Takashi; Fujikawa, Hirohito; Yukawa, Norio; Oshima, Takashi; Rino, Yasushi; Masuda, Munetaka

    2014-06-01

    Laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer may prevent the development of an impaired nutritional status due to reduced surgical stress compared with open distal gastrectomy (ODG). This study was performed as an exploratory analysis of a phase III trial comparing LADG and ODG for stage I gastric cancer during the period between May and December of 2011. All patients received the same perioperative care via fast-track surgery. The level of surgical stress was evaluated based on the white blood cell count and the interleukin-6 (IL-6) level. The nutritional status was measured according to the total body weight, amount of lean body mass, lymphocyte count, and prealbumin level. Twenty-six patients were randomized to receive ODG (13 patients) or LADG (13 patients). The baseline characteristics and surgical outcomes were similar between the two groups. The median IL-6 level increased from 0.8 to 36.3 pg/dl in the ODG group and from 1.5 to 53.3 pg/dl in the LADG group. The median amount of lean body mass decreased from 48.3 to 46.8 kg in the ODG group and from 46.6 to 46.0 kg in the LADG group. There are no significant differences between two groups. The level of surgical stress and the nutritional status were found to be similar between the ODG and LADG groups in a randomized comparison using the same perioperative care of fast-track surgery.

  18. Insurance status effects on stage of diagnosis and surgical options used in the treatment of breast cancer.

    Science.gov (United States)

    Lukavsky, Robert; Sariego, Jack

    2015-05-01

    Insurance status has the potential to play a significant role in an individual's health care by affecting the time of diagnosis and the treatment options used. Our study reviewed insurance status as a determinant of the time of a breast cancer diagnosis as well as the surgical treatment options offered. The American College of Surgeons' National Cancer Database benchmark reports were used to examine first-course surgery stratified by the stage of breast cancer diagnosed between 2000 and 2010. The data were stratified according to insurance status with a focus on insured patients versus underinsured patients. The relations among insurance status, breast cancer stage at the time of presentation, and initial treatment offered were then evaluated. There was a statistically significant relation between breast cancer stage at the time of diagnosis and insurance status. There also was a relation between insurance status and the treatment offered. Adequately insured patients presented at an earlier stage than did underinsured patients. In addition, in patients who present with early-stage disease, insured patients had a higher rate of breast-conserving surgery than did underinsured patients, 62.4% and 55.5%, respectively. This trend continued in late-stage breast cancer, in which mastectomy was the predominant treatment option overall. Despite this, insured patients underwent breast-conserving therapy more frequently than did underinsured patients, 24.2% and 21.2%, respectively. The discrepancy of the stage of diagnosis between insured patients and underinsured patients can be attributed to a host of factors, among which are access to regular office visits and screening tests for breast cancer. In addition, the surgical treatment options used may depend on the cost of treatment and accessibility to and compliance with follow-up care.

  19. Current status of prophylactic surgical treatment for familial adenomatous polyposis in Japan.

    Science.gov (United States)

    Yamadera, Masato; Ueno, Hideki; Kobayashi, Hirotoshi; Konishi, Tsuyoshi; Ishida, Fumio; Yamaguchi, Tatsuro; Hinoi, Takao; Inoue, Yasuhiro; Kanemitsu, Yukihide; Tomita, Naohiro; Ishida, Hideyuki; Sugihara, Kenichi

    2017-06-01

    We conducted this study to clarify the current clinical practice of prophylactic colectomy for patients with familial adenomatous polyposis (FAP) in Japan. This retrospective multi-center cohort study involved 23 specialized institutions for colorectal disease in Japan. We analyzed the records of 147 patients who underwent prophylactic surgical treatment between 2000 and 2012. Patients were divided into Group 1 (2000-2006) and Group 2 (2007-2012) based on their date of surgery. Age at the time of prophylactic surgery was 27 and 31 years in Groups 1 and 2, respectively. The proportion of attenuated FAP was significantly lower in Group 2 than in Group 1 (1.0 vs. 13 %, respectively). Pathological examination revealed an increased incidence of malignant polyps in the resected specimens from Group 2 patients (10 vs. 23 %, respectively; P = 0.034). Laparoscopic surgery was more frequent in Group 2 than in Group 1 (61 vs. 40 %, respectively). There was no surgical mortality in either group. Prophylactic surgery for FAP results in good short-term surgical outcomes in Japan. The current surgical approach is characterized by limited surgical indications for patients with attenuated FAP, delayed timing of colectomy, and the increasing standardization of laparoscopic surgery.

  20. The effect of HIV status on clinical outcomes of surgical sepsis in ...

    African Journals Online (AJOL)

    Background. KwaZulu-Natal Province, South Africa (SA), has long been the epicentre of the HIV epidemic, but the impact of HIV co-infection on the clinical outcomes of emergency surgical patients with sepsis remains largely unknown. Objective. To review our experience with the management of patients with HIV ...

  1. The impact of caudate lobe resection on margin status and outcomes in patients with hilar cholangiocarcinoma: a multi-institutional analysis from the US Extrahepatic Biliary Malignancy Consortium.

    Science.gov (United States)

    Bhutiani, Neal; Scoggins, Charles R; McMasters, Kelly M; Ethun, Cecilia G; Poultsides, George A; Pawlik, Timothy M; Weber, Sharon M; Schmidt, Carl R; Fields, Ryan C; Idrees, Kamran; Hatzaras, Ioannis; Shen, Perry; Maithel, Shishir K; Martin, Robert C G

    2018-04-01

    The objective of this study was to determine the impact of caudate resection on margin status and outcomes during resection of extrahepatic hilar cholangiocarcinoma. A database of 1,092 patients treated for biliary malignancies at institutions of the Extrahepatic Biliary Malignancy Consortium was queried for individuals undergoing curative-intent resection for extrahepatic hilar cholangiocarcinoma. Patients who did versus did not undergo concomitant caudate resection were compared with regard to demographic, baseline, and tumor characteristics as well as perioperative outcomes. A total of 241 patients underwent resection for a hilar cholangiocarcinoma, of whom 85 underwent caudate resection. Patients undergoing caudate resection were less likely to have a final positive margin (P = .01). Kaplan-Meier curve of overall survival for patients undergoing caudate resection indicated no improvement over patients not undergoing caudate resection (P = .16). On multivariable analysis, caudate resection was not associated with improved overall survival or recurrence-free survival, although lymph node positivity was associated with worse overall survival and recurrence-free survival, and adjuvant chemoradiotherapy was associated with improved overall survival and recurrence-free survival. Caudate resection is associated with a greater likelihood of margin-negative resection in patients with extrahepatic hilar cholangiocarcinoma. Precise preoperative imaging is critical to assess the extent of biliary involvement, so that all degrees of hepatic resections are possible at the time of the initial operation. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Values of iodine metabolism biomarkers in assessing the iodine nutrition status in surgically treated patients with thyroid disease.

    Science.gov (United States)

    Han, Jian-hua; Wu, Lian; Yu, Song-lin; Fang, Hui-ling; Kamg, Wei-ming; Cheng, Xin-qi; Lu, Jie; Yu, Jian-chun; Qiu, Ling

    2015-04-01

    To assess the clinical application value of iodine metabolism biomarkers in assessing iodine nutrition status in surgically treated patients with thyroid disease. Blood,morning urine and 24-hour urine samples were collected in 31 healthy volunteers and in 30 surgically treated patients with thyroid disease before and after surgery. Iodine concentration was analyzed by inductively coupled plasma mass spectrometry. The iodine metabolism biomarkers including serum iodine (SI), morning urine iodine(UI), morning urine iodine/urine creatinine ratio (UI/UCr), 24-hour urine iodine (24 h UI), and 24-hour urine iodine excretion (24 h UIE) were evaluated in these two groups. In addition, the validation coincidence rate of iodine metabolism biomarkers in healthy volunteers to different reference ranges including World Health Organization, Mayo Clinic, and Quest Diagnostics were calculated. The UI/UCr ratio of pre-operative thyroid disease patients was significantly lower than that of healthy volunteers (P0.05) between these two groups. The SI, UI ,and 24 h UI in postoperative thyroid disease patients were significantly higher than those of the pre-operative patients (all Piodine metabolism biomarkers. The UI/UCr ratio may be used for iodine nutrition evaluation in surgically treated patients with thyroid disease.

  3. Virtual reality simulators: current status in acquisition and assessment of surgical skills.

    Science.gov (United States)

    Cosman, Peter H; Cregan, Patrick C; Martin, Christopher J; Cartmill, John A

    2002-01-01

    Medical technology is currently evolving so rapidly that its impact cannot be analysed. Robotics and telesurgery loom on the horizon, and the technology used to drive these advances has serendipitous side-effects for the education and training arena. The graphical and haptic interfaces used to provide remote feedback to the operator--by passing control to a computer--may be used to generate simulations of the operative environment that are useful for training candidates in surgical procedures. One additional advantage is that the metrics calculated inherently in the controlling software in order to run the simulation may be used to provide performance feedback to individual trainees and mentors. New interfaces will be required to undergo evaluation of the simulation fidelity before being deemed acceptable. The potential benefits fall into one of two general categories: those benefits related to skill acquisition, and those related to skill assessment. The educational value of the simulation will require assessment, and comparison to currently available methods of training in any given procedure. It is also necessary to determine--by repeated trials--whether a given simulation actually measures the performance parameters it purports to measure. This trains the spotlight on what constitutes good surgical skill, and how it is to be objectively measured. Early results suggest that virtual reality simulators have an important role to play in this aspect of surgical training.

  4. Identification of predisposing factors for osteonecrosis of the jaw after marginal mandibulectomy in the surgical management of oral squamous cell carcinoma.

    Science.gov (United States)

    Ito, Ran; Huang, Jung-Ju; Hsieh, Wei-Chuan; Kao, Huang-Kai; Lao, William Wei-Kai; Fang, Ku-Hao; Huang, Yenlin; Chang, Yu-Liang; Cheng, Ming-Huei; Chang, Kai-Ping

    2018-03-01

    The aim of this study is to evaluate osteonecrosis of the jaw (ONJ) with the extent of marginal mandibulectomy. Between January 2006 and December 2012, 3087 patients undergoing ablative resection were consecutively enrolled. Among them, 345 cases undergoing marginal mandibulectomy were retrospectively reviewed. The occurrence of ONJ was 5.51% and associated with body mass index, overall stage, diabetes, concomitant mandibulotomy, and radiotherapy (P = 0.023, 0.033, 0.009, 0.016, and 0.006, respectively). As for bone parameters based on radiological measurements after marginal mandibulectomy, resected bone height, remaining bone height to original bone height ratio, and resected bone height to original bone height ratio were associated with ONJ. In multivariate logistic analyses, concomitant mandibulotomy, radiotherapy, diabetes, resected bone height of >14.5 mm, resected bone height to original bone height ratio of >49.5%, and remaining bone height to original bone height ratio of marginal mandibulectomy; more caution is necessitated in performing marginal mandibulectomy in patients with multiple risks to prevent ONJ. © 2017 Wiley Periodicals, Inc.

  5. Interim Report on Metallic Component Margins Under High Seismic Loads. Survey of Existing Practices and Status of Benchmark Work

    International Nuclear Information System (INIS)

    2015-01-01

    OECD/NEA/CSNI Working Group on Integrity and Ageing of Components and Structures (WGIAGE) has the main mission to advance the current understanding of those aspects relevant to ensuring the integrity of structures, systems and components under design and beyond design loads, to provide guidance in choosing the optimal ways of dealing with challenges to the integrity of operating as well as new nuclear power plants, and to make use of an integrated approach to design, safety and plant life management. The activity (CAPS) of the WGIAGE group, entitled 'Metallic Component Margins under High Seismic Loads (MECOS)', was initially proposed by the metal sub-group of WGIAGE and approved by the CSNI in June 2012 as a Fukushima activity (F-CAPS). The proposal is aimed to assess the consequences of external hazards on plant safety. The main objectives of the MECOS project were to quantify the existing margins in seismic analysis of safety class components for high seismic loads and assess the existing design practices within a benchmark activity. The first phase of MECOS work included a survey on the existing seismic regulations and design analysis methods in the member countries. The survey was conducted by means of a questionnaire and a total of 24 questions were asked. The questionnaire consists of three parts: Seismic Input, Seismic Design Basis, and Beyond Seismic Design Basis. The majority of the respondents use the Standard or Modified Shape Spectrum and only a few countries are using the Uniform Seismic Hazard Spectra (UHS) in their seismic design regulations. All of the respondents have minimum seismic demand in their national or adopted standards. The number of defined and used seismic levels for the design of mechanical components is one or two. Almost all of the respondents are using combined testing and analysis methods for seismic qualification and design. Some countries (e.g. Canada, Finland, USA, France, Japan and UK) have specific requirements for

  6. Health and social status in Danish women surgically treated for ovarian cancer

    DEFF Research Database (Denmark)

    Seibæk, Lene; Petersen, Lone Kjeld; Blaakær, Jan

    be requested when surgical treatment and care are centralized and standardised.   Material and methods Data constitute the Danish population of ovarian cancer patients in 2007, originating from the Danish Gynaecological Cancer Database and Statistics Denmark. 649 of 667 ids were suitable for analysis.......   Results Estimated by ASA scores 39 % of the patients were healthy, forty-seven % were moderate systemic ill and 14 % had severe or life threatening disease. Fifty-three % of the patients had a normal BMI, 43 % in a condition of moderate to severe overweight. Twenty-five % of the patients had borderline...... ovarian tumours; seventy-five % had cancer. Thirteen % of the operations had complications, eighty % of these patients with stage III-IV disease. Median range of age were 63 years; the youngest 16 the oldest 95. Fifty-two % were married, thirty-seven % widows/ divorced. Sixty-six % lived in houses and 31...

  7. Clinical And Morphological Androgenic Status Characteristics At Children Suffering From Hypospadias And Its Influence On Results Of Surgical Correction

    Directory of Open Access Journals (Sweden)

    F.K. Napolnikov

    2009-09-01

    Full Text Available The goal of this article is to estimate the androgenic status and analyze its influence on the surgical treatment of hypospadias. From 2000 till 2008 there were 209 children under treatment, whose age varied from 8 months till 15 years old (average age — 4,5+ 1,5. 49 patients were subjected to clinical, humoral and morphological study. Preoperational preparation was carried out by testosterone medications. The comparison group consisted of 10 boys with cicatricial phimosis. The patients with the medium and back forms of hypospadias suffered from the androgenic deficit characterized by proximal level of meatus ectopia, diminution of penis length and prostate volume, decrease of blood vessels in deep layers of penis skin. The testosterone pre-operational medication of patients makes possible to improve the results of surgical correction due to blood supply of plastic material. On the basis of recieved data logistically regressive model has been worked out and the prognosis of results has been estimated

  8. A Study on the Dietary Intake and the Nutritional Status among the Pancreatic Cancer Surgical Patients.

    Science.gov (United States)

    Kang, Jimin; Park, Joon Seong; Yoon, Dong Sup; Kim, Woo Jeong; Chung, Hae-Yun; Lee, Song Mi; Chang, Namsoo

    2016-10-01

    The adequate dietary intake is important to maintain the nutritional status of the patients after pancreatic cancer surgery. This prospective study was designed to investigate the dietary intake and the nutritional status of the patients who had pancreatic cancer surgery. Thirty-one patients (15 men, 16 women) were enrolled and measured body weight, body mass index (BMI), nutritional risk index (NRI), and Malnutrition Universal Screening Tool (MUST). Actual oral intake with nutritional impact symptoms recorded on the clinical research foam at every meal and medical information were collected from electronic medical charts. The rates of malnutrition at admission were 45.1% (14/31) and 28.9% (9/31) by NRI and MUST method, respectively, but those were increased to 87% (27/31) and 86.6% (26/31) after operation on discharge. The median values of daily intake of energy, carbohydrates, fat, and protein were 588.1 kcal, 96.0 g, 11.8 g, and 27.0 g, respectively. Most patients (n = 20, 64.5%) experienced two or more symptoms such as anorexia, abdominal bloating and early satiety. There were negative correlations between C-reactive protein (CRP) levels and the intake of total energy, protein, fat, and zinc. The rates of malnutrition were increased sharply after surgery and the dietary intake also influenced the inflammatory indicators. The results suggested that need of considering special therapeutic diets for the patients who received pancreatic surgery.

  9. [System for assessing the nutritional status of the surgical patient at admission. Nutritional assessment in surgery].

    Science.gov (United States)

    López Caballero, M; Pérez Suárez, I; Martínez García, C; Román García, I; Martínez Gallego, R M; Ruiz Coracho, P

    1991-01-01

    Many studies have shown that the prevalence of malnutrition in hospitals is high. Our aim in this study is to ensure the systematic use of a preoperative nutritional evaluation (PNE) that ensures simplicity and usefulness in hospital nursing assistance. A total of 96 patients were studied, of whom 31 were diagnosed as having neoplasia and 65 non-neoplasia. For the purpose of this evaluation, the Chang method was used, completed with the application of retarded immunity skin tests. Malnutrition was observed in 71% por patients with neoplasia, mainly corresponding to slight Marasmo grade. In non-neoplasic patients malnutrition was 46%, also corresponding to slight Marasmo grade. In patients with neoplasia, anergy was evident in 54.9% of cases, and accounted for 23.1% in non-neoplasic patients. The development of anergy in both types of patients was significantly greater (p less than 0.05) in patients over 65 years of age. The inclusion of a PNE should form part of the nursing protocols, being used systematically in the study and control of surgical patients.

  10. Current status of robotic simulators in acquisition of robotic surgical skills.

    Science.gov (United States)

    Kumar, Anup; Smith, Roger; Patel, Vipul R

    2015-03-01

    This article provides an overview of the current status of simulator systems in robotic surgery training curriculum, focusing on available simulators for training, their comparison, new technologies introduced in simulation focusing on concepts of training along with existing challenges and future perspectives of simulator training in robotic surgery. The different virtual reality simulators available in the market like dVSS, dVT, RoSS, ProMIS and SEP have shown face, content and construct validity in robotic skills training for novices outside the operating room. Recently, augmented reality simulators like HoST, Maestro AR and RobotiX Mentor have been introduced in robotic training providing a more realistic operating environment, emphasizing more on procedure-specific robotic training . Further, the Xperience Team Trainer, which provides training to console surgeon and bed-side assistant simultaneously, has been recently introduced to emphasize the importance of teamwork and proper coordination. Simulator training holds an important place in current robotic training curriculum of future robotic surgeons. There is a need for more procedure-specific augmented reality simulator training, utilizing advancements in computing and graphical capabilities for new innovations in simulator technology. Further studies are required to establish its cost-benefit ratio along with concurrent and predictive validity.

  11. Documentation of Pregnancy Status, Gynaecological History, Date of Last Menstrual Period and Contraception Use in Emergency Surgical Admissions: Time for a Change in Practice?

    Science.gov (United States)

    Powell-Bowns, M; Wilson, M S J; Mustafa, A

    2015-12-01

    To determine whether pregnancy status, gynaecological history, date of last menstrual period and contraceptive use are documented in emergency female admissions of reproductive age admitted to general surgery. This is a retrospective study. This study was conducted in the United Kingdom. Females of reproductive age (12-50 years) admitted as an emergency to general surgery with abdominal pain were considered in this study. Retrospective analysis of medical notes of emergency female admissions with abdominal pain between January and September 2012. We recorded whether a pregnancy test result was documented (cycle 1). Results were analysed and a prompt added to the medical clerk-in document. We re-audited (cycle 2) between January and June 2013 looking for improvement. Documented pregnancy status within 24 h of admission and prior to any surgical intervention. 100 case notes were reviewed in stage 1. 30 patients (30 %) had a documented pregnancy status. 32 (32 %), 25 (25 %) and 29 (29 %) had a documented gynaecology history, contraceptive use and date of last menstrual period (LMP), respectively. 24 patients underwent emergency surgery, 6 (25 %) had a documented pregnancy status prior to surgery. Of 50 patients reviewed in stage 2, 37 (75.0 %) had a documented pregnancy status (p contraceptive use (p < 0.0001) documented. 40 patients (80 % had a documented LMP (p < 0.0001). 7 patients required surgery, of whom 6 (85.7 %) had a documented pregnancy test prior to surgery (p = 0.001). All pregnancy tests were negative. A simple prompt in the surgical admission document has significantly improved the documentation of pregnancy status and gynaecological history in our female patients, particularly in those who require surgical intervention. A number of patient safety concerns were addressed locally, but require a coordinated, interdisciplinary discussion and a national guideline. A minimum standard of care, in females of reproductive age, should include mandatory objective

  12. SOCIAL MARGINALIZATION AND HEALTH

    Directory of Open Access Journals (Sweden)

    Marjana Bogdanović

    2007-04-01

    Full Text Available The 20th century was characterized by special improvement in health. The aim of WHO’s policy EQUITY IN HEALTH is to enable equal accessibility and equal high quality of health care for all citizens. More or less some social groups have stayed out of many social systems even out of health care system in the condition of social marginalization. Phenomenon of social marginalization is characterized by dynamics. Marginalized persons have lack of control over their life and available resources. Social marginalization stands for a stroke on health and makes the health status worse. Low socio-economic level dramatically influences people’s health status, therefore, poverty and illness work together. Characteristic marginalized groups are: Roma people, people with AIDS, prisoners, persons with development disorders, persons with mental health disorders, refugees, homosexual people, delinquents, prostitutes, drug consumers, homeless…There is a mutual responsibility of community and marginalized individuals in trying to resolve the problem. Health and other problems could be solved only by multisector approach to well-designed programs.

  13. Effect of two different sublingual dosages of vitamin B12 on cobalamin nutritional status in vegans and vegetarians with a marginal deficiency: A randomized controlled trial.

    Science.gov (United States)

    Del Bo', Cristian; Riso, Patrizia; Gardana, Claudio; Brusamolino, Antonella; Battezzati, Alberto; Ciappellano, Salvatore

    2018-02-15

    Vegetarians and vegans are more vulnerable to vitamin B 12 deficiency with severe risks of megaloblastic anemia, cognitive decline, neuropathy, and depression. An easy and simple method of supplementation consists of taking one weekly dosage of 2000 μg. However, single large oral doses of vitamin B 12 are poorly absorbed. The present research evaluates the ability of two different sublingual dosages of vitamin B 12 (350 μg/week vs 2000 μg/week) in improving cyanocobalamin (vitamin B 12 ) nutritional status in vegans and vegetarians with a marginal deficiency. A 12-week randomized, double-blind, controlled, parallel intervention trial was performed. Forty subjects with marginal vitamin B 12 deficiency were enrolled and randomly divided into two groups: test group Ld (low dose, 350 μg/week) and control group Hd (high dose, 2000 μg/week) vitamin B 12 supplementation. Blood samples were collected at baseline and after 15, 30, 60, and 90 days from the intervention for the determination of vitamin B 12 , related metabolic markers, and blood cell counts. Two-way analysis of variance showed a significant effect of time (P < 0.0001) and of time × treatment interaction (P = 0.012) on serum concentration of vitamin B 12 that increased after 90-day supplementation (Ld and Hd) compared to baseline. Both the supplements increased (P < 0.0001, time effect) the levels of holotranscobalamin, succinic acid, methionine and wellness parameter, while decreased (P < 0.0001, time effect) the levels of methylmalonic acid, homocysteine and folate compared to baseline. No difference was observed between groups (LdvsHd). No effect was detected for vitamin B 6 and blood cell count. In our experimental conditions, both supplements were able to restore adequate serum concentrations of vitamin B 12 and to improve the levels of related metabolic blood markers in subjects with a marginal deficiency. The results support the use of a sublingual dosage of 50 μg/day (350

  14. Menopausal status dependence of the timing of breast cancer recurrence after surgical removal of the primary tumour

    International Nuclear Information System (INIS)

    Demicheli, Romano; Bonadonna, Gianni; Hrushesky, William JM; Retsky, Michael W; Valagussa, Pinuccia

    2004-01-01

    Information on the metastasis process in breast cancer patients undergoing primary tumour removal may be extracted from an analysis of the timing of clinical recurrence. The hazard rate for local-regional and/or distant recurrence as the first event during the first 4 years after surgery was studied in 1173 patients undergoing mastectomy alone as primary treatment for operable breast cancer. Subset analyses were performed according to tumour size, axillary nodal status and menopausal status. A sharp two-peaked hazard function was observed for node-positive pre-menopausal patients, whereas results from node-positive post-menopausal women always displayed a single broad peak. The first narrow peak among pre-menopausal women showed a very steep rise to a maximum about 8–10 months after mastectomy. The second peak was considerably broader, reaching its maximum at 28–30 months. Post-menopausal patients displayed a wide, nearly symmetrical peak with maximum risk at about 18–20 months. Peaks displayed increasing height with increasing axillary lymph node involvement. No multi-peaked pattern was evident for either pre-menopausal or post-menopausal node-negative patients; however, this finding should be considered cautiously because of the limited number of events. Tumour size influenced recurrence risk but not its timing. Findings resulting from the different subsets of patients were remarkably coherent and each observed peak maintained the same position on the time axis in all analysed subsets. The risk of early recurrence for node positive patients is dependent on menopausal status. The amount of axillary nodal involvement and the tumour size modulate the risk value at any given time. For pre-menopausal node-positive patients, the abrupt increase of the first narrow peak of the recurrence risk suggests a triggering event that synchronises early risk. We suggest that this event is the surgical removal of the primary tumour. The later, broader, more symmetrical risk

  15. Risk of biochemical recurrence and timing of radiotherapy in pT3a N0 prostate cancer with positive surgical margin. A single center experience

    International Nuclear Information System (INIS)

    Hegemann, Nina-Sophie; Morcinek, Sebastian; Corradini, Stefanie; Li, Minglun; Belka, Claus; Ganswindt, Ute; Buchner, Alexander; Karl, Alexander; Stief, Christian; Knuechel, Ruth

    2016-01-01

    Despite improved biochemical recurrence-free survival rates by the use of immediate adjuvant radiotherapy (RT) in patients with locally advanced prostate cancer, disagreement about the need and timing of RT remains. From 2005-2009, 94 patients presenting with a stage pT3a N0 and microscopic positive resection margin were retrospectively analyzed after radical prostatectomy. Special attention was given to patients' outcome, the frequency of additive RT, and its efficacy. Median follow-up was 80 months. A total of 71 patients had a negative postoperative prostate-specific antigen (PSA) level (<0.07 ng/ml). Thirty-six of them did not experience any PSA relapse (subgroup 1). Fourteen of them received additive RT and during follow-up all 36 patients remained PSA negative. Of 71 initially PSA-negative patients, 35 had a biochemical relapse (subgroup 2); 28 patients underwent salvage RT. The median PSA value before salvage RT was 0.24 ng/ml and was subsequently negative (<0.07 ng/ml) in 23 patients after RT. Of the entire cohort, 23 patients had persisting PSA after surgery (subgroup 3). Of these, 18 patients received salvage RT at a median PSA level of 0.4 ng/ml. One patient in subgroup 1, 5 patients in subgroup 2, and 9 patients in subgroup 3 had ongoing androgen deprivation therapy. The present study of 94 pT3a N0 R1 prostate cancer patients provides insight into medical care of this patient cohort and underlines the need for additive RT for the majority of patients to achieve long-term biochemical control. Although immediate adjuvant RT was applied with restraint (20 %), during the observation period 60 of 94 patients (63.8 %) received RT - highlighting the need of postoperative treatment. (orig.) [de

  16. Risk factors for positive margins in conservative surgery for breast cancer after neoadjuvant chemotherapy.

    Science.gov (United States)

    Bouzón, Alberto; Acea, Benigno; García, Alejandra; Iglesias, Ángela; Mosquera, Joaquín; Santiago, Paz; Seoane, Teresa

    2016-01-01

    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.

  17. Marginal Matter

    Science.gov (United States)

    van Hecke, Martin

    2013-03-01

    All around us, things are falling apart. The foam on our cappuccinos appears solid, but gentle stirring irreversibly changes its shape. Skin, a biological fiber network, is firm when you pinch it, but soft under light touch. Sand mimics a solid when we walk on the beach but a liquid when we pour it out of our shoes. Crucially, a marginal point separates the rigid or jammed state from the mechanical vacuum (freely flowing) state - at their marginal points, soft materials are neither solid nor liquid. Here I will show how the marginal point gives birth to a third sector of soft matter physics: intrinsically nonlinear mechanics. I will illustrate this with shock waves in weakly compressed granular media, the nonlinear rheology of foams, and the nonlinear mechanics of weakly connected elastic networks.

  18. Margins in breast conserving surgery: The financial cost & potential savings associated with the new margin guidelines.

    Science.gov (United States)

    Singer, Lauren; Brown, Eric; Lanni, Thomas

    2016-08-01

    In this study, we compare the indications for re-excision, the findings of additional tumor in the re-excision specimen as they relate to margin status, and costs associated with re-excision based on recent new consensus statements. A retrospective analysis was performed on 462 patients with invasive breast carcinoma who underwent at least one lumpectomy between January 2011 and December 2013. Postoperative data was analyzed based on where additional disease was found, as it relates to the margin status of the initial lumpectomy and the additional direct costs associated with additional procedures. Of the 462 patients sampled, 149 underwent a re-excision surgery (32.2%). Four patients underwent mastectomy as their second operation. In the 40 patients with additional disease found on re-excision, 36 (90.0%) of them had a positive margin on their initial lumpectomy. None of the four mastectomy patients had residual disease. The mean cost of the initial lumpectomy for all 462 patients was $2118.01 plus an additional $1801.92 for those who underwent re-excision. A positive margin was most predictive of finding residual tumor on re-excision as would be expected. Using old criteria only 0.07% (4/61) of patients who had undergone re-excision with a 'clear' margin, had additional tumor found, at a total cost of $106,354.11. Thus, the new consensus guidelines will lead to less overall cost, at no clinical risk to patients while reducing a patient's surgical risk and essentially eliminating delays in adjuvant care. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Influence of the glutation S-transferases T1 and M1 gene polymorphisms on androgenic status and semen quality after surgical treatment of varicocele

    Directory of Open Access Journals (Sweden)

    P. V. Glybochko

    2013-01-01

    Full Text Available Aim: to examine androgenic status in men after surgical treatment of varicocele; to investigate genotype GSTT1 and GSTM1 in patients with pathozoospermia. Thirty men after surgical treatment of varicocele were recruited to this study. All subjects were evaluated by history, physical examination, semen analysis, serum FSH, LH, E2, PL, inhibin B and total testosterone determination. GSTT1, CSTM1 gene polymorphisms were determined by polymerase chain reaction. Total testosterone and inhibin B levels were significantly lower in patients with pathozoospermia. Patients with the GSTM1(- genotype had lower sperm concentrations than those with the GSTM1(+ genotype.Our results suggest that the GSTM1(- genotype is risk factor for androgen deficiency and pathozoospermia.

  20. Marginal kidney donor

    Directory of Open Access Journals (Sweden)

    Ganesh Gopalakrishnan

    2007-01-01

    Full Text Available Renal transplantation is the treatment of choice for a medically eligible patient with end stage renal disease. The number of renal transplants has increased rapidly over the last two decades. However, the demand for organs has increased even more. This disparity between the availability of organs and waitlisted patients for transplants has forced many transplant centers across the world to use marginal kidneys and donors. We performed a Medline search to establish the current status of marginal kidney donors in the world. Transplant programs using marginal deceased renal grafts is well established. The focus is now on efforts to improve their results. Utilization of non-heart-beating donors is still in a plateau phase and comprises a minor percentage of deceased donations. The main concern is primary non-function of the renal graft apart from legal and ethical issues. Transplants with living donors outnumbered cadaveric transplants at many centers in the last decade. There has been an increased use of marginal living kidney donors with some acceptable medical risks. Our primary concern is the safety of the living donor. There is not enough scientific data available to quantify the risks involved for such donation. The definition of marginal living donor is still not clear and there are no uniform recommendations. The decision must be tailored to each donor who in turn should be actively involved at all levels of the decision-making process. In the current circumstances, our responsibility is very crucial in making decisions for either accepting or rejecting a marginal living donor.

  1. Indigenous women's voices: marginalization and health.

    Science.gov (United States)

    Dodgson, Joan E; Struthers, Roxanne

    2005-10-01

    Marginalization may affect health care delivery. Ways in which indigenous women experienced marginalization were examined. Data from 57 indigenous women (18 to 65 years) were analyzed for themes. Three themes emerged: historical trauma as lived marginalization, biculturalism experienced as marginalization, and interacting within a complex health care system. Experienced marginalization reflected participants' unique perspective and were congruent with previous research. It is necessary for health care providers to assess the detrimental impact of marginalization on the health status of individuals and/or communities.

  2. Splenic marginal zone lymphoma.

    Science.gov (United States)

    Piris, Miguel A; Onaindía, Arantza; Mollejo, Manuela

    Splenic marginal zone lymphoma (SMZL) is an indolent small B-cell lymphoma involving the spleen and bone marrow characterized by a micronodular tumoral infiltration that replaces the preexisting lymphoid follicles and shows marginal zone differentiation as a distinctive finding. SMZL cases are characterized by prominent splenomegaly and bone marrow and peripheral blood infiltration. Cells in peripheral blood show a villous cytology. Bone marrow and peripheral blood characteristic features usually allow a diagnosis of SMZL to be performed. Mutational spectrum of SMZL identifies specific findings, such as 7q loss and NOTCH2 and KLF2 mutations, both genes related with marginal zone differentiation. There is a striking clinical variability in SMZL cases, dependent of the tumoral load and performance status. Specific molecular markers such as 7q loss, p53 loss/mutation, NOTCH2 and KLF2 mutations have been found to be associated with the clinical variability. Distinction from Monoclonal B-cell lymphocytosis with marginal zone phenotype is still an open issue that requires identification of precise and specific thresholds with clinical meaning. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Marital status independently predicts gastric cancer survival after surgical resection--an analysis of the SEER database

    OpenAIRE

    Shi, Rong-liang; Chen, Qian; Yang, Zhen; Pan, Gaofeng; Zhang, Ziping; Wang, WeiHua; Liu, Shaoqun; Zhang, Dongbin; Jiang, Daowen; Liu, Weiyan

    2016-01-01

    Marital status was found to be an independent prognostic factor for survival in various cancer types, but it hasn't been studied in gastric cancer. The Surveillance, Epidemiology and End Results database was used to compare survival outcomes with marital status. A total of 16,106 eligible patients were identified. Patients in the widowed group had the highest proportion of women, more common site of stomach, more prevalence of elderly patients, higher percentage of adenocarcinoma, and more tu...

  4. Mammographically detected ductal carcinoma in situ of the breast treated with breast-conserving surgery and definitive breast irradiation: long-term outcome and prognostic significance of patient age and margin status

    International Nuclear Information System (INIS)

    Solin, Lawrence J.; Fourquet, Alain; Vicini, Frank A.; Haffty, Bruce; Taylor, Marie; McCormick, Beryl; McNeese, Marsha; Pierce, Lori J.; Landmann, Christine; Olivotto, Ivo A.; Borger, Jacques; Kim, Jung-Soo; Rochefordiere, Anne de la; Schultz, Delray J.

    2001-01-01

    Purpose: This study was performed to determine the long-term outcome for women with mammographically detected ductal carcinoma in situ (DCIS; intraductal carcinoma) of the breast treated with breast-conserving surgery followed by definitive breast irradiation. Methods and Materials: An analysis was performed of 422 mammographically detected intraductal breast carcinomas in 418 women from 11 institutions in North America and Europe. All patients were treated with breast-conserving surgery followed by definitive breast irradiation. The median follow-up time was 9.4 years (mean, 9.4 years; range, 0.1-19.8 years). Results: The 15-year overall survival rate was 92%, and the 15-year cause-specific survival rate was 98%. The 15-year rate of freedom from distant metastases was 94%. There were 48 local failures in the treated breast, and the 15-year rate of any local failure was 16%. The median time to local failure was 5.0 years (mean, 5.7 years; range, 1.0-15.2 years). Patient age at the time of treatment and final pathology margin status from the primary tumor excision were both significantly associated with local failure. The 10-year rate of local failure was 31% for patient age ≤ 39 years, 13% for age 40-49 years, 8% for age 50-59 years, and 6% for age ≥ 60 years (p=0.0001). The 10-year rate of local failure was 24% when the margins of resection were positive, 9% when the margins of resection were negative, 7% when the margins of resection were close, and 12% when the margins of resection were unknown (p=0.030). Patient age ≤ 39 years and positive margins of resection were both independently associated with an increased risk of local failure (p=0.0006 and p=0.023, respectively) in the multivariable Cox regression model. Conclusions: The 15-year results from the present study demonstrated high rates of overall survival, cause-specific survival, and freedom from distant metastases following the treatment of mammographically detected ductal carcinoma in situ of the

  5. Electricity prices in a competitive environment: Marginal cost pricing of generation services and financial status of electric utilities. A preliminary analysis through 2015

    International Nuclear Information System (INIS)

    1997-08-01

    The emergence of competitive markets for electricity generation services is changing the way that electricity is and will be priced in the United States. This report presents the results of an analysis that focuses on two questions: (1) How are prices for competitive generation services likely to differ from regulated prices if competitive prices are based on marginal costs rather than regulated open-quotes cost-of-serviceclose quotes pricing? (2) What impacts will the competitive pricing of generation services (based on marginal costs) have on electricity consumption patterns, production costs, and the financial integrity patterns, production costs, and the financial integrity of electricity suppliers? This study is not intended to be a cost-benefit analysis of wholesale or retail competition, nor does this report include an analysis of the macroeconomic impacts of competitive electricity prices

  6. Electricity prices in a competitive environment: Marginal cost pricing of generation services and financial status of electric utilities. A preliminary analysis through 2015

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-08-01

    The emergence of competitive markets for electricity generation services is changing the way that electricity is and will be priced in the United States. This report presents the results of an analysis that focuses on two questions: (1) How are prices for competitive generation services likely to differ from regulated prices if competitive prices are based on marginal costs rather than regulated {open_quotes}cost-of-service{close_quotes} pricing? (2) What impacts will the competitive pricing of generation services (based on marginal costs) have on electricity consumption patterns, production costs, and the financial integrity patterns, production costs, and the financial integrity of electricity suppliers? This study is not intended to be a cost-benefit analysis of wholesale or retail competition, nor does this report include an analysis of the macroeconomic impacts of competitive electricity prices.

  7. Robot-Assisted Versus Laparoscopy-Assisted Proximal Gastrectomy for Early Gastric Cancer in the Upper Location: Comparison of Oncological Outcomes, Surgical Stress, and Nutritional Status.

    Science.gov (United States)

    Zhang, Kecheng; Huang, Xiaohui; Gao, Yunhe; Liang, Wenquan; Xi, Hongqing; Cui, Jianxin; Li, Jiyang; Zhu, Minghua; Liu, Guoxiao; Zhao, Huazhou; Hu, Chong; Liu, Yi; Qiao, Zhi; Wei, Bo; Chen, Lin

    2018-01-01

    An increasing amount of attention has been paid to minimally invasive function-preserving gastrectomy, with an increase in incidence of early gastric cancer in the upper stomach. This study aimed to compare oncological outcomes, surgical stress, and nutritional status between robot-assisted proximal gastrectomy (RAPG) and laparoscopy-assisted proximal gastrectomy (LAPG). Eighty-nine patients were enrolled in this retrospective study between November 2011 and December 2013. Among them, 27 patients underwent RAPG and 62 underwent LAPG. Perioperative parameters, surgical stress, nutritional status, disease-free survival, and overall survival were compared between the 2 groups. Sex, age, and comorbidity were similar in the RAPG and LAPG groups. There were also similar perioperative outcomes regarding operation time, complications, and length of hospital stay between the groups. The reflux esophagitis rates following RAPG and LAPG were 18.5% and 14.5%, respectively ( P = .842). However, patients in the RAPG group had less blood loss ( P = .024), more harvested lymph nodes ( P = .021), and higher costs than those in the LAPG group ( P .05). There appeared to be higher hemoglobin levels at 6 months ( P = .053) and a higher body mass index at 12 months ( P = .056) postoperatively in patients in the RAPG group compared with those in the LAPG group, but this difference was not significant. Similar disease-free survival and overall survival rates were observed between the groups. RAPG could be an alternative to LAPG for patients with early gastric cancer in the upper stomach with comparable oncological safety and nutritional status. Further well-designed, prospective, large-scale studies are needed to validate these results.

  8. [Resection margins in conservative breast cancer surgery].

    Science.gov (United States)

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

    2013-01-01

    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.

  9. 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: morrowm@mskcc.org [Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2014-03-01

    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.

  10. 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

    International Nuclear Information System (INIS)

    Moran, Meena S.; Schnitt, Stuart J.; Giuliano, Armando E.; Harris, Jay R.; Khan, Seema A.; Horton, Janet; Klimberg, Suzanne; Chavez-MacGregor, Mariana; Freedman, Gary; Houssami, Nehmat; Johnson, Peggy L.; Morrow, Monica

    2014-01-01

    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

  11. Psychological status as a function of residual scarring and facial asymmetry after surgical repair of cleft lip and palate.

    Science.gov (United States)

    Millar, Keith; Bell, Aileen; Bowman, Adrian; Brown, Denise; Lo, Tsz-Wai; Siebert, Paul; Simmons, David; Ayoub, Ashraf

    2013-03-01

    Objective : Objective measure of scarring and three-dimensional (3D) facial asymmetry after surgical correction of unilateral cleft lip (UCL) and unilateral cleft lip (UCLP). It was hypothesized that the degree of scarring or asymmetry would be correlated with poorer psychological function. Design : In a cross-sectional design, children underwent 3D imaging of the face and completed standardized assessments of self-esteem, depression, and state and trait anxiety. Parents rated children's adjustment with a standard scale. Setting : Glasgow Dental School, School of Medicine, College of Medical, Veterinary and Life Sciences. Patients : Fifty-one children aged 10 years with UCLP and 43 with UCL were recruited from the cohort treated with the surgical protocol of the CLEFTSIS managed clinical network in Scotland. Methods : Objective assessment to determine the luminance and redness of the scar and facial asymmetry. Depression, anxiety, and a self-esteem assessment battery were used for the psychological analysis. Results : Cleft cases showed superior psychological adjustment when compared with normative data. Prevalence of depression matched the population norm. The visibility of the scar (luminance ratio) was significantly correlated with lower self-esteem and higher trait anxiety in UCLP children (P  =  .004). Similar but nonsignificant trends were seen in the UCL group. Parental ratings of poorer adjustment also correlated with greater luminance of the scar. Conclusions : The objectively defined degree of postoperative cleft scarring was associated with subclinical symptoms of anxiety, depression, and low self-esteem.

  12. Marital status independently predicts gastric cancer survival after surgical resection--an analysis of the SEER database.

    Science.gov (United States)

    Shi, Rong-Liang; Chen, Qian; Yang, Zhen; Pan, Gaofeng; Zhang, Ziping; Wang, WeiHua; Liu, Shaoqun; Zhang, Dongbin; Jiang, Daowen; Liu, Weiyan

    2016-03-15

    Marital status was found to be an independent prognostic factor for survival in various cancer types, but it hasn't been studied in gastric cancer. The Surveillance, Epidemiology and End Results database was used to compare survival outcomes with marital status. A total of 16,106 eligible patients were identified. Patients in the widowed group had the highest proportion of women, more common site of stomach, more prevalence of elderly patients, higher percentage of adenocarcinoma, and more tumors at localized stage (P married group had better 5year cause-specific survival (CSS) than those unmarried (P married patients at Localized stage (77.2% vs 70.1%, P vs 28.6%, P vs 8.6%, P unmarried patients were at greater risk of cancer specific mortality. Despite favorable clinicpathological characteristics, widowed patients were at highest risk of death compared with other groups.

  13. [Thyroid status peculiarities of elderly patients 5 years after operation depending on the volume of surgical intervention].

    Science.gov (United States)

    Aristarhov, V G; Danilov, N V; Aristarkhov, R V; Puzin, D A; Birykov, C V

    2016-01-01

    Long-term results of treatment of 180 patients operated 5 years ago for benign thyroid nodular pathology have been analyzed in the present paper, the results being analyzed depending on the volume of surgical intervention. The rate of postoperative hypothyrodism is lower in patients who had undergone limited thyroid resection, recurrent cases are more frequent, but they are not clinically significant and seldom require reoperation. It should also be noted that those patients have fewer cardiac complaints as the dose of hormone replacement therapy preparations is small. Elder patients who had undergone functionally significant thyroidectomy and need to take great doses of Thyroxin (107-150 mcg/day) have cardiac complaints more often (43 %) comparing to those who had undergone limited resections (35 %).

  14. Surgical Assisting

    Science.gov (United States)

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

  15. Postoperative perceived health status in adolescent following idiopathic scoliosis surgical treatment: results using the adapted French version of Scoliosis Research Society Outcomes questionnaire (SRS-22).

    Science.gov (United States)

    Chaib, Y; Bachy, M; Zakine, S; Mary, P; Khouri, N; Vialle, R

    2013-06-01

    Assessing functional outcome from patient-based outcomes questionnaires are essential to the evaluation of adolescent idiopathic scoliosis surgical treatment At the minimum follow-up of 2 years, 45 operated on adolescent idiopathic scoliosis patients were mailed the French version of the Scoliosis Research Society Outcome Instrument (SRS-22) questionnaires containing items on pain, activities of daily living, and satisfaction. Mean values of the SRS-22 domains were 3,66 for the Pain domain, 3,85 for the Self-perceived image domain, 4,32 for the Function domain, 3,52 for the Mental health domain and 4,12 for the Global satisfaction with management domain. Mean value of the global SRS-22 score was 3,88. We showed no differences in functional SRS-22 health status in patients according to the type of curve (Lenke classification). We showed statistically significant correlations between the gain of Cobb angle and Patients self-image and function domain scores. There was a statistically significant correlation between preoperative Cobb angle and patient satisfaction with management. Even if Function and Self-image scores in our patients are close to control group values, indicating good short to mid-term outcome of surgical treatment, scores for pain and mental health status were significantly lower in patients than controls. Long-term follow-up studies conducted by multiple surgeons over successive generations are mandatory to assess clinical significance of these differences. Level IV. Retrospective study. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  16. Abortion - surgical

    Science.gov (United States)

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

  17. The circumferential resection margins status: A comparison of robotic, laparoscopic and open total mesorectal excision for mid and low rectal cancer.

    Science.gov (United States)

    de Jesus, J P; Valadão, M; de Castro Araujo, R O; Cesar, D; Linhares, E; Iglesias, A C

    2016-06-01

    Minimally invasive surgery for rectal cancer (RC) is now widely performed via the laparoscopic approach, but robotic-assisted surgery may overcome some limitations of laparoscopy in RC treatment. We compared the rate of positive circumferential margins between robotic, laparoscopic and open total mesorectal excision (TME) for RC in our institution. Mid and low rectal adenocarcinoma patients consecutively submitted to robotic surgery were compared to laparoscopic and open approach. From our prospective database, 59 patients underwent robotic-assisted rectal surgery from 2012 to 2015 (RTME group) were compared to our historical control group comprising 200 open TME (OTME group) and 41 laparoscopic TME (LTME group) approaches from July 2008 to February 2012. Primary endpoint was to compare the rate of involved circumferential resection margins (CRM) and the mean CRM between the three groups. Secondary endpoint was to compare the mean number of resected lymph nodes between the three groups. CRM involvement was demonstrated in 20 patients (15.5%) in OTME, 4 (16%) in LTME and 9 (16.4%) in the RTME (p = 0.988). The mean CRM in OTME, LTME and RTME were respectively 0.6 cm (0-2.7), 0.7 cm (0-2.0) and 0.6 cm (0-2.0) (p = 0.960). Overall mean LN harvest was 14 (0-56); 16 (0-52) in OTME, 13 (1-56) in LTME and 10 (0-45) in RTME (p = 0.156). Our results suggest that robotic TME has the same oncological short-term results when compared to the open and laparoscopic technique, and it could be safely offered for the treatment of mid and low rectal cancer. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Analysis of Surgical Pathology Data in the HIRA Database: Emphasis on Current Status and Endoscopic Submucosal Dissection Specimens

    Directory of Open Access Journals (Sweden)

    Sun-ju Byeon

    2016-05-01

    Full Text Available Background: In Korea, medical institutions make claims for insurance reimbursement to the Health Insurance Review and Assessment Service (HIRA. Thus, HIRA databases reflect the general medical services that are provided in Korea. We conducted two pathology-related studies using a HIRA national patient sample (NPS data (selection probability, 0.03. First, we evaluated the current status of general pathologic examination in Korea. Second, we evaluated pathologic issues associated with endoscopic submucosal dissection (ESD. Methods: The sample data used in this study was HIRA-NPS-2013-0094. Results: In the NPS dataset, 163,372 pathologic examinations were performed in 103,528 patients during the year 2013. Considering sampling weight (33.3, it is estimated that 5,440,288 (163,372 × 33.3 pathologic examinations were performed. Internal medicine and general surgery were the most common departments requesting pathologic examinations. The region performing pathologic examinations were different according to type of medical institution. In total, 490 patients underwent ESD, and 43.4% (213/490 underwent ESD due to gastric carcinoma. The results of the ESD led to a change in disease code for 10.5% (29/277 of non-gastric carcinoma patients. In addition, 21 patients (4.3% underwent surgery following the ESD. The average period between ESD and surgery was 44 days. Conclusions: HIRA sample data provide the nation-wide landscape of specific procedure. However, in order to reduce the statistical error, further studies using entire HIRA data are needed.

  19. Impact of Consumption of Chicory Leaf Extract in Adjunct with Non-surgical Periodontal Therapy on Serum Antioxidant and Lipid Status in Patients with Periodontal Disease: Preliminary Study

    Directory of Open Access Journals (Sweden)

    Ahmad Zare-Javid

    2016-04-01

    Full Text Available Background and Objectives: Periodontal disease is a chronic disorder with a high prevalence. There are few studies about the role of diet in prevention and treatment of periodontal disease. The aim of this study was to evaluate the effect of consumption of Chicory leaf extract in adjunct with non-surgical periodontal therapies on serum antioxidant and lipid status. Materials and Methods: This study was a double-blind, randomized controlled clinical trial conducted on 40 patients in Sina Hospital of Ahvaz Jundishapur University of Medical Sciences (Iran in 2014. The intervention (n=20 and control groups (n=20 were allocated using blocked randomization. The intervention group received 2 capsules (2 g of Chicory leaf extract daily for 8 weeks. All subjects underwent non-surgical periodontal therapy during the intervention period. Anthropometric indices, 24-hour diet records, total antioxidant capacity, malate di-aldehyde (MDA, uric acid, total cholesterol, triglyceride (TG and HDL-c was measured before and after intervention. Results: The mean level of total antioxidant capacity (1.89 ± 0.49; 1.20 ± 0.25, respectively; P<0.001 and uric acid (7.15±1.98; 4.48±1.34, respectively; P<0.001 increased in the intervention group compared with the control group post intervention. The mean level of MDA decreased in the intervention group compared with the control group post-intervention (3.01±1.15; 3.97±1.19, respectively; P.d<0.001. Cholesterol difference was not significant pre- and post-intervention between the two groups (P=0.35. The mean level of serum triglyceride (TG was significantly lower in the intervention group compared with the control group post intervention (149.50±97.88; 109.35±58.00, respectively; P.d<0.001. The mean level of HDL-c was also significantly lower in the intervention group compared with the control group post treatment (42.25±8.47; 39.80±8.94, respectively; P.d<0.001. Conclusions: It seems that consumption of Chicory

  20. Diagnostic accuracy of computed tomography and magnetic resonance imaging obtained after neoadjuvant chemoradiotherapy in predicting the local tumor stage and circumferential resection margin status of rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jin Hoon; Kim, Young Hoon; Lee, Yoon Jin; Lee, Kyoung Ho; Kang, Sung Bum; Kim, Duck Woo; Kim, Jae Hyun; Kim, Jae Sung; Lee, Hye Seung [Dept. of Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (Korea, Republic of); Lee, Sang Min [Dept. of Radiology, Seoul National University Hospital, Seoul (Korea, Republic of)

    2014-02-15

    To measure the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) obtained after neoadjuvant chemoradiotherapy (CRT) in patients with rectal cancer for a prediction of the local tumor stage and circumferential resection margin (CRM). Two independent radiologists reviewed CT and MRI obtained after neoadjuvant CRT. The accuracy of the local tumor staging and the diagnostic performance for the prediction of CRM involvement were calculated. The agreement between the measurements of the distance to potential CRM on both imaging modalities and the histopathology findings was assessed using Bland-Altman plots. 57 patients (mean age, 59.2 years; 24 females) were included. The accuracy of T and N staging were 43.9% (95% confidence interval, 30.8-57.7%) and 77.2% (64.2-87.3%) on CT and 63.2% (49.4-75.6%) and 77.2% (64.2-87.3%) on MRI for Observer 1. The accuracy of T and N staging were 54.4% (40.7-67.7%) and 77.2% (64.2-87.3%) on CT and 68.4% (54.7-80.1%) and 80.7% (68.1-90.0%) on MRI for Observer 2. Sensitivity and specificity on CRM involvement were 83.3% (43.7-97.0%) and 88.2% (76.6-94.5%) on CT and 100% (61.0-100%) and 90.2% (79.0-95.7%) on MRI for Observer 1. Sensitivity and specificity on CRM involvement were 66.7% (30.0-90.3%) and 88.2% (76.7-94.5%) on CT and 100% (61.0-100%) and 90.2% (79.0-95.7%) on MRI for Observer 2. Bland-Altman plots showed wide discrepancies between measurements of the distance to CRM on each CT and MRI and those on histopathology findings. CT and MRI showed limited performance in predicting the local tumor staging and CRM involvement in patients with neoadjuvant CRT although MRI tended to show a better performance than CT.

  1. Diagnostic accuracy of computed tomography and magnetic resonance imaging obtained after neoadjuvant chemoradiotherapy in predicting the local tumor stage and circumferential resection margin status of rectal cancer

    International Nuclear Information System (INIS)

    Park, Jin Hoon; Kim, Young Hoon; Lee, Yoon Jin; Lee, Kyoung Ho; Kang, Sung Bum; Kim, Duck Woo; Kim, Jae Hyun; Kim, Jae Sung; Lee, Hye Seung; Lee, Sang Min

    2014-01-01

    To measure the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) obtained after neoadjuvant chemoradiotherapy (CRT) in patients with rectal cancer for a prediction of the local tumor stage and circumferential resection margin (CRM). Two independent radiologists reviewed CT and MRI obtained after neoadjuvant CRT. The accuracy of the local tumor staging and the diagnostic performance for the prediction of CRM involvement were calculated. The agreement between the measurements of the distance to potential CRM on both imaging modalities and the histopathology findings was assessed using Bland-Altman plots. 57 patients (mean age, 59.2 years; 24 females) were included. The accuracy of T and N staging were 43.9% (95% confidence interval, 30.8-57.7%) and 77.2% (64.2-87.3%) on CT and 63.2% (49.4-75.6%) and 77.2% (64.2-87.3%) on MRI for Observer 1. The accuracy of T and N staging were 54.4% (40.7-67.7%) and 77.2% (64.2-87.3%) on CT and 68.4% (54.7-80.1%) and 80.7% (68.1-90.0%) on MRI for Observer 2. Sensitivity and specificity on CRM involvement were 83.3% (43.7-97.0%) and 88.2% (76.6-94.5%) on CT and 100% (61.0-100%) and 90.2% (79.0-95.7%) on MRI for Observer 1. Sensitivity and specificity on CRM involvement were 66.7% (30.0-90.3%) and 88.2% (76.7-94.5%) on CT and 100% (61.0-100%) and 90.2% (79.0-95.7%) on MRI for Observer 2. Bland-Altman plots showed wide discrepancies between measurements of the distance to CRM on each CT and MRI and those on histopathology findings. CT and MRI showed limited performance in predicting the local tumor staging and CRM involvement in patients with neoadjuvant CRT although MRI tended to show a better performance than CT

  2. Subsets of Women With Close or Positive Margins After Breast-Conserving Surgery With High Local Recurrence Risk Despite Breast Plus Boost Radiotherapy

    International Nuclear Information System (INIS)

    Lupe, Krystine; Truong, Pauline T.; Alexander, Cheryl; Lesperance, Mary; Speers, Caroline; Tyldesley, Scott

    2011-01-01

    Purpose: (1) To examine the effect of surgical margin status on local recurrence (LR) and survival following breast-conserving therapy; (2) To identify subsets with close or positive margins with high LR risk despite whole breast radiotherapy (RT) plus boost. Methods and Materials: Subjects were 2,264 women with pT1–3, any N, M0 invasive breast cancer, treated with breast-conserving surgery and whole breast ± boost RT. Five-year Kaplan-Meier (KM) LR, breast cancer–specific and overall survival (BCSS and OS) were compared between cohorts with negative (n = 1,980), close (n = 222), and positive (n = 62) margins. LR rates were analyzed according to clinicopathologic characteristics. Multivariable Cox regression modeling and matched analysis of close/positive margin cases and negative margin controls were performed. Results: Median follow-up was 5.2 years. Boost RT was used in 92% of patients with close or positive margins. Five-year KM LR rates in the negative, close and positive margin cohorts were 1.3%, 4.0%, and 5.2%, respectively (p = 0.001). BCSS and OS were similar in the three margin subgroups. In the close/positive margin cohort, LR rates were 10.2% with age 10% despite whole breast plus boost RT. These patients should be considered for more definitive surgery.

  3. Study Suggests Smaller Melanoma Excision Margins May Be Option for Some Patients

    Science.gov (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.

  4. Effect of marital status on the survival of patients with hepatocellular carcinoma treated with surgical resection: an analysis of 13,408 patients in the surveillance, epidemiology, and end results (SEER) database.

    Science.gov (United States)

    Wu, Chao; Chen, Ping; Qian, Jian-Jun; Jin, Sheng-Jie; Yao, Jie; Wang, Xiao-Dong; Bai, Dou-Sheng; Jiang, Guo-Qing

    2016-11-29

    Marital status has been reported as an independent prognostic factor for survival in various cancers, but it has been rarely studied in hepatocellular carcinoma (HCC) treated by surgical resection. We retrospectively investigated Surveillance, Epidemiology, and End Results (SEER) population-based data and identified 13,408 cases of HCC with surgical treatment between 1998 and 2013. The patients were categorized according to marital status, as "married," "never married," "widowed," or "divorced/separated." The 5-year HCC cause-specific survival (HCSS) data were obtained, and Kaplan-Meier methods and multivariate Cox regression models were used to ascertain whether marital status is also an independent prognostic factor for survival in HCC. Patients in the widowed group had the higher proportion of women, a greater proportion of older (>60 years) patients, more frequency in latest year of diagnosis (2008-2013), a greater number of tumors at TNM stage I/II, and more prevalence at localized SEER Stage, all of which were statistically significant within-group comparisons (P Married patients had better 5-year HCSS than did unmarried patients (46.7% vs 37.8%) (P < 0.001); conversely, widowed patients had lowest HCSS compared with all other patients, overall, at each SEER stage, and for different tumor sizes. Marital status is an important prognostic factor for survival in patients with HCC treated with surgical resection. Widowed patients have the highest risk of death compared with other groups.

  5. Convexity and Marginal Vectors

    NARCIS (Netherlands)

    van Velzen, S.; Hamers, H.J.M.; Norde, H.W.

    2002-01-01

    In this paper we construct sets of marginal vectors of a TU game with the property that if the marginal vectors from these sets are core elements, then the game is convex.This approach leads to new upperbounds on the number of marginal vectors needed to characterize convexity.An other result is that

  6. "We call ourselves marginalized"

    DEFF Research Database (Denmark)

    Jørgensen, Nanna Jordt

    2014-01-01

    of the people we refer to as marginalized. In this paper, I discuss how young secondary school graduates from a pastoralist community in Kenya use and negotiate indigeneity, marginal identity, and experiences of marginalization in social navigations aimed at broadening their current and future opportunities. I...

  7. Surgical lighting

    NARCIS (Netherlands)

    Knulst, A.J.

    2017-01-01

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

  8. Does the placement of surgical clips within the excision cavity influence local control for patients treated with breast conserving surgery and irradiation?

    Energy Technology Data Exchange (ETDEWEB)

    Fein, Douglas A; Fowble, Barbara L; Hanlon, Alexandra L; Hoffman, John P; Sigurdson, Elin R; Eisenberg, Burton L

    1995-07-01

    PURPOSE: A number of authors have demonstrated the importance of using surgical clips to define the tumor bed in the treatment planning of early stage breast cancer. The clips have been useful in delineating the borders of the tangential fields especially for very medial and very lateral lesions as well as the boost volume. If surgical clips better define the tumor bed then a reduction in true or marginal recurrences should be appreciated. We sought to compare the incidence of breast recurrence in women with and without surgical clips controlling for other recognized prognostic factors. METHODS AND MATERIALS: Between 1980 and 1992, 1364 women with clinical Stage I or II invasive breast cancer underwent excisional biopsy, axillary dissection, and definitive irradiation. Median follow-up was 60 months. Median age was 55 years. Seventy-one percent of patients were path N0, 22% had 1-3 nodes and 7% had {>=} 4 nodes. Sixty-one percent were ER positive and 49% PR positive. Margin status was negative in 62%, positive in 10%, close in 9%, and unknown in 19%. Fifty-seven percent of women underwent a reexcision. Adjuvant chemotherapy {+-} tamoxifen was administered in 29%, and tamoxifen alone in 17%. Surgical clips were placed in the excision cavity in 556 patients while the other 808 did not have clips placed. All patients had a boost to the tumor bed. Patients had their boost planned with CT scanning or stereo shift radiographs. No significant differences between the 2 groups were noted for median age, T stage, nodal status, race, ER/PR receptor status, region irradiated, or tumor location. Patients without clips had negative margins less often, a higher rate of unknown or positive margins and more often received no adjuvant therapy compared to patients with surgical clips. RESULTS: Twenty-three and 27 patients with and without surgical clips, respectively developed a true or marginal recurrence in the treated breast. The actuarial probability of a breast recurrence was 2

  9. Does the placement of surgical clips within the excision cavity influence local control for patients treated with breast conserving surgery and irradiation?

    International Nuclear Information System (INIS)

    Fein, Douglas A.; Fowble, Barbara L.; Hanlon, Alexandra L.; Hoffman, John P.; Sigurdson, Elin R.; Eisenberg, Burton L.

    1995-01-01

    PURPOSE: A number of authors have demonstrated the importance of using surgical clips to define the tumor bed in the treatment planning of early stage breast cancer. The clips have been useful in delineating the borders of the tangential fields especially for very medial and very lateral lesions as well as the boost volume. If surgical clips better define the tumor bed then a reduction in true or marginal recurrences should be appreciated. We sought to compare the incidence of breast recurrence in women with and without surgical clips controlling for other recognized prognostic factors. METHODS AND MATERIALS: Between 1980 and 1992, 1364 women with clinical Stage I or II invasive breast cancer underwent excisional biopsy, axillary dissection, and definitive irradiation. Median follow-up was 60 months. Median age was 55 years. Seventy-one percent of patients were path N0, 22% had 1-3 nodes and 7% had ≥ 4 nodes. Sixty-one percent were ER positive and 49% PR positive. Margin status was negative in 62%, positive in 10%, close in 9%, and unknown in 19%. Fifty-seven percent of women underwent a reexcision. Adjuvant chemotherapy ± tamoxifen was administered in 29%, and tamoxifen alone in 17%. Surgical clips were placed in the excision cavity in 556 patients while the other 808 did not have clips placed. All patients had a boost to the tumor bed. Patients had their boost planned with CT scanning or stereo shift radiographs. No significant differences between the 2 groups were noted for median age, T stage, nodal status, race, ER/PR receptor status, region irradiated, or tumor location. Patients without clips had negative margins less often, a higher rate of unknown or positive margins and more often received no adjuvant therapy compared to patients with surgical clips. RESULTS: Twenty-three and 27 patients with and without surgical clips, respectively developed a true or marginal recurrence in the treated breast. The actuarial probability of a breast recurrence was 2% at

  10. Does the placement of surgical clips within the excision cavity influence local control for patients treated with breast-conserving surgery and irradiation?

    International Nuclear Information System (INIS)

    Fein, Douglas A.; Fowble, Barbara L.; Hanlon, Alexandra L.; Hoffman, John P.; Sigurdson, Elin R.; Eisenberg, Burton L.

    1996-01-01

    Purpose: A number of authors have demonstrated the importance of using surgical clips to define the tumor bed in the treatment planning of early-stage breast cancer. The clips have been useful in delineating the borders of the tangential fields, especially for very medial and very lateral lesions as well as the boost volume. If surgical clips better define the tumor bed, then a reduction in true or marginal recurrences should be appreciated. We sought to compare the incidence of breast recurrence in women with and without surgical clips, controlling for other recognized prognostic factors. Methods and Materials: Between 1980 and 1992, 1364 women with clinical Stage I or II invasive breast cancer underwent excisional biopsy, axillary dissection, and definitive irradiation. Median follow-up was 60 months. Median age was 55 years. Seventy-one percent of patients were path N0, 22% had one to three nodes, and 7% had > four nodes. Sixty-one percent were ER positive and 49% PR positive. Margin status was negative in 62%, positive in 10%, close in 9%, and unknown in 19%. Fifty-seven percent of women underwent a reexcision. Adjuvant chemotherapy + tamoxifen was administered in 29%, and tamoxifen alone in 17%. Surgical clips were placed in the excision cavity in 556 patients, while the other 808 did not have clips placed. All patients had a boost to the tumor bed. Patients had their boost planned with CT scanning or stereo shift radiographs. No significant differences between the two groups were noted for median age, T stage, nodal status, race, ER/PR receptor status, region irradiated, or tumor location. Patients without clips had negative margins less often, a higher rate of unknown or positive margins and more often received no adjuvant therapy compared to patients with surgical clips. Results: Twenty-five and 27 patients with and without surgical clips, respectively, developed a true or marginal recurrence in the treated breast. The actuarial probability of a breast

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

    International Nuclear Information System (INIS)

    Demirci, Senem; Broadwater, Gloria; Marks, Lawrence B.; Clough, Robert; Prosnitz, Leonard R.

    2012-01-01

    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

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

    Energy Technology Data Exchange (ETDEWEB)

    Demirci, Senem, E-mail: senem.demirci@ege.edu.tr [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)

    2012-07-01

    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

  13. Surgical smoke.

    Science.gov (United States)

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

    2009-10-01

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

  14. Refining margins and prospects

    International Nuclear Information System (INIS)

    Baudouin, C.; Favennec, J.P.

    1997-01-01

    Refining margins throughout the world have remained low in 1996. In Europe, in spite of an improvement, particularly during the last few weeks, they are still not high enough to finance new investments. Although the demand for petroleum products is increasing, experts are still sceptical about any rapid recovery due to prevailing overcapacity and to continuing capacity growth. After a historical review of margins and an analysis of margins by regions, we analyse refining over-capacities in Europe and the unbalances between production and demand. Then we discuss the current situation concerning barriers to the rationalization, agreements between oil companies, and the consequences on the future of refining capacities and margins. (author)

  15. Marginalization of the Youth

    DEFF Research Database (Denmark)

    Jensen, Niels Rosendal

    2009-01-01

    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....

  16. On marginal regeneration

    NARCIS (Netherlands)

    Stein, H.N.

    1991-01-01

    On applying the marginal regeneration concept to the drainage of free liquid films, problems are encountered: the films do not show a "neck" of minimum thickness at the film/border transition; and the causes of the direction dependence of the marginal regeneration are unclear. Both problems can be

  17. Indian Ocean margins

    Digital Repository Service at National Institute of Oceanography (India)

    Naqvi, S.W.A

    in the latter two areas. Some of these fluxes are expected to be substantial in the case of Indonesian continental margins and probably also across the eastern coasts of Africa not covered in this chapter. However, a dearth of information makes these margins...

  18. Matthew and marginality

    Directory of Open Access Journals (Sweden)

    Denis C. Duling

    1995-12-01

    Full Text Available This article explores marginality theory as it was first proposed in  the social sciences, that is related to persons caught between two competing cultures (Park; Stonequist, and, then, as it was developed in sociology as related to the poor (Germani and in anthropology as it was related to involuntary marginality and voluntary marginality (Victor Turner. It then examines a (normative scheme' in antiquity that creates involuntary marginality at the macrosocial level, namely, Lenski's social stratification model in an agrarian society, and indicates how Matthean language might fit with a sample inventory  of socioreligious roles. Next, it examines some (normative schemes' in  antiquity for voluntary margi-nality at the microsocial level, namely, groups, and examines how the Matthean gospel would fit based on indications of factions and leaders. The article ,shows that the author of the Gospel of Matthew has an ideology of (voluntary marginality', but his gospel includes some hope for (involuntary  marginals' in  the  real world, though it is somewhat tempered. It also suggests that the writer of the Gospel is a (marginal man', especially in the sense defined by the early theorists (Park; Stone-quist.

  19. Fixing soft margins

    NARCIS (Netherlands)

    P. Kofman (Paul); A. Vaal, de (Albert); C.G. de Vries (Casper)

    1993-01-01

    textabstractNon-parametric tolerance limits are employed to calculate soft margins such as advocated in Williamson's target zone proposal. In particular, the tradeoff between softness and zone width is quantified. This may be helpful in choosing appropriate margins. Furthermore, it offers

  20. Refining margins: recent trends

    International Nuclear Information System (INIS)

    Baudoin, C.; Favennec, J.P.

    1999-01-01

    Despite a business environment that was globally mediocre due primarily to the Asian crisis and to a mild winter in the northern hemisphere, the signs of improvement noted in the refining activity in 1996 were borne out in 1997. But the situation is not yet satisfactory in this sector: the low return on invested capital and the financing of environmental protection expenditure are giving cause for concern. In 1998, the drop in crude oil prices and the concomitant fall in petroleum product prices was ultimately rather favorable to margins. Two elements tended to put a damper on this relative optimism. First of all, margins continue to be extremely volatile and, secondly, the worsening of the economic and financial crisis observed during the summer made for a sharp decline in margins in all geographic regions, especially Asia. Since the beginning of 1999, refining margins are weak and utilization rates of refining capacities have decreased. (authors)

  1. Pickering seismic safety margin

    International Nuclear Information System (INIS)

    Ghobarah, A.; Heidebrecht, A.C.; Tso, W.K.

    1992-06-01

    A study was conducted to recommend a methodology for the seismic safety margin review of existing Canadian CANDU nuclear generating stations such as Pickering A. The purpose of the seismic safety margin review is to determine whether the nuclear plant has sufficient seismic safety margin over its design basis to assure plant safety. In this review process, it is possible to identify the weak links which might limit the seismic performance of critical structures, systems and components. The proposed methodology is a modification the EPRI (Electric Power Research Institute) approach. The methodology includes: the characterization of the site margin earthquake, the definition of the performance criteria for the elements of a success path, and the determination of the seismic withstand capacity. It is proposed that the margin earthquake be established on the basis of using historical records and the regional seismo-tectonic and site specific evaluations. The ability of the components and systems to withstand the margin earthquake is determined by database comparisons, inspection, analysis or testing. An implementation plan for the application of the methodology to the Pickering A NGS is prepared

  2. The influence of intraoperative radiation therapy (IORT) on outcome of surgically resectable adenocarcinoma of the pancreas

    International Nuclear Information System (INIS)

    Ono, Mark K.; Ahmad, Neelofur; Huq, M. Saiful; Vernick, Jerome; Rosato, Francis E.

    1996-01-01

    Purpose/Objective: Surgical resection offers an opportunity for long term survival for patients with cancer of the pancreas. Unfavorable pathologic prognostic factors following resection of these lesions include positive surgical margins and positive lymph nodes. The purpose of this study was to analyze the influence of IORT on survival of completely resected adenocarcinomas of the pancreas in patients with these poor pathologic features. Materials and Methods: From 1988 to 1994, 391 newly diagnosed patients with carcinoma of the pancreas were seen at Thomas Jefferson University Hospital. Pre-operative work-up identified 166 patients with clinically localized disease. These patients were evaluated by the Department of Radiation Oncology for possible treatment with IORT. These patients underwent exploratory laparotomy and 26 had a complete surgical resection (i.e. Whipple procedure or total pancreatectomy) and received IORT. Mean patient age was 66 ± 2 years (range: 43-80) with 15 male and 11 female patients. All patients had histologically proven adenocarcinoma of the pancreas. IORT was delivered to the surgical tumor bed and regional lymph nodes with a median dose of 15.0 Gy (range: 10.0-20.0 Gy). Technique, field size, and energy of the electron radiation beam varied with the clinical situation and were determined by the radiation oncologist. All 26 patients received post-operative external beam radiation therapy (EBRT) with concurrent weekly 5-FU chemotherapy. Follow-up times ranged from one to 84 months (median: 15 months). Actuarial survival rates were calculated by the Life-Table Method. Patient outcome was evaluated with respect to surgical margin and pathological lymph node status. Results: The overall actuarial 2-year survival rate was 44%. The overall median survival time (MST) was 19 months. At pathological review, five of the 26 patients (19%) were found to have positive surgical margins, four of whom also had involved lymph nodes. Thus, only one

  3. Surgical orthodontics.

    Science.gov (United States)

    Strohl, Alexis M; Vitkus, Lauren

    2017-08-01

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

  4. Comparison of stress and burnout among anesthesia and surgical residents in a tertiary care teaching hospital in North India.

    Science.gov (United States)

    Gandhi, K; Sahni, N; Padhy, S K; Mathew, P J

    2017-10-23

    The residents undergoing training at hospitals in our country face challenges in terms of infrastructure and high workload with undefined working hours. The aim of the study was to compare the stress and burnout levels in trainee doctors doing residency in surgical fields and anesthesia at a tertiary care academic center in North India. A comparative, observational study was conducted in a tertiary care teaching hospital in North India. After Ethics Committee approval, 200 residents (100 each from surgical branches and anesthesia) were required to fill a questionnaire with information about age, sex, year of residency, marital status, and the Perceived Stress Scale-10, and Burnout Clinical Subtype Questionnaire-12. Burnout and perceived stress were compared between residents of anesthesia and surgical specialties. Residents of both surgical and anesthesia branches scored high in perceived stress, namely 21 and 18, respectively. The score was significantly higher in surgical residents (P = 0.03) and increased progressively with the year of residency. The majority of residents (90% surgical, 80% anesthesia) felt that they were being overloaded with work. However, only 20%-30% of respondents felt that there was lack of development of individual skills and still fewer (<10%) reported giving up in view of difficulties. There is high level of stress and overload dimension of burnout among the residents of anesthesia and surgical branches at our tertiary care academic institution and the surgical residents score marginally higher than anesthesia residents.

  5. Treatment of osteonecrosis of the femoral head by free vascularized fibular grafting: an analysis of surgical outcome and patient health status

    Science.gov (United States)

    Louie, Brian E.; McKee, Michael D.; Richards, Robin R.; Mahoney, James L.; Waddell, James P.; Beaton, Dorcas E.; Schemitsch, Emil H.; Yoo, Daniel J.

    1999-01-01

    Objective To evaluate the limb-specific outcome and general health status of patients with osteonecrosis of the femoral head treated with vascularized fibular grafting. Design A retrospective review. Setting A single tertiary care centre. Patients Fifty-five consecutive patients with osteonecrosis of the femoral head who underwent fibular grafting (8 bilaterally). Intervention Vascularized fibular grafting. Outcome measures Limb-specific scores (Harris Hip Score, St. Michael’s Hospital Hip Score), general health status (Nottingham Health Profile, SF-36 health status survey) and radiographic outcome measures (Steinberg stage). Results Patients were young (mean age 34 years, range from 18 to 52 years) and 80% had advanced osteonecrosis (Steinberg stages IV and V). Fifty-nine hips were followed up for an average of 50 months (range from 24 to 117 months) after vascularized fibular grafting. Sixteen hips (27%) were converted to total hip arthroplasty (THA). To date, 73% of hips treated with vascularized fibular grafting have required no further surgery. Preoperative and postoperative Harris Hip Scores were 57.3 and 83.6 respectively (p < 0.001). As measured by patient-oriented health status questionnaires (SF-36, Nottingham Health Profile) and compared with population controls, patients had normal mental health scores and only slight decreases in physical component scores. Conclusions Free vascularized fibular grafting for osteonecrosis of the femoral head provides satisfactory pain relief, functional improvement and general health status and halts the progression of symptomatic disease. PMID:10459327

  6. From Borders to Margins

    DEFF Research Database (Denmark)

    Parker, Noel

    2009-01-01

    of entities that are ever open to identity shifts.  The concept of the margin possesses a much wider reach than borders, and focuses continual attention on the meetings and interactions between a range of indeterminate entities whose interactions may determine both themselves and the types of entity...... 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...

  7. Komorbiditet ved marginal parodontitis

    DEFF Research Database (Denmark)

    Holmstrup, Palle; Damgaard, Christian; Olsen, Ingar

    2017-01-01

    Nærværende artikel præsenterer en oversigt over den foreliggende væsentligste viden om sammenhængen mellem marginal parodontitis og en række medicinske sygdomme, herunder hjerte-kar-sygdomme, diabetes mellitus, reumatoid arthritis, osteoporose, Parkinsons sygdom, Alzheimers sygdom, psoriasis og...

  8. Marginally Deformed Starobinsky Gravity

    DEFF Research Database (Denmark)

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

    2015-01-01

    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....

  9. Deep continental margin reflectors

    Science.gov (United States)

    Ewing, J.; Heirtzler, J.; Purdy, M.; Klitgord, Kim D.

    1985-01-01

    In contrast to the rarity of such observations a decade ago, seismic reflecting and refracting horizons are now being observed to Moho depths under continental shelves in a number of places. These observations provide knowledge of the entire crustal thickness from the shoreline to the oceanic crust on passive margins and supplement Consortium for Continental Reflection Profiling (COCORP)-type measurements on land.

  10. Marginalization and School Nursing

    Science.gov (United States)

    Smith, Julia Ann

    2004-01-01

    The concept of marginalization was first analyzed by nursing researchers Hall, Stevens, and Meleis. Although nursing literature frequently refers to this concept when addressing "at risk" groups such as the homeless, gays and lesbians, and those infected with HIV/AIDS, the concept can also be applied to nursing. Analysis of current school nursing…

  11. Surgical outcome of motor deficits and neurological status in brainstem cavernous malformations based on preoperative diffusion tensor imaging: a prospective randomized clinical trial.

    Science.gov (United States)

    Li, Da; Jiao, Yu-Ming; Wang, Liang; Lin, Fu-Xin; Wu, Jun; Tong, Xian-Zeng; Wang, Shuo; Cao, Yong

    2018-03-16

    OBJECTIVE Surgical management of brainstem lesions is challenging due to the highly compact, eloquent anatomy of the brainstem. This study aimed to evaluate the safety and efficacy of preoperative diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) in brainstem cavernous malformations (CMs). METHODS A prospective randomized controlled clinical trial was performed by using stratified blocked randomization. The primary eligibility criterion of the study was being a surgical candidate for brainstem CMs (with informed consent). The study enrolled 23 patients who underwent preoperative DTI/DTT and 24 patients who did not (the control group). The pre- and postoperative muscle strength of both limbs and modified Rankin Scale (mRS) scores were evaluated. Muscle strength of any limb at 12 months after surgery at the clinic visit was the primary outcome; worsened muscle strength was considered to be a poor outcome. Outcome assessors were blinded to patient management. This study reports the preliminary results of the interim analysis. RESULTS The cohort included 47 patients (22 women) with a mean age of 35.7 years. The clinical baselines between these 2 groups were not significantly different. In the DTI/DTT group, the corticospinal tract was affected in 17 patients (73.9%): it was displaced, deformed/partially interrupted, or completely interrupted in 6, 7, and 4 patients, respectively. The surgical approach and brainstem entry point were adjusted in 3 patients (13.0%) based on DTI/DTT data. The surgical morbidity of the DTI/DTT group (7/23, 30.4%) was significantly lower than that of the control group (19/24, 79.2%, p = 0.001). At 12 months, the mean mRS score (1.1, p = 0.034) and percentage of patients with worsened motor deficits (4.3%, p = 0.006) were significantly lower in the DTI/DTT group than in the control group (1.7% and 37.5%). Multivariate logistic regression identified the absence of preoperative DTI/DTT (OR 0.06, 95% CI 0.01-0.73, p = 0

  12. Surgical competence.

    Science.gov (United States)

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

    2003-08-01

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

  13. Middlemen Margins and Globalization

    OpenAIRE

    Pranab Bardhan; Dilip Mookherjee; Masatoshi Tsumagari

    2013-01-01

    We develop a theory of trading middlemen or entrepreneurs who perform financing, quality supervision and marketing roles for goods produced by suppliers or workers. Brand-name reputations are necessary to overcome product quality moral hazard problems; middlemen margins represent reputational incentive rents. We develop a two sector North-South model of competitive equilibrium, with endogenous sorting of agents with heterogenous entrepreneurial abilities into sectors and occupations. The Sout...

  14. Containment safety margins

    International Nuclear Information System (INIS)

    Von Riesemann, W.A.

    1980-01-01

    Objective of the Containment Safety Margins program is the development and verification of methodologies which are capable of reliably predicting the ultimate load-carrying capability of light water reactor containment structures under accident and severe environments. The program was initiated in June 1980 at Sandia and this paper addresses the first phase of the program which is essentially a planning effort. Brief comments are made about the second phase, which will involve testing of containment models

  15. Marginalized Youth. An Introduction.

    OpenAIRE

    Kessl, Fabian; Otto, Hans-Uwe

    2009-01-01

    The life conduct of marginalized groups has become subject to increasing levels of risk in advanced capitalist societies. In particular, children and young people are confronted with the harsh consequences of a “new poverty” in the contemporary era. The demographic complexion of today’s poverty is youthful, as a number of government reports have once again documented in recent years in Australia, Germany, France, Great Britain, the US or Scandinavian countries. Key youth studies have shown a ...

  16. Surgical Navigation

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  17. Surgical Instrument

    NARCIS (Netherlands)

    Dankelman, J.; Horeman, T.

    2009-01-01

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

  18. [Surgical therapy of gynecomastia].

    Science.gov (United States)

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

    2011-09-01

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

  19. Breast surgical specimen radiographs: How reliable are they?

    International Nuclear Information System (INIS)

    Britton, P.D.; Sonoda, L.I.; Yamamoto, A.K.; Koo, B.; Soh, E.; Goud, A.

    2011-01-01

    Radiography of the excised surgical specimen following wire guided localisation of impalpable breast lesions is standard surgical practice. The aims of the study were to establish the reliability of the breast specimen radiograph (SR) in determining lesion excision and to determine whether the radiographic margin correlated with the histological margin. The clinical, imaging, SR and pathological details of 106 patients with a pre-operative diagnosis of breast cancer were retrospectively reviewed. The reliability of orientation was estimated and the appearance and distance from the mammographic abnormality to each radial margin were measured and correlated with surgical histological findings. The overall accuracy of the specimen radiograph in determining whether the mammographic lesion was present was 99%. The SR could be orientated 'very reliably' or 'reliably' in 80% of patients however in only 48% of patients did the closest margin on the SR correspond with the same nearest margin at final histology. A maximum measurement of 11 mm or more from the lesion to the specimen edge was associated with a 77% likelihood of having a clear final histological margin (taken as 5 mm or more) and if <11 mm a 58% chance of having involved final histological margins. There was however a wide overlap in the results with patients having an apparently wide SR margin but histologically involved margins and vice versa. The SR is reliable at determining whether the target lesion has been removed. The correlation of SR margin orientation and measurement with final histological measurement is however far less reliable.

  20. Marginal Models for Categorial Data

    NARCIS (Netherlands)

    Bergsma, W.P.; Rudas, T.

    2002-01-01

    Statistical models defined by imposing restrictions on marginal distributions of contingency tables have received considerable attention recently. This paper introduces a general definition of marginal log-linear parameters and describes conditions for a marginal log-linear parameter to be a smooth

  1. Energy and protein intake and nutritional status in non-surgically treated patients with small cell anaplastic carcinoma of the lung

    International Nuclear Information System (INIS)

    Enig, B.; Winther, E.; Hessov, I.; Aarhus Univ.

    1986-01-01

    The spontaneous food intake and nutritional status was assessed in 23 patients with small cell anaplastic carcinoma of the lung before and two times during a treatment period of 6 weeks. Radiation therapy was given for 2 weeks followed by a course of chemotherapy and another 2 weeks of radiation therapy. The energy intake decreased during the treatment from 146 to 130 per cent of basal metabolic rate (p>0.10). The protein intake remained unchanged (mean 0.9 g/kg body weight).There were insignificant and small losses of weight, body fat, free body mass and arm muscle circumference, and no changes were seen in serum albumin and serum transferrin. However, 6 patients suffered a weight loss of 5 per cent or more. No correlation existed between the nutritional parameters measured before treatment and the changes during treatment. Patients who suffered a loss of body weight could therefore not be singled out before the treatment. (orig.)

  2. Masculinity at the margins

    DEFF Research Database (Denmark)

    Jensen, Sune Qvotrup

    2010-01-01

    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...... 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....

  3. The Efficacy and Utilisation of Preoperative Magnetic Resonance Imaging in Robot-assisted Radical Prostatectomy: Does it Change the Surgical Dissection Plan? A Preliminary Report

    Directory of Open Access Journals (Sweden)

    Hasan Hüseyin Tavukçu

    2015-06-01

    Full Text Available Purpose: We investigated the effect of prostate magnetic resonance imaging (MRI on the dissection plan of the neurovascular bundle and the oncological results of our patients who underwent robotic radical prostatectomy operation. Materials and Methods: We prospectively evaluated 30 consecutive patients, 15 of whom had prostate MRI before the operation, and 15 of whom did not. With the findings of MRI, the dissection plan was changed as intrafascial, interfascial, and extrafascial technique in the MRI group. Two groups were compared in terms of age, prostate-specific antigen (PSA, and Gleason scores (GSs. Surgical margin status was also checked with the final pathology. Results: There was no significant difference between the two groups in terms of age, PSA, biopsy GS, and final pathological GS. MRI changed the initial surgical plan to a nerve-sparing technique in 7 of the 15 patients. Only one patient in the MRI group had a positive surgical margin on bladder neck. MRI was confirmed as the primary tumour localisation in the final pathology in 93.3% of patients. Conclusion: Preoperative prostate MRI influenced the decision to carry out a nerve-sparing technique in 46% of the patients in our study; however, the change to a nerve-sparing technique did not seem to compromise the surgical margin positivity.

  4. A Politics of Marginability

    DEFF Research Database (Denmark)

    Pallesen, Cecil Marie

    2015-01-01

    always been contested and to some extent vulnerable. However, the Indian communities are strong socially and economically, and the vast majority of its people have great international networks and several potential plans or strategies for the future, should the political climate in Tanzania become......In the end of the 19th century, Indians began settling in East Africa. Most of them left Gujarat because of drought and famine, and they were in search for business opportunities and a more comfortable life. Within the following decades, many of them went from being small-scale entrepreneurs to big...... hostile towards them. I argue that this migrant group is unique being marginalized and strong at the same time, and I explain this uniqueness by several features in the Indian migrants’ cultural and religious background, in colonial and post-colonial Tanzania, and in the Indians’ role as middlemen between...

  5. The Effect of Resveratrol Supplementation in Adjunct with Non-surgical Periodontal Treatment on Blood Glucose, Triglyceride, Periodontal Status and Some Inflammatory Markers in Type 2 Diabetic Patients with Periodontal Disease

    Directory of Open Access Journals (Sweden)

    Ahmad Zare Javid

    2016-02-01

    Full Text Available Background and Objectives: Diabetes mellitus and periodontal disease are two chronic and common diseases with close relationship together affecting public health and quality of life. The aim of this study was to investigate the effect of resveratrol supplementation in adjunct with non-surgical periodontal treatment (NST on blood glucose, triglyceride, periodontal status and inflammatory markers in type 2 diabetic patients with periodontal disease. Materials and Methods: This double-blind clinical trial study was conducted on 43 diabetic patients with periodontitis referred to the Endocrinology Clinic at Golestan Hospital in Ahvaz, Iran. All subjects were randomly assigned into two groups of intervention and control. The intervention and control groups received either 480 mg/d resveratrol or placebo capsules (2 PCs for four weeks. All subjects underwent non-surgical periodontal therapy during the intervention period. Anthropometric parameters, 24-hour dietary recall, fasting blood sugar, insulin, insulin resistance (HOMA-IR, triglycerides, pocket depth (PD, IL6 and TNF&alpha were evaluated in all subjects pre- and post-intervention. Results: The mean serum levels of fasting insulin and insulin resistance (HOMA-IR were significantly (P=0.02, P=0.045, respectively lower in the intervention group compared with the control group (10.42 ± 0.28 and 10.92 ± 0.9 3.66 ± 0.97 and 4.49 ± 1.56, respectively . Moreover, significant difference (P < 0.001 was obtained in the mean pocket depth (PD between the intervention and control groups (2.35 ± 0.6 and 3.38 ± 0.5, respectively post-intervention. In the intervention group, the mean serum level of IL6 was reduced significantly (P= 0.039 post-intervention (1.58 ± 1.06 and 2.19± 1.09. No significant differences were seen in the mean levels of fasting blood sugar, triglycerides, IL6 and TNF&alpha between the two groups post-intervention. Conclusions: It is suggested that resveratrol may be recommended as

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

    Science.gov (United States)

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

    2013-04-01

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

  7. SURGICAL RETIREMENT

    African Journals Online (AJOL)

    . 3. Drag LL, et al. Cognitive functioning, retirement status, and age: results from the Cognitive Changes and Retirement among. Senior Surgeons study. J Am Coll Surg. 2010;211(3):303-7. 4. Wang DS, Winfield HN. Survey of urological laparoscopic practice patterns in the Midwest.

  8. Surgical treatment for residual or recurrent strabismus

    Directory of Open Access Journals (Sweden)

    Tao Wang

    2014-12-01

    Full Text Available Although the surgical treatment is a relatively effective and predictable method for correcting residual or recurrent strabismus, such as posterior fixation sutures, medial rectus marginal myotomy, unilateral or bilateral rectus re-recession and resection, unilateral lateral rectus recession and adjustable suture, no standard protocol is established for the surgical style. Different surgical approaches have been recommended for correcting residual or recurrent strabismus. The choice of the surgical procedure depends on the former operation pattern and the surgical dosages applied on the patients, residual or recurrent angle of deviation and the operator''s preference and experience. This review attempts to outline recent publications and current opinion in the management of residual or recurrent esotropia and exotropia.

  9. The effects of photodynamic laser therapy in the treatment of marginal chronic periodontitis

    Science.gov (United States)

    Chifor, Radu; Badea, Iulia; Avram, Ramona; Chifor, Ioana; Badea, Mîndra Eugenia

    2016-03-01

    The aim of this study was to assess the effects of the antimicrobial photodynamic laser therapy performed during the treatment of deep periodontal disease by using 40 MHz high frequency ultrasonography. The periodontal data recorded during the clinical examination before each treatment session were compared with volumetric changes of the gingiva measured on periodontal ultrasound images. The results show a significant decrease of gingival tissue inflammation proved both by a significant decrease of bleeding on probing as well as by a decrease of the gingival tissues volume on sites where the laser therapy was performed. Periodontal tissues that benefit of laser therapy besides classical non-surgical treatment showed a significant clinical improvement of periodontal status. Based on these findings we were able to conclude that the antimicrobial photodynamic laser therapy applied on marginal periodontium has important anti-inflamatory effect. The periodontal ultrasonography is a method which can provide useful data for assessing the volume changes of gingival tissues, allowing a precise monitoring of marginal periodontitis.

  10. Limited resection for duodenal gastrointestinal stromal tumors: Surgical management and clinical outcome

    Science.gov (United States)

    Hoeppner, Jens; Kulemann, Birte; Marjanovic, Goran; Bronsert, Peter; Hopt, Ulrich Theodor

    2013-01-01

    AIM: To analyze our experience in patients with duodenal gastrointestinal stromal tumors (GIST) and review the appropriate surgical approach. METHODS: We retrospectively reviewed the medical records of all patients with duodenal GIST surgically treated at our medical institution between 2002 and 2011. Patient files, operative reports, radiological charts and pathology were analyzed. For surgical therapy open and laparoscopic wedge resections and segmental resections were performed for limited resection (LR). For extended resection pancreatoduodenectomy was performed. Age, gender, clinical symptoms of the tumor, anatomical localization, tumor size, mitotic count, type of resection resectional status, neoadjuvant therapy, adjuvant therapy, risk classification and follow-up details were investigated in this retrospective study. RESULTS: Nine patients (5 males/4 females) with a median age of 58 years were surgically treated. The median follow-up period was 45 mo (range 6-111 mo). The initial symptom in 6 of 9 patients was gastrointestinal bleeding (67%). Tumors were found in all four parts of the duodenum, but were predominantly located in the first and second part of the duodenum with each 3 of 9 patients (33%). Two patients received neoadjuvant medical treatment with 400 mg imatinib per day for 12 wk before resection. In one patient, the GIST resection was done by pancreatoduodenectomy. The 8 LRs included a segmental resection of pars 4 of the duodenum, 5 wedge resections with primary closure and a wedge resection with luminal closure by Roux-Y duodeno-jejunostomy. One of these LRs was done minimally invasive; seven were done in open fashion. The median diameter of the tumors was 54 mm (14-110 mm). Using the Fletcher classification scheme, 3/9 (33%) tumors had high risk, 1/9 (11%) had intermediate risk, 4/9 (44%) had low risk, and 1/9 (11%) had very low risk for aggressive behaviour. Seven resections showed microscopically negative transsection margins (R0), two

  11. Workers' marginal costs of commuting

    DEFF Research Database (Denmark)

    van Ommeren, Jos; Fosgerau, Mogens

    2009-01-01

    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...

  12. Margin improvement initiatives: realistic approaches

    Energy Technology Data Exchange (ETDEWEB)

    Chan, P.K.; Paquette, S. [Royal Military College of Canada, Chemistry and Chemical Engineering Dept., Kingston, ON (Canada); Cunning, T.A. [Department of National Defence, Ottawa, ON (Canada); French, C.; Bonin, H.W. [Royal Military College of Canada, Chemistry and Chemical Engineering Dept., Kingston, ON (Canada); Pandey, M. [Univ. of Waterloo, Waterloo, ON (Canada); Murchie, M. [Cameco Fuel Manufacturing, Port Hope, ON (Canada)

    2014-07-01

    With reactor core aging, safety margins are particularly tight. Two realistic and practical approaches are proposed here to recover margins. The first project is related to the use of a small amount of neutron absorbers in CANDU Natural Uranium (NU) fuel bundles. Preliminary results indicate that the fuelling transient and subsequent reactivity peak can be lowered to improve the reactor's operating margins, with minimal impact on burnup when less than 1000 mg of absorbers is added to a fuel bundle. The second project involves the statistical analysis of fuel manufacturing data to demonstrate safety margins. Probability distributions are fitted to actual fuel manufacturing datasets provided by Cameco Fuel Manufacturing, Inc. They are used to generate input for ELESTRES and ELOCA. It is found that the fuel response distributions are far below industrial failure limits, implying that margin exists in the current fuel design. (author)

  13. Ocean Margins Programs, Phase I research summaries

    Energy Technology Data Exchange (ETDEWEB)

    Verity, P. [ed.

    1994-08-01

    During FY 1992, the DOE restructured its regional coastal-ocean programs into a new Ocean Margins Program (OMP), to: Quantify the ecological and biogeochemical processes and mechanisms that affect the cycling, flux, and storage of carbon and other biogenic elements at the land/ocean interface; Define ocean-margin sources and sinks in global biogeochemical cycles, and; Determine whether continental shelves are quantitatively significant in removing carbon dioxide from the atmosphere and isolating it via burial in sediments or export to the interior ocean. Currently, the DOE Ocean Margins Program supports more than 70 principal and co-principal investigators, spanning more than 30 academic institutions. Research funded by the OMP amounted to about $6.9M in FY 1994. This document is a collection of abstracts summarizing the component projects of Phase I of the OMP. This phase included both research and technology development, and comprised projects of both two and three years duration. The attached abstracts describe the goals, methods, measurement scales, strengths and limitations, and status of each project, and level of support. Keywords are provided to index the various projects. The names, addresses, affiliations, and major areas of expertise of the investigators are provided in appendices.

  14. Surgical therapy in chronic pancreatitis.

    Science.gov (United States)

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

    2012-12-01

    valid surgical option for the treatment of pain. Though previously dismissed as a valid treatment due to the resultant brittle diabetes, the advent of islet cell autotransplantation has enabled this procedure to produce excellent long-term results in relation to pain, endocrine status and quality of life. Given these excellent short- and long-term results of surgical therapy for chronic pancreatitis, and the poor symptom control provided by conservative and endoscopic treatment (coupled to near inevitable progression to exocrine and endocrine failure), it is likely that future years will see a further shift towards the earlier and more frequent surgical treatment of chronic pancreatitis. Furthermore, the expansion of islet cell autotransplantation to a wider range of pancreatic resections has the potential to even further improve the outcomes of surgical treatment for this problematic yet increasingly common disease.

  15. Supraglottic carcinoma: Impact of radiation therapy on outcome of patients with positive margins and extracapsular nodal disease

    International Nuclear Information System (INIS)

    Devineni, V.R.; Simpson, J.R.; Sessions, D.; Spector, J.G.; Hayden, R.; Fredrickson, J.; Fineberg, B.

    1991-01-01

    Seventy-nine patients with supraglottic carcinoma treated between 1966 and 1985 are reviewed. All patients were treated with surgery and postoperative radiation therapy. Thirty-five percent of the patients had positive margins at the site of resection of the primary tumor. Of the 25 patients who had positive nodal disease, 13 patients (52%) had either extracapsular extension or soft-tissue or adjacent organ invasion, referred to in composite as grave signs. The median follow-up of the patients was 4.9 years and all patients were followed for a minimum of 3 years. The disease-free survival for all patients was 76% at 2 years and 71% at 3 years. The locoregional control rate for all patients was 70%. This study demonstrates that there is no difference in local recurrence or disease-free survival, or time to recurrence relative to the status of the surgical margins, which may be a benefit of the postoperative radiation therapy. This study also demonstrates that there is an increase in the number of patients with grave signs with increasing nodal stage. The rate of neck recurrence in patients with grave signs was substantially higher (54%) than in patients without grave signs (8%), even though these patients also had positive lymph nodes. Interestingly, there was also a higher rate of local recurrence among patients who had grave signs. Patients receiving doses higher than 6000 cGy to the primary site had fewer local failures, although within each group of patients with positive or negative surgical margins the differences in survival were minimal

  16. HISTOPATHOLOGY OF MARGINAL SUPERFICIAL PERIODONTIUM AT MENOPAUSE

    Directory of Open Access Journals (Sweden)

    A. Georgescu

    2012-03-01

    Full Text Available Premises: Sexual hormones may affect the general health condition of women, as early as puberty, continuing during pregnancy and also after menopause. Variations of the hormonal levels may cause different – either local or general – pathological modifications. Sexual hormones may also affect periodontal status, favourizing gingival inflammations and reducing periodontal resistance to the action of the bacterial plaque. Scope: Establishment of the correlations between the debut or the manifestation of menopause and the modifications produced in the superficial periodontium. Materials and method: Clinical and paraclinical investigations were performed on female patients with ages between 45 and 66 years, involving macroscopic, microscopic and radiological recording of the aspect of the superificial periodontium (gingiva. Results: Analysis of the histological sections evidenced atrophic and involutive modifications in the marginal superficial periodontium of female patients at menopause. Conclusions: Sexual hormones intervene in the histological equilibrium of the marginal superficial periodontium, influencing the periodontal health status, which explains the correlation between the subjective symptomatology specific to menopause and the histopatological aspect at epithelial level.

  17. Oral antioxidant therapy for marginal dry eye.

    Science.gov (United States)

    Blades, K J; Patel, S; Aidoo, K E

    2001-07-01

    To assess the efficacy of an orally administered antioxidant dietary supplement for managing marginal dry eye. A prospective, randomised, placebo controlled trial with cross-over. Eye Clinic, Department of Vision Sciences, Glasgow Caledonian University. Forty marginal dry eye sufferers composed of 30 females and 10 males (median age 53 y; range 38-69 y). Baseline assessments were made of tear volume sufficiency (thread test), tear quality (stability), ocular surface status (conjunctival impression cytology) and dry eye symptoms (questionnaire). Each subject was administered courses of active treatment, placebo and no treatment, in random order for 1 month each and results compared to baseline. Tear stability and ocular surface status were significantly improved following active treatment (Ptreatment (P>0.05). Absolute increase in tear stability correlated with absolute change in goblet cell population density. Tear volume was not improved following any treatment period and dry eye symptom responses were subject to placebo effect. Oral antioxidants improved both tear stability and conjunctival health, although it is not yet understood whether increased ocular surface health mediates increased tear stability or vice versa. This study was supported by a PhD scholarship funded by the Department of Vision Sciences, Glasgow Caledonian University, Scotland. Antioxidant supplements and placebos were kindly donated by Vitabiotics.

  18. Estado nutricional en la marginación y la pobreza de adultos triquis del estado de Oaxaca, México Nutritional status of the poor, marginalized adults of the Triqui ethnic group in Oaxaca, Mexico

    Directory of Open Access Journals (Sweden)

    Rosa María Ramos Rodríguez

    2007-10-01

    .OBJECTIVES: To further understanding of the nutritional transition process by studying possible changes over time in the nutritional status of the Triqui ethnic group in the state of Oaxaca, Mexico. METHODS: A retrospective study was conducted using anthropometric data available from three prior studies (end of the 19th century, 1940, and 2002. Means and z scores for height, weight, and body mass index of Triqui adults were calculated using Frisancho reference data. Statistical analyses of the results were performed with Student's t and chi-square tests. Sociocultural information was collected through interviews and direct observations, as well as from the available literature. RESULTS: The height of Triqui adults has remained very low. A majority of Triqui women were found to be short or very short; this, coupled with the low level of education and high rates of illiteracy and monolingualism, is indicative of a culture that does not favor females. The appearance of overweight and obesity among the men studied in 2002, relative to those studied in 1940, is cause for concern. Overweight was also recorded among the women in 2002. CONCLUSIONS: Despite the limitations shared by all retrospective studies, these results confirm that the nutritional status of the Triquis is different now from what it was 60 years ago and that these changes are related to the cultural changes the group is experiencing. To further understand this epidemiologic phenomenon, where malnutrition and obesity coexist, cross-disciplinary studies are needed to analyze the biological, social, and cultural factors involved, so that culturally-appropriate measures can be adopted.

  19. Learning Convex Inference of Marginals

    OpenAIRE

    Domke, Justin

    2012-01-01

    Graphical models trained using maximum likelihood are a common tool for probabilistic inference of marginal distributions. However, this approach suffers difficulties when either the inference process or the model is approximate. In this paper, the inference process is first defined to be the minimization of a convex function, inspired by free energy approximations. Learning is then done directly in terms of the performance of the inference process at univariate marginal prediction. The main ...

  20. Steel Industry Marginal Opportunity Analysis

    Energy Technology Data Exchange (ETDEWEB)

    none,

    2005-09-01

    The Steel Industry Marginal Opportunity Analysis (PDF 347 KB) identifies opportunities for developing advanced technologies and estimates both the necessary funding and the potential payoff. This analysis determines what portion of the energy bandwidth can be captured through the adoption of state-of-the-art technology and practices. R&D opportunities for addressing the remainder of the bandwidth are characterized and plotted on a marginal opportunity curve.

  1. Urinary Bladder Leiomyosarcoma: Primary Surgical Treatment

    Directory of Open Access Journals (Sweden)

    Hakim Slaoui

    2014-07-01

    Full Text Available Cases of bladder leiomyosarcoma represent 0.1% of all nonurothelial tumors. We present a case report of a 73-year-old man who underwent a radical cystoprostatectomy for a high-grade bladder leiomyosarcoma with an ileal diversion. The patient recovered uneventfully and no surgical margins were verified in final pathology. Early follow-up at 3 months shows no signs of computed tomography recurrence and adequate adaptation to ileal diversion. Although bladder sarcomas were once thought to have a grim prognosis, recent studies suggest that adequate surgical treatment is able to achieve optimal cancer control outcomes.

  2. Sparing Sphincters and Laparoscopic Resection Improve Survival by Optimizing the Circumferential Resection Margin in Rectal Cancer Patients.

    Science.gov (United States)

    Keskin, Metin; Bayraktar, Adem; Sivirikoz, Emre; Yegen, Gülcin; Karip, Bora; Saglam, Esra; Bulut, Mehmet Türker; Balik, Emre

    2016-02-01

    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.

  3. Micro-surgical endodontics.

    Science.gov (United States)

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

    2014-02-01

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

  4. Disparities at the intersection of marginalized groups

    Science.gov (United States)

    Jackson, John W.; Williams, David R.; VanderWeele, Tyler J.

    2016-01-01

    Mental health disparities exist across several dimensions of social inequality, including race/ethnicity, socioeconomic status and gender. Most investigations of health disparities focus on one dimension. Recent calls by researchers argue for studying persons who are marginalized in multiple ways, often from the perspective of intersectionality, a theoretical framework applied to qualitative studies in law, sociology, and psychology. Quantitative adaptations are emerging but there is little guidance as to what measures or methods are helpful. Here, we consider the concept of a joint disparity and its composition, show that this approach can illuminate how outcomes are patterned for social groups that are marginalized across multiple axes of social inequality, and compare the insights gained with that of other measures of additive interaction. We apply these methods to a cohort of males from the National Longitudinal Survey of Youth, examining disparities for black males with low early life SES vs. white males with high early life SES across several outcomes that predict mental health, including unemployment, wages, and incarceration. We report striking disparities in each outcome, but show that the contribution of race, SES, and their intersection varies. PMID:27531592

  5. Considerations about an administrative ''margin of prognosis''

    International Nuclear Information System (INIS)

    Tettinger, P.J.

    1982-01-01

    The investigation is concerned with the limitations of certain judicial concepts, and the descretion of the appropriate administrative authorities to interpret them, especially in the area of necessary precautionary measures with regard to nuclear power plants safety. Thereby the question arises, whether by interpreting undefined judicial concepts (such as ''the status of science and technology'', e.g. section 1 sub-section 2, number 3 of the Atomic Energy Law), administrative authorities should be given a flexible margin of judgement which could not be examined, by the administrative courts, especially in view of risk analysis and risk assessments. Diverging opinions in legal literature and the administration of justice will be presented and critically analyzed. The author argues for an integral administrative procedure. Controlling the licensing of nuclear power plants, which - if need be - should only be limited by a ''plausibility control'' in cases where several security-safety related technical solutions appear acceptable. (WBI) [de

  6. The Marginal Source of Finance

    OpenAIRE

    Lindhe, Tobias

    2002-01-01

    This paper addresses the ongoingdebate on which view of equity, traditional or new, that best describes firm behavior. According to the traditional view, the marginal source of finance is new equity, whereas under to the new view, marginal financing comes from retained earnings. In the theoretical part, we set up a model where the firm faces a cost of adjusting the dividend level because of an aggravated free cash flow problem. The existence of such a cost - which has been used in arguing the...

  7. Marginal Biotin Deficiency Is Teratogenic in ICR Mice1,2

    OpenAIRE

    Mock, Donald M.; Mock, Nell I.; Stewart, Christopher W.; LaBorde, James B.; Hansen, Deborah K.

    2003-01-01

    The incidence of marginal biotin deficiency in normal human gestation is approximately one in three. In ICR mice, maternal biotin deficiency results in cleft palate, micrognathia, microglossia and limb hypoplasia. However, the relationships among the severity of maternal biotin deficiency, fetal biotin status and malformations have not been reported. This study utilized validated indices of biotin status to investigate the relationships among maternal biotin status, fetal biotin status and th...

  8. Surgical management of venous malformations.

    Science.gov (United States)

    Loose, D A

    2007-01-01

    Among vascular malformations, the predominantly venous malformations represent the majority of cases. They form a clinical entity and therefore need clear concepts concerning diagnosis and treatment. This paper presents an overview of contemporary classification as well as tactics and techniques of treatment. According to the Hamburg Classification, predominantly venous malformations are categorized into truncular and extratruncular forms, with truncular forms distinguished as obstructions and dilations, and extratruncular forms as limited or infiltrating. The tactics of treatment represent surgical and non-surgical methods or combined techniques. Surgical approaches utilize different tactics and techniques that are adopted based on the pathologic form and type of the malformation: (I) operation to reduce the haemodynamic activity of the malformation; (II) operation to eliminate the malformation; and (III) reconstructive operation. As for (I), a type of a tactic is the operation to derive the venous flow. In (II), the total or partial removal of the venous malformation is demonstrated subdivided into three different techniques. In this way, the infiltrating as well as the limited forms can be treated. An additional technique is dedicated to the treatment of a marginal vein. Approach (III) involves the treatment of venous aneurysms, where a variety of techniques have been successful. Long-term follow-up demonstrates positive results in 91% of the cases. Congenital predominantly venous malformations should be treated according to the principles developed during the past decades in vascular surgery, interventional treatment and multidisciplinary treatment. The days of predominantly conservative treatment should be relegated to the past. Special skills and experiences are necessary to carry out appropriate surgical strategy, and the required operative techniques should be dictated by the location and type of malformation and associated findings.

  9. Biodiversity and agro-ecology in field margins.

    Science.gov (United States)

    De Cauwer, B; Reheul, D; Nijs, I; Milbau, A

    2005-01-01

    diminish the risk of species ingrowth into adjacent crops by creeping roots and rhizomes. Seed dispersal was only problematic one year after the installation of the field margin strips particularly nearby the unsown margin strip and wind-borne seeds were dispersed over limited distances, mainly within 4 m of field margins. Annual herbage yield was not affected by mowing management. DM yield of sown/unsown communities converged over time. Compared to herbage from an intensively managed fertilized grassland, field margin herbage revealed a low feeding value, owing to a low crude protein content, a low digestibility and a high crude fibre content. The unsown community had a higher forage quality than communities sown to bred commercially available grass varieties. Both digestibility and crude protein content decreased over time irrespective of plant community or location. Mid June cuts were more productive than mid September cuts but digestibility and crude protein content was lower. The use of herbage from field margins as hay for horses or as a component in farmland compost are good alternatives. A strong relation was found between the distribution of pest insects and their antagonist families along field margin strips indicating a status of biological equilibrium. From environmental concern, field margin strips buffered boundary vegetation and watercourses against cropped areas loaded with high levels of mineral nitrogen. Margin strips reduced the mineral nitrogen content of the soil in the margin and mineral nitrogen loss during wintermonths. Mineral nitrogen loss was not affected by field margin type but by distance from the field crop. A minimal width of 5 m is necessary to reach an optimal reduction in mineral soil N and N losses.

  10. Characterizing Convexity of Games using Marginal Vectors

    NARCIS (Netherlands)

    van Velzen, S.; Hamers, H.J.M.; Norde, H.W.

    2003-01-01

    In this paper we study the relation between convexity of TU games and marginal vectors.We show that if specfic marginal vectors are core elements, then the game is convex.We characterize sets of marginal vectors satisfying this property, and we derive the formula for the minimum number of marginal

  11. Improving quality of breast cancer surgery through development of a national breast cancer surgical outcomes (BRCASO research database

    Directory of Open Access Journals (Sweden)

    Aiello Bowles Erin J

    2012-04-01

    Full Text Available Abstract Background Common measures of surgical quality are 30-day morbidity and mortality, which poorly describe breast cancer surgical quality with extremely low morbidity and mortality rates. Several national quality programs have collected additional surgical quality measures; however, program participation is voluntary and results may not be generalizable to all surgeons. We developed the Breast Cancer Surgical Outcomes (BRCASO database to capture meaningful breast cancer surgical quality measures among a non-voluntary sample, and study variation in these measures across providers, facilities, and health plans. This paper describes our study protocol, data collection methods, and summarizes the strengths and limitations of these data. Methods We included 4524 women ≥18 years diagnosed with breast cancer between 2003-2008. All women with initial breast cancer surgery performed by a surgeon employed at the University of Vermont or three Cancer Research Network (CRN health plans were eligible for inclusion. From the CRN institutions, we collected electronic administrative data including tumor registry information, Current Procedure Terminology codes for breast cancer surgeries, surgeons, surgical facilities, and patient demographics. We supplemented electronic data with medical record abstraction to collect additional pathology and surgery detail. All data were manually abstracted at the University of Vermont. Results The CRN institutions pre-filled 30% (22 out of 72 of elements using electronic data. The remaining elements, including detailed pathology margin status and breast and lymph node surgeries, required chart abstraction. The mean age was 61 years (range 20-98 years; 70% of women were diagnosed with invasive ductal carcinoma, 20% with ductal carcinoma in situ, and 10% with invasive lobular carcinoma. Conclusions The BRCASO database is one of the largest, multi-site research resources of meaningful breast cancer surgical quality data

  12. Operational margin monitoring system for boiling water reactor power plants

    International Nuclear Information System (INIS)

    Fukutomi, S.; Takigawa, Y.

    1992-01-01

    This paper reports on an on-line operational margin monitoring system which has been developed for boiling water reactor power plants to improve safety, reliability, and quality of reactor operation. The system consists of a steady-state core status prediction module, a transient analysis module, a stability analysis module, and an evaluation and guidance module. This system quantitatively evaluates the thermal margin during abnormal transients as well as the stability margin, which cannot be evaluated by direct monitoring of the plant parameters, either for the current operational state or for a predicted operating state that may be brought about by the intended operation. This system also gives operator guidance as to appropriate or alternate operations when the operating state has or will become marginless

  13. Marginality and Variability in Esperanto.

    Science.gov (United States)

    Brent, Edmund

    This paper discusses Esperanto as a planned language and refutes three myths connected to it, namely, that Esperanto is achronical, atopical, and apragmatic. The focus here is on a synchronic analysis. Synchronic variability is studied with reference to the structuralist determination of "marginality" and the dynamic linguistic…

  14. Texas curve margin of safety.

    Science.gov (United States)

    2013-01-01

    This software can be used to assist with the assessment of margin of safety for a horizontal curve. It is intended for use by engineers and technicians responsible for safety analysis or management of rural highway pavement or traffic control devices...

  15. Ethnographies of marginality [Review article

    NARCIS (Netherlands)

    Beuving, J.J.

    2016-01-01

    Africanist discourse today displays a strong, widespread and growing sense of optimism about Africa's economic future. After decades of decline and stagnation in which Africa found itself reduced to the margins of the global economic stage, upbeat Afro-optimism seems fully justified. One only needs

  16. Profit margins in Japanese retailing

    NARCIS (Netherlands)

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

    1993-01-01

    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

  17. Pushing the Margins of Responsibility

    DEFF Research Database (Denmark)

    Santoni de Sio, Filippo; Di Nucci, Ezio

    2018-01-01

    David Shoemaker has claimed that a binary approach to moral responsibility leaves out something important, namely instances of marginal agency, cases where agents seem to be eligible for some responsibility responses but not others. In this paper we endorse and extend Shoemaker’s approach by pres...

  18. A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy.

    Science.gov (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

    2015-12-01

    A detailed understanding of renal surgical anatomy is necessary to optimize preoperative planning and operative technique and provide a basis for improved outcomes. 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). A literature review was conducted. 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. 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. In this report we review renal surgical anatomy. Renal mass imaging allows detailed delineation of the

  19. Surgical Approaches to the Oral Cavity Primary and Neck

    International Nuclear Information System (INIS)

    Shah, Jatin P.

    2007-01-01

    Purpose: A variety of surgical approaches used to treat primary oral cavity tumors are described to delineate the technique and rationale behind each treatment choice. Methods and Materials: Size, location, proximity to bone, lymph node status, histology, and prior treatment considerations are employed to determine the most appropriate surgical approach for primary oral cavity tumors. Results: Oncologic outcomes and physical function show the best results from surgical treatment of many primary oral cavity, but necessitates careful selection of surgical approach. Conclusion: Each surgical approach must be selected based upon relevant tumor, patient and physician factors

  20. American Pediatric Surgical Association

    Science.gov (United States)

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

  1. Abortion - surgical - aftercare

    Science.gov (United States)

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

  2. Urogynecologic Surgical Mesh Implants

    Science.gov (United States)

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

  3. Contributions to knowledge of the continental margin of Uruguay. Uruguayan continental margin: Physiographic and seismic analysis

    International Nuclear Information System (INIS)

    Preciozzi, F

    2014-01-01

    This work is about the kind of continental margins such as a )Atlantic type passive margins which can be hard or soft b) An active or Pacific margins that because of the very frequent earthquakes develop a morphology dominated by tectonic processes. The Uruguayan continental margin belongs to a soft Atlantic margin

  4. Margins related to equipment design

    International Nuclear Information System (INIS)

    Devos, J.

    1994-01-01

    Safety margins related to design of reactor equipment are defined according to safety regulations. Advanced best estimate methods are proposed including some examples which were computed and compared to experimental results. Best estimate methods require greater computation effort and more material data but give better variable accuracy and need careful experimental validation. Simplified methods compared to the previous are less sensitive to material data, sometimes are more accurate but very long to elaborate

  5. Benchmarking circumferential resection margin (R1) resection rate for rectal cancer in the neoadjuvant era.

    Science.gov (United States)

    Chambers, W; Collins, G; Warren, B; Cunningham, C; Mortensen, N; Lindsey, I

    2010-09-01

    Circumferential resection margin (CRM) involvement (R1) is used to audit rectal cancer surgical quality. However, when downsizing chemoradiation (dCRT) is used, CRM audits both dCRT and surgery, its use reflecting a high casemix of locally advanced tumours. We aimed to evaluate predictors of R1 and benchmark R1 rates in the dCRT era, and to assess the influence of failure of steps in the multidisciplinary team (MDT) process to CRM involvement. A retrospective analysis of prospectively collected rectal cancer data was undertaken. Patients were classified according to CRM status. Uni- and multivariate analysis was undertaken of risk factors for R1 resection. The contribution of the steps of the MDT process to CRM involvement was assessed. Two hundred and ten rectal cancers were evaluated (68% T3 or T4 on preoperative staging). R1 (microscopic) and R2 (macroscopic) resections occurred in 20 (10%) and 6 patients (3%), respectively. Of several factors associated with R1 resections on univariate analysis, only total mesorectal excision (TME) specimen defects and threatened/involved CRM on preoperative imaging remained as independent predictors of R1 resections on multivariate analysis. Causes of R1 failure by MDT step classification found that less than half were associated with and only 15% solely attributable to a suboptimal TME specimen. Total mesorectal excision specimen defects and staging-predicted threatened or involved CRM are independent strong predictors of R1 resections. In most R1 resections, the TME specimen was intact. It is important to remember the contribution of both the local staging casemix and dCRT failure when using R1 rates to assess purely surgical competence.

  6. Innovative financing for rural surgical patients: Experience in mission hospitals

    Directory of Open Access Journals (Sweden)

    Gnanaraj Jesudian

    2016-01-01

    Full Text Available In rural India most of the surgical patients become impoverished due to surgical treatment pushing several families below poverty line. We describe the various methods that we tried to help these patients pay for the surgical procedures without becoming impoverished. Some of them were successful and many of them were not so successful. The large turnover and innovative methods helped the mission hospitals to serve the poor and the marginalized. Some of these methods might not be relevant in areas other than Northeast India while many could be used in other areas.

  7. Occurrence and prognostic value of circumferential resection margin involvement for patients with rectal cancer.

    Science.gov (United States)

    Wang, Cun; Zhou, Zong-guang; Yu, Yong-yang; Shu, Ye; Li, Yuan; Yang, Lie; Li, Li

    2009-04-01

    Total mesorectal excision (TME) was advocated owning to the reduction in local failure, while deficiency in pathologic details limited monitoring of surgical quality assurance. Here, we aimed to examine circumferential resection margin (CRM) by large tissue slice, discussing its rule in occurrence and relationship with prognosis, thus providing proof for the adoption of TME principles and the application of adjuvant therapy. Specimens of 106 patients with rectal cancer, who underwent potentially curative resection from December 2001 to September 2002, were examined. Follow-up data were collected. Altogether, 2,068 mesorectal nodes were examined with 272 involved by tumor. CRM involvement (CRMI) was examined in 20 specimens. In these 20 cases, seven, nine, and four were caused by tumor infiltration, lymph node metastasis, and both, respectively. Occurrence of CRMI was more common for lower-located cancers while also statistically related to tumor differentiation, infiltration, and lymph node metastasis. The difference in local recurrence rate, general recurrence rate, disease-free survival rate, and overall survival rate between the group with CRMI and the group without were all proven to be significant. Detailed pathologic examination, including status of CRM, is advocated since it provides accurate prognostic information. Surgeons could maximize the probability of cure by following the principle of TME. Preoperative adjuvant therapy was essential for advanced staged and lower-located lesions, which implied likelihood of CRMI.

  8. Marginalism, quasi-marginalism and critical phenomena in micellar solutions

    International Nuclear Information System (INIS)

    Reatto, L.

    1986-01-01

    The observed nonuniversal critical behaviour of some micellar solutions is interpreted in terms of quasi-marginalism, i.e. the presence of a coupling which scales with an exponent very close to the spatial dimensionality. This can give rise to a preasymptotic region with varying effective critical exponents with a final crossover to the Ising ones. The reduced crossover temperature is estimated to be below 10 -6 . The exponents β and γ measured in C 12 e 5 are in good agreement with the scaling law expected to hold for the effective exponents. The model considered by Shnidman is found unable to explain the nonuniversal critical behaviour

  9. Hepatocellular carcinoma with marginal superparamagnetic iron oxide uptake on T2*-weighted magnetic resonance imaging: Histopathologic correlation

    International Nuclear Information System (INIS)

    Ishigami, Kousei; Tajima, Tsuyoshi; Fujita, Nobuhiro; Nishie, Akihiro; Asayama, Yoshiki; Kakihara, Daisuke; Nakayama, Tomohiro; Okamoto, Daisuke; Taketomi, Akinobu; Shirabe, Ken; Honda, Hiroshi

    2011-01-01

    Purpose: To evaluate the characteristics of hepatocellular carcinomas (HCCs) with marginal superparamagnetic iron oxide (SPIO) uptake on T2*-weighted MRI. Materials and methods: The study group consisted of 73 patients with 83 surgically resected HCCs. Preoperative SPIO-enhanced MRI studies were retrospectively reviewed. Marginal SPIO uptake was considered positive if a rim-like or band-like low intensity area was present on SPIO-enhanced T2*-weighted images. The prevalence of marginal SPIO uptake was evaluated. Pathological specimens with hematoxylin and eosin staining and immunohistochemical staining of CD68 were reviewed in HCCs with marginal SPIO uptake and 33 HCCs without marginal SPIO uptake (control group). Results: Ten of 83 (12%) HCCs showed marginal SPIO uptake. All HCCs were hypervascular, and only one nodule showed a nodule-in-nodule appearance on imaging findings. The pathology specimens suggested possible causes of marginal SPIO uptake, including marginal macrophage infiltration in moderately or poorly differentiated HCC (n = 4), residual normal hepatic tissue at the marginal area of confluent multinodular or single nodular with extranodular growth type HCC (n = 3), and a well-differentiated HCC component in nodule-in-nodule type HCC (n = 3). Marginal macrophage infiltration was not seen in the control group. Conclusion: SPIO-enhanced MRI may be able to demonstrate marginal macrophage infiltration in HCC.

  10. Reliabilityy and operating margins of LWR fuels

    International Nuclear Information System (INIS)

    Strasser, A.A.; Lindquist, K.O.

    1977-01-01

    The margins to fuel thermal operating limits under normal and accident conditions are key to plant operating flexibility and impact on availability and capacity factor. Fuel performance problems that do not result in clad breach, can reduce these margins. However, most have or can be solved with design changes. Regulatory changes have been major factors in eroding these margins. Various methods for regaining the margins are discussed

  11. Wrong to be Right: Margin Laterality is an Independent Predictor of Biochemical Failure After Radical Prostatectomy.

    Science.gov (United States)

    Kang, Jung J; Reiter, Robert E; Kummer, Nicolas; DeKernion, Jean; Steinberg, Michael L; King, Christopher R

    2018-01-01

    To examine the impact of positive surgical margin (PSM) laterality on failure after radical prostatectomy (RP). A PSM can influence local recurrence and outcomes after salvage radiation. Unlike intrinsic risk factors, a PSM is caused by intervention and thus iatrogenic failures may be elucidated by analyzing margin laterality as surgical approach is itself lateralized. We reviewed 226 RP patients between 1991 and 2013 with PSM. Data includes operation type, pre/postoperative PSA, surgical pathology, and margin type (location, focality, laterality). The median follow-up was 47 months. Biochemical recurrence after RP was defined as PSA≥0.1 ng/mL or 2 consecutive rises above nadir. Ninety-two patients received salvage radiation therapy (SRT). Failure after SRT was defined as any PSA≥0.2 ng/mL or greater than presalvage. Kaplan-Meier and Cox multivariate analyses compared relapse rates. The majority of PSM were iatrogenic (58%). Laterality was associated with differences in median relapse: right 20 versus left 51 versus bilateral 14 months (PRight-sided margins were more likely to progress than left (hazard ratio, 1.67; P=0.04). More right-sided margins were referred for SRT (55% right vs. 23% left vs. 22% bilateral), but were equally salvaged. Only T-stage and pre-SRT PSA independently influenced SRT success. Most PSM are iatrogenic, with right-sided more likely to progress (and sooner) than left sided. Margin laterality is a heretofore unrecognized independent predictor of biochemical relapse and hints at the need to modify the traditional unilateral surgical technique.

  12. [Surgical managment of retinal detachment].

    Science.gov (United States)

    Haritoglou, C; Wolf, A

    2015-05-01

    The detachment of the neurosensory retina from the underlying retinal pigment epithelium can be related to breaks of the retina allowing vitreous fluid to gain access to the subretinal space, to exudative changes of the choroid such as tumours or inflammatory diseases or to excessive tractional forces exerted by interactions of the collagenous vitreous and the retina. Tractional retinal detachment is usually treated by vitrectomy and exudative detachment can be addressed by treatment of the underlying condition in many cases. In rhegmatogenous retinal detachment two different surgical procedures, vitrectomy and scleral buckling, can be applied for functional and anatomic rehabilitation of our patients. The choice of the surgical procedure is not really standardised and often depends on the experience of the surgeon and other more ocular factors including lens status, the number of retinal breaks, the extent of the detachment and the amount of preexisting PVR. Using both techniques, anatomic success rates of over 90 % can be achieved. Especially in young phakic patients scleral buckling offers the true advantage to prevent the progression of cataract formation requiring cataract extraction and intraocular lens implantation. Therefore, scleral buckling should be considered in selected cases as an alternative surgical option in spite of the very important technical refinements in modern vitrectomy techniques. Georg Thieme Verlag KG Stuttgart · New York.

  13. Application of da Vinci surgical robotic system in hepatobiliary surgery

    Directory of Open Access Journals (Sweden)

    Chen Jiahai

    2018-01-01

    Full Text Available The development of minimally invasive surgery has brought a revolutionary change to surgery techniques, and endoscopic surgical robots, especially Da Vinci robotic surgical system, has further broaden the scope of minimally invasive surgery, which has been applied in a variety of surgical fields including hepatobiliary surgery. Today, the application of Da Vinci surgical robot can cover most of the operations in hepatobiliary surgery which has proved to be safe and practical. What’s more, many clinical studies in recent years have showed that Da Vinci surgical system is superior to traditional laparoscopy. This paper summarize the advantage and disadvantage of Da Vinci surgical system, and outlines the current status of and future perspectives on the robot-assisted hepatobiliary surgery based on the cases reports in recent years of the application of Da Vinci surgical robot.

  14. Silenced, Silence, Silent: Motherhood in the Margins

    Science.gov (United States)

    Carpenter, Lorelei; Austin, Helena

    2007-01-01

    This project explores the experiences of women who mother children with ADHD. The authors use the metaphor of the text and the margin. The text is the "motherhood myth" that describes a particular sort of "good" mothering. The margin is the space beyond that text. This marginal space is inhabited by some or all of the mothers they spoke with, some…

  15. 12 CFR 220.4 - Margin account.

    Science.gov (United States)

    2010-01-01

    ... Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM CREDIT BY... securities. The required margin on a net long or net short commitment in a when-issued security is the margin...) Interest charged on credit maintained in the margin account; (ii) Premiums on securities borrowed in...

  16. Assessment of the nutrition status of 1 002 selected operative patients in general surgical department%1002例普外择期手术住院病人营养状态评价

    Institute of Scientific and Technical Information of China (English)

    贾汝梅; 李雅慧; 王景顺; 李志增; 玉树峰

    2000-01-01

    Objective Appraisal of nutrition status of patients has been recognized to be important. The objective of nutrition assessment is to understand whether the patients are malnutritioned and to evaluate the type and degree of malnutrition for therapy plan, evalnating therapy effects and the prognosis. Methods We treated 1 002 (430 M, 572 F) selected operative cases (aged 15 to 89) within 15 months in general surgical dept of our hospital. Of 1002 eases, 411 have digestive tract disease (benign 181, malignant 230) and 591 have nondigestive tract disease (benign 506, malignant 85). Several nutrition indexes are examined in all patients in three days after hospitalization. Above mentioned indexes included: 1, Anthropometry: WT/HT, TSF, MAC, AMC and GS. 2. laboratory examnation: Hb, Alb, Tf, CHI and TLC. 3. Body fat measurement with bioetectricity impedance method. A special person was responsible for the anthropometry and the collection of 24 hours urine samples. Clinical laboratory of our hospital undertaked the laboratory examination. In assessing the degree of malnutrition, we adopted the criteria that the majority of scholars applied. Measuring body fat was performed using "Body Fat Analysis Appliance" made by Institution of Military Medicine of BeiJing Military Area and its nutrition effect was appraised according to suggested criterion for body fat ( % ) of different aged chinese. Results The incidence of abnormal nutrition indexes: WT/HT ( 18.1% ), TSF ( 25.8% ), AMC ( 22.2 %), GS ( 65.5% ), Hb (51.2), Alb (6.1% ) TG (24.9% ), CHI (47.6% ), TLC (23.7% ), Fat (63.6% ). Among these patients, 42.3 % had 1~2 abnormal parameters, 41.3% and 3~5 abnormal and 11.4 %, 6~8 abnormal. Of all patients with lower Alb, 44 cases ( 81% ) were accompanied with other 3~7 abnormal parameters. Both these results demonstrated that the incidence of malnutrition of surgery inpatients is very high. It' s very important for surgeons to evaluate nutrition status of paitnets before

  17. Rectal cancer: involved circumferential resection margin - a root cause analysis.

    Science.gov (United States)

    Youssef, H; Collantes, E C; Rashid, S H; Wong, L S; Baragwanath, P

    2009-06-01

    An involved circumferential resection margin (CRM) following surgery for rectal cancer is the strongest predictor of local recurrence and may represent a failure of the multidisciplinary team (MDT) process. The study analyses the causes of positive CRM in patients undergoing elective surgery for rectal cancer with respect to the decision-making process of the MDT, preoperative rectal cancer staging and surgical technique. From March 2002 to September 2005, data were collected prospectively on all patients undergoing elective rectal cancer surgery with curative intent. The data on all patients identified with positive CRM were analysed. Of 158 patients (male:female = 2.2:1) who underwent potentially curative surgery, 16 (10%) patients had a positive CRM on postoperative histology. Four were due to failure of the pelvic magnetic resonance imaging (MRI) staging scans to predict an involved margin, two with an equivocal CRM on MRI did not have preoperative radiotherapy, one had an inaccurate assessment of the site of primary tumour and in one intra-operative difficulty was encountered. No failure of staging or surgery was identified in the remaining eight of the 16 patients. Abdominoperineal resection (APR) was associated with a 26% positive CRM, compared with 5% for anterior resection. No single consistent cause was found for a positive CRM. The current MDT process and/or surgical technique may be inadequate for low rectal tumours requiring APR.

  18. Factors associated with a primary surgical approach for sinonasal squamous cell carcinoma.

    Science.gov (United States)

    Cracchiolo, Jennifer R; Patel, Krupa; Migliacci, Jocelyn C; Morris, Luc T; Ganly, Ian; Roman, Benjamin R; McBride, Sean M; Tabar, Viviane S; Cohen, Marc A

    2018-03-01

    Primary surgery is the preferred treatment of T1-T4a sinonasal squamous cell carcinoma (SNSCC). Patients with SNSCC in the National Cancer Data Base (NCDB) were analyzed. Factors that contributed to selecting primary surgical treatment were examined. Overall survival (OS) in surgical patients was analyzed. Four-thousand seven hundred and seventy patients with SNSCC were included. In T1-T4a tumors, lymph node metastases, maxillary sinus location, and treatment at high-volume centers were associated with selecting primary surgery. When primary surgery was utilized, tumor factors and positive margin guided worse OS. Adjuvant therapy improved OS in positive margin resection and advanced T stage cases. Tumor and non-tumor factors are associated with selecting surgery for the treatment of SNSCC. When surgery is selected, tumor factors drive OS. Negative margin resection should be the goal of a primary surgical approach. When a positive margin resection ensues, adjuvant therapy may improve OS. © 2017 Wiley Periodicals, Inc.

  19. Seismic margin analysis technique for nuclear power plant structures

    International Nuclear Information System (INIS)

    Seo, Jeong Moon; Choi, In Kil

    2001-04-01

    In general, the Seismic Probabilistic Risk Assessment (SPRA) and the Seismic Margin Assessment(SAM) are used for the evaluation of realistic seismic capacity of nuclear power plant structures. Seismic PRA is a systematic process to evaluate the seismic safety of nuclear power plant. In our country, SPRA has been used to perform the probabilistic safety assessment for the earthquake event. SMA is a simple and cost effective manner to quantify the seismic margin of individual structural elements. This study was performed to improve the reliability of SMA results and to confirm the assessment procedure. To achieve this goal, review for the current status of the techniques and procedures was performed. Two methodologies, CDFM (Conservative Deterministic Failure Margin) sponsored by NRC and FA (Fragility Analysis) sponsored by EPRI, were developed for the seismic margin review of NPP structures. FA method was originally developed for Seismic PRA. CDFM approach is more amenable to use by experienced design engineers including utility staff design engineers. In this study, detailed review on the procedures of CDFM and FA methodology was performed

  20. Safety margins in deterministic safety analysis

    International Nuclear Information System (INIS)

    Viktorov, A.

    2011-01-01

    The concept of safety margins has acquired certain prominence in the attempts to demonstrate quantitatively the level of the nuclear power plant safety by means of deterministic analysis, especially when considering impacts from plant ageing and discovery issues. A number of international or industry publications exist that discuss various applications and interpretations of safety margins. The objective of this presentation is to bring together and examine in some detail, from the regulatory point of view, the safety margins that relate to deterministic safety analysis. In this paper, definitions of various safety margins are presented and discussed along with the regulatory expectations for them. Interrelationships of analysis input and output parameters with corresponding limits are explored. It is shown that the overall safety margin is composed of several components each having different origins and potential uses; in particular, margins associated with analysis output parameters are contrasted with margins linked to the analysis input. While these are separate, it is possible to influence output margins through the analysis input, and analysis method. Preserving safety margins is tantamount to maintaining safety. At the same time, efficiency of operation requires optimization of safety margins taking into account various technical and regulatory considerations. For this, basic definitions and rules for safety margins must be first established. (author)

  1. Surgical Management of Adenocarcinoma of the Pancreatic Uncinate Process in a Cancer Hospital in Egypt

    Directory of Open Access Journals (Sweden)

    Sameh Roshdy

    2015-08-01

    Full Text Available Introduction Pancreatic carcinoma affecting the uncinate process is a challenging surgical condition. Several considerations affect the management plan, including the need for vascular resection and the ability to achieve a clear margin. Methods The data of 19 patients who had curative resection for pancreatic adenocarcinoma of the uncinate process were reviewed. Operative mortality and morbidity, and disease-free survival (DFS were calculated. Results The study population included 13 male and 6 female patients with a mean age of 55 years. Nine patients (47.4% had stage I disease, seven patients (36.8% had stage II disease, and three patients (15.8% had stage III disease. A total of 12 patients had Whipple procedure and 7 patients had total pancreatectomy. In total, there were 9 R0 and 10 R1 resections. Operative mortality rate was 10.5% (2/19, postoperative leakage rate was 21.1% (4/19, and wound sepsis rate was 21.1%. Median DFS was 19.2 months. Survival was superior in the Whipple procedure group than in the total pancreatectomy group (median survival 19 months vs 4 months, respectively. Vascular resection and retroperitoneal safety margin status did not affect disease relapse. Conclusion Non-metastatic pancreatic adenocarcinoma of the uncinate process should be offered R0 or R1 resection whenever technically feasible.

  2. A Longitudinal View of the Relationship Between Social Marginalization and Obesity

    Science.gov (United States)

    Apolloni, Andrea; Marathe, Achla; Pan, Zhengzheng

    We use 3 Waves of the Add Health data collected between 1994 and 2002 to conduct a longitudinal study of the relationship between social marginalization and the weight status of adolescents and young adults. Past studies have shown that overweight and obese children are socially marginalized. This research tests (1) if this is true when we account for the sample size of each group, (2) does this phenomenon hold over time and (3) is it obesity or social marginalization that precedes in time. Our results show that when the sample size for each group is considered, the share of friendship is conforming to the size of the group. This conformity seems to increase over time as the population becomes more obese. Finally, we find that obesity precedes social marginalization which lends credence to the notion that obesity causes social marginalization and not vice versa.

  3. Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy

    International Nuclear Information System (INIS)

    Gage, Irene; Nixon, Asa J.; Schnitt, Stuart J.; Recht, Abram; Gelman, Rebecca; Silver, Barbara; Connolly, James L.; Harris, Jay R.

    1995-01-01

    PURPOSE: To assess the relationship between microscopic margin status and recurrence after breast-conserving therapy for tumors with or without an extensive intraductal component (EIC). MATERIALS AND METHODS: During the years 1968 to 1986, 1865 women with unilateral clinical stage I or II breast cancer were treated with radiation therapy for breast conservation. Of these, 340 received ≥60 Gy to the tumor bed and had margins that were evaluable on review of their pathologic slides; these constitute the study population. The median follow-up was 109 months. All available slides were reviewed by one of the study pathologists (SS, JC). Final radial margins of excision were classified as negative >1 mm (no invasive or ductal carcinoma in-situ within 1 mm of the inked margin), negative ≤1 mm (any carcinoma ≤1 mm of the inked margin but not at ink) or positive (any carcinoma at the inked margin). A focally positive margin was defined as any invasive or in-situ carcinoma at the margin in ≤3 LPF. The extent of positivity was not evaluable in 2 patients and the distance of the tumor from the margin was not evaluable in 48 patients with a negative margin. Thirty-nine percent of EIC-negative and 46% of EIC-positive patients underwent a re-excision and, for these, the final margin analyzed was from the re-excised specimen. The median dose to the tumor bed was 63 Gy for patients with positive margins and 62 Gy for patients with negative margins. Recurrent disease was classified as ipsilateral breast recurrence (IBR) or distant metastasis/regional nodal failure (DM/RNF). RESULTS: Five year crude rates for the first site of recurrence were calculated for 340 patients evaluable at 5 years. Results were tabulated separately for all patients, EIC-negative and EIC-positive. All p-values tested for differences in the distribution of sites of first failure. CONCLUSIONS: The risk of ipsilateral breast recurrence is equally low for patients with close (≤1 mm) or negative (>1 mm

  4. Deriving DICOM surgical extensions from surgical workflows

    Science.gov (United States)

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

    2007-03-01

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

  5. Recognizing surgical patterns

    NARCIS (Netherlands)

    Bouarfa, L.

    2012-01-01

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

  6. Surgical medical record

    DEFF Research Database (Denmark)

    Bulow, S.

    2008-01-01

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

  7. Controlling marginally detached divertor plasmas

    Science.gov (United States)

    Eldon, D.; Kolemen, E.; Barton, J. L.; Briesemeister, A. R.; Humphreys, D. A.; Leonard, A. W.; Maingi, R.; Makowski, M. A.; McLean, A. G.; Moser, A. L.; Stangeby, P. C.

    2017-06-01

    A new control system at DIII-D has stabilized the inter-ELM detached divertor plasma state for H-mode in close proximity to the threshold for reattachment, thus demonstrating the ability to maintain detachment with minimal gas puffing. When the same control system was instead ordered to hold the plasma at the threshold (here defined as T e  =  5 eV near the divertor target plate), the resulting T e profiles separated into two groups with one group consistent with marginal detachment, and the other with marginal attachment. The plasma dithers between the attached and detached states when the control system attempts to hold at the threshold. The control system is upgraded from the one described in Kolemen et al (2015 J. Nucl. Mater. 463 1186) and it handles ELMing plasmas by using real time D α measurements to remove during-ELM slices from real time T e measurements derived from divertor Thomson scattering. The difference between measured and requested inter-ELM T e is passed to a PID (proportional-integral-derivative) controller to determine gas puff commands. While some degree of detachment is essential for the health of ITER’s divertor, more deeply detached plasmas have greater radiative losses and, at the extreme, confinement degradation, making it desirable to limit detachment to the minimum level needed to protect the target plate (Kolemen et al 2015 J. Nucl. Mater. 463 1186). However, the observed bifurcation in plasma conditions at the outer strike point with the ion B   ×  \

  8. Towards intraoperative assessment of tumor margins in breast surgery using optical coherence elastography (Conference Presentation)

    Science.gov (United States)

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

    2016-03-01

    Surgical excision of tumor is a critical factor in the management of breast cancer. The most common surgical procedure is breast-conserving surgery. The surgeon's goal is to remove the tumor and a rim of healthy tissue surrounding the tumor: the surgical margin. A major issue in breast-conserving surgery is the absence of a reliable tool to guide the surgeon in intraoperatively assessing the margin. A number of techniques have been proposed; however, the re-excision rate remains high and has been reported to be in the range 30-60%. New tools are needed to address this issue. Optical coherence elastography (OCE) shows promise as a tool for intraoperative tumor margin assessment in breast-conserving surgery. Further advances towards clinical translation are limited by long scan times and small fields of view. In particular, scanning over sufficient areas to assess the entire margin in an intraoperative timeframe has not been shown to be feasible. Here, we present a protocol allowing ~75% of the surgical margins to be assessed within 30 minutes. To achieve this, we have incorporated a 65 mm-diameter (internal), wide-aperture annular piezoelectric transducer, allowing the entire surface of the excised tumor mass to be automatically imaged in an OCT mosaic comprised of 10 × 10 mm tiles. As OCT is effective in identifying adipose tissue, our protocol uses the wide-field OCT to selectively guide subsequent local OCE scanning to regions of solid tissue which often present low contrast in OCT images. We present promising examples from freshly excised human breast tissue.

  9. Lateral view dissection of the prostato-urethral junction to reduce positive apical margin in laparoscopic radical prostatectomy.

    Science.gov (United States)

    Sasaki, Hiroshi; Miki, Jun; Kimura, Takahiro; Sanuki, Kunitaro; Miki, Kenta; Takahashi, Hiroyuki; Egawa, Shin

    2009-08-01

    To assess the impact of lateral view apical dissection in laparoscopic radical prostatectomy (LRP) on the reduction of positive surgical margin rates and recovery of postoperative continence. One hundred and forty-four consecutive patients underwent LRP from October 2004 to March 2008. Lateral view dissection of the prostato-urethral junction was conducted in 76 of them (Group 2). Standard dissection was used in the remaining patients (Group 1). The effect of this technical modification on the reduction of positive surgical margin rates and postoperative recovery of urinary continence was assessed in the two groups. Overall, the incidence of positive margins decreased from 23 (35.9%) in Group 1 to 16 cases (21.9%) in Group 2 (P = 0.07). Positive margin rates in pT2 decreased from 30.6% to 6.5% (P = 0.006). Apical and dorso-apical margins were reduced from 26.5% to 4.3% (P = 0.009) and from 10.2% to 0% (P Lateral view dissection of the prostato-urethral junction is an easily applicable technical modification. It provides better visualization of apical anatomy substantially contributing to the reduction of positive surgical margin rates, especially at the level of prostatic apex.

  10. Marginal cost application in the power industry

    International Nuclear Information System (INIS)

    Twardy, L.; Rusak, H.

    1994-01-01

    Two kind of marginal costs, the short-run and the long-run, are defined. The former are applied in conditions when the load increase is not accompanied neither by the increase of the transmission capacity not the installed capacity while the latter assume new investments to expand the power system. The long-run marginal costs be used to forecast optimized development of the system. They contain two main components: the marginal costs of capacity and the marginal costs of energy. When the long-run marginal costs are calculated, each component is considered for particular voltage levels, seasons of the year, hours of the day - selected depending on the system reliability factor as well as on its load level. In the market economy countries the long-run marginal costs can be used for setting up the electric energy tariffs. (author). 7 refs, 11 figs

  11. Evolving issues in the prevention of surgical site infections.

    LENUS (Irish Health Repository)

    Quinn, A

    2009-06-01

    Surgical site infection is one of the more common causes of post-operative morbidity. Such infections contribute to prolonged recovery, delayed discharge and increasing costs to both patients and the health service. In the current climate increased emphasis is being placed on minimising the risks of acquiring or transmitting these nosocomial infections. This article reviews the current literature obtained from a Pubmed database search in relation to three specific aspects of surgical site infection: compliance with prophylactic antibiotics, post-discharge surveillance and novel methods for preventing surgical site infections. These topics represent areas where many institutions will find room for improvement in the prevention of surgical site infections. Tight adherence to prophylactic antibiotic guidelines, close followup of surgical wounds during and after hospital discharge, and attention to oxygenation status and the body temperature of patients may all prove to be useful adjuncts in significantly decreasing surgical site infections.

  12. Preoperative diffusion tensor imaging-fiber tracking for facial nerve identification in vestibular schwannoma: a systematic review on its evolution and current status with a pooled data analysis of surgical concordance rates.

    Science.gov (United States)

    Savardekar, Amey R; Patra, Devi P; Thakur, Jai D; Narayan, Vinayak; Mohammed, Nasser; Bollam, Papireddy; Nanda, Anil

    2018-03-01

    OBJECTIVE Total tumor excision with the preservation of neurological function and quality of life is the goal of modern-day vestibular schwannoma (VS) surgery. Postoperative facial nerve (FN) paralysis is a devastating complication of VS surgery. Determining the course of the FN in relation to a VS preoperatively is invaluable to the neurosurgeon and is likely to enhance surgical safety with respect to FN function. Diffusion tensor imaging-fiber tracking (DTI-FT) technology is slowly gaining traction as a viable tool for preoperative FN visualization in patients with VS. METHODS A systematic review of the literature in the PubMed, Cochrane Library, and Web of Science databases was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and those studies that preoperatively localized the FN in relation to a VS using the DTI-FT technique and verified those preoperative FN tracking results by using microscopic observation and electrophysiological monitoring during microsurgery were included. A pooled analysis of studies was performed to calculate the surgical concordance rate (accuracy) of DTI-FT technology for FN localization. RESULTS Fourteen studies included 234 VS patients (male/female ratio 1:1.4, age range 17-75 years) who had undergone preoperative DTI-FT for FN identification. The mean tumor size among the studies ranged from 29 to 41.3 mm. Preoperative DTI-FT could not visualize the FN tract in 8 patients (3.4%) and its findings could not be verified in 3 patients (1.2%), were verified but discordant in 18 patients (7.6%), and were verified and concordant in 205 patients (87.1%). CONCLUSIONS Preoperative DTI-FT for FN identification is a useful adjunct in the surgical planning for large VSs (> 2.5 cm). A pooled analysis showed that DTI-FT successfully identifies the complete FN course in 96.6% of VSs (226 of 234 cases) and that FN identification by DTI-FT is accurate in 90.6% of cases (205 of 226

  13. Surgical ethics: surgical virtue and more.

    Science.gov (United States)

    Vercler, Christian J

    2015-01-01

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

  14. Tectonic signatures on active margins

    Science.gov (United States)

    Hogarth, Leah Jolynn

    High-resolution Compressed High-Intensity Radar Pulse (CHIRP) surveys offshore of La Jolla in southern California and the Eel River in northern California provide the opportunity to investigate the role of tectonics in the formation of stratigraphic architecture and margin morphology. Both study sites are characterized by shore-parallel tectonic deformation, which is largely observed in the structure of the prominent angular unconformity interpreted as the transgressive surface. Based on stratal geometry and acoustic character, we identify three sedimentary sequences offshore of La Jolla: an acoustically laminated estuarine unit deposited during early transgression, an infilling or "healing-phase" unit formed during the transgression, and an upper transparent unit. The estuarine unit is confined to the canyon edges in what may have been embayments during the last sea-level rise. The healing-phase unit appears to infill rough areas on the transgressive surface that may be related to relict fault structures. The upper transparent unit is largely controlled by long-wavelength tectonic deformation due to the Rose Canyon Fault. This unit is also characterized by a mid-shelf (˜40 m water depth) thickness high, which is likely a result of hydrodynamic forces and sediment grain size. On the Eel margin, we observe three distinct facies: a seaward-thinning unit truncated by the transgressive surface, a healing-phase unit confined to the edges of a broad structural high, and a highly laminated upper unit. The seaward-thinning wedge of sediment below the transgressive surface is marked by a number of channels that we interpret as distributary channels based on their morphology. Regional divergence of the sequence boundary and transgressive surface with up to ˜8 m of sediment preserved across the interfluves suggests the formation of subaerial accommodation during the lowstand. The healing-phase, much like that in southern California, appears to infill rough areas in the

  15. Aspects of marginal expenditures in energy sector

    International Nuclear Information System (INIS)

    Stojchev, D.; Kynev, K.

    1994-01-01

    Technical and economical problems of marginal analysis methodology, its application procedure in energy sector and marginal expenditures determination are outlined. A comparative characteristics of the application is made for different periods of time. The differences in calculation of the marginal expenditures and prices are discussed. The operational costs, investments and inflation are analyzed. The mechanism of application of this approach in different planing horizon is outlined. The role of the change in the costs in time, the time unit, volume, the scope of application, etc. are determined. The areas of transition from one to other form of marginal expenditures are shown. 4 refs. (orig.)

  16. The marginal costs of greenhouse gas emissions

    International Nuclear Information System (INIS)

    Tol, R.S.J.

    1999-01-01

    Estimates of the marginal costs of greenhouse gas emissions are on important input to the decision how much society would want to spend on greenhouse gas emission reduction. Marginal cost estimates in the literature range between $5 and $25 per ton of carbon. Using similar assumptions, the FUND model finds marginal costs of $9--23/tC, depending on the discount rate. If the aggregation of impacts over countries accounts for inequalities in income distribution or for risk aversion, marginal costs would rise by about a factor of 3. Marginal costs per region are an order of magnitude smaller than global marginal costs. The ratios between the marginal costs of CO 2 and those of CH 4 and N 2 O are roughly equal to the global warming potentials of these gases. The uncertainty about the marginal costs is large and right-skewed. The expected value of the marginal costs lies about 35% above the best guess, the 95-percentile about 250%

  17. On the evaluation of marginal expected shortfall

    DEFF Research Database (Denmark)

    Caporin, Massimiliano; Santucci de Magistris, Paolo

    2012-01-01

    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...

  18. Assessment of seismic margin calculation methods

    International Nuclear Information System (INIS)

    Kennedy, R.P.; Murray, R.C.; Ravindra, M.K.; Reed, J.W.; Stevenson, J.D.

    1989-03-01

    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

  19. Regional Marginal Abatement Cost Curves for NOx

    Data.gov (United States)

    U.S. Environmental Protection Agency — Data underlying the figures included in the manuscript "Marginal abatement cost curve for NOx incorporating controls, renewable electricity, energy efficiency and...

  20. Manufacturing Marginality among Women and Latinos in Neoliberal America.

    Science.gov (United States)

    Massey, Douglas S

    2014-01-01

    Intersectionality is the study of how categorical distinctions made on the basis of race, class, and gender interact to generate inequality, and this concept has become a primary lens by which scholars have come to model social stratification in the United States. In addition to the historically powerful interaction between race and class, gender interactions have become increasingly powerful in exacerbating class inequalities while the growing exclusion of foreigners on the basis of legal status has progressively marginalized Latinos in U.S. society. As a result, poor whites and immigrant-origin Latinos have increasingly joined African Americans at the bottom of American society to form a new, expanded underclass.

  1. Marginal cost pricing of electricity

    International Nuclear Information System (INIS)

    Edsbaecker, G.

    1980-01-01

    The discipline is economics and the phenomenon is the power system. The purpose of this system is to produce, transmit and consume electricity in such a way that the sum of consumers and suppliers surplus in maximized. This is accomplished by the means of marginal cost pricing. The concepts of the power system and the relations prevailing between and among them are picked out, defined and analyzed in the frames of economic theory and operations research. Methods are developed aiming at efficient prices so that the short run function of the power system is managed in such a way that the sum of conumers and suppliers surplus is maximized within the framwork of this system, i.e. value of service of the power system is maximized. The task of developing such methods is accomplished subject to mixed production resources, transmission losses, periodic demand and also when there is lack of information concerning future and cost conditions. The main results are methods which take to account the conditions stated above. Methods not only allowing for traditional cost minimizing but also for maximation of value of service including a process of reaching optimum by gradual adaption when demand and cost curves are not known in advance. (author)

  2. Surgical site infections

    African Journals Online (AJOL)

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

  3. Surgical Critical Care Initiative

    Data.gov (United States)

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

  4. Ambulatory Surgical Measures - Facility

    Data.gov (United States)

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

  5. Surgical Management of Hemorrhoids

    Science.gov (United States)

    Agbo, S. P.

    2011-01-01

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

  6. Surgical site infections

    African Journals Online (AJOL)

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

  7. Surgical management of pain

    African Journals Online (AJOL)

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

  8. [Simulation in surgical training].

    Science.gov (United States)

    Nabavi, A; Schipper, J

    2017-01-01

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

  9. Categorical marginal models: quite extensive package for the estimation of marginal models for categorical data

    OpenAIRE

    Wicher Bergsma; Andries van der Ark

    2015-01-01

    A package accompanying the book Marginal Models for Dependent, Clustered, and Longitudinal Categorical Data by Bergsma, Croon, & Hagenaars, 2009. It’s purpose is fitting and testing of marginal models.

  10. Technical specification improvement through safety margin considerations

    International Nuclear Information System (INIS)

    Howard, R.C.; Jansen, R.L.

    1986-01-01

    Westinghouse has developed an approach for utilizing safety analysis margin considerations to improve plant operability through technical specification revision. This approach relies on the identification and use of parameter interrelations and sensitivities to identify acceptable operating envelopes. This paper summarizes technical specification activities to date and presents the use of safety margin considerations as another viable method to obtain technical specification improvement

  11. The homogeneous marginal utility of income assumption

    NARCIS (Netherlands)

    Demuynck, T.

    2015-01-01

    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

  12. Values and marginal preferences in international business

    NARCIS (Netherlands)

    Maseland, Robbert; van Hoorn, Andre

    2010-01-01

    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.

  13. Exactly marginal deformations from exceptional generalised geometry

    Energy Technology Data Exchange (ETDEWEB)

    Ashmore, Anthony [Merton College, University of Oxford,Merton Street, Oxford, OX1 4JD (United Kingdom); Mathematical Institute, University of Oxford,Andrew Wiles Building, Woodstock Road, Oxford, OX2 6GG (United Kingdom); Gabella, Maxime [Institute for Advanced Study,Einstein Drive, Princeton, NJ 08540 (United States); Graña, Mariana [Institut de Physique Théorique, CEA/Saclay,91191 Gif-sur-Yvette (France); Petrini, Michela [Sorbonne Université, UPMC Paris 05, UMR 7589, LPTHE,75005 Paris (France); Waldram, Daniel [Department of Physics, Imperial College London,Prince Consort Road, London, SW7 2AZ (United Kingdom)

    2017-01-27

    We apply exceptional generalised geometry to the study of exactly marginal deformations of N=1 SCFTs that are dual to generic AdS{sub 5} flux backgrounds in type IIB or eleven-dimensional supergravity. In the gauge theory, marginal deformations are parametrised by the space of chiral primary operators of conformal dimension three, while exactly marginal deformations correspond to quotienting this space by the complexified global symmetry group. We show how the supergravity analysis gives a geometric interpretation of the gauge theory results. The marginal deformations arise from deformations of generalised structures that solve moment maps for the generalised diffeomorphism group and have the correct charge under the generalised Reeb vector, generating the R-symmetry. If this is the only symmetry of the background, all marginal deformations are exactly marginal. If the background possesses extra isometries, there are obstructions that come from fixed points of the moment maps. The exactly marginal deformations are then given by a further quotient by these extra isometries. Our analysis holds for any N=2 AdS{sub 5} flux background. Focussing on the particular case of type IIB Sasaki-Einstein backgrounds we recover the result that marginal deformations correspond to perturbing the solution by three-form flux at first order. In various explicit examples, we show that our expression for the three-form flux matches those in the literature and the obstruction conditions match the one-loop beta functions of the dual SCFT.

  14. Steep microbial boundstone-dominated plaform margins

    NARCIS (Netherlands)

    Kenter, J.A.M.; Harris, P.M.; Della Porta, G.P.

    2005-01-01

    Seaward progradation of several kilometers has been documented mostly for leeward margin low-angle carbonate slope systems with a dominant platform top sediment source. However, steep and high-relief margins fronting deep basins can also prograde and as such are somewhat perplexing. Characteristics

  15. Pre-surgical register of tobacco consumption.

    Science.gov (United States)

    Gavilán, Eva; Moreno, Montse; Pérez, Àngels; Castellano, Yolanda; Fernández, Esteve; Martínez, Cristina

    2018-03-24

    Smoking cessation before surgery decreases the risk of complications. The aim of this study was to analyse the smoking register, associated variables and a short talk given to smokers in pre-surgical visits. Cross-sectional study. The pre-surgical records of 680 patients were assessed. We selected patient sociodemographic variables, surgical intervention characteristics, smoking status and consumption pattern. Logistic regression was used to study the variables association with smoking. A percentage of 97.2 of the pre-surgical records include information on tobacco consumption. Overall 20% of surgical patients are smokers. The probability of smoking is higher among men (adjusted odds ratio [aOR] 2.6, 95% confidence interval [CI] 1.7-4.0) and≤60 years (aOR 5.4, 95% CI 3.2-9.1). None of the records had information regarding a short talk given to patients to give up smoking. Smoking consumption was prevalent, but the characterisation of a smoker's profile and short talk given to patient before surgery was practically nonexistent. Ensuring that patients who smokes receives a short talk to give up smoking before surgery is necessary. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

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

    African Journals Online (AJOL)

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

  17. 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...... premium depends on demand pressure: If end-users are on the long side of the market, option returns decrease with margins, while they increase otherwise. Our results are statistically and economically significant and robust to different margin specifications and various control variables. We explain our...... findings by a model of funding-constrained derivatives dealers that require compensation for satisfying end-users’ option demand....

  18. 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...... premium depends on demand pressure: If end-users are on the long side of the market, option returns decrease with margins, while they increase otherwise. Our results are statistically and economically significant and robust to different margin specifications and various control variables. We explain our...... findings by a model of funding-constrained derivatives dealers that require compensation for satisfying end-users’ option demand....

  19. MARGINS: Toward a novel science plan

    Science.gov (United States)

    Mutter, John C.

    A science plan to study continental margins has been in the works for the past 3 years, with almost 200 Earth scientists from a wide variety of disciplines gathering at meetings and workshops. Most geological hazards and resources are found at continental margins, yet our understanding of the processes that shape the margins is meager.In formulating this MARGINS research initiative, fundamental issues concerning our understanding of basic Earth-forming processes have arisen. It is clear that a business-as-usual approach will not solve the class of problems defined by the MARGINS program; the solutions demand approaches different from those used in the past. In many cases, a different class of experiment will be required, one that is well beyond the capability of individual principle investigators to undertake on their own. In most cases, broadly based interdisciplinary studies will be needed.

  20. Fibroadenomas of the breast showing an ill-defined margin on ultrasonogram: Correlation with histopathologic findings

    International Nuclear Information System (INIS)

    Hwang, Ji Young; Choi, Hye Young; Shim, Sung Shine; Rhee, Chung Sik; Sung, Soon Hee

    2002-01-01

    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.

  1. 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)

    2002-12-15

    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.

  2. Lumbar posterior marginal intra-osseous cartilaginous node

    Energy Technology Data Exchange (ETDEWEB)

    Laredo, J.D.; Bard, M.; Chretien, J.; Kahn, M.F.

    1986-03-01

    This report concerns 12 patients, eight young adults and four adolescents, presenting with lumbar or sciatic pain. This was associated with an unusual defect of the inferior and posterior edges of the vertebral bodies of L4 or L5, together with a small bony ridge protruding into the spinal canal. We found 11 similar cases in the literature, all involving adolescents except for one young adult. It has been considered to be the result of a fracture of the posterior ring apophysis in association with a herniated disc. In our cases, in the absence of any known previous trauma, the radiological features and surgical results and the similarity and frequent association with typical lesions of Scheuermann disease, all suggest a posterior marginal cartilaginous node. The inferior lumbar location and frequent association with herniated disc and sciatic nerve root compression in young patients are discussed.

  3. Lumbar posterior marginal intra-osseous cartilaginous node

    International Nuclear Information System (INIS)

    Laredo, J.D.; Bard, M.; Chretien, J.; Kahn, M.F.

    1986-01-01

    This report concerns 12 patients, eight young adults and four adolescents, presenting with lumbar or sciatic pain. This was associated with an unusual defect of the inferior and posterior edges of the vertebral bodies of L4 or L5, together with a small bony ridge protruding into the spinal canal. We found 11 similar cases in the literature, all involving adolescents except for one young adult. It has been considered to be the result of a fracture of the posterior ring apophysis in association with a herniated disc. In our cases, in the absence of any known previous trauma, the radiological features and surgical results and the similarity and frequent association with typical lesions of Scheuermann disease, all suggest a posterior marginal cartilaginous node. The inferior lumbar location and frequent association with herniated disc and sciatic nerve root compression in young patients are discussed. (orig.)

  4. 3D Surgical Simulation

    Science.gov (United States)

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

    2009-01-01

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

  5. Anxiety in veterinary surgical students

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  6. Effect of Margin Designs on the Marginal Adaptation of Zirconia Copings.

    Science.gov (United States)

    Habib, Syed Rashid; Al Ajmi, Mohammed Ginan; Al Dhafyan, Mohammed; Jomah, Abdulrehman; Abualsaud, Haytham; Almashali, Mazen

    2017-09-01

    The aim of this in vitro study was to investigate the effect of Shoulder versus Chamfer margin design on the marginal adaptation of zirconia (Zr) copings. 40 extracted molar teeth were mounted in resin and prepared for zirconia crowns with two margin preparation designs (20=Shoulder and 20=Chamfer). The copings were manufactured by Cercon® (DeguDent GmbH, Germany) using the CAD/CAM system for each tooth. They were tried on each tooth, cemented, thermocycled, re-embedded in resin and were subsequently cross sectioned centrally into two equal mesial and distal halves. They were examined under electron microscope at 200 X magnification and the measurements were recorded at 5 predetermined points in micrometers (µm). The o verall mean marginal gap for the two groups was found to be 206.98+42.78µm with Shoulder margin design (Marginal Gap=199.50+40.72µm) having better adaptation compared to Chamfer (Marginal Gap=214.46+44.85µm). The independent-samples t-test showed a statistically non-significant difference (p=.113) between the means of marginal gap for Shoulder and Chamfer margin designs and the measurements were recorded at 5 predetermined points for the two groups. The Chamfer margin design appeared to offer the same adaptation results as the Shoulder margin design.

  7. Marginal and happy? The need for uniqueness predicts the adjustment of marginal immigrants.

    Science.gov (United States)

    Debrosse, Régine; de la Sablonnière, Roxane; Rossignac-Milon, Maya

    2015-12-01

    Marginalization is often presented as the strategy associated with the worst adjustment for immigrants. This study identifies a critical variable that buffers marginal immigrants from the negative effects of marginalization on adjustment: The need for uniqueness. In three studies, we surveyed immigrants recruited on university campuses (n = 119, n = 116) and in the field (n = 61). Among marginal immigrants, a higher need for uniqueness predicted higher self-esteem (Study 1), affect (Study 2), and life satisfaction (Study 3), and marginally higher happiness (Study 2) and self-esteem (Study 3). No relationship between the need for uniqueness and adjustment was found among non-marginal immigrants. The adaptive value of the need for uniqueness for marginal immigrants is discussed. © 2015 The British Psychological Society.

  8. The Margins as "Third Space": EAP Teacher Professionalism in Canadian Universities

    Science.gov (United States)

    MacDonald, Jennifer

    2016-01-01

    Teachers of English for Academic Purposes (EAP) in the Canadian university setting often experience professional marginalization in terms of lack of status, clarity of mandate, or administrative home within their institutions. Despite having broadly benefited the ESL/EAL sector in Canada, traditional trait-focused professionalization efforts have…

  9. Surgical Site Infection Following Fixation of Acetabular Fractures.

    Science.gov (United States)

    Iqbal, Faizan; Younus, Sajid; Asmatullah; Zia, Osama Bin; Khan, Naveed

    2017-09-01

    Acetabular fractures are mainly caused by high energy trauma. Surgical fixation of these fractures requires extensive surgical exposure which increases the length of operation and blood loss as well. This may increase the risk of surgical site infection. Our aim is to evaluate the prevalence of surgical site infections and the risk factors associated with it so as to minimize its chances. A total of 261 patients who underwent acetabular fracture surgery were retrospectively reviewed. Patients were divided into 2 groups, with or without surgical site infection. Factors examined include patients' gender, age, body mass index (BMI), time between injury and surgery, operative time, estimated blood loss, number of packed red blood cell transfused, length of total intensive care unit (ICU) stay, fracture type, surgical approach, smoking status, patients' comorbids and associated injuries. Fourteen patients (5.4%) developed surgical site infection. Out of 14 infections, 4 were superficial and 10 were deep. The factors that were found to be associated with surgical site infection following acetabular fracture fixation were prolonged operation time, increased BMI, prolonged ICU stay, larger amount of packed red blood cell transfused and associated genitourinary and abdominal trauma. In our study, we conclude that measures should be undertaken to attenuate the chances of surgical site infection in this major surgery by considering the risk factors significantly associated with it.

  10. SURGICAL SITE INFECTION: REVIEW

    Directory of Open Access Journals (Sweden)

    P. H. M. Bonai

    2016-07-01

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

  11. Impact of Millimeter-Level Margins on Peripheral Normal Brain Sparing for Gamma Knife Radiosurgery

    International Nuclear Information System (INIS)

    Ma, Lijun; Sahgal, Arjun; Larson, David A.; Pinnaduwage, Dilini; Fogh, Shannon; Barani, Igor; Nakamura, Jean; McDermott, Michael; Sneed, Penny

    2014-01-01

    Purpose: To investigate how millimeter-level margins beyond the gross tumor volume (GTV) impact peripheral normal brain tissue sparing for Gamma Knife radiosurgery. Methods and Materials: A mathematical formula was derived to predict the peripheral isodose volume, such as the 12-Gy isodose volume, with increasing margins by millimeters. The empirical parameters of the formula were derived from a cohort of brain tumor and surgical tumor resection cavity cases (n=15) treated with the Gamma Knife Perfexion. This was done by first adding margins from 0.5 to 3.0 mm to each individual target and then creating for each expanded target a series of treatment plans of nearly identical quality as the original plan. Finally, the formula was integrated with a published logistic regression model to estimate the treatment-induced complication rate for stereotactic radiosurgery when millimeter-level margins are added. Results: Confirmatory correlation between the nominal target radius (ie, R T ) and commonly used maximum target size was found for the studied cases, except for a few outliers. The peripheral isodose volume such as the 12-Gy volume was found to increase exponentially with increasing Δ/R T , where Δ is the margin size. Such a curve fitted the data (logarithmic regression, R 2 >0.99), and the 12-Gy isodose volume was shown to increase steeply with a 0.5- to 3.0-mm margin applied to a target. For example, a 2-mm margin on average resulted in an increase of 55% ± 16% in the 12-Gy volume; this corresponded to an increase in the symptomatic necrosis rate of 6% to 25%, depending on the Δ/R T values for the target. Conclusions: Millimeter-level margins beyond the GTV significantly impact peripheral normal brain sparing and should be applied with caution. Our model provides a rapid estimate of such an effect, particularly for large and/or irregularly shaped targets

  12. Retained surgical sponge

    International Nuclear Information System (INIS)

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

    1993-01-01

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

  13. Recommendations for CTV margins in radiotherapy planning for non melanoma skin cancer.

    Science.gov (United States)

    Khan, Luluel; Choo, Richard; Breen, Dale; Assaad, Dalal; Fialkov, Jefferey; Antonyshyn, Oleh; McKenzie, David; Woo, Tony; Zhang, Liying; Barnes, Elizabeth

    2012-08-01

    To provide practice guidelines for delineating clinical target volume (CTV) for radiotherapy planning of non melanoma (NMSC) skin cancers. A prospective, single arm, study. Preoperatively, a radiation oncologist outlined the boundary of a gross lesion, and drew 5-mm incremental marks in four directions from the delineated border. Under local anesthesia, the lesion was excised, and resection margins were assessed microscopically by frozen section. Once resection margins were clear, the microscopic tumor extent was calculated using the presurgical incremental markings as references. A potential relationship between the distance of microscopic tumor extension and other variables was analyzed. A total of 159 lesions in 150 consecutive patients, selected for surgical excision with frozen section assisted assessment of resection margins, were accrued. The distance of microscopic tumor extension beyond a gross lesion varied from 1mm to 15 mm, with a mean of 5.3mm. The microscopic tumor extent was positively correlated with the size of gross lesion, histology and number of surgical attempts required to obtain a clear margin. To provide a 95% or greater chance of covering microscopic disease we make the following recommendations for CTV margins; 10mm for BCC less than 2 cm, 13 mm for BCC greater than 2 cm, 11 mm for SCC less than 2 cm, and 14 mm for SCC greater than 2 cm. Tumors greater than 2 cm and SCC histology required larger margins to adequately cover the microscopic extent of disease. This information is crucial in radiation planning of NMSC. Clinicians should be cautioned, as these guidelines may not offer optimum treatment for patients with extremely large or small lesions. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  14. Recommendations for CTV margins in radiotherapy planning for non melanoma skin cancer

    International Nuclear Information System (INIS)

    Khan, Luluel; Choo, Richard; Breen, Dale; Assaad, Dalal; Fialkov, Jefferey; Antonyshyn, Oleh; McKenzie, David; Woo, Tony; Zhang Liying; Barnes, Elizabeth

    2012-01-01

    Purpose: To provide practice guidelines for delineating clinical target volume (CTV) for radiotherapy planning of non melanoma (NMSC) skin cancers. Methods and materials: A prospective, single arm, study. Preoperatively, a radiation oncologist outlined the boundary of a gross lesion, and drew 5-mm incremental marks in four directions from the delineated border. Under local anesthesia, the lesion was excised, and resection margins were assessed microscopically by frozen section. Once resection margins were clear, the microscopic tumor extent was calculated using the presurgical incremental markings as references. A potential relationship between the distance of microscopic tumor extension and other variables was analyzed. Results: A total of 159 lesions in 150 consecutive patients, selected for surgical excision with frozen section assisted assessment of resection margins, were accrued. The distance of microscopic tumor extension beyond a gross lesion varied from 1 mm to 15 mm, with a mean of 5.3 mm. The microscopic tumor extent was positively correlated with the size of gross lesion, histology and number of surgical attempts required to obtain a clear margin. To provide a 95% or greater chance of covering microscopic disease we make the following recommendations for CTV margins; 10 mm for BCC less than 2 cm, 13 mm for BCC greater than 2 cm, 11 mm for SCC less than 2 cm, and 14 mm for SCC greater than 2 cm. Conclusions: Tumors greater than 2 cm and SCC histology required larger margins to adequately cover the microscopic extent of disease. This information is crucial in radiation planning of NMSC. Clinicians should be cautioned, as these guidelines may not offer optimum treatment for patients with extremely large or small lesions.

  15. Updates in Refractory Status Epilepticus

    Science.gov (United States)

    Mahulikar, Advait; Suchdev, Kushak; Shah, Aashit

    2018-01-01

    Refractory status epilepticus is defined as persistent seizures despite appropriate use of two intravenous medications, one of which is a benzodiazepine. It can be seen in up to 40% of cases of status epilepticus with an acute symptomatic etiology as the most likely cause. New-onset refractory status epilepticus (NORSE) is a recently coined term for refractory status epilepticus where no apparent cause is found after initial testing. A large proportion of NORSE cases are eventually found to have an autoimmune etiology needing immunomodulatory treatment. Management of refractory status epilepticus involves treatment of an underlying etiology in addition to intravenous anesthetics and antiepileptic drugs. Alternative treatment options including diet therapies, electroconvulsive therapy, and surgical resection in case of a focal lesion should be considered. Short-term and long-term outcomes tend to be poor with significant morbidity and mortality with only one-third of patients reaching baseline neurological status. PMID:29854452

  16. Positive Margins by Oropharyngeal Subsite in Transoral Robotic Surgery for T1/T2 Squamous Cell Carcinoma.

    Science.gov (United States)

    Persky, Michael J; Albergotti, William G; Rath, Tanya J; Kubik, Mark W; Abberbock, Shira; Geltzeiler, Mathew; Kim, Seungwon; Duvvuri, Umamaheswar; Ferris, Robert L

    2018-04-01

    Objective To compare positive margin rates between the 2 most common subsites of oropharyngeal transoral robotic surgery (TORS), the base of tongue (BOT) and the tonsil, as well as identify preoperative imaging characteristics that predispose toward positive margins. Study Design Case series with chart review. Setting Tertiary care referral center. Subjects and Methods We compared the final and intraoperative positive margin rate between TORS resections for tonsil and BOT oropharyngeal squamous cell carcinoma (OPSCC), as well as the effect of margins on treatment. A blinded neuroradiologist examined the preoperative imaging of BOT tumors to measure their dimensions and patterns of spread and provided a prediction of final margin results. Results Between January 2010 and May 2016, a total of 254 patients underwent TORS for OPSCC. A total of 140 patients who underwent TORS for T1/T2 OPSCC met inclusion criteria. A final positive margin is significantly more likely for BOT tumors than tonsil tumors (19.6% vs 4.5%, respectively, P = .004) and likewise for intraoperative margins of BOT and tonsil tumors (35.3% vs 12.4%, respectively; P = .002). A positive final margin is 10 times more likely to receive chemoradiation compared to a negative margin, controlling for extracapsular spread and nodal status (odds ratio, 9.6; 95% confidence interval, 1.6-59.6; P = .02). Preoperative imaging characteristics and subjective radiologic examination of BOT tumors did not correlate with final margin status. Conclusion Positive margins are significantly more likely during TORS BOT resections compared to tonsil resections. More research is needed to help surgeons predict which T1/T2 tumors will be difficult to completely extirpate.

  17. Spectrum estimation method based on marginal spectrum

    International Nuclear Information System (INIS)

    Cai Jianhua; Hu Weiwen; Wang Xianchun

    2011-01-01

    FFT method can not meet the basic requirements of power spectrum for non-stationary signal and short signal. A new spectrum estimation method based on marginal spectrum from Hilbert-Huang transform (HHT) was proposed. The procession of obtaining marginal spectrum in HHT method was given and the linear property of marginal spectrum was demonstrated. Compared with the FFT method, the physical meaning and the frequency resolution of marginal spectrum were further analyzed. Then the Hilbert spectrum estimation algorithm was discussed in detail, and the simulation results were given at last. The theory and simulation shows that under the condition of short data signal and non-stationary signal, the frequency resolution and estimation precision of HHT method is better than that of FFT method. (authors)

  18. Methylation patterns in marginal zone lymphoma.

    Science.gov (United States)

    Arribas, Alberto J; Bertoni, Francesco

    Promoter DNA methylation is a major regulator of gene expression and transcription. The identification of methylation changes is important for understanding disease pathogenesis, for identifying prognostic markers and can drive novel therapeutic approaches. In this review we summarize the current knowledge regarding DNA methylation in MALT lymphoma, splenic marginal zone lymphoma, nodal marginal zone lymphoma. Despite important differences in the study design for different publications and the existence of a sole large and genome-wide methylation study for splenic marginal zone lymphoma, it is clear that DNA methylation plays an important role in marginal zone lymphomas, in which it contributes to the inactivation of tumor suppressors but also to the expression of genes sustaining tumor cell survival and proliferation. Existing preclinical data provide the rationale to target the methylation machinery in these disorders. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Pathology of nodal marginal zone lymphomas.

    Science.gov (United States)

    Pileri, Stefano; Ponzoni, Maurilio

    Nodal marginal zone B cell lymphomas (NMZLs) are a rare group of lymphoid disorders part of the spectrum of marginal zone B-cell lymphomas, which encompass splenic marginal one B-cell lymphoma (SMZL) and extra nodal marginal zone of B-cell lymphoma (EMZL), often of MALT-type. Two clinicopathological forms of NMZL are recognized: adult-type and pediatric-type, respectively. NMZLs show overlapping features with other types of MZ, but distinctive features as well. In this review, we will focus on the salient distinguishing features of NMZL mostly under morphological/immunophenotypical/molecular perspectives in views of the recent acquisitions and forthcoming updated 2016 WHO classification of lymphoid malignancies. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Policy Implementation, Role Conflict and Marginalization

    African Journals Online (AJOL)

    Prince Acheampong

    governance, their role has been politically, administratively, and financially ... of marginalization of the Traditional Systems in terms of legal, financial and ..... the President as the Chief Executive Officer of the district is another controlling factor.

  1. Limitations of ''margin'' in qualification tests

    International Nuclear Information System (INIS)

    Clough, R.L.; Gillen, K.T.

    1984-01-01

    We have carried out investigations of polymer radiation degradation behaviors which have brought to light a number of reasons why this concept of margin can break down. First of all, we have found that dose-rate effects vary greatly in magnitude. Thus, based on high dose-rate testing, poor materials with large dose-rate effects may be selected over better materials with small effects. Also, in certain cases, material properties have been found to level out (as with PVC) or reverse trend (as with buna-n) at high doses, so that ''margin'' may be ineffective, misleading, or counterproductive. For Viton, the material properties were found to change in opposite directions at high and low dose rates, making ''margin'' inappropriate. The underlying problem with the concept of ''margin'' is that differences in aging conditions can lead to fundamental differences in degradation mechanisms

  2. Mental Depreciation and Marginal Decision Making

    Science.gov (United States)

    Heath; Fennema

    1996-11-01

    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.

  3. Surgical infections with Mycoplasma

    DEFF Research Database (Denmark)

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

    1997-01-01

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

  4. Surgical manifestations of filariasis

    Directory of Open Access Journals (Sweden)

    Subrahmanyam M

    1978-01-01

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

  5. Improving surgical weekend handover.

    Science.gov (United States)

    Culwick, Caroline; Devine, Chris; Coombs, Catherine

    2014-01-01

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

  6. [Surgical complications of colostomies].

    Science.gov (United States)

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

    2014-07-01

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

  7. Application of geoinformation techniques in sustainable development of marginal rural

    Science.gov (United States)

    Leszczynska, G.

    2009-04-01

    The basic objective of the studies is to create a geographic information system that would assure integration of activities aimed at protecting biological diversity with sustainable development of marginal rural areas through defining the conditions for development of tourism and recreation in the identified areas. The choice of that solution is a consequence of the fact that numerous phenomena and processes presented in maps are linked to functional relations or they can be viewed as functions of space, time and attributes. The paper presents the system development stage aimed at elaborating the template for the system serving solution of the above-presented problem. In case of this issue the geographic information system will be developed to support development of marginal rural areas through selection of appropriate forms of tourism for the endangered areas including indication of locations for development of appropriate tourist infrastructure. Selection of the appropriate form of tourism will depend on natural, tourist and infrastructure values present in a given area and conditioned by the need to present the biodiversity component present in those areas together with elements of traditional agricultural landscape. The most important problem is to reconcile two seemingly contradictory aims: 1. Preventing social and economic marginalization of the restructured rural areas. 2. Preserving biological diversity in the restructured areas.Agriculture influences many aspects of the natural environment such as water resources, biodiversity and status of natural habitats, status of soils, landscape and, in a wider context, the climate. Project implementation will involve application of technologies allowing analysis of the systems for managing marginal rural areas as spatial models based on geographic information systems. Modelling of marginal rural areas management using the GIS technologies will involve creating spatial models of actual objects. On the basis of data

  8. Marketing margins and agricultural technology in Mozambique

    DEFF Research Database (Denmark)

    Arndt, Channing; Jensen, Henning Tarp; Robinson, Sherman

    2000-01-01

    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......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...

  9. Time Safety Margin: Theory and Practice

    Science.gov (United States)

    2016-09-01

    Air Education and Training Command Handbook 99-107, T-38 Road to Wings, Randolph Air Force Base, Texas, July 2013. 65 This page was intentionally left...412TW-TIH-16-01 TIME SAFETY MARGIN: THEORY AND PRACTICE WILLIAM R. GRAY, III Chief Test Pilot USAF Test Pilot School SEPTEMBER 2016... Safety Margin: The01y and Practice) was submitted by the Commander, 4 I 2th Test Wing, Edwards AFB, Ca lifornia 93524-6843. Foreign announcement and

  10. In silico particle margination in blood flow

    OpenAIRE

    Müller, Kathrin

    2015-01-01

    A profound knowledge of margination, the migration of blood components to the vessel wall in blood flow, is required in order to understand the genesis of various diseases, as e.g., cardiovascular diseases or bleeding disorders. Margination of particles is a pre-condition for potential adhesion. Adhesion to the vessel wall is required for platelets, the protein von Willebrand factor (VWF), but also for drug and imaging agent carriers in order to perform their particular tasks. In the haemosta...

  11. Professional Commitment and Professional Marginalism in Teachers

    Directory of Open Access Journals (Sweden)

    Kalashnikov A.I.

    2017-11-01

    Full Text Available The article reviews teachers' attitudes towards the teaching profession which can be expressed both in professional commitment and in professional marginalism. The dominance of professional marginalism could affect destructively the students as well as the teacher’s personality, hence the issues related to the content of personal position of a marginal and the rate of marginalism among teachers. It was suggested that marginalism could be revealed in the study of professional commitment. The study involved 81 teachers of Sverdlovsk secondary schools aged 21—60 years with work experience ranging from 1 month to 39 years. The Professional Commitment Questionnaire was used as the study technique. The results showed that negative emotional attitude towards the profession and reluctance to leave the profession were grouped as a separate factor. The dispersion factor was 12,5%. The factor loadings ranged from 0.42 to 0.84. The study proved that professional marginalism in teachers includes dissatisfaction with work, feelings of resentment against profession and an unwillingness to leave the profession.

  12. NRC Seismic Design Margins Program Plan

    International Nuclear Information System (INIS)

    Cummings, G.E.; Johnson, J.J.; Budnitz, R.J.

    1985-08-01

    Recent studies estimate that seismically induced core melt comes mainly from earthquakes in the peak ground acceleration range from 2 to 4 times the safe shutdown earthquake (SSE) acceleration used in plant design. However, from the licensing perspective of the US Nuclear Regulatory Commission, there is a continuing need for consideration of the inherent quantitative seismic margins because of, among other things, the changing perceptions of the seismic hazard. This paper discusses a Seismic Design Margins Program Plan, developed under the auspices of the US NRC, that provides the technical basis for assessing the significance of design margins in terms of overall plant safety. The Plan will also identify potential weaknesses that might have to be addressed, and will recommend technical methods for assessing margins at existing plants. For the purposes of this program, a general definition of seismic design margin is expressed in terms of how much larger that the design basis earthquake an earthquake must be to compromise plant safety. In this context, margin needs to be determined at the plant, system/function, structure, and component levels. 14 refs., 1 fig

  13. A quantitative analysis of transtensional margin width

    Science.gov (United States)

    Jeanniot, Ludovic; Buiter, Susanne J. H.

    2018-06-01

    Continental rifted margins show variations between a few hundred to almost a thousand kilometres in their conjugated widths from the relatively undisturbed continent to the oceanic crust. Analogue and numerical modelling results suggest that the conjugated width of rifted margins may have a relationship to their obliquity of divergence, with narrower margins occurring for higher obliquity. We here test this prediction by analysing the obliquity and rift width for 26 segments of transtensional conjugate rifted margins in the Atlantic and Indian Oceans. We use the plate reconstruction software GPlates (http://www.gplates.org) for different plate rotation models to estimate the direction and magnitude of rifting from the initial phases of continental rifting until breakup. Our rift width corresponds to the distance between the onshore maximum topography and the last identified continental crust. We find a weak positive correlation between the obliquity of rifting and rift width. Highly oblique margins are narrower than orthogonal margins, as expected from analogue and numerical models. We find no relationships between rift obliquities and rift duration nor the presence or absence of Large Igneous Provinces (LIPs).

  14. [da Vinci surgical system].

    Science.gov (United States)

    Watanabe, Gou; Ishikawa, Norihiro

    2014-07-01

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

  15. Adjuvant Radiation Therapy Improves Local Control After Surgical Resection in Patients With Localized Adrenocortical Carcinoma

    International Nuclear Information System (INIS)

    Sabolch, Aaron; Else, Tobias; Griffith, Kent A.; Ben-Josef, Edgar; Williams, Andrew; Miller, Barbra S.; Worden, Francis; Hammer, Gary D.; Jolly, Shruti

    2015-01-01

    Purpose: Adrenocortical carcinoma (ACC) is a rare malignancy known for high rates of local recurrence, though the benefit of postoperative radiation therapy (RT) has not been established. In this study of grossly resected ACC, we compare local control of patients treated with surgery followed by adjuvant RT to a matched cohort treated with surgery alone. Methods and Materials: We retrospectively identified patients with localized disease who underwent R0 or R1 resection followed by adjuvant RT. Only patients treated with RT at our institution were included. Matching to surgical controls was on the basis of stage, surgical margin status, tumor grade, and adjuvant mitotane. Results: From 1991 to 2011, 360 ACC patients were evaluated for ACC at the University of Michigan (Ann Arbor, MI). Twenty patients with localized disease received postoperative adjuvant RT. These were matched to 20 controls. There were no statistically significant differences between the groups with regard to stage, margins, grade, or mitotane. Median RT dose was 55 Gy (range, 45-60 Gy). Median follow-up was 34 months. Local recurrence occurred in 1 patient treated with RT, compared with 12 patients not treated with RT (P=.0005; hazard ratio [HR] 12.59; 95% confidence interval [CI] 1.62-97.88). However, recurrence-free survival was no different between the groups (P=.17; HR 1.52; 95% CI 0.67-3.45). Overall survival was also not significantly different (P=.13; HR 1.97; 95% CI 0.57-6.77), with 4 deaths in the RT group compared with 9 in the control group. Conclusions: Postoperative RT significantly improved local control compared with the use of surgery alone in this case-matched cohort analysis of grossly resected ACC patients. Although this retrospective series represents the largest study to date on adjuvant RT for ACC, its findings need to be prospectively confirmed

  16. Adjuvant Radiation Therapy Improves Local Control After Surgical Resection in Patients With Localized Adrenocortical Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Sabolch, Aaron [Department of Radiation Oncology, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Else, Tobias [Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Griffith, Kent A. [Center for Cancer Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mchigan (United States); Ben-Josef, Edgar [Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Williams, Andrew [University of Michigan Medical School, Ann Arbor, Mchigan (United States); Miller, Barbra S. [Division of Endocrine Surgery, Department of General Surgery, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Worden, Francis [Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Hammer, Gary D. [Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Jolly, Shruti, E-mail: shrutij@med.umich.edu [Department of Radiation Oncology, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States)

    2015-06-01

    Purpose: Adrenocortical carcinoma (ACC) is a rare malignancy known for high rates of local recurrence, though the benefit of postoperative radiation therapy (RT) has not been established. In this study of grossly resected ACC, we compare local control of patients treated with surgery followed by adjuvant RT to a matched cohort treated with surgery alone. Methods and Materials: We retrospectively identified patients with localized disease who underwent R0 or R1 resection followed by adjuvant RT. Only patients treated with RT at our institution were included. Matching to surgical controls was on the basis of stage, surgical margin status, tumor grade, and adjuvant mitotane. Results: From 1991 to 2011, 360 ACC patients were evaluated for ACC at the University of Michigan (Ann Arbor, MI). Twenty patients with localized disease received postoperative adjuvant RT. These were matched to 20 controls. There were no statistically significant differences between the groups with regard to stage, margins, grade, or mitotane. Median RT dose was 55 Gy (range, 45-60 Gy). Median follow-up was 34 months. Local recurrence occurred in 1 patient treated with RT, compared with 12 patients not treated with RT (P=.0005; hazard ratio [HR] 12.59; 95% confidence interval [CI] 1.62-97.88). However, recurrence-free survival was no different between the groups (P=.17; HR 1.52; 95% CI 0.67-3.45). Overall survival was also not significantly different (P=.13; HR 1.97; 95% CI 0.57-6.77), with 4 deaths in the RT group compared with 9 in the control group. Conclusions: Postoperative RT significantly improved local control compared with the use of surgery alone in this case-matched cohort analysis of grossly resected ACC patients. Although this retrospective series represents the largest study to date on adjuvant RT for ACC, its findings need to be prospectively confirmed.

  17. Relationship between occurrence of surgical complications and hospital finances.

    Science.gov (United States)

    Eappen, Sunil; Lane, Bennett H; Rosenberg, Barry; Lipsitz, Stuart A; Sadoff, David; Matheson, Dave; Berry, William R; Lester, Mark; Gawande, Atul A

    2013-04-17

    The effect of surgical complications on hospital finances is unclear. To determine the relationship between major surgical complications and per-encounter hospital costs and revenues by payer type. Retrospective analysis of administrative data for all inpatient surgical discharges during 2010 from a nonprofit 12-hospital system in the southern United States. Discharges were categorized by principal procedure and occurrence of 1 or more postsurgical complications, using International Classification of Diseases, Ninth Revision, diagnosis and procedure codes. Nine common surgical procedures and 10 major complications across 4 payer types were analyzed. Hospital costs and revenue at discharge were obtained from hospital accounting systems and classified by payer type. Hospital costs, revenues, and contribution margin (defined as revenue minus variable expenses) were compared for patients with and without surgical complications according to payer type. Of 34,256 surgical discharges, 1820 patients (5.3%; 95% CI, 4.4%-6.4%) experienced 1 or more postsurgical complications. Compared with absence of complications, complications were associated with a $39,017 (95% CI, $20,069-$50,394; P financial consequences for decreasing postsurgical complications.

  18. Using laser irradiation for the surgical treatment of periodontal disease

    Science.gov (United States)

    Vieru, Rozana D.; Lefter, Agafita; Herman, Sonia

    2002-10-01

    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.

  19. Victimization of old people as members of a special marginal group

    Directory of Open Access Journals (Sweden)

    Kostić Miomira P.

    2004-01-01

    Full Text Available In this paper the authors explain the role of the old in status systems both in modern societies and throughout history. The authors point out the role of the ageing process in defining the marginal status of old people and their risks to become victims of abuse. Because of their biological and psychological characteristics and their social status, the old are vulnerable to various forms of abuse: physical, psychological and sexual violence, negligence, and self-negligence, abandonment and economic exploitation. The case study has been done in cooperation with the expert team of Gerontology center of the town Niš.

  20. [Economic development and married women's employment in Taiwan: a study of female marginalization].

    Science.gov (United States)

    Lu, Y

    1994-07-01

    As in other developing countries, the industrial development in Taiwan seems to marginalize female workers. This study tries to examine the trend of women's employment status, using both macro- and micro-level data. The statistics suggest that female employment had significantly declined during the early stages of industrialization. Although rapid economic development has expanded women's job opportunities, most women are concentrated in lower-status jobs and the informal sector. Informal employment is especially prevalent among married women. In the micro-level analysis the study examines the factors that led to the marginalization of women's labor force. The empirical analysis applies a multinomial logistic model to a 1980 KAP (knowledge, attitude, and practice) survey sample of 3859 married women. The results suggest that married women's work patterns in terms of formal vs. informal employment are determined by the family organization rather than by labor market conditions. Wives from families with small businesses are more likely to be involved in informal employment. Wives also tend to work informally when they have young children. On the other hand, the effects of labor market conditions are mediated by the types of family economy. Therefore the women's informal employment in Taiwan, as a characteristic of female marginalization, is the result of the sexual division of labor in the family organization and the prevalence of the family business, rather than that of being excluded into the marginal forms of employment through the process of capitalistic production, as argued by the female marginalization theorists.

  1. Primary cutaneous marginal zone B-cell lymphoma: clinical and histological aspects.

    Science.gov (United States)

    Khaled, A; Sassi, S; Fazaa, B; Ben Hassouna, J; Ben Romdhane, K; Kamoun, M R

    2009-02-01

    According to the WHO-EORTC classification of cutaneous lymphomas, primary cutaneous marginal zone B-cell lymphoma are now well characterized. We report here a case of primary cutaneous marginal zone B-cell lymphoma in a 51 year-old man in which the diagnosis was made using both histology and immunopathology. The patient had no remarkable medical history, no history of either acute inflammation or insect bite, and presented with a 5 cm solitary asymptomatic erythematous firm, multinodular and infiltrated plaque on the back for 12 months. Histological examination and immunohistochemical study of a cutaneous biopsy provided a differential diagnosis between B cell lymphoma and lymphocytoma cutis. Full body work up revealed no signs of extracutaneous dissemination. The patient underwent surgical excision of the nodule. Histological examination showed a histological and immunophenotyping profile typical of primary cutaneous marginal zone B-cell lymphoma. The lesion was completely excised with clear margins and no recurrence occurred after a 12 month-follow-up period. Primary cutaneous marginal zone B-cell lymphoma are low-grade lymphomas that have an indolent course and a high tendency to recur. They should be differentiated from lymphocytoma cutis and from the other types of cutaneous B cell lymphomas that have a different course and prognosis.

  2. Supply versus demand: a review of application trends to Canadian surgical training programs.

    Science.gov (United States)

    Austin, Ryan E; Wanzel, Kyle R

    2015-04-01

    Despite increases in medical school enrolment, applications to surgical residency programs in Canada have been in decline over the past decade, with an increasing number of unmatched surgical residency positions. We examined the current status of surgical residency in Canada and analyzed application trends (2002–2013) for surgical training programs across Canada. Our findings suggest that most undergraduate medical schools across Canada are having difficulty fostering interest in surgical careers. We propose that a lack of adequate early exposure to the surgical specialties during undergraduate training is a critical factor. Moving forward, we must examine how the best-performing institutions and surgical programs have maintained interest in pursuing surgical careers and adapt our recruitment methods to both maintain and grow future interest. As Mary Engelbreit said, "If you don't like something, change it; if you can't change it, change the way you think about it."

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

    African Journals Online (AJOL)

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

  4. Efficacy of Surgical Airway Plasty for Benign Airway Stenosis.

    Science.gov (United States)

    Tsukioka, Takuma; Takahama, Makoto; Nakajima, Ryu; Kimura, Michitaka; Inoue, Hidetoshi; Yamamoto, Ryoji

    2016-01-01

    Long-term patency is required during treatment for benign airway stenosis. This study investigated the effectiveness of surgical airway plasty for benign airway stenosis. Clinical courses of 20 patients, who were treated with surgical plasty for their benign airway stenosis, were retrospectively investigated. Causes of stenosis were tracheobronchial tuberculosis in 12 patients, post-intubation stenosis in five patients, malacia in two patients, and others in one patient. 28 interventional pulmonology procedures and 20 surgical plasty were performed. Five patients with post-intubation stenosis and four patients with tuberculous stenosis were treated with tracheoplasty. Eight patients with tuberculous stenosis were treated with bronchoplasty, and two patients with malacia were treated with stabilization of the membranous portion. Anastomotic stenosis was observed in four patients, and one to four additional treatments were required. Performance status, Hugh-Jones classification, and ventilatory functions were improved after surgical plasty. Outcomes were fair in patients with tuberculous stenosis and malacia. However, efficacy of surgical plasty for post-intubation stenosis was not observed. Surgical airway plasty may be an acceptable treatment for tuberculous stenosis. Patients with malacia recover well after surgical plasty. There may be untreated patients with malacia who have the potential to benefit from surgical plasty.

  5. Margins for treatment planning of proton therapy

    International Nuclear Information System (INIS)

    Thomas, Simon J

    2006-01-01

    For protons and other charged particles, the effect of set-up errors on the position of isodoses is considerably less in the direction of the incident beam than it is laterally. Therefore, the margins required between the clinical target volume (CTV) and planning target volume (PTV) can be less in the direction of the incident beam than laterally. Margins have been calculated for a typical head plan and a typical prostate plan, for a single field, a parallel opposed and a four-field arrangement of protons, and compared with margins calculated for photons, assuming identical geometrical uncertainties for each modality. In the head plan, where internal motion was assumed negligible, the CTV-PTV margin reduced from approximately 10 mm to 3 mm in the axial direction for the single field and parallel opposed plans. For a prostate plan, where internal motion cannot be ignored, the corresponding reduction in margin was from 11 mm to 7 mm. The planning organ at risk (PRV) margin in the axial direction reduced from 6 mm to 2 mm for the head plan, and from 7 mm to 4 mm for the prostate plan. No reduction was seen on the other axes, or for any axis of the four-field plans. Owing to the shape of proton dose distributions, there are many clinical cases in which good dose distributions can be obtained with one or two fields. When this is done, it is possible to use smaller PTV and PRV margins. This has the potential to convert untreatable cases, in which the PTV and PRV overlap, into cases with a gap between PTV and PRV of adequate size for treatment planning

  6. Evaluating Surgical Margins with Optical Spectroscopy and Spectral Imaging Following Breast Cancer Resection

    Science.gov (United States)

    2009-08-01

    Raman spectral features of hydroxyapatite crystals (found in breast calcifications) through overlying lean chicken breast tissue [18]. Thus, the...Raman signature of bone through several mm of soft tissue [3-5]. It has also been used to detect the Ram an spectral features of hydroxyapatite ...all f eaturing in- line f iltering at the ir tips (Em vision). All seve n f ibers we re bin ned a fter a sing le 3 se cond acquisition, and these

  7. Impact of Close and Positive Margins in Transoral Laser Microsurgery for Tis-T2 Glottic Cancer.

    Science.gov (United States)

    Fiz, Ivana; Mazzola, Francesco; Fiz, Francesco; Marchi, Filippo; Filauro, Marta; Paderno, Alberto; Parrinello, Giampiero; Piazza, Cesare; Peretti, Giorgio

    2017-01-01

    Transoral laser microsurgery (TLM) represents one of the most effective treatment strategies for Tis-T2 glottic squamous cell carcinomas (SCC). The prognostic influence of close/positive margins is still debated, and the role of narrow band imaging (NBI) in their intraoperative definition is still to be validated on large cohort of patients. This study analyzed the influence of margin status on recurrence-free survival (RFS) and disease-specific survival (DSS). We retrospectively studied 507 cases of pTis-T1b (Group A) and 127 cases of pT2 (Group B) glottic SCC. We identified the following margin status: negative ( n  = 232), close superficial ( n  = 79), close deep (CD) ( n  = 35), positive single superficial ( n  = 146), positive multiple superficial ( n  = 94), and positive deep ( n  = 48) and analyzed their impact on RFS and DSS. Close margins were defined by tumor-margin distance <1 mm. Pre-TLM margins were defined by white light in 323 patients, whereas NBI was employed in 311 patients. In Group A, DSS and RFS were reduced in positive multiple superficial and positive deep margins (DSS = 96.1 and 97%, both p  < 0.05; RFS = 72%, p  < 0.001 and 75.8%, p  < 0.01). In Group B, DSS was reduced in positive multiple superficial margins (82.4%, p  < 0.05). RFS was reduced in positive single superficial, positive multiple superficial, and positive deep margins (62.5, 41.2, and 53.3%, p  < 0.01). In the entire population, RFS was reduced in CD margins (77.1%, p  < 0.05). Use of NBI led to improvement in RFS and DSS. The study indicates that close and positive single superficial margins do not affect DSS. By contrast, all types of margin positivity predict the occurrence of relapses, albeit with different likelihood, depending on stage/margin type. CD margins should be considered as a single risk factor. Use of NBI granted better intraoperative margins definition.

  8. Impact of Close and Positive Margins in Transoral Laser Microsurgery for Tis–T2 Glottic Cancer

    Directory of Open Access Journals (Sweden)

    Ivana Fiz

    2017-10-01

    Full Text Available IntroductionTransoral laser microsurgery (TLM represents one of the most effective treatment strategies for Tis–T2 glottic squamous cell carcinomas (SCC. The prognostic influence of close/positive margins is still debated, and the role of narrow band imaging (NBI in their intraoperative definition is still to be validated on large cohort of patients. This study analyzed the influence of margin status on recurrence-free survival (RFS and disease-specific survival (DSS.MethodsWe retrospectively studied 507 cases of pTis–T1b (Group A and 127 cases of pT2 (Group B glottic SCC. We identified the following margin status: negative (n = 232, close superficial (n = 79, close deep (CD (n = 35, positive single superficial (n = 146, positive multiple superficial (n = 94, and positive deep (n = 48 and analyzed their impact on RFS and DSS. Close margins were defined by tumor-margin distance <1 mm. Pre-TLM margins were defined by white light in 323 patients, whereas NBI was employed in 311 patients.ResultsIn Group A, DSS and RFS were reduced in positive multiple superficial and positive deep margins (DSS = 96.1 and 97%, both p < 0.05; RFS = 72%, p < 0.001 and 75.8%, p < 0.01. In Group B, DSS was reduced in positive multiple superficial margins (82.4%, p < 0.05. RFS was reduced in positive single superficial, positive multiple superficial, and positive deep margins (62.5, 41.2, and 53.3%, p < 0.01. In the entire population, RFS was reduced in CD margins (77.1%, p < 0.05. Use of NBI led to improvement in RFS and DSS.ConclusionThe study indicates that close and positive single superficial margins do not affect DSS. By contrast, all types of margin positivity predict the occurrence of relapses, albeit with different likelihood, depending on stage/margin type. CD margins should be considered as a single risk factor. Use of NBI granted better intraoperative margins definition.

  9. Surgical camps: the Ugandan experience

    African Journals Online (AJOL)

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

  10. Research on the margin of futures markets and the policy spillover effect

    Institute of Scientific and Technical Information of China (English)

    Difang Wan; Yang Yang; Dong Fang; Guang Yang

    2011-01-01

    Purpose-The purpose of this paper is to investigate whether the change of margin in Chinese futures markets has policy spillover effects.Design/methodology/approach-The paper constructs a model based on Harzmark and on Chng,taking Chinese futures markets status quo as a single species and restrictions on foreign investment into consideration,introduces the assumptions of spillover effect of speculators,then obtains investor's demand function.Subsequently,the effects of Shanghai Futures Exchange's 11 instances of margin changing are analyzed.Findings-The paper finds that in the Chinese futures market,margin changing has impact on the open interest (OI) and the speculator spillover effect is validated.Research limitations/implications-The irrational behavior of investors in markets is not taken into account in the model and data about spillover speculators were not directly available.Originality/value-The paper usefully analyzes the effects of the Shanghai Futures Exchange's 11 instances of margin changing from 2000 to 2007 and examines the actual effects of margin-changing policy,in the views of OI,trading volume and the externality,the results showing that margin changing has impact on investor structure and validates the existence of the assumed speculator spillover effect.

  11. Is Radiation Indicated in Patients With Ductal Carcinoma In Situ and Close or Positive Mastectomy Margins?

    International Nuclear Information System (INIS)

    Chan, Linda W.; Rabban, Joseph; Hwang, E. Shelley; Bevan, Alison; Alvarado, Michael; Ewing, Cheryl; Esserman, Laura; Fowble, Barbara

    2011-01-01

    Purpose: Resection margin status is one of the most significant factors for local recurrence in patients with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery with or without radiation. However, its impact on chest wall recurrence in patients treated with mastectomy is unknown. The purpose of this study was to determine chest wall recurrence rates in women with DCIS and close ( 5 cm or diffuse disease. Median width of the close final margin was 2 mm. Nineteen patients had margins of <1 mm. One of these 59 patients experienced a chest wall recurrence with regional adenopathy, followed by distant metastases 2 years following skin-sparing mastectomy. The DCIS was high-grade, 4 cm, with a 5-mm deep margin. A second patient developed an invasive cancer in the chest wall 20 years after her mastectomy for DCIS. This cancer was considered a new primary site arising in residual breast tissue. Conclusions: The risk of chest wall recurrence in this series of patients is 1.7% for all patients and 3.3% for high-grade DCIS. One out of 20 (5%) patients undergoing skin sparing or total skin-sparing mastectomy experienced a chest wall recurrence. This risk of a chest wall recurrence appears sufficiently low not to warrant a recommendation for postmastectomy radiation therapy for patients with margins of <5 mm. There were too few patients with positive margins to draw any firm conclusions.

  12. Improving surgical weekend handover

    OpenAIRE

    Culwick, Caroline; Devine, Chris; Coombs, Catherine

    2014-01-01

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

  13. Acquiring minimally invasive surgical skills

    OpenAIRE

    Hiemstra, Ellen

    2012-01-01

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

  14. Reconstructing Rodinia by Fitting Neoproterozoic Continental Margins

    Science.gov (United States)

    Stewart, John H.

    2009-01-01

    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

  15. Robotic surgical training.

    Science.gov (United States)

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

    2013-01-01

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

  16. Ferritin associates with marginal band microtubules

    International Nuclear Information System (INIS)

    Infante, Anthony A.; Infante, Dzintra; Chan, M.-C.; How, P.-C.; Kutschera, Waltraud; Linhartova, Irena; Muellner, Ernst W.; Wiche, Gerhard; Propst, Friedrich

    2007-01-01

    We characterized chicken erythrocyte and human platelet ferritin by biochemical studies and immunofluorescence. Erythrocyte ferritin was found to be a homopolymer of H-ferritin subunits, resistant to proteinase K digestion, heat stable, and contained iron. In mature chicken erythrocytes and human platelets, ferritin was localized at the marginal band, a ring-shaped peripheral microtubule bundle, and displayed properties of bona fide microtubule-associated proteins such as tau. Red blood cell ferritin association with the marginal band was confirmed by temperature-induced disassembly-reassembly of microtubules. During erythrocyte differentiation, ferritin co-localized with coalescing microtubules during marginal band formation. In addition, ferritin was found in the nuclei of mature erythrocytes, but was not detectable in those of bone marrow erythrocyte precursors. These results suggest that ferritin has a function in marginal band formation and possibly in protection of the marginal band from damaging effects of reactive oxygen species by sequestering iron in the mature erythrocyte. Moreover, our data suggest that ferritin and syncolin, a previously identified erythrocyte microtubule-associated protein, are identical. Nuclear ferritin might contribute to transcriptional silencing or, alternatively, constitute a ferritin reservoir

  17. Risk insights from seismic margin reviews

    International Nuclear Information System (INIS)

    Budnitz, R.J.

    1990-01-01

    This paper discusses the information that has been derived from the three seismic-margin reviews conducted so far, and the information that is potentially available from using the seismic-margin method more generally. There are two different methodologies for conducting seismic margin reviews of nuclear power plants, one developed under NRC sponsorship and one developed under sponsorship of the Electric Power Research Institute. Both methodologies will be covered in this paper. The paper begins with a summary of the steps necessary to complete a margin review, and will then outline the key technical difficulties that need to be addressed. After this introduction, the paper covers the safety and operational insights derived from the three seismic-margin reviews already completed: the NRC-sponsored review at Maine Yankee; the EPRI-sponsored review at Catawba; and the joint EPRI/NRC/utility effort at Hatch. The emphasis is on engineering insights, with attention to the aspects of the reviews that are easiest to perform and that provide the most readily available insights

  18. Marginal Hospital Cost of Surgery-related Hospital-acquired Pressure Ulcers.

    Science.gov (United States)

    Spector, William D; Limcangco, Rhona; Owens, Pamela L; Steiner, Claudia A

    2016-09-01

    Patients who develop hospital-acquired pressure ulcers (HAPUs) are more likely to die, have longer hospital stays, and are at greater risk of infections. Patients undergoing surgery are prone to developing pressure ulcers (PUs). To estimate the hospital marginal cost of a HAPU for adults patients who were hospitalized for major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characteristics. Data are from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and the Medicare Patient Safety Monitoring System for 2011 and 2012. PU information was obtained using retrospective structured record review from trained MPMS data abstractors. Costs are derived using HCUP hospital-specific cost-to-charge ratios. Marginal cost estimates were made using Extended Estimating Equations. We estimated the marginal cost at the 25th, 50th, and 75th percentiles of the cost distribution using Simultaneous Quantile Regression. We find that 3.5% of major surgical patients developed HAPUs and that the HAPUs added ∼$8200 to the cost of a surgical stay after adjusting for comorbidities, patient characteristics, procedures, and hospital characteristics. This is an ∼44% addition to the cost of a major surgical stay but less than half of the unadjusted cost difference. In addition, we find that for high-cost stays (75th percentile) HAPUs added ∼$12,100, whereas for low-cost stays (25th percentile) HAPUs added ∼$3900. This paper suggests that HAPUs add ∼44% to the cost of major surgical hospital stays, but the amount varies depending on the total cost of the visit.

  19. Surgical experts: born or made?

    Science.gov (United States)

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

    2013-01-01

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

  20. Surgical navigation with QR codes

    Directory of Open Access Journals (Sweden)

    Katanacho Manuel

    2016-09-01

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

  1. Nigerian Journal of Surgical Research

    African Journals Online (AJOL)

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

  2. Carfilzomib With or Without Rituximab in the Treatment of Waldenstrom Macroglobulinemia or Marginal Zone Lymphoma

    Science.gov (United States)

    2018-02-05

    Marginal Zone Lymphoma; Recurrent Marginal Zone Lymphoma; Recurrent Waldenstrom Macroglobulinemia; Refractory Marginal Zone Lymphoma; Refractory Waldenstrom Macroglobulinemia; Waldenstrom Macroglobulinemia

  3. Fission product margin in burnup credit analyses

    International Nuclear Information System (INIS)

    Finck, P.J.; Stenberg, C.G.

    1998-01-01

    The US Department of Energy (DOE) is currently working toward the licensing of a methodology for using actinide-only burnup credit for the transportation of spent nuclear fuel (SNF). Important margins are built into this methodology. By using comparisons with a representative experimental database to determine bias factors, the methodology ensures that actinide concentrations and worths are estimated conservatively; furthermore, the negative net reactivity of certain actinides and all fission products (FPs) is not taken into account, thus providing additional margin. A future step of DOE's effort might aim at establishing an actinide and FP burnup credit methodology. The objective of this work is to establish the uncertainty to be applied to the total FP worth in SNF. This will serve two ends. First, it will support the current actinide-only methodology by demonstrating the margin available from FPs. Second, it will identify the major contributions to the uncertainty and help set priorities for future work

  4. Refining prices and margins in 1998

    International Nuclear Information System (INIS)

    Favennec, J.P.; Baudoin, C.

    1999-01-01

    Despite a business environment that was globally mediocre due primarily to the Asian crisis and to a mild winter in the northern hemisphere, the signs of improvement noted in the refining activity in 1996 were borne out in 1997. But the situation is not yet satisfactory in this sector: the low return on invested capital and the financing of environmental protection expenditure are giving cause for concern. In 1998, the drop in crude oil prices and the concomitant fall in petroleum product prices was ultimately rather favorable to margins. Two elements tended to put a damper on this relative optimism. First of all, margins continue to be extremely volatile and, secondly, the worsening of the economic and financial crisis observed during the summer made for a sharp decline in margins in all geographic regions, especially Asia

  5. Digital Margins : How spatially and socially marginalized communities deal with digital exclusion

    NARCIS (Netherlands)

    Salemink, Koen

    2016-01-01

    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

  6. Marginal Zone Lymphoma Complicated by Protein Losing Enteropathy

    Directory of Open Access Journals (Sweden)

    Nadine Stanek

    2016-01-01

    Full Text Available Protein losing enteropathy (PLE refers to excessive intestinal protein loss, resulting in hypoalbuminemia. Underlying pathologies include conditions leading to either reduced intestinal barrier or lymphatic congestion. We describe the case of a patient with long-lasting diffuse abdominal problems and PLE. Repetitive endoscopies were normal with only minimal lymphangiectasia in biopsies. Further evaluations revealed an indolent marginal zone lymphoma with minor bone marrow infiltration. Monotherapy with rituximab decreased bone marrow infiltration of the lymphoma but did not relieve PLE. Additional treatments with steroids, octreotide, a diet devoid of long-chain fatty-acids, and parenteral nutrition did not prevent further clinical deterioration with marked weight loss (23 kg, further reduction in albumin concentrations (nadir 8 g/L, and a pronounced drop in performance status. Finally, immunochemotherapy with rituximab and bendamustine resulted in hematological remission and remarkable clinical improvement. 18 months after therapy the patient remains free of gastrointestinal complaints and has regained his body weight with normal albumin levels. We demonstrate a case of PLE secondary to indolent marginal zone lymphoma. No intestinal pathologies were detected, contrasting a severe and almost lethal clinical course. Immunochemotherapy relieved lymphoma and PLE, suggesting that a high suspicion of lymphoma is warranted in otherwise unexplained cases of PLE.

  7. Breast MR imaging for the assessment of residual disease following initial surgery for breast cancer with positive margins

    Energy Technology Data Exchange (ETDEWEB)

    Krammer, Julia [University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany); Memorial Sloan-Kettering Cancer Center, Breast Imaging Section, Department of Radiology, New York, NY (United States); Price, Elissa R. [University of California, San Francisco, Department of Radiology and Biomedical Imaging, Division of Women' s Imaging, San Francisco, CA (United States); Jochelson, Maxine S.; Watson, Elizabeth; Morris, Elizabeth A. [Memorial Sloan-Kettering Cancer Center, Breast Imaging Section, Department of Radiology, New York, NY (United States); Murray, Melissa P. [Memorial Sloan-Kettering Cancer Center, Department of Pathology, New York, NY (United States); Schoenberg, Stefan O. [University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany)

    2017-11-15

    To determine the accuracy of post-operative MR in predicting residual disease in women with positive margins, emphasizing the size thresholds at which residual disease can be confidently identified. This IRB-approved HIPAA-compliant retrospective study included 175 patients with MR after positive margins following initial surgery for breast cancer. Two expert readers independently re-evaluated MR images for evidence of residual disease at the surgical cavity and multifocal/multicentric disease. All patients underwent definitive surgery and MR findings were correlated to histopathology. 139/175 (79.4%) patients had residual disease at surgery. Average overall sensitivity, specificity, PPV and NPV for residual disease at the surgical cavity were 73%, 72%, 91% and 45%, respectively. The readers identified 42/45 (93%, reader 1) and 43/45 (95%, reader 2) patients with residual invasive disease at the cavity of ≥5 mm and 22/22 (100%, both readers) patients with disease ≥10 mm. Average sensitivity, specificity, PPV and NPV for unknown multifocal/multicentric disease were 90%, 96%, 93% and 86%, respectively. Post-operative breast MR can accurately depict ≥5-mm residual disease at the surgical cavity and unsuspected multifocal/multicentric disease. These findings have the potential to lead to more appropriate selection of second surgical procedures in women with positive margins. (orig.)

  8. Breast MR imaging for the assessment of residual disease following initial surgery for breast cancer with positive margins

    International Nuclear Information System (INIS)

    Krammer, Julia; Price, Elissa R.; Jochelson, Maxine S.; Watson, Elizabeth; Morris, Elizabeth A.; Murray, Melissa P.; Schoenberg, Stefan O.

    2017-01-01

    To determine the accuracy of post-operative MR in predicting residual disease in women with positive margins, emphasizing the size thresholds at which residual disease can be confidently identified. This IRB-approved HIPAA-compliant retrospective study included 175 patients with MR after positive margins following initial surgery for breast cancer. Two expert readers independently re-evaluated MR images for evidence of residual disease at the surgical cavity and multifocal/multicentric disease. All patients underwent definitive surgery and MR findings were correlated to histopathology. 139/175 (79.4%) patients had residual disease at surgery. Average overall sensitivity, specificity, PPV and NPV for residual disease at the surgical cavity were 73%, 72%, 91% and 45%, respectively. The readers identified 42/45 (93%, reader 1) and 43/45 (95%, reader 2) patients with residual invasive disease at the cavity of ≥5 mm and 22/22 (100%, both readers) patients with disease ≥10 mm. Average sensitivity, specificity, PPV and NPV for unknown multifocal/multicentric disease were 90%, 96%, 93% and 86%, respectively. Post-operative breast MR can accurately depict ≥5-mm residual disease at the surgical cavity and unsuspected multifocal/multicentric disease. These findings have the potential to lead to more appropriate selection of second surgical procedures in women with positive margins. (orig.)

  9. Being and feeling unique: statistical deviance and psychological marginality.

    Science.gov (United States)

    Frable, D E

    1993-03-01

    Two studies tested the hypothesis that people with culturally stigmatized and concealable conditions (e.g., gays, epileptics, juvenile delinquents, and incest victims) would be more likely to feel unique than people with culturally valued or conspicuous conditions (e.g., the physically attractive, the intellectually gifted, the obese, and the facially scarred). In Study 1, culturally stigmatized individuals with concealable conditions were least likely to perceive consensus between their personal preferences and those of others. In Study 2, they were most likely to describe themselves as unique and to make these self-relevant decisions quickly. Marginality is a psychological reality, not just a statistical one, for those with stigmatized and concealable "master status" conditions.

  10. Deregulated model and locational marginal pricing

    International Nuclear Information System (INIS)

    Sood, Yog Raj; Padhy, N.P.; Gupta, H.O.

    2007-01-01

    This paper presents a generalized optimal model that dispatches the pool in combination with privately negotiated bilateral and multilateral contracts while maximizing social benefit has been proposed. This model determines the locational marginal pricing (LMP) based on marginal cost theory. It also determines the size of non-firm transactions as well as pool demand and generations. Both firms as well as non-firm transactions are considered in this model. The proposed model has been applied to IEEE-30 bus test system. In this test system different types of transactions are added for analysis of the proposed model. (author)

  11. Seismic safety margins research program overview

    International Nuclear Information System (INIS)

    Tokarz, F.J.; Smith, P.D.

    1978-01-01

    A multiyear seismic research program has been initiated at the Lawrence Livermore Laboratory. This program, the Seismic Safety Margins Research Program (SSMRP) is funded by the U.S. Nuclear Regulatory Commission, Office of Nuclear Regulatory Research. The program is designed to develop a probabilistic systems methodology for determining the seismic safety margins of nuclear power plants. Phase I, extending some 22 months, began in July 1978 at a funding level of approximately $4.3 million. Here we present an overview of the SSMRP. Included are discussions on the program objective, the approach to meet the program goal and objectives, end products, the probabilistic systems methodology, and planned activities for Phase I

  12. Slope failure of chalk channel margins

    DEFF Research Database (Denmark)

    Gale, A.; Anderskouv, Kresten; Surlyk, Finn

    2015-01-01

    provide evidence for recurring margin collapse of a long-lived Campanian channel. Compressionally deformed and thrust chalk hardgrounds are correlated to thicker, non-cemented chalk beds that form a broad, gentle anticline. These chalks represent a slump complex with a roll-over anticline of expanded, non......-cemented chalk in the head region and a culmination of condensed hardgrounds in the toe region. Observations strongly suggest that the slumping represents collapse of a channel margin. Farther northwards, the contemporaneous succession shows evidence of small-scale penecontemporaneous normal faulting towards...

  13. Evaluation of thermal margin for HANARO core

    Energy Technology Data Exchange (ETDEWEB)

    Park, Cheol; Chae, Hee Taek; Kim Heon Il; Lim, I. C.; Lee, C. S.; Kim, H

    1999-08-01

    During the commissioning and the start-up of the HANARO, various design parameters were confirmed and measured. For safer operation of HANARO and resolution of the CHF penalty issue which is one of unresolved licensing problems, thermal margins for normal and transient conditions were re-evaluated reflecting the commissioning and the start-up test results and the design modifications during operation. The re-evaluation shows that the HANARO meets the design criteria for ONB margin and fuel centerline temperature under normal condition. For upset condition, it also satisfies the safety limits for CHFR and fuel centerline temperature. (Author). 11 refs., 13 tabs., 4 figs.

  14. On probabilistically defined margins in radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Papiez, Lech; Langer, Mark [Department of Radiation Oncology, Indiana University, Indianapolis, IN (United States)

    2006-08-21

    Margins about a target volume subject to external beam radiation therapy are designed to assure that the target volume of tissue to be sterilized by treatment is adequately covered by a lethal dose. Thus, margins are meant to guarantee that all potential variation in tumour position relative to beams allows the tumour to stay within the margin. Variation in tumour position can be broken into two types of dislocations, reducible and irreducible. Reducible variations in tumour position are those that can be accommodated with the use of modern image-guided techniques that derive parameters for compensating motions of patient bodies and/or motions of beams relative to patient bodies. Irreducible variations in tumour position are those random dislocations of a target that are related to errors intrinsic in the design and performance limitations of the software and hardware, as well as limitations of human perception and decision making. Thus, margins in the era of image-guided treatments will need to accommodate only random errors residual in patient setup accuracy (after image-guided setup corrections) and in the accuracy of systems designed to track moving and deforming tissues of the targeted regions of the patient's body. Therefore, construction of these margins will have to be based on purely statistical data. The characteristics of these data have to be determined through the central limit theorem and Gaussian properties of limiting error distributions. In this paper, we show how statistically determined margins are to be designed in the general case of correlated distributions of position errors in three-dimensional space. In particular, we show how the minimal margins for a given level of statistical confidence are found. Then, how they are to be used to determine geometrically minimal PTV that provides coverage of GTV at the assumed level of statistical confidence. Our results generalize earlier recommendations for statistical, central limit theorem

  15. On probabilistically defined margins in radiation therapy

    International Nuclear Information System (INIS)

    Papiez, Lech; Langer, Mark

    2006-01-01

    Margins about a target volume subject to external beam radiation therapy are designed to assure that the target volume of tissue to be sterilized by treatment is adequately covered by a lethal dose. Thus, margins are meant to guarantee that all potential variation in tumour position relative to beams allows the tumour to stay within the margin. Variation in tumour position can be broken into two types of dislocations, reducible and irreducible. Reducible variations in tumour position are those that can be accommodated with the use of modern image-guided techniques that derive parameters for compensating motions of patient bodies and/or motions of beams relative to patient bodies. Irreducible variations in tumour position are those random dislocations of a target that are related to errors intrinsic in the design and performance limitations of the software and hardware, as well as limitations of human perception and decision making. Thus, margins in the era of image-guided treatments will need to accommodate only random errors residual in patient setup accuracy (after image-guided setup corrections) and in the accuracy of systems designed to track moving and deforming tissues of the targeted regions of the patient's body. Therefore, construction of these margins will have to be based on purely statistical data. The characteristics of these data have to be determined through the central limit theorem and Gaussian properties of limiting error distributions. In this paper, we show how statistically determined margins are to be designed in the general case of correlated distributions of position errors in three-dimensional space. In particular, we show how the minimal margins for a given level of statistical confidence are found. Then, how they are to be used to determine geometrically minimal PTV that provides coverage of GTV at the assumed level of statistical confidence. Our results generalize earlier recommendations for statistical, central limit theorem

  16. Surgical management of splenic echinococcal disease

    Directory of Open Access Journals (Sweden)

    Meimarakis G

    2009-04-01

    Full Text Available Abstract Background Infection of the spleen with echinococcus is a rare clinical entity. Because the diagnosis of a splenic infestation with echinococcus is sometimes delayed, large hydatid cysts or pseudotumors may develop, demanding a differential surgical approach to cure the disease. Methods In a retrospective study 10 patients out of 250 with abdominal echinococcosis (4% were identified to have splenic infestation, either limited to the spleen (n = 4 or with synchronous involvement of the liver (n = 4, major omentum (n = 1, or the liver and lung (n = 1. Only one patient had alveolar echinococcosis whereas the others showed hydatid cysts of the spleen. Surgical therapy included splenectomy in 7 patients or partial cyst excision combined with omentoplasty in 3 patients. In case of liver involvement, pericystectomy was carried out simultaneously. Results There was no mortality. Postoperative complications were observed in 4 patients. Hospital stay and morbidity were not influenced when splenic procedures were combined with pericystectomies of the liver. Mean follow- up was 8.8 years and all of the patients are free of recurrence at this time. Conclusions Splenectomy should be the preferred treatment of hydatid cysts but partial cystectomy is suitable when the cysts are located at the margins of the spleen. Due to low morbidity rates, simultaneous treatment of splenic and liver hydatid cysts is recom mended.

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

    Science.gov (United States)

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

    2017-02-01

    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.

  18. Hemipelvectomy: outcome in 84 dogs and 16 cats. A veterinary society of surgical oncology retrospective study.

    Science.gov (United States)

    Bray, Jonathan P; Worley, Deanna R; Henderson, Ralph A; Boston, Sarah E; Mathews, Kyle G; Romanelli, Giorgio; Bacon, Nicholas J; Liptak, Julius M; Scase, Tim J

    2014-01-01

    To report clinical findings, perioperative complications and long-term outcome in dogs and cats that had hemipelvectomy surgery for treatment of neoplasia. Multi-institutional retrospective case series. Dogs (n = 84) and cats (16). Medical records (January 2000 to December 2009) of dogs and cats that had hemipelvectomy at participating institutions were reviewed. Postoperative progress and current status of the patient at the time of the study was determined by either medical record review, or via telephone contact with the referring veterinarian or owner. Complications were infrequent and usually minor. Hemorrhage was the main intraoperative complication; 2 dogs required blood transfusion. One dog developed an incisional hernia. In dogs, hemangiosarcoma had the worst prognosis with a median survival time (MST) of 179 days. MST for chondrosarcoma (1232 days), osteosarcoma (533 days), and soft tissue sarcoma (373 days) were not statistically different. Median disease-free interval (DFI) for local recurrence of all tumor types was 257 days. Cats had 75% survival at 1 year, which was significantly longer than dogs. Survival times for most tumor types can be good, but surgical margins should be carefully evaluated to ensure complete tumor removal. Adjuvant therapies may be advisable particularly for dogs to reduce rates of local recurrence or distant metastasis. © Copyright 2013 by The American College of Veterinary Surgeons.

  19. Comparison of best estimate methods for judging design margins of advanced water-cooled reactors. Proceedings of a IAEA technical committee meeting. Working material

    International Nuclear Information System (INIS)

    1994-01-01

    The objectives of the Technical Committee Meeting on Significance of design and Operational Margins for advanced Water Cooled Reactor Systems were: to provide an international forum for presentation and discussion of recent results on best estimate methods for judging design margins of mentioned reactors; to identify and describe the technical features of best estimate methods for predicting margins and to provide input for a status report on a comparison of best estimate methods for assessing margins in different countries and organisations. Participants from thirteen countries presented fifteen papers describing their methods, state of art and experiences. Each of those is presented here by a separate abstract

  20. Comparison of best estimate methods for judging design margins of advanced water-cooled reactors. Proceedings of a IAEA technical committee meeting. Working material

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1994-12-31

    The objectives of the Technical Committee Meeting on Significance of design and Operational Margins for advanced Water Cooled Reactor Systems were: to provide an international forum for presentation and discussion of recent results on best estimate methods for judging design margins of mentioned reactors; to identify and describe the technical features of best estimate methods for predicting margins and to provide input for a status report on a comparison of best estimate methods for assessing margins in different countries and organisations. Participants from thirteen countries presented fifteen papers describing their methods, state of art and experiences. Each of those is presented here by a separate abstract Refs, figs, tabs

  1. Clinical review: surgical management of locally advanced and recurrent colorectal cancer.

    LENUS (Irish Health Repository)

    Courtney, D

    2014-01-01

    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.

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

    NARCIS (Netherlands)

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

    2002-01-01

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

  3. Evolution of surgical techniques for a progressive risk reduction.

    Science.gov (United States)

    Amato, Bruno; Santoro, Mario; Izzo, Raffaele; Servillo, Giuseppe; Compagna, Rita; Di Domenico, Lorenza; Di Nardo, Veronica; Giugliano, Giuseppe

    2017-07-18

    Advanced age is a strong predictor of high perioperative mortality in surgical patients and patients aged 75 years and older have an elevated surgical risk, much higher than that of younger patients. Progressive advances in surgical techniques now make it possible to treat high-risk surgical patients with minimally invasive procedures. Endovascular techniques have revolutionized the treatment of several vascular diseases, in particular carotid stenosis, aortic pathologies, and severely incapacitating intermittent claudication or critical limb ischemia. The main advantages of the endovascular approach are the low complication rate, high rate of technical success and a good clinical outcome. Biliary stenting has improved the clinical status of severely ill patients with bile duct stricture before major surgery, and represents a good palliative therapy in the case of malignant biliary obstruction.

  4. STATUS GIZI DAN STATUS KESEHATAN SUKU BADUY

    Directory of Open Access Journals (Sweden)

    Faisal Anwar

    2012-03-01

    Full Text Available 800x600 Normal 0 false false false IN X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Calibri","sans-serif"; mso-bidi-font-family:"Times New Roman";} The objectives of the study were: (1 To analyze the socio-economic and demographic characteristics of Baduy people; (2 To analyze the health status and nutritional status of Baduy people and its influential factors. This research is an explorative and descriptive study on the socio-cultural aspects of food system. The data were collected through a direct interview and discussion with respondents as well as a direct observation at the location of respondents. A sample size of 338 households was drawn from the population. To obtain the data on the cultural aspects, history and  socio aspect of food, in-depth interviews was conducted with 19 key persons. The study was last for 12 months. In Outer Baduy, the factors significantly related to nutritional status are age, number of household size, income, nutritional knowledge, and wife’s ability to read. In Moslem Baduy, only age and income are related to the nutritional status of children. In Moslem Baduy and the Outer Baduy, the correlation between age and W/A or W/H is similar: namely, the higher the age, the lower would the Z-score for the W/A or W/H. The income is significantly correlated to the child nutritional status according to Z-score for W/A with a high correlation coefficient, that is, 0.61. This means that the higher the income, the higher would be the Z-score value for the W/A.  The distribution of adults according to BMI classification in Outer Baduy it shows that 12.7% husbands and 17.6% wives are thin (wasted, while the

  5. Surgical management of hyperthyroidism.

    Science.gov (United States)

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

    2015-04-01

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

  6. [Duane vertical surgical treatment].

    Science.gov (United States)

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

    2014-04-01

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

  7. In search of the rainbow: Colored inks in surgical pathology

    Directory of Open Access Journals (Sweden)

    Chandralekha Tampi

    2012-01-01

    Full Text Available Introduction: Although surgical pathologists are aware of the multiple advantages that coloured inks contribute to surgical pathology practice, these coloured inks are not available in India and importing them is not a viable proposition. A systematic search for locally available coloring agents was done, and resulted in identifying specific shades within a popular set of children′s hobby colors of a particular brand. They retain their bright distinct colors on paraffin blocks and sections. These paints are available all over India, and are cheap, safe, and easy to use. Coloring gross specimen excision margins with different colors, adds precision to margin examination. It allows three-dimensional microscopic reconstruction of the tumor vis-a-vis its various neighboring anatomic structures. It allows postoperative comparison of tissue planes predicted by preoperative imaging. It maintains orientation of grossed and dissected specimens, enabling the pathologist to re-visit the grossed specimen, if required, and confidently allows further sampling if necessary. Aim: A systematic search for indigenous coloring agents was carried out, which included the dyes used in the histopathology laboratory, gelatin, commercially available paints, including acrylic paints and inks. Results: The study identified specific shades within a brand of acrylic colors that are easily available and simple to use, with good results on microscopic examination. Conclusion: Colored inks lend precision to margin examination. A set of easily procurable colors are available in our country, which are easy to use, with distinct bright colors, safe, and reliable.

  8. Multi-perspective workflow modeling for online surgical situation models.

    Science.gov (United States)

    Franke, Stefan; Meixensberger, Jürgen; Neumuth, Thomas

    2015-04-01

    Surgical workflow management is expected to enable situation-aware adaptation and intelligent systems behavior in an integrated operating room (OR). The overall aim is to unburden the surgeon and OR staff from both manual maintenance and information seeking tasks. A major step toward intelligent systems behavior is a stable classification of the surgical situation from multiple perspectives based on performed low-level tasks. The present work proposes a method for the classification of surgical situations based on multi-perspective workflow modeling. A model network that interconnects different types of surgical process models is described. Various aspects of a surgical situation description were considered: low-level tasks, high-level tasks, patient status, and the use of medical devices. A study with sixty neurosurgical interventions was conducted to evaluate the performance of our approach and its robustness against incomplete workflow recognition input. A correct classification rate of over 90% was measured for high-level tasks and patient status. The device usage models for navigation and neurophysiology classified over 95% of the situations correctly, whereas the ultrasound usage was more difficult to predict. Overall, the classification rate decreased with an increasing level of input distortion. Autonomous adaptation of medical devices and intelligent systems behavior do not currently depend solely on low-level tasks. Instead, they require a more general type of understanding of the surgical condition. The integration of various surgical process models in a network provided a comprehensive representation of the interventions and allowed for the generation of extensive situation descriptions. Multi-perspective surgical workflow modeling and online situation models will be a significant pre-requisite for reliable and intelligent systems behavior. Hence, they will contribute to a cooperative OR environment. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. The stability margin on EAST tokamak

    International Nuclear Information System (INIS)

    Jin-Ping, Qian; Bao-Nian, Wan; Biao, Shen; Bing-Jia, Xiao; Walker, M.L.; Humphreys, D.A.

    2009-01-01

    The experimental advanced superconducting tokamak (EAST) is the first full superconducting tokamak with a D-shaped cross-sectional plasma presently in operation. Its poloidal coils are relatively far from the plasma due to the necessary thermal isolation from the superconducting magnets, which leads to relatively weaker coupling between plasma and poloidal field. This may cause more difficulties in controlling the vertical instability by using the poloidal coils. The measured growth rates of vertical stability are compared with theoretical calculations, based on a rigid plasma model. Poloidal beta and internal inductance are varied to investigate their effects on the stability margin by changing the values of parameters α n and γ n (Howl et al 1992 Phys. Fluids B 4 1724), with plasma shape fixed to be a configuration with k = 1.9 and δ = 0.5. A number of ways of studying the stability margin are investigated. Among them, changing the values of parameters κ and l i is shown to be the most effective way to increase the stability margin. Finally, a guideline of stability margin M s (κ, l i , A) to a new discharge scenario showing whether plasmas can be stabilized is also presented in this paper

  10. Fedme og risiko for marginal parodontitis

    DEFF Research Database (Denmark)

    Kongstad, Johanne; Keller, Amélie Cléo; Rohde, Jeanett Friis

    2017-01-01

    Oversigtsartiklen, der er af narrativ karakter, beskriver sammenhængen mellem overvægt/ fedme og marginal parodontitis. Artiklen er baseret på et udvalg af nyere engelsksproget litteratur og motiveres af den øgede forekomst af overvægtige og fede i befolkningen. Desuden er det afgørende, at tandl......Oversigtsartiklen, der er af narrativ karakter, beskriver sammenhængen mellem overvægt/ fedme og marginal parodontitis. Artiklen er baseret på et udvalg af nyere engelsksproget litteratur og motiveres af den øgede forekomst af overvægtige og fede i befolkningen. Desuden er det afgørende......, at tandlæger forholder sig kritisk til systemiske tilstandes mulige konsekvens for udvikling, forværring og behandling af marginal parodontitis. Der nævnes forskellige mål for fedme, hvor body mass index (BMI) og taljeomkreds er de mest anvendte. Problematikken vedrørende tidligere studiers anvendelse af...... forskellige kriterier for marginal parodontitis berøres. Litteraturgennemgangen tager udgangspunkt i de biologiske mekanismer, der udløses i fedtvæv ved overvægt/fedme og medfører en kronisk inflammatorisk tilstand med frigivelse af bl.a. adipokiner. Epidemiologiske tværsnitsog longitudinelle studier af...

  11. Second Language Learners' Use of Marginal Glosses

    Science.gov (United States)

    O'Donnell, Mary E.

    2012-01-01

    The use of marginal reading glosses by 18 second language (L2) learners is examined through a quantitative and qualitative analysis of audiotaped think-aloud protocols. How these readers interact with the glosses is identified and divided into five categories or gloss interactions. Examples from each are presented. The primary research question…

  12. Large margin image set representation and classification

    KAUST Repository

    Wang, Jim Jing-Yan

    2014-07-06

    In this paper, we propose a novel image set representation and classification method by maximizing the margin of image sets. The margin of an image set is defined as the difference of the distance to its nearest image set from different classes and the distance to its nearest image set of the same class. By modeling the image sets by using both their image samples and their affine hull models, and maximizing the margins of the images sets, the image set representation parameter learning problem is formulated as an minimization problem, which is further optimized by an expectation - maximization (EM) strategy with accelerated proximal gradient (APG) optimization in an iterative algorithm. To classify a given test image set, we assign it to the class which could provide the largest margin. Experiments on two applications of video-sequence-based face recognition demonstrate that the proposed method significantly outperforms state-of-the-art image set classification methods in terms of both effectiveness and efficiency.

  13. RISK-INFORMED SAFETY MARGIN CHARACTERIZATION

    International Nuclear Information System (INIS)

    Dinh, Nam; Szilard, Ronaldo

    2009-01-01

    The concept of safety margins has served as a fundamental principle in the design and operation of commercial nuclear power plants (NPPs). Defined as the minimum distance between a system's 'loading' and its 'capacity', plant design and operation is predicated on ensuring an adequate safety margin for safety-significant parameters (e.g., fuel cladding temperature, containment pressure, etc.) is provided over the spectrum of anticipated plant operating, transient and accident conditions. To meet the anticipated challenges associated with extending the operational lifetimes of the current fleet of operating NPPs, the United States Department of Energy (USDOE), the Idaho National Laboratory (INL) and the Electric Power Research Institute (EPRI) have developed a collaboration to conduct coordinated research to identify and address the technological challenges and opportunities that likely would affect the safe and economic operation of the existing NPP fleet over the postulated long-term time horizons. In this paper we describe a framework for developing and implementing a Risk-Informed Safety Margin Characterization (RISMC) approach to evaluate and manage changes in plant safety margins over long time horizons

  14. Early math intervention for marginalized students

    DEFF Research Database (Denmark)

    Overgaard, Steffen; Tonnesen, Pia Beck

    2016-01-01

    This study is one of more substudies in the project Early Math Intervention for Marginalized Students (TMTM2014). The paper presents the initial process of this substudy that will be carried out fall 2015. In the TMTM2014 project, 80 teachers, who completed a one week course in the idea of TMTM...

  15. Mundhulens mikroflora hos patienter med marginal parodontitis

    DEFF Research Database (Denmark)

    Larsen, Tove; Fiehn, Nils-Erik

    2011-01-01

    Viden om marginal parodontitis’ mikrobiologi tog for alvor fart for ca. 40 år siden. Den tidlige viden var baseret på mikroskopiske og dyrkningsmæssige undersøgelser af den subgingivale plak. Anvendelsen af de nyere molekylærbiologiske metoder har betydet, at vor viden om de ætiologiske faktorer ...

  16. Large margin image set representation and classification

    KAUST Repository

    Wang, Jim Jing-Yan; Alzahrani, Majed A.; Gao, Xin

    2014-01-01

    In this paper, we propose a novel image set representation and classification method by maximizing the margin of image sets. The margin of an image set is defined as the difference of the distance to its nearest image set from different classes and the distance to its nearest image set of the same class. By modeling the image sets by using both their image samples and their affine hull models, and maximizing the margins of the images sets, the image set representation parameter learning problem is formulated as an minimization problem, which is further optimized by an expectation - maximization (EM) strategy with accelerated proximal gradient (APG) optimization in an iterative algorithm. To classify a given test image set, we assign it to the class which could provide the largest margin. Experiments on two applications of video-sequence-based face recognition demonstrate that the proposed method significantly outperforms state-of-the-art image set classification methods in terms of both effectiveness and efficiency.

  17. 17 CFR 31.18 - Margin calls.

    Science.gov (United States)

    2010-04-01

    ... transaction merchant is unable to effect personal contact with a leverage customer, a telegram sent to the....18 Commodity and Securities Exchanges COMMODITY FUTURES TRADING COMMISSION LEVERAGE TRANSACTIONS § 31.18 Margin calls. (a) No leverage transaction merchant shall liquidate a leverage contract because of...

  18. Thinking on the Margin: A Classroom Experiment

    Science.gov (United States)

    Bangs, Joann

    2009-01-01

    One of the most important concepts being taught in principles classes is the idea of "thinking on the margin." It can also be one of the most difficult to get across. One of the most telling examples, according to this author, comes in trying to get students to learn the profit maximizing condition for perfectly competitive firms. She…

  19. Persistence of the embryonic lateral marginal vein: report of two cases

    Directory of Open Access Journals (Sweden)

    Rojas Martinez Raúl

    2001-01-01

    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.

  20. Breast conservation therapy based on liberal selection criteria and less extensive surgery. Analysis of cases with positive margins

    International Nuclear Information System (INIS)

    Amemiya, Atsushi; Kondo, Makoto

    1999-01-01

    The relationship between the margin status and the risk of in-breast recurrence (IBR) is an important consideration in patients treated with breast conservation therapy but has not been defined adequately. To address this issue, 1533 clinical stage I and II patients who completed irradiation therapy between 1983 and 1998 were evaluated. Only selection criterion was whether she could be satisfied with cosmesis after lumpectomy. Size and location of the tumor, nodal status, histology and age were not primary consideration. The tumor was excised in such a way to obtain macroscopically clear margins. The breast was treated with 50 Gy of external irradiation but without boost. Margins were evaluated by serially sectioning of the specimen and the margin was judged positive only when cancer cells were present on the inked surface. Margins were also evaluated by scratch cytology. Seventy two IBR were experienced within 5 years. Only age and margin status were found to be independent risk factors. Five-year IBR rate with negative and positive margins was 3.7% and 10.0%, respectively. In patients with positive margins, number of positive site and positive cytology were independent risk factor for IBR. IBR rate among patients with focally involved margins by non-comedo, comedo and invasive ca, was 0.0%, 3.5%, and 8.7%, respectively. IBR rate in more than focal involvement by non-comedo, comedo, and invasive ca, was 4.0%, 33.0% and 30.0%, respectively. If histologically positive margin was also positive cytologically, IBR was 14.8%, whereas only 3.6% if negative cytologically. Even with liberal patient selection and less extensive local treatment, adequate local control can be obtained, provided that margins are histologically and/or cytologically negative. Focal margin involvement by DCIS or more than focal involvement by non-comedo type DCIS does not jeopardize local control. More than focal involvement by comedo DCIS or involvement by invasive ca results in high IBR rate

  1. The Seismicity of Two Hyperextended Margins

    Science.gov (United States)

    Redfield, Tim; Terje Osmundsen, Per

    2013-04-01

    A seismic belt marks the outermost edge of Scandinavia's proximal margin, inboard of and roughly parallel to the Taper Break. A similar near- to onshore seismic belt runs along its inner edge, roughly parallel to and outboard of the asymmetric, seaward-facing escarpment. The belts converge at both the northern and southern ends of Scandinavia, where crustal taper is sharp and the proximal margin is narrow. Very few seismic events have been recorded on the intervening, gently-tapering Trøndelag Platform. Norway's distribution of seismicity is systematically ordered with respect to 1) the structural templates of high-beta extension that shaped the thinning gradient during Late Jurassic or Early Cretaceous time, and 2) the topographically resurgent Cretaceous-Cenozoic "accommodation phase" family of escarpments that approximate the innermost limit of crustal thinning [See Redfield and Osmundsen (2012) for diagrams, definitions, discussion, and supporting citations.] Landwards from the belt of earthquake epicenters that mark the Taper Break the crust consistently thickens, and large fault arrays tend to sole out at mid crustal levels. Towards the sea the crystalline continental crust is hyperextended, pervasively faulted, and generally very thin. Also, faulting and serpentinization may have affected the uppermost parts of the distal margin's lithospheric mantle. Such contrasting structural conditions may generate a contrasting stiffness: for a given stress, more strain can be accommodated in the distal margin than in the less faulted proximal margin. By way of comparison, inboard of the Taper Break on the gently-tapered Trøndelag Platform, faulting was not penetrative. There, similar structural conditions prevail and proximal margin seismicity is negligible. Because stress concentration can occur where material properties undergo significant contrast, the necking zone may constitute a natural localization point for post-thinning phase earthquakes. In Scandinavia

  2. CRBRP structural and thermal margin beyond the design base

    International Nuclear Information System (INIS)

    Strawbridge, L.E.

    1979-01-01

    Prudent margins beyond the design base have been included in the design of Clinch River Breeder Reactor Plant to further reduce the risk to the public from highly improbable occurrences. These margins include Structural Margin Beyond the Design Base to address the energetics aspects and Thermal Margin Beyond the Design Base to address the longer term thermal and radiological consequences. The assessments that led to the specification of these margins are described, along with the experimental support for those assessments. 8 refs

  3. Factors of U.S. Hospitals Associated with Improved Profit Margins: An Observational Study.

    Science.gov (United States)

    Ly, Dan P; Cutler, David M

    2018-02-14

    Hospitals face financial pressure from decreased margins from Medicare and Medicaid and lower reimbursement from consolidating insurers. The objectives of this study are to determine whether hospitals that became more profitable increased revenues or decreased costs more and to examine characteristics associated with improved financial performance over time. The design of this study is retrospective analyses of U.S. non-federal acute care hospitals between 2003 and 2013. There are 2824 hospitals as subjects of this study. The main measures of this study are the change in clinical operating margin, change in revenues per bed, and change in expenses per bed between 2003 and 2013. Hospitals that became more profitable had a larger magnitude of increases in revenue per bed (about $113,000 per year [95% confidence interval: $93,132 to $133,401]) than of decreases in costs per bed (about - $10,000 per year [95% confidence interval: - $28,956 to $9617]), largely driven by higher non-Medicare reimbursement. Hospitals that improved their margins were larger or joined a hospital system. Not-for-profit status was associated with increases in operating margin, while rural status and having a larger share of Medicare patients were associated with decreases in operating margin. There was no association between improved hospital profitability and changes in diagnosis related group weight, in number of profitable services, or in payer mix. Hospitals that became more profitable were more likely to increase their admissions per bed per year. Differential price increases have led to improved margins for some hospitals over time. Where significant price increases are not possible, hospitals will have to become more efficient to maintain profitability.

  4. Mohs micrographic surgery in dermatofibrosarcoma protuberans allows tumour clearance with smaller margins and greater preservation of healthy tissue compared with conventional surgery: a study of 74 primary cases.

    Science.gov (United States)

    Serra-Guillén, C; Llombart, B; Nagore, E; Guillén, C; Requena, C; Traves, V; Kindem, S; Alcalá, R; Rivas, N; Sanmartín, O

    2015-01-01

    Dermatofibrosarcoma protuberans (DFSP) is an uncommon skin tumour with aggressive local growth. Whether DFSP should be treated with conventional surgery (CS) or Mohs micrographic surgery (MMS) has long been a topic of debate. To calculate, in a large series of DFSP treated by MMS, the minimum margin that would have been needed to achieve complete clearance by CS. Secondly, to calculate the percentage of healthy tissue that was preserved by MMS rather than CS with 2- and 3-cm margins. The minimum margin was calculated by measuring the largest distance from the visible edge of the tumour to the edge of the definitive surgical defect. Tumour and surgical defect areas for hypothetical CS with 2- and 3-cm margins were calculated using AutoCAD for Windows. A mean minimum margin of 1·34 cm was required to achieve complete clearance for the 74 tumours analysed. The mean percentages of skin spared using MMS rather than CS with 2- and 3-cm margins were 49·4% and 67·9%, respectively. MMS can achieve tumour clearance with smaller margins and greater preservation of healthy tissue than CS. © 2014 British Association of Dermatologists.

  5. Consideration of margins for hypo fractionated radiotherapy

    International Nuclear Information System (INIS)

    Herschtal, A.; Foroudi, F.; Kron, T.

    2010-01-01

    Full text: Geographical misses of the tumour are of concern in radiotherapy and are typically accommodated by introducing margins around the target. However, there is a trade-off between ensuring the target receives sufficient dose and minimising the dose to surrounding normal structures. Several methods of determining margin width have been developed with the most commonly used one proposed by M. VanHerk (VanHerk UROBP 52: 1407, 2002). VanHerk's model sets margins to achieve 95% of dose coverage for the target in 90% of patients. However, this model was derived assuming an infinite number of fractions. The aim of the present work is to estimate the modifications necessary to the model if a finite number of fractions are given. Software simulations were used to determine the true probability of a patient achieving 95% target coverage if different fraction numbers are used for a given margin width. Model parameters were informed by a large data set recently acquired at our institution using daily image guidance for prostate cancer patients with implanted fiducial markers. Assuming a 3 mm penumbral width it was found that using the VanHerk model only 74 or 54% of patients receive 95% of the prescription dose if 20 or 6 fractions are given, respectively. The steep dose gradients afforded by IMRT are likely to make consideration of the effects of hypofractionation more important. It is necessary to increase the margins around the target to ensure adequate tumour coverage if hypofractionated radiotherapy is to be used for cancer treatment. (author)

  6. [Surgical treatment of gynecomastia].

    Science.gov (United States)

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

    2008-01-01

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

  7. Surgical Management of Post-Prostatectomy Incontinence

    Directory of Open Access Journals (Sweden)

    Arthi Satyanarayan

    2016-04-01

    Full Text Available Post-prostatectomy incontinence (PPI is a common and significant issue that can affect the quality of life in men who are undergoing treatment for prostate cancer. While some patients opt for conservative management of their incontinence, many elect to undergo surgical treatment as a result of the significant impact to quality of life. The most commonly employed surgical techniques to address PPI are placement of a male sling or artificial urinary sphincter (AUS. Currently, the AUS continues to serve as the gold standard for management, with robust data concerning longitudinal outcomes available. However, in recent years, the various methods to place the male sling have emerged as viable, less complex alternatives that avoid the need for pump manipulation. In the present review, we discuss these main surgical treatment modalities for PPI, and focus on the selection criteria that may influence appropriate operative stratification of PPI patients. Indeed, an individualised, comprehensive assessment of baseline urinary function, age, radiation, prior surgeries, functional status, and other comorbidities must be considered in the context of shared decision-making between the treatment provider and the patient in determining the optimal approach to managing PPI.

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

    Science.gov (United States)

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

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

  9. The value of breast lumpectomy margin assessment as a predictor of residual tumor burden

    International Nuclear Information System (INIS)

    Wazer, David E.; Schmidt-Ullrich, Rupert K.; Schmid, Christopher H.; Ruthazer, Robin; Kramer, Bradley; Safaii, Homa; Graham, Roger

    1997-01-01

    lobular ILC cases (p = 0.01). The extent of margin positivity was significantly related to the size of the tumor such that tumor size ≤ 20 mm was associated with a greater probability of focal or minimal margin involvement. Positive margins graded as focal, minimal, moderate/extensive were associated with a +RE in 26%, 58%, and 84%, respectively (p = 0.001). Further, the extent of positivity was significantly correlated with the extent of residual tumor such that focal/minimal positivity was more commonly associated with micro/small +RE, whereas moderate/extensive positivity was associated with medium/large +RE. When the closest margin of the initial excision specimen was positive, >0≤1 mm, or 1.1-2 mm, a +RE was found in 56%, 41%, and 17%, respectively (p = 0.01) but did not correlate with the amount of residual tumor. The extent of specimen processing as reflected in the S:V ratio did not correlate with the probability of defining a measured margin as positive nor the probability of a +RE. In a univariate model, the extent of tumor in the re-excision and the histologic type of tumor in the re-excision were significantly associated with margin status and initial histopathology, respectively. The probability of finding a +RE, based on a multivariate model, was associated with the closeness and extent of margin involvement and initial histopathology of an EIC. Conclusion: The relative closeness of tumor to the specimen edge and the extent of margin positivity are predictive for residual tumor, though with an error consistent with its limitations as a sampling procedure. The histopathology of tumor in the initial excision is predictive of the type of residual tumor and the extent of margin positivity was correlated with the amount of residual tumor

  10. Study of hormonal status of surgical patients with endometrial carcinoma

    International Nuclear Information System (INIS)

    Musina, R.Kh.; Kiseleva, N.S.; Modnikov, O.P.

    1987-01-01

    A radioimmunoassay was conducted in the pituitary-ovary and pituitary-adrenals systems in 37 cases of endometrial carcinoma treatment and 1, 3, 5 and 14 days after extirpation of the uterus and appendages. The levels of follicle - stimulating (FSH) and luteinizing (LH) hormones of the pituitary, prolactin, ACTH, estradiol, progesterone, testosterone, cortisol and aldosterone were studied. Such disturbances as decreased production of FSH, LH, progesterone and testosterone were observed before operation. Surgery was followed by a considerable rise in prolactin production and basal levels of FSH and LH, a decrease in estradiol, progesterone and testosterone concentrations and was accompanied by a sizeable release of cortisol and aldosterone

  11. Development of the Canadian Marginalization Index: a new tool for the study of inequality.

    Science.gov (United States)

    Matheson, Flora I; Dunn, James R; Smith, Katherine L W; Moineddin, Rahim; Glazier, Richard H

    2012-04-30

    Area-based measures of socio-economic status are increasingly used in population health research. Based on previous research and theory, the Canadian Marginalization Index (CAN-Marg) was created to reflect four dimensions of marginalization: residential instability, material deprivation, dependency and ethnic concentration. The objective of this paper was threefold: to describe CAN-Marg; to illustrate its stability across geographic area and time; and to describe its association with health and behavioural problems. CAN-Marg was created at the dissemination area (DA) and census tract level for census years 2001 and 2006, using factor analysis. Descriptions of 18 health and behavioural problems were selected using individual-level data from the Canadian Community Health Survey (CCHS) 3.1 and 2007/08. CAN-Marg quintiles created at the DA level (2006) were assigned to individual CCHS records. Multilevel logistic regression modeling was conducted to examine associations between marginalization and CCHS health and behavioural problems. The index demonstrated marked stability across time and geographic area. Each of the four dimensions showed strong and significant associations with the selected health and behavioural problems, and these associations differed depending on which of the dimensions of marginalization was examined. CAN-Marg is a census-based, empirically derived and theoretically informed tool designed to reflect a broader conceptualization of Canadian marginalization.

  12. Global curriculum in surgical oncology.

    Science.gov (United States)

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

    2016-06-01

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

  13. Seaward dipping reflectors along the SW continental margin of India: Evidence for volcanic passive margin

    Digital Repository Service at National Institute of Oceanography (India)

    Ajay, K.K.; Chaubey, A.K.; Krishna, K.S.; Rao, D.G.; Sar, D.

    Multi-channel seismic reflection profiles across the southwest continental margin of India (SWCMI) show presence of westerly dipping seismic reflectors beneath sedimentary strata along the western flank of the Laccadive Ridge-northernmost part...

  14. Conference Report: The New Discovery of Margins: Theory-Based Excursions in Marginal Social Fields

    Directory of Open Access Journals (Sweden)

    Babette Kirchner

    2014-05-01

    Full Text Available At this year's spring conference of the Sociology of Knowledge Section of the German Sociological Association, a diverse range of theoretical concepts and multiple empirical insights into different marginal social fields were presented. As in everyday life, drawing a line between center and margin can be seen as an important challenge that must equally be faced in sociology. The socially constructed borderline appears to be highly variable. Therefore it has to be delineated or fixed somehow. The construction of margins is necessary for society in general and smaller social groupings alike to confirm one's own "normal" identity, or one's own membership on the fringes. The different contributions exemplify what was established at the beginning of the conference: Namely that society and its margins are defined differently according to the empirical as well as conceptual focus. URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1402148

  15. VEIL Surgical Steps.

    Science.gov (United States)

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

    2017-03-01

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

  16. Aggressive surgical management of craniopharyngiomas

    Directory of Open Access Journals (Sweden)

    Manmohan Singh

    2013-01-01

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

  17. Surgical treatment of parastomal hernia

    International Nuclear Information System (INIS)

    Basti, Z.; Mayer, A.

    2013-01-01

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

  18. Decoding the Margins: What Can the Fractal Geometry of Basaltic Flow Margins Tell Us?

    Science.gov (United States)

    Schaefer, E. I.; Hamilton, C.; Neish, C.; Beard, S. P.; Bramson, A. M.; Sori, M.; Rader, E. L.

    2016-12-01

    Studying lava flows on other planetary bodies is essential to characterizing eruption styles and constraining the bodies' thermal evolution. Although planetary basaltic flows are common, many key features are not resolvable in orbital imagery. We are thus developing a technique to characterize basaltic flow type, sub-meter roughness, and sediment mantling from these data. We will present the results from upcoming fieldwork at Craters of the Moon National Monument and Preserve with FINESSE (August) and at Hawai'i Volcanoes National Park (September). We build on earlier work that showed that basaltic flow margins are approximately fractal [Bruno et al., 1992; Gaonac'h et al., 1992] and that their fractal dimensions (D) have distinct `a`ā and pāhoehoe ranges under simple conditions [Bruno et al., 1994]. Using a differential GPS rover, we have recently shown that the margin of Iceland's 2014 Holuhraun flow exhibits near-perfect (R2=0.9998) fractality for ≥24 km across dm to km scales [Schaefer et al., 2016]. This finding suggests that a fractal-based technique has significant potential to characterize flows at sub-resolution scales. We are simultaneously seeking to understand how margin fractality can be modified. A preliminary result for an `a'ā flow in Hawaii's Ka'ū Desert suggests that although aeolian mantling obscures the original flow margin, the apparent margin (i.e., sediment-lava interface) remains fractal [Schaefer et al., 2015]. Further, the apparent margin's D is likely significantly modified from that of the original margin. Other factors that we are exploring include erosion, transitional flow types, and topographic confinement. We will also rigorously test the intriguing possibility that margin D correlates with the sub-meter Hurst exponent H of the flow surface, a common metric of roughness scaling [e.g., Shepard et al., 2001]. This hypothesis is based on geometric arguments [Turcotte, 1997] and is qualitatively consistent with all results so far.

  19. Conference Report: The New Discovery of Margins: Theory-Based Excursions in Marginal Social Fields

    OpenAIRE

    Kirchner, Babette; Lorenzen, Jule-Marie; Striffler, Christine

    2014-01-01

    At this year's spring conference of the Sociology of Knowledge Section of the German Sociological Association, a diverse range of theoretical concepts and multiple empirical insights into different marginal social fields were presented. As in everyday life, drawing a line between center and margin can be seen as an important challenge that must equally be faced in sociology. The socially constructed borderline appears to be highly variable. Therefore it has to be delineated or fixed somehow. ...

  20. The marginal band system in nymphalid butterfly wings.

    Science.gov (United States)

    Taira, Wataru; Kinjo, Seira; Otaki, Joji M

    2015-01-01

    Butterfly wing color patterns are highly complex and diverse, but they are believed to be derived from the nymphalid groundplan, which is composed of several color pattern systems. Among these pattern systems, the marginal band system, including marginal and submarginal bands, has rarely been studied. Here, we examined the color pattern diversity of the marginal band system among nymphalid butterflies. Marginal and submarginal bands are usually expressed as a pair of linear bands aligned with the wing margin. However, a submarginal band can be expressed as a broken band, an elongated oval, or a single dot. The marginal focus, usually a white dot at the middle of a wing compartment along the wing edge, corresponds to the pupal edge spot, one of the pupal cuticle spots that signify the locations of color pattern organizing centers. A marginal band can be expressed as a semicircle, an elongated oval, or a pair of eyespot-like structures, which suggest the organizing activity of the marginal focus. Physical damage at the pupal edge spot leads to distal dislocation of the submarginal band in Junonia almana and in Vanessa indica, suggesting that the marginal focus functions as an organizing center for the marginal band system. Taken together, we conclude that the marginal band system is developmentally equivalent to other symmetry systems. Additionally, the marginal band is likely a core element and the submarginal band a paracore element of the marginal band system, and both bands are primarily specified by the marginal focus organizing center.

  1. [Croatian guidelines for perioperative enteral nutrition of surgical patients].

    Science.gov (United States)

    Zelić, Marko; Bender, Darija Vranesić; Kelecić, Dina Ljubas; Zupan, Zeljko; Cicvarić, Tedi; Maldini, Branka; Durut, Iva; Rahelić, Velimir; Skegro, Mate; Majerović, Mate; Perko, Zdravko; Sustić, Alan; Madzar, Tomislav; Kovacić, Borna; Kekez, Tihomir; Krznarić, Zeljko

    2014-01-01

    Nutritional status of patients significantly affects the outcome of surgical treatment, whether it's about being obese or malnutrition with loss of muscle mass. Inadequate nutritional support in the perioperative period compromises surgical procedures even in patients who are adequately nourished. In this paper, particular attention was paid to malnourished patients, and their incidence in population hospitalized in surgical wards can be high up to 30%. Special emphasis was paid to the appropriateness of preoperative fasting and to the acceptance of new knowledge in this area of treatment. The aim of this working group was to make guidelines for perioperative nutritional support with different modalities of enteral nutrition. The development of these guidelines was attended by representatives of Croatian Medical Association: Croatian Society for Digestive Surgery, Croatian Society for Clinical Nutrition, Croatian Society of Surgery, Croatian Society for Endoscopic Surgery, Croatian Trauma Society and the Croatian Society of Anesthesiology and Intensive Care. The guidelines are designed as a set of questions that arise daily in clinical practice when preparing patients for surgery and after the surgical treatment, which relate to the assessment of nutritional status, perioperative nutritional support, duration of preoperative fasting period and the selection of food intake route. Assessment of nutritional status and the use of different modes of enteral nutrition should enter into standard protocols of diagnosis and treatment in the Croatian hospitals.

  2. The stability margin of elongated plasmas

    International Nuclear Information System (INIS)

    Portone, Alfredo

    2005-01-01

    Passive stabilization is a key feature in tokamak design since it indicates the efficiency of the metallic structures to 'oppose' plasma displacements. As far as plasma vertical displacement modes are concerned, usually their passive stabilization is characterized in terms of two main indices, namely the instability growth time and the stability margin. In this study-after recalling the governing equations-we extend the definition of the stability margin given in the literature (Lazarus E. et al 1990 Nucl. Fusion 30 111, Albanese R. et al 1990 IEEE Trans. Magn. 26, Kameari A. et al 1985 Nucl. Eng. Des./Fusion 365-73) for the rigid body displacement model to the non-rigid plasma model. Numerical examples are also given for the reduced task objectives/reduced cost ITER design

  3. Passive target tracking using marginalized particle filter

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    A marginalized particle filtering(MPF)approach is proposed for target tracking under the background of passive measurement.Essentially,the MPF is a combination of particle filtering technique and Kalman filter.By making full use of marginalization,the distributions of the tractable linear part of the total state variables are updated analytically using Kalman filter,and only the lower-dimensional nonlinear state variable needs to be dealt with using particle filter.Simulation studies are performed on an illustrative example,and the results show that the MPF method leads to a significant reduction of the tracking errors when compared with the direct particle implementation.Real data test results also validate the effectiveness of the presented method.

  4. 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....... The increasing trend of land acquisition for biofuels has led to the widespread debate about food versus biofuel because of the perceived competition for land and water. To avoid the food versus fuel debate, the use of “marginal” land for biofuel feedstock production (jatropha) has emerged as a dominant...... 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...

  5. Distributions with given marginals and statistical modelling

    CERN Document Server

    Fortiana, Josep; Rodriguez-Lallena, José

    2002-01-01

    This book contains a selection of the papers presented at the meeting `Distributions with given marginals and statistical modelling', held in Barcelona (Spain), July 17-20, 2000. In 24 chapters, this book covers topics such as the theory of copulas and quasi-copulas, the theory and compatibility of distributions, models for survival distributions and other well-known distributions, time series, categorical models, definition and estimation of measures of dependence, monotonicity and stochastic ordering, shape and separability of distributions, hidden truncation models, diagonal families, orthogonal expansions, tests of independence, and goodness of fit assessment. These topics share the use and properties of distributions with given marginals, this being the fourth specialised text on this theme. The innovative aspect of the book is the inclusion of statistical aspects such as modelling, Bayesian statistics, estimation, and tests.

  6. Marginal Loss Calculations for the DCOPF

    Energy Technology Data Exchange (ETDEWEB)

    Eldridge, Brent [Federal Energy Regulatory Commission, Washington, DC (United States); Johns Hopkins Univ., Baltimore, MD (United States); O' Neill, Richard P. [Federal Energy Regulatory Commission, Washington, DC (United States); Castillo, Andrea R. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2016-12-05

    The purpose of this paper is to explain some aspects of including a marginal line loss approximation in the DCOPF. The DCOPF optimizes electric generator dispatch using simplified power flow physics. Since the standard assumptions in the DCOPF include a lossless network, a number of modifications have to be added to the model. Calculating marginal losses allows the DCOPF to optimize the location of power generation, so that generators that are closer to demand centers are relatively cheaper than remote generation. The problem formulations discussed in this paper will simplify many aspects of practical electric dispatch implementations in use today, but will include sufficient detail to demonstrate a few points with regard to the handling of losses.

  7. The rifted margin of Saudi Arabia

    Science.gov (United States)

    McClain, J. S.; Orcutt, J. A.

    The structure of rifted continental margins has always been of great scientific interest, and now, with dwindling economic oil deposits, these complex geological features assume practical importance as well. The ocean-continent transition is, by definition, laterally heterogeneous and likely to be extremely complicated. The southernmost shotpoints (4, 5, and 6) in the U.S. Geological Survey seismic refraction profile in the Kingdom of Saudi Arabia lie within a transition region and thus provide a testing ground for methods that treat wave propagation in laterally heterogeneous media. This portion of the profile runs from the Farasan Islands in the Red Sea across the coast line and the Hijaz-Asir escarpment into the Hijaz-Asir tectonic province. Because the southernmost shotpoint is within the margin of the Saudi sub-continent, the full transition region is not sampled. Furthermore, such an experiment is precluded by the narrowness of the purely oceanic portion of the Red Sea.

  8. Multiple imputation to account for measurement error in marginal structural models

    Science.gov (United States)

    Edwards, Jessie K.; Cole, Stephen R.; Westreich, Daniel; Crane, Heidi; Eron, Joseph J.; Mathews, W. Christopher; Moore, Richard; Boswell, Stephen L.; Lesko, Catherine R.; Mugavero, Michael J.

    2015-01-01

    Background Marginal structural models are an important tool for observational studies. These models typically assume that variables are measured without error. We describe a method to account for differential and non-differential measurement error in a marginal structural model. Methods We illustrate the method estimating the joint effects of antiretroviral therapy initiation and current smoking on all-cause mortality in a United States cohort of 12,290 patients with HIV followed for up to 5 years between 1998 and 2011. Smoking status was likely measured with error, but a subset of 3686 patients who reported smoking status on separate questionnaires composed an internal validation subgroup. We compared a standard joint marginal structural model fit using inverse probability weights to a model that also accounted for misclassification of smoking status using multiple imputation. Results In the standard analysis, current smoking was not associated with increased risk of mortality. After accounting for misclassification, current smoking without therapy was associated with increased mortality [hazard ratio (HR): 1.2 (95% CI: 0.6, 2.3)]. The HR for current smoking and therapy (0.4 (95% CI: 0.2, 0.7)) was similar to the HR for no smoking and therapy (0.4; 95% CI: 0.2, 0.6). Conclusions Multiple imputation can be used to account for measurement error in concert with methods for causal inference to strengthen results from observational studies. PMID:26214338

  9. Multiple Imputation to Account for Measurement Error in Marginal Structural Models.

    Science.gov (United States)

    Edwards, Jessie K; Cole, Stephen R; Westreich, Daniel; Crane, Heidi; Eron, Joseph J; Mathews, W Christopher; Moore, Richard; Boswell, Stephen L; Lesko, Catherine R; Mugavero, Michael J

    2015-09-01

    Marginal structural models are an important tool for observational studies. These models typically assume that variables are measured without error. We describe a method to account for differential and nondifferential measurement error in a marginal structural model. We illustrate the method estimating the joint effects of antiretroviral therapy initiation and current smoking on all-cause mortality in a United States cohort of 12,290 patients with HIV followed for up to 5 years between 1998 and 2011. Smoking status was likely measured with error, but a subset of 3,686 patients who reported smoking status on separate questionnaires composed an internal validation subgroup. We compared a standard joint marginal structural model fit using inverse probability weights to a model that also accounted for misclassification of smoking status using multiple imputation. In the standard analysis, current smoking was not associated with increased risk of mortality. After accounting for misclassification, current smoking without therapy was associated with increased mortality (hazard ratio [HR]: 1.2 [95% confidence interval [CI] = 0.6, 2.3]). The HR for current smoking and therapy [0.4 (95% CI = 0.2, 0.7)] was similar to the HR for no smoking and therapy (0.4; 95% CI = 0.2, 0.6). Multiple imputation can be used to account for measurement error in concert with methods for causal inference to strengthen results from observational studies.

  10. Important predictors of response determined by surgical staging prior to triple modality therapy for esophageal cancer

    International Nuclear Information System (INIS)

    Suntharalingam, M.; Vines, E.; Slawson, R.; Doyle, A.; Schuetz, J.; Greenwald, B.; Sonnet, J.; Krasna, M.

    1997-01-01

    status of regional lymph nodes at the time of pretreatment staging. Sixty-four percent of node negative patients achieved a CR whereas none of the patients with microscopic evidence of LN metastasis were rendered disease free with preoperative therapy (p=.0001 Chi square). When the variables were analyzed for the impact on disease free survival, histology proved to be the most significant prognostic factor. Patients with adenocarcinoma had a 15 month median DFS versus patients with squamous cell whose median survival has not been reached (65% at 36 months p=.02). Only two patients have failed locally (both in field) while nine have presented back with evidence of distant failure. No marginal field recurrences have been noted. Sites of distant failure have included liver, eye, peritoneum and brain. Conclusions: Our experience has shown that pretreatment surgical staging provides a more accurate definition of extent of disease prior to therapy. This information can be utilized to limit the radiation treatment fields without compromising local control. Patients found to have evidence of microscopic nodal involvement of regional lymphatics are less likely to achieve a pathologic CR. Patients who do achieve a pathologic CR have a slightly improved disease free survival. This experience supports the continued use of thoracoscopy and laparoscopy as part of routine pretreatment staging for patients presenting with carcinoma of the esophagus

  11. Systems considerations in seismic margin evaluations

    International Nuclear Information System (INIS)

    Buttermer, D.R.

    1987-01-01

    Increasing knowledge in the geoscience field has led to the understanding that, although highly unlikely, it is possible for a nuclear power plant to be subjected to earthquake ground motion greater than that for which the plant was designed. While it is recognized that there are conservatisms inherent in current design practices, interest has developed in evaluating the seismic risk of operating plants. Several plant-specific seismic probabilistic risk assessments (SPRA) have been completed to address questions related to the seismic risk of a plant. The results from such SPRAs are quite informative, but such studies may entail a considerable amount of expensive analysis of large portions of the plant. As an alternative to an SPRA, it may be more practical to select an earthquake level above the design basis for which plant survivability is to be demonstrated. The principal question to be addressed in a seismic margin evaluation is: At what ground motion levels does one have a high confidence that the probability of seismically induced core damage is sufficiently low? In a seismic margin evaluation, an earthquake level is selected (based on site-specific geoscience considerations) for which a stable, long-term safe shutdown condition is to be demonstrated. This prespecified earthquake level is commonly referred to as the seismic margin earthquake (SME). The Electric Power Research Institute is currently supporting a research project to develop procedures for use by the utilities to allow them to perform nuclear plant seismic margin evaluations. This paper describes the systems-related aspects of these procedures

  12. Marginal longitudinal semiparametric regression via penalized splines

    KAUST Repository

    Al Kadiri, M.

    2010-08-01

    We study the marginal longitudinal nonparametric regression problem and some of its semiparametric extensions. We point out that, while several elaborate proposals for efficient estimation have been proposed, a relative simple and straightforward one, based on penalized splines, has not. After describing our approach, we then explain how Gibbs sampling and the BUGS software can be used to achieve quick and effective implementation. Illustrations are provided for nonparametric regression and additive models.

  13. Origins of saline fluids at convergent margins

    Science.gov (United States)

    Martin, Jonathan B.; Kastner, Miriam; Egeberg, Per Kr.

    The compositions of pore and venting fluids at convergent margins differ from seawater values, reflecting mixing and diagenesis. Most significantly, the concentration of Cl-, assumed to be a conservative ion, differs from its seawater value. Chloride concentrations could be elevated by four processes, although two, the formation of gas hydrate and ion filtration by clay membranes, are insignificant in forming saline fluids at convergent margins. During the formation of gas hydrate, the resulting Cl--rich fluids, estimated to contain an average excess of ˜140 mM Cl- over seawater value, probably would be flushed from the sediment when the pore fluids vent to seawater. Ion filtration by clay membranes requires compaction pressures typical of >2 km burial depths. Even at these depths, the efficiency of ion filtration will be negligible because (1) fluids will flow through fractures, thereby bypassing clay membranes, (2) concentrations of clay minerals are diluted by other phases, and (3) during burial, smectite converts to illite, which has little capacity for ion filtration. A third process, mixing with subaerially evaporated seawater, elevates Cl- concentrations to 1043 mM in forearc basins along the Peru margin. Evaporation of seawater, however, will be important only in limited geographic regions that are characterized by enclosed basins, arid climates, and permeable sediments. At the New Hebrides and Izu-Bonin margins, Cl- concentrations are elevated to a maximum of 1241 mM. The process responsible for this increase is the alteration of volcanic ash to hydrous clay and zeolite minerals. Mass balance calculations, based on the decrease in δ18O values to -9.5‰ (SMOW), suggest that the Cl- concentrations could increase solely from the formation of smectite in a closed system. The diagenesis of volcanic ash also alters the concentrations of most dissolved species in addition to Cl-. Depending on the volume of this altered fluid, it could influence seawater

  14. Marginal longitudinal semiparametric regression via penalized splines

    KAUST Repository

    Al Kadiri, M.; Carroll, R.J.; Wand, M.P.

    2010-01-01

    We study the marginal longitudinal nonparametric regression problem and some of its semiparametric extensions. We point out that, while several elaborate proposals for efficient estimation have been proposed, a relative simple and straightforward one, based on penalized splines, has not. After describing our approach, we then explain how Gibbs sampling and the BUGS software can be used to achieve quick and effective implementation. Illustrations are provided for nonparametric regression and additive models.

  15. PENDIDIKAN ALTERNATIF UNTUK PEREMPUAN MARGINAL DI PEDESAAN

    Directory of Open Access Journals (Sweden)

    Ratnawati Tahir

    2011-11-01

    Full Text Available Abstract: Alternative Education for Marginalized Women in Rural Areas. The study aims to find alter­native forms of education for marginalized women, the process of forming study groups and gender based learning process that serves the center of the development of education, leadership and a source of economic empowerment. The study uses qualitative methods, involving a group of women who have attended an al­ternative education. Researchers and informants from community leaders. The results showed that the form of alternative education is a method of adult education or andragogy. Study groups consisted of basic literacy and functional literacy. The learning process begins with the sharing of learning, reflection on life experience and role play method. The result is 65% of participants have increased the ability of reading, writing and numeracy, and understanding of the issues of women who have confidence in the decision making of households and communities. Abstrak: Pendidikan Alternatif untuk Perempuan Marginal di Pedesaan. Penelitian ini bertujuan mengetahui bentuk pendidikan alternatif untuk perempuan marginal, proses pembentukan kelompok belajar, dan proses pembelajaran berperspektif gender yang berfungsi menjadi pusat pengembangan pendidikan, kepemimpinan, dan sumber penguatan ekonomi. Penelitian menggunakan metode kualitatif, mengambil satu kelompok perempuan yang telah mengikuti pendidikan alternatif. Informan terdiri atas tokoh masyarakat, seperti Kepala Desa, Ketua RT/RW, dan ibu rumah tangga. Hasil penelitian menunjukkan bahwa bentuk pembelajaran pendidikan alternatif adalah metode pendidikan orang dewasa atau andragogy. Pembentukan kelompok belajar terdiri atas; kelompok baca tulis dan keaksaraan fungsional. Proses pembe­lajaran dimulai dengan sharing pembelajaran, refleksi pengalaman hidup, dan metode role play. Hasilnya 65% peserta pembelajaran mengalami peningkatan kemampuan membaca, menulis, dan berhitung, serta pema

  16. Atlantic continental margin of the United States

    Science.gov (United States)

    Grow, John A.; Sheridan, Robert E.; Palmer, A.R.

    1982-01-01

    The objective of this Decade of North American Geology (D-NAG) volume will be to focus on the Mesozoic and Cenozoic evolution of the U.S. Atlantic continental margin, including the onshore coastal plain, related onshore Triassic-Jurassic rift grabens, and the offshore basins and platforms. Following multiple compressional tectonic episodes between Africa and North America during the Paleozoic Era that formed the Appalachian Mountains, the Mesozoic and Cenozoic Eras were dominated by tensional tectonic processes that separated Africa and North America. Extensional rifting during Triassic and Early Jurassic times resulted in numerous tensional grabens both onshore and offshore, which filled with nonmarine continental red beds, lacustrine deposits, and volcanic flows and debris. The final stage of this breakup between Africa and North America occurred beneath the present outer continental shelf and continental slope during Early or Middle Jurassic time when sea-floor spreading began to form new oceanic crust and lithosophere between the two continents as they drifted apart. Postrift subsidence of the marginal basins continued in response to cooling of the lithosphere and sedimentary loading.Geophysical surveys and oil-exploration drilling along the U.S. Atlantic continental margin during the past 5 years are beginning to answer many questions concerning its deep structure and stratigraphy and how it evolved during the rifting and early sea-floor-spreading stages of the separation of this region from Africa. Earlier geophysical studies of the U.S. continental margin used marine refraction and submarine gravity measurements. Single-channel seismic-reflection, marine magnetic, aeromagnetic, and continuous gravity measurements became available during the 1960s.

  17. Marginal microfiltration in amalgam restorations. Review

    OpenAIRE

    Lahoud Salem, Víctor

    2014-01-01

    The present articule is review references from phenomenon of microfiltration in restorations with amalgam and yours consecuents in changes of color in the interface tooth-restorations, margin deterioted , sensitivity dentinarea postoperate, caries secondary and pulp inflamation. Besides naming the mechanicals for to reduce microfiltration, and yours effects for use of sealers dentinaries representation for the varnish cavitys and adhesive systens Conclusive indicate wath the amalgam is the ma...

  18. Work culture and migrant women's welfare marginalization

    OpenAIRE

    Psimmenos, Iordanis

    2007-01-01

    Central to this paper is the relationship between work and welfare marginalization ofmigrant women domestic workers. Based upon the findings of a recent (2005-2007)research study on Albanian and Ukrainian domestic workers’ access to socialinsurance, medical and children’s care (i.e. nurseries, kindergartens), the paper claimsthat welfare barriers are constituted around lack of resources, discriminations as well asconditions and values at work.At the highest level of generality, paid domestic ...

  19. PREDICTIVE METHODS FOR STABILITY MARGIN IN BWR

    OpenAIRE

    MELARA SAN ROMÁN, JOSÉ

    2016-01-01

    [EN] Power and flow oscillations in a BWR are very undesirable. One of the major concerns is to ensure, during power oscillations, compliance with GDC 10 and 12. GDC 10 requires that the reactor core be designed with appropriate margin to assure that specified acceptable fuel design limits will not be exceeded during any condition of normal operation, including the effects of anticipated operational occurrences. GDC 12 requires assurance that power oscillations which can result in conditions ...

  20. Status epilepticus

    NARCIS (Netherlands)

    Hensiek, AE; Absalom, Anthony

    2006-01-01

    Status epilepticus is defined as epileptic activity that continues for more than 30 minutes as a single seizure or as recurrent seizures without inter-ictal return of consciousness. The seizure activity is usually classified as partial or generalized. Although status epilepticus is an uncommon

  1. On marginally resolved objects in optical interferometry

    Science.gov (United States)

    Lachaume, R.

    2003-03-01

    With the present and soon-to-be breakthrough of optical interferometry, countless objects shall be within reach of interferometers; yet, most of them are expected to remain only marginally resolved with hectometric baselines. In this paper, we tackle the problem of deriving the properties of a marginally resolved object from its optical visibilities. We show that they depend on the moments of flux distribution of the object: centre, mean angular size, asymmetry, and curtosis. We also point out that the visibility amplitude is a second-order phenomenon, whereas the phase is a combination of a first-order term, giving the location of the photocentre, and a third-order term, more difficult to detect than the visibility amplitude, giving an asymmetry coefficient of the object. We then demonstrate that optical visibilities are not a good model constraint while the object stays marginally resolved, unless observations are carried out at different wavelengths. Finally, we show an application of this formalism to circumstellar discs.

  2. Maximum Margin Clustering of Hyperspectral Data

    Science.gov (United States)

    Niazmardi, S.; Safari, A.; Homayouni, S.

    2013-09-01

    In recent decades, large margin methods such as Support Vector Machines (SVMs) are supposed to be the state-of-the-art of supervised learning methods for classification of hyperspectral data. However, the results of these algorithms mainly depend on the quality and quantity of available training data. To tackle down the problems associated with the training data, the researcher put effort into extending the capability of large margin algorithms for unsupervised learning. One of the recent proposed algorithms is Maximum Margin Clustering (MMC). The MMC is an unsupervised SVMs algorithm that simultaneously estimates both the labels and the hyperplane parameters. Nevertheless, the optimization of the MMC algorithm is a non-convex problem. Most of the existing MMC methods rely on the reformulating and the relaxing of the non-convex optimization problem as semi-definite programs (SDP), which are computationally very expensive and only can handle small data sets. Moreover, most of these algorithms are two-class classification, which cannot be used for classification of remotely sensed data. In this paper, a new MMC algorithm is used that solve the original non-convex problem using Alternative Optimization method. This algorithm is also extended for multi-class classification and its performance is evaluated. The results of the proposed algorithm show that the algorithm has acceptable results for hyperspectral data clustering.

  3. Pricing district heating by marginal cost

    International Nuclear Information System (INIS)

    Difs, Kristina; Trygg, Louise

    2009-01-01

    A vital measure for industries when redirecting the energy systems towards sustainability is conversion from electricity to district heating (DH). This conversion can be achieved for example, by replacing electrical heating with DH and compression cooling with heat-driven absorption cooling. Conversion to DH must, however, always be an economically attractive choice for an industry. In this paper the effects for industries and the local DH supplier are analysed when pricing DH by marginal cost in combination with industrial energy efficiency measures. Energy audits have shown that the analysed industries can reduce their annual electricity use by 30% and increase the use of DH by 56%. When marginal costs are applied as DH tariffs and the industrial energy efficiency measures are implemented, the industrial energy costs can be reduced by 17%. When implementing the industrial energy efficiency measures and also considering a utility investment in the local energy system, the local DH supplier has a potential to reduce the total energy system cost by 1.6 million EUR. Global carbon dioxide emissions can be reduced by 25,000 tonnes if the industrial energy efficiency measures are implemented and when coal-condensing power is assumed to be the marginal electricity source

  4. Marginalized Student Access to Technology Education

    Science.gov (United States)

    Kurtcu, Wanda M.

    The purpose of this paper is to investigate how a teacher can disrupt an established curriculum that continues the cycle of inequity of access to science, technology, engineering, and math (STEM) curriculum by students in alternative education. For this paper, I will focus on the technology components of the STEM curriculum. Technology in the United States, if not the world economy, is developing at a rapid pace. Many areas of day to day living, from applying for a job to checking one's bank account online, involve a component of science and technology. The 'gap' in technology education is emphasized between the 'haves and have-nots', which is delineated along socio-economic lines. Marginalized students in alternative education programs use this equipment for little else than remedial programs and credit recovery. This level of inequity further widens in alternative education programs and affects the achievement of marginalized students in credit recovery or alternative education classes instead of participation technology classes. For the purposes of this paper I focus on how can I decrease the inequity of student access to 21st century technology education in an alternative education program by addressing the established curriculum of the program and modifying structural barriers of marginalized student access to a technology focused curriculum.

  5. Surgical Management of Perineural Spread of Head and Neck Cancers.

    Science.gov (United States)

    Solares, C Arturo; Mason, Eric; Panizza, Benedict J

    2016-04-01

    The surgical management of perineural spread of head and neck cancers has become an integral part in the contemporary treatment of this pathology. We now understand that tumour spreads within the epineurium and in a continuous fashion. We also can rely on the accuracy of magnetic resonance neurography in detecting and defining the extent of disease. With modern skull base techniques and a greater understanding of the anatomy in this region, specific operations can be designed to help eradicate disease. We review the current approaches and techniques used that enable us to better obtain tumour free margins and hence improve survival.

  6. Periodontal status and treatment needs of primary school teachers ...

    African Journals Online (AJOL)

    Periodontal status and treatment needs of primary school teachers in the absence of ... on probing, periodontal pocketing and treatment needs with CPITN and tooth ... Is In the form of oral prophylaxis and non-surgical periodontal treatment.

  7. Development of an Integrated Theory of Surgical Recovery in Older Adults.

    Science.gov (United States)

    Ann DiMaria-Ghalili, Rose

    2016-01-01

    Experts argue the health care system is not prepared to meet the unique needs of older surgical patients, including how to provide the best care during the recovery phase. Nutrition plays a critical role in the recovery of surgical patients. Since older adults are at risk for malnutrition, examining the role of nutrition as a mediator for surgical recovery across the care continuum in older adults is critical. Presently there is a paucity of frameworks, models, and guidelines that integrate the role of nutrition on the trajectory of postoperative recovery in older surgical patients. The purpose of this article is to introduce the Integrated Theory of Surgical Recovery in Older Adults, an interdisciplinary middle-range theory, so that scholars, researchers, and clinicians can use this framework to promote recovery from surgery in older adults by considering the contribution of mediators of recovery (nutritional status, functional status, and frailty) unique to the older adults.

  8. Perforated marginal ulcers after laparoscopic gastric bypass.

    Science.gov (United States)

    Felix, Edward L; Kettelle, John; Mobley, Elijah; Swartz, Daniel

    2008-10-01

    Perforated marginal ulcer (PMU) after laparoscopic Roux-en-Y gastric bypass (LRYGB) is a serious complication, but its incidence and etiology have rarely been investigated. Therefore, a retrospective review of all patients undergoing LRYGB at the authors' center was conducted to determine the incidence of PMU and whether any causative factors were present. A prospectively kept database of all patients at the authors' bariatric center was retrospectively reviewed. The complete records of patients with a PMU were examined individually for accuracy and analyzed for treatment, outcome, and possible underlying causes of the marginal perforation. Between April 1999 and August 2007, 1% of the patients (35/3,430) undergoing laparoscopic gastric bypass experienced one or more perforated marginal ulcers 3 to 70 months (median, 18 months) after LRYGB. The patients with and without perforation were not significantly different in terms of mean age (37 vs 41 years), weight (286 vs 287 lb), body mass index (BMI) (46 vs 47), or female gender (89% vs 83%). Of the patients with perforations, 2 (6%) were taking steroids, 10 (29%) were receiving nonsteroidal antiinflammatory drugs (NSAIDs) at the time of the perforation, 18 (51%) were actively smoking, and 6 of the smokers also were taking NSAIDs. Eleven of the patients (31%) who perforated did not have at least one of these possible risk factors, but 4 (36%) of the 11 patients in this group had been treated after bypass for a marginal ulcer. Only 7 (20%) of the 35 patients who had laparoscopic bypass, or 7 (0.2%) in the entire group of 3,430 patients, perforated without any warning. There were no deaths, but three patients reperforated. The incidence of a marginal ulcer perforating after LRYGB was significant (>1%) and appeared to be related to smoking or the use of NSAIDs or steroids. Because only 0.2% of all patients acutely perforated without some risk factor or warning, long-term ulcer prophylaxis or treatment may be necessary

  9. Access to Specialized Surgical Care

    African Journals Online (AJOL)

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

  10. Surgical residency: A tenant's view

    African Journals Online (AJOL)

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

  11. Surgical innovations in canine gonadectomy

    NARCIS (Netherlands)

    Van Goethem, Bart

    2016-01-01

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

  12. Acquiring minimally invasive surgical skills

    NARCIS (Netherlands)

    Hiemstra, Ellen

    2012-01-01

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

  13. Prognostic significance of surgical extranodal extension in head and neck squamous cell carcinoma patients.

    Science.gov (United States)

    Matsumoto, Fumihiko; Mori, Taisuke; Matsumura, Satoko; Matsumoto, Yoshifumi; Fukasawa, Masahiko; Teshima, Masanori; Kobayashi, Kenya; Yoshimoto, Seiichi

    2017-08-01

    Lymph node metastasis with extranodal extension represents one of the most important adverse prognostic factors for survival in patients with head and neck squamous cell carcinoma. We propose that extranodal extension occurs to differing extents. The aim of this study was to determine the prognostic significance of extranodal extension in patients with head and neck squamous cell carcinoma. Two hundred and ninety-eight patients with head and neck squamous cell carcinoma who underwent surgical resection and neck dissection were included. Cervical lymph nodes were classified into four categories: (i) pathological N negative, (ii) extranodal extension negative, (iii) non-surgical extranodal extension and (iv) surgical extranodal extension. Lymph node metastases were detected in 67.1% of laryngeal/hypopharyngeal cancer patients and 52.7% of oral cancer patients. The 3-year disease-specific survival rates for patients in the pathological N negative, extranodal extension negative, non-surgical extranodal extension and surgical extranodal extension groups were 90.9%, 79.6%, 63.8% and 48.3%, respectively. In laryngeal/hypopharyngeal cancer patients, surgical extranodal extension was associated with a significantly poorer disease-specific survival than a pathological N negative, extranodal extension negative or non-surgical extranodal extension status. In oral cancer patients, no significant differences were observed between the non-surgical and surgical extranodal extension groups. However, non-surgical extranodal extension was associated with a poorer disease-specific survival than a pathological N negative or extranodal extension negative status. Surgical extranodal extension was a poor prognostic factor in patients with head and neck squamous cell carcinoma. The prognostic significance of surgical extranodal extension differed between laryngeal/hypopharyngeal and oral cancer patients. The clinical significance of surgical extranodal extension was much greater for

  14. Tumor-related markers in histologically normal margins correlate with locally recurrent oral squamous cell carcinoma: a retrospective study.

    Science.gov (United States)

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

    2016-02-01

    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.

  15. Combined Surgical Treatment of Gynecomastia

    Directory of Open Access Journals (Sweden)

    Yordanov Y.

    2015-05-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

  17. Energy crop (Sida hermaphrodita) fertilization using digestate under marginal soil conditions: A dose-response experiment

    Science.gov (United States)

    Nabel, Moritz; Bueno Piaz Barbosa, Daniela; Horsch, David; Jablonowski, Nicolai David

    2014-05-01

    The global demand for energy security and the mitigation of climate change are the main drivers pushing energy-plant production in Germany. However, the cultivation of these plants can cause land use conflicts since agricultural soil is mostly used for plant production. A sustainable alternative to the conventional cultivation of food-based energy-crops is the cultivation of special adopted energy-plants on marginal lands. To further increase the sustainability of energy-plant cultivation systems the dependency on synthetic fertilizers needs to be reduced via closed nutrient loops. In the presented study the energy-plant Sida hermaphrodita (Malvaceae) will be used to evaluate the potential to grow this high potential energy-crop on a marginal sandy soil in combination with fertilization via digestate from biogas production. With this dose-response experiment we will further identify an optimum dose, which will be compared to equivalent doses of NPK-fertilizer. Further, lethal doses and deficiency doses will be observed. Two weeks old Sida seedlings were transplanted to 1L pots and fertilized with six doses of digestate (equivalent to a field application of 5, 10, 20, 40, 80, 160t/ha) and three equivalent doses of NPK-fertilizer. Control plants were left untreated. Sida plants will grow for 45 days under greenhouse conditions. We hypothesize that the nutrient status of the marginal soil can be increased and maintained by defined digestate applications, compared to control plants suffering of nutrient deficiency due to the low nutrient status in the marginal substrate. The dose of 40t/ha is expected to give a maximum biomass yield without causing toxicity symptoms. Results shall be used as basis for further experiments on the field scale in a field trial that was set up to investigate sustainable production systems for energy crop production under marginal soil conditions.

  18. [Motor nerves of the face. Surgical and radiologic anatomy of facial paralysis and their surgical repair].

    Science.gov (United States)

    Vacher, C; Cyna-Gorse, F

    2015-10-01

    Motor innervation of the face depends on the facial nerve for the mobility of the face, on the mandibular nerve, third branch of the trigeminal nerve, which gives the motor innervation of the masticator muscles, and the hypoglossal nerve for the tongue. In case of facial paralysis, the most common palliative surgical techniques are the lengthening temporalis myoplasty (the temporal is innervated by the mandibular nerve) and the hypoglossal-facial anastomosis. The aim of this work is to describe the surgical anatomy of these three nerves and the radiologic anatomy of the facial nerve inside the temporal bone. Then the facial nerve penetrates inside the parotid gland giving a plexus. Four branches of the facial nerve leave the parotid gland: they are called temporal, zygomatic, buccal and marginal which give innervation to the cutaneous muscles of the face. Mandibular nerve gives three branches to the temporal muscles: the anterior, intermediate and posterior deep temporal nerves which penetrate inside the deep aspect of the temporal muscle in front of the infratemporal line. The hypoglossal nerve is only the motor nerve to the tongue. The ansa cervicalis, which is coming from the superficial cervical plexus and joins the hypoglossal nerve in the submandibular area is giving the motor innervation to subhyoid muscles and to the geniohyoid muscle. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  19. Availability of cardiac surgical care in surgical correction of acquired heart defects in patients of older age group

    Directory of Open Access Journals (Sweden)

    Kubatbek S. Urmanbetov

    2018-02-01

    Full Text Available Objective: A study of accessibility of surgical care to elderly patients (aged 60 and above with valvular heart disease has been conducted at the BSCCS "Bakulev Scientific Center of Cardiovascular Surgery» of the Ministry of Health of the Russian Federation. Methods: A retrospective analysis of structure of hospitalizations of 1726 patients, that were hospitalized between 2009 and 2010 at the BSCCS for surgical correction of valvular heart disease was performed. Results: Our study demonstrated that age, on one hand, is not the most significant barrier in the geographical accessibility of cardiac surgical care. On the other hand, it can influence the availability in general, taking into account other factors (urban / rural areas, the presence of cardiac surgical clinics, and clinical status. Provision of cardiac surgical care for patients with heart defects at the BSCCS per 1 million population varies considerably in the context of federal districts and is 0.4 for the Siberian Federal District 30 for the Central Federal District (the highest is 42 for the Moscow Region. Conclusion: Thus, our study demonstrated accessibility of surgical care for elderly patients is the highest for the urban areas with specialized cardiac surgery centers, where patients referred from rural regions

  20. Surgical Stress Abrogates Pre-Existing Protective T Cell Mediated Anti-Tumor Immunity Leading to Postoperative Cancer Recurrence.

    Directory of Open Access Journals (Sweden)

    Abhirami A Ananth

    Full Text Available Anti-tumor CD8+ T cells are a key determinant for overall survival in patients following surgical resection for solid malignancies. Using a mouse model of cancer vaccination (adenovirus expressing melanoma tumor-associated antigen (TAA-dopachrome tautomerase (AdDCT and resection resulting in major surgical stress (abdominal nephrectomy, we demonstrate that surgical stress results in a reduction in the number of CD8+ T cell that produce cytokines (IFNγ, TNFα, Granzyme B in response to TAA. This effect is secondary to both reduced proliferation and impaired T cell function following antigen binding. In a prophylactic model, surgical stress completely abrogates tumor protection conferred by vaccination in the immediate postoperative period. In a clinically relevant surgical resection model, vaccinated mice undergoing a positive margin resection with surgical stress had decreased survival compared to mice with positive margin resection alone. Preoperative immunotherapy with IFNα significantly extends survival in surgically stressed mice. Importantly, myeloid derived suppressor cell (MDSC population numbers and functional impairment of TAA-specific CD8+ T cell were altered in surgically stressed mice. Our observations suggest that cancer progression may result from surgery-induced suppression of tumor-specific CD8+ T cells. Preoperative immunotherapies aimed at targeting the prometastatic effects of cancer surgery will reduce recurrence and improve survival in cancer surgery patients.

  1. Margination of Stiffened Red Blood Cells Regulated By Vessel Geometry.

    Science.gov (United States)

    Chen, Yuanyuan; Li, Donghai; Li, Yongjian; Wan, Jiandi; Li, Jiang; Chen, Haosheng

    2017-11-10

    Margination of stiffened red blood cells has been implicated in many vascular diseases. Here, we report the margination of stiffened RBCs in vivo, and reveal the crucial role of the vessel geometry in the margination by calculations when the blood is seen as viscoelastic fluid. The vessel-geometry-regulated margination is then confirmed by in vitro experiments in microfluidic devices, and it establishes new insights to cell sorting technology and artificial blood vessel fabrication.

  2. Marginal and Interaction Effects in Ordered Response Models

    OpenAIRE

    Debdulal Mallick

    2009-01-01

    In discrete choice models the marginal effect of a variable of interest that is interacted with another variable differs from the marginal effect of a variable that is not interacted with any variable. The magnitude of the interaction effect is also not equal to the marginal effect of the interaction term. I present consistent estimators of both marginal and interaction effects in ordered response models. This procedure is general and can easily be extended to other discrete choice models. I ...

  3. Eagle syndrome surgical treatment with piezosurgery.

    Science.gov (United States)

    Bertossi, Dario; Albanese, Massimo; Chiarini, Luigi; Corega, Claudia; Mortellaro, Carmen; Nocini, Pierfrancesco

    2014-05-01

    Eagle syndrome (ES) is an uncommon complication of styloid process elongation with stylohyoideal complex symptomatic calcification. It is an uncommon condition (4% of the population) that is symptomatic in only 4% of the cases. Eagle syndrome is usually an acquired condition that can be related to tonsillectomy or to a neck trauma. A type of ES is the styloid-carotid syndrome, a consequence of the irritation of pericarotid sympathetic fibers and compression on the carotid artery. Clinical manifestations are found most frequently after head turning and neck compression. Although conservative treatment (analgesics, anticonvulsants, antidepressants, local infiltration with steroids, or anesthetic agents) have been used, surgical treatment is often the only effective treatment in symptomatic cases. We present the case of a 55-year-old patient, successfully treated under endotracheal anesthesia. The cranial portion of the calcified styloid process was shortened through an external approach, using a piezoelectric cutting device (Piezosurgery Medical II; Mectron Medical Technology, Carasco, Italy) with MT1-10 insert, pump level 4, vibration level 7. No major postoperative complications such as nerve damage, hematoma, or wound dehiscence occurred. After 6 months, the patient was completely recovered. Two years after the surgery, the patient did not refer any symptoms related to ES. The transcervical surgical approach in patients with ES seems to be safe and effective, despite the remarkable risk for transient marginal mandibular nerve palsy. This risk can be decreased by the use of the piezoelectric device for its distinctive characteristics--such as precision, selective cut action, and bloodless cut.

  4. Stock Status

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — These data inform the public of the most recent stock status for all stocks (FSSI and non-FSSI) in the fishery management unit contained in a fishery managment plan....

  5. Brain abscess: surgical experiences of 162 cases

    Directory of Open Access Journals (Sweden)

    Forhad Hossain Chowdhury

    2015-01-01

    Full Text Available Aim: Brain abscess still poses a public health challenge in spite of the advent of modern neurosurgical techniques and antibiotics. Here, we present our surgical experiences and ultimate outcome in the management of brain abscess. Methods: Totally, 162 patients with proved brain abscess who underwent surgical treatment were included in this study. The prospectively recorded data of surgical management of brain abscess and the ultimate outcome (by Glasgow outcome scale were studied retrospectively. Results: Total number of cases was 162, of which 113 were acute pyogenic abscess while 49 were chronic abscess. Among the chronic abscess, 29 were chronic pyogenic abscess, 14 were tubercular, 3 aspergillus, and 3 abscesses were in malignant brain metastases. In acute cases, common clinical features were headache, fever, vomiting, focal deficit and seizure. In chronic abscesses, common clinical features were mild to moderate headache and progressive focal deficit. Seventy-three (45.06% patients had adjacent localized sinus, middle ear or cranial infection. The common predisposing factors included postneurosurgery, postpenetrating injury to brain, chronic suppurative otitis media, and congenital heart disease, infective endocarditis, sinusitis and sub optimum immuno-status. Frontal lobe involved in 30.2% cases, temporal lobe is next to involved. Single time burr hole aspiration in 111 (68.5% cases, two or more times burr hole aspiration were done in 34 (21% cases. Pus culture was negative in 129 (79.62% cases. Total number of death was 22 (13.58% cases. Complete resolution of abscess with complete recovery of preoperative neuro-deficit was seen in 80.86% cases and recovery with major neuro-deficit was observed in 5.55% cases. There is a significant association between Glasgow coma scale (GCS on admission and mortality in brain abscess. Conclusion: In most of the cases, pus culture did not yield growth of any causative organism. Mortality was not

  6. Principals' Perceived Supervisory Behaviors Regarding Marginal Teachers in Two States

    Science.gov (United States)

    Range, Bret; Hewitt, Paul; Young, Suzie

    2014-01-01

    This descriptive study used an online survey to determine how principals in two states viewed the supervision of marginal teachers. Principals ranked their own evaluation of the teacher as the most important factor when identifying marginal teachers and relied on informal methods to diagnose marginal teaching. Female principals rated a majority of…

  7. Quantifying motion for pancreatic radiotherapy margin calculation

    International Nuclear Information System (INIS)

    Whitfield, Gillian; Jain, Pooja; Green, Melanie; Watkins, Gillian; Henry, Ann; Stratford, Julie; Amer, Ali; Marchant, Thomas; Moore, Christopher; Price, Patricia

    2012-01-01

    Background and purpose: Pancreatic radiotherapy (RT) is limited by uncertain target motion. We quantified 3D patient/organ motion during pancreatic RT and calculated required treatment margins. Materials and methods: Cone-beam computed tomography (CBCT) and orthogonal fluoroscopy images were acquired post-RT delivery from 13 patients with locally advanced pancreatic cancer. Bony setup errors were calculated from CBCT. Inter- and intra-fraction fiducial (clip/seed/stent) motion was determined from CBCT projections and orthogonal fluoroscopy. Results: Using an off-line CBCT correction protocol, systematic (random) setup errors were 2.4 (3.2), 2.0 (1.7) and 3.2 (3.6) mm laterally (left–right), vertically (anterior–posterior) and longitudinally (cranio-caudal), respectively. Fiducial motion varied substantially. Random inter-fractional changes in mean fiducial position were 2.0, 1.6 and 2.6 mm; 95% of intra-fractional peak-to-peak fiducial motion was up to 6.7, 10.1 and 20.6 mm, respectively. Calculated clinical to planning target volume (CTV–PTV) margins were 1.4 cm laterally, 1.4 cm vertically and 3.0 cm longitudinally for 3D conformal RT, reduced to 0.9, 1.0 and 1.8 cm, respectively, if using 4D planning and online setup correction. Conclusions: Commonly used CTV–PTV margins may inadequately account for target motion during pancreatic RT. Our results indicate better immobilisation, individualised allowance for respiratory motion, online setup error correction and 4D planning would improve targeting.

  8. Medical and Social Determinants of Subsequent Labour Market Marginalization in Young Hospitalized Suicide Attempters.

    Science.gov (United States)

    Niederkrotenthaler, Thomas; Tinghög, Petter; Goldman-Mellor, Sidra; Wilcox, Holly C; Gould, Madelyn; Mittendorfer-Rutz, Ellenor

    2016-01-01

    Individuals with a history of suicide attempt have a high risk for subsequent labour market marginalization. This study aimed at assessing the effect of individual and parental factors on different measures of marginalization. Prospective cohort study based on register linkage of 5 649 individuals who in 1994 were 16-30 years old, lived in Sweden and were treated in inpatient care for suicide attempt during 1992-1994. Hazard ratios (HRs) for labour market marginalization defined as long-term unemployment (>180 days), sickness absence (>90 days), or disability pension in 1995-2010 were calculated with Cox regression. Medical risk factors, particularly any earlier diagnosed specific mental disorders (e.g., schizophrenia: HR 5.4 (95% CI: 4.2, 7.0), personality disorders: HR 3.9, 95% CI: 3.1, 4.9), repetitive suicide attempts (HR 1.6, 95% CI: 1.4, 1.9) were associated with a higher relative risk of disability pension. Individual medical factors were of smaller importance for long-term sickness absence, and of only marginal relevance to long-term unemployment. Country of birth outside Europe had an opposite effect on disability pension (HR 0.6, 95% CI: 0.4, 0.8) and long-term unemployment (HR 1.5, 95% CI: 1.3, 1.8). Female sex was positively correlated with long-term sickness absence (HR 1.6, 95% CI: 1.4, 1.7), and negatively associated with long-term unemployment (HR: 0.8, 95% CI: 0.7, 0.9). As compared to disability pension, long-term sickness absence and unemployment was more strongly related to socio-economic variables. Marginalization pathways seemed to vary with migration status and sex. These findings may contribute to the development of intervention strategies which take the individual risk for marginalization into account.

  9. Potency following high-dose three-dimensional conformal radiotherapy and the impact of prior major urologic surgical procedures in patients treated for prostate cancer

    International Nuclear Information System (INIS)

    Chinn, Daniel M.; Holland, John; Crownover, Richard L.; Roach, Mack

    1995-01-01

    Purpose: To assess the impact of high-dose three-dimensional conformal radiotherapy (3DCRT) on potency in patients treated for clinically localized prostate cancer and to identify factors that might predict the outcome of sexual function following treatment. Methods and Materials: One hundred twenty-four consecutive patients treated with 3DCRT for localized prostate cancer at UCSF between 1991-1993 were included in this retrospective analysis. Patient responses were obtained from a mailed questionnaire, telephone interviews, or departmental records. Median follow-up was 21 months. Results: Sixty patients reported having sexual function prior to 3DCRT, including 47 who were fully potent and 13 who were marginally potent. Of the remaining 64 patients, 45 were impotent, 7 were on hormones, 1 was status-postorchiectomy, and 11 were not evaluable. Following 3DCRT, 37 of 60 patients (62%) retained sexual function sufficient for intercourse. Of those with sexual function before irradiation, 33 of 47 (70%) of patients fully potent and 4 of 13 (31%) of patients marginally potent maintained function sufficient for intercourse (p < 0.01). Potency was retained in 6 of 15 (40%) patients with a history of a major urologic surgical procedure (MUSP) and in 31 of 45 (69%) with no history of a MUSP (p < 0.04). Transurethral resection of the prostate was the MUSP in eight of these patients, with four (50%) maintaining sexual function. Conclusions: Patients who receive definitive 3DCRT for localized prostate cancer appear to maintain potency similar to patients treated with conventional radiotherapy. However, patients who are marginally potent at presentation or who have a history of a MUSP appear to be at increased risk of impotence following 3DCRT

  10. Deep Structures of The Angola Margin

    Science.gov (United States)

    Moulin, M.; Contrucci, I.; Olivet, J.-L.; Aslanian, D.; Géli, L.; Sibuet, J.-C.

    1 Ifremer Centre de Brest, DRO/Géosciences Marines, B.P. 70, 29280 Plouzané cedex (France) mmoulin@ifremer.fr/Fax : 33 2 98 22 45 49 2 Université de Bretagne Occidentale, Institut Universitaire Europeen de la Mer, Place Nicolas Copernic, 29280 Plouzane (France) 3 Total Fina Elf, DGEP/GSR/PN -GEOLOGIE, 2,place de la Coupole-La Defense 6, 92078 Paris la Defense Cedex Deep reflection and refraction seismic data were collected in April 2000 on the West African margin, offshore Angola, within the framework of the Zaiango Joint Project, conducted by Ifremer and Total Fina Elf Production. Vertical multichannel reflection seismic data generated by a « single-bubble » air gun array array (Avedik et al., 1993) were recorded on a 4.5 km long, digital streamer, while refraction and wide angle reflection seismic data were acquired on OBSs (Ocean Bottom Seismometers). Despite the complexity of the margin (5 s TWT of sediment, salt tectonics), the combination of seismic reflection and refraction methods results in an image and a velocity model of the ground structures below the Aptian salt layer. Three large seismic units appear in the reflection seismic section from the deep part on the margin under the base of salt. The upper seismic unit is layered with reflectors parallel to the base of the salt ; it represents unstructured sediments, filling a basin. The middle unit is seismically transparent. The lower unit is characterized by highly energetic reflectors. According to the OBS refraction data, these two units correspond to the continental crust and the base of the high energetic unit corresponds to the Moho. The margin appears to be divided in 3 domains, from east to west : i) a domain with an unthinned, 30 km thick, continental crust ; ii) a domain located between the hinge line and the foot of the continental slope, where the crust thins sharply, from 30 km to less than 7 km, this domain is underlain by an anormal layer with velocities comprising between 7,2 and 7

  11. The marginal cost of public funds

    DEFF Research Database (Denmark)

    Kleven, Henrik Jacobsen; Kreiner, Claus Thustrup

    2006-01-01

    This paper extends the theory and measurement of the marginal cost of public funds (MCF) to account for labor force participation responses. Our work is motivated by the emerging consensus in the empirical literature that extensive (participation) responses are more important than intensive (hours...... of work) responses. In the modelling of extensive responses, we argue that it is crucial to account for the presence of non-convexities created by fixed work costs. In a non-convex framework, tax and transfer reforms give rise to discrete participation responses generating first-order effects...

  12. Intacs for early pellucid marginal degeneration.

    Science.gov (United States)

    Kymionis, George D; Aslanides, Ioannis M; Siganos, Charalambos S; Pallikaris, Ioannis G

    2004-01-01

    A 42-year-old man had Intacs (Addition Technology Inc.) implantation for early pellucid marginal degeneration (PMD). Two Intacs segments (0.45 mm thickness) were inserted uneventfully in the fashion typically used for low myopia correction (nasal-temporal). Eleven months after the procedure, the uncorrected visual acuity was 20/200, compared with counting fingers preoperatively, while the best spectacle-corrected visual acuity improved to 20/25 from 20/50. Corneal topographic pattern also improved. Although the results are encouraging, concern still exists regarding the long-term effect of this approach for the management of patients with PMD.

  13. TENNESSEE WILLIAMS E O TEATRO MARGINAL GAY

    Directory of Open Access Journals (Sweden)

    Adriana Falqueto Lemos

    2014-06-01

    Full Text Available The work developed in this text aims to read the dramatist Tennnessee Williams in a play in two scenes “E Contar Tristes Histórias das Mortes das Bonecas” which was published in Brazil in the book “Mister Paradise e outras peças em um ato” (2011. The intention is to reflect upon one of his recurring themes, the marginalization. In order to perform the analysis, the theoretical support was grounded in “Literatura e Sociedade” by Antonio Candido (2006, concerning the participation of society and authorship in a piece of literature.

  14. TENNESSEE WILLIAMS E O TEATRO MARGINAL GAY

    Directory of Open Access Journals (Sweden)

    Adriana Falqueto Lemos

    2014-09-01

    Full Text Available The work developed in this text aims to read the dramatist Tennnessee Williams in a play in two scenes “E Contar Tristes Histórias das Mortes das Bonecas” which was published in Brazil in the book “Mister Paradise e outras peças em um ato” (2011. The intention is to reflect upon one of his recurring themes, the marginalization. In order to perform the analysis, the theoretical support was grounded in “Literatura e Sociedade” by Antonio Candido (2006, concerning the participation of society and authorship in a piece of literature.

  15. Absenteeism, efficiency wages, and marginal taxes

    OpenAIRE

    Dale-Olsen, Harald

    2013-01-01

    In this paper, I test the argument that increased taxes on earnings correspond to increased incentives to shirk, thus causing an increase in the rate of worker absenteeism. After fixed job effects are taken into account, panel register data on prime-age Norwegian males who work full-time show that a higher marginal net-of-earnings-tax rate reduces the rate of absenteeism. When the net-of-tax rate is increased by 1.0 percent, absenteeism decreases by 0.3−0.5 percent. Injury-related absences ar...

  16. OPTION OF USERS IN SURGICAL CONTRACEPTION FAMILY HEALTH UNIT

    Directory of Open Access Journals (Sweden)

    Vagner Ferreira do Nascimento

    2013-09-01

    Full Text Available The study is a descriptive and quantitative approach, which aimed to meet customers the option of surgical contraception by a Family Health Unit in the municipality of Barra do Herons - Mato Grosso. Data were collected on 22 forms of reference that would be forwarded to the sector and family planning counseling. Data were collected and grouped by age, marital status, gender, children and quantitative choice of surgical method of contraception. The period of data collection occurred from March to December 2011. The age group with the highest participation was from 18 to 25 years. Predominantly single, female, with two sons and opting for sterilization. The variety of options to be used as contraceptive methods should be widely publicized and encouraged by health professionals, leaving the surgical methods of reversible or irreversible disruption as a last choice.

  17. Surgical Skills Beyond Scientific Management.

    Science.gov (United States)

    Whitfield, Nicholas

    2015-07-01

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

  18. CT and sonographic diagnosis of retained surgical sponge

    International Nuclear Information System (INIS)

    Matsumoto, Syunro; Aikawa, Hisayuki; Miyake, Hidetoshi; Mori, Hiromu; Maeda, Tohru; Nishimura, Hiro; Monzen, Yoshio; Ashizawa, Akira; Isomoto, Ichiro.

    1990-01-01

    Seven cases of pathologically proven retained surgical sponge were reviewed and classified into four types, depending on CT and US findings. CT showed a mass with tiny gas bubbles, and sonogram showed an echogenic area with strong posterior shadow (Type I). CT showed an irregular high density mass with no gas bubble, and sonogram showed an echogenic area with strong posterior shadow (Type II). CT showed a low density mass with irregular internal high density areas, and somogram showed a cystic mass with zigzag internal components (Type III). CT showed an eliptic high density mass with low density area internally. Judging from the experiment and operative findings, these patterns were decided by the number and status of the gauze, volume of the exudate and hematoma, and status of the granulation. The author concludes that these characteristic CT and US findings, together with a history of surgery, permit the correct diagnosis of retained surgical sponge. (author)

  19. Surgical management of giant posterior communicating artery aneurysms.

    Science.gov (United States)

    Velat, Gregory J; Zabramski, Joseph M; Nakaji, Peter; Spetzler, Robert F

    2012-09-01

    Giant posterior communicating artery (PCoA) aneurysms (> 25 mm) are rare lesions associated with a poor prognosis and high rates of morbidity and mortality. To review the clinical results of giant PCoA aneurysms surgically treated at our institution, focusing on operative nuances. All cases of giant PCoA aneurysms treated surgically at our institution were identified from a prospectively maintained patient database. Patient demographic factors, medical comorbidities, rupture status, neurological presentation, clinical outcomes, and surgical records were critically reviewed. From 1989 to 2010, 11 patients (10 women) underwent surgical clipping of giant PCoA aneurysms. Presenting signs and symptoms included cranial nerve palsies, diminished mental status, headache, visual changes, and seizures. Five aneurysms were ruptured on admission. All aneurysms were clipped primarily except 1, which was treated by parent artery sacrifice and extracranial-to-intracranial bypass after intraoperative aneurysm rupture. Perioperative morbidity and mortality rates were 36% (4 of 11) and 18.3% (2 of 11), respectively. Excellent or good clinical outcomes, defined as modified Rankin Scale scores ≤ 2, were achieved in 86% (5 of 6) of patients available for long-term clinical follow-up (mean, 12.5 ± 13.6 months). Giant PCoA aneurysms are rare vascular lesions that may present with a variety of neurological signs and symptoms. These lesions can be successfully managed surgically with satisfactory morbidity and mortality rates. To the best of our knowledge, this is the largest surgical series of giant PCoA aneurysms published to date.

  20. On recent developments in marginal separation theory.

    Science.gov (United States)

    Braun, S; Scheichl, S

    2014-07-28

    Thin aerofoils are prone to localized flow separation at their leading edge if subjected to moderate angles of attack α. Although 'laminar separation bubbles' at first do not significantly alter the aerofoil performance, they tend to 'burst' if α is increased further or if perturbations acting upon the flow reach a certain intensity. This then either leads to global flow separation (stall) or triggers the laminar-turbulent transition process within the boundary layer flow. This paper addresses the asymptotic analysis of the early stages of the latter phenomenon in the limit as the characteristic Reynolds number [Formula: see text], commonly referred to as marginal separation theory. A new approach based on the adjoint operator method is presented that enables the fundamental similarity laws of marginal separation theory to be derived and the analysis to be extended to higher order. Special emphasis is placed on the breakdown of the flow description, i.e. the formation of finite-time singularities (a manifestation of the bursting process), and on its resolution being based on asymptotic arguments. The passage to the subsequent triple-deck stage is described in detail, which is a prerequisite for carrying out a future numerical treatment of this stage in a proper way. Moreover, a composite asymptotic model is developed in order for the inherent ill-posedness of the Cauchy problems associated with the current flow description to be resolved.

  1. Characterizing entanglement with global and marginal entropic measures

    International Nuclear Information System (INIS)

    Adesso, Gerardo; Illuminati, Fabrizio; De Siena, Silvio

    2003-01-01

    We qualify the entanglement of arbitrary mixed states of bipartite quantum systems by comparing global and marginal mixednesses quantified by different entropic measures. For systems of two qubits we discriminate the class of maximally entangled states with fixed marginal mixednesses, and determine an analytical upper bound relating the entanglement of formation to the marginal linear entropies. This result partially generalizes to mixed states the quantification of entanglement with marginal mixednesses holding for pure states. We identify a class of entangled states that, for fixed marginals, are globally more mixed than product states when measured by the linear entropy. Such states cannot be discriminated by the majorization criterion

  2. Primary megaureter: outcome of surgical treatment

    International Nuclear Information System (INIS)

    Shaikh, N.A.; Shaikh, G.S.

    2015-01-01

    Objective: To assess the clinical outcome after surgical treatment of primary megaureter. Methodology: A retrospective analysis of 15 patients who had reimplantation of primary megaureters between January 2007 and April 2012 was performed. Patients who had additional urinary tract pathology were excluded from the study. Results: Out of 15 patients, 10 presented with abdominal pain and febrile urinary tract infections, while five presented with failure to thrive and post feed vomiting. Diameter of the megaureter prior to operation was 20 mm (range 15-30 mm). On ultrasound, hydronephrosis decreased in 12 and was unchanged in three after 1 month, postoperatively. After three months postoperatively, hydroureter was no longer detected in 10 and was reduced in five patients. Conclusion: Reimplantation of a primary mega ureter resulted in improved clinical status, reduced dilation of the ureter and renal pelvis, and free drainage of the upper urinary tract. (author)

  3. Task Group on Safety Margins Action Plan (SMAP). Safety Margins Action Plan - Final Report

    International Nuclear Information System (INIS)

    Hrehor, Miroslav; Gavrilas, Mirela; Belac, Josef; Sairanen, Risto; Bruna, Giovanni; Reocreux, Michel; Touboul, Francoise; Krzykacz-Hausmann, B.; Park, Jong Seuk; Prosek, Andrej; Hortal, Javier; Sandervaag, Odbjoern; Zimmerman, Martin

    2007-01-01

    The international nuclear community has expressed concern that some changes in existing plants could challenge safety margins while fulfilling all the regulatory requirements. In 1998, NEA published a report by the Committee on Nuclear Regulatory Activities on Future Nuclear Regulatory Challenges. The report recognized 'Safety margins during more exacting operating modes' as a technical issue with potential regulatory impact. Examples of plant changes that can cause such exacting operating modes include power up-rates, life extension or increased fuel burnup. In addition, the community recognized that the cumulative effects of simultaneous changes in a plant could be larger than the accumulation of the individual effects of each change. In response to these concerns, CSNI constituted the safety margins action plan (SMAP) task group with the following objectives: 'To agree on a framework for integrated assessments of the changes to the overall safety of the plant as a result of simultaneous changes in plant operation / condition; To develop a CSNI document which can be used by member countries to assess the effect of plant change on the overall safety of the plant; To share information and experience.' The two approaches to safety analysis, deterministic and probabilistic, use different methods and have been developed mostly independently of each other. This makes it difficult to assure consistency between them. As the trend to use information on risk (where the term risk means results of the PSA/PRA analysis) to support regulatory decisions is growing in many countries, it is necessary to develop a method of evaluating safety margin sufficiency that is applicable to both approaches and, whenever possible, integrated in a consistent way. Chapter 2 elaborates on the traditional view of safety margins and the means by which they are currently treated in deterministic analyses. This chapter also discusses the technical basis for safety limits as they are used today

  4. [Surgical management of minor salivary gland tumors].

    Science.gov (United States)

    Zhou, Liang; Chen, Xiaoling; Huang, Weiting; Li, Kelan; Zhang, Xiaotong; Wang, Wei

    2007-11-01

    To study the clinical features of minor salivary gland tumors and to discuss the treatment modalities for these tumors. Retrospective analysis of 54 cases with minor salivary gland tumor operated in our hospital from 1997 to 2004. Among 54 cases with minor salivary gland tumors in this series, 16 patients lost of follow up. Among the remaining 38 patients, 2 patients with nasal cavity adenoid cystic carcinoma died of tumor recurrence 2 and 3 years after the surgery respectively, one patient with laryngeal myoepithelial carcinoma died of tumor recurrence 3 years after the surgery and one patient with paranasal sinus mucoepidermoid carcinoma died of recurrence 17 months after the surgery. Two patients with paranasal sinus adenoid cystic carcinoma recurred after the primary surgery and were survived without tumor after salvage surgery. The other patients survived with no tumor recurrence. While different histopathology of minor salivary gland tumors were found in this group, malignant tumors were predominant, accounting for 81.4%. The choice of treatment for minor salivary gland tumors depends upon the location and the histopathology of the tumors. The treatment policy for benign tumors is simple tumor excision, while that for malignant tumors is surgery combined with pre- or post-operative radiation therapy. Complete surgical resection of tumor masses and tumor free margin is essential for successful treatment of malignant minor salivary gland tumors.

  5. Beyond Diversity as Usual: Expanding Critical Cultural Approaches to Marginalization in Engineering Education

    Science.gov (United States)

    Secules, Stephen

    In general, what we think of as "diversity work" in undergraduate engineering education focuses in the following ways: more on the overlooked assets of minority groups than on the acts of overlooking, more on the experiences of marginalized groups than on the mechanisms of marginalization by dominant groups, more on supporting and increasing minority student retention than on critiquing and remediating the systems which lead minority students to leave engineering. This dissertation presents a series of arguments which push beyond a status quo understanding of diversity in engineering education. The first approach the dissertation takes up is to problematize educational facts around failure by interrogating their roots in interactions and cultural norms in an engineering classroom. In another argument, the dissertation places the engineering classroom cultural norms of competition, whiteness, and masculinity in a critical historical context of the discipline at large. Finally, I demonstrate how engaging students in a critique of marginalizing educational culture can be an important source of agency. In addition to applying and demonstrating the value of specific novel approaches in engineering education, the dissertation contributes to the research community by discussing the respective affordances between these and other possible scholarly approaches to culture and marginalization in education. I also suggest how a consideration of the taken-for-granted culture of engineering education can be an important tool for instructors seeking to gain insight into persistent educational problems. In addition, this dissertation makes implications for diversity support practice, envisioning new forms of support programming rooted in intersectionality and critical praxis.

  6. ANAESTHESIA FOR OPHTHALMIC SURGICAL PROCEDURES

    African Journals Online (AJOL)

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

  7. uniportal vats for surgical repair

    African Journals Online (AJOL)

    2017-03-23

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

  8. Spinal surgery: non surgical complications

    African Journals Online (AJOL)

    Adele

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

  9. Patient-specific surgical simulation.

    Science.gov (United States)

    Soler, Luc; Marescaux, Jacques

    2008-02-01

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

  10. Stonequist’s Concept of “The Marginal Man” in Langston Hughes’ Play Mulatto

    Directory of Open Access Journals (Sweden)

    Farshid Nowrouzi Roshnavand

    2012-09-01

    Full Text Available Born with the inception of the slave trade, interracial mixing has always been a moot point throughout the history of the United States. In America’s racist climate, the mulatto offspring of every interracial relationship was deemed by the dominant white society to be born of transgression and thus was marginalized and disenfranchised as an alleged tainter of white “pure blood” and a threat to the societal system of structural positions. Facing discrimination and injustice like black Americans, white-black mulattoes also suffered from not belonging to a definite racial group. This duality of a mixed-blood’s life has grabbed the attention of many scholars including Everett Verner Stonequist who discussed the fragile subalternized status of the “marginal man” in an antagonistic environment while he rejects and craves for both of his racial ancestries at the same time. Envisioning a three-phase life-cycle for a mulatto, Stonequist maintained that the mulatto has either to conform to the status quo and survive or defy the power structures and embrace, mostly unfavorable, consequences. This paper aims to apply Stonequist’s concept of “marginal man” to Langston Hughes’ play Mulatto (1935 and tries to show how the alienated and rootless protagonist is inevitably precipitated into death and destruction.

  11. Marginal and mindful: deviants in social interactions.

    Science.gov (United States)

    Frable, D E; Blackstone, T; Scherbaum, C

    1990-07-01

    Master status people's behavior, physical appearance, or life circumstance is statistically unusual and centrally defining (e.g., the physically attractive, the obese, the intellectually gifted, the facially scarred, the talented, the athletic, Blacks, gays, the wealthy, rape and incest victims). These individuals were paired with people without such conditions. Each pair was left alone on a pretext and covertly videotaped. Pairs were then separated; each member spontaneously recalled information about her partner and the experimental room and provided a record of her thoughts and feelings during the interaction. As hypothesized, all master status Ss were particularly likely to be mindful in social interactions; they recalled detailed information about the situation and often took their partner's perspective during the interaction. The positive or negative connotations of the master status conditions were irrelevant in predicting Ss cognitions (mindfulness) but were critical in determining Ss behaviors (interaction strategies).

  12. New Safety Margins for Melanoma Surgery: Nice Possibility for Drinking of "Just That Cup of Coffee"?

    Science.gov (United States)

    Tchernev, Georgi; Chokoeva, Anastasiya Atanasova

    2017-06-15

    The American Joint Committee on Cancer (AJCC's) skin melanoma surgical treatment recommendations from 2011 are characterised by a prima facie "freedom of choice" regarding how extensive should be the excisions for melanomas with tumour thickness up to 2 mm and melanoma in situ. It is unclear why the recommended surgical security margins vary between 0.5 and 1 cm for melanoma in situ, whereas for melanomas with a tumour thickness of up to 1.99 mm, the range of variation is also between 1 and 2 cm, without specifying when the surgical field should be broader and, narrower, accordingly. This "uncertainty or lack of intent" of the guilders often leads to the same surgical approach to melanomas at different stages, or to a different approach in cases of melanomas at the same stage, in contrast. Therefore, this should be defined as wrong, logically. We present 3 patients with cutaneous melanomas, treated with similar fields of surgical security. Current issues, generated within the framework of melanoma's surgery guided by the recommendations of the AJCC are also discussed. A new surgical approach in patients with melanoma is recommended, discussed for the first time in world literature. We hypothesize that the introduction of a certain recommendations for a 2 cm surgical field in all directions during the initial excision, combined with the parallel performance of a sentinel lymph node biopsy, will lead in fact to several important advantages: 1) avoiding of the secondary excision in at least 70% - 90% of the patients (depending on the tumor thickness), 2) minimizing the risk of lymphatic effusion change and misinterpretation of the sentinel lymph node biopsy's results in patients with secondary excision; 3) optimization of the surgical team's work; 4) minimizing the possibility of unprepared/uninformed personnel to take part in decisions for treating a specific disease such as skin melanoma, 4) facilitating the appropriate patients' group selection at the appropriate

  13. Surgical management of Crohn's disease.

    Science.gov (United States)

    Lu, Kim C; Hunt, Steven R

    2013-02-01

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

  14. Surgical innovations in canine gonadectomy

    OpenAIRE

    Van Goethem, Bart

    2016-01-01

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

  15. Congenital vascular malformations: the persistence of marginal and embryonal veins.

    Science.gov (United States)

    Weber, J; Daffinger, N

    2006-05-01

    In about 18% of cases with conginental vascular malformations we find a perspective of an atypical truncular vein, located along the outside of the leg, frequently extended from the dorsal foot up to the bottom. In presence of a normally developed system of the deep collecting veins of the lower limb and within the pelvic outflow we are talking about a persisting marginal vein (MV). Hypoplasia or even aplasia of the main deep veins in contrary defines the persisting embryonal vein (EV). Already in childhood these truncular dysplastic veins tend to develop varicose enlargement, causing severe reflux of a huge volume of blood--even more when being associated with av-fistulas (46%). In consequence a rapidly growing chronic venous insufficiency will guide to additional injuries. We have analysed 97 patients showing a persisting MV (n: 92 ) within a total of 102 legs. A persistent embryonal vein (EV) was seen 10 times within this clientel. The persisting truncular veins, associated with phlebectasias and typical clinical symptoms have been examined in a diagnostic "step-by-step" procedure, mainly phlebographically (ascending leg phlebography and varicography), including direct venous blood pressure measurements (phlebodynamometry) and--if needed--by arteriography, showing av-shunting fistulae in 46% of cases. CT and MRI were consulted for the exact therapy planing (frequently initially offered as a non-invasive, however, inadequate key of diagnostic). Actually now these techniques cannot replace pre-operatively the angiographic imaging techniques. The analysis of clinical, morphologic and functional signs, guiding to a specific therapy-relevant classification of MV's and EV's will be presented. And a specific strategy of surgical repair, interventional treatment of av-fistulas and conservative compressive follow-up treatment attempting palliative recompensation of the diseased venous outflow will be discussed also.

  16. Thick tissue diffusion model with binding to optimize topical staining in fluorescence breast cancer margin imaging

    Science.gov (United States)

    Xu, Xiaochun; Kang, Soyoung; Navarro-Comes, Eric; Wang, Yu; Liu, Jonathan T. C.; Tichauer, Kenneth M.

    2018-03-01

    Intraoperative tumor/surgical margin assessment is required to achieve higher tumor resection rate in breast-conserving surgery. Though current histology provides incomparable accuracy in margin assessment, thin tissue sectioning and the limited field of view of microscopy makes histology too time-consuming for intraoperative applications. If thick tissue, wide-field imaging can provide an acceptable assessment of tumor cells at the surface of resected tissues, an intraoperative protocol can be developed to guide the surgery and provide immediate feedback for surgeons. Topical staining of margins with cancer-targeted molecular imaging agents has the potential to provide the sensitivity needed to see microscopic cancer on a wide-field image; however, diffusion and nonspecific retention of imaging agents in thick tissue can significantly diminish tumor contrast with conventional methods. Here, we present a mathematical model to accurately simulate nonspecific retention, binding, and diffusion of imaging agents in thick tissue topical staining to guide and optimize future thick tissue staining and imaging protocol. In order to verify the accuracy and applicability of the model, diffusion profiles of cancer targeted and untargeted (control) nanoparticles at different staining times in A431 tumor xenografts were acquired for model comparison and tuning. The initial findings suggest the existence of nonspecific retention in the tissue, especially at the tissue surface. The simulator can be used to compare the effect of nonspecific retention, receptor binding and diffusion under various conditions (tissue type, imaging agent) and provides optimal staining and imaging protocols for targeted and control imaging agent.

  17. Talking (and Not Talking) about Race, Social Class and Dis/Ability: Working Margin to Margin

    Science.gov (United States)

    Ferri, Beth A.; Connor, David J.

    2014-01-01

    In this article we examine some of the omnipresent yet unacknowledged discourses of social and economic disadvantage and dis/ability within schools in the US. First, we document ways that social class, race, and dis/ability function within schools to further disadvantage and exclude already marginalized students. Next, we show how particular ways…

  18. Evolution of surgical skills training

    Science.gov (United States)

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

    2006-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Heidecke Claus-Dieter

    2010-07-01

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

  20. Narrating the marginalized Oriental female: silencing the colonized subaltern

    Directory of Open Access Journals (Sweden)

    Saddik Gohar

    2015-12-01

    Full Text Available A scrutinized reading of the early fiction of Naguib Mahfouz, particularly his masterpiece Midaq Alley, reveals that the author's outward tendency to offer what seems to be a neutral presentation of Egyptian-Arab women is thwarted by a hegemonic master narrative originated in local patriarchal traditions. It either marginalizes the female subaltern downsizing her role in the fictional canvas or conflates her with a status of gender inferiority by assigning her a role which conforms to her image in the patriarchal taxonomy of Oriental women. In other words, the authorial attempt to create an objective narrative of the male/ female controversy in Midaq Alley is totally undermined by a plethora of male voices dominating the fictional text and deploying patriarchal discourses about the depravity of the female race and the invalidity of women's struggle for independence. In this context, the paper argues that due to a hegemonic narrative mechanism, Mahfouz's representation of the female protagonist conforms to domestic patriarchal visions of femininity while on the surface it masks itself as a progressive image of womanhood.

  1. Informing practice regarding marginalization: the application of the Koci Marginality Index.

    Science.gov (United States)

    Koci, Anne Floyd; McFarlane, Judith; Nava, Angeles; Gilroy, Heidi; Maddoux, John

    2012-12-01

    The 49th World Health Assembly of the World Health Organization (WHO) declared violence as the leading worldwide public health problem with a focus on the increase in the incidence of injuries to women. Violence against women is an international epidemic with specific instruments required to measure the impact on women's functioning. This article describes the application of the Koci Marginality Index (KMI), a 5-item scale to measure marginality, to the baseline data of a seven-year prospective study of 300 abused women: 150 first time users of a shelter and 150 first time applicants for a protection order from the justice system. Validity and reliability of the Koci Marginality Index and its usefulness for best clinical practice and for policy decisions for abused women's health are discussed. The 49th World Health Assembly of the World Health Organization (WHO) declared violence as the leading worldwide public health problem and focused on the increase in the incidence of injuries to women (Krug et al., 2002 ). Violence against women in the form of intimate partner violence (IPV) is costly in terms of dollars and health. In the United States in 2003, estimated costs of IPV approached $8.3 billion (Centers for Disease Control and Prevention [CDC], 2011). Outcomes related to severity of IPV vary but in 2003 victims suffering severe IPV lost nearly 8 million days of paid work, and greater than 5 million days of household productivity annually (CDC, 2011). Besides the evident financial cost of IPV, research confirms that exposure to IPV impacts a woman's health immediately and in the long-term (Breiding, Black, & Ryan, 2008 ; Campbell, 2002 ; CDC, 2011). Such sequela adversely affect the health of women and may increase their marginalization, a concept akin to isolation that may further increase negative effects on health outcomes. Immigrant women are at high risk for IPV (Erez, 2002 ) and those without documentation are at higher risk for marginalization (Montalvo

  2. Impact of geriatric factors on surgical and prognostic outcomes in elderly patients with soft-tissue sarcoma.

    Science.gov (United States)

    Tsuda, Yusuke; Ogura, Koichi; Kobayashi, Eisuke; Hiruma, Toru; Iwata, Shintaro; Asano, Naofumi; Kawai, Akira; Chuman, Hirokazu; Ishii, Takeshi; Morioka, Hideo; Kobayashi, Hiroshi; Kawano, Hirotaka

    2017-05-01

    Patients aged ≥65 years requiring surgery for soft-tissue sarcoma are a concern in an aging society. We aimed to reveal the association of clinical/geriatric factors with survival period or postoperative events in such patients who underwent surgery. We enrolled patients aged ≥65 years who underwent surgery for localized soft-tissue sarcoma at five institutions. We retrospectively collected clinical/geriatric factors and laboratory data, and analyzed their association with outcomes using univariate and multivariate analyses. Among the 202 patients included, mean age at presentation was 73 years. Surgical margin was R0 in 139 patients (69%). The Eastern Cooperative Oncology Group performance status was ≥2 in 15 (7%). Thirty patients (15%) showed thinness (body mass index sarcoma-specific survival (hazard ratio for R1 vs. R0, 3.17; P = 0.001) and event-free survival (hazard ratio for R1 vs. R0, 2.56; P sarcoma-specific survival (hazard ratio for ≥2 vs. 0 or 1, 2.15; P = 0.038), and higher sensitivity-modified Glasgow prognostic score was significantly associated with poor event-free survival (hazard ratio for ≥1 vs. 0, 1.74; P = 0.046). Severe thinness (body mass index sarcoma patients. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. Economic assessment of Operational Energy reduction options in a house using Marginal Benefit and Marginal Cost: A case in Bangi, Malaysia

    International Nuclear Information System (INIS)

    Wan Rahmah Mohd Zaki; Abdul Hadi Nawawi; Sabarinah Sh Ahmad

    2010-01-01

    Energy Efficient (EE) appliances such as Compact Fluorescent Light (CFL) bulbs and Renewable Energy (RE), namely solar Photovoltaic (PV) can help to reduce Operational Energy (OE) in a house. In addition, a house should also incorporate Passive Architecture (PA) design strategies which in the hot and humid tropical climate, mean avoiding direct heat gain, encouraging natural cross ventilation and optimising the abundant daylight. Nevertheless, reducing OE must also mean economic gain to households to encourage their participation. Common economic gauges such as Return on Investment, Payback Period, Cost Benefit Analysis, Life Cycle Assessment and Life Cycle Cost are not suitable to validate OE options in households. These economic gauges approach economic assessment as an end-result on the cost side of the product and may result for good intention to be shelved, primarily because EE equipment and RE have high capital cost compared with the alternatives. On the other hand, reducing OE in houses is actually a continual progression from the status quo and there is always a marginal gain in doing so. The challenge is to know how much is the marginal benefit against the marginal cost of investing in EE and RE. In Economics, the ratio of Marginal Cost (MC) and Marginal Benefits (MB) measure additional benefits of every additional costs of investment at a specific level of production and consumption; and Economists suggests that effective gain and loss should be compared to the status quo, i.e., Relative Position (RP). The Economics theories of MC, MB and RP are being adapted to measure the progression of reducing OE. The living/dining area in two types of houses: with and without PA design strategies are simulated to use conventional incandescent light bulbs and CFL as well as solar PV in lieu of the mains electricity supply. The power requirement for artificial lighting in every case is translated into monetary value and the ratio of MB against MC for each case shows

  4. Robot-assisted laparoscopic versus open partial nephrectomy in patients with chronic kidney disease: A propensity score-matched comparative analysis of surgical outcomes.

    Science.gov (United States)

    Takagi, Toshio; Kondo, Tsunenori; Tachibana, Hidekazu; Iizuka, Junpei; Omae, Kenji; Kobayashi, Hirohito; Yoshida, Kazuhiko; Tanabe, Kazunari

    2017-07-01

    To compare surgical outcomes between robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy in patients with chronic kidney disease. Of 550 patients who underwent partial nephrectomy between 2012 and 2015, 163 patients with T1-2 renal tumors who had an estimated glomerular filtration rate between 30 and 60 mL/min/1.73 m 2 , and underwent robot-assisted laparoscopic partial nephrectomy or open partial nephrectomy were retrospectively analyzed. To minimize selection bias between the two surgical methods, patient variables were adjusted by 1:1 propensity score matching. The present study included 75 patients undergoing robot-assisted laparoscopic partial nephrectomy and 88 undergoing open partial nephrectomy. After propensity score matching, 40 patients were included in each operative group. The mean preoperative estimated glomerular filtration rate was 49 mL/min/1.73 m 2 . The mean ischemia time was 21 min in robot-assisted laparoscopic partial nephrectomy (warm ischemia) and 35 min in open partial nephrectomy (cold ischemia). Preservation of the estimated glomerular filtration rate 3-6 months postoperatively was not significantly different between robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy (92% vs 91%, P = 0.9348). Estimated blood loss was significantly lower in the robot-assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group (104 vs 185 mL, P = 0.0025). The postoperative length of hospital stay was shorter in the robot-assisted laparoscopic partial nephrectomy group than in the open partial nephrectomy group (P negative surgical margin status were not significantly different between the two groups. In our experience, robot-assisted laparoscopic partial nephrectomy and open partial nephrectomy provide similar outcomes in terms of functional preservation and perioperative complications among patients with chronic kidney disease. However, a lower estimated blood loss and

  5. Specifically requesting surgical tattoo removal: are deep personal motivations involved?

    Science.gov (United States)

    Koljonen, V; Kluger, N

    2012-06-01

      Motivations for tattoo removal include employment reasons, stigmata, changes in lifestyles or partners, incompatibility with present attitudes and values and clothing problems. Most studies on the motivations for tattoo removal have focused on patients seeking laser therapy. We hypothesized that patients seeking surgical tattoo removal would present with different motivations.   We analysed the characteristics and motivations of patients specifically requesting surgical tattoo removal.   We retrospectively reviewed the medical records of 16 patients in Helsinki, Finland, from 2005 to 2011. Demographic, clinical data, number of tattoos, location and size, time elapsed since tattooing, reason(s) for wanting surgical tattoo removal and surgical operations were analysed and compared with the other literature on tattoo removal.   Patients were mainly Caucasian females (ratio 3 : 1, median age of 26 years). Tattoos were all done by studio artists, most measured less than 30 cm², and were quite recent (median 5.3 years). Personal reasons accounted for 42.8% of all reasons, professional/social reasons for 37.5% and miscellaneous for 18.8%. Personal concerns were usually marital status changes, with few expressing dissatisfaction with the actual design of the tattoo. Tattoos were excised during a single procedure in 70% of the cases with only one case producing a hypertrophic scar.   Patients seeking surgical removal were aware of the limits and risks of the technique. They expressed intense personal reasons for wanting radical surgical removal. The possibility of surgical tattoo removal should be accessible to patients if the tattoo is small and discussion reveals strong personal motivation. © 2011 The Authors. Journal of the European Academy of Dermatology and Venereology © 2011 European Academy of Dermatology and Venereology.

  6. Quality of life before surgical ICU admission.

    Science.gov (United States)

    Abelha, Fernando J; Santos, Cristina C; Barros, Henrique

    2007-11-12

    Examining the quality of life (QOL) of patients before ICU admission will allow outcome variables to be compared and analyzed in relation to it. The objective of this study was to analyze QOL of patients before admission to a surgical ICU and to study its relationship to outcome and to the baseline characteristics of the patients. All adult patients consecutively admitted to the surgical ICU between November 2004 and April 2005, who underwent non-cardiac surgery, were enrolled in this observational and prospective study. The following patient characteristics were recorded: age, gender, body mass index, ASA physical status, type and magnitude of surgical procedure, length of stay (LOS), in ICU and in hospital, mortality, Simplified Acute Physiology Score II (SAPS), history of co-morbidities and quality of life survey score (QOLSS). The relationships between QOLSS and ICU variables and outcome were evaluated. The relationship between the total QOLSS and each variable or outcome was assessed by multiple linear regression. One hundred eighty seven patients completed the study. The preadmission QOLSS of the patients studied was 4.43 +/- 4.90; 28% of patients had a normal quality of life (0 points), 38% had between 1 and 5 points (considered mild deterioration), 21% had between 6 and 10 points (moderate deterioration), 10% had between 11 and 15 points (considered major deterioration) and 3% had more than 15 points (severe limitation of quality of life). A worse preadmission QOLSS was associated with higher SAPS II scores, with older patients (age> 65 years) and with ASA physical status (ASA III/IV). Total QOLSS was significantly worse in elderly patients and in patients with co-morbidities and in patients more severely ill at ICU admission. Patients who died in the ICU and in hospital had worse QOLSS scores compared to those who survived. However, no statistical differences in QOLSS were found in relation to longer ICU stays (ICU LOS). Preadmission QOL correlates with

  7. Quality of life before surgical ICU admission

    Directory of Open Access Journals (Sweden)

    Barros Henrique

    2007-11-01

    Full Text Available Abstract Background: Examining the quality of life (QOL of patients before ICU admission will allow outcome variables to be compared and analyzed in relation to it. The objective of this study was to analyze QOL of patients before admission to a surgical ICU and to study its relationship to outcome and to the baseline characteristics of the patients. Methods: All adult patients consecutively admitted to the surgical ICU between November 2004 and April 2005, who underwent non-cardiac surgery, were enrolled in this observational and prospective study. The following patient characteristics were recorded: age, gender, body mass index, ASA physical status, type and magnitude of surgical procedure, length of stay (LOS, in ICU and in hospital, mortality, Simplified Acute Physiology Score II (SAPS, history of co-morbidities and quality of life survey score (QOLSS. The relationships between QOLSS and ICU variables and outcome were evaluated. The relationship between the total QOLSS and each variable or outcome was assessed by multiple linear regression. Results: One hundred eighty seven patients completed the study. The preadmission QOLSS of the patients studied was 4.43 ± 4.90; 28% of patients had a normal quality of life (0 points, 38% had between 1 and 5 points (considered mild deterioration, 21% had between 6 and 10 points (moderate deterioration, 10% had between 11 and 15 points (considered major deterioration and 3% had more than 15 points (severe limitation of quality of life. A worse preadmission QOLSS was associated with higher SAPS II scores, with older patients (age> 65 years and with ASA physical status (ASA III/IV. Total QOLSS was significantly worse in elderly patients and in patients with co-morbidities and in patients more severely ill at ICU admission. Patients who died in the ICU and in hospital had worse QOLSS scores compared to those who survived. However, no statistical differences in QOLSS were found in relation to longer ICU stays

  8. Northeast Atlantic Igneous Province volcanic margin development

    Science.gov (United States)

    Mjelde, R.; Breivik, A. J.; Faleide, J. I.

    2009-04-01

    Early Eocene continental breakup in the NE Atlantic Volcanic Province (NAIP) was associated with voluminous extrusive and intrusive magmatism, and initial seafloor spreading produced anomalously thick oceanic crust. Recent publications based on crustal-scale wide-angle seismic data show that there is a positive correlation between igneous crustal thickness (H) and average P-wave velocity (Vp) on all investigated margins in the NAIP. Vp can be used as a proxy for crustal composition, which can be related to the mode of mantle melting. A positive H-Vp correlation indicates that excessive mantle melting the first few million years after breakup was driven by an initial increased temperature that cools off as seafloor spreading develops, consistent with a mantle plume model. Variations in mantle composition can explain excess magmatism, but will generate a negative H-Vp correlation. Active mantle convection may increase the flux of mantle rocks through the melting zone above the rate of passive corner flow, which can also produce excessive magmatism. This would produce little H-Vp correlation, and place the curve lower than the passive flow melting curve in the diagram. We have compiled earlier published results with our own analyses of published and unpublished data from different groups to look for systematic variations in the mantle melting mode along the NAIP margins. Earlier studies (Holbrook et al., 2002, White et al, 2008) on the southeast Greenland conjugate system, indicate that the thick igneous crust of the southern NAIP (SE Greenland ? Hatton Bank) was dominated by increased mantle temperature only, while magmatism closer to the southern side of and including the Greenland-Iceland-Færøy Ridge (GIFR) was created by combined temperature increase and active mantle convection. Recent publications (Breivik et al., 2008, White et al, 2008) north of the GIFR for the Norway Basin segment, indicate temperature dominated magmatism between the Jan Mayen Fracture

  9. MARGINAL EXPENSE OIL WELL WIRELESS SURVEILLANCE MEOWS

    Energy Technology Data Exchange (ETDEWEB)

    Mason M. Medizade; John R. Ridgely; Donald G. Nelson

    2004-11-01

    A marginal expense oil well wireless surveillance system to monitor system performance and production from rod-pumped wells in real time from wells operated by Vaquero Energy in the Edison Field, Main Area of Kern County in California has been successfully designed and field tested. The surveillance system includes a proprietary flow sensor, a programmable transmitting unit, a base receiver and receiving antenna, and a base station computer equipped with software to interpret the data. First, the system design is presented. Second, field data obtained from three wells is shown. Results of the study show that an effective, cost competitive, real-time wireless surveillance system can be introduced to oil fields across the United States and the world.

  10. Cenozoic evolution of the Vietnamese coastal margin

    Energy Technology Data Exchange (ETDEWEB)

    Fyhn, M.B.W.; Nielsen, Lars Henrik; Boldreel, L.O. (Geological Survey of Denmark and Greenland, Copenhagen (DK))

    2007-10-15

    One of the main risk factors regarding petroleum exploration in the Vietnamese offshore basins is the presence of adequate source rock intervals. Onshore data from the ENRECA-1 core through the Song Ba Trough in central Vietnam show, however, that thick intervals of excellent oil- and gas-prone lacustrine mudstone and humic coals may develop even in small basins characterised by high sediment input. Although the Song Ba Trough is an order of magnitude smaller than the Vietnamese offshore basins, seismic data in the latter show apparent depositional similarities suggesting the presence of similar high-quality source rocks in the offshore basins. In addition, seismic facies analysis as well as oil and gas compositions indicate that other source rock types, such as Neogene fluvio-deltaic coals, carbonaceous shales and fore-reef marls are present in some of the basins and thus testify to the great petroleum potential of the Vietnamese margin. (LN)

  11. Optimization of fuel cycles: marginal loss values

    International Nuclear Information System (INIS)

    Gaussens, J.; Lasteyrie, B. de; Doumerc, J.

    1965-01-01

    Uranium processing from the pit to the fuel element rod entails metal losses at every step. These losses become more and more expensive with the elaboration of the metal. Some of the uranium must be accepted as definitely lost whilst the rest could be recovered and recycled. The high cost of these losses, whether they are recycled or not, and the fact that the higher the enrichment is the higher their costs are, make it necessary to take them into account when optimizing fuel cycles. It is therefore felt important to determine their most desirable level from an economic point of view at the various nuclear fuel processing stages. However, in France as in some other countries, fissile material production is a state concern, whilst fuel element fabrication is carried out by private enterprise. Optimization criteria and the economic value of losses are therefore different for each of the two links in the fabrication chain. One can try in spite of this to reach an optimum which would conform to public interest, without interfering with the firm's sales policy. This entails using the fact that for a given output marginal costs are equal at the optimum. One can therefore adjust the level of the losses to attain this equation of marginal costs, as these are easier to obtain from the firm than a justification of the actual prices. One notices moreover that, although mainly concerned with losses, this global analysis can bring both the state and the firm to a better use of other production factors. An account is given of the theory of this economic optimization method and practical applications in the field of natural uranium-graphite moderated and CO 2 cooled reactor fuel element fabrication are offered. (authors) [fr

  12. Surgical procedures in esophagus cancer treatment. Our experience

    International Nuclear Information System (INIS)

    Villena, Freddy; Carrasco, Edgar

    2005-01-01

    Esophagus cancer represents a very lethal neoplasm. Esophageal resection is going to be the therapeutic alternative to patients considered surgical candidates. It had been described some esophagus resection procedure. Although, there is not any agreement between surgeon about which are best procedure to patients with esophagus carcinoma. Most of patients who came advanced phase have poor prognostic and only patients, who have illness in early stage, exist expectative to improve survival with lymphadenectomy extended and neoadjuvant. We analyzes retrospectively files of 23 patients submitted to esophagectomy in hospital Solca Quito from 1985 to 2004 with the diagnostic of esophagus carcinoma, considering histology type, location, surgical proceeded, pathologic staging, surgical mortally, mobility and survival time live. Also it makes a review about proceeds of esophagus resection and adjuvant therapy to the esophagus cancer. Conclusions: Esophagectomy transhiatal has limitations in oncological resection and recommend it early lower esophagus lesions and cardiac orifice (dysplasia high grade, T is, TI, NO, MO) in patients of high risk. Right trans thoracic esophagectomy it is considered in all lesions advanced locally lower middle third, and cardias orifice with lymphadenectomy of two areas and have avoid of trans thoracic anastomotic risk. Trans operatively margins upper have been 10 cm and 5 cm distal, always freeze those margins trans operatively. Extended lymphadenectomy to three areas we have no order yet conclusive dates and the chemotherapy neoadjuvant had been a positive impact in the survival in those chemosensitive tumors with appropriate answer and could be totally remove, but randomized testing future could determine his efficacy real. (The author)

  13. Workshop on Program for Elimination of Requirements Marginal to Safety: Proceedings

    International Nuclear Information System (INIS)

    Dey, M.

    1993-09-01

    These are the proceedings of the Public Workshop on the US Nuclear Regulatory Commission's Program for Elimination of Requirements Marginal to Safety. The workshop was held at the Holiday Inn, Bethesda, on April 27 and 28, 1993. The purpose of the workshop was to provide an opportunity for public and industry input to the program. The workshop addressed the institutionalization of the program to review regulations with the purpose of eliminating those that are marginal. The objective is to avoid the dilution of safety efforts. One session was devoted to discussion of the framework for a performance-based regulatory approach. In addition, panelists and attendees discussed scope, schedules and status of specific regulatory items: containment leakage testing requirements, fire protection requirements, requirements for environmental qualification of electrical equipment, requests for information under 10CFR50.54(f), requirements for combustible gas control systems, and quality assurance requirements

  14. Workshop on Program for Elimination of Requirements Marginal to Safety: Proceedings

    Energy Technology Data Exchange (ETDEWEB)

    Dey, M. [Nuclear Regulatory Commission, Washington, DC (United States). Div. of Safety Issue Resolution; Arsenault, F.; Patterson, M.; Gaal, M. [SCIENTECH, Inc., Rockville, MD (United States)

    1993-09-01

    These are the proceedings of the Public Workshop on the US Nuclear Regulatory Commission`s Program for Elimination of Requirements Marginal to Safety. The workshop was held at the Holiday Inn, Bethesda, on April 27 and 28, 1993. The purpose of the workshop was to provide an opportunity for public and industry input to the program. The workshop addressed the institutionalization of the program to review regulations with the purpose of eliminating those that are marginal. The objective is to avoid the dilution of safety efforts. One session was devoted to discussion of the framework for a performance-based regulatory approach. In addition, panelists and attendees discussed scope, schedules and status of specific regulatory items: containment leakage testing requirements, fire protection requirements, requirements for environmental qualification of electrical equipment, requests for information under 10CFR50.54(f), requirements for combustible gas control systems, and quality assurance requirements.

  15. Diversity and Inclusion in Youth Development: What We Can Learn from Marginalized Young People

    Directory of Open Access Journals (Sweden)

    Stephen T. Russell

    2011-09-01

    Full Text Available As we commemorate 100 years of youth development programs whose origins are traced to organizations founded in the United States, we consider key insights as well as strategies relevant for diversity and inclusion. Many of the large, mainstream youth development organizations and programs that were founded over a century ago now primarily serve youth in the “mainstream”: youth from the middle classes, traditional families, and dominant cultural groups. A growing body of scholarship considers the positive development of youth who are marginalized due to their social class, ability, sexuality, citizenship status, race, ethnicity, or culture. We draw insights from studies of youth and families who are immigrants, or who are lesbian, gay, bisexual, and transgender (LGBT. These findings provide a vantage point for considering ways that contemporary youth development organizations might stretch the margins, or adapt their practices, in order to reach and include all youth.

  16. [Malnutrition and cognitive development if infants in rural marginalized areas in Mexico].

    Science.gov (United States)

    Carrasco Quintero, María Del Refugio; Ortiz Hernández, Luis; Roldán Amaro, José Antonio; Chávez Villasana, Adolfo

    2016-01-01

    To analyze the relationship between nutritional status measured by anthropometry and the mental, psychomotor and language development of infants in marginalized rural areas of Mexico. Cross-sectional study with 576 infants aged from 7 to 26 months in four rural locations. Variables consisted of measures of anthropometric and cognitive development. Infants with short stature had a lower rate of language development, while birth weight was marginally associated with psychomotor development. Although acute malnutrition (identified by underweight) is no longer a problem in rural areas of Mexico, chronic malnutrition (expressed as stunting) is still common and is associated with alterations in mental development in the child population. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

  17. Compliance status

    International Nuclear Information System (INIS)

    Black, D.G.

    1995-01-01

    This section of the 1994 Hanford Site Environmental Report summarizes the activities conducted to ensure that the Hanford Site is in compliance with federal environmental protection statutes and related Washington State and local environmental protection regulations and the status of Hanford's compliance with these requirements. Environmental permits required under the environmental protection regulations are discussed under the applicable statute

  18. Compliance status

    Energy Technology Data Exchange (ETDEWEB)

    Black, D.G.

    1995-06-01

    This section of the 1994 Hanford Site Environmental Report summarizes the activities conducted to ensure that the Hanford Site is in compliance with federal environmental protection statutes and related Washington State and local environmental protection regulations and the status of Hanford`s compliance with these requirements. Environmental permits required under the environmental protection regulations are discussed under the applicable statute.

  19. STATUS REPORT

    Indian Academy of Sciences (India)

    First page Back Continue Last page Graphics. STATUS REPORT. Raman scattering observed – 90, 135, 180 degrees and back scattering. Traditionally specific angle dependence to learn about polarization response. Learn molecular information from the surface or materials just below the surface (upto 12 mm depth) ...

  20. Pre-surgical planning and MR-tractography utility in brain tumour resection

    Energy Technology Data Exchange (ETDEWEB)

    Romano, A.; Fantozzi, L.M.; Bozzao, A. [University Sapienza, Department of Neuroradiology, S. Andrea Hospital, Rome (Italy); D' Andrea, G.; Mastronardi, L.; Ferrante, L. [University Sapienza, Department of Neurosurgery, S. Andrea Hospital, Rome (Italy); Minniti, G. [University Sapienza, Department of Radiotherapy, S. Andrea Hospital, Rome (Italy)

    2009-12-15

    The purposes of this study were (1) to evaluate the possible identification of trajectories of fibre tracts, (2) to examine the useful of a neuronavigation system for pre-surgical planning, (3) to assess pre- and post-surgery patients' clinical condition and (4) to evaluate the impact of this information on surgical planning and procedure. Twenty-eight right-handed patients were prospectively and consecutively studied. All the patients were clinically assessed by a neurologist in both pre- and post-surgical phases. Separately the pyramidal tract, optic radiation and arcuate fasciculus were reconstructed. The trajectories were considered suitable for surgical planning if there were no interruptions of any of the layers at the level of the lesion. Dedicated software 'merged' the acquired images with the tractographic processing, and the whole dataset was sent to the neuronavigation system. The assessment of the 37 visualised trajectories close to the tumour resulted in a modification of the surgical approach to corticotomy in six patients (21%); the impact on the definition of the resection margins during surgery was 64% (18 cases). The overall impact percentage on the surgical procedure was 82%. In 27 cases, the symptoms had not changed. MR-tractography provides the neurosurgeon with a new anatomical view that has an impact on the surgical resection planning for brain neoplasms. (orig.)